Benthic marine litter in shallow fishing grounds in the NW Mediterranean Sea.

Fisheries are one of the main economic sectors affected by marine litter, which can damage gear, reduce catch, and require time to repair or clean nets. This study aims to evaluate the type and density of marine litter in two shallow fishing grounds in the NW Mediterranean Sea, both belonging to the Natura 2000 network. Moreover, it quantifies the fraction of marine litter within the total catch to help understand the potential influence of marine litter on fisheries. Two study areas were selected, one in the vicinity of urban populated areas and high navigational traffic and one in a rural site off an agricultural area. The urban area had more benthic marine litter (393 to 198 kg km-2) including clinker (residue from coal-burning steamships), fabric, plastics, and processed wood and accounting for up to 38% of the total catch. The rural area had far less marine litter (34-56 kg km-2), accounting for only 5% of the total catch. Marine litter may have potential negative effects on fisheries; thus we propose that government credit trading programs could be promoted to help recover litter from fishing catches, to reduce fishing costs and hazards to marine ecosystems.

In-hospital prognosis and long-term mortality of STEMI in a reperfusion network. "Head to head" analisys: invasive reperfusion vs optimal medical therapy.

BACKGROUND: ST Segment Elevation Acute myocardial infarction (STEMI) preferred treatment is culprit artery reperfusion with primary percutaneous coronary intervention (PPCI). We ought to analyze the benefit of early reperfusion vs. optimal medical therapy in STEMI before and after the set-up of a regional STEMI network that prioritizes PPCI. METHODS: Between January 2002 and December 2013, 1268 STEMI patients were consecutively admitted in a University Hospital. Patients were classified in two groups: pre-STEMI Network (January 2002-June 2009; n = 670) and post-STEMI network (July 2009-December 2013; n = 598). Vital status was available at 2-year follow-up. RESULTS: The STEMI network increased reperfusion (89.2% vs 64.4%, p < 0.001) mainly using PCI (99.0% vs 43.9%, p < 0.001). In univariate analysis, in-hospital mortality was significantly lower in the post-STEMI network period (2.51% vs. 7.16%, p < 0.001). After multivariate adjustment, including age, sex, comorbidities, severity and reperfusion therapy, a trend to a lower in-hospital mortality was observed (post-Network OR: 0.50, 95% CI:0.16-1.59, p = 0.24); this trend disappeared when optimal medical therapy was included in the model (post-Network OR: 1.14, 95% CI:0.32-4.08, p = 0.840). No differences in 2-year mortality were observed (post-Network HR: 0.83; CI 95%: 0.55-1.25, p = 0.37). CONCLUSION: A STEMI network with PPCI 24/7 improved reperfusion therapy, resulting in an increase on PPCI. Despite in-hospital mortality decreased with a STEMI network, 2-year mortality remained similar in both periods, pre- and post-Network. Optimal medical therapy could be as important as reperfusion therapy in a STEMI reperfusion network.

Ceftolozane-tazobactam for the treatment of ventilator-associated infections by colistin-resistant Pseudomonas aeruginosa.

The use of colistin for the treatment of multiresistant bacteria has led to the emergence of colistin-resistant strains of Gram-negative bacilli. Treatment of infections caused by these pan-drug-resistant bacteria is difficult owing to the paucity of effective antibiotics. We report two cases of ventilator-associated respiratory infection caused by pan-drug-resistant, colistin-resistant Pseudomonas aeruginosa that were successfully treated with ceftolozane-tazobactam.

[Acute coronary syndrome during a cesarean section in a healthy young woman]. / Síndrome coronario agudo durante una cesárea en mujer joven sana.

Acute coronary syndrome (ACS) during pregnancy and delivery is a rare event that is usually related to prior disease or family history. Factors that contribute to the appearance of ACS during delivery in women with healthy coronary arteries include high doses of drugs to suppress contractions or increase uterine muscle tone and cardiovascular instability of any kind. Clinical and electrocardiographic abnormalities (eg, ST segment depression) that are suggestive of ACS have been reported to occur during cesarean section but without subsequent enzyme or echocardiographic abnormalities.

Síndrome coronario agudo durante una cesárea en mujer joven sana / Acute coronary syndrome during a cesarean section in a healthy young woman

El síndrome coronario agudo (SCA) durante la gestacióny el parto es una entidad muy poco frecuente quesuele estar relacionado con patología previa o antecedentes familiares. Puede contribuir a la aparición del SCA durante el parto en una mujer con arterias coronarias sanas, las dosis altas de tocolíticos o de uterotónicos y la inestabilidad cardiovascular de cualquier etiología. Se han descrito alteraciones clínicas y electrocardiográficas, como la depresión del segmento ST, durante la cesárea sugestiva de SCA, sin alteraciones enzimáticas ni ecocardiográficas posteriores

Acute coronary syndrome (ACS) during pregnancyand delivery is a rare event that is usually related toprior disease or family history. Factors that contributeto the appearance of ACS during delivery in womenwith healthy coronary arteries include high doses ofdrugs to suppress contractions or increase uterine muscletone and cardiovascular instability of any kind. Clinicaland electrocardiographic abnormalities (eg, STsegment depression) that are suggestive of ACS havebeen reported to occur during cesarean section butwithout subsequent enzyme or echocardiographicabnormalities

Influencia del modelo organizativo en los Servicios de Urgencias sobre la eficiencia de la atención de procesos críticos / Influence of the organisational model on the efficiency of critical care in the Emergency Department

