Temporal Approach, Digitally Assisted Phacovitrectomy in a Patient with Severe Kyphosis due to Axial Spondyloarthritis.

PURPOSE: To describe a temporal approach, digitally assisted phacovitrectomy in a patient with severe kyphosis due to axial spondyloarthritis. Case Report. A 70-year-old male patient with proliferative diabetic retinopathy with vitreous hemorrhage and cataract and ankylosing spondylitis with severe kyphosis. A temporal approach, digitally assisted 25 G phacovitrectomy was performed with a Constellation platform and the NGENUITY visualization system. The Trendelenburg position was utilized. CONCLUSION: A temporal approach, digitally assisted phacovitrectomy may be used in select cases of severe kyphosis with positive outcomes.

Influencia de la edad gestacional, el tipo de parto y la reanimación en el riesgo de neumotórax en neonatos mayores de 37 semanas / Influence of gestational age, type of delivery, and resuscitation, on the incidence of pneumothorax in term neonates

INTRODUCCIÓN: La cesárea electiva antes de las 39 semanas de edad gestacional (EG) se ha asociado a un incremento en la incidencia de distrés respiratorio iatrogénico y de neumotórax en el recién nacido a término (RNT), probablemente en relación con una mayor morbilidad respiratoria y necesidad de reanimación. Estos aspectos no han sido evaluados sistemáticamente en nuestro medio. OBJETIVO: Conocer si la EG, el tipo de parto y la intensidad de la reanimación cardiopulmonar (RCP) se asocian con un incremento en la incidencia de neumotórax en el RNT. PACIENTES Y MÉTODOS: Se estudiaron todos los RNT (≥ 37 semanas de EG) nacidos en nuestra maternidad durante el periodo 2006-2010, según el tipo de parto (vaginal, cesárea o fórceps) y su indicación en el caso de las cesáreas. Se consideró RCP avanzada la aplicación de presión positiva con mascarilla, intubación, o necesidad de compresiones torácicas y/o medicación. El diagnóstico de neumotórax fue clínico y radiológico. RESULTADOS: Se incluyeron un total de 32.238 RNT. Tipo de parto: vaginal 76,1%, cesárea 12,4% y fórceps 11,5%. La incidencia de neumotórax fue del 0,316%, siendo significativamente mayor en las cesáreas (0,85%) que en los fórceps (0,59%) o nacimientos vaginales (0,19%) (p < 0,001); en ≥ 40 semanas de EG (0,37%) frente a ≤ 39 semanas de EG (0,24%) (p = 0,033) y en RCP avanzada (4,29%) frente a RCP básica (0,18%) (p < 0,001). CONCLUSIONES: La EG ≥ 40 semanas, el parto mediante cesárea o fórceps y la RCP avanzada se asociaron significativamente a una mayor incidencia de neumotórax en el RNT. En nuestra población no se observó un aumento en la incidencia de neumotórax tras cesárea electiva en menores de 39 semanas de EG

BACKGROUND: Elective caesarean section before 39 weeks gestational age (GA) has been associated with a higher incidence of iatrogenic respiratory distress and pneumothorax in term newborn babies, probably because of a higher respiratory morbidity and the need for resuscitation. These factors have not been systematically evaluated in our patients. OBJECTIVE: To determine whether the gestational age, type of delivery, and intensity of resuscitation, are associated with an increase in the incidence of pneumothorax in term neonates. PATIENTS AND METHODS: Full term neonates (≥37 weeks GA) born in our maternity unit from January 2006 to December 2010 were studied, along with the type of delivery (vaginal, forceps or caesarean section). Advanced cardiopulmonary resuscitation (CPR) was defined as the need of bag and mask intermittent ventilation, intubation, chest compression, and/or administration of medication. The diagnosis of pneumothorax was clinical and radiological in all cases. RESULTS: A total of 32,238 full term newborns were included. Type of delivery: vaginal 76.1%, C-section 12.4%, and forceps 11.5%. The incidence of pneumothorax was 0.316%. It was significantly higher in C-section (0.85%), than in forceps (0.59%), or non-instrumental vaginal deliveries (0.19%) (P < 0.001), and in infants ≥40 weeks GA (0.37%) compared to ≤39 weeks GA (0.24%) (P = 0.033), and in advanced CPR (4.29%) compared to basic CPR (0.18%) (P < 0.001). CONCLUSIONS: A GA≥40 weeks, C-section, or forceps delivery, and advanced CPR immediately after birth were significantly associated with a higher incidence of pneumothorax in full term newborn babies. In our population, we did not observe an increase in pneumothorax among neonates born by elective C-section before 39 weeks of gestation

[Influence of gestational age, type of delivery, and resuscitation, on the incidence of pneumothorax in term neonates]. / Influencia de la edad gestacional, el tipo de parto y la reanimación en el riesgo de neumotórax en neonatos mayores de 37 semanas.

