Complicaciones del uso de la Máscara Laríngea en Pacientes Pediátricos. Estudio Multicéntrico / Complications of the use laryngeal mask in Pediatric Patients. Multicenter Study

Introducción: La máscara laríngea es el equipamiento con el objetivo de aumentar la calidad, seguridad, cuidado, sin embargo, a pesar de tener uso universal y alta eficacia para la ventilación no está exenta de complicaciones. El objetivo de la presente Investigación fue identificar la frecuencia de complicaciones con el uso de mascara laríngea en los hospitales públicos Vicente Corral Moscoso y José Carrasco en la ciudad de Cuenca. Métodos: Es un estudio observacional, descriptivo, prospectivo, en 220 pacientes pediátricos, ASA I , II y III intervenidos en cirugías electivas y emergentes bajo anestesia general en un intervalo de tiempo de 30 a 240 minutos, de todas las especialidades médicas quirúrgicas del año 2018 ,se utilizaron los diferentes tipos de máscara. La muestra se obtuvo aplicando la fórmula para población desconocida (n = (Z2 x p x q)/ e2), nivel de confianza (Z): 95%. (1.96) Margen de error (e): 5% Probabilidad de ocurrencia del evento (p): 15% Probabilidad de no ocurrencia del evento (q): 85%. Resultados: 220 casos ingresados al estudio. El índice de complicaciones laríngeas es 5.9% , frecuentemente la tos y secreción sanguinolenta, asociándose factores como mascara clásica, edad (2-5 años), tiempo mayor de 60 minutos, mayor número de intentos, ASA> I, estado nutricional sobrepeso, e insertar en formación. Conclusión: La máscara laríngea es validada como dispositivo en anestesia pediátrica por aprendizaje rápido, baja tasa de fracaso, menores complicaciones y utilidad en vías aéreas difíciles, Es insuficiente la evidencia para respaldar el uso de un determinado dispositivo por encima de otro

Introduction: The laryngeal mask is the equipment with the aim of increasing quality, safety, care, however, despite having universal use and high efficacy for ventilation, it is not without complications. The objective of this research was to identify the frequency of complications with the use of a laryngeal mask in the Vicente Corral Moscoso and José Carrasco public hospitals in the city of Cuenca. Methods: It is an observational, descriptive, prospective study in 220 pediatric patients, ASA I, II and III who underwent elective and emergent surgeries under general anesthesia in a time interval of 30 to 240 minutes, of all surgical medical specialties of the year 2018, the different types of mask were used. The sample was obtained by applying the formula for unknown population (n = (Z2 x p x q) / e2), confidence level (Z): 95%. (1.96) Margin of error (e): 5% Probability of occurrence of the event (p): 15% Probability of non-occurrence of the event (q): 85%. Results: 220 cases entered the study. The rate of laryngeal complications is 5.9%, frequently cough and bloody discharge, associating factors such as classic mask, age (2-5 years), time greater than 60 minutes, greater number of attempts, ASA> I, nutritional status, overweight, and insert in formation. Conclusion: The laryngeal mask is validated as a device in pediatric anesthesia due to rapid learning, low failure rate, fewer complications and usefulness in difficult airways. The evidence is insufficient to support the use of a certain device over another.

Chronic, but not acute, fatigue predicts self-reported attentional driving errors in mothers attending infant children.

Mothers attending infant children usually experience high levels of fatigue, and fatigue has been shown to be related to car crashes through attentional errors, among other causes. The current study investigates the effects of fatigue on the attentional errors while driving of women attending infant children. A sample of 112 women-67 attending infant children and 45 not attending-filled out self-report questionnaires assessing acute fatigue, chronic fatigue, and attention-related driving errors. A mediational analysis showed that women attending infant children had higher levels of fatigue, and that chronic fatigue, but not acute fatigue, was related to attentional errors while driving.

Well-being, behavioral patterns and cycling crashes of different age groups in Latin America: Are aging adults the safest cyclists?

