Introducción: Dada la importancia del inicio temprano de un tratamiento antiviral en los neonatos con hipoacusia neurosensorial secundaria a infección congénita por citomegalovirus (CMVc), ...presentamos un protocolo de diagnóstico precoz del CMVc en función del resultado del cribado auditivo neonatal universal con potenciales evocados auditivos automatizados (PEATC-A). Material y métodos: Partiendo del conocimiento actual que aporta la literatura, elaboramos un algoritmo de actuación consensuado entre los coordinadores del Programa de Detección Precoz de la Hipoacusia Infantil en la Comunidad de Castilla y León (España). Resultados: Si la primera prueba de PEATC-A en el neonato es un no pasa de uno o ambos oídos, solicitamos en el plazo de 15 días la identificación del genoma viral mediante PCR en una muestra de orina. La confirmación posterior de hipoacusia neurosensorial uni o bilateral, permitirá el inicio del tratamiento antiviral, antes del primer mes de vida. Discusión: Si bien el cribado universal del CMVc haría posible el seguimiento de todos los neonatos infectados, detectando más precozmente los casos de hipoacusia tardía/progresiva; ante la presencia de una hipoacusia neurosensorial de causa desconocida, a partir de las dos semanas de vida posnatal, se debe intentar descartar una infección por CMVc, aunque en estas condiciones resulta más complicado. Conclusión: La incorporación del diagnóstico del CMVc en el programa de cribado auditivo neonatal, permitirá la detección precoz de algunos niños con infección congénita, pudiéndoles mejorar su calidad de vida.
Our objective is the description of the technique of vagus nerve stimulation in carotid triangle in order to monitor the recurrent laryngeal nerve (RLN) during thyroid and parathyroid surgery.
We ...stimulated the vagus nerve in the carotid triangle during 150 thyroid or parathyroid surgeries using a monopolar electromyography electrode inserted under the mastoid process towards the jugular foramen as a cathode, and using another subdermal electrode in the mastoid as an anode. Another complementary method of vagus stimulation was achieved with a pair of subdermal electrodes, placing the cathode at the mandibular angle and the anode at the mastoid.
In all patients, compound muscle action potential (CMAP) was recorded in the vocal cords with both stimulation techniques, allowing semi-continuous monitoring to be carried out. Intraoperative lesions were detected in 16 of the cases; 9 of them were transient with CMAP recovery achieved when modifying surgical maneuvers.
Vagus nerve stimulation in the carotid triangle is a reliable technique for monitoring the RLN in thyroid surgery. Vagus nerve stimulation in the carotid triangle is effective and safe for RLN monitoring, and it is a clear alternative to direct continuous stimulation of the nerve that by contrast requires its dissection in the carotid sheath.
Surgical site infection in cardiac surgery is uncommon. The aim of the present study was to examine the incidence of this infection, compare it with national and international data, and evaluate its ...risk factors.
This prospective cohort study included patients who underwent valve surgery or coronary revascularization during a 6-year period. The incidence of surgical site infection was studied. Associations between risk factors and infection were evaluated using odds ratios (OR). The infection rate was compared with Spanish and American data using the standardized infection ratio.
A total of 1557 patients were included. The overall cumulative incidence of infection was 4% (95% confidence interval 95%CI, 3.6%-5.6%), 3.6% in valve surgery (95%CI, 2.5%-4.7%) and 4.3% in coronary revascularization (95%CI, 2.3%-6.3%). Risk factors for surgical site infection in valve surgery were diabetes mellitus (OR=2.8; P<.05) and obesity (OR=6.6; P<.05). Risk factors for surgical site infection in coronary revascularization were diabetes mellitus (OR=2.9; P<.05) and reoperation for bleeding (OR=8.8; P<.05).
Diabetes mellitus and obesity favor surgical site infection in valve surgery, whereas diabetes mellitus and reoperation for bleeding favor surgical site infection in coronary revascularization. Infection surveillance and control programs permit evaluation and comparison of infection rates in cardiac surgery.
