Sepsis and septic shock in emergency departments of Mexico: a multicenter point prevalence study.

INTRODUCTION: Sepsis is one of the main reasons for consultation at emergency departments. OBJECTIVE: To identify the prevalence of sepsis in emergency departments of Mexico. METHOD: Cross-sectional study with a 30-day follow-up of patients diagnosed with sepsis or septic shock; demographic variables, management and outcomes were analyzed. RESULTS: In 68 emergency departments analyzed, 2379 patients were attended to, out of whom 307 had sepsis. The prevalence of sepsis was 12.9 %, and overall mortality was 16.93 %, which in the cases of sepsis was 9.39 %, and in those of septic shock, 65.85 %; no significant differences were identified in demographic variables or type of hospital. A significantly higher fluid balance was observed within the first three hours in those patients who died, as well as a lack of adherence to international resuscitation recommendations. CONCLUSIONS: A high prevalence of sepsis was found in Mexican emergency departments. Mortality of patients with septic shock was similar and even higher than that internationally reported. INTRODUCCIÓN: La sepsis es una de las principales causas de consulta en los servicios de urgencias médicas. OBJETIVO: Identificar la prevalencia de la sepsis en servicios de urgencias médicas de México. MÉTODO: Estudio transversal con seguimiento a 30 días de los pacientes con diagnóstico de sepsis o choque séptico; se analizaron las variables demográficas, el manejo y los desenlaces. RESULTADOS: En 68 servicios de urgencias médicas analizados se atendió a 2379 pacientes, de los cuales 307 presentaron sepsis. La prevalencia de la sepsis fue de 12.9 %, con mortalidad global de 16.93 %, que en los casos de sepsis fue de 9.39 % y en los de choque séptico, de 65.85 %; no se identificaron diferencias significativas en las variables demográficas o tipo de hospital. Se observó balance hídrico alto en las primeras tres horas y falta de apego a las recomendaciones internacionales de reanimación superior en los pacientes que fallecieron. CONCLUSIONES: Se encontró alta prevalencia de la sepsis en los servicios de urgencias médicas mexicanos. La mortalidad de los pacientes con choque séptico fue similar e, incluso, mayor a la reportada internacionalmente.

Monitoring and control interface based on virtual sensors.

In this article, a toolbox based on a monitoring and control interface (MCI) is presented and applied in a heat exchanger. The MCI was programed in order to realize sensor fault detection and isolation and fault tolerance using virtual sensors. The virtual sensors were designed from model-based high-gain observers. To develop the control task, different kinds of control laws were included in the monitoring and control interface. These control laws are PID, MPC and a non-linear model-based control law. The MCI helps to maintain the heat exchanger under operation, even if a temperature outlet sensor fault occurs; in the case of outlet temperature sensor failure, the MCI will display an alarm. The monitoring and control interface is used as a practical tool to support electronic engineering students with heat transfer and control concepts to be applied in a double-pipe heat exchanger pilot plant. The method aims to teach the students through the observation and manipulation of the main variables of the process and by the interaction with the monitoring and control interface (MCI) developed in LabVIEW©. The MCI provides the electronic engineering students with the knowledge of heat exchanger behavior, since the interface is provided with a thermodynamic model that approximates the temperatures and the physical properties of the fluid (density and heat capacity). An advantage of the interface is the easy manipulation of the actuator for an automatic or manual operation. Another advantage of the monitoring and control interface is that all algorithms can be manipulated and modified by the users.

Perioperative Management of Painful Phantom Limb Syndrome: A Narrative Review and Clinical Management Proposal.

OBJECTIVE: Painful Phantom Limb Syndrome (PPLS) occurs in 50 to 80% of patients undergoing amputation, having a great impact on quality of life, productivity and psychosocial sphere. The objective of this review is to summarize the pharmacological and non-pharmacological strategies, surgical optimization, and provide a multidisciplinary approach aimed at reducing the incidence of chronic pain associated with PPLS in patients undergoing limb amputation. METHODS: A narrative review was carried out using Medline, Pubmed, Proquest, LILACS and Cochrane, searching for articles between 2000 and 2021. Articles describing the epidemiology, pathophysiological considerations, and current treatments were selected after a screening process. RESULTS: A multidisciplinary and multimodal approach is required in PPLS, and should include the use of regional techniques, and adjuvants such as NSAIDs, ketamine, lidocaine and gabapentinoids. In addition, an evaluation and continuous management of risk factors for chronic pain in conjunction with the surgical team is necessary. CONCLUSION: The current literature does not support that a single technique is effective inthe prevention of PPLS. However, adequate acute pain control, rehabilitation and early restoration of the body scheme under a multidisciplinary and multimodal approach have shown benefit in the acute setting.