OBJECTIVES: This study aimed at analyzing the cycling safety-related factors and the mental health indicators of elderly cyclists in comparison with other age groups. METHODS: For this cross-sectional study, we analyzed the data of 911 bicyclists from two Latin American countries that have been experiencing a substantial growth of urban cycling during the last few years: Colombia and Argentina. Participants responded to an e-questionnaire on bicycling behaviors, mental health and cycling safety. RESULTS: Aging adults reported lower rates of risky behaviors and traffic crashes (around .38 in five years), and, on the other hand, more cycling protective behaviors, a higher risk perception and a better knowledge of traffic norms than both other adults (26-50 years old) and young cyclists (<26). Cycling behaviors and crashes were found to be significantly related to mental health indicators, the latter being higher in aging cyclists. However, this population remains more prone to distractions experienced while cycling than other age groups. CONCLUSIONS: Although the behavioral features of aging adults were comparatively "safer" than the ones displayed by other age groups, factors such as cycling distractions and this population's over-representation in traffic crashes suggest the need of enforcing policymaking for a better integration of this age segment in alternative transportation dynamics.

Estudio de Cohortes: Angioplastia Primaria con Trombectomía versus Angioplastia Primaria Convencional en Pacientes con Infarto Agudo de Miocardio con Elevación del Segmento S-T. Hospital de Especialidades José Carrasco Arteaga, 2009 ­ 2016 / Cohort Study: Primary Angioplasty with Thrombectomy versus Conventional Primary Angioplas-ty in Patients with ST - segment Elevation Myocardial Infarction. José Carrasco Arteaga Hospital, 2009 ­ 2016

INTRODUCCIÓN: Durante la angioplastia primaria (AP) en pacientes con infarto agudo de miocar-dio con elevación del segmento ST; los trombos intracoronarios pueden embolizar a la microcircu-lación y aumentar el tamaño del infarto. Este fenómeno podría ser reducido mediante la trombec-tomía; no obstante, estudios recientes no han demostrado mejoría en la reperfusión coronaria o en la presentación de eventos clínicos mayores, razón por la que su uso rutinario es controvertido. MÉTODOS:Se realizó un estudio de cohortes retrospectivo. El universo incluyó a 206 pacientes con IAMEST del Instituto Ecuatoriano de Seguridad Social, fueron divididos en dos grupos; grupo 1: AP con trombectomía (107 pacientes), y grupo 2: AP convencional (99 pacientes). El objetivo fue com-parar reperfusión coronaria (resolución del segmento ST, flujo TIMI final 3, no reflujo, y recuperación de la fracción de eyección del ventrículo izquierdo) y eventos clínicos mayores a los 30 días (muerte cardiaca, muerte por otra causa, perforación, trombosis del stent, ictus, sangrado mayor, reinfarto, shock cardiogénico, revascularización de emergencia, falla cardiaca NYHA IV). Para el análisis se uti-lizaron medidas de asociación, riesgo relativo e intervalo de confianza; para un nivel de significancia p= <0.05. RESULTADOS: En relación a la reperfusión coronaria, la resolución del segmento ST en el grupo de trombectomía versus el grupo convencional fue del 29.9% y 43.3% respectivamente (RR 0.68, IC 95%: 0.47­0.99, p= 0.04). Considerando los eventos clínicos mayores, la muerte de causa cardíaca ocurrió en el 4.7% de pacientes del grupo de trombectomía versus un 13.1% en el grupo conven-cional (RR 0.35, IC 95%: 0.13­0.96, p= 0.032). Los demás parámetros de reperfusión y los eventos clínicos mayores no presentaron diferencia estadísticamente significativa. CONCLUSIÓN: La AP con trombectomía no se relacionó con mejoría en la reperfusión coronaria, pero si con disminución de muerte por causa cardíaca(AU)

