[Sepsis Code: dodging mortality in a tertiary hospital]. / Código Sepsis: esquivando la mortalidad en un hospital terciario.

OBJECTIVE: In the hospital of La Princesa, the "Sepsis Code" (CSP) began in 2015, as a multidisciplinary group that provides health personnel with clinical, analytical and organizational tools, with the aim of the detection and early treatment of patients with sepsis. The objective of this study is to evaluate the impact of CSP implantation on mortality and to determine the variables associated with an increase in it. METHODS: A retrospective analytical study of patients with CSP alert activation from 2015 to 2018 was conducted. Clinical-epidemiological variables, analytical parameters, and severity factors such as admission to critical care units (UCC) and the need for amines were collected. Statistical significance was established at p < 0.05. RESULTS: We included 1,121 patients. The length of stay was 16 days and 32% required admission to UCC. Mortality showed a statistically significant linear downward trend from 24% in 2015 to 15% in 2018. The predictive mortality variables with statistically significant association were lactate > 2 mmol/L, creatinine > 1.6 mg/dL and the need for amines.>5.0%, mortality at the time of chart review 62.0%, and 6-months-post-discharge readmission 47.7%. CONCLUSIONS: The implementation of Sepsis Code decreases the mortality of patients with sepsis and septic shock. The presence of a lactate > 2 mmol/L, creatinine > 1.6 mg/dL and/or the need to administer amines in the first 24 hours, are associated with an increase in mortality in the patient with sepsis.

Dermolipoma conjuntival / Conjunctival dermolipoma

No disponible

Initial clinical outcomes and prognostic variables in the implementation of a Code Sepsis in a high complexity University Hospital.

OBJECTIVE: To assess the impact of the first months of application of a Code Sepsis in a high complexity hospital, analyzing patient´s epidemiological and clinical characteristics and prognostic factors. METHODS: A long-term observational study was carried out throughout a consecutive period of seven months (February 2015 - September 2015). The relationship with mortality of risk factors, and analytic values was analyzed using uni- and multivariate analyses. RESULTS: A total of 237 patients were included. The in-hospital mortality was 24% at 30 days and 27% at 60 days. The mortality of patients admitted to Critical Care Units was 30%. Significant differences were found between the patients who died and those who survived in mean levels of creatinine (2.30 vs 1.46 mg/dL, p <0.05), lactic acid (6.10 vs 2.62 mmol/L, p <0.05) and procalcitonin (23.27 vs 12.73 mg/dL, p<0.05). A statistically significant linear trend was found between SOFA scale rating and mortality (p<0.05). In the multivariate analysis additional independent risk factors associated with death were identified: age > 65 years (OR 5.33, p <0.05), lactic acid > 3 mmol/L (OR 5,85, p <0,05), creatinine > 1,2 mgr /dL (OR 4,54, p <0,05) and shock (OR 6,57, P <0,05). CONCLUSIONS: The epidemiological, clinical and mortality characteristics of the patients in our series are similar to the best published in the literature. The study has identified several markers that could be useful at a local level to estimate risk of death in septic patients. Studies like this one are necessary to make improvements in the Code Sepsis programs.

Pliegues coroideos. Diagnóstico diferencial a propósito de un caso / Choroidal folds. Differential diagnosis and report of a case

Caso clínico: Presentamos un casos clínico de una paciente con pliegues coroideos unilaterales en el polo posterior en los cuales, tras un completo examen oftalmológico encontramos la causa subyacente. Discusion: Los pliegues coroideos están presentes en una gran variedad de procesos oculares. Pese a que se han descrito frecuentemente asociados a un síndrome benigno consistente en hipermetropía adquirida, existen una gran variedad de procesos oculares y orbitarios que hay que tener en cuenta. Por ello, es muy importante realizar un correcto diagnóstico diferencial (AU)

Case report: We present a cases of a patient withunilateral choroidals folds in the posterior pole in which, after a complete ophthalmic examination, we found a subsequent cause. Discussion: Choroidal folds are present in a variety of ocular disease. Despite there were associated as a benign condition consisted in acquired hyperopia, there are a variety of ocular and orbital disease that have to be considered. For that reason, an exhaustive differential diagnosis is essential (AU)

Enzyme-assisted extraction of κ/ι-hybrid carrageenan from Mastocarpus stellatus for obtaining bioactive ingredients and their application for edible active film development.

