Determinants of the optimal selection of vascular access devices: A systematic review underpinned by the COM-B behavioural model.

BACKGROUND: Optimal selection of vascular access devices is based on multiple factors and is the first strategy to reduce vascular access device-related complications. This process is dependent on behavioural and human factors. The COM-B (Capability, Opportunity, Motivation, Behaviour) model was used as a theoretical framework to organize the findings of this systematic review. METHODS/AIMS: To synthesize the evidence on determinants shaping the optimal selection of vascular access devices, using the COM-B behavioural model as the theoretical framework. DESIGN: Systematic review of studies which explore decision-making at the time of selecting vascular access devices. DATA SOURCES: The Medline, Web of Science, Scopus and EbscoHost databases were interrogated to extract manuscripts published up to 31 December 2021, in English or Spanish. RESULTS: Among 16 studies included in the review, 8/16 (50%) focused on physical capability, 8/16 (50%) psychological capability, 15/16 (94%) physical opportunity, 12/16 (75%) social opportunity, 1/16 (6%) reflective motivation and 0/16 (0%) automatic motivation. This distribution represents a large gap in terms of interpersonal and motivational influences and cultural and social environments. Specialist teams (teams created for the insertion or maintenance of vascular access devices) are core for the optimal selection of vascular access devices (75% physical capability, 62% psychological capability, 80% physical opportunity and 100% social opportunity). CONCLUSION: Specialist teams predominantly lead all actions undertaken towards the optimal selection of vascular access devices. These actions primarily centre on assessing opportunity and capability, often overlooking motivational influences and social environments. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: A more implementation-focused professional approach could decrease inequity among patients and complications associated with vascular access devices. IMPACT: Optimal selection of vascular access devices is the primary strategy in mitigating complications associated with these devices. There is a significant disparity between interpersonal and motivational influences and the cultural and social environments. Furthermore, specialized teams play a pivotal role in facilitating the optimal selection of vascular access devices. The study can benefit institutions concerned about vascular access devices and their complications. REPORTING METHOD: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution. WHAT DOES THIS ARTICLE CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: Optimal selection of vascular devices remains a growing yet unresolved issue with costly clinical and patient experience impact. Interventions to improve the optimal selection of vascular devices have focused on training, education, algorithms and implementation of specialist vascular teams; alas, these approaches do not seem to have substantially addressed the problem. Specialist vascular teams should evolve and pivot towards leading the implementation of quality improvement interventions, optimizing resource use and enhancing their role.

The application of antimicrobial stewardship knowledge to nursing practice: A national survey of United Kingdom pre-registration nursing students.

AIM: To assess student nurses understanding and skills in the application of antimicrobial stewardship knowledge to practice. DESIGN: Quantitative. METHODS: Cross-sectional survey. RESULTS: Five hundred and twenty three student nurses responded across 23 UK universities. Although students felt prepared in competencies in infection prevention and control, patient-centred care and interprofessional collaborative practice, they felt less prepared in competencies in which microbiological knowledge, prescribing and its effect on antimicrobial stewardship is required. Problem-based learning, activities in the clinical setting and face-to-face teaching were identified as the preferred modes of education delivery. Those who had shared antimicrobial stewardship teaching with students from other professions reported the benefits to include a broader understanding of antimicrobial stewardship, an understanding of the roles of others in antimicrobial stewardship and improved interprofessional working. CONCLUSION: There are gaps in student nurses' knowledge of the basic sciences associated with the antimicrobial stewardship activities in which nurses are involved, and a need to strengthen knowledge in pre-registration nurse education programmes pertaining to antimicrobial management, specifically microbiology and antimicrobial regimes and effects on antimicrobial stewardship. Infection prevention and control, patient-centred care and interprofessional collaborative practice are areas of antimicrobial stewardship in which student nurses feel prepared. Interprofessional education would help nurses and other members of the antimicrobial stewardship team clarify the role nurses can play in antimicrobial stewardship and therefore maximize their contribution to antimicrobial stewardship and antimicrobial management. IMPLICATIONS FOR THE PROFESSION: There is a need to strengthen knowledge from the basic sciences, specifically pertaining to antimicrobial management, in pre-registration nurse education programmes. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution. IMPACT: What Problem Did the Study Address? Nurses must protect health through understanding and applying antimicrobial stewardship knowledge and skills (Nursing and Midwifery Council 2018); however, there is no research available that has investigated nurses understanding and skills of the basic sciences associated with the antimicrobial stewardship activities in which they are involved. What Were the Main Findings? There are gaps in student nurses' knowledge of the basic sciences (specifically microbiology and prescribing) associated with the antimicrobial stewardship activities in which nurses are involved. Problem-based learning, and activities in the clinical setting, were reported as useful teaching methods, whereas online learning, was seen as less useful. Where and on Whom Will the Research Have an Impact? Pre-registration nurse education programmes. REPORTING METHOD: The relevant reporting method has been adhered to, that is, STROBE.

