Innovative approaches to accurately assess the effectiveness of biocide-based treatments to fight biodeterioration of Cultural Heritage monuments.

The development of diagnostic methods to accurately assess the effects of treatments on lithobiont colonization remains a challenge for the conservation of Cultural Heritage monuments. In this study, we tested the efficacy of biocide-based treatments on microbial colonization of a dolostone quarry, in the short and long-term, using a dual analytical strategy. We applied a metabarcoding approach to characterize fungal and bacterial communities over time, integrated with microscopy techniques to analyze the interactions of microorganisms with the substrate and evaluate the effectiveness. These communities were dominated by the bacterial phyla Actinobacteriota, Proteobacteria and Cyanobacteria, and the fungal order Verrucariales, which include taxa previously reported as biodeteriogenic agents and observed here associated with biodeterioration processes. Following the treatments, changes over time in the abundance profiles depend on taxa. While Cyanobacteriales, Cytophagales and Verrucariales decreased in abundance, other groups, such as Solirubrobacteriales, Thermomicrobiales and Pleosporales increased. These patterns could be related not only to the specific effects of the biocide on the different taxa, but also to different recolonization abilities of those organisms. The different susceptibility to treatments could be associated with the inherent cellular properties of different taxa, but differences in biocide penetration to endolithic microhabitats could be involved. Our results demonstrate the importance of both removing epilithic colonization and applying biocides to act against endolithic forms. Recolonization processes could also explain some of the taxon-dependent responses, especially in the long-term. Taxa showing resistance, and those benefiting from nutrient accumulation in the form of cellular debris following treatments, may have an advantage in colonizing treated areas, pointing to the need for long-term monitoring of a wide range of taxa. This study highlights the potential utility of combining metabarcoding and microscopy to analyze the effects of treatments and design appropriate strategies to combat biodeterioration and establish preventive conservation protocols.

Factores relacionados con el riesgo de reintervención en pacientes operados de reducción cerrada de fractura de huesos propios / Factors related to the risk of reoperation in patients operated on for closed reduction of nasal bone fractures

INTRODUCCIÓN Y OBJETIVO: La fractura de huesos nasales es la fractura facial más frecuente. En relación a la cirugía, la técnica habitualmente empleada ante ella es la reducción cerrada bajo anestesia local o general. Presentamos nuestra experiencia en pacientes intervenidos de fractura de huesos nasales y valoramos el riesgo de reintervención en relación al tipo de técnica anestésica empleada. MATERIAL Y MÉTODO: Recopilamos datos de manera retrospectiva de pacientes intervenidos de reducción cerrada de fractura nasal en nuestro centro entre diciembre de 2014 y junio de 2019. Estudiamos la variable cualitativa analizada (la reintervención) con el test exacto de Fisher y las variables cuantitativas analizadas (días desde el traumatismo hasta cirugía y grados de desviación nasal) con el test U de Mann-Whitney. RESULTADOS: Incluimos 128 pacientes (91 hombres y 37 mujeres). La causa de fractura más frecuente fue la agresión, seguida por el traumatismo por caída y los deportes. Las fracturas por agresión se produjeron con mayor frecuencia los sábados y domingos entre las 3 y las 5 horas de la madrugada. Las fracturas por caída los lunes y martes a la 1 del mediodía. En 99 casos la cirugía se llevó a cabo en las primeras 24 horas, y en 29 pasado ese tiempo. Con respecto a la técnica anestésica, 9 pacientes fueron intervenidos bajo anestesia local, 24 bajo sedación y 95 bajo anestesia general. Tres de los intervenidos con anestesia local y 4 con anestesia general precisaron reintervención por mal resultado tras la primera cirugía. Ninguno de los pacientes intervenidos con sedación fue reintervenido. CONCLUSIONES: En nuestra experiencia, la reducción de la fractura nasal bajo sedación tiene buenos resultados, por lo que consideramos que es una buena alternativa en los casos de fractura nasal quirúrgica para reducir los efectos adversos de la anestesia general

