Safety and efficacy of endoscopic vacuum therapy for the treatment of perforations and anastomotic leaks of the upper gastrointestinal tract. / Eficacia y seguridad de la terapia de vacío endoscópica para el tratamiento de perforaciones y dehiscencias anastomóticas del tracto digestivo superior.

AIM: To evaluate the efficacy and safety of endoscopic vacuum therapy (EVT) in the management of perforations and anastomotic leaks of the upper gastrointestinal tract. PATIENTS AND METHODS: This is a retrospective observational study which included patients who underwent EVT due to any upper gastrointestinal defect between April 2017 and February 2019 in three Spanish Hospitals. To this end, we used the only medical device approved to date for endoscopic use (Eso-SPONGEr; B. Braun Melsungen AG, Melsungen, Germany). RESULTS: 11 patients were referred for EVT of an anastomotic leak after esophagectomy (n=7), gastrectomy (n=2), esophageal perforation secondary to endoscopic Zenker's septomiotomy (n=1) and Boerhaave syndrome (n=1). The median size of the cavity was 8×3cm. The median delay between surgery and EVT was 7 days. The median of EVT duration was 28 days. The median number of sponges used was 7 and the mean period replacement was 3.7 days. In 10 cases (91%), the defect was successfully closed. In 9 cases (82%) clinical resolution of the septic condition was achieved. 5 patients presented some adverse event: 3 anastomotic strictures, 1 retropharyngeal pain and 1 case of new-onset pneumonia. The median hospital stay from the start of EVT was 45 days. 1 patient died owing to septic complications secondary to the anastomotic leak. CONCLUSION: EVT was successful in over 90% of perforations and anastomotic leaks of the upper gastrointestinal tract. Moreover, this is a safe therapy with only mild adverse events associated.

Using Positive Deviance in the prevention and control of MRSA infections in a Colombian hospital: a time-series analysis.

Positive Deviance (PD) is a process to achieve a social and cultural change. This strategy has been used for the control of methicillin-resistant Staphylococcus aureus (MRSA) infection in some health institutions in the United States, but has rarely been adopted in institutions from developing countries where resources are limited. We describe our experience of PD in the control of healthcare-associated infections (HAIs) due to MRSA in a Colombian hospital with the aim of reducing HAI rates through a cultural change in processes. A time-series study was conducted based on the MRSA-HAI rate and the number of months with zero MRSA infections before and after application of PD (2001-2012). On comparing the pre-intervention and intervention periods, the mean overall rates of MRSA-HAI was 0·62 and 0·36, respectively (P = 0·0005); the number of months with zero MRSA-HAIs were 3/70 and 12/74 (odds ratio 0·264, 95% confidence interval 0·078-0·897); the percentage of MRSA-HAIs was 53·2% and 41·0%. These results are consistent with other published data. Implementation of PD was associated with a significant reduction of MRSA-HAIs, it did not involve high costs and the changes have been lasting.

Genetic characterization of oropharyngeal trichomonad isolates from wild birds indicates that genotype is associated with host species, diet and presence of pathognomonic lesions.

Oropharyngeal trichomonad isolates of wild birds from Spain were studied. A total of 1688 samples (1214 of predator birds and 474 of prey species) from wildlife recovery centres and scientific bird-ringing campaigns were analysed from 2011 to 2013. The overall infection prevalence was 20.3% (11.4% in predator birds and 43.3% in prey species). Pathognomonic lesions were present in 26% of the infected birds (57.3% in predator birds and 4.9% in prey species). The most commonly parasitized species were the goshawk (Accipiter gentilis, 74.5%) and the rock pigeon (Columba livia, 79.4%). Host species in which the parasite has not been previously analysed by polymerase chain reaction and sequencing in Spain are also reported: Columba palumbus, Streptopelia turtur, Pica pica, A. gentilis, Accipiter nisus, Asio otus, Bubo bubo, Buteo buteo, Circus aeruginosus, Circus cyaneus, Falco naumanni, Falco peregrinus, Neophron percnopterus, Otus scops, Pernis apivorus and Strix aluco. Sequence analysis of the ITS1/5.8S/ITS2 region revealed five different genotypes and also some mixed infections. A relationship between genotype and host species was observed, but only two genotypes (ITS-OBT-Tg-1and ITS-OBT-Tg-2) were widely distributed. Genotype ITS-OBT-Tg-1 was most frequently found in predator birds and statistically associated with pathognomonic lesions. Non-strict ornithophagous species were at higher risk to develop disease than ornithophagous ones. Genotypes ITS-OBT-Tcl-1 and ITS-OBT-Tcl-2 are new reports, and ITS-OBT-Tvl-5 is reported for the first time in Spain. They showed higher genetic homology to Trichomonas canistomae and Trichomonas vaginalis than to Trichomonas gallinae, indicating the possibility of new species within this genus.

