SLUČAJEVI AFAZIJE U JEDNOM MEDICINSKOM DJELU IZ XVI. STOLJEĆA

The purpose of this paper is to bring to the attention of the international community the role in the history of aphasiology of the eminent Renaissance figure, the Extremaduran Francisco Arceo de Fregenal. To present the subject, after a brief biography of this surgeon, we will trace the development of the concept of aphasia up to the 16th century. In some ancient cultures we find that this disorder was described as a “cerebral accident”, to be presented subsequently in the Middle Ages as a divine punishment, only for the original idea to be taken up again during the Renaissance. This return to the concept of the early civilisations was not to lead to the formal classification of this condition however, until the studies of Broca and Wernicke were published in the 19th century. The contribution of Arceo lies in the description of clinical cases included in his book De Recta cvrandorum, which are presented in their original written version in Latin accompanied by a translation in English. The first of these cases tells of spontaneous recovery from the disease, and the second of the evolution of a patient with aphasia secondary to traumatic brain injury following surgery. Despite the great value of Arceo’s report, the historical context and his professional attitude did not allow for a localisationist interpretation of the concept of aphasia.Cilj je ovog rada skrenuti pažnju međunarodne publike na ulogu eminentnog renesansnog čovjeka, Extremadurana Francisca Arcea de Fregenala, u povijesti afaziologije. Da bi predstavili temu, nakon kratke biografije ovog kirurga, ocrtati ćemo razvoj koncepta afazije sve do 16. stoljeća. U nekim starim kulturama otkrivamo da je ovaj poremećaj opisan kao «cerebralni udes», da bi kasnije u srednjem vijeku bio predstavljen kao božanska kazna, da bi naposljetku kao izvorna ideja opet bila razmatrana tijekom renesanse. Međutim ovaj povratak konceptu ranijih civilizacija nije doveo do formalne klasifikacije ovog stanja, sve dok u XIX. stoljeću nisu objavljene studije Broce i Wernicka. Arceov doprinos leži u opisu kliničkih slučajeva uključenih u njegovoj knjizi De recta cvrandorum, koji su predstavljeni u svojoj izvornoj verziji pisanoj na latinskom jeziku praćenom prijevodom na engleski jezik. Prvi od tih slučajeva govori o spontanom oporavku od bolesti, a drugi o razvoju pacijenta sa afazijom dobivenom uslijed traumatske ozljede mozga nakon operacije. Unatoč velikoj vrijednosti Arceova izvješća, povijesni kontekst i njegov profesionalni stav nisu omogućili alokalizacijsko tumačenja pojma afazije

Integrated Transmission and Distribution System Expansion Planning Under Uncertainty

The increased deployment of distributed generation calls for the coordination and interaction between the transmission and distribution levels. This requirement is particularly relevant for planning purposes when renewable-based generation is involved. Unfortunately, in current industry practice, transmission and distribution network planners solve their problems independent of each other, thereby leading to suboptimal solutions. Within this context, this paper addresses the integrated expansion planning problem of transmission and distribution systems where investments in network and generation assets are jointly considered. Several alternatives are available for the installation of lines as well as conventional and renewable-based generators at both system levels. Thus, the optimal expansion plan identifies the best alternative for the candidate assets under the uncertainty associated with demand and renewable-based power production. The proposed model is an instance of stochastic programming wherein uncertainty is characterized through a set of scenarios that explicitly capture the correlation between the uncertain parameters. The resulting stochastic program is driven by the minimization of the expected total cost, which comprises the costs related to investment decisions and system operation. The associated scenario-based deterministic equivalent is formulated as a mixed-integer linear program for which finite convergence to optimality is guaranteed. Numerical results show the effective performance of the proposed approachEl mayor despliegue de generación distribuida exige la coordinación e interacción entre los niveles de transmisión y distribución. Este requisito es particularmente relevante a efectos de planificación cuando se trata de generación basada en energías renovables. Desafortunadamente, en la práctica actual de la industria, los planificadores de redes de transmisión y distribución resuelven sus problemas de forma independiente, lo que conduce a soluciones subóptimas. En este contexto, este documento aborda el problema de la planificación integrada de la expansión de los sistemas de transmisión y distribución donde se consideran conjuntamente las inversiones en activos de red y generación. Hay varias alternativas disponibles para la instalación de líneas y generadores convencionales y renovables en ambos niveles del sistema. De este modo, el plan de expansión óptimo identifica la mejor alternativa para los activos candidatos bajo la incertidumbre asociada con la demanda y la producción de energía renovable. El modelo propuesto es una instancia de programación estocástica donde la incertidumbre se caracteriza a través de un conjunto de escenarios que capturan explícitamente la correlación entre los parámetros inciertos. El programa estocástico resultante está impulsado por la minimización del costo total esperado, que comprende los costos relacionados con las decisiones de inversión y la operación del sistema. El equivalente determinista basado en escenarios asociado se formula como un programa lineal de enteros mixtos para el que se garantiza una convergencia finita a la optimización. Los resultados numéricos muestran el desempeño efectivo del enfoque propuest