Overview of the Participation of Nurses in Antimicrobial Stewardship Activities.

Antibiotic resistance is a planetary threat demanding maximum attention from health and social care services worldwide due to the clinical, economic, and human costs. Interventions to address resistance-antimicrobial stewardship (AMS) programs-are multipronged and require the close collaboration of all health care workers involved in antimicrobial decisions and use. Nurses have traditionally been absent from such engagement. This Commentary highlights existing evidence of the need for, and impact of, nursing involvement and leadership in AMS. In addition, four barriers (ie, foundational, ownership, education, and leadership) to the increased involvement of nurses in AMS are discussed, with implications and potential solutions.

'The Emperor's new clothes?' Healthcare professionals' perceptions of the nursing associate role in two UK National Health Service hospitals: A qualitative interview study.

Background: The introduction of nursing associates in England in 2017 as a professional 'bridging' role aimed to mitigate chronic staffing shortages, enable career progression of healthcare assistants and release registered nurses to provide more complex care. Limited evidence exists about the alignment between the identity and purpose of nursing associate roles described by the UK independent regulator, the Nursing & Midwifery Council, and the expectations, obligations, and team dynamics encountered in practice. Purpose: Investigate the perceptions of nursing associate roles through the views and experiences of role holders, registered nurses, and healthcare assistants. Setting: Two British National Health Service (NHS) Hospital Trusts in London, England (UK). Methods: For this registered service evaluation, data were collected via in-person, semi-structured interviews. Verbatim transcripts were coded inductively. An adapted framework analysis method, suitable for use with Excel, was applied to support the identification of cross cutting themes. We used the Standards for Reporting Qualitative Research checklist for reporting this study. Results: Eleven registered nurses, five nursing associates, and five healthcare assistants participated. Their experiences seldom reflected the policy vision of the nursing associate role in practice. Several participants likened the nursing associate role to the fable of the 'Emperor's New Clothes' in which expectations and reality diverge. With this over-arching theme, four sub-themes were identified: (1) preparedness of organisational infrastructure to support this role; (2) credibility of the role in practice; (3) perceived organisational "blindness" to the ambiguities of the role and (4) increasing task orientation and segmentation in care delivery. Conclusion: There is a discrepancy between the identity of the nursing associate role as imagined in the policy agenda and its reality in practice. There is a need for more protected and well-defined training, clear role boundaries, and accessible career progression pathways for nursing associates. Moreover, honest dialogue at an organisational and policy level must continue, so that the challenges and opportunities of the nursing associate role are properly realised. Tweetable abstract: Emperor's new clothes! Experiences and views of new nursing associate roles in NHS (UK) acute hospitals @CarolynSpring3.

[Sociodemographic and environmental factors associated with mask use during the COVID-19 pandemic]. / Factores sociodemográficos y ambientales relacionados con el uso de mascarillas en la población durante la pandemia por la COVID-19.

OBJECTIVE: During COVID-19 pandemic, prevention measures were implemented to mitigate the community transmission of SARS-CoV-2. Compliance with these measures was influenced by several sociodemographic and environmental factors. However, literature addressing compliance with these prevention measures among the general population remains limited. The study aimed to assess the association of sociodemographic and environmental factors and mask usage during close contact situations. METHODS: A cross-sectional study was conducted with a sample of 1,778 individuals identified through close contact tracing of individuals diagnosed with SARS-CoV-2 by the COVID-19 Coordination Center of Mallorca, from February to June 2021. A descriptive analysis was conducted, and a logistic regression model was utilized to evaluate factors associated with mask non-compliance. RESULTS: The mean age of the participants was 42.8±17.4 years, with 53.6% being female. Among close contacts, 60.8% (95% CI: 57.8-62.3) did not use masks during their contact. No significant differences were observed between genders or across age groups (p=0.497 and p=0.536, respectively). Factors linked to mask non-compliance included the home setting, indoor spaces without ventilation, and closer physical distances (p<0.001). CONCLUSIONS: Our findings indicate that mask adherence was notably lower among close contacts exposed to higher risk. In future public health crises, interventions should be developed to raise awareness about risks and promote adherence to preventive and control measures.

