Lactate produced by alveolar type II cells suppresses inflammatory alveolar macrophages in acute lung injury.

Alveolar inflammation is a hallmark of acute lung injury (ALI), and its clinical correlate is acute respiratory distress syndrome-and it is as a result of interactions between alveolar type II cells (ATII) and alveolar macrophages (AM). In the setting of acute injury, the microenvironment of the intra-alveolar space is determined in part by metabolites and cytokines and is known to shape the AM phenotype. In response to ALI, increased glycolysis is observed in AT II cells, mediated by the transcription factor hypoxia-inducible factor (HIF) 1α, which has been shown to decrease inflammation. We hypothesized that in acute lung injury, lactate, the end product of glycolysis, produced by ATII cells shifts AMs toward an anti-inflammatory phenotype, thus mitigating ALI. We found that local intratracheal delivery of lactate improved ALI in two different mouse models. Lactate shifted cytokine expression of murine AMs toward increased IL-10, while decreasing IL-1 and IL-6 expression. Mice with ATII-specific deletion of Hif1a and mice treated with an inhibitor of lactate dehydrogenase displayed exacerbated ALI and increased inflammation with decreased levels of lactate in the bronchoalveolar lavage fluid; however, all those parameters improved with intratracheal lactate. When exposed to LPS (to recapitulate an inflammatory stimulus as it occurs in ALI), human primary AMs co-cultured with alveolar epithelial cells had reduced inflammatory responses. Taken together, these studies reveal an innate protective pathway, in which lactate produced by ATII cells shifts AMs toward an anti-inflammatory phenotype and dampens excessive inflammation in ALI.

Metal-Catalyzed and Metal-Free Nucleophilic Substitution of 7-I-B18H21.

In this work, two pathways of reactivity are investigated to generate site-specific substitutions at the B7 vertex of the luminescent boron cluster, anti-B18H22. First, a palladium-catalyzed cross-coupling reaction utilizing the precursor 7-I-B18H21 and a series of model nucleophiles was developed, ultimately producing several B-N- and B-O-substituted species. Interestingly, the B-I bond in this cluster can also be substituted in an uncatalyzed fashion, leading to the formation of various B-N, B-O, and B-S products. This work highlights intricate differences corresponding to these two reaction pathways and analyzes the role of solvents and additives on product distributions. As a result of our synthetic studies, seven new B18-based clusters were synthesized, isolated, and characterized by mass spectrometry and nuclear magnetic resonance (NMR) spectroscopy. The photoluminescence properties of two structurally similar ether and thioether products were further investigated, with both exhibiting blue fluorescence in solution at 298 K and long-lived green or yellow phosphorescence at 77 K. Overall, this work shows, for the first time, the ability to perform substitution of a boron-halogen bond with nucleophiles in a B18-based cluster, resulting in the formation of photoluminescent molecules.

Paediatricians provide higher quality care to children and adolescents in primary care: A systematic review.

AIM: The number of primary care paediatricians is decreasing in Europe without a justifiable reason. We aimed to compare the clinical practice of paediatricians and family doctors attending children and adolescents in primary care. METHODS: MEDLINE, Embase, CENTRAL, TRIP and Google Scholar were searched from December 2008 to February 2018. No language or study design restrictions were applied. Three reviewers assessed eligibility of the studies. Seven pairs of reviewers performed the data extraction and assessed the methodological quality independently. Discrepancies were resolved by consensus. RESULTS: Fifty-four, out of 1150 studies preselected, were included. We found that paediatricians show more appropriate pharmacology prescription patterns for the illness being treated; they achieve higher vaccination rates and have better knowledge of vaccines and fewer doubts about vaccine safety; their knowledge and implementation of different screening tests are better; they prescribe psychoactive drugs more cautiously and more in line with current practice guidelines; their evaluation and treatment of obesity and lipid disorders follow criteria more consistently with current clinical practice guidelines; and they perform fewer diagnostic test, show a more suitable use of the test and request fewer referrals to specialists. CONCLUSION: According to published data, in developed countries, paediatricians provide higher quality care to children than family doctors.

