This paper shows how the indiscriminate combination of the form-function criterion in the traditional presentation of modal verbs brings more confusion than light to the subject due mostly to the ...fact that the grammatical simplicity of modal verbs clashes with their semantic complexity. In order to verify the treatment of modals in the EFL classroom, both a reduced but representative sample of textbooks and English grammar books will be analysed. Based on the findings of research conducted in this field, this article concludes that when studying modals in the EFL classroom the pragmatic uses of modal verbs should be primed over potential polysemic often indeterminate semantic values and/or grammatical criteria based on a higher or lower rank of graded modality.
Among the main social and legislative changes in Spanish family law in recent years, are (i) the increase of judicialised conflicts between parents and (ii) the enactment of the Spanish Law 26/2015, ...which amended the Spanish Autonomy Law 41/2002, and sought to balance the rights of minors and parents, especially minors who had not reached 16 years of age or, having reached it, faced decisions that could put their lives or health at serious risk. Likewise, recent jurisprudence has determined that, regardless of minor's age, there are sensitive “extraordinary” or “transcendent” healthcare acts, such as psychotherapeutic or surgical interventions, which require the consent of both parents, with some exceptions. All this, however, is subject to the discretion of the responsible physician, who must always ensure the best interest of the minor. Child health care therefore often raises complex conflicts involving parental rights to information and consent, especially when parental opinions differ. We present a review of the current legislative framework and the most relevant legal concepts that regulate the care of minors with regard to rights to information and minor vs. parental consent. We also present clinical guidelines for caring for minors in situations of parental conflict developed at Gregorio Marañón University Hospital in Madrid, Spain, and endorsed by the Official College of Physicians of Madrid, Spain. Resumen: Entre los principales cambios sociales y legislativos que se han producido en España en los últimos años en materia de familia, se encuentran (i) el aumento progresivo de situaciones de conflicto judicializado entre progenitores y (ii) la aparición de la Ley 26/2015 de Protección a la Infancia, que modificó la Ley 41/2002 de Autonomía del Paciente, y buscó un cierto equilibrio entre los derechos de los menores y las facultades de los progenitores, sobre todo cuando aquéllos no habían alcanzado los 16 años o la suficiente madurez o, habiéndola alcanzado, la decisión ponía en grave riesgo su vida o salud. Asimismo, se ha generado jurisprudencia que determina que, para cualquier menor de edad, existen actos asistenciales especialmente sensibles, “extraordinarios” o “trascendentes”, como las intervenciones psicoterapéuticas o las quirúrgicas, las cuales requieren, salvo excepciones, el consentimiento de ambos progenitores para llevarse a cabo. Todo ello, sin embargo, sujeto al criterio del facultativo responsable, quien debe siempre velar por el mejor interés del menor. La asistencia a menores plantea, por ello, en ocasiones, conflictos complejos en materia de información y consentimiento por parte de los progenitores, sobre todo cuando la opinión de estos no es coincidente. Presentamos una revisión del marco legislativo vigente y de los principales conceptos jurídicos que regulan la asistencia a menores en materia de información y consentimiento relativos a la salud, así como un protocolo asistencial para la atención a menores en situaciones de conflicto entre progenitores, desarrollado en el Hospital Gregorio Marañón de Madrid y avalado por el Ilustre Colegio Oficial de Médicos de Madrid.
Introduction
Azithromycin (AZI) may be an effective immune modulator in lung transplant (LT) recipients, and can decrease chronic lung allograft dysfunction (CLAD) rates, the leading cause of ...mortality after the 1st year post‐LT. The aim of the study is to assess the effect of AZI initiation and its timing on the incidence and severity of CLAD in LT recipients.
Methods
Single‐center retrospective study, including LT recipients from 01/01/2011 to 30/06/2020. Four groups were established: those who started AZI at the 3rd week post‐LT (group A), those who received AZI later than the 3rd week post‐LT and had preserved FEV1 (B), those who did not receive AZI (C) and those who started AZI due to a decline in FEV1 (D). The dosage of AZI prescribed was 250 mg three times per week. CLAD was defined and graduated according to the 2019 ISHLT criteria.
Results
We included 358 LT recipients: 139 (38.83%) were in group A, 94 (26.25%) in group B, 91 (25.42%) in group C, and 34 (9.50%) in group D. Group A experienced the lowest CLAD incidence and severity at 1 (p = .01), 3 (p < .001), and 5 years post‐LT, followed by Group B. Groups C and D experienced a higher incidence and severity of CLAD (p = .015). Initiation of AZI prior to FEV1 decline (Groups A and B) proved to be protective against CLAD after adjusting for differences between the treatment groups.
Conclusions
Early initiation of AZI in LT recipients could have a role in decreasing the incidence and severity of CLAD. In addition, as long as FEV1 is preserved, initiating AZI at any time could also be useful to prevent the incidence of CLAD and reduce its severity.
