Glycemic variability after mechanical thrombectomy for anterior circulation acute ischemic stroke. / Variabilidad glucémica tras trombectomía mecánica en el ictus isquémico agudo de la circulación anterior.

INTRODUCTION: Morbidity remains high among patients who undergo successful mechanical thrombectomy (MT) for anterior circulation large vessel occlusion (LVO). Stress hyperglycemia worsens the prognosis after acute ischemic stroke (AIS), but aggressively treating hyperglycemia does not improve the outcome. There is no consensus on how to best manage glycemia after AIS. Glycemic variability (GV) reflects glycemic fluctuations over time and could be the culprit. We aimed to elucidate how GV impacts outcome of AIS patients treated with MT. PATIENTS AND METHODS: This was a single-center retrospective study. We consecutively included AIS patients who received MT for anterior circulation LVO. We recorded discrete blood glucose measurements within the first 24 hours post thrombectomy, from which we calculated two measures of GV: standard deviation (SD) and coefficient of variation. Univariate and multivariate analyses were conducted to identify predictors of poor functional outcome (modified Ranking scale score 3-6) and mortality at 3-month follow-up. RESULTS: We included 657 patients. Patients with poor functional outcome (42.5%) and patients that died (14.8%) had significantly higher GV as measured by SD. In a multivariable model adjusted for confounders, higher SD was associated with mortality -adjusted odds ratio: 1.020 (95% CI 1.001-1.040)- but not with functional outcome -adjusted odds ratio for modified Ranking scale score 3-6: 1.007 (95% CI 0.990-1.025)-. CONCLUSIONS: Our results suggest that higher GV after MT for anterior circulation AIS is an independent risk factor for 3-month mortality. Future trials should evaluate the benefit of reducing GV in this setting.

TITLE: Variabilidad glucémica tras trombectomía mecánica en el ictus isquémico agudo de la circulación anterior.Introducción. La morbilidad de los pacientes con ictus isquémico agudo (IIA) sometidos a trombectomía mecánica (TM) exitosa permanece alta. La hiperglucemia empeora el pronóstico tras un IIA, pero tratarla agresivamente no mejora los resultados. No existe consenso sobre el tratamiento óptimo de la glucemia después de un IIA. La variabilidad glucémica (VG), que refleja las fluctuaciones glucémicas a lo largo del tiempo, puede ser un factor importante. Nuestro objetivo fue investigar cómo la VG afecta el resultado de pacientes con IIA tratados con TM. Pacientes y métodos. Realizamos un estudio retrospectivo unicéntrico que incluyó a pacientes con IIA que recibieron TM para la oclusión de un gran vaso de la circulación anterior. Se registraron mediciones discretas de glucemia en las primeras 24 horas postrombectomía, a partir de las cuales se calcularon dos medidas de VG: desviación estándar y coeficiente de variación. Se realizó un análisis univariado y multivariado para identificar predictores de resultado funcional desfavorable (escala de Rankin modificada: 3-6) y mortalidad a los tres meses. Resultados. Se incluyó a 657 pacientes. Los que tenían una puntuación en la escala de Rankin modificada = 3 (42,5%) y los fallecidos (14,8%) tuvieron una VG significativamente mayor medida por desviación estándar. En un modelo multivariado, una mayor desviación estándar se asoció de forma independiente con la mortalidad ­odds ratio ajustada: 1,02 (intervalo de confianza al 95%: 1,001-1,04)­ pero no con el resultado funcional ­odds ratio ajustada de la escala de Rankin modificada = 3: 1,007 (intervalo de confianza al 95%: 0,99-1,025)­. Conclusiones. Nuestros resultados sugieren que una mayor VG tras la TM para el IIA de la circulación anterior es un factor de riesgo independiente de mortalidad a los tres meses. Los futuros ensayos deben evaluar el beneficio de reducir la VG en este contexto.

Clinical impact and cost-consequence analysis of ePlex® blood culture identification panels for the rapid diagnosis of bloodstream infections: a single-center randomized controlled trial.

