Management of splenic abscess: report on 16 cases from a single center

Summary Objectives Splenic abscess is an uncommon disease, with a reported incidence of 0.14–0.7% in autoptic series. The best treatment option remains unclear. We report our experience of percutaneous drainage of splenic abscess under ultrasound (US) guidance. Methods From 1979 to 2005, 16 consecutive patients (12 male and four female; mean age 39.9 years, range 16–72 years) were diagnosed with splenic abscess by means of US, and were treated with medical therapy alone or combined with US-guided percutaneous aspiration or catheter drainage. Results Ten of 16 patients had bacterial abscesses (including one case of tubercular abscess), two had an amebic abscess, and four had fungal abscesses. Seven of ten patients with bacterial abscesses were successfully treated with fine needle aspiration alone, one patient was successfully treated with fine needle aspiration for one abscess and catheter drainage for another, and one patient, who subsequently required a splenectomy for an abdominal trauma, successfully underwent percutaneous catheter drainage alone. Four patients with fungal lesions were treated with medical therapy alone, and two patients later required a splenectomy. One patient with a bacterial abscess due to endocarditis was treated with medical therapy alone, and his recovery was uneventful. Conclusions US-guided percutaneous aspiration of splenic abscesses is a safe and effective procedure. It can be used as a bridge to surgery in patients who are critically ill or have several comorbidities. Percutaneous aspiration may allow complete non-operative healing of splenic abscesses or temporize patients at risk for surgery

Un nuevo universo, breve investigación sobre geometría hiperbólica

Este trabajo pretende ser una introducción a la geometría hiperbólica. Se trata de comprender algunos aspectos de esta rama de la matemática a partir de su historia y de sus principales actores. La realización de esta investigación significó el estudio de una parte de la geometría de la cual hasta ahora conocíamos apenas su nombre. Para ello, primero, fue necesario hacer el esfuerzo en cambiar las imágenes que estaban en nuestras mentes e imaginar un universo con parámetros diferentes a los que habíamos utilizado hasta ahora. Fue un trabajo de estudio e investigación importante, no solo por el fruto final, sino por el cambio que debíamos seguir para poder concretarlo. Está compuesto, por una pequeña descripción de la investigación del proceso histórico que llevó a las distintas geometrías no euclidianas, un estudio particular de la geometría hiperbólica viendo sus principales características, algunos modelos de esta, y un estudio más detallado del modelo semiplanar de Poincaré

Los irracionales en ciclo básico

La idea de este trabajo surge a través de la pregunta de un alumno de segundo año. Trabajando con los diferentes conjuntos numéricos, este alumno preguntó: ¿Cuántos irracionales existen? A lo que otro alumno le respondió infinitos. ¿Igual que los racionales? Como consecuencia de este diálogo surgen dos actividades: 1- Observamos un video de Adrián Paenza. Una vez observado el mismo, otro alumno dijo, no entiendo, porque siendo más, ¿hasta ahora no hemos trabajado con ellos? 2- "Si imagináramos que tiramos un dardo sobre la representación de una recta ¿Cuál es la probabilidad de que justo caiga en un racional?" Esto nos movilizó para tener a estos números más presentes en nuestros trabajos. Nuestra propuesta es ver cómo ha evolucionado el trabajo con números irracionales en ciclo básico, la idea es ver que figura en los programas oficiales desde el año 86 en adelante. Paralelamente veremos que ocurre con la bibliografía del alumno Luego presentaremos dos propuestas de trabajo, una es una ficha de trabajo de clase (ejercicios) y la otra es una propuesta de trabajo domiciliario en equipo, para realizar una vez de terminado el tema y haber realizado una salida didáctica

Impact of hospital mergers. A systematic review focusing on healthcare quality measures

