Cardioembolic ischemic stroke associated with undertreated atrial fibrillation: an observational study / Accidente cerebrovascular isquémico cardioembólico asociado con fibrilación auricular no tratada: estudio observacional

Objectives: To describe the characteristics of patients and to determine the risk factors associated with second Emergency Department visits at 30 and 180 days in sick people admitted to the Emergency Department for cardioembolic stroke with a previous diagnosis of atrial fibrillation.Methods: Retrospective, observational study of adult patients admitted to the Emergency Department at our institution for cardioembolic stroke from January 1, 2019 to December 31, 2019. All study participants had a previous diagnosis of Atrial Fibrillation, CHADs2-VASc ≥2, and no contraindications for anticoagulants. The patients were retrospectively identified through a database search. A univariate analysis was performed to assess variables potentially associated with readmission (any cause) at 30 and 180 days. All variables with a p<0.2 were included in a multivariate analysis.Results: During the study period, 547 patients presented to the ED with ischemic stroke and 113 (20.6%) met the study inclusion criteria. Of these, 53 patients (46.9%) did not receive anticoagulant therapy before the stroke and 28 (24.7%) were taking doses lower than recommended in the technical data sheet. The pharmacological stroke prevention strategy was modified in 44 patients (38.9%) at discharge. On the multivariate analysis, diabetes was the only risk factor significantly associated with early readmission to the ED.Conclusions: Most patients (71.6%) with a previous diagnosis of AF who presented to the emergency department for cardioembolic stroke had not received optimal anticoagulant preventive treatment before the event. Diabetes was the only risk factor associated with early readmission to the Emergency Department. (AU)

Objetivos: Describir las características de los pacientes y determinar los factores de riesgo asociados a las segundas visitas al Servicio de Urgencias a los 30 y 180 días en los enfermos ingresados en el Servicio de Urgencias por ictus isquémico cardioembólico con diagnóstico previo de fibrilación auricular.Métodos: Estudio retrospectivo y observacional de pacientes adultos ingresados en el Servicio de Urgencias del Hospital de la Santa Creu i Sant Pau (HSP) por un ictus cardioembólico desde el 1 de enero de 2019 hasta el 31 de diciembre de 2019. Todos los participantes en el estudio tenían un diagnóstico previo de fibrilación auricular, CHADs2-VASc ≥2, y no tenían contraindicaciones para los anticoagulantes. Los pacientes fueron identificados retrospectivamente mediante una búsqueda en una base de datos del hospital. Se realizó un análisis univariante para evaluar las variables potencialmente asociadas al reingreso (cualquier causa) a los 30 y 180 días. Todas las variables con una p <0,2 se incluyeron en un análisis multivariante.Resultados: Durante el periodo de estudio, 547 pacientes acudieron a urgencias con ictus isquémico y 113 (20,6%) cumplieron los criterios de inclusión del estudio. De ellos, 53 pacientes (46,9%) no recibían tratamiento anticoagulante antes del ictus y 28 (24,7%) tomaban dosis inferiores a las recomendadas en la ficha técnica. La estrategia de prevención farmacológica del ictus se modificó en 44 pacientes (38,9%) al alta. En el análisis multivariante, la diabetes fue el único factor de riesgo que se asoció significativamente con el reingreso temprano en urgencias.Conclusiones: La mayoría de los pacientes (71,6%) con diagnóstico previo de FA que acudieron a urgencias por ictus cardioembólico no habían recibido un tratamiento preventivo anticoagulante óptimo antes del evento. La diabetes fue el único factor de riesgo asociado al reingreso temprano en el servicio de urgencias. (AU)

Psychotic symptoms in COVID-19 patients. A retrospective descriptive study.

Psychotic symptoms have been related to other coronavirus infections. We conducted a single-centre retrospective and observational study to describe new-onset psychotic episodes in COVID-19 patients. Ten patients infected by the novel coronavirus with psychotic symptoms and no previous history of psychosis were identified by the emergency and liaison psychiatry departments. Nine of the cases presented with psychotic symptoms at least two weeks after the first somatic manifestations attributed to COVID-19 and receiving pharmacological treatment. Structured delusions mixed with confusional features were the most frequent clinical presentations. Hence, COVID-19 patients can develop psychotic symptoms as a consequence of multiple concurrent factors.

[Multicentre study of infection incidence in knee prosthesis]. / Estudio multicéntrico sobre la incidencia de infección en prótesis de rodilla.

