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La sección de Vía Aérea de la Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor (SEDAR), la Sociedad Española de Medicina de Urgencias y Emergencias (SEMES) y la Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL-CCC) presentan la Guía para el manejo integral de la vía aérea difícil en el paciente adulto. Sus principios están focalizados en el factor humano, los procesos cognitivos para la toma de decisiones en situaciones críticas y la optimización en la progresión de la aplicación de estrategias para preservar una adecuada oxigenación alveolar con el objeto de mejorar la seguridad y la calidad asistencial. El documento proporciona recomendaciones basadas en la evidencia científica actual, herramientas teórico-educativas y de implementación, fundamentalmente ayudas cognitivas, aplicables al tratamiento de la vía aérea (VA) en el campo de la anestesiología, cuidados críticos, urgencias y medicina prehospitalaria. Para ello, se realizó una amplia búsqueda bibliográfica según las directrices PRISMA-R y se analizó utilizando la metodología GRADE. Las recomendaciones se formularon de acuerdo con esta metodología. Las recomendaciones de aquellas secciones con evidencia de baja calidad se basaron en la opinión de expertos mediante el consenso alcanzado a través de un cuestionario Delphi.

Comparar las características, evolución y pronóstico de los pacientes con enfermedad pulmonar obstructiva crónica (EPOC) hospitalizados por COVID-19 en España en la primera ola con los de la segunda ola.

Existen pocos estudios sobre pacientes con insuficiencia cardíaca (IC) ingresados por COVID-19. Nuestro objetivo fue describir las características clínicas de los pacientes con IC ingresados por COVID-19 e identificar los factores de riesgo al ingreso de mortalidad intrahospitalaria.

ObjectivesTo study prevalence of infection in essential workers of Madrid City Council by occupation, related characteristics, use of protective devices, risk perception, and main concerns about COVID-19 during lockdown.MethodsA total of 30 231 workers were PCR tested for SARS-CoV-2 infection. Information was collected on COVID-19-related symptoms, risk factors, preventive equipment, and risk perception. The crude prevalence was calculated for infection, use of protective devices, perceived risk and main concerns. Additionally, adjusted prevalence and prevalence ratios (PR) were estimated for these variables using logistic regression models with age, gender, occupation, epidemiological week and laboratory as confounding factors.ResultsOverall prevalence of infection was 3.2% (95% CI 3.0% to 3.4%), being higher among policemen (4.4%) and bus drivers (4.2%), but lower among emergency healthcare personnel, firefighters, food market workers and burial services (<2%). Lower excess risk was observed in workers reporting occupational contact with COVID-19 cases only (PR=1.42; 95% CI 1.18 to 1.71) compared with household exposure only (PR=2.75; 95% CI 2.32 to 3.25). Infection was more frequent in symptomatic workers (PR=1.28; 95% CI 1.11 to 1.48), although 42% of detected infections were asymptomatic. Use of facial masks (78.7%) and disinfectants (86.3%) was common and associated with lower infection prevalence (PRmasks=0.68; 95% CI 0.58 to 0.79; PRdisinfectants=0.75; 95% CI 0.61 to 0.91). Over 50% of workers felt being at high risk of infection and worried about infecting others, yet only 2% considered quitting their work.ConclusionsThis surveillance system allowed for detecting and isolating SARS-CoV-2 cases among essential workers, identifying characteristics related to infection and use of protective devices, and revealing specific needs for work-safety information and psychological support.

España ha sido uno de los países más afectados por la pandemia de COVID-19.

La inducción de secuencia rápida (ISR) en adultos ha experimentadcambios en los últimos años debido a los avances farmacológicos y tecnológicos. El objetivo de esta encuesta fue evaluar la práctica actual entre los anestesiólogos españoles.

Non-cardiac chest pain is defined as a clinical syndrome characterized by retrosternal pain similar to that of angina pectoris, but of non-cardiac origin and produced by esophageal, musculoskeletal, pulmonary, or psychiatric diseases.

