Long hydraulic retention time mediates stable volatile fatty acids production against slight pH oscillations.

The effect of operational conditions on the stability of acidogenic fermentation (AF) devoted to volatile fatty acids (VFAs) production still presents numerous gaps to achieve high yields and fully understand the responses of open microbiomes associated to this technology. To cope with that, this investigation was designed to assess the stability of VFAs production via AF of agro-food wastes at high hydraulic retention times (HRTs) (20 and 30 d) and pH oscillations (5.8-6.2). Similar bioconversion efficiencies (∼50 %) were reached regardless of the HRT, revealing that HRT of 20 d can be considered as a threshold from which, no further improvement was achieved. The combination of long HRTs, 25 °C and acid pHs promoted a robust microbiome that resulted in a stable outcome against pH variations, being Clostridiales order identified as key player of AF stability. These conditions mediated a high selectivity in the VFAs production profile, with acetic and butyric acids, prevailing in the VFAs pool (∼80 % of total VFAs) at HRT 20 d. The selection of appropriated conditions was shown to be critical to maximize the hydrolysis and acidogenesis of the substrate and attain a stable effluent against pH oscillations.

Microbial lipids from organic wastes: Outlook and challenges.

Microbial lipids have recently drawn a lot of attention as renewable sources for biochemicals production. Strong research efforts have been addressed to efficiently use organic wastes as carbon source for microbial lipids, which would definitively increase the profitability of the production process and boost a bio-based economy. This review compiles interesting traits of oleaginous microorganisms and highlights current trends on microbial- and process-oriented approaches to maximize microbial oil production from inexpensive substrates like lignocellulosic sugars, volatile fatty acids and glycerol. Furthermore, downstream processes such as cell harvesting or lipid extraction, that are decisive for the cost-effectiveness of the process, are discussed. To underpin microbial oils within the so demanded circular economy, associated challenges, recent advances and possible industrial applications that are also identified in this review.

Nanopolystyrene beads affect motility and reproductive success of oyster spermatozoa (Crassostrea gigas).

Oysters are keystone species that use external fertilization as a sexual mode. The gametes are planktonic and face a wide range of stressors, including plastic litter. Nanoplastics are of increasing concern because their size allows pronounced interactions with biological membranes, making them a potential hazard to marine life. In the present study, oyster spermatozoa were exposed for 1 h to various doses (from 0.1 to 25 µg mL-1) of 50-nm polystyrene beads with amine (50-NH2 beads) or carboxyl (50-COOH beads) functions. Microscopy revealed adhesion of particles to the spermatozoa membranes, but no translocation of either particle type into cells. Nevertheless, the 50-NH2 beads at 10 µg mL-1 induced a high spermiotoxicity, characterized by a decrease in the percentage of motile spermatozoa (-79%) and in the velocity (-62%) compared to control spermatozoa, with an overall drop in embryogenesis success (-59%). This major reproduction failure could be linked to a homeostasis disruption in exposed spermatozoa. The 50-COOH beads hampered spermatozoa motility only when administered at 25 µg mL-1 and caused a decrease in the percentage of motile spermatozoa (-66%) and in the velocity (-38%), but did not affect embryogenesis success. Microscopy analyses indicated these effects were probably due to physical blockages by microscale aggregates formed by the 50-COOH beads in seawater. This toxicological study emphasizes that oyster spermatozoa are a useful and sensitive model for (i) deciphering the fine interactions underpinning nanoplastic toxicity and (ii) evaluating adverse effects of plastic nanoparticles on marine biota while waiting for their concentration to be known in the environment.

[Unplanned extubation in ICU, and the relevance of non-dependent patient variables the quality of care]. / Extubación no programada en UCI y variables no dependientes del enfermo para mejorar la calidad.

