Cancelación de procedimientos quirúrgicos programados: causas, consecuencias y soluciones

La cancelación de procedimientos quirúrgicos programados repercute negativamente en los pacientes afectados (trastorno social, económico y de salud), y también en el conjunto de la población atendida, al reducir la efectividad y la eficiencia del su sistema sanitario. Conocer y analizar las causas de este fenómeno es un paso previo necesario para poder reducir su incidencia. La implicación de los anestesiólogos en este proceso de análisis es imprescindible, dado que estos ocupan posiciones clave en la organización y funcionamiento del bloque quirúrgico

Cancelación de procedimientos quirúrgicos programados: causas, consecuencias y soluciones: González-Arévalo A, Gómez Arnau JI, De la Cruz FJ, Marzal JM, Ramírez S, Corral EM, García del Valle S. Causes for cancellation of elective surgical procedures in a Spanish general hospital. Anaesthesia 2009; 64: 487-493.

La cancelación de procedimientos quirúrgicos programados repercute negativamente en los pacientes afectados (trastorno social, económico y de salud), y también en el conjunto de la población atendida, al reducir la efectividad y la eficiencia del su sistema sanitario. Conocer y analizar las causas de este fenómeno es un paso previo necesario para poder reducir su incidencia. La implicación de los anestesiólogos en este proceso de análisis es imprescindible, dado que estos ocupan posiciones clave en la organización y funcionamiento del bloque quirúrgico

From magma source to volcanic sink under Tagoro Volcano (El hierro, Canary Islands): Petrologic, Geochemical and Physiographic Evolution of the 2011-2012 Submarine Eruption

Active volcanoes are key laboratories to carry out detailed research -and monitoring- about the history of magmas before, during and after eruptions. Tagoro, the submarine active vol- cano at El Hierro Island (Canary archipelago), is a highly favorable case to assess and monitor its daily ongoing behaviour, as well as to study the links between the processes of magma genesis occurring at depth and their derived eruptive events at the surface. In this interdisciplinary research we combine new results of classical petrology (petrography, geochemistry, and thermodynamics) on the volcanic products expelled by Tagoro during the 2011–2012 eruption, with a high- resolution (5 m grid) bathymetry model car- ried out during 2017, and recent data from magnetometry, to refine the current knowl- edge of this eruption. Our results mainly reveal (i) slight magma differentiation and mixing processes at c. 12 km depth during a continuous eruptive pulse; (ii) a similar mag- matic evolution and residence times at depth between previous and 2011–2012 eruptions on the island; (iii) an insignificant interaction of external fluids with the magma at depth or within the ascent conduit; (iv) a present-day magnetometric anomaly under the Tagoro’s area; (v) a minimum volume estimate for the magma withdrawn from the plumbing system at depth.MINECO and FEDER: VULCANO I (CTM2012-36317). Instituto Español de Oceanografía.VULCANA (Vulcana IEO-2015-2017). Instituto Español de OceanografíaMINECO AND MEC. EXPLORA-CIENCIA (CGL2014—61775-EXP)MINECO AND MEC. EXPLORA-CIENCIA (CAS14-00189; MEC)Programa Propio mod. 1B— 2019 (USAL)EC Grant EVE (DG ECHO H2020 826292)PhD grant “Programa Propio III Universidad de Salamanca, cofounded by Banco de Santander”The PTI VOLCAN research initiatives.Peer reviewe

Role of age and comorbidities in mortality of patients with infective endocarditis

[Purpose]: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. [Methods]: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. [Results]: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39–1.88),and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. [Conclusion]: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group

Experimental study of differentially rotating supersonic plasma flows produced by aluminium wire array Z-pinches

A novel approach to cylindrical wire array z-pinches has been developed in order to create a rotating plasma flow analogous to astrophysical accretion discs. The method involves subjecting the wire array to a cusp magnetic field (B_r) to create converging off axis ablation streams to form a rotating flow. The rotation is sustained by the ram pressure of the ablation streams in a quasi-equilibrium state for approximately 150 ns. This corresponds to one full rotation of the plasma about the axis. The rotating plasma is supersonic with Mach number ~2 and a radially constant rotation velocity between 60 and 75 km/s; the angular velocity therefore has an r^-1 dependence and the flow is differential. A Thomson scattering diagnostic is used to measure the electron and ion temperatures as Te ~30 eV and Ti >55 eV and the ionisation of the plasma (Z) between 6 and 8. These parameters are used to calculate the Reynolds number (10^5 to 10^6) and magnetic Reynolds numbers (20 to 100) which are large enough for viscous and resistive effects to be negligible on the large scale of the flow. These are of sufficient magnitude for the experiment to be scalable to astrophysical accretion discs. Further more the Reynolds number for the experiment is large enough for shear instabilities to manifest in the plasma. Some evidence for this can be seen in XUV images and Thomson spectra which indicate the development of perturbations and vorticity within the flow. Predictions for the growth rate of the Kelvin Helmholtz instability, 12 to 40 ns, agree reasonably well with the observed perturbation growth of ~30 ns. It is also possible that shear instabilities are driving hydrodynamic turbulence. Turbulent heating of the plasma could explain the approximately 500 eV increase in the ion temperature observed from some Thomson spectra. Further work is required however to prove the existence of shear flows and turbulence within the experiments.Open Acces

