Inoculum effect of CTX-M-15, OXA-48, and KPC-2 producing Klebsiella pneumoniae on meropenem and ceftazidime-avibactam efficacy.

The inoculum effect, characterized by diminished antibacterial activity at high bacterial inocula, is studied in the context of beta-lactam and beta-lactamase inhibitor combinations against beta-lactamase-producing Enterobacterales. The inhibition of ESBL + OXA-48 and KPC enzymes, in combination with ceftazidime, demonstrates encouraging results. In this study, 20 Klebsiella pneumoniae isolates were tested with different inocula (1-5 × 105 and 1-5 × 107 cfu/ml) using broth microdilution methods. The inoculum effect was observed in meropenem against OXA-48 + CTX-M-15- and KPC-2-producing isolates but not with ceftazidime/avibactam. Notably, meropenem exhibited inoculum effect against carbapenemase-producing strains, whereas ceftazidime-avibactam remained effective. We conclude that ceftazidime-avibactam is recommended for high-inoculum infections.

Severe penile fibrotic reaction secondary to a non-absorbable suture: a case report. / Reacción fibrótica peneana severa secundaria a una sutura no absorbible: reporte de un caso.

INTRODUCTION: Circumcision is one of the most frequent urological surgical procedures in the pediatric population globally. Complications, although rare, can be severe. CLINICAL CASE: We present the case of a Senegalese 10-year-old male patient who had undergone ritual circumcision in his early childhood and developed a progressive circumferential tumor in the penile body with no further associated symptoms. Surgical exploration was carried out. A fibrotic-looking penile ring, which was interpreted as an injury secondary to the non-absorbable suturing material used in the previous surgery, was identified. The tissue involved was removed, and on-demand preputioplasty was conducted. Due to technical limitations, the resected tissue could not be analyzed, which means diagnosis could not be histopathologically confirmed. The patient had a favorable progression. CONCLUSIONS: This case demonstrates that the medical personnel in charge of performing circumcisions should be adequately trained in order to prevent severe complications.

INTRODUCCION: La circuncisión es uno de los procedimientos quirúrgicos urológicos más frecuentemente realizados en la población pediátrica en todo el mundo. Las complicaciones, aunque infrecuentes, pueden ser graves. CASO CLINICO: Presentamos el caso de un paciente varón senegalés de 10 años que fue sometido a una circuncisión ritual en la primera infancia y que desarrolló una tumoración circunferencial progresiva en el cuerpo del pene sin otra sintomatología asociada. Se realizó una exploración quirúrgica y se identificó un rodete peneano de aspecto fibrótico que se interpretó como lesión secundaria al material de sutura no absorbible utilizado en la cirugía anterior. Se realizó una exéresis del tejido afecto y una prepucioplastia a demanda. Por limitaciones técnicas, no se pudo analizar el tejido resecado y por tanto no se pudo confirmar histopatológicamente el diagnóstico. El paciente evolucionó favorablemente. CONCLUSIONES: Este caso pone de manifiesto la necesidad de formar adecuadamente al personal que realiza la circuncisión para evitar complicaciones severas.

Reacción fibrótica peneana severa secundaria a una sutura no absorbible: reporte de un caso / 144J. Arredondo M ontero et al. CIRUGÍA PEDIÁTRICA Resumen Introducción. La circuncisión es uno de los procedimientos qui- rúrgicos urológicos más frecuentemente realizados en la población pe- diátrica en todo el mundo. Las complicaciones, aunque infrecuentes, pueden ser graves. Caso clínico. Presentamos el caso de un paciente varón senegalés de 10 años que fue sometido a una circuncisión ritual en la primera infancia y que desarrolló una tumoración circunferencial progresiva en el cuerpo del pene sin otra sintomatología asociada. Se realizó una exploración quirúrgica y se identificó un rodete peneano de aspecto fibrótico que se interpretó como lesión secundaria al material de sutura no absorbible utilizado en la cirugía anterior. Se realizó una exéresis del tejido afecto y una prepucioplastia a demanda. Por limitaciones técnicas, no se pudo analizar el tejido resecado y por tanto no se pudo confirmar histopa- tológicamente el diagnóstico. El paciente evolucionó favorablemente. Conclusiones. Este caso pone de manifiesto la necesidad de for- mar adecuadamente al personal que realiza la circuncisión para evitar complicaciones severas. Palabras Clave: Fimosis; Circuncisión, Varón; Fibrosis. Severe penile fibrotic reaction secondary to a non- absorbable suture: a case report