OBJECTIVE: To evaluate, for a consecutive year, the magnitude of unplanned extubation, looking for non-dependent patient variables. MATERIAL AND METHODS: Prospective, observational study of cases and controls in a mixed intensive care unit within in a tertiary hospital. Patients were considered cases with more than 24 hours who had an episode of unplanned extubation. Prospective collection of variables case as time of unplanned extubation (collection time), identification of the box where the patient was admitted, presence and type of physical restraint, development of ventilator-associated pneumonia (VAP) and death. RESULTS: There were 17 unplanned extubation in 15 patients, 1.21 unplanned extubation per 100 days of MV. The unplanned extubation had an inhomogeneous spatial distribution (number of boxes). The time distribution of cases compared with controls showed significant differences in time distribution (P=.02). The comparative analysis between cases and controls, showed increased mortality, increased length of ICU stay, longer hospital stay and increased risk for VAP when patients suffer an episode of unplanned extubation. DISCUSSION: Unplanned extubation occurs most frequently in a given time slot of the day, may play a role in the spatial location of the patient; occurs most often in patients who are in the process of weaning from mechanical ventilation, and develop greater VAP.

Extubación no programada en UCI y variables no dependientes del enfermo para mejorar la calidad / Unplanned extubation in ICU, and the relevance of non-dependent patient variables the quality of care

Objetivo: Evaluar durante un año consecutivo la magnitud de la auto-extubación (AE), buscando las variables no dependientes del enfermo relacionadas. Material y métodos: Estudio prospectivo y observacional de casos y controles en una unidad de cuidados intensivos polivalente, dentro de un complejo hospitalario de tercer nivel. Fueron considerados casos enfermos con ventilación mecánica superior a las 24 h que presentaban un episodio de AE. Se realizó recogida prospectiva de variables de casos. Como principales variables de interés se estudiaron momento de AE (recogida horaria), identificación del box donde el enfermo se encontraba ingresado, presencia y tipo de contención física, desarrollo de neumonía asociada a ventilación mecánica (NAVM) y fallecimiento. Resultados: Se produjeron 17 AE en 15 pacientes, 1,21 AE por cada 100 días de VM. Las AE tuvieron una distribución espacial (número de box) no homogénea. La distribución horaria de los casos, comparada con los controles, evidenció diferencias de distribución horaria significativas (p = 0,02). El análisis comparativo entre los casos y los controles evidenció mayor mortalidad, mayor estancia en la UCI, mayor estancia hospitalaria y mayor riesgo de contraer una NAVM cuando los enfermos sufren un episodio de AE. Discusión: La AE ocurre con mayor frecuencia en una franja horaria determinada del día, pudiendo jugar un papel la situación espacial del enfermo; ocurre con mayor frecuencia en enfermos que se encuentran en proceso de destete de la ventilación mecánica, y desarrollan mayor NAVM (AU)

Objective: To evaluate, for a consecutive year, the magnitude of unplanned extubation, looking for non-dependent patient variables. Material and methods: Prospective, observational study of cases and controls in a mixed intensive care unit within in a tertiary hospital. Patients were considered cases with more than 24 hours who had an episode of unplanned extubation. Prospective collection of variables case as time of unplanned extubation (collection time), identification of the box where the patient was admitted, presence and type of physical restraint, development of ventilator-associated pneumonia (VAP) and death. Results: There were 17 unplanned extubation in 15 patients, 1.21 unplanned extubation per 100 days of MV. The unplanned extubation had an inhomogeneous spatial distribution (number of boxes). The time distribution of cases compared with controls showed significant differences in time distribution (P = .02). The comparative analysis between cases and controls, showed increased mortality, increased length of ICU stay, longer hospital stay and increased risk for VAP when patients suffer an episode of unplanned extubation. Discussion: Unplanned extubation occurs most frequently in a given time slot of the day, may play a role in the spatial location of the patient; occurs most often in patients who are in the process of weaning from mechanical ventilation, and develop greater VAP (AU)

Effect of organic loading rate on anaerobic digestion of thermally pretreated Scenedesmus sp. biomass.

Biogas production is one of the means to produce a biofuel from microalgae. Biomass consisting mainly of Scenedesmus sp. was thermally pretreated and optimum pretreatment length (1 h) and temperature (90 °C) was selected. Different chemical composition among batches stored at 4 °C for different lengths of time resulted in organic matter hydrolysis percentages ranging from 3% to 7%. The lower percentages were attributed to cell wall thickening observed during storage for 45 days. The different hydrolysis percentages did not cause differences in anaerobic digestion. Pretreatment of Scenedesmus sp. at 90 °C for 1h increased methane production 2.9 and 3.4-fold at organic loading rates (OLR) of 1 and 2.5 kg COD m(-3) day(-1), respectively. Regardless the OLR, inhibition caused by organic overloading or ammonia toxicity were not detected. Despite enhanced methane production, anaerobic biodegradability of this biomass remained low (32%). Therefore, this microalga is not a suitable feedstock for biogas production unless a more suitable pretreatment can be found.

