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INTRODUCTION: We analysed the frequency of atrial fibrillation (AF) delayed diagnosis and the factors associated with it in newly diagnosed patients. METHODS: This was a descriptive, cross-sectional, multicentre study. Data were collected from newly diagnosed patients with AF through medical records review and interviews during cardiology, internal medicine, primary care and emergency department consultations in Spain. RESULTS: A total of 201 physicians participated in the study (64.2% cardiologists, 21.4% internists). 948 patients (58% men; mean age 72.8 years) were included. In 41.8% of patients, AF was classified as paroxysmal at diagnosis, 30.9% as persistent and 27.3% as permanent. The diagnosis was coincidental in 37%. It was considered that a delayed diagnosis occurred in 49.3% of patients. This delay was associated with the presence of permanent or persistent AF, older age or valvular disease. 74.8% of patients had some contact with the healthcare system in the preceding year. The diagnosis could have been established between 1 and 6 months earlier in 50.7% of cases and more than six months earlier in 20.1%. 54.4% of the patients had experienced AF compatible symptomatology previously. Of these, 32.6% had a consultation without a diagnosis. CONCLUSIONS: In a significant proportion of AF cases, there is a diagnostic delay. Many people with compatible symptoms neither seek consultations nor contact the healthcare system facilities. Consequently, the opportunity for early diagnosis is lost.
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The Portland cement industry is continuously exploring new admixture alternatives to manipulate building materials properties, including mechanical, rheological, and durability properties. Cactus mucilage is such an admixture alternative. This study reviews the literature on the use of cactus mucilage (specifically, prickly pear cactus) as a bioadmixture in building materials, particularly Portland-cement-based materials. Moreover, the influences on mechanical strength, rheology, and durability are examined. The results show that cactus mucilage, which has been used since ancient times in America, could enhance materials like lime-, Portland-cement-, and earth-based building materials.
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OBJECTIVES: To review the tolerance to and medium-term efficacy of ultrasound-guided cryoablation as an alternative to surgical treatment of fibroadenomas of the breast in our hospital. METHODS: We analyzed data from the 12 patients with fibroadenomas treated with ultrasound-guided cryoablation in our hospital between November 2020 and July 2022. Cryoablation was performed with a system using argon gas (Galil Boston Scientific®) or liquid nitrogen (Prosense Ice Cure®) following a triple-phase (freeze-thaw-freeze) protocol of variable duration depending on the size of the lesion. Patients were followed up with ultrasonography at 3, 6, 12, and 18 months. RESULTS: All patients tolerated the procedure well. Two patients reported moderate pain in the hours immediately after the procedure; no other complications occurred. The findings during follow-up included decreased volume of the fibroadenoma (47.07% at 3 months, 77.79% at 6 months, 81.77% at 12 months, and 88.81% at 18 months), blurring of the nodule's margins, a significantly reduced or absent signal within the lesion in the Doppler study, an echogenic band (representing edema, hemorrhage, and fat necrosis), and hypoechoic areas suggestive of fibrosis surrounding the fibroadenoma. CONCLUSIONS: Cryoablation is done on an outpatient basis, avoiding general anesthesia, thus making it less expensive. Cryoablation yields better cosmetic results than surgery.
