The effect of synthesis conditions and process parameters on aerogel properties.

Aerogels are remarkable nanoporous materials with unique properties such as low density, high porosity, high specific surface area, and interconnected pore networks. In addition, their ability to be synthesized from various precursors such as inorganics, organics, or hybrid, and the tunability of their properties make them very attractive for many applications such as adsorption, thermal insulation, catalysts, tissue engineering, and drug delivery. The physical and chemical properties and pore structure of aerogels are crucial in determining their application areas. Moreover, it is possible to tailor the aerogel properties to meet the specific requirements of each application. This review presents a comprehensive review of synthesis conditions and process parameters in tailoring aerogel properties. The effective parameters from the dissolution of the precursor step to the supercritical drying step, including the carbonization process for carbon aerogels, are investigated from the studies reported in the literature.

Hybrid Methacrylated Gelatin and Hyaluronic Acid Hydrogel Scaffolds. Preparation and Systematic Characterization for Prospective Tissue Engineering Applications.

Hyaluronic acid (HA) and gelatin (Gel) are major components of the extracellular matrix of different tissues, and thus are largely appealing for the construction of hybrid hydrogels to combine the favorable characteristics of each biopolymer, such as the gel adhesiveness of Gel and the better mechanical strength of HA, respectively. However, despite previous studies conducted so far, the relationship between composition and scaffold structure and physico-chemical properties has not been completely and systematically established. In this work, pure and hybrid hydrogels of methacroyl-modified HA (HAMA) and Gel (GelMA) were prepared by UV photopolymerization and an extensive characterization was done to elucidate such correlations. Methacrylation degrees of ca. 40% and 11% for GelMA and HAMA, respectively, were obtained, which allows to improve the hydrogels' mechanical properties. Hybrid GelMA/HAMA hydrogels were stiffer, with elastic modulus up to ca. 30 kPa, and porous (up to 91%) compared with pure GelMA ones at similar GelMA concentrations thanks to the interaction between HAMA and GelMA chains in the polymeric matrix. The progressive presence of HAMA gave rise to scaffolds with more disorganized, stiffer, and less porous structures owing to the net increase of mass in the hydrogel compositions. HAMA also made hybrid hydrogels more swellable and resistant to collagenase biodegradation. Hence, the suitable choice of polymeric composition allows to regulate the hydrogels´ physical properties to look for the most optimal characteristics required for the intended tissue engineering application.

Fetal cardiac function at 35-37 weeks' gestation in pregnancies that subsequently develop pre-eclampsia.

OBJECTIVE: To compare fetal cardiac morphology and function between pregnancies that subsequently developed pre-eclampsia (PE) and those that remained normotensive. METHODS: This was a prospective observational study in 1574 pregnancies at 35-37 weeks' gestation, including 76 that subsequently developed PE. We carried out comprehensive assessment of fetal cardiac morphology and function including novel imaging modalities, such as speckle-tracking echocardiography, and measured uterine artery pulsatility index, mean arterial pressure (MAP), serum placental growth factor (PlGF), soluble fms-like tyrosine kinase-1 (sFlt-1) and cerebroplacental ratio (CPR). The findings in the group that subsequently developed PE were compared to those in pregnancies that remained normotensive. RESULTS: In fetuses of mothers who subsequently developed PE, compared to those from normotensive pregnancies, there was a more globular right ventricle, as shown by reduced right ventricular sphericity index, reduced right ventricular systolic contractility, as shown by reduced global longitudinal strain, and reduced left ventricular diastolic function, as shown by increased E/A ratio. On multivariable regression analysis, these indices demonstrated an association with PE, independent of maternal characteristics and fetal size. In pregnancies that subsequently developed PE, compared to those that remained normotensive, MAP, sFlt-1 and the incidence of low birth weight were higher, whereas serum PlGF, CPR and the interval between assessment and delivery were lower. These findings demonstrate that, in pregnancies that develop PE, there is evidence of impaired placentation, reflected in low PlGF and reduced birth weight, placental ischemia, evidenced by increased sFlt-1 which becomes apparent in the interval of 2-4 weeks preceding the clinical onset of PE, and consequent fetal hypoxia-induced redistribution in the fetal circulation, reflected in the low CPR. CONCLUSION: Although the etiology of the observed fetal cardiac changes in pregnancies that subsequently develop PE remains unclear, it is possible that the reduction in right-heart systolic function is the consequence of high afterload due to increased placental resistance, whilst the early left ventricular diastolic changes could be due to fetal hypoxia-induced redistribution in the fetal circulation. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.

