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La realización de estudios sobre el estado de conservación previo a las intervenciones rehabilitadoras y restauradoras permite conocer y actuar de forma coherente sobre el patrimonio arquitectónico. En esta línea se ha llevado a cabo la investigación de localización gráfica de alteraciones, estudio puntual de materiales de alteración y medición de parámetros ambientales (T y H) en las yeserías del Oratorio de la Madraza de Granada, espacio singular por sus antecedentes históricos y constructivos. Los resultados obtenidos determinan el nivel de alteración y presencia de los diferentes deterioros, así como la justificación de las causas de alteración que los han motivado. Igualmente se valida la metodología seguida en este estudio, consistente en diversos protocolos sucesivos que facilitan la determinación de las intervenciones restauradoras. De igual manera este método puede ser extrapolable a otros edificios con alto nivel de protección patrimonial.

Santa Pudia limestone, a biocalcarenite highly sensitive to decay, is one of the most commonly used building materials in historical monuments in the city of Granada, Spain. The compatibility between a variety of stone treatments (consolidants and/or water repellents) and this calcarenite was analyzed and the resulting improvement in durability assessed. To this end, a two-stage accelerated ageing process was implemented. In the first, freshly quarried, undamaged specimens were altered to resemble the weathered stone in buildings. The second was conducted after applying the various treatments to the artificially aged stone to test their effectiveness. While all the treatments studied (Tegosivin HL100, Silo 111, Estel 1100 and Tegovakon V) enhanced stone resistance to decay while barely affecting chromatic parameters, the most effective was Tegowakon V, as it provided the best results in the hydric tests on the limestone.

“Sierra Elvira stone” is one of the ornamental building stones most widely used in the historical monuments of eastern Andalusia. A Liassic age limestone, it appears in the central section of the Baetic Mountains and more specifically in the Middle Subbaetic domain. While the most common variety is a crinoid limestone, a micritic limestone of the same age has also been quarried, albeit in much smaller quantities. These stones form very thick beds, up to nearly 5 m deep, that run in consistently parallel lines and have a dip angle that facilitates quarrying. With petrographic, physical and mechanical properties that ensure stone strength and durability, it is a high quality building material suitable for both structural and ornamental purposes. These properties can be attributed to the minimal open porosity and concomitant excellent water resistance that characterize the stone, as well as to its high mechanical strength and low textural anisotropy, both elastic and mechanical. With such attributes, the stone can be successfully used for any number of purposes, including decorative stonework (portals, fountains, plinths), structural members (column shafts and bases) or urban curbing and paving. Intervention on Sierra de Elvira limestone structures should be limited to cleaning or repair, for consolidating or protective materials are scantly effective.

This work focuses on the chemical-mineralogical, textural and physical-mechanical properties of hydraulic lime mortars made with siliceous and calcareous aggregate. Mortars were cured at 60% and 90% of relative humidity, so as to assess the variability of mortar petrophysical properties in the hardened state due to the moisture conditions. The final aim was to determine the most adequate moisture conditions to be maintained during application and hardening of hydraulic mortars intended for repair interventions. We found out that using a calcareous aggregate and curing mortar at 90% of relative humidity give place to better textural and mechanical properties. However, these characteristics mostly depend on the maximum size of the aggregate grains, which should be smaller than 6 mm, in order to avoid the occurrence of mechanical discontinuities in the mortar.

We have studied the physical-mechanical behaviour of solid bricks treated with consolidants and/or water-repellents in accelerated aging tests to determine their durability. The bricks were manufactured with a quartz-rich clay lacking in carbonates to which was added small amounts of different additives (calcite, dolomite or sodium chloride). During the manufacturing process, we attempted to replicate solid bricks similar to those used in many Cultural Heritage buildings. We have concluded that silicon resin gives the best results, whatever the additive used, whereas acrylic resin gives the least satisfactory results.