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Neoplasias de la Mama , Criocirugía , Fibroadenoma , Ultrasonografía Intervencional , Humanos , Criocirugía/métodos , Neoplasias de la Mama/cirugía , Neoplasias de la Mama/diagnóstico por imagen , Fibroadenoma/cirugía , Fibroadenoma/diagnóstico por imagen , Femenino , Adulto , Ultrasonografía Intervencional/métodos , Persona de Mediana Edad , Resultado del Tratamiento , Estudios RetrospectivosRESUMEN
The sub-ventricular zone (SVZ) is the most well-characterized neurogenic area in the mammalian brain. We previously showed that in 65% of patients with glioblastoma (GBM), the SVZ is a reservoir of cancer stem-like cells that contribute to treatment resistance and emergence of recurrence. Here, we built a single-nucleus RNA-sequencing-based microenvironment landscape of the tumor mass (T_Mass) and the SVZ (T_SVZ) of 15 GBM patients and 2 histologically normal SVZ (N_SVZ) samples as controls. We identified a mesenchymal signature in the T_SVZ of GBM patients: tumor cells from the T_SVZ relied on the ZEB1 regulatory network, whereas tumor cells in the T_Mass relied on the TEAD1 regulatory network. Moreover, the T_SVZ microenvironment was predominantly characterized by tumor-supportive microglia, which spatially co-exist and establish heterotypic interactions with tumor cells. Lastly, differential gene expression analyses, predictions of ligand-receptor and incoming/outgoing interactions, and functional assays revealed that the IL-1ß/IL-1RAcP and Wnt-5a/Frizzled-3 pathways are therapeutic targets in the T_SVZ microenvironment. Our data provide insights into the biology of the SVZ in GBM patients and identify specific targets of this microenvironment.
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In this study, neural networks and support vector regression (SVR) were employed to predict the degradation over three pharmaceutically active compounds (PhACs): Ibuprofen (IBP), diclofenac (DCF), and caffeine (CAF) within a stirred reactor featuring a flotation cell with two non-concentric ultraviolet lamps. A total of 438 datapoints were collected from published works and distributed into 70% training and 30% test datasets while cross-validation was utilized to assess the training reliability. The models incorporated 15 input variables concerning reaction kinetics, molecular properties, hydrodynamic information, presence of radiation, and catalytic properties. It was observed that the Support Vector Regression (SVR) presented a poor performance as the ε hyperparameter ignored large error over low concentration levels. Meanwhile, the Artificial Neural Networks (ANN) model was able to provide rough estimations on the expected degradation of the pollutants without requiring information regarding reaction rate constants. The multi-objective optimization analysis suggested a leading role due to ozone kinetic for a rapid degradation of the contaminants and most of the results required intensification with hydrogen peroxide and Fenton process. Although both models were affected by accuracy limitations, this work provided a lightweight model to evaluate different Advanced Oxidation Processes (AOPs) by providing general information regarding the process operational conditions as well as know molecular and catalytic properties.
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Diclofenaco , Peróxido de Hidrógeno , Ibuprofeno , Aprendizaje Automático , Redes Neurales de la Computación , Diclofenaco/química , Peróxido de Hidrógeno/química , Ibuprofeno/química , Cinética , Contaminantes Químicos del Agua/química , Contaminantes Químicos del Agua/análisis , Cafeína/química , Oxidación-Reducción , Preparaciones Farmacéuticas/química , Preparaciones Farmacéuticas/análisis , Ozono/química , Máquina de Vectores de Soporte , Análisis Costo-Beneficio , Rayos Ultravioleta , Catálisis , FotólisisRESUMEN
Selenium (Se) is an essential trace element present as selenocysteine (SeCys) in selenoproteins, which have an important role in thyroid metabolism and the redox system in humans. Se deficiency affects between 500 and 1000 million people worldwide. Increasing Se intake can prevent from bacterial and viral infections. Se deficiency has been associated with cancer, Alzheimer, Parkinson, decreased thyroid function, and male infertility. Se intake depends on the food consumed which is directly related to the amount of Se in the soil as well as on its availability. Se is unevenly distributed on the earth's crust, being scarce in some regions and in excess in others. The easiest way to counteract the symptoms of Se deficiency is to enhance the Se status of the human diet. Se salts are the most toxic form of Se, while Se amino acids and Se-nanoparticles (SeNPs) are the least toxic and most bio-available forms. Some bacteria transform Se salts into these Se species. Generally accepted as safe selenized microorganisms can be directly used in the manufacture of selenized fermented and/or probiotic foods. On the other hand, plant growth-promoting bacteria and/or the SeNPs produced by them can be used to promote plant growth and produce crops enriched with Se. In this chapter we discuss bacterial Se metabolism, the effect of Se on human health, the applications of SeNPs and Se-enriched bacteria, as well as their effect on food fortification. Different strategies to counteract Se deficiency by enriching foods using sustainable strategies and their possible implications for improving human health are discussed.