Introducción: La circuncisión es uno de los procedimientos quirúrgicos urológicos más frecuentemente realizados en la población pediátrica en todo el mundo. Las complicaciones, aunque infrecuentes,pueden ser graves. Caso clínico: Presentamos el caso de un paciente varón senegalés de10 años que fue sometido a una circuncisión ritual en la primera infanciay que desarrolló una tumoración circunferencial progresiva en el cuerpodel pene sin otra sintomatología asociada. Se realizó una exploraciónquirúrgica y se identificó un rodete peneano de aspecto fibrótico que seinterpretó como lesión secundaria al material de sutura no absorbibleutilizado en la cirugía anterior. Se realizó una exéresis del tejido afectoy una prepucioplastia a demanda. Por limitaciones técnicas, no se pudoanalizar el tejido resecado y por tanto no se pudo confirmar histopatológicamente el diagnóstico. El paciente evolucionó favorablemente. Conclusiones: Este caso pone de manifiesto la necesidad de formar adecuadamente al personal que realiza la circuncisión para evitarcomplicaciones severas.(AU)

Introduction: Circumcision is one of the most frequent urologicalsurgical procedures in the pediatric population globally. Complications,although rare, can be severe.Clinical case: We present the case of a Senegalese 10-year-oldmale patient who had undergone ritual circumcision in his early childhood and developed a progressive circumferential tumor in the penilebody with no further associated symptoms. Surgical exploration was carried out. A fibrotic-looking penile ring, which was interpreted asan injury secondary to the non-absorbable suturing material used inthe previous surgery, was identified. The tissue involved was removed,and on-demand preputioplasty was conducted. Due to technical limitations, the resected tissue could not be analyzed, which means diagnosiscould not be histopathologically confirmed. The patient had a favorableprogression. Conclusions: This case demonstrates that the medical personnelin charge of performing circumcisions should be adequately trained inorder to prevent severe complications.(AU)

Single-port transumbilical pediatric cholecystectomy: any benefits for the patient? / Colecistectomía pediátrica por puerto único transumbilical: ¿aporta algo al paciente?

OBJECTIVE: To compare the perioperative results of single-port laparoscopic cholecystectomy (SPLC) with those of laparoscopic cholecystectomy (LC), and to analyze whether there were any differences between both techniques in our patients. MATERIALS AND METHODS: A retrospective, observational analysis was carried out in non-homogeneous groups of patients under 15 years of age undergoing LC and SPLC over a 6-year period. LC was conducted using four ports, while SPLC was performed through an umbilical incision using a wound retractor to which a surgical glove was coupled for the insertion of 3 ports and instruments curved as required. 15 clinical, surgical, and economic variables were compared by means of a univariate and bivariate analysis. RESULTS: 11 patients underwent surgery - 5 through SPLC and 6 through LC. No significant differences were found in terms of mean operating time (SPLC: 144 minutes vs. LC: 139, P= 0.855) or hospital stay, but a slight increase in hospital cost was noted (SPLC: 1,160 € vs. LC: 1,177 €). The cost of LC was 1,322 € vs. 1,367 € for SPLC, with a premium of 44.30 € owing to the use of the wound retractor. None of the patients had perioperative complications, and all of them felt the cosmetic result was excellent. CONCLUSIONS: In our limited experience, the differences between SPLC and LC do not clearly support one or the other. SPLC could provide patients with a better cosmetic result and allow surgeons to improve their skills. However, we believe cholecystectomy is not the most adequate procedure to start a career in single-port laparoscopy because potential complications may be severe.

OBJETIVO: Comparar los resultados perioperatorios de la colecistectomía laparoscópica por puerto único (CLPU) respecto a la colecistectomía laparoscópica (CL) y analizar si, en nuestra casuistica, existen diferencias entre estas tecnicas. MATERIAL Y METODO: Análisis retrospectivo y observacional en grupos no homogeneos de pacientes menores de 15 años sometidos a CL y CLPU durante un periodo de 6 años. La CL se realizó con cuatro puertos y la CLPU mediante una incisión umbilical y colocación de un retractor de heridas al que se acopló un guante quirúrgico, a través del cual se insertaron 3 trócares para el instrumental convenientemente curvado. Se compararon 15 variables clínicas, quirúrgicas y económicas mediante análisis univariado y bivariado. RESULTADOS: Fueron intervenidos 11 pacientes, cinco mediante CLPU y 6 por CL. No hubo diferencias significativas en el tiempo operatorio medio (CLPU: 144 minutos vs. CL: 139, P= 0,855) ni en estancia hospitalaria, aunque sí un ligero aumento del coste hospitalario (CLPU:1.160 €, CL:1.177 €). El coste de la CL fue de 1.322 € frente a 1.367 de la CLPU, con un sobreprecio de +44,30 € debido al uso del retractor de heridas. Ningún paciente presentó complicaciones perioperatorias y todos percibían un resultado cosmético excelente. CONCLUSIONES: Las diferencias entre CLPU y CL, en nuestra reducida experiencia, no justifican decidirse claramente por una u otra técnica. La CLPU podría aportar al paciente un mejor resultado cosmético y al cirujano una mejora de sus habilidades, aunque creemos que la colecistectomía no es la intervención adecuada para iniciarse en laparoscopia por puerto único debido a la gravedad de las posibles complicaciones.