El objetivo de este estudio es el de comparar la eficiencia de los diferentes modelos organizativos y gestión de la atención en Servicios de urgencias existentes en diversos hospitales de la provincia de Barcelona. El trabajo está diseñado como un estudio multicéntrico observacional de cohortes. El ámbito fue el de los Servicios de Urgencias de Hospitales de segundo y tercer niel, con distintos modelos organizativos de atención al paciente crítico: modelo de atención integrada: coordinación y atención de los pacientes que acuden a Urgencias por médico polivalentes; el médico especialista interviene en las técnicas diagnósticas y terapéuticas específicas. Modelo de atención especializada: intervención del especialista en primera línea sobre los pacientes que acuden a Urgencias. Modelo de atención en centro no especializado: servicios de Urgencias de Hospitales sin disponibilidad de recursos especializados y que requiere la colaboración de un centro de referencia para completar el diagnóstico y tratamiento. Se estudiaron todos los pacientes que llegan al Servicio de Urgencias y que reunían los siguientes criterios de inclusión: Síndrome coronario agudo con o sin elevación del ST. Accidente vascular cerebral isquémico o hemorragia subaracnoidea. Traumatismo craneoencefálico con GCS < 13. Enfermedad pulmonar obstructiva crónica agudizada que requerirá soporte ventilatorio mecánico.

The objective of this article is to compare the efficiency according to different organisational and management models of the existing care provided in Emergency Services in different hospitals of the provence of Barcelona. It presents a comparative analysis model which makes it possible to obtain certified conclusions and possibilities for improvement (AU)

Endothelial dysfunction of the non-infarct related, angiographically normal, coronary artery in patients with an acute myocardial infarction.

BACKGROUND: Patients with acute myocardial infarction and single-vessel disease may have early atherosclerosis in other angiographically normal coronary arteries. METHODS: Coronary endothelial responses were analysed in 20 non-diabetic patients with an acute myocardial infarction and one-vessel disease. In an angiographically normal, non-infarct related, coronary artery serial acetylcholine doses of 10(-7) M, 10(-6) M, 10(-5) M and 10(-4) M and nitroglycerin 40 micrograms were infused over 3 min. The responses of the coronary vessel were measured with quantitative angiography. Coronary blood flow was also measured with a Doppler catheter in 11 of the 20 patients. RESULTS: Four patients showed a trend towards vasodilation during acetylcholine infusion in the proximal and distal segments: from 2.49 +/- 0.23 mm to 2.95 +/- 0.42 mm and 2.43 +/- 0.56 mm to 2.81 +/- 0.66 mm, respectively. Coronary vascular resistance decreased to 57 +/- 4% (P = 0.03). The other 16 patients presented vasoconstriction in the proximal and distal segments: 2.61 +/- 0.75 mm to 2.03 +/- 0.65 mm (P = 0.0001), and 2.40 +/- 0.58 to 1.81 +/- 0.56 mm (P = 0.0036), respectively. Nitroglycerin caused vasodilation in the proximal (2.69 +/- 0.61 mm, P = 0.017, ANOVA) and distal segments (2.48 +/- 0.45 mm, P = 0.009, ANOVA). Coronary vascular resistance increased to 141 +/- 43% (P = 0.03) over the basal value in this group of patients. CONCLUSION: Endothelial dysfunction of the epicardial and resistance vessels was found in angiographically normal coronary arteries of patients with one-vessel disease in 75% of this population.

Improvement of exercise-induced ischaemia and myocardial perfusion after aminophylline.

BACKGROUND: Previous studies have suggested that aminophylline improves exercise-induced ischaemia by preventing the redistribution of the coronary flow from ischaemic to non-ischaemic myocardium. The purpose of the study was to assess whether aminophylline improves myocardial perfusion in zones supplied by collateral circulation. METHODS: Twenty-three patients with an occluded coronary artery and collateral circulation from a non-diseased vessel underwent two symptom-limited exercise 99mTc-MIBI, single-photon emission computed tomography (SPECT) myocardial scintigraphy experiments, which were preceded by an intravenous infusion of either aminophylline (5 mg/kg over 20 min) or saline solution in a randomized double-blind control procedure. The MIBI SPECT images were analysed by two experienced observers who were blinded to each other's data. RESULTS: All patients underwent cardiac catheterization. For 16 patients this was because of stable angina and the remaining eight were post-myocardial infarction patients with a positive exercise test. Aminophylline significantly increased the time to the onset of ischaemia in the 15 patients with a positive exercise test (mean +/- SD, 6.5 +/- 1.9 compared with 5.3 +/- 1.8 min, P < 0.005); and ischaemia occurred at higher rate-pressure product (230 +/- 68 compared with 195 +/- 68 HB x mmHg, P < 0.03). After aminophylline, exercise ST-segment depression was 1.1 +/- 0.5 mV, compared with 1.5 +/- 0.8 mV after placebo (P < 0.01). All patients had perfusion defects that resolved partially or completely in the rest images. The imaging score was significantly lower after aminophylline infusion than after placebo (9.7 +/- 9 compared with 12.1 +/- 10, P < 0.01). CONCLUSIONS: Aminophylline significantly delayed the time to onset of exercise-induced ischaemia and improved perfusion in zones supplied by collateral circulation. Aminophylline-like drugs may be useful in the treatment of selected patients with ischaemic heart disease.