Organizational climate in Spanish Public Health Services: Administration and Services Staff

The main goal of this research is to explore the organizational climate perceived by administrative and healthcare personnel working in Spanish healthcare services, analyzing the differences according to their health specialization, sex, age and professional status. The sample was made up of 3,787 individuals working in the administrative and healthcare services of the Public Health System of the Principality of Asturias, 88.7 % were working in specialist care and 11.3 % in primary care. Mean age was 51.88 (standard deviation of 6.28); 79.9 % were women and 20.1 % men. The organizational climate was assessed with the CLIOR scale. The organizational climate perceived is moderately positive, with a global mean of 3.03 on a scale of 1 to 5 points. The differences are statistically significant (p < .01) according to specialty, age and profession. A better working climate is perceived in primary care than in specialist care, and among older as compared to younger workers. The results indicate that the working climate perceived by administration and services staff employees in the Spanish healthcare context is moderately positive, with a better perceived climate in primary care than in specialist care

Renal brucelloma: A case report

Descripción del caso clínico: Paciente en contacto habitual con ganado ovino y bovino, astenia, anemia y fiebre de origen desconocido. En este contexto se realizan varias pruebas complementarias, entre ellas un TC abdominal que revela masa renal calcificada. Con la sospecha de brucelosis, tras obtenerse un resultado positivo en Rosa de Bengala, se comienza tratamiento antibiótico y se realiza nefrectomía simple derecha por lumbotomía, la pieza quirúrgica confirmó el diagnóstico con PCR positiva para Brucella Melitensis. Relevancia: Existen muy pocos casos de bruceloma renal descritos en la literatura, por ello, es importante divulgar los casos que surjan para ampliar el conocimiento sobre esta patología y su tratamiento. Implicaciones clínicas: En ocasiones las pruebas no invasivas no son suficientes para su diagnóstico y el tratamiento quirúrgico junto con la antibioterapia es de elección en la mayoría de los casos descritos en la literatura. Conclusiones: La brucelosis es una enfermedad poco frecuente pero endémica en algunas zonas. El diagnóstico suele darse en el contexto de un estudio por fiebre de origen desconocido. El tratamiento del bruceloma renal suele ser la combinación de antibioterapia y cirugía. Clinical case description: A patient in regular contact with cattle and sheep presented with asthenia, anemia, and fever of unknown origin. Among the complementary studies carried out, an abdominal CT scan revealed a calcified renal mass. Brucellosis was suspected, and after a positive Bengal Rose test, antibiotic therapy was begun. Right nephrectomy was performed through lumbotomy and the diagnosis was confirmed by the surgical specimen, with a PCR test positive for Brucella melitensis. Relevance: There are very few cases of renal brucelloma reported in the literature, thus the description of cases that arise is important to broaden the knowledge of the pathology and its treatment. Clinical implications: Noninvasive tests are often not sufficient for making the diagnosis. The surgical approach, together with antibiotic therapy, is the treatment of choice in the majority of the cases reported in the literature. Conclusions: Brucellosis is an uncommon disease, but endemic in certain areas. Diagnosis tends to be made in the context of evaluating cases of fever of unknown origin. The combination of antibiotic therapy and surgery is the usual treatment for renal brucelloma

Cateterismo ureteral iatrogeno: A propósito de dos casos y revisión de la literatura

Background: Bladder catheterization is one of the most frequent procedures in Urology, but it is not exempt from complications. Relevance: Unintentional Foley catheter placement in the ureter is a rare occurrence that can produce serious complications. Few cases are described in the literature. Case report: We present herein two cases of inadvertent Foley catheter balloon inflation in the ureter. Case 1: an 85-year-old-patient with an indwelling Foley catheter was admitted to our emergency department due to abdominal pain in the hypogastrium, dysuria, and diagnosis of septic shock from extended-spectrum beta-lactamase-producing Escherichia coli. Case 2: a 75-year-old patient underwent transurethral resection of the bladder and presented with persistent hematuria and abdominal pain in the postoperative period. Conclusion: Unintentional urinary catheter placement in the ureter is an unusual complication and a diagnostic challenge that should be suspected in the presence of abdominal pain after bladder catheterization

