A quality improvement intervention on surgical prophylaxis impact in antibiotic consumption and cost in selected surgical procedures.

BACKGROUND: Improper compliance with antibiotic prophylaxis (AP) in surgery is associated with an increased risk of surgical site infection (SSI), and impacts the efficiency of healthcare. OBJECTIVE: Evaluate the impact of an intervention in compliance with AP in selected surgical procedures and its effect on antibiotic consumption and cost. METHODS: A prospective interventional study was performed in a community hospital from January to December 2022. The baseline period was considered January-April 2022 and the intervention period May-December 2022. All patients who underwent cesarean section, appendectomies, hernia surgery, open reduction and internal fixation (ORIF), abdominoplasty, and cholecystectomy during the study period were selected. The intervention includes staff education, pharmacy interventions, monitoring the quality of prescriptions and feedback, and improved role of anesthesia staff, and department champions. RESULTS: The study involved 192 and 617 surgical procedures in the baseline and intervention periods respectively. The compliance with timing, selection, dose, and discontinuation achieved 100%, 99.2%, and 97.6% from baseline figures of 92.7%, 95.8%, and 81.3%, respectively. The antibiotic consumption was reduced by 55.1% during the intervention with a higher contribution of other antibiotics (94.1% reduction) in comparison with antibiotics as per policy (31.2% reduction). The cost was reduced by 47.2% (antibiotic as per policy 31.9%, other antibiotics 94.2%). CONCLUSION: The implemented strategy was effective in improving the quality of antibiotic prophylaxis with a significant impact in reducing antibiotic consumption and cost.

Artificial neural networks for closed loop control of in silico and ad hoc type 1 diabetes.

The closed loop control of blood glucose levels might help to reduce many short- and long-term complications of type 1 diabetes. Continuous glucose monitoring and insulin pump systems have facilitated the development of the artificial pancreas. In this paper, artificial neural networks are used for both the identification of patient dynamics and the glycaemic regulation. A subcutaneous glucose measuring system together with a Lispro insulin subcutaneous pump were used to gather clinical data for each patient undergoing treatment, and a corresponding in silico and ad hoc neural network model was derived for each patient to represent their particular glucose-insulin relationship. Based on this nonlinear neural network model, an ad hoc neural network controller was designed to close the feedback loop for glycaemic regulation of the in silico patient. Both the neural network model and the controller were tested for each patient under simulation, and the results obtained show a good performance during food intake and variable exercise conditions.

Growth of nanocrystals in a Nd3+-Yb3+ codoped oxyfluoride glass by laser irradiation.

A local nanocrystalline formation in a Neodymium-Ytterbium codoped oxyfluoride glass has been obtained. It has been studied the intense emissions around 880 and 975 nm originated from the 4F3/2(Nd3+) and 2F5/2(Yb3+) levels when the glass structure changes to a glass ceramic structure due to the irradiation of the laser beam. The emission spectra before and after the irradiation with 2900 mW reveals that the desvitrification process made by the laser power beam has been successfully achieved. The intensities and lifetime changes of these levels inside and outside the hole made by the laser damage have been analyzed. These results confirm that nanocrystals of betaPbF2 have been created by the laser action confirming that the transition from glass to glass ceramic has been completed. These results are in agreement with the bulk spectroscopic measurements.

Influencia de la anestesia regional en el embarazo.

Se consultó una amplia y actualizada bibliografía nacional e internacional, mediante la red de información médica y sus importantes enlaces, con el objetivo de: divulgar la influencia de los anestésicos durante el embarazo y describir la influencia genética de las principales drogas, de uso común, en la paciente gestante. Se llegó a la conclusión que estos estudios brindan a los anestesiólogos obstetras y neonatólogos, un cierto margen de seguridad, a pesar de quedar caminos indeterminados en la clasificación de riesgo de algunas drogas anestésicas.

