El papel de anakinra en la fiebre mediterránea familiar / The role of anakinra in familial mediterranean fever

La fiebre mediterránea familiar (FMF) pertenece al grupo de las fiebres periódicas hereditarias, se caracteriza por presentar episodios febriles recurrentes y autolimitados con poliserositis, sinovitis y manifestaciones cutáneas. Es una enfermedad hereditaria transmitida de forma autosómica recesiva y afecta principalmente a descendientes de poblaciones mediterráneas. El tratamiento contempla varios objetivos: el alivio sintomático, la prevención y el tratamiento de los ataques agudos, así como evitar la aparición de amiloidosis secundaria. El fármaco de elección es, de manera clásica, es la colchicina. Aunque hoy día también se dispone de fármacos inhibidores de la interleucina 1. (AU)

Familial Mediterranean fever (FMF) belongs to the group of hereditary periodic fevers, characterised by recurrent and self-limited febrile episodes with polyserositis, synovitis and skin manifestations. It is a hereditary disease transmitted in an autosomal recessive manner and mainly affects descendants of Mediterranean populations. Treatment has several goals: symptomatic relief, prevention and treatment of acute attacks, and avoidance of secondary amyloidosis. The drug of choice is classically colchicine. However, interleukin-1 inhibitors are now also available. (AU)

Additional pre-extubation local anaesthetic application to improve the postoperative course in orthognathic surgery: a randomised controlled trial.

A clinical trial was performed to assess the analgesic efficacy of adding ropivacaine pre-extubation for pain management after bimaxillary osteotomy. Forty-eight patients were assigned to receive general anaesthesia followed by either a single pre-incisional infiltration with lidocaine (control group, n = 24) or the same pre-incisional infiltration with lidocaine and an additional second infiltration with ropivacaine before awakening (test group, n = 24). Postoperative pain was assessed subjectively using a visual analogue scale and objectively based on the frequency of postoperative rescue opioid consumption. The dose of opioids (methadone) consumed and frequency of postoperative-nausea-vomiting were also recorded. Patients who received the two infiltrations of local anaesthetic had better results in terms of lesser pain during the first 8 hours postoperative (P<0.001 at 2 and 4 hours; P = 0.028 at 8 h), a lesser need for rescue opioids (P = 0.020) and lower doses of rescue opioids (P = 0.011), and consequently a lesser incidence of postoperative-nausea-vomiting (0-4 hours postoperative, P<0.03). The results obtained suggest that the infiltration of an additional dose of local anaesthetic is a simple strategy for reducing pain perception and opioid use, and for ensuring greater patient comfort after bimaxillary osteotomy.

Research priorities in perioperative fluid therapy and hemodynamic monitoring: A Delphi Consensus Survey from the Fluid Therapy and Hemodynamic Monitoring Subcommittee of the Hemostasis, Transfusion Medicine and Fluid Therapy Section (SHTF) of the Spanish Society of Anesthesiology and Critical Care (SEDAR).

BACKGROUND: Research in fluid therapy and perioperative hemodynamic monitoring is difficult and expensive. The objectives of this study were to summarize these topics and to prioritize these topics in order of research importance. METHODS: Electronic structured Delphi questionnaire over three rounds among 30 experts in fluid therapy and hemodynamic monitoring identified through the Fluid Therapy and Hemodynamic Monitoring Subcommittee of the Hemostasis, Transfusion Medicine and Fluid Therapy Section of the Spanish Society of Anesthesiology and Critical Care. RESULTS: 77 topics were identified and ranked in order of prioritization. Topics were categorized into themes of crystalloids, colloids, hemodynamic monitoring and others. 31 topics were ranked as essential research priority. To determine whether intraoperative hemodynamic optimization algorithms based on the invasive or noninvasive Hypotension Prediction Index versus other management strategies could decrease the incidence of postoperative complications. As well as whether the use of renal stress biomarkers together with a goal-directed fluid therapy protocol could reduce hospital stay and the incidence of acute kidney injury in adult patients undergoing non-cardiac surgery, reached the highest consensus. CONCLUSIONS: The Fluid Therapy and Hemodynamic Monitoring Subcommittee of the Hemostasis, Transfusion Medicine and Fluid Therapy Section of the Spanish Society of Anesthesiology and Critical Care will use these results to carry out the research.

