Vulnerabilidad sociolaboral y riesgo a la salud en mineros de subsistencia en las principales cuencas de Colombia / Combined hydration and effects on the vocal health in speech language pathology students

Objetivos: Evaluar la influencia de las condiciones socio-demográficas y de la existencia de asociaciones entre las condiciones de seguridad laboral y la prevalencia de efectos en la salud. Material y Métodos: Estudio transversal con intensión analítica realizado con fuentes secundarias de variables socio-demográficas, laborales, de condición y efectos sobre la salud asociados a la práctica de la minería aurífera y al uso de mercurio, los registros n=367. La realización de pruebas y estimaciones estadísticas de rigor a un nivel de confianza del 95% (p<0,05). Resultados: Las mujeres en su mayoría, de 45 a 49 años, analfabetos. Los efectos sobre la condición física y la salud asociados a su labor, demuestran la prevalencia de alteraciones como pérdida de: fuerza, visión y cabello. Las regresiones lineales entre las concentraciones orgánicas de Hg (sangre, orina y cabello) y el tiempo de realización de esta labor, apuntan que existen asociaciones proporcionales significativas (p<0,05) Conclusiones: El uso de medidas de seguridad laboral puede incidir significativamente en la reducción de riesgos asociados a la exposición al mercurio, principalmente en segmentos poblacionales con mayor vulnerabilidad. (AU)

Objectives: Develop an assessment of socio-demographic conditions influence as well significant associations among occupational safety conditions and health effects prevalence on gold small-scale miners vulnerability in Colombia. Material and Methods: Cross-sectional study with analytical intent conducted with secondary sources of socio-demographic, labor, condition and health effects variables associated with the practice of gold mining and the use of mercury, records n=367. The performance of tests and statistical estimates of rigor at a confidence level of 95% (p<0.05). Results: Women are mostly illiterate aged 45 to 49. The effects on physical condition and health associated with their work demonstrate the prevalence of alterations such as loss of: strength, vision and hair. The linear regressions between the organic concentrations of Hg (blood, urine and hair) and the time of performance of this work, indicate that there are significant proportional associations (p<0.05). Conclusions: The assessment of occupational safety measures might have a significant impact on potential risks reduction associated with mercury usage and exposure, mainly in population segments with higher vulnerability tendencies. (AU)

CDN1163, an activator of sarco/endoplasmic reticulum Ca2+ ATPase, up-regulates mitochondrial functions and protects against lipotoxicity in pancreatic ß-cells.

BACKGROUND AND PURPOSE: High levels of Ca2+ in the endoplasmic reticulum (ER), established by the sarco/endoplasmic reticulum Ca2+ ATPase (SERCA), are required for protein folding and cell signalling. Excessive ER Ca2+ release or decreased SERCA activity induces unfolded protein accumulation and ER stress in pancreatic ß-cells, leading to defective insulin secretion and diabetes. Here we have investigated the consequences of enhancing ER Ca2+ uptake on ß-cell survival and function. EXPERIMENTAL APPROACH: The effects of SERCA activator, CDN1163, on Ca2+ homeostasis, protein expression, mitochondrial activities, insulin secretion, and lipotoxicity have been studied in mouse pancreatic ß-cells and MIN6 cells. KEY RESULTS: CDN1163, increased insulin synthesis and exocytosis from islets. CDN1163 also increased the sensitivity of the cytosolic Ca2+ oscillation response to glucose and potentiated it in dispersed and sorted ß-cells. CDN1163 augmented the ER and mitochondrial Ca2+ content, the mitochondrial membrane potential, respiration, and ATP synthesis. CDN1163 up-regulated expression of inositol 1,4,5-trisphosphate receptors and antioxidant enzymes, and mitochondrial biogenesis, including peroxisome proliferator-activated receptor γ coactivator 1α (PGC1α). Overexpression of SERCA2a or 2b replicated the effects of CDN1163, while knockdown of SERCA2 abolished the stimulatory actions of CDN1163. In palmitate-treated ß-cells, CDN1163 prevented ER Ca2+ depletion, mitochondrial dysfunction, cytosolic and mitochondrial oxidative stress, defective insulin secretion, and apoptotic cell death. CONCLUSIONS AND IMPLICATIONS: Activation of SERCA enhanced mitochondrial bioenergetics and antioxidant capability, suppressing the cytotoxic effects of palmitate. Our results suggest that targeting SERCA could be a novel therapeutic strategy to protect ß-cells from lipotoxicity and the development of Type 2 diabetes.

Anaerobic digestion of organic fraction combinations from food waste, for an optimal dynamic release of biogas, using H2 as an indicator.