To assess clinical impact and perform cost-consequence analysis of the broadest multiplex PCR panels available for the rapid diagnosis of bloodstream infections (BSI). Single-center, randomized controlled trial conducted from June 2019 to February 2021 at a French University hospital with an institutional antimicrobial stewardship program. Primary endpoint was the percentage of patients with optimized antimicrobial treatment 12 h after transmission of positivity and Gram stain results from the first positive BC. This percentage was significantly higher in the multiplex PCR (mPCR) group (90/105 = 85.7% %, CI95% [77.5 ; 91.8] vs. 68/107 = 63.6%, CI95% [53.7 ; 72.6]; p < 10- 3) at interim analysis, resulting in the early termination of the study after the inclusion of 309 patients. For patients not optimized at baseline, the median time to obtain an optimized therapy was much shorter in the mPCR group than in the control group (6.9 h, IQR [2.9; 17.8] vs. 26.4 h, IQR [3.4; 47.5]; p = 0.001). Early optimization of antibiotic therapy resulted in a non-statistically significant decrease in mortality from 12.4 to 8.8% (p = 0.306), with a trend towards a shorter median length of stay (18 vs. 20 days; p = 0.064) and a non-significant reduction in the average cost per patient of €3,065 (p = 0.15). mPCR identified all the bacteria present in 88% of the samples. Despite its higher laboratory cost, the use of multiplex PCR for BSI diagnosis leads to early-optimised therapy, seems cost-effective and could reduce mortality and length of stay. Their impact could probably be improved if implemented 24/7.

Apical hypertrophic cardiomyopathy: A case series at a Brazilian referral center with a maximal follow-up of 15 years.

BACKGROUND: Apical hypertrophic cardiomyopathy (AHCM) is a rare cardiomyopathy, in which hypertrophy occurs predominantly in the ventricular apex, and in some cases with a high risk of sudden cardiac death. OBJECTIVE: The aim of this paper is to present a case series of patients with AHCM and describe their main clinical, echocardiographic and electrocardiographic characteristics, the recommendation for an implantable cardioverter-defibrillator (ICD) and the frequency of sudden cardiac death (SCD). METHODS: A retrospective case series was conducted at the referral center of a federal teaching hospital, between the years 2005 to 2020, involving patients with an echocardiographic diagnosis of AHCM. The parameters of the American College of Cardiology and the European Society of Cardiology were used to assess the risk of SCD. RESULTS: A total of 11 individuals were assessed with a mean age of 55.3 years, mean follow-up of 41.2 months, most of whom were symptomatic at diagnosis (72.7%). The most frequent symptom was dyspnea (27.3%). A family history of SCD was described in 45.5% of cases. Due to a high risk of SCD, four patients received ICDs. One patient presented sudden cardiac death after having refused the ICD. CONCLUSIONS: Symptoms and alterations in the imaging exams are significant factors in the clinical and prognostic assessment of patients with AHCM.

COVID-19 and Acute Respiratory Distress Syndrome. Impact of corticosteroid treatment and predictors of poor outcome.

OBJECTIVE: To assess the impact of corticosteroids on inflammatory and respiratory parameters of patients with COVID-19 and acute respiratory distress syndrome (ARDS). METHODS: Longitudinal, retrospective, observational study conducted in an ICU of a second level hospital. Adult patients with COVID-19 were included. Baseline characteristics, data on SARS-CoV-2 infection, treatment received, evolution of respiratory and inflammatory parameters, and ICU and hospital stay and mortality were analyzed. RESULTS: A total of 27 patients were included, 63% men, median age: 68.4 (51.8, 72.2) years. All patients met ARDS criteria and received MV and corticosteroids. After corticosteroids treatment we observed a reduction in the O2 A-a gradient [day 0: 322 (249, 425); day 3: 169 (129.5, 239.5) p<0.001; day 5: 144 (127.5, 228.0) p<0.001; day 7: 192 (120, 261) p=0.002] and an increase in the pO2/FiO2 ratio on days 3 and 5, but not on day 7 [day 0: 129 (100, 168); day 3: 193 (140, 236) p=0.002; day 5: 183 (141, 255) p=0.004; day 7: 170 (116, 251) p=0.057]. CRP also decreased on days 3 and 5 and increased again on day 7 [day 0: 16 (8.6, 24); day 3: 3.4 (1.7, 10.2) p<0.001; day 5: 4.1 (1.4, 10.2) p<0.001; day 7: 13.5 (6.8, 17.3) p=0.063]. Persistence of moderate ARDS on day 7 was related to a greater risk of poor outcome (OR 6.417 [1.091-37.735], p=0.040). CONCLUSIONS: Corticosteroids appears to reduce the inflammation and temporarily improve the oxygenation in COVID-19 and ARDS patients. Persistence of ARDS after 7 days treatment is a predictor of poor outcome.