[Evaluation of the effectiveness of the new perioperative model to recover surgical activity during the COVID-19 pandemic]. / Evaluación de la efectividad del nuevo modelo perioperatorio para recuperar la actividad quirúrgica durante la pandemia de COVID-19.

INTRODUCTION: The first wave of the COVID-19 pandemic caused the cancellation of elective interventions. After the improvement of the epidemiological situation, new models of care were applied in hospitals to restart the programmed surgical activity. The aim was to evaluate the effectiveness of the organizational model established to recover surgical activity during the transition period of the COVID-19 pandemic. METHODS: Retrospective observational study comparing patients who underwent schedule surgery from September 1 until October 31, 2020, study group, with a control group of the same period of time corresponding to the year 2019 at the General Hospital from the Vall d'Hebron University Hospital. RESULTS: The total population included 1,825 patients, 888 in the study group and 937 in the control group. Global surgical activity decreased 6.43% during the study period compared to the same period in 2019, with a 25.5% decrease in cancer surgeries. Seven patients became infected with SARS-CoV-2 during their hospital stay. In hospital mortality was 0.9% in the study group compared to 0.7% in control group (p=0.8). The survival rate in cancer patients at 90 days was lower in the study group (95.7% vs 98.7%; p=0.02). CONCLUSIONS: The change in the management model during the transition period of the COVID-19 pandemic allowed the recovery of programmed surgical activity to levels similar to those existing prior to the pandemic with a greater impact on cancer surgery.

Prevalencia preoperatoria de portadores asintomáticos de COVID-19 en hospitales de Cataluña durante la primera ola tras el reinicio de la actividad quirúrgica / Pre-operative prevalence of asymptomatic carriers of COVID-19 in hospitals in Catalonia during the first wave after the resumption of surgical activity

Introducción La pandemia producida por COVID-19 ocasionó la cancelación de los procedimientos quirúrgicos no esenciales en marzo de 2020. Con el reinicio de la actividad quirúrgica, los pacientes que se sometían a una cirugía fueron uno de los primeros grupos poblacionales a los que se realizó test PCR de forma sistemática. El objetivo de este estudio fue determinar la prevalencia de portadores asintomáticos de SARS-CoV-2 tras el reinicio de la actividad quirúrgica no esencial. Métodos Estudio observacional multicéntrico retrospectivo de los pacientes programados para cirugía o que se sometieron a cirugía urgente en Cataluña entre el 20 de abril y el 31 de mayo de 2020. Se revisaron los resultados microbiológicos de los test PCR preoperatorios, las historias clínicas y se realizó una encuesta epidemiológica a los pacientes con PCR positiva para SARS-CoV-2. Resultados Un total de 10.838 pacientes programados para una intervención quirúrgica o a los que se realizó una cirugía urgente fueron sometidos a cribado para COVID-19. Ciento dieciocho pacientes (1,09%) fueron positivos para SARS-CoV-2 en las 72h previas a la cirugía. La prevalencia de portadores asintomáticos fue del 0,7% (IC95%: 0,6-0,9%). La primera semana del estudio presentó la prevalencia más alta de portadores asintomáticos [1,9% (IC95%: 1,1-3,2%)]. Conclusiones Los bajos niveles de portadores asintomáticos de infección por COVID-19 obtenidos en la población quirúrgica de los hospitales de Cataluña tras el reinicio de la actividad quirúrgica muestran que la mayoría de pacientes se pudieron someter a procedimientos quirúrgicos sin los riesgos de las complicaciones asociadas al COVID-19 en el periodo perioperatorio (AU)

