La terapia ocupacional al final de la vida / Occupational therapy at the end of life

Este manuscrito pretende hacer visible la función del terapeuta ocupacional en la etapa final de la vida. Se plantea otra forma de atención muy necesaria en la cual la terapia ocupacional también toma partido. (AU)

This manuscript aims to make visible the role of the occupational therapist in the final stage of life. Another much- needed form of care is proposed in which occupational therapy also takes part. (AU)

Determination of glyphosate exposure in the Iberian hare: A potential focal species associated to agrosystems.

Glyphosate is the most used herbicide worldwide. It is a small and highly polar pesticide whose physicochemical properties makes its analytical determination difficult. Here, a procedure based on liquid chromatography-high resolution tandem mass spectrometry (LC-HRMS/MS) was developed for glyphosate determination in samples of gastric content from wildlife. Iberian hare (Lepus granatensis), a herbivorous mammal species, strongly associated to agrosystems was selected as model species. The procedure involves direct analysis of sample without derivatization or instead of neither further cleaning steps. The procedure was validated by inter-day accuracy and precision studies with gastric content of hare spiked with glyphosate at ecologically relevant concentrations for the species (0.1-6 µg/g), and with 1 µg/g of isotopically labelled internal standard (glyphosate-2-13C,15N). Finally, glyphosate residues in hunted animals from pesticide-treated and pesticide-free areas (n = 75 and 28, respectively), as well as from hares found dead in the field (n = 11) were analysed. The linearity of both standards in extraction solutions and procedural calibration curves with spiked samples was similar, both with determination coefficients (r2) higher than 0.99. Satisfactory recoveries in spiked samples were achieved within the range of 95% to 118% (CV ≤ 20%). The limit of detection of glyphosate in hare gastric content was 0.03 µg/g. Prevalence of glyphosate in hunted animals from pesticide-treated areas ranged between 9 and 22%, increasing to 45% in animals found dead. The glyphosate concentrations detected in the gastric content of hares ranged from 0.11 to 16 µg/g. No residues were detected in animals from pesticide-free areas. In practice, the developed methodology may be particularly useful in the context of research and other work on the exposure in wildlife of one of the most used pesticides nowadays.

Prophylactic Use of Negative Pressure Therapy in General Abdominal Surgery: A Systematic Review and Meta-Analysis.

Background: Surgical site infections (SSIs) represent an economic burden to healthcare systems. The use of negative pressure wound therapy (NPWT) for SSI prophylaxis remains uncertain. Methods: A systematic literature search was conducted in Medline/PubMed, CINAHL, and Web of Science for relevant studies. The primary outcome was the evaluation of the effectiveness of NPWT for prophylaxis of SSI rates in general abdominal surgery. Secondary outcomes were rates of seroma and wound dehiscence, length of hospital stay, and re-admission rates. The statistical analysis was performed with random effect models. Results: A total of 3,193 patients from 20 articles (six randomized controlled trials [RCT], three prospective, eight retrospective, and three ambispective studies) were analyzed. Negative pressure wound therapy was associated with decreased rate of SSIs compared with standard dressing in a pooled analysis of non-randomized studies and RCTs (0.57; 95% confidence interval [CI], -0.4 to 0.8; p < 0.001). This result, however, needs to be challenged because of a significant statistical heterogeneity of the included studies (I2 = 71%; p < 0.01). A separate analysis of the six RCTs failed to confirm the superiority of NPWT (0.64; 95% CI, -0.4 to 1.04; p = 0.07), also disclosing significant heterogeneity. The analysis of secondary outcomes was only possible in combination of randomized and non-randomized studies because of incomplete datasets in RCTs. Re-admission rates were lower after NPWT and no difference was observed for the incidence of seroma, wound dehiscence, and length of hospital stay. Conclusions: Based on available evidence, the routine use of NPWT for SSI prophylaxis after laparotomy in general abdominal surgery cannot be generally recommended.

Procalcitonina en sangre de cordón en la valoración del riesgo de sepsis neonatal precoz / Cord blood procalcitonin in the assessment of early-onset neonatal sepsis

Introducción: El diagnóstico precoz es esencial para disminuir la morbimortalidad en la sepsis neonatal precoz (SNP). La procalcitonina (PCT) en sangre de cordón permitiría identificar al nacimiento a los pacientes infectados. Objetivo: Estudiar la utilidad y seguridad de un protocolo de valoración de recién nacidos con riesgo de SNP, basado en los valores de procalcitonina en sangre de cordón. Pacientes y métodos: Se incluyeron los nacidos en nuestro hospital de octubre de 2013 a enero de 2015, con factores de riesgo infeccioso. Se procedió según un algoritmo basado en los valores de procalcitonina (<0,6 ng/ml frente a ≥0,6 ng/ml). Posteriormente se clasificaron como infección comprobada, probable o no infección. Resultados y conclusiones: De 2.519 nacidos en el periodo de estudio 136 cumplieron criterios de inclusión. De 120 casos con PCT <0,6 ng/ml ninguno desarrolló SNP (valor predictivo negativo 100%). Por el contrario, de 16 casos con PCT ≥0,6 ng/ml, diez presentaron infección comprobada o probable (valor predictivo positivo 62,5%). La sensibilidad de la PCT frente a infección fue 100% y la especificidad 95,2% (área bajo la curva operador receptor 0,969). La incidencia de infección en el grupo de estudio fue de 7,4%; en RN de madre con corioamnionitis 26,1%. Recibieron antibioterapia 21 recién nacidos (15,4%). El protocolo clínico estudiado ha demostrado ser efectivo y seguro para diferenciar entre pacientes con mayor riesgo de SNP, en los que la aproximación diagnóstica y terapéutica fue más intervencionista, frente a aquellos con menor probabilidad de sepsis, que se beneficiaron de un manejo más conservador (AU)

