Prevalencia de esteatosis hepática no alcohólica en una ciudad española: estudio poblacional / Prevalence of nonalcoholic fatty liver disease in a Spanish town: A population-based study

Objetivo La esteatosis hepática no alcohólica (EHNA) es la causa más importante de esteatosis hepática e hipertransaminasemia en los países occidentales. El objetivo consistía en determinar la prevalencia de EHNA entre 261025 personas del área de salud pública de Valladolid Este en España. Métodos Se seleccionó al azar a 1800 participantes a partir de una base de datos de tarjetas del sistema sanitario público, que fueron representativos de la mayor parte de la población. En todos los pacientes se realizó una historia clínica, medición de parámetros antropométricos, ecografía abdominal y análisis de sangre para descartar hepatopatía. También se calculó la puntuación FLI en todos los casos. Resultados Cuatrocientos cuarenta y ocho participantes aceptaron participar en el estudio. La prevalencia de EHNA en nuestro estudio fue del 22,3% (18,5-26,2%). La prevalencia fue máxima entre los 50 y los 70 años, y se incrementó con la edad (p <0,006). No hubo diferencias significativas en cuanto al sexo (p=0,338). La mediana del índice de masa corporal fue de 27,2 y la EHNA se relacionó con el peso (p <0,001) y el perímetro abdominal (p <0,001). El análisis de regresión logística reveló que una γ-GT inferior a 26 UI/ml, un índice de masa corporal superior a 31 y una puntuación HOMA-IR superior a 2,54 fueron factores predictivos independientes de EHNA en la muestra. El diagnóstico de EHNA se correspondió con una puntuación FLI elevada en el 88% de los casos. Conclusiones De acuerdo con otros estudios epidemiológicos, la prevalencia de EHNA es muy alta. Un estudio completo con consulta clínica, estudios de imagen y análisis de sangre en todos los pacientes permite determinar la prevalencia de EHNA en la población (AU)

Objective Nonalcoholic fatty liver disease (NAFLD) is western countries’ most important cause of hepatic steatosis and hypertransaminasemia. The objective was to evaluate the prevalence of NAFLD among 261,025 people in the East Valladolid public healthcare area in Spain. Methods We randomly selected 1800 participants from a public healthcare system card database, representing most of the population. We performed a medical record, measurement of anthropometric parameters, abdominal ultrasound, and blood tests to rule out hepatic disease in all patients. We calculated the FLI score in all patients. Results Four hundred and forty-eight participants agreed to participate in the study. The prevalence of nonalcoholic fatty liver disease in our study was 22.3% [18.5–26.2%]. Prevalence was highest between 50 and 70 years, increasing with age (p < 0.006). There were no significant differences in sex (p = 0.338). The median body mass index was 27.2, and NAFLD was related to the weight (p < 0.001) and abdominal perimeter (p < 0.001). Logistic regression analysis showed GGT lower than 26UI/ml, body mass index higher than 31, and HOMA IR greater than 2.54 as independent factors to predict NAFLD in the sample. NAFLD diagnosis matched with an elevated FLI score in 88% of cases. Conclusion According to other epidemiological studies, NAFLD's prevalence is very high. A complete study with a clinical consultation, image studies, and blood tests in all patients allows us to assess the prevalence of NAFLD in the population (AU)

Prevalence of nonalcoholic fatty liver disease in a Spanish town: a population-based study.

OBJECTIVE: Nonalcoholic fatty liver disease (NAFLD) is western countries' most important cause of hepatic steatosis and hypertransaminasemia. The objective was to evaluate the prevalence of NAFLD among 261,025 people in the East Valladolid public healthcare area in Spain. METHODS: We randomly selected 1800 participants from a public healthcare system card database, representing most of the population. We performed a medical record, measurement of anthropometric parameters, abdominal ultrasound, and blood tests to rule out hepatic disease in all patients. We calculated the FLI score in all patients. RESULTS: 448 participants agreed to participate in the study. The prevalence of nonalcoholic fatty liver disease in our study was 22.3% [18.5%-26.2%]. Prevalence was highest between 50 and 70 years, increasing with age (p < 0.006). There were no significant differences in sex (p = 0.338). The median Body mass index was 27.2, and NAFLD was related to the weight (p < 0,001) and abdominal perimeter (p < 0.001). Logistic regression analysis showed GGT lower than 26 UI/ml, body mass index higher than 31, and HOMA IR greater than 2.54 as independent factors to predict NAFLD in the sample. NAFLD diagnosis matched with an elevated FLI score in 88% of cases. CONCLUSION: According to other epidemiological studies, NAFLD's prevalence is very high. A complete study with a clinical consultation, image studies, and blood tests in all patients allows us to assess the prevalence of NAFLD in the population.

