Epidemiologic analysis: Prophylaxis and multidrug-resistance in surgery. / Análisis epidemiológico: profilaxis y multirresistencia en cirugía.

BACKGROUND: Surgical site infection is defined as an infection related to the surgical procedure in the area of manipulation occurring within the first 30 postoperative days. The diagnostic criteria include: purulent drainage, isolation of microorganisms, and signs of infection. AIMS: To describe the epidemiologic characteristics and differences among the types of prophylactic regimens associated with hospital-acquired infections at the general surgery service of a tertiary care hospital. MATERIAL AND METHODS: The electronic case records of patients that underwent general surgery at a tertiary care hospital within the time frame of January 1, 2013 and December 31, 2014 were reviewed. A convenience sample of 728 patients was established and divided into the following groups: Group 1: n=728 for the epidemiologic study; Group 2: n=638 for the evaluation of antimicrobial prophylaxis; and Group 3: n=50 for the evaluation of multidrug-resistant bacterial strains in the intensive care unit. The statistical analysis was carried out with the SPSS 19 program, using the Mann-Whitney U test and the chi-square test. RESULTS: A total of 728 procedures were performed (65.9% were elective surgeries). Three hundred twelve of the patients were males and 416 were females. Only 3.98% of the patients complied with the recommended antimicrobial prophylaxis, and multidrug-resistant bacterial strains were found in the intensive care unit. DISCUSSION: A single prophylactic dose is effective, but adherence to this recommendation was not adequate. CONCLUSIONS: The prophylactic guidelines are not strictly adhered to in our environment. There was a significant association between the development of nosocomial infections from multidrug-resistant germs and admission to the intensive care unit.

Quality of life two years after radical prostatectomy, prostate brachytherapy or external beam radiotherapy for clinically localised prostate cancer: the Catalan Institute of Oncology/Bellvitge Hospital experience.

OBJECTIVE: The objective was to compare the short- and long-term impact of 3 different treatment modalities on health-related quality of life (HRQOL) in patients treated for localised prostate cancer at a single centre in Catalonia, Spain. MATERIAL AND METHODS: This was a longitudinal, prospective study of 304 patients from a single centre in Catalonia, Spain. Patients underwent 1 of 3 treatment procedures: radical prostatectomy (114 patients), external beam radiation (134) or interstitial brachytherapy (56). HRQOL was assessed by both general and specific questionnaires, including the SF-36 health survey and the Expanded Prostate Cancer Index Composite (EPIC). Interviews were administered prior to treatment and at months 1, 3, 6, 12 and 24. One-way analysis of variance and generalised estimating equations models were constructed to assess between group differences in HRQOL. RESULTS: After initial deterioration, HRQOL scores partially recovered, although significant differences between treatment groups persisted at two years. Worsening of urinary incontinence was especially marked for the radical prostatectomy group (11.45, p=0.005), while deterioration in the urinary irritative/obstructive domain was worse following brachytherapy treatment (4.76, p=0.025). Decline in sexual function was significantly greater for the radical prostatectomy group than for the brachytherapy group (18.74, p<0.001). No significant between-group differences were observed in bowel domain scores. CONCLUSIONS: Quality of life 2 years after treatment for prostate cancer shows wide variability. Radical prostatectomy had the largest negative impact on the sexual and urinary incontinence domains. Differences between external radiation and brachytherapy were relatively small. Brachytherapy led to a moderate increase in urinary irritation compared to the other 2 groups.

Supplementation with bypass fat in silvopastoral systems diminishes the ratio of milk saturated/unsaturated fatty acids.

This study was conducted to evaluate if supplementing bypass fat to cows under silvopastoral systems, increases the concentration of unsaturated fatty acids in milk, thus improving the saturated/ unsaturated ratio without a negative effect on total milk yield in fat or protein. Two concentrations of two different sources of bypass fat were evaluated for 40 days, each in a group of 24 multiparous Lucerna (Colombian breed) cows. A cross-over design of 8 Latin squares 3 x 3 was used. The variables submitted to analysis were body condition, daily milk production and milk composition. Body condition, milk yield and milk quality were not different but there was a significant decrease in the amount of saturated fatty acid in both experiments while the unsaturated fat increased significantly in experiment 1 and remained stable in experiment 2. Results, such as these have as far as we know, not been reported previously and they provide an approach for the improvement of milk as a "functional food".