Dolor torácico no cardíaco (DTNC) se define como un síndrome clínico caracterizado por dolor retroesternal semejante a la angina de pecho, pero de origen no cardiaco y generado por enfermedades esofágicas, osteomusculares, pulmonares o psiquiátricas.

To describe potential regional variations in therapies for severe asthma exacerbations in Chilean children and estimate the associated health expenditures.

El estudio tenía como objetivo describir las características y los resultados de los pacientes según la PaO2/FiO2(PAFI) y el grado de inflamación.

Goh et al. propusieron en 2008 un algoritmo clasificatorio de SSc-EPID limitada o extensa. La prevalencia de ambos en el momento del diagnóstico de SSc-EPID no se conoce con exactitud.

Multicenter collaborative networks are essential for advancing research and improving clinical care for a variety of conditions. Research networks are particularly important for central nervous system infections, which remain difficult to study due to their sporadic occurrence and requirement for collection and testing of cerebrospinal fluid. Establishment of long-term research networks in resource-limited areas also facilitates diagnostic capacity building, surveillance for emerging pathogens, and provision of appropriate treatment where needed. We review our experience developing a research network for encephalitis among twelve hospitals in five Peruvian cities since 2009. We provide practical suggestions to aid other groups interested in advancing research on central nervous system infections in resource-limited areas.

Asthma hospitalization rates in Chilean children have increased in the last 14 years, but little is known about the factors associated with this.

Since the late 1990s, European Association of Zoos and Aquaria (EAZA)‐member zoos have worked collaboratively to achieve a self‐sustaining population for gorilla through the European Endangered Species Programme (EEP). The Association of Zoos and Aquariums (AZA) in the United States has similarly worked through the Species Survival Plan (SSP). These populations are all registered in the International Studbook for the Western Lowland GorillaGorilla g. gorilla Savage & Wyman, 1847,which is updated annually. Demographic and genetic analyses of these data are carried out to monitor population development. This paper presents the results of the genetic and demographic analysis of EAZAand AZApopulations of the Western lowland gorilla Gorilla gorilla gorilla, considering the individuals registered since the beginning of the studbook (1950) until 2014, and the analyses are mainly focused on the results for both populations around the last decade. The data have been gathered from the 2014 international studbook and data registered in the Single Population Analysis and Records Keeping System (Sparks). Genetic and demographic analyses were carried out using PMx software. The results of the demographic analyses show that the EEPpopulation is growing, demonstrating positive life parameters; for example, a finite growth rate of λ = 1·007, an instantaneous growth rate of r= 0·007 and a net reproductive rate of R0= 1·160. However, the results of the demographic analyses for the SSPpopulation show a general tendency for population reduction; that is, a finite growth rate of λ = 0·992, an instantaneous rate of growth rate r= −0·008 and a net reproductive rate of R0= 0·864. When comparing the results from both populations it would appear that the application of strict breeding policies in the SSPfor a few years had a noticeable impact on the SSPdemographic results. The long‐term aim of the European Endangered Species Programme (EEP) and North American Species Survival Plan (SSP) programme for Western lowland gorilla Gorilla gorilla gorillais to preserve genetically and demographically healthy, and behaviourally self‐sustaining populations. Demographic and genetic analyses of the data of individuals registered in the international studbook (1950–2014) were carried out to monitor population development. This paper presents the results of these analyses, mainly focusing on information for the last decade. Results show that the EEP population is growing, demonstrating positive life parameters (finite growth rate, λ = 1·007; instantaneous growth rate, r= 0·007; net reproductive rate, R0= 1·160). Results for the SSP population show a general tendency for population reduction (finite growth rate, λ = 0·992; instantaneous growth rate, r= −0·008; net reproductive rate, R0= 0·864). Different management policies in the two regions may affect demographic results. (Photo: J. Fábregas, Barcelona Zoo)

