Unexpected high yield of acrolein underlies the importance of the hydrogen-abstraction mechanism in photooxidation of allyl methyl sulfide (AMS).

This work explores theoretically the gas phase oxidation of allyl methyl sulfide (AMS, H2CCHCH2SCH3) initiated by •OH radicals, focusing on the H-abstraction pathway at the M06-2X-D3/aug-cc-pVTZ and MN15/aug-cc-pVTZ levels of theory (m06Tz and mn15Tz). The formation of a prereactive complex (PRC) is involved in H-abstraction processes with two potential directions of approach for the OH radical, denoted as "α" and "ß". The PRCs, demonstrate increased reactivity, primarily due to the interaction between the sulfur atoms and the hydroxyl hydrogen. A scheme for the H-abstraction mechanism that supports the experimentally identified products and predicts the formation of some S-containing low volatility products is proposed. The comparison of the potential energy surface (PES) between the double bond addition and H-abstraction paths in the AMS molecule shows that at the m06Tz level of theory, the H-abstraction on C3 and the addition to C1 have nearly the same profile of energy, while at the mn15Tz level, the minimum energy channel is the addition to C1. The theoretical rate coefficient for each reaction channel was calculated, considering the formation of a PRC prior to reaching the transition state of each channel and assuming thermal equilibrium between reactants and the PRC. The rate constants were calculated in a multi-TS/multi-conformer way at the SVECV-f12/m06Tz and SVECV-f12/mn15Tz levels of theory. The SVECV-f12 method is consistent in its predictions in both systems and exhibits only minor deviations from the experimental rate constants. Despite some specific differences due to the DFT method supporting the SVECV-f12 calculations, both methodologies predict a significant H-abstraction contribution in the AMS + OH gas phase reaction, which explains the high formation yield for acrolein determined experimentally.

What a difference a chlorine makes: The remarkable unimolecular ion chemistry of phenyl formate and phenyl chloroformate.

Imaging photoelectron photoion coincidence (iPEPICO) spectroscopy and tandem mass spectrometry were employed to explore the ionisation and dissociative ionisation of phenyl formate (PF) and phenyl chloroformate (PCF). The threshold photoelectron spectra of both compounds are featureless and lack a definitive origin transition, owing to the internal rotation of the formate functional group relative to the benzene ring, active upon ionisation. CBS-QB3 calculations yield ionisation energies of 8.88 and 9.03 eV for PF and PCF, respectively. Ionised PF dissociates by the loss of CO via a transition state composed of a phenoxy cation and HCO moieties. The dissociation of PCF ions involves the competing losses of CO (m/z 128/130), Cl (m/z 121) and CO2 (m/z 112/114), with Cl loss also shown to occur from the second excited state in a non-statistical process. The primary CO- and Cl-loss fragment ions undergo sequential reactions leading to fragment ions at m/z 98 and 77. The mass-analysed ion kinetic energy (MIKE) spectrum of PCF+ showed that the loss of CO2 occurs with a large reverse energy barrier, which is consistent with the computationally derived minimum energy reaction pathway.

The Unimolecular Chemistry of Methyl Chloroformate Ions and Neutrals: A Story of Near-Threshold Decomposition.

The near-threshold dissociation of ionized and neutral methyl chloroformate (CH3COOCl, MCF) was explored with imaging photoelectron photoion coincidence spectroscopy. The threshold photoelectron spectrum (TPES) for MCF was acquired for the first time; the large geometry changes upon ionization of MCF result in a broad, poorly defined TPES. Franck-Condon simulations are consistent with an adiabatic ionization energy (IE) of 10.90 ± 0.05 eV. Ionized MCF dissociates by chlorine atom loss at a measured 0 K appearance energy (AE) of 11.30 ± 0.01 eV. Together with the above IE, this AE suggests a reaction barrier of 0.40 ± 0.05 eV, consistent with the SVECV-f12 computational result of 0.41 eV. At higher internal energies, the loss of CH3O• becomes competitive due to its lower entropy of activation. Pyrolysis of neutral MCF formed the anticipated major products CH3Cl + CO2 (R1) and the minor products HCl + CO + CH2O (R2). The thermal decomposition products were identified by their photoion mass-selected threshold photoelectron spectrum (ms-TPES). Possible reaction pathways were explored computationally to confirm the dominant ones: R1 proceeds by a concerted Cl atom migration via a four-membered transition state in agreement with the mechanism proposed in the literature. R2 is a two-step reaction first yielding 2-oxiranone by HCl loss, which then decomposes to CH2O and CO. Kinetic modeling of the neutral decomposition could simulate the observed reactions only if the vibrational temperature of the MCF was assumed not to cool in the expansion.

