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Objective: To assess the trend in hepatitis A, hepatitis B, pneumococcal, tetanus and seasonal influenza vaccination in people with HIV infection and to analyse associated factors., Methods: The Hospital Survey of Patients with HIV, an annual cross-sectional study conducted on a fixed day (2006-2021), was used. Inpatients and outpatients were included. Trends in vaccination and associated factors were analysed using logistic regression., Results: A total of 8643 participants were included. Vaccination rates increased to 65.3% for hepatitis A, 83.7% for hepatitis B, 49.3% for tetanus, 68.9% for pneumococcal and 74.5% for seasonal influenza in 2021. Factors positively associated with vaccination were older age for pneumococcal and influenza vaccination; higher educational level for hepatitis A and tetanus; living in a closed institutions or prison for tetanus, pneumococcal and influenza; and having acquired HIV through sex between men for hepatitis A, B and pneumococcal. In addition, being on antiretroviral treatment and having a high CD4 count were positively associated with vaccination for all these diseases. Factors inversely associated with vaccination were being older (hepatitis A, B and tetanus), being an immigrant (tetanus and seasonal influenza) and being an injection drug user/ex-user for hepatitis A and B., Conclusions: Vaccination in people with HIV has increased in the study period. The results are in line with the recommendations in this population, although there is still room to reach the established vaccination indicators., (Copyright © 2023 Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. Published by Elsevier España, S.L.U. All rights reserved.)

Mathematical algorithms 3D-reconstruction techniques and artificial intelligence are a current line of innovation in colorectal surgical oncology. The objective of this study is to show the initial experience of a 3D image processing and reconstruction system to perform complete mesocolic excision and D3-lymphadenectomy in colon cancer. It is applied to a splenic flexure neoplasm and in a right colon cancer with suspected retroperitoneal infiltration. 3D image processing and reconstruction was employed to delimit 10 cm proximal and distal intestinal margins to the tumor and define its corresponding vascularization. In right colon cancer it showed position and exact dimensions of D3-lymphadenectomy area and possible retroperitoneal fascia infiltration. 3D image processing and reconstruction allows to obtain valuable information from computerized tomography scan. It could be employed during surgical strategy planification to improve oncological results and reduce intraoperative complications., (Copyright © 2023. Published by Elsevier España, S.L.U.)

Introduction: We distributed a survey in order to determine the current indications for the use of colonic stents to treat colonic obstruction in Spain and its compliance with international guidelines., Methods: Descriptive study of a survey distributed by the Spanish Association of Surgeons (Asociación Española de Cirujanos), the Catalan Society of Surgery (Societat Catalana de Cirurgia) and the Spanish Society of Digestive Endoscopy (Sociedad Española de Endoscopia Digestiva)., Results: 340 valid responses were received: 25% from gastrointestinal specialists, and 75% from general surgeons. During the last year, 44.4% of respondents assessed between 10 and 20 COC. Of these, 52.2% indicated less than 5 stents/year, 75% of which were indicated as a prior step to preferential surgery and only 25% were performed with palliative intent. 55.3% of the participants reported knowing the official guidelines, and 64% of respondents would use the stent as a step prior to surgery in elderly patients with localized disease. 75.9% would place stents as palliative therapy in young patients with carcinomatosis, and 61.8% would use them in stage IV malignancies under treatment with chemotherapy. Only 18.1% knew of the risk of colon perforation after stent placement in patients undergoing treatment with antiangiogenics., Conclusions: In Spain, the indication for colonic stents is reserved for selected cases and varies according to the specialty and the years of experience of the respondent. The compliance with international guidelines of most respondents is moderate. It is important to insist on the high risk of perforation after angiogenics, which is unknown to most surgeons., (Copyright © 2020 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.)

Marfan syndrome is a hereditary connective tissue disorder. The main cause of mortality in these patients is due to cardiovascular complications related to dilation of an aneurysm and dissection of the aortic root, a situation that increases their risk due to the physiological changes that occur during pregnancy, childbirth and puerperium. The case is presented of a pregnant woman with Marfan syndrome and aortic root dilatation of 42mm. The issues are discussed, such as the mode of delivery (vaginal delivery vs. caesarean section) depending on the aortic root diameter or the choice of type of anaesthesia (general vs. neuraxial) in these cases., (Copyright © 2018 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.)

