Eficacia de la monoterapia con piperacilina-tazobactam en las infecciones del pie diabético

Resumen. Introducción. Las infecciones en el pie diabético constituyen un motivo habitual de consulta para los especialistas quirúrgicos y son en la actualidad el motivo más frecuente por el que los diabéticos ingresan en los hospitales, así como la causa principal de amputación no traumática. Objetivo. Estas infecciones son frecuentemente polimicrobianas, por lo que el objetivo del presente estudio ha sido evaluar la eficacia y la seguridad de un antibiótico de amplio espectro como la piperacilina-tazobactam en pacientes con infecciones graves del pie diabético. Pacientes y métodos. Estudio multicéntrico y prospectivo en donde 150 pacientes con infecciones del pie diabético recibieron piperacilina-tazobactam como tratamiento antibiótico. Resultados. La evolución clínica fue favorable en un 92,3% de los pacientes y la eficacia microbiológica obtenida al final del tratamiento fue del 89,9%. Se presentaron reacciones adversas al tratamiento en 10 pacientes (6,6%), y 84 necesitaron amputación (56%); se realizaron amputaciones menores en 78 enfermos y mayores en 6. Conclusiones. La eficacia clínica y microbiológica, junto con la escasez de efectos adversos presentados, hace de la piperacilina-tazobactam una alternativa eficaz en el manejo de estas infecciones

Tratamiento endovascular de la patología aórtica excepcional

Objetivo. Realizar una revisión de la literatura referente al tratamiento de la ruptura de la aorta torácica de etiología no traumática y la valoración de los resultados del tratamiento endovascular. Desarrollo. La ruptura de la aorta, independientemente de su localización, es una patología extremadamente grave. La ruptura aórtica se asocia con el hematoma mediastínico, el hemotórax y la fístula aortobronquial o aortoesofágica. La cirugía abierta continúa teniendo una mortalidad significativamente elevada y posiblemente no asumible, por lo que la conducta actual, cuando las condiciones anatómicas lo permiten, suele ser decantarse por el tratamiento endovascular; sin embargo, el beneficio de el tratamiento endovascular urgente permanece incierto. Las endoprótesis aórticas se han usado para tratar los aneurismas de aorta torácica en pacientes de alto riesgo, incluidos aquellos que presentaban una fístula aortobronquial o aortoesofágica. Conclusiones. Si no se trata, la ruptura de la aorta torácica es una situación mortal, los resultados de la cirugía abierta son desalentadores y la morbilidad de los supervivientes elevada. A pesar de que la terapia endovascular consigue una reducción significativa de la morbimortalidad, la información actual se basa en series cortas o casos aislados, por lo que es necesario completar los registros actuales para poder confirmar las expectativas generada

The T2K experiment

The T2K experiment is a long baseline neutrino oscillation experiment. Its main goal is to measure the last unknown lepton sector mixing angle θ13 by observing νe appearance in a νμ beam. It also aims to make a precision measurement of the known oscillation parameters, and sin22θ23, via νμ disappearance studies. Other goals of the experiment include various neutrino cross-section measurements and sterile neutrino searches. The experiment uses an intense proton beam generated by the J-PARC accelerator in Tokai, Japan, and is composed of a neutrino beamline, a near detector complex (ND280), and a far detector (Super-Kamiokande) located 295 km away from J-PARC. This paper provides a comprehensive review of the instrumentation aspect of the T2K experiment and a summary of the vital information for each subsystem

A horizon scan exercise for aquatic invasive alien species in Iberian inland waters