The capillary pressure vs. saturation curve for a fractured rock mass: fracture and matrix contributions.

The fractal topography of fracture surfaces challenges the upscaling of laboratory test results to the field scale, therefore the study of rock masses often requires numerical experimentation. We generate digital fracture analogues and model invasion percolation to investigate the capillarity-saturation Pc-Sw fracture response to changes in boundary conditions. Results show that aperture is Gaussian-distributed and the coefficient of variation is scale-independent. The aperture contraction during normal stress increments causes higher capillary pressures and steeper Pc-Sw curves, while shear displacement results in invasion anisotropy. The three-parameter van Genutchen model adequately fits the fracture capillary response in all cases; the capillary entry value decreases with fracture size, yet the fracture Pc-Sw curve normalized by the entry value is size-independent. Finally, we combine the fracture and matrix response to infer the rock mass response. Fracture spacing, aperture statistics and matrix porosity determine the rock mass capillarity-saturation Pc-Sw curve. Fractures without gouge control the entry pressure whereas the matrix regulates the residual saturation at high capillary pressure Pc.

Erythema multiforme in a Central American tapir (Tapirus bairdii) calf, clinical case report.

A 7-month-old male Central American tapir with a history of recurrent respiratory diseases and repeated prolonged administration of amoxicillin with clavulanic acid presented with lethargy, severe hyperalgesia, and interscapular ulcerating vesicular lesions with serosanguineous content, as well as dorsal skin peeling, oral ulcers, and thoracic limb, abdominal, and submandibular pustules with surrounding erythema and alopecia. The histopathological analysis and clinical manifestations were compatible with erythema multiforme, which was treated with daily wound cleaning and silver sulfadiazine cream application, as well as oral prednisolone for 15 days, with five daily tapering doses, achieving clinical improvement and an adequate cure of the disease. Vesicular dermatitis syndrome of tapirs is a disease complex including erythema multiforme, a condition rarely diagnosed, since the analyses required for a definitive diagnosis are almost never performed; therefore, it is important to carry out the necessary tests that allow the differentiation of the dermatopathies included in this complex of vesicular skin diseases.

Probing the pyrolysis of ethyl formate in the dilute gas phase by synchrotron radiation and theory.

The thermal decomposition of the atmospheric constituent ethyl formate was studied by coupling flash pyrolysis with imaging photoelectron photoion coincidence (iPEPICO) spectroscopy using synchrotron vacuum ultraviolet (VUV) radiation at the Swiss Light Source (SLS). iPEPICO allows photoion mass-selected threshold photoelectron spectra (ms-TPES) to be obtained for pyrolysis products. By threshold photoionization and ion imaging, parent ions of neutral pyrolysis products and dissociative photoionization products could be distinguished, and multiple spectral carriers could be identified in several ms-TPES. The TPES and mass-selected TPES for ethyl formate are reported for the first time and appear to correspond to ionization of the lowest energy conformer having a cis (eclipsed) configuration of the O=C(H)-O-C(H2 )-CH3 and trans (staggered) configuration of the O=C(H)-O-C(H2 )-CH3 dihedral angles. We observed the following ethyl formate pyrolysis products: CH3 CH2 OH, CH3 CHO, C2 H6 , C2 H4 , HC(O)OH, CH2 O, CO2 , and CO, with HC(O)OH and C2 H4 pyrolyzing further, forming CO + H2 O and C2 H2  + H2 . The reaction paths and energetics leading to these products, together with the products of two homolytic bond cleavage reactions, CH3 CH2 O + CHO and CH3 CH2  + HC(O)O, were studied computationally at the M06-2X-GD3/aug-cc-pVTZ and SVECV-f12 levels of theory, complemented by further theoretical methods for comparison. The calculated reaction pathways were used to derive Arrhenius parameters for each reaction. The reaction rate constants and branching ratios are discussed in terms of the residence time and newly suggest carbon monoxide as a competitive primary fragmentation product at high temperatures.

Experimental and Theoretical Kinetic Studies of the Ozonolysis of Selected Allyl Sulfides (H2C═CHCH2SR, R = CH3, CH3CH2): The Effect of Nascent OH Radicals.