Revisión de las miopatías inflamatorias a propósito de 3 casos en unidades de recuperación funcional de hospitales de media estancia / Review of inflamatory myopathies based on 3 cases in functional recovery units in long-term care hospitals

Las miopatías inflamatorias idiopáticas son un grupo heterogéneo de enfermedades sistémicas de etiopatogenia autoinmune. Se caracterizan por debilidad muscular, alteraciones miopáticas en el electromiograma y elevación de las enzimas musculares. Pueden darse de forma aislada, o asociarse a otras enfermedades autoinmunes o a neoplasias. Realizamos una aproximación a estos procesos a propósito de 3 pacientes tratados en Unidades de Recuperación Funcional de 2 hospitales de media estancia. En todos se produce debilidad muscular bilateral y simétrica de predominio en cinturas, con grave repercusión funcional. Por este motivo precisan realizar tratamiento en régimen de ingreso hospitalario. El objetivo terapéutico es doble: por un lado, frenar de forma urgente la actividad autoinmune para evitar el daño muscular progresivo y, por el otro, instaurar un tratamiento rehabilitador de forma precoz que minimice el deterioro funcional. En todos los casos se obtiene beneficio de la intervención, ya que permite la vuelta al domicilio con distintos grados de independencia (AU)

Idiopathic inflammatory myopathies are a heterogeneous group of systemic autoimmune diseases characterised by bilateral and symmetric muscle weakness, myopathic alterations on electromyography and elevated muscle enzymes. They can be associated with other autoimmune diseases or neoplastic processes. We provide a review of these processes based on 3 patients in the Functional Recovery Units of 2 long-term care hospitals. All 3 patients had bilateral and symmetrical muscle weakness, predominantly in the waist, with severe functional impairment. Consequently, these patients required hospital admission. The goal of rehabilitation is twofold: on the one hand, to urgently halt the autoimmune activity in order to avoid further muscle damage, and, on the other hand, to start early rehabilitation treatment to minimise functional impairment. All 3 patients benefited from the intervention, allowing discharge to home, with varying degrees of independence (AU)

Polysaccharide-based aerogel microspheres for oral drug delivery.

Polysaccharide-based aerogels in the form of microspheres were investigated as carriers of poorly water soluble drugs for oral administration. These bio-based carriers may combine the biocompatibility of polysaccharides and the enhanced drug loading capacity of dry aerogels. Aerogel microspheres from starch, pectin and alginate were loaded with ketoprofen (anti-inflammatory drug) and benzoic acid (used in the management of urea cycle disorders) via supercritical CO2-assisted adsorption. Amount of drug loaded depended on the aerogel matrix structure and composition and reached values up to 1.0×10(-3) and 1.7×10(-3) g/m(2) for ketoprofen and benzoic acid in starch microspheres. After impregnation, drugs were in the amorphous state in the aerogel microspheres. Release behavior was evaluated in different pH media (pH 1.2 and 6.8). Controlled drug release from pectin and alginate aerogel microspheres fitted Gallagher-Corrigan release model (R(2)>0.99 in both cases), with different relative contribution of erosion and diffusion mechanisms depending on the matrix composition. Release from starch aerogel microspheres was driven by dissolution, fitting the first-order kinetics due to the rigid starch aerogel structure, and showed different release rate constant (k1) depending on the drug (0.075 and 0.160 min(-1) for ketoprofen and benzoic acid, respectively). Overall, the results point out the possibilities of tuning drug loading and release by carefully choosing the polysaccharide used to prepare the aerogels.