Introduction The COVID-19 pandemic led to the cancellation of non-essential surgical procedures in March 2020. With the resumption of surgical activity, patients undergoing surgery were one of the first population groups to be systematically tested for PCR. The aim of this study was to determine the prevalence of asymptomatic SARS-CoV-2 carriers after the resumption of non-essential surgical activity. Methods Retrospective multicenter observational study of patients scheduled for surgery or undergoing emergency surgery in Catalonia between 20 April and 31 May 2020. The microbiological results of preoperative PCR tests and clinical records were reviewed, and an epidemiological survey was conducted on patients with positive PCR for SARS-CoV-2. Results A total of 10,838 patients scheduled for surgery or who underwent emergency surgery were screened for COVID-19. One hundred and eighteen patients (1.09%) were positive for SARS-CoV-2 in the 72hours prior to surgery. The prevalence of asymptomatic carriers was 0.7% (95%CI: 0.6% - 0.9%). The first week of the study presented the highest prevalence of asymptomatic carriers [1.9% (95%CI: 1.1%-3.2%)]. Conclusions The low levels of asymptomatic carriers of COVID-19 infection obtained in the surgical population of hospitals in Catalonia after the resumption of surgical activity, shows that most patients were able to undergo surgical procedures without the risks of COVID-19 associated complications in the perioperative period (AU)

Influence of different types of LEDs lights on the formation of volatile sulfur compounds in white and rosé wines.

The effect of LEDs light on the formation of volatile sulfur compounds (VSCs) and the final sensory quality of white and rosé wines was evaluated. Thus, different commercial wines were exposed for ten days to three types of lights. All wine samples were analyzed throughout the exposure period to determine the usual oenological parameters together with some other chemical characteristics (color evolution; riboflavin, cysteine and methionine photodegradation), VSC amounts and sensory characteristics. The results showed that the wines exposed to ultraviolet light suffered greater degradation of the aromatic precursors, mainly riboflavin, and had higher concentrations of VSCs. Regarding LED lights, these produced minimal degradative effects. So that we can consider this type of light as an alternative to reduce the economic impact that currently occurs due to the photodegradation of bottled wines.

Liver transplant with controlled donors after circulatory death with normothermic regional perfusion and brain dead donors: A multicenter cohort study of transfusion, one-year graft survival and mortality.

BACKGROUND: Controlled donation after circulatory death (cDCD) has expanded the donor pool for liver transplantation (LT). However, transfusion requirements and perioperative outcomes should be elucidated. The aim of this multicenter study was to assess red blood cell (RBC) transfusions, one-year graft and patient survival after LT after cDCD with normothermic regional perfusion (NRP) compared with donors after brain death (DBD). METHODS: 591 LT carried out in ten centers during 2019 were reviewed. Thromboelastometry was used to manage coagulation and blood product transfusion in all centers. Normothermic regional perfusion was the standard technique for organ recovery. RESULTS: 447 patients received DBD and 144 cDCD with NRP. Baseline MCF Extem was lower in the cDCD group There were no differences in the percentage of patients (63% vs. 61% p = 0.69), nor in the number of RBC units transfused (4.7 (0.2) vs 5.5 (0.4) in DBD vs cDCD, p = 0.11. Twenty-six patients (6%) died during admission for LT in the DBD group compared with 3 patients (2%) in the cDCD group (p = 0.15). To overcome the bias due to a worse coagulation profile in cDCD recipients, matched samples were compared. No differences in baseline laboratory data, or in intraoperative use of RBC or one-year outcome data were observed between DBD and cDCD recipients. CONCLUSIONS: cDCD with NRP is not associated with increased RBC transfusion. No differences in graft and patient survival between cDCD and DBD were found. Donors after controlled circulatory death with NRP can increasingly be utilized with safety, improving the imbalance between organ donors and the ever-growing demand.

Daily multidisciplinary COVID-19 meeting: Experiences from a French university hospital.