Should scintigraphy be completely excluded from the diagnosis of periprosthetic joint infection?

AIM: To analyse the diagnostic performance of bone and leukocyte scintigraphy for periprosthetic joint infection before excluding the test from routine practice, and to analyse the possible benefit of bone marrow scintigraphy in inconclusive cases. MATERIALS AND METHODS: From 2012 to 2018, all patients with a total hip or knee arthroplasty who had a bone and leukocyte scintigraphy performed and underwent revision surgery were included. Bone marrow scintigraphy was indicated only in cases in which bone and leukocyte scintigraphy were inconclusive. Diagnosis of periprosthetic joint infection was confirmed by positive intraoperative cultures after revision surgery. RESULTS: A total of 105 patients were included. Eighteen patients had total hip arthroplasties (18.1%) and 86 had total knee arthroplasties (81.9%). Mean age was 74 years. Nineteen cases were diagnosed with a periprosthetic joint infection. Bone and leukocyte scintigraphy had 64% sensitivity and 97% specificity. Bone marrow scintigraphy increased sensitivity and specificity to 88% and 100%, respectively. CONCLUSION: Bone and leukocyte scintigraphy possesses high sensitivity and specificity for the diagnosis of chronic periprosthetic joint infection. The additional use of bone marrow scintigraphy significantly increases diagnostic performance. For these reasons, bone scintigraphy is reserved for inconclusive cases of chronic periprosthetic joint infection.

Epidemiology and outcome of HIV-infected patients admitted to the ICU in the current highly active antiretroviral therapy era.

PURPOSE: To describe the epidemiology of critical disease in HIV-infected patients during the current highly active antiretroviral therapy (HAART) era and to identify hospital mortality predictors. METHODS: A longitudinal, retrospective observational study was made of HIV-infected adults admitted to the ICU in two Spanish hospitals between 1 January 2000 and 31 December 2014. Demographic and HIV-related variables were analyzed, together with comorbidities, severity scores, reasons for admission and need for organ support. The chi-squared test was used to compare categorical variables, while continuous variables were contrasted with the Student's t-test, Mann-Whitney U-test or Kruskal-Wallis test, assuming an alpha level=0.05. Multivariate logistic regression analysis was used to calculate odds ratios for assessing correlations to mortality during hospital stay. Joinpoint regression analysis was used to study mortality trends over time. RESULTS: A total of 283 episodes were included for analyses. Hospital mortality was 32.9% (95%CI: 21.2-38.5). Only admission from a site other than the Emergency Care Department (OR 3.64, 95%CI: 1.30-10.20; p=0.01), moderate-severe liver disease (OR 5.65, 95%CI: 1.11-28.87; p=0.04) and the APACHE II score (OR 1.14, 95%CI: 1.04-1.26; p<0.01) and SOFA score at 72h (OR 1.19, 95%CI: 1.02-1.40; p=0.03) maintained a statistically significant relationship with hospital mortality. CONCLUSIONS: Delayed ICU admission, comorbidities and the severity of critical illness determine the prognosis of HIV-infected patients admitted to the ICU. Based on these data, HIV-infected patients should receive the same level of care as non-HIV-infected patients, regardless of their immunological or nutritional condition.

Bilateral Rapidly Destructive Osteoarthritis of the Hip: Could We be Misdiagnosing? A Case Report.