Rate coefficients of the O3-initiated oxidation of allyl methyl sulfide (H2C═CHCH2SCH3, AMS) and allyl ethyl sulfide (H2C═CHCH2SCH2CH3, AES) were determined at atmospheric conditions by "in situ" FTIR. The relative kinetic experiments were performed using methylcyclohexane (McH) and carbon monoxide (CO) as nascent OH radical scavengers and in the absence of any scavenger, to determine the impact that the formation of OH radicals has on the rate coefficients. In the absence of scavengers, values of kAMS+O3 = (5.23 ± 3.57) × 10-18 and kAES+O3 = (5.76 ± 1.80) × 10-18 cm3 molecule-1 s-1 were obtained. In the presence of the scavengers, however, the rates decreased to kAMS+O3+McH = (3.92 ± 1.92) × 10-18 and kAMS+O3+CO = (2.63 ± 0.47) × 10-18 cm3 molecule-1 s-1 for AMS, and kAES+O3+McH = (4.78 ± 1.38) × 10-18 and kAES+O3+CO = (3.50 ± 0.27) × 10-18 cm3 molecule-1 s-1 for AES. On the basis of these results, we have decided to recommend the values obtained using CO as scavenger as those best representing the rate coefficient for the reactions of O3 with AMS and AES. The reaction mechanism was explored using DFT and post-Hartree-Fock computational methods. It is shown that the barrier for the common cyclization to primary ozonide (-3.7 ± 0.1 kcal mol-1) followed by other reactions, as well as that for the reaction with the sulfur atom (-5.1 ± 0.1 kcal mol-1), is small and quite close, meaning that both reaction paths should contribute significantly to the global reaction rate.

Probing the pyrolysis of methyl formate in the dilute gas phase by synchrotron radiation and theory.

The thermal dissociation of the atmospheric constituent methyl formate was probed by coupling pyrolysis with imaging photoelectron photoion coincidence spectroscopy (iPEPICO) using synchrotron VUV radiation at the Swiss Light Source (SLS). iPEPICO allows threshold photoelectron spectra to be obtained for pyrolysis products, distinguishing isomers and separating ionic and neutral dissociation pathways. In this work, the pyrolysis products of dilute methyl formate, CH3 OC(O)H, were elucidated to be CH3 OH + CO, 2 CH2 O and CH4 + CO2 as in part distinct from the dissociation of the radical cation (CH3 OH+• + CO and CH2 OH+ + HCO). Density functional theory, CCSD(T), and CBS-QB3 calculations were used to describe the experimentally observed reaction mechanisms, and the thermal decomposition kinetics and the competition between the reaction channels are addressed in a statistical model. One result of the theoretical model is that CH2 O formation was predicted to come directly from methyl formate at temperatures below 1200 K, while above 1800 K, it is formed primarily from the thermal decomposition of methanol.

Degradation mechanism of 2-fluoropropene by Cl atoms: experimental and theoretical products distribution studies.

The gas-phase reaction products of 2-fluoropropene (2FP) with Cl atoms have been determined for the first time at 298 K and atmospheric pressure using a 1080 L quartz-glass photoreactor coupled with in situ FTIR spectroscopy to monitor reactants and products. Acetyl fluoride and formyl chloride were observed as the main products with yields of (106 ± 10)% and (100 ± 11)%, respectively. Electronic structure calculations of reactants, intermediates, products and transition states on a detailed mechanism of the reaction were performed by DFT procedures (BMK, M06, M062X/D3), as well as accurate composite methods on both the addition and abstraction reaction channels. From the joint experimental and theoretical studies, we concluded that the reaction occurs primarily via addition to the Cα carbon, with a smaller participation of the addition on the Cß carbon, which is not produced directly from the separated reactants but from the CH3CFCH2Cl intermediate radical through a submerged transition state. The abstraction channel occurs at larger energies than the addition ones, and also presents a submerged transition state, with a lower barrier. No products arising from this channel are expected. The proposed mechanism explains also why formaldehyde, predicted as a product by former theoretical studies, is not found among the experimental products. The atmospheric implications of the reaction products are assessed.

Kinetics, product distribution and atmospheric implications of the gas-phase oxidation of allyl sulfides by OH radicals.