BACKGROUND AND OBJECTIVE: Nasal bone fracture is the most frequent facial fracture. In relation to surgery, the most frequently employed technique is closed reduction under local or under general anesthesia. We present our experience with patients who underwent nasal bone fracture surgery and the risk of reintervention in relation to the type of anesthetic technique used. METHODS: Data were collected retrospectively of patients who underwent closed reduction of nasal fracture in our center between December 2014 and June 2019. Qualitative variable analyzed (reintervention) were studied with Fisher's exact test and the quantitative variables analyzed (days from trauma to surgery and degrees of nasal deviation) with the Mann-Whitney U test. RESULTS: One hundred and twenty-eight patients (91 men and 37 women) were included in the study. The most frequent cause of fracture was aggression, followed by falls and sports. Aggression fractures occurred most frequently on Saturdays and Sundays between 3 and 5 a.m. Fall fractures occurred most frequently on Mondays and Tuesdays at 1 p.m. In 99 cases the surgery was performed in the first 24 hours, while in 29 cases it was performed after that time. Regarding the anesthetic technique, 9 patients were operated under local anesthesia, 24 under sedation and 95 under general anesthesia. Three of the patients operated with local anesthesia and 4 with general anesthesia required reoperation because of poor results after the first surgery. None of the patients operated with sedation were reoperated. CONCLUSIONS: In our experience, nasal fracture reduction under sedation has good results making it a good alternative in cases of surgical nasal fracture reducing the deleterious effects of general anesthesia

Deep inferior epigastric artery perforator free flap in head and neck reconstruction: A systematic review.

BACKGROUND: Perforator flaps yield the best results for the patient with the least morbidity, and they should be considered the gold standard in head and neck reconstruction. Although deep inferior epigastric perforator (DIEP) flap is considered as the gold standard in breast reconstruction, its use in head and neck reconstructive surgery does not seem so widespread. The objective of this study is to conduct a systematic review of the use, applications and results of the DIEP flap in the head and neck area. METHODS: Search was conducted in different indexed databases (PubMed/MEDLINE, the Cochrane Library, Scielo and Web of Science) and through meta-searcher Trip Database with deep inferior epigastric perforator flap AND head neck keywords. Studies on animal and human experiments published in peer-reviewed journals, where investigators assessed the use of DIEP flap, according to the Koshima criteria, in the head and neck area were considered. RESULTS: A total of 31 articles and 185 flaps with 95% of survival were found. Thrombosis or venous stasis is the most frequent cause of flap loss and 16.1% presented some type of complication, the most frequent being the dehiscence. The most use was in the reconstruction of glossectomy defect secondary to squamous cell carcinoma (30.51%), being able potentially to re-establish sensory innervation in oral cavity. The assessment of risk bias (National Institutes of Health) highlights the lack of uniformity, with no standardisation of the outcome variable collection and monitoring. DISCUSSION: By virtue of its versatility, reliable vascular supply and high flap survival rate, the DIEP flap reconstruction could be an option in complicated 3-dimensional head and neck defects while maintaining the standard of low donor site morbidity.

Trends in burn injuries in Galicia (Spain): An epidemiological study.

The treatment of burns is one of the earliest medical activities on record, probably because of the powerful impact of their physical consequences among other sequelae. The aim of the present paper is to perform an epidemiological study of burn patients. The data were obtained by reviewing the medical histories of all those patients admitted or treated in the Outpatients Department of the Burn Unit of our hospital between 2013 and 2017. A sample was gathered of 1401 patients, made up of 716 males (51.11%) and 685 females (48.89%), in a ratio of males to females of 1.05, with a mean age of 40.74 years old. The burns were mainly suffered in a domestic setting (60.96%), mostly as a result of contact with hot liquids. Most of the burns were second degree superficial burns (60.03%), and affected a mean total body surface area (TBSA) of 4.61%. They were most often produced on the hands. It was found that the frequency of burns increased during the summer and during the main mealtimes of the day. These data may be used to make specific plans of prevention, and as a basis for new studies and databases to be made.