Hacia un mejor manejo de la insuficiencia cardiaca: papel de las unidades multidisciplinares y de la colaboración ntre niveles asistenciales en la continuidad de la asistencia: experiencia en el noroeste de Madrid / No disponible

No disponible

[Complete response in a patient with a metastatic cutaneous melanoma]. / Respuesta completa tras tratamiento con bioquimioterapia en un caso de melanoma cutáneo diseminado.

BACKGROUND: The management of patients with disseminated disease is a difficult problem. There is currently no consensus on the standard first-line treatment for metastatic melanoma. We present a case because of his exceptional evolution. RESULTS: A 43 year old male diagnosed in 1999 with malignant melanoma stage IIA. In May 2000 hepatic and splenic metastases were detected. He received 6 cycles of biochemotherapy (cisplatin and DTIC, plus interleukin-2 and interferon-α) and another 6 cycles with single immunotherapy (interleukin-2 and interferon-α). Today, the patient is still alive and without evidence of disease. CONCLUSION: Metastatic cutaneous melanoma, sometimes presents an unusual, favourable evolution. In the near future, the methods of detection of molecular markers are expected to identify factors involved in this type of response. Furthermore, new targeted therapies may become essential to maintain this positive trend.

Respuesta completa tras tratamiento con bioquimioterapia en un caso de melanoma cutáneo diseminado / Complete response in a patient with a metastatic cutaneous melanoma

Fundamento. El pronóstico del melanoma diseminadoes muy sombrío. Actualmente no hay consensosobre el tratamiento estándar en primera línea parael melanoma metastático. Se presenta un caso por sucomportamiento excepcional.Resultados. Varón de 43 años diagnosticado en1999 de melanoma maligno estadio IIA. En mayo de2000 se objetivaron metástasis hepáticas y esplénicas.Recibió 6 ciclos de bioquimioterapia (cisplatino y DTICjunto con interleukina-2 e interferón-α) cada 21 días yotros 6 ciclos con inmunoterapia sola (interleukina-2 einterferón-α). Actualmente el paciente sigue vivo y sinevidencia de enfermedad.Conclusión. El melanoma cutáneo metastático, enocasiones, presenta una inusual evolución favorable. Esde esperar que los métodos de detección de marcadoresmoleculares logren determinar factores implicadosen este tipo de respuesta y que los nuevos tratamientosdirigidos consigan mantener esta tendencia positiva (AU)

Background. The management of patients withdisseminated disease is a difficult problem. Thereis currently no consensus on the standard first-linetreatment for metastatic melanoma. We present a casebecause of his exceptional evolution.Results. A 43 year old male diagnosed in 1999with malignant melanoma stage IIA. In May 2000, hepaticand splenic metastases were detected. He received6 cycles of biochemotherapy (cisplatin andDTIC, plus interleukin-2 and interferon-α) and another6 cycles with single immunotherapy (interleukin-2and interferon-α). Today, the patient is still alive andwithout evidence of disease.Conclusion. Metastatic cutaneous melanoma, sometimes,presents and unusual and favourable evolution. Inthe near future, the methods of detection of molecularmarkers are expected to identify factors involved in thistype of response. Furthermore, new targeted therapiesmay become essential to maintain this positive trend (AU)

Resultados de un programa de prevención de exposiciones accidentales a fluidos biológicos en personal sanitario basado en la mejora del grado de cumplimiento de las precauciones estándar / Results of a program of prevention of accidental exposure to biological fluids in healthcare workers based on the improvement of the compliance of Standard Precautions