[Developmental cerebral thrombosed venous anomaly: findings in magnetic resonance imaging]. / Anomalía venosa del desarrollo cerebral trombosada: hallazgos en la resonancia magnética.

INTRODUCTION: Developmental venous anomalies are the most common cerebral vascular malformations. They are usually incidental and benign, although about 40% are associated with cavernous malformations, and so it is essential to look for other associated vascular or neurocutaneous anomalies. CASE REPORT: We report the case of a 34-year-old pregnant woman who presented with seizures and dysarthria, and was submitted to an urgent cranial MRI scan. She showed the classic 'Medusa head' sign and was diagnosed with developmental venous anomaly with partial peripheral thrombosis and slow proximal flow. CONCLUSIONS: Thrombosis rarely occurs as a complication of developmental venous anomalies and case reports in the literature suggest that they should be managed conservatively, leaving surgery for other associated complications. As radiologists, we must be aware of the main imaging features so as to be able to make an accurate diagnosis.

TITLE: Anomalía venosa del desarrollo cerebral trombosada: hallazgos en la resonancia magnética.Introducción. Las anomalías venosas del desarrollo son las malformaciones vasculares cerebrales más comunes, suelen ser incidentales y benignas, aunque alrededor del 40% se asocian a malformaciones cavernosas, por lo que es esencial buscar otras anomalías vasculares o neurocutáneas asociadas. Caso clínico. Se presenta una mujer de 34 años embarazada que acude por convulsiones y disartria, a la cual se le realiza una resonancia magnética de cráneo urgente. En ella se aprecia el clásico signo de la 'cabeza de Medusa', y se concluye como diagnóstico anomalía venosa del desarrollo con trombosis parcial periférica y flujo lento proximal. Conclusiones. La complicación con trombosis de las anomalías venosas del desarrollo es rara y los informes de casos de la bibliografía sugieren que deben manejarse de forma conservadora, como una trombosis del seno venoso, dejando la cirugía para otras complicaciones asociadas. Como radiólogos, debemos conocer las principales características por imagen para elaborar un diagnóstico certero.

Emphysematous osteomyelitis: a rare and aggressive disease.

Emphysematous osteomyelitis is an extremely rare entity consisting of the presence of intraosseous gas that can extend to the joints and adjacent soft tissues. It is an aggressive infectious process associated with high mortality, especially in patients with risk factors such as tumors or diabetes mellitus. Because early diagnosis and immediate treatment are crucial to prevent the potentially devastating consequences of this condition, imaging tests such as computed tomography play a fundamental role in its diagnosis and management. Therefore, radiologists must be aware that intraosseous gas is a rare but alarming sign that is pathognomonic of emphysematous osteomyelitis, especially in the axial skeleton.

Genetic monitoring on the world's first MSC eco-labeled common octopus (O. vulgaris) fishery in western Asturias, Spain.

Octopus vulgaris (Cuvier, 1797) is a cephalopod species with great economic value. In western Asturias (northwest of Spain), O. vulgaris artisanal fisheries are relatively well monitored and conditionally eco-labeled by the Marine Stewardship Council (MSC). Despite this, the Asturian octopus stocks have not been genetically assessed so far. In order to improve the current fishery plan and contrast the octopus eco-label validity in Asturias, 539 individuals from five regions of the O. vulgaris geographic distribution, including temporal samplings in Asturias, were collected and genotyped at thirteen microsatellite loci. All the samples under analysis were in agreement with Hardy-Weinberg expectations. Spatial levels of genetic differentiation were estimated using F-statistics, multidimensional scaling, and Bayesian analyses. Results suggested that the O. vulgaris consists of at least four genetically different stocks coming from two ancestral lineages. In addition, temporal analyses showed stability in terms of genetic variation and high NE (> 50) for several generations in different localities within Asturias, pointing out to indeed sustainable fishery exploitation levels. Even though, the current Asturias fishery plan shows no significant genetic damages to the stocks, the regional-specific management plans need systematic genetic monitoring schemes as part of an efficient and preventive regional fishery regulation strategy.