Relative rate coefficients of the OH radical -initiated oxidation of allyl methyl sulfide (AMS, H2CCHCH2SCH3) and allyl ethyl sulfide (AES, H2CCHCH2SCH2CH3) have been measured at atmospheric pressure of synthetic air and 298 K: kAMS= (4.98 ± 1.42) and kAES= (6.88 ± 1.49) × 10-11 cm3 molecule-1 s-1 by means of in situ FTIR spectroscopy. In addition, the molar yields of the main reaction products of AMS with OH radicals formed in the absence and presence of nitric oxides (NOX) were determined to be the following: sulfur dioxide (95 ± 12) % and (51 ± 12) % for acrolein (50 ± 9) % and (41 ± 9) %. In the reaction of AES with OH radicals, the following molar yields were obtained: for sulfur dioxide (88 ± 13) % and (56 ± 12) % for acrolein (36 ± 9) % and (41 ± 9) %. The present results suggest that the abstraction at C3 plays an important role in the oxidation mechanism as the addition to the double bond. This work represents the first study of the OH radical interaction with AMS and AES carried out under atmospheric conditions. The atmospheric implications were discussed in terms of the atmospheric residence times of the sulfur-containing compounds studied and the products formed in the presence and absence of NOx. SO2 formation seems to be the main fate of the gas-phase allyl sulfides oxidation with significant acidifying potentials and short-chain aldehydes production like formaldehyde and acetaldehyde.

Autochthonous Angiostrongylus cantonensis, Angiostrongylus vasorum and Aelurostrongylus abstrusus infections in native terrestrial gastropods from the Macaronesian Archipelago of Spain.

The presence of zoonotic relevant Angiostrongylus cantonensis infections has recently been reported in rat final hosts and gastropod intermediate hosts in Tenerife, Spain. However, data on A. cantonensis, Angiostrongylus vasorum and Aelurostrongylus abstrusus prevalences in endemic gastropods for other islands of the Macaronesian Archipelago are still missing. In order to fill this gap, we conducted an epidemiological study on terrestrial native slug (Plutonia lamarckii) and snail (Cornu aspersum, Theba pisana, Rumina decollata) species in 27 selected locations of Tenerife, Gran Canaria, El Hierro, Lanzarote, La Palma and Fuerteventura. Overall, 131 terrestrial gastropods were collected in winter/spring season 2018/2019 and examined for the presence of metastrongyloid lungworm larvae via artificial digestion. The current data revealed a total prevalence of 4.6% for A. vasorum, 3.8% for A. abstrusus and 0.8% for A. cantonensis. In Tenerife, three lungworm species were detected, thereby re-confirming A. cantonensis endemicity for this island. Prevalences of snails (C. aspersum) originating from El Hierro were 5% for A. abstrusus and 15% for A. vasorum, respectively, with larval burdens up to 290 larvae per specimen. This epidemiological study indicates the presence of human, canine and feline lungworm species in Macaronesia, Spain. The current data-particularly those on anthropozoonotic A. cantonensis-call for a regular large-scale monitoring on intermediate hosts, paratenic hosts and definitive hosts to prevent further spread of lungworm-related diseases in humans and animals.

Síndrome de trabajador quemado: Existencia del Burnout sector salud / Burnout syndrome: Existence of Burnout in the health sector

En tiempos donde nuestra vida laboral ocupa la mayor parte del tiempo y en el menor de los casos, pasamos mínimo una tercera parte del día en nuestro trabajo o desa-rrollando actividades asociadas con el mismo, además, de manera personal y profesional buscamos ser más productivos, eficientes y porque no decirlo, competitivos; y es así como de manera inevitable se pueden presentar efectos secundarios, que de alguna manera irán manifestándose de manera física y/o psicologica. Por eso hemos decidido compartir un poco acerca de un síndrome que cada día adquiere más fuerza y se hace común en la población trabajadora, el cual, desde el momento en que fue considerada su existencia ha adquirido varias maneras para referírsele como son síndrome de desgaste profesional, síndrome de sobrecarga emocional, síndrome de la cabeza quemada, quemarse en el tra-bajo, síndrome del quemado o síndrome de fatiga en el trabajo, del trabajador desgastado y cualquier otro sinónimo de agotamiento o desgaste mental, su nombre: Síndrome de Burnout.Es importante lograr comprender en qué consiste dicho síndrome, tanto para las empre-sas como para los colaboradores que se pueden ver afectados por dicha enfermedad; los primeros desde un alto ausentismo laboral que se convierte es un elevado costo finan-ciero y los segundos con una sensación de infelicidad con aquello que antes generaba motivación, desinterés laboral, derivando en productividad y rendimientos bajo sumán-dose a ello las manifestaciones físicas como la cefalea, fatiga, irritabilidad, etc.; teniendo en cuenta y como se indicó anteriormente, son aquellos trabajadores que pasaron de un extremo a otro de manera progresiva.El síndrome de Burnout es una enfermedad moderna que afecta al individuo en el plano mental, es decir, un riesgo psicosocial para los colaboradores y es por esta razón, que al igual que los otros de los riesgos ocupacionales que se presentan en las organizaciones, debe ser tratado desde la promoción y la prevención, además, de implementar estrategias de intervención y tratamientos sobre los colaboradores.