Background Despite mergers have increasingly affected hospitals in the recent decades, literature on the impact of hospitals mergers on healthcare quality measures (HQM) is still lacking. Our research aimed to systematically review evidence regarding the impact of hospital mergers on HQM focusing especially on process indicators and clinical outcomes. Methods The search was carried out until January 2020 using the Population, Intervention, Comparison and Outcome model, querying electronic databases (MEDLINE, Scopus, Web Of Science) and refining the search with hand search. Studies that assessed HQM of hospitals that have undergone a merger were included. HQMs were analyzed through a narrative synthesis and a strength of the evidence analysis based on the quality of the studies and the consistency of the findings. Results The 16 articles, included in the narrative synthesis, reported inconsistent findings and few statistically significant results. All indicators analyzed showed an insufficient strength of evidence to achieve conclusive results. However, a tendency in the decrease of the number of beds, hospital staff and inpatient admissions and an increase in both mortality and readmission rate for acute myocardial infarction and stroke emerged in our analysis. Conclusions In our study, there is no strong evidence of improvement or worsening of HQM in hospital mergers. Since a limited amount of studies currently exists, additional studies are needed. In the meanwhile, hospital managers involved in mergers should adopt a clear evaluation framework with indicators that help to periodically and systematically assess HQM ascertaining that mergers ensure and primarily do not reduce the quality of care

Edmodo: un aporte a la comunicación y organización del aula de matemática

Las nuevas tecnologías están irrumpiendo en el aula de matemática, los docentes se enfrentan a nuevos desafíos y a otros no tan nuevos como es lograr que los alumnos dediquen tiempo fuera del aula al aprendizaje de la matemática. ¿Cómo estimular que lo hagan? Edmodo es una plataforma virtual de uso libre que resulta atractiva para los estudiantes por su formato similar a las plataformas sociales. La plataforma permite que el profesor: interaccione con sus alumnos de manera virtual, comparta material tanto el elaborado por él como aquellos sitios de la web que él seleccione para sus alumnos, realizar evaluaciones online, manejar un calendario de entrega de actividades, que los padres puedan acceder al trabajo de sus hijos, que el alumno pueda conocer sus calificaciones y visualizar los errores que cometió al hacer alguna prueba. En este taller se pretende que el profesor explore como trabajar con esta plataforma educativa, en primer lugar como alumno y después diseñe una propuesta para sus propias clases

Infants' sex affects neural responses to affective touch in early infancy

Social touch is closely related to the establishment and maintenance of social bonds in humans, and the sensory brain circuit for gentle brushing is already active soon after birth. Brain development is known to be sexually dimorphic, but the potential effect of sex on brain activation to gentle touch remains unknown. Here, we examined brain activation to gentle skin stroking, a tactile stimulation that resembles affective or social touch, in term-born neonates. Eighteen infants aged 11–36 days, recruited from the FinnBrain Birth Cohort Study, were included in the study. During natural sleep, soft brush strokes were applied to the skin of the right leg during functional magnetic resonance imaging (fMRI) at 3 cm/s velocity. We examined potential differ- ences in brain activation between males (n = 10) and females (n = 8) and found that females had larger blood oxygenation level dependent (BOLD) responses (brushing vs. rest) in bilateral orbitofrontal cortex (OFC), right ventral striatum and bilateral inferior striatum, pons, and cerebellum compared to males. Moreover, the psychophysiologi- cal interactions (PPI) analysis, setting the left and right OFC as seed regions, revealed significant differences between males and females. Females exhibited stronger PPI connectivity between the left OFC and posterior cingulate or cuneus. Our work sug- gests that social touch neural responses are different in male and female neonates, which may have major ramifications for later brain, cognitive, and social development. Finally, many of the sexually dimorphic brain responses were subcortical, not captured by surface-based neuroimaging, indicating that fMRI will be a relevant technique for future studies

Pensar el acompañamiento de las trayectorias educativas… entre sujetos, acciones y utopías