BACKGROUND: During primary angioplasty in patients with ST-segment elevation myocardial Infarc-tion (STEMI); intracoronary thrombi can embolize in the microcirculation and increase the size of the infarct. This phenomenon could be reduced by thrombectomy; however, recent studies have shown no improvement in coronary reperfusion or in the presentation of major clinical events, which is why its routine use remains controversial. METHODS: A retrospective cohort study was conducted. The universe included 206 patients with STEMI from the Ecuadorian Social Security Institute, two groups were made; group 1: PA with thrombectomy (107 patients), and group 2: conventional PA (99 patients). The aim was to compare coronary reper-fusion outcomes (ST segment resolution, TIMI 3 final flow, no reflow, and recovery of left ventricular ejection fraction) and major clinical events in 30 days (cardiac death, death from another cause, perfo-ration, stent thrombosis, stroke, major bleeding, re infarction, cardiogenic shock, emergency revascu-larization, NYHA IV heart failure). For the analysis of the information, measures of association, relative risk and confidence interval were used; for a level of significance p= <0.05. RESULTS: In relation to coronary reperfusion outcomes, resolution of ST segment in the thrombectomy group versus conventional group was 29.9% and 43.3% respectively (RR 0.68, 95% CI: 0.47 - 0.99, p=0.04). Considering the major clinical events, cardiac death occurred in 4.7% of patients in the throm-bectomy group versus 13.1% in the conventional group (RR 0.35, 95% CI: 0.13 - 0.96, p= 0.032). Other re-perfusion parameters and major clinical end points did not present a statistically significant difference. CONCLUSION: Thrombectomy was not associated with improvement in coronary reperfusion however it was associated with a decrease in cardiac death.(AU)

Workplace burnout and health issues among Colombian correctional officers.

INTRODUCTION: Correctional employees typically work under adverse conditions that may enhance the occurrence of different negative psychological states. Burnout constitutes a high-risk phenomenon that may affect people's physical/mental health and welfare, especially in vulnerable occupational groups. OBJECTIVES: The aim of this study was to characterize the burnout profile of correctional officers, and to associate their burnout profile with health issues and lifestyle factors. METHODS: The full sample was composed of 219 Colombian correctional officers with a mean age of 30.18 years. A questionnaire composed of three sections was employed: demographic data, burnout, and health information. RESULTS: A high proportion of participants reported burnout indicators, also significantly correlated to their health indicators and lifestyle factors. Cluster analyses were used in order to characterize the burnout/age (model A) and burnout/age/psychological disturbance (model B) profiles of correctional officers. Furthermore, significant differences were found when comparing frequencies of alcohol consumption and physical exercise (lifestyle indicators) and perceived social support of officers depending on their profile. CONCLUSIONS: the discussion focused on the negative impact of burnout on health, and on the importance of strengthening occupational programs aimed at reducing the impact of hazardous working conditions that contribute to the development of burnout, and to the arise different mid and long-term health complains among correctional workers.

Nivel de Producción y Características de la Investigación Científica en Salud en la Facultad de Ciencias Médicas de la Universidad de Cuenca, 2009 - 2014 / Level of Production and Characteristics of Scientific Research in Health in the Faculty of Medical Sciences of the University of Cuenca, 2009 - 2014