INTRODUCTION: Rapidly destructive osteoarthritis (RDO) of the hip is characterized by rapid joint destruction with no specific underlying diagnosis. Diagnostic protocols and algorithms to rule out other possible causes of the rapid destruction of the hip have not been described. Furthermore, microbiological diagnostic procedures in the medical field have dramatically changed since RDO was first described. CASE REPORT: We report the case of bilateral RDO in a Caucasian 84-year-old female treated with a bilateral total hip replacement and propose an etiology for this condition. This is the first case that specifically mentions obtaining cultures intraoperatively as a definitive diagnostic method. It is also a rare case as it describes a patient with the bilateral rapid destruction of the hip joints. CONCLUSION: Total hip arthroplasty remains as the gold-standard for treatment of RDO due to clinical severity and radiographic findings. All current clinical guidelines do not recommend using a one stage total hip replacement in an active infected site due to high risk of early prosthetic joint infection. The evidence of an infectious etiology in all or some cases of RDO would have large-scale implications regarding diagnosis and treatment of this condition.

Distributed natural gas venting offshore along the Cascadia margin.

Widespread gas venting along the Cascadia margin is investigated from acoustic water column data and reveals a nonuniform regional distribution of over 1100 mapped acoustic flares. The highest number of flares occurs on the shelf, and the highest flare density is seen around the nutrition-rich outflow of the Juan de Fuca Strait. We determine ∼430 flow-rates at ∼340 individual flare locations along the margin with instantaneous in situ values ranging from ∼6 mL min-1 to ∼18 L min-1. Applying a tidal-modulation model, a depth-dependent methane density, and extrapolating these results across the margin using two normalization techniques yields a combined average in situ flow-rate of ∼88 × 106 kg y-1. The average methane flux-rate for the Cascadia margin is thus estimated to ∼0.9 g y-1m-2. Combined uncertainties result in a range of these values between 4.5 and 1800% of the estimated mean values.

El bloqueo iliofascial en el tratamiento analgésico de la fractura de cadera del anciano / Fascia iliaca block for pain control in hip fracture patients

Introducción. La analgesia en pacientes con fractura de cadera se ha basado en la utilización de antiinflamatorios no esteroideos y opiáceos, que se asocian a múltiples efectos secundarios. El bloqueo iliofascial es una alternativa analgésica relativamente novedosa en el tratamiento del dolor de estos pacientes. Nuestro objetivo es evaluar la eficacia analgésica del bloqueo iliofascial realizado en Urgencias a pacientes mayores de 65años con fractura de cadera. Material y métodos. Entre enero y diciembre de 2016 fueron estudiados prospectivamente 216 pacientes. Las variables analizadas fueron: dolor al llegar a Urgencias y después del bloqueo, necesidad de rescate, cumplimiento del protocolo, demora en la administración de la analgesia y demora para la cirugía. Resultados. Se observaron diferencias estadísticamente significativas entre los valores de EVA antes y después del bloqueo (p<0,001). La puntuación EVA media pre-bloqueo fue de 6,16 (DE=2,82). Tras el bloqueo, la disminución media de la EVA fue de 2,99 (IC95%: 2,45-3,53%). El 26% de los pacientes recibieron morfina de rescate en las primeras 8h. La tasa de cumplimiento del protocolo analgésico fue del 84%. El bloqueo se administró en 16mins de media (DE=10,33). La mediana de demora para intervención quirúrgica fue de 1día (RIQ 25-75%: 1-2). Conclusión. El bloqueo iliofascial es una técnica analgésica reproducible, efectiva y segura. Constituye un pilar fundamental en la estrategia analgésica de los pacientes con fractura de cadera en nuestro centro. Los otros dos pilares incluyen la analgesia precoz y la disminución de la demora para la intervención quirúrgica (AU)