Liderazgo y satisfacción laboral del personal de enfermería

La evolución de la profesión de enfermería ha desarrollado la figura del líder de unidad, convirtiéndola en fundamental. El estilo de liderazgo influye en el ambiente laboral y la satisfacción del personal, influyendo en el funcionamiento y la calidad de los cuidados que presta el personal de la unidad. Mediante una revisión bibliográfica, se analizan los estilos de liderazgo, las competencias que debe tener un líder de enfermería, la influencia sobre los factores estresantes y los elementos de satisfacción en el trabajo. Las publicaciones encontradas sobre los modelos usados en España evidencian cómo un buen líder influye sobre estos factores y afectan a la calidad asistencial. Asimismo la bibliografía ha mostrado experiencias en otros países y las maneras de afrontar estas situaciones donde el liderazgo de enfermería se está poniendo de relieve

Tuberculosis prophylaxis with levofloxacin in liver transplant patients is associated with a high incidence of tenosynovitis: safety analysis of a multicenter randomized trial

This work was supported by the Ayudas para el fomento de la investigacion clinica independiente [EC 10-120] and Programa Intramural Consorcio de Apoyo a la Investigación Biomédica en Red 2010. Other funding sources: National R&D&I Plan 2008–2011 and the Instituto de Salud Carlos III (ISCIII), Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Economía y Competitividad, Spanish Network for Research in Infectious Diseases [RD06/0008, RD12/0015] - co-financed by European Development Regional Fund “A way to achieve Europe” ERDF. Consorcio de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas is financed by the ISCIII.Background: It is necessary to develop a safe alternative to isoniazid for tuberculosis prophylaxis in liver transplant recipients. This study was designed to investigate the efficacy and safety of levofloxacin. Methods: An open-label, prospective, multicenter, randomized study was conducted to compare the efficacy and safety of levofloxacin (500 mg q24h for 9 months) initiated in patients awaiting liver transplantation and isoniazid (300 mg q24h for 9 months) initiated post-transplant when liver function was stabilized. Efficacy was measured by tuberculosis incidence at 18 months after transplantation. All adverse events related to the medication were recorded. Results: CONSORT guidelines were followed in order to present the results. The safety committee suspended the study through a safety analysis when 64 patients had been included (31 in the isoniazid arm and 33 in the levofloxacin arm). The reason for suspension was an unexpected incidence of severe tenosynovitis in the levofloxacin arm (18.2%). Although the clinical course was favorable in all cases, tenosynovitis persisted for 7 weeks in some patients. No patients treated with isoniazid, developed tenosynovitis. Only 32.2% of patients randomized to isoniazid (10/31) and 54.5% of patients randomized to levofloxacin (18/33, P = .094) completed prophylaxis. No patient developed tuberculosis during the study follow-up (median 270 days). Conclusions: Levofloxacin prophylaxis of tuberculosis in liver transplant candidates is associated with a high incidence of tenosynovitis that limits its potential utility.Ayudas para el fomento de la investigación clínica independiente [EC 10-120]Programa Intramural Consorcio de Apoyo a la Investigación Biomédica en Red 2010National R&D&I Plan 2008–2011Instituto de Salud Carlos III (ISCIII)Ministerio de Economía y Competitividad RD06/0008, RD12/0015European Development Regional Fun

Viruses and Mycoplasma pneumoniae are the main etiological agents of community-acquired pneumonia in hospitalized pediatric patients in Spain