OBJECTIVE: Durante la pandemia de la COVID-19 se implementaron medidas de prevención con el propósito de reducir su transmisión comunitaria. El grado de cumplimiento con estas medidas estuvo influenciado por diversos factores sociodemográficos y ambientales. Sin embargo, existe escasa literatura científica que aborde el cumplimiento de las medidas preventivas en la población general. El objetivo de este estudio fue analizar la asociación entre factores sociodemográficos y ambientales, así como la adhesión al uso de mascarillas en contactos estrechos. METHODS: Se realizó un estudio transversal con 1.778 individuos, identificados mediante el rastreo de contactos estrechos de personas con SARS-CoV-2 por la Central de Coordinación de la COVID-19 de Mallorca, entre febrero y junio de 2021. Se realizó un análisis descriptivo y se utilizó un modelo de regresión logística para determinar los factores asociados al incumplimiento del uso de mascarillas. RESULTS: La edad media de los participantes fue de 42,8±17,4 años (53,6% de mujeres). El 60,8% (IC 95%: 57,8-62,3) de los contactos estrechos no utilizó mascarilla durante su contacto. No se observaron diferencias estadísticamente significativas en función del sexo o grupo etario (p=0,497 y p=0,536, respectivamente). Las situaciones de mayor incumplimiento con el uso de mascarillas se dieron en el entorno domiciliario, espacios cerrados sin ventilación y al mantener distancias cortas (p<0,001). CONCLUSIONS: Nuestros hallazgos indican una menor adhesión al uso de mascarillas en escenarios de mayor riesgo. Frente a futuras situaciones de crisis sanitaria, se deberían diseñar intervenciones que realcen la conciencia sobre los riesgos y que promuevan una mayor adhesión a medidas de prevención y control.

Identifying the interplay between protective measures and settings on the SARS-CoV-2 transmission using a Bayesian network.

Contact tracing played a crucial role in minimizing the onward dissemination of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) in the recent pandemic. Previous studies had also shown the effectiveness of preventive measures such as mask-wearing, physical distancing, and exposure duration in reducing SARS-CoV-2 transmission. However, there is still a lack of understanding regarding the impact of various exposure settings on the spread of SARS-CoV-2 within the community, as well as the most effective preventive measures, considering the preventive measures adherence in different daily scenarios. We aimed to evaluate the effect of individual protective measures and exposure settings on the community transmission of SARS-CoV-2. Additionally, we aimed to investigate the interaction between different exposure settings and preventive measures in relation to such SARS-CoV-2 transmission. Routine SARS-CoV-2 contact tracing information was supplemented with additional data on individual measures and exposure settings collected from index patients and their close contacts. We used a case-control study design, where close contacts with a positive test for SARS-CoV-2 were classified as cases, and those with negative results classified as controls. We used the data collected from the case-control study to construct a Bayesian network (BN). BNs enable predictions for new scenarios when hypothetical information is introduced, making them particularly valuable in epidemiological studies. Our results showed that ventilation and time of exposure were the main factors for SARS-CoV-2 transmission. In long time exposure, ventilation was the most effective factor in reducing SARS-CoV-2, while masks and physical distance had on the other hand a minimal effect in this ventilation spaces. However, face masks and physical distance did reduce the risk in enclosed and unventilated spaces. Distance did not reduce the risk of infection when close contacts wore a mask. Home exposure presented a higher risk of SARS-CoV-2 transmission, and any preventive measures posed a similar risk across all exposure settings analyzed. Bayesian network analysis can assist decision-makers in refining public health campaigns, prioritizing resources for individuals at higher risk, and offering personalized guidance on specific protective measures tailored to different settings or environments.

Adapting the Nominal Group Technique to a virtual version: an experience report.

