Hernias diafragmáticas traumáticas

The diafragm is a thin and flat musculo-fascial structure that separates the chest from the abdominal cavity.Traumatic diaphragmatic hernia is an infrequent and life-threatening injury that may happen in patients with severe blunt or penetrating thoracoabdominal trauma. Diaphragmatic rupture is an important indicator of the severity of the trauma.These ruptures may be recognized at the time of the initial trauma, but are diagnosed months or even years later during the follow-up for related symptoms. If it is not detected early, the mortality rate could increase due to severe complications.The diagnosis of traumatic diaphragmatic hernia is difficult and often missed, because it could be accompanied by injuries to other organs. Supine chest radiography, despite its known limitations, is the initial most commonly performed imaging test to evaluate a traumatic injury in the thorax. However, computed tomography (CT) is the imaging tool of choice, as it is the key element for the detection of diaphragmatic injury after trauma.In hemodynamically stable patients, either videolaparoscopy or videothoracoscopy are recommended for the diagnosis and repair of a missed diaphragmatic injury. The surgical repair with nonabsorbable simple sutures is adequate in most cases, and the use of mesh should be reserved for chronic and large defects.El diafragma es una estructura músculo-aponeurótica delgada y aplanada que separa la cavidad torácica de la abdominal. La hernia diafragmática traumática es una lesión poco frecuente y potencialmente mortal que puede presentarse en pacientes que han sufrido un traumatismo tóraco-abdominal tanto cerrado como penetrante. La ruptura diafragmática es un importante indicador de la gravedad del traumatismo. Suelen identificarse en el momento del traumatismo, pero en ocasiones pueden pasar desapercibidas y diagnosticarse meses, e incluso años, más tarde debido a la presencia de síntomas relacionados con las estructuras y órganos afectados. Si no se detecta a tiempo, la tasa de mortalidad puede aumentar debido a la aparición de graves complicaciones. El diagnóstico de la hernia diafragmática traumática es difícil y, a menudo, puede pasar desapercibido debido a la gravedad de las lesiones acompañantes. La radiografía de tórax en decúbito supino, a pesar de sus limitaciones, es el método de imagen más habitual y el más frecuentemente utilizado para evaluar los traumatismos torácicos. Sin embargo, la tomografía computarizada (TAC) es actualmente la exploración idónea y el principal método diagnóstico de las hernias diafragmáticas traumáticas. En pacientes hemodinámicamente estables la videolaparoscopia y la videotoracoscopia permiten el diagnóstico y en muchos casos el tratamiento de la lesión diafragmática. En la mayoría de los casos la sutura de los bordes de la herida diafragmática es suficiente para corregir la lesión. En los grandes defectos diafragmáticos puede ser necesario el uso de prótesis

Calendario de vacunaciones de la Asociación Española de Pediatría: recomendaciones 2021

The CAV-AEP annually publishes the immunisation schedule considered optimal for all children and adolescent resident in Spain, taking into account the available evidence. The 2+1 schedule is recommended (2, 4, and 11 months) with hexavalent vaccines (DTPa-VPI-Hib-HB) and with 13-valent pneumococcal conjugate.A 6-year booster is recommended, preferably with DTPa (if available), with a dose of polio for those who received 2+1 schemes, as well as vaccination with Tdpa in adolescents and in each pregnancy, preferably between 27 and 32 weeks. Rotavirus vaccine should be systematic for all infants. Meningococcal B vaccine, with a 2+1 schedule, should be included in routine calendar. In addition to the inclusion of the conjugated tetravalent meningococcal vaccine (MenACWY) at 12 years of age with catch up to 18 years, inclusive, the CAV recommends this vaccine to be also included at 12 months of age, replacing MenC. Likewise, it is recommended in those over 6 weeks of age with risk factors or who travel to countries with a high incidence of these serogroups. Two-dose schedules for triple viral (12 months and 3-4 years) and varicella (15 months and 3-4 years) will be used. The second dose could be applied as a tetraviral vaccine. Universal systematic vaccination against HPV is recommended, regardless of gender, preferably at 12 years, and greater effort should be made to improve coverage. The 9 genotype extends coverage for both genders

Pediatric Chagas disease in the non-endemic area of Madrid: A fifteen-year review (2004-2018)

Background: Chagas disease (CD) has become an emerging global health problem in association with the immigration of individuals from endemic areas (in LatinAmerica) to other countries.Spain is the country in Europe with the highest number of CD cases. Concerning pediatric CD, treatment is not only better tolerated by younger children but also has greater cure possibilities. The aim of this study was to describe clinical and epidemiological aspects of CD in a pediatric population diagnosed of 10 hospitals in the Community of Madrid during the 2004-2018 period, as well as the safety and efficacy of CD treatment on this population. Methodology/principal findings: A multicenter, retrospective, descriptive study was conducted. The studied population included all identified children under the age of 18 with a diagnosis of CD. Diagnosis was performed with a positive parasitological test (with subsequent confirmation) or confirmed persistence of positive serology beyond 9 months, for children younger than one year-old, and with two different positive serological tests, for children older than one. Fifty-one children were included (59% male; 50.9% born in Spain). All mothers were from Latin America. The median age at diagnosis was 0.7 months for those under one year of age, and 11.08 years for those older than one year-old. Only one case presented a symptomatic course (hydrops faetalis, haemodynamic instability at birth, ascites, anaemia). For 94% treatment was completed. Considering patients who received benznidazole (47), AE were recorded in 48,9%. Among the 32 patients older than one year-old treated with benznidazole, 18 (56.25%) had adverse events whereas in the 15 under one year, 5(33,3%) did. Eigtheen (78.2%) of the patients with benznidazole AE were older than one year-old(median age 11.4 years). Of the patients treated with nifurtimox (9), AE were reported in 3 cases (33,3%). Cure was confirmed in 80% of the children under one year-old vs 4.3% in those older (p<0.001). Loss to follow- up occurred in 35.3% of patients. Conclusions/significances: Screening programs of CD since birth allow early diagnosis and treatment, with a significantly higher cure rate in children treated before one year of age, with lower incidence of adverse events. The high proportion of patients lost to follow-up in this vulnerable population is of concern.S