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Nanopartículas , Compuestos de Selenio , Selenio , Humanos , Selenio/química , Selenio/metabolismo , Sales (Química) , Bacterias/genética , Bacterias/metabolismoRESUMEN
Sepiolite is an important raw fibrous material. A method to prepare red pigments based on sepiolite through the thermal treatment of sepiolite with sulfur and sodium sulfide hydrate is reported. Sepiolite was heated until 800 °C in order to remove zeolitic water, the first coordinated water, the second coordinated water, and structural hydroxyls. Several [S/Na2S]molar ratios in the range 0.5-7 were employed. The properties of these pigments were studied by different analytical techniques, such as colorimetric analysis, thermal analysis, Fourier transform infrared (FTIR) spectroscopy, X-ray diffraction and scanning electron microscopy. The samples with [S/Na2S] = 0.5 and 1, corresponding to high contents of sodium sulfide in the synthesis procedure, exhibit high values of the colorimetric parameter CIE a* and a maximum reflectance in the visible zone belonging to red, based on the red colour of the samples. Under the reducing conditions of the synthesis, sulfur forms polysulfides of the general formula [Sx]2-. The sodium sulfide reacts with the excess S to form polysulfides as well. From the polysulfides, the radical anions of the general formula [Sx/2]Ë- originate and they are identified as the chromophore groups responsible for the color in the sulfur-based pigment analogues of ultramarines. The red colour of the samples could be mainly attributed to the presence of S4 and S4Ë- identified by FTIR.
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Objetivos Identificar posibles factores predictores de crisis epilépticas en acúmulos o estado epiléptico (EE) y evaluar si estos pacientes reciben una mayor intervención en urgencias. Metodología Análisis secundario del Registro ACESUR el cual es un registro observacional de cohortes multipropósito, prospectivo y multicéntrico de pacientes adultos con crisis epilépticas en 18 servicios de urgencias. Se recogen variables clínico-asistenciales. Se identifican factores y modelo de riesgo de presentar crisis en acúmulos o EE y se evalúa el efecto de intervención en servicios de urgencias extrahospitalarios y hospitalarios. Resultados Del registro ACESUR se analizan 186 (28%) con crisis en acúmulos (126; 19%) o EE (60; 9%) frente a 478 (72%) pacientes con crisis aislada. El modelo de riesgo de crisis en acúmulo o EE en urgencias incluyó la presencia de alta comorbilidad según índice de Charlson > 3 (OR: 1,60; IC95%: 1,05-2,46; p = 0,030), > 2 fármacos antiepilépticos habituales (OR: 2,29; IC95%: 1,49-3,51; p < 0,001) y crisis focal (OR: 1,56; IC95%: 1,05-2,32; p = 0,027). El ABC del modelo fue de 0,735 (IC95%: 0,693-0,777; p = 0,021). La intervención en pacientes con crisis en acúmulos y EE fue mayor en los servicios de urgencias extrahospitalarios (OR: 2,89; IC95%: 1,91-4,36; p < 0,001) y en los servicios de urgencias hospitalarios (OR: 4,41; IC95%: 2,69-7,22; p < 0,001). Conclusiones El modelo presentado podría ser una herramienta con valor predictivo de utilidad para identificar al paciente adulto con riesgo de presentar crisis en acúmulos o EE en urgencias. Estos pacientes recibieron una mayor intervención frente a pacientes con crisis epiléptica aislada por parte de los servicios de urgencias extrahospitalarios y más aún por los servicios de urgencias hospitalarios en nuestra muestra. (AU)
