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Abstract Background Mid-Regional pro-Adrenomedullin (MR-proADM) is an inflammatory biomarker that improves the prognostic assessment of patients with sepsis, septic shock and organ failure. Previous studies of MR-proADM have primarily focussed on bacterial infections. A limited number of small and monocentric studies have examined MR-proADM as a prognostic factor in patients infected with SARS-CoV-2, however there is need for multicenter validation. An evaluation of its utility in predicting need for hospitalisation in viral infections was also performed. Methods An observational retrospective analysis of 1861 patients, with SARS-CoV-2 confirmed by RT-qPCR, from 10 hospitals across Europe was performed. Biomarkers, taken upon presentation to Emergency Departments (ED), clinical scores, patient demographics and outcomes were collected. Multiclass random forest classifier models were generated as well as calculation of area under the curve analysis. The primary endpoint was hospital admission with and without death. Results Patients suitable for safe discharge from Emergency Departments could be identified through an MR-proADM value of ≤ 1.02 nmol/L in combination with a CRP (C-Reactive Protein) of ≤ 20.2 mg/L and age ≤ 64, or in combination with a SOFA (Sequential Organ Failure Assessment) score 0.85 nmol/L, in combination with a SOFA score ≥ 2 and LDH > 720 U/L, or in combination with a CRP > 29.26 mg/L and age ≤ 64, when MR-proADM was > 1.02 nmol/L. Conclusions This international study suggests that for patients presenting to the ED with confirmed SARS-CoV-2 infection, MR-proADM in combination with age and CRP or with the patient’s SOFA score could identify patients at low risk where outpatient treatment may be safe.

Abstract Early recognition of sepsis is a key factor to improve survival to this disease in surgical patients, since it allows prompt control of the infectious source. Combining pro-inflammatory and immunosupression biomarkers could represent a good strategy to improve sepsis detection. Here we evaluated the combination of procalcitonin (PCT) with gene expression levels of HLA-DRA to detect sepsis in a cohort of 154 surgical patients (101 with sepsis and 53 with no infection). HLA-DRA expression was quantified using droplet digital PCR, a next-generation PCR technology. Area under the receiver operating curve analysis (AUROC) showed that the PCT/HLA-DRA ratio outperformed PCT to detect sepsis (AUROC [CI95%], p): PCT: 0.80 [0.73–0.88],

A phosphatase inhibition assay for detection of okadaic acid (OA) toxins in shellfish, OkaTest, was single laboratory validated according to international recognized guidelines (AOAC, EURACHEM). Special emphasis was placed on the ruggedness of the method and stability of the components. All reagents were stable for more than 6 months and the method was highly robust under normal laboratory conditions. The limit of detection and quantification were 44 and 56 µg/kg, respectively; both below the European legal limit of 160 µg/kg. The repeatability was evaluated with 2 naturally contaminated samples. The relative standard deviation (RSD) calculated was 1.4% at a level of 276 µg/kg and 3.9% at 124 µg/kg. Intermediate precision was estimated by testing 10 different samples (mussel and scallop) on three different days and ranged between 2.4 and 9.5%. The IC50 values of the phosphatase used in this assay were determined for OA (1.2 nM), DTX-1 (1.6 nM) and DTX-2 (1.2 nM). The accuracy of the method was estimated by recovery testing for OA (mussel, 78–101%; king scallop, 98–114%), DTX-1 (king scallop, 79–102%) and DTX-2 (king scallop, 93%). Finally, the method was qualitatively compared to the mouse bioassay and LC-MS/MS.

To identify the most annoying noises in the hospital environment. One hundred and ninety-three patients took part in the study. A questionnaire collected the perceptions of patients from four hospitals in Spain, with three distinct units. The most annoying noises were the repetitive ones and the most unbearable source was the people who talk loudly. The daily hours were the noisiest and the most annoying, especially when patients wanted to rest and indicated that noise was annoying for them to get to sleep. Our results demonstrate how sensitive patients are toward noise in Spain. We also suggest some strategies to reduce the noise and the harmful physiological effects of increased sound levels in order to improve the quality of life in a healthcare environment.

Background: Rhodococcus equi is a Gram-positive microorganism that causes infections, particularly in immunocompromised patients. Treatment duration can be prolonged. While vancomycin is an effective drug in this scenario, its use may lead to renal damage. Studies have shown that continuous vancomycin infusion appears to be a safe strategy in terms of adverse effects compared to bolus administration. Case description: We present the case of a 71-year-old female liver transplant recipient. After being diagnosed with a mediastinal infection caused by Rhodococcus equi with poor response to initial therapy, she required 12 months of continuous intravenous domiciliary infusion of vancomycin combined with oral levofloxacin and rifampicin. There was no drug-related complication throughout the follow-up. Conclusions: The use of continuous vancomycin infusion has emerged as a safer, more efficient, and cost-effective alternative to intermittent administration. We want to emphasise the uniqueness of this case, where despite the unprecedented treatment duration, no adverse effects occurred.