[Evaluation of the effectiveness of a Mindfulness and Self-Compassion program to reduce stress and prevent burnout in Primary Care health professionals]. / Evaluación de la efectividad de un programa de mindfulness y autocompasión para reducir el estrés y prevenir el burnout en profesionales sanitarios de atención primaria.

OBJECTIVE: To evaluate the effectiveness of a Mindfulness and Self-Compassion Program on the levels of stress and burnout in Primary Care health professionals. DESIGN: Randomised, controlled clinical trial. PARTICIPANTS AND SETTING: Training in Mindfulness was offered to 1,281 health professionals in Navarra (Spain) Primary Care, and 48 of them accepted. The participants were randomly assigned to groups: 25 to the intervention group, and the remaining 23 to the control group. INTERVENTION: The Mindfulness and Self-Compassion training program consisted of sessions of 2.5chours/week for 8 weeks. The participants had to attend at least 75% of the sessions and perform a daily practical of 45minutes. MAIN MEASUREMENTS: The levels of mindfulness, self-compassion, perceived stress, and burnout were measured using four questionnaires before and after the intervention. RESULTS: After the intervention, the scores of the intervention group improved significantly in mindfulness (P<.001); perceived stress (P<.001); self-compassion: self-kindness P<.001, shared humanity P=.004, mindfulness P=.001; and burnout: emotional fatigue (P=.046). The comparison with the control group showed significant differences in mindfulness (P<.001), perceived stress (P<.001), self-kindness (P<.001) and emotional fatigue (P=.032). CONCLUSIONS: This work suggests that it may be beneficial to encourage mindfulness and self-compassion practices in the health environment.

[Main changes in the «COVID-19 in paediatrics¼ clinical practice guideline]. / Principales modificaciones en la guía de práctica clínica «COVID-19 en pediatría¼.

We present a summary of the main modifications to the «COVID-19 in Paediatrics¼ clinical practice guideline made from its initial version, published in 2021, and the version published in 2022. The document was developed following the structured steps of evidence-based medicine and applying the GRADE system to synthesize the evidence, assess its quality and, when appropriate, issue graded recommendations (based on the quality of the evidence, values and preferences, the balance between benefits, risks and costs, equity and feasibility). This update also includes the modifications proposed by external reviewers.We summarised the main modifications in the following sections: epidemiology, clinical features, diagnosis, prevention, treatment and vaccines. In relation to the body of knowledge achieved in the first year of the pandemic, the literature published in the second year contributed additional data, but without substantial modifications in many of the areas. The main changes took place in the field of vaccine research. This update was completed in December 2021, coinciding with the emergence of infections by the omicron variant, so the document will need to be updated in the future.

Main changes in the "COVID-19 in paediatrics" clinical practice guideline.

We present a summary of the main modifications to the "COVID-19 in Paediatrics" clinical practice guideline made from its initial version, published in 2021, and the version published in 2022. The document was developed following the structured steps of evidence-based medicine and applying the GRADE system to synthesize the evidence, assess its quality and, when appropriate, issue graded recommendations (based on the quality of the evidence, values and preferences, the balance between benefits, risks and costs, equity and feasibility). This update also includes the modifications proposed by external reviewers. We summarised the main modifications in the following sections: epidemiology, clinical features, diagnosis, prevention, treatment and vaccines. In relation to the body of knowledge achieved in the first year of the pandemic, the literature published in the second year contributed additional data, but without substantial modifications in many the areas. The main changes took place in the field of vaccine research. This update was completed in December 2021, coinciding with the emergence of infections by the omicron variant, so the document will need to be updated in the future.

Safety of combining dabrafenib plus trametinib in elderly BRAF V600 mutation-positive advanced melanoma patients: real-world data analysis of Spanish patients (ELDERLYMEL).