OBJETIVO: Determinar el nivel y características de la producción científica de la Facultad de Ciencias Mé-dicas de la Universidad de Cuenca, en el período 2009 ­ 2014. MÉTODOS: Se realizó una investigación analítica de cor-te transversal. La muestra, aleatoria y representativa, estuvo constituida por 460 trabajos de investigación, 272 de grado, 98 de posgrado y 100 de la Revista de la Facultad de Ciencias Médicas. Los datos se obtuvieron de los archivos digitales de la Biblioteca. Se estudiaron las características en los niveles académicos de grado, posgrado y docente. Las diferencias significativas se establecieron mediante el estadístico chi cuadrado y un valor de p<0.005.RESULTADOS: Se produjeron 996 trabajos de investigación a razón de 166 trabajos por año, predominó la investigación biomédica (74.6%), clínica (73%), observacional (88.5%), cuantitativa (89.3%), descriptiva (65.7%), aplicada (96.7%) y se realizó más a nivel hospitalario (42.4%); en el grado y en la Revista hay más coautoría, en posgrado la autoría es individual; la producción de la Revista, en la que la mayor parte publican profesores de la Facultad, es baja en comparación con la magni-tud del grado y posgrado; la tendencia es a incrementar el número de trabajos de investigación; existiendo baja colaboración internacional (4.1%) e interinstitucional (8.5%).CONCLUSIONES: La investigación es limitada en su magnitud, aunque con tendencia al incremento, es predominantemente observacional, cuantitativa, descriptiva, biomédica, clínica, que se realiza con muy poca colaboración internacional e interinstitucional.

OBJECTIVE: To determine the level and characteristics of the scientific production in the Medical Sciences Facul-ty of the University of Cuenca, in the period 2009-2014.METHODS: A cross-sectional analytical research was conducted. The sample, which was, random and repre-sentative, was consisted by 460 research papers, 272 graduate, 98 post graduate and 100 of the Faculty of Medical Sciences Magazine. The data were obtained from the digital files of the Library. The characteristics were studied in academic levels of graduate, postgra-duate and teacher. Significant differences were establi-shed using the chi square and a value of p <0.005.RESULTS: A total of 996 research papers were produ-ced at a rate of 166 jobs per year, predominated the biomedical research (74.6%), clinical (73%), observa-tional (88.5%), quantitative (89.3%), descriptive (65.7%) applied (96.7%) and it was performed more in hospitals (42.4%); in the graduate and in the magazine there is more co-authored, in the postgraduate the authorship is individual; according to the production of the maga-zine, which published most professors of the Faculty, is low compared to the magnitude of graduate and post-graduate; the tendency is to increase the number of research papers; existing a low international (4.1%) and inter-institutional (8.5%) collaboration.CONCLUSIONS: The research is limited, but with a ten-dency to increase, it is mainly observational, quantitati-ve, descriptive, biomedical, and clinical, which is done with very little international and inter-institutional collaboration.

Características de la investigación en el posgrado: avances y limitaciones. Facultad de Ciencias Médicas. Universidad de Cuenca. 2009 ­ 2014 / Characteristics of postgraduate research: advances and limitations. Faculty of Medical Sciences. University of Cuenca. 2009-2014

Objective: To determine the characteristics of the postgraduate research in order to generate research policies.Methods: A cross-sectional analytical re-search was conducted to determine the characteristics of research in the various postgraduate levels. A stratified random sample of the database of postgraduate research contained in the website of the University of Cuenca was used. Chi2 sta-tistic was used, and a level of significance was accepted p <0.05 in hypothesis tes-ting. The sample consisted of 98 research papers.Results: The model for biomedical research is predominant (79.6%) in the Masters is the social (65.5%). (p: 0.000). Most are clinics (78.6%) investigations. Research with so-cial components developed in the masters (72.4%). (p: 0.000). The number of resear-chers males (50.0%) is similar to that of wo-men (50.0%). The investigations are made by an author. Investigations are applied (100.0%) and quantitative (94.9%). Only the Masters there are qualitative (6.9%), mixed (6.9%) and other (3.4%) investigations. (p = 0.051). Dominated by observational stu-dies (78.6%); the intervention constitute 21.4% (p = 0.889). The descriptive research (36.7%), analytical (39.8%) have greater weight than those of intervention (23.5%), p: 0.321). In the analytical cross-sectional research predominate (89.7%), and the ex-perimental intervention (78.3%). There is no international cooperation and inter is mini-mal (7.1%) referred to the Masters. There is good correspondence with the lines of ins-titutional research (57.1%) in most research and the use of international bibliographic standards is high (99.6%).Conclusions: The fundamental characte-ristics of research at the graduate has not changed substantially. The predominant biomedical research remains, quantitati-ve, clinical, observational, there has been progress in reducing the descriptive inves-tigations and have increased (transverse) and experimental analytics. The master has developed more social health research. Research has failed to overcome the aca-demic and personal interest level, no inter-national collaboration and inter is scarce. It has improved the technical component, is majority use international bibliographic standards.