La presente publicación configura un espacio destinado a sistematizar algunas experiencias de análisis referidas a las acciones de acompañamiento a las trayectorias educativas, generadas en los cursos de formación para tutores organizados por el CFE en 2016, 2017 y 2018 desde el IPES. Ellos respondieron a la necesidad de pensar en torno a las diversas modalidades de acompañamiento a las trayectorias que se desarrollan en los subsistemas de la ANEP (CES, CETP, y CFE)Presentación Los trabajos Elena Crapuchett, Johana Tagliani, Soraya Olivera El rol del DOE en el acompañamiento de alumnos privados de libertad ambulatoria Álvaro Berro, Altamira Chuy, Natalia Lena, Yamandú Vera Alcances y limitaciones de los dispositivos de acompañamiento institucional Mariana Albistur, María Noel Capdevila, Cecilia Luzardo, Matías Méndez Construyendo acompañamientos educativos Adriana Fittipaldi. Mi “caso” de acompañamiento, la historia, el aula, los grupos Mauricio Berón, Virginia Martínez. Escritura de nuestras prácticas de acompañamiento. Una epistemología diferente a incorporar desde el paradigma de la complejidad Julieta Aguirre, Alicia Fagundez. Estudio de caso acerca de la deserción en primer año de profesorado (CERP-Florida). Un análisis desde el rol de Docente Orientador Educacional Luz, Blanco, Jorge, González. Acompañamiento a las trayectorias educativa

Exigência de energia metabolizável e lisina digestível para codornas japonesas (Coturnix coturnix japonica) em crescimento

Este trabalho objetivou estimar as exigências nutricionais de energia metabolizável (EM) e lisina digestível (LD) para codornas Japonesas nas fases de cria (1 a 14 dias) e recria (15 a 42 dias) e verificar suas implicações na composição química corporal, peso relativo dos órgãos, parâmetros sanguíneos e ósseos. O delineamento adotado foi o inteiramente casualizado em esquema fatorial 4 x 4 (EM = 2.830, 2.970, 3.110 e 3.250 kcal x LD = 0,90; 1,07; 1,24 e 1,41%), perfazendo 16 tratamentos com 3 repetições cada, contendo 50 codornas por unidade experimental na fase de cria (totalizando 2.400 aves) e 35 codornas por unidade experimental na fase de recria (totalizando 1.680 aves). Não foi verificada interação entre os fatores sobre o desempenho de codornas Japonesas na fase de cria, sendo que as variáveis peso médio, ganho de peso, consumo de ração e conversão alimentar apresentaram efeito quadrático tanto para EM quanto para LD. Nesta fase, o extrato etéreo da carcaça e o índice de Seedor do fêmur e da tíbia exibiram interação significativa, e o peso relativo do fígado apresentou efeito linear da LD. Na fase de recria houve interação dos fatores para ganho de peso e consumo de ração. A conversão alimentar apresentou efeito quadrático de ambos os fatores e o peso médio foi influenciado de modo quadrático pela EM, que também influenciou de modo quadrático o índice de Seedor nos dois ossos e a densidade óssea do fêmur. Considerando as estimativas obtidas por meio dos gráficos de contornos sobrepostos, os níveis de 3.030 kcal de EM e 1,221% de LD foram estimados para a fase de cria e os níveis de 3.055 kcal de EM e 1,202% de LD foram estimados para a fase de recria

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

ITALIAN CANCER FIGURES - REPORT 2015: The burden of rare cancers in Italy = I TUMORI IN ITALIA - RAPPORTO 2015: I tumori rari in Italia