Efficacy and safety of dabrafenib and trametinib in metastatic melanoma have been demonstrated in two-phase III and one-phase I/II clinical trials. However, patients at least 75 years old (y.o.) were largely underrepresented. Additionally, the safety profile of dabrafenib and trametinib based on age is unknown. ELDERLYMEL is a retrospective noninterventional multicenter study, describing the effectiveness and safety of at least 75 y.o. patients compared with less than 75 y.o. patients with advanced BRAF V600-mutated melanoma treated with dabrafenib plus trametinib or dabrafenib monotherapy. A total of 159 patients were included, 130 less than 75 y.o. and 29 at least 75 y.o. Clinical features were similar between the groups, except in the number of comorbidities, number of metastatic sites, Eastern Cooperative Oncology Group (ECOG) performance status, and BRAF V600-mutation type. Five patients per group received dabrafenib monotherapy. There were no differences in adverse events (AEs) rate or grade between the groups. However, AE profiles were different between the groups, being pyrexia infrequent in patients at least 75 y.o. (13.8% vs. 42.3%; P = 0.005). Dabrafenib and trametinib dose intensities were lower in at least 75 y.o. patients ( P = 0.018 and P = 0.020), but there were no differences in effectiveness between the groups. Finally, in a multivariate analysis, sex (female) was the only variable independently associated with an increased risk of AE grade ≥3. Data from the ELDERLYMEL study demonstrate that dabrafenib plus trametinib is safe and effective in at least 75 y.o. patients with advanced BRAF V600-mutated melanoma without increasing toxicity. Additionally, we describe a different safety profile depending on age and sex.

High plasma levels of soluble P-Selectin and Factor VIII predict venous thromboembolism in non-small cell lung cancer patients: The Thrombo-Nsclc risk score.

INTRODUCTION: Venous thromboembolism (VTE) is common in non-small cell lung cancer (NSCLC) patients undergoing systemic chemotherapy. The usefulness of Khorana score (KRS) to predict risk in lung cancer patients is limited, and the identification of patients who would benefit most from thromboprophylaxis is challenging. We aimed to identify variables whose values before chemotherapy helped in predicting VTE occurrence, and build a model to assess VTE risk. MATERIALS AND METHODS: A cohort of newly diagnosed NSCLC patients to undergo outpatient chemotherapy, not under anticoagulant treatment, was recruited. Pre-chemotherapy demographic, clinical, analytical and tumor-specific variables were collected. Patients were prospectively followed-up for 12 months to record VTE events. Bivariate and multivariate analyses were performed to identify VTE-associated variables, and a prediction model was built and compared with KRS. RESULTS: 90 patients were recruited, 18 of whom had a VTE event during follow-up. High baseline levels of factor VIII (FVIII) and, especially, soluble P-selectin (sP-selectin), were independently associated with VTE risk (hazard ratio [HR] 4.15, 95% confidence interval [CI] 1.17-14.71, and 66.40 [8.70-506.69], respectively). Our so-called Thrombo-NSCLC risk score, which assigns 1 and 3 points to high FVIII and sP-selectin values, respectively, was significantly better than KRS in predicting VTE (area under the curve [AUC] 0.93 vs. 0.55, sensitivity 94.4 vs. 35.0%, specificity 93.1 vs. 60.0%). Our prediction model showed significant discriminating capacity between high risk vs. intermediate/low risk patients, while KRS did not. CONCLUSIONS: The Thrombo-NSCLC risk score may be useful to identify those NSCLC patients who would benefit most from thromboprophylaxis.

Good practice regarding smoking cessation management in Spain: Challenges and opportunities for primary care physicians and nurses.

INTRODUCTION: We analyze the activities carried out by primary care (PC) physicians and nurses with respect to smoking cessation and evaluate their self-reported training, knowledge, and behavior. METHODS: A cross-sectional study was conducted including 1514 PC physicians and nurses from June 2016 to March 2017, in Spain. The main variable was Good Practice (GP) in attention to smokers. To identify associated factors, a multilevel logistic regression model was used adjusted for sex, age, type of center, contract, years of employment, tobacco consumption, and self-reported training/knowledge. RESULTS: Of the 792 physicians and 722 nurses, 48.6% referred to GP in smoking cessation management. The finding related to: being a non-smoker (OR=1.8; 95% CI: 1.2-2.5) or ex-smoker (OR=1.4; 95% CI: 1.02-2.1), having a good level of knowledge (OR=1.8; 95% CI: 1.3-2.4) and training (OR=2.4; 95% CI: 1.8-3.2), and, to a lesser extent, being female (OR=1.3; 95% CI: 1.03-1.7), and work experience >10 years (OR=1.4; 95% CI: 1.03-1.9). The main GP barriers were: lack of time (45.5%), organizational problems (48.4%), and 35.4% lack of training. CONCLUSIONS: The GP of PC physicians and nurses regarding smoking cessation management is related to being non-smokers or ex-smokers, and having sufficient training and knowledge. Lack of time and organizational problems were considered to be the main barriers. The promotion of training activities in the Spanish National Health Service with the support of scientific societies is required.