Introduction. Pain treatment for patients with hip fracture has been based on the use of nonsteroidal anti-inflammatories and opioid derived drugs. These medications have been associated with multiple adverse effects. Fascia iliaca block is a recent pain management alternative for these patients. The objective of this study was to evaluate the effectiveness of fascia iliaca block performed in the emergency room (ER) for patients over 65years of age with hip fracture. Materials and methods. A cohort of 216 patients, from January to December 2016, was studied prospectively. Analyzed variables were: pain upon arrival at ER, pain after fascia iliaca block, need for rescue medication, protocol compliance, delay in analgesia administration and delay for surgery. Results. Differences between visual analogue scale (VAS), before and after the fascia iliaca block, were statistically significant (P<.001). Pre-block VAS recorded was 6.16 (SD=2.82). The mean VAS reduction after the block was 2.99 (95%CI: 2.45-3.53%). Twenty-six percent of patients required morphine as rescue medication in the first 8hours after diagnosis. Compliance with protocol administration was of 84%. Fascia iliaca block was performed in a mean time of 16minutes (SD=10.33) after diagnosis. The median delay for surgery was 1 day (RIQ 25-75%: 1-2). Conclusion. Fascia iliaca block is a reproducible, safe and effective technique for pain management. It is a keystone in pain treatment for patients with a proximal femur fracture at our institution. Other objectives in our pain management protocol include early analgesia administration and reduction of time to surgery (AU)

Fascia iliaca block for pain control in hip fracture patients. / El bloqueo iliofascial en el tratamiento analgésico de la fractura de cadera del anciano.

INTRODUCTION: Pain treatment for patients with hip fracture has been based on the use of nonsteroidal anti-inflammatories and opioid derived drugs. These medications have been associated with multiple adverse effects. Fascia iliaca block is a recent pain management alternative for these patients. The objective of this study was to evaluate the effectiveness of fascia iliaca block performed in the emergency room (ER) for patients over 65years of age with hip fracture. MATERIALS AND METHODS: A cohort of 216 patients, from January to December 2016, was studied prospectively. Analyzed variables were: pain upon arrival at ER, pain after fascia iliaca block, need for rescue medication, protocol compliance, delay in analgesia administration and delay for surgery. RESULTS: Differences between visual analogue scale (VAS), before and after the fascia iliaca block, were statistically significant (P<.001). Pre-block VAS recorded was 6.16 (SD=2.82). The mean VAS reduction after the block was 2.99 (95%CI: 2.45-3.53%). Twenty-six percent of patients required morphine as rescue medication in the first 8hours after diagnosis. Compliance with protocol administration was of 84%. Fascia iliaca block was performed in a mean time of 16minutes (SD=10.33) after diagnosis. The median delay for surgery was 1 day (RIQ 25-75%: 1-2). CONCLUSION: Fascia iliaca block is a reproducible, safe and effective technique for pain management. It is a keystone in pain treatment for patients with a proximal femur fracture at our institution. Other objectives in our pain management protocol include early analgesia administration and reduction of time to surgery.

Neurovascular ultrasound in emergency settings: diagnostic and therapeutic aspects. / Ecografia neurovascular en urgencias: aspectos diagnosticos y terapeuticos.

INTRODUCTION: Neurovascular ultrasound is a non-invasive, portable and fast imaging method that, when performed by an experienced neurosonologist, offers reliable and reproducible information on the morphological and hemodynamic status of cervical and intracranial vessels. AIM: To review the available evidence regarding the use of this tool in the approach to acute stroke. DEVELOPMENT: Neurovascular ultrasound can be used in one of two ways: diagnostic and therapeutic. Considering the low recanalization rates of internal carotid artery and proximal medial cerebral artery occlusions with intravenous recombinant tissue plasminogen activator (r-tPA), neurovascular ultrasound used shortly in Emergency Department may help to select patients that could benefit from endovascular therapy. Moreover, ultrasound monitorization during intravenous r-tPA treatment allows the analysis of the pattern of arterial recanalization. Cervical ultrasound allows the assessment of the stenosis degree and the composition/surface of an arterial plaque that could, for instance, reveal earlier a candidate for carotid intervention. Finally, the therapeutic potential of ultrasound is also being investigated. Sonothrombolysis and sonolysis, that combine ultrasound technology with r-tPA and use exclusively the ultrasound to lyse the clot, respectively, showed promising results. CONCLUSION: Neurovascular ultrasound has greatly expanded to assume an important role in the study of cerebrovascular disorders.