Hematopoietic stem cell transplantation (HSCT) with sibling donors (s.d.) is a life-saving intervention for patients with hematological malignancies. Numerous genetic factors have a role in transplant outcome. Several functional polymorphisms have been identified in TGF-β1gene, such as single-nucleotide polymorphism (SNP) at +29C>T within exon 1. Two hundred and forty five patient/donor pairs who underwent a s.d. HSCT in our centers were genotyped for this SNP. In the myeloablative cohort, +29CC donors were associated with an increase in severe chronic GvHD (32% vs 16%, hazard ratio (HR) 9.0, P=0.02). Regarding survival outcomes, +29CC patients developed higher non relapse mortality (NRM) (1–5 years CC 28–32% vs TC/TT 7–10%; HR 5.1, P=0.01). Recipients of +29TT donors experienced a higher relapse rate (1–5 years TT 37–51% vs TC 19–25% vs CC 13%–19%; HR 2.4, P=0.01) with a decreased overall survival (OS) (1–5 years TT 69–50% vs TC/CC 77–69%; HR 1.9, P=0.05). Similar to previous myeloablative unrelated donors HSCT results, we confirmed that +29CC patients had higher NRM. In addition we found that +29TT donors might be associated with a higher relapse rate and lower OS. These results should be confirmed in larger series. Identification of these SNPs will allow personalizing transplant conditioning and immunosuppressant regimens, as well as assisting in the choice of the most appropriate donor.

Haematopoietic cell transplant activity in the 28 countries comprising Latin America is poorly defined. We conducted a voluntary survey of members of the Latin American Bone Marrow Transplantation Group regarding transplant activity 2009–2012. Collated responses were compared with data of transplant rates from the Worldwide Network for Blood and Marrow Transplantation for other geographic regions. Several socio-economic variables were analysed to determine correlations with transplant rates. In total, 94 teams from 12 countries reported 11 519 transplants including 7033 autotransplants and 4486 allotransplants. Annual activity increased from 2517 transplants in 2009 to 3263 in 2012, a 30% increase. Median transplants rate (transplant per million inhabitants) in 2012 was 64 (autotransplants, median 40; allotransplants, median 24). This rate is substantially lower than that in North America and European regions (482 and 378) but higher than that in the Eastern Mediterranean and Asia Pacific regions (30 and 45). However, the Latin America transplant rate is 5–8-fold lower than that in America and Europe, suggesting a need to increase transplant availability. Transplant team density in Latin America (teams per million population; 1.8) is 3–4-fold lower than that in North America (6.2) or Europe (7.6). Within Latin America, there is substantial diversity in transplant rates by country partially explained by diverse socio-economic variables including per capitagross national income, health expenditure and physician density. These data should help inform future health-care policy in Latin America.

El diagnóstico de la alergia a alimentos (AA) mediada por IgE es de gran importancia para poder establecer una adecuada dieta de evitación que sigue siendo la única alternativa terapéutica en la mayoría de los pacientes.

El objetivo de este estudio fue determinar las consecuencias clínicas expresadas en índices COPD y ceod y su relación con la presencia de hipomineralización incisivo molar (HIM) en una población de escolares de 6 a 12 años de la provincia de Santiago.

ErbB-2 amplification/overexpression accounts for an aggressive breast cancer (BC) subtype (ErbB-2-positive). Enhanced ErbB-2 expression was also found in gastric cancer (GC) and has been correlated with poor clinical outcome. The ErbB-2-targeted therapies trastuzumab (TZ), a monoclonal antibody, and lapatinib, a tyrosine kinase inhibitor, have proved highly beneficial. However, resistance to such therapies remains a major clinical challenge. We here revealed a novel mechanism underlying the antiproliferative effects of both agents in ErbB-2-positive BC and GC. TZ and lapatinib ability to block extracellular signal-regulated kinases 1/2 and phosphatidylinositol-3 kinase (PI3K)/AKT in sensitive cells inhibits c-Myc activation, which results in upregulation of miR-16. Forced expression of miR-16 inhibited in vitroproliferation in BC and GC cells, both sensitive and resistant to TZ and lapatinib, as well as in a preclinical BC model resistant to these agents. This reveals miR-16 role as tumor suppressor in ErbB-2-positive BC and GC. Using genome-wide expression studies and miRNA target prediction algorithms, we identified cyclin J and far upstream element-binding protein 1 (FUBP1) as novel miR-16 targets, which mediate miR-16 antiproliferative effects. Supporting the clinical relevance of our results, we found that high levels of miR-16 and low or null FUBP1 expression correlate with TZ response in ErbB-2-positive primary BCs. These findings highlight a potential role of miR-16 and FUBP1 as biomarkers of sensitivity to TZ therapy. Furthermore, we revealed miR-16 as an innovative therapeutic agent for TZ- and lapatinib-resistant ErbB-2-positive BC and GC.