OBJECTIVE: To report on the adaptations made to the original Nominal Group Technique (NGT), allowing it to be applied to the virtual format, preserving all its key elements. METHOD: An experience report on the adaptations and adjustments made to the original NGT to the virtual format using Information and Communication Technologies (ICT), using digital tools that are available free of charge or are low cost and easy to use. RESULTS: The NGT was carried out entirely virtually and underwent adaptations in each of its four stages through the incorporation of specific digital resources. It was possible to present the most voted ideas and obtain final approval from the participants. The participants had no difficulty in using the virtual resources provided and, based on the reaction evaluation, they were satisfied with the tools provided. CONCLUSION: The adapted NGT proved to be an effective method when used in a virtual setting, capable of producing a significant number of ideas and developing consensus. The adapted tool can be used by other researchers in countries with similar resources or dimensions to Brazil.

RNA-Seq Data Analysis: A Practical Guide for Model and Non-Model Organisms.

RNA sequencing (RNA-seq) has emerged as a powerful tool for assessing genome-wide gene expression, revolutionizing various fields of biology. However, analyzing large RNA-seq datasets can be challenging, especially for students or researchers lacking bioinformatics experience. To address these challenges, we present a comprehensive guide to provide step-by-step workflows for analyzing RNA-seq data, from raw reads to functional enrichment analysis, starting with considerations for experimental design. This is designed to aid students and researchers working with any organism, irrespective of whether an assembled genome is available. Within this guide, we employ various recognized bioinformatics tools to navigate the landscape of RNA-seq analysis and discuss the advantages and disadvantages of different tools for the same task. Our protocol focuses on clarity, reproducibility, and practicality to enable users to navigate the complexities of RNA-seq data analysis easily and gain valuable biological insights from the datasets. Additionally, all scripts and a sample dataset are available in a GitHub repository to facilitate the implementation of the analysis pipeline. © 2024 The Authors. Current Protocols published by Wiley Periodicals LLC. Basic Protocol 1: Analysis of data from a model plant with an available reference genome Basic Protocol 2: Gene ontology enrichment analysis Basic Protocol 3: De novo assembly of data from non-model plants.

Health facilities readiness for standard precautions to infection prevention and control in Nepal: A secondary analysis of Nepal Health Facility Survey 2021.

BACKGROUND: Improvements in standard precaution related to infection prevention and control (IPC) at the national and local-level health facilities (HFs) are critical to ensuring patient's safety, preventing healthcare-associated infections (HAIs), mitigating Antimicrobial Resistance (AMR), protecting health workers, and improving trust in HFs. This study aimed to assess HF's readiness to implement standard precautions for IPC in Nepal. METHODS: This study conducted a secondary analysis of the nationally-representative Nepal Health Facility Survey (NHFS) 2021 data and used the Service Availability and Readiness Assessment (SARA) Manual from the World Health Organization (WHO) to examine the HF's readiness to implement standard precautions for IPC. The readiness score for IPC was calculated for eight service delivery domains based on the availability of eight tracer items: guidelines for standard precautions, latex gloves, soap and running water or alcohol-based hand rub, single use of standard disposal or auto-disable syringes, disinfectant, safe final disposal of sharps, safe final disposal of infectious wastes, and appropriate storage of infectious waste. We used simple and multiple linear regression and quantile regression models to examine the association of HF's readiness with their characteristics. Results were presented as beta (ß) coefficients and 95% confidence interval (95% CI). RESULTS: The overall readiness scores of all HFs, federal/provincial hospitals, local HFs, and private hospitals were 59.9±15.6, 67.1±14.4, 59.6±15.6, and 62.6±15.5, respectively. Across all eight health service delivery domains, the HFs' readiness for tuberculosis services was the lowest (57.8±20.0) and highest for delivery and newborn care services (67.1±15.6). The HFs performing quality assurance activities (ß = 3.68; 95%CI: 1.84, 5.51), reviewing clients' opinions (ß = 6.66; 95%CI: 2.54, 10.77), and HFs with a monthly meeting (ß = 3.28; 95%CI: 1.08, 5.49) had higher readiness scores. The HFs from Bagmati, Gandaki, Lumbini, Karnali and Sudurpaschim had readiness scores higher by 7.80 (95%CI: 5.24, 10.36), 7.73 (95%CI: 4.83, 10.62), 4.76 (95%CI: 2.00, 7.52), 9.40 (95%CI: 6.11, 12.68), and 3.77 (95%CI: 0.81, 6.74) compared to Koshi. CONCLUSION: The readiness of HFs to implement standard precautions was higher in HFs with quality assurance activities, monthly HF meetings, and mechanisms for reviewing clients' opinions. Emphasizing quality assurance activities, implementing client feedback mechanisms, and promoting effective management practices in HFs with poor readiness can help to enhance IPC efforts.

