Invasive device-related infections after heart surgery.

OBJECTIVE: To analyze postoperative infections in critically ill patients undergoing heart surgery. SETTING: Intensive care units (ICUs). DESIGN: An observational, prospective, multicenter study was carried out. PATIENTS: Patients in the postoperative period of heart surgery admitted to the ICU and included in the ENVIN-HELICS registry between 2005 and 2011. MAIN OUTCOME VARIABLES: Mechanical ventilation associated pneumonia (MVP), urinary catheter-related infection (UCI), primary bacteremia (PB), PB related to vascular catheters (PB-VC) and secondary bacteremia. RESULTS: Of a total of 97,692 patients included in the study, 9089 (9.3%) had undergone heart surgery. In 440 patients (4.8%), one or more infections were recorded. Infection rates were 9.94 episodes of MVP per 1000 days of mechanical ventilation, 3.4 episodes of UCI per 1000 days of urinary catheterization, 3.10 episodes of BP-VC per 1000 days of central venous catheter, and 1.84 episodes of secondary bacteremia per 1000 days of ICU stay. Statistically significant risk factors for infection were ICU stay (odds ratio [OR] 1.18, 95%CI 1.16-1.20), APACHE II upon admission to the ICU (OR 1.05, 95%CI 1.03-1.07), emergency surgery (OR 1.67, 95%CI 1.13-2.47), previous antibiotic treatment (OR 1.38, 95%CI 1.04-1.83), and previous colonization by Pseudomonas aeruginosa (OR 18.25, 95%CI 3.74-89.06) or extended spectrum beta-lactamase producing enterobacteria (OR 16.97, 95%CI 5.4-53.2). The overall ICU mortality rate was 4.1% (32.2% in patients who developed one or more infections and 2.9% in uninfected patients) (P < .001). CONCLUSIONS: Of the patients included in the ENVIN-HELICS registry, 9.3% were postoperative heart surgery patients. The overall mortality was low but increased significantly in patients who developed one or more infection episodes.

Fluoride accumulation by plants grown in acid soils amended with flue gas desulphurisation gypsum.

The application of flue gas desulphurisation (FGD) gypsum as an acid soil ameliorant was studied in order to establish the possible detrimental effects on plants and animals feeding on them caused by the high fluoride content in this by-product. A greenhouse experiment was conducted under controlled conditions to determine the F accumulation by two plant species (alfalfa (Medicago sativa L.) and ryegrass (Lolium perenne L.)) grown in acid soils amended with different FGD gypsum doses (0-10%). The F concentrations in plant aerial parts were comprised in the range 22-65 mg kg(-1), and those in plant roots varied from 49 to 135 mg kg(-1). The F contents in the above-ground plant tissues showed to decrease with the FGD gypsum application rate, whereas an inverse trend was manifested by plant roots. The increase in the soil content of soluble Ca as a result of the FGD gypsum addition seemed to play an important role in limiting the translocation of F to plant aerial parts.

Use of FGD gypsum in fire resistant panels.

Gypsum from power plant flue gas desulphurization units (FGD gypsum) is a combustion by-product produced in high quantities. In this paper, gypsum panels composed of 100% FGD gypsum from two power plants have been subjected to different physico-chemical (density, pH, humidity), mechanical (flexural and compressive strength, surface hardness, impact resistance), fire resistance and environmental tests (leaching and radioactivity). The results obtained have been compared with the requirements established in some European standards for commercial gypsum and other standards for similar products. In addition, the panels manufactured have been compared with commercial gypsum panels in order to determine the recycling possibilities of this kind of material in this application.

[Characteristics of acute pyelonephritis at a short-stay medical unit]. / Características de la pielonefritis aguda en una unidad de corta estancia.

