Efecto del calentamiento activo previo a la cirugía en la hipotermia perioperatoria de pacientes sometidos a anestesia loco-regional y general: ensayo clínico aleatorio

OBJETIVO: Evaluar el efecto del calentamiento activo previo (en adelante precalentamiento) sobre la frecuencia, duración y magnitud de la hipotermia definida como una temperatura < 36ºC. MATERIAL Y MÉTODO: Ensayo clínico aleatorio, unicéntrico, ciego, de adultos programados para cirugía no cardiaca, aleatorizados a un grupo con precalentamiento de al menos 5 minutos y calentados intraoperatoriamente con dispositivos de aire caliente versus un grupo no precalentado y calentado intraoperatoriamente con dispositivos de aire caliente, llevado a cabo en el Hospital Universitario de Torrejón (HUT), Madrid, España. La medición de la temperatura se realizó mediante el SpotOn de 3M®, dispositivo situado sobre la frente del paciente, que proporciona la temperatura central de los participantes. El objetivo primario fue identificar diferencias entre los grupos en la frecuencia de hipotermia, en la magnitud de la hipotermia calculada mediante el área bajo la curva por debajo de 36 ºC, y el tiempo gastado en hipotermia entre la inducción anestésica y la llegada a reanimación. Los resultados secundarios fueron identificar si existían diferencias en la frecuencia, magnitud y tiempo gastado en hipotermia entre los diferentes tiempos de precalentamiento, así como diferente frecuencia en las infecciones de la herida quirúrgica, pérdida de sangre, transfusiones, confort, temblores. RESULTADOS: Se analizaron 197 pacientes, 104 en el grupo control y 93 en el grupo precalentamiento. No encontramos diferencias en la frecuencia de hipotermia entre el grupo control 35 (33.7%) y los precalentados 37 (39.8%); p = 0.37. Tampoco se encontraron diferencias expresada como mediana [rango intercuartílico] en el tiempo gastado en hipotermia entre controles 45.22 [20.64-71.12] % y precalentados 41.57 [17.78-78.13] %; p = 0.83, ni en el área bajo la curva entre controles 0.2 [0.05-0.70] ºC.h-1 precalentados 0.19 [0.09-0.54] ºC.h-1; p =0.91. Los participantes mostraron diferencias en la sensación térmica, mostrando los precalentados más frecuencia de calor y disconfort que los controles. CONCLUSIÓN: En nuestro estudio, un mínimo de 10 minutos de precalentamiento combinado con calentamiento intraoperatorio con dispositivos de aire caliente no previene la hipotermia por redistribución pero puede favorecer una mayor preservación de calor y una temperatura más homogénea que los pacientes sin precalentamiento y con calentamiento intraoperatorio cuando existe un protocolo estricto de calentamiento intraoperatorio. El precalentamiento con dispositivos de aire caliente no reduce la frecuencia, magnitud y tiempo gastado en hipotermia, incluso aumenta el disconfort en el contexto de un estricto control de la temperatura ambiente en la sala antequirófano

Victus Ordine Constituto: la alimentación en la medicina de Amato Lusitano, una aproximación

The medical practice of João Rodrigues de Castelo Branco, also known as Amatus Lusitanus (1511-1568), pays particular attention to the establishment or modification of the dietary customs of his patients. The prescriptions included in the third volume (Centuria Tertia) of his book&nbsp;Curationum Medicinalium Centuriae&nbsp;show the wide range of food products used for therapy purposes, some of them really expensive. It is also remarkable that Amatus demands obedience to his dietary regulations from his patients.Parte de la tarea médica del portugués João Rodrigues de Castelo Branco, pseudónimo de Amato Lusitano (1511-1568), consiste en atender o modificar la dieta de sus pacientes. A través de las prescripciones de la&nbsp;Centuria Tertia, uno de los libros que componen su obra&nbsp;Curationum Medicinalium Centuriae, podemos ver el amplio número de alimentos utilizados con fines terapéuticos, algunos realmente costosos. También conocemos cómo la atención de este médico por la dieta exige la obediencia del paciente

Protocolo de prevención de la hipotermia perioperatoria: Una estrategia de manejo de la temperatura basada en la evidencia actual para evitar las complicaciones asociadas a la hipotermia

Perioperative hypothermia is a very frequent complication that compromises the safety of our surgical patients, increasing perioperative morbidity and mortality. Hypothermia also considerably increases health costs due to the increase in complications and hospital length of stay. Recently, the clinical practice guide for unintentional perioperative hypothermia of the Spanish Society of Anaesthesia (SEDAR) has been published. This guide presents current scientific evidence on perioperative hypothermia and recommendations on its management. Based on this guide, we present the protocol for the prevention of perioperative hypothermia in our institution. This protocol is based on a strategy that includes central temperature monitoring and 3 measures that have shown to reduce perioperative complications and be cost-effective: the use of convective air, warming of intravenous and irrigation fluids, and active warming prior to surgery.La hipotermia perioperatoria es una complicación muy frecuente en nuestro medio que compromete la seguridad de nuestros pacientes quirúrgicos aumentando la morbimortalidad perioperatoria. La hipotermia también aumenta de manera considerable los costes sanitarios por el aumento de las complicaciones y la estancia hospitalaria. Recientemente se ha publicado la guía de práctica clínica de hipotermia perioperatoria no intencionada de la SEDAR. En esta guía se presenta la evidencia científica actual sobre la hipotermia perioperatoria y las recomendaciones sobre su manejo. Basado en esta guía, presentamos el protocolo de prevención de la hipotermia perioperatoria de nuestro centro con una estrategia basada en la monitorización de la temperatura central y en 3 medidas que han demostrado disminuir las complicaciones perioperatorias y ser coste-efectivas: el uso de mantas de aire convectivo, el calentamiento de los fluidos intravenosos y de irrigación, y el calentamiento activo previo a la cirugía