•Early abdominal complications are frequent after lung transplantation.•A high percentage of abdominal complications require invasive treatment.•Hemodynamic instability is a risk factor for abdominal ...complications.
Patients undergoing lung transplantation (LT) are at high risk of developing serious abdominal complications, which can lead to higher rates of morbidity and mortality. The aim of this study was to investigate the incidence and spectrum of these complications when they develop during the first 30 days after LT, as well as their possible association with possible risk factors.
A retrospective study of 552 patients undergoing LT between 01/02/2006 and 06/03/2021 was carried out. A descriptive and analytical evaluation of the patients who experienced complications and those who did not was performed comparatively. Data related to patient characteristics and the lung transplantation procedure were collected.
Overall, 8.2% of patients developed severe abdominal complications during the first 30 days; paralytic ileus was the most frequent (31.1%), closely followed by visceral perforation (26.7%). The percentage of patients who required an invasive procedure to manage post-transplant complications was 57.8%. Surgical intervention was required in 39.8%. The variables that showed a significant relationship with the development of severe short-term abdominal complications in the univariate analysis were the time of surgery, the use of ECMO/ ECC and red blood cell transfusion during or after surgery. In the multivariate study, however, only duration of surgery remained significant (p=0.03).
The incidence of severe short-term abdominal complications after LT period was 8%. The commonest complications were paralytic ileus and intestinal perforation. Most patients did not require surgery. The only risk factor found associated with these complications was the duration of the surgical intervention.
Botulinum toxin type A (BTA) is a bacterial endotoxin, whose therapeutic use has had a dramatic impact on different neurological disorders, such as dystonia and spasticity.
To analyze and summarize ...different questions about the use of BTA in our clinical practice.
A group of experts in neurology developed a list of topics related with the use of BTA. Two groups were considered: neuropharmacology and dystonia. A literature search at PubMed, mainly for English language articles published up to June 2016 was performed. The manuscript was structured as a questionnaire that includes those questions that, according to the panel opinion, could generate more controversy or doubt. The initial draft was reviewed by the expert panel members to allow modifications, and after subsequent revisions for achieving the highest degree of consensus, the final text was then validated. Different questions about diverse aspects of neuropharmacology, such as mechanism of action, bioequivalence of the different preparations, immunogenicity, etc. were included. Regarding dystonia, the document included questions about methods of evaluation, cervical dystonia, blepharospasm, etc.
This review does not pretend to be a guide, but rather a tool for continuous training of residents and specialists in neurology, about different specific areas of the management of BTA.
Pulmonary hypertension (PH) secondary to lung disease (Group-3 PH) is the second leading cause of PH. The role of PH as a risk factor for primary graft dysfunction (PGD) following lung transplant ...(LT) is controversial.
To assess the impact that the new definition of PH had on the prevalence of PH in patients with advanced lung disease—candidate for LT, and its association with the occurrence of PGD.
A retrospective study was performed in all patients undergoing cardiac catheterisation referred for consideration as candidates to LT in a centre between 1 January 2017 and 31 December 2022. The baseline and haemodynamic characteristics of patients were analysed, along with the occurrence of PGD and post-transplant course in those who ultimately underwent transplantation.
A total of 396 patients were included. Based on the new 2022 European Society of Cardiology/European Respiratory Society definitions, as many as 70.7% of patients met PH criteria. Since the introduction of the 2022 definition, a significant reduction was observed in the frequency of severe Group-3 PH (41.1% vs 10.3%; p<0.001), with respect to the 2015 definition. As many as 236 patients underwent transplantation. None of the variables associated with PH was identified as a risk factor for PGD.
The new classification did not have any impact on the prevalence of PGD after transplantation. These results exclude that any significant differences exist in the baseline characteristics or post-transplant course of patients with Group-3 PH vs unclassified PH.
Some studies have reviewed lung explants histology to determine the frequency of pretransplant non-identified neoplasms or explore its diagnostic correlation with a previous diagnosis of interstitial ...lung disease (ILD). This study aims to review the histopathology of explants from patients who underwent lung transplantation (LT).
A retrospective, single-center study that included patients who underwent LT for emphysema between 01 January 2011 and 31 October 2021. The control group was composed of patients with lung cancer who underwent a lung resection between 01 November 2011 and 31 December 2019 and had a previous diagnosis of chronic obstructive pulmonary disease (COPD) prior to lung resection surgery. A systematic review was performed of histological findings to compare the frequency of additional histological diagnoses.
The study sample included 160 patients (43.8%) who received a lung transplant for emphysema and 205 patients with COPD and lung cancer treated surgically. Although the patients in the cancer group were significantly older and had more comorbidities and higher cumulative tobacco consumption, transplant recipients received an additional significative histologic diagnosis more frequently (58.1%
12.7%; P<0.001) including ILD, pneumoconiosis and others.
