In-vitro evaluation of the adhesion to polypropylene sutures of non-pigmented, rapidly growing mycobacteria

AbstractThe ability of non-pigmented, rapidly growing mycobacteria (NPRGM) to attach to polypropylene sutures was evaluated using an in-vitro assay. Thirty clinical isolates and five culture collection strains of NPRGM, together with Staphylococcus epidermidis ATCC 35983, were tested. Mycobacterium fortuitum and Mycobacterium chelonae showed the highest attachment ability, which differed significantly from the results obtained with Mycobacterium peregrinum. According to these results, NPRGM are able to attach to polypropylene sutures, and the species implicated most frequently in human infection showed increased levels of attachment in comparison with the other mycobacteria studied

Variabilidad en las medidas de tensión arterial realizada por estudiantes de 5.º y 6.º de medicina Variability of arterial pressure measurements performed by advanced medical students

Introducción. No se ha definido objetivamente si los estudiantes de medicina avanzados dominan destrezas básicas, como la medida de tensión arterial. Sujetos y métodos. Se determinó la variabilidad de medida de tensión arterial por estudiantes de 5.º y 6.º cursos de medicina. Resultados. Se encontraron coeficientes de variación significativamente más elevados en la tensión arterial diastólica derecha y frecuencia cardíaca, y grupos e individuos con error sistemático de medición. Conclusión. Resulta necesario un refuerzo docente en la medida de tensión arterial diastólica y su realización en los dos brazos.Introduction. No objective data are available to know whether advanced medical students are in command of basic practical skills, ie, arterial pressure measurement. Subjects and methods. Variability of arterial pressure measurements was examined in 5th- and 6th-year medical students. Results. Significantly higher variability coefficients were found in right arm diastolic arterial pressure and heart rate. A systematic measurement error was detected in some groups and individuals. Conclusion. A teaching effort will be necessary to improve arterial pressure measurement skills, with special emphasis in diastolic arterial pressure and bilateral measurements

Hallazgos artroscópicos en un caso de disco articular adherido de la ATM

Abstract: The anchored disc phenomenon (ADP) or ¿stuck syndrome¿ of the TMJ is a phenomenon that has only recently been described, with a physiopathogeny of biochemical disturbances that are produced in some TMJs with temporomandibular dysfunction. In this article we describe a clinical case and, in particular, the interesting arthroscopic findings that help to corroborate the physiopathogenic mechanisms proposed. Of special relevance is the correct position of the disc within the joint and an erythematous area found in the synovial membrane covering the glenoid fossa-eminence of the joint.El síndrome de disco adherido (SDA) o stuck syndrome de la articulación temporomandibular (ATM) es un fenómeno que ha sido descrito recientemente y cuya fisiopatogenia es una alteración bioquímica que se produce en algunas ATMs con disfunción temporomandibular. En el presente artículo describimos un caso clínico y especialmente los interesantes hallazgos artoscópicos encontrados que ayudarían a corroborar el mecanismo fisiopatológico propuesto. Son de especial relevancia la correcta posición discal dentro de la articulación y una zona eritematosa encontrada en la sinovial que recubre la fosa-eminencia glenoidea de la articulación

Variabilidad en las medidas de tensión arterial realizada por estudiantes de 5.º y 6.º de medicina

Introducción. No se ha definido objetivamente si los estudiantes de medicina avanzados dominan destrezas básicas, como la medida de tensión arterial. Sujetos y métodos. Se determinó la variabilidad de medida de tensión arterial por estudiantes de 5.º y 6.º cursos de medicina. Resultados. Se encontraron coeficientes de variación significativamente más elevados en la tensión arterial diastólica derecha y frecuencia cardíaca, y grupos e individuos con error sistemático de medición. Conclusión. Resulta necesario un refuerzo docente en la medida de tensión arterial diastólica y su realización en los dos brazos

Infections of implantable cardioverter-defibrillators: frequency, predisposing factors and clinical significance