The objective of this study is to assess the effects of mixing the three elemental organic waste fractions (fruit and vegetable, meat, and fish) during anaerobic digestion. Batch experiments were carried out with fraction mixtures of different proportions. The results were compared, concerning the single digestion of each fraction, the gas generation, and the process performance, using H2 as an indicator. It was determined that the optimal mixture was the one with the fractions in equal proportion. This mixture achieved a balanced composition, a faster process by 58 %, and a 12 % increase in methane production. It was also determined that, as a rule, mixtures increase the hydrolysis speed and that the meat fraction mixtures manage to make this substrate suitable for anaerobic treatment by increasing the rate of hydrolysis by 148 % and buffering the acidification inhibition that suffers in its single digestion.

Liposarcoma pleomórfico originado en una localización inusual. Presentación de caso / Pleomorphic liposarcoma arising in an unusual site. A case report

Los liposarcomas son el grupo más común de las neoplasias mesenquimatosas malignas. Suelen aparecer en las extremidades y en el retroperitoneo. Es excepcional su localización intestinal. Se presenta el caso de un varón de 75 años que fue hospitalizado por anemia severa, en cuya TC se objetivó un engrosamiento de asa yeyunal de 5cm sospechoso de neoplasia. Se realizó resección parcial de intestino delgado. Macroscópicamente se identificó una tumoración polipoide ulcerada de 12×6cm. Microscópicamente se observó una neoplasia bien delimitada, ulcerada, de transición abrupta con una mucosa circundante normal, compuesta por lipoblastos pleomórficos sobre un fondo sarcomatoso. Existen muy pocos casos publicados de liposarcomas intestinales, la mayoría de los cuales eran liposarcomas bien diferenciados o desdiferenciados. Se presenta el caso de un liposarcoma pleomórfico de intestino delgado por su excepcional localización y la importancia en su diagnóstico diferencial.(AU)

Liposarcomas are the most common group of malignant mesenchymal neoplasms. They usually occur in the extremities and the retroperitoneum and only rarely in the intestine. We report the case of a 75-year-old man presenting with severe anaemia. A CAT scan revealed a 5cm thickening of the jejunal loop, arousing the suspicion of a neoplasm. A partial resection of the small intestine was performed. Macroscopy showed a 12×6cm ulcerated, polypoid mass. Microscopically, a well circumscribed, ulcerated tumour was seen, which had well-defined margins with the surrounding normal mucosa. It consisted of pleomorphic lipoblasts within a sarcomatous background. Very few cases of intestinal liposarcomas have been published and the majority report well-differentiated or undifferentiated liposarcomas. We present a case of a pleomorphic liposarcoma of the small intestine, which is an unusual location and emphases the importance of a comprehensive differential diagnosis.(AU)

[Pleomorphic liposarcoma arising in an unusual site. A case report]. / Liposarcoma pleomórfico originado en una localización inusual. Presentación de caso.

Liposarcomas are the most common group of malignant mesenchymal neoplasms. They usually occur in the extremities and the retroperitoneum and only rarely in the intestine. We report the case of a 75-year-old man presenting with severe anaemia. A CAT scan revealed a 5cm thickening of the jejunal loop, arousing the suspicion of a neoplasm. A partial resection of the small intestine was performed. Macroscopy showed a 12×6cm ulcerated, polypoid mass. Microscopically, a well circumscribed, ulcerated tumour was seen, which had well-defined margins with the surrounding normal mucosa. It consisted of pleomorphic lipoblasts within a sarcomatous background. Very few cases of intestinal liposarcomas have been published and the majority report well-differentiated or undifferentiated liposarcomas. We present a case of a pleomorphic liposarcoma of the small intestine, which is an unusual location and emphases the importance of a comprehensive differential diagnosis.

Enhancing Energy Recovery in Form of Biogas, from Vegetable and Fruit Wholesale Markets By-Products and Wastes, with Pretreatments.

Residues and by-products from vegetables and fruit wholesale markets are suitable for recovery in the form of energy through anaerobic digestion, allowing waste recovery and introducing them into the circular economy. This suitability is due to their composition, structural characteristics, and to the biogas generation process, which is stable and without inhibition. However, it has been observed that the proportion of methane and the level of degradation of the substrate is low. It is decided to study whether the effect of pretreatments on the substrate is beneficial. Freezing, ultrafreezing and lyophilization pretreatments are studied. A characterization of the substrates has been performed, the route of action of pretreatment determined, and the digestion process studied to calculate the generation of biogas, methane, hydrogen and the proportions among these. Also, a complete analysis of the process has been performed by processing the data with mathematical and statistical methods to obtain disintegration constants and levels of degradation. It has been observed that the three pretreatments have positive effects, when increasing the solubility of the substrate, increasing porosity, and improving the accessibility of microorganisms to the substrate. Generation of gases are greatly increased, reaching a methane enrichment of 59.751%. Freezing seems to be the best pretreatment, as it increases the biodegradation level, the speed of the process and the disintegration constant by 306%.