Personal protective measures and settings on the risk of SARS-COV-2 community transmission: a case-control study.

Background: During the SARS-CoV-2 pandemic, nurses of primary health care has been an important role in Spain. Even so, the data obtained in the tracing have been scarcely used to investigate the possible mechanisms of transmission. Few studies focused on community transmission, evaluating the effectiveness of individual protective measures and exposure environment. The main aim of the study was to evaluate the association between individual protective measures and SARS-CoV-2 transmission in the community and to compare secondary attack rates in different exposure settings. Methods: A case-control study from contact tracing of SARS-CoV-2 index patients. COVID-19 contact tracing was led by nurses at the COVID-19 Coordinating Centre in Majorca (Spain). During the systematic tracing, additional information for this study was collected from the index patient (social-demographic variables, symptoms, the number of close contacts). And also, the following variables from their close contacts: contact place, ventilation characteristics mask-wearing, type of mask, duration of contact, shortest distance, case-contact relationship, household members, and handwashing, the test result for SARS-CoV-2 diagnostic. Close contacts with a positive test for SARS-CoV-2 were classified as "cases" and those negative as "controls." Results: A total of 1,778 close contacts from 463 index patients were identified. No significant differences were observed between the sexes but between age groups. Overall Secondary Attack Rate (SAR) was 24.0% (95% CI: 22.0-26.0%), 36.9% (95% CI: 33.2-40.6%) in closed spaces without ventilation and 50.7% (95% CI: 45.6-55.8%) in exposure time > 24 h. A total of 49.2% of infections occurred among household members. Multivariate logistic regression analysis showed that open-air setting (OR 0.43, 95% CI: 0.27-0.71), exposure for less than 1 h (OR 0.19, 95% CI: 0.11-0.32), and wearing a mask (OR 0.49, 95% CI: 0.28-0.85) had a protective effect transmission of SARS-CoV-2 in the community. Conclusion: Ventilation of the space, mask-wearing and shorter exposure time were associated with a lower risk of transmission in the community. The data obtained allowed an assessment of community transmission mechanisms and could have helped to improve and streamline tracing by identifying close contacts at higher risk.

Adapting the Nominal Group Technique to a virtual version: an experience report / Adaptación de la Técnica del Grupo Nominal a una versión virtual: informe de una experiencia / Adaptação da Técnica de Grupo Nominal para versão virtual: relato de experiência

ABSTRACT Objective: To report on the adaptations made to the original Nominal Group Technique (NGT), allowing it to be applied to the virtual format, preserving all its key elements. Method: An experience report on the adaptations and adjustments made to the original NGT to the virtual format using Information and Communication Technologies (ICT), using digital tools that are available free of charge or are low cost and easy to use. Results: The NGT was carried out entirely virtually and underwent adaptations in each of its four stages through the incorporation of specific digital resources. It was possible to present the most voted ideas and obtain final approval from the participants. The participants had no difficulty in using the virtual resources provided and, based on the reaction evaluation, they were satisfied with the tools provided. Conclusion: The adapted NGT proved to be an effective method when used in a virtual setting, capable of producing a significant number of ideas and developing consensus. The adapted tool can be used by other researchers in countries with similar resources or dimensions to Brazil.

RESUMEN Objetivo: Informar sobre las adaptaciones realizadas a la Técnica de Grupo Nominal (TGN) original, permitiendo su aplicación al formato virtual, preservando todos sus elementos clave. Método: Se trata de un informe de experiencia sobre las adaptaciones y ajustes realizados a la TGN original para el formato virtual mediante el uso de las Tecnologías de la Información y la Comunicación (TIC), utilizando herramientas digitales disponibles de forma gratuita o de bajo coste y fácil uso. Resultados: El TGN se realizó íntegramente de manera virtual y sufrió adaptaciones en cada una de sus cuatro etapas mediante la incorporación de recursos digitales específicos. Fue posible presentar las ideas más votadas y obtener la aprobación final de los participantes. Los participantes no tuvieron dificultades para utilizar los recursos virtuales proporcionados y, según los comentarios recibidos, se mostraron satisfechos con las herramientas facilitadas. Conclusión: El TGN adaptado demostró ser un método eficaz cuando se utiliza en un entorno virtual, capaz de producir un número significativo de ideas y desarrollar el consenso. La herramienta adaptada puede ser utilizada por otros investigadores en países con recursos o dimensiones similares a las de Brasil.