TITLE: Ecografia neurovascular en urgencias: aspectos diagnosticos y terapeuticos.Introduccion. La ecografia neurovascular es una tecnica de diagnostico por imagenes rapida, portatil e incruenta que en manos de un ecografista experimentado aporta informacion reproducible y fiable acerca del estado hemodinamico y morfologico de los vasos craneales y cervicales. Objetivo. Revisar los datos disponibles sobre el uso de esta herramienta en el abordaje del ictus isquemico agudo. Desarrollo. La ecografia neurovascular se divide en dos modalidades de uso: diagnostica y terapeutica. A la luz de los bajos porcentajes de recanalizacion de las oclusiones de la arteria carotida interna y del segmento proximal de la arteria cerebral media logradas por el activador del plasminogeno tisular recombinante (r-tPA) por via intravenosa, el uso diligente de la ecografia neurovascular en el servicio de urgencias ayuda a dirimir que pacientes son susceptibles de beneficiarse del tratamiento endovascular. Asimismo, la vigilancia ecografica durante el curso del tratamiento con el r-tPA permite analizar la evolucion de la recanalizacion arterial. La ecografia cervical permite valorar el grado de estenosis y la composicion o la superficie de la placa arterial, extremos que, por ejemplo, pueden indicar la idoneidad de una intervencion carotidea. Por ultimo, tambien se esta investigando el potencial terapeutico de la ecografia. La sonotrombolisis y la sonolisis, la primera combinando el r-tPA con las ondas ultrasonicas y la segunda sirviendose unicamente de ellas como medio para lisar el trombo, han evidenciado hasta el momento resultados alentadores. Conclusion. La ecografia neurovascular ha progresado enormemente hasta adquirir un protagonismo destacado en el estudio de los trastornos cerebrovasculares.

Development of novel simple sequence repeat markers from a genomic sequence survey database and their application for diversity assessment in Jatropha curcas germplasm from Guatemala.

The last few years have seen a significant increase in the number of large-scale sequencing projects generating whole genome databases. These sequence databases can be surveyed (genome sequence survey) for tandem repeats as an alternative means to develop microsatellites for monitoring and selecting natural populations and cultivars of Jatropha curcas. A total of 100 tandem repeats were revealed from mining 368 genomic surveyed sequences available in the Kazusa DNA Research Institute database. Twenty microsatellite sequences were successfully amplified, resulting in repeatable and scorable polymerase chain reaction products. Genotyping of J. curcas accessions from the Guatemalan population revealed 18 polymorphic loci. The average number of alleles per locus was 6.9, and allelic sizes ranged from 94 to 299 bp. Expected and observed heterozygosities ranged from 0.118 to 0.906 and from 0.082 to 0.794, respectively. Polymorphic information content values ranged from 0.114 (JcSSR-34) to 0.886 (JcSSR-33) with an average of 0.627. Analysis with Micro-Checker indicated few null alleles for locus JcSSR-37 in Guatemalan populations, which may be a possible cause of its deviation from Hardy-Weinberg equilibrium, even after Bonferroni's correction. No loci showed significant linkage disequilibrium. These microsatellite loci are expected to be valuable molecular markers in J. curcas because they show high levels of polymorphism and heterozygosity.

Dúplex transcraneal en la enfermedad moyamoya / No disponible

No disponible

Impact of overweight and obesity in carotid intima-media thickness of portuguese adolescents.

AIM: To measure carotid intima-media thickness (cIMT) in obese, overweight and normal-weight Portuguese adolescents, to evaluate the association between body weight early signs of atherosclerosis. METHODS: Cross-sectional study, enrolling 150 adolescents (50 normal weight, 50 overweight and 50 obese) with mean age of 12.9 years. All underwent clinical, analytical and carotid common artery ultrasonographic evaluation. RESULTS: After adjusting for systolic blood pressure and plasma High-density lipoprotein, Low-density lipoprotein and Triglycerides levels, higher mean cIMT values were observed in both overweight and obese patients, when compared to normal-weight group. Moreover, adolescents with metabolic syndrome (MS) had greater cIMT [normal-weight: cIMT mean 0.418 mm (95% confidence intervals (95% CI) 0.399-0.437); overweight: 0.461 mm (95% CI: 0.444-0.477); obese: 0.472 mm (95% CI: 0.455-0.488); MS: 0.482 mm (95% CI: 0.444-0.520) p = 0.001]. When normal-weight and overweight adolescents were exclusively compared, differences in cIMT remained significant (p < 0.001). cIMT was positively correlated with body mass index (BMI) (r = 0.439, p < 0.001), waist circumference (r = 0.301, p = 0.018) and diastolic blood pressure (r = 0.266, p = 0.001). CONCLUSIONS: We have shown that cIMT is positively associated with BMI increase in adolescents, even in moderate overweight ranges, independent of age, gender, systolic blood pressure and plasma lipid concentrations.