Objetivo: Evaluar un programa de prevención de exposiciones accidentales a fluidos biológicos basado en la mejora del grado de cumplimiento (GC) de las Precauciones Estándar (PE). Material y métodos: Intervenciones: primera (realización sesiones de actualización y reparto de trípticos informativos), y segunda (reparto de trípticos). Indicadores: Nivel de Conocimientos (NC), medido con un cuestionario de cinco preguntas, se consideró inadecuado cuando se fallaban tres o más preguntas; GC de PE medido en cuatro áreas (Higiene Manos -HM-, utilización de guantes -UG-, utilización adecuada métodos barrera -UAMB- y manejo adecuado objetos cortantes -MAOC-; Incidencia de inoculaciones y de exposiciones de mucosas a fluidos corporales. Resultados. La frecuencia de cuestionarios inadecuados paso del 54,6% al 23,3%(<0.001). La frecuencia HM pasó del 53,5% al 58,2%(<0,01), la UG del 78,7% al 84,6%(0,058), el UAMB del 53,8% al 55.5%(N.S.) y el MAOC del 52,9% al 54,0%(N.S.). La Incidencia inoculaciones paso del 5,53% al 4,98%(N.S.) y las exposiciones de mucosas del 0,95% al 0,81%(N.S.). Conclusiones: El programa ha mejorado los conocimientos del personal sobre PE, y el GC de PE y ha disminuido la incidencia exposiciones accidentales a fluidos biológicos aunque no de manera estadísticamente significativa (AU)

Introduction: The aim is to evaluate a program of prevention of accidental exposure to biological fluids based on the improvement of the compliance to Standard Precautions (SP). Methods: Interventions: first (update sessions and distributing pamphlets), and second (distributing pamphlets). Indicators: Level of knowledge (LK), measured with a 5-item questionnaire, with three or more incorrect answers considered inadequate; Compliance to SP measured in four areas (Hand Hygiene Hands -HH-, utilization of gloves - GU-, suitable utilization methods barrier - SUMB - and suitable managing cutting objects - SMCO-; Incident of percutaneus injuries and of exposure of mucous to corporal fluids. Results: The frequency of inadequate questionnaires I happen from 54,6 % to 23,3 % (<0.001). The frequency HH happened from 53,5 % to 58,2 % (<0,01), the GU of 78,7 % to 84,6 % (0,058), the SUMB of 53,8 % to 55.5 % (N.S.) and the SMCO of 52,9 % to 54,0 % (N.S.). The Incident percutaneus injuries from 5,53 % to 4,98 % (N.S.) and the exposure of mucous from 0,95 % to 0,81 % (N.S.). Conclusion: The program has improved in the knowledge of the personnel on SP, and has improved SP compliance and the Incident has diminished accidental exhibitions to biological fluids though not in a statistically significant way (AU)

Production of hybrid lipid-based particles loaded with inorganic nanoparticles and active compounds for prolonged topical release.

The production of particulate hybrid carriers containing a glyceryl monostearate (Lumulse GMS-K), a waxy triglyceride (Cutina HR), silanized TiO(2) and caffeine were investigated with the aim of producing sunscreens with UV-radiation protection properties. Particles were obtained using the supercritical PGSS (Particles from Gas Saturated Solutions) technique. This method takes advantages of the lower melting temperatures of the lipids obtained from the dissolution of CO(2) in the bulk mixture. Experiments were performed at 13 MPa and 345 K, according to previous melting point measurements. Blends containing Lumulse GMS-K and Cutina HR lipids (50 wt%) were loaded with silanized TiO(2) and caffeine in percentile proportions of 6 and 4 wt%, respectively. The particles produced were characterized using several analytical techniques as follows: system crystallinity was checked by X-ray diffraction and differential scanning calorimetry, thermal stability by thermogravimetric analysis, and morphology by scanning and transmission electron microscopy. Further, the UV-shielding ability of TiO(2) after its dispersion in the lipidic matrix was assessed by solid UV-vis spectroscopy. Preliminary results indicated that caffeine-loaded solid lipid particles presented a two-step dissolution profile, with an initial burst of 60 wt% of the loaded active agent. Lipid blends loaded with TiO(2) and caffeine encompassed the UV-filter behavior of TiO(2) and the photoaging prevention properties of caffeine.

