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La sección de Vía Aérea de la Sociedad Española De Anestesiología, Reanimación y Terapéutica del Dolor (SEDAR), la Sociedad Española de Medicina de Urgencias y Emergencias (SEMES) y la Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL-CCC) presentan la Guía para el manejo integral de la vía aérea difícil en el paciente adulto. Sus principios están focalizados en el factor humano, los procesos cognitivos para la toma de decisiones en situaciones críticas y la optimización en la progresión de la aplicación de estrategias para preservar una adecuada oxigenación alveolar con el objeto de mejorar la seguridad y la calidad asistencial. El documento proporciona recomendaciones basadas en la evidencia científica actual, herramientas teórico/educativas y herramientas de implementación, fundamentalmente ayudas cognitivas, aplicables al tratamiento de la vía aérea en el campo de la anestesiología, cuidados críticos, urgencias y medicina prehospitalaria. Para ello se realizó una amplia búsqueda bibliográfica según las directrices PRISMA-R y se analizó utilizando la metodología GRADE. Las recomendaciones se formularon de acuerdo con esta metodología. Las recomendaciones de aquellas secciones con evidencia de baja calidad se basaron en la opinión de expertos mediante consenso alcanzado a través de un cuestionario Delphi.(AU)
The Airway Management section of the Spanish Society of Anesthesiology, Resuscitation, and Pain Therapy (SEDAR), the Spanish Society of Emergency Medicine (SEMES), and the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) present the Guide for the comprehensive management of difficult airway in adult patients. Its principles are focused on the human factor, cognitive processes for decision-making in critical situations, and optimization in the progression of strategies application to preserve adequate alveolar oxygenation in order to enhance safety and the quality of care. The document provides evidence-based recommendations, theoretical-educational tools, and implementation tools, mainly cognitive aids, applicable to airway management in the fields of anesthesiology, critical care, emergencies, and prehospital medicine. For this purpose, an extensive literature search was conducted following PRISMA-R guidelines and was analyzed using the GRADE methodology. Recommendations were formulated according to the GRADE methodology. Recommendations for sections with low-quality evidence were based on expert opinion through consensus reached via a Delphi questionnaire.(AU)
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Humanos , Masculino , Feminino , Manuseio das Vias Aéreas/métodos , Manejo da Dor , Traqueostomia , Máscaras Laríngeas , Intubação Intratraqueal , Espanha , Anestesia Geral , Sedação Consciente , AnestesiologiaRESUMO
La sección de Vía Aérea de la Sociedad Española De Anestesiología, Reanimación y Terapéutica del Dolor (SEDAR), la Sociedad Española de Medicina de Urgencias y Emergencias (SEMES) y la Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL-CCC) presentan la Guía para el manejo integral de la vía aérea difícil en el paciente adulto. Sus principios están focalizados en el factor humano, los procesos cognitivos para la toma de decisiones en situaciones críticas y la optimización en la progresión de la aplicación de estrategias para preservar una adecuada oxigenación alveolar con el objeto de mejorar la seguridad y la calidad asistencial. El documento proporciona recomendaciones basadas en la evidencia científica actual, herramientas teórico/educativas y herramientas de implementación, fundamentalmente ayudas cognitivas, aplicables al tratamiento de la vía aérea en el campo de la anestesiología, cuidados críticos, urgencias y medicina prehospitalaria. Para ello se realizó una amplia búsqueda bibliográfica según las directrices PRISMA-R y se analizó utilizando la metodología GRADE. Las recomendaciones se formularon de acuerdo con esta metodología. Las recomendaciones de aquellas secciones con evidencia de baja calidad se basaron en la opinión de expertos mediante consenso alcanzado a través de un cuestionario Delphi.(AU)
The Airway Management section of the Spanish Society of Anesthesiology, Resuscitation, and Pain Therapy (SEDAR), the Spanish Society of Emergency Medicine (SEMES), and the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) present the Guide for the comprehensive management of difficult airway in adult patients. Its principles are focused on the human factor, cognitive processes for decision-making in critical situations, and optimization in the progression of strategies application to preserve adequate alveolar oxygenation in order to enhance safety and the quality of care. The document provides evidence-based recommendations, theoretical-educational tools, and implementation tools, mainly cognitive aids, applicable to airway management in the fields of anesthesiology, critical care, emergencies, and prehospital medicine. For this purpose, an extensive literature search was conducted following PRISMA-R guidelines and was analyzed using the GRADE methodology. Recommendations were formulated according to the GRADE methodology. Recommendations for sections with low-quality evidence were based on expert opinion through consensus reached via a Delphi questionnaire.(AU)