•We analyze intra- and inter-cultural differences in trust and reciprocity between Turks, Turkish, and Greek Cypriots.•We find that Cypriots have similar levels of trust towards others in general.•We find no inter-cultural differences of trust among Cypriots which is against the popular belief.•However, Turkish Cypriots are less reciprocal towards Greek Cypriots than they are towards members of their own community.•Greek Cypriots who had at least one parent displaced after the civil war trust Turks less than those whose parents weren't.

Banco Chinchorro is the largest reef in the Mexican Caribbean. Historically, spiny lobster, queen conch and over 20 other reef species have been exploited here. Multispecies intervention management from an ecosystem perspective has been developed in this area; however, an assessment of the effects of such practices on ecosystem health is required. Five quantitative trophic models were constructed using Ecopath with Ecosim. The results show that, in terms of biomass, benthic autotrophs are the dominant group in all communities. Ecosystem Network Analysis indices showed that Cueva de Tiburones was the most mature, developed, complex and healthy subsystem, but, El Colorado and La Baliza were the subsystems most resistant to disturbances. The fisheries mainly concentrate on primary (La Baliza and Cueva de Tiburones sites) and secondary consumers (La Caldera, Chancay, and El Colorado). The greatest propagation of direct and indirect effects, estimated by Mixed Trophic Impactsand Ecosimsimulations, were generated by the benthic autotrophs, small benthic epifauna, benthic-pelagic carnivorous fish and benthic carnivorous fish, among others. In contrast, the System Recovery Timeshowed different patterns among subsystems, indicating several compartments that reduce resilience. Considering the structure, dynamics, trophic functioning and ecosystem health of Banco Chinchorro, its ecological heterogeneity highlights the need for the design of a specific (by subsystem) management strategy, particularly because different species or functional groups present greater sensitivity to human interventions in each community.

Banco Chinchorro is the largest reef in the Mexican Caribbean. Historically, spiny lobster, queen conch and over 20 other reef species have been exploited here. Multispecies intervention management from an ecosystem perspective has been developed in this area; however, an assessment of the effects of such practices on ecosystem health is required. Five quantitative trophic models were constructed using Ecopath with Ecosim. The results show that, in terms of biomass, benthic autotrophs are the dominant group in all communities. Ecosystem Network Analysis indices showed that Cueva de Tiburones was the most mature, developed, complex and healthy subsystem, but, El Colorado and La Baliza were the subsystems most resistant to disturbances. The fisheries mainly concentrate on primary (La Baliza and Cueva de Tiburones sites) and secondary consumers (La Caldera, Chancay, and El Colorado). The greatest propagation of direct and indirect effects, estimated by Mixed Trophic Impactsand Ecosimsimulations, were generated by the benthic autotrophs, small benthic epifauna, benthic-pelagic carnivorous fish and benthic carnivorous fish, among others. In contrast, the System Recovery Timeshowed different patterns among subsystems, indicating several compartments that reduce resilience. Considering the structure, dynamics, trophic functioning and ecosystem health of Banco Chinchorro, its ecological heterogeneity highlights the need for the design of a specific (by subsystem) management strategy, particularly because different species or functional groups present greater sensitivity to human interventions in each community.

In daily clinical practice, the dermatologic surgeon frequently has to excise closely adjacent tumors in the facial region. In such cases, planning of an appropriate reconstruction technique is essential. The aim is to treat all of the lesions in a single surgical intervention, if possible, and to achieve a good functional and cosmetic outcome. We present 5 patients in whom a single flap was used to repair multiple adjacent defects.