Nefrostomía: diseño e implantaciónde una guía de cuidados al alta / No disponible

Los pacientes a los que se realiza una nefrostomía, cada vez permanecen ingresados menos tiempo en el hospital. Esto nos llevó al equipode enfermería de nuestra unidad a la elaboración de una guía que facilite la adaptación a la situación que se plantea a las personasportadoras de una nefrostomía, que garantice la continuidad de los cuidados en el domicilio y por el equipo de Atención Primaria (AU)

The patients to whom a nefrostomy is carried out, every time remain admitted less time in the hospital. This took us to the nursingequipment of our Unit to the elaboration of a guide that facilitates the adaptation to the situation that it is suggested to the peoplecarry a nefrostomy, that guarantee the continuity of the cares in the residence and for the team of Primary Care (AU)

Application of principal component analysis to the thermal characterization of silanized nanoparticles obtained at supercritical carbon dioxide conditions.

Samples resulting from reaction of TiO(2) with octyltriethoxysilane, developed using a supercritical carbon dioxide procedure, have been studied by infrared and Raman spectroscopies and thermogravimetric analysis. Different reaction conditions have been applied to the preparation of samples in order to study the influence of experimental factors on the sample properties. Vibrational techniques have first been used to verify the presence of silanized structures on the surface of TiO(2) through the detection of specific bands characteristic of the Si-O-Si cross-linking. Thermogravimetric profiles consisting of weight loss values as a function of temperature have been analyzed by principal component analysis to extract information about the characteristics of the linkage between silane and TiO(2) as well as the thermal stability of the prepared materials. The mathematical treatment of data has provided conclusions on the properties of the samples and analogies and differences with respect to the commercial material.

Composite fibrous biomaterials for tissue engineering obtained using a supercritical CO2 antisolvent process.

Several techniques have been proposed for producing porous structures or scaffolds for tissue engineering but, as yet, with no optimal solution. With regard to this topic, this paper focuses on the preparation of biocompatible nanometric filler-polymer composites organized in a network of fibers. Titanium dioxide (TiO2) or hydroxyapatite (HAP) nanopowders as the guest particles and poly(lactic acid) (L-PLA) or the blend poly(methylmethacrylate)/poly(epsilon-caprolactone) (PMMA/PCL) as the polymer carrier were selected as model systems for this purpose. A supercritical antisolvent technique was used to produce the composites. In the process developed, the non-soluble particulate filler was suspended in a polymer solution, and both components were sprayed simultaneously into supercritical carbon dioxide (scCO2). Using this technique, polymeric matrices were loaded with approximately 10-20 wt.% of inorganic phase distributed throughout the composite. Two different hybrid materials were prepared: a PMMA/PCL+TiO2 system where either fibers or microparticles were prepared by varying the molecular weight of the used PMMA; and fibers in the case of L-PLA+HAP system. After further post-processing in a three-dimensional network, these nanofibers can potentially be used as scaffolds for tissue engineering.

Efectividad de un programa de control de la infección nosocomial en un hospital de media estancia / No disponible

Objetivo: Evaluar la efectividad de un programa de control de la infección nosocomial en el Hospital de Guadarrama de Madrid. Material y método: Estudio observacional prospectivo antes-después con intervención durante los años 2002-2006. Monitorización de la incidencia de infección nosocomial en seis cohartes de pacientes de tres Unidades de hospitalización. Monitorización de la calidad de los cuidados prestados mediante realización de audits de enfermería semestrales durante todo el período de estudio. Evaluación del cumplimiento de las recomendaciones de higiene de manos mediante el consumo de solución alcohólica. Resultados: Se estudiaron 284 pacientes antes y 401 después de la intervención. La incidencia de infección disminuyó tras la intervención. Se realizaron un total de diez audits de enfermería a lo largo de los cinco años. Se incluyeron 580 pacientes y se evaluaron 1.406 cuidados. El cumplimiento global con los estándares de cuidados al inicio del estudio fue de 73% y de 83% al final del estudio. El consumo de solución alcohólica fue de 2 ml/estancia en el 2002 y de 20 ml/estancia en el 2006 (p<0,05). Conclusiones: La puesta en marcha de un programa de control de la infección nosocomial adaptado al tipo de pacientes y las características del hospital ha mostrado ser una herramienta eficaz para la mejora del cumplimiento de las recomendaciones de cuidados y de la higiene de manos y en la disminución del riesgo de infección nosocomial (AU)