ABSTRACTThe prognosis for patients with ventricular arrhythmias has improved dramatically with the aid of implantable cardioverter-defibrillators (ICDs). Although infection is a serious complication that frequently causes dysfunction and loss of ICDs, the frequency, predisposing risk-factors, and clinical and microbiological features are only partially understood. This study describes a retrospective review of 423 procedures in 278 patients with ICD primary implants and replacements performed at a tertiary-care hospital. Generators were placed in either a pectoral (68%) or abdominal (32%) site, and electrodes were placed transvenously in 97% of the patients. Most (95%) interventions were performed in a one-stage procedure. Infection developed with ten (2.4%) implanted devices. Four cases occurred within 30 days of surgery (‘early infections’) and six occurred > 1 month after surgery (‘late infections’). In univariate analysis, factors associated with the development of an early infection were: two-stage surgery, a sub-costal approach, and abdominal generator placement. In patients with late infections, a significant association was found with trauma or decubitus ulcer in the generator area. Infection presented with local signs without systemic complications. Seven of the ten patients required complete removal of the system

Retrospective multicentre observational study on clinical management and treatment of different types of status epilepticus in clinical practice

Introduction: Status epilepticus (SE) is a neurological emergency associated with significant mortality and morbidity. We analyse characteristics of this entity in our population. Methods: Data from electronic medical records of adults diagnosed with SE were collected retrospectively from 5 hospitals over 4 years. Results: Data reflected 84 episodes of SE in 77 patients with a mean age of 60.3 years. Of this sample, 52.4% had a previous history of epilepsy. Status classification: 47.6% tonic–clonic, 21.4% complex partial, 17.9% partial motor, 6% partial simple, 3.6% myoclonic, and 3.6% subtle SE. Based on the duration of the episode, SE was defined in this study as early stage (up to 30 min) in 13.1%, established (30-120 min) in 20.2%, refractory (more than 120 min) in 41.7%, and super-refractory (episodes continuing or recurring after more than 24 h of anaesthesia) in 13.1%. Ten patients (11.9%) died when treatment failed to control SE. The cumulative percentage of success achieved was 8.3% with the first treatment, 27.3% for the second, 48.7% for the third, 58.2% for the fourth, 70.1% for the fifth, 80.8% for the sixth, 83.2% for the seventh, and 84.4% for the eighth. Conclusions: In our study, we found that SE did not respond to treatment within 2 hours in approximately half the cases and 11.9% of the patients died without achieving seizure control, regardless of the type of status. Half the patients responded by the third treatment but some patients needed as many as 8 treatments to resolve seizures. Using large registers permitting analysis of the different types and stages of SE is warranted. Resumen: Introducción: El estatus epiléptico es una urgencia neurológica asociada a una mortalidad y morbilidad significativa. Analizamos las características en nuestra población. Métodos: Se recogieron los datos de manera retrospectiva de la historia clínica electrónica de adultos con diagnóstico de estatus epiléptico en 5 centros hospitalarios durante 4 años. Resultados: Se obtuvieron datos de un total de 84 episodios en 77 pacientes, con edad media de 60,3 años. El 52,4% tenían historia previa de epilepsia. Clasificación según el tipo de estatus: 47,6% tónico-clónico; 21,4% parcial complejo; 17,9% parcial motor; 6% parcial simple; 3,6% mioclónico y 3,6% sutil. Si analizamos el momento que finalizó el estatus según las fases definidas para este estudio obtenemos: 13,1% precoz (hasta 30 min); 20,2% establecido (entre 30-120 min); 41,7% refractario (más de 120 min) y 13,1% superrefractario (continúan o recurren después de más de 24 h de anestesia). Diez casos (11,9%) fallecieron sin haberse controlado el estatus. El porcentaje acumulativo de éxito alcanzado con el primer tratamiento fue de 8,3%; segundo 27,3%; tercero 48,7%; cuarto 58,2%; quinto 70,1%; sexto 80,8%; séptimo 83,2% y octavo 84,4%. Conclusiones: En nuestro estudio encontramos que el estatus no se controló en las primeras 2 h en casi la mitad de los casos, y un 11,9% fallecieron sin controlarse, sin haber diferencias significativas entre el tipo de estatus. En casi la mitad se logró el control del estatus con el tercer tratamiento, pero en algún caso se precisó hasta 8. Son necesarios registros amplios que permitan analizar el manejo en los distintos tipos y fases. Keywords: Status epilepticus, Treatment, Prognosis, Tonic–clonic, Complex partial, Partial motor, Palabras clave: Estatus epileptico, Tratamiento, Pronóstico, Tónico-clonico, Parcial complejo, Parcial moto