Seguridad oncológica del lipofilling como técnica de reconstrucción mamaria secundaria / Oncologic safety of autologous fat grafting as a secondary breast reconstructive technique

Objetivos: El objetivo de este estudio es comparar de manera retrospectiva aquellas pacientes en las se emplearon lipoinjertos para su reconstrucción mamaria con aquellas en las que no. Materiales y métodos: Fueron incluidas 104 pacientes sometidas a cirugía oncológica y reconstructiva tras cáncer de mama entre enero de 2012 y diciembre de 2016. El estudio se centra en las complicaciones y recurrencias de la enfermedad. Resultados: En 25 de estas 104 pacientes se emplearon lipoinjertos para su reconstrucción, mientras que en las restantes 79 no se empleó esta técnica. Tras la cirugía de lipofilling, 3 pacientes presentaron complicaciones; en un caso consistió en un hematoma posquirúrgico y en los otros dos casos en la aparición de un nódulo, evidenciando la presencia de necrosis grasa en uno y recidiva tumoral en el otro. Hubo un caso de recidiva locorregional en cada uno de los grupos. En cuanto a las metástasis a distancia, no hubo ningún caso en el grupo de lipofilling, mientras que hubo 6 casos en el grupo control. Conclusiones: El lipofilling como opción reconstructiva tras cáncer de mama parece una técnica con una baja tasa de complicaciones. Sin embargo, es necesario realizar otros estudios que confirmen su seguridad oncológica

Objectives: The objective of this study was to retrospectively compare patients whose breast reconstruction surgery included fat grafts with those whose reconstruction did not. Material and methods: A total of 104 patients undergoing oncological and reconstructive surgery after breast cancer between January 2012 and December 2016 were included. The study focused on the complications and recurrences of the disease. Results: Fat grafts were used in the reconstructive surgery of 25 of the 104 patients, and not in the remaining 79 patients. After lipofilling surgery, 3 patients developed complications, consisting of a post-surgical hematoma in 1 patient and the appearance of a nodule in 2, showing the presence of fat necrosis in one and tumour relapse in the other. There was one case of locoregional recurrence in each of the groups. There were no cases of distant metastases in the lipofilling group, while there were 6 cases in the control group. Conclusions: Lipofilling as a reconstructive option after breast cancer seems to have a low complication rate. However, more studies are needed to confirm its oncological safety

Experiencia en el desbridamiento con Nexobrid(R) y cura húmeda con Prontosan(R) wound gel en el paciente quemado / Experience with Nexobrid(R) debridement and Prontosan(R) wound healling gel moist in the treatment of burn patients

Introducción y Objetivo. El desbridamiento tangencial y autoinjerto ha sido el tratamiento de elección de las quemaduras profundas. Actualmente, la disponibilidad de técnicas no quirúrgicas, como el desbridamiento enzimático con Nexobrid(R), introduce un cambio de concepto permitiendo mayor selectividad en la eliminación de la escara y optimizar la preservación de la dermis sana, menor cicatrización patológica, mejor resultado estético, y sobre todo menor agresión al paciente. Prontosan(R)Wound Gel es un hidrogel con propiedades antibacterianas para mantener cura húmeda, y no interfiere en la epitelización. Presentamos nuestra experiencia en desbridamiento enzimático y aplicación de cura húmeda con estos productos en quemaduras de segundo grado profundo y/o tercer grado faciales, en manos, extremidades inferiores y tronco. Material y Método. Incluimos todos los pacientes quemados de segundo grado profundo y/o tercer grado de cualquier extensión tratados con Nexobrid(R) para Unidad de Quemados entre diciembre de 2015 y febrero de 2017. Realizamos desbridamiento enzimático en las primeras 24 horas aplicándolo en un máximo del 15% de superficie corporal, seguido de cura con Prontosán(R) y oclusión con apósito hidrocoloide. Cobertura de quemaduras profundas que no curaron espontáneamente en quirófano, con injertos laminares. Las variables recogidas fueron: edad, sexo, agente causal, extensión, localización y profundidad, tiempo de hospitalización, localización, superficie corporal y profundidad de la quemadura en la zona en la que se aplicó Nexobrid®, eficacia del desbridamiento enzimático, necesidad de desbridamiento quirúrgico, necesidad de injerto, tiempo hasta epitelización y complicaciones. Resultados.Analizamos 17 pacientes con SCQ del 3 al 55%. Valoramos visualmente el desbridamiento enzimático inicial como completo en todos ellos. Solo 5 pacientes precisaron injertos laminares. En los que no precisaron desbridamiento quirúrgico, la epitelización se produjo a los 15 días como promedio. Estudio histopatológico en 3 pacientes: desbridamiento completo de la quemadura en 1 y parcial en 2, con abundante infiltrado inflamatorio linfocítico perivascular postratamiento. Los hallazgos histopatológicos se correlacionaron con la eficacia del desbridamiento valorado clínicamente en 1 de los 3 casos, y con el diagnóstico clínico de la quemadura en los 3 casos. Ningún caso precisó cirugía de secuelas tras un seguimiento medio de 7 meses. Conclusiones. Nexobrid(R) en combinación con Prontosan(R) Wound Gel en nuestra experiencia preliminar parece una alternativa viable en el tratamiento de quemaduras en cara, extremidad superior, extremidad inferior y tronco