Objectives To identify possible predictors of seizure cluster or status epilepticus (SE) and to evaluate whether these patients receive greater interventions in emergency departments. Methodology We conducted a secondary analysis of the ACESUR Registry, a multipurpose, observational, prospective, multicentre registry of adult patients with seizures from 18 emergency departments. Clinical and care-related variables were collected. We identified risk factors and risk models for seizure cluster or SE and assessed the effect of interventions by prehospital emergency services and the hospital emergency department. Results We identified a total of 186 (28%) patients from the ACESUR registry with seizure cluster (126 [19%]) or SE (60 [9%]); the remaining 478 patients (72%) had isolated seizures. The risk model for seizure cluster or SE in the emergency department included Charlson Comorbidity Index scores ≥ 3 (OR: 1.60; 95% CI, 1.05-2.46; P = .030), ≥ 2 habitual antiepileptic drugs (OR: 2.29; 95% CI, 1.49-3.51; P < .001), and focal seizures (OR: 1.56; 95% CI, 1.05-2.32; P = .027). The area under the curve of the model was 0.735 (95% CI, 0.693-0.777; P = .021). Patients with seizure cluster and SE received more aggressive interventions both by prehospital emergency services (OR: 2.89; 95% CI, 1.91-4.36; P < .001) and at the emergency department (OR: 4.41; 95% CI, 2.69-7.22; P < .001). Conclusions This risk model may be of prognostic value in identifying adult patients at risk of presenting seizure cluster or SE in the emergency department. In our sample, these patients received more aggressive treatment than adult patients with isolated seizures before arriving at hospital, and even more so in the emergency department. (AU)
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Adulto Joven , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Convulsiones/prevención & control , Estado Epiléptico/prevención & control , Servicios Médicos de Urgencia , Modelos de Riesgos ProporcionalesRESUMEN
Objetivos Identificar posibles factores predictores de crisis epilépticas en acúmulos o estado epiléptico (EE) y evaluar si estos pacientes reciben una mayor intervención en urgencias. Metodología Análisis secundario del Registro ACESUR el cual es un registro observacional de cohortes multipropósito, prospectivo y multicéntrico de pacientes adultos con crisis epilépticas en 18 servicios de urgencias. Se recogen variables clínico-asistenciales. Se identifican factores y modelo de riesgo de presentar crisis en acúmulos o EE y se evalúa el efecto de intervención en servicios de urgencias extrahospitalarios y hospitalarios. Resultados Del registro ACESUR se analizan 186 (28%) con crisis en acúmulos (126; 19%) o EE (60; 9%) frente a 478 (72%) pacientes con crisis aislada. El modelo de riesgo de crisis en acúmulo o EE en urgencias incluyó la presencia de alta comorbilidad según índice de Charlson > 3 (OR: 1,60; IC95%: 1,05-2,46; p = 0,030), > 2 fármacos antiepilépticos habituales (OR: 2,29; IC95%: 1,49-3,51; p < 0,001) y crisis focal (OR: 1,56; IC95%: 1,05-2,32; p = 0,027). El ABC del modelo fue de 0,735 (IC95%: 0,693-0,777; p = 0,021). La intervención en pacientes con crisis en acúmulos y EE fue mayor en los servicios de urgencias extrahospitalarios (OR: 2,89; IC95%: 1,91-4,36; p < 0,001) y en los servicios de urgencias hospitalarios (OR: 4,41; IC95%: 2,69-7,22; p < 0,001). Conclusiones El modelo presentado podría ser una herramienta con valor predictivo de utilidad para identificar al paciente adulto con riesgo de presentar crisis en acúmulos o EE en urgencias. Estos pacientes recibieron una mayor intervención frente a pacientes con crisis epiléptica aislada por parte de los servicios de urgencias extrahospitalarios y más aún por los servicios de urgencias hospitalarios en nuestra muestra. (AU)