Influence of epidemiological and clinical factors in the reactogenicity to Comirnaty® vaccine in health care workers of a Spanish university teaching hospital (COVIVAC study).

OBJECTIVE: Comirnaty® is an mRNA vaccine against COVID-19 which has been administered to millions of people since the end of 2020. Our aim was to study epidemiological and clinical factors influencing reactogenicity and functional limitation after the first two doses of the vaccine in health care workers (HCWs). METHODS: Prospective post-authorization cohort study to monitor safety and effectiveness of the vaccine. RESULTS: Local side effects were mild and presented both with first and second dose of Comirnaty. Systemic side effects were more frequent after 2nd dose. Nevertheless, previous SARS-CoV-2 infection was associated with systemic effects after the first dose of the vaccine (OR ranging from 2 to 6). No severe adverse effects were reported. According to multivariate analysis, the degree of self-reported functional limitation after the first dose increased with age, female sex, previous COVID-19 contact, previous SARS-CoV-2 infection, and Charlson Comorbidity Index (CCI). After the second dose, the degree of functional limitation observed was lower in those with previous SARS-CoV-2 infection, and it was positively associated to the degree of functional limitation after the first dose. CONCLUSIONS: Systemic adverse effects were more frequent after the second dose of Comirnaty. Previous SARS-CoV-2 infection was associated with systemic effects after the first dose. Age, female sex, previous COVID-19, previous isolation due to COVID-19 contact, and CCI showed to be independent predictors of the degree of functional limitation after the 1st dose of Comirnaty®. After the 2nd dose, the degree of functional limitation was lower in those who previously had SARS-CoV-2 infection.

Impact of two sport education units on learning outcomes in primary school / Impacto de dos unidades didácticas de educación deportiva sobre objetivos de aprendizaje en educación primaria / Impacto de dúas unidades didáticas de educação esportiva nos objetivos de aprendizagem do ensino fundamental

The purposes of the study were (a) to explore the effect of two-Sport Education units (basketball and floorball) on game performance and game knowledge of Primary Education students according to their skill level, and (b) to know whether there were differences according to the sport taught (basketball and floorball). The participants were 33 students from two primary school classes. This study followed a mixed-methods approach. Quantitative data were obtained through a cuasi-experimental pretest-posttest design. Qualitative data were obtained after the intervention. Two teaching units (basketball and floorball) were applied in two different classes, one class experienced the basketball unit and the other the floorball unit and vice versa. We analysed game performance variables (decision making, skill execution, game performance, game involvement) and game knowledge. Students' performance was also measured using qualitative data which were collected through two methods: (a) experts' analysis on game performance of students, and (b) students' and teacher's perception of students´ performance with Sport Education. The results were affected both the sport taught and the skill level of students. The teacher emphasized that it was very complex for the primary students to understand some tactical and technical concepts, especially in floorball. At the primary level, student previous experience with the content and skill level conditioned the results in the variables related with game performance and knowledge. It is suggested that enacting Sport Education units of invasion games with implement such as floorball, at the primary level, might require more explicit instruction and longer teaching units in order to guarantee a minimum level of technical and tactical improvement. (AU)

