Assessment of seabed litter at Concepción Seamount (Canary island) using a remotely operated towed vehicle.

The seafloor is recognised as a major sink for marine litter. However, studies conducted in this compartment addressing marine litter densities and its interactions with fauna are scarce, mainly due to sampling constraints. In this paper, we assess marine litter density, composition and interactions with marine communities and evaluate its relationship with fishing activities at the "Banco de la Concepción" seamount (Canary Islands, Spain). We took advantage of underwater video records taken with a Remotely Operated Towed Vehicle in the framework of the LIFE IP INTEMARES project. A total of 56 video transects were analysed covering about 9 km with 19 h of video recording. Transects were categorised as high, low, and null fishing effort based on the Vessel Monitoring System (VMS) positional data registered between 2009 and 2017. Litter items were recorded in 70% of the transects with a mean density of 2122 (±2464) items km-2. There were significant differences in litter densities over the three levels of fishing pressure, with a density decrease from stations of high to stations of null fishing pressure. Regarding categories, plastic was by far the most abundant category found (83.1%), mainly consisting of fishing lines, both monofilaments and entangled longlines. The study of the interactions of marine litter with fauna showed that less than 20% of the items presented an interaction with benthic organisms either by causing or not a visible impact. The sponge Asconema setubalense accounted for more than half (57.4%) of all interactions, but only 5% of all A. setubalense specimens showed physical damage.

Association between genetic variations at 8q24 and prostate cancer risk in Mexican Men.

BACKGROUND: Variants of 8q24 locus have been associated with prostate cancer (PCa) susceptibility. This study aims to analyze the genetic basis of PCa susceptibility in Mexican men by analyzing SNPs in the 8q24 locus for the first time. METHODS: A case-control study was performed in 875 men recruited from the Mexican Social Security Institute, 326 patients with PCa, and 549 non-PCa patients (88 with benign prostatic hyperplasia BPH and 461 healthy controls). The 8q24 locus SNPs: rs16901979, rs16983267, rs1447295, and rs7837328 were genotyped by allelic discrimination assays using TaqMan probes. Statistical analysis was performed using Epi Info statistical 7.0 and SNPstats softwares. RESULTS: All genotype frequencies were in Hardy-Weinberg Equilibrium. No differences were observed in genotype distribution between PCa and non-PCa patients for rs6983267. Under different inheritance models, the rs16901979, rs1447295, and rs7837328 SNPs were associated with PCa (OR = 2.8, 1.8, and 1.72, respectively; Pc < 0.001) when comparing PCa patients against controls. This association remains between PCa and BPH patients under different models (OR = 8.5, 2.2, and 1.9, respectively; Pc < 0.001). There were no significant differences in allele and genotype distribution among BPH patients and controls. The combined effect of the alleles CGAA for the SNPs rs16901979, rs6983267, rs1447295, and rs7837328 showed significant differences between PCa patients and controls (OR = 2.9, 95% CI = 1.48-5.83, Pc = 0.008). Four 8q24 variants were not associated with D'Amico score, age at diagnosis, and bone metastases. CONCLUSIONS: Our study provides the first confirmation that variants rs16901979, rs1447295, and 7837328 at 8q24 locus are associated with PCa susceptibility in Mexican men.

[Antimicrobial stewardship programme implementation in a medical ward]. / Implantación de un programa de optimización y uso racional de antimicrobianos en un modelo de área clínica médica.

OBJECTIVE: Antimicrobial stewardship programmes (ASP) have proven to be effective tools for reducing the use of antimicrobials. The purpose of the study is to evaluate the effect of an ASP implantation in a medical Ward. METHODS: Prospective intervention study in a medical ward with a heterogeneous composition. In September 2014, an ASP based on prospective audits was implemented. Antimicrobial consumption and the length of stay and mortality in all patients admitted, as well as in the main infections present in the unit, were compared before and after two years of the ASP implementation. RESULTS: A total of 378 infectious episodes of 335 pa-tients were evaluated in 168 meetings. The prescriber ac-cepted 92.3% of the suggestions. The consumption of an-timicrobials reviewed was reduced from 31.3 to 17.6 DDD / 100-stays (ß =-0.40, P = 0.015). The average cost per income was reduced from € 161.4 to € 123.3 (-23.6%). No differences were found in total length of stay or mortality. There were no changes in the incidence of Clostridium difficile infection or candidemia between the two periods. There were no significant differences in length of stay or mortality in total bacteremia, candidemia, and urinary tract infections caused by multiresistant bacteria. CONCLUSIONS: The implementation of an ASP in a heterogeneous medical ward significantly reduces the use of antimicrobials in a short time horizon without adversely affecting the evolution of the patients..