En la práctica diaria, es frecuente que el cirujano dermatológico deba extirpar varias lesiones tumorales próximas entre sí en la región facial. Para ello, es importante planificar una técnica reconstructiva adecuada que permita, si es posible, abordar las lesiones en un solo acto quirúrgico, proporcionando buenos resultados funcionales y estéticos. A continuación se presentan 5 casos de pacientes en los que se ha empleado un único colgajo para realizar el cierre de varios defectos próximos.

La sección de Vía Aérea de la Sociedad Española De Anestesiología, Reanimación y Terapéutica del Dolor (SEDAR), la Sociedad Española de Medicina de Urgencias y Emergencias (SEMES) y la Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL-CCC) presentan la Guía para el manejo integral de la vía aérea difícil en el paciente adulto. Sus principios están focalizados en el factor humano, los procesos cognitivos para la toma de decisiones en situaciones críticas y la optimización en la progresión de la aplicación de estrategias para preservar una adecuada oxigenación alveolar con el objeto de mejorar la seguridad y la calidad asistencial. El documento proporciona recomendaciones basadas en la evidencia científica actual, herramientas teórico/educativas y herramientas de implementación, fundamentalmente ayudas cognitivas, aplicables al tratamiento de la vía aérea en el campo de la anestesiología, cuidados críticos, urgencias y medicina prehospitalaria. Para ello se realizó una amplia búsqueda bibliográfica según las directrices PRISMA-R y se analizó utilizando la metodología GRADE. Las recomendaciones se formularon de acuerdo con esta metodología. Las recomendaciones de aquellas secciones con evidencia de baja calidad se basaron en la opinión de expertos mediante consenso alcanzado a través de un cuestionario Delphi.

Realizar una revisión sistemática de la literatura para conocer la efectividad de la imaginería motora o práctica mental como tratamiento de pacientes con ictus en la recuperación motora del miembro superior e inferior.

The non-O157 Shiga toxin-producing Escherichia coli(STEC) contamination in carcasses and feces of 811 bovines in nine beef abattoirs from Argentina was analyzed during a period of 17 months. The feces of 181 (22.3%) bovines were positive for non-O157 STEC, while 73 (9.0%) of the carcasses showed non-O157 STEC contamination. Non-O157 STEC strains isolated from feces (227) and carcasses (80) were characterized. The main serotypes identified were O178:H19, O8:H19, O130:H11, and O113:H21, all of which have produced sporadic cases of hemolytic-uremic syndrome in Argentina and worldwide. Twenty-two (7.2%) strains carried a fully virulent stx/eae/ehxAgenotype. Among them, strains of serotypes O103:[H2], O145:NM, and O111:NM represented 4.8% of the isolates. Xbalpulsed-field gel electrophoresis pattern analysis showed 234 different patterns, with 76 strains grouped in 30 clusters. Nine of the clusters grouped strains isolated from feces and from carcasses of the same or different bovines in a lot, while three clusters were comprised of strains distributed in more than one abattoir. Patterns AREXSX01.0157, AREXBX01.0015, and AREXPX01.0013 were identified as 100% compatible with the patterns of one strain isolated from a hemolytic-uremic syndrome case and two strains previously isolated from beef medallions, included in the Argentine PulseNet Database. In this survey, 4.8% (39 of 811) of the bovine carcasses appeared to be contaminated with non-O157 STEC strains potentially capable of producing sporadic human disease, and a lower proportion (0.25%) with strains able to produce outbreaks of severe disease.