Se ha realizado un estudio geoquímico de la fracción arcillosa de los sedimentos miopliocenos y de la muestra total de rocas metamórficas de los relieves adyacentes con el fin de determinar las características geoquímicas del medio de sedimentación y la influencia de las rocas circundantes sobre los sedimentos. Tras relacionar elementos químicos con rocas y minerales mediante un (ACP), se ha realizado una clasificación jerárquica ascendente (CJA), que ha reagrupado las muestras con características geoquímicas similares en 8 clases. La comparación gráfica de su composición geoquímica media pone de manifiesto una clara relación genética entre los sedimentos y las rocas metapelíticas de la Cordillera Bética oriental, siendo la influencia de gneises, rocas carbonatadas metamórficas y metabasitas muy localizada o inexistente. Finalmente, los contenidos de B y Mg nos han permitido distinguir varios tipos de medios de depósito que presentan diferentes grados de confinamiento y que, en relación con los cambios del nivel del mar producidos durante la crisis messiniense, se han visto influenciados sucesivamente por aguas marinas y continentales.

En nuestro país, el grupo de pacientes Adultos Mayores (sobre 65 años) ha tenido un crecimiento explosivo en los últimos años, reflejo de la expectativa de vida que ha aumentado casi 10 años desde 1981 a la fecha. Con mayor frecuencia, el grupo etario en cuestión requiere ingreso a Unidades más complejas. Estudios internacionales estiman que los adultos mayores ocupan en promedio más de la mitad de los días cama de las Unidades de Tratamiento Intensivo (UTI) a nivel mundial y están cobrando relevancia en la Medicina Intensiva dada particularidades específicas que presentan para su manejo en estas unidades. En Chile, existen escasos datos acerca de ingresos y mortalidad en este grupo de pacientes en las UTI. El objetivo de esta revisión es mostrar datos epidemiológicos de la realidad local en relación a pacientes admitidos en la UTI del Centro de Pacientes Críticos (CPC) de Clínica Las Condes (CLC).

Thrombotic thrombocytopenic purpura (TTP) is a thrombotic microangiopathy (TMA) characterized by the development of microangiopathic haemolytic anaemia, thrombocytopenia, and ischaemic organ dysfunction associated with ADAMTS13 levels lower than 10% in most cases. Recently there have been numerous advances in the field of PTT, new, rapid and accessible techniques capable of quantifying ADAMTS13 activity and inhibitors. The massive sequencing systems facilitate the identification of polymorphisms in the ADAMTS13 gene. In addition, new drugs such as caplacizumab have appeared and relapse prevention strategies are being proposed with the use of rituximab. The existence of TTP patient registries allow a deeper understanding of this disease but the great variability in the diagnosis and treatment makes it necessary to elaborate guidelines that homogenize terminology and clinical practice. The recommendations set out in this document were prepared following the AGREE methodology. The research questions were formulated according to the PICO format. A search of the literature published during the last 10 years was carried out. The recommendations were established by consensus among the entire group, specifying the existing strengths and limitations according to the level of evidence obtained. In conclusion, this document contains recommendations on the management, diagnosis, and treatment of TTP with the ultimate objective of developing guidelines based on the evidence published to date that allow healthcare professionals to optimize TTP treatment., (Copyright © 2021 Elsevier España, S.L.U. All rights reserved.)

Introduction: Autoimmune hemolytic anemia (AIHA) is a rare and generally self-limiting disease in children., Material and Methods: A descriptive cross-sectional study was performed in children under 18 years diagnosed with AIHA from January/1997 to July/2019. Clinical variables were collected and AIHA was classified according to the direct antiglobulin test (DAT) in warm AIHA (IgG+/-C3d) and cold AIHA (C3d). Response to treatment and evolution were analyzed., Results: 25 patients were included and 72% were males. The median age at diagnosis was 2 years (range 0.4 to 9). Fever (72%), pallor (68%), jaundice (64%), hepatosplenomegaly and coluria (48%) were the most common presenting symptoms. The median hemoglobin at diagnosis was 5.4 g/dl. DAT was positive in 96%, with detection of IgG antibodies in 76%. A single case presented negative DAT. 20% of the patients associated another cytopenia, one of which was subsequently diagnosed with common variable immunodeficiency. Concomitant viral infection was suspected or documented in 32%. Most of the cases were self-limiting and responded to corticosteroid treatment (72%). Those with partial response (24%), mainly those associated with other cytopenias, required other lines of treatment (rituximab, mycophenolate, immunoglobulins). Complications (32%) and relapses (26%) were detected only in warm AIHA., Conclusions: Our case series confirms that AIHA is a very rare disease in childhood. Most cases evolve favorably, although up to a quarter of them require second lines of treatment and, in exceptional cases, they need very aggressive treatments. These latter cases generally correspond to patients who present more than one cytopenia in the course of the disease., (Copyright © 2021 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.)