Attitudes towards anti-smoking legislation and prevalence of tobacco consumption in Spanish primary healthcare personnel.

INTRODUCTION: Our aim was to ascertain how the anti-smoking legislation of 2005/2010 has affected the behavior of primary healthcare center (PHC) personnel (medical and nonmedical) with respect to their attitudes towards tobacco, its consumption and the legislative changes. METHODS: We conducted a multi-center descriptive study of a randomized conglomerate sample of PHC personnel from each Autonomous Community in Spain. The questionnaire covered tobacco consumption, and knowledge/attitudes towards smoking and legislation. The statistical analysis used SPSS software. RESULTS: The sample consisted of 2040 PHC employees (1578 women, 77.4%). Never smokers, ex-smokers, and smokers represented 46.7%, 37.8%, and 15.5% of the sample, respectively. Tobacco prevalence amongst physicians and nurses was 12.3%. Following the introduction of the antismoking legislation, a decrease in consumption was observed. Most of the participants considered that tobacco consumption affected health, was an addictive illness, and passive smoking had an impact on the health of non-smokers. Whilst 91.6% agreed with the current legislation, only 25% felt that it encouraged cessation. CONCLUSIONS: Spanish primary healthcare professionals have a relatively low prevalence of smoking compared to the general population. It is necessary to implement more legislative measures to improve and maintain this outcome.

Principales modificaciones en la guía de práctica clínica «COVID-19 en pediatría» / Main changes in the «COVID-19 in paediatrics» clinical practice guideline

Presentamos el resumen de las principales modificaciones surgidas en la guía de práctica clínica «COVID-19 en Pediatría» entre su versión inicial publicada en el año 2021 y la publicada en el año 2022. El documento se ha elaborado siguiendo los pasos estructurados de la medicina basada en la evidencia e incorporando el sistema GRADE para realizar síntesis de la evidencia, con valoración de su calidad y, cuando se consideró apropiado, emitir recomendaciones jerarquizadas (en función de la calidad de la evidencia, los valores y preferencias, el balance entre beneficios, riesgos y costes, la equidad y la factibilidad). En esta actualización se incluyen también los cambios recomendados por los revisores externos. Se sintetizan las principales modificaciones en los siguientes apartados: epidemiología, clínica, diagnóstico, prevención, tratamiento y vacunas. En el conjunto del conocimiento alcanzado a lo largo del primer año de pandemia, las publicaciones durante el segundo año añaden nuevos datos, sin que en muchas de las áreas se produzcan modificaciones sustanciales. Los principales cambios acaecen en el campo de investigación de las vacunas. Esta actualización finaliza en diciembre de 2021, coincidiendo con el aumento de la infección por ómicron, por lo que será necesario una futura actualización del documento.(AU)

We present a summary of the main modifications to the «COVID-19 in Paediatrics» clinical practice guideline made from its initial version, published in 2021, and the version published in 2022. The document was developed following the structured steps of evidence-based medicine and applying the GRADE system to synthesize the evidence, assess its quality and, when appropriate, issue graded recommendations (based on the quality of the evidence, values and preferences, the balance between benefits, risks and costs, equity and feasibility). This update also includes the modifications proposed by external reviewers.We summarised the main modifications in the following sections: epidemiology, clinical features, diagnosis, prevention, treatment and vaccines. In relation to the body of knowledge achieved in the first year of the pandemic, the literature published in the second year contributed additional data, but without substantial modifications in many of the areas. The main changes took place in the field of vaccine research. This update was completed in December 2021, coinciding with the emergence of infections by the omicron variant, so the document will need to be updated in the future. (AU)

Dabrafenib plus trametinib for compassionate use in metastatic melanoma: A STROBE-compliant retrospective observational postauthorization study.