Comparison of ultrasound and thermal pretreatment of Scenedesmus biomass on methane production.

Ultrasound at 20Hz was applied at different energy levels (Es) to treat Scenedesmus biomass, and organic matter solubilization, particle size distribution, cell disruption and biochemical methane potential were evaluated. An Es of 35.5 and 47.2MJ/kg resulted in floc deagglomeration but no improvement in methane production compared to untreated biomass. At an Es of 128.9, cell wall disruption was observed together with a 3.1-fold organic matter solubilization and an approximately 2-fold methane production in comparison with untreated biomass. Thermal pretreatment at 80°C caused cell wall disruption and improved anaerobic biodegradability 1.6-fold compared to untreated biomass. Since sonication caused a temperature increase in samples to as high as 85°C, it is likely that thermal effects accounted for much of the observed changes in the biomass. Given that ultrasound treatment at the highest Es studied only increased methane production by 1.2-fold over thermal treatment at 80°C, the higher energy requirement of sonication might not justify the use of this approach over thermal treatment.

Valor de la fracción de espacio muerto (Vd/Vt) como predictor de éxito en la extubación / Utility of the dead space fraction (Vd/Vt) as a predictor of extubation success

Objetivo: Comprobar qué valor tiene la fracción de espacio muerto (Vd/Vt) como predictor del fracaso en la extubación de los enfermos que necesitaron ventilación mecánica (VM) ingresados en las unidades de cuidados intensivos. Diseño: Estudio de cohortes, prospectivo, observacional. Desde el 1 de septiembre de 2010hasta 1 de marzo de 2011.Ámbito: Unidad de cuidados intensivos generales (UCIG), del complejo hospitalario de tercer nivel Hospital Universitario Marqués de Valdecilla. Pacientes o participantes: Se han incluido en el estudio aquellos enfermos que recibían VM por un espacio de tiempo superior a las 12 horas; y quienes en el proceso de destete seguían un protocolo de presión soporte de bajo nivel. Han sido criterios de exclusión la edad inferior a 18anos, enfermos ventilados a través de traqueotomía y enfermos considerados no colaboradores ˜por diversas causas. Durante el periodo de estudio, ingresaron en UCIG 392 enfermos. De ellos 214 precisaron ventilación mecánica. En 154 se inició proceso de destete. Fueron excluidos del estudio 54 enfermos y no fueron extubados de VM 24. Finalmente 76 enfermos fueron extubados y analizados. Variables de interés principales: Se calculó Vd/Vt como el cociente (PaCO2-PC CO2)/PaCO2;con los parámetros registrados. Resultados: El análisis de regresión logística mostró una asociación significativa entre la variable Vd/Vt y el fracaso en la extubación con una OR de 1,52 (IC 95%: 1,11-2,09; p = 0,008). El área bajo la curva ROC, con respecto a predecir el fracaso en la extubación mediante el valor deVd/Vt fue de 0,94 (IC 95%: 0,86-0,98; p < 0,0001) (AU)

Purpose: To determine the value of Vd/Vt as a predictor of extubation failure in patients with mechanical ventilation admitted to the intensive care units. Design: A prospective, observational cohort study conducted from 1 September 2010 to 1 March2011.Setting: General intensive care unit (G-ICU) of a third level university hospital. Patients or participants: The study included patients on mechanical ventilation (MV) for over12 hours, and who in the process of weaning were subjected to low-level pressure support. Exclusion criteria were age under 18 years, ventilation via tracheotomy and patients failing to cooperate for different reasons. During the study, 392 patients were admitted to the G-ICU; of these, 214 required MV. The weaning process was started in 154 cases. Fifty-four patients were excluded from the study, and 24 were not extubated from MV. A total of 76 patients were finally extubated and analyzed. Variables of interest: Vd/Vt was calculated as the ratio (PaCO2-PC CO2)/PaCO2, with the recorded parameters. Results: Logistic regression analysis showed a significant association between the Vd/Vt and extubation failure, with OR = 1.52 (95%CI 1.11 to 2.09, p = 0.008).The area under the ROC curve with respect to the prediction of extubation failure according to the Vd/Vt value was 0.94 (95%CI 0.86 to 0.98, p < 0.0001) (AU)