Los objetivos del estudio fueron: (a) explorar el efecto de dos unidades didácticas de educación deportiva (baloncesto y floorball) sobre el rendimiento de juego y el conocimiento de alumnado de educación primaria, de acuerdo con su nivel de habilidad, y (b) conocer si hubo diferencias de acuerdo con el deporte (baloncesto y floorball). Los participantes fueron 33 alumnos de dos clases de educación primaria. Este estudio siguió un enfoque de métodos mixtos. Los datos cuantitativos se obtuvieron mediante un diseño cuasi-experimental pretest-postest. Los datos cualitativos se obtuvieron después de la intervención. Se aplicaron dos unidades didácticas (baloncesto y floorball) en dos clases diferentes, una clase experimentó la unidad de baloncesto y la otra la de floorball y viceversa. Se analizaron variables relacionadas con el rendimiento de juego (toma de decisión, ejecución técnica, rendimiento de juego, implicación en el juego) y el conocimiento. Los resultados de aprendizaje del alumnado fueron también analizados utilizando datos cualitativos del: (a) análisis realizado por expertos y (b) la percepción de los propios alumnos y el maestro. Los resultados fueron afectados por el deporte enseñado y el nivel de habilidad del alumnado. El maestro enfatizó que fue complejo para el alumnado de primaria comprender determinados conceptos tácticos y técnicos, especialmente en floorball. En educación primaria, la experiencia previa del alumnado con el contenido y el nivel de habilidad condicionó los resultados de las variables relacionadas con el rendimiento de juego y el conocimiento. Se sugiere que las unidades didácticas basadas en el modelo de educación deportiva en deportes de invasión con implemento, como ocurre en floorball en educación primaria, podría requerir de una instrucción más concreta y unidades didácticas más largas con el fin de garantizar un nivel mínimo de aprendizaje técnico y táctico. (AU)

Os objetivos do estudo foram: (a) explorar o efeito de duas unidades didáticas de educação esportiva (basquete e floorball) no desempenho de jogo e no conhecimento de alunos do ensino fundamental, de acordo com seu nível de habilidade, e (b) saber se houve diferenças de acordo com o esporte (basquete e floorball). Os participantes foram 33 alunos de duas turmas do ensino fundamental. Este estudo seguiu uma abordagem de métodos mistos. Os dados quantitativos foram obtidos por meio de um desenho pré-teste-pós-teste quase experimental. Os dados qualitativos foram obtidos após a intervenção. Duas unidades didáticas (basquete e floorball) foram aplicadas em duas turmas distintas, uma aula experimentou a unidade de basquete e a outra a unidade de floorball e vice-versa. Variáveis relacionadas ao desempenho do jogo (tomada de decisão, execução técnica, desempenho do jogo, envolvimento no jogo) e conhecimento foram analisadas. Os resultados de aprendizagem dos alunos também foram analisados com base em dados qualitativos de: (a) análise realizada por especialistas e (b) a percepção dos próprios alunos e do professor. Os resultados foram afetados pelo esporte ensinado e pelo nível de habilidade dos alunos. O professor enfatizou que foi difícil para os alunos do ensino fundamental entender alguns conceitos táticos e técnicos, principalmente no floorball. No ensino fundamental, a experiência prévia dos alunos com o conteúdo e o nível de habilidade condicionou os resultados das variáveis relacionadas ao desempenho e conhecimento do jogo. Sugere-se que a utilização de unidades didáticas baseadas no modelo de educação esportiva em esportes de invasão com implemento, como ocorre no floorball no ensino fundamental, poderia exigir instrução mais específica e unidades didáticas mais longas para garantir um nível mínimo de aprendizagem técnico e tático. (AU)

Recommendations for the management of critically ill patients with COVID-19 in Intensive Care Units.

The COVID-19 pandemic has led to the admission of a high number of patients to the ICU, generally due to severe respiratory failure. Since the appearance of the first cases of SARS-CoV-2 infection, at the end of 2019, in China, a huge number of treatment recommendations for this entity have been published, not always supported by sufficient scientific evidence or with methodological rigor necessary. Thanks to the efforts of different groups of researchers, we currently have the results of clinical trials, and other types of studies, of higher quality. We consider it necessary to create a document that includes recommendations that collect this evidence regarding the diagnosis and treatment of COVID-19, but also aspects that other guidelines have not considered and that we consider essential in the management of critical patients with COVID-19. For this, a drafting committee has been created, made up of members of the SEMICYUC Working Groups more directly related to different specific aspects of the management of these patients.