Objective: Evaluate the effectiveness of an infection control program in the Hospital de Guadarrama, Madrid. Methods: In 2002.-2006 an observational prospective study before and after intervention was carried out. Incidence of Nosocomial infection in six cohorts of hospitalized patients in three Units was analysed. The quality of care provided by nurses to hospitalized patients was assessed through biannual audits. Compliance with hand hygiene was measured with the consumption of alcohol based handrub solution. Results: 284 patients before and 401 after the intervention were compared. Nosocomial Infection rates decreased after intervention. Ten audits were done in total during the five years of the study. 580 patients and 1406 observations were evaluated. Global compliance with protocols of care was 73% before and 83% after intervention. The consumption of alcohol-based handrub solution increased from 2 to 20 mL per patient-day between 2002 and 2006 (p<0.05). Conclusions: Introduction of an infection control program and adaptation to the patient hospitalized in a non-acute hospital produced a sustained improvement in compliance with protocols and hand hygiene, and reduction of nosocomial infections (AU)

Leucemia aguda mieloblástica en gestante de 28 semanas / Acute myeloblastic leukemia in a 28-week pregnant woman

La leucemia aguda es un proceso poco frecuente durante la gestación. Es un problema multidisciplinario que precisa la participación de obstetras, hematólogos, pediatras y la familia, para tomas las decisiones adecuadas tanto para la madre como para el feto. Las pautas de tratamiento con quimioterapia no se modifican durante el embarazo, y las tasas de supervivencia son similares a las de la población general. Pero dependiendo del momento de la gestación es preciso tomar decisiones sobre el bienestar fetal. Presentamos un caso de una gestación de 28 semanas con leucemia aguda mieloblástica de mal pronóstico, con buena evolución materna y fetal tras la administración de quimioterapia durante la gestación (AU)

Acute leukemia is very rare during pregnancy. This process requires a multidisciplinary approach, with the participation of obstetricians, hematologists, pediatricians, and the family in order to make correct decisions for both the mother and the fetus. Treatment guidelines on chemotherapy are not modified during pregnancy and survival rates are similar to those among the general population. However, depending on the stage of pregnancy, decisions must be taken on fetal well-being. We present the case of a 28-weekpregnant woman with acute myeloblastic leukemia and poor prognosis. After chemotherapy administration during pregnancy, good maternal and fetal outcomes were obtained (AU)

Medidas preventivas en la plagiocefalia postural / Preventive measures in positional plagiocephaly

Objetivo. Describir las medidas preventivasde la plagiocefalia postural. Estrategia de búsqueda. Se ha revisado la base de datos Medline hasta septiembre de 2007, que se completó con una búsqueda en la biblioteca Cochrane, en otras bases de datos y revisando las citas bibliográficas de los artículos seleccionados.Selección de estudios y datos. No se encontró ningún ensayo clínico aleatorizado que valorase la efectividad de las medidas preventivas. Se localizaron tres estudios de cohorte prospectivo y uno de caso-control, junto con diversos estudios epidemiológicos menos específicos y una guía general de práctica clínica de las plagiocefalias. Síntesis de resultados y conclusiones. La evidencia científica de las medidas preventivas es escasa, basada exclusivamente en artículos recientes relacionados con la historia natural, los factores de riesgo y las consecuencias a largo plazo. Se recogen las medidas preventivas divididas en prevención primaria,dirigidas al niño sano, y medidas de prevención secundaria, para el niño con deformidad craneal y/o preferencia postural o tortícolis. Se destacan como aspectos más importantes que los principales factores de riesgo son posnatales/medioambientales, que las medidas preventivas deben adoptarse de forma precoz (en particular en las primeras 6 semanas de vida) y que la actuación preventiva debe ser enérgica, con elempleo de medidas posturales, y cuando estén indicadosejercicios cervicales y estimulación del desarrollo motor