Colecistectomía pediátrica por puerto único transumbilical: ¿aporta algo al paciente? / Single-port transumbilical pediatric cholecystectomy: any benefits for the patient?

Objetivo: Comparar los resultados perioperatorios de la colecistectomía laparoscópica por puerto único (CLPU) respecto a la colecistectomía laparoscópica (CL) y analizar si, en nuestra casuistica, existendiferencias entre estas tecnicas. Material y métodos: Análisis retrospectivo y observacional engrupos no homogeneos de pacientes menores de 15 años sometidos aCL y CLPU durante un periodo de 6 años. La CL se realizó con cuatropuertos y la CLPU mediante una incisión umbilical y colocación deun retractor de heridas al que se acopló un guante quirúrgico, a travésdel cual se insertaron 3 trócares para el instrumental convenientementecurvado. Se compararon 15 variables clínicas, quirúrgicas y económicasmediante análisis univariado y bivariado. Resultados: Fueron intervenidos 11 pacientes, cinco medianteCLPU y 6 por CL. No hubo diferencias significativas en el tiempooperatorio medio (CLPU: 144 minutos vs. CL: 139, P= 0,855) ni enestancia hospitalaria, aunque sí un ligero aumento del coste hospitalario(CLPU:1.160 €, CL:1.177 €). El coste de la CL fue de 1.322 € frentea 1.367 de la CLPU, con un sobreprecio de +44,30 € debido al uso delretractor de heridas. Ningún paciente presentó complicaciones perioperatorias y todos percibían un resultado cosmético excelente. Conclusiones: Las diferencias entre CLPU y CL, en nuestra reduci-da experiencia, no justifican decidirse claramente por una u otra técnica.La CLPU podría aportar al paciente un mejor resultado cosmético y alcirujano una mejora de sus habilidades, aunque creemos que la colecistectomía no es la intervención adecuada para iniciarse en laparoscopiapor puerto único debido a la gravedad de las posibles complicaciones.(AU)

Objective: To compare the perioperative results of single-portlaparoscopic cholecystectomy (SPLC) with those of laparoscopic cholecystectomy (LC), and to analyze whether there were any differencesbetween both techniques in our patients. Materials and methods: A retrospective, observational analysis wascarried out in non-homogeneous groups of patients under 15 years ofage undergoing LC and SPLC over a 6-year period. LC was conductedusing four ports, while SPLC was performed through an umbilical incision using a wound retractor to which a surgical glove was coupled forthe insertion of 3 ports and instruments curved as required. 15 clinical,surgical, and economic variables were compared by means of a univariate and bivariate analysis. Results: 11 patients underwent surgery – 5 through SPLC and 6through LC. No significant differences were found in terms of meanoperating time (SPLC: 144 minutes vs. LC: 139, P= 0.855) or hospitalstay, but a slight increase in hospital cost was noted (SPLC: 1,160 € vs.LC: 1,177 €). The cost of LC was 1,322 € vs. 1,367 € for SPLC, witha premium of 44.30 € owing to the use of the wound retractor. Noneof the patients had perioperative complications, and all of them felt thecosmetic result was excellent. Conclusions: In our limited experience, the differences betweenSPLC and LC do not clearly support one or the other. SPLC couldprovide patients with a better cosmetic result and allow surgeons toimprove their skills. However, we believe cholecystectomy is not themost adequate procedure to start a career in single-port laparoscopybecause potential complications may be severe.(AU)

Differential diagnosis of congenital megaprepuce: therapeutic and prognostic relevance. / Diagnóstico diferencial del megaprepucio congénito: relevancia terapéutica y pronóstica.

Congenital megaprepuce is a urological pathology typical of childhood. It can be easily mistaken for other clinical entities such as physiological phimosis or buried penis. Owing to the risk of associated complications - primarily infectious and obstructive complications, with upper urinary tract involvement -, achieving an accurate diagnosis proves particularly significant for early treatment initiation. We present three cases of congenital megaprepuce diagnosed and operated on at our department from January 2019 to May 2020. Diagnosis, therapy, and clinical progression are described.

El megaprepucio congénito es una patología urológica propia de la infancia que puede ser fácilmente confundida con otras entidades clínicas como la fimosis fisiológica o el pene enterrado. Debido al riesgo de complicaciones asociadas, principalmente de carácter infeccioso u obstructivo con afectación del tracto urinario superior, es importante incidir en su correcto diagnóstico de cara a ofertar un tratamiento precoz. Presentamos tres casos de megaprepucio congénito, diagnosticados e intervenidos en nuestro servicio durante el periodo comprendido entre enero de 2019 y mayo de 2020, describiéndose el diagnóstico, la terapéutica empleada y la evolución clínica.