RESUMO Objetivo: Relatar as adaptações realizadas na Técnica de Grupo Nominal (TGN) original, permitindo sua aplicação ao formato virtual, preservando todos os seus elementos-chave. Método: Relato de experiência sobre as adaptações e adequações realizadas na TGN original ao formato virtual aplicando as Tecnologias da Informação e Comunicação (TIC), por meio de ferramentas digitais disponibilizadas gratuitamente ou de baixo custo e de fácil manejo. Resultados: A TGN foi realizada integralmente de forma virtual e sofreu adaptações em cada uma das suas quatro etapas através da incorporação de recursos digitais específicos. Foi possível apresentar as ideias mais votadas e obter a aprovação final dos participantes. Os participantes não apresentaram dificuldade para utilizar os recursos virtuais disponibilizados, e, partir da avaliação de reação, mostram-se satisfeitos com as ferramentas disponibilizadas. Conclusão: A TGN adaptada mostrou-se um método efetivo quando utilizada em cenário virtual, sendo capaz de produzir um significativo número de ideias e desenvolver consenso. A ferramenta adaptada pode ser usada por outros pesquisadores em países com recursos ou dimensões semelhantes ao Brasil.

Manifestación cutánea de histoplasmosis diseminada en un paciente con trasplante renal / Cutaneous manifestation of disseminated histoplasmosis in a renal transplant patient

Introducción: La infección por Histoplasma capsulatum ocurre con frecuencia en pacientes con inmunosupresión por VIH o en trasplantados que reciben tratamiento inmunosupresor. La infección primaria se adquiere por vía inhalatoria con afectación pulmonar y posteriormente puede diseminarse a otros órganos como hígado, intestinos, corazón, riñones, piel o tejido óseo. Es muy raro que ocurra en pacientes con trasplante renal, aunque sí es común en el trasplante pulmonar. Objetivo: Presentar el caso de un paciente con antecedente de trasplante renal 9 años antes que ingresó por presentar lesiones cutáneas no típicas de histoplasmosis, quien desarrolló 2 semanas después histoplasmosis diseminada, sin compromiso pulmonar. Caso clínico: Paciente masculino de 65 años de edad postrasplante renal, que desarrolló manifestación cutánea caracterizada por pápulas y placas eritematodescamativas con superficies costrosas y atróficas, acompañado de fiebre persistente y adenopatías. No presentó signos o síntomas pulmonares como manifestación de infección primaria. El diagnóstico definitivo se estableció mediante histopatología de piel y ganglios cervicales, además del crecimiento de H. capsulatum en hemocultivos específicos para hongos. Recibió tratamiento con anfotericina B liposomal y posteriormente con itraconazol de forma ambulatoria con evolución favorable. Conclusión: El caso descrito es importante, ya que no se asemeja a la presentación típica de esta entidad, es decir, con afectación pulmonar primaria y posteriormente cutánea. Se espera haber enriquecido el conocimiento de esta enfermedad en pacientes trasplantados.

Introduction: Histoplasma capsulatum infection frequently occurs in patients with HIV immunosuppression or in transplant recipients receiving immunosuppressive therapy. Primary infection is acquired by inhalation with pulmonary involvement, and may subsequently spread to other organs such as liver, intestines, heart, kidneys, skin or bone tissue. It is very rare in renal transplant patients, although it is common in lung transplantation. Objective: To present the case of a patient with a history of renal transplantation nine years earlier, who was admitted for presenting skin lesions not typical of histoplasmosis, developing disseminated histoplasmosis two weeks later, without pulmonary involvement. Clinical Case: Post-renal transplant male patient, aged 65, who developed cutaneous manifestations characterized by erythematous and scaly papules and plaques with crusty and atrophic surfaces, accompanied by persistent fever and lymphadenopathy. There were no pulmonary signs or symptoms of a primary infection. The definitive diagnosis was made by histopathology of skin and cervical nodes, in addition to the growth of H. capsulatum in specific blood cultures for fungi. The patient was treated with liposomal amphotericin B and later with itraconazole on an outpatient basis with favorable evolution. Conclusion: The case described is important since it does not resemble the typical presentation of this entity, that is, with primary pulmonary and subsequently cutaneous involvement. It is expected to have enriched the knowledge of this disease in transplanted patients.