Trasplante pulmonar con donantes de edad marginal (≥ 55 años) / No disponible

Objetivo: Analizar la supervivencia a corto (un mes), medio (un año) y largo plazo (cinco años)en todos los pacientes sometidos a un trasplante pulmonar (TP) cuyo donante tuviera al menos 55 años.Pacientes y métodos: Se incluyó a todos los pacientes sometidos a un TP cuyo donante tuviera55 años o más. Se analizó la asociación de las diferentes variables estudiadas con la mortalidad precoz, anual y al quinto año. Se utilizó la regresión logística en el estudio de factores de riesgo para mortalidad precoz y se utilizó la regresión de riesgos proporcionales de Cox en el estudio de factores de riesgo para la mortalidad al año y al quinto año, introduciendo las variables con un valor de p < 0,2 en el análisis bivariante. Se efectuó un análisis de supervivencia mediante el método de Kaplan-Meier.Resultados: Se analizó un total de 33 pacientes sometidos a un TP con donantes de 55 años omás. La probabilidad de supervivencia fue del 90,9, el 78,5 y el 44,8% al mes, año y cinco años respectivamente. La edad elevada del receptor (p = 0,16) y la realización de un trasplante unipulmonar(p = 0,09) fueron las variables que se asociaron o mostraron tendencia a la asociación con la mortalidad.Conclusiones: La decisión final en la aceptación de un injerto pulmonar se debe basar en la evaluación individual de cada donante y receptor. Sin embargo, dada la escasez de injertos pulmonares, parece adecuado considerar de inicio para la donación pulmonar a los pacientes de 55 o más años (AU)

[Utility of the dead space fraction (Vd/Vt) as a predictor of extubation success]. / Valor de la fracción de espacio muerto (Vd/Vt) como predictor de éxito en la extubación.

PURPOSE: To determine the value of Vd/Vt as a predictor of extubation failure in patients with mechanical ventilation admitted to the intensive care units. DESIGN: A prospective, observational cohort study conducted from 1 September 2010 to 1 March 2011. SETTING: General intensive care unit (G-ICU) of a third level university hospital. PATIENTS OR PARTICIPANTS: The study included patients on mechanical ventilation (MV) for over 12 hours, and who in the process of weaning were subjected to low-level pressure support. Exclusion criteria were age under 18 years, ventilation via tracheotomy and patients failing to cooperate for different reasons. During the study, 392 patients were admitted to the G-ICU; of these, 214 required MV. The weaning process was started in 154 cases. Fifty-four patients were excluded from the study, and 24 were not extubated from MV. A total of 76 patients were finally extubated and analyzed. VARIABLES OF INTEREST: Vd/Vt was calculated as the ratio (PaCO(2)-Pє CO(2))/PaCO(2), with the recorded parameters. RESULTS: Logistic regression analysis showed a significant association between the Vd/Vt and extubation failure, with OR=1.52 (95%CI 1.11 to 2.09, p=0.008). The area under the ROC curve with respect to the prediction of extubation failure according to the Vd/Vt value was 0.94 (95%CI 0.86 to 0.98, p<0.0001). CONCLUSIONS: Vd/Vt is a powerful predictor of extubation failure in patients on MV.

[Lung transplantation using donors 55 years and older]. / Trasplante pulmonar con donantes de edad marginal (≥ 55 años).