Primary squamous cell carcinoma of the thyroid. Initial assessment and follow-up using 18F-FDG PET/CT. / Carcinoma epidermoide primario de tiroides. Valoración inicial y control evolutivo mediante 18F-FDG PET/TC.

Squamous cell carcinoma of thyroid is an uncommon, very aggressive neoplasm, having a poor prognosis and poor response to chemotherapy and radiotherapy. Surgery is the initial treatment of choice, although it often presents as a widespread disease at the time of diagnosis, usually with cervical swelling that causes most of the symptoms due to local infiltration or metastasis. Local infiltration from adjacent tumour and metastatic disease needs to be excluded from other primary epidermoid carcinomas, in order to make a correct diagnosis. This also requires the typical cytokeratin pattern seen in histological studies. The case is presented of a 53 year-old man with a medical history of hepatocarcinoma, with a cervical hypermetabolic lesion detected in an 18F-FDG PET/CT performed to exclude widespread disease. The follow-up of this lesion with this technique and its usefulness is also described.

Burden assessment in caregivers of patients with home artificial nutrition: a need and a challenge.

BACKGROUND/OBJECTIVES: Caregiving can be a stressful task with severe consequences on caregivers' health. Our aim was to evaluate the profile and the burden of caregivers of patients with home artificial nutrition (HAN) in our area. SUBJECTS/METHODS: We conducted a prospective observational study of patients who had started HAN over a period of a year (n=573) and their home caregivers (n=103). Epidemiological characteristics of the patients and the type of HAN were registered. Caregivers' profile data (gender, age and degree of kinship) and Zarit Burden Assessments were recorded. RESULTS: Care recipients had a median age of 79.0 (IQR 87) years, neurological and oncological diseases in 50% and a high rate of mobility limitations (80%). Oral supplements with high-calorie formulas were predominant (60%). The usual caregiver profile was a patient's daughter with a mean age of 53.1 (s.d. 13.4) years acting as the primary caregiver. Burden was absent in 49.5%, light in 18.4% and intense in 32% of caregivers. Intense burden was more frequent in oral over enteral nutrition (42% versus 22.6%; P=0.036). Supplementary nutrition was also associated with higher caregiver burden scores compared with complete diets. In patients with functional limitations, a tendency toward a slightly higher burden was observed. No differences in caregiver burden were detected according to other patient or caregiver characteristics. CONCLUSIONS: HAN type appears to be a factor influencing caregiver burden and therefore, evaluation of caregiver burden should be part of HAN programs.

ANG1005 for breast cancer brain metastases: correlation between 18F-FLT-PET after first cycle and MRI in response assessment.

PURPOSE: Improved therapies and imaging modalities are needed for the treatment of breast cancer brain metastases (BCBM). ANG1005 is a drug conjugate consisting of paclitaxel covalently linked to Angiopep-2, designed to cross the blood-brain barrier. We conducted a biomarker substudy to evaluate 18F-FLT-PET for response assessment. METHODS: Ten patients with measurable BCBM received ANG1005 at a dose of 550 mg/m2 IV every 21 days. Before and after cycle 1, patients underwent PET imaging with 18F-FLT, a thymidine analog, retention of which reflects cellular proliferation, for comparison with gadolinium-contrast magnetic resonance imaging (Gd-MRI) in brain metastases detection and response assessment. A 20 % change in uptake after one cycle of ANG1005 was deemed significant. RESULTS: Thirty-two target and twenty non-target metastatic brain lesions were analyzed. The median tumor reduction by MRI after cycle 1 was -17.5 % (n = 10 patients, lower, upper quartiles: -25.5, -4.8 %) in target lesion size compared with baseline. Fifteen of twenty-nine target lesions (52 %) and 12/20 nontarget lesions (60 %) showed a ≥20 % decrease post-therapy in FLT-PET SUV change (odds ratio 0.71, 95 % CI: 0.19, 2.61). The median percentage change in SUVmax was -20.9 % (n = 29 lesions; lower, upper quartiles: -42.4, 2.0 %), and the median percentage change in SUV80 was also -20.9 % (n = 29; lower, upper quartiles: -49.0, 0.0 %). Two patients had confirmed partial responses by PET and MRI lasting 6 and 18 cycles, respectively. Seven patients had stable disease, receiving a median of six cycles. CONCLUSIONS: ANG1005 warrants further study in BCBM. Results demonstrated a moderately strong association between MRI and 18F-FLT-PET imaging.