Two hydrolysates were obtained from dried Mastocarpus stellatus using alcalase. The phenolic content was partially removed from one of them. The phenolic-partially-removed hydrolysate (H) was found to be a potent angiotensin-I converting enzyme (ACE) inhibitor. However, the phenolic-containing hydrolysate (Hp) showed a higher Folin-reactive substance content and antioxidant capacity (reducing power and radical scavenging capacity). Hp was therefore selected for the development of antioxidant Mastocarpus carrageenan-based films. F-Hp0 (without the hydrolysate), F-Hp15 (with 15% hydrolysate) and F-Hp30 (with 30% hydrolysate) films were developed. κ/ι-hybrid carrageenan was the main film constituent and hydrolysate addition resulted in an increased sulfated proportion, higher protein content and higher number of hydrogen bonds. Therefore interactions between carrageenan helices, plasticizers and peptides in the film-forming solution were enhanced, especially in F-Hp15, and consequently the water vapour permeability (WVP) of the resulting film decreased. Nevertheless, F-Hp30 considerably improved the transparency, UV/Vis light barrier, water resistance and elongation at break (EAB). The presence of Hp increased both puncture force (F) and puncture elongation (E), but not tensile strength (TS) or Young's modulus (Y). The addition of an increased concentration of hydrolysate to the films led to a considerable increase in the Folin-reactive substance content and the antioxidant activity, especially the radical scavenging capacity.

[Orbital rhabdomyosarcoma: difficulties with European treatment protocol]. / Rabdomiosarcoma orbitario: dificultades con el protocolo de tratamiento Europeo.

UNLABELLED: PURPOSE, MATERIAL AND METHODS: To present the experience in management of orbital rhabdomiosarcoma over 21 years in our centre. Review of the 12 cases of paediatric rhabdomiosarcoma and results of treatment in terms of mortality and morbidity comparing our results with other studies. RESULTS/CONCLUSION: Management of orbital rhabdomyosarcoma following the European Protocol leads to poor results compared with the American protocol. Early radiotherapy and complete tumoral excision could play a role in management of this tumour

Rabdomiosarcoma orbitario: dificultades con el protocolo de tratamiento europeo / Orbital rhabdomyosarcoma: difficulties with european treatment protocol

Objetivo, material y método: Presentar la experiencia en el manejo del rabdomiosarcoma orbitario en nuestro centro a lo largo de 21 años. Se revisan 12 casos de rabdomiosarcoma orbitario pediátrico y los resultados del tratamiento en términos de mortalidad y morbilidad, comparándolos con otros estudios publicados.Resultados/Conclusiones: El manejo del rabdomiosarcoma orbitario siguiendo el protocolo europeo conlleva unos resultados pobres comparados con los del protocolo americano. La radioterapia precoz y la cirugía excisional completa podrían jugar papel en el manejo de estos tumores

Purpose, Material and methods: To present the experience in management of orbital rhabdomiosarcoma over 21 years in our centre. Review of the 12 cases of paediatric rhabdomiosarcoma and results of treatment in terms of mortality and morbidity comparing our results with other studies. Results/Conclusion: Management of orbital rhabdomyosarcoma following the European Protocol leads to poor results compared with the American protocol. Early radiotherapy and complete tumoral excision could play a role in management of this tumour

Respiratory disorders and quality of sleep in patients on the waiting list for lung transplantation.

