Elective Recurrent Inguinal Hernia Repair: Value of an Abdominal Wall Surgery Unit.

BACKGROUND: The aim of this study was to analyze the impact of an abdominal wall surgery unit on postoperative complications (within 90 days postoperatively), hernia recurrence and chronic postoperative inguinal pain after elective recurrent inguinal hernia repair. METHODS: We conducted a retrospective cohort study of all adult patients who underwent elective recurrent inguinal hernia repair between January 2010 and October 2021. Short- and long-term outcomes were compared between the group of patients operated on in the abdominal wall surgery unit and the group of patients operated on by other units not specialized in abdominal wall surgery. A logistic regression model was performed for hernia recurrence. RESULTS: A total of 250 patients underwent elective surgery for recurrent inguinal hernia during the study period. The patients in the abdominal wall surgery group were younger (P ≤ 0.001) and had fewer comorbidities (P ≤ 0.001). There were no differences between the groups in terms of complications. The patients in the abdominal wall surgery group presented fewer recurrences (15% vs. 3%; P = 0.001). Surgery performed by the abdominal wall surgery unit was related to fewer recurrences in the multivariate analysis (HR = 0.123; 95% CI = 0.21-0.725; P = 0.021). CONCLUSIONS: Specialization in abdominal wall surgery seems to have a positive impact in terms of recurrence in recurrent inguinal hernia repair. The influence of comorbidities or type of surgery (i.e., outpatient surgery) require further study.

Simultaneous incisional hernia repair and colorectal surgery: one or two-step procedure?

PURPOSE: Patients requiring colorectal surgery in the context of an incisional hernia are common, but it is not clear whether the repair should be performed as a single or two-step surgery. Our aim was to evaluate complications after concomitant abdominal wall repair and colorectal surgery compared to those after incisional hernia repair alone. METHODS: Adult patients who underwent elective incisional hernia surgery from 2012-2022 from the EVEREG registry were included. Patients who underwent midline incisional hernia repair as a single procedure and patients who underwent midline incisional hernia repair concomitant with colorectal surgery were included. The primary outcome was surgical site infection (SSI). The secondary outcomes were the Clavien-Dindo classification grade, in-hospital mortality and recurrence. RESULTS: A total of 7783 patients were included: 256(3.3%) who underwent concomitant surgery and 7527(96.7%) who underwent only midline incisional hernia repair. The first group included more comorbid patients and complex hernias. SSI was found in 55.4% of patients who underwent simultaneous surgery compared to 30.7% of patients who underwent hernia repair alone (P = 0.000). Multivariate analysis revealed that the risk factors for SSI were BMI (OR = 1.07, 95% CI 1.02-1.11; P = 0.004), smoking (OR = 1.89, 95% CI 1.12-3.19; P = 0.017), transverse diameter (OR = 1.06, 95% CI 1.01-1.11; P = 0.017), component separation (OR = 1.996, 95% CI 1.25-3.08; P = 0.037) and clean-contaminated and contaminated surgeries(OR = 3.86, 95% CI 1.36-10.66; P = 0.009). Higher grades of Clavien-Dindo (P = 0.001) and mortality rates (P < 0.001) were found in the colorectal surgery group, although specific risk factors were detected. No differences were observed in terms of recurrence (P = 0.104). CONCLUSIONS: Concomitant surgery is related to greater risk of complications, especially in patients with comorbidities and complex hernias. In properly selected cases, simultaneous procedures can yield satisfactory results.

The microbiology of sepsis is more than the application of new technologies in diagnosis.

Adequate and rapid microbiological diagnosis of sepsis is essential for correct treatment, having a direct impact on patient prognosis. Clinical Microbiology Services must adapt fast circuits that allow prioritizing and individualizing the diagnosis of these patients. The measures adopted should not be based solely on the incorporation of new technologies but, to a large extent, on ensuring accurately collection and processing of samples, avoiding unnecessary losses of time in processing and ensuring that the information derived from this process adequately reaches the prescribing physician.

Diagnostic performance of PWI/DWI MRI parameters in discriminating hyperacute versus acute ischaemic stroke: finding the best thresholds.