[Recommendations for the management of critically ill patients with COVID-19 in Intensive Care Units]. / Recomendaciones para el manejo de los pacientes críticos con COVID-19 en las Unidades de Cuidados Intensivos.

The COVID-19 pandemic has led to the admission of a high number of patients to the ICU, generally due to severe respiratory failure. Since the appearance of the first cases of SARS-CoV-2 infection, at the end of 2019, in China, a huge number of treatment recommendations for this entity have been published, not always supported by sufficient scientific evidence or with methodological rigor necessary. Thanks to the efforts of different groups of researchers, we currently have the results of clinical trials, and other types of studies, of higher quality. We consider it necessary to create a document that includes recommendations that collect this evidence regarding the diagnosis and treatment of COVID-19, but also aspects that other guidelines have not considered and that we consider essential in the management of critical patients with COVID-19. For this, a drafting committee has been created, made up of members of the SEMICYUC Working Groups more directly related to different specific aspects of the management of these patients.

[Vasoactive drugs in the treatment of septic shock]. / Fármacos vasoactivos en el tratamiento del shock séptico.

Septic shock is a high mortality complication frequently associated with sepsis. Early initiation of vasopressor treatment, even before completion of initial fluid resuscitation, is a determining factor in prognosis. In this sense, norepinephrine continues to be the drug of first choice, although there is increasing evidence of benefit combining it with other non-adrenergic drugs, such as vasopressin, instead of escalating norepinephrine doses. The pathophysiology of septic shock is multifactorial, and sometimes is associated with a situation of myocardial dysfunction that contributes to hemodynamic instability. It is essential to identify this situation since it worsens the prognosis and may benefit from combined treatment with inotropic drugs. There are novel vasoactive agents under study, more selective than the classic ones that in a next future could help to design more individualized and precise treatments. In the present work, the current knowledge about vasoactive drugs and their use in the management of septic shock is summarized according to the most recent scientific evidence.

Manejo de las complicaciones infecciosas asociadas con la infección por coronavirus en pacientes graves ingresados en UCI / Management of infectious complications associated with coronavirus infection in severe patients admitted to ICU

Las infecciones se han convertido en una de las principales complicaciones de los pacientes con neumonía grave por SARS-CoV-2 que ingresan en UCI. El deficiente estado inmunitario, el desarrollo frecuente de fracaso orgánico con necesidad de tratamientos de soporte invasivos y las estancias prolongadas en áreas estructurales en gran medida saturadas de enfermos son factores de riesgo para el desarrollo de infecciones. El Grupo de Trabajo de Enfermedades Infecciosas y Sepsis GTEIS de la Sociedad Española de Medicina Intensiva y Unidades Coronarias SEMICYUC enfatiza la importancia de las medidas de prevención de infecciones relacionadas con los cuidados sanitarios, y de la detección y tratamiento precoz de las principales infecciones en el paciente con infección por SARS-CoV-2. La coinfección bacteriana, las infecciones respiratorias relacionadas con la ventilación mecánica, bacteriemia relacionada con el catéter, infección del tracto urinario asociado a dispositivo e infecciones oportunistas son desarrolladas. (AU)

Infections have become one of the main complications of patients with severe SARS-CoV-2 pneumonia admitted in ICU. Poor immune status, frequent development of organic failure requiring invasive supportive treatments, and prolonged ICU length of stay in saturated structural areas of patients are risk factors for infection development. The Working Group on Infectious Diseases and Sepsis GTEIS of the Spanish Society of Intensive Medicine and Coronary Units SEMICYUC emphasizes the importance of infection prevention measures related to health care, the detection and early treatment of major infections in the patient with SARS-CoV-2 infections. Bacterial co-infection, respiratory infections related to mechanical ventilation, catheter-related bacteremia, device-associated urinary tract infection and opportunistic infections are review in the document. (AU)

Management of infectious complications associated with coronavirus infection in severe patients admitted to ICU.

