Cirugía Cardiovascular en España en el año 2005. Registro de intervenciones de la Sociedad Española de Cirugía Torácica y Cardiovascular

El registro de intervenciones de la Sociedad Española de Cirugía Torácica y Cardiovascular del año 2005 recoge los datos de 51 hospitales. Se intervinieron un total de 29.801 pacientes, con una media de 585 intervenciones/centro. Veintidós mil cuatrocientas diecisiete fueron consideradas intervenciones mayores, ya fuese bajo circulación extracorpórea (CEC), revascularización coronaria u otras intervenciones importantes sin CEC, o cirugía congénita también sin CEC. La media de intervenciones/hospital fue de 439. Por tipos de intervención se dividen en: cirugía coronaria aislada 30,5%, cirugía valvular 40,4%, cirugía combinada 9%, cirugía de las cardiopatías congénitas 9,1% y misceláneas 3,9%. El número de intervenciones valvulares (7.535) es superior al de las revascularizaciones coronarias realizadas (5.698), mientras que la cantidad de cirugías combinadas, valvulares y coronarias fue de 1.678 operaciones. La mortalidad global para la cirugía de revascularización coronaria aislada con CEC fue del 4%, y sin CEC 3,5%. La media de injertos/paciente fue de 2,9 y 2,4, respectivamente. La mortalidad hospitalaria de los pacientes intervenidos con CEC, según el número de injertos/paciente, fue de 3,4, 4,6, 3,9, 3,4 y 4,3% para uno, dos, tres, cuatro y cinco o más injertos. Se implantaron un total de 10.079 prótesis valvulares, de las que el 52,1% eran mecánicas y el 11,4% anillos protésicos mitrales o tricúspides. De un total de 7.535 intervenciones de cirugía valvular, en 5.628 se actuó sobre una vál- vula, y de ellos en 3.739 (66,4%) fue sobre la válvula aórtica, con una mortalidad del 6,2 y 9,2% si se asoció revascularización. Se realizaron 1.843 (32,7%) intervenciones sobre la válvula mitral aislada, con una mortalidad del 8,3 y 11,3% si además hubo revascularización. Se practicaron 1.273 intervenciones sobre dos válvulas y 231 sobre tres válvulas, con una mortalidad del 8,1 y 12,1%, respectivamente. Se intervinieron 1.702 pacientes para corrección de sus cardiopatías congénitas, de éstos 1.240 fueron procedimientos con CEC y 462 sin ella. Se realizaron 278 trasplantes cardíacos en adultos, con una mortalidad hospitalaria del 14,8%. Se llevaron a cabo 3.909 implantaciones de marcapasos, 1.411 cambios de generador, 530 implantaciones de desfibriladores y 158 cambios de generador desfibrilador.Se intervinieron 3.549 pacientes de cirugía vascular periférica. Mil trescientos setenta y siete enfermos fueron intervenidos por aneurisma aórtico de alguna localización, de los que 1.137 (82,6%) necesitaron CEC para realizar la corrección.The Spanish Society of Thoracic and Cardiovascular Surgery Registry for the year 2005 includes data from 51 hospitals. Within this year a total of 29,801 patients were operated on, with an average of 585 operations/center. With extracorporeal circulation, aortocoronary bypass off-pump and congenital cardiac surgery were operated 22,417 patients with an average of 439 cases/hospital. Interventions were 30.5% coronary surgery, valvular surgery 40.4%, combined valvular and coronary surgery 9%, congenital heart surgery 9.1% and 3.9% miscellaneous. The number of valvular surgeries was superior to that coronary procedures (7535 vs. 5698) and combined 1678. Total hospital mortality was 4% for the coronary revascularization with extracorporeal circulation and 3.5% in off-pump. The average of coronary graft/patient was 2.9 with ECC and 2.4 without ECC. The hospital mortality for revascularization with extracorporeal circulation was 3.4, 4.6, 3.9, 3.4 and 4.3% for one, two, three, four or five or more grafts.The number of valvular prosthesis implanted was 10,079, and the 52.1% of these are mechanical and 11.4% valvular rings. From the total number of 7535 patients with valvular surgery, 5628 underwent one valve surgery. Aortic valve was operated 3739 (66.4%) patients with a hospital mortal- ity of 6.2 and 9.2% if associated with coronary revascularization. Mitral valve surgery was done in 1843 (32.7%) patients and with hospital mortality of 8.3 and 11.3% in cases combined with revascularization. Two valve surgery was done in 1273 patients and 231 patients was three valve surgery and hospital mortality was 8.1 and 12.1% respectively.The number of patients operated on for congenital cardiac defects was 1702 and there were 1240 open heart surgeries and 462 closed. Heart transplant were done in 278 adults patients with hospital mortality of 14.8%. Pacemakers were implanted in 3909 patients and pacemaker generator exchange was done in 1411. Implantation of defibrillator in 530 cases and defibrillator exchange in 158 patients.There were 3549 operations by peripheral vascular surgery. The number of aortic aneurysms operated on during this year was 1377 for all localizations and them 1137 (82,6%) was done with extracorporeal circulation