Effects of reactive oxygen species generation induced by Wonju City particulate matter on mitochondrial dysfunction in human middle ear cell.

Atmospheric particulate matter (PM) contains different components that can elicit varying adverse health effects in humans and animals. Studies on PM toxicity and its underlying mechanisms in the middle ear are limited, and they generally use a PM standard. However, as PM composition varies temporally and geographically, it is crucial to identify the toxic PM constituents according to season and region and investigate their associated health effects. Thus, we sought to determine whether PM induces cytotoxicity and inflammatory factor and reactive oxygen species (ROS) generation in human middle ear epithelial cells obtained from patients with otitis media. The cells were treated with both standard urban PM and PM directly captured from the atmosphere in Wonju City. The association between mitochondrial dysfunction and PM was investigated. PM exposure significantly increased COX-2 and TNF-α mRNA expression, increased ROS generation, induced inflammatory responses, and caused abnormalities in mitochondrial motility and function. Furthermore, PM induced cell apoptosis, which consequently reduced cell survival, particularly at the concentration of 100 µg/mL. Overall, our study provides new insights into the toxic effects of standard and atmospheric PM on middle ear cell line.

Anaerobic digestion in wastewater reactors of separated organic fractions from wholesale markets waste. Compositional and batch characterization. Energy and environmental feasibility.

The food industry is one of the major industrial sectors in Europe and Spain, and therefore one of the major waste emitters, especially organic ones that can be classified into three different fractions (fruit and vegetables, meat and fish). One way to treat this waste environmentally responsible, energy-sustainable and economically cost-effective is anaerobic digestion. The generated biogas can be used as fuel and renewable energy source (providing a solution to the energy problem from an environmental point of view). As there must be a sewage treatment plant with anaerobic digesters in the wholesale markets, and if waste is treated on it, these facilities can be converted into power generators. It has been studied that, when treated along with sludge from a UASB reactor, the residue of fruit and vegetables produces about 900 ml per 100 g of residue with a stable and robust process; the meat residue generates 1300 ml of biogas per 100 g with a process that is slightly affected by the accumulation of acidic elements, internally reversed by the buffer effect of ammonia released; and the fish residue generates 700 ml of biogas, but with very low novels of methane since the process is inhibited early by excessive accumulation of ammonia. The proposed solution is positive, and the methods used to determine it are novel and robust, such as the use of hydrogen as an indicator of process stability. A deep characterization of the development of the process is provided, and feasibility for its application at the industrial level is studied. It is thus proven that wholesale markets can be converted into power generating plants up to 600 kW, assuming a reduction of up to 70 tons of CO2 equivalent (50%) if the generated biogas is used, replacing a conventional source such as natural gas.

Environmental analysis of the use of plant fiber blocks in building construction.

Construction is a sector which produces high greenhouse gas emissions, which cause global warming. As such, it is becoming increasingly important to use sustainable materials which reduce the environmental impacts. The properties of the plant fiber block make it one of the most adequate building materials for the construction of the building envelope. However, there is no in-depth research that encompasses the extraction of the raw material, the transport to the factory and the manufacturing process. The present research analyzes the environmental impact associated with the production of plant fiber blocks as a building material, using the Life Cycle Assessment methodology. In addition to looking at the sustainability of this material, it also compares it with other conventional building materials. The results show that the impact category which made the biggest contribution in the manufacturing of a plant fiber block for its use in construction was that of the total primary energy consumption (9.74 MJ/kg straw). With reference to the emission of the greenhouse gases produced during manufacturing, the main contributors are the nitrogen and urea-based fertilizers used in cereal cultivation (0.73 kg of the total 0.96 kg of CO2 per kg of straw). However, the impacts caused by manufacturing a PFB are much lower than those produced from other insulating materials such as expanded polystyrene, extruded polystyrene or polyurethane foam (4.67E+03 kg CO2 eq. for the PFB compared to 1.23E+04 kg CO2 eq. for the fiberglass and 1.33E+04 kg CO2 eq. for the polyurethane).

[Diagnostic and therapeutic management in a series of 1156 patients with the diagnosis of prostate cancer in Castilla y Leon during 2014.] / Manejo diagnóstico y actitud terapeútica de 1156 pacientes diagnosticados de cáncer de próstata en la comunidad de Castilla y León durante el año 2014.

