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Resumen: Presentamos el caso de una mujer de 26 años con síndrome antifosfolípido primario y trombosis valvular obstructiva de prótesis mecánica en posición mitral que requirió una reintervención quirúrgica urgente. Abstract: We report a case of a 26 years old female with primary antiphospholipid syndrome and obstructive valvular thrombosis of mechanical prothesis in mitral position that required urgent surgical reintervention. Palabras clave: Síndrome antifosfolípido, Prótesis valvular cardíaca, Trombosis, Keywords: Antiphospholipid syndrome, Heart valve prosthesis, Thrombosis

Objective To know organization, management and training in airway (AW) in Spanish Intensive Care Units (ICUs), with special interest in difficult airway (DAW). Design Descriptive cross-sectional study and χ2 subanalysis, conducted through a national survey from November 1st to December 15th, 2016. With the SEMICYUC's support, an online questionnaire of 27 items was sent to 179 ICUs. Setting ICUs of public, private centers, and consortia. Results In total, 101 units responded (56.4%), corresponding to 1827 beds and almost 95,000 incomes/year. The 85.1% are public hospitals, and 83.2% had residents. Of the responders, 22.8% do not use routinely AW assessment scales, being the most frequently used the Cormack–Mallampati association (35.6%). There is no intubation (IOT) protocol in 77.2%, or DAW protocol in 75.2%. An 82.2% have a DAW cart. The 48.5% have training in IOT, and in VAD 53.5%. Having a DAW expert is significantly associated with greater training in IOT (60% vs. 39.3%; p = 0.03), DAW (64.4% vs. 44.6%; p = 0.04), and more AW protocols (73.4% vs. 37.5%; p = 0.000). Having a specific guideline for DAW management in UCI is considered necessary in 99%. Conclusions There is room for improvement in AW management. It is necessary to identify an expert in DAW in each Unit, and the development of a specific guideline for DAW management in critical care.

Resumen Objetivo Conocer la organizacion, el manejo y la formacion en via aerea (VA) en las unidades de cuidados intensivos (UCI) espanolas, con especial interes en la via aerea dificil (VAD). Diseno Estudio transversal descriptivo y subanalisis con χ2, elaborado mediante una encuesta nacional realizada del 1 de noviembre al 15 de diciembre de 2016. Con el aval de la SEMICYUC, se envio a 179 UCI un cuestionario online con 27 apartados. Ambito UCI de hospitales publicos, privados y consorcios. Resultados Responden 101 UCI (56,4%), que suponen 1.827 camas y casi 95.000 ingresos/ano. El 85,1% son hospitales publicos, y el 83,2%, con residentes. El 22,8% no utilizan rutinariamente escalas de valoracion de VA, siendo la mas frecuente la asociacion Cormack-Mallampati (35,6%). El 77,2% no tienen protocolo de intubacion (IOT), ni el 75,2% protocolo de VAD. El 82,2% tienen carro de VAD. El 48,5% refieren formacion en IOT, y el 53,5%, en VAD. Identificar a un experto en VAD se asocia significativamente con mayor formacion en IOT (60% vs. 39,3%; p = 0,03), VAD (64,4% vs. 44,6%; p = 0,04) y mas protocolos de VA (73,4% vs. 37,5%; p = 0,000). El 99% estima necesario disponer de una guia especifica de manejo de VAD en UCI. Conclusiones Existe un amplio margen de mejora para el manejo de la VA. Es necesario identificar un experto en VAD en cada unidad y elaborar una guia especifica de manejo de VAD en el paciente critico.

La juventud es una etapa vulnerable a la aparición de alteraciones nutricionales. Para poder prevenirlas es fundamental que los jóvenes, entre los que se encuentran los estudiantes de formación profesional, tengan unos conocimientos adecuados de alimentación. En el presente estudio se han valorado los conocimientos nutricionales de un grupo de estudiantes de formación profesional de Antequera, detectando un nivel intermedio de conocimientos, así como una diferencia significativa entre la puntuación obtenida por el alumnado de ciclos formativos que cursan materias relacionadas con la nutrición y el alumnado de ciclos formativos que no cursan dichas materias, obteniendo éstos últimos peores resultados. Youth is a stage especially vulnerable to the appearance of nutritional alterations. In order to prevent their emergence, it is essential that young people, including vocational training students, have adequate knowledge of nutrition. In the present study, the nutritional knowledge of a group of students of professional training of Antequera has been assessed, detecting an intermediate level of knowledge, as well as a significant difference between the score obtained by the students of training courses that study subjects related to the nutrition and the students of training courses that do not attend these subjects, obtaining these last worse results.

El aumento de la prevalencia de la obesidad es un problema importante de nuestra sociedad. Para frenar este incremento es necesario llevar a cabo estrategias de educación nutricional que promuevan hábitos de vida saludables. Estos programas, dentro del ámbito escolar, deben estar dirigidos no sólo al alumnado de educación primaria y secundaria, sino también al alumnado de formación profesional. Para que estas estrategias sean eficaces, es clave identificar los conocimientos previos que poseen los estudiantes. Por ello, el objetivo de este trabajo es elaborar un cuestionario que permita evaluar los conocimientos nutricionales que posee el alumnado de formación profesional. The increase in the prevalence obesity is a major problem in our society. To curb this increase it is necessary to carry out nutrition education strategies that promote healthy lifestyles. These programs, within the school environment, should be aimed not only at primary and secondary school students, but also at vocational training students. For these strategies to be effective, it is key to identify the prior knowledge that students have in this area. For this reason, the objective of this work is to elaborate a questionnaire that allows to evaluate the nutritional knowledge of the students of vocatioinal training.

This article deals with a methodology for the design of routes for the "bin to bin" (BTB) collection of paper and cardboard waste (PCB) from small businesses, as well as with the new location and calculation of the number of containers needed in the streets for both commercial and non-commercial use due to the large amount of PCB deposited in them. This study was carried out in five shopping areas of the city of Leganés (Community of Madrid, Spain). One of the characteristics of the area is a high density of population and urban traffic. The tool used is the Geographical Information System (GIS-Arc-View). With it we can generate PCB points of high population density in commercial streets based on territorial analysis. We placed the special routes and the new container locations within a distance of 60 m of these collection points (CPT). The system calculates and optimizes six routes according to different urban restrictions. Finally, we provided service to 59% of the shops, which generate almost 82% of the PCB waste, using 160 min per day to collect 1027 kg of high quality PCB. If we compare the system with the system in place previously, we can conclude that the "bin to bin" (BTB) system improves the quality of the PCB in the containers, avoiding overflow and reducing the percentage of rejected material.