Objectives To identify possible predictors of seizure cluster or status epilepticus (SE) and to evaluate whether these patients receive greater interventions in emergency departments. Methodology We conducted a secondary analysis of the ACESUR Registry, a multipurpose, observational, prospective, multicentre registry of adult patients with seizures from 18 emergency departments. Clinical and care-related variables were collected. We identified risk factors and risk models for seizure cluster or SE and assessed the effect of interventions by prehospital emergency services and the hospital emergency department. Results We identified a total of 186 (28%) patients from the ACESUR registry with seizure cluster (126 [19%]) or SE (60 [9%]); the remaining 478 patients (72%) had isolated seizures. The risk model for seizure cluster or SE in the emergency department included Charlson Comorbidity Index scores ≥ 3 (OR: 1.60; 95% CI, 1.05-2.46; P = .030), ≥ 2 habitual antiepileptic drugs (OR: 2.29; 95% CI, 1.49-3.51; P < .001), and focal seizures (OR: 1.56; 95% CI, 1.05-2.32; P = .027). The area under the curve of the model was 0.735 (95% CI, 0.693-0.777; P = .021). Patients with seizure cluster and SE received more aggressive interventions both by prehospital emergency services (OR: 2.89; 95% CI, 1.91-4.36; P < .001) and at the emergency department (OR: 4.41; 95% CI, 2.69-7.22; P < .001). Conclusions This risk model may be of prognostic value in identifying adult patients at risk of presenting seizure cluster or SE in the emergency department. In our sample, these patients received more aggressive treatment than adult patients with isolated seizures before arriving at hospital, and even more so in the emergency department. (AU)
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Adulto Joven , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Convulsiones/prevención & control , Estado Epiléptico/prevención & control , Servicios Médicos de Urgencia , Modelos de Riesgos ProporcionalesRESUMEN
OBJECTIVES: To identify possible predictors of seizure cluster or status epilepticus (SE) and to evaluate whether these patients receive greater interventions in emergency departments. METHODOLOGY: We conducted a secondary analysis of the ACESUR Registry, a multipurpose, observational, prospective, multicentre registry of adult patients with seizures from 18 emergency departments. Clinical and care-related variables were collected. We identified risk factors and risk models for seizure cluster or SE and assessed the effect of interventions by prehospital emergency services and the hospital emergency department. RESULTS: We identified a total of 186 (28%) patients from the ACESUR registry with seizure cluster (126 [19%]) or SE (60 [9%]); the remaining 478 patients (72%) had isolated seizures. The risk model for seizure cluster or SE in the emergency department included Charlson Comorbidity Index scores ≥ 3 (OR: 1.60; 95% CI, 1.05-2.46; P=.030), ≥ 2 habitual antiepileptic drugs (OR: 2.29; 95% CI, 1.49-3.51; P<.001), and focal seizures (OR: 1.56; 95% CI, 1.05-2.32; P=.027). The area under the curve of the model was 0.735 (95% CI, 0.693-0.777; P=.021). Patients with seizure cluster and SE received more aggressive interventions both by prehospital emergency services (OR: 2.89; 95% CI, 1.91-4.36; P<.001) and at the emergency department (OR: 4.41; 95% CI, 2.69-7.22; P<.001). CONCLUSIONS: This risk model may be of prognostic value in identifying adult patients at risk of presenting seizure cluster or SE in the emergency department. In our sample, these patients received more aggressive treatment than adult patients with isolated seizures before arriving at hospital, and even more so in the emergency department.