OBJECTIVES: To evaluate the current clinical practice for patients with Prostate Cancer (CP) in the Health Areas of Castilla y León (CyL) in 2014. METHODS: A retrospective multicenter study was designed to provide data on the diagnosis and treatment of PC in CyL: 87.8% of patients were screened. Descriptive statistics on variables related to characteristics of the patient, the tumor and the treatment modality of the first line to which it was submitted are provided. RESULTS: A total of 1156 new cases of PC were analyzed with a mean age of 68.2 years and a mean PSA of 8.40 ng/ml. The Gleason score (GS) showed 538 (46.2%), 418 (35.9 %) and 200 (17.1%) patients for GS ≤ 6, 7 and  ≥ 8 respectively. 91% of patients (1053 patients) are diagnosed at a localized stage. 56 (4.8%) patients received treatment with active surveillance/ watchful waiting, 423 (36.6%) radical prostatectomy (PR), 348 (30.1%) radiotherapy (RT), 98 (8.4%) brachytherapy (BT) and 170 (14.7%) hormone therapy (HT) respectively. CONCLUSIONS: Differed strategies still accounted for a small percentage of treatments. PR and RT/BT were of choice in patients with localized stages of the disease and younger than 70 years. More advanced stages and older patients were treated with HT mainly. Age is postulated as the main factor involved in therapeutic decision making.

OBJETIVO: Conocer la práctica clínica real en pacientes con Cáncer de Próstata (CP) en las Áreas Sanitarias de Castilla y León (CyL) en el año 2014. MATERIAL Y MÉTODOS: Se diseña un estudio multicéntrico con carácter retrospectivo para disponer de datos sobre el diagnóstico y tratamiento del CP en CyL: se logra una cobertura del 87,8% de los pacientes comunitarios. Se aporta estadística descriptiva sobre las variables referentes a características del paciente, del tumor y de la modalidad de tratamiento de primera línea a la que fue sometido. RESULTADOS: Se analizan 1.156 nuevos casos de CP con una edad media de 68,2 años y una mediana de PSA de 8,4 ng/ml. La puntuación de Gleason (PG) muestra 538 (46,2%), 418 (35,9%) y 200 (17,1%) pacientes para PG ≤  6, 7 y  ≥ 8 respectivamente. El 91,0% de los pacientes (1.053 pacientes) son diagnosticados en estadio localizado. 56 pacientes (4,8%) son tratados con estrategias diferidas (EDs), vigilancia activa/ observación, 423 (36,6%) con prostatectomia radical (PR), 348 (30,1%) con radioterapia, 98 (8,4%) con braquiterapia (BT) y 170 (14,7%) con hormonoterapia (HT). CONCLUSIONES: Las EDs aún supusieron un porcentaje pequeño de los tratamientos. PR y RT/BT fueron de elección en pacientes con estadios localizados de la enfermedad y menores de 70 años. Estadios más avanzados y pacientes mayores fueron tratados con HT principalmente. La edad se postula como el principal factor implicado en la toma de decisiones terapéuticas.

Manejo diagnóstico y actitud terapeútica de 1156 pacientes diagnosticados de cáncer de próstata en la comunidad de Castilla y León durante el año 2014 / Diagnostic and therapeutic management in a series of 1156 patients with the diagnosis of prostate cancer in Castilla y Leon during 2014

Objetivo: Conocer la práctica clínica real en pacientes con Cáncer de Próstata (CP) en las Áreas Sanitarias de Castilla y León (CyL) en el año 2014. Material y métodos: Se diseña un estudio multicéntrico con carácter retrospectivo para disponer de datos sobre el diagnóstico y tratamiento del CP en CyL: se logra una cobertura del 87,8% de los pacientes comunitarios. Se aporta estadística descriptiva sobre las variables referentes a características del paciente, del tumor y de la modalidad de tratamiento de primera línea a la que fue sometido. Resultados: Se analizan 1.156 nuevos casos de CP con una edad media de 68,2 años y una mediana de PSA de 8,4 ng/ml. La puntuación de Gleason (PG) muestra 538 (46,2%), 418 (35,9%) y 200 (17,1%) pacientes para PG ≤ 6, 7 y ≥ 8 respectivamente. El 91,0% de los pacientes (1.053 pacientes) son diagnosticados en estadio localizado. 56 pacientes (4,8%) son tratados con estrategias diferidas (EDs), vigilancia activa/ observación, 423 (36,6%) con prostatectomia radical (PR), 348 (30,1%) con radioterapia, 98 (8,4%) con braquiterapia (BT) y 170 (14,7%) con hormonoterapia (HT). Conclusiones: Las EDs aún supusieron un porcentaje pequeño de los tratamientos. PR y RT/BT fueron de elección en pacientes con estadios localizados de la enfermedad y menores de 70 años. Estadios más avanzados y pacientes mayores fueron tratados con HT principalmente. La edad se postula como el principal factor implicado en la toma de decisiones terapéuticas