The main objective of the study was to evaluate the efficacy and safety of dabrafenib alone or combined with trametinib for compassionate use in patients with metastatic melanoma.This retrospective, observational study involved 135 patients with unresectable stage IIIC or stage IV melanoma from an expanded-access program at 30 Spanish centers.Forty-eight patients received dabrafenib monotherapy and 87 received combination dabrafenib and trametinib; 4.4% and 95.6% of the patients had stage IIIC and IV melanoma, respectively. All patients showed BRAF mutations in their primary or metastatic lesions; 3 were positive for V600K while the remainder had V600E or V600+. A positive response to treatment was reported in 89.3% of the patients. Overall survival rates at 12 and 24 months were 59.6% (95% confidence interval [CI], 52.5-68.9%) and 36.4% (95% CI, 27.8-45%), respectively. Progression-free survival rates at 12 and 24 months were 39.3% (95% CI, 31.1-47.5%) and 21.6% (95% CI, 14.5-28.7%), respectively. Fifty-seven patients (42.2%) reported cutaneous toxicity of any type, mainly hyperkeratosis (14.8%) and rash (11.9%). The most frequent adverse events were pyrexia (27.4%), asthenia (19.3%), arthralgia (16.9%), and diarrhoea (13.2%).Our results suggest that both dabrafenib alone or in combination with trametinib are effective for compassionate use in terms of response and/or survival rates. However, differences in patients' prognostic features ought to be considered. No new findings were revealed regarding the safety profiles of either regimen. This is the first study to evaluate the efficacy of these 2 selective BRAF and mitogen-activated extracellular signal-regulated kinase inhibitors in a real-world setting in Spain.

Mantener abiertos los colegios no parece aumentar la incidencia de COVID-19 en niños / Keep schools open does not appear to increase COVID-19 incidence in children

Conclusiones de los autores del estudio: el cierre de las escuelas no tuvo un efecto apreciable en el número de casos de COVID-19 entre los niños. Estos no son un grupo de riesgo importante de la COVID-19 y tampoco parecen jugar un papel predominante en la transmisión de la enfermedad.Comentario de los revisores: aunque el estudio tiene limitaciones metodológicas, sus resultados concuerdan con la mayoría de los que examinan la transmisibilidad de la infección por SARS-CoV-2 entre niños y entre niños y maestros, demostrando que el cierre de los colegios tiene escaso impacto en el número de casos en la población pediátrica y en la mortalidad por COVID-19. (AU)

Authors’ conclusions: school closure did not have a measurable effect on the number of COVID-19 cases among children. Children were not a significant risk group for COVID-19 and they do not appear to play a very important role from the point of view of disease transmission.Reviewers’ commentary: despite its limitations, the results are consistent with most studies that examine the transmissibility of SARS-CoV-2 infection among children, and among children and teachers, demonstrating that school closure has little impact on the number of cases in the pediatric population and mortality from COVID-19. (AU)

Accidente cerebrovascular secundario a síndrome de HELLP y sus Implicaciones cognitivas / Stroke secondary to HELLP syndrome and its cognitive implications

Resumen El accidente cerebrovascular es una afección clínica que tiene entre uno de sus factores de riesgo la presión arterial alta. En la gestación, la complejidad de esta afección puede desembocar en un cuadro hipertensivo severo, comúnmente conocido como síndrome de HELLP, el cual es una de las variaciones más complejas de la hipertensión gestacional, que conlleva a múltiples alteraciones en la salud de aquellas que lo padecen. La mayoría de los estudios en el área se han enfocado en conocer su etiología, epidemiología y las consecuencias físicas que acarrean este síndrome; sin embargo, poca es la información que se tiene sobre las secuelas cognitivas a largo plazo que produce en la madre un embarazo complicado posterior a un cuadro hipertensivo severo. El presente estudio tuvo como objetivo analizar el caso de una mujer, quien presentó síndrome de HELLP con una complicación de encefalopatía en tallo cerebral y su posterior perfil cognitivo. Se realizó un análisis descriptivo de exploración neuropsicológica y se compararon sus resultados con datos normativos. Entre los resultados se encontraron dificultades en todas las áreas del funcionamiento, además de un déficit cognitivo secundario al cuadro clínico de base. Se concluyó que la hipertensión gestacional es más severa cuando se acompaña de una afectación vascular. Esto afecta la cognición, teniendo un impacto negativo en la vida de la mujer en sus diferentes áreas de ajuste.