La Directiva Europea sobre el Horario de Trabajo y su impacto sobre la formación quirúrgica. Resultados de una encuesta entre los residentes de Cirugía Cardiovascular en España

ObjetivosLa Directiva Europea del Horario de Trabajo (European Working time Directive [EWTD]) de 1993 debería estar en funcionamiento para cirujanos cardiovasculares y residentes en agosto de 2009, como respuesta a las dudas sobre la calidad del cuidado del paciente y la calidad de vida de los profesionales causadas por el trabajo excesivo y la fatiga laboral. Hay temor al impacto negativo de la fatiga en la calidad de la atención al paciente y de las residencias quirúrgicas, en especial en Cirugía Cardiovascular. Evaluamos el nivel de conocimiento de los residentes españoles sobre la EWTD.MétodosEncuesta individual a los residentes asistentes al XIII Curso de Residentes de la Sociedad Española de Cirugía Torácica y Cardiovascular de mayo de 2008. Incluye un resumen de los objetivos principales de la EWTD.ResultadosAsistieron 58 de 70 residentes posibles. La encuesta fue completada por 26. El 92,3% no había leído la EWTD y el 26,9% no tenía el mínimo conocimiento. El 54,2% estaba de acuerdo con su contenido; 53,8% la considera incompatible con su modelo ideal de formación; 68% cree que tendrá impacto negativo en la misma; 87% cree que discrimina a los residentes quirúrgicos; 65,2% cree que reducirá sus ingresos anuales; 84,6% cree que parte de la plantilla de sus servicios se opondrá.ConclusionesExiste un desconocimiento muy importante sobre la EWTD por los residentes españoles de Cirugía Cardiovascular. Sorprendentemente, la mayoría está de acuerdo con la EWTD a pesar de que pueda tener impacto negativo en su formación y retribución económica. Se requiere una profunda reflexión por parte de las sociedades profesionales sobre este tema para promover y proteger la formación en nuestra especialidad.ObjectivesThe 1993 European Working Time Directive (EWTD) should be implemented to its entirety for cardiovascular surgeons and residents by August 2009 as an answer to the concern about patient care and quality of life of professionals caused by fatigue and excessive continuous work. Great concern rose regarding its negative impact in the quality of surgical residencies, specifically in cardiovascular surgery. Our objective was to assess the knowledge of Spanish Cardiovascular Surgery residents on the EWTD and their level of agreement with its content.MethodsA survey questionnaire was given to all residents attending the XIII Annual Course organized by the Spanish Society of Thoracic-Cardiovascular Surgery in May 2008. It included a brief summary of the key features of the EWTD.ResultsOut of 70 eligible residents, 58 attended. Of these, 26 completed and returned the survey. 92,3% never read and 26,9% knew absolutely nothing about the EWTD. 54,2% agreedwith its content; 53,8% think it is not compatible with their ideal training model; 68% believe it will have a negative impact on their training; 87% think it negatively discriminates surgical residents; 65,2% believe it will decrease their annual stipends; 84,6% think it will find the opposition of part of the staff in their respective departments.ConclusionsKnowledge about the contents of the EWTD among Spanish Cardiovascular Surgery residents is scarce. The majority of them agree with the EWTD even realizing it may have a negative impact on training quality and economic retribution. A deep reflection on this by national and European societies to protect and promote the quality of the training in our specialty is required