OBJECTIVE: We analyzed short, medium and long-term mortality in transplant recipients who received lungs from donors aged 55 years or more. PATIENTS AND METHODS: All patients who underwent lung transplantation from donors aged 55 years or more were included. The association between the different study variables and early death and death at 1 year and 5 years was studied. A logistic regression model was used to study the association between early death and variables with a trend towards significance (P<.2) in the bivariate analysis. The risk factors for mortality at 1 year and 5 years were analyzed with a Cox regression model. The Kaplan-Meier method was used to analyze survival. RESULTS: A total of 33 patients were included. The probability of survival was 90.9%, 78.5% and 44.8% at 1 month, 1 year, and 5 years after lung transplantation, respectively. The elevated age of the recipient (P=.16) and single-lung transplantation (P=.09) were the variables associated to or with a trend towards significant associations with mortality. CONCLUSIONS: The final decision to accept a lung graft should be based on individual evaluation of each donor and recipient. However, given the lack of lung donors, donors aged 55 years or more should be considered for lung transplantation.

[Traumatic dissection of the internal carotid artery by a safety belt: a report of two cases]. / Disección traumática de la arteria carótida interna por el cinturón de seguridad: descripción de dos casos.

Traumatic internal carotid artery dissection secondary to blunt trauma is a rare event accounting for 0.08 to 0.4% of all traumatic lesions. The spectrum of traumatic lesions that can affect the internal carotid artery includes minor lesions like spasm, intimal tears, or mural contusions and serious lesions like pseudoaneurysms and complete occlusion. Delayed clinical presentation is typical and can include headache, hemiparesis, partial Horner's syndrome, and cranial nerve palsy. Embolization secondary to the dissection can have devastating effects because it may cause ischemic stroke. Traumatic internal carotid artery dissection after safety belt trauma is very rare; it is usually due to direct cervical trauma on the side of the shoulder fixation point, which causes external bruising along the pathway of the safety belt. We present two cases of traumatic internal carotid artery dissection with concomitant cerebral infarcts caused by safety belts; we discuss the clinical, diagnostic, and therapeutic aspects of this lesion.

Disección traumática de la arteria carótida interna por el cinturón de seguridad: descripción de dos casos / Traumatic dissection of the internal carotid artery by a safety belt: a report of two cases

La disección traumática de la arteria carótida interna (DTACI) por traumatismo cerrado es una entidad rara e infradiagnosticada, y su incidencia es del 0,08-0,4% entre los pacientes que presentan lesiones traumáticas. El espectro de la lesión traumática de la arteria carótida interna incluye desde lesiones menores, como el espasmo, lesiones intimales o contusiones hasta seudoaneurismas y oclusión completa. La presentación clínica tardía es típica, incluyendo cefalea, hemiparesia, síndrome de Horner y parálisis de nervios craneales. La embolización secundaria a la disección puede provocar ictus isquémico con resultados que pueden ser fatales. La DTACI secundaria al cinturón de seguridad es muy rara, debida habitualmente al trauma cervical directo en el lado de la fijación al hombro con lesiones equimóticas externas típicas en el trayecto del cinturón. Presentamos 2 casos de DTACI con infarto cerebral asociado debida al cinturón de seguridad, y se discuten los aspectos clínicos, diagnósticos y terapéuticos propios de la lesión (AU)

Traumatic internal carotid artery dissection secondary to blunt trauma is a rare event accounting for 0.08 to 0.4% of all traumatic lesions. The spectrum of traumatic lesions that can affect the internal carotid artery includes minor lesions like spasm, intimal tears, or mural contusions and serious lesions like pseudoaneurysms and complete occlusion. Delayed clinical presentation is typical and can include headache, hemiparesis, partial Horner's syndrome, and cranial nerve palsy. Embolization secondary to the dissection can have devastating effects because it may cause ischemic stroke. Traumatic internal carotid artery dissection after safety belt trauma is very rare; it is usually due to direct cervical trauma on the side of the shoulder fixation point, which causes external bruising along the pathway of the safety belt. We present two cases of traumatic internal carotid artery dissection with concomitant cerebral infarcts caused by safety belts; we discuss the clinical, diagnostic, and therapeutic aspects of this lesion (AU)

Two cases of cyclic vomiting syndrome in systemic autoimmune conditions: SLE and autoimmune hepatitis.

Vomiting directly attributable to SLE occurs in approximately 8% of patients, and its causes are sometimes obscure when common conditions are ruled out. Cyclic vomiting syndrome is a common functional disorder which usually starts from childhood. We report the first two cases of patients affected by systemic autoimmune conditions associated to cyclic vomiting syndrome. Identification and proper treatment may guide to diagnosis and alleviate neglected manifestations of autoimmune patients.