Immune thrombocytopenia (ITP) is a relatively common disorder in childhood. Although it usually achieves spontaneous remission at this age, the management of persistent or chronic ITP in children is still controversial. The aim of this article is to address current controversies related to the treatment of persistent, chronic, and refractory ITP in children, including the role of rituximab and splenectomy, as well as focusing on a new approach with thrombopoietin receptor agonists (TPO-RAs). Eltrombopag and romiplostim are safe and useful drugs for paediatric ITP. These two TPO-RAs might delay surgery and other treatments such as rituximab. However, the potential side effects described in adult patients should be considered. Paediatric patients with refractory ITP, undergoing new treatments, should be supervised in specialised centres., (Copyright © 2018 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: Streptococcus pneumoniae is the main cause of community-acquired pneumonia in adults., Aim: To describe baseline characteristics, risk factors and clinical outcomes of adult patients hospitalized with pneumococcal pneumonia., Material and Methods: Prospective study of adult patients admitted for a community acquired pneumonia in a clinical hospital. Immune deficient patients and those with a history of a recent hospitalization were excluded., Results: One hundred fifty one immuno-competent patients, aged 16 to 92 years, 58% males, were studied. Seventy-five percent had other diseases, 26% were admitted to the intensive care unit and 9% needed mechanical ventilation. There were no differences in clinical features, ICU admission or hospital length of stay among bacteremic and non-bacteremic patients. Thirty days lethality for bacteremic and non-bacteremic patients was 10.9% and 11.5%, respectively. The predictive values for lethality of Fine pneumonia severity index and CURB-65 (Confusion, Urea nitrogen, Respiratory rate, Blood pressure, 65 years of age and older) had an area under the ROC curve of 0.8 and 0.69, respectively. Multivariate analysis disclosed blood urea nitrogen over 30 mg/ dL (odds ratio (OR), 6.8), need for mechanical ventilation (OR, 7.4) and diastolic blood pressure below 50 mmHg (OR, 3.9), as significant independent predictors of death., Conclusions: Pneumococcal pneumonia was associated with a substantial rate of complications and mortality. Clinical presentation and outcome did not differ significantly among patients with and without bacteremia.

Introduction: Wide studies and substantial controversies build on utilization of actual mobile phones and appearance of systemic disorders or even tumours, but there is no knowledge about an eventual involvement on early hearing loss., Patients and Methods: In a group of three hundred and twenty-three healthy and normoacoustic volunteers who were usual costumers of mobile phones an audiometric evaluation was made at the beginnig of its use and three years later, inquiring about the periods of time per day and year employed on direct contacts with phone. A healthy and normoacoustic control group of non users was studied too., Results: Cases carried out 24.3 +/- 8.2 active contacts, reaching 50.4 +/- 27.8 days of mobile phone employment in three years. Audiometric curve was similar in cases and controls at the beginning of the study. After this follow-up, cases showed an increase on hearing threshold between 1 and 5 dB HL more than controls in speech tones (p<0.001). Moreover, there was a trend to correlate time of phone use to hearing impairment, but this finding did not result statistically significative., Conclusions: Frequent management of mobile phones in a middle period of time allows to detect a mild hearing loss, but the cause of this disorder keeps unclear.