Infections have become one of the main complications of patients with severe SARS-CoV-2 pneumonia admitted in ICU. Poor immune status, frequent development of organic failure requiring invasive supportive treatments, and prolonged ICU length of stay in saturated structural areas of patients are risk factors for infection development. The Working Group on Infectious Diseases and Sepsis GTEIS of the Spanish Society of Intensive Medicine and Coronary Units SEMICYUC emphasizes the importance of infection prevention measures related to health care, the detection and early treatment of major infections in the patient with SARS-CoV-2 infections. Bacterial co-infection, respiratory infections related to mechanical ventilation, catheter-related bacteremia, device-associated urinary tract infection and opportunistic infections are review in the document.

Management of infectious complications associated with coronavirus infection in severe patients admitted to ICU. / Manejo de las complicaciones infecciosas asociadas con la infección por coronavirus en pacientes graves ingresados en UCI.

Infections have become one of the main complications of patients with severe SARS-CoV-2 pneumonia admitted in ICU. Poor immune status, frequent development of organic failure requiring invasive supportive treatments, and prolonged ICU length of stay in saturated structural areas of patients are risk factors for infection development. The Working Group on Infectious Diseases and Sepsis GTEIS of the Spanish Society of Intensive Medicine and Coronary Units SEMICYUC emphasizes the importance of infection prevention measures related to health care, the detection and early treatment of major infections in the patient with SARS-CoV-2 infections. Bacterial co-infection, respiratory infections related to mechanical ventilation, catheter-related bacteremia, device-associated urinary tract infection and opportunistic infections are review in the document.

[Management of infectious complications associated with coronavirus infection in severe patients admitted to ICU]. / Manejo de las complicaciones infecciosas asociadas con la infección por coronavirus en pacientes graves ingresados en UCI.

Infections have become one of the main complications of patients with severe SARS-CoV-2 pneumonia admitted in ICU. Poor immune status, frequent development of organic failure requiring invasive supportive treatments, and prolonged ICU length of stay in saturated structural areas of patients are risk factors for infection development. The Working Group on Infectious Diseases and Sepsis GTEIS of the Spanish Society of Intensive Medicine and Coronary Units SEMICYUC emphasizes the importance of infection prevention measures related to health care, the detection and early treatment of major infections in the patient with SARS-CoV-2 infections. Bacterial co-infection, respiratory infections related to mechanical ventilation, catheter-related bacteremia, device-associated urinary tract infection and opportunistic infections are review in the document.

Educación deportiva, roles y vulnerabilidad. Influencia en la responsabilidad e interculturalidad / Sport Education, Roles and Vulnerability. Influence on Responsibility and Intercultural Competence

El presente estudio examinó los efectos de dos dinámicas de roles (fija y rotativa) sobre los niveles de responsabilidad y competencia intercultural en adolescentes españoles de un contexto socialmente vulnerable. Formaron parte del estudio 96 estudiantes de primer curso de educación secundaria (Medad = 12.2) de un centro ubicado en Andalucía (España). Siguiendo un diseño cruzado simple, cuasi-experimental y con medidas repetidas (pretest-post1-post2), los participantes asistieron a dos unidades didácticas consecutivas con Educación Deportiva sobre baloncesto y floorball, respectivamente. Se recabó información mediante entrevistas semi-estructuradas y cuestionarios. Se evidenció un mayor impacto de los roles fijos en la responsabilidad social y en las variables interculturales (sensibilidad y comportamiento), con especial incidencia en varones. Ligeras consecuencias negativas fueron halladas en los niveles de responsabilidad de estudiantes de sexo femenino. Se desvela la importancia de asumir roles fijos en contextos socialmente vulnerables, así como en experiencias iniciales con Educación Deportiva

This paper examines the effect of two different roles' strategies (permanent and rotating) on Spanish adolescents' responsibility and intercultural competence levels. Following a quasi-experimental, simple crossover design with repeated measures (pretest-post1-post2), 96 high school students (Mage = 12.2) and one teacher participated part in two consecutive Sport Education-based teaching units of basketball and floorball, respectively. Data was collected through semi-structured interviews and questionnaires. Permanent roles were associated with improvements on social responsibility and intercultural variables (sensibility and behavior), especially in males. There are slightly negative consequences on female' responsibility levels. Findings reveal and emphasize the importance of using permanent roles when dealing with socially vulnerable contexts, as well as first experiences with Sport Education

Learning Conflicts for C-arm Kinematic Modeling using Artificial Intelligence.

