Resident physician duty hours, resting times and European Working Time Directive compliance in Spain: a cross-sectional study.

BACKGROUND: There is a growing interest in understanding the impact of duty hours and resting times on training outcomes and the well-being of resident physicians. However, to this date no state-wide analysis exists in any European country. OBJECTIVES: Our aim is to describe the shift work scheduling and to detail the degree of compliance with the Spanish legislation and the European Working Time Directive (EWTD) of Spanish resident physicians, focusing on territorial and specialty distribution. MATERIAL AND METHODS: A descriptive cross-sectional analytical study was designed through an online survey adapted from the existing literature. RESULTS: Out of the 2035 surveyed resident physicians undergoing PGT in Spain, 80.49% exceeded the 48 h per week limit set by the EWTD and 13% of them did not rest after a 24-h on-call shift. The mean number of on-call shifts in the last 3 months was 15.03, with the highest mean reported in Asturias, La Rioja, and Extremadura. 51.6% of respondents had a day-off after a Saturday on-call shift. Significant differences are observed by region and type of specialty. CONCLUSION: Resident physicians in Spain greatly exceed the established 48 h/week EWTD limit. Likewise, non-compliance with labor regulations regarding mandatory rest after on-call duty and minimum weekly rest periods are observed.

Paget-Schroetter syndrome in an active young female after unsupervised exercise.

INTRODUCTION AND IMPORTANCE: Thoracic outlet syndrome (TOS) is a rare syndrome caused by compression of one of the three neurovascular structures in their passage from the cervical area toward the axilla and proximal arm either at the interscalene triangle, the costoclavicular triangle, or the sub coracoid space. The mainstay of management is nonsurgical; however, surgery may be needed when patients persist with symptoms despite conservative management and when vascular structures are involved. Symptoms are non-specific and require high clinical awareness since this pathology tends to affect otherwise healthy young patients. CASE PRESENTATION: We present the case of a 45-year-old female without any past medical history. She was active and did plenty of exercises. After a high-intensity routine without any guidance, she presented with acute upper limb swelling with pain. After further examination, a venous thoracic outlet syndrome was identified and treated without complications. CLINICAL DISCUSSION & CONCLUSION: Venous TOS is a rare pathology associated with high long-term morbidity and disability if left untreated; heightened clinical awareness of the possibility of acute thrombosis obstructing venous return and producing these rare symptoms should lead the medical team to assess the patient further and lead to the appropriate medical and surgical intervention.

Impact of Treatment with Unilateral Implant- Supported Fixed Partial Prosthesis on the Frequency of Masticatory Side Switches in Patients with Unilateral Posterior Missing Teeth.

This study aimed to determine the impact of treatment with an implant-supported fixed partial prosthesis (ISFPP) on the frequency of masticatory side switches in patients with unilateral posterior missing teeth. This was a prospective study of 30 patients with unilateral posterior missing teeth treated with one-, two-, or three-unit ISFPPs. Comparison was with 10 healthy individuals with complete natural dentitions. Each participant performed masticatory assays, which involved chewing pieces of silicon inside a latex bag, at baseline and at 3-months' follow-up. The frequency of masticatory side switches was reported as the masticatory side-switch index: the number of side switches divided by the maximum number of possible switches. Data were analyzed by Kruskal-Wallis, Mann-Whitney U test, or Wilcoxon test, as appropriate. At baseline, the masticatory side-switch index was lower only in patients with three missing teeth than in controls. At 3 months after treatment, a significant increase in the masticatory side-switch index was only observed in patients treated with three restorative units. Treatment with ISFPPs does not change the masticatory side-switch frequency in patients with unilateral posterior missing teeth, though it could increase it in patients with three missing teeth.

Management of hypertension and renin-angiotensin-aldosterone system blockade in adults with diabetic kidney disease: Association of British Clinical Diabetologists and the Renal Association UK guideline update 2021.

