Prevalence of chronic rhinosinusitis without/with nasal polyps according to severity in Spain.

BACKGROUND: The worldwide prevalence range of chronic rhinosinusitis (CRS) is 5-12%; from this, 20 % have nasal polyps. Due to the little epidemiological data about CRS in the Spanish population, this study analyses the prevalence and severity of CRS with (CRSwNP) or without (CRSsNP) nasal polyps, and their connection with other coexisting type 2 inflammatory diseases in Spain. METHODOLOGY: This is a retrospective, large-scale, nationwide, epidemiological study based on the electronic medical records from the BIG-PAC® database. Patients diagnosed of CRSsNP and CRSwNP were identified using specific disease codes. The severe form of the disease was defined as patients who received at least a long course of antibiotics in CRSsNP or ≥2 short courses of systemic corticosteroids in CRSwNP in ≤12 months during the last 2 years, and/or had previous sinus surgery. Physician-diagnosed prevalence, sociodemographic and clinical characteristics, and disease severity were assessed. RESULTS: Out of a cohort of 1,012,257 patients (≥18 years old), 42,863 and 7,550 patients with diagnosed CRSsNP and CRSwNP, respectively, were analysed. The overall prevalence of diagnosed CRS was 5.1%, being 4.3% and 0.8% for CRSsNP and CRSwNP, respectively. Patients with CRSwNP and severe forms of the disease were older and had higher levels of type 2 inflammatory biomarkers than CRSsNP patients and non-severe disease. CONCLUSIONS: Although CRSsNP was more prevalent than CRSwNP, the severe forms of CRS were more frequent in patients with CRSwNP. In addition, CRSwNP patients had a higher incidence of coexisting type 2 inflammatory diseases.

Concentrations of chlorinated pollutants in adipose tissue of yellow-legged gulls (Larus michahellis) from Spain: Role of gender and age.

Concentrations of 7 different polychlorinated biphenyl (PCB) congeners, and eleven organochlorine pesticides (OCPs) and metabolites, including DDTs (dichlorodiphenyltrichloroethane), HCHs (hexachlorocyclohexane isomers), Endosulfan, Endosulfan sulfate, Endrin, Dieldrin and HCB (hexachlorobenzene), were determined in adipose tissue of 57 yellow-legged gulls collected from NW and N Spain. Furthermore, the possible differences due to two endogenous factors, age and gender, were determined. All the analyzed PCBs were detected in over 66% of the samples, with levels of 291.9 (PCB 180), 34.5 (PCB 118), 0.7 (PCB 28), 432.6 (PCB 153), 225.5 (PCB 138), 1.3 (PCB 101) and 0.4 (PCB 52) µg/kg of adipose tissue. With respect to the OCPs and metabolites, only 4,4'-DDE and HCB were detected in more than 50% of the samples, with means of 360.6 and 2.5 µg/kg of adipose tissue, respectively. From all the considered contaminants, only 4,4'-DDE levels presented significant differences depending on the gender, with females showing higher values than males (p < 0.01). Significant differences (p < 0.001) were also found related to age for the levels of PCBs 180, 138, 101, 28 and 153, as well as 4,4'-DDE, with adult levels being higher than those in young birds. The results of the present study constitute a baseline to better assess the environmental impacts of PCB and OCP contamination at other coastal sites for future biomonitoring studies, with particular emphasis on gender- and age-related differences.

EUFOREA Rhinology Research Forum 2016: report of the brainstorming sessions on needs and priorities in rhinitis and rhinosinusitis.

