Effectiveness of hypnoanalgesia for dermatological surgery in children: Randomised clinical trial

Background and Objective. Diagnostic or therapeutic procedures may generate pain, fear or anxiety. The aim of this paper is to assess whether hypnosedation in children undergoing dermatological surgery is effective in reducing the doses of sedation and analgesia during the periprocedure. Patients and methods. Clinical trial in which paediatric patients scheduled for removal of benign skin lesions in a hospital were randomised to receive hypnosis (intervention group) or attention-distracting techniques (control group). The outcome measures used were doses of sedation (propofol) during surgery, and the need for analgesia (paracetamol and others) and pain assessment by visual analogue scale (VAS), post-surgery and at 24 hours. Results. Thirty patients between 5 and 16 years of age were selected consecutively, two of them being excluded because they did not meet the criteria; 15 patients were assigned to the hypnosis group and 13 to the control. Patients treated with hypnosis as an adjuvant to conscious sedation showed a lower need for propofol (median 1.8 mg/Kg; P25-75 1.6 - 2.0) than those treated with distraction (2.9; 2.5 - 3.0; p=0.001). Eighty percent of the children in the hypnosis group needed post-surgical paracetamol versus 100% in the control (p=0.226); after 24 h after discharge the difference in need of ibuprofen was 6.7% versus 38.5% (p=0.041) and of analgesics in general 46.7% versus 84.6% (p=0.082). The VAS of pain during the procedure in the hypnosis group was VAS 0 (0-0) vs 0 (0-5.5) (p=0.142). Conclusions. Hypnosis as an adjuvant to sedation in children undergoing major outpatient surgery&nbsp

Fracturas en el paciente hemofílico

Tesis doctoral inédita. Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Medicina. Fecha de lectura: 6 de Abril de 199

Cytochrome c signalosome in mitochondria

Cytochrome c delicately tilts the balance between cell life (respiration) and cell death (apoptosis). Whereas cell life is governed by transient electron transfer interactions of cytochrome c inside the mitochondria, the cytoplasmic adducts of cytochrome c that lead to cell death are amazingly stable. Interestingly, the contacts of cytochrome c with its counterparts shift from the area surrounding the heme crevice for the redox complexes to the opposite molecule side when the electron flow is not necessary. The cytochrome c signalosome shows a higher level of regulation by post-translational modifications—nitration and phosphorylation—of the hemeprotein. Understanding protein interfaces, as well as protein modifications, would puzzle the mitochondrial cytochrome c-controlled pathways out and enable the design of novel drugs to silence the action of pro-survival and pro-apoptotic partners of cytochrome c.Spanish Ministry of Science and Innovation BFU2009-07190Andalusian Government BIO198 P08-CVI-387

Evaluation of the coupled reaction-adsorptionof Ca 2+ ions on ashes from sugar cane bagasse. Kinetic and thermodynamic approaches

The adsorption of Ca2+ ions and the pozzolanic reaction between ashes from sugar cane bagasse (bio-reactant) and Ca(OH)2, are studied in the present paper. The characterization of the bio-reactant by means of XRD, specificsurface Brunauer-Emmett-Teller (BET), thermal differentialanalys is (TDA), thermo-gravimetric analysis and other physical parameters such as pignometric density, porosity,compressibility, form factor and flow velocity, is developed. A four stages mechanism is proposed to describe the pozzolanic reaction according to Zhulaev postulations. Once the reaction takes place, an 85.15% of Ca2+ is converted and the rest remains as adsorbed specie validating a dual adsorption-reaction process. The kinetics of the adsorption process can be described by means of a pseudo-firstorder model and the mechanism is controlled by the film diffusion model. The thermodynamics of the adsorption process fits to the Freundlich isotherm

New approach to managing COVID-19 pandemic in a complex tertiary care medical centre in Madrid, Spain