Prospective epidemiological study of basketball injuries during one competitive season in professional and amateur Spanish basketball.

INTRODUCTION: There are few Spanish epidemiological studies of basketball injuries, even though it is the second most played sport and the leading sport played by females in Spain. POPULATION: We studied 117 male and female basketball players from ten amateur or professional teams from four leagues in the 2014-2015 season. RESULTS: There were 11.6 injuries per 1,000 hours of sporting activity, 9.6 injuries per 1,000 hours of training and 47.3 injuries per 1,000 hours of competition. The rate of injuries requiring downtime was 2.99 per 1,000 hours of training, 41.7 per 1,000 hours of competition and 4.1 per 1,000 hours of sporting activity overall. No significant differences were found in the incidence of injuries between leagues, but a higher incidence by season was found in teams participating in international competitions, due to the increased competition time. The ankle was the main site of injuries causing ≥ 8 days of downtime and knee injuries the site of those causing ≥ 29 days of downtime. The most frequent injuries were sprains, bruises, and muscle overloads and 63.8% of players had ≥ 1 potentially-recurring injury. The most prevalent injuries were ankle sprains (50%), thigh muscle injuries (12.2%) and knee tendinitis (7.4%). The only significant predisposing factor for injury was recurrent injury (adjusted OR 1.93, 95% CI 1.029-3.62). Age, sex, height, weight, position, body mass index, and professional/amateur competition were not significantly associated with the number of injuries or ≥ 7 days downtime in the multivariate analysis. CONCLUSION: Preventive measures should be applied to the team as a whole at an early age, since recurrent injuries only explained a small percentage of the total injuries.

Diagnóstico diferencial del megaprepucio congénito: relevancia terapéutica y pronóstica / Differential diagnosis of congenital megaprepuce: therapeutic and prognostic relevance

El megaprepucio congénito es una patología urológica propia dela infancia que puede ser fácilmente confundida con otras entidadesclínicas como la fimosis fisiológica o el pene enterrado. Debido al riesgode complicaciones asociadas, principalmente de carácter infeccioso uobstructivo con afectación del tracto urinario superior, es importanteincidir en su correcto diagnóstico de cara a ofertar un tratamiento precoz.Presentamos tres casos de megaprepucio congénito, diagnosticados eintervenidos en nuestro servicio durante el periodo comprendido entreenero de 2019 y mayo de 2020, describiéndose el diagnóstico, la tera-péutica empleada y la evolución clínica.

Congenital megaprepuce is a urological pathology typical ofchildhood. It can be easily mistaken for other clinical entities such asphysiological phimosis or buried penis. Owing to the risk of associ-ated complications – primarily infectious and obstructive complications,with upper urinary tract involvement –, achieving an accurate diagnosisproves particularly significant for early treatment initiation. We presentthree cases of congenital megaprepuce diagnosed and operated on atour department from January 2019 to May 2020. Diagnosis, therapy,and clinical progression are described.

[Cranio-facial-cervical and subglottic hemangioma with respiratory symptoms. A therapeutic emergency].

We describe the case of a 41-day-old infant with a left craniofacial cervical and subglottic hemangioma with respira-tory symptoms. Although infantile hemangiomas are occasional benign vascular tumors that appear predominantly on the skin, 1-2% of patients may have airway lesions that can sometimes cause potentially life-threatening respiratory condi-tions. The decision was made to immediately commence treatment with propranolol, without waiting to complete the exten-sion and syndromic diagnoses. There was a positive clinical response and respiratory symptoms dissipated in twelve hours. Early treatment with beta-blockers is essential for children with hemangiomas whose location causes symptoms or significant functional changes: in some cases it may be a matter of urgency.

Hemangioma cráneo-facio-cervical y subglótico con clínica respiratoria. Una urgencia terapéutica / Cranio-facial-cervical and subglottic hemangioma with respiratory symptoms. A therapeutic emergency

Se describe el caso de una lactante de 41 días de vida con un hemangioma cráneo-facio-cervical izquierdo y subglótico con repercusión respiratoria. Aunque los hemangiomas infantiles son tumores vasculares benignos que se presentan predominantemente en piel y de forma aislada, un 1-2% de los pacientes pueden tener lesiones en la vía aérea que ocasionalmente provocan cuadros respiratorios potencialmente mortales. Se decidió iniciar inmediatamente el tratamiento con propranolol, sin esperar a completar el diagnóstico de extensión y sindrómico, con buena respuesta clínica y desaparición de la sintomatología respiratoria en las siguientes doce horas. En los niños con hemangiomas que por su localización produzcan síntomas o alteración funcional importante, es imprescindible iniciar el tratamiento betabloqueante de forma precoz y en algunos casos, urgentemente