Purpose: The aim of this study was to evaluate the efficiency of a joint intervention that included educational components, self-assessment, and information to optimise diabetes control through the introduction of instant capillary glycosylated haemoglobin (HbA1c) determination in Primary Care., Materials and Methods: A multicentre prospective descriptive study was carried out over 3years in 10Primary Care Centres of the Area VII Murcia East. At the end of the study there were 804 patients with type 2 diabetes (DM2). Patients were divided into 4 groups based on initial values of HbA1c, and if changes in their treatment were needed. HbA1c, body mass index, and blood pressure were monitored. A financial assessment was also performed on the impact of the implementation of a protocol to measure instant capillary RESULTS: A significant reduction was observed in HbA1c values. The initial HbA1c mean value was 7.4±1.4%, which decreased to a final value of 6.9±1.0% (P<.001). At the end of the study, 71.4% of patients included reached diabetic control objectives. In addition, the financial assessment demonstrated that the implementation of this diabetes control system led to a decrease of the 24.7% in spending on glucose strips after the first year of study in Area VII Murcia Health Service., Conclusions: The introduction of capillary HbA1c determination in Primary Care has demonstrated to improve diabetes control and the efficiency of the health personnel. Furthermore, a reduction in the health costs of patients with DM2 was also shown., (Copyright © 2016 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: Cost-minimization analysis of onabotulinumtoxinA and abobotulinumtoxinA, taking into account the real dose administered to children with spasticity associated with dynamic equinus foot deformity due to cerebral palsy., Method: A single centre, observational, longitudinal, and retrospective study which included spastic paediatric patients aged 2-to-18-years and treated with onabotulinumtoxinA or abobotulinumtoxinA from December 1995 to October 2012, in the Paediatric Neurology Unit of a first-level Spanish hospital. A longitudinal analysis of spasticity severity was made to confirm the similar efficacy of both treatments. Cost minimization was analyzed using the dose administered and the direct costs (pharmacological and medical visits costs) from the perspective of the National Health System (in euros from 2016)., Results: We analyzed 895 patients with paediatric spasticity: 543 were treated only with onabotulinumtoxinA, 292 only with abobotulinumtoxinA, and 60 with both treatments. The mean doses administered were 5.44 U/kg (SD = 2.17) for onabotulinumtoxinA, and 14.73 U/kg (5.26) for abobotulinumto xinA. The total annual direct cost (pharmacological and medical visits) was € 839.56 for onabotulinumtoxinA and € 631.23 for abobotulinumtoxinA, which represents a difference of € 208.34 per year in favour of treatment with abobotulinumtoxinA., Conclusions: It has been demonstrated that in real clinical practice, the cost per patient and year for treatment of paediatric spasticity was lower when abobotulinumtoxinA was used., (Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.)

Objectives: Describe a school outbreak of tuberculosis and compare the features with other outbreaks. Propose mediastinal ultrasound as an aid in its diagnosis and monitoring., Patients and Methods: Retrospective descriptive study of the transmission of tuberculosis infection in a micro-epidemic. Infection criteria: Mantoux ≥ 5mm, asymptomatic patient, with normal radiological, microbiological and analytical studies. Disease criteria: Mantoux ≥ 5mm and any of the above pathological studies. Mediastinal ultrasound was used as a complementary method of chest radiography (CXR). Computed tomography (CT) as the combined result of ultrasound and CXR was inconclusive., Results: Seventeen out of 412 students were infected and 16 with tuberculosis disease. In addition, 4 out-school contacts were diagnosed of tuberculosis., Clinical Manifestations: one erythema nodosum, one Henoch-Schönlein purpura, twelve with cough and fever nine. CXR results in patients: 3 normal, 7 inconclusive, and 10 with the following findings: 2 pneumonia, 2 pulmonary atelectasis, 2 primary complexes, 4 patients only with lymphadenopathy. All patients with normal or indeterminate CXR showed mediastinal lymphadenopathy visualized on ultrasound but 3 demonstrated by CT. Microbiological isolation: 6 cases (31%)., Conclusions: The number of infected patients was higher compared to other outbreaks There is great variability in the diagnostic approach to tuberculosis micro-epidemics. It is complex to differentiate between infection and disease. The clinical, laboratory and CXR are nonspecific. There are patients with normal CXR, pathological ultrasound and microbiological isolation. Mediastinal ultrasound can play an important role in the diagnosis and management of tuberculosis disease., (Copyright © 2012 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.)