Abstract Stroke is a clinical condition that has between one of its risk factors high blood pressure. In gestation, the complexity of this condition can lead to a severe hypertensive picture, commonly known as HELLP syndrome, which is one of the most complex variations of gestational hypertension, which leads to multiple alterations in the Health of those who suffer from it. Most studies in the area have focused on knowing its etiology epidemiology, and physical consequences of this syndrome; however little information exists on long-term cognitive sequel when the mother experiences a complicated pregnancy following a severe hypertensive condition. The present study aimed to analyze the case of a woman with HELLP syndrome with a complication of brain stem encephalopathy and her subsequent cognitive profile. It was performed a descriptive analysis of neuropsychological exploration and compared the results with normative data. Among the results were difficulties in all areas of functioning and cognitive impairment secondary to clinical basis. In conclusion, gestational hypertension is most severe when it´s combined with vascular involvement. This affects cognition, which has a negative impact on the life of the woman in different areas of adjustment.

Evaluación de la efectividad de un programa de mindfulness y autocompasión para reducir el estrés y prevenir el burnout en profesionales sanitarios de atención primaria / Evaluation of the effectiveness of a Mindfulness and Self-Compassion program to reduce stress and prevent burnout in Primary Care health professionals

Objetivo: Evaluar la efectividad de un programa de mindfulness y autocompasión sobre los niveles de estrés y burnout en profesionales sanitarios de atención primaria. Diseño: Ensayo clínico controlado aleatorizado. Participantes y emplazamiento: Se ofertó entrenamiento en mindfulness a los 1.281 profesionales sanitarios de atención primaria de Navarra y aceptaron 48. Se asignaron por sorteo 25 participantes al grupo intervención, quedando los 23 restantes en el grupo control. Intervención: El programa de entrenamiento en mindfulness y autocompasión consistía en sesiones de 2,5 h/semana durante 8 semanas, a las que había que asistir al menos al 75% de las sesiones y realizar una práctica diaria de 45 min. Mediciones principales: Antes-después de la intervención se midieron mediante cuatro cuestionarios los niveles de mindfulness, autocompasión, estrés percibido y burnout. Resultados: Tras la intervención, las puntuaciones del grupo intervención mejoran significativamente en mindfulness (p < 0,001); estrés percibido (p < 0,001); autocompasión: auto-amabilidad p < 0,001, humanidad compartida p=0,004, mindfulness p=0,001; y burnout: cansancio emocional (p = 0,046). La comparación respecto al grupo control muestra diferencias significativas en mindfulness (p < 0,001), estrés percibido (p < 0,001), auto-amabilidad (p < 0,001) y cansancio emocional (p < 0,032). Conclusiones: Este trabajo sugiere que puede ser beneficioso impulsar las prácticas de mindfulness y autocompasión en el ámbito sanitario (AU)

Objective: To evaluate the effectiveness of a Mindfulness and Self-Compassion Program on the levels of stress and burnout in Primary Care health professionals. Design: Randomised, controlled clinical trial. Participants and setting: Training in Mindfulness was offered to 1,281 health professionals in Navarra (Spain) Primary Care, and 48 of them accepted. The participants were randomly assigned to groups: 25 to the intervention group, and the remaining 23 to the control group. Intervention: The Mindfulness and Self-Compassion training program consisted of sessions of 2.5 chours/week for 8 weeks. The participants had to attend at least 75% of the sessions and perform a daily practical of 45 minutes. Main measurements: The levels of mindfulness, self-compassion, perceived stress, and burnout were measured using four questionnaires before and after the intervention. Results: After the intervention, the scores of the intervention group improved significantly in mindfulness (P < .001); perceived stress (P < .001); self-compassion: self-kindness P < .001, shared humanity P = .004, mindfulness P = .001; and burnout: emotional fatigue (P = .046). The comparison with the control group showed significant differences in mindfulness (P < .001), perceived stress (P < .001), self-kindness (P < .001) and emotional fatigue (P = .032). Conclusions: This work suggests that it may be beneficial to encourage mindfulness and self-compassion practices in the health environment (AU)

Seguridad del paciente. Bacteriemia Zero: Prevenir la infección relacionada con el catéter venoso central / Patient safety. Zero bacteriemia: prevent infection related to the central venous catheter