Seasonal influenza is an acute respiratory infection caused by the influenza virus which constitutes a significant public health issue associated with high morbidity and mortality. The aim of this study was to investigate changes in attitudes, perceptions, and practices regarding influenza vaccination in the Spanish adult population during the COVID-19 pandemic, as well as their vaccination intentions, with special attention paid to those over 65 years old and in high-risk groups. To this end, a cross-sectional study was conducted through 2219 telephone interviews, and the results were compared with results obtained a year earlier. Regarding the reasons for deciding to get vaccinated in the 2022/23 season, a significant increase was observed in vaccine confidence (36.7% vs. 42.8%), social responsibility (32.5% vs. 43.8%), and in awareness of the importance of vaccination due to COVID-19 (21.7% vs. 25.4%). Advanced age (OR 2.8, 95% CI 2.0–3.9), belonging to high-risk groups (OR 2.7, 95% CI 2.0–3.7), and prior vaccination (OR 25.3, 95% CI 19.5–32.7) emerged as significant predictors for the intent to receive the influenza vaccine in the 2022/23 season. Continuously observing shifts in perceptions and behaviors related to influenza immunization is crucial to pinpoint factors that may influence the willingness to receive the vaccine and, in this way, design public health strategies that achieve a greater acceptance of it.

Objetivo: Describir los efectos del uso del teléfono móvil sobre la seguridad del paciente en el áreaquirúrgica. Método: Se realizó una revisión bibliográfica sistemática de las bases de datos Web of Science,Scopus y PubMed, con una estrategia de búsqueda en los idiomas inglés y español utilizando términos claves DeCS y de uso coloquial. Resultados: Sobre 203 artículos estudiados, 18 estudios resultaron válidos para elanálisis, detectando un uso del teléfono móvil durante la práctica clínica con múltiples beneficios para losprofesionales de la salud y para el paciente, destacando mejoras en la información, administración,organización, comunicación y seguridad del paciente, así como distracciones, percepción desfavorable de lospacientes y/o familiares, propagación de agentes patógenos e interferencias con instrumentos electrónicoscomo efectos adversos asociados al uso del teléfono móvil por los profesionales sanitarios con importantepresencia enfermera. Conclusión: Se constata que el equipo quirúrgico utiliza el teléfono móvil durante supraxis clínica, siendo susceptible de importantes mejoras manifiestamente claras en la comunicación,gestión de recursos e información, así como en la seguridad del paciente. Los posibles efectos adversosdeben ser analizados desde una perspectiva crítica constructiva y con mayor profundidad investigadora.

Onychomycosis accounts for 50% of nail disorders, making it one of the most prevalent fungal diseases and a therapeutic challenge. Photodynamic therapy (PDT) could constitute a therapeutic alternative, owing to its good adherence, the low probability of resistance, the lack of interaction with antimicrobials, and its favorable adverse effect profile. This retrospective observational study included all patients with a microbiological diagnosis of onychomycosis treated with PDT at Miguel Servet University Hospital, Zaragoza (Spain), between January 2013 and June 2021. The protocol consisted of pre-treatment with 40% urea for 7 days, followed by 16% methyl-aminolevulinate (MAL) for 3 h and subsequent irradiation with a red-light LED lamp (37 J/cm2), every 1 or 2 weeks. Combined treatment with oral and/or topical antifungals was recorded. Of the 20 patients included (mean age, 59 ± 17 years), 55% were men. The most frequently detected microorganism was Trichophyton rubrum (55%). The most commonly affected location was the feet (90%): 50% of these cases were associated with tinea pedis. The median (standard deviation) number of PDT sessions was 6 (2.8). PDT was combined with systemic terbinafine (250 mg/day) in 10 cases (in 8 cases, this was administered for only 1 month), and with topical terbinafine in 3 cases. A complete clinical response was achieved in 80% (16) of cases and microbiological cure in 60% (12). PDT is a therapeutic alternative for onychomycosis, and can be administered either in monotherapy or combined with antifungals, allowing for a reduction in the duration and possible adverse effects of antifungal treatment and achieving higher cure rates than those obtained with either treatment alone.