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Epilepsia , Estado Epiléptico , Adulto , Humanos , Anticonvulsivantes/uso terapéutico , Servicio de Urgencia en Hospital , Epilepsia/tratamiento farmacológico , Estudios Prospectivos , Convulsiones/tratamiento farmacológico , Estado Epiléptico/terapiaRESUMEN
Las metástasis espinales representan una importante carga sobre la calidad de vida en los pacientes afectados por una enfermedad oncológica activa, debido a la alta incidencia de síndromes dolorosos, deformidad espinal y deterioro neurológico. La cirugía juega un papel determinante a la hora de mejorar la calidad de vida mediante el control del dolor, el restablecimiento de la función neurológica y el mantenimiento de la estabilidad espinal, además de contribuir a la respuesta de la terapia médica. La cirugía mínimamente invasiva (MIS) es una opción de tratamiento en determinados pacientes con alto riesgo quirúrgico, ya que tiene una baja tasa de complicaciones, de sangrado intraoperatorio, de estancia hospitalaria y ofrece resultados similares a la cirugía abierta. Presentamos en esta revisión el papel de la MIS en esta enfermedad, y algunos casos tratados en nuestro centro hospitalario.(AU)
Spinal metastases represent a significant burden on the quality of life in patients affected by active oncological disease due to the high incidence of pain syndromes, spinal deformity, and neurological impairment. Surgery plays a decisive role in improving quality of life by controlling pain, restoring neurological function and maintaining spinal stability, as well as contributing to the response to medical therapy. Minimally invasive surgery (MIS) is a treatment option in certain patients with high surgical risk since it has a low rate of complications, intraoperative bleeding, hospital stay, and offers similar results to open surgery. In this review, we present the role of MIS in this pathology and some cases treated in our hospital.(AU)
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Humanos , Masculino , Femenino , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Columna Vertebral/cirugía , Metástasis de la Neoplasia/tratamiento farmacológico , Neoplasias de la Columna Vertebral/cirugía , Calidad de Vida , Neoplasias de la Médula Espinal/cirugía , Procedimientos Ortopédicos , Ortopedia , Traumatología , Neoplasias de la Médula Espinal/terapia , Cirugía General/métodosRESUMEN
Las metástasis espinales representan una importante carga sobre la calidad de vida en los pacientes afectados por una enfermedad oncológica activa, debido a la alta incidencia de síndromes dolorosos, deformidad espinal y deterioro neurológico. La cirugía juega un papel determinante a la hora de mejorar la calidad de vida mediante el control del dolor, el restablecimiento de la función neurológica y el mantenimiento de la estabilidad espinal, además de contribuir a la respuesta de la terapia médica. La cirugía mínimamente invasiva (MIS) es una opción de tratamiento en determinados pacientes con alto riesgo quirúrgico, ya que tiene una baja tasa de complicaciones, de sangrado intraoperatorio, de estancia hospitalaria y ofrece resultados similares a la cirugía abierta. Presentamos en esta revisión el papel de la MIS en esta enfermedad, y algunos casos tratados en nuestro centro hospitalario.(AU)
Spinal metastases represent a significant burden on the quality of life in patients affected by active oncological disease due to the high incidence of pain syndromes, spinal deformity, and neurological impairment. Surgery plays a decisive role in improving quality of life by controlling pain, restoring neurological function and maintaining spinal stability, as well as contributing to the response to medical therapy. Minimally invasive surgery (MIS) is a treatment option in certain patients with high surgical risk since it has a low rate of complications, intraoperative bleeding, hospital stay, and offers similar results to open surgery. In this review, we present the role of MIS in this pathology and some cases treated in our hospital.(AU)
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Humanos , Masculino , Femenino , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Columna Vertebral/cirugía , Metástasis de la Neoplasia/tratamiento farmacológico , Neoplasias de la Columna Vertebral/cirugía , Calidad de Vida , Neoplasias de la Médula Espinal/cirugía , Procedimientos Ortopédicos , Ortopedia , Traumatología , Neoplasias de la Médula Espinal/terapia , Cirugía General/métodosRESUMEN