The first European Rhinology Research Forum organized by the European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA) was held in the Royal Academy of Medicine in Brussels on 17th and 18th November 2016, in collaboration with the European Rhinologic Society (ERS) and the Global Allergy and Asthma European Network (GA2LEN). One hundred and thirty participants (medical doctors from different specialties, researchers, as well as patients and industry representatives) from 27 countries took part in the multiple perspective discussions including brainstorming sessions on care pathways and research needs in rhinitis and rhinosinusitis. The debates started with an overview of the current state of the art, including weaknesses and strengths of the current practices, followed by the identification of essential research needs, thoroughly integrated in the context of Precision Medicine (PM), with personalized care, prediction of success of treatment, participation of the patient and prevention of disease as key principles for improving current clinical practices. This report provides a concise summary of the outcomes of the brainstorming sessions of the European Rhinology Research Forum 2016.

[Salmonella enteritidis bacteraemia as clinical onset of acquired immune deficiency syndrome]. / Bacteriemia por Salmonella enteritidis como debut clínico de síndrome de inmunodeficiencia adquirida.

The case is presented of a 38 year-old patient who was admitted in the Emergency Department due to a severe acute respiratory failure and who was transferred to the Critical Care Unit with a suspected initial diagnosis of community acquired pneumonia caused by an atypical microorganism, which was complicated with an acute respiratory distress syndrome. This was able to be treated with non-invasive mechanical ventilation. At 48 hours after admission, the growth of Gram negative bacilli in the blood culture was reported, which was subsequently identified as Salmonella enteritidis. This information, along with the lymphopenia suffered by the patient, suggested an immunodepressed state, thus serological tests were performed which showed positive for HIV. Antibiotic treatment was started based on the microbiological findings, with a favourable clinical outcome for the patient.

[Control of bleeding in the military environment]. / Control de la hemorragia en el ámbito militar.

One of the basics of military medicine is the control of haemorrhagic shock. Haemorrhage is the first cause of preventable death in combat, with the adequate control of bleeding being considered as fundamental to estimate the survival of the combatant as well as therapeutic support aimed at minimising blood loss being a challenge within military health logistics. The aim of this work is to review the medical and logistics advances in the treatment of bleeding in the military environment and combat during the latest conflicts, and to describe what is the current contribution of the Spanish Armed Forces and to profile future lines of investigation.

[Urinary tract infections in a postoperative recovery unit]. / Infecciones urinarias en una unidad de reanimación.

OBJECTIVE: To analyze the frequency, etiology, risk factors, and mortality relating to urinary tract infection (UTI) in a postoperative recovery unit. MATERIALS AND METHODS: A prospective study was carried out from 1998 through 2003 of all patients who stayed longer than 48 hours in a 12-bed critical care unit and who were followed to 48 hours following discharge from the unit. A descriptive statistics were compiled and univariate and multiple variable Cox regression analyses were performed for episodes of nosocomial UTI. RESULTS: The incidence density for UTI associated with bladder catheterization was 8.4 cases per 1000 patient-days. The pathogens most frequently isolated in patients with bacteriuria were Candida albicans and Escherichia coli. The pathogen most frequently isolated in UTI in trauma patients was E. coli, whereas C. albicans was most often found in the postoperative patients. Multivariable analysis identified 3 risk factors: degree of severity on admission, duration of catheterization, and presence of diabetes mellitus. The mortality risk in patients with bladder catheterization and UTI was 2.20. CONCLUSIONS: UTIs can have serious consequences and are responsible for excess mortality. The real importance of UTI is unknown and is probably underestimated despite the publication of many studies. We found that the UTI microbiology findings were markedly different for the trauma and postoperative cohorts in our department.

[Incidences of early- and late-onset ventilator-associated pneumonia in a postanesthesia and critical care unit]. / Incidencia de las neumonías nosocomiales precoces y tardías asociadas a ventilación mecánica en una unidad de reanimación- críticos polivalente.