"Do not do" recommendations of the Spanish Society of Anaesthesiology, Critical Care and Pain Therapy. "Commitment to Quality by Scientific Societies" Project. / Recomendaciones de «no hacer¼ de la Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Proyecto «Compromiso por la Calidad de las Sociedades Científicas¼.

In April 2013 the Ministry of Health (MSSSI) adopted the project called "Commitment to Quality by Scientific Societies in Spain", in response to social and professional demands for sustainability of the health system. The initiative is part of the activities of the Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System, and is coordinated jointly by the Quality and Cohesion Department, the Aragon Institute of Health Sciences (IACS), and the Spanish Society of Internal Medicine (SEMI). All the scientific societies in Spain have been included in this project, and its main objective is to reduce the unnecessary use of health interventions in order to agree "do not do" recommendations, based on scientific evidence. The primary objective was to identify interventions that have not proven effective, have limited or doubtful effectiveness, are not cost-effective, or do not have priority. Secondary objectives were: reducing variability in clinical practice, to spread information between doctors and patients to guide decision-making, the appropriate use of health resources and, the promotion of clinical safety and reducing iatrogenesis. The selection process of the 5 "do not do" recommendations was made by Delphi methodology. A total of 25 panellists (all anaesthesiologists) chose between 15 proposals based on: evidence that supports quality, relevance, or clinical impact, and the people they affect. The 5 recommendations proposed were: Do not maintain deep levels of sedation in critically ill patients without a specific indication; Do not perform preoperative chest radiography in patients under 40 years-old with ASA physical status I or II; Do not systematically perform preoperative tests in cataract surgery unless otherwise indicated based on clinical history and physical examination; Do not perform elective surgery in patients with anaemia at risk of bleeding until a diagnostic workup is performed and treatment is given; and not perform laboratory tests (blood count, biochemistry and coagulation) prior to surgery in healthy or low risk patients (ASA I and II) with minimal estimated blood loss.

A multicentric study regarding the use of hormone therapy during female mid-age (REDLINC VI).

BACKGROUND: Menopausal hormone therapy (HT) has shown benefits for women; however, associated drawbacks (i.e. risks, costs, fears) have currently determined its low use. OBJECTIVE: To determine the prevalence of current HT use among mid-aged women and describe the characteristics of those who have never used, have abandoned or are currently using HT. In addition, reasons for not using HT were analyzed. METHOD: This was a cross-sectional study that analyzed a total of 6731 otherwise healthy women (45-59 years old) of 15 cities in 11 Latin American countries. Participants were requested to fill out the Menopause Rating Scale (MRS) and a questionnaire containing sociodemographic data and items regarding the menopause and HT use. RESULTS: The prevalence of current HT use was 12.5%. Oral HT (43.7%) was the most frequently used type of HT, followed by transdermal types (17.7%). The main factors related to the current use of HT included: positive perceptions regarding HT (odds ratio (OR) 11.53, 95% confidence interval (CI) 9.41-14.13), being postmenopausal (OR 3.47, 95% CI 2.75-4.36) and having a better socioeconomic level. A total of 48.8% of surveyed women had used HT in the past, but abandoned it due to symptom improvement or being unconcerned; fear of cancer or any other secondary effects were also reported but in less than 10%. Among women who had never used HT, 28% reported the lack of medical prescription as the main reason, followed by the absence of symptoms (27.8%). Among those reporting lack of prescription as the main reason for not using HT, 30.6% currently had severe menopausal symptoms (total MRS score > 16); 19.5% of women were using alternative 'natural' therapies, with 35.1% of them displaying severe menopausal symptoms as compared to a 22.5% observed among current HT users. CONCLUSION: The use of HT has not regained the rates observed a decade ago. Positive perceptions regarding HT were related to a higher use. Lack of medical prescription was the main reason for not using HT among non-users, many of whom were currently displaying severe menopausal symptoms.