Improved inter-device variability in graphene liquid gate sensors by laser treatment

We investigate the influence of a visible laser treatment on the electrical performance of CVD-grown graphene-based liquid gate sensors. This method allows to treat locally the graphene sheet, improving the electrical characteristic for biochemical sensing applications. Optimizing the laser exposure, the Dirac point (minimum conductivity voltage) was shifted around 300 mV to lower voltages, together with a decrease of the inter-device electrical variability. These results open the door to use the laser treatment to increase the sensibility and reproducibility of liquid gate graphene-based devices as sensors or biosensors.Grupo de Nanoelectrónica, TIC216, Departamento de Electronica y Tecnología de los ComputadoresEuropean Union’s Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No 895322Spanish Program (TEC2017-89800-R)SUPERA COVID19 Fund and CRUE-SantanderRegional Program FEDER UGRVID (CV20-36685), P18-RT-4826 projectUGRMADOC CEMIX 2D-EDE

Reversions of QuantiFERON-TB Gold Plus in tuberculosis contact investigation: A prospective multicentre cohort study

Background: Interferon-y Release Assays (IGRA) reversions have been reported in different clinical scenarios for the diagnosis of tuberculosis (TB) infection. This study aimed to determine the rate of QuantiFERON-TB Gold Plus (QFT-Plus) reversions during contact investigation as a potential strategy to reduce the number of preventive treatments. Methods: Prospective, multicentre cohort study of immunocompetent adult contacts of patients with pulmonary TB tested with QFT-Plus. Contacts with an initial positive QFT-Plus (QFT-i) underwent a second test within 4 weeks (QFT-1), and if negative, underwent a repeat test 4 weeks later (QFT-2). Based on the QFT-2 result, we classified cases as sustained reversion if they remained negative and as temporary reversion if they turned positive. Results: We included 415 contacts, of whom 96 (23.1%) had an initial positive test (QFT-i). Following this, 10 had negative QFT-1 results and 4 (4.2%) of these persisted with a negative result in the QFT-2 (sustained reversions). All four sustained reversions occurred in contacts with IFN-γ concentrations between ≥0.35 and ≤0.99 IU•mL-1 in one or both QFT-i tubes. Conclusion: In this study, TB contact investigations rarely reveal QFT-Plus reversion. These results do not support retesting cases with an initial positive result to reduce the number of preventive treatments

EMIR, the GTC NIR multi-object imager-spectrograph

EMIR, currently entering into its fabrication and AIV phase, will be one of the first common user instruments for the GTC, the 10 meter telescope under construction by GRANTECAN at the Roque de los Muchachos Observatory (Canary Islands, Spain). EMIR is being built by a Consortium of Spanish and French institutes led by the Instituto de Astrofísica de Canarias (IAC). EMIR is designed to realize one of the central goals of 10m class telescopes, allowing observers to obtain spectra for large numbers of faint sources in a time-efficient manner. EMIR is primarily designed to be operated as a MOS in the K band, but others a wide range of observing modes, including imaging and spectroscopy, both long slit and multi-object, in the wavelength range 0.9 to 2.5 um. It is equipped with two innovative subsystems: a robotic reconfigurable multi-slit mask and dispersive elements formed by the combination of high quality distraction grating and conventional prisms, both at the heart of the instrument. The present status of development, expected performances, schedule and plans for scientific exploitation are described and discussed. The development and fabrication of EMIR is funded by GRANTECAN and the Plan Nacional de Astronomía y Astrofísica (National Plan for Astronomy and Astrophysics, Spain).Peer ReviewedPostprint (published version

Effectiveness of Modified Vaccinia Ankara-Bavaria Nordic Vaccination in a Population at High Risk of Mpox: A Spanish Cohort Study

Background: With over 7,500 cases notified since April 2022, Spain has experienced the highest incidence of mpox in Europe. From July 12th onwards, the Modified Vaccinia Ankara-Bavaria Nordic (MVA-BN) smallpox vaccine was offered as pre-exposure prophylaxis for individuals at high-risk of mpox, including those receiving pre-exposure prophylaxis for HIV (HIV-PrEP). Our aim was to assess the effectiveness of one dose of MVA-BN vaccine as pre-exposure against mpox virus (MPXV) infection in persons on HIV-PrEP. Methods: We conducted a national retrospective cohort study between July 12 and December 12, 2022. Individuals ≥18 years, receiving HIV-PrEP as of July 12 and with no previous MPXV infection or vaccination were eligible. Each day, we matched individuals receiving a first dose of MVA-BN vaccine and unvaccinated controls of the same age group and region. We used a Kaplan-Meier estimator and calculate risk ratios (RR) and vaccine effectiveness (VE = 1-RR). Results: We included 5,660 matched pairs, with a median follow-up of 62 days (interquartile range 24-97). Mpox cumulative incidence was 5.6 per 1,000 (25 cases) in unvaccinated and 3.5 per 1,000 (18 cases) in vaccinated. No effect was found during days 0-6 post-vaccination (VE -38.3; 95% confidence interval (95%CI): -332.7; 46.4), but VE was 65% in ≥7 days (95%CI 22.9; 88.0) and 79% in ≥14 days (95%CI 33.3; 100.0) post-vaccination. Conclusions: One dose of MVA-BN vaccine offered protection against mpox in a most-at-risk population shortly after the vaccination. Further studies need to assess the VE of a second dose and the duration of protection over time.S

Asesoría lingüística digital e internacional: prácticas online para futuros docentes de lengua española

Memoria ID-039. Ayudas de la Universidad de Salamanca para la innovación docente, curso 2018-2019

Reseñas informativas

Not available.No disponible