The diagnosis of the middle interhemispheric variant of holoprosencephaly with fetal MRI.

Congenital anomalies of the central nervous system comprise a wide spectrum of malformations associated with a wide variety of genetic syndromes and chromosomal anomalies, and they are among the principal causes of morbidity and mortality in infants. Among these anomalies, holoprosencephaly arises from the complete or partial failure of the brain to divide into the cerebral hemispheres. Imaging tests are fundamental for the prenatal diagnosis of holoprosencephaly; the diagnostic process usually starts with sonography and then the findings are refined with fetal MRI. Radiologists need to be familiar with the possible findings because the prognosis varies.

The diagnosis of the middle interhemispheric variant of holoprosencephaly with fetal MRI. / Variante interhemisférica media de holoprosencefalia: diagnóstico mediante resonancia magnética fetal.

Congenital anomalies of the central nervous system comprise a wide spectrum of malformations associated with a wide variety of genetic syndromes and chromosomal anomalies, and they are among the principal causes of morbidity and mortality in infants. Among these anomalies, holoprosencephaly arises from the complete or partial failure of the brain to divide into the cerebral hemispheres. Imaging tests are fundamental for the prenatal diagnosis of holoprosencephaly; the diagnostic process usually starts with sonography and then the findings are refined with fetal MRI. Radiologists need to be familiar with the possible findings because the prognosis varies.

[Analysis of the predictive value of preventive isolation criteria in the intensive care unit]. / Análisis del valor predictivo de los criterios de aislamiento preventivo en una unidad de cuidados intensivos.

OBJECTIVE: To assess the diagnostic accuracy of the criteria used to detect patients carrying multiresistant microorganisms (MRMs). DESIGN: A prospective observational study was carried out from May 2014 to May 2015. SETTING: Polyvalent Intensive Care Unit. PATIENTS: A cohort of consecutively admitted patients meeting the following criteria for preventive isolation according to the "Zero Resistance" project: hospital length of stay>4 days in the last three months ("hospital"); antibiotherapy during one week in the last month ("antibiotic"); institutionalized patients or recurrent contact with healthcare ("institution or care"); MRM carrier in the last 6 months ("previous MRM"). VARIABLES: Demographic data, culture results and isolation time. A multivariate analysis was performed using multiple logistic regression between each of the risk factors and patient MRM carrier status. RESULTS: During the study period, 575 patients were admitted, of which 28% met the isolation criteria (162). Fifty-one (31%) were MRM carriers. Of the patients who did not meet the criteria, 29 (7%) were carriers. In the multivariate analysis, the only variable independently associated to carrier status was "previous MRM", with OR=12.14 (95%CI 4.24-34.77). CONCLUSIONS: The only criterion independently associated with the ability to detect patients with MRMs upon admission to the ICU was the existence of "previous MRM".

Genetic diversity and antimicrobial resistance of Flavobacterium psychrophilum isolated from cultured rainbow trout, Onchorynchus mykiss (Walbaum), in Spain.

Flavobacterium psychrophilum is the causative agent of bacterial cold-water disease (CWD) and rainbow trout fry syndrome (RTFS) in salmonids. These diseases are a major problem in the aquaculture industry in Spain, and a better understanding of the epidemiology of F. psychrophilum isolates is necessary to improve management strategies. In this study, to investigate genetic variability of this bacterium, pulsed-field gel electrophoresis after DNA digestion with endonuclease StuI, plasmid profiling analysis and antimicrobial susceptibility testing were undertaken with 25 isolates of F. psychrophilum from Spain. These isolates were classified into 17 patterns by PFGE analysis, which were grouped into four clusters and seven independent branches. Twenty isolates (80%) possessed plasmids of 3.5 kb (n = 13) or 5.5 kb (n = 7). No plasmids were associated with antibiotic resistance to oxytetracycline (OTC) or florfenicol (FLO). Twenty isolates (80%) had minimum inhibitory concentrations (MICs) to OTC of between 2.4 and 9.7 microg mL(-1), and all isolates were susceptible to FLO. A relationship between the origin of the isolates and PFGE genotypes was found. Plasmid profile typing correlated with PFGE profile typing, whereas no correlation was found between antimicrobial susceptibility testing and PFGE profiles. These results suggest that the population of F. psychrophilum with pathogenic potential in northern Spain is quite heterogeneous.

