El objetivo de esta investigación se centra en analizar el proceso seguido en la recuperación del patrimonio histórico educativo a partir del estudio de caso de la Cátedra de Latinidad de Lois, ...fundada en la montaña leonesa en 1744, y que permaneció activa más de dos siglos, lo que supuso una extraordinaria experiencia pedagógica y social merecedora de su conservación y recuperación. Dicho proceso ha sido estudiado desde una triple vertiente en la que se analizó el contexto normativo, institucional y social. Se ha empleado el método histórico siguiendo las fases convencionales en las que, en primer término, se efectúa una selección de las fuentes. Entre las fuentes primarias se destacan tanto las orales, plasmadas en las entrevistas en profundidad efectuadas a los agentes implicados en el fenómeno estudiado, como las escritas procedentes de documentos del Archivo Diocesano de León. Tras la recogida la información se efectuó un exhaustivo análisis crítico, lo que ha arrojado como resultado principal el hecho de que la conservación de la Cátedra de Lois ha sido posible gracias al fuerte sentimiento de comunidad local que actúa como impulsor del proyecto y a la colaboración de las instituciones implicadas (obispado, ayuntamiento y administración autonómica) las cuales han liderado los esfuerzos en la conservación arquitectónica concluyendo que sería muy enriquecedor que para la recuperación del patrimonio histórico educativo, además del arquitectónico, se tengan en cuenta el valor pedagógico y educativo en el proceso de recuperación.
Introduction: At the hospital, it was considered to know the incidence of infectious strains in BAS and in peritraqueostoma cultures in patients with tracheotomy tube.
Material and methods: For two ...years, samples of bronchial and peritraqueostoma secretions of patients with tracheotomy tube were gathered at the moment of tube change. These data were processed according to standard procedures of the Microbiology Service at the Hospital Nacional Parapléjicos (Toledo). The study was carried out from March, 2008 to October, 2010.
Outcomes: During the study period, 706 BAS´s and peritraqueostoma samples were processed, with a positive result in 93.77% and 82.15% respectively, and 813 microorganisms were isolated.
Discusion: In our hospital, only 6.23% of the cultures BAS and 17.85 % of the peritraqueostoma cultures are negative. Pseudomonas Aeruginosa and Candida Albicans have turned out to be important agents of nosocominal infection in patients with tracheotomy tube, as they are present in 25.95 % and 18.45%, respectively, of microbiological strains from such patients. Discussion: In order to prevent nosocomial infections in patients with tracheotomy tube, it is very important to extreme hygienic measures at tracheotomy tube changes procedures.
Introducción: En el hospital nos planteamos la necesidad de conocer la incidencia de cepas infecciosas en cultivos BAS y de peritraqueostoma en los pacientes traqueostomizados.
Materiales y métodos: Durante dos años, se recogieron muestras de secreciones bronquiales y peritraqueostoma de pacientes traqueostomizados durante los cambios de cánula, procesándose según los procedimientos estándar del servicio de microbiología del Hospital Nacional de Parapléjicos de Toledo. El estudio se realizó desde marzo del 2008 a octubre del 2010.
Resultados: Durante el periodo de estudio, se procesaron 706 muestras de BAS y peritraqueostoma, siendo positivas el 93’77% y 82’15% respectivamente y se aislaron 813 microoorganismos. Conclusiones: En nuestro hospital, sólo el 6’23% de los cultivos BAS y el 17’85% de los de peritraqueostoma son negativos. Pseudomona Aeruginosa y Candida Albicans se han convertido en un importante agente de infección nosocomial en los pacientes traqueostomizados, ya que suponen el 25’95% y 18’45%, respectivamente, de las cepas encontradas en los cultivos de dichos pacientes.
Discusión: Para prevenir posibles infecciones nosocomiales en los pacientes traqueostomizados, es de suma importancia extremar el uso de medidas higiénicas en los procedimientos de cambio de cánula.
BACKGROUND Trauma to the left submandibular gland is an infrequent entity, with only a few cases reported in the literature. Recommended management consists of excision of the gland if trauma is ...suspected; if trauma is not clearly identified during the surgical exploration and the gland is not removed, post-traumatic complications such as fistula or sialocele may occur. In such cases, conservative measures including aspiration, pressure bandages, and anti-sialogogues are the first step of treatment and surgical excision is reserved for unsuccessful cases. CASE REPORT This report describes a case of post-traumatic surgical emphysema and sialocele with fistula following knife wounds to the head and neck of a 30-year-old woman. The patient had an incised wound to the left submandibular gland. Subsequently, a painful slow-growing mass developed and the diagnosis of sialocele was considered. Confirmation of this diagnosis was achieved by performing a fine-needle aspiration, which revealed a high amylase level within the collection. Afterwards, pressure bandages were applied and no recurrence of the sialocele was observed in imaging follow-up. CONCLUSIONS This report shows that although submandibular gland trauma is rare, it can lead to salivary fistula or sialocele. The diagnosis of sialocele can be confirmed by imaging combined with fine-needle aspiration and measurement of amylase levels in the aspirate. Identification of traumatic sialocele and fistula at an early stage will lead to the most appropriate management.