We describe the case of a 41-day-old infant with a left craniofacial cervical and subglottic hemangioma with respiratory symptoms. Although infantile hemangiomas are occasional benign vascular tumors that appear predominantly on the skin, 1-2% of patients may have airway lesions that can sometimes cause potentially life-threatening respiratory conditions. The decision was made to immediately commence treatment with propranolol, without waiting to complete the extension and syndromic diagnoses. There was a positive clinical response and respiratory symptoms dissipated in twelve hours. Early treatment with beta-blockers is essential for children with hemangiomas whose location causes symptoms or significant functional changes: in some cases it may be a matter of urgency

Value of lipocalin 2 as a potential biomarker for bacterial meningitis.

OBJECTIVES: Central nervous system (CNS) infections are common causes of morbidity and mortality worldwide. We aimed to discover protein biomarkers that could rapidly and accurately identify the likely cause of the infections, essential for clinical management and improving outcome. METHODS: We applied liquid chromatography tandem mass spectrometry on 45 cerebrospinal fluid (CSF) samples from a cohort of adults with and without CNS infections to discover potential diagnostic biomarkers. We then validated the diagnostic performance of a selected biomarker candidate in an independent cohort of 364 consecutively treated adults with CNS infections admitted to a referral hospital in Vietnam. RESULTS: In the discovery cohort, we identified lipocalin 2 (LCN2) as a potential biomarker of bacterial meningitis (BM) other than tuberculous meningitis. The analysis of the validation cohort showed that LCN2 could discriminate BM from other CNS infections (including tuberculous meningitis, cryptococcal meningitis and virus/antibody-mediated encephalitis), with sensitivity of 0.88 (95% confident interval (CI), 0.77-0.94), specificity of 0.91 (95% CI, 0.88-0.94) and diagnostic odds ratio of 73.8 (95% CI, 31.8-171.4). LCN2 outperformed other CSF markers (leukocytes, glucose, protein and lactate) commonly used in routine care worldwide. The combination of LCN2, CSF leukocytes, glucose, protein and lactate resulted in the highest diagnostic performance for BM (area under the receiver operating characteristics curve, 0.96; 95% CI, 0.93-0.99). Data are available via ProteomeXchange with identifier PXD020510. CONCLUSIONS: LCN2 is a sensitive and specific biomarker for discriminating BM from a broad spectrum of other CNS infections. A prospective study is needed to assess the diagnostic utility of LCN2 in the diagnosis and management of CNS infections.

La mortalidad del primer cuatrimestre de 2020 en la pandemia por COVID-19. Análisis del Comité de Mortalidad del Hospital Central de la Defensa «Gómez Ulla», Madrid / Mortality in the first four months of 2020 in the COVID-19 pandemic. Analysis of the Mortality Committee of the Hospital Central de la Defensa «Gómez Ulla», Madrid

INTRODUCCIÓN: En diciembre de 2019, Wuhan, China, tuvo un brote de la enfermedad COVID-19, causado por el síndrome respiratorio agudo severo coronavirus 2 (SARS-CoV-2). La enfermedad en poco tiempo se convirtió en pandemia. Los factores de riesgo asociados a su mortalidad están aún por determinar. El Comité de Mortalidad estudia los fallecimientos hospitalarios con el objetivo principal de reducir las muertes evitables. OBJETIVOS: Describir las características de comorbilidad y demográficas de los exitus del primer cuatrimestre de 2020 en el Hospital Central de la Defensa y su relación con COVID-19. MATERIAL Y MÉTODOS: Estudio transversal, descriptivo, observacional y retrospectivo. Datos clínicos y demográficos de los exitus en relación a la presencia de COVID-19. RESULTADOS: De 371 fallecidos, 271 COVID-19 positivos y 100 COVID-19 negativos. Casi 1,8 veces más de la mortalidad esperada en el cuatrimestre (208 a 371). Edad media de los grupos 80 y 84 años, rango entre 35 y 104 años. Estancia hospitalaria en COVID-19 positivos del 10,1% frente a 5,5% en COVID-19 negativos. Exitus extranjeros menor de 70 años 80%. Lugar del exitus: planta hospitalaria (84%). Puntuación media del índice de Charlson: 4 puntos (intercuartil, 2-6), 53% supervivencia estimada a 10 años. Comorbilidades más frecuentes: HTA (70,5%); DM (36,5%); Oncológico (31%); Neumonía (86,7%). Mal estado general al ingreso (81,9%). CONCLUSIONES: La variable con mayor potencia relacionada con la mortalidad fue la edad avanzada. Otro grupo, sin comorbilidades, menor de 51 años, presentó evolución fatal. A pesar de la dificultad para establecer la tasa de mortalidad real por COVID-19, la diferencia entre los exitus esperados y los registrados por el Comité de Mortalidad Hospitalario constituye el valor más aproximado