AIM: To determine the accuracy of the perfusion/diffusion-weighted imaging (PWI/DWI) parameters [time to peak (TTP), mean time to peak (MTT), relative cerebral blood volume (rCBV), and relative cerebral blood flow (rCBF) maps]; in the evaluation of acute versus hyperacute ischaemic stroke. MATERIALS AND METHODS: Fifty-five patients with symptomatic hyperacute (first 6h) or acute (7-24h) ischaemic stroke underwent diffusion and perfusion evaluation. Statistical analysis included Student's t-test, receiver operating characteristics (ROC) analysis of apparent diffusion coefficient (ADC), TTP, MTT, CBV, and CBF; correlation, linear, and logistic regression analysis. RESULTS: Area under receiver operating characteristics (AUROC) analysis identified the ADC cut-off value 385×10(-6)mm(2)/s, MTT at 109.5%, TTP at 3.05s, CBV at 129%, and CBF at 98.5% (the record of the time of onset was considered the reference standard). The best performance corresponded to TTP, which showed a sensitivity of 0.94 and specificity of 0.88 (p<0.001). CONCLUSIONS: Based on the present findings, hyperacute penumbra is reliably defined with a TTP >3s with no visible changes in diffusion. ADC, rCBF, and rCBV are not useful for discriminating between acute and hyperacute ischaemic stroke.

Public Perception of Organ Donation and Transplantation Policies in Southern Spain.

BACKGROUND: This research explores how public awareness and attitudes toward donation and transplantation policies may contribute to Spain's success in cadaveric organ donation. MATERIALS AND METHODS: A representative sample of 813 people residing in Andalusia (Southern Spain) were surveyed by telephone or via Internet between October and December 2018. RESULTS: Most participants trust Spain's donation and transplantation system (93%) and wish to donate their organs after death (76%). Among donors, a majority have expressed their consent (59%), and few nondonors have expressed their refusal (14%). Only a minority are aware of the presumed consent system in force (28%) and feel sufficiently informed regarding the requirements needed to be an organ donor (16%). Participants mainly consider that relatives should represent the deceased's preferences and be consulted when the deceased's wishes are unknown, as is the case in Spain. CONCLUSION: Public trust in the transplant system may contribute to Spain's high performance in organ donation. High levels of societal support toward organ donation and transplantation do not correspond with similar levels of public awareness of donation and transplantation policies in Spain.

Molecular assembly of multi-wall carbon nanotubes with amino crown ether: synthesis and characterization.

Synthetic methodology and physicochemical characterization of multi-wall carbon nanotubes (MWCNTs) functionalized with a crown ether molecule is reported. The MWCNTs were synthesized by spray pyrolysis technique using toluene as carbon source and ferrocene as catalyst. The nanotubes were characterized by scanning electron microscopy (SEM) and transmission electron microscopy (TEM). Oxidation of MWCNTs was carried out by 8 h of sonication in a mixture of sulfuric and nitric acid (3:1). The MWCNT-COOH was amidated with 4-aminobenzo-15-crown-5 under mild reaction conditions using N,N'-dicyclohexylcarbodiimide and dimethylaminopyridine as catalyst and dimethylformamide as solvent, at room temperature for 24 h. The amidation product was characterized by scanning electron microscopy, infrared spectroscopy, X-ray photoelectron spectroscopy, atomic force microscopy and a mass spectrometry study to determine the fragmentation pattern being m/z 309, 177 and 149 the most important ions.

[Henoch-Schönlein purpura. Study of factors associated with the development and course of the disease]. / Púrpura de Schönlein-Henoch. Estudio de factores asociados con el desarrollo y evolución de la enfermedad.

INTRODUCTION: Henoch-Schönlein purpura (HSP) is the most common form of pediatric vasculitis. The objective of this study was to determine the factors associated with the development and course of this disease. PATIENTS AND METHODS: A case-control study was performed. The case group included patients with HSP followed-up at the pediatric rheumatology and nephrology units of a tertiary university hospital over a 2-year period. The control group included children followed-up at the pediatric rheumatology unit for mechanical or non-inflammatory conditions. A medical history including data on infectious conditions and previous medication was taken. A throat culture was performed and antistreptolysin 0 levels were quantified. The seroprevalence of different viruses was investigated. Subsequently, the patients were prospectively followed-up and disease manifestations were compared with reported epidemiological factors. RESULTS: Seventy patients and 58 controls were studied. A history of a recent upper respiratory infection (URI) and antibiotic intake were independently associated with development of HSP. Palpable purpura was present in 100 % of the patients. Gastrointestinal manifestations were recorded in 63 %, articular in 50 %, and renal in 18.6 %. Arthralgias were more frequent in girls and purpura duration was longer when disease onset occurred in spring or summer. Other factors studied were not associated with disease development or with a worse clinical course. CONCLUSIONS: Factors associated with the development of HSP were a history of URI and antibiotic administration. Other epidemiological factors studied were not associated with either the development or the course of the disease.

Detection and differentiation of Entamoeba histolytica and Entamoeba dispar in clinical samples through PCR-denaturing gradient gel electrophoresis.