Objectives To analyse the physical activity carried out by the adolescents in the study, its relationship to being overweight (overweight+obese) and to analyse the structure of the social network of friendship established in adolescents doing group sports, using different parameters indicative of centrality.Setting It was carried out in an educational environment, in 11 classrooms belonging to 5 Schools in Ponferrada (Spain).Participants 235 adolescents were included in the study (49.4% female), who were classified as normal weight or overweight.Primary and secondary outcome measures Physical Activity Questionnaire for Adolescents (PAQ-A) was used to study the level of physical activity. A social network analysis was carried out to analyse structural variables of centrality in different degrees of contact.Results 30.2% of the participants in our study were overweight. Relative to female participants in this study, males obtained significantly higher scores in the PAQ-A (OR: 2.11; 95% CI: 1.04 to 4.25; p value: 0.036) and were more likely to participate in group sport (OR: 4.59; 95% CI: 2.28 to 9.22; p value: 0.000). We found no significant relationship between physical activity and the weight status in the total sample, but among female participants, those with overweight status had higher odds of reporting high levels of physical exercise (OR: 4.50; 95% CI: 1.21 to 16.74; p value: 0.025). In terms of centrality, differentiating by gender, women who participated in group sports were more likely to be classified as having low values of centrality, while the opposite effect occurred for men, more likely to be classified as having high values of centrality.Conclusions Our findings, with limitations, underline the importance of two fundamental aspects to be taken into account in the design of future strategies: gender and the centrality within the social network depending on the intensity of contact they have with their peers.

La aplicación de la genética a la alimentación es tan antigua como la agricultura o la ganadería. Desde que el hombre comenzó a cultivar vegetales o domesticar animales viene llevando a cabo un proceso de mejora genética valiéndose sobre todo de la técnica del cruce sexual. Por ello podemos afirmar que ninguno de los alimentos que consumimos en nuestra dieta es, desde el punto de vista genético, igual al que comían nuestros abuelos. Los últimos años han dado lugar a la aplicación de técnicas genéticas novedosas como la ingeniería genética a la tecnología de alimentos. La consecuencia ha sido la aparición de los denominados alimentos transgénicos. La comercialización de estos nuevos alimentos ha generado una gran polémica en los países miembros de la Unión Europea. Sus posibles riesgos sanitarios, medioambientales o económicos son tema constante de debate, en la mayoría de los casos con grandes dosis de apasionamiento y pocas de racionalidad. En este trabajo se pretende llevar a cabo una revisión sobre dicha situación. La aplicación de la genética a la alimentación es tan antigua como la agricultura o la ganadería. Desde que el hombre comenzó a cultivar vegetales o domesticar animales viene llevando a cabo un proceso de mejora genética valiéndose sobre todo de la técnica del cruce sexual. Por ello podemos afirmar que ninguno de los alimentos que consumimos en nuestra dieta es, desde el punto de vista genético, igual al que comían nuestros abuelos. Los últimos años han dado lugar a la aplicación de técnicas genéticas novedosas como la ingeniería genética a la tecnología de alimentos. La consecuencia ha sido la aparición de los denominados alimentos transgénicos. La comercialización de estos nuevos alimentos ha generado una gran polémica en los países miembros de la Unión Europea. Sus posibles riesgos sanitarios, medioambientales o económicos son tema constante de debate, en la mayoría de los casos con grandes dosis de apasionamiento y pocas de racionalidad. En este trabajo se pretende llevar a cabo una revisión sobre dicha situación.

En este artículo vamos a abordar el estudio de una forma de expresión que cuenta cada vez con mayor prestigio y presencia en los medios de comunicación: la infografía. Para eso nos centraremos en un hecho histórico: la I Guerra del Golfo, como primer gran acontecimiento mundial ocurrido en el momento en el que la informática comienza a asentarse en las redacciones; y en un periódico: La Voz de Galicia, como publicación de referencia en España y, fundamentalmente, en Galicia. En las próximas páginas estudiaremos las características, estructura, composición, contenido y funciones de los infográficos realizados en aquella época y comprobaremos si, como ocurrió en otros diarios españoles, la I Guerra del Golfo fue el motor que propició el desarrollo de la infografía en La Voz de Galicia.

The right to good Administration, is being coined from the Doctrine and Jurisprudence and encouraged by the Governance, as a real need to demand citizenship not only the situation of economic crisis, but by the failure of the guiding principles and values our public institutions, also in health. The situations of impunity fragrant actions-activities of many public servants and mismanagement (arbitrariness, corruption, cuts and health services access…) always contrary to the broad concept of Lex Artis professional, innovative active current in order, to value the obligations of the upright in the public, all public servants of the defaulting government, establishing a pattern that must necessarily pass through the general interest service oriented as the supreme principle, together with the correction of poor performance transparent, the motivation for their actions meager and insufficient participation from the observance of the principles already declared as of right and not as mere prerogative. The relevance and timeliness of the subject, let us add that all figure to develop this pattern, dusting principles from the requirement of a good public health authority, to the great task of facilitating its incorporation into public life and effectively, as expeditiously possible.