El estudio tuvo como objetivo identificar perfiles de locus de control en deportistas y examinar su relación con la ira y personalidad resistente. La muestra fue de 383 deportistas (Medad= 28.14; DT= 9.42) que completaron una serie de cuestionarios para medir: locus de control (E I-E), ira (STAXI-II) y personalidad resistente (EPRM). El análisis de conglomerados reveló dos perfiles distintos. Los análisis de ANOVA mostraron diferencias significativas en temperamento, reacción, expresión interna de ira, expresión externa de ira, control externo de ira, compromiso, desafío, control y el factor general de personalidad resistente. En este sentido, el perfil de locus de control externo bajo reportó los niveles más bajos de ira y niveles más altos de personalidad resistente. Como conclusión, del análisis de conglomerados surgieron dos perfiles de locus de control externo, de los cuales el perfil de locus de control externo bajo resultó ser un perfil más funcional (AU)
The study aimed to identify the locus of control profiles in athletes and examine whether participants from distinct profiles significantly differed on anger and hardiness. The sample was made up of 383 athletes (Mage = 28.14; SD =9.42) that completed a series of self-report questionnaires designed to measure: locus of control (E I-E), anger (STAXI-II) and hardiness (EPRM). Cluster analysis revealed two distinct profiles. Results of follow-up ANOVAs showed significant differences in temperament,reaction, internal anger expression, external anger expression, external anger control, commitment, challenge, control and hardy personality general factor. The low external locus of control profile reported the lowest anger levels and the highest hardiness levels. In 0354134conclusion, two locus of control external profiles emerged from the cluster analysis, in which the low external locus of control profile turned out to be the most functional profile (AU)
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Humanos , Personalidad , Atletas , Atletas/psicología , Conducta Competitiva , Encuestas y Cuestionarios , Análisis de VarianzaRESUMEN
Background: Delirium is difficult to measure in the Intensive Care Unit (ICU). It is possible that by considering the rate of screening, incidence, and rate of treatment with antipsychotic medications (APMs) for suspected delirium, a clearer picture can emerge. Methods: A retrospective, observational study was conducted at two ICUs in Australia, between April and June of 2020. All adult ICU patients were screened; those who spoke English and did not have previous neurocognitive pathology or intracranial pathology were included in the analysis. Data were collected from the hospitals' electronic medical records. The primary outcome was incidence of delirium based on the use of the Confusion Assessment Method for ICU (CAM-ICU). Secondary outcomes included measures of screening for delirium, treatment of suspected delirium with APMs, and identifying clinical factors associated with both delirium and the use of APMs. Results: From 736 patients that were screened, 665 were included in the analysis. The incidence of delirium was 11.3% (75/665); on average, the Richmond Agitation and Sedation Scale (RASS) was performed every 2.9 h and CAM-ICU every 40 h. RASS was not performed in 8.4% (56/665) of patients and CAM-ICU was not performed in 40.6% (270/665) of patients. A total of 17% (113/665) of patients were prescribed an APM, with quetiapine being the most used. ICU length of stay (LOS), APACHE-III score, and the use of alpha-2 agonists were associated with the presence of delirium, while ICU LOS, the use of alpha-2 agonists, and the presence of delirium were associated with patients receiving APMs. Conclusions: The incidence of delirium was lower than previously reported, at 11.3%. The rate of screening for delirium was low, while the use of APMs for delirium was higher than the incidence of delirium. It is possible that the true incidence is higher than what was measured. Critical prospective assessment is required to optimize APM indications in the ICU.
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Background The Pacman flap is a modified V-Y advancement flap that showed to be versatile in repairing surgical and non-surgical wounds. Indeed, this flap has been used in any anatomical localization, except for the scalp, where its use has not been reported. Moreover, the versatility of the Pacman flap can be enhanced by applying simple modifications to its original design. Materials and methods A case-series of 23 patients whose surgical breaches were repaired using standard or modified Pacman flap were included in this retrospective study. Results Most patients were male (65.2%) with a median age of 75.7 years. Squamous cell carcinoma was the tumor most commonly removed (60.9%), while scalp and face were the most frequent localizations (30.4%). Although 18 flaps were sculpted in the traditional Pacman shape, 5 were modified to fit the defect and localization. Complications occurred in 30% of flaps, but all of them were minor except for 1 extended necrosis. Conclusions The Pacman flap can be used to repair surgical wounds localized in any body area, including the scalp. Three modifications can enhance the versatility of the flap and offer new repair options to dermatologic surgeons (AU)