BACKGROUND: The purpose of this study was to assess the quality of sleep and extent of respiratory disorders in patients awaiting lung transplantation as compared with a control group. METHODS: From September 2003 to November 2003, 17 clinically stable patients on the waiting list for lung transplantation and 14 healthy controls (with similar age, gender, and body mass index) were studied. Diagnostic polysomnography (PSG) was carried out for all subjects. RESULTS: Seventeen patients were included, 15 men and 2 women, aged 51 +/- 14 years. The indication for lung transplantation was emphysema in 7 cases, pulmonary fibrosis in 6, and "other" in 4. Patients awaiting lung transplantation had the following respiratory values: mean FEV1, 1105 mL (34% of predicted); PaO2, 54 mm Hg; and PaCO2, 44 mm Hg. Significant differences were found among the waiting-list patients in terms of predominance of light sleep, wakeful periods, and phase changes per sleep-hour, as compared with the control group. The recording of the respiratory events showed an apnea-hypopnea index of 6.13, sleeping time with SaO2 <90% of 1.80%, and a mean number of significant desaturations (<4%) of 6.38. There were no statistically significant differences with respect to the control group. CONCLUSIONS: Poor quality of sleep was observed in patients awaiting lung transplantation as compared with a healthy control group. There was no evidence of more respiratory events or significant desaturations in these patients, probably due to the provision of supplementary oxygen therapy during the PSG.

[Treatment of nasolacrimal duct obstruction with Song's stent. Long term efficacy]. / Tratamiento de la obstrucción del conducto naso-lagrimal mediante prótesis de Song. Eficacia a largo plazo.

PURPOSE: To evaluate the long-term efficacy (5 years) of Song's stent in the treatment of naso-lachrymal duct obstruction. MATERIALS AND METHODS: We examined Song's stents installed in 64 eyes from 62 patients with naso-lachrymal duct obstruction (NLD). Of the 64, 48 were women and 14 men of mean age 60 SD 13.17 years. Obstructions of right side 62.5% and left side 37.5%, and location in dacriocystography: sac-NLD junction 82.8%, distant NLD 10.9%, medium NLD 3.1% and both proximal and complete NLD 1.6%. CLINICAL PRESENTATION: chronic epiphora 96.8%, acute dacriocystitis 67.2%, purulent discharge 25% and mucocele 17.2%. Mean follow-up period was 25.23 months. RESULTS: 13 stents were removed and 2 changed during the follow-up. 67.2% were patent at the end of the study; epiphora reduced to 32.8%, number of acute dacryocystitis, purulent discharge and mucocele to 1.6%. Subjective improvement was found in 73.5%. Surgical complications included epistaxis (15.6%) and pain (14.1%), and post-operative complications included reobstruction in 22 cases within a mean time of 8.6 months. CONCLUSIONS: Song's stent is a quick and useful option in treatment of epiphora. Despite not being efficient in all cases, it leads to improvement of symptoms and avoidance of surgery in the majority of cases. However, it requires periodical washes to maintain its patency.

Tratamiento de la obstrucción del conducto naso-lagrimal mediante prótesis de Song: Eficacia a largo plazo / Treatment of nasolacrimal duct obstruction with songs stent. Long term efficacy