OBJECTIVE: To determine the incidence of surgical site infection in knee prosthesis surgical procedure for a follow-up period of one year in twelve hospitals in Madrid region. MATERIAL AND METHOD: A prospective study was carried out from January to December 2009 using a national surveillance system called Indicadores Clínicos de Mejora Continua de Calidad. Primary and revision knee joint replacements in patients operated on in the previous year were included. Criteria used to define surgical site infection and patient risk index categories were those established by the Centers for Disease Control and Prevention and National Nosocomial Infections Surveillance. The incidence rates were worked out crude and adjusted by hazard ratio. RESULTS: 2,088 knee prosthesis procedures were analyzed. The overall incidence of surgical site infection was 2.1%. Sixty-five percent of the infections were organ/space. Sixty percent of the infections were identified in the early postoperative period. Of all surgical site infections, 41.9% were microbiologically confirmed. Antibiotic prophylaxis was implemented correctly in 63.3% of the cases. The most important cause of inappropriate prophylaxis was an unsuitable duration in 85.7% of the cases. The presurgical preparation was carried out correctly in 50.3% of surgical operations. The incidence of knee arthroplasty infection was twice as high as in the National Healthcare Safety Network and similar to national rates. DISCUSSION: In this study, the incidence of infection was within the range of infection rates in other published European studies. Surveillance and control strategies of health care for associated infections allow us to assess trends and the impact of preventive measures.

Estudio multicéntrico sobre la incidencia de infección en prótesis de rodilla / Multicentre study of infection incidence in knee prosthesis

Objetivo. Determinar la incidencia de infección de localización quirúrgica en el procedimiento prótesis de rodilla, durante un año de seguimiento en 12 hospitales madrileños. Material y método. Estudio prospectivo de enero a diciembre de 2009, utilizando el programa Indicadores Clínicos de Mejora Continua de Calidad. Se incluyeron prótesis de rodilla primarias y de revisión intervenidas el año previo. Se utilizaron criterios de infección de localización quirúrgica y categorías por índice de riesgo de los Centros para el Control y Prevención de Enfermedades y del National Nosocomial Infections Surveillance. Se calcularon tasas crudas y ajustadas por índice de riesgo. Resultados. Se analizaron 2.088 procedimientos quirúrgicos de prótesis de rodilla. La tasa global de infección de localización quirúrgica fue del 2,1%. El 65% de las infecciones fueron de órgano/espacio. El 60% de las infecciones se identificaron precozmente. Se obtuvo confirmación microbiológica en el 41,9% de los casos. La profilaxis quirúrgica fue adecuada en el 63,3%, siendo la principal causa de inadecuación su duración en el 85,7%. La preparación prequirúrgica fue correcta en el 50,3% de los pacientes. La tasa de infección en artroplastias de rodilla fue dos veces superior a la esperada según el National Healthcare Safety Network y similares a las tasas nacionales. Discusión. La tasa de infección de nuestro estudio se encuentra dentro del rango de las tasas de infección descritas en otros estudios europeos ya publicados. Las estrategias de vigilancia y control de las infecciones asociadas a la asistencia sanitaria permiten evaluar tendencias y el impacto de las medidas de prevención (AU)

Objective. To determine the incidence of surgical site infection in knee prosthesis surgical procedure for a follow-up period of one year in twelve hospitals in Madrid region. Material and method. A prospective study was carried out from January to December 2009 using a national surveillance system called Indicadores Clínicos de Mejora Continua de Calidad. Primary and revision knee joint replacements in patients operated on in the previous year were included. Criteria used to define surgical site infection and patient risk index categories were those established by the Centers for Disease Control and Prevention and National Nosocomial Infections Surveillance. The incidence rates were worked out crude and adjusted by hazard ratio. Results. 2,088 knee prosthesis procedures were analyzed. The overall incidence of surgical site infection was 2.1%. Sixty-five percent of the infections were organ/space. Sixty percent of the infections were identified in the early postoperative period. Of all surgical site infections, 41.9% were microbiologically confirmed. Antibiotic prophylaxis was implemented correctly in 63.3% of the cases. The most important cause of inappropriate prophylaxis was an unsuitable duration in 85.7% of the cases. The presurgical preparation was carried out correctly in 50.3% of surgical operations. The incidence of knee arthroplasty infection was twice as high as in the National Healthcare Safety Network and similar to national rates. Discussion. In this study, the incidence of infection was within the range of infection rates in other published European studies. Surveillance and control strategies of health care for associated infections allow us to assess trends and the impact of preventive measures (AU)

Colgajo fronto-nasal paramedial en la reconstrucción de defectos nasales extensos / Paramedian Forehead Flap for the Reconstruction of Extensive Nasal Defects

Introducción: El Servicio de Dermatología del Hospital Universitario de Guadalajara es un centro de referencia en cirugía de Mohs, por lo que con cierta frecuencia nos vemos enfrentados al problema de la reconstrucción de defectos quirúrgicos nasales de gran tamaño. El colgajo frontonasal paramedial está considerado en la actualidad como una de las técnicas de elección en la reconstrucción de defectos nasales extensos. Material y métodos: Revisamos nuestra experiencia en la reconstrucción nasal mediante el colgajo fronto-nasal paramediano entre los años 2004 y 2008. Describimos la técnica quirúrgica, las complicaciones y los resultados finales. Resultados: Diez pacientes con una media de edad de 75,1 años fueron reconstruidos mediante este colgajo. Un 20% requirió además injertos cartilaginosos y reconstrucción de la cobertura nasal interna. Las complicaciones más frecuentes fueron el sangrado (60%) y la necrosis parcial (10%). Los resultados finales, tanto estéticos como funcionales, fueron considerados buenos o excelentes en el 90% de los pacientes. Conclusiones: El colgajo fronto-nasal sigue siendo una de las mejores alternativas para el cierre de defectos quirúrgicos mayores de 2 cm localizados en la pirámide nasal. El conocimiento de su técnica y su realización cuidadosa permite obtener excelentes resultados con pocas complicaciones (AU)