Introducción El colgajo Pacman es un colgajo de avance V-Y modificado, que resulta versátil para la reparación de las heridas quirúrgicas y no-quirúrgicas. De hecho, este colgajo ha sido utilizado en cualquier localización anatómica excepto en el cuero cabelludo, donde no se ha descrito su aplicación. Además, aplicando simples modificaciones al diseño original del colgajo Pacman se aumenta su versatilidad. Material y métodos Se realizó un estudio retrospectivo con una serie de casos de 23 pacientes en los que se empleó el colgajo Pacman estándar o modificado en la reconstrucción de sus heridas quirúrgicas. Resultados La mayoría de los pacientes fueron varones (65,2%) con una media de edad de 75,7 años. La mayoría de las extirpaciones fueron de carcinoma escamoso cutáneo (60,9%). Las localizaciones más frecuentes fueron el cuero cabelludo y la cara (30,4%). Aunque 18 colgajos se diseñaron siguiendo las directrices originales del colgajo Pacman, 5 fueron modificados para adaptarlo al defecto y la localización. El 30% de los colgajos desarrollaron complicaciones, todas ellas menores a excepción de un caso de necrosis extensa. Conclusión El colgajo Pacman puede utilizarse para reparar defectos quirúrgicos en cualquier localización corporal, incluyendo el cuero cabelludo. Mediante 3 sencillas modificaciones puede mejorarse la versatilidad de este colgajo y ofrecer una nueva opción reconstructiva a los cirujanos dermatológicos (AU)
Asunto(s)
Humanos , Masculino , Femenino , Anciano , Anciano de 80 o más Años , Procedimientos de Cirugía Plástica/métodos , Cuero Cabelludo/cirugía , Neoplasias Cutáneas/cirugía , Colgajos Quirúrgicos , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Introducción El colgajo Pacman es un colgajo de avance V-Y modificado, que resulta versátil para la reparación de las heridas quirúrgicas y no-quirúrgicas. De hecho, este colgajo ha sido utilizado en cualquier localización anatómica excepto en el cuero cabelludo, donde no se ha descrito su aplicación. Además, aplicando simples modificaciones al diseño original del colgajo Pacman se aumenta su versatilidad. Material y métodos Se realizó un estudio retrospectivo con una serie de casos de 23 pacientes en los que se empleó el colgajo Pacman estándar o modificado en la reconstrucción de sus heridas quirúrgicas. Resultados La mayoría de los pacientes fueron varones (65,2%) con una media de edad de 75,7 años. La mayoría de las extirpaciones fueron de carcinoma escamoso cutáneo (60,9%). Las localizaciones más frecuentes fueron el cuero cabelludo y la cara (30,4%). Aunque 18 colgajos se diseñaron siguiendo las directrices originales del colgajo Pacman, 5 fueron modificados para adaptarlo al defecto y la localización. El 30% de los colgajos desarrollaron complicaciones, todas ellas menores a excepción de un caso de necrosis extensa. Conclusión El colgajo Pacman puede utilizarse para reparar defectos quirúrgicos en cualquier localización corporal, incluyendo el cuero cabelludo. Mediante 3 sencillas modificaciones puede mejorarse la versatilidad de este colgajo y ofrecer una nueva opción reconstructiva a los cirujanos dermatológicos (AU)
Background The Pacman flap is a modified V-Y advancement flap that showed to be versatile in repairing surgical and non-surgical wounds. Indeed, this flap has been used in any anatomical localization, except for the scalp, where its use has not been reported. Moreover, the versatility of the Pacman flap can be enhanced by applying simple modifications to its original design. Materials and methods A case-series of 23 patients whose surgical breaches were repaired using standard or modified Pacman flap were included in this retrospective study. Results Most patients were male (65.2%) with a median age of 75.7 years. Squamous cell carcinoma was the tumor most commonly removed (60.9%), while scalp and face were the most frequent localizations (30.4%). Although 18 flaps were sculpted in the traditional Pacman shape, 5 were modified to fit the defect and localization. Complications occurred in 30% of flaps, but all of them were minor except for 1 extended necrosis. Conclusions The Pacman flap can be used to repair surgical wounds localized in any body area, including the scalp. Three modifications can enhance the versatility of the flap and offer new repair options to dermatologic surgeons (AU)