In times during which our work life occupies a majority of our time where at the very least we spend a third of the day working or developing skills related to our jobs, we seek to be more productive, efficient, and why not admit, competitive, in personal and professional manners; this is how inevitably the side effects present themselves, whether manifesting physically and/or psychologically. Due to this we have decided to share a bit about an illness that has become more common in the working population and gains strength every day. An illness which has since the day it was recognized, obtained several names such as professional attrition syndrome, emotional overdose symptom, burned head syndrome, work burnout, burnout syndrome or work fatigue syndrome or any oth-er synonym for exhaustion and mental fatigue: Burnout Syndrome.It is important to understand what this syndrome consists of, both for employers/compa-nies and employees who may be affected by it; the former affected due to an increase in absenteeism that translates into a large financial cost due to lost labor and the latter due to a sensation of unhappiness with what used to generate motivation and lack of interest in work, which results in low productivity in addition to physical manifestations such as headaches, fatigue, irritability, etc. Understanding this and taking into account the above, these workers are the ones who changed from one extreme to the other progressively.Burnout Syndrome is a modern illness that affects individuals in the mental plane, that is to say, a psychological risk for employees and for that reason, just like other occupational risks that are found in the workplace, it should be treated with awareness and prevention strategies in addition to intervention and treatment for affected employees.

Gas-phase degradation of 2-butanethiol initiated by OH radicals and Cl atoms: kinetics, product yields and mechanism at 298 K and atmospheric pressure.

Relative rate coefficients and product distribution of the reaction of 2-butanethiol (2butSH) with OH radicals and Cl atoms were obtained at atmospheric pressure and 298 K. The experiments were performed in a 480 L borosilicate glass photoreactor in synthetic air coupled to a long path "in situ" FTIR spectrometer. The rate coefficients obtained by averaging the values from different experiments were: k OH = (2.58 ± 0.21) × 10-11 cm3 per molecule per s and k Cl = (2.49 ± 0.19) × 10-10 cm3 per molecule per s. The kinetic values were compared with related alkyl thiols and homologous alkyl alcohols, where it was found that thiols react faster with both oxidants, OH radicals and Cl atoms. SO2 and 2-butanone were the major products identified for the reactions of 2-butanethiol with OH radicals and Cl atoms. The product yield of the reaction of 2-butanethiol and OH radicals were (81 ± 2)%, and (42 ± 1)% for SO2 and 2-butanone, respectively. For the reactions of 2-butanethiol with Cl atom, yields of SO2 and 2-butanone were (59 ± 2)% and (39 ± 2)%, respectively. A degradation mechanism was proposed for the pathways that leads to formation of identified products. The product distribution observed indicated that the H-atom of the S-H group abstraction channel is the main pathway for the reaction of OH radicals and Cl atoms with 2-butanethiol.

Health-related quality of life of patients with rotator cuff injuries, Cofee Triangle, Colombia, 2013.

OBJECTIVE: To determine the quality of life related to health and its related factors in patients diagnosed with rotator cuff lesions in the Municipality of Pereira, Colombia, 2013. METHODS: Cross-sectional study. Simple random sampling of 239 patients over 18 years of age attended at five health care institutions in the urban area of Pereira. Socio-demographic, biological, clinical and self-perception aspects of the disability were collected regarding the quality of life related to health. Use of measures of frequency, Chi-square and logistic regression for analysis. RESULTS: 72% (173) reported poor quality of life related to health in the physical health status component and 60% (144) in the mental health status component. Factors associated with poor quality of life related to health according to physical health status were: schooling, having caregiver, and shoulder disability in manual activities, daily activities and pain and physical limitation. While the factors associated with poor quality of life related to health in mental health status components were: schooling, having caregiver and shoulder disability due to pain and physical limitation. The greater the perception of shoulder disability, the worse the perception of health status. CONCLUSION: The introduction of psychometric measures for the evaluation of the health status of patients with shoulder injuries contributes to a treatment adjusted to individual requirements and daily activities of the patient.