Objective: To evaluate the influence of different otoscopic findings on body thermometry in children using an infra-red tympanic thermometer., Patients and Methods: Body temperature was measured on healthy right and left ear canals with Thermoscan systems. Moreover, it was determined on children with altered otoscopy, companng to normal contralateral ear. To assess its diagnostic fiability, accuracy ratios were calculated in different temperatures., Results: Temperature measured bilaterally did not offer differences, and intra/interassay variation ratios were always less than 0.34%. Acute otitis externa increased tympanic thermometry a mean of 0.36 degrees C (p < 0.001), and cerumen and previously radical surgery decreased a mean of 0.62 and 0.53 degrees C, respectively (p < 0.001)., Conclusions: The conditions mentioned before modify body thermometry if measured by infra-red tympanic thermometer. So, this system must be avoided in these circumstances. Otitis media, fluid in middle ear, tympanic perforation and ventilation tubes did not modify thermometric results.

We report two cases of sudden deafness which appeared during vaso-occlusive crisis of a sickle cell anaemia (homozygous form of disease) and a sickle cell trait (heterozygous form) in two males aged sixteen and twenty-two, respectively. A high erythrocyte aggregability and low deformability were proved in both young men. Although hearing disorders have been reported in this disease, a sudden onset is not common. The treatment used was useful in the removal of painful crisis and infections, but deafness did not improve in either of then.

We show two atypical Cogan's syndrome cases in forty-seven and fifty-six years old individuals. Characteristical symptoms of the syndrome were detected in both (interstitial keratitis, sensorineural deafness and vestibular dysfunction), but they could be considered as unusual because of the association of systematic symptoms and an onset with hearing loss. In both cases there was an increase in erythrosedimentation rate and immunoglobulins levels, as well as high titles for rheumatoid factor and non-specific autoantibodies. By means of a Western-blot technique, several chochlear antibodies with distinct molecular weight were detected, but the 68 KD appeared in both. Metil-prednisolone treatment did not avoid ocular and auditive reactivation in ne of the patients.

We present a case of Cogan's syndrome (interstitial keratitis, rapidly evolving sensorineural hearing loss and vestibular dysfunction) in a 12-year-old girl. Diagnosis was made by clinical and audiologic examination as well as by nonspecific laboratory findings (increased erythrosedimentation rate and positive IgA and IgM rheumatoid factor titers and antineutrophil cytoplasmic autoantibodies). Detection of specific autoantibodies against cochlear antigenic epitopes with a molecular weight of 68 kDa by Western-blot assay confirmed an organ-specific autoimmune mechanism. Therapy with deflazacort 1 mg/kg per day 3 three weeks decreasing progressively thereafter was successful and the patient remains symptom-free.

Objectives: To find how common post-natal depression is in our area and its relationship with social and demographic variables, vital events and morbidity., Design: Descriptive crossover study based on initial interview face-to-face, and follow-up telephone interview., Setting: Community framework; our area's health districts., Participants: 190 women who attended our reference hospital to give birth between February and April 1998., Measurement and Results: Through face-to-face interview at the hospital, social and demographic variables, morbidity, intercurrent vital events and family support were collected for 190 women. Six to eight weeks after the birth, these women were phoned and the Edinburgh Depression Scale (EPDS) was conducted. According to the EPDS, the frequency of depression was 13.16% (95% CI, 8.86-19). Characteristics of the sample were: mean age 30.13 (SD 4.63), rural setting. 56% had basic schooling. 32% had psychiatric history, and 44% had family history of depression. 80% thought they were going to be supported after the birth: after seven weeks this figure was 75%. In comparison between women with and without post-natal depression, we found statistically significant differences on relating it to psychiatric history of the woman (p < 0.05) and of the women's family (p < 0.01). For mother's educational level, we found a nearly significant association (p < 0.1). No significant differences were found with the other variables studied., Conclusions: The frequency of post-natal depression found was similar to in the literature. Our profile of women with post-natal depression was: medium-low educational level, personal and family history of depression. Unlike other studies, we found no relationship between post-natal depression and family support during the puerperium.