Oral trichomonosis: Description and severity of lesions in birds in Spain.

Avian trichomonosis is a parasitic disease caused by the flagellated protozoan Trichomonas gallinae. Columbiformes are the reservoir host of the parasite, with high levels of infection, but also other domestic and wild birds from a variety of orders are susceptible to the infection and development of gross lesions. In this paper we describe the type and severity of lesions in wild birds in four avian orders (Accipitriformes, Falconiformes, Strigiformes and Columbiformes). A total of 94 clinical cases diagnosed of trichomonosis were selected for the categorization of their lesions in the upper digestive tract. The affected birds were classified into three different categories (mild, moderate and severe) based on size (in relation to the tracheal opening), depth and location of the lesions. Mild cases are those with small and superficial lesions far from the oropharyngeal opening; moderate cases possess larger and deeper lesions, and severe cases very large and deep lesions that impede swallowing or affect the skull. Mild lesions were found in 10.6 % of cases; moderate lesions were observed in 18.1 % of the birds and severe lesions in 71.3 %. Treatment outcomes in birds with either mild or moderate lesions were favorable, while severe lesions were related to poor body score, leading to death or euthanasia in most cases. A relationship between severe lesions and avian order was found, with a higher percentage of birds with this type in Falconiformes, Columbiformes and Strigiformes. Multifocal lesions were more frequent in Columbiformes and Falconiformes. In Strigiformes, 93.3 % of birds showed lesions in the upper jaw. This study seeks to further understanding of avian trichomonosis and to provide information that will be useful to veterinarians and related professionals for assessment, prognosis and treatment choice for these birds.

Psychogenic non-epileptic and epileptic seizures: clues for a differential diagnosis. Findings from a Colombian study. / Crisis psicogenas no epilepticas y crisis epilepticas: pistas para un diagnostico diferencial. Hallazgos de un estudio colombiano.

INTRODUCTION: Psychogenic non-epileptic seizures (PNES) are paroxysmal changes in behavior that resemble epileptic seizures, although they have no electrophysiological correlation or clinical evidence of epilepsy. AIM: To compare clinical and sociodemographic characteristics of patients diagnosed with PNES-alone and PNES-and-epilepsy. PATIENTS AND METHODS: A cross-sectional study of consecutive patients diagnosed with PNES in a 20-month period was carried out. A video-EEG was performed in all patients. Socio-demographical, clinical and semiological characteristics were compared between those patients with and without concomitant epilepsy. RESULTS: Sixty-five patients were included, 35 (53.9%) had PNES-alone and 30 (46.1%) had PNES-and-epilepsy. The proportion of women in the study was 70.8%. The median age at seizure onset was 16 years. A late start was recorded in PNES-alone group (23 years) compared to PNES-and-epilepsy group (11 years), however, it was not significant. There was a lower frequency of antiepileptic drugs use in the PNES-alone group compared with the PNES-and-epilepsy group. The most frequent semiological features were the gradual onset of events (69.2%) and the duration longer than two minutes (63.1%). CONCLUSION: The waxing and waning pattern during paroxysmal events suggest a non-epileptic origin. However, it is not uncommon to find patients with concomitant epileptic seizures.

TITLE: Crisis psicogenas no epilepticas y crisis epilepticas: pistas para un diagnostico diferencial. Hallazgos de un estudio colombiano.Introduccion. Las crisis psicogenas no epilepticas (CPNE) son cambios paroxisticos en el comportamiento que se asemejan a las crisis epilepticas, aunque no tienen correlacion electrofisiologica ni evidencia clinica de epilepsia. Objetivo. Comparar las caracteristicas clinicas y sociodemograficas entre pacientes diagnosticados con CPNE, con y sin epilepsia concomitante. Pacientes y metodos. Estudio transversal de pacientes consecutivamente diagnosticados de CPNE durante un periodo de 20 meses. A todos los participantes se les realizo un videoelectroencefalograma (video-EEG). Se compararon las caracteristicas sociodemograficas, clinicas y semiologicas entre los que presentaban y los que no presentaban epilepsia concomitante. Resultados. Se incluyo a 65 pacientes, 35 con CPNE (53,9%), y 30 con CPNE y epilepsia (46,1%). La edad mediana en el inicio del video-EEG fue de 33 años, y un 70,8% eran mujeres. La edad mediana de inicio de las crisis fue de 16 años. En el grupo de CPNE hubo un inicio mas tardio (23 años) en comparacion con el grupo de CNPE y epilepsia (11 años), pero la diferencia no fue significativa. La proporcion de pacientes en terapia con farmacos antiepilepticos fue significativamente mayor en el grupo con CPNE y epilepsia comparado con el grupo con CPNE. Las caracteristicas semiologicas mas frecuentemente encontradas fueron el inicio gradual de las crisis (69,2%) y una duracion de mas de dos minutos (63,1%). Conclusion. La variabilidad en los sintomas sugiere un origen no epileptico de los eventos paroxisticos, los cuales se presentan frecuentemente en pacientes con epilepsia.