Deformidad torácica como causa de compresión traqueobronquial. A propósito de un caso clínico pediátrico / Chest deformity as a cause of tracheobronchial compression. A pediatric case

La escoliosis idiopática es la flexión y rotación anómala de los cuerpos vertebrales, que puede causar sintomatología respiratoria y alteración de función pulmonar. El síndrome de la espalda recta es una alteración caracterizada por una disminución del diámetro anteroposterior del tórax. Se presenta a una paciente de 13 años afectada de escoliosis idiopática que desarrolló disnea de esfuerzo progresiva, estridor inspiratorio y disminución importante de función pulmonar, secundaria a compresión extrínseca del bronquio principal derecho y tercio medio traqueal por cuerpos vertebrales torácicos. A su vez, tenía una disminución del diámetro anteroposterior del tórax, factor determinante en la aparición de los síntomas. Se intervino mediante fijación de vértebra torácica T3-T11, con posterior mejoría clínica y funcional respiratoria.La escoliosis asociada a alteración de función pulmonar y estridor debe hacer sospechar la existencia de compresión de la vía aérea, especialmente, en pacientes con reducción del diámetro anteroposterior del tóra

Idiopathic scoliosis is the abnormal flexion and rotation of the vertebral bodies, causing respiratory symptoms and altered pulmonary function. Straight back syndrome is a decreased in the anteroposterior diameter of the thorax. We present a 13-year-old patient with idiopathic scoliosis who developed progressive dyspnea, inspiratory stridor and a significant decrease in pulmonary function, because of extrinsic compression of the right main bronchus and the middle third of trachea by the thoracic vertebral bodies. She had also a decreased anteroposterior diameter of the thorax, being a determining factor in the appearance of symptoms. Surgery was performed by thoracic vertebra fixation T3 to T11, with subsequent clinical and functional respiratory improvement.Scoliosis associated with altered pulmonary function and stridor should make us suspect the existence of airway compression, especially in patients with reduction of the anteroposterior diameter of the thorax

Ecografía del tercer trimestre combinada con un método clínico para mejorar la predicción del peso del recién nacido a término: un estudio de cohortes en España / Third trimester ultrasound scan combined with a clinical method for accurate birthweight prediction at term: a cohort study in spain

Abstract Objective: To develop and assess an equation based on maternal clinical parameters and third trimester ultrasound biometry (combined method), and compare it with ultrasound estimated foetal weight (EFW) calculated using the Hadlock 2 formula. Material and methods: Cohort study. A total of 1,224 women with singleton pregnancies who had undergone foetal ultrasound scanning (USS) at 34 weeks were recruited. The study was conducted at a reference center in Valencia (Spain) between January and December 2016. A gestation-adjusted projection (GAP) method was applied to estimated foetal-weight-for-gestational-age by foetal gender at delivery (EFWa). A multivariate regression was created to estimate foetal weight at term (EFWmr) using anthropometric, demographic, ultrasonographic and obstetric-neonatal variables. EFWa and EFWmr were calculated and compared with actual birthweight. Results: The proportion for EFWmr within <10% of actual birthweight was greater than EFWa (82% vs. 65%, p<0.001). The mean relative error in foetal-weight predictions by using EFWmr was reduced from 6.7% to 0.9% (difference 5.7% 95% CI: 5.4 to 6.0) paired t-test p<0.001, significantly improving the accuracy attainable with USS. The EFWmr outperformed the GAP method in predicting birthweight, within 1% relative error. For new- borns <2,500 g, the proportion of estimates within <10% of the actual birthweight for the EFWmr was greater than that of the EFWa (20.4 vs. 16.3%, p=0.005). For babies with normal birthweight (2,500-3,999 g), EFWmr was a better predictor of birthweight than EFWa (84.5 vs. 65.7%, p<0.001). Conclusions: Mathematical modelling to predict birthweight improves third trimester routine ultrasound measurement to estimate neonatal weight at term.