Ketamina epidural en cirugía de hemiabdomen inferior / Epidural ketamine in low abdominal surgery

Introducción: La ketamina de uso corriente es una droga utilizada principalmente para la inducción y el mantenimiento de la anestesia, compuesta por una mezcla racémica de enantiómeros R (-) y S (+). En la década de los años 80 comienza la administración humana de la ketamina por vía epidural. A partir de entonces se han presentado disímiles investigaciones para justificar su acción analgésica en este espacio con varias hipótesis: 1 supresión específica laminar de las astas dorsales, 2 mediación por el sistema opioide endógeno y sustancia gris periacueductal, y 3 bloqueo de los canales del calcio por antagonismo no competitivo de los receptores N-metil-d-aspartato. Objetivo: Demostrar la eficacia de la ketamina por vía epidural como analgésico postoperatorio en la cirugía de hemiabdomen inferior. Material y Método: Se realizó un ensayo clínico aleatorizado y prospectivo en una muestra de 50 pacientes operados de hernia inguinal electiva. Los pacientes fueron divididos en dos grupos, un grupo tratado con 50 mg de ketamina y otro grupo al que se le administró una dosis de 2 mg de morfina liofilizada. Resultados: la ketamina por vía epidural en una dosis de 50 mg proporciona una analgesia adecuada por un período de al menos de 6 horas. La morfina brinda una analgesia por encima de las 18 horas. Conclusión: La ketamina por vía epidural es menos efectiva que la morfina desde el punto de vista analgésico, pero es una alternativa importante pues permite disminuir la dosis de morfina si se combinan ambos fármacos o se asocia a anestésicos locales (AU)

Introduction: Ketamine is a drug used for induction and maintenance of anesthesia, exists as a racemic mixture of R- and S+-enantiomers. Epidural ketamine starts to human administration about 80’ years. After that, various studies have been published about the mechanism of analgesic action of ketamine: lamina-specific suppression of dorsal-horn unit activity (1), opiate agonist at the spinal level in the same way as opioids (2) and non-competitive N-methyl-D-aspar-tate NMDA receptor antagonist (3). Purpose: To evaluate the efficacy of epidural ketamine for postoperative pain relief in lower abdominal procedures. Materials and Methods: 50 patients undergoing inguinal herniotomy were studied in a comparative propective trial. They were divided into two groups to receive epidural ketamine 50 mg or epidural morphine 2 mg. Results: Epidural ketamine in doses to 50 mg provide adequate analgesia during 6 hours. Morphine administered epidurally obtained analgesia more than 18 hours. Conclusion: Epidurally administered ketamine is less effective than epidural morphine for postoperative analgesia, but it playes an important role in morphine-induced analgesia and during the combination with local anaesthetic (AU)

ketamina epidural en cirugía de hemiabdomen inferior / s. t

La ketamina de uso corriente es una droga utilizada principalmente para la inducción y el mantenimiento de la anestesia, compuesta por una mescla rac‚mica de enantiómeros R(-) y S(+). En la década de los años 80 comienza la administración humana de la ketamina por vía epidural...[AU]

[Prevalence of dental caries and rampant caries in a preschool population]. / Estudio sobre prevalencia de caries dental y caries rampante en población preescolar.

The results from a study on prevalence of ordinary dental caries and rampant caries in a children population are presented. The study was carried out at Dentistry Out patient Service in the Children Hospital "San Juan de Aragón" of the Federal District Department. The DMF index was obtained and its was proposed another one, in order to classify the different degrees of rampant caries in function of dental damage. An interview was applied to the fathers of the children of the study group in order to determinate hygiene oral habits, eating and familiar antecedents that could influence in the process of the ordinary and rampant caries and to compare between them. Serum and saliva were analyzed to determinate levels of albumin and IgM, IgG and IgA; there were also others factors tested that could indicate caries development.

[Mast cells in Peyer's patches in the mouse]. / Mastocitos en placa de Peyer de ratón.

Mast Cells participate in immediate and late hypersensitivity activities, immunoregulation and inflammation. Recently two groups of them have been detected on the basis to its morphology, content of granules and function: a) Those who are localized in connective tissue and b) Those of the intestinal mucosa. Those of the intestinal mucosa are T dependent and proliferate in parasitic as well as in intestinal hypersensitivity conditions to diverse antigens, in turn, Peyer's Patches (PP) are considered antigen catcher and initiators of intestinal immune responses; these are subject to the influence of diverse substances, several of which are within mast cells (for example: histamine, prostaglandins, etc); for which in this work we investigate the morphology relation between PP and mast cells. Balb/c mice small intestine segments with muscular layer and PP of proximal, middle and distal levels where studied; were histologically processed, toluidine blues stained and mast cells counted in different intestinal layers (PP underlying zone, rest of the muscular, corium and submucosa. Data were analyzed by the paired double T test for mean differences. A greater Quantity of mast cells were observed at the marginal zone of the PP in comparison to the rest of the muscular layer, submucosa and corium. The abundance of mast cells in relation to the PP possibly indicates its modulatory influence on the function of lymphoid cells of the PP.