The COVID-19 pandemic is putting healthcare systems under unprecedented stress to accommodate unexpected numbers of patients forcing a quick re-organization. This article describes the staff management experience of a third level referral hospital in the city of Madrid, Spain, one of the cities and hospitals with the largest number of COVID19 cases. A newly created COVID-19-specific Clinical Management Unit (CMU) coordinated all clinical departments and conducted real-time assessments of the availability and needs of medical staff, alongside the hospital's general management board. The Unit was able to (i) redeploy up to 285 physicians every week to bolster medical care in COVID-19 wards and forecast medical staff requirements for the upcoming week so all departments could organize their work while coping with COVID-19 needs, (ii) overview all clinical activities conducted in a medicalized hotel, and (iii) recruit a team of roughly 90 volunteer medical students to accelerate data collection and evidence generation. The main advantage of a clinical management unit composed by a member of every job category - its ability to generate rapid, locally-adapted responses to unexpected challenges - made it perfect for the unprecedented increase in healthcare need generated by the COVID-19 pandemic

Combining H-FABP and GFAP increases the capacity to differentiate between CT-positive and CT-negative patients with mild traumatic brain injury

Mild traumatic brain injury (mTBI) patients may have trauma-induced brain lesions detectable using CT scans. However, most patients will be CT-negative. There is thus a need for an additional tool to detect patients at risk. Single blood biomarkers, such as S100B and GFAP, have been widely studied in mTBI patients, but to date, none seems to perform well enough. In many different diseases, combining several biomarkers into panels has become increasingly interesting for diagnoses and to enhance classification performance. The present study evaluated 13 proteins individually—H-FABP, MMP-1, MMP-3, MMP-9, VCAM, ICAM, SAA, CRP, GSTP, NKDA, PRDX1, DJ-1 and IL-10—for their capacity to differentiate between patients with and without a brain lesion according to CT results. The best performing proteins were then compared and combined with the S100B and GFAP proteins into a CT-scan triage panel. Patients diagnosed with mTBI, with a Glasgow Coma Scale score of 15 and one additional clinical symptom were enrolled at three different European sites. A blood sample was collected at hospital admission, and a CT scan was performed. Patients were divided into two two-centre cohorts and further dichotomised into CT-positive and CT-negative groups for statistical analysis. Single markers and panels were evaluated using Cohort 1. Four proteins—H-FABP, IL-10, S100B and GFAP—showed significantly higher levels in CT-positive patients. The best-performing biomarker was H-FABP, with a specificity of 32% (95% CI 23–40) and sensitivity reaching 100%. The best-performing two-marker panel for Cohort 1, subsequently validated in Cohort 2, was a combination of H-FABP and GFAP, enhancing specificity to 46% (95% CI 36–55). When adding IL-10 to this panel, specificity reached 52% (95% CI 43–61) with 100% sensitivity. These results showed that proteins combined into panels could be used to efficiently classify CT-positive and CT-negative mTBI patients

COPAS: A New Algorithm for the Partial Input Encoding Problem

Frequently, the logic designer deals with functions with symbolic input variables. The binary encoding of such symbols should be chosen to optimize the final implementation. Conventionally, this input encoding (IE) problem has been solved in a two-step process. First step generates constraints on the relationship between codes for different symbols, called group constraints. In a following step, symbols are encoded such that constraints are satisfied. This paper addresses the partial input encoding problem (PIE), a variation of the IE problem which generates codes of minimum length. The role of group constraints within the framework of the PIE problem has been questioned. This paper describes an algorithm that unlike conventional approaches, which try to maximize the number of satisfied constraints, targets the economical implementation of each input constraint. The proposed approach is based on a powerful heuristic that produces high quality results in shorter time compared to previous algorithm

Distributed feedback lasers based on dichromated poly(vinyl alcohol) reusable surface-relief gratings