OBJETIVO: Determinar la Calidad de Vida Relacionada con la Salud y sus factores relacionados en pacientes diagnosticados con lesiones de manguito rotador del Municipio de Pereira, Colombia, 2013. MÉTODOS: Estudio de corte transversal. Muestreo aleatorio simple de 239 pacientes mayores de 18 años atendidos en cinco Instituciones Prestadoras de Salud del área urbana de Pereira. Se recogen aspectos sociodemográficos, biológicos, clínicos y de autopercepción de la discapacidad respecto de la Calidad de Vida Relacionada con la Salud. Utilización de medidas de frecuencia, Chi-cuadrado y regresión logística para análisis. RESULTADOS: 72%(173) reportaron mala Calidad de Vida Relacionada con la Salud en el componente del estado de salud física y 60%(144) en componente del estado de salud mental. Los factores asociados con mala Calidad de Vida Relacionada con la Salud según estado de salud física fueron: escolaridad, tener cuidador, y discapacidad del hombro en actividades manuales, en actividades cotidianas y por dolor y limitación física. Mientras los factores asociados a mala Calidad de Vida Relacionada con la Salud en componente del estado de salud mental fueron: escolaridad, tener cuidador y la discapacidad de hombro por dolor y limitación física. A mayor percepción de discapacidad del hombro, peor percepción del estado de salud. CONCLUSIÓN: La introducción de medidas psicométricas para la evaluación del estado de salud de pacientes con lesiones de hombro contribuye a un tratamiento ajustado a requerimientos individuales y a las actividades diarias del paciente.

Health-related quality of life of patients with rotator cuff injuries, Cofee Triangle, Colombia, 2013 / Calidad de vida relacionada con la salud de pacientes con lesiones de manguito rotador, Eje Cafetero, Colombia, 2013

ABSTRACT Objective To determine the quality of life related to health and its related factors in patients diagnosed with rotator cuff lesions in the Municipality of Pereira, Colombia, 2013. Methods Cross-sectional study. Simple random sampling of 239 patients over 18 years of age attended at five health care institutions in the urban area of Pereira. Socio-demographic, biological, clinical and self-perception aspects of the disability were collected regarding the quality of life related to health. Use of measures of frequency, Chi-square and logistic regression for analysis. Results 72% (173) reported poor quality of life related to health in the physical health status component and 60% (144) in the mental health status component. Factors associated with poor quality of life related to health according to physical health status were: schooling, having caregiver, and shoulder disability in manual activities, daily activities and pain and physical limitation. While the factors associated with poor quality of life related to health in mental health status components were: schooling, having caregiver and shoulder disability due to pain and physical limitation. The greater the perception of shoulder disability, the worse the perception of health status. Conclusion The introduction of psychometric measures for the evaluation of the health status of patients with shoulder injuries contributes to a treatment adjusted to individual requirements and daily activities of the patient.

RESUMO Objetivo Determinar la Calidad de Vida Relacionada con la Salud y sus factores relacionados en pacientes diagnosticados con lesiones de manguito rotador del Municipio de Pereira, Colombia, 2013. Métodos Estudio de corte transversal. Muestreo aleatorio simple de 239 pacientes mayores de 18 años atendidos en cinco Instituciones Prestadoras de Salud del área urbana de Pereira. Se recogen aspectos sociodemográficos, biológicos, clínicos y de autopercepción de la discapacidad respecto de la Calidad de Vida Relacionada con la Salud. Utilización de medidas de frecuencia, Chi-cuadrado y regresión logística para análisis. Resultados 72%(173) reportaron mala Calidad de Vida Relacionada con la Salud en el componente del estado de salud física y 60%(144) en componente del estado de salud mental. Los factores asociados con mala Calidad de Vida Relacionada con la Salud según estado de salud física fueron: escolaridad, tener cuidador, y discapacidad del hombro en actividades manuales, en actividades cotidianas y por dolor y limitación física. Mientras los factores asociados a mala Calidad de Vida Relacionada con la Salud en componente del estado de salud mental fueron: escolaridad, tener cuidador y la discapacidad de hombro por dolor y limitación física. A mayor percepción de discapacidad del hombro, peor percepción del estado de salud. Conclusión La introducción de medidas psicométricas para la evaluación del estado de salud de pacientes con lesiones de hombro contribuye a un tratamiento ajustado a requerimientos individuales y a las actividades diarias del paciente.