Acriaster aresensis sp. nov. (Echinoidea: Cassiduloida) from the Barremian of Ares del Maestrat

Les investigacions sobre la sistemàtica de la classe Echinoidea a la conca sedimentària del Maestrat representen, en aquest moment, un dels centres d’interès actual en els estudis d’equinologia. Potser aquesta conca, al marge oest del Tetis, va jugar una paper important al Cretaci Inferior en l’aparició, radiació i dispersió d’alguns grups d’equínids. Durant els últims anys una sèrie d’estudis han contribuït a millorar el coneixement dels equinoïdeus de la conca i millorar-ne la sistemàtica. Però s’està molt lluny de completar la tasca. Aquest article només és una petita contribució per avançar cap aquest objectiu. El treball té interès perquè permet ampliar el coneixement sobre el gènere Acriaster Smith, 1991, del qual es disposava, fins ara, d’un registre fòssil mundial extraordinàriament escàs: un únic exemplar, sobre el qual es va descriure el gènere i l’espècie A. sergipensis Smith, 1991. Mitjançant aquest estudi el registre del gènere es veu ampliat a tres exemplars i dues espècies. Les noves dades ajuden a intuir la relació entre la fauna del marge oest del Tetis i les faunes americanes amb l’obertura de l’oceà Atlàntic. Es descriu una espècie nova: Acriaster aresensis. S’ha eixamplat la distribució estratigràfica del gènere Acriaster, del qual es retrocedeix el registre fins al Barremià, i la geogràfica amb la presència constatada a la conca del Maestrat. I s’ha endarrerit el registre fòssil de la família Archiaciidae Cotteau &Triger, 1869 fins al Barremià. El treball suposa una millora en el coneixement d’un gènere molt poc conegut. Permet plantejar-se una altra hipòtesi, que altera, de forma radical, el que es suposava fins ara, com a conseqüència que l’única espècie coneguda fins aquest treball era de l’Albià de Brasil. Ara es pot plantejar que l’origen del gènere Acriaster va estar al marge oest del Tetis, potser a la mateixa conca del Maestrat, des de la qual més tard va arribar a Amèrica. Aquest estudi amplia el coneixement sobre la biodiversa i complexa fauna d’equínids de la conca del Maestrat.Research on the systematics of the Echinoidea class in the Maestrat sedimentary basin is one of the current interests in echinology. Perhaps this basin, on the western margin of the Tethys, played an important role during the Lower Cretaceous in the appearance, radiation and dispersal of some groups of echinoids. In recent years, a number of studies have helped to improve the knowledge of the echinoids in the basin and to improve their systematics. But it is far from complete. This article is just a small contribution to this goal. The work is interesting because it expands the knowledge about the genus Acriaster Smith, 1991, which until now had an extraordinarily scarce world fossil record: a single specimen, on which the genus and the species were described: A. sergipensis Smith, 1991. Through this study the genus register is extended to three specimens and two species. The new data helps us to hypothesise about the relationship between wildlife on the western margin of the Tethys and American wildlife with the opening of the Atlantic Ocean. A new species is described: Acriaster aresensis. The stratigraphic distribution of the genus Acriaster has been widened, starting back in the Barremian, as well as its geographical distribution with its presence found in the Maestrat basin. The fossil record of the Archiaciidae Cotteau & Triger family, 1869, has been pushed back to Barremian. This paper improves the knowledge of a very little-known genus. It allows the raising of a different hypothesis than the present one, based on the single presence of the Acriaster in the Albian of Brazil. It is now possible that the origin of the genus Acriaster was on the western Tethys, perhaps in the same Maestrat basin, from which it later reached America. This paper expands the knowledge about the biodiversity and complex fauna of echinoids in the Maestrat basin

Detección en urgencias de infección por VIH en pacientes que consultan por condiciones potencialmente relacionadas con infección oculta: resultados iniciales del programa "Urgències VIHgila"