RESUMEN Objetivos: desarrollar y evaluar un modelo predictivo de acuerdo con los parámetros clínicos maternos y la biometría de la ecografía del tercer trimestre, que pueda mejorar el poder de predicción del peso al nacer en el recién nacido a término, en comparación con la estimación calculada por ecografía del peso fetal (PFE) usando la fórmula de Hadlock II. Materiales y métodos: revisión de 1224 mujeres con embarazos únicos que se habían sometido a una ecografía fetal a las 34 semanas (EF). El estudio se realizó en un centro de referencia en Valencia (España) entre enero y diciembre de 2016. Se aplicó un método de proyección ajustada de gestación (PAG) para estimar el peso al nacer para la edad gestacional y sexo fetal en el parto (PFEa). Se creó una regresión multivariante para estimar el peso fetal al nacer (PFErm) mediante variables antropométricas, demográficas, ecográficas y obstétrico-neonatales. Los modelos PFErm y PFEa fueron calculados para comparar sus diferencias respecto al peso real al nacer. Resultados: la proporción de PFErm dentro de < 10 % del peso real al nacer fue mayor que la de PFEa (82 % vs. 65 %, p< 0,001). El error relativo medio en las predicciones de peso fetal mediante el uso PFErm pasó de 6, a 0,9 % (Diferencia de proporciones: 5,7 %; IC 95 %: 5,4-6,0); medias pareadas: p < 0,001, siendo significativamente mejor que la precisión que puede ser obtenida con el método ecográfico. El PFErm superó al método PAG y predice el peso al nacer con un error relativo del 1 %. Para recién nacidos con < 2500 g la proporción de estimaciones del peso real < 10 % del PFErm fue mayor que la del PFEa (20,4 % vs. 16,3 %; p = 0,005). En los recién nacidos con peso normal al nacer (2500-3999 g), la capacidad predictiva para estimar el peso al nacer realizada mediante PFErm fue mejor que la realizada mediante PFEa (84,5 % vs. 65,7%; p < 0,001). Conclusiones: el modelo matemático creado para predecir el peso al nacer mejora la medición rutinaria de la ecografía en el tercer trimestre del embarazo para estimar el peso del recién nacido a término.

Fertilidad después del tratamiento laparoscópico del embarazo ectópico, en la Clínica del Prado en Medellín, Colombia. Estudio de cohorte / Fertility following laparoscopic treatment of ectopic pregnancy at the Prado Clinic in Medellín, Colombia. A cohort study

Objetivo: conocer y comparar los índices de fertilidad luego de salpingostomía vs. salpingectomía laparoscópicas en pacientes con embarazo ectópico.Diseño y población: cohorte concurrente de pacientes sometidas a cirugía de embarazo ectópico por laparoscopia en la Unidad de Cirugía Endoscópica Ginecológica, Clínica del Prado, Medellín, Colombia.Metodología: revisión de historias clínicas e interrogatorio telefónico a pacientes que cumplieron criterios de inclusión.Variables principales: tasa global de embarazo intrauterino, tasa acumulada por año de embarazo intrauterino, tasa de recurrencia de ectópico, tasa de persistencia de ectópico.Resultados: 31 pacientes en el grupo de salpingostomía y 14 pacientes en el grupo de salpingectomía. La tasa global de embarazo intrauterino después de salpingostomía fue de 54,8 por ciento comparada con 57,1 por ciento para salpingectomía (p = 0,88). Se presentaron recurrencias en el 10,5 por ciento de las salpingostomías y en el 20 por ciento de las salpingectomías (p = 0,77). La tasa de persistencia de ectópico después de manejo conservador fue de 9,6 por ciento.Conclusiones: este estudio no demuestra diferencias significativas en los índices reproductivos al comparar salpingostomía vs. salpingectomía laparoscópicas.

Factores de riesgo de la sepsis neonatal / Risk factors of neonatal sepsis

Se realizó un estudio de 85 casos con sepsis y 179 controles escogidos entre los neonatos que no tenían dicho antecedente, con vista a identificar los factores de riesgo que favorecieron la aparición de sepsis neonatal en el Hospital Clinicoquirúrgico Juan Bruno Zayas de Santiago de Cuba durante el período enero-diciembre del 2002. Para medir la fuerza de asociación se utilizó el odds ratio, con un nivel de significación de 95 por ciento. Los factores de riesgo predominantes fueron: rotura prematura de membranas, sepsis vaginal, parto pretérmino y cateterismo umbilical. Se recomendó capacitar a los profesionales de la salud sobre el control de la sepsis neonatal, así como trazar estrategias de trabajo para identificar los factores de riesgo con asociación causal, a fin de mejorar la atención médica y disminuir la incidencia de la enfermedad en el territorio