Olive Nutritional Status and Tolerance to Biotic and Abiotic Stresses.

The role of nutrients in plant growth is generally explained in terms of their functions in plant metabolism. Nevertheless, there is evidence that plant tolerance or resistance to biotic or abiotic stresses could be affected by the nutritional status. Although not well studied, an adequate nutritional status for optimal plant growth is thought to also be optimal for plant tolerance to stress. Considering the current global trend toward sustainability, studies that clarify the relationships between nutrition and stress are of great interest. For example, potassium plays an important role in the regulation of water status in the olive, improving drought tolerance, while calcium is involved in sodium exclusion mechanism, which can increase tolerance to salinity. Nitrogen excess, in contrast, increases susceptibility to spring frost and olive leaf spot. Silicon is not an essential element for plant growth, but it is considered a beneficial element; among its roles in the control of pests and diseases is the formation of a physical barrier that occurs through silicon deposition in the epidermal cells of the leaves. The presence of soluble silicon also facilitates the deposition of phenolic and other compounds at sites of infection, which is a general defense mechanism to pathogen attack. In olive, silicon application, either by foliar sprays or through irrigation water, reduces the incidence of olive leaf spot. This review summarizes the current status of olive nutrition, the relationships with biotic and abiotic stresses, and the effects of silicon.

Substance use disorders among older adults: A review of randomized controlled pharmacotherapy trials.

Substance use disorders (SUDs) are a growing problem among older adults. Acamprosate, disulfiram, and naltrexone are United States Food and Drug Administration (referred to as FDA) approved for the treatment of alcohol use disorder, and buprenorphine is approved for the treatment of opiate use disorder among adults. However, the data on the use of these medications for the treatment of SUDs among older adults are unclear from randomized controlled trials (referred to as RCTs). A review of the literature indicates that there are only two RCTs that evaluated the use of pharmacologic agents for SUDs among older adults (≥ 50 years). One trial evaluated the use of naltrexone when compared to placebo for the treatment of alcohol use disorder among individuals, 50-70 years in age. The other trial evaluated the use of naltrexone or placebo as adjuncts with sertraline in the treatment of alcohol use disorder among individuals older than 55 years in age. Both trials indicated that the use of naltrexone reduced the rates of relapse among older adults with alcohol use disorder. However, we did not identify any RCTs that studied the use of buprenorphine, acamprosate, or disulfiram for SUDs among older adults. Based on available evidence, it would be safe to conclude that limited data indicate some efficacy for naltrexone in the treatment of alcohol use disorder among older adults. However, data from controlled trials on the use of other medications that are FDA approved for the treatment of SUDs among younger adults are nonexistent among older adults with SUDs.

Impacto de una intervención educativa en el conocimiento de la prevención de la neoplasia del cuello uterino en estudiantes de enfermería y sus familias / Impact of an educational intervention on the knowledge of cervical cancer prevention in nursing students and their families

Resumen El objetivo fue evaluar el impacto de una intervención educativa en el conocimiento de la prevención de la neoplasia del cuello uterino en un grupo de estudiantes de enfermería y sus familias bajo el modelo de Nola Pender. El método fue un estudio cuasi-experimental con muestra no probabilística; se evaluó el conocimiento sobre la prevención y el control de la neoplasia del cuello uterino antes y después de una intervención educativa utilizando la encuesta validada por la Dra. Dina Rubio en 2009 con su previo consentimiento. La información fue tabulada mediante una hoja de cálculo del programa Microsoft Excel; se calcularon frecuencias específicas y frecuencias absolutas, y para el análisis se tomó el modelo de Nola Pender. Los resultados desde el punto de vista estadístico fueron que hay una información instalada en la estructura mental de las participantes sobre lo que es, implica y comporta como riesgo la neoplasia del cuello uterino. La percepción que está en el fondo de sus creencias denota un nivel favorable de conciencia y claridad, lo que posibilita que en las prácticas de autocuidado y la aplicación de la citología se reconozca frecuencia de uso, regularidad en el tiempo y atención a los resultados. En conclusión, al evaluar el impacto de la intervención educativa a través del modelo de Nola Pender se encontraron cambios en los conocimientos y un modelo ideal para utilizarse en grupos poblacionales heterogéneos en edades, niveles educativos, formación profesional y hábitos sexuales, porque integra la experiencia personal, el entorno y las prácticas de salud como tres elementos sin los cuales no es posible practicar el autocuidado y la cultura de intervención.