A simple, low-cost and versatile holographic method to produce reusable surface-relief gratings on dichromated poly(vinyl alcohol) (DCPVA) films, with periods Λ ≥ 270 nm and modulation depths up to 300 nm, is reported. DCPVA presents processing advantages with respect to other photoresists, such as dichromated gelatine, i.e. higher light sensitivity, simpler fabrication process and better batch to batch reproducibility. The successful use of these DCPVA relief gratings as distributed feedback (DFB) laser resonators is demonstrated. Second-order DFB devices emitting in the wavelength range 577-614 nm have been easily prepared by coating a dye-doped polymer film on top of the resonators.We thank the Spanish Government (MINECO) and the European Union (FEDER) for grant no. MAT2011-28167-C02

Reparación de furca de segundo molar inferior permanente utilizando Agregado de Trióxido Mineral. Presentación de un caso

A consulta acude una paciente femenina de 47 años refiriendo dolor pulsátil que no alivia con analgésico, en hemiarcada inferior izquierda. El examen clínico muestra restauración desplazada y gran recidiva de caries en el 37. Radiográficamente se obseva una lesión en la bifurcación radicular. La paciente anhela conservar su pieza dentaria y se le practica un tratamiento endodóntico tradicional en 3 sesiones. Posterior a esto, se aplica MTA en el piso de la cámara pulpar y se evolucionó a los 5 y 10 días, lo que resultó un procedimiento donde se logró la conservación del diente, con el tratamiento equilibrado y la garantía de una mejor calidad de vida y atención. El presente estudio tiene como objetivo describir la evolución a los 10 días del empleo del Agregado de Trióxido Mineral en esa lesión de furca de un segundo molar permanente inferior izquierdo.ABSTRACTFemale patient of 47 years old comes to the consultation referring sharp pain in left lower side that doesn’t relief with analgesics. On the clinical examination was discovered restoration displaced and large dental caries below of cavity on 37. The x-ray showed injury of furca. The patient reaffirms her desire of keeping her tooth and make a treatment endodontic traditional in 3 times. Then, after applicant MTA in the flat of the pulpar camera and to see the evolutions around 5 to 10 days, resulting in a procedure on which the preservation of the tooth, equilibrate the expectative of treatment and warranty a better style life and attention for our patients. The objective of this study is to show the evolution in 10 days with employ of MTA in a furcal lesion in a permanent lower left second molar

Appropriate use of red blood cell transfusion in emergency departments: A study in five emergency departments

BACKGROUND: Transfusion of blood components continues to be an important therapeutic resource into the 21st century. Between 5 and 58% of transfusions carried out are estimated to be unnecessary. According to several studies, at least 20% of packed red blood cell transfusions (RBCT) are administered in hospital emergency departments (ED), but few data are available about the appropriateness of RBCT in this setting. This multicentre, cross-sectional observational study aims to assess the appropriateness of RBCT indications and transfused volumes in patients who attend ED. MATERIALS AND METHODS: The study cohort is made up of consecutive consenting adult patients (≥18 years old) who received RBCT in ED over a 3-month period and for whom relevant clinical data were collected and analysed. RESULTS: Data from 908 RBCT episodes (2±1 units per transfused patient) were analysed. RBCT was considered appropriate in 21.4% (n=195), with significant differences according to RBCT indication (p<0.001), hospital level (p<0.001) and prescribing physician (p=0.002). Pre-transfusion haemoglobin level (Hb) negatively correlated with RBCT appropriateness (r=-0.616; p<0.01). Only 72.4% of appropriate RBCT had a post-transfusion Hb assessment (n=516). Of these, 45% were considered to be over-transfused (n=232), with significant differences according to RBCT indication (p=0.012) and prescribing physician (p=0.047). Overall, 584/1,433 (41%) of evaluable RBC units were unnecessarily transfused. DISCUSSION: The appropriateness of RBCT in ED is similar to other hospital departments, but the rate of over-transfusion was high. These data support the need for a reassessment after transfusion of each RBC unit before further units are prescribed. In view of these results, we recommend that physicians should be made more aware of the need to prescribe RBCT appropriately in order to reduce over-transfusionThis project has received funding from the Spanish Ministry of Health, Social Policy and Equality through the SAS/2377/2010 call for granting aid for the promotion of independent clinical research (Department of Pharmacy and Health Products), file n. EC10-21