[Analysis of subdural intracraneal empyemas in a third level hospital]. / Análisis de los empiemas subdurales intracraneales en un hospital de tercer nivel.

INTRODUCTION: Intracranial subdural empyema (ISE) is an infrequent infectious disorder of diverse etiology and difficult to diagnose because of its non-specific clinical features. PATIENTS AND METHODS: Retrospective study of patients diagnosed of ISE in a third-level university hospital in a 15-year period. RESULTS: Five men were included (mean age: 39.3 years). The most frequent primary source of infection was otic and sinusal (60%). The initial clinical manifestations were fever, headache, alteration of consciousness, and neurological focal symptoms. The mean time elapsed between onset of symptoms and diagnosis was 3.6 days. Diagnosis was performed by computed tomography in all patients. ISE was localized in the left hemisphere in 60% of cases mainly affecting the parietal lobe (80%). Anaerobic and streptococci germs were the most frequently isolated microorganisms. Therapy was based on antibiotics and surgical drainage in 100% of the cases. The surgical procedure used in the evacuation of empyema was craniotomy in all the patients. The mean time elapsed between diagnosis and surgery was 8.4 days. The mean Intensive Care Unit stay was 12.8 days, whereas the overall mean in-hospital stay was 45.2 days. Mortality was 40%. CONCLUSION: ISE, although infrequent, displays a high morbimortality that can be reduced with an early therapeutic approach which may include the surgical evacuation in all the cases.

Valoración de la capacidad preoperatoria al ejercicio como factor predictivo de supervivencia en enfermos sometidos a trasplante pulmonar / Evaluation of the pre-operative exercise capacity as survival marker in the lung transplant recipients

Objetivo. Evaluar de manera independiente la capacidad al ejercicio como factor predictivo de supervivencia en el trasplante pulmonar. Diseño. Estudio retrospectivo. Ámbito. Unidad de trasplante pulmonar de la Unidad de Cuidados Intensivos (UCI) de un hospital universitario. Pacientes. Se realizaron y analizaron 132 trasplantes pulmonares, en un total de 130 enfermos. El seguimiento de cada caso se realizó hasta fecha de 18 de junio de 2005 o fallecimiento del paciente. Variables de interés. Se valoró la capacidad preoperatoria al ejercicio mediante la prueba de marcha de los 6 minutos (PM6M). También se valoró la supervivencia a largo plazo en relación con el valor obtenido en la PM6M. Las curvas de supervivencia se estimaron por el método de Kaplan-Meier; la comparación entre curvas se hizo por el método de Log-Rank y las hazard ratios se estimaron por regresión de Cox. Resultados. El estudio de asociación a mortalidad de la PM6M mostró un riesgo relativo de 0,99 (intervalo de confianza del 95%: 0,99-1,00) por cada unidad de medida métrica (metro) (p = 0,282). Se clasificó a los enfermos según la distancia recorrida en 4 grupos: grupo I (distancia recorrida menor de 100 metros), grupo II (distancia recorrida entre 101-200 metros), grupo III (distancia recorrida entre 201 y 300 metros) y grupo 4 (distancia mayor de 301 metros). No se encontraron diferencias significativas al comparar las curvas de supervivencia entre los grupos (p = 0,709). El análisis multivariante tampoco aportó significación estadística. Conclusión. La distancia recorrida en la PM6M realizada en el protocolo de estudio de candidatos a trasplante pulmonar no creemos que sea útil como marcador de mortalidad a largo plazo en los enfermos sometidos a recambio pulmonar