OBJECTIVES: To analyze the epidemiological characteristics of the population admitted to a short-stay medical unit (SSMU) during 2005 due to acute pyelonephritis. To describe and analyze microbiological aspects recorded in these infections and their clinical implication. MATERIAL AND METHOD. A retrospective study was carried out in a cohort of 208 patients admitted in the SSMU during 2005 because of acute pyelonephritis. Epidemiological, clinical and microbiological data were collected. The statistical analysis was done with the SPSS v. 14.0. RESULTS: 208 patients were included, 74% of whom were females. Average age was 43.6 (16-87). Mean length of stay was 4.7+/-1.2 days and 96.6% of patients were discharged successfully from SSMU. Urine culture was valid in 173 patients, 51.4% of which were positive. Escherichia coli was isolated in 93.2% of urine cultures. Blood cultures were valid in 178 cases and in 37 of which were positive. E. coli was isolated in 64.8% of these. In E. coli urine samples, resistance rate to ampicillin was 68.7%, to cotrimoxazole 22.9%, to ciprofloxacin 18.1%; to amoxicillin/clavulanic acid 16.9% and to fosfomycin 2.4. Seven patients were transferred to hospital home care, there being no deaths. CONCLUSIONS: Acute pyelonephritis with admission criteria can be managed successfully in the SSMU with the applicable therapeutics guidelines with regard to the most common microbiological aspects registered and the low incidence of complications.

Risk minimisation of FGD gypsum leachates by incorporation of aluminium sulphate.

The incorporation of aluminium sulphate to (flue gas desulphurisation) FGD gypsum before its disposal was investigated as a way to minimise the risk supposed by the high fluoride content of its leachates. Using a bath method the kinetic and equilibrium processes of fluoride removal by aluminium sulphate were studied at fluoride/aluminium molar concentration (F/Al) ratios in the range 1.75 10(-2)-1.75 under the pH conditions (about 6.5) of FGD gypsum leachates. It was found that fluoride removal was a very fast process at any of the (F/Al) ratios subject of study, with equilibrium attained within the first 15 min of interaction. High decreases in solution fluoride concentrations (50-80%) were found at the equilibrium state. The use of aluminium sulphate in the stabilization of FGD gypsum proved to greatly decrease its fluoride leachable content (in the range 20-90% for aluminium sulphate doses of 0.1-5%, as determined by the European standard EN 12457-4). Such fluoride leaching minimisation assures the characterization of this by-product as a waste acceptable at landfills for non-hazardous wastes according to the Council Decision 2003/33/EC on waste disposal. Furthermore, as derived from column leaching studies, the proposed stabilization system showed to be highly effective in simulated conditions of disposal, displaying fluoride leaching reduction values about 55 and 80% for aluminium sulphate added amounts of 1 and 2%, respectively.

[Oral anticoagulation excess: analysis from an emergency department]. / Exceso de anticoagulación oral: análisis desde un servicio de Urgencias.

OBJECTIVES: To analyze the environmental factors associated to anticoagulation excess in adult patients who come to an emergency department of a tertiary hospital. To describe the characteristics of anticoagulant therapy, their diseases and associated drugs, clinical presentation and treatment received. METHODS: Prospective study of randomized patients conducted in the Emergency Department of Hospital Gregorio Marañón in Madrid during 6 months. Those patients whose INR was greater than or equal to 6 due to having taken acenocoumarol were included. Variables collected for all of them were: age, gender, INR when coming to the emergency department, anticoagulation indication, its beginning and duration, physician anticoagulation controlling, time since previous INR control, last INR assessment, treatment changes. Other variables were: comorbidity, associated medications, dietary changes, presence of bleeding, its location and treatment received. The statistical analysis was performed with the SPSS program (vs 13). RESULTS: A total of 49 adult patients, 63.3% female, whose average age was 77.9 (48-94) were included. Mean INR value was 8.2 (6-12). Indication due to atrial fibrillation was found in 71.4%. The most common associated diseases were heart failure and chronic nephropathy (18.4% and 16.3%, respectively). Twelve patients (24.5%) had consumed paracetamol recently. Active hemorrhage occurred in 34.7% of cases. CONCLUSIONS: Anticoagulation excess is a common problem in people over 70, where comorbidity and medications may determine the INR value. Bleeding risk is significant so that this group of patients should be closely monitored.

[A study on breakfast and school performance in a group of adolescents]. / Estudio sobre el desayuno y el rendimiento escolar en un grupo de adolescentes.