Oral health assessment in the San Blas and Santa Ana populations of Nicaragua.

AIM: The aim of this study was to assess the oral health of a population in rural Nicaragua. METHODS: A total of 241 individuals were recruited from areas around San Blas and Santa Ana, Nicaragua. A demographic questionnaire assessing income, access to oral health care, means of transportation and presence of dental/health insurance was collected for each patient. Oral screenings were also conducted to assess for evidence of untreated decayed teeth, restorations, missing/extracted teeth and presence/absence of periodontal disease. RESULTS: The majority of residents in San Blas and Santa Ana, Nicaragua, have little income if any, no medical or dental insurance of any kind and no means of transportation. There was a very high prevalence of untreated decayed teeth among the population studied where 51.1% of our sample had three or more dental caries. Children aged fewer than 20 years had five times the prevalence of dental decay than those in the United States. No statistically significant difference was found in untreated decayed teeth by age or gender. A smaller percentage (25.2%) of all patients had restorations with a statistically significant difference found between genders (P < 0.0001). There was also a relationship between gender and number of missing/extracted teeth (P < 0.001). There was no significant difference in amount of untreated decayed teeth among those who reported having been seen by a dentist within the previous one-to-three, greater than 3 years or never at all. CONCLUSION: Among a population of individuals from San Blas and Santa Ana, Nicaragua, there are major socio-economic barriers present, and a significant burden of oral pathology is evident.

[Spanish growth studies: the current situation, their effectiveness and recommendations for their use]. / Estudios españoles de crecimiento: situación actual, utilidad y recomendaciones de uso.

The child growth assessment is useful not only for the follow up of children's health but also for social purposes, as an indicator of the equity advances in the world. In Spain there has been a long tradition in carrying out growth studies. During the last decade five Spanish research groups have conducted studies among the population of Andalucía, Barcelona, Bilbao, Madrid and Zaragoza. They have combined their data and have produced the "Transversal Spanish Studies 2008 and 2010" and the "Longitudinal Spanish Study 1978/2000". These studies have showed that in Spain the regional differences on growth have disappeared, and that this has had a secular trend in the last decades. The Spanish adult height has approached to other European and American countries, still below some Centre and North European countries. There are some differences between the Spanish growth studies and the multicentric World Health Organization (WHO) growth study. This is due, among other reasons, to the different criteria that are used for the sample selection. In Spain the studies are based on the "population" criteria, whereas the WHO study is based on the "socioeconomic" and "nutritional" criteria. Currently for the Spanish population is appropriate to use, as standard reference, the Spanish multicentric studies, which are the transversal as well as the longitudinal studies. Due to the recent secular trend, it would be convenient to carry out, in the future, prospective transversal growth studies, methodologically homogeneous, representatives of the different Spanish regions, and preferably made every ten to fifteen years.

Immigration and sexual partner risk among Latino adolescents in San Francisco.

Sexual partner characteristics increase risk for adverse reproductive health outcomes. Evidence is limited regarding whether choice of sexual partners among Latino adolescents changes with U.S. acculturation/adaptation. We used generalized estimating equations to assess the associations between immigrant generation (recent immigrant, 1.5 [immigrated prior to adolescence], 2nd and 3rd) and sexual partner risk in a prospective cohort study of 411 Latino adolescents aged 14-19. We examined three measures of partner risk and mediating effects of family influence (familism and parental monitoring). The odds of reporting a partner with frequent substance use increased with increasing immigrant generation (odds ratios (OR) [reference = recent immigrants]: 2.3, 3.4, and 5.6) as did having a partner who was in a gang/incarcerated (OR [reference = recent immigrants]: 2.4, 3.6, and 5.7). Though the odds of having high-risk partners decreased with higher parental monitoring, neither family influence measure mediated these relationships. Findings underscore the need for a prevention focus on partner choice with attention to increased risk with increasing U.S. generation.