Objectives: To evaluate the current clinical practice for patients with Prostate Cancer (CP) in the Health Areas of Castilla y León (CyL) in 2014. Methods: A retrospective multicenter study was designed to provide data on the diagnosis and treatment of PC in CyL: 87.8% of patients were screened. Descriptive statistics on variables related to characteristics of the patient, the tumor and the treatment modality of the first line to which it was submitted are provided. Results: A total of 1156 new cases of PC were analyzed with a mean age of 68.2 years and a mean PSA of 8.40 ng/ml. The Gleason score (GS) showed 538 (46.2%), 418 (35.9 %) and 200 (17.1%) patients for GS ≤6, 7 and ≥8 respectively. 91% of patients (1053 patients) are diagnosed at a localized stage. 56 (4.8%) patients received treatment with active surveillance/ watchful waiting, 423 (36.6%) radical prostatectomy (PR), 348 (30.1%) radiotherapy (RT), 98 (8.4%) brachytherapy (BT) and 170 (14.7%) hormone therapy (HT) respectively. Conclusions: Differed strategies still accounted for a small percentage of treatments. PR and RT/BT were of choice in patients with localized stages of the disease and younger than 70 years. More advanced stages and older patients were treated with HT mainly. Age is postulated as the main factor involved in therapeutic decision making

Preeclampsia grave de aparición precoz confirmada con biomarcador / Severe early-onset biomarker-confirmed preeclampsia

RESUMEN La aparición de preeclampsia antes de las 20 semanas de gestación es rara y generalmente se asocia con enfermedades trofoblásticas o con el síndrome antifosfolípido. Presentamos el caso de una paciente con preeclampsia severa asociada al síndrome de distress respiratorio del adulto (SDRA) de forma precoz en la semana 15 de gestación en ausencia de los trastornos antes mencionados. Su confirmación diagnóstica se realizó mediante el empleo del biomarcador sFlt-1/P1GF.

ABSTRACT The occurrence of preeclampsia before 20 weeks of gestation is rare and usually associated with trophoblastic diseases or antiphospholipid syndrome. We present the case of a patient with severe preeclampsia associated with adult respiratory distress syndrome early in week 15 of gestation in the absence of the aforementioned disorders. Its confirmation was carried out through the use of biomarker sFlt-1/P1GF.

Comparison of postoperative costs of two surgical techniques for hallux valgus (Kramer vs. scarf).

BACKGROUND: Most studies of hallux valgus surgery focus on the radiological findings or on medium-term clinical follow-up. The results obtained using various osteotomy techniques do not differ greatly. However, patient comfort and the need for postoperative care do appear to present differences. In the Kramer technique, the osteotomy is secured with a wire extruding from the skin of the foot. In this situation, patients may well experience problems (or at least discomfort) in the immediate postoperative period. Previous studies of the Kramer technique (also known as SERI, or percutaneous distal metatarsal osteotomy) do not report an increased number of complications. Early complications may not influence the outcome in the medium to long term, and patient discomfort during the postoperative period is rarely reflected in the analysis of one-year results obtained with standard scales such as AOFAS; in our experience, however, patient discomfort, the care burden (i.e., the number of visits and emergency service consultations) and the economic cost of immediate postoperative care are all aspects that should be borne in mind when assessing the merits of different surgical techniques. In this study we compare the care burden and economic cost of two surgical approaches to hallux valgus correction--the Kramer and the scarf techniques--during the first postoperative year. METHODS: Retrospective review of two independent patient cohorts. Sixty-nine feet underwent Kramer osteotomy and 133 the scarf technique. Care burden was assessed by the number of visits each patient required and the complications. The follow-up and costs of each were assessed and compared independently. RESULTS: Both techniques obtain satisfactory clinical results at one year. However, comparison of clinical progression showed AOFAS score increases of 34.7 points for Kramer and 41.1 points for the scarf technique (p-value<0.05). Patients in the Kramer group required a higher number of visits, especially postoperative emergency department visits (p<0.05), and had a significantly higher number of complications (27.5% vs. 6.7%, p<0.05). The mean cost of follow-up was significantly higher in the Kramer group (€ 218.97 vs. € 171.41, p<0.05). CONCLUSIONS: Kramer osteotomy presented significantly higher care burdens, complication rates and associated costs during the first year of follow-up. It is therefore a less cost-effective technique. Thus, even though according to the results of AOFAS we would not have changed our clinical practice, the analysis of these data has made us change our treatment strategy for hallux valgus and practically abandoned the use of the Kramer osteotomies.