OBJECTIVES: TO know the relationship between breakfast, from a qualitative perspective, and school performance. MATERIAL AND METHODS: The study was performed in 141 students (70 males and 71 females) with ages ranging 12-13 years, of 1st grade of Mandatory Secondary Education (ESO) from an institute of Saragossa, by means of recalling the breakfast of the day before. Breakfast quality has been assessed according to criteria of the Kid study: GOOD QUALITY: contains at least one food from each one of dairy, cereals, or fruit groups. IMPROVABLE QUALITY: lacks one of the groups. INSUFFICIENT QUALITY: lacks two groups. POOR QUALITY: does not have breakfast. We considered that quality was improved only when a mid-morning snack with a different food from those taken with breakfast was added. Average mark at the end of the school year has been the criterion used to assess school performance. Statistical analysis of data gathered for the present study has been done with SPSS software. This analysis comprises descriptive and inferential statistics. For analysis of global significance between the differences the Analysis of Variance method has been applied, followed by post hoe tests with Bonferroni's and Turkey's methods to detect specific groups explaining global significance. RESULTS: Average mark systematically increases as breakfast quality increases from an average score of 5.63 in the group with poor quality breakfast to 7.73 average score in the group with a good quality breakfast. An analysis of variance has been performed to study the statistical significance of the mean differences between both groups. The outcomes yield significant global differences between groups (p value = 0.001), i.e., the average mark significantly varies according to breakfast quality. When pooled quality of breakfast and mid-morning snack is analyzed, the average mark systematically increases as breakfast-snack quality increases, from an average mark of 5,77 in the group with poor or insufficient quality up to 7.61 in the group with good quality. An analysis of variance has been used to study the statistical significance between the mean differences between groups. The outcome was that there exist global significant differences between groups (p-value = 0.0004), i.e. the average mark significantly varies according to pooled breakfast-snack quality. Besides, we have analyzed the issue of the relative contribution of the snack quality to a determined breakfast quality. For that purpose, average marks for each combination of "breakfast quality" and "breakfast + snack quality". Thus, in the group of poor breakfast quality, those children remaining with poor or insufficient breakfast + snack quality have an average mark of 5.55, where-as those upgrading to "improvable quality" (just one child) have an average mark of 6.10. The students having an insufficient quality breakfast obtained an average mark of 5.91 if they remained with an insufficient or poor quality, and 6.30 if they upgraded to Improvable" quality, and 8.00 if they upgraded to good quality. Students having an "improvable" quality breakfast obtained an average mark of 6.82 if they remained at the same quality level, and 6.96 if they upgraded to good quality. CONCLUSIONS: Relationship between breakfast quality and marks: 1. The average mark increases as breakfast quality increases (descriptive level). 2. The average mark significantly increases when breakfast quality is upgraded from poor or insufficient to good (inferential level). Relationship between pooled breakfast and mid-morning snack quality and marks: 3. The average mark increases as pooled breakfast and snack quality increases (descriptive level). 4. The average mark significantly increases when pooled breakfast and snack quality is upgraded from poor, insufficient, or improvable to good (inferential level). Specific contribution of mid-morning snack: 5. For a given breakfast quality, mean mark increases as pooled breakfast and snack quality increases (descriptive level).

[Cardiac tamponade in a woman with primary hypothyroidism]. / Taponamiento cardiaco en una mujer con hipotiroidismo primario.

Pericardial effusion is not infrequent as a manifestation of hypothyroidism, however, cardiac tamponade is exceptional in these patients. We report a case of a female patient with cardiac tamponade that in the forward workshop was diagnosed of primary hypothyroidism. A brief presentation of clinical history is reported. The literature's review emphasizes the rarity of this case, the importance of the knowledge of triggering factors to establish a precious diagnosis and satisfactory clinical evolution with hormonal treatment without recurrences of the cardiac tamponade after pericardiocentesis is performed, although the resolution of the pericardial effusion is usually slow.

[Charcot-Marie-Tooth disease, dilated myocardiopathy and cardiac conduction disorders]. / Enfermedad de Charcot-Marie-Tooth, miocardiopatía dilatada y trastornos de la conducción cardiaca.

We describe the case of two brothers with Charcot-Marie-Tooth disease, dilated cardiomyopathy and disorders in the cardiac conduction. We review the literature in order to find physiological grounds for these associations. Despite the absence of consolidated data on this question, the genetic grounds could play some role here. In this sense, our cases contribute with the novelty that the disease affects two brothers. This has never been described before and could contribute, along with future observations, to clarify some etiopathogenic aspects of the disease.