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Humanos , Masculino , Feminino , Manuseio das Vias Aéreas/métodos , Manejo da Dor , Traqueostomia , Máscaras Laríngeas , Intubação Intratraqueal , Espanha , Anestesia Geral , Sedação Consciente , AnestesiologiaRESUMO
The Airway Management section of the Spanish Society of Anesthesiology, Resuscitation, and Pain Therapy (SEDAR), the Spanish Society of Emergency Medicine (SEMES), and the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) present the Guide for the comprehensive management of difficult airway in adult patients. Its principles are focused on the human factors, cognitive processes for decision-making in critical situations, and optimization in the progression of strategies application to preserve adequate alveolar oxygenation in order to enhance safety and the quality of care. The document provides evidence-based recommendations, theoretical-educational tools, and implementation tools, mainly cognitive aids, applicable to airway management in the fields of anesthesiology, critical care, emergencies, and prehospital medicine. For this purpose, an extensive literature search was conducted following PRISMA-R guidelines and was analyzed using the GRADE methodology. Recommendations were formulated according to the GRADE methodology. Recommendations for sections with low-quality evidence were based on expert opinion through consensus reached via a Delphi questionnaire.
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Manuseio das Vias Aéreas , Humanos , Manuseio das Vias Aéreas/normas , Manuseio das Vias Aéreas/métodos , Medicina de Emergência/normas , Adulto , Intubação IntratraquealRESUMO
The Airway Management section of the Spanish Society of Anesthesiology, Resuscitation, and Pain Therapy (SEDAR), the Spanish Society of Emergency Medicine (SEMES), and the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) present the Guide for the comprehensive management of difficult airway in adult patients. Its principles are focused on the human factors, cognitive processes for decision-making in critical situations, and optimization in the progression of strategies application to preserve adequate alveolar oxygenation in order to enhance safety and the quality of care. The document provides evidence-based recommendations, theoretical-educational tools, and implementation tools, mainly cognitive aids, applicable to airway management in the fields of anesthesiology, critical care, emergencies, and prehospital medicine. For this purpose, an extensive literature search was conducted following PRISMA-R guidelines and was analyzed using the GRADE methodology. Recommendations were formulated according to the GRADE methodology. Recommendations for sections with low-quality evidence were based on expert opinion through consensus reached via a Delphi questionnaire.
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Manuseio das Vias Aéreas , Humanos , Manuseio das Vias Aéreas/normas , Manuseio das Vias Aéreas/métodos , Medicina de Emergência/normas , Adulto , Intubação IntratraquealRESUMO
Beaches combined with sloping structures are frequently the first element of defense to protect urban areas from the impact of extreme coastal flooding events. However, these structures are rarely designed for null wave overtopping discharges, accepting that waves can pass above the crest and threat exposed elements in hinterland areas, such as pedestrians, urban elements and buildings, and vehicles. To reduce risks, Early Warning Systems (EWSs) can be used to anticipate and minimize the impacts of flooding episodes on those elements. A key aspect of these systems is the definition of non-admissible discharge levels that trigger significant impacts. However, large discrepancies in defining these discharge levels and the associated impacts are found among the existing methods to assess floodings. Due to the lack of standardization, a new conceptual and quantitative four-level (from no-impact to high-impact) categorization of flood warnings (EW-Coast) is proposed. EW-Coast integrates and unifies previous methods and builds on them by incorporating field-based information. Thus, the new categorization successfully predicted the impact level on 70%, 82%, and 85% of the overtopping episodes affecting pedestrians, urban elements and buildings, and vehicles, respectively. This demonstrates its suitability to support EWSs in areas vulnerable to wave-induced flooding.