Background and Objective. Tangential debridement and autograft have been the gold standard surgical treatment of deep burns. Nowadays, the availability of non surgical enzymatic debridement techniques, such as Nexobrid(R) has introduced a new concept in the treatment of burn patients, allowing an increase in the selectivity for the scar removal leading to the preservation of healthy dermis, reducing scarring, improving cosmetic outcome, and even more, minimizing aggression to the patient. Prontosan(R) Wound Gel is a hydrogel with antibacterial properties that can be used to keep wound bed moist, without interfering epithelialization. We present our experience with these combined products in deep dermal and/or subdermal burns affecting face, upper and lower extremities, perineal and trunk. Methods. All patients with deep dermal and/or subdermal burns treated with Nexobrid(R) in our Burn Unit between December 2015 and February 2017 were included. Enzymatic debridement was performed within the first 24 hours, applied up to 15% of body surface. After that, Prontosan(R) was applied and Varihesive(R) was used as a sealed dressing. Whenever grafting was necessary, it was performed in operating room adding split thickness grafts. Variables collected were: age, sex, agent, extension, location and depth of the burn, period of hospitalization, location, extension and depth of the burn in the area where Nexobrid ® was applied, efficacy of enzymatic debridement, needing for surgical debridement, needing of grafting, time to epithelialization and complications. Results. Seventeen patients with 3 to 55% burn body surface were included. Initial enzymatic debridement was complete in all patients. Only 5 patients needed split thickness grafting. Complete epithelialization was achieved on an average of 15 days. Histopathology studies were performed on 3 patients. Histopathology findings correlated to the clinical efficacy of the debridement in 1 out of the 3 cases, and to the clinical diagnosis of the burn in the 3 cases. After 7 months follow up, no patients required surgery for correction of sequelae. Conclusions. In our preliminary experience, combines use of Nexobrid(R) and Prontosan (R)Wound Gel seems a feasible alternative in the treatment of facial, upper and lower extremities and trunk burns

Evaluación del Hospital de Día Infanto Juvenil / Evaluation of the child and adolescent psychiatrc day hospital

El Hospital de Día Infanto Juvenil (HDDIJ) basa su modelo de intervención en la terapia institucional. Este recurso ha sido ampliamente validado en el tratamiento de diferentes trastornos mentales de la infancia y adolescencia, y se propone para la intervención de la patología mental grave en esta población. Sin embargo, la estructura óptima de este dispositivo no ha sido bien establecida. En este trabajo presentamos a modo de ejemplo un posible esquema para estructurar la guía de actuación interna de un hospital de día infanto juvenil y del plan de intervención individualizado de trabajo con cada niño, basado en la experiencia del Hospital Mancha Centro. Así mismo, presentamos el proyecto de investigación actualmente en marcha en nuestra unidad de elaboración de un algoritmo de evaluación neuropsicológica para Trastornos del Espectro Autista en el HDDIJ. Abrimos igualmente el debate para la propuesta de posibles indicadores clínicos de evolución en HDDIJ (AU)

Child and Adolescent psychiatric Day Hospital (CAPDH)bases its intervention model in institutional therapy. This intervention has been extensively validated in the treatment of various mental disorders in childhood and adolescence, and it has been proposed for the intervention of severe mental illness in this population. However , the optimal structure of this device has not been well established. We present a possible structural scheme for a clinical actuation guide in child and adolescent day hospital and individual action plan work, based on the experience of the Hospital Mancha Centro. Also , we present the research project currently underway in our unit developing a neuropsychological evaluation algorithm for Autism Spectrum Disorders in (CAPDH). Also we opened the discussion for the proposed clinical indicators of possible developments in HDDIJ (AU)