Significant additional histological findings were more frequent in the group of lung transplant recipients with emphysema. Notably, these findings were not explained by tobacco use, and they were significantly more frequent in transplant recipients than in patients with a previous diagnosis of COPD and higher cumulative tobacco consumption but with a better respiratory functional status.
To describe the clinical features, history and association with intestinal disease in central nervous system (CNS) S. bovis infections.
Four cases of S. bovis CNS infections from our institution are ...presented. Additionally a systematic literature review of articles published between 1975 and 2021 in PubMed/MEDLINE was conducted.
52 studies with 65 cases were found; five were excluded because of incomplete data. In total 64 cases were analyzed including our four cases: 55 with meningitis and 9 with intracranial focal infections. Both infections were frequently associated with underlying conditions (70.3%) such as immunosuppression (32.8%) or cancer (10.9%). In 23 cases a biotype was identified, with biotype II being the most frequent (69.6%) and S. pasteurianus the most common within this subgroup. Intestinal diseases were found in 60.9% of cases, most commonly neoplasms (41.0%) and Strongyloides infestation (30.8%). Overall mortality was 17.1%, with a higher rate in focal infection (44.4% vs 12.7%; p=0.001).
CNS infections due to S. bovis are infrequent and the most common clinical form is meningitis. Compared with focal infections, meningitis had a more acute course, was less associated with endocarditis and had a lower mortality. Immunosuppression and intestinal disease were frequent in both infections.
Streptococcus suis (S. suis) infection is poorly described zoonosis in our country, which is related with exposure to pigs or their meat. The most common clinical presentation is meningitis, while ...spinés involvement is rare.
We report 2 cases of S. suis infection and perform a systematic review of the articles published on S. suis spondylodiscitis between January 1994 and May 2020 with the aim of defining the clinical characteristics, predisposing factors and evolution.
17 cases are described, 76.5% males with a mean age of 57.6 years, generally without associated underlying disease. Enolism was a factor present in 17.6%. 70.6% had exposure to pigs or their meat and 20% hand injuries. The mean duration of symptoms was 10.2 days and the most affected segment was the lumbar level. 70.6% had meningitis. All were treated with beta-lactams with an average duration of 53.2 days. There was a recurrence and none died.
There are few cases of S. suis spondylodiscitis in the literature. When occurs, it is associated with another type of infection in most cases. They present a good response to medical treatment and a good prognosis.
Streptococcus suis spondylodiscitis: 2 new cases and a literature review Romay-Lema, Eva-María; Ventura-Valcárcel, Pablo; Iñiguez-Vázquez, Iria ...
Enfermedades infecciosas y microbiologia clinica (English ed.),
February 2022, 2022-Feb, 2022-02-00, 20220201, Letnik:
40, Številka:
2
Journal Article
Recenzirano
Streptococcus suis (S. suis) infection is poorly described zoonosis in our country, which is related with exposure to pigs or their meat. The most common clinical presentation is meningitis, while ...spine’s involvement is rare.
We report 2 cases of S. suis infection and perform a systematic review of the articles published on S. suis spondylodiscitis between January 1994 and May 2020 with the aim of defining the clinical characteristics, predisposing factors and evolution.
17 cases are described, 76.5% males with a mean age of 57.6 years, generally without associated underlying disease. Enolism was a factor present in 17.6%. 70.6% had exposure to pigs or their meat and 20% hand injuries. The mean duration of symptoms was 10.2 days and the most affected segment was the lumbar level. 70.6% had meningitis. All were treated with beta-lactams with an average duration of 53.2 days. There was a recurrence and none died.
There are few cases of S. suis spondylodiscitis in the literature. When occurs, it is associated with another type of infection in most cases. They present a good response to medical treatment and a good prognosis.
La infección por Streptococcus suis (S. suis) es una zoonosis poco descrita en nuestro país, que se relaciona con la exposición al ganado porcino o su carne. La forma de presentación más frecuente es la meningitis, mientras que la afectación de la columna vertebral es rara.
Presentamos 2 casos de infección por S. suis y realizamos una revisión sistemática de los trabajos publicados sobre espondilodiscitis por S. suis entre el enero de 1994 y mayo de 2020 con el objetivo de definir las características clínicas, sus factores predisponentes y su evolución.
Se describen 17 casos, el 76,5% varones con una edad media de 57,6 años, generalmente sin enfermedad de base asociada. El enolismo fue un factor presente en casi el 17.6% de los pacientes. Un 70.6% presentaron exposición a ganado porcino o su carne y un 20% heridas en manos. La duración media de los síntomas fue de 10,2 días y el segmento más afectado fue el lumbar. Un 70.6% cursó con meningitis. Todos se trataron con betalactámicos con una duración media de 53,2 días. Hubo una recidiva y ninguno falleció.
Existen pocos casos de espondilodiscitis porS. suis en la literatura. Cuando ocurre, se asocia a otro tipo de infección en la mayoría de los casos. Presentan buena respuesta al tratamiento médico y buen pronóstico.
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