People with type 1 and type 2 diabetes are at risk of developing progressive chronic kidney disease (CKD) and end-stage kidney failure. Hypertension is a major, reversible risk factor in people with diabetes for development of albuminuria, impaired kidney function, end-stage kidney disease and cardiovascular disease. Blood pressure control has been shown to be beneficial in people with diabetes in slowing progression of kidney disease and reducing cardiovascular events. However, randomised controlled trial evidence differs in type 1 and type 2 diabetes and different stages of CKD in terms of target blood pressure. Activation of the renin-angiotensin-aldosterone system (RAAS) is an important mechanism for the development and progression of CKD and cardiovascular disease. Randomised trials demonstrate that RAAS blockade is effective in preventing/ slowing progression of CKD and reducing cardiovascular events in people with type 1 and type 2 diabetes, albeit differently according to the stage of CKD. Emerging therapy with sodium glucose cotransporter-2 (SGLT-2) inhibitors, non-steroidal selective mineralocorticoid antagonists and endothelin-A receptor antagonists have been shown in randomised trials to lower blood pressure and further reduce the risk of progression of CKD and cardiovascular disease in people with type 2 diabetes. This guideline reviews the current evidence and makes recommendations about blood pressure control and the use of RAAS-blocking agents in different stages of CKD in people with both type 1 and type 2 diabetes.

Impact of the first superspreading outbreak of COVID-19 related to a nightlife establishment in Andalusia, Spain.

INTRODUCTION AND AIM OF THE STUDY: A notable proportion of COVID outbreaks are generated by "super-spreading events", where a few subjects transmit the pathogen to many secondary cases, increasing contact networks and the spread of the pathogen. We conducted a description of a COVID-19 superspreading event in Córdoba during July 2020, linked to a nightlife establishment. MATERIAL AND METHODS: Retrospective observational study describing characteristics of person, time, PCR result and contact network of confirmed cases. PCR results in Córdoba during July and August and information collected in surveillance systems were analyzed. RESULTS: 935 individuals associated with the outbreak were included; 120 (12.83%) became confirmed cases. July 17 was the day with the highest incidence, with 27 new cases (22.5% of the total). People under 25 years old represented 69.2% of the cases. The average number of close contacts per person was 10.7, with a decrease as age raised. During the outbreak, incidence increased at the provincial level compared to previous weeks; at the end, incidence did not return to initial values but remained high with a relevant percentage of cases having unknown epidemiological association. CONCLUSIONS: A greater transmission capacity of SARS-CoV-2 was observed in a closed, crowded space, and among young people that tended to report a greater number of social contacts and may present little or no symptoms. Developing preventive measures in scenarios that combine these factors and early detection of cases are essential to avoid an increase in the spread of the virus.

[Patient safety: Patients perception at primary care level at an urban healthcare district]. / Seguridad del paciente: percepción de los pacientes en atención primaria de un distrito sanitario urbano.

OBJECTIVES: Patient safety is a quality objective and a priority in healthcare. Most of the research has focused on the hospital setting and from the professional perspective. The objective of our study is to know the opinion of the patient who attends primary care regarding its safety in this area. MATERIAL AND METHODS: Cross-sectional observational study. A survey carried out with patients chosen through four health centres representing different socioeconomic levels of the same Basic Health Zone. Fifty patients per centre were surveyed. RESULTS: Two hundred patients surveyed of whom more than 90% reported no negative experiences in terms of errors in medication, identification, diagnosis or clinical management, highlighting the good care received and the good resolution of their problem. However, only around half claimed to understand the explanations of the healthcare professionals or to have had the opportunity to give an opinion or have shared decision-making on their management. These factors were closely related to the perceived lack of time in consultation and constant change of physician. CONCLUSIONS: The vast majority of our patients report no adverse effects or safety issues during their primary care attendance. However, there is evidence of the need to strengthen aspects related to consultation time and increase the number and stability of human resources in health centres to improve patient satisfaction with the health system.

Implantes estrechos como alternativa para la restauración del sector estético anterior / Narrow implants as altenative for the rehabilitation of anterioraesthetic area

Existen determinadas situaciones donde los implantes, considerados estándar, no se pueden colocar o suponen un riesgo para el mantenimiento de la cresta marginal. Los implantes de diámetro estrecho se han empleado para numerosas indicaciones, estableciéndose protocolos de tratamiento, científicamente fundamentados, con excelentes resultados a largo plazo. En el presente trabajo presentamos una revisión histórica de los implantes estrechos, destacando sus indicaciones y limitaciones y presentamos un caso clínico en el que se han mostrado útiles Caso clínico: Se presenta el caso de una mujer de 59 años de edad, con antecedentes de cáncer de mama en el 2008, que precisa la extracción de los cuatro incisivos supriores. El caso se resuelve con dos implantes estrechos postextracción y prótesis inmediata para preservar el aspecto estético. Conclusiones: En el caso que presentamos se evidencia que los implantes estrechos son una alternativa cuando rehabilitamos espacios edéntulos con poca disponibilidad ósea en el sentido horizontal o espacios mesio-distales reducidos en zonas estéticas. (AU)