A novel contact model of piezoelectric traveling wave rotary ultrasonic motors with the finite volume method.

The operating principle of the piezoelectric traveling wave rotary ultrasonic motor is based on two energy conversion processes: the generation of the stator traveling wave and the rectification of the stator movement through the stator-rotor contact mechanism. This paper presents a methodology to model in detail the stator-rotor contact interface of these motors. A contact algorithm that couples a model of the stator which is discretized with the finite volume method and an analytical model of the rotor is presented. The outputs of the proposed model are the normal and tangential force distribution produced at the stator-rotor contact interface, contact length, height and shape of the stator traveling wave and rotor speed. The torque-speed characteristic of the USR60 is calculated with the proposed model, and the results of the model are compared versus the real torque-speed of the motor. A good agreement between the proposed model results and the torque-speed characteristic of the USR60 was observed.

A dynamic model of the piezoelectric traveling wave rotary ultrasonic motor stator with the finite volume method.

This manuscript presents a method to model in detail the piezoelectric traveling wave rotary ultrasonic motor (PTRUSM) stator response under the action of DC and AC voltages. The stator is modeled with a discrete two dimensional system of equations using the finite volume method (FVM). In order to obtain accurate results, a model of the stator bridge is included into the stator model. The model of the stator under the action of DC voltage is presented first, and the results of the model are compared versus a similar model using the commercial finite element software COMSOL Multiphysics. One can observe that there is a difference of less than 5% between the displacements of the stator using the proposed model and the one with COMSOL Multiphysics. After that, the model of the stator under the action of AC voltages is presented. The time domain analysis shows the generation of the traveling wave in the stator surface. One can use this model to accurately calculate the stator surface velocities, elliptical motion of the stator surface and the amplitude and shape of the stator traveling wave. A system of equations discretized with the finite volume method can easily be transformed into electrical circuits, because of that, FVM may be a better choice to develop a model-based control strategy for the PTRUSM.

Pathological features in marine birds affected by the prestige's oil spill in the north of Spain.

A total of 2,465 seabirds, mainly common murres (Uria aalge), razorbills (Alca torda), and puffins (Fratercula arctica) that beached in the northwestern part of Spain after the "Prestige" oil spill on 19 November 2002 were examined by pathological methods. Birds were divided into three groups: dead birds with the body covered (group 1) or uncovered (group 2) by oil and birds recovered alive but which died after being treated at a rescue center (group 3). The main gross lesions were severe dehydration and emaciation. Microscopically, hemosiderin deposits, related to cachexia and/or hemolytic anemia, were observed in those birds harboring oil in the intestine. Severe aspergillosis and ulcers in the ventriculus were found only in group 3 birds, probably because of stress associated with attempted rehabilitation at the rescue center. The mild character of the pathological changes suggests that petroleum oil toxicosis causes multiple sublethal changes that have an effect on the ability of the birds to survive at sea, especially weak and young, inexperienced animals. Dehydration and exhaustion seem to be the most likely cause of death.

SEOM guidelines for the management of Malignant Melanoma 2015.

All melanoma patients must be confirmed histologically and resected according to Breslow. Sentinel node biopsy must be done when tumor is over 1 mm or if less with high-risk factors. Adjuvant therapy with interferon must be offered for patients with high-risk melanoma and in selected cases radiotherapy can be added. Metastatic melanoma treatment is guided by mutational BRAF status. BRAF wild type patients must receive anti-PD1 therapy and BRAF mutated patients BRAF/MEK inhibitors or anti-PD1 therapy. Up to 10 years follow up is recommended for melanoma patients with dermatologic examinations and physical exams.