OBJECTIVES: In March 2020, the World Health Organization declared the coronavirus disease 2019 (COVID-19) a pandemic. In absence of official recommendations, implementing daily multidisciplinary team (MDT) COVID-19 meetings was urgently needed. Our aim was to describe our initial institutional standard operating procedures for implementing these meetings, and their impact on daily practice. METHODS: All consecutive patients who were hospitalized in our institution due to COVID 19, from March 31 to April 15, 2020, were included. Criteria to be presented at MDT meetings were defined as a proven COVID-19 by PCR or strongly suspected on CT scan, requiring hospitalization and treatment not included in the standard of care. Three investigators identified the patients who met the predefined criteria and compared the treatment and outcomes of patients with predefined criteria that were presented during MDT meeting with those not presented during MDT meeting. COVID-19 MDT meeting implementation and adhesion were also assessed by a hospital medical staff survey. RESULTS: In all, 318 patients with confirmed or suspected COVID-19 were examined in our hospital. Of these, 230 (87%) were hospitalized in a COVID-19 unit, 91 (40%) of whom met predefined MDT meeting criteria. Fifty (55%) patients were presented at a MDT meeting versus 41 (45%) were not. Complementary exploration and inclusion in the CorImmuno cohort were higher in MDT meeting group (respectively 35 vs. 15%, P=0.03 and 80 versus 49%, P=0.0007). Prescription of hydrocortisone hemisuccinate was higher in group of patients not presented during MDT meeting (24 vs. 51%, P=0.007). Almost half of the patients fulfilling the inclusion criteria were not presented at MDT meeting, which can be partly explained by technical software issues. CONCLUSIONS: Multidisciplinary COVID-19 meetings helped implementing a single standard of care, avoided using treatments that were untested or currently being tested, and facilitated the inclusion of patients in prospective cohorts and therapeutic trials.

Peritoneal dialysis (PD) technique training: what features influence learning time?

BACKGROUND: Within peritoneal dialysis (PD) complications, peritonitis remains a primary challenge for the long-term success of the technique. Proper technique training is essential, since it reduces peritonitis rates, but the adequacy of training has not been standardized. Furthermore, factors influencing training duration have not been well identified. METHODS: We retrospectively analyzed all consecutive training sessions of incident PD patients in our Unit from January 2001 to December 2018. RESULTS: Our analysis included 135 patients, 25.9% were diabetic and median Charlson index (CCI) was 4 (IQR 2-6). Above 13 sessions was chosen as the cut off between usual and prolonged training, as it was our cohort's 75th percentile: 23% (31) had an extended training duration as per our study definition and 77% (104) had a usual training duration. The number of training sessions required increased with age (Spearman Rho 0.404; p = 0.000001), diabetic status (p = 0.001), unemployment status (p = 0.046) and CCI (Spearman Rho 0.369; p = 0.00001). Neither gender, cohabitation status, scheduled PD start, education level nor referral origin, were significant factors impacting training duration. Requiring longer training (> 13 sessions) was a significant risk factor for higher peritonitis risk, but extended training was not related to a shorter technique survival. CONCLUSION: Number of PD training sessions depends on the patient's age and comorbidities, but is not related to social, educational or employment status. Prolonged training duration was a statistically significant predictor of higher peritonitis risk, but it was not related to shorter permanence in PD in our series. Identifying these patients since the training period would be useful to adapt training schedule as an early prevention strategy to minimize the risk of peritonitis and plan a preemptive retraining.