During common surgical tasks related to orthopedic applications, it is necessary to carefully manipulate a mobile C-arm device to achieve the desired position. In this work, we propose the application of learning conflicts analysis to improve the performance of an artificial neural network to compute the inverse kinematics of a C-arm device. Using the forward kinematics equations of a C-arm device (and the respective patient table) a training set for machine learning was generated. However, as an inverse kinematics problem may have multiple solutions, it is likely that training a neural network using forward kinematics data may generate machine learning conflicts. In this sense, we show that it is possible to eliminate those C-arm positions that may represent a learning conflict for the neural network, and thus, improve the accuracy of the model. Finally, we randomly generated a suitable validation set to verify the performance of our proposed model with data different from those used for training.

Endothelial dysfunction is an early indicator of sepsis and neutrophil degranulation of septic shock in surgical patients.

BACKGROUND: Stratification of the severity of infection is currently based on the Sequential Organ Failure Assessment (SOFA) score, which is difficult to calculate outside the ICU. Biomarkers could help to stratify the severity of infection in surgical patients. METHODS: Levels of ten biomarkers indicating endothelial dysfunction, 22 indicating emergency granulopoiesis, and six denoting neutrophil degranulation were compared in three groups of patients in the first 12 h after diagnosis at three Spanish hospitals. RESULTS: There were 100 patients with infection, 95 with sepsis and 57 with septic shock. Seven biomarkers indicating endothelial dysfunction (mid-regional proadrenomedullin (MR-ProADM), syndecan 1, thrombomodulin, angiopoietin 2, endothelial cell-specific molecule 1, vascular cell adhesion molecule 1 and E-selectin) had stronger associations with sepsis than infection alone. MR-ProADM had the highest odds ratio (OR) in multivariable analysis (OR 11·53, 95 per cent c.i. 4·15 to 32·08; P = 0·006) and the best area under the curve (AUC) for detecting sepsis (0·86, 95 per cent c.i. 0·80 to 0·91; P < 0·001). In a comparison of sepsis with septic shock, two biomarkers of neutrophil degranulation, proteinase 3 (OR 8·09, 1·34 to 48·91; P = 0·028) and lipocalin 2 (OR 6·62, 2·47 to 17·77; P = 0·002), had the strongest association with septic shock, but lipocalin 2 exhibited the highest AUC (0·81, 0·73 to 0·90; P < 0·001). CONCLUSION: MR-ProADM and lipocalin 2 could be alternatives to the SOFA score in the detection of sepsis and septic shock respectively in surgical patients with infection.

ANTECEDENTES: La estratificación de la gravedad de una infección se basa actualmente en la puntuación SOFA (Sequential Organ Failure Assessment), que es difícil de calcular fuera de la unidad de cuidados intensivos. Los biomarcadores podrían ayudar a estratificar la gravedad de la infección en pacientes quirúrgicos. MÉTODOS: Se compararon las concentraciones de 10 biomarcadores que denotan disfunción endotelial, 22 que indican granulopoyesis de emergencia y 6 que expresan la degranulación de neutrófilos en tres grupos de pacientes de tres hospitales españoles (100 con infección, 95 con sepsis y 57 con shock séptico) en las primeras doce horas después del diagnóstico. RESULTADOS: Siete biomarcadores que expresan disfunción endotelial (proadrenomedulina, sindecan-1, trombomodulina, angiopoyetina-2, endocan-1, molécula de adhesión endotelial 1 y E-selectina) mostraron una fuerte asociación con la sepsis en comparación con la infección aislada. La proadrenomedulina presentó el valor más alto de la razón de oportunidades (odds ratio, OR) en el análisis multivariable (OR 11,53, i.c. del 95% 4,15-32,08, P = 0,006) y la mejor área bajo la curva para detectar sepsis (AUC 0,86, i.c. del 95% 0,80-0,91, P < 0,001). En la comparación entre sepsis y shock séptico, los biomarcadores que mostraron la asociación más estrecha con el shock séptico fueron dos biomarcadores de degranulación de neutrófilos (proteinasa-3 y lipocalina-2) (OR 8,09, i.c. del 9% 1,34-48,91, P = 0,028; OR 6.62, i.c. del 95% 2,47-17,77, P = 0,002), pero la lipocalina-2 presentó la mejor AUC (0,81, i.c. del 95% 0,73-0,90, P < 0,001). CONCLUSIÓN: la proadrenomedulina y la lipocalina-2 podrían representar alternativas a la puntuación SOFA para detectar sepsis y shock séptico en pacientes quirúrgicos con infección.