Background
The use of Mohs micrographic surgery (MMS) for rare cutaneous tumors is poorly defined. We aim to describe the demographics, tumor presentation and topography, surgery characteristics and ...complications of MMS for rare cutaneous tumors in a national registry.
Methods
Prospective cohort study of patients treated with MMS in Spain between July 2013 and June 2018. The inclusion criteria were patients with cutaneous tumors with final diagnosis different from basal cell carcinoma, squamous cell carcinoma, dermatofibrosarcoma protuberans, or any kind of melanoma.
Results
Five thousand and ninety patients were recorded in the registry, from which only 73 tumors (1.4%) fulfilled the inclusion criteria: atypical fibroxanthoma (18), microcystic adnexal carcinoma (10), extramammary Paget's disease (7), Merkel cell carcinoma (5), dermatofibroma (4), trichilemmal carcinoma (4), desmoplastic trichoepithelioma (4), sebaceous carcinoma (3), leiomyosarcoma (2), porocarcinoma (2), angiosarcoma (2), trichoblastoma (1), superficial acral fibromyxoma (1), and others (10). No intra‐surgery morbidity was registered. Postsurgery complications appeared in six patients (9%) and were considered mild. Median follow‐up time was 0.9 years during which three Merkel cell carcinomas, one angiosarcoma, one microcystic adnexal carcinoma, and four others recurred (12.3%).
Conclusion
This national registry shows that rare cutaneous tumors represent a negligible part of the total MMS performed in our country with a low complication rate.
Abstract The role of vegetation as the key feature of infective endocarditis is universally recognized. Nowadays, the wide availability of transesophageal echocardiography has made of it the most ...employed technique to establish the diagnosis by visualizing vegetations. However, the factors which influence the size of vegetation when first detected are not clearly determined. Furthermore, there is considerable controversy regarding the prognostic implications of the size of vegetation. This is of paramount significance to early identify patients at high risk for complications, which might benefit from aggressive attitudes. We present a study based on TEE. Our results show that the size of vegetation at admission is mostly determined by anatomical and not microbiological factors, and the prognostic influence of vegetations on the risk of embolisms, need of surgery, persistent infection and septic shock.
The Interventional Cardiology Association of the Spanish Society of Cardiology (ACI-SEC) presents its annual activity report for 2020, the year of the coronavirus disease (COVID-19) pandemic.
All ...Spanish centers with catheterization laboratories were invited to participate. Data were collected online and were analyzed by an external company, together with the members of the ACI-SEC.
A total of 123 centers participated (4 more than 2019), of which 83 were public and 40 were private. Diagnostic coronary angiograms decreased by 9.4%, percutaneous coronary interventions by 10.1%, primary percutaneous coronary interventions by 4.1%, transcatheter aortic valve replacements by 0.9%, and left atrial appendage closure by 8.3%. The only procedures that increased with respect to previous years were edge-to-edge mitral valve repair (13.8%) and patent foramen ovale closure (19.4%). The use of pressure wire (5.5%), intravascular imaging devices and plaque preparation devices decreased (with the exception of lithotripsy, which increased by 62%).
In the year of the COVID-19 pandemic, the registry showed a marked drop in activity in all procedures except for percutaneous mitral valve repair and patent foramen ovale closure. This decrease was less marked than previously described, suggesting a rebound in interventional activity after the first wave.
La Asociación de Cardiología Intervencionista de la Sociedad Española de Cardiología (ACI-SEC) presenta su informe anual de actividad de 2020, año de la pandemia de la COVID-19.
Se invitó a participar a todos los centros españoles con sala de hemodinámica. La recogida de datos se realizó por vía telemática y una empresa externa, junto con los miembros de la ACI-SEC, llevó a cabo su análisis.