Objective. To describe the preventive measuresof the positional or deformational plagiocephaly.Search strategy. We reviewed the Medline database up toSeptember 2007, completing this with a search in the Cochrane Library, in other databases and reviewed the articles selected.Study and data selection. No randomized clinical trials that evaluated the effectiveness of the preventive measures were found. Three prospective cohort studies and 1 case-control study were found together with other less specific epidemiological studies and 1 general clinical practice guideline on plagiocephaly.Synthesis of results and conclusions. Scientific evidence of preventive measures is scarce, only based on recent reports related to natural history, risk factors and long-term outcome. We propose a series of preventive measures, aimed at the healthy child and secondary preventive ones, for the child with cranial deformation and/or positional preference or torticollis. The more important aspects outlined are that the main risk factors are postnatal/environmental ones; thepreventive measures must be adopted as soon as possible, especially during the first 6 weeks of life; and the preventive performance must be energetic, with the employment of positional therapy, together with cervical exercises and motor developmental achievements stimulating when it is indicated

Evaluación de un programa de actualización de las recomendaciones sobre la higiene de manos / Evaluation of a program for updating recommendations about hand hygiene

Introducción. La higiene de manos (HM) es la medida más importante para prevenir las infecciones nosocomiales. El objetivo es evaluar el programa de actualización de las recomendaciones sobre HM implantado. Material y métodos. Intervenciones: marzo-octubre/2005 se realizaron sesiones de actualización sobre cuándo y cómo realizar la HM y mayo/2006 se repartió un tríptico explicativo a todos los trabajadores informando del grado de cumplimiento de las recomendaciones. Indicadores: nivel conocimientos (NC) medido con un cuestionario de cinco preguntas que se pasaba antes y después de las sesiones y se consideró respuesta inadecuada cuando se fallaban tres o más preguntas; el consumo soluciones alcohólicas (CSA) en ml/estancia agrupado en semestres desde 2004-2006; el grado cumplimiento de recomendaciones (GCR) sobre la HM medida por observación directa en dos momentos (diciembre/2005-febrero/2006 y octubre-noviembre/ 2006) y la prevalencia de infecciones nosocomiales (PI) y de pacientes con infección nosocomial (PPI) a partir estudios EPINE 2004-2005-2006. Resultados. La frecuencia de respuestas inadecuadas para evaluar NC pasó de un 57,5% antes a 18,9% después (p<0,001). El CSA para HM pasó de 3 ml/estancia en 2º semestre/2004 a 17 ml/estancia en 2º semestre/2006 (p<0,001). El GCR ha pasado del 31,0% al 55,6% (p<0,001). La PI y PPI han pasado del 11,4% y el 9,6% respectivamente en el 2004 al 9,4% y 8,9% en 2006 (N.S.). Conclusión. El programa está consiguiendo de manera progresiva sus objetivos ya que los tres indicadores de proceso (NC, CSA, GC) han mejorado de manera estadísticamente significativa, y los de resultado (PI y PPI) han mejorado aunque sin significación estadística

Background. Hand Hygiene (HH) is the most important measure in the prevention of nosocomial infections. The objective was to evaluate the program for updating recommendations on HH that had been introduced. Methods. Interventions: between March-October/2005 realisation of updating sessions about when and how to realize HH and May/2006 distribution of an explicative three-part document to all healthcare workers reporting on compliance with the recommendations. Indicators: level of knowledge (LK) measured with a questionnaire of five questions that was given to those attending before and after sessions, responses were considered inadequate when three or more questions were not answered; consumption of alcoholic solutions (CAS) on ml/stay grouped into semesters from 2004-2006; compliance (CO) with recommendations on HH was measured by direct observation at two times (December/2005-February/2006 and October- November/2006); and infections prevalence (IP) and patients with infection (IPP) for EPINE studies 2004-2005-2006. Results. The frequency of inadequate answers for evaluating LK has fallen from 57,5% before to 18,9% afterwards (p <0.001). The CAS for HH has passed from 3 ml/stay in 2nd semester/2004 to 17 ml/stay 2nd semester/2006 (p <0.001). The CO with HH has risen from 31,0% to 55,6% (p <0.001). The IP and IPP have risen respectively from 11,4% and 9,6% in 2004 to 9,4% and 8,9% in 2006 (N.S.). Conclusion. The program is progressively achieving its objectives as the three process indicators (LK, CAS, CO) have improved in a statistically significant way, and the indicators of results (IP and IPP) have improved but without achieving statistical significance

Síndrome de Mikity Wilson.