Hipertensión arterial postoperatoria / Post-operative high blood pressure

La hipertensión arterial (HTA) postoperatoria se define como una elevación significativa en la presión arterial (PA) durante el postoperatorio inmediato que puede conducir a complicaciones neurológicas, cardiovasculares o quirúrgicas graves requiriendo un manejo urgente. En cirugía no cardíaca, la HTA postoperatoria es frecuente y conlleva un aumento de eventos adversos, incluyendo accidente cerebrovascular, lesión e infarto de miocardio, y hemorragia. En ciertos procedimientos, como la endarterectomía carotídea, la cirugía de aneurisma aórtico o la cirugía intracraneal, la HTA postoperatoria presenta consideraciones específicas que no están presentes en otras cirugías y puede asociarse a peores resultados neurológicos. Entre los factores de riesgo para su aparición destaca el antecedente de HTA previo a la cirugía, aunque no todos los episodios de hipertensión postoperatoria corresponden a pacientes hipertensos crónicos. En las primeras horas tras la cirugía, el dolor, la agitación, la hipoxemia o distensión vesical, entre otros factores, pueden contribuir a la aparición de HTA. Aunque no existe un claro consenso sobre los umbrales y objetivos del tratamiento antihipertensivo, este suele iniciarse cuando la PA sistólica es >180mmHg o la PA diastólica es >110mmHg, especialmente si persiste después de tratar las posibles causas subyacentes. El uso de la medicación por vía oral en el postoperatorio puede estar limitado por las circunstancias de la cirugía, pero también por el lento inicio de acción de los fármacos y la dificultad de controlar el grado de descenso de la presión. Si la administración oral de medicamentos no es factible, se recomienda usar fármacos intravenosos de acción corta. La elección del fármaco antihipertensivo dependerá de la situación clínica y las condiciones del paciente, y deberá tener en cuenta los parámetros farmacocinéticos y farmacodinámicos de los distintos agentes disponibles

Postoperative hypertension (HT) is defined as a significant rise in blood pressure (BP) during the immediate postoperative period that can lead to serious neurological, cardiovascular or surgical complications requiring urgent management. In non-cardiac surgery, HT is common and leads to an increase in adverse events, including stroke, injury and myocardial infarction, and bleeding. In certain procedures, such as carotid endarterectomy, aortic aneurysm surgery or intracranial surgery, postoperative HT has specific considerations not present in other surgeries and may be associated with worse neurological outcomes. Among the risk factors for its occurrence is the history of hypertension prior to surgery, although not all episodes of postoperative hypertension correspond to chronic hypertensive patients. In the first hours after surgery, pain, agitation, hypoxemia or bladder distension, among other factors, may contribute to the appearance of hypertension. Although there is no clear consensus on the thresholds and goals of antihypertensive therapy, it is usually initiated when the systolic BP is >180mmHg or the diastolic BP is >110mmHg, especially if it persists after treating possible underlying causes. The use of oral medication in the postoperative period may be limited by the circumstances of the surgery, but also by the slow onset of action of the drugs and the difficulty of controlling the degree of pressure drop. If oral administration of medication is not feasible, we recommend the use of short-acting intravenous drugs. The choice of antihypertensive drug will depend on the clinical situation and conditions of the patient, and should take into account the pharmacokinetic and pharmacodynamic parameters of the different agents available

Dabigatrán en pacientes con lesión miocárdica después de cirugía no cardiaca. A propósito del estudio MANAGE / Dabigatran in patients with myocardial injury after non-cardiac surgery. Report on the MANAGE trial

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Informe especial: Transmisión vertical de Chagas: situación epidemiológica de Chagas en embarazo y Chagas congénito en la maternidad Sardá: Primer semestre de 2018 / Special report: Vertical transmission of Chagas: epidemiological situation of Chagas in pregnancy and congenital Chagas in Sardá Maternity: first semester of 2018

Hasta la Semana Epidemiológica 36 de 2018 se notificaron en la Ciudad de Buenos Aires 104 casos de Chagas congénito, de los cuales se confirmaron 6 (5,8%), se descartaron 6 y el 88% restante aún no cuenta con el cierre de caso. Las comunas del sur de la Ciudad acumulan el 56% de los casos. Durante el primer semestre de 2018 se diagnosticaron en la Maternidad Sardá 67 mujeres con Chagas en el embarazo, de un total de 2972 partos realizados en la institución en ese periodo, lo que representa una prevalencia de 22,54 por cada mil embarazadas En este informe se busca describir la situación de la transmisión vertical de la enfermedad de Chagas en el primer semestre de 2018, entre SE 1 y 26; describir la modalidad de notificación de los casos por la Unidad de Promoción y Protección de la Salud (P y P); y reforzar la importancia de la notificación de Enfermedades de Notificación Obligatoria debido a su relevancia en la Salud Pública. Se presentan los casos de Chagas en embarazo por grupo etario, y según provincia de residencia, y se detallan propuestas para la optimización de resultados.