There are certainly situations where the standard implants can not be placed or suppose a risk for the crestal bone maintenance. The narrow implants have been used for a wide variety of indications, stablishing scientifically-based treatment protocols with excellent long-term results.In the present study we present a narrative review of narrow implants highlighting their indications and limitations, and a case report where narrow implants have been shown useful. Case Report:A 59-year-old woman case report is presented, with a breast cancer history in 2008, who required the extraction of the four upper incisors. The case is solved with two post-extraction narrow implants and an immediate prosthesis to preserve aesthetics. Conclusions: In this case report, it is evident that narrow implants are an alternative when rehabilitate edentulous spaces with low available bone in the horizontal direction or reduced mesio-distal spaces in aesthetic areas. (AU)

Tratamiento Laser-Lok® en implantes dentales. A propósito de un caso clínico / Laser-Lok® treatment on implants dental. About a clinical case

Uno de los retos más importantes, hoy en día, en implantología oral es evitar la pèrdida ósea alrededor de los implantes oseointegrados y funcionales con el paso del tiempo. Una de las superficies que se ha desarrollado en los últimos años es la resultante de la microtexturación mediante láser. Diversos estudios han demostrado la adhesión del tejido conectivo a las superficies tratadas con láser en la zona cervical de los implantes oseointegrados, consiguiendo de este modo un sellado biológico a este nivel. Revisamos lo publicado sobre este tema y presentamos un caso clínico de inserción de un implante unitario con tratamiento láser en su zona cervical desde su colocación hasta la restauración final, donde se observa la buena integración de los tejidos y el èxito del caso a largo plazo. (AU)

There are certainly situations where the standard implants can not be placed or suppose a risk for the crestal bone maintenance. The narrow implants have been used for a wide variety of indications, stablishing scientifically-based treatment protocols with excellent long-term results.In the present study we present a narrative review of narrow implants highlighting their indications and limitations, and a case report where narrow implants have been sh it is evident that narrow implants are an alternative when rehabilitate edentulous spaces with low available bone in the horizontal direction or reduced mesio-distal spaces in aesthetic areas. (AU)

[Discussion groups as an approach to assess knowledge, attitudes and practices of hand hygiene among the adult intensive care unit professionals from a referral hospital]. / Grupos de discusión como abordaje para valorar conocimiento, actitudes y prácticas de higiene de manos en profesionales de la unidad de cuidados intensivos de adultos de un hospital de referencia.

OBJECTIVES: The adherence to hand hygiene practices among the adult Intensive Care Unit (ICU) professionals in this hospital has not improved substantially in the last years, regardless of the theoretical training sessions conducted. A study was made of the knowledge, attitudes, and practices of the ICU personnel in this field. METHODS: Several small discussion groups with ICU staff organised by preventive medicine professionals were scheduled in March 2018. Semi-structured questions on hand hygiene and use of gloves were included. The points discussed were listed into strengths and weaknesses. Knowledge was then assessed using an anonymous questionnaire, after the sessions. RESULTS: Thirteen 60-minute sessions were carried out with 157 participants from all professional categories (82% from ICU, median=11 participants / session). The majority perceived hand hygiene as a priority issue of personal responsibility for patient safety. They identified factors that limit their ability to improve their adherence. Certain habits have more to do with personal preferences than with theoretical knowledge or technical indications. CONCLUSIONS: The discussion groups have helped to make a diagnosis of the situation that will be useful to strengthen those areas of improvement that have been identified. If we aim for a cultural change, and eliminate incorrect habits, it seems more useful to carry out adequate continuing education as part of the daily routine of professionals.

SEOM clinical guideline of venous thromboembolism (VTE) and cancer (2019).

In 2011, the Spanish Society of Medical Oncology (SEOM) first published a clinical guideline of venous thromboembolism (VTE) and cancer. This guideline was updated in 2014, and since then, multiple studies and clinical trials have changed the landscape of the treatment and prophylaxis of VTE in cancer patients. To incorporate the most recent evidence, including data from direct oral anticoagulants (DOACs) randomized clinical trials, SEOM presents a new update of the guideline.

Chilean aquaculture and the new challenges: Pathogens, immune response, vaccination and fish diversification.

