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The present outbreak of Human Monkeypox (HMPX) that has begun in May 2022 and has spread across all continents in less than two months has qualitative and quantitative characteristics that make it different from the pattern of human disease previously caused by this virus. It has spread with enormous ease, affects almost exclusively adults, behaves as a sexually transmitted disease and focuses on very specific groups and transmission conditions. The high incidence in the city of Madrid in males that have sex with males (MSM) has allowed us to observe and report the experience with the first 30 cases diagnosed in our institution. Patients presented with febrile symptoms, genital and paragenital skin lesions reminiscent of smallpox, but less extensive and severe. The disease may also cause proctitis, pharyngitis and perioral lesions. The PCR test for diagnostic confirmation has been shown to be very sensitive and effective, not only in skin lesions but also in blood and other fluids such as pharyngeal, rectal exudates and blood. A very high proportion of patients with HMPX also have other sexually transmitted diseases that must be actively detected in this context. The spontaneous evolution of our patients has been good and hospitalization has been practically unnecessary. Transmission to non-sexual cohabitants and health personnel has been nonexistent and the lesions have disappeared in less than 30 days without leaving sequelae and no need for specific antiviral treatment.

El presente texto nace del proyecto de investigación en gestión empresarial que se adelanta en el programa de administración de empresas donde están vinculados los autores. Se presenta la persecución del éxito empresarial y la ética sindical como la finalidad de consolidar el desarrollo sustentable latinoamericano. En ese sentido las nuevas realidades laborales se han estado enfocando recientemente en la productividad, en la eliminación del trabajo estático dando lugar al trabajo remoto y la formación de equipos de trabajo sinérgicos, que respondan a las inclinaciones de esta nueva descendencia de subalternos, afectando así a las organizaciones sindicales que dependen del claustro de trabajo.

La presente obra titulada Visiones Socio Jurídicas de la Sociedad Contemporánea, constituye una valiosa contribución para la comprensión de temáticas sociales y jurídicas de la actualidad relatadas desde la perspectiva de sus autores, quienes producto de un riguroso análisis colocan en relieve la realidad e implicaciones socio jurídicas de nuestra sociedad. Toda una correlación de esfuerzo entre el Centro de Estudios Administrativo y Políticas Públicas (CEAPP) como organismo de investigación que acredita esta producción científica, el grupo de investigación Gestión de Políticas Públicas y Desarrollo Social promoviendo esta participación y los autores por el meritorio aporte al conocimiento. Juntos en un esfuerzo mancomunado ofrecemos este libro de mucho interés, actualidad, análisis, vivencias, experiencias y reflexiones que permite ubicar en el contexto a los estudiosos del tema. Dentro del marco referencial anterior, donde que a en evidencia el trabajo colaborativo de redes de investigaciones nacionales e internacionales, esperamos que este aporte editorial realizado por el Fondo Editorial UNERMB, cumpla con los propósitos formulados, cubra las expectativas de sus lectores y genere una mayor comprensión de las temáticas estudiadas.

El artículo evidencia el estado del arte de las investigaciones sobre el maltrato prenatal y su incidencia en las dificultades del desarrollo infantil. A través de una revisión bibliográfica en bases de datos sobre tópicos como el maltrato en la etapa gestacional, factores de riesgo de la violencia fetal, vínculo materno-infantil y las implicaciones en el desarrollo, identificando las consecuencias e implicaciones que estos acarrean en la vida del infante, obteniendo como resultado que aquellas víctimas de algún tipo de maltrato en el período gestacional, presentan modificaciones en la estructura de la corteza, bajo peso al nacer, prematuridad, muerte fetal y perinatal, depresión, estrés, ansiedad y concepto negativo de sí mismo; además de trastornos externalizantes como déficit de atención e hiperactividad, agresión y desadaptación social, los cuales influyen de manera significativa en el desarrollo integral desde los primeros años hasta la adultez.

In the exercise of teaching, teachers give account of different forms of organization: emerging, self-managed and autonomous product of conceptions that arise from training, performance and experiences where the socio-political nature of both his being and individual that integrates and makes part of social groups, as in the exercise of professional practice. Under this horizon, the aim of this work is to analyze from the social function of the teacher the sociopolitical role of their task as far as the political vision has, ability to understand social problems and generate actions for which is part of a frame of reference where the concepts that allow to develop theoretical analysis to identify the sociopolitical expression of the teaching exercise are exposed, considering that in this practice this type of content is revealed in the teachers as actors of the teaching-learning process, both in the training in their performance based on the training they receive, the historical geographical relationship and the experiences that their activity provides them with what has framed this work. It is concluded that in the exercise of teaching work are present sociopolitical categories that affect both the understanding of social phenomena and the pretense of practical actions that transform these realities from the institution-teacher-student interaction.