Serum nitrotyrosine and psychometric tests as indicators of impaired fitness to drive in cirrhotic patients with minimal hepatic encephalopathy.

BACKGROUND & AIMS: Cirrhotic patients with minimal hepatic encephalopathy (MHE) show impaired driving ability and increased vehicle accidents. The neurological deficits contributing to impair driving and the underlying mechanisms are poorly understood. Early detection of driving impairment would help to reduce traffic accidents in MHE patients. It would be therefore useful to have psychometric or biochemical parameters reflecting driving impairment. The aims of this work were as follows: (i) to shed light on the neurological deficits contributing to impair driving; (ii) to assess whether some psychometric test or biochemical parameter is a good indicator of driving impairment. METHODS: We assessed in 22 controls, 36 cirrhotic patients without and 15 with MHE, driving performance using a driving simulator (SIMUVEG) and Driver Test. MHE was diagnosed using the psychometric hepatic encephalopathy score (PHES). Psychometric tests assessing different neurological functions (mental processing speed, attention, visuo-spatial and bimanual coordination) were performed. Blood ammonia and parameters related with nitric oxide-cGMP metabolism, IL-6, IL-18 and 3-nitrotyrosine were measured. RESULTS: Patients with MHE showed impaired driving ability correlating with MHE grade, with impaired vehicle lateral control in spite of reduced driving speed. Patients with MHE show psychomotor slowing, longer reaction times, impaired bimanual and visuo-spatial coordination and concentrated attention and slowed speed of anticipation and increased blood ammonia, cGMP, IL-6, IL-18 and 3-nitrotyrosine. CONCLUSIONS: Impaired mental processing speed, attention and alterations in visuo-spatial and motor coordination seem main contributors to impaired driving ability in patients with MHE. Increased serum 3-nitrotyrosine is associated with impaired driving ability.

Modeling offenses among motorcyclists involved in crashes in Spain.

In relative terms, Spanish motorcyclists are more likely to be involved in crashes than other drivers and this tendency is constantly increasing. The objective of this study is to identify the factors that are related to being an offender in motorcycle accidents. A binary logit model is used to differentiate between offender and non-offender motorcyclists. A motorcyclist was considered to be offender when s/he had committed at least one traffic offense at the moment previous to the crash. The analysis is based on the official accident database of the Spanish general directorate of traffic (DGT) for the 2003-2008 time period. A number of explanatory variables including motorcyclist characteristics and environmental factors have been evaluated. The results suggest that inexperienced, older females, not using helmets, absent-minded and non-fatigued riders are more likely to be offenders. Moreover, riding during the night, on weekends, for leisure purposes and along roads in perfect condition, mainly on curves, predict offenses among motorcyclists. The findings of this study are expected to be useful in developing traffic policy decisions in order to improve motorcyclist safety.

Driver training interests of a Spanish sample of young drivers and its relationship with their self-assessment skills concerning risky driving behavior.