BACKGROUND: Elective caesarean section before 39 weeks gestational age (GA) has been associated with a higher incidence of iatrogenic respiratory distress and pneumothorax in term newborn babies, probably because of a higher respiratory morbidity and the need for resuscitation. These factors have not been systematically evaluated in our patients. OBJECTIVE: To determine whether the gestational age, type of delivery, and intensity of resuscitation, are associated with an increase in the incidence of pneumothorax in term neonates. PATIENTS AND METHODS: Full term neonates (≥ 37 weeks GA) born in our maternity unit from January 2006 to December 2010 were studied, along with the type of delivery (vaginal, forceps or caesarean section). Advanced cardiopulmonary resuscitation (CPR) was defined as the need of bag and mask intermittent ventilation, intubation, chest compression, and/or administration of medication. The diagnosis of pneumothorax was clinical and radiological in all cases. RESULTS: A total of 32,238 full term newborns were included. Type of delivery: vaginal 76.1%, C-section 12.4%, and forceps 11.5%. The incidence of pneumothorax was 0.316%. It was significantly higher in C-section (0.85%), than in forceps (0.59%), or non-instrumental vaginal deliveries (0.19%) (P<.001), and in infants ≥ 40 weeks GA (0.37%) compared to ≤ 39 weeks GA (0.24%) (P=.033), and in advanced CPR (4.29%) compared to basic CPR (0.18%) (P<.001). CONCLUSIONS: A GA ≥ 40 weeks, C-section, or forceps delivery, and advanced CPR immediately after birth were significantly associated with a higher incidence of pneumothorax in full term newborn babies. In our population, we did not observe an increase in pneumothorax among neonates born by elective C-section before 39 weeks of gestation.

[Study of the nutritional status of elders in Cantabria]. / Estudio del estado nutricional de los ancianos de Cantabria.

INTRODUCTION: Population ageing is a main concern under the biosanitary point of view. AIM: To assess the nutritional status of people 65 year-old and older in Cantabria (Spain) METHOD: A total of 1605 persons were studied by means of the MNA (Mini Nutritional Assessment); a) by primary care (59.9% in the unit, and 4.7% at home) and, b) in nursing homes (35.4%). RESULTS: Nutritional score (NS) was 23.4 ± 4.1 for women and 24.4 ± 4 in males (p < 0.001). We emphasize the fact that 22.3% of people studied in the nursing homes were malnourished or at risk of malnutrition, compared with 14.2% of those studied at the unit, and only 3.3% of the home visited elders. The correlation between the value of the NS and the subjective estimation of nutrition status showed a high value (0.65). We emphasize the negative correlation (-0.53) between BNI value and the incidence of skin lesions. CONCLUSION: Our results highlight the importance of identifying malnutrition or its risk in elders in order to prevent the negative consequences of this deficiency.

Estudio del estado nutricional de los ancianos de Cantabria / Study of the nutritional status of elders in Cantabria

Introducción: El envejecimiento de la población representa uno de los retos más importantes desde el punto de vista biosanitario Objetivo: Valorar el estado nutricional de las personas de 65 y más años de Cantabria. Métodos: Un total de 1605 personas fueron evaluadas por medio del MNA; a) en atención primaria (59,9% en la consulta y 4,7% en domicilios) y, b) en residencias de ancianos (35,4%).Resultados: La puntuación nutricional (PN) obtenida de la suma de los ítems del MNA fue 23,4 ± 4,1 para las mujeres y 24,4 ± 4 en los varones (p < 0,001). Destaca el hecho de que el 22,3% de las personas estudiadas en residencias está malnutrida o en riesgo de malnutrición, frente al 14,2% de las que acuden a consulta, y sólo el3,3% de las estudiadas en su domicilio. La correlación entre los valores de la PN y la apreciación subjetiva del estado de nutrición mostró un valor elevado (0,65). Destacamos la correlación negativa (-0,53) entre los valores del IMC y la incidencia de lesiones cutáneas. Conclusiones: Nuestros resultados indican la importancia de la identificación de la desnutrición o su riesgo, en personas mayores, por las consecuencias negativas que presenta este estado carencial (AU)

Introduction: Population ageing is a main concern under the biosanitary point of view. Aim: To assess the nutritional status of people 65 year old and older in Cantabria (Spain) Method: A total of 1605 persons were studied by means of the MNA (Mini Nutritional Assessment); a) by primary care (59.9% in the unit, and 4.7% at home) and, b) in nursing homes (35.4%).Results: Nutritional score (NS) was 23.4 ± 4.1 for women and 24.4 ± 4 in males (p < 0.001). We emphasize the fact that 22.3% of people studied in the nursing homes were malnourished or at risk of malnutrition, compared with 14.2% of those studied at the unit, and only 3.3% of the home visited elders. The correlation between the value of the NS and the subjective estimation of nutrition status showed a high value (0.65).We emphasize the negative correlation (-0.53) between BNI value and the incidence of skin lesions. Conclusion: Our results highlight the importance of identifying malnutrition or its risk in elders in order to prevent the negative consequences of this deficiency (AU)