Las infecciones nosocomiales (IN) ocurren en todo el planeta, afectando a países evolucionados y países con recursos insuficientes. Las infecciones en las instituciones de salud son una de las razones primordiales del aumento de la mortalidad y la morbilidad entre los pacientes hospitalizados.Los principales tipos de IN están vinculados con actividades invasivas. Podemos distinguir la infección de tracto respiratorio, relacionada con la ventilación mecánica; la infección del lecho quirúrgico, relacionadas con el procedimiento quirúrgico; la infección del Tracto Urinario (ITU), que tiene relación con los sondajes vesicales; y la bacteriemia relacionada con los catéteres intravasculares (BRC).La bacteriemia se define como la presencia de bacterias en la sangre. Junto con la neumonía relacionada con la ventilación mecánica, es la infección nosocomial más común en pacientes ingresados en la UCI y se relaciona con una morbilidad y mortalidad significativas. La primera causa de bacteriemia en estos pacientes son los catéteres intravasculares.Bacteriemia Zero es el acuerdo desarrollado por la Sociedad de Medicina Intensiva Crítica y Unidades Coronarias (SEMICYUC), la Alianza Mundial para la Seguridad de la Organización Mundial de la Salud (OMS) y la Agenda de Calidad del Ministerio de Sanidad, para prevenir la bacteriemia relacionada con el uso de catéter Venoso Central (CVC), con la intención de bajar la incidencia de BRC.Su objetivo principal es disminuir el promedio de la densidad de incidentes de bacteriemia relacionados con la inserción de CVC, fomentar y fortalecer la cultura de seguridad en la práctica de enfermería, y asegurar el registro de tecnologías obteniendo así un mayor control. (AU)

Nosocomial infections occur all over the world, affecting both developed and under-resourced countries. Infections in healthcare institutions are one of the primary reasons for increased mortality and morbidity among hospitalized patients.The main types of NI are linked to invasive activities. We can distinguish respiratory tract infection, related to mechanical ventilation; surgical bed infection, related to the surgical procedure; UTI, related to bladder catheterization; and bacteremia related to intravascular catheters (BRC).Bacteremia is defined as the presence of bacteria in the blood. Together with pneumonia related to mechanical ventilation, it is the most common nosocomial infection in patients admitted to the ICU and it is associated with significant morbidity and mortality. The leading cause of bacteremia in these patients is intravascular catheters.Bacteremia Zero is the agreement developed by the Society of Critical Intensive Care Medicine and Coronary Units (SEMICYUC), the World Health Organization (WHO) Global Alliance for Safety and the Ministry of Health (MOH) Quality Agenda, to prevent CVC-related bacteremia, with the intention of lowering the incidence of BRC.Its main objective is to reduce the average density of bacteremia incidents related to CVC insertion, to promote and strengthen the culture of safety in nursing practice, and to ensure the registration of technologies, thus obtaining greater control. (AU)

Seguridad del paciente. Estudio observacional y descriptivo centrado en las curas de los catéteres venosos centrales consiguiendo bacteriemia cero / Patient safety. Observational and descriptive study focused on cures of central venous catheters, obtaining zero bacteriemia

El diseño del estudio es observacional, retrospectivo y des-criptivo centrado en las curas de los Catéteres Venosos Cen-trales (CVC). El procedimiento establecido para ello es la reali-zación de una primera cura en la UCI una vez que el paciente llega desde quirófano. Se observa diariamente el punto de inserción del mismo para observar si existen o no signos de infección y no se vuelve a realizar una cura hasta pasados 7 días, tanto si el paciente continúa ingresado en la UCI como si ha sido dado de alta a una unidad de hospitalización.Los datos recopilados en la investigación retrospectiva comprenden a los de aquellos pacientes ingresados en el Complejo Hospitalario Ruber Juan Bravo desde el 14 de mayo del 2019 hasta el 22 de marzo del 2020. Se han incluido en el estudio a un total de 90 pacientes que son los que cumplían los distintos criterios de inclusión y exclusión.El facultativo canaliza un CVC a la llegada del paciente al quirófano, siguiendo siempre el programa Bacteriemia Zero. Cuando los pacientes llegan a la UCI, el personal de enferme-ría realiza una primera cura estéril de ese catéter, basado en el protocolo interno del centro.Cuando el paciente sale de UCI a hospitalización, se hace una valoración diaria del acceso venoso con la intención de no volver a curarlo hasta los 7 días después, siempre y cuando no haya sospecha de infección en la zona donde se inserta el catéter, no haya sangrado activo del mismo, o que el apósito esté despegado. Con el estudio observacional llevado a cabo, se pueden extrapolar los protocolos de la UCI al resto de unidades, con-siguiendo el mismo éxito de bacteriemia cero, gracias a los cuidados asistenciales por parte de la enfermería con curas semanales. En el tiempo del estudio no hubo ninguna In-fección Relacionada con el catéter (IRC). De los 90 pacientes estudiados, sólo en el 2.2% hubo colonización por contamina-ción de la punta del catéter porStaphylococcus epidermidis. (AU)