Amebiasis is one of the twenty major causes of disease in Mexico; however, the diagnosis is difficult due to limitations of conventional microscopy-based techniques. In this study, we analyzed stool samples using polymerase chain reaction-denaturing gradient gel electrophoresis (PCR-DGGE) to differentiate between Entamoeba histolytica (pathogenic) and E. dispar (non-pathogenic). The target for the PCR amplification was a small region (228 bp) of the adh112 gene selected to increase the sensitivity of the test. The study involved 62 stool samples that were collected from individuals with complaints of gastrointestinal discomfort. Of the 62 samples, 10 (16.1%) were positive for E. histolytica while 52 (83.9%) were negative. No sample was positive for E. dispar. These results were validated by nested PCR-RFLP (restriction fragment length polymorphism) and suggest that PCR-DGGE is a promising tool to differentiate among Entamoeba infections, contributing to determine the specific treatment for patients infected with E. histolytica, and therefore, avoiding unnecessary treatment of patients infected with the non-pathogenic E. dispar.

Sources of abnormal EEG activity in the presence of brain lesions.

In routine clinical EEG, a common origin is assumed for delta and theta rhythms produced by brain lesions. In previous papers, we have provided some experimental support, based on High Resolution qEEG and dipole fitting in the frequency domain, for the hypothesis that delta and theta spectral power have independent origins related to lesion and edema respectively. This paper describes the results obtained with Frequency Domain VARETA (FD-VARETA) in a group of 13 patients with cortical space-occupying lesions, in order to: 1) Test the accuracy of FD-VARETA for the localization of brain lesions, and 2) To provide further support for the independent origin of delta and theta components. FD VARETA is a distributed inverse solution, constrained by the Montreal Neurological Institute probabilistic atlas that estimates the spectra of EEG sources. In all patients, logarithmic transformed source spectra were compared with age-matched normative values, defining the Z source spectrum. Maximum Z values were found in 10 patients within the delta band (1.56 to 3.12 Hz); the spatial extent of these sources in the atlas corresponded with the location of the tumors in the CT. In 2 patients with small metastases and large volumes of edema and in a patient showing only edema, maximum Z values were found between 4.29 and 5.12 Hz. The spatial extent of the sources at these frequencies was within the volume of the edema in the CT. These results provided strong support to the hypothesis that both delta and theta abnormal EEG activities are the counterparts of two different pathophysiological processes.

[Risk assessment of thrombotic events after the use of activated factor VII]. / Evaluación del riesgo de fenómenos trombóticos tras el uso de factor vii activado.

INTRODUCTION: The objective of this study was to analyze the incidence of thrombotic complications related to recombinant human factor viia (rFVIIa) therapy for severe postoperative bleeding in cardiac surgery. MATERIAL AND METHODS: A retrospective matched case-control study was conducted over two years, including 72 children admitted to intensive care unit and treated with rFVIIa because of a severe bleeding during or after cardiac surgery. A control group of 63 patients was chosen, who were statistically comparable in sex, weight, diagnosis, surgical risk according RASCH-1 score, and surgical characteristics, was chosen. RESULTS: There were no significant differences between cases and controls either in the rate of thrombosis (20% vs 28%, P=.540), or in the mortality rate (16% vs 9.5%, P=.208). CONCLUSIONS: In our study, the rFVIIa therapy was shown to be useful in controlling severe operative bleeding in pediatric cardiac surgery, but does not seem to increase the risk of thrombotic complications or mortality rate in the postoperative period.

[Prevalence of diabetes in an adult population in the region of Madrid (Spain). The Madrid Cardiovascular Risk study]. / Prevalencia de diabetes en una población adulta de Madrid (España). Estudio MADRIC (MADrid RIesgo Cardiovascular).

OBJECTIVE: To estimate the prevalence of diabetes mellitus and impaired fasting glycemia in an adult population living in Madrid (Spain). METHODS: In this cross-sectional, population-based survey, we studied 1,344 adults aged 31-70 years, randomly selected from the population living in 14 primary care districts of the Madrid region. All participants underwent a clinical evaluation that included a clinical interview, physical examination and fasting blood analysis (glycemia, cholesterol and triglyceride levels). The participants were considered to be diabetic if they had been previously diagnosed with diabetes by their general physician or had a fasting glycemia ≥ 126 mg/dl without a previous diabetes diagnosis. Impaired fasting glycemia was defined as fasting glycemia between 100mg/dl and 125 mg/dl in non-diabetic participants. RESULTS: The sex- and age-adjusted prevalence figures for diabetes and impaired fasting glucose were 6.6% (95% CI: 5.9-8.7) and 14.1% (95% CI: 12.1-15.8), respectively. A substantial proportion of diabetic patients [17.2% (95% CI: 10.9-23.5)] had not been previously diagnosed. The variables independently associated with diabetes were age, male gender, abdominal obesity and hypertension. CONCLUSIONS: Our prevalence figure for diabetes is similar to those reported in other Spanish regions. The high frequency of impaired fasting glucose is worrisome, particularly when combined with obesity, as this association confers a high risk for developing diabetes mellitus.

