Pseudoaneurisma asociado a pseudoquiste pancreático complicado / Pseudoaneurysm associated with complicated pancreatic pseudocysts

El pseudoaneurisma asociado a pseudoquiste es una complicación grave e infrecuente de la pancreatitis crónica. Su tratamiento es complejo por su elevada mortalidad y la necesidad de un manejo multidisciplinar. La medida inicial consiste en la localización de la hemorragia mediante tomografía computarizada dinámica y arteriografía. El tratamiento de elección es controvertido por la ausencia de estudios controlados. Para el manejo de la hemorragia en pacientes estables, la medida terapéutica inicial más aceptada actualmente es la embolización arterial. Ante fracaso de la misma, inestabilidad hemodinámica o imposibilidad de drenaje del pseudoquiste la cirugía es la siguiente opción terapéutica (AU)

A pseudoaneurysm associated with a pseudocyst is a serious and unusual complication of chronic pancreatitis. Its treatment is complex due to its elevated mortality and the need for multidisciplinary management. Initial measures consist in locating the hemorrhage through computerized dynamic tomography and arteriography. The treatment of choice is controversial due to the lack of controlled studies. For managing hemorrhages in stable patients, the most accepted initial measure currently is arterial embolization. In the event of failure of the same, hemodynamic instability or the impossibility of drainage of the pseudocyst, surgery is the subsequent therapeutic option(AU)

Pseudoaneurysm associated with complicated pancreatic pseudocysts.

A pseudoaneurysm associated with a pseudocyst is a serious and unusual complication of chronic pancreatitis. Its treatment is complex due to its elevated mortality and the need for multidisciplinary management. Initial measures consist in locating the hemorrhage through computerized dynamic tomography and arteriography. The treatment of choice is controversial due to the lack of controlled studies. For managing hemorrhages in stable patients, the most accepted initial measure currently is arterial embolization. In the event of failure of the same, hemodynamic instability or the impossibility of drainage of the pseudocyst, surgery is the subsequent therapeutic option.

La cadena de frío vacunal en un departamento de salud de la Comunidad Valenciana / The vaccine cold chain in a Valencian health department (Spain)

Objetivo: Evaluar la cadena de frío en los puntos de vacunación de un departamento de salud de la Comunidad Valenciana, incluida la formación de los responsables de esta cadena.Método: Estudio transversal de revisión de un departamento de salud de la Comunidad Valenciana con 50 puntos de vacunación y 68 frigoríficos. Se utilizó una encuesta estructurada que recogía información relativa a las características del centro de vacunación, el personal responsable, la infraestructura y el control de los elementos que componen la cadena de frío, los procedimientos usados en la conservación y el manejo de las vacunas, así como los conocimientos del personal.Resultados: Se obtuvo una tasa de respuesta del 100%. Los frigoríficos eran, en su mayor parte, equipos domésticos sin alarma de avería o corte eléctrico (76,7%), alarma de puerta abierta (98,5%), termómetro exterior (92,6%), descongelación automática (76,5%), sensores internos de temperatura ni conexión a circuitos de emergencia (85,3%). La mayoría tenía la temperatura en el rango correcto (83,9%), las vacunas estaban adecuadamente situadas (88,2%) y todos los centros contaban con un responsable de vacunas. En un 33,8% de las neveras había alimentos; en el 32,4% los viales se conservaban en la mesa durante la jornada vacunal y el gráfico de temperatura no se cumplimentaba diariamente (75%).Conclusión: Pese a que 5 de cada 6 neveras mantenían la temperatura adecuada, parece necesario mejorar la infraestructura vacunal de los centros de salud de atención primaria y la formación de los profesionales que intervienen en la cadena de frío (AU)

Objective: To evaluate the cold chain in the vaccination points of a health department in the autonomous region of Valencia, including training of the staff responsible for the cold chain.Method: We performed a crosssectional study to review all the vaccination points (n=50, with 68 refrigerators) of a health department in the autonomous region of Valencia. A structured questionnaire was used to gather information on the characteristics of the vaccination center, the staff responsible for the cold chain, the infrastructure and control of the elements composing the cold chain, the procedures used in vaccine conservation and handling, and knowledge of the staff.Results: The response rate was 100%. Most of the refrigerators were domestic refrigerators without alarm systems to alert staff to technical failure or electrical cuts (76.7%), open door alarm (98.5%), external thermometer (92.6%), automatic defrosting facilities (76.5%), internal temperature sensors or connection to emergency circuits (85.3%). Temperatures were mostly in the correct range (83.9%) and the vaccines were correctly located (88.2%). At least one staff member was responsible for the vaccines in all centers. Food was found in 33.8% of the refrigerators, vaccines were conserved on the vaccination table on the day of vaccination in 32.4%, and the temperature chart was not recorded daily in 75%.Conclusion: The appropriate temperature was maintained in five out of every six refrigerators. However, the vaccine infrastructure in primary care centers, as well as training of the staff responsible for the cold chain, should be improved (AU)

[The vaccine cold chain in a Valencian health department (Spain)]. / La cadena de frío vacunal en un departamento de salud de la Comunidad Valenciana.

OBJECTIVE: To evaluate the cold chain in the vaccination points of a health department in the autonomous region of Valencia, including training of the staff responsible for the cold chain. METHOD: We performed a crosssectional study to review all the vaccination points (n = 50, with 68 refrigerators) of a health department in the autonomous region of Valencia. A structured questionnaire was used to gather information on the characteristics of the vaccination center, the staff responsible for the cold chain, the infrastructure and control of the elements composing the cold chain, the procedures used in vaccine conservation and handling, and knowledge of the staff. RESULTS: The response rate was 100%. Most of the refrigerators were domestic refrigerators without alarm systems to alert staff to technical failure or electrical cuts (76.7%), open door alarm (98.5%), external thermometer (92.6%), automatic defrosting facilities (76.5%), internal temperature sensors or connection to emergency circuits (85.3%). Temperatures were mostly in the correct range (83.9%) and the vaccines were correctly located (88.2%). At least one staff member was responsible for the vaccines in all centers. Food was found in 33.8% of the refrigerators, vaccines were conserved on the vaccination table on the day of vaccination in 32.4%, and the temperature chart was not recorded daily in 75%. CONCLUSION: The appropriate temperature was maintained in five out of every six refrigerators. However, the vaccine infrastructure in primary care centers, as well as training of the staff responsible for the cold chain, should be improved.