Abstract A large number of factors influence the level of information that people may have regarding cervical cancer and the way to prevent it, since education is not only provided by health personnel but also by the family. When making important decisions regarding self-care, people must have effective sex education, in which protection is of vital importance, since misinformation is one of the main factors that promotes cervical cancer. The objective of this study was to evaluate the impact of an educational intervention on the knowledge of cervical cancer prevention in a group of nursing students and their families under the Nola Pender model. The method used in the study was a quasi-experimental, non-probabilistic sample; the knowledge about cervical cancer prevention and control was evaluated before and after the intervention, using the survey validated by Dr. Dina Rubio in 2009 (with her consent). The information was included in a Microsoft Excel spreadsheet: the items were placed in columns and the subjects were included in the rows. Specific frequencies and absolute frequencies were calculated, the Nola Pender model was used for the analysis. The units of analysis were selected manually or randomly and these selections do not depend on probability but are generated based on the criteria of the researcher or the specific needs of the research. From a statistical point of view, information about what cervical cancer is, what it implies and how it behaves as a risk is engrained in the mental structure of the participants. To these implications of a technical and methodological nature, others of a structural and conceptual nature are added to build an integrative analysis of the results obtained in the field work. In this case, they include opinions, appraisals, judgments, and evaluations about cervical cancer. This research was organized in the following stages: (1) Evaluation of prior knowledge on cervical cancer prevention and control. The starting point of the investigation was the recognition that the participating women had a basic conceptual scaffolding, acquired through their own experience and self-training or by going to sources such as academia, social networks, specialized magazines, health institutions, medical staff and other specialists who help in the creation of an important background to consolidate an individual perspective. (2) Application of an educational intervention. In this stage, designed workshops were implemented and evaluated by the students with the advice of a teacher, and included the following topics: general concepts, signs and symptoms, associated risk factors, screening techniques, benefits, and exam precautions. The students contributed a theoretical, methodological and evaluative foundation to the design of each workshop, considering the expected training objectives, the characteristics included in its development, and a diversity of pedagogical actions that guarantee the efficiency of the transmitted message. (3) Reevaluation of the knowledge acquired. By applying a post-test, the knowledge acquired during the implementation of the workshops was recovered and resized. In this stage, the variability of the responses measured the transforming effect of the training, either by improving the knowledge acquired or by introducing new knowledge into the participant's cognitive model. The perception that participants have about self-care practices is linked to their beliefs, denoting a favorable level of awareness and clarity, which makes it possible for the application of cytology to recognize the frequency of use, regularity over time, and attention to the results. In conclusion, when evaluating the impact of educational intervention through the Nola Pender model, changes in knowledge were found. Results also indicate that this is an ideal model for employees in heterogeneous popu lation groups in ages, educational levels, professional training, and sexual habits, because it integrates personal experience, the environment and health practices as three elements without which it is not possible to practice self-care and the culture of intervention.

Mirada sistémica de lo imprevisto desde la percepción del funcionario público para el diseño de modelos de gestión administrativa eficiente / A systemic view of the unforeseen from the public official's perception for the design of efficient administrative management models / Uma visão sistémica do imprevisto a partir da perceção do funcionário público para a conceção de modelos de gestão administrativa eficazes

Introducción: resultados del proyecto de investigación en el que lo imprevisto se construye sistémicamente desde la percepción de funcionarios públicos que a través de prácticas conversacionales comparten sus relatos y respuestas emocionales. Método: investigación acción participación, fomentar el dialogo creativo que se construye mediante el uso de la entrevista estructurada, el grupo de discusión, el testimonio focalizado y la observación participante. muestreo no probabilístico intencional y voluntario, para lograr la vinculación activa de directivos y funcionarios de entidades públicas para recuperar sus voces anónimas y sus trayectorias vitales. Resultados Todo este bagaje subjetivo, ontológico y formativo proporciona datos que se transforman en categorías de análisis y redes semánticas donde se cruzan las percepciones para administrar eficientemente y con calidad humana la imprevisión y la adversidad. Conclusiones: Abordar lo imprevisto desde una mirada sistémica logra un equilibrio entre las perspectivas de los funcionarios con los acontecimientos que surgen en la realidad.