Intensive care admission and hospital mortality in the elderly after non-cardiac surgery / Ingreso en cuidados intensivos y mortalidad hospitalaria en pacientes de edad avanzada tras cirugía no cardiaca

OBJECTIVE: To assess whether patient age is independently associated to Intensive Care Unit (ICU) admission after non-cardiac surgery. DESIGN: An observational cohort study of the Spanish subset of the European Surgical Outcome Study (EuSOS) was carried out. SETTING: Hospitals of the public National Health Care System and private hospitals in Spain. Intervention: None. PATIENTS AND METHODS: All patients over 16 years of age undergoing inpatient non-cardiac surgery in the participating hospitals during a 7-day period in the month of April 2011 were consecutively included. Main variables of interest: ICU admission rate, factors associated with ICU admission and hospital mortality were assessed using logistic regression analysis and fractional polynomial regression. RESULTS: Out of 5412 patients, 677 (12.5%) were admitted to the ICU after surgery. The adjusted odds ratio (95% confidence interval [CI]) for ICU admission was 1.1 (0.8-1.4) for patients aged 65-74 years, 0.7 (0.5-1) for patients aged 75-85 years, and 0.4 (0.2-0.8) for patients over 85 years, respectively. Age, ASA score, grade of surgery (minor, intermediate, major), urgent surgery, surgical specialty, laparoscopic surgery and metastatic disease were independent factors for ICU admission. Global risk-adjusted mortality was 1.4 (95% CI 0.9-2.2). The ASA score, urgent surgery, surgical specialty and diabetes were predictors of hospital mortality. CONCLUSIONS: Elderly patients (over 80 years) appear less likely to be admitted to ICU after non-cardiac surgery in Spanish hospitals. There was no significant association between age and postoperative mortality in this cohort

OBJETIVO: Evaluar si la edad del paciente se asociaba independientemente con el ingreso en la unidad de cuidados intensivos (UCI) tras cirugía no cardiaca. DISEÑO: Estudio observacional de cohortes del subgrupo español del European Surgical Outcome Study (EuSOS). Ámbito: Hospitales públicos y privados en España. Intervención: Ninguna. PACIENTES Y MÉTODOS: Pacientes consecutivos mayores de 16 años sometidos a cirugía no cardiaca con ingreso durante un periodo de 7 días del mes de abril de 2011. Variables de interés principal: Tasa de ingreso en la UCI, factores asociados con ingreso en la UCI y mortalidad hospitalaria, analizadas mediante regresión logística y regresión fraccional polinómica. RESULTADOS: De 5.412 pacientes, 677 (12,5%) fueron ingresados en la UCI tras la cirugía. La odds ratio ajustada (intervalo de confianza [IC] del 95%) de ingreso en la UCI fue de 1,1 (0,8-1,4) para 65-74 años, 0,7 (0,5-1) para 75-85 años y de 0,4 (0,2-0,8) para más de 85 años, respectivamente. La edad, el grado ASA, el grado de la cirugía (menor, intermedia, mayor), la cirugía urgente, la especialidad quirúrgica, la cirugía laparoscópica y la enfermedad metastásica fueron factores independientes de ingreso en la UCI. El riesgo global ajustado de mortalidad fue de 1,4 (IC 95%: 0,9-2,2). El grado ASA, cirugía urgente, especialidad quirúrgica y diabetes fueron predictores de mortalidad hospitalaria. CONCLUSIONES: En los hospitales españoles, los pacientes ancianos (más de 80 años) son menos propensos a ser ingresados en la UCI tras cirugía no cardiaca. En esta cohorte, la edad y la mortalidad hospitalaria no se asociaron significativamente

Comparing dietary and non-dietary source contribution of BPA and DEHP to prenatal exposure: A Catalonia (Spain) case study.