Proceso de Atención de Enfermería a una lactante con neumonía basado en patrones funcionales de Marjory Gordon / Nursing Care Process on an infant suffering from pneumonia based on the Marjory Gordon Functional Patterns

El Proceso de Atención de Enfermería (PAE) que se presenta tiene como objetivo: Identificarlas necesidades alteradas, corregir, mantener y rehabilitar al paciente por medio de la aplicación de conocimientos y procedimientos, con la finalidad de que este recobre en el menor tiempo posible su salud, en este caso una lactante con neumonía. Hoy en día, la neumonía es la causa principal de muerte de niños menores de 5 años en todo el mundo, su principal afectación son los alvéolos pulmonares, lo que compromete el patrón respiratorio. Esta enfermedad si no es tratada oportunamente puede tener complicaciones como: fallo respiratorio agudo, absceso pulmonar, insuficiencia cardiaca congestiva. Es entonces cuando el personal de Enfermería juega un papel importante en la ejecución de intervenciones, que ayuden a mantener la permeabilidad y la estabilidad de la vía aérea. Se identificaron las necesidades prioritarias con base en los 11 patrones funcionales de Marjory Gordon; se diseñó un plan de cuidados individualizado encaminado al mantenimiento del patrón respiratorio, para este se utilizaron las taxonomías: NANDA, NIC y NOC. Los resultados obtenidos fueron satisfactorios, se logró disminución de la dificultad respiratoria, mejoría en la permeabilidad de la vía aérea, mantenimiento de la frecuencia cardiaca y prolongación de periodos de sueño; sin embargo debido a que la paciente presentaba una desnutrición severa con evolución de 6 meses, no pudo modificarse ese patrón y aunado a la gravedad del padecimiento falleció.

The Nursing Attention Process (NAP) aims to identify altered needs, and correct, maintain and rehabilitate the patient through the use of knowledge and procedures, so that he/she can be healthy as soon as possible. In this study, the patient was an infant suffering from pneumonia. Currently, pneumonia is the world's principal cause of death in children younger than 5 years old. Indeed, consequences of not treating this illness on time include acute respiratory arrest, lung abscesses, and congestive cardiac insufficiency. Here, is when the nursing staff has a crucial role at maintaining the permeability and stability of the respiratory airways of these patients. Priority needs were identified through the 11 functional pattern of Marjory Gordon. An individualized care plan was designed and aimed to the maintenance of the child's respiratory patterns. NANDA, NIC and NOC taxonomies were used. Satisfactory results included a decrease in the respiratory difficulty, an improvement in the airway permeability, the maintenance of the cardiac rate, and the improvement of sleep time. However, due to a 6 month previous malnutrition, and the complications of this illness, unfortunately this patient died.

[European impact of Spanish Internal Medicine]. / Proyección europea de la Medicina Interna española.

OBJECTIVES: To evaluate the scientific contributions of spanish specialists in Internal Medicine in the Congresses of the European Federation of Internal Medicine (EFIM) during the period from 1997 to 2003. MATERIAL AND METHODS: Communications and posters from the books of abstracts of the last four EFIM meetings held in Maastricht (1997), Florence (1999), Edinburgh (2001) and Berlin (2003) were studied. The field of research was recorded and case reports were excluded. RESULTS: 1,616 scientific communications were taken in account. Two percent (31) were from countries outside Europe. Spain ranked first with 487 communications (30.1%), followed by Italy (11.9%), France (10.5%) and Portugal (10.2%). In Spain, Madrid, Galicia, Andalusia and Valencia were the regional communities with the most contributions. The main fields of research were cardiovascular diseases and infectious diseases-AIDS infections. CONCLUSIONS: The speciality of Internal Medicine in Spain is very active in terms of scientific contributions as judged by the number of communications to the european congresses.

Thermographic patterns of the breast: a critical analysis of interpretation.

In a prospective evaluation, 1,000 consecutive breast thermograms were categorized as either normal or having 1 of 4 abnormal patterns: diffuse, asymmetrical, focal, or peri-areolar. Of 49 proved carcinomas, 43 produced an abnormal patterns; the asymmetric type was 3 times as common as the focal. Tumors producing focal patterns were slightly smaller than those producing asymmetrical patterns. Almost 30% of the non-malignant lesions produced an abnormal thermogram. This procedure can not generally be used to distinguish between benign and malignant lesions; there may be, therefore, little diagnostic value in categorizing abnormal thermograms. The usefulness of thermography in the detection of occult carcinomas has not been established.