In Argentina, Escherichia coliO157:H7/NM (STEC O157) is the prevalent serotype associated with hemolytic uremic syndrome (HUS), which is endemic in the country with more than 400 cases per year. In order to estimate the prevalence and characteristics of STEC O157 in beef cattle at slaughter, a survey of 1,622 fecal and carcass samples was conducted in nine beef exporting abattoirs from November 2006 to April 2008. A total of 54 samples were found positive for STEC O157, with an average prevalence of 4.1% in fecal content and 2.6% in carcasses. Calves and heifers presented higher percentages of prevalence in feces, 10.5 and 8.5%, respectively. All STEC O157 isolates harbored stx2(Shiga toxin 2), eae(intimin), ehxA(enterohemolysin), and fliCH7(H7 flagellin) genes, while stx1(Shiga toxin 1) was present in 16.7% of the strains. The prevalent (56%) stxgenotype identified was stx2combined with variant stx2c(vh-a), the combination of which is also prevalent (>90%)in STEC O157 post-enteric HUS cases in Argentina. The clonal relatedness of STEC O157 strains was established by phage typing and pulsed-field gel electrophoresis (PFGE). The 54 STEC isolates were categorized into 12 different phage types and in 29 Xbal-PFGE patterns distributed in 27 different lots. STEC O157 strains isolated from 5 of 21 carcasses were identical by PFGE (100% similarity) to strains of the fecal content of the same or a contiguous bovine in the lot. Five phage type-PFGE-stxprofiles of 10 strains isolated in this study matched with the profiles of the strains recovered from 18 of 122 HUS cases that occurred in the same period.

The growing development of composite tissue allografts (CTA) highlights the need for tolerance induction protocols. Herein, we developed a mouse model of heterotopic limb allograft in a stringent strain combination in which potentially tolerogenic strategies were tested taking advantage of donor stem cells in the grafted limb. BALBc allografts were transplanted into C57BL6 mice treated with anti-CD154 mAb, nondepleting anti-CD4 combined to either depleting or nondepleting anti-CD8 mAbs. Some groups received additional rapamycin. Both depleting and nondepleting mAb combinations without rapamycin only delayed limb allograft rejection, whereas the addition of rapamycin induced long-term allograft survival in both combinations. Nevertheless, robust donor-specific tolerance, defined by the acceptance of a fresh donor-type skin allograft and simultaneous rejection of third-party grafts, required initial CD8T-cell depletion. Mixed donor-recipient chimerism was observed in lymphoid organs and recipient bone marrow of tolerant but not rejecting animals. Tolerance specificity was confirmed by the inability to produce IL-2, IFN-? and TNF-? in MLC with donor antigen while significant alloreactivity persisted against third- party alloantigens. Collectively, these results show that robust CTA tolerance and mixed donor-recipient chimerism can be achieved in response to the synergizing combination of rapamycin, transient CD8T-cell depletion and costimulationcoreceptor blockade.

Argentina has a high incidence of hemolytic uremic syndrome (HUS); 12.2 cases per 100,000 children younger than 5 years old were reported in 2002. Shiga toxin (Stx)–producing Escherichia coli (STEC) is the primary etiologic agent of HUS, and STEC O157 is the predominant serogroup isolated. The main objective of the present work was to establish the phenotypic and genotypic characteristics of the STEC strains in general isolated from Argentine children during a prospective study and the clonal relatedness of STEC O157:H7 strains using subtyping techniques. One hundred and three STEC strains isolated from 99 children were included. The phenotypic and genotypic features were established, and a polymerase chain reaction–restriction fragment length polymorphism (PCRRFLP) was performed to determine stx2 variants. The clonal relatedness of E. coli O157 isolates was established by phage typing and pulsed-field gel electrophoresis (PFGE). The 103 STEC strains belonged to 18 different serotypes, and 59% were of serotype O157:H7. Stx2 was identified in 90.3%, and stx1 in 9.7%. Among the 61 STEC O157 strains, 93.4% harbored the stx2/stx2vh-a genes; PT4 (39.3%) and PT2 (29.5%) were the predominant phage types. Using PFGE with the enzyme XbaI, a total of 41 patterns with at least 80% similarity were identified, and seven clusters with identical profiles were established. Some of the clusters were further split by PFGE using BlnI as the second enzyme. Isolates with indistinguishable PFGE patterns were with one exception also indistinguishable by phage typing and stx genotyping. These findings confirmed that some isolates were genetically related. However, no epidemiological linkages were identified. STEC strains with different genotypes and belonging to diverse serotypes were isolated in Argentina. Some STEC O157 strains could not be distinguished by applying subtyping techniques such as PFGE and phage typing.