Programa piloto para pacientes beneficiarios de Fonasa, que padecen esclerosis multiple: tratamiento con inmunomoduladores en el sistema público de salud de Chile: Informe del primer año, 10 de julio 2008-30 de Junio 2009 / Pilot national treatment program for multiple sclerosis patients belonging to the public health care system of Chile (FONASA) with immunomodulating disease-modifying therapies: first year report from July 2008 to June 2009

Multiple Sclerosis (MS) is a chronic disease of the central nervous system. It is manifested in the young adult who presents at the beginning alternation between transient neurological dysfunction and normality, followed by a progressive level of disability. MS affects the quality of life in the young adults in their full productive and creative age limiting not only in their personal lives but also affects to the whole society in terms of "dreams and life projects". Besides, this illness also influences the family group who has to assume progressively the help and care for the patient. In healthcare aspect MS implies intensive and progressive resources. In Chile, although we don't have epidemiological studies that indicate which is the MS prevalence it exist a projection that states 14 per 100.000 inhabitants. Considering a population of 16.5 million of inhabitants our expectative of patients with MS is of 2310 cases in our country. The MS immunomodulating injectable disease-modifying therapies are of high cost and were not available in a regular way in the state health care system of Chile (FONASA) that attends the 70 percent of the population; the other 30 percent has different private health insurances. In 2008 the ministry of health decided to initiate and pilot (exploratory) program which had a great meaning and impact concerning to start offering immunomodulating therapies to relapsing remitting MS, for patients belonging to FONASA system. The pilot program was thought with a double mission, on the one hand to achieve that a very limited group of MS patients belonging to FONASA system (80 cases) from all over the country had access to immunomodulating injectable disease-modifying therapies of high cost in a regular way. The second objective was to obtain clinical and epidemiological information which let us to evaluate the clinical and administrative obstacles generated by the incorporation of this treatment in the public health...

Introducción El presente documento corresponde al informe del primer año de trabajo operativo del "Programa piloto de tratamiento con inmunomoduladores, para pacientes beneficiarios de Fonasa1, que padecen esclerosis múltiple (EM)", elaborado por el equipo del centro de referencia nacional, para este programa, con sede en el Servicio de Neurología del Complejo Asistencial Barros Luco (CABL) del SSMS2. Dado su origen no incluye antecedentes del proceso de gestión ni toma de decisiones del nivel Minsal3 o Fonasa. Este trabajo, no es ni aspira ser: un ensayo clínico, una guía de práctica clínica, una revisión bibliográfica, ni una puesta al día sobre el tratamiento de la Esclerosis Múltiple (EM), es simplemente el informe anual de un centro de referencia, para una tarea específica, a la autoridad ministerial competente. El informe incluye algunos antecedentes generales y referencias presentadas como "notas al pie", sólo para contextualizar la información presentada4. La EM es una enfermedad crónica del SNC, de origen incierto, inmunológicamente mediada, bien definida en sus características inmunopatogénicas, patológicas, imagenológicas y clínicas. Se expresa en el adulto joven, quien presenta inicialmente alternancia entre disfunción neurológica transitoria y normalidad y cuya progresión determina múltiples efectos discapacitantes. La EM afecta la calidad de vida de adultos jóvenes en plena edad productiva y creativa limitando tanto los "sueños y proyectos de vida" como el desarrollo laboral, social y afectivo. Además trasciende al grupo familiar, cuando deben asumir la asistencia del paciente. En lo sanitario, la EM, genera uso intensivo y progresivo de recursos. Las terapias inmunomoduladores para la EM, que tienen la posibilidad de detener o reducir la evolución de la modalidad recurrente remitente de la EM, no se encontraban disponibles en forma regular en el sector público de salud de nuestro país, por esto el presente programa piloto...

[Analysis of judicial sentences against neurosurgeons resolved in second court of justice in Spain in the period from 1995 to 2007]. / Análisis de las sentencias judiciales contra neurocirujanos resueltas en segunda instancia en España entre 1995 y 2007.