The study design is observational, retrospective, and de-scriptive, focusing on CVC cures. The established procedure for this is the performance of a first treatment in the ICU once the patient arrives f rom the operating room. The point of insertion of the CVC is observed daily to see whether there are signs of infection, and no further treatment is performed for 7 days, whether the patient is still admitted to the ICU or has been discharged to a hospitalization unit.The data collected in the retrospective investigation com-prised those patients admitted to the Ruber Juan Bravo Hospital Complex f rom May 14, 2019 to March 22, 2020. A total of 90 patients who met the different inclusion and exclusion criteria were included in the study.The physician cannulates a CVC on the patient’s arrival to the operating room, always following the Bacteremia Zero program. When patients arrive at the ICU, the nursing staff performs an initial sterile treatment of that catheter, based on the center’s internal protocol.When the patient leaves the ICU for hospitalization, a daily assessment of the venous access is made with the inten-tion of not re-treatment until 7 days later, as long as there is no suspicion of infection in the area where the catheter is inserted, there is no active bleeding f rom it, or the dressing is not detached.With the observational study carried out, the ICU protocols can be extrapolated to the rest of the units, achieving the same success of zero bacteremia, thanks to the nursing care with weekly cures. During the study period there was no CRI. Out of the 90 patients studied, only 2.2% were colo-nized by Staphylococcus epidermidis contamination of the catheter tip. (AU)

Biochemotherapy in the treatment of metastatic melanoma in selected patients.

INTRODUCTION: Bioimmunochemotherapy (BCT) is a combination of biological agents and cytostatics that has shown an increase in response rate (RR) in metastatic melanoma patients. The aim of the study is to evaluate RR, progression- free survival (PFS), overall survival (OS) and treatment toxicity. MATERIALS AND METHODS: Retrospective analysis of 11 metastatic melanoma patients treated from January 2002 to June 2008 with cisplatin 20 mg/m(2) i.v. days 1.4, dacarbazine 800 mg/m(2) i.v. day 1, vinblastine 1.5 mg/m(2) i.v. days 1.4, interleukin (IL)-2 9 MIU/m(2) s.c. 5.8 days and interferon (IFN)-alpha-2b 5 MIU/m2 s.c. days 5.9, 11, 13 and 15, with the support of granulocyte colony-stimulating factor (G-CSF) and antibiotics. Patients with ECOG 0, age < or = 65 years and with measurable disease were included. The planned number of courses was 4. RR was measured by Revised Evaluation Criteria in Solid Tumour (RECIST) criteria (computed tomography [CT]+/-proton emission tomography [PET]). Toxicity was measured according to the National Cancer Institute (NCI) common toxicity criteria. RESULTS: Observed RRs were 18% complete response (CR), 27% partial response (PR), 9% stable disease (SD) and 46% disease progression. The median PFS was 4 months (95% CI, 0.10 m), with a 23% one-year PFS. Median OS was 4.6 months (95% CI, 0.9.19 m), with a 29% one-year OS. Eighty-three percent of patients experienced grade 3-4 toxicity, mainly due to neutropenia, thrombocytopenia and flu-like syndrome. CONCLUSIONS: Treatment with BCT shows an increase in RR, some achieving durable CR; nevertheless it cannot be considered a standard treatment and should be employed only in selected patients.