Background: The Department of Dermatology at Hospital Universitario de Guadalajara in Spain is a referral center for Mohs micrographic surgery. Consequently, we are regularly faced with the problem of repairing large surgical defects on the nose. The paramedian forehead flap is currently one of the techniques of choice for the repair of such defects. Materials and methods: We review our experience in the repair of nasal defects using the paramedian forehead flap over the period from 2004 to 2008. We describe the surgical technique, complications, and final results. Results: Ten patients (mean age, 75.1 years) were treated using this flap. Two patients also required cartilage grafts and reconstruction of the internal nasal lining. The most common complications were bleeding (60%) and partial necrosis (10%). The final cosmetic and functional results were considered good or excellent in 90% of cases. Conclusions: The forehead flap continues to be one of the best options for the closure of surgical defects of the nasal pyramid larger than 2 cm. Adequate knowledge and careful application of the technique allows excellent results to be obtained with few complications (AU)

[Paramedian forehead flap for the reconstruction of extensive nasal defects]. / Colgajo fronto-nasal paramedial en la reconstrucción de defectos nasales extensos.

BACKGROUND: The Department of Dermatology at Hospital Universitario de Guadalajara in Spain is a referral center for Mohs micrographic surgery. Consequently, we are regularly faced with the problem of repairing large surgical defects on the nose. The paramedian forehead flap is currently one of the techniques of choice for the repair of such defects. MATERIALS AND METHODS: We review our experience in the repair of nasal defects using the paramedian forehead flap over the period from 2004 to 2008. We describe the surgical technique, complications, and final results. RESULTS: Ten patients (mean age, 75.1 years) were treated using this flap. Two patients also required cartilage grafts and reconstruction of the internal nasal lining. The most common complications were bleeding (60%) and partial necrosis (10%). The final cosmetic and functional results were considered good or excellent in 90% of cases. CONCLUSIONS: The forehead flap continues to be one of the best options for the closure of surgical defects of the nasal pyramid larger than 2 cm. Adequate knowledge and careful application of the technique allows excellent results to be obtained with few complications.

Riesgos virales en odontoestomatología. Campaña de vacunación frente a hepatitis / Viral risks in odontoestomatology. Vaccination campaign in front of hepatitis

Se han descrito los principales riesgos biológicos en la práctica odontoestomatológica así como las precauciones estándar que deben tenerse presentes. Se presenta la Campaña de Vacunación frente a la hepatitis A y B ofertada por un Colegio de Odontólogos y Estomatólogos con los datos de aceptación de la misma. Entre los candidatos a vacunarse frente a la hepatitis B, el 69 por ciento de los odontólogos, el 59 por ciento de los estomatólogos y el 63 por ciento de los ayudantes completaron la pauta vacunal. La vacunación frente a hepatitis en la práctica odontoestomatológica es la forma más contundente de evitar enfermedades no deseadas (AU)

To describe and review the main biological risks in dental practice and the standard precautions to be adopted by dentists and stomatologists. A vaccination campaign against hepatitis A and S organised by the Madrid College of Dentists and stomalogists is presented along with data on its acceptance. Of the 197 dentists candidates for hepatitis S vaccination, 69% underwent the complete vaccination program; Of the 85 stomatologists candidates for hepatitis S vaccination, 59% completed the vaccination programo 63.3% of the dental assistants, hygienists, prothetists and registered nurses completed the vaccination programo We can consider this hepatitis S as the most important risk for dentists and stomatologists. The Madrid College of Dentists and Stomatologists was especially aware, when it organised this campaign, of the need to protect colleagues at the beginning of their professional life (AU)

[Erythrocyte levels of ALA-dehydrase and uro-synthetase in chronic renal insufficiency (author's transl)]. / Estudio de los niveles eritrocitarios de ala-dehidrasa y uro-sintetasa en la insuficiencia renal crónica.

Erythrocyte levels of ala-dehydrase and uro-synthetase as well as hematocrit, hemoglobin, iron levels and serum iron binding capacity were studied in a group of 28 patients with chronic renal failure in hemodialysis and compared to those of a control group. As is usual, hematocrit, hemoglobin an iron levels were significantly decreased, as were ala-dehydrase levels, while uro-synthetase levels were within normal levels. These results are interpreted as a blockade of the biosynthetic pathway of the protoporphyrins, which lends support to the hypothesis of an existing defect in hemoglobin synthesis in patients with chronic renal failure.