Introduction: results of the research project in which the unforeseen is constructed systemically from the perception of public officials who through conversational practices share their stories and emotional responses. Method: participatory action research, encouraging creative dialogue that is constructed through the use of the structured interview, the focus group, the focused testimony and participant observation. Non-probabilistic, intentional and voluntary sampling, to achieve the active involvement of managers and officials of public entities in order to recover their anonymous voices and their life trajectories. Results All this subjective, ontological and formative baggage provides data that are transformed into categories of analysis and semantic networks where perceptions are crossed to efficiently and with human quality manage unpredictability and adversity. Conclusions: Addressing the unforeseen from a systemic view achieves a balance between the perspectives of the staff members with the events that arise in reality.

Introdução: resultados do projeto de investigação em que o inesperado é construído sistematicamente a partir da perceção dos funcionários públicos que partilham as suas histórias e respostas emocionais através de práticas de conversação. Método: investigação-ação participativa, incentivando o diálogo criativo que se constrói através da utilização de entrevistas estruturadas, grupos focais, testemunho focalizado e observação participante. Amostragem não probabilística, intencional e voluntária, para conseguir o envolvimento ativo de gestores e funcionários de entidades públicas para recuperar as suas vozes anónimas e as suas trajectórias de vida. Resultados Toda esta bagagem subjectiva, ontológica e formativa fornece dados que se transformam em categorias de análise e redes semânticas onde as percepções se cruzam para gerir eficazmente e com qualidade humana a imprevisibilidade e a adversidade. Conclusões: Abordar o imprevisto a partir de uma visão sistémica permite alcançar um equilíbrio entre as perspectivas dos colaboradores e os acontecimentos que surgem na realidade.

Effect of moderate high temperature on the vegetative growth and potassium allocation in olive plants.

There is little information about the prolonged effect of a moderately high temperature on the growth of olive (Olea europaea L.). It has been suggested that when the temperature of the air rises above 35°C the shoot growth of olive is inhibited while there is any reference on how growth is affected when the soil is warmed. In order to examine these effects, mist-cuttings and young plants generated from seeds were grown under moderate high temperature (37°C) for 64 and 42days respectively. In our study, plant dry matter accumulation was reduced when the temperature of both the air and the root medium was moderately high. However, when the temperature of the root medium was 25°C, the inhibitory effect of air high temperature on plant growth was not observed. The exposure of both the aerial part and the root to moderate high temperature also reduced the accumulation of K+ in the stem and the root, the water use efficiency and leaf relative water content. However, when only the aerial part was exposed to moderate high temperature, the accumulation of K+ in the stem, the water use efficiency and leaf relative water content were not modified. The results from this study suggest that the olive is very efficient in regulating the water and potassium transport through the plant when only the atmosphere surrounding the aerial part is warmed up. However, an increase in the soil temperature decrease root K+ uptake and its transport to the aerial parts resulting in a reduction in shoot water status and growth.

Sepsis y choque séptico en los servicios de urgencias de México: estudio multicéntrico de prevalencia puntual / Sepsis and septic shock in emergency departments of Mexico: a multicenter point-prevalence study

Resumen Introducción: La sepsis es una de las principales causas de consulta en los servicios de urgencias médicas. Objetivo: Identificar la prevalencia de la sepsis en servicios de urgencias médicas de México. Método: Estudio transversal con seguimiento a 30 días de los pacientes con diagnóstico de sepsis o choque séptico; se analizaron las variables demográficas, el manejo y los desenlaces. Resultados: En 68 servicios de urgencias médicas analizados se atendió a 2379 pacientes, de los cuales 307 presentaron sepsis. La prevalencia de la sepsis fue de 12.9 %, con mortalidad global de 16.93 %, que en los casos de sepsis fue de 9.39 % y en los de choque séptico, de 65.85 %; no se identificaron diferencias significativas en las variables demográficas o tipo de hospital. Se observó balance hídrico alto en las primeras tres horas y falta de apego a las recomendaciones internacionales de reanimación superior en los pacientes que fallecieron. Conclusiones: Se encontró alta prevalencia de la sepsis en los servicios de urgencias médicas mexicanos. La mortalidad de los pacientes con choque séptico fue similar e, incluso, mayor a la reportada internacionalmente.