Objective: A nursing task is to look after the pain associated with surgical procedures in order to maintain patient wellbeing. The first objective of this study was to measure the level of the patient satisfaction with management of post-operative pain. Secondly, we wanted to identify the determining factors of an adequate postoperative analgesia and the predictive value of the visual analogical scale (VAS)., Material and Methods: A sample of patients who had an operation was interviewed. The VAS was administered two hours and 24h after the surgical procedure with the American Society of Pain questionnaire. ROC curves were applied to establish the cut-off point for the VAS. We determined the contribution of different variables to adequate pain management by means of logistic regression., Results: We interviewed 237 patients in 2007 and 2008. Pain during the first 24h was perceived by 54% of them, 98% were satisfied with pain management and 95% expressed that analgesic treatment relieved their pain. Variables statistically associated with pain were specialty, and a value on the VAS higher than 0 two hours after the procedure., Conclusions: The management of post operative pain is satisfactory. The use of the VAS during the first two hours identifies an important percentage of patients who require more intensive analgesic treatment.

Background: Analysis of serum cortisol concentrations in patients with appropriate adrenocortical function and acute non-critical illness, in three periods of the day (11.30-15.00; 15.00-18.30; 18.30-22.00)., Patients and Method: One hundred and thirteen patients(40, 38 and 35, respectively) were evaluated at the Emergency Department. Every patient had a definite diagnosis., Results: In each period, minimum and mean serum cortisol concentrations were:8-8-8 microg/dl(220,8-220,8-220,8 nmol/l) and 27,8-24,1-29,3 microg/dl (767,3-665,2-808,7 nmol/l). No statistically significant differences were found between period means. A quarter of patients did not show serum cortisol concentrations >= 18 microg/dl (496,8 nmol/l)., Conclusions: Inpatients with acute disease, a random cortisol concentration below 8 microg/dL (220,8 nmol/L) is a strong presumptive evidence of adrenocortical insufficiency.

Background: To compare and evaluate two commercial methods for Mycoplasma hominis and Ureaplasma urealyticum with the isolation in agar A7 medium., Method: One hundred and twenty three vaginal and cervical swabs in women prostitutes, and urethral swabs in men, were studied for Mycoplasma hominis and Ureaplasma urealyticum isolation in agar A7 medium (BioMérieux; France), Mycoplasma IST (BioMérieux, France) and MycoFast ALL-IN (Unipath, U.K.)., Results: Of all 123 samples studied, it was isolated 24 Mycoplasma hominis (19.5%) and 56 Ureaplasma urealyticum (45.5%) in agar A7. The sensitivity was 100% for Mycoplasma hominis and Ureaplasma urealyticum in Mycoplasma IST versus 29.2% and 50% in MycoFast ALL-IN, both respectively. Specificity was lower for Ureaplasma urealyticum (59.7%) in Mycoplasma IST than in MycoFast ALL-IN (100%). It was found a tetracycline resistance of 15% and 12.5% for Ureaplasma urealyticum and Mycoplasma hominis, both respectively., Conclusions: The use of commercial methods permits to count the genital mycoplasmas, being Mycoplasma IST better than MycoFast ALL-IN for Mycoplasma hominis isolation. Both methods have limitations for Ureaplasma urealyticum and they require the use of agar A7. Mycoplasma IST could be a good method to survey tetracycline resistance.