As the number of introduced species keeps increasing unabatedly, identifying and prioritising current and potential Invasive Alien Species (IAS) has become essential to manage them. Horizon Scanning (HS), defined as an exploration of potential threats, is considered a fundamental component of IAS management. By combining scientific knowledge on taxa with expert opinion, we identified the most relevant aquatic IAS in the Iberian Peninsula, i.e., those with the greatest geographic extent (or probability of introduction), severe ecological, economic and human health impacts, greatest difficulty and acceptability of management. We highlighted the 126 most relevant IAS already present in Iberian inland waters (i.e., Concern list) and 89 with a high probability of being introduced in the near future (i.e., Alert list), of which 24 and 10 IAS, respectively, were considered as a management priority after receiving the highest scores in the expert assessment (i.e., top-ranked IAS). In both lists, aquatic IAS belonging to the four thematic groups (plants, freshwater invertebrates, estuarine invertebrates, and vertebrates) were identified as having been introduced through various pathways from different regions of the world and classified according to their main functional feeding groups. Also, the latest update of the list of IAS of Union concern pursuant to Regulation (EU) No 1143/2014 includes only 12 top-ranked IAS identified for the Iberian Peninsula, while the national lists incorporate the vast majority of them. This fact underlines the great importance of taxa prioritisation exercises at biogeographical scales as a step prior to risk analyses and their inclusion in national lists. This HS provides a robust assessment and a cost-effective strategy for decision-makers and stakeholders to prioritise the use of limited resources for IAS prevention and management. Although applied at a transnational level in a European biodiversity hotspot, this approach is designed for potential application at any geographical or administrative scale, including the continental one

A horizon scan exercise for aquatic invasive alien species in Iberian inland waters

As the number of introduced species keeps increasing unabatedly, identifying and prioritising current and potential Invasive Alien Species (IAS) has become essential to manage them. Horizon Scanning (HS), defined as an exploration of potential threats, is considered a fundamental component of IAS management. By combining scientific knowledge on taxa with expert opinion, we identified the most relevant aquatic IAS in the Iberian Peninsula, i.e., those with the greatest geographic extent (or probability of introduction), severe ecological, economic and human health impacts, greatest difficulty and acceptability of management. We highlighted the 126 most relevant IAS already present in Iberian inland waters (i.e., Concern list) and 89 with a high probability of being introduced in the near future (i.e., Alert list), of which 24 and 10 IAS, respectively, were considered as a management priority after receiving the highest scores in the expert assessment (i.e., top-ranked IAS). In both lists, aquatic IAS belonging to the four thematic groups (plants, freshwater invertebrates, estuarine invertebrates, and vertebrates) were identified as having been introduced through various pathways from different regions of the world and classified according to their main functional feeding groups. Also, the latest update of the list of IAS of Union concern pursuant to Regulation (EU) No 1143/2014 includes only 12 top-ranked IAS identified for the Iberian Peninsula, while the national lists incorporate the vast majority of them. This fact underlines the great importance of taxa prioritisation exercises at biogeographical scales as a step prior to risk analyses and their inclusion in national lists. This HS provides a robust assessment and a cost-effective strategy for decision-makers and stakeholders to prioritise the use of limited resources for IAS prevention and management. Although applied at a transnational level in a European biodiversity hotspot, this approach is designed for potential application at any geographical or administrative scale, including the continental one

Delay in diagnosis of influenza A (H1N1)pdm09 virus infection in critically ill patients and impact on clinical outcome