OBJECTIVES: This collaborative study, based on data collected by the network of Italian Cancer Registries (AIRTUM), describes the burden of rare cancers in Italy. Estimated number of new rare cancer cases yearly diagnosed (incidence), proportion of patients alive after diagnosis (survival), and estimated number of people still alive after a new cancer diagnosis (prevalence) are provided for about 200 different cancer entities. MATERIALS AND METHODS: Data herein presented were provided by AIRTUM population- based cancer registries (CRs), covering nowadays 52% of the Italian population. This monograph uses the AIRTUM database (January 2015), which includes all malignant cancer cases diagnosed between 1976 and 2010. All cases are coded according to the International Classification of Diseases for Oncology (ICD-O-3). Data underwent standard quality checks (described in the AIRTUM data management protocol) and were checked against rare-cancer specific quality indicators proposed and published by RARECARE and HAEMACARE (www.rarecarenet.eu; www.haemacare.eu). The definition and list of rare cancers proposed by the RARECAREnet "Information Network on Rare Cancers" project were adopted: rare cancers are entities (defined as a combination of topographical and morphological codes of the ICD-O-3) having an incidence rate of less than 6 per 100,000 per year in the European population. This monograph presents 198 rare cancers grouped in 14 major groups. Crude incidence rates were estimated as the number of all new cancers occurring in 2000-2010 divided by the overall population at risk, for males and females (also for gender-specific tumours).The proportion of rare cancers out of the total cancers (rare and common) by site was also calculated. Incidence rates by sex and age are reported. The expected number of new cases in 2015 in Italy was estimated assuming the incidence in Italy to be the same as in the AIRTUM area. One- and 5-year relative survival estimates of cases aged 0-99 years diagnosed between 2000 and 2008 in the AIRTUM database, and followed up to 31 December 2009, were calculated using complete cohort survival analysis. To estimate the observed prevalence in Italy, incidence and follow-up data from 11 CRs for the period 1992-2006 were used, with a prevalence index date of 1 January 2007. Observed prevalence in the general population was disentangled by time prior to the reference date (≤2 years, 2-5 years, ≤15 years). To calculate the complete prevalence proportion at 1 January 2007 in Italy, the 15-year observed prevalence was corrected by the completeness index, in order to account for those cancer survivors diagnosed before the cancer registry activity started. The completeness index by cancer and age was obtained by means of statistical regression models, using incidence and survival data available in the European RARECAREnet data. RESULTS: In total, 339,403 tumours were included in the incidence analysis. The annual incidence rate (IR) of all 198 rare cancers in the period 2000-2010 was 147 per 100,000 per year, corresponding to about 89,000 new diagnoses in Italy each year, accounting for 25% of all cancer. Five cancers, rare at European level, were not rare in Italy because their IR was higher than 6 per 100,000; these tumours were: diffuse large B-cell lymphoma and squamous cell carcinoma of larynx (whose IRs in Italy were 7 per 100,000), multiple myeloma (IR: 8 per 100,000), hepatocellular carcinoma (IR: 9 per 100,000) and carcinoma of thyroid gland (IR: 14 per 100,000). Among the remaining 193 rare cancers, more than two thirds (No. 139) had an annual IR <0.5 per 100,000, accounting for about 7,100 new cancers cases; for 25 cancer types, the IR ranged between 0.5 and 1 per 100,000, accounting for about 10,000 new diagnoses; while for 29 cancer types the IR was between 1 and 6 per 100,000, accounting for about 41,000 new cancer cases. Among all rare cancers diagnosed in Italy, 7% were rare haematological diseases (IR: 41 per 100,000), 18% were solid rare cancers. Among the latter, the rare epithelial tumours of the digestive system were the most common (23%, IR: 26 per 100,000), followed by epithelial tumours of head and neck (17%, IR: 19) and rare cancers of the female genital system (17%, IR: 17), endocrine tumours (13% including thyroid carcinomas and less than 1% with an IR of 0.4 excluding thyroid carcinomas), sarcomas (8%, IR: 9 per 100,000), central nervous system tumours and rare epithelial tumours of the thoracic cavity (5%with an IR equal to 6 and 5 per 100,000, respectively). The remaining (rare male genital tumours, IR: 4 per 