Signo de la "lengua brillante" en esclerosis lateral amiotrófica / "bright tongue" sign in amyotrophic lateral sclerosis / Sinal da "lingua lustrosa" em esclerose lateral amiotrófica

La esclerosis lateral amiotrófica (ELA) es una enfermedad neurodegenerativa. Aunque su diagnóstico sigue siendo clínico, los exámenes adicionales pueden ser utilizados para excluir otras enfermedades, así como para confirmar el diagnóstico. Uno de ellos son las neuroimagenes, donde la más utilizada es la resonancia nuclear magnética (RNM). En la literatura hay pocos signos específicos; el tracto corticoespinal, giro precentral y el cuerpo calloso son los principales sitios de alteración. Un signo patognomónico es el signo de la lengua brillante, debido a la alteración de la lengua en su estructura interna con áreas de aumento y disminución de intensidad de señal, en fases de severo compromiso bulbar con mayor intensidad en T1.

Amyotrophic lateral sclerosis is a progressive neurodegenerative disease, but its diagnosis remains clinical, additional tests may be used to exclude other diseases and to confirm the diagnosis. One of them is the images studies, and the most commonly used is magnetic resonance imaging. In literature there are few signs specific finding as major sites of alteration: the corticospinal tract, precentral gyrus, corpus callosum.. A pathognomonic sign"bright tongue sign'', because alteration in the internal structure with areas of increased and decreased signal intensity in severe bulbar commitment phases with greater intensity in T1.

A esclerose lateral amiotrófica é uma doença neuro-degenerativa. Embora seu diagnóstico ainda seja clínico, os examines podem-se aplicar para excluir outras doenças, assim como para confirmar o diagnóstico. Um de eles são as neuroimagens, onde as mais aplicada é a ressonância nuclear magnética (RNM). Na literatura ha poucas sinales específicas: o trato corticoespinal, giro precentrarl y o corpo caloso são os principais sites de alteração. Una sinal patognómica é a sinal da língua lustrosa, devido a alteração da língua na estrutura interna com áreas de aumento e diminuição de intensidade da sinal, em fases de severo compromisso bulbar com maior intensidades em T1.

Laryngeal mask, laryngeal tube, and Frova introducer in simulated difficult airway.

BACKGROUND: The use of supraglottic devices is rising in the prehospital management of difficult airway; moreover, we think that patients with multiple trauma or cervical instability can take advantage of these devices without opening or retiring the cervical collar. OBJECTIVE: To compare speed and ease of use between Laryngeal Tube S (LTS) and the Ambu AuraOnce laryngeal mask (LMA).Our second objective was to evaluate changing these devices to an endotracheal tube (ETT) using a Frova introducer. METHODS: We studied the use of LTS and LMA in an experimental model, represented by a manikin with a rigid cervical collar and a limited mouth opening. This study was carried out in Complutense University of Madrid with 145 2(nd)-year students for the degree in Dentistry who have knowledge of the airway but lack experience in intubation. Number of attempts and time for the device's insertion were measured, as well as time for the exchange maneuver using the Frova introducer. RESULTS: Insertion of all devices was possible on the first attempt; time for insertion was LTS 12.2 ± 1.28 s and LMA 6.87 ± 0.97 s. Once these devices were inserted, a Frova introducer is used to perform an exchange by an endotracheal tube; all devices could be exchanged on the first attempt, and exchange time was LTS 26.9 ± 1.2 s and LMA 16.79 ± 1.32 s. Results for both time for insertion and exchange of the LMA were significantly lower than those for the LTS (p < 0.001). CONCLUSION: The method used can be considered quick and easy, even for personnel inexperienced in intubation. This exchange maneuver has not been described previously, so we can consider it as a new application of the Frova introducer.

Laparoscopy in elderly patients.