Bisphenol A (BPA) and Di-(2-ethylhexyl) phthalate (DEHP) are two wide spread chemicals classified as endocrine disruptors (ED). The present study aims to estimate the non-dietary (dermal, non-dietary ingestion and inhalation) exposure to BPA and DEHP for a pregnant women cohort. In addition, to assess the prenatal exposure for the fetus, a physiologically based pharmacokinetic (PBPK) model was used. It was adapted for pregnancy in order to assess the internal dosimetry levels of EDs (BPA and DEHP) in the fetus. Estimates of exposure to BPA and DEHP from all pathways along with their relative importance were provided in order to establish which proportion of the total exposure came from diet and which came from non-dietary exposures. In this study, the different oral dosing scenarios (dietary and non-dietary) were considered keeping inhalation as a continuous exposure case. Total non-dietary mean values were 0.002 µg/kgbw/day (0.000; 0.004 µg/kgbw/day for 5th and 95th percentile, respectively) for BPA and 0.597 µg/kgbw/day (0.116 µg/kgbw/day and 1.506 µg/kgbw/day for 5th and 95th percentile, respectively) for DEHP. Indoor environments and especially dust ingestion were the main non-dietary contributors to the total exposure of BPA and DEHP with 60% and 81%. However, as expected, diet showed the higher contribution to total exposure with > 99.9% for BPA and 63% for DEHP. Although diet was considered the primary source of exposure to BPA and phthalates, it must be taken into account that with non-dietary sources the first-pass metabolism is lacking, so these may be of equal or even higher toxicological relevance than dietary sources. The present study is in the framework of "Health and environmental-wide associations based on large population surveys" (HEALS) project (FP7-603946).

Intensive care admission and hospital mortality in the elderly after non-cardiac surgery.

OBJECTIVE: To assess whether patient age is independently associated to Intensive Care Unit (ICU) admission after non-cardiac surgery. DESIGN: An observational cohort study of the Spanish subset of the European Surgical Outcome Study (EuSOS) was carried out. SETTING: Hospitals of the public National Health Care System and private hospitals in Spain. INTERVENTION: None. PATIENTS AND METHODS: All patients over 16 years of age undergoing inpatient non-cardiac surgery in the participating hospitals during a 7-day period in the month of April 2011 were consecutively included. MAIN VARIABLES OF INTEREST: ICU admission rate, factors associated with ICU admission and hospital mortality were assessed using logistic regression analysis and fractional polynomial regression. RESULTS: Out of 5412 patients, 677 (12.5%) were admitted to the ICU after surgery. The adjusted odds ratio (95% confidence interval [CI]) for ICU admission was 1.1 (0.8-1.4) for patients aged 65-74 years, 0.7 (0.5-1) for patients aged 75-85 years, and 0.4 (0.2-0.8) for patients over 85 years, respectively. Age, ASA score, grade of surgery (minor, intermediate, major), urgent surgery, surgical specialty, laparoscopic surgery and metastatic disease were independent factors for ICU admission. Global risk-adjusted mortality was 1.4 (95% CI 0.9-2.2). The ASA score, urgent surgery, surgical specialty and diabetes were predictors of hospital mortality. CONCLUSIONS: Elderly patients (over 80 years) appear less likely to be admitted to ICU after non-cardiac surgery in Spanish hospitals. There was no significant association between age and postoperative mortality in this cohort.

Electron-Pair Distribution in Chemical Bond Formation.

The chemical formation process has been studied from relaxation holes, Δh(u), resulting from the difference between the radial intracule density and the nonrelaxed counterpart, which is obtained from atomic radial intracule densities and the pair density constructed from the overlap of the atomic densities. Δh(u) plots show that the internal reorganization of electron pairs prior to bond formation and the covalent bond formation from electrons in separate atoms are completely recognizable processes from the shape of the relaxation hole, Δh(u). The magnitude of Δh(u), the shape of Δh(u) ∀ u < Req, and the distance between the minimum and the maximum in Δh(u) provide further information about the nature of the chemical bond formed. A computational affordable approach to calculate the radial intracule density from approximate pair densities has been also suggested, paving the way to study electron-pair distributions in larger systems.

Salivary scintigraphy for Sjögren's syndrome in patients with xerostomia: A retrospective study.