Objetivo: Evaluar la eficacia a largo plazo (5 años) de la prótesis nasolagrimal de Song en el tratamiento de la obstrucción del conducto naso-lagrimal. Material y métodos: Se estudiaron 64 ojos (62 pacientes) con prótesis de Song por obstrucción del conducto naso-lagrimal (CNL), 48 mujeres y 14 hombres de edad media 60 años DE 13,17. El lado más frecuentemente obstruido fue el derecho (62,5%), siendo en el ojo izquierdo de 37,5%; y el tipo de obstrucción en la dacriocistografía: unión CNL-saco 82,8%, CNL distal 10,9%, CNL medio 3,1%, y proximal y completo, ambos del 1,6%. La clínica previa más frecuente fue la epífora (96,8%), dacriocistitis aguda (67,2%), conjuntivitis de repetición (25%) y mucocele (17,2%). El tiempo medio de seguimiento fue de 25,23 meses (máximo 53 y mínimo 2). Resultados: Durante el seguimiento se retiraron 13 prótesis y recambiaron 2. Al final siguen permeables 43 (67,2%); la epífora se redujo al 32,8% y el número de episodios de dacriocistitis aguda, conjuntivitis de repetición y mucocele se redujo al 1,6%. El 73,5% de los encuestados manifestaron una mejoría subjetiva. La complicación intraoperatoria más frecuente fue la epístaxis (15,6%) y dolor (14,1%), y de las post-operatorias la obstrucción en 22 casos, con un tiempo medio de 8,6 meses. Conclusiones: La prótesis de Song es una opción útil y rápida en el tratamiento de las obstrucciones del CNL. Pese a no ser eficaz en todos, produce una mejoría sintomática en la mayoría, permitiendo evitar la cirugía. No obstante, se requieren lavados periódicos para mantener su permeabilidad(AU)

Purpose: To evaluate the long-term efficacy (5 years) of Songs stent in the treatment of naso-lachrymal duct obstruction. Materials and methods: We examined Songs stents installed in 64 eyes from 62 patients with naso-lachrymal duct obstruction (NLD). Of the 64, 48 were women and 14 men of mean age 60 SD 13.17 years. Obstructions of right side 62.5% and left side 37.5%, and location in dacriocystography: sac-NLD junction 82.8%, distant NLD 10.9%, medium NLD 3.1% and both proximal and complete NLD 1.6%. Clinical presentation: chronic epiphora 96.8%, acute dacriocystitis 67.2%, purulent discharge 25% and mucocele 17.2%. Mean follow-up period was 25.23 months. Results: 13 stents were removed and 2 changed during the follow-up. 67.2% were patent at the end of the study; epiphora reduced to 32.8%, number of acute dacryocystitis, purulent discharge and mucocele to 1.6%. Subjective improvement was found in 73.5%. Surgical complications included epistaxis (15.6%) and pain (14.1%), and post-operative complications included reobstruction in 22 cases within a mean time of 8.6 months. Conclusions: Songs stent is a quick and useful option in treatment of epiphora. Despite not being efficient in all cases, it leads to improvement of symptoms and avoidance of surgery in the majority of cases. However, it requires periodical washes to maintain its patency(AU)

Quantity does matter. Juvenile hormone and the onset of vitellogenesis in the German cockroach.

We aimed to elucidate why cockroaches do not produce vitellogenin in immature stages, by studying the appearance of vitellogenin mRNA in larvae of Blattella germanica. Treatment of female larvae in any of the last three instars with 1 microg of juvenile hormone (JH) III induces vitellogenin gene transcription, which indicates that the fat body is competent to transcribe vitellogenin at least from the antepenultimate instar larvae. In untreated females, vitellogenin production starts on day 1 after the imaginal molt, when corpora allata begin to synthesize JH III at rates doubling the maximal of larval stages. This coincidence suggests that the female reaches the threshold of JH production necessary to induce vitellogenin synthesis on day 1 of adult life. These data lead to postulate that larvae do not synthesize vitellogenin simply because they do not produce enough JH, not because their fat body is incompetent.

Síndrome de Brugada versus IAM anteroseptal. Un toque de atención / Brugada's syndrome versus anteroseptal AMI:a call for attention

El síndrome de Brugada es una enfermedad caracterizada por la presencia de un bloqueo de rama derecha atípico con corazón estructuralmente sano y riesgo de muerte súbita. Se ha alertado acerca de su riesgo y la necesidad de estudios diagnósticos no invasivos e invasivos precoces. La única terapéutica conocida, y muy eficaz, es la colocación de un desfibrilador automático implantable. Presentamos el caso de un paciente joven que consulta por dolor precordial que responde a los nitritos y que su ECG muestra alteraciones típicas compatibles con esta entidad (AU)