Objective. To make an independent evaluation of the capacity for exercise as a predictive factor in lung transplant recipients. Design. Retrospective study. Scope. Lung transplant unit of the Intensive Care Unit (ICU) of a university hospital. Patients. We analyzed 132 lung transplants in a total of 130 patients. The patients were monitorized up to June 18, 2005 or their death. Variables of interest. An evaluation was made of their pre-operative exercise capacity with the 6-minute walking test (6MWT). Long-term survival in relationship with the walking test value was also assessed. The survival curves were estimated using the Kaplan-Meier method. Comparison between curves was made with the Log-Rank methods and the hazard ratios were estimated by Cox regression. Results. The association between mortality and the walking test value showed a hazard ratio of 0.99 (95% CI: 0.99-1.00) per metric unit (meter), (p = 0.282). The patients were classified according to the distance covered in the 4 groups: group 1 (distance covered less than 100 meters), group II (distance covered between 101-200 meters), group III (distance covered between 201 and 300 meters) and group IV (distance greater than 301 meters). No significant differences were found when comparing the survival curves of the four groups (p = 0.709). The multivariant analysis also did not show any statistical significance. Conclusions. We do not believe that the distance covered in the 6MWT conducted in the study protocol in the lung transplant candidates is useful as a marker to predict long-term mortality in patients undergoing lung transplant

Análisis de los empiemas subdurales intracraneales en un hospital de tercer nivel / Analysis of subdural intracranial empyemas in a third level hospital

El empiema subdural intracraneal (ESI) es un proceso infeccioso infrecuente, de etiología diversa yde difícil diagnóstico por presentar una clínica inespecífica. Pacientes y métodos. Estudio retrospectivo de los pacientes diagnosticados de ESI en un hospital universitario de tercer nivel durante un período de 15 años. Resultados. Se diagnosticaron cinco varones (media de edad: 39,3 años). El foco primario más frecuente fue ótico y sinusal (60%). Las manifestaciones clínicasiniciales fueron fiebre, cefalea, alteración del nivel de conciencia y síntomas neurológicos focales. El tiempo medio transcurrido desde el inicio de los síntomas hasta el diagnóstico fue de 3,6 días. El diagnóstico se realizó mediante tomografía computarizada en todos los pacientes. El ESI asentó sobre el hemisferio izquierdo en el 60% de los casos y afectó predominantementeal lóbulo parietal (80%). Los microorganismos aislados con mayor frecuencia fueron gérmenes anaerobios yestreptococos. El tratamiento se basó en terapia antibiótica y drenaje quirúrgico en el 100% de los casos. La técnica empleada para la evacuación del ESI fue la craneotomía en todos los pacientes. El tiempo medio transcurrido entre el diagnóstico yla intervención quirúrgica fue de 8,4 días. La estancia media en la Unidad de Cuidados Intensivos fue de 12,8 días, mientras que la hospitalaria global fue de 45,2 días. La mortalidad fue del 40%. Conclusión. El ESI, aunque infrecuente, presenta unaalta morbimortalidad, que puede disminuir con un abordaje terapéutico precoz, que debe incluir en todos los casos la evacuación quirúrgica de la colección

Intracranial subdural empyema (ISE) is an infrequent infectious disorder of diverse etiology anddifficult to diagnose because of its non-specific clinical features. Patients and methods. Retrospective study of patients diagnosed of ISE in a third-level university hospital in a 15-year period. Results. Five men were included (mean age: 39.3 years). Themost frequent primary source of infection was otic and sinusal (60%). The initial clinical manifestations were fever, headache, alteration of consciousness, and neurological focal symptoms. The mean time elapsed between onset of symptoms and diagnosis was 3.6 days. Diagnosis was performed by computed tomography in all patients. ISE was localized in the left hemisphere in 60% of cases mainly affecting the parietal lobe (80%). Anaerobic and streptococci germs were the most frequently isolated microorganisms. Therapy was based on antibiotics and surgical drainage in 100% of the cases. The surgical procedure used in the evacuation of empyema was craniotomy in all the patients. The mean time elapsed between diagnosis and surgery was 8.4 days. The mean Intensive Care Unit stay was 12.8 days, whereas the overall mean in-hospital stay was 45.2 days. Mortality was 40%. Conclusion. ISE, although infrequent, displays a high morbimortality that can be reduced with an early therapeutic approach which may include the surgical evacuation in all the cases

[Evaluation of the pre-operative exercise capacity as survival marker in the lung transplant recipients]. / Valoración de la capacidad preoperatoria al ejercicio como factor predictivo de supervivencia en enfermos sometidos a trasplante pulmonar.