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The objective of this guide is to provide to nuclear medicine physicians a tool based on scientific evidence and prepared by consensus of experts, to perform the 18F-DCFPyL PET/CT procedure with safely and efficiently for patients with prostate cancer who present PSMA overexpression. For them, some recommendations will be established for 18F-DCFPyL PET/CT examination: reconstruction parameters, presentation of the images and their interpretation. The possible false positives of the procedure will be analysed, how to interpret them and how to avoid them. Finally, all exploration should lead to the preparation of a report that answers the clinician's question. For this, it is recommended to prepare a structured report that includes the PROMISE criteria as well as the classification of the findings according to PSMA-RADS parameters.
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Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Neoplasias da Próstata , Masculino , Humanos , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Lisina , Ureia , Neoplasias da Próstata/diagnóstico por imagemRESUMO
PURPOSE: Evaluate the percentage of patients with prostate cancer treated with luteinizing hormone-releasing hormone analogues (LHRHa) that develop castration resistance after a follow-up period of 3 years. The secondary objective is to evaluate the variables potentially related to the progression to castration resistant prostate cancer (CRPC). METHODS: A post-authorization, nation-wide, multicenter, prospective, observational, and longitudinal study that included 416 patients treated with LHRHa between 2012 and 2017 is presented. Patients were followed for 3 years or until development of CRPC, thus completing a per-protocol population of 350 patients. A Cox regression analysis was carried out to evaluate factors involved in progression to CRPC. RESULTS: After 3 years of treatment with LHRHa 18.2% of patients developed CRPC. In contrast, in the subgroup analysis, 39.6% of the metastatic patients developed CRPC, compared with 8.8% of the non-metastatic patients. The patients with the highest risk of developing CRPC were those with a nadir prostate-specific antigen (PSA) > 2 ng/ml (HR 21.6; 95% CI 11.7-39.8; p < 0.001) and those receiving concomitant medication, most commonly bicalutamide (HR 1.8; 95% CI 1-3.1, p = 0.0431). CONCLUSIONS: The proportion of metastatic patients developing CRPC after 3 years of treatment with LHRHa is consistent with what has been previously described in the literature. In addition, this study provides new findings on CRPC in non-metastatic patients. Concomitant medication and nadir PSA are statistically significant predictive factors for the time to diagnosis of CRPC, the nadir PSA being the strongest predictor.
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Neoplasias de Próstata Resistentes à Castração , Neoplasias da Próstata , Antagonistas de Androgênios/uso terapêutico , Castração , Hormônio Liberador de Gonadotropina , Humanos , Estudos Longitudinais , Masculino , Estudos Prospectivos , Antígeno Prostático Específico , Neoplasias da Próstata/tratamento farmacológico , Neoplasias de Próstata Resistentes à Castração/diagnóstico , Neoplasias de Próstata Resistentes à Castração/tratamento farmacológicoRESUMO
BACKGROUND: Rapid sequence induction (RSI) in adults has undergone changes in recent years due to pharmacological and technological advances. The objective of this survey was to evaluate current practice among Spanish anesthesiologists. METHODS: A 31-item questionnaire regarding RSI practice was sent to anesthesiologists working in Spanish public hospitals. Differences in responses according to the type of hospital or experience of the respondent were compared for all data using the chi-square and Fisher's exact test. RESULTS: Approximately 15.89% of Spanish anesthesiologists participated in the survey (1002 questionnaires). The results show considerable heterogeneity in most aspects of RSI. Less than 20% of respondents administer sodium citrate. Sixty-four percent place a nasogastric tube in patients with intestinal obstruction. Gastric residue is assessed by ultrasound in 6% of cases. Only 25% of respondents measure ETO2 to check the effectiveness of preoxygenation, and 22% use nasal oxygen insufflation with nasal prongs or THRIVE. Sixty two percent of respondents apply cricoid pressure, but only 50% release the pressure when encountering intubation difficulty. Up to 40% of respondents reported cases of aspiration despite applying cricoid pressure. Propofol was the most commonly used hypnotic (97.6%), but there was no clear preference in the choice of neuromuscular relaxant (suxamethonium versus rocuronium ratio of approximately 1:1). Only 44% of respondents calculated the dose of sugammadex that would be required for emergency reversal of rocuronium. CONCLUSIONS: The survey showed significant variation in RSI practice, similar to that of other countries. Quality prospective studies are needed to standardize clinical practice.