INTRODUCTION: In December 2019, Wuhan, China had an outbreak of the COVID-19 disease, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The disease quickly turned into a pandemic. The risk factors associated with its mortality are yet to be determined. The Mortality Committee studies hospital deaths with the main objective of reducing preventable deaths. OBJECTIVES: To describe the comorbidity and demographic characteristics of the deaths from the first four-month period of 2020 at the Central Defense Hospital and their relationship with COVID-19. MATERIAL AND METHODS: Cross-sectional, descriptive, observational and retrospective study. Clinical and demographic data of deaths in relation to the presence of COVID-19. RESULTS: Of 371 deceased, 271 positive COVID-19 and 100 negative COVID-19-. Almost 1.8 times more than the expected mortality in the four-month period (208 to 371). Average age of the groups 80 and 84 years, range between 35 and 104 years. Hospital stay at positive COVID-19 10.1% compared to 5.5% at negative COVID-19. Foreign exitus under 70 years 80%. Exit location: hospital plant (84%). Average Charlson index score: 4 points (interquartile, 2-6), 53% estimated survival at 10 years. Most frequent comorbidities: HTN (70.5%); DM (36.5%); Oncological (31%); Pneumonia (86.7%). Poor general condition at admission (81.9%). CONCLUSIONS: The variable with the greatest power related to mortality was advanced age. Another group, without comorbidities, younger than 51 years, presented fatal evolution. Despite the difficulty in establishing the actual mortality rate from COVID-19, the difference between the expected deaths and those recorded by the Hospital Mortality Committee constitutes the most approximate value

Impact of incidental parathyroidectomy and mediastinal-recurrent cellular and lymph-node dissection on parathyroid function after total thyroidectomy.

OBJECTIVES: To determine the impact of incidental parathyroidectomy and mediastinal-recurrent cellular and lymph-node dissection on parathyroid function after total thyroidectomy. MATERIAL AND METHODS: A single-center retrospective study was conducted for a 5-year period in a university hospital center, including 605 patients undergoing total thyroidectomy, 52 of whom had mediastinal-recurrent cellular and lymph-node dissection. ENDPOINTS: The main endpoint was intraoperative number of parathyroid glands as predictor of parathyroid hormone (PTH) level and postoperative hypocalcemia. The secondary endpoint was the correlation between associated mediastinal-recurrent cellular and lymph-node dissection and incidental parathyroidectomy and its impact on PTH level and calcemia in the immediate postoperative period and at 1 month. RESULTS: 161 patients (26.61%) showed hypocalcemia in the immediate postoperative period and 12 (1.98%) at 1 month. Mediastinal-recurrent cellular and lymph-node dissection increased incidental parathyroidectomy risk 4.6-fold. Mediastinal-recurrent cellular and lymph-node dissection was associated with a statistically "suggestive" decrease in day-1 calcemia (P=0.03), and no significant decrease at 1 month (P=0.52). Incidental parathyroidectomy (6.7% of cases with parathyroidectomy versus 1.3% without) did not significantly increase the rate of early hypocalcemia (P=0.28), but was associated with a "suggestive" worsening at 1 month (P=0.02). CONCLUSION: Hypocalcemia after total thyroidectomy is a complex, probably multifactorial issue. Systematic parathyroid gland identification is not recommended due to the increased risk of gland lesion, mainly by devascularization. Incidental parathyroidectomy may induce hypocalcemia at 1 month postoperatively (statistically "suggestive" association).

Head and neck squamous cell carcinoma and metachronous second primaries.

OBJECTIVES: To assess the rate of second (or more) primaries after treatment for head and neck squamous cell carcinoma (HNSCC), and survival compared to patients with a single head and neck cancer. MATERIAL AND METHOD: A single-center retrospective study was performed in a University Hospital Center in 541 patients between 2002 and 2010. RESULTS: One hundred and forty-one patients (26.06%) presented 172 metachronous cancers. Overall 5-year survival was 20.3% with and 38.1% without metachronous cancer. Median and mean survival were respectively 21.9 and 51 months in patients with a single cancer, versus 13.9 and 26.5 months in case of metachronous cancer. Specific survival was comparable to overall survival. All-cause and specific survival were significantly poorer in metachronous cancer (P=0.001; log-rank α=0.05). CONCLUSION: At least a quarter of HNSCC patients go on to develop a metachronous second primary. These are of poor prognosis, whatever their location.