OBJECTIVES: With the aim of identifying the factors related to sentences against neurosurgeons, we have analyzed all the sentences issued in the second court of justice in Spain against neurosurgeons in the period from 1995 to 2007. MATERIAL AND METHODS: Of a total of 1899 sentences of the second or last appeal, during the period from 1995 to 2007 issued in Spain, 61 were chosen which fulfill the criteria to be included in our study. 25 variables were included on the record of compiled data. A complete descriptive and comparative study was elaborated, as well as an analysis of the type of suits, circumstances, and professionals involved. RESULTS: In a third of the cases, complete malpraxis was identified. In regards to the sentences, they were absolved in approximately half the cases, resolved with one fifth of the cases being penal, and four fifths with compensation. Indemnity quantities range from 60,000 to 600,000euro. Deficiency of information or consent was noted in 17% of lawsuits. 62.5% of operations in our sample were on the anatomic region of the vertebral column followed in frequency by the cranial region with 28.6%. Consequences of surgical procedure included major permanent sequelae in 40% of the cases and death in 22%. CONCLUSIONS: It is wise to invest time to deal with patients, including the verbal informed consent, which must be confirmed by the written informed consent form. It is also important to leave a written proof of medical praxis, both related to surgical records and to diagnosis and follow-up of the patient. Procedures with a lower life-threatening risk should not be underestimated, since they comprise the greatest demanded group. The greatest amount of demands is related to economic reimbursement, especially in private practice.

Development of a short olfactory test based on the Connecticut Test (CCCRC).

OBJECTIVE: To create a short olfactory test, Connecticut Smell Test (CST), based on the CCCRC (Connecticut Chemosensor and Clinical Research Center). DESIGN: A prospective patient-based study. SETTINGS: Smell and Taste Outpatient Clinic at the Fundación Hospital Alcorcón, Madrid, Spain. MATERIAL AND METHODS: We compared a short test based on the CCCRC with the Pocket Smell Test (PST) based on the University of Pennsylvania Smell Identification Test) UPSIT in 40 patients with nasal polyposis, in order to determine the specificity, sensitivity, positive predictive and negative predictive values. The validity index was 95% with an accuracy rate of 10%. We determined unit cost, the time required to perform the test in the outpatient office and the difficulty to perform the test. RESULTS: The sensibility was 93.3% and the specificity was 76% with a positive predictive value of 70% and a negative predictive value of 95%. The unitary cost of CST was euro0.65 when it is performed by a doctor. The unitary cost of PST is euro1.76. Our short test took 34 seconds to perform. More than 96% of the patients thought the test was easy to do. CONCLUSION: Our test is a valid, easy and quick test to be used in patients with nasal polyposis.

[Specialized home care of medical diseases in an urban tertiary university hospital. Coordination between the medical services of the hospital and the primary health care]. / Atención especializada domiciliaria de patologías médicas desde un hospital universitario terciario urbano. Coordinación entre los servicios médicos del hospital y la Atención Primaria de salud del territorio.

INTRODUCTION: The experience of an urban Tertiary University Hospital in the design and implementation of Hospital at Home Program (HaHP) integrated in a Department of Internal Medicine and highly coordinated with Medical Services of the Hospital and the Primary Health Care, that contemplates the like main objectives of the promotion of specialized home care medical diseases and the improvement of the coordination with the primary health care. PATIENTS AND METHOD: Systematic collection in all the patients admitted between April 2006 and March 2007 in the HaHP of the following variables: age, gender, service of origin, main diagnosis, Barthel and Charlson index, number of visits per day to doctors and nurses, destination on discharge and medical team. The descriptive statistical analysis was made in April 2007. The results are presented globally and differentiated by teams (internal medicine, respiratory and nutritional support teams). RESULTS: 506 admissions in 390 patients with a mean age of 66.5 (18) years, 53% being women. The Charlson index was 2 (2.2) and the Barthel index 63.5 (40,4). Average stay was 7.9 (8.2) days. The main reasons for admission were the infections and domiciliary intravenous antibiotic therapy in 153 (30.5%) cases, followed by patients with chronic obstructive pulmonary disease or cardiac failure in 107 (21%) cases, and home enteral and parenteral nutrition in 102 (20%) cases. Two hundred (39.5) patients were subsequently controlled by their primary care team after discharger, 241 (47.5) patients were followed-up in the hospital consultations, and 45 (9%) of the patients had to return directly to the hospital. CONCLUSIONS: The creation of a HaHP, for medical diseases, in internal medicine department that is highly coordinated with medical services of the hospital, especially with emergency, respiratory, and nutritional support teams, and with the primary health care, facilitates specialized home care of medical diseases and improves coordination with the primary health care.

[Assessment of activity of care of a nutritional support multidisciplinary team in the follow-up of total parenteral nutrition]. / Evaluación de la actividad asistencial de un equipo multidisciplinario de soporte nutricional en el seguimiento de la nutrición parenteral total.