OBJECTIVES: To ascertain the frequency, risk factors, and causes of early- and late-onset ventilator-associated pneumonia (VAP) in a postanesthesia and critical care unit. MATERIAL AND METHODS: A prospective study was carried out between January 1, 1996 and December 31, 2001 of all ventilated patients staying longer than 48 hours in the critical care unit, with follow-up for 48 hours following discharge from the unit. Descriptive statistics were compiled for episodes of early- and late-onset VAP for a period of up to 4 days after intubation; univariate and multiple variable Cox regression analyses were also carried out. RESULTS: A total of 3614 patients were admitted to the unit (study cohort, 652 patients). The mean length of stay in the unit for the study cohort was 13.64 days. The most frequent diagnosis was multiple trauma (50.46%). The incidence density of VAP was 20.31 cases per 1000 patient-days on mechanical ventilation. The pathogens most often isolated in early-onset VAP cases were Staphylococcus aureus and Pseudomonas aeruginosa. In late-onset cases, the pathogens were Pseudomonas species. Early-onset VAP was 2.54 and 2.81 times more frequent in comatose and head-injury patients, respectively. Those rates were significantly different in late-onset cases. CONCLUSIONS: Early-onset VAP was more common in comatose and head-injury patients. The risk of developing late-onset versus early-onset VAP was twice as great for postoperative patients.

[Intracranial hypotension syndrome treated with an epidural blood patch]. / Síndrome de hipotensión intracraneal espontánea tratada con parche hemático epidural.

A 41-year-old woman was admitted to the internal medicine department to assess incapacitating postural headache. Clinical findings suggested the need for computed tomography and nuclear magnetic resonance scanning of the head, which led to a diagnosis of spontaneous intracranial hypotension syndrome. Later, isotopic cysternography and nuclear magnetic resonance imaging of the spine were used unsuccessfully to try to locate the cerebrospinal fluid leak that caused the syndrome. When conservative treatment proved ineffective, the pain clinic was called in to perform an epidural blood patch procedure. The patch led to an improvement in symptoms and the syndrome resolved completely after a second lumbar blood patch was used.

An oral soft tissue lesion associated with a sinus mass.

A case of an inflammatory nasal polyp extending through an oroantral fistula and appearing as an intraoral soft tissue lesion is discussed. Although this is apparently a rare occurrence, the nature of the lesion was suggested by the history, clinical appearance, and radiographic findings. Surgical intervention and removal of the inflammatory lesion was followed by complete healing with closure of the oroantral fistula.

A radiolucent lesion adjacent to the roots of the mandibular right first and second premolars.

A distinct odontogenic cyst of developmental origin, the lateral periodontal cyst has characteristic clinical, radiographic, and histopathologic findings. In addition to inflammatory lesions, lateral periodontal cysts may appear similar radiographically to an ameloblastoma or odontogenic keratocyst in its early stage; therefore, clinical and histologic correlations are necessary to establish the diagnosis and ensure proper treatment.

[Four patients with mucormycosis in a postoperative recovery unit]. / Estudio descriptivo de cuatro pacientes afectados de mucormicosis ingresados en nuestra unidad de reanimación.

Mucormycosis, a rare opportunistic infection caused by fungi belonging to the Mucorales order, is a potentially fatal disease. We describe 4 patients with mucormycosis. Risk factors (chronic renal insufficiency and chronic lung disease treated with corticosteroids) were identified for 2 of the patients who did not respond favorably to appropriate surgical and medical treatment. Of the 2 remaining patients, only the one with milder disease responded to treatment. The prognosis for this opportunistic infection, whose low incidence has increased in postoperative intensive care units, is very poor if early treatment is not given.

[PiCCO monitoring of 4 critically ill patients]. / Utilización del monitor PiCCO en cuatro pacientes en estado crítico.