Sangrado intraoperatorio de amigdalectomía en población pediátrica. Influencia de factores quirúrgicos y anestésicos / Intraoperative bleeding of tonsillectomy in pediatric patients. Effects of surgical and anesthesia technique

INTRODUCTION: Tonsillectomy with or without adenoidectomy is one of the most frequent surgeries in the pediatric population. It has become predomi- nantly an outpatient procedure. Therefore, it is of utmost importance identi- fying the factors that influence the intraoperative bleeding to prevent posto- perative complications and rehospitalization. MATERIAL AND METHODS: An observational cross-sectional study was carried out. Patients between 1 and 14 years old that underwent to tonsillectomy with or without adenoidectomy since November 2015 to May 2017 were included. 709 cases were evaluated. Intraoperative bleeding was assessed by the volumetric method. A multivariate analysis was performed using a generalized linear regression model. RESULTS: The average intraoperative bleeding was estimated in 1.9 ml/kg (95% CI: 1.7 -2.05). The use of propofol (30% increase in bleeding) and surgical time (2% increase for every minute) were risk factors. The use of electrocautery was as- sociated with a 50% decrease in bleeding in comparison with conventional dis- section (p = 0.001). CONCLUSION: The use of propofol and a prolonged surgical time were risk factors for intraoperative bleeding. The use of electrosurgery was a protective factor.

INTRODUCCIÓN: La amigdalectomía con o sin adenoidectomía, es una de las cirugías más frecuente en población pediátrica. Desde hace varios años se ha vuelto una intervención predominantemente ambulatoria, por lo que lograr identificar los factores que influyen en el sangrado intraoperatorio es de suma importancia para prevenir complicaciones postoperatorias y reshospitalización. MATERIAL Y MÉTODO: Se realizó un estudio observacional de corte-transversal. Se incluyó a pacientes entre 1 y 14 años sometidos a amigdalectomía con o sin adenoidectomía entre noviembre de 2015 y mayo de 2017, obteniendo un total de 709 casos evaluados. Se determinó el sangrado intraoperatorio de forma volumétrica. Posteriormente, se realizó un análisis multivariado con un modelo de regresión lineal generalizado. RESULTADOS: Se cuantificó el sangrado intraoperatorio promedio en 1,9 ml/kg (IC 95%; 1,7-2,05). El uso de propofol (aumento del 30% del sangrado) y tiempo quirúrgico (2% por cada incremento de un minuto) fueron factores de riesgo. Mientras que el uso de electro bisturí se asoció con una disminución del 50% en relación al no uso (p = 0,001). CONCLUSIONES: Fueron factores de riesgo para sangrado intraoperatorio el uso de propofol y un tiempo quirúrgico prolongado. El uso de electrobisturí constituyó un factor protector.

Lymphopenic hospital acquired sepsis (L-HAS): An immunological phenotype conferring higher risk of mortality / Sepsis nosocomial linfopénica: un fenotipo inmunológico que confiere un mayor riesgo de mortalidad

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Proliferative leukoplakia: Proposed new clinical diagnostic criteria.