Psoriasis y artritis psoriásica / Psoriasis and psoriasica arthritis

La psoriasis es una enfermedad inflamatoria de la piel, de carácter crónico y recurrente, caracterizada por lesiones eritemato - descamativas. En su patogénesis se conjugan factores inmunogenéticos y ambientales. La artritis psoriática, que es una artropatía seronegativa, en la mayoría de los casos sigue a un curso crónico de psoriasis cutánea. En este artículo analizamos las formas mas frecuentes de presentación de la psoriasis cutánea y revisamos la artropatía psoriática, con indicaciones para el tratamiento de esta última

[Intrahepatic cholestasis of pregnancy. Maternofetal implications]. / Colestasis gravídica intrahepática. Implicaciones maternofetales.

OBJECTIVE: To analyze a group of pregnancies complicated by intrahepatic cholestasis in order to favour an early recognition and to decrease maternal and fetal morbid-mortality. PATIENTS AND METHODS: Retrospective study of 46 pregnancies with intrahepatic gravidic cholestasis between 1990-94. We review the most relevant epidemiologic, clinical and biological features and the obstetric and perinatal results. The study group was compared with 1652 non complicated pregnancies (control group) from the same period of time. The statistic evaluation was made with t Student and chi 2. RESULTS: The incidence was 0.18% (mean age of 27.8 +/- 6.7 years) similar to the control group, and a greater rate of primiparity (p < 0.05) and twin pregnancies (p < 0.001). The most frequent symptom was pruritus, followed by choluria (23.9%) and signs of cutaneous scratching (17.3%). Only 5 patients (10.8%) had jaundice. The GPT was greater than 100 U/1 in 29 cases (63.1%) and the GOT in 17 (37%). In 25 pregnancies (54.3%) the alkaline phosphatase exceeded 600 U/L and 28 (60.8%) had bilirubin normal values. Urinary tract infections (26%) and preterm labor (17.3%) were significantly more frequent (p < 0.001) in patients with intrahepatic cholestasis of pregnancy, as well as induced labor rate and cesarean section percentages (p < 0.001). The neonatal prognosis was significantly worse, with 10 preterm babies, 6 with 5 minutes Apgar score lower than 7, and 3 perinatal deaths. All the patients recovered their normal status after delivery. CONCLUSIONS: In intrahepatic gravidic cholestasis moderate cytolysis, infrequent jaundice and cholestasis can be important. The pregnancies should be considered of high risk, and should be managed aggressively as soon as fetal maturity allows it.

[Papillary tumor of the pancreas diagnosed by fine-needle aspiration]. / Tumor papilar de páncreas diagnosticado mediante punción aspiración con aguja fina.

We report the case of a 48 year-old woman with an epigastric palpable mass identified by abdominal echography and computed tomography as a solid pancreatic tumor. A cytology taken by fine needle aspiration guided by computed tomography was diagnostic of papillary pancreatic tumor, which was confirmed by surgical resection. We emphasize the low frequency and good prognosis of this type of tumor after surgical resection, and the utility of image techniques and fine needle aspiration to obtain a preoperative diagnosis.

[Esophageal stenosis due to a dissecting intramural hematoma following the endoscopic sclerotherapy of esophageal varices]. / Estenosis esofágica por hematoma intramural disecante tras escleroterapia endoscópica de varices esofágicas.

The dissecting intramural hematoma of the esophagus (DEH) is a rare complication of endoscopic variceal sclerotherapy (EVS). We present a 37 years male with Laennec's cirrhosis who developed a submucosal hematoma with complete obstruction of the esophagus 24 h. after the second session of EVS diagnosed by endoscopy. After conservative treatment the patient recovered well with complete resolution of the lesion. The review of the literature shows no correlation between DEH and type or volume of sclerosant, site of injection or previous number of sessions. Unknown in children. Most of these patients had abnormal hemostasis. We have performed EVS in 227 patients (879 sessions), with only a case of DEH (rate 0.13%). In this case the bad tolerance and movements during of EVS were very important.