The PiCCO physiological monitor (Pulsion Medical Systems, Munich, Germany) was used for hemodynamic diagnosis and monitoring of 4 patients: a polytraumatized female patient with septic shock and ventilator-associated pneumonia; a man with congestive heart failure and cor pulmonale who developed acute heart failure while recovering from anterior resection of the rectum; a man with severe head injury and acute respiratory distress syndrome; and a polytraumatized male patient with a myocardial contusion. All were in a life-threatening situation, either immediately as in the case of the patient with myocardial contusion or eventually as in the patient with septic shock. The PiCCO monitor recorded hemodynamic parameters satisfactorily, facilitating adjustments to optimize treatment. The risks and complications of the usual method of monitoring by Swan-Ganz catheter are well-known. New less invasive monitoring systems designed to record parameters similar to those detected by the Swan-Ganz catheter but with fewer complications and risks have become available. One example, the PiCCO monitor, combines arterial thermodilution with analysis of the pulse waveform, providing a series of hemodynamic parameters useful for managing the critically ill patient.

[Open cholecystectomy under thoracic epidural anesthesia in diffuse interstitial lung disease]. / Colecistectomía abierta bajo anestesia epidural torácica en enfermedades intersticiales difusas del pulmón.

Two patients, aged 73 and 58 years, with diffuse pulmonary fibrosis underwent emergency open cholecystectomies (subcostal approach) under thoracic epidural anesthesia with 0.5% ropivacaine and fentanyl in spontaneous ventilation. Pulmonary fibrosis was due to amiodarone administration in the first patient and of unknowon cause in the second. Both developed arterial hypotension without bradycardia in spite of optimal preloading. Inotropoic support with low doses of norepinephrine was requiered for recovery in both cases with no adverse events after reversion of the sympathetic blocks. Postoperative epidural analgesia was very satisfactory. Thoracic epidural anesthesia is a useful alternative to general anesthesia for subcostal cholecystectomy in patients with diffuse interstitial lung disease in advanced stages.

Graded defragmentation of cortical neuronal firing during recovery of consciousness in rats.

State-dependent neuronal firing patterns reflect changes in ongoing information processing and cortical function. A disruption of neuronal coordination has been suggested as the neural correlate of anesthesia. Here, we studied the temporal correlation patterns of ongoing spike activity, during a stepwise reduction of the volatile anesthetic desflurane, in the cerebral cortex of freely moving rats. We hypothesized that the recovery of consciousness from general anesthesia is accompanied by specific changes in the spatiotemporal pattern and correlation of neuronal activity. Sixty-four contact microelectrode arrays were chronically implanted in the primary visual cortex (contacts spanning 1.4-mm depth and 1.4-mm width) for recording of extracellular unit activity at four steady-state levels of anesthesia (8-2% desflurane) and wakefulness. Recovery of consciousness was defined as the regaining of the righting reflex (near 4%). High-intensity firing (HI) periods were segmented using a threshold (200-ms) representing the minimum in the neurons' bimodal interspike interval histogram under anesthesia. We found that the HI periods were highly fragmented in deep anesthesia and gradually transformed to a near-continuous firing pattern at wakefulness. As the anesthetic was withdrawn, HI periods became longer and increasingly correlated among the units both locally and across remote recording sites. Paradoxically, in 4 of 8 animals, HI correlation was also high at the deepest level of anesthesia (8%) when local field potentials (LFP) were burst-suppressed. We conclude that recovery from desflurane anesthesia is accompanied by a graded defragmentation of neuronal activity in the cerebral cortex. Hypersynchrony during deep anesthesia is an exception that occurs only with LFP burst suppression.

[Resuscitation damage control in the patient with severe trauma]. / Reanimación de control de daños en el paciente adultocon trauma grave.

Severe trauma is the principle cause of death among young people in developed countries, with the main causes being due to road traffic accidents and accidents at work. The principle cause of death in severe trauma is the massive uncontrolled loss of blood. Most of the severe traumas with a massive haemorrhage develop coagulopathy, with some controversy over what is the best treatment for this. Patients with severe trauma are complex patients; they have a high mortality, they consume a significant amount of sources and can require rapid, intensive and multidisciplinary treatment encompassed within the concept of resuscitation damage control. In this article we attempt to present a current view of the pathophysiology of severe trauma and resuscitation damage control that may be applied to these types of patients.