OBJECTIVE: We aimed to characterize proliferative verrucous leukoplakia (PVL) from a clinical and histopathological standpoint and suggest an updated classification. SUBJECTS AND METHODS: Records of patients seen at three oral medicine centers with a clinical diagnosis of PVL were reviewed for clinical and histopathological features and malignant transformation (MT). RESULTS: There were 42 patients (median age: 69 years [range: 36-88]; 35 females). 12.2% were current smokers. Family history of cancer was present in 43.7% of patients. Partial demarcation of lesion margins was present in 31.3% of lesions, followed by verrucous (27.5%), smooth (22.7%) erythematous (22.3%), and fissured (18.3%) appearance. Large and contiguous and multisite and non-contiguous lesions comprised 57.1% (24/42) and 35.7% (15/42) of PVL cases, respectively. 19.1% had prominent erythema (erythroleukoplakia). The most common histopathological diagnosis at first visit was hyperkeratosis without dysplasia (22/42; 56.4%). MT occurred in 71.4% patients after a median of 37 months [range: 1-210] from initial visit; erythroleukoplakia exhibited MT in 100% of cases. CONCLUSION: The generic term "proliferative leukoplakia (PL)" may be more appropriate than PVL because 18.3% were fissured and 22.7% erythematous. We also propose the term proliferative erythroleukoplakia to more accurately describe the subset of PL with prominent erythema, which had the highest MT rate.

Clinical factors influencing mortality risk in hospital-acquired sepsis.

BACKGROUND: Identification of factors that confer an increased risk of mortality in hospital-acquired sepsis (HAS) is necessary to help prevent, and improve the outcome of, this condition. AIM: To evaluate the clinical characteristics and factors associated with mortality in patients with HAS. METHODS: Retrospective study of patients with HAS in a major Spanish Hospital from 2011 to 2015. Data from adults receiving any of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes associated with sepsis were collected. Those fulfilling the SEPSIS-2 definition with no evidence of infection during the first 48 h following hospitalization were included (N = 196). Multivariate analysis was employed to identify the risk factors of mortality. FINDINGS: HAS patients were found to have many of the risk factors associated with cardiovascular disease (male sex, ageing, antecedent of cardiac disease, arterial hypertension, dyslipidaemia, smoking habit) and cancer. Vascular disease or chronic kidney disease were associated with 28-day mortality. Time from hospital admission to sepsis diagnosis, and the presence of organ failure were risk factors for 28-day and hospital mortality. Experiencing more than one episode of sepsis increased the risk of hospital mortality. 'Sepsis code' for the early identification of sepsis was protective against hospital mortality. CONCLUSION: This study identifies several major factors associated with mortality in patients suffering from HAS. Implementation of surveillance programmes for the early identification and treatment of sepsis translate into a clear benefit.

Ventilator-associated pneumonia by methicillin-susceptible Staphylococcus aureus: do minimum inhibitory concentrations to vancomycin and daptomycin matter?

The use of vancomycin minimum inhibitory concentration (MIC) as an outcome predictor in patients with methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia has become an important topic for debate in the last few years. Given these previous results, we decided to investigate whether MICs to vancomycin or daptomycin had any effect on the evolution of patients with ventilator-associated pneumonia (VAP) due to MSSA. An observational, retrospective, multicenter study was conducted among patients with MSSA VAP. We analyzed the relationship between vancomycin and daptomycin MICs and early clinical response (72 h), 30-day mortality, intensive care unit (ICU) length of stay (LOS), and duration on mechanical ventilation. Univariate and multivariate analyses were performed. Sixty-six patients from 12 centers were included. Twenty-six patients (39%) had an infection due to MSSA strains with a vancomycin MIC ≥1.5 µg/mL. Daptomycin MIC was determined in 58 patients, of whom 17 (29%) had an MIC ≥1.0 µg/mL. Ten patients (15%) did not respond to first-line treatment. Only daptomycin MIC ≥1.0 µg/mL had a significant association [odds ratio (OR): 30.00; 95% confidence interval (CI): 2.91-60.41] with early treatment failure. The 30-day mortality was 12% (n = 8). Any variable was associated with mortality in the multivariate analysis. None of the variables studied were associated with ICU LOS or duration on mechanical ventilation. In patients with MSSA VAP, vancomycin MIC does not influence the response to antibiotic treatment or the 30-day mortality. Daptomycin MIC was directly related to early treatment failure.