Adverse events in critical care: Search and active detection through the Trigger Tool.

AIM: To investigate the incidence of disadvantageous events by using the Global Trigger Tool in an intensive care unit (ICU). METHODS: A retrospective descriptive study was performed in a 12-bed university ICU in the city of Medellin, Colombia. Clinical charts of hospitalized patients were reviewed, between January 1 and December 31, 2016, with the following inclusion criteria: subjects aged over 18 years, with at least 24 h of hospitalization and who had a complete medical history that could be accessed. Interventions: Trained reviewers conducted a retrospective examination of medical charts searching for clue events that elicit investigation, in order to detect an unfavorable event. Measurements: Information was processed through SPSS software version 21; for numerical variables, the mean was reported with standard deviation (SD). Percentages were calculated for qualitative variables. RESULTS: Two hundred and forty-four triggers occurred, with 82.4% of subjects having presented with at least one and an average of 3.37 (SD 3.47). A total of 178 adverse events (AEs) took place in 48 individuals, with an incidence of 52.1%. On average, four events per patient were recorded, and for each unfortunate event, 1.98 triggers were presented. The most frequent displeasing issues were: pressure ulcers (17.6%), followed by complications or reactions to medical devices (4.3%), and lacerations or skin defects (3.7%); the least frequent was delayed diagnosis or treatment (0.56%). Thirty-eight point four percent of mishap events caused temporary damage that required intervention, and 48.9% of AEs were preventable. Comparison between AEs and admission diagnoses found that hypertension and sepsis were the only diagnoses that had statistical significance (P = 0.042 and 0.022, respectively). CONCLUSION: Almost half of the unfavorable issues were classified as avoidable, which leaves a very wide field of work in terms of preventative activities.

Nefrocalcinosis como complicación de hipercalcemia por ingesta excesiva de calcio en el embarazo

Antecedentes: La hipercalcemia durante el embarazo es un hallazgo raro. La exposición prolongada a los altos niveles de calcio puede llevar a calcificaciones en distintos órganos maternos y en el feto puede llevar a abortos espontáneos y mortinatos. Caso clínico: Paciente primípara, con gestación de 20+4 semanas, remitida por falla renal aguda e hipertensión arterial. Ella reportó ingesta excesiva de queso, leche y multivitamínicos. Con calcio de 9,2 mg/dL y relación BUN/Creatinina de 6,8 se diagnostica intoxicación alimentaria y nefrocalcinosis medular por alta ingesta de calcio. Al cuarto día de hospitalización presenta sangrado vaginal y debido a las condiciones de la madre se termina el embarazo. Posteriormente presenta una mejoría clínica significativa y se da de alta. Discusión: La relevancia de este caso es que la presencia de hipercalcemia en el embarazo y su no identificación, aumenta el riesgo de aborto, y de hipocalcemia neonatal, que a su vez puede causar muerte materna. En este cuadro se pueden presentar varias complicaciones, siendo una de las más frecuentes la nefrocalcinosis, identificada en este reporte. Conclusión: La ingesta de calcio excesiva en gestantes puede causar nefrocalcinosis. Es importante la educación para evitar ésta y otras complicaciones.

Background: Hypercalcemia during pregnancy is a strange finding. The long exposure to high calcium levels can take to calcifications in different maternal organs and it can lead to miscarriage and stillborn. Case presentation: A woman with 20+4 weeks' gestation, who was remitted because of an acute renal failure and hypertension. She reported excessive intake of cheese, milk and multivitaminics. With a calcium level of 9.2 mg/dL and BUN/Creatinine of 6.8, diagnosed with food poisoning and medullary nephrocalcinosis as a result of the high calcium intake. At the fourth day at the hospital she presented vaginal bleeding and due to the conditions of the mother the pregnancy was ended. Afterwards she presented a significant clinical improvement and she was discharged from the hospital. Discussion: The relevance of this case is that the presence of hypercalcemia during pregnancy and not identifying it elevates the risk of miscarriage and neonatal hypocalcemia, which can cause maternal death. In this aspect, many complications can develop, being one of the most important the nephrocalcinosis, identified in this report. Conclusion: The excessive calcium intake in pregnant women can cause nephrocalcinosis. It is important to educate them to avoid this and other complications.