Long-term effect of 2 intensive statin regimens on treatment and incidence of cardiovascular events in familial hypercholesterolemia : The SAFEHEART study

Funding: This study was supported by Fundación Hipercolesterolemia Familiar; Grant G03/181 Grant 08-2008 Centro Nacional de Investigaci?n Cardiovascular (CNIC).Background: Maximal doses of potent statins are the basement of treatment of familial hypercholesterolemia (FH). Little is known about the use of different statin regimens in FH. Objectives: The objectives of the study were to describe the treatment changes and low-density lipoprotein cholesterol (LDL-C) goal achievement with atorvastatin (ATV) and rosuvastatin (RV) in the SAFEHEART cohort, as well as to analyze the incidence of atherosclerotic cardiovascular events (ACVEs) and changes in the cardiovascular risk. Methods: SAFEHEART is a prospective follow-up nationwide cohort study in a molecularly defined FH population. The patients were contacted on a yearly basis to obtain relevant changes in life habits, medication, and ACVEs. Results: A total of 1939 patients were analyzed. Median follow-up was 6.6 years (5-10). The estimated 10-year risk according the SAFEHEART risk equation was 1.61 (0.67-3.39) and 1.22 (0.54-2.93) at enrollment for ATV and RV, respectively (P <.001). There were no significant differences at the follow-up: 1.29 (0.54-2.82) and 1.22 (0.54-2.76) in the ATV and RV groups, respectively (P =.51). Sixteen percent of patients in primary prevention with ATV and 18% with RV achieved an LDL-C <100 mg/dL and 4% in secondary prevention with ATV and 5% with RV achieved an LDL-C <70 mg/dL. The use of ezetimibe was marginally greater in the RV group. One hundred sixty ACVEs occurred during follow-up, being its incidence rate 1.1 events/100 patient-years in the ATV group and 1.2 in the RV group (P =.58). Conclusion: ATV and RV are 2 high-potency statins widely used in FH. Although the reduction in LDL-C levels was greater with RV than with ATV, the superiority of RV for reducing ACVEs was not demonstrated

La infección del tracto urinario como causa principal de ingreso en pacientes cistectomizados

Introducción y objetivos La cistectomía radical con derivación urinaria asociada a linfadenectomía pélvica ampliada continúa siendo el tratamiento de elección en el cáncer vesical musculoinvasivo. Un 64% de los pacientes presentan complicaciones postoperatorias, siendo la infección urinaria responsable en un 20-40% de los casos. El objetivo del presente proyecto es valorar la tasa de infección urinaria como causa de reingreso tras cistectomía, e identificar factores protectores y predisponentes de infección urinaria en nuestro medio. Por último, conocer los resultados obtenidos al aplicar el protocolo de profilaxis antibiótica tras la retirada de los catéteres ureterales. Material y métodos Estudio descriptivo retrospectivo de pacientes cistectomizados en el Servicio de Urología del Hospital Clínico Universitario desde enero de 2012 hasta diciembre de 2018. Desde octubre de 2017, de forma estandarizada, a todo paciente se le aplica un protocolo de prevención de infección del tracto urinario (ITU) tras la retirada de catéteres. Resultados La ITU es responsable del 54, 7% de los reingresos, siendo un 55, 1% de estos por causa de una ITU tras la retirada de los catéteres ureterales. El 9, 5% de los pacientes con profilaxis presenta ITU tras la retirada, frente a un 10, 6% en el grupo de pacientes sin profilaxis. El paciente que reingresa por ITU tras la retirada tiene un tiempo de catéteres medio de 24, 3 ± 7, 2 días, frente a los 24, 5 ± 7, 4 días en el grupo sin ITU (p = 0, 847). Conclusiones El tipo de derivación urinaria empleada no guarda relación con la tasa de infección urinaria. El modelo de regresión no identifica la profilaxis antibiótica, ni tampoco el tiempo de catéteres, como factores independientes de ITU tras la retirada de los catéteres. Introduction and objectives: Radical cystectomy with urinary diversion associated with extended pelvic lymphadenectomy continues to be the treatment of choice in muscle invasive bladder cancer. Sixty-four percent of patients submitted to this procedure present postoperative complications, with urinary infection being responsible in 20-40% of cases. The aim of this project is to assess the rate of urinary infection as a cause of re-admission after cystectomy, and to identify protective and predisposing factors for urinary infection in our environment. Finally, we will evaluate the outcomes after the establishment of a prophylactic antibiotic protocol after removal of ureteral catheters. Material and methods: Retrospective descriptive study of cystectomized patients in the Urology Service of the Hospital Clínico Universitario of Zaragoza, from January 2012 to December 2018. A urinary tract infection (UTI) prevention protocol after catheter removal is established for all patients since October 2017. Results: UTI is responsible for 54.7% of readmissions, with 55.1% of these being due to UTI after removal of ureteral catheters. Of the patients who received with prophylaxis, 9.5% presented UTIs after withdrawal, compared to 10.6% in the group of patients without prophylaxis. The patient who is re-admitted for UTI after withdrawal has a mean catheter time of 24.3 ± 7.2 days, compared to 24.5 ± 7.4 days for patients in the group without UTI (P =.847). Conclusions: The type of urinary diversion performed is not related to the rate of urinary infection. The regression model does not identify antibiotic prophylaxis, nor catheter time, as independent factors of UTI after catheter removal