[Biometric analysis of the Spanish studies on neurorehabilitation in cases of stroke indexed in Medline (2008-2017)]. / Analisis bibliometrico de las investigaciones españolas sobre neurorrehabilitacion en el ictus indizadas en Medline (2008-2017).

TITLE: Analisis bibliometrico de las investigaciones españolas sobre neurorrehabilitacion en el ictus indizadas en Medline (2008-2017).

Is it possible to measure hemodynamic changes in the prefrontal cortex through the frontal sinus using continuous wave DOT systems?

The present work shows the capability of near infrared (NIR) light to reach the cerebral cortex through the frontal sinus using continuous-wave techniques (CW-DOT) in a dual study. On the one hand, changes in time during the tracking of a blood dye in the prefrontal cortex were monitored. On the other hand, hemodynamic changes induced by low frequency of transcranial magnetic stimulation applied on the prefrontal cortex were recorded. The results show how NIR light projected through the frontal sinus reaches the cerebral cortex target, providing enough information to have a reliable measurement of cortical hemodynamic changes using CW-DOT.

Results of a surgical cricothyrotomy workshop with a pig trachea model. / Resultados de un taller de cricotiroidotomía quirúrgica con un modelo de tráquea de cerdo.

BACKGROUND: The latest Difficult Airway Society (DAS) guidelines recommend that all anaesthesiologists should to be trained in the performing of a surgical cricothyrotomy (CtQ). The aim of this study was to analyse the learning results of a CtQ workshop by assessing the success rate and time to perform CtQ on a porcine tracheal model. MATERIAL AND METHODS: A workshop was designed in which each student completed a questionnaire with demographic data and theoretical knowledge about surgical approaches of airway. During the following hour, a review was presented theoretical aspects of CtQ. The model was shown and a CtQ was performed using a classical technique. Afterwards, in groups of 3-4 students with an instructor, each one of the students performed 6 CtQ. A record was made on whether the ventilation was correct, the time to perform CtQ, and the ease of performing the CtQ by the students and instructors. Finally, students completed a questionnaire on the theoretical aspects. Students and instructors performed a workshop debriefing. A statistical analysis was performed, considering a P-value <0.05 as statistically significant. RESULTS: A total of 8 workshop sessions were held with a total of 91 students. At first attempt, 86% of students performed a CtQ with successful ventilation, and 92% at the sixth attempt (P<.0001). Time taken was 163 [107-211] seconds at first attempt, and 70 [55-85] seconds at the sixth (P<.0001). At the end of workshop, students had improved their theoretical knowledge (P<.0001) and perception of the ease of the technique. CONCLUSION: Workshop performance improved theoretical knowledge and competence in surgical cricothyrotomy.

Psychometric properties of the well-being index (WHO-5) spanish version in a sample of euthymic patients with bipolar disorder.

BACKGROUND: The concept of well-being which focuses on positive emotions has received increased research attention. However, a consensus definition of this term is lacking. The Well-Being Index scale (WHO-5) is a generic, self-report scale that contains five Likert-type items to evaluate psychological well-being. This construct may provide a relevant outcome in bipolar disorder (BD) research and care beyond the rating of mood symptoms. Thus, in the current study, the psychometric properties of the WHO-5 Spanish version were assessed in a sample of euthymic patients with BD. METHODS: Patients with BD- I and BD-II and healthy controls completed the Well-Being Index (WHO-5) together with an assessment of depressive (Hamilton Depression Rating Scale-17; HAM-D) and manic symptoms (Young Mania Rating Scale; YMRS); and a measure of psychosocial functioning (Functioning Assessment Short Test; FAST). Internal consistency reliability was measured through Cronbach's alpha. Test-retest reliability was calculated comparing the WHO-5 total score at baseline and after 10 days of the first administration. To assess the structure of the scale, a principal component analysis (PCA) was carried out. Correlations between the WHO-5, HAM-D, YMRS and FAST were calculated. Finally, a t-test for independent samples was applied to compare the WHO-5 total score in the patient and control groups. RESULTS: A total of 104 patients with BD and 40 healthy controls were included in this study. A Chronbach's alpha of 0.83 indicated acceptable internal consistency. A paired sample t-test revealed no significant differences between WHO-5 total score at baseline and at follow-up (tn = - 0.72; df = 15; p = 0.48). The PCA provided a single factor solution that accounted for 59.74% of the variation in WHO-5. Test-retest reliability was high (r = 0.83; p < 0.001). Moderate negative correlations were observed between the WHO-5 total score, the FAST (r = - 0.46.; p < 0.001) and the HAM-D (r = - 0.68; p < 0.001), but not with the YMRS (r = - 0.07; p = 0.42). Finally, significant differences were found when comparing the WHO-5 total score between patient and healthy controls (t = 5.1; df = 147; p < 0.001). LIMITATIONS: some limitations include the lack of a comparator scale to test for validity construct and the small sample size in the test-retest reliability CONCLUSIONS: The WHO-5 shows an acceptable reliability index and measures a unitary construct in a Spanish population of euthymic patients with BD.