Participaron 123 centros (4 más que el año previo), 83 públicos y 40 privados. Se observó una reducción del 9,4% de coronariografías, el 10,1% de intervenciones coronarias percutáneas, el 4,1% de angioplastias primarias, el 0,9% de válvulas aórticas transcatéter y el 8,3% de cierre de orejuelas. Los únicos procedimientos que se incrementaron con respecto a años previos fueron la reparación mitral con clips (13,8%) y el cierre del foramen oval permeable (19,4%). En cuanto a los dispositivos, disminuyeron las guías de presión (5,5%), la imagen intravascular y los dispositivos de preparación de placa (a excepción de la litotricia, que aumentó un 62%).
El registro en el año de la pandemia de la COVID-19 demuestra una marcada caída en la actividad de todos los procedimientos a excepción de la reparación percutánea de la válvula mitral con clips y el cierre del foramen oval permeable. Dicha caída es menor que lo descrito previamente, lo cual indica un rebote de la actividad intervencionista tras la primera ola.
β
-Tricalcium phosphate (
β
-TCP) has been encapsulated with poly(ethylene glycol) (PEG) to improve the filler/cement interface, and it was later incorporated to a poly(methyl methacrylate) bone ...cement in order to obtain cements with improved stability in the long term. Size and size distribution of the agglomerates forming the initial powder was drastically changed after its dispersion in a PEG aqueous solution. Whereas the initial
β
-TCP particles had a 584
μm average diameter, the treated particles (TCP-PEG) presented more than 60% of the particles in a range of 2–6
μm. The effect of adding the treated particles to an acrylic cement was evaluated in terms of curing parameters, in vitro behaviour and mechanical performance. The presence of the TCP-PEG particles did not affect either peak temperature or setting time, indicating a good homogeneity of polymerising mass in contrast to the effect observed with the plain
β
-TCP particles, which gave rise to higher setting times. In vitro behaviour studies revealed hydration degree values of the modified cements comparable to that of PMMA cements. Early stages of water uptake was Fickian in nature for all the experimental formulations indicating that the water absorption followed a diffusion controlled mechanism. After 3 months of storage in SBF the experimental formulations presented values of compressive strength in the range 76–78
MPa, higher than the minimum required by ISO 5833 (70
MPa) and those of tensile strength in the range 42–48
MPa, higher than the minimum reported for commercial formulations (30
MPa), but no significant differences in the strengths and elastic modulus were observed with the treatment of the filler particles. This observation was confirmed by ESEM analysis of the tensile fracture surfaces, which revealed a rather good cohesion between the bioceramic particles with some gaps around them, independently of the type of particles. The themogravimetric analysis of dry and wet specimens showed a higher dissolution rate of the plain
β
-TCP particles in comparison to the encapsulated ones, indicating that the PEG adsorbed on the surface of the TCP particles could be a way to control the resorbability of the bioceramic component.
Mutants in the lipopolysaccharide of Soler-Lloréns, Pedro; Gil-Ramírez, Yolanda; Zabalza-Baranguá, Ana ...
Veterinary research (Paris),
2014, Letnik:
45, Številka:
1
Journal Article
Previous studies showed a plausible association between herpetic burden and ischemic heart disease. Our aim is to test this hypothesis in an spanish seroepidemiological context.
Sex and age matched ...case-control study (1:1) including patients with chronic ischemic heart disease and healthy controls. Herpetic burden was defined as the aggregate number of antibody seropositivities (IgG) for Epstein Barr Virus, cytomegalovirus, varicella zoster virus, Herpes simplex type 1 and type 2.
We found that 90.7% of cases and 70,7% of controles (P=.002), were seropositive to 4 or more herpesvirus (high herpetic burden). Within control group, hypercholesterolemic subjects had a higher proportion of high burden (88,5% vs. 61,2%, P=.02). High herpetic burden was associated with ischemic heart disease, even after adjusting for diabetes, smoking, hypertension and literacy level, (OR: 4,5 1,23-16,53), but not when hypercholesterolemia was included in the model (OR 2,2 0,45-10,62).
The hypothesized relationship is independent from most but not all classical cardiovascular risk factors.
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