Alargamiento conjunto del flexor hallucis longus y del flexor digitorum longus en el tratamiento quirúrgico del pie equino varo congénito: una técnica de tenodesis / Lengthening and tenodesis of flexor hallucis longus and flexor digitorum longus in clubfoot surgical treatment

Introducción: el pie equino varo congénito (PEVC) ha sido un severo trastorno ortopédico del paciente recién nacido y lactante. El estándar de oro en su tratamiento es el método de Ponseti; sin embargo, cuando es necesario realizar un tratamiento quirúrgico de esta patología se ha empleado la liberación posteromedial ampliada. Este artículo muestra los resultados de la utilización de una modificación de esta técnica, en la cual se realiza un alargamiento conjunto del flexor hallucis longus y del flexor digitorum longus. Materiales y métodos: se diseñó una serie de casos de los pacientes con PEVC que requirieron tratamiento quirúrgico con la técnica propuesta, entre 1995 y 2002, en el Hospital Universitario San Jorge de Pereira. Se midió la capacidad de flexión activa eficiente de los dedos del pie y el patrón de marcha en un periodo mínimo de seguimiento de 2 años. Resultados: se incluyeron 30 pacientes, la mitad con deformidad bilateral. La edad al momento de la intervención fue de menos de un año en el 80% de los pacientes. El tiempo de seguimiento promedio fue de 5 años. Se encontró una buena fuerza y un uso balanceado y funcional de los flexores durante la marcha en todos los pacientes. Discusión: los tendones del flexor hallucis longus y del flexor digitorum longus son pequeños y su alargamiento individual muy dispendioso, dejando grandes superficies cruentas para cicatrización y fibrosis en el trayecto de trabajo. Con esta técnica se logran zonas de deslizamiento que permiten el sinergismo de los tendones y aseguran su buena función, por lo que se recomienda su uso en el procedimiento de liberación posteromedial.

Estabilización operatoria con placas y tornillos en costillas para tratar un caso de tórax inestable complicado / Plate ostesynthesis in unstable thorax: case report

Las fracturas costales son uno de los traumas de mayor frecuencia, siendo el 10% de los traumas cerrados. Cuando la lesión es de múltiples arcos costales y es inestable recibe el nombre de tórax inestable. El manejo de éste ha sido controversial durante mucho tiempo. El proceso fisiopatológico generado por el movimiento paradójico de la caja torácica lleva a un desequilibrio en la mecánica respiratoria lo que, asociado a la contusión pulmonar, aumenta la severidad del daño. Con el fin de restablecer la fisiología normal de la mecánica pulmonar, los métodos de tratamiento se han basado en la estabilización neumática interna mediante ventilación mecánica, lo que conlleva a una larga estancia en la UCI y a mayores riesgos adicionales debido al método ventilatorio. La otra alternativa es la estabilización quirúrgica mediante osteosíntesis que permite un proceso de recuperación de la mecánica respiratoria mucho más rápido y una menor estancia hospitalaria; sin embargo, aunque se conocen unas claras indicaciones para la ejecución de este procedimiento, en los diferentes centros de trauma no se realiza este tipo de cirugía de manera rutinaria. En este artículo se reporta el caso de un paciente del HUSJ a quien se le realizó fijación quirúrgica del tórax inestable con mejoría de la función pulmonar, con un periodo de ventilación posoperatorio de 20 horas, una estancia en la UCI de 40 horas y una estancia hospitalaria de 6 días.

Traqueomegalia y artririts reumatoide / Traqueomegalia and rheumatoid arthritis

La traqueo-broncomegalia es una rara condición de etiología desconocida que ha sido descrita en asociación con enfermedades del tejido conectivo ocasionalmente. Presentamos un caso de traqueomegalia en una paciente con artritis reumatoide de larga evolución. Este es el segundo caso reportado en la literatura médica hasta ahora. La asociación entre estas patologías es incierta y no se puede establecer una clara relación fisiopatológica debido a la rareza de su ocurrencia y el inicio tardío de los síntomas.

Tracheobronchomegaly is a rare condition of unknown etiology that has been described in association with connective tissue diseases. We present a case of tracheomegaly in a patient with a long evolution rheumatoid arthritis. This is the second case reported in the medical literature until now. Association between these pathologies is uncertain and we can not establish a clear pathophysiological link due to the rarity of its occurrence and the late onset of symptoms.