Guía rápida de fármacos en soporte vital avanzado / No disponible

Durante las últimas reuniones de la American Heart Association (AHA) y el European Resuscitation Council(ERC), la tendencia es la de minimizar tanto las maniobrasen soporte vital avanzado (SVA), como el uso de fármacos. Por ello, cada vez más, se van simplificando el número o tipo de fármacos que se usan en reanimación cardiopulmonar (RCP). A pesar de ello, la premura de su utilización hace necesario que conozcamos las dosis exactas, el modo y el momento en que deben administrarse. Por todo esto, se elaboró una guía rápida de uso de estos fármacos usados en RCP adecuada para la utilización que se podría hacer en el Servicio de Urgencias de Atención Primaria (SUAP),en la que se muestran las posibles vías de administración, la dosis para un individuo adulto, así como algunas precauciones que deben tenerse en cuenta en su utilización (AU)

The tendency during the last meetings of the American Heart Association (AHA) and European Resuscitation Council(ERC) has been to minimize both maneuvers in advanced cardiac life support (ACLS) as well as the use of drugs. Thus, the number or type of drugs used in cardiopulmonary resuscitation(CPR) is being increasingly reduced. In spite of it, the urgency of their use makes it necessary for us to know the exact doses to administer, method and moment. Therefore, a rapid guide to the use of these drugs in CPR has been elaborated, that is adapted to its use in the Primary Care Emergency Service. This guide demonstrates the possible administration routes, dose for an adult individual as well as some precautions to bear in mind during its use (AU)

Bilateral ovarian Burkitt's lymphoma.

Primary ovarian lymphoma is a rare entity. We submit a case of a 34-year-old black patient presenting with a bilateral adnexal tumor. She underwent hysterectomy with double salpingo-oophorectomy followed by polychemotherapy treatment. Histology confirmed Epstein-Barr virus-positive bilateral Burkitt's lymphoma. The patient died from septic shock after a month of treatment. Endemic Burkitt's lymphoma has a predilection for the female genital tract, manifesting itself clinically as a pelvic mass and less frequently as a menstrual disorder. It is a rare entity in our environment but should be kept in mind when treating patients of African origin.

Determination of cocaine and benzoylecgonine by direct injection of human urine into a column-switching liquid chromatography system with diode-array detection.

A method for the determination of cocaine (COC) and benzoylecgonine (BZE) in human urine using a column-switching liquid chromatography system is reported. A homemade precolumn (20 mm x 4.6 mm i.d.) dry-packed with Alltech ODS-C18 (35-750 microm) was employed as an extraction precolumn in order to extract and concentrate the COC and BZE from the human urine sample. The analytes were continuously transferred to the analytical column (Spherisorb-C8, 250 mm x 4.6 mm i.d.; dp = 5 microm) by means of the switching arrangement in the backflush mode. Detection was carried out at 235 nm in a UV-diode array detector. The validation of the method revealed analytes quantitative recoveries (96-102%) at three concentrations in the range from 0.25 to 4.00 and from 0.5 to 12.0 microg/mL for COC and BZE, respectively. These values demonstrate the excellent extraction efficiency of the precolumn. The detection limits for COC and BZE at a signal-to-noise ratio of 3 were 0.08 and 0.15 microg/mL when a sample volume of 50 microL was injected. The overlap of sample preparation, analysis and recondition of the precolumn increases the sample throughput to four samples per hour. The proposed method has been applied to the determination of COC and BZE in human urine samples from 73 suspecting drug addicts. Urine concentrations of 1.0-118.10 microg of BZE/mL and 0.1-41.0 microg of COC/mL were found.

A parasitological survey of wild red foxes (Vulpes vulpes) from the province of Guadalajara, Spain.

An epizootiological survey of leishmaniosis, coccidiosis and parasitic helminths in 67 foxes (Vulpes vulpes) was conducted in Guadalajara (central Spain). Examination for parasitic protozoa revealed prevalences of 74% Leishmania (determined by molecular methods) and 2.9% coccidia oocysts (fecal flotation). Survey of parasitic helminths (fecal flotation/necropsy) demonstrated the presence of nine species, including six nematodes, two cestodes and one trematode. Nematodes were the most common parasites of foxes, followed by cestodes and trematodes. Greater levels of nematodes like Uncinaria, with a free-living stage in its life-cycle, were found in foxes in areas where moist soils were likely to exist, in contrast to areas of semiarid characteristics, where Toxascaris leonina or Trichuris vulpis were predominant. With regard to helminths of importance as human pathogens, trichinoscopy revealed the presence of a relatively high number of foxes (8.9%) infected with Trichinella spiralis. Finally, Toxocara canis infection was less frequent (4.4%) than trichinellosis.

Plastias por deslizamiento en la cirugía del quiste pilonidal

Se hace una revisión de la etiopatogenia de la enfermedad pilonidal. Se hace una somera revisión del tratamiento de la enfermedad pilonidal detallando las técnicas de las incisiones en H e I. El 93 porciento de los pacientes curaron de su quiste pilonidal, el 50 porciento de primera intención y el 43 porciento de segunda intención. Se reporta un 7 porciento de recidivas con las técnicas en H e I. Creemos que la incisión en I es apropiada para los quistes de forma alargada y la incisión en H para los quistes anchos (AU)