INTRODUCTION: In total parenteral nutrition (TPN) nutritional support multidisciplinary teams (NSMT) must provide a high quality nutritional assistance based on evidence and daily follow-up of patients with TPN. OBJECTIVES: To assess the degree of adherence to quality standards of care provided to patients on TPN by the NSMT in two consecutive annual periods, according to structure, procedure, and outcomes indicators, previously defined in the team working protocol. PATIENTS AND METHODS: Prospective study of all patients that received TPN at our Center (421-bed general teaching hospital) during the years 2002 and 2003, using the data introduced in NUTRIDATA by daily follow-up of clinical and analytical conditions, and nutritional and non-nutritional complications, comparing both periods and considering an statistical significance level of p < 0.05. RESULTS: One hundred and sixty-three patients and 145 patients received TPN during 2002 and 2003(65.9% male), respectively, with similar parameters of gender, age, indications for TPN, baseline nutritional status, mean nutritional supply, and non-nutritional complications. As to the different quality indicators established in the comparative study, we found a significant improvement in 2003 vs. 2002 in relation to initial anthropometrical assessment (71.03% vs 51.53%; p < 0.001), initial biochemical assessment (97.93% vs. 92.63%; p < 0.04), performance of systematic monitoring analysis (84.83% vs. 71.78%; p < 0.01), hypernatremia incidence (8.27% vs. 15.34%; p = 0.05) and moderate hyperphosphatemia (26.89% vs. 40.49%; p < 0.02), TPN ending for clinical improve- ment (76.60% vs. 64.40%; p = 0.04), and reduction of days on TPN (15.74 +/- 20.43 vs. 11.88 +/- 8.34; p < 0.02), the impaired electrolyte levels significantly improving as a whole. We also observed a non-significant trend towards an improvement of adequacy of TPN indications, hyperphosphatemia, severe hypophosphatemia, total stay, and post-surgical stay, in 2003 vs. 2002. CONCLUSIONS: The NSMT experience shows that analysis of indicators based on quality standards, in two successive annual periods allows assessing the improvement of efficiency of nutritional intervention in hospital-admitted patients with TPN with regards to indication, assessment, follow-up, and course.

Uso de la tomografía de emisión de positrones PET con F18-FDG en la evaluación de lesiones pulmonares sospechosas de neoplasia / Use of positron-emission tomography with F18-fluorodeoxyglucose for the assessment of lung lesions suspicious of malignancy

Positron-emission tomography (PET) with F18-fluorodeoxyglucose (FDG) is very helpful in the evaluation and management of lung lesions. It is specially useful for the characterization of solitary nodules, for the staging, evaluation of recurrence and therapeutic response in non-small cell lung cancer, for the evaluation of small cell lung cancer and for the assessment of pulmonary metastases. This article is a literature review on PET with FDG in lung cancer. A preliminary analysis of PET results at the Military Hospital in Santiago, Chile, is also presented.

A new area multidetector dosemeter for mixed n-gamma fields.

A new instrument to assess neutron ambient doses has been designed and constructed. In its design, spectrometric capabilities have been implemented that allow to take into account the energy spectrum of the neutron field in the evaluation of the operational magnitude, ambient dose equivalent, H*(10). This dosemeter is based on the moderation-absorption technique and can be employed over a wide range of energies from thermal to 20 MeV. It consists of a spherical shaped polyethylene moderator with a set of thermoluminescence dosemeters (TLDs) inserted in different positions of its interior to evaluate the external neutron energy spectrum. At this moment the system uses pairs 6LiF:Mg,Ti (TLD-600) and 7LiF:Mg,Ti (TLD-700) thermoluminescence dosemeters for a better gamma discrimination. The dosemeter response matrix was calculated using the MCNP4C Monte Carlo code (MC). The viability of the dosemeter for area dosemetry has been examined experimentally showing its capabilities over a wide range of energies.