In Chile, the salmon and trout farmed fishing industries have rapidly grown during the last years, becoming one of the most important economic sources for the country. However, infectious diseases caused by bacteria, virus, mycoses and parasites, result in losses of up to 700 million dollars per year for the Chilean aquaculture production with the consequent increase of antibiotic and antiparasitic usage. After 30 years of its first appearance, the main salmon health problem is still the salmonid rickettsial septicaemia (SRS), which together with other disease outbreaks, reveal that vaccines do not provide acceptable levels of long-lasting immune protection in the field. On the other hand, due to the large dependence of the industry on salmonids production, the Chilean government promoted the Aquaculture diversification program by 2009, which includes new species such as Merluccius australis, Cilus gilberti and Genypterus chilensis, however, specific research regarding the immune system and vaccine development are issues that still need to be addressed and must be considered as important as the farm production technologies for new fish species. Based on the experience acquired from the salmonid fish farming, should be mandatory an effort to study the immune system of the new species to develop knowledge for vaccination approaches, aiming to protect these aquaculture species before diseases outbreaks may occur. This review focuses on the current status of the Chilean aquaculture industry, the challenges related to emerging and re-emerging microbial pathogens on salmonid fish farming, and the resulting needs in the development of immune protection by rational designed vaccines. We also discussed about what we have learn from 25 years of salmonid researches and what can be applied to the new Chilean farmed species on immunology and vaccinology.

Horizontal augmentation of the maxillary alveolar ridge to change the prosthetic profile: Clinical and radiological results of a retrospective study.

BACKGROUND: In this retrospective study, we aimed to analyze the clinical and radiological results of compensating the long-term deficiencies in hard and soft tissues of edentulous patients by placing dental implants and performing a horizontal ridge augmentation. MATERIAL AND METHODS: We treated patients with edentulous maxillaries (Cawood-Howell type III or IV) by combining 4 implants, or 6 implants, or using zygomatic and conventional anterior implants as appropriate. Simultaneously, horizontal ridge augmentation was performed by combining autologous bone with Bio-Oss and membranes. RESULTS: A total of 14 zygomatic and 80 standard implants were used for the rehabilitations in 16 edentulous patients. The success rates were 93.75% and 85.71% for the standard and zygomatic implants, respectively. Also, respective gains of 5.79mm and 3.25mm were obtained at the levels of the midsagittal line and canines, with respective resorption rates of 10% and 8.6% after 20months. CONCLUSION: The millimeters gained by performing a horizontal augmentation optimizes the relation between the implant position and the prosthetic profile. This allows the different prostheses to be selected and for rehabilitation to be optimized. In this way, mucosal coverage can be avoided and fixed prosthetic design can be enhanced.

Mass transfer enhancement and improved nitrification in MABR through specific membrane configuration.

One of the main energy consumptions in wastewater treatment plants (WWTPs) is due to the oxygenation of aerobic biological processes. In order to approach to an energy self-sufficient scenario in WWTPs, Membrane Aerated Biofilm Reactors (MABRs) provide a good opportunity to reduce the impact of aeration on the global energy balance. However, mass transfer limitations derived from poor flow distribution must be tackled to take advantage of this technology. In this work, in order to improve mass transfer between biofilm and bulk water, a specific configuration was developed and studied at laboratory scale, aimed at compactness, energy efficiency and high nitrification rates. Nitrification rates were higher in the innovative configuration than in the conventional one, achieving a Volumetric Nitrification Rate (VNR) as high as 575.84 g NH4-N m-3 d-1, which is comparable with confirmed technologies. Regarding energy consumption due to aeration, a reduction of 83.7% was reached in comparison with aeration through diffusers with the same Oxygen Transfer Efficiency (OTE). These results highlight the importance of hydrodynamic conditions and the membranes configuration on treatment performance.

Inclusión de 4CMenB (Bexsero(R)) en el calendario vacunal sistemático en España / No disponible

No disponible

A collapsed-cone based transit EPID dosimetry method.