Unidad de Cirugia Mayor Ambulatoria integrada en un hospital de tercer nivel de nueva creación / Artibulattiry major surgery unit integrated within a newly created tertiary hospital

Introducción: En junio de 2014, se produjo el traslado del Hospital Universitario Central de Asturias a un edificio de nueva construcción, pasando de contar con más de 1.200 camas a no llegar a las 1.000. En el contexto de la Cirugía Mayor Ambulatoria (CMA) supuso un gran desafío para todo el personal implicado. La cirugía ambulatoria en el nuevo hospital se gestiona mediante un circuito independiente desde el momento en el que el paciente es clasificado como ambulatorio en la consulta quirúrgica, y solo vuelve al circuito con ingreso si, en la valoración preanestésica, se descarta como paciente ambulatorio. Durante 2015 se ha conseguido la integración de todos los servicios quirúrgicos en la cirugía ambulatoria. Objetivos: Realizar balance del periodo 2014-2016 respecto al incremento de la cirugía ambulatoria en el nuevo contexto, así como exponer y comparar las cifras de los índices de ambulatorización y de sustitución durante estos años. Material y método: Estudio descriptivo, observacional realizado en la Unidad de Cirugía Mayor Ambulatoria durante 2014-2016. Los datos se obtuvieron de nuestra base de datos, sus cifras fueron proporcionadas por el Servicio de Admisiones y Unidad de Control de Gestión. Resultados: A partir del traslado al nuevo hospital, el porcentaje de ambulatorización alcanza el 40 % del total de la cirugía programada. En el año 2016 es del 43,8 %, observándose unos elevados índices en Oftalmología, Cirugía Plástica, ORL y Cirugía Maxilofacial; Urología y Cirugía General muestran evolución ascendente (AU)

Introduction: In June 2014, the Central University Hospital of Asturias was moved to a new building, having more than 1,200 beds initially and not reaching 1,000 laten In the context of Ambulatory Major Surgery (AMS), it was a great challenge to the staff involved. Outpatient surgery in the new hospital is managed through an independent circuit since the patient is classified as an outpatient at the surgery consultation. The patient is included in the hospitalization circuit only, if in the pre-anesthetic evaluation, is not classified as outpatient. During the year 2015, the integration of all surgical services in ambulatory surgery has been achieved. Objectives: To make a balance of the period 2014-2016 regarding the increase of the ambulatory surgery in the new context, as well as to expose and compare the outpatient surgery and substitution rates during these years. Material and methods: Descriptive, observational study performed at the Ambulatory Major Surgery Unit during the period 2014-2016. The data was obtained from our database and its figures were provided by the Admissions Service and the Management Control Unit. Results: With the new hospital the percentage of outpatient surgery reaches 40% of the total of the scheduled surgery. In 2016 it is 43.8%, with high rates in Ophthalmology, Plastic Surgery, Otorhinolaryngology and Maxillofacial Surgery. Urology and General Surgery show ascending evolution (AU)

Supplementation of arachidonic acid rich oil in European sea bass juveniles (Dicentrarchus labrax) diets: Effects on leucocytes and plasma fatty acid profiles, selected immune parameters and circulating prostaglandins levels.

The main objective of this study was to assess the effects of graded levels of dietary arachidonic acid (ARA), supplemented from alternative sources, on fatty acid composition of plasma and head kidney leucocytes of European sea bass (Dicentrarchus labrax). For that purpose, sea bass juveniles were fed four diets containing graded levels of ARA as follows: 0.5% (ARA0.5), 1% (ARA1), 2% (ARA2) and 4% (ARA4) during 60 days. At the end of the feeding trial fatty acid profiles of plasma and head kidney leucocytes were analyzed. Besides, plasma prostaglandins levels, head kidney leucocytes respiratory burst activity; peroxidase activity and phagocytic index were assayed. Reducing dietary ARA levels below 1% markedly reduced European sea bass growth performance. However, fish fed diet ARA0.5 tried to compensate this dietary ARA deficiency by a selective deposition of ARA on plasma and head kidney leucocytes, reaching similar levels to those fish fed diet ARA1 after 60 days of feeding. Nevertheless, head kidney phagocytic capacity was reduced as dietary ARA content in relation not only to variations on membrane composition but also to changes on fish basal prostaglandins levels. Results obtained demonstrated the importance to supply the necessary quantity n-6 LC-PUFA, and not only n-3 LC-PUFA levels, in European sea bass diets, in relation to not only growth performance but also immune system function.