[Objectives]: To describe the etiology of community-acquired pneumonia (CAP) in hospitalized children in Spain and analyze the predictors of the etiology.[Hypothesis]: The different etiological groups of pediatric CAP are associated with different clinical, radiographic, and analytical data.[Design]: Observational, multicenter, and prospective study.[Patient selection]: This study included children aged 1 month to 17 years with CAP, who were hospitalized between April 2012 and May 2019.[Methods]: An extensive microbiological workup was performed. The clinical, radiographic, and analytical parameters were analyzed for three etiological groups.[Results]: Among the 495 children included, at least one causative pathogen was identified in 262 (52.9%): pathogenic viruses in 155/262 (59.2%); atypical bacteria (AB), mainly Mycoplasma pneumonia, in 84/262 (32.1%); and typical bacteria (TyB) in 40/262 (15.3%). Consolidation was observed in 89/138 (64.5%) patients with viral CAP, 74/84 (88.1%) with CAP caused by AB, and 40/40 (100%) with CAP caused by TyB. Para-pneumonic pleural effusion (PPE) was observed in 112/495 (22.6%) patients, of which 61/112 (54.5%) presented a likely causative pathogen: viruses in 12/61 (19.7%); AB in 23/61 (37.7%); and TyB in 26/61 (42.6%). Viral etiology was significantly frequent in young patients and in those with low oxygen saturation, wheezing, no consolidation, and high lymphocyte counts. CAP patients with AB as the etiological agent had a significantly longer and less serious course as compared to those with other causative pathogens.[Conclusions]: Viruses and M. pneumoniae are the main causes of pediatric CAP in Spain. Wheezing, young age, and no consolidation on radiographs are indicative of viral etiology. Viruses and AB can also cause PPE. Since only a few cases can be directly attributed to TyB, the indications for antibiotics must be carefully considered in each patient.Instituto de Investigación Hospital 12 de Octubre (i+12), Grant/Award Number: AY191212‐1; Instituto de Salud Carlos III (Ministry of Economy, Industry and Competitiveness) and co‐funded by the European Regional Development Funds, Grant/Award Number: Project PI17/01458; Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Grant/Award Number: PCAPE 2011_0025 Register 320/11; Research Project of Universidad Europea de Madrid, Grant/Award Number: 2017/UEM03Peer reviewe

Healthcare workers hospitalized due to COVID-19 have no higher risk of death than general population. Data from the Spanish SEMI-COVID-19 Registry

Aim To determine whether healthcare workers (HCW) hospitalized in Spain due to COVID-19 have a worse prognosis than non-healthcare workers (NHCW). Methods Observational cohort study based on the SEMI-COVID-19 Registry, a nationwide registry that collects sociodemographic, clinical, laboratory, and treatment data on patients hospitalised with COVID-19 in Spain. Patients aged 20-65 years were selected. A multivariate logistic regression model was performed to identify factors associated with mortality. Results As of 22 May 2020, 4393 patients were included, of whom 419 (9.5%) were HCW. Median (interquartile range) age of HCW was 52 (15) years and 62.4% were women. Prevalence of comorbidities and severe radiological findings upon admission were less frequent in HCW. There were no difference in need of respiratory support and admission to intensive care unit, but occurrence of sepsis and in-hospital mortality was lower in HCW (1.7% vs. 3.9%; p = 0.024 and 0.7% vs. 4.8%; p<0.001 respectively). Age, male sex and comorbidity, were independently associated with higher in-hospital mortality and healthcare working with lower mortality (OR 0.211, 95%CI 0.067-0.667, p = 0.008). 30-days survival was higher in HCW (0.968 vs. 0.851 p<0.001). Conclusions Hospitalized COVID-19 HCW had fewer comorbidities and a better prognosis than NHCW. Our results suggest that professional exposure to COVID-19 in HCW does not carry more clinical severity nor mortality

Resultados de una encuesta sobre el soporte nutricional perioperatorio en la cirugía pancreática y biliar en España

