Hepatic hematoma following endoscopic retrograde cholangiopancreatography: overview and case report

Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure with a high risk of complications. Hepatic subcapsular hematoma is an infrequent complication, with few cases reported in the international literature. Treatment can be conservative with the patient under close surveillance in an intensive care unit and surgical management is reserved for failure of conservative treatment and cases with hemodynamic instability. We present a case of subcapsular and intraparenchymal hepatic hematoma in an adult male who presented sudden hemodynamic instability, associated with hemoglobin decrease, which required surgical management. The challenge in the therapeutic decision due to sudden hemodynamic instability is clearly demonstrated; therefore, there was a need for surgical treatment as the best measure of hemorrhage control. Conservative management should be reserved for hemodynamically stable patients and invasive management by interventional radiology or surgery for cases of acute abdomen associated with hemodynamic instability

Reflexion critica acerca de las clausulas abusivas en los contratos de adhesion

39 h. ; 28 cm.En este trabajo buscamos esquematizar, a través del método lógico deductivo, los contratos de adhesión y las cláusulas abusivas. En especial de una: la letra g) del artículo 16 Ley de Protección al Consumidor Nº 19.496 modificada por ley 19.955 de 14 de julio de 2004. En el primer capítulo encontraremos algunas definiciones de contrato de adhesión, características y aspectos generales, referencias al nuevo enfoque de la contratación, en especial de la libertad contractual, y por último la interpretación de estos contratos. En el segundo capítulo analizamos las cláusulas abusivas propiamente tales y como son vistas en nuestra doctrina. En el tercer capítulo analizamos la letra g) del artículo 16, especialmente aspectos como la buena fe y el desequilibrio en las prestaciones entre las partes. Por último en el cuarto capítulo nos referiremos a los mecanismos de control de estas cláusulas y remedios que nos ofrece la doctrina para evitarlas

Influence of Bitartrate Ion Concentration in the Copper Electrodeposition Onto a Polycrystalline Gold Electrode

In the present work, the influence of the concentration of bitartrate ions (HT) on the copper electrodeposition process was analyzed. The study was carried out from an aqueous solution containing 0.001 M of CuX (where X = (NO3–)2 ,(Cl–)2, SO42–) and x M KHT (where x = 0.005 M, 0.01 M, and 0.015 M). From voltammetric and chronoamperometric studies, the results indicate that copper electrodeposition is a diffusion-controlled process. The current density transients were well described through a kinetic mechanism involving capacitive and faradaic contributions. The diffusion coefficient values of Cu1+ and Cu2+ result to be similar at the different concentration values of potassium bitartrate used in this work. This work is licensed under a Creative Commons Attribution 4.0 International License

Detection of the Endosomal Sorting Complex Required for Transport in Entamoeba histolytica and Characterization of the EhVps4 Protein

Eukaryotic endocytosis involves multivesicular bodies formation, which is driven by endosomal sorting complexes required for transport (ESCRT). Here, we showed the presence and expression of homologous ESCRT genes in Entamoeba histolytica. We cloned and expressed the Ehvps4 gene, an ESCRT member, to obtain the recombinant EhVps4 and generate specific antibodies, which immunodetected EhVps4 in cytoplasm of trophozoites. Bioinformatics and biochemical studies evidenced that rEhVps4 is an ATPase, whose activity depends on the conserved E211 residue. Next, we generated trophozoites overexpressing EhVps4 and mutant EhVps4-E211Q FLAG-tagged proteins. The EhVps4-FLAG was located in cytosol and at plasma membrane, whereas the EhVps4-E211Q-FLAG was detected as abundant cytoplasmic dots in trophozoites. Erythrophagocytosis, cytopathic activity, and hepatic damage in hamsters were not improved in trophozoites overexpressing EhVps4-FLAG. In contrast, EhVps4-E211Q-FLAG protein overexpression impaired these properties. The localization of EhVps4-FLAG around ingested erythrocytes, together with our previous results, strengthens the role for EhVps4 in E. histolytica phagocytosis and virulence

Hospitalisation by tick-borne diseases in the last 10 years in two hospitals in South Spain: analysis of tick exposure data collected in the Emergency Department

Tick-borne diseases (TBDs) can sometimes cause severe symptoms and lead to hospitalisation, but they often go unnoticed in the Emergency Department (ED). The aim of this study was twofold: (i) to describe the profile of patients hospitalised by TBDs; and (ii) to evaluate the data collected in the medical records from the ED in order to analyse their potential clinical consequences. A total of 84 cases that included all TBD diagnoses registered in the ED records were identified and analysed. These corresponded to all the hospitalisations by TBDs in the last 10 years (2009–2019) in two tertiary hospitals in Granada, Spain. Statistical analyses were made using RStudio. Coinciding with the absence of patient’s report of exposure to ticks, 64.3% of TBDs were not suspected in the ED. Intensive care unit admission was required in 8.3% of cases, and the mortality rate was 2.4%. Non-suspected cases showed longer hospital stay (P < 0.001), treatment duration (P = 0.02) and delay in the initiation of antibiotic treatment (P < 0.001). Our findings indicate that symptoms associated with TBDs are highly non-specific. In the absence of explicit information related to potential tick exposure, TBDs are not initially suspected. As a consequence, elective treatment administration is delayed and hospitalisation time is prolonged. In conclusion, our results highlight the importance of addressing potential exposure to ticks during the ED contact with patients presenting with febrile syndrome

Prevalence of Multi-Resistant Microorganisms and Antibiotic Stewardship among Hospitalized Patients Living in Residential Care Homes in Spain: A Cross-Sectional Study

Antimicrobial resistance is a growing global health problem. Patients living in care homes are a vulnerable high-risk population colonized by multidrug-resistant organisms (MDRO). We identified a case series of 116 residents of care homes from a cohort of 540 consecutive patients admitted to the internal medicine service of our hospital. We performed early diagnostic tests of MDRO through anal exudates in our sample. The prevalence of MDRO colonization was 34.5% of residents and 70% of them had not been previously identified in the clinical records. Previous hospitalizations and in-hospital antibiotic administration were significantly associated with the presence of MDRO. Our results emphasize the need to consider care homes in the planning of regional and national infection control measures and for implementing surveillance systems that monitor the spread of antimicrobial resistance in Spain. Systematic early testing upon admission to hospital services with a high prevalence of patients with MDRO colonization (e.g., internal medicine) could contribute to the adoption of adequate prevention measures. Specific educational programs for care home staff should also be implemented to address this increasing problem.Catedra de Docencia e Investigacion SEMERGEN-Medicina de Familia, University of Granada, Spai

Puerta Interactiva para el acceso a una sala de clases

La tecnología moderna ha permitido actualmente que la sociedad como parte de una solución para sus actividades diarias, utilice equipos, aplicaciones y muchos otros dispositivos electrónicos que conjuntamente con la tecnología móvil permitan mejorar procesos y tareas, convirtiéndose en una herramienta de trabajo para la interacción hombre-máquina. En el presente trabajo se detalla el diseño y construcción de un prototipo de puerta interactiva controlada mediante módulo Arduino Uno y una aplicación de Android basada en el lenguaje de programación Eclipse permitiéndole a los docentes utilizarla como instrumento de trabajo durante sus horas laborables. Este tipo de puerta permitirá automatizar el ingreso al aula de clases, disminuyendo los inconvenientes que pueden presentarse ya sea por dejarla abierta o por no estar disponible la persona encargada de su apertura