100,000; tumours of eye, IR: 0.7 per 100,000; neuroendocrine tumours, IR: 4 per 100,000; embryonal tumours, IR: 0.4 per 100,000; rare skin tumours and malignant melanoma of mucosae, IR: 0.8 per 100,000) each constituted <4% of all solid rare cancers. Patients with rare cancers were on average younger than those with common cancers. Essentially, all childhood cancers were rare, while after age 40 years, the common cancers (breast, prostate, colon, rectum, and lung) became increasingly more frequent. For 254,821 rare cancers diagnosed in 2000-2008, 5-year RS was on average 55%, lower than the corresponding figures for patients with common cancers (68%). RS was lower for rare cancers than for common cancers at 1 year and continued to diverge up to 3 years, while the gap remained constant from 3 to 5 years after diagnosis. For rare and common cancers, survival decreased with increasing age. Five-year RS was similar and high for both rare and common cancers up to 54 years; it decreased with age, especially after 54 years, with the elderly (75+ years) having a 37% and 20% lower survival than those aged 55-64 years for rare and common cancers, respectively. We estimated that about 900,000 people were alive in Italy with a previous diagnosis of a rare cancer in 2010 (prevalence). The highest prevalence was observed for rare haematological diseases (278 per 100,000) and rare tumours of the female genital system (265 per 100,000). Very low prevalence (<10 prt 100,000) was observed for rare epithelial skin cancers, for rare epithelial tumours of the digestive system and rare epithelial tumours of the thoracic cavity. COMMENTS: One in four cancers cases diagnosed in Italy is a rare cancer, in agreement with estimates of 24% calculated in Europe overall. In Italy, the group of all rare cancers combined, include 5 cancer types with an IR>6 per 100,000 in Italy, in particular thyroid cancer (IR: 14 per 100,000).The exclusion of thyroid carcinoma from rare cancers reduces the proportion of them in Italy in 2010 to 22%. Differences in incidence across population can be due to the different distribution of risk factors (whether environmental, lifestyle, occupational, or genetic), heterogeneous diagnostic intensity activity, as well as different diagnostic capacity; moreover heterogeneity in accuracy of registration may determine some minor differences in the account of rare cancers. Rare cancers had worse prognosis than common cancers at 1, 3, and 5 years from diagnosis. Differences between rare and common cancers were small 1 year after diagnosis, but survival for rare cancers declined more markedly thereafter, consistent with the idea that treatments for rare cancers are less effective than those for common cancers. However, differences in stage at diagnosis could not be excluded, as 1- and 3-year RS for rare cancers was lower than the corresponding figures for common cancers. Moreover, rare cancers include many cancer entities with a bad prognosis (5-year RS <50%): cancer of head and neck, oesophagus, small intestine, ovary, brain, biliary tract, liver, pleura, multiple myeloma, acute myeloid and lymphatic leukaemia; in contrast, most common cancer cases are breast, prostate, and colorectal cancers, which have a good prognosis. The high prevalence observed for rare haematological diseases and rare tumours of the female genital system is due to their high incidence (the majority of haematological diseases are rare and gynaecological cancers added up to fairly high incidence rates) and relatively good prognosis. The low prevalence of rare epithelial tumours of the digestive system was due to the low survival rates of the majority of tumours included in this group (oesophagus, stomach, small intestine, pancreas, and liver), regardless of the high incidence rate of rare epithelial cancers of these sites. This AIRTUM study confirms that rare cancers are a major public health problem in Italy and provides quantitative estimations, for the first time in Italy, to a problem long known to exist. This monograph provides detailed epidemiologic indicators for almost 200 rare cancers, the majority of which (72%) are very rare (IR<0.5 per 100,000). These data are of major interest for different stakeholders. Health care planners can find useful information herein to properly plan and think of how to reorganise health care services. Researchers now have numbers to design clinical trials considering alternative study designs and statistical approaches. Population-based cancer registries with good quality data are the best source of information to describe the rare cancer burden in a population