Objective: To estimate the prevalence of unknown HIV infection in patients who consulted in hospital emergency services (ED) for conditions defined in the SEMES-GESIDA Consensus Document (DC), evaluate the efficiency of its im-plementation and investigate the efficiency of HIV serology determination in other conditions. Methods: Results were reviewed in 10 Catalan EDs for 12 months (July-21-June-22) after implementing CD recommendations: request HIV serology in case of suspected sexually transmitted infection, chemsex, post-exposure prophylaxis (PEP), mononucleosis syndrome, community pneumonia (18-65 y-o) or herpes zoster (18-65 y-o). Other reasons for request were included. Prevalence (%) of global seropositivity and for each circumstance was calculated, with a 95% confidence interval (95%CI). The efficient strategy was considered if the lower limit of the CI95%>0.1%. Results: A total of5,107 HIV serologies were performed: 2,847(56%) in situations specified in CD, and 2,266 (44%) in other 138 circumstances. Forty-eight unknown HIV infections were detected (prevalence=0.94%;95%CI=0.69-1.24). The prevalence was somewhat higher in DC requests (30 cas-es 1.12%) than the rest (18 cases 0.71%; p=0.16). The individualized prevalence of CD reasons ranged between 7.41% (95%CI=0.91-24.3) in chemsex and 0.42% 95%CI=0.14-0.98 in PPE, always efficient except herpes zoster (0.76%; CI95%=0.02-4.18). In other reasons, cases were detected in 12 circumstances, and in four the determination could be efficient: lymphopenia (10%;CI95%=0.25-44.5), fever with polyarthralgia-polyarthritis (7.41%;CI95% =0.91-24.3), behavioral alteration-confusion-encephalopathy (3.45%;95%CI=0.42-11.9) and fever of unknown origin (2.50%;95%CI=0.82-5.74). Conclusions: The determination of HIV serology in HES in the processes defined by DC SEMES-GESIDA is efficient. Some circumstances are identified that could be added to those previously contemplated to increase efficiency

a retrospective multicenter study

Funding This study was supported in part by a grant from the French government through the « Programme Investissement d’Avenir» (I-SITE ULNE) managed by the Agence Nationale de la Recherche (coVAPid project). Prof. Ignacio Martin-Loeches has been supported by SFI (Science Foundation Ireland), Grant number 20/COV/0038. The funders of the study had no role in the study design, data collection, analysis or interpretation, writing of the report or deci sion to submit for publication.BACKGROUND: Ventilator-associated pneumonia (VAP) is common in patients with severe SARS-CoV-2 pneumonia. The aim of this ancillary analysis of the coVAPid multicenter observational retrospective study is to assess the relationship between adjuvant corticosteroid use and the incidence of VAP. METHODS: Planned ancillary analysis of a multicenter retrospective European cohort in 36 ICUs. Adult patients receiving invasive mechanical ventilation for more than 48 h for SARS-CoV-2 pneumonia were consecutively included between February and May 2020. VAP diagnosis required strict definition with clinical, radiological and quantitative microbiological confirmation. We assessed the association of VAP with corticosteroid treatment using univariate and multivariate cause-specific Cox's proportional hazard models with adjustment on pre-specified confounders. RESULTS: Among the 545 included patients, 191 (35%) received corticosteroids. The proportional hazard assumption for the effect of corticosteroids on the incidence of VAP could not be accepted, indicating that this effect varied during ICU stay. We found a non-significant lower risk of VAP for corticosteroid-treated patients during the first days in the ICU and an increased risk for longer ICU stay. By modeling the effect of corticosteroids with time-dependent coefficients, the association between corticosteroids and the incidence of VAP was not significant (overall effect p = 0.082), with time-dependent hazard ratios (95% confidence interval) of 0.47 (0.17-1.31) at day 2, 0.95 (0.63-1.42) at day 7, 1.48 (1.01-2.16) at day 14 and 1.94 (1.09-3.46) at day 21. CONCLUSIONS: No significant association was found between adjuvant corticosteroid treatment and the incidence of VAP, although a time-varying effect of corticosteroids was identified along the 28-day follow-up.publishersversionpublishe