OBJECTIVES: Aging of the current population is an evident fact, and the surgical treatment of these patients is something we find in our daily practice. In this sense, all doubts that may arise when it comes to carrying out this technique in patients with important comorbidities appear to be cleared, as even patients with prior respiratory or heart disease benefit from the laparoscopic approach. METHODS: An analysis was carried out on a total of 99 patients over 70 years of age who underwent renal laparoscopic surgery, compared, on one hand, to 173 patients under 70 years of age undergoing the same procedure, and on the other, to 95 patients over 70 years of age who underwent open surgery We collected and compared all complications described intraoperatively and in the immediate postoperative period, as well as hospital stay. RESULTS: Patients over 70 years of age have a greater comorbidity compared to patients under 70 (ICH 1.46 vs. 0.89 p<0.05), but there are no statistical differences in terms of intraoperative or postoperative complications, or mean hospital stay. When compared to patients over 70 years of age with a similar comorbidity who underwent classic surgery, (ICH 1.46 vs. 1.45), we found a lower rate of complications (12.2 vs. 28.4% transfusion, 1.4 vs. 4.0% fever, p<0.05) and a shorter hospital stay (4.9 vs. 7.1%p<0.002). CONCLUSION: Patient age does not seem to have a determining effect on complications or on the postoperative period of kidney disease when laparoscopy is used, which is why this method of treatment seems adequate in such cases.

Laparoscopia renal en pacientes añosos / Laparoscopy in elderly patients

OBJETIVO: El envejecimiento de la población actual es un hecho evidente y el tratamiento quirúrgico de estos pacientes es una situación que nos encontramos en nuestro ejercicio habitual. En este sentido, las dudas que nos puede surgir en realizar esta técnica en enfermos con importante comorbilidad parece despejarse, ya que incluso en pacientes con patología respiratoria o cardiológica previa se benefician del abordaje laparoscópico. MÉTODOS: Se analiza un total de 99 pacientes mayores de 70 años operados por laparoscopia renal comparados por una parte a los 173 menores de 70 años sometidos a la misma técnica y por otra parte a los 95 pacientes mayores de 70 años operados por cirugía abierta. Recogemos y comparamos las complicaciones intraoperatorias descritas, postoperatorias inmediatas y estancia hospitalaria. RESULTADOS: Los pacientes mayores de 70 años presentan una mayor comorbilidad respecto a los menores de 70 (Indice de Charlson 1,46 vs 0,89 p <0,05), pero no hay diferencias estadisticas en cuanto a complicaciones intraoperatorias, postoperatorias ni estancia media. Al comparar con los pacientes mayores de 70 años intervenidos por cirugía clásica, con una comorbilidad similar (Indice de Charlson 1,46 vs 1,45) encontramos una menor tasa de complicaciones (12,2 vs 28,4% transfusión, 1,4 vs 4,9% fiebre, p< 0,05) y una menor estancia hospitalaria (4,9 vs 7,1% p< 0,002). CONCLUSIÓN: La edad no parece ser un factor de riesgo que aumente las complicaciones intraoperatorias y postoperatorias en los pacientes sometidos a cirugía renal laparoscópica(AU)

OBJECTIVES: Aging of the current population is an evident fact, and the surgical treatment of these patients is something we find in our daily practice. In this sense, all doubts that may arise when it comes to carrying out this technique in patients with important comorbidities appear to be cleared, as even patients with prior respiratory or heart disease benefit from the laparoscopic approach. METHODS: An analysis was carried out on a total of 99 patients over 70 years of age who underwent renal laparoscopic surgery, compared, on one hand, to 173 patients under 70 years of age undergoing the same procedure, and on the other, to 95 patients over 70 years of age who underwent open surgery. We collecteded and compared all complications described intraoperatively and in the immediate postoperative period, as well as hospital stay. RESULTS: Patients over 70 years of age have a greater comorbidity compared to patients under 70 (ICH 1.46 vs. 0.89 p<0.05), but there are no statistical differences in terms of intraoperative or postoperative complications, or mean hospital stay. When compared to patients over 70 years of age with a similar comorbidity who underwent classic surgery, (ICH 1.46 vs. 1.45), we found a lower rate of complications (12.2 vs. 28.4% transfusion, 1.4 vs. 4.0% fever, p<0.05) and a shorter hospital stay (4.9 vs. 7.1% p<0.002). CONCLUSION: Patient age does not seem to have a determining effect on complications or on the postoperative period of kidney disease when laparoscopy is used, which is why this method of treatment seems adequate in such cases(AU)

Incidencia de efectos adversos en una unidad de medicina intensiva / No disponible