Análisis markoviano de un proceso de estancia hospitalaria en un hospital de tercer nivel de complejidad / Markovian analysis of a stay process in a hospital of third level of complexity

Objetivo: estimar el número esperado de pacientes con trauma en los servicios de hospitalización, cirugía y unidad de cuidados intensivos y en la condición de egreso vivo y muerto, luego de ingresar por urgencias a un hospital de tercer nivel de complejidad. Materiales y métodos: con base en la información derivada de un estudio de seguimiento con 2.084 registros correspondientes a ingresos a urgencias por trauma en un hospital de tercer nivel de complejidad, se estimó la matriz de probabilidades de transición y el número esperado de pacientes en cada estado en una unidad de tiempo de 12 horas para todas las cohortes de pacientes, mediante el análisis de cadenas de Markov. Resultados: se obtuvo un análisis de sensibilidad para la probabilidad de permanecer en el servicio de cirugía y de ser trasladado de la unidad de cuidados intensivos a hospitalización. Conclusión: el modelo utilizado es adecuado para la reproducción de lo observado y puede utilizarse para predecir configuraciones observables si se conoce el ritmo de ingreso de las cohortes de pacientes o si se tiene un modelo teórico para ellas

[Assessment of risk factors in the incidence of hepatic artery thrombosis in a consecutive series of 687 liver transplantations]. / Valutazione dei fattori di rischio nell'incidenza di trombosi dell'arteria epatica in una serie consecutiva di 687 trapianti di fegato.

AIM: The aim of this retrospective study was to characterize the risk factors of hepatic artery thrombosis (HAT) after orthotopic liver transplantation (OLT) in a consecutive series of 687 OLT, comparing the branch patch anastomosis (BPA) with the end-to-end anastomosis (EEA), in order to investigate, moreover, which technique may be statistically associated with a reduced incidence of HAT. METHODS: Between 1986-1999 we performed 687 OLT in 601 patients, of which 592 were adult and 95 pediatric. Preservation of all donor livers was accomplished with the University of Wisconsin solution since OLT No. 112, at the beginning of 1990. A multivariate analysis was performed in order to find independent variables influencing HAT. We compared, between the two study groups EEA (n = 340) vs BPA (n = 347), HAT incidences with the following variables: adult OLT; pediatric OLT; pre '90 period; post '90 period; donor age; ABO incompatibility; graft type; cold ischemia time; warm ischemia time; double anastomoses; retransplantation; whole blood, fresh frozen plasma and platelet transfusions. RESULTS: HAT was identified in 17/687 OLT (2.47%). HAT incidence was 2.0% in adults (12/592) and 5.2% in children (5/95) (p = 0.059). In the EEA group, HAT was diagnosed in 12/340 cases (3.53%), whereas in the BPA group 5/347 patients experienced HAT (1.44%) (p = 0.078). The need of back table reconstruction occurred in 2/17 HAT cases (11.7%). Possible causative factors included rejection in 5 patients, whereas were unknown in 7 cases. A clear mechanical cause for HAT was identified in one patient, in whom a mechanical intraabdominal compression caused poor inflow. In two cases an intimal dissection was found, while poor inflow occurred in two cases. After a univariate analysis of 44 variables, compared between the two study groups (EEA vs BPA) in patients who developed HAT after OLT (n = 17), only intraoperative PT (p = 0.0525), postoperative SGOT (48 h) (p = 0.0006) and postoperative SGPT (48 h) (p = 0.0222) correlated significantly with the occurrence of HAT. After a multivariate analysis, the variables found to be independent in increasing HAT incidence were: pre '90 period (HAT incidence was 4.5 times more frequent in the pre '90 period: p = 0.0093), ABO incompatibility (HAT incidence was 7.8 times more frequent in incompatible cases: p = 0.0363) and a shorter warm ischemia time (p = 0.0112). DISCUSSION: HAT after OLT is more common in the pediatric population, where it occurs in 10% to 26% of the cases, considerably higher than the 1.6% to 10.5% rate seen in the adult patients. In our series the risk of thrombosis was 2.6 times greater in children than in adults. Moreover, after a multivariate analysis, it was observed that the EEA was associated with an increased risk of thrombosis (2.4 times greater than in the BPA group). In this retrospective study we described a large number of variables, that may influence the development of HAT after OLT, identifying a group of risk factors that correlated statistically with this complication. The results of our report stressed the importance of medical factors compared with surgical factors in the incidence of HAT. CONCLUSIONS: Even if the type of arterial reconstruction was not found to be an independent risk factor in reducing HAT incidence after OLT, our current preferred method of arterial anastomosis is the branch patch technique, using the hepatic-gastroduodenal bifurcation, with a HAT rate of 1.44%.