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Anestesiologia , Padrões de Prática Médica , Indução e Intubação de Sequência Rápida/normas , Pesquisas sobre Atenção à Saúde , Humanos , EspanhaRESUMO
We have calculated the biological variation (BV) of different bone metabolism biomarkers on a large, well-described cohort of subjects. BV is important to calculate reference change value (or least significant change) which allows evaluating if the difference observed between two consecutive measurements in a patient is biologically significant or not. INTRODUCTION: Within-subject (CVI) and between-subject (CVG) biological variation (BV) estimates are essential in determining both analytical performance specifications (APS) and reference change values (RCV). Previously published estimates of BV for bone metabolism biomarkers are generally not compliant with the most up-to-date quality criteria for BV studies. We calculated the BV and RCV for different bone metabolism markers, namely ß-isomerized C-terminal telopeptide of type I collagen (ß-CTX), N-terminal propeptide of type I collagen (PINP), osteocalcin (OC), intact fibroblast growth factor 23 (iFGF-23), and uncarboxylated-unphosphorylated Matrix-Gla Protein (uCuP-MGP) using samples from the European Biological Variation Study (EuBIVAS). METHODS: In the EuBIVAS, 91 subjects were recruited from six European laboratories. Fasting blood samples were obtained weekly for ten consecutive weeks. The samples were run in duplicate on IDS iSYS or DiaSorin Liaison instruments. The results were subjected to outlier and variance homogeneity analysis before CV-ANOVA was used to obtain the BV estimates. RESULTS: We found no effect of gender upon the CVI estimates. The following CVI estimates with 95% confidence intervals (95% CI) were obtained: ß-CTX 15.1% (14.4-16.0%), PINP 8.8% (8.4-9.3%), OC 8.9% (8.5-9.4%), iFGF23 13.9% (13.2-14.7%), and uCuP-MGP 6.9% (6.1-7.3%). CONCLUSIONS: The EuBIVAS has provided updated BV estimates for bone markers, including iFGF23, which have not been previously published, facilitating the improved follow-up of patients being treated for metabolic bone disease.
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Variação Biológica da População , Biomarcadores , Colágeno Tipo I , Osteoporose , Química Clínica , Fator de Crescimento de Fibroblastos 23 , Fatores de Crescimento de Fibroblastos , Humanos , Osteocalcina , Osteoporose/diagnóstico , Peptídeos , alfa-GalactosidaseRESUMO
Flow coefficients v_{n} of the orders n=1-6 are measured with the High-Acceptance DiElectron Spectrometer (HADES) at GSI for protons, deuterons, and tritons as a function of centrality, transverse momentum, and rapidity in Au+Au collisions at sqrt[s_{NN}]=2.4 GeV. Combining the information from the flow coefficients of all orders allows us to construct for the first time, at collision energies of a few GeV, a multidifferential picture of the angular emission pattern of these particles. It reflects the complicated interplay between the effect of the central fireball pressure on the emission of particles and their subsequent interaction with spectator matter. The high precision information on higher order flow coefficients is a major step forward in constraining the equation of state of dense baryonic matter.