Amaurosis bilateral como secuela de la intoxicación aguda por metanol: a propósito de un caso / Bilateral blindness as a consequence of acute methanol intoxication: a case report

La intoxicación por metanol supone una preocupación para la salud pública y ambiental por las acciones selectivas de su metabolito neurotóxico, formaldehído en la retina, nervio óptico y sistema nervioso central. Se presenta un caso de ceguera por metanol y se discute su fisiopatología, diagnóstico y tratamiento. Pese a que esta neuropatía es rara actualmente, el diagnóstico precoz y el tratamiento adecuado son cruciales para mejorar el pronóstico (AU)

Screening of antifeedant activity in brain extracts led to the identification of sulfakinin as a satiety promoter in the German cockroach. Are arthropod sulfakinins homologous to vertebrate gastrins-cholecystokinins?

The feeding cycle of the adult female cockroach Blattella germanica parallels vitellogenesis. The study of the mechanisms that regulate this cycle led us to look for food-intake inhibitors in brain extracts. The antifeedant activity of brain extracts was tested in vivo by injecting the extract and measuring the carotenoids contained in the gut from carrot ingested after the treatment. By HPLC fractionation and tracking the biological activity with the carrot test, we isolated the sulfakinin EQFDDY(SO3H) GHMRFamide (Pea-SK). A synthetic version of the peptide inhibited food intake when injected at doses of 1 microg (50% inhibition) and 10 microg (60% inhibition). The sulfate group was required for food-intake inhibition. These biological and structural features are similar to those of the gastrin-cholecystokinin (gastrin-CCK) family of vertebrate peptides. However, heterologous feeding assays (human CCK-8 tested on B. germanica, and Pea-SK tested on the goldfish Carassius auratus) were negative. In spite of this, alignment and cluster analysis of these and other structurally similar peptide families suggest that sulfakinins and gastrin-CCKs are homologous, and that mechanisms of feeding regulation involving these regulatory peptides may have been conserved during evolution between insects and vertebrates.

First record of Aedes albopictus (Skuse) from Argentina.

Aedes albopictus was collected in San Antonio City, Misiones Province, Argentina, near the border with Brazil in March, 1998. Collected material included 12 pupae, 1 recently emerged adult female, and a few larvae, which were found in a dish, a plough disk, and a tin pot. From the collected pupae, 5 males and 4 females emerged in the laboratory.

Incidence of hypercalcaemia in haemodialysis patients.

Secondary hyperparathyroidism is still one of the main problems affecting the dialysis population. The use of aluminium hydroxide as a phosphate binder is limited by significant long-term toxicity. Therefore, actually, most patients on haemodialysis receive treatment with calcium containing phosphate binders to avoid hyperphosphataemia.

Quantification of ecdysteroids by immunoassay: comparison of enzyme immunoassay and radioimmunoassay.

The performance of enzyme immunoassay (EIA) and radioimmunoassay (RIA) in the quantitative analysis of ecdysteroids was compared. The EIA was found to be at least equivalent to the RIA with respect to analytical range and sensitivity and to be more comfortable with respect to safety and time saving. When biological samples were analyzed by both assays a good correlation (r = 0.83) was found. Since the EIA has certain advantages over the RIA, we now recommend the use of the former assay for the quantification of ecdysteroids.

Induction of choriogenesis by 20-hydroxyecdysone in the German cockroach.

Experiments in vitro have shown that 20-hydroxyecdysone (at a concentration of 0.2 and 2 microM and after 12 and 24 hr of incubation) is able to induce the precocious deposition of chorion materials by the follicular epithelium of young oocytes of the cockroach Blattella germanica. Since previous studies had shown that 20-hydroxyecdysone levels in B. germanica ovaries increase with oocyte maturation to reach a peak just before oviposition, we therefore hypothesize that ovarian ecdysteroids trigger Choriogenesis in this species through an autocrine action.