A Search for Photons with Energies Above 2 × 1017^{17} eV Using Hybrid Data from the Low-Energy Extensions of the Pierre Auger Observatory

Ultra-high-energy photons with energies exceeding 10$^{17}$ eV offer a wealth of connections to different aspects of cosmic-ray astrophysics as well as to gamma-ray and neutrino astronomy. The recent observations of photons with energies in the 10$^{15}$ eV range further motivate searches for even higher-energy photons. In this paper, we present a search for photons with energies exceeding 2 × 10$^{17}$ eV using about 5.5 yr of hybrid data from the low-energy extensions of the Pierre Auger Observatory. The upper limits on the integral photon flux derived here are the most stringent ones to date in the energy region between 10$^{17}$ and 10$^{18}$ eV

Searches for Ultra-High-Energy Photons at the Pierre Auger Observatory

The Pierre Auger Observatory, being the largest air-shower experiment in the world, offers an unprecedented exposure to neutral particles at the highest energies. Since the start of data taking more than 18 years ago, various searches for ultra-high-energy (UHE, $E\gtrsim10^{17}\,\text{eV}$) photons have been performed: either for a diffuse flux of UHE photons, for point sources of UHE photons or for UHE photons associated with transient events like gravitational wave events. In the present paper, we summarize these searches and review the current results obtained using the wealth of data collected by the Pierre Auger Observatory.Comment: Review article accepted for publication in Universe (special issue on ultra-high energy photons

Cosmological implications of photon-flux upper limits at ultra-high energies in scenarios of Planckian-interacting massive particles for dark matter

We present a thorough search for signatures that would be suggestive of super-heavy $X$ particles decaying in the Galactic halo, in the data of the Pierre Auger Observatory. From the lack of signal, we derive upper limits for different energy thresholds above ${\gtrsim}10^8$\,GeV on the expected secondary by-product fluxes from $X$-particle decay. Assuming that the energy density of these super-heavy particles matches that of dark matter observed today, we translate the upper bounds on the particle fluxes into tight constraints on the couplings governing the decay process as a function of the particle mass. We show that instanton-induced decay processes allow us to derive a bound on the reduced coupling constant of gauge interactions in the dark sector: \alpha_X \alt 0.09, for 10^{9} \alt M_X/\text{GeV} < 10^{19}. This upper limit on $\alpha_X$ is complementary to the non-observation of tensor modes in the cosmic microwave background in the context of Planckian-interacting massive particles for dark matter produced during the reheating epoch. Viable regions for this scenario to explain dark matter are delineated in several planes of the multidimensional parameter space that involves, in addition to $M_X$ and $\alpha_X$, the Hubble rate at the end of inflation, the reheating efficiency, and the non-minimal coupling of the Higgs with curvature.Comment: 15 pages, 8 figures, Accompanying paper of arXiv:2203.0885