Background: Patients infected with influenza A (H1N1)pdm09 virus requiring admission to the ICU remain an important source of mortality during the influenza season. The objective of the study was to assess the impact of a delay in diagnosis of community-acquired influenza A (H1N1)pdm09 virus infection on clinical outcome in critically ill patients admitted to the ICU. Methods: A prospective multicenter observational cohort study was based on data from the GETGAG/SEMICYUC registry (2009–2015) collected by 148 Spanish ICUs. All patients admitted to the ICU in which diagnosis of influenza A (H1N1)pdm09 virus infection had been established within the first week of hospitalization were included. Patients were classified into two groups according to the time at which the diagnosis was made: early (within the first 2 days of hospital admission) and late (between the 3rd and 7th day of hospital admission). Factors associated with a delay in diagnosis were assessed by logistic regression analysis. Results: In 2059 ICU patients diagnosed with influenza A (H1N1)pdm09 virus infection within the first 7 days of hospitalization, the diagnosis was established early in 1314 (63.8 %) patients and late in the remaining 745 (36.2 %). Independent variables related to a late diagnosis were: age (odds ratio (OR) = 1.02, 95 % confidence interval (CI) 1.01–1.03, P < 0.001); first seasonal period (2009–2012) (OR = 2.08, 95 % CI 1.64–2.63, P < 0.001); days of hospital stay before ICU admission (OR = 1.26, 95 % CI 1.17–1.35, P < 0.001); mechanical ventilation (OR = 1.58, 95 % CI 1.17–2.13, P = 0.002); and continuous venovenous hemofiltration (OR = 1.54, 95 % CI 1.08–2.18, P = 0.016). The intra-ICU mortality was significantly higher among patients with late diagnosis as compared with early diagnosis (26.9 % vs 17.1 %, P < 0.001). Diagnostic delay was one independent risk factor for mortality (OR = 1.36, 95 % CI 1.03–1.81, P < 0.001). Conclusions: Late diagnosis of community-acquired influenza A (H1N1)pdm09 virus infection is associated with a delay in ICU admission, greater possibilities of respiratory and renal failure, and higher mortality rate. Delay in diagnosis of flu is an independent variable related to death

Beneficial effects of biochar to contaminated soils on the bioavailability of Cd, Pb and Zn and the biomass production of rapeseed (Brassica napus L.).

The observation of the recent electron neutrino appearance in a muon neutrino beam and the high-precision measurement of the mixing angle $\theta_{13}$ have led to a re-evaluation of the physics potential of the T2K long-baseline neutrino oscillation experiment. Sensitivities are explored for CP violation in neutrinos, non-maximal $\sin^22\theta_{23}$, the octant of $\theta_{23}$, and the mass hierarchy, in addition to the measurements of $\delta_{CP}$, $\sin^2\theta_{23}$, and $\Delta m^2_{32}$, for various combinations of $\nu$-mode and $\bar{\nu}$-mode data-taking. With an exposure of $7.8\times10^{21}$~protons-on-target, T2K can achieve 1-$\sigma$ resolution of 0.050(0.054) on $\sin^2\theta_{23}$ and $0.040(0.045)\times10^{-3}~\rm{eV}^2$ on $\Delta m^2_{32}$ for 100\%(50\%) neutrino beam mode running assuming $\sin^2\theta_{23}=0.5$ and $\Delta m^2_{32} = 2.4\times10^{-3}$ eV$^2$. T2K will have sensitivity to the CP-violating phase $\delta_{\rm{CP}}$ at 90\% C.L. or better over a significant range. For example, if $\sin^22\theta_{23}$ is maximal (i.e $\theta_{23}$=$45^\circ$) the range is $-115^\circ<\delta_{\rm{CP}}<-60^\circ$ for normal hierarchy and $+50^\circ<\delta_{\rm{CP}}<+130^\circ$ for inverted hierarchy. When T2K data is combined with data from the NO$\nu$A experiment, the region of oscillation parameter space where there is sensitivity to observe a non-zero $\delta_{CP}$ is substantially increased compared to if each experiment is analyzed alone.Comment: 40 pages, 27 figures, accepted by PTE

Recent Results from the T2K Experiment

The Tokai to Kamioka (T2K) experiment studies neutrino oscillations using a beam of muon neutrinos produced by an accelerator. The neutrinos travel from J-PARC on the east coast of Japan and are detected 295 kilometers further away in the Super-Kamiokande detector. A complex of near detectors located 280 meters away from the neutrino production target is used to better characterize the neutrino beam and reduce systematic uncertainties. The experiment aims at measuring electronic neutrino appearance (νμ→νe oscillation) to measure the neutrino mixing angle θ13, and muon neutrino disappearance to measure the neutrino mixing angleθ23 and mass splitting |Δm232|. We report here electron neutrino appearance results using three years of data, recorded until the 2012 summer, as well as muon neutrino disappearance results based on the data coming from the first two years of the experiment