The standard treatment of rejection episodes post-heart transplantation is based on high dose of steroids followed by monoclonal or policlonal antibodies directed against T lymphocytes like ATG or OKT3. When this treatment is insufficient it can be used other drugs like metothrexate, ciclofosfamide and another procedures such as total lymphoid irradiation, plasmapheresis or photopheresis. Cardiac allograft rejection is defined by histologic features that include the presence of lymphocytic infiltration of the myocardium with or without necrosis and this histologic pattern is termed cellular rejection. However there is a second form of acute rejection, associated with capillary injury, usually mediated by humoral immune response and without interstitial infiltrates which has been named vascular or humoral rejection. Vascular allograft rejection is commonly resistant to standards forms of immunosuppressive therapy and may result in irreversible allograft dysfunction and reduced patient survival.

We show a case of right neck abscess, in which the Eikenella corrodens, acted as pathogen together which other microorganism. We call attention to this germ that has a slow growing in culture and generally intervene in infections in which it is assumed the presence of anaerobic germs (intrathoracic abscess, neck abscess, etc.) and the are habitually treated with clindamycin, antibiotic which Eikenella corrodens is systematically resistant (to this antibiotic).

The yearly changes in the accumulated incidence (AI), localizations and responsible microorganisms of nosocomial infections (NI) which occurred over the period from 1984 to 1988 in the Urology Department of the Ramón y Cajal Hospital are described and a study of the seasonal tendency of such infections is carried out with data obtained from the Watch Out System by means of the annual AI rates to a ponderate regression curve. The yearly decrease in the risk of suffering a NI (expressed as the slope of the graph line) was 2.05% which was statistically significant. The most frequent localizations of NI were urinary, superficial postoperative wounds and bacteremia, representing the three of them almost 90% of the total number of infections each year. Urinary infection was the localization which presented the greatest annual decrease in risk (2.21%). Bacteremia also presented a decrease, although this was not significant. On the contrary, the risk of acquiring an infection in a superficial postoperative wound experimented during this period a significant annual increase (0.36%). E. coli, S. marcescens, and P. aeruginosa were the microorganisms most frequently isolated in NI.

The aim of the present work was to study hospital infection tendencies and to analyze the variations that have occurred in the accumulated incidence, the localization and the responsible microorganisms in a medical ICU of the Hospital Ramón y Cajal, Madrid during a 5 years period. Nosocomial infections appear with a statistically significant decreasing tendency: the simple regression curve, estimated from the monthly accumulated incidence, presents a slope = -0.16 (p less than 0.05); the adjustment made with the annual accumulated incidence values shows a slope = -2.15 (p less than 0.001). The most frequent localization of hospital infections were: lower respiratory tract, urine, and blood. These infections show in general a decreasing tendency existing a statistical difference in respiratory = -1.5 (p less than 0.001) and urinary = -1.48 (p less than 0.001) infections. The microorganisms most frequently isolated in these patients were P. aeruginosa, S. marcescens and E. coli.

Human albumin and dextran 70 were used as volume expanders in extracorporeal circulation in two homogeneous series of patients. Comparative results were statistically processed. No significant differences were observed either to early postoperative bleeding or needed volume of transfused blood. Postoperative complications neither developed in the two groups of patients. The total number of platelets showed a 50 percent decrease in relation to basal extraction figures and those after immediate heparin neutralization. Results of platelet function tests were similar in both series, except for a statistical significant decrease in ADP-induced platelet aggregation in the group with dextran 70. Such decrease, however, was not followed by an increase of postoperative bleeding. Thus, dextran 70 has showed to be a valuable substitute for human albumin in extracorporeal circulation.

The results of a survey carried out in our hospital about the use of cigarettes in which 680 staff members participated (257 men and 423 women) are presented. The percentage of current smokers was 50% (51.8% amongst women and 45.1% amongst men). The highest percentages of smokers were found amongst nurses (61%), maintenance staff (50%) and administrative staff (45.1%); 41% of physicians smoked. Quitting the smoking habit was more frequent amongst physicians and higher grade staff, with a predominance of older males. The smallest number of quitters was found amongst nurses. 93.5% of the surveyed subjects agreed with the establishment of restrictive measures, finding no differences according to age, sex, or professional status, although there were differences according to the smoking habit. The results obtained point out the importance of the smoking problem amongst health professionals and could be used to promote programs against smoking in hospitals.