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Resumen Staphylococcus aureus se caracteriza por ser la principal causa de bacteriemia nosocomial en el mundo, debido al incremento en la resistencia, a los diferentes factores de patogenicidad y virulencia y la expresión de una gran variedad de proteínas las cuales pertenecen a las moléculas de la matriz adhesiva (MSCRAMM), presentes en la superficie de la bacteria cuya función es la colonización e invasión celular al hospedero y favorecer la formación de biopelícula, El conjunto de estos mecanismos de patogenicidad y virulencia, le permiten a la bacteria persistir en el huésped y en el ambiente, sobreviviendo a factores adversos, al sistema inmune y a los antimicrobianos.
Abstract Staphylococcus aureus is a microorganism characterized by being the main cause of nosocomial bacteremia in different places of the world, due to the different virulence and pathogenicity factors. One of the most important is the biofilm formation, which greatly favors bacterial resistance. For the adhesion of the biofilm to biotic and abiotic surfaces, the microbial surface components recognizing adhesive matrix molecules (MSCRAMM), these proteins play a key role in host cell colonization and invasion by the bacteria.
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Staphylococcus aureus , Bacteriemia , Fatores de Virulência , Sistema Imunitário , Anti-InfecciososRESUMO
We present the first observation of K^{-} and Ï absorption within nuclear matter by means of π^{-}-induced reactions on C and W targets at an incident beam momentum of 1.7 GeV/c studied with HADES at SIS18/GSI. The double ratio (K^{-}/K^{+})_{W}/(K^{-}/K^{+})_{C} is found to be 0.319±0.009(stat)_{-0.012}^{+0.014}(syst) indicating a larger absorption of K^{-} in heavier targets as compared to lighter ones. The measured Ï/K^{-} ratios in π^{-}+C and π^{-}+W reactions within the HADES acceptance are found to be equal to 0.55±0.04(stat)_{-0.07}^{+0.06}(syst) and to 0.63±0.06(stat)_{-0.11}^{+0.11}(syst), respectively. The similar ratios measured in the two different reactions demonstrate for the first time experimentally that the dynamics of the Ï meson in nuclear medium is strongly coupled to the K^{-} dynamics. The large difference in the Ï production off C and W nuclei is discussed in terms of a strong ÏN in-medium coupling. These results are relevant for the description of heavy-ion collisions and the structure of neutron stars.
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BACKGROUND: Objective interpretation of laboratory test results used to diagnose and monitor diabetes mellitus in part requires the application of biological variation data (BVD). The quality of published BVD has been questioned. The aim of this study was to quality assess publications reporting BVD for diabetes-related analytes using the Biological Variation Data Critical Appraisal Checklist (BIVAC); to assess whether published BVD are fit for purpose and whether the study design and population attributes influence BVD estimates and to undertake a meta-analysis of the BVD from BIVAC-assessed publications. METHODS: Publications reporting data for glucose, HbA1c, adiponectin, C-peptide, fructosamine, insulin like growth factor 1 (IGF-1), insulin like growth factor binding protein 3 (IGFBP-3), insulin, lactate and pyruvate were identified using a systematic literature search. These publications were assessed using the BIVAC, receiving grades A, B, C or D, where A is of highest quality. A meta-analysis of the BVD from the assessed studies utilised weightings based upon BIVAC grades and the width of the data confidence intervals to generate global BVD estimates. RESULTS: BIVAC assessment of 47 publications delivered 1 A, 3 B, 39C and 4 D gradings. Publications relating to adiponectin, C-peptide, IGF-1, IGFBP-3, lactate and pyruvate were all assessed as grade C. Meta-analysis enabled global BV estimates for all analytes except pyruvate, lactate and fructosamine. CONCLUSIONS: This study delivers updated and evidence-based BV estimates for diabetes-related analytes. There remains a need for delivery of new high-quality BV studies for several clinically important analytes.