Background
Proton pump inhibitors (PPIs) are one of the most frequently used drugs worldwide. Previous research has shown that they could increase the risk of fracture and interfere with the fracture ...healing process. In this study, we analyzed the effect of PPIs on the risk of fracture non-union in patients with femoral and tibial shaft fractures.
Methods
A case–control study was conducted at our institution, including a total of 254 patients who underwent fixation surgery for a femoral or tibial shaft fracture between January 2012 and December 2017. We defined cases as patients who experienced a delayed union (case group A;
n
= 44), or non-union (cases group B;
n
= 12). Cases were matched by age, sex, and fractured bone, to 144 controls who did not experience delayed fracture union and did not require further procedures. A conditional logistic regression analysis was performed adjusted to potential confounders, and to the proportion of days covered (PDC) with PPIs.
Results
Adjusted ORs (95% CI) for undergoing a nail dynamization following a tibial or femoral shaft fracture were 1.38 (0.70–2.65) for any use PPIs. Patients with a longer PPI treatment courses (PDC ≥ 0.5) had an adjusted OR of 1.86 (0.70–4.76) for undergoing nail dynamization when compared with controls. Contrastingly, patients with a PDC < 0.5 had an adjusted OR of 1.03 (0.43–2.48). The adjusted OR (95% CI) for undergoing additional surgical procedures due to non-union was 4.5 (0.62–32.8) for any use of PPIs, and 12.3 (1.9–81.0) in patients with a PDC ≥ 0.5.
Conclusions
A prolonged use of PPIs use was associated with a higher risk of fracture non-union in tibial and femoral shaft fractures.
Determinar el porcentaje de Staphylococcus aureus resistente a meticilina (SARM) entre los pacientes ingresados en un servicio de urgencias del Hospital Lluís Alcanyís de Xàtiva (Valencia), España, ...desde enero a junio de 2012.
Los datos se recogieron mediante un cuestionario con los siguientes ítems: edad, sexo, antecedentes personales, tratamiento antibiótico previo, ingresos hospitalarios anteriores y origen. Los médicos de Urgencias utilizaron torundas humedecidas con suero fisiológico (TranSystems® COPAN) para recoger el material de las fosas nasales de los pacientes citados.
Se estudiaron 120 pacientes con alto riesgo de colonización por SARM. Se detectaron 19 (15,83%) pacientes con aislamientos positivos para SARM; de ellos, el 52,63% eran mujeres, con una edad media de 66,6 años. Solo 5 (26,31%) pacientes habían tomado antibiótico previamente, 4 (21,05%) habían tenido algún ingreso hospitalario anterior, 7 (36,84%) provenían de residencias de la tercera edad, 12 (63,15%) estaban en su domicilio, 4 (21,05%) tenían obesidad mórbida, 9 (47,36%) padecían diabetes mellitus, 6 (31,57%) presentaban enfermedad pulmonar obstructiva crónica y ninguno tenía alergia a betalactámicos.
La proporción de infecciones por SARM fue del 16%. Los cultivos de vigilancia activa deben ser considerados en pacientes con alto riesgo de colonización por SARM e ingresados desde Urgencias.
To determine the percentage of methicillin-resistant Staphylococcus aureus (MRSA) among patients admitted from an emergency department of the Hospital Lluís Alcanyís de Xàtiva (Valencia), Spain, from January to June 2012.
The data were collected using a questionnaire with the following items: age, sex, personal history, previous antibiotic treatment, previous hospital admission, and origin. The emergency department doctors used swabs moistened with physiological saline (TranSystems® COPAN) to collect the material from the nasal cavity of the cited patients.
A total of 120 patients with a high risk of MRSA colonisation were studied. Positive isolation of MRSA was detected in 19 (15.83%) patients, of whom 52.63% were women, with a median age of 66.6 years. Only 5 (26.31%) patients had taken antibiotics previously, 4 (21.05%) had a previous admission, 7 (36.84%) were from homes for the elderly, 12 (63.15%) were from home, 4 (21.05%) had morbid obesity, 9 (47.36%) suffered from diabetes mellitus, 6 (31.57%) with chronic obstructive pulmonary disease, and none of them were allergic to beta-lactams.
The proportion of infections due to MRSA was 16%. Active surveillance cultures must be considered in patients with a high risk of MRSA colonisation and admitted from emergency departments.
To analyse the characteristics and predictors of death in hospitalized patients with coronavirus disease 2019 (COVID-19) in Spain.
A retrospective observational study was performed of the first ...consecutive patients hospitalized with COVID-19 confirmed by real-time PCR assay in 127 Spanish centres until 17 March 2020. The follow-up censoring date was 17 April 2020. We collected demographic, clinical, laboratory, treatment and complications data. The primary endpoint was all-cause mortality. Univariable and multivariable Cox regression analyses were performed to identify factors associated with death.