Objetivos: Los pacientes críticos tienen un riesgo especialmente alto de presentar efectos adversos (EA). En este trabajo estudiamos la incidencia de EA en una unidad de cuidados intensivos (UCI) para identificar los factores que incrementan el riesgo de presentarlos,los clasificamos según su gravedad y medimos su influencia en la estancia en UCI.Material y método: Estudio prospectivo de cohortes realizado en los pacientes ingresados en una UCI de un hospital pequeño en 1 año. La revisión se llevó a cabo en dos fases: primero se utilizó una guíade cribado y en segundo lugar se revisaron las historias seleccionadas mediante un cuestionario de confirmación para identificar los EA. Se analizó la influencia de la edad, el sexo, el diagnóstico, la puntuaciónAPACHE y la estancia en la aparición de EA. Se determinó la repercusión de los EA en la estancia del paciente en la unidad. Se clasificaron los EA en tres grupos: graves, moderados y leves. Resultados: Se revisaron 416 historias clínicas y la guía de cribadoseleccionó 259. El 29% de los pacientes (121) presentaron172 EA. La edad y el sexo no demostraron influencia. Los pacientes con estancias prolongadas presentaron EA con mayor frecuencia (49%) que los que tuvieron estancias cortas (24%). La puntuación APACHE fue más elevada en los pacientes que presentaron EA. El grupo diagnóstico que con mayor frecuencia presentó EA fue el de pacientes sépticos. Ocurrieron un 59,3% de EA graves,un 14% de EA moderados y un 26,7% de EA leves. Los EAmotivaron 323 estancias, es decir, el 22,5% del total de las estancias en UCI. Conclusiones: Los EA son frecuentes entre los pacientes críticos. Lamayor gravedad y la estancia prolongada incrementaron el riesgo de EA. Los EA fueron graves y prolongaron la estancia de los pacientes en la UCI

Objectives: Critically ill patients have an especially high risk of adverse events (AE). We sought to study the incidence of AE in an intensive care unit (ICU) to identify which factors could increase therisk of AE, determine their severity, and evaluate their influence on length of stay.Material and method: We performed a prospective 1-year cohort study in patients admitted to the ICU of a small hospital. The study was carried out in two phases: in the first phase, a screening guidewas used and in the second phase, positively screened records were reviewed to identify AEs. The influence of age, sex, diagnosis, APACHEscore and length of stay on the occurrence of AE were analyzed and the effect of these events on the patient’s length of stay in the unit was determined. AE were classified in three groups: serious,moderate and minor. Results: We reviewed 416 records and screened 259. One hundred twenty-one (29%) patients had 172 AE. Age and sex had no influence.AE were more frequent in patients with longer stays (49%)than in those with shorter stays (24%). The APACHE score was higher in patients with AE. The most frequent diagnosis in the AE group was sepsis. A total of 59.3% AE were serious, 14% were moderateand 26.7% were minor. AE prolonged ICU stay by 323 patient-days, representing 22.5% of ICU time.Conclusions: AE were frequent in critically ill patients. Greater severity and prolonged stay increased the risk of AE. AE were serious and prolonged ICU stay

Idoneidad de los ingresos de los pacientes muy ancianos en las unidades de cuidados intensivos / Appropriateness of admissions to the intensive care unit in the oldest-old

La edad supone a veces el único criterio de selección para la admisión de los ancianos en unidades de cuidados intensivos (UCI) debido al gran consumo de recursos de un segmento de edad con expectativa de vida acortada. En este estudio se evalúa la idoneidad del ingreso de 80 pacientes mayores de 84 años (edad media, 87) ingresados durante 5 años en una UCI por diversas enfermedades. Durante el período de estudio falleció un 21,3%. Los pacientes fallecidos tenían una estancia inferior, mayor puntuación APACHE II y mayor proporción de afecciones cardíacas que el resto (p < 0,05) y, además, precisaron con mayor frecuencia ventilación mecánica. Las características clínicas del segmento de edad más joven (65-84 años) no indica que los más ancianos no tengan que ser ingresados en UCI en relación con su gravedad. La edad no se mostró como variable asociada a mortalidad o peor pronóstico en ancianos; el diagnóstico, las posibilidades terapéuticas y la recuperación del estado basal de salud fueron las indicaciones básicas de su admisión

Age is sometimes the only selection criteria for admission of old patients to the intensive care unit (ICU) due to high resource consumption in an age segment with short life expectancy. The present study evaluated the appropriateness of ICU admission in 80 patients aged more than 84 years old (mean age 87.0 years). The patients were admitted to an ICU for various causes over a 5-year period. During the study period, 21.3% died. Patients who died had a lower length of stay, higher APACHE II score and a greater proportion of cardiac problems than other patients (p < 0.05) and more frequently required mechanical ventilation. The clinical characteristics of the youngest age segment (65-84 years) did not indicate that the oldest patients should not be admitted to the ICU on the basis of severity. Age was not associated with mortality or worse outcome in the old. The basic indications for admission among these patients were diagnosis, therapeutic possibility and recovery of basal health status