Estudio de la fidelidad de clientes aplicado al sector hotelero

En un sector tan competitivo como es el hotelero, la excelencia de productos y servicios juega una importancia decisiva. Ponerse en la piel de los consumidores finales del producto y servicio es vital para comprender mejor de qué manera perciben estos cada uno de los componentes que forman el total. La utilización de estas técnicas tiene un único objetivo: la mejora constante de la calidad y el compromiso pleno con la satisfacción de sus clientes. La gestión de las relaciones con los clientes, y en especial la gestión de su satisfacción, es determinante para el éxito o fracaso de cualquier empresa, tanto en las relaciones con el mercado como en el ámbito de la propia empresa. Las iniciativas para la mejora de la calidad del servicio, basadas únicamente en resultados internos, en las que falta información de los clientes, están inevitablemente condenadas al fracaso. Estas iniciativas se frustran por el desconocimiento de los requerimientos de los clientes y la necesidad de conectar la satisfacción y la medida de los avances internos. Palabras clave: Fidelidad, Clientes, Hoteles

Riesgo quirúrgico tras resección pulmonar anatómica en cirugía torácica. Modelo predictivo a partir de una base de datos nacional multicéntrica

Introduction: the aim of this study was to develop a surgical risk prediction model in patients undergoing anatomic lung resections from the registry of the Spanish Video-Assisted Thoracic Surgery Group (GEVATS). Methods: data were collected from 3,533 patients undergoing anatomic lung resection for any diagnosis between December 20, 2016 and March 20, 2018. We defined a combined outcome variable: death or Clavien Dindo grade IV complication at 90 days after surgery. Univariate and multivariate analyses were performed by logistic regression. Internal validation of the model was performed using resampling techniques. Results: the incidence of the outcome variable was 4.29% (95% CI 3.6-4.9). The variables remaining in the final logistic model were: age, sex, previous lung cancer resection, dyspnea (mMRC), right pneumonectomy, and ppo DLCO. The performance parameters of the model adjusted by resampling were: C-statistic 0.712 (95% CI 0.648-0.750), Brier score 0.042 and bootstrap shrinkage 0.854. Conclusions: the risk prediction model obtained from the GEVATS database is a simple, valid, and reliable model that is a useful tool for establishing the risk of a patient undergoing anatomic lung resection

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Structural changes in zinc ferrites as regenerable sorbents for hot coal gas desulfurization

It is well known that zinc ferrites can be used as regenerable sorbents for hot coal gas desulfurization in IGCC processes. The H2S concentration in the outlet gas from a fixed-bed reactor can be as low as a few ppmv and the sorbent conversion at breakthrough may be above 70%, indicating that the sorbent reactivity in the sulfidation process is high. Experiments show that the reactivity is highly dependent on the calcination temperature used for spinel formation, the concentration of component oxides above or below stoichiometry and the possible use of γ-alumina as an inert diluent or support. These features are frequently associated with structural changes occurring both in the fresh or regenerated and in the sulfided sorbent, but, unfortunately, these changes are not detected by the usual characterization techniques. In this study, the structural changes occurring in zinc ferrites during calcination at high temperature or regeneration in oxidant atmosphere and those in iron sulfides during the sulfidation process have been investigated in detail by Moessbauer spectroscopy (MS) and powder X-ray diffraction (XRD) using Rietveld methods for structure refinement. The study reveals that fresh sorbents prepared by calcination at low temperature consist of lattice-strained small domain-size zinc ferrites that relax if the calcination temperature is high enough. Structural changes are also observed through the formation of different types of iron sulfides in the sulfidation process. These apparent structural changes can explain the changes exhibited in the sulfidation reactivity of the sorbent.The authors are indebted to ECSSC, Research Project 7220-ED/093, for financial support.Peer Reviewe

Management of small intestinal bacterial overgrowth by pediatric gastroenterologists in Spain.

small intestinal bacterial overgrowth (SIBO) is a heterogeneous condition with nonspecific symptoms. This study aimed to report its management by pediatric gastroenterologists in Spain. a descriptive study was performed by means of a survey sent to 184 active members of the Spanish Society of Pediatric Gastroenterology, Hepatology and Nutrition (SEGHNP). one hundred and forty-eight responses (80.4 %) were received. Forty-four patients had no predisposing condition, 31.1 % used antibiotics followed by probiotics, 33.1 % antibiotherapy concomitant with probiotics, 24.3 % only antibiotics and 10.8 % only probiotics. The diagnosis was established via clinical parameters in 73.8 % of participants and the therapeutic response was checked only by clinical data in 90 %. there is high variability in the management of SIBO among pediatric population in Spain