Of the 4035 patients, male subjects accounted for 2433 (61.0%) of 3987, the median age was 70 years and 2539 (73.8%) of 3439 had one or more comorbidity. The most common symptoms were a history of fever, cough, malaise and dyspnoea. During hospitalization, 1255 (31.5%) of 3979 patients developed acute respiratory distress syndrome, 736 (18.5%) of 3988 were admitted to intensive care units and 619 (15.5%) of 3992 underwent mechanical ventilation. Virus- or host-targeted medications included lopinavir/ritonavir (2820/4005, 70.4%), hydroxychloroquine (2618/3995, 65.5%), interferon beta (1153/3950, 29.2%), corticosteroids (1109/3965, 28.0%) and tocilizumab (373/3951, 9.4%). Overall, 1131 (28%) of 4035 patients died. Mortality increased with age (85.6% occurring in older than 65 years). Seventeen factors were independently associated with an increased hazard of death, the strongest among them including advanced age, liver cirrhosis, low age-adjusted oxygen saturation, higher concentrations of C-reactive protein and lower estimated glomerular filtration rate.
Our findings provide comprehensive information about characteristics and complications of severe COVID-19, and may help clinicians identify patients at a higher risk of death.
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Introduction: At the hospital, it was considered to know the incidence of infectious strains in BAS and in peritraqueostoma cultures in patients with tracheotomy tube. Material and methods: For two ...years, samples of bronchial and peritraqueostoma secretions of patients with tracheotomy tube were gathered at the moment of tube change. These data were processed according to standard procedures of the Microbiology Service at the Hospital Nacional Parapléjicos (Toledo). The study was carried out from March, 2008 to October, 2010. Outcomes: During the study period, 706 BAS´s and peritraqueostoma samples were processed, with a positive result in 93.77% and 82.15% respectively, and 813 microorganisms were isolated. Discusion: In our hospital, only 6.23% of the cultures BAS and 17.85 % of the peritraqueostoma cultures are negative. Pseudomonas Aeruginosa and Candida Albicans have turned out to be important agents of nosocominal infection in patients with tracheotomy tube, as they are present in 25.95 % and 18.45%, respectively, of microbiological strains from such patients. Discussion: In order to prevent nosocomial infections in patients with tracheotomy tube, it is very important to extreme hygienic measures at tracheotomy tube changes procedures.
Daily spontaneous breathing trials (SBTs) are the best approach to determine whether patients are ready for disconnection from mechanical ventilation, but mode and duration of SBT remain ...controversial.
To evaluate the effect of an SBT consisting of 30 minutes of pressure support ventilation (an approach that is less demanding for patients) vs an SBT consisting of 2 hours of T-piece ventilation (an approach that is more demanding for patients) on rates of successful extubation.
Randomized clinical trial conducted from January 2016 to April 2017 among 1153 adults deemed ready for weaning after at least 24 hours of mechanical ventilation at 18 intensive care units in Spain. Follow-up ended in July 2017.
Patients were randomized to undergo a 2-hour T-piece SBT (n = 578) or a 30-minute SBT with 8-cm H2O pressure support ventilation (n = 557).
The primary outcome was successful extubation (remaining free of mechanical ventilation 72 hours after first SBT). Secondary outcomes were reintubation among patients extubated after SBT; intensive care unit and hospital lengths of stay; and hospital and 90-day mortality.
Among 1153 patients who were randomized (mean age, 62.2 SD, 15.7 years; 428 37.1% women), 1018 (88.3%) completed the trial. Successful extubation occurred in 473 patients (82.3%) in the pressure support ventilation group and 428 patients (74.0%) in the T-piece group (difference, 8.2%; 95% CI, 3.4%-13.0%; P = .001). Among secondary outcomes, for the pressure support ventilation group vs the T-piece group, respectively, reintubation was 11.1% vs 11.9% (difference, -0.8%; 95% CI, -4.8% to 3.1%; P = .63), median intensive care unit length of stay was 9 days vs 10 days (mean difference, -0.3 days; 95% CI, -1.7 to 1.1 days; P = .69), median hospital length of stay was 24 days vs 24 days (mean difference, 1.3 days; 95% CI, -2.2 to 4.9 days; P = .45), hospital mortality was 10.4% vs 14.9% (difference, -4.4%; 95% CI, -8.3% to -0.6%; P = .02), and 90-day mortality was 13.2% vs 17.3% (difference, -4.1% 95% CI, -8.2% to 0.01%; P = .04; hazard ratio, 0.74 95% CI, 0.55-0.99).
Among patients receiving mechanical ventilation, a spontaneous breathing trial consisting of 30 minutes of pressure support ventilation, compared with 2 hours of T-piece ventilation, led to significantly higher rates of successful extubation. These findings support the use of a shorter, less demanding ventilation strategy for spontaneous breathing trials.
ClinicalTrials.gov Identifier: NCT02620358.
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