Introduction: Early diagnosis of early-onset neonatal sepsis (EONS) is essential to reduce morbidity and mortality. Procalcitonin (PCT) in cord blood could provide a diagnosis of infected patients from birth. Objective: To study the usefulness and safety of a procedure for the evaluation of newborns at risk of EONS, based on the determination of PCT in cord blood. Patients and methods: Neonates with infectious risk factors, born in our hospital from October 2013 to January 2015 were included. They were processed according to an algorithm based on the values of cord blood procalcitonin (< 0.6 ng/ml versus ≥0.6 ng/ml). They were later classified as proved infection, probable, or no infection. Results and conclusions: Of the 2,519 infants born in the study period, 136 met inclusion criteria. None of 120 cases with PCT<0.6 ng/ml in cord blood developed EONS (100% negative predictive value). On the other hand, of the 16 cases with PCT ≥0.6 ng/ml, 10 were proven or probably infected (62.5% positive predictive value). The sensitivity of the PCT against infection was 100%, with a specificity of 95.2% (area under the receiver operator curve 0.969). The incidence of infection in the study group was 7.4%, and 26.1% in cases with maternal chorioamnionitis. 21 newborn (15.4%) received antibiotic therapy. The studied protocol has shown to be effective and safe to differentiate between patients with increased risk of developing an EONS, in those where the diagnostic and therapeutic approach was more interventionist, versus those with less likelihood of sepsis, who would benefit from a more conservative management (AU)

[Cord blood procalcitonin in the assessment of early-onset neonatal sepsis]. / Procalcitonina en sangre de cordón en la valoración del riesgo de sepsis neonatal precoz.

INTRODUCTION: Early diagnosis of early-onset neonatal sepsis (EONS) is essential to reduce morbidity and mortality. Procalcitonin (PCT) in cord blood could provide a diagnosis of infected patients from birth. OBJECTIVE: To study the usefulness and safety of a procedure for the evaluation of newborns at risk of EONS, based on the determination of PCT in cord blood. PATIENTS AND METHODS: Neonates with infectious risk factors, born in our hospital from October 2013 to January 2015 were included. They were processed according to an algorithm based on the values of cord blood procalcitonin (< 0.6ng/ml versus ≥0.6ng/ml). They were later classified as proved infection, probable, or no infection. RESULTS AND CONCLUSIONS: Of the 2,519 infants born in the study period, 136 met inclusion criteria. None of 120 cases with PCT<0.6ng/ml in cord blood developed EONS (100% negative predictive value). On the other hand, of the 16 cases with PCT ≥0.6ng/ml, 10 were proven or probably infected (62.5% positive predictive value). The sensitivity of the PCT against infection was 100%, with a specificity of 95.2% (area under the receiver operator curve 0.969). The incidence of infection in the study group was 7.4%, and 26.1% in cases with maternal chorioamnionitis. 21 newborn (15.4%) received antibiotic therapy. The studied protocol has shown to be effective and safe to differentiate between patients with increased risk of developing an EONS, in those where the diagnostic and therapeutic approach was more interventionist, versus those with less likelihood of sepsis, who would benefit from a more conservative management.

Foot infections associated with Arcanobacterium pyogenes in free-living fallow deer (Dama dama).

We describe foot infection associated with Arcanobacterium pyogenes in three adult male free-living fallow deer (Dama dama) from Sueve Regional Hunting Reserve (Principality of Asturias, Spain). Affected fallow deer were culled in November 1997 and 1998 during the hunting season. Necropsy, radiography, and microbiologic analysis were carried out for each animal. Unilateral swelling of one extremity at the coronary band was observed in all three cases. Areas of bone loss, severe periosteal reaction, and soft tissue swelling were seen on radiography. Lead fragments were observed in one fallow deer. Seven bacterial species were isolated, but only Arcanobacterium pyogenes was routinely found. Weather conditions in the area (mild temperatures and high humidity), the land (alternating pasture land and rock), the animal population density (both fallow deer and domestic herds of cows, horses, sheep, and goats, live side by side in the same areas), and hunting activities could be related to the frequency of these infections.