Fractions composition study of the pyrolysis oil obtained from sewage sludge treatment plant.

In this work the parameters of Low Temperature Conversion--LTC were applied in a centrifuged sludge from a sewage treatment plant located in Rio de Janeiro, Brazil. Before the conversion, the sludge was dried and analyzed by TGA to observe its behavior with increasing temperature. The chemical composition of the crude pyrolysis oil was analyzed by FTIR, 1H NMR and GC-MS. The results showed that the oil is a mixture of hydrocarbons, oxygenated and nitrogenated compounds. Using a catalytic treatment it was possible to fractionate the oil where the predominant constituents were hydrocarbons showing that the cracking was effective. An important result was the difference between the calorific value of dry sludge (10 MJ kg(-1)), the pyrolysis oil (36 MJ kg(-1)) and one of the fractions separated by catalytic cracking (40 MJ kg(-1)) when compared with commercial diesel (45 MJ kg(-1)).

Control ecográfico post inserción de dispositivo intrauterino / Ultrasound control post insertion of intrauterine device

INTRODUCCIÓN: Los dispositivos intrauterinos (DIU) son métodos de anticoncepción reversible, ampliamente usados en el mundo. Se estima que 120 millones de mujeres usan un DIU en el mundo como método anticonceptivo. OBJETIVO: Evaluar los factores de riesgo que puedan relacionarse con una incorrecta inserción del DIU. MÉTODO: 93 pacientes de un Centro de Salud Familiar de la ciudad de Talca, Chile. Utilizando tablas de contingencia se calcularon diferentes medidas de asociación y se compararon los casos de DIU mal posicionado con los casos con uno o más factores de riesgo identificados. RESULTADOS: Se encontró una incidencia de DIU incorrectamente posicionado de un 15,8%, de los cuales hubo un 2,1% de perforación uterina, 2,1% para DIU incrustado y 11,8% para DIU descendido. Se identificaron como factores de riesgo de DIU incorrectamente posicionado la cicatriz de cesárea (RR: 2,31), inserción dificultosa (RR: 3,31) y opinión de un resultado dudoso (RR: 3,64), con una sensibilidad de 73,3%. CONCLUSIONES: La ecotomografía transvaginal es una herramienta crucial para la confirmación de una correcta inserción del DIU y debería ser un examen de rutina ante la presencia de cualquiera de los factores de riesgo identificados.

BACKGROUND: Intrauterine devices (lUDs) are reversible birth control methods that are widely used throug-hout the world. It is estimated that 120 million women use an IUD in the world as a contraceptive. AIM: To assess the risk factors that may relate to incorrect insertion of the IUD. METHODS: The sample included 93 patients of a Family Health Center, Talca, Chile. Using contingency tables, various measures of association were calculated, and the cases of incorrectly positioned IUD were compared with the cases where one or more risk factors were identified. RESULTS: We found an incidence of 15.8% of incorrectly positioned IUD, of which 2.1% presented with uterine perforation, 2.1% with embedment of the IUD and 11.8% with a descended IUD. We identified the following risk factors for incorrectly positioned IUD: cesarean section (RR: 2.31), difficulty on insertion (RR: 3.31) and practitioner's opinión of an uncertain result (RR: 3.64), with a sensitivity of 73.3%. CONCLUSIONS: Transvaginal ultrasound is a crucial tool for confirmation of proper insertion of an IUD and should be considered a routine examination when any of the identified risk factors are present.