Introduction: a survey on peri-operative nutritional support in pancreatic and biliary surgery among Spanish hospitals in 2007 showed that few surgical groups followed the 2006 ESPEN guidelines. Ten years later we sent a questionnaire to check the current situation. Methods: a questionnaire with 21 items sent to 38 centers, related to fasting time before and after surgery, nutritional screening use and type, time and type of peri-operative nutritional support, and number of procedures. Results: thirty-four institutions responded. The median number of pancreatic resections (head/total) was 29.5 (95% CI: 23.0-35; range, 5-68) (total, 1002); of surgeries for biliary malignancies (non-pancreatic), 9.8 (95% CI: 7.3-12.4; range, 2-30); and of main biliary resections for benign conditions, 10.4 (95% CI: 7.6-13.3; range, 2-33). Before surgery, only 41.2% of the sites used nutritional support (&lt; 50% used any nutritional screening procedure). The mean duration of preoperative fasting for solid foods was 9.3 h (range, 6-24 h); it was 6.6 h for liquids (range, 2-12). Following pancreatic surgery, 29.4% tried to use early oral feeding, but 88.2% of the surveyed teams used some nutritional support; 26.5% of respondents used TPN in 100% of cases. Different percentages of TPN and EN were used in the other centers. In malignant biliary surgery, 22.6% used TPN always, and EN in 19.3% of cases. Conclusions: TPN is the commonest nutrition approach after pancreatic head surgery. Only 29.4% of the units used early oral feeding, and 32.3% used EN; 22.6% used TPN regularly after surgery for malignant biliary tumours. The 2006 ESPEN guideline recommendations are not regularly followed 12 years after their publication in our country.Introducción: realizamos una encuesta sobre soporte nutricional perioperatorio en cirugía pancreática y biliar en hospitales españoles en 2007, que mostró que pocos grupos quirúrgicos seguían las guías de ESPEN 2006. Diez años después enviamos un cuestionario para comprobar la situación actual. Métodos: treinta y ocho centros recibieron un cuestionario con 21 preguntas sobre tiempo de ayunas antes y después de la cirugía, cribado nutricional, duración y tipo de soporte nutricional perioperatorio, y número de procedimientos. Resultados: respondieron 34 grupos. La mediana de pancreatectomías (cabeza/total) fue de 29,5 (IC 95 %: 23,0-35; rango, 5-68) (total, 1002), la de cirugías biliares malignas de 9,8 (IC 95 %: 7,3-12,4; rango, 2-30) y la de resecciones biliares por patología benigna de 10,4 (IC 95 %: 7,6-13,3; rango, 2-33). Solo el 41,2 % de los grupos utilizaban soporte nutricional antes de la cirugía (< 50 % habian efectuado un cribado nutricional). El tiempo medio de ayuno preoperatorio para sólidos fue de 9,3 h (rango, 6-24 h), y de 6,6 h para líquidos (rango, 2-12). Tras la pancreatectomía, el 29,4 % habían intentado administrar una dieta oral precoz, pero el 88,2 % de los grupos usaron algún tipo de soporte nutricional y el 26,5 % usaron NP en el 100 % de los casos. Los demás grupos usaron diferentes porcentajes de NP y NE en sus casos. En la cirugía biliar maligna, el 22,6 % utilizaron NP siempre y NE en el 19,3 % de los casos. Conclusiones: la NP es el soporte nutricional más utilizado tras la cirugía de cabeza pancreática. Solo el 29,4 % de las unidades usan nutrición oral precoz y el 32,3 % emplean la NE tras este tipo de cirugía. El 22,6 % de las instituciones usan NP habitualmente tras la cirugía de tumores biliares malignos. Las guías ESPEN 2006 no se siguen de forma habitual en nuestro país tras más de 10 años desde su publicación

Infecciones por enterobacterias productoras de betalactamasas de espectro extendido tras cirugía cardiaca: su impacto en la mortalidad

Introducción: Las enterobacterias productoras de betalactamasas de espectro extendido (EP BLEE) causan infecciones nosocomiales de modo creciente. Es controvertido si se asocian a peor pronóstico. El objetivo de este trabajo fue analizar si las infecciones por EP BLEE tras cirugía cardiaca presentan peor pronóstico que las causadas por enterobacterias no multirresistentes. Material y método: Estudio retrospectivo de las infecciones postquirúrgicas por enterobacterias, diagnosticadas en el Servicio de Cirugía Cardiaca de un Hospital Universitario (1/12/2007-1/12/2012). Se analizó la presencia de BLEE, la idoneidad del tratamiento empírico y la mortalidad global y relacionada. Resultados: Se analizaron 61 pacientes (67,2 ± 10 años). En 16 (26,2%) se aislaron EP BLEE. Las especies más frecuentes fueron Escherichia coli (20 casos/9 BLEE), Enterobacter spp (18/1), Serratia marcescens (11/3), Proteus mirabilis (11/1) y Klebsiella spp (9/2). Las localizaciones más frecuentes fueron la sangre (54,1%), las vías respiratorias (31,1%) y la herida quirúrgica (19,7%). El tratamiento empírico inicial fue no idóneo en mayor proporción en las infecciones por EP BLEE (66,7% frente a 15,9%, p < 0,0001). Fallecieron 26 pacientes (42,6%). La mortalidad global se asoció a infección por EP BLEE (odds ratio 5,3; IC 95% 1,3-21,5). La mortalidad atribuida a enterobacterias (14 pacientes) fue mayor cuando hubo bacteriemia (75% frente a 22%, p < 0,02) y el tratamiento empírico fue no idóneo (87,5% frente a 43,7%, p = 0,05). Conclusiones: La infección por EP BLEE en la post-cirugía cardiaca puede asociarse a mayor mortalidad, especialmente cuando hay bacteriemia. Ante la sospecha de infección post-quirúrgica por enterobacterias, se debe ajustar el tratamiento empírico según la incidencia local de EP BLEE