OBJECTIVE: To make an independent evaluation of the capacity for exercise as a predictive factor in lung transplant recipients. DESIGN: Retrospective study. SCOPE: Lung transplant unit of the Intensive Care Unit (ICU) of a university hospital. PATIENTS: We analyzed 132 lung transplants in a total of 130 patients. The patients were monitorized up to June 18, 2005 or their death. VARIABLES OF INTEREST: An evaluation was made of their pre-operative exercise capacity with the 6-minute walking test (6MWT). Long-term survival in relationship with the walking test value was also assessed. The survival curves were estimated using the Kaplan-Meier method. Comparison between curves was made with the Log-Rank methods and the hazard ratios were estimated by Cox regression. RESULTS: The association between mortality and the walking test value showed a hazard ratio of 0.99 (95% CI: 0.99-1.00) per metric unit (meter), (p = 0.282). The patients were classified according to the distance covered in the 4 groups: group 1 (distance covered less than 100 meters), group II (distance covered between 101-200 meters), group III (distance covered between 201 and 300 meters) and group IV (distance greater than 301 meters). No significant differences were found when comparing the survival curves of the four groups (p = 0.709). The multivariant analysis also did not show any statistical significance. CONCLUSIONS: We do not believe that the distance covered in the 6MWT conducted in the study protocol in the lung transplant candidates is useful as a marker to predict long-term mortality in patients undergoing lung transplant.

[Training in the care of the critical and multiple-injured patient: role of clinical simulation]. / Formación en la asistencia al paciente crítico y politraumatizado: papel de la simulación clínica.

Clinical simulation is suggested as a new educational instrument to learn and train in different medical skills. It is conceived as a new method that integrates scientific knowledge and human factors. Experience with these systems has been limited up to now, but it is now being widely accepted since it seems to accelerate acquisition of skills and knowledge in a safe setting, that is, without risk for the patient. However, its effect on clinical performance has not been validated yet. They are two types of simulators for intensive cares: screen based and human patient simulator (HPS). These systems make it possible to simulate different situations that require the application of action protocols or the management of new drugs in the clinical practice, promoting the rational use of resources in urgent care of the critical and multiple-injured patients. The limiting factors that prevent the expansion of the simulation for clinical training are its high cost, human resources needed, and the difficulties to assess the effectiveness of the training in real situations.

Formación en la asistencia al paciente crítico y politraumatizado: papel de la simulación clínica / Training in the care of the critical and multiple-injured patient: role of clinical simulation

La simulación clínica está surgiendo como un nuevo instrumento educativo para aprender y entrenar diferentes habilidades médicas. Está concebida como un novedoso método que integra conocimiento científico y factores humanos. La experiencia con estos sistemas es hasta ahora limitada, pero está siendo ampliamente aceptada, ya que parece acelerar la adquisición de habilidades y conocimientos en un ambiente seguro, es decir, sin riesgo para el paciente; si bien su efecto en el rendimiento clínico aún no ha sido validado. Hay dos tipos de simuladores para cuidados intensivos: de pantalla y simuladores de paciente a escala real (SER). Estos sistemas permiten simular distintas situaciones que requieren la aplicación de protocolos de actuación o el manejo de nuevos fármacos en la práctica clínica, fomentando el uso racional de recursos en la asistencia urgente del paciente crítico y politraumatizado. Los factores limitantes que impiden la expansión de la simulación para el entrenamiento clínico son su alto coste, los recursos humanos necesarios y las dificultades para valorar la efectividad del entrenamiento en situaciones reales

Clinical simulation is suggested as a new educational instrument to learn and train in different medical skills. It is conceived as a new method that integrates scientific knowledge and human factors. Experience with these systems has been limited up to now, but it is now being widely accepted since it seems to accelerate acquisition of skills and knowledge in a safe setting, that is, without risk for the patient. However, its effect on clinical performance has not been validated yet. They are two types of simulators for intensive cares: screen based and human patient simulator (HPS). These systems make it possible to simulate different situations that require the application of action protocols or the management of new drugs in the clinical practice, promoting the rational use of resources in urgent care of the critical and multiple-injured patients. The limiting factors that prevent the expansion of the simulation for clinical training are its high cost, human resources needed, and the difficulties to assess the effectiveness of the training in real situations