Tras una serie de consideraciones sobre el Síndrome Mikity Wilson, entidad poco frecuente en estos momentos en el período neonatal. Se presenta un caso visto en nuestra Unidad en un recién nacido de 20 días de edad, el cual presenta desde su nacimiento un cuadro de dificultad respiratoria, que se considero como moderado, dado por tiraje, taquipnea transitoria, retracción y cianosis. Todo este cuadro fue evaluado en este momento como una sepsis respiratoria, ya que la madre tenía antecedentes de bolsa rota e infección vaginal durante el embarazo. Así evoluciona en los primeros días de vida con tratamiento de antibiótico y oxigenoterapia, evolucionando de forma estable y suspendiéndose el tratamiento anterior a los 10 días. Pasados ya los 25 días presenta nuevamente un cuadro de dificultad respiratoria, (cianosis, taquipnea, apnea e hiperbilirrubinemia), se realizan complementarios constatándose en el rayos x de tórax imágenes difusas bilaterales con refuerzo grosero de la trama, alternando con diminutos focos de hiperaereación, se inicia nuevamente tratamiento con antibiótico, y otros procederes mejorando paulatinamente hasta los 38 días de vida, donde se concluye el paciente sea portador del síndrome de Mikity Wilson, presentando en el rayos x del tórax las imágenes similares al estudio radiológico anterior. Esta entidad debe tenerse en cuenta en todo niño con antecedente de patología respiratoria al nacer que mejora rápidamente para luego presentar un cuadro respiratorio tardío. Los hallazgos clínicos y complementarios permitieron confirmar el diagnostico [AU]

[Evaluation of a program for updating recommendations about hand hygiene]. / Evaluación de un programa de actualización de las recomendaciones sobre la higiene de manos.

BACKGROUND: Hand Hygiene (HH) is the most important measure in the prevention of nosocomial infections. The objective was to evaluate the program for updating recommendations on HH that had been introduced. INTERVENTIONS: between March-October/2005 realisation of updating sessions about when and how to realize HH and May/2006 distribution of an explicative three-part document to all healthcare workers reporting on compliance with the recommendations. Indicators: level of knowledge (LK) measured with a questionnaire of five questions that was given to those attending before and after sessions, responses were considered inadequate when three or more questions were not answered; consumption of alcoholic solutions (CAS) on ml/stay grouped into semesters from 2004-2006; compliance (CO) with recommendations on HH was measured by direct observation at two times (December/2005-February/2006 and October-November/2006); and infections prevalence (IP) and patients with infection (IPP) for EPINE studies 2004-2005-2006. RESULTS: The frequency of inadequate answers for evaluating LK has fallen from 57.5% before to 18.9% afterwards (p <0.001). The CAS for HH has passed from 3 ml/stay in 2nd semester/2004 to 17 ml/stay 2nd semester/2006 (p <0.001). The CO with HH has risen from 31.0% to 55.6% (p <0.001). The IP and IPP have risen respectively from 11.4% and 9.6% in 2004 to 9.4% and 8.9% in 2006 (N.S.). CONCLUSION: The program is progressively achieving its objectives as the three process indicators (LK, CAS, CO) have improved in a statistically significant way, and the indicators of results (IP and IPP) have improved but without achieving statistical significance.

Constitutional duplication 11q23 de novo involving the MLL gene.

We report a child with mental retardation, brain anomalies and congenital heart defect. His karyotype, after G-banding and FISH with a whole chromosome probe for chromosome 11 and a locus-specific probe for the MLL gene, was 46,XY,dup(11)(q23q23).ish dup(11)(q23q23)(wcp11+, MLL++) de novo; i.e., he had a pure partial 11q23 duplication. Clinical and cytogenetic findings of the present case were compared with the 7 previously reported cases with pure partial trisomy 11q; in 6/8 cases the region 11q23 was involved. We conclude that the scarce number of cases and their heterogeneity do not allow to establish a reliable genotype-phenotype correlation.