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Diabetes Mellitus/diagnóstico , Adiponectina/análise , Glicemia/análise , Peptídeo C/análise , Frutosamina/análise , Hemoglobinas Glicadas/análise , Humanos , Insulina/análise , Proteína 3 de Ligação a Fator de Crescimento Semelhante à Insulina/análise , Fator de Crescimento Insulin-Like I/análise , Ácido Láctico/análise , Ácido Pirúvico/análiseRESUMO
PURPOSE: To determine differences between open bite and normal vertical overbite regarding distribution, size and clinical appearance of palatal rugae, depth and length of the palate, intercanine and intermolar widths and arch perimeter. METHODS: A cross-sectional study was performed in 264 superior models were studied with a 3D analysis system. A total of 132 individuals with AOB and 132 individuals with normal vertical overbite were evaluated, chosen from public schools with ages between 8 and 16 years. Palatal anthropometric features were evaluated. Qualitative analysis of palatal rugae was performed, exploring the shape, direction, unification and sensitivity of the palate. The Mann Whitney and Chi Square tests were used for statistical analyses. RESULTS: The average age was 11.37 ± 2.27 years for normal overbite and 11.87 for anterior open bite, with 54.9% of women. No significant differences were found between subjects with AOB and subjects with normal vertical overbite regarding intermolar or intercanine width. The maxillary length and depth and the height and width of palatal rugae were lower in the AOB group. The most common rugae shapes were curved and wavy, predominating in the horizontal direction with a parallel distribution. CONCLUSION: Qualitative evaluation demonstrated asymmetry in the shape, direction and unification of rugae in both groups. Most arch measurements were greater in individuals with AOB.
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Mordida Aberta/epidemiologia , Sobremordida/epidemiologia , Palato Duro/anatomia & histologia , Adolescente , Criança , Colômbia/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Modelos DentáriosRESUMO
INTRODUCTION: A tension hydrothorax is defined as a massive pleural effusion presenting with hemodynamic abnormalities secondary to mediastinal compression. In these patients pleural volume increases intrathoracic pressure to the point of compromising diastolic filling and cardiac output simulating a cardiac tamponade physiology. This is an uncommon yet potentially fatal medical emergency that if left untreated may progress to cardiac arrest. Early detection and rapid intervention of these patients prevents cardiorespiratory collapse. CASE PRESENTATION: We present a two-case report of patients presenting with malignant tension hydrothoraxes decompressed with ultrasound-guided thoracentesis and tube thoracostomy in the ED. CONCLUSION: Although these life-saving decompressive interventions appear simple, not having proper training is an independent factor for chest tube and thoracentesis complications. Courses and simulation training can benefit physicians to minimize potential complications when managing emergency conditions such as tension hydrothoraxes which continue to be a medical challenge. Whether thoracentesis or thoracostomy is superior in managing this condition remains in debate and a clinical dilemma.
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Tamponamento Cardíaco/etiologia , Hidrotórax/cirurgia , Derrame Pleural/fisiopatologia , Toracentese/efeitos adversos , Adulto , Tubos Torácicos/efeitos adversos , Descompressão Cirúrgica/efeitos adversos , Emergências , Feminino , Hemodinâmica , Humanos , Masculino , Toracostomia/efeitos adversosRESUMO
Hemibrycon iqueima sp. nov., is described from small streams in the Magdalena drainage at the foothills of the western slope of the Eastern Cordillera of the Colombian Andes, Suarez municipality, Tolima Department, Colombia. The new species is distinguished from its congeners in the Magdalena-Cauca River basin by a combination of characters related to snout-anal-fin origin length, head length, dorsal-pectoral fin distance, dorsal-fin-hypural distance, postorbital distance, orbital diameter, snout length, number of total vertebrae, pre-dorsal scales, scale rows between anal-fin origin and lateral line, number of branched rays of the anal fin, maxillary teeth number and number and arrangement of hooks on the branched rays of the pectoral and dorsal fins. In addition, the validity of this species is supported by previous molecular analyses that included specimens of the new species that had been erroneously identified. Phylogenetic relationships between the new species and congeners from Pacific coast basins are discussed.