Abstract Introduction: Sepsis is one of the main reasons for consultation at emergency departments. Objective: To identify the prevalence of sepsis in emergency departments of Mexico. Method: Cross-sectional study with a 30-day follow-up of patients diagnosed with sepsis or septic shock; demographic variables, management and outcomes were analyzed. Results: In 68 emergency departments analyzed, 2379 patients were attended to, out of whom 307 had sepsis. The prevalence of sepsis was 12.9 %, and overall mortality was 16.93 %, which in the cases of sepsis was 9.39 %, and in those of septic shock, 65.85 %; no significant differences were identified in demographic variables or type of hospital. A significantly higher fluid balance was observed within the first three hours in those patients who died, as well as a lack of adherence to international resuscitation recommendations. Conclusions: A high prevalence of sepsis was found in Mexican emergency departments. Mortality of patients with septic shock was similar and even higher than that internationally reported.

The easier, the better: age, creatinine, ejection fraction score for operative mortality risk stratification in a series of 29,659 patients undergoing elective cardiac surgery.

OBJECTIVE: Age, preoperative creatinine value, and ejection fraction are easily arranged in the age, creatinine, ejection fraction score to predict operative mortality in elective cardiac operations, as recently shown. We validate the age, creatinine, ejection fraction score in a large multicentric study. METHODS: We analyzed 29,659 consecutive patients who underwent elective cardiac operations in 14 Italian institutions during the period from 2004 to 2009. The operative (30-day) mortality rate was recorded for the entire population and for subgroups of patients based on the risk distribution. The predicted mortality was assessed using the additive and logistic European System for Cardiac Operative Risk Evaluations, and the age, creatinine, ejection fraction score. Accuracy and clinical performance of the different models were tested. RESULTS: The observed mortality rate was 2.77% (95% confidence interval, 2.59-2.96). The predicted mortality rate was 2.84% (95% confidence interval, 2.79-2.88) for the age, creatinine, ejection fraction score (not significantly different from the observed rate), 6.26% for the additive European System for Cardiac Operative Risk Evaluation, and 9.67% for the logistic European System for Cardiac Operative Risk Evaluation (both significantly overestimated). For all deciles of risk distribution, the European System for Cardiac Operative Risk Evaluation significantly overestimated mortality risk; the age, creatinine, ejection fraction score slightly overestimated the mortality risk in very low-risk patients and significantly underestimated the mortality risk in very high-risk patients, correctly estimating the risk in 7 of 10 deciles. The accuracy of the age, creatinine, ejection fraction score was acceptable (area under the curve of 0.702). In a separate analysis, this value increased to 0.74 by excluding centers that reported no operative mortality. These values were similar or worse for the European System for Cardiac Operative Risk Evaluation. CONCLUSIONS: The age, creatinine, ejection fraction score provides an accuracy level comparable to that of the European System for Cardiac Operative Risk Evaluation, with far superior clinical performance.

Low relapse with oral antibiotics and two-stage exchange for late arthroplasty infections in 40 patients after 2-9 years.

BACKGROUND AND PURPOSE: Exchange surgery in late arthroplasty infection is directed against bacteria adhering to implants. Therapies based on antibiotics that are effective intracellularly have been proposed recently. We have combined both strategies to improve the cure rate. METHODS: 40 consecutive patients (16 hips, 24 knees) were diagnosed with late arthroplasty infection. The organisms isolated were 35 Staphylococcus, 19 of which were methicillin-resistant, 4 Enterococcus, 6 Gram-negative bacilli, and 4 Corynebacterium. The infections were managed by a combined therapy consisting of two-stage exchange surgery and two oral intracellularly-effective antibiotics. The antibiotics were selected according to bacterial sensitivity and intracellular and biofilm effectiveness. Second re-implantation surgery was delayed until clinical and analytical normalization. Patients were in hospital for only 1 week after each surgery, and were followed up prospectively on an outpatient basis (2-9 years). Cure of the infection was defined as absence of clinical, serological, and radiographic signs of infection during the whole follow-up. RESULTS: The infection was resolved in 38/40 patients (15/16 hips and 23/24 knees). INTERPRETATION: Oral antibiotics that are effective intracellularly in combination with two-stage exchange surgery is a promising alternative for treating late arthroplasty infections. Oral antibiotics shorten hospitalization and reduce patient discomfort.