PURPOSE: To develop a transit-dose portal dosimetry method based on a commercial collapsed-cone algorithm. METHODS: A Varian Clinac21EX (Varian Medical Systems, USA), equipped with an amorphous-silicon EPID aS1000, was used. Dose calculations were performed with the collapsed-cone algorithm of Pinnacle3 v8.0 m (Philips Medical Systems, USA). A model for the energy of 6 MV was made in Pinnacle3 and afterwards validated for clinical use. A virtual phantom with different densities was contoured and superimposed on the patient images, simulating the presence of the EPID during the treatment. Corrections for photon spectral variations were introduced using Matlab (Mathworks, USA). Transit dosimetry was verified with an anthropomorphic phantom, on which different treatment fields were simulated in locations of skull, thorax and pelvis. In addition, a prostate treatment with IMRT was administered thereon. Dose distributions were compared with gamma index. RESULTS: The dose differences at the central point did not exceed 2%, except for the 20 x 20 cm2 field size centered in the skull. The model presented in this work, assumes that the dimensions of the solid water phantom, are infinite, except for the thickness. The mean values for the gamma index pass rates were 85.62% for (3%, 3 mm), 91.73% (4%, 3 mm) and 95.68% (5%, 3 mm). CONCLUSIONS: The value of 95% for γ (5%, 3 mm) can be established as the value below which the origin of the discrepancies should be investigated. It should be considered that the proposed method is complementary and not a substitute for pre-treatment dosimetry.

Autogenous teeth used for bone grafting: A systematic review.

BACKGROUND: Recently, bone graft materials using permanent teeth have come to light, and clinical and histological outcomes of this material have been confirmed by some studies. The aim of this systematic review was to evaluate the reliability of the autogenous tooth bone graft material applied to alveolar ridge augmentation procedures. MATERIAL AND METHODS: A systematic review of literature was conducted analyzing articles published between 2007 and 2017. The following four outcome variables were defined: a) implant stability b) post-operative complication c) evaluation of implant survival and failure rates, and d) histological analysis. A total of 108 articles were identified; 6 were selected for review. Based on the PICO (problem, intervention, comparison, outcome) model, the chief question of this study was: Can patients with alveolar ridge deficiency be successfully treated with the autogenous teeth used as bone graft? RESULTS: The mean primary stability of the placed implants was 67.3 ISQ and the mean secondary stability was 75.5 ISQ. The dehiscence of the wound was the most frequent complication with a rate of 29.1%. Of the 182 analyzed implants, the survival rate was 97.7% and the failure rate was 2.3%. In the histological analysis, most of studies reported bone formation. CONCLUSIONS: There is insufficient evidence regarding the effects of autogenous teeth used for bone grafting to support any definitive conclusions, although it has been shown clinically safe and good bone forming capacity, and good results are shown about implant stability.

Histological differences in the adherence of connective tissue to laser-treated abutments and standard abutments for dental implants. An experimental pilot study in humans.

BACKGROUND: The goal of the current study is to assess the difference in connective tissue adherence to laser microtextured versus machined titanium abutments. MATERIAL AND METHODS: Six patients were selected and each of them received 2 implants, one combined with a laser treated abutment and one with a machined abutment. After three months, the abutments were retrieved together with their surrounding gingival tissue for histological analysis. Qualitative and quantitative evaluation of microscopical images was performed to assess the presence or absence of adherence between the soft tissues and the abutment, and the percentage of soft tissue adhered to the two different surfaces. RESULTS: Intimate adherence between connective tissue and the laser treated abutments, while on machined abutments no adherence was detected. A significant difference was found in the percentage of surface in contact with soft tissue between both implant abutments p=0.03. CONCLUSIONS: Within the limitation of the current study, it can be concluded that connective tissues show enhanced adherence to microtextured abutments compared to machined abutments.

Long term variations measurement of electromagnetic field exposures in Alcalá de Henares (Spain).

Electromagnetic radiowave exposure is a major concern in most countries due to possible adverse health effects. Over the last 10years, many technological changes (digital television, mobile technologies, wireless networks…) have led to variations in the electromagnetic field (EMF) levels. A large number of studies devoted to the analysis of EMF levels with personal dosimeters or computer models of the exposure of mobile stations have been conducted. However, the study of the exposure values, taking into account all the existing sources, and their evolution in a wide area, using measurements, has rarely been performed. In this paper, we provide a comparison of the EMF exposure levels for the city of Alcalá de Henares (Spain) over a ten-year period using a broadband isotropic probe in the range from 100kHz to 3GHz. A statistical and spatial analysis of the measurements and their variations are also presented for the study of the global and local variations. The measured values in the period from 2006 to 2015 were ranging from 0.02 to 2.05V/m. Our global results show a moderate increase from 2006 to 2010 and they are almost invariant from 2010 to 2015. Although the whole dataset does not have relevant statistical difference, we have found marked local differences. In the city areas where the population density has remained unaltered, we have measured lower exposure levels. Conversely, new urban and industrial developments have demanded new resources, which have potentially contributed to the observed increase in the measured electric field levels within these areas.