Spatiotemporal Characteristics of the Largest HIV-1 CRF02_AG Outbreak in Spain: Evidence for Onward Transmissions

Background and Aim: The circulating recombinant form 02_AG (CRF02_AG) is the predominant clade among the human immunodeficiency virus type-1 (HIV-1) non-Bs with a prevalence of 5.97% (95% Confidence Interval-CI: 5.41–6.57%) across Spain. Our aim was to estimate the levels of regional clustering for CRF02_AG and the spatiotemporal characteristics of the largest CRF02_AG subepidemic in Spain.Methods: We studied 396 CRF02_AG sequences obtained from HIV-1 diagnosed patients during 2000–2014 from 10 autonomous communities of Spain. Phylogenetic analysis was performed on the 391 CRF02_AG sequences along with all globally sampled CRF02_AG sequences (N = 3,302) as references. Phylodynamic and phylogeographic analysis was performed to the largest CRF02_AG monophyletic cluster by a Bayesian method in BEAST v1.8.0 and by reconstructing ancestral states using the criterion of parsimony in Mesquite v3.4, respectively.Results: The HIV-1 CRF02_AG prevalence differed across Spanish autonomous communities we sampled from (p &lt; 0.001). Phylogenetic analysis revealed that 52.7% of the CRF02_AG sequences formed 56 monophyletic clusters, with a range of 2–79 sequences. The CRF02_AG regional dispersal differed across Spain (p = 0.003), as suggested by monophyletic clustering. For the largest monophyletic cluster (subepidemic) (N = 79), 49.4% of the clustered sequences originated from Madrid, while most sequences (51.9%) had been obtained from men having sex with men (MSM). Molecular clock analysis suggested that the origin (tMRCA) of the CRF02_AG subepidemic was in 2002 (median estimate; 95% Highest Posterior Density-HPD interval: 1999–2004). Additionally, we found significant clustering within the CRF02_AG subepidemic according to the ethnic origin.Conclusion: CRF02_AG has been introduced as a result of multiple introductions in Spain, following regional dispersal in several cases. We showed that CRF02_AG transmissions were mostly due to regional dispersal in Spain. The hot-spot for the largest CRF02_AG regional subepidemic in Spain was in Madrid associated with MSM transmission risk group. The existence of subepidemics suggest that several spillovers occurred from Madrid to other areas. CRF02_AG sequences from Hispanics were clustered in a separate subclade suggesting no linkage between the local and Hispanic subepidemics

C-protein reactive as a marker of surgical stress reduction with an ERAS protocol (enhanced recovery after surgery) in colorectal surgery: a proxpective cohort study.

Background: The aim of this study is to evaluate the effectiveness of an Enhanced Recovery After Surgery Protocol (ERAS) in relation to reduce the Systemic Inflammatory Response (SIR) to surgery using C-reactive protein (CRP) in the first (POD1), second (POD2) and third (POD3) postoperative day. Methods: We enrolled 121 patients (ERAS group) that underwent elective colorectal surgery with ERAS, and compared them with 135 patients (preERAS group) that had undergone surgery prior to the implementation. We made a univariate analysis to compare the CRP values in POD1, POD2, and POD3 between preERAS/ERAS group, laparoscopic/open surgery and the presence or not of Clavien Dindo complications. Multivariable lineal regression was used to assess if the ERAS had a decreasing effect on the CRP in POD1, POD2, and POD3, and was adjusted by age, male sex, use of laparoscopy, and complications. Results: The presence of complications was independently associated with an increase in CRP values ​​in POD1, POD2, and POD3. Laparoscopy in POD1 and POD2, and ERAS in POD2 was independently associated with a decrease in CRP values. Conclusion: The analysis shows an increase in SIR measured as a CRP value in those patients that had complications. The SIR decreased with laparoscopy in POD1 and POD2 and with ERAS in POD2.Depto. de CirugíaFac. de MedicinaTRUEpu