Poor driving self-assessment skills (e.g., over-confidence) have been pointed out as an important explanatory factor behind young drivers' accident involvement. This paper explores (1) what young drivers miss in their training as drivers in order to analyze whether an assessment of one's own driving skills plays an important role in their desire to improve as drivers, and (2) how these training interests are related to an estimate of their self-assessment skills concerning risky driving behavior. For this purpose, a study was conducted using a survey with a blocked sampling design of novice drivers. The survey solicited respondents' self-report about (1) the contents of training courses that they feel would improve their driving, (2) their risky driving behavior, and (3) their likelihood of being involved in a risky driving situation. From the initial sample invited to participate, of nearly 1300 people, we finally obtained complete data from 321 young Spanish drivers. Two main results were apparent from our data analysis: (1) the novice drivers were mainly interested in improving their ability to recognize their strengths and weaknesses as drivers (i.e., self-assessment skills); (2) a significant relationship was found between novice drivers' interests and their current self-assessment skills concerning risky driving behavior. Specifically, there was greater general interest expressed in post-license training by the under-confident self-assessors than the over-confident ones. These results provide a relevant input which should be taken into account when designing driver training programs for novice drivers. Moreover, the relationship between their training interests and their risky driving self-assessment skills introduces an additional factor to be considered in the implementation of these training programs.

Further insight into the photostability of the pyrene fluorophore in halogenated solvents.

Pyrene fluorophores of pyrene-functionalized CdSe quantum dots (QD@Py), as well as alkylpyrene and pyrene itself (Py), undergo fast degradation in aerated chloroform under ultraviolet-A (UV-A, 316<λ<400 nm) illumination. Steady-state fluorescence studies of irradiated chloroform solutions of QD@Py show formation of new bands, red-shifted compared to that of the pyrene moiety. Similar behaviour is observed for pyrene and the alkylpyrene system. Column chromatography of the pyrene photolysate in chloroform allowed us to isolate photoproducts arising from pyrene degradation, and to obtain information on the structure of the photoproducts responsible for the emission bands. The most predominant photoproducts were those originating from the reaction of pyrene with dichloromethyl radicals. The phototransformation of QD@Py and the alkylpyrene involves mainly detachment of the alkyl chain from the aromatic ring, induced also by dichloromethyl radicals, and oxidation of the alkyl chain at the benzylic position was detected as well. By contrast, these pyrene systems show a high photostability in aerated dichloromethane. Transient absorption measurements showed formation of both pyrene triplet and pyrene radical cation for all pyrene systems in these halogenated solvents. The yield of pyrene radical cations for Py is higher than for QD@Py and the alkylpyrene. In addition, pyrene radical cations were longer-lived in dichloromethane than in chloroform. The reason for the pyrene photostability in dichloromethane is the different reactivity of chloromethyl and dichloromethyl radicals towards pyrene and oxygen. These studies show that the use of dichloromethane can be a suitable alternative to chloroform when the good solubility properties of these halogenated solvents are needed to dissolve pyrene when this chromophore is used as a fluorescent probe.

Post-license education for novice drivers: evaluation of a training programme implemented in Spain.

INTRODUCTION: This study evaluated the implementation of a second phase training program for novice drivers in Spain, which puts the primary focus of the training on the higher hierarchical levels of driver behavior. METHOD: Two hundred and sixty-three participants took part throughout the study, which was implemented as an experimental design with the test and control groups assessed before and after the one day safety training. Measurement of the impact of the training program focused on the participants' self-evaluation and self-reporting of some driving behavior indicators related to accident risk. RESULTS: Data analysis showed a change in the expected direction in the scale related to the skills for careful driving, but not for the other four scales considered. A feedback survey about the training course offered some important input for evaluating the organization, contents, tuition, and results of the three parts of the training program (discussion group, on-road and track training) as reported by the participants in the test group. CONCLUSIONS AND SUGGESTIONS: The results of the experiment show that using a one day driver safety course, it is possible to change some of the drivers' evaluations connected to safe driving style into safe direction. The follow-up period was exceptionally long (9 months) and the design (randomly divided experimental and control groups with before and after measurements) was reliable. More effort should be devoted to improving the on-road part of the training, which was often perceived as a typical driving lesson rather than a feedback drive. IMPACT ON INDUSTRY: The findings suggest consideration of a mandatory 2nd phase driver training programme as a means to raise awareness of the full range of risks encountered by novice drivers, and as already introduced in 5 EU countries: Austria, Estonia, Finland, Luxembourg and Switzerland.