OBJECTIVES: The value of salivary gland scintigraphy in the diagnosis of Sjögren's syndrome remains controversial. The primary aim of this study was to estimate the diagnostic accuracy of salivary gland scintigraphy in the diagnosis of Sjögren's syndrome among 237 patients with xerostomia. METHODS: We retrospectively compared eight scintigraphy parameters between 106 Sjögren patients and 131 non-Sjögren patients. RESULTS: Seven of the eight parameters were significantly decreased in patients with Sjögren; however, their diagnostic accuracy was low, with areas under the curves (AUCs) ranging from 0.58 (95% CI 0.50-0.65) to 0.63 (95% CI: 0.55-0.70). The prestimulatory oral activity index allowed discrimination between primary and secondary Sjögren's syndrome (AUC 0.73, 95% CI: 0.62-0.84), and the secretion velocity for parotid glands allowed discrimination between patients with Sjögren and burning mouth syndrome (AUC 0.71, 95% CI 0.59-0.82). CONCLUSION: The accuracy of scintigraphy parameters for the diagnosis of Sjögren's syndrome among patients with xerostomia was low; however, some functional indices appeared to assist discrimination between primary and secondary SS patients and between subgroups of patients with different causes of xerostomia.

Prenatal exposure estimation of BPA and DEHP using integrated external and internal dosimetry: A case study.

Prenatal exposure to Endocrine disruptors (EDs), such as Bisphenol A (BPA) and di (2-ethylhexyl) phthalate (DEHP), has been associated with obesity and diabetes diseases in childhood, as well as reproductive, behavioral and neurodevelopment problems. The aim of this study was to estimate the prenatal exposure to BPA and DEHP through food consumption for pregnant women living in Tarragona County (Spain). Probabilistic calculations of prenatal exposure were estimated by integrated external and internal dosimetry modelling, physiologically based pharmacokinetic (PBPK) model, using a Monte-Carlo simulation. Physical characteristic data from the cohort, along with food intake information from the questionnaires (concentrations of BPA and DEHP in different food categories and the range of the different food ratios), were used to estimate the value of the total dietary intake for the Tarragona pregnancy cohort. The major contributors to the total dietary intake of BPA were canned fruits and vegetables, followed by canned meat and meat products. In turn, milk and dairy products, followed by ready to eat food (including canned dinners), were the most important contributors to the total dietary intake of DEHP. Despite the dietary variations among the participants, the intakes of both chemicals were considerably lower than their respective current tolerable daily intake (TDI) values established by the European Food Safety Authority (EFSA). Internal dosimetry estimates suggest that the plasma concentrations of free BPA and the most important DEHP metabolite, mono (2-ethylhexyl) phthalate (MEHP), in pregnant women were characterized by transient peaks (associated with meals) and short half-lives (< 2h). In contrast, fetal exposure was characterized by a low and sustained basal BPA and MEHP concentration due to a lack of metabolic activity in the fetus. Therefore, EDs may have a greater effect on developing organs in young children or in the unborn child.

[Scabies of the nail unit in an infant]. / Scabiose de l'appareil unguéal chez un nourrisson.

BACKGROUND: There are no guidelines regarding the management of scabies in infants and recurrence is common at this age. We report the case of an infant with subungual hyperkeratosis and ungual lesions subsequent to classic scabies. PATIENTS AND METHODS: A 7-month-girl, treated 6 weeks earlier with esdepallethrin for scabies, consulted for acquired lesions on 3 toe nails. These nails were thickened and displayed subungual hyperkeratosis. Physical examination of the skin, the finger nails and mucous membranes was otherwise normal. Fungal analyses were negative, but direct microscopic examination revealed numerous larvae of Sarcoptes scabiei as well as ovular debris. The child was treated with urea 40% to obtain chemical avulsion of the nails, and with topical esdepallethrin and a quarter tablet of ivermectin orally; there was no follow-up of the child. DISCUSSION: Ungual scabies has already been reported in crusted scabies and very rarely in classic scabies. Subungual and ungual locations of S. scabiei may constitute a source of reinfestation with scabies in infants. Treatment is not well defined and currently involves chemical avulsion of the nails and the application of topical antiscabies treatment.