LA EDUCACIÓN, LA EMPRESA Y LA SOCIEDAD UNA MIRADA TRANSDICIPLINARIA TOMO TRES COLECCIÓN RESULTADO DE INVESTIGACIÓN Primera Edición 2020 Escuela Internacional de Negocios y Desarrollo Empresarial de Colombia – EIDEC www.eidec.com.co Centro de Investigación Científica, Empresarial y Tecnológica de Colombia – CEINCET www.ceincet.com Red de Investigación en Educación, Empresa y Sociedad – REDIEES www.rediee.org Editorial EIDEC Sello editorial (978-958-52636) ISBN: 978-958-53018-1-8 DOI: https://doi.org/10.34893/sfv2-2q75 Fecha Publicación: 2020-10-23 comiteeditorial@editorialeidec.com www.editorialeidec.com Colombia

LA EDUCACIÓN, LA EMPRESA Y LA SOCIEDAD UNA MIRADA TRANSDICIPLINARIA TOMO CUATRO COLECCIÓN RESULTADO DE INVESTIGACIÓN Primera Edición 2020 Escuela Internacional de Negocios y Desarrollo Empresarial de Colombia – EIDEC www.eidec.com.co Centro de Investigación Científica, Empresarial y Tecnológica de Colombia – CEINCET www.ceincet.com Red de Investigación en Educación, Empresa y Sociedad – REDIEES www.rediee.org Editorial EIDEC Sello editorial (978-958-52636) ISBN: 978-958-53018-3-2 DOI: https://doi.org/10.34893/hqxc-r887 Fecha Publicación: 2020-10-23 comiteeditorial@editorialeidec.com www.editorialeidec.com Colombia

RESUMEN El objetivo del artículo es analizar desde las políticas públicas el proceso de contabilidad medioambiental, como sistema de gestión de información administrativa y financiera. Metodológicamente, se basó en el paradigma positivista, bajo un estudio cuantitativo y diseño de campo. La población estuvo conformada por Contadores Públicos y Gerentes de Gestión Ambiental, que se desempeñan en empresas agroindustriales de palma de aceite. diseñándose un instrumento con escala tipo Likert. Se concluye que el indicador fortalecido es el de Unidad de Medida, como el medio efectivo para el intercambio de bienes y servicios, y para registrar los efectos económicos de los eventos que afectan a la organización. ABSTRACT The objective of the article is to analyze from the public policies the environmental accounting process, as a management system for administrative and financial information. Methodologically, it was based on the positivist paradigm, under a quantitative study and field design. The population was made up of Public Accountants and Environmental Management Managers, who work in agro-industrial oil palm companies. Design an instrument with a Likert-type scale. It is concluded that the strengthened indicator is the Unit of Measure, as the effective means of exchanging goods and services, and to record the economic effects of events that affect the organization.

RESUMEN El objetivo del artículo es analizar desde las políticas públicas el proceso de contabilidad medioambiental, como sistema de gestión de información administrativa y financiera. Metodológicamente, se basó en el paradigma positivista, bajo un estudio cuantitativo y diseño de campo. La población estuvo conformada por Contadores Públicos y Gerentes de Gestión Ambiental, que se desempeñan en empresas agroindustriales de palma de aceite. diseñándose un instrumento con escala tipo Likert. Se concluye que el indicador fortalecido es el de Unidad de Medida, como el medio efectivo para el intercambio de bienes y servicios, y para registrar los efectos económicos de los eventos que afectan a la organización. ABSTRACT The objective of the article is to analyze from the public policies the environmental accounting process, as a management system for administrative and financial information. Methodologically, it was based on the positivist paradigm, under a quantitative study and field design. The population was made up of Public Accountants and Environmental Management Managers, who work in agro-industrial oil palm companies. Design an instrument with a Likert-type scale. It is concluded that the strengthened indicator is the Unit of Measure, as the effective means of exchanging goods and services, and to record the economic effects of events that affect the organization.

Purpose: To analyze the influence of adding gentamicin to a regimen consisting of β-lactam or vancomycin plus rifampicin on survival in patients suffering from Staphylococcal prosthetic valve endocarditis (SPVE). Methods: From January 2008 to September 2016, 334 patients with definite SPVE were attended in the participating hospitals. Ninety-four patients (28.1%) received treatment based on β-lactam or vancomycin plus rifampicin and were included in the study. Variables were analyzed which related to patient survival during admission, including having received treatment with gentamicin. Results: Seventy-seven (81.9%) were treated with cloxacillin (or vancomycin) plus rifampicin plus gentamicin, and 17 patients (18.1%) received the same regimen without gentamicin. The causative microorganism was Staphylococcus aureus in 40 cases (42.6%) and coagulase-negative staphylococci in 54 cases (57.4%). Overall, 40 patients (42.6%) died during hospital admission, 33 patients (42.9%) in the group receiving gentamicin and 7 patients in the group that did not (41.2%, P = 0.899). Worsening renal function was observed in 42 patients (54.5%) who received gentamicin and in 9 patients (52.9%) who did not (p = 0.904). Heart failure as a complication of endocarditis (OR: 4.58; CI 95%: 1.84–11.42) and not performing surgery when indicated (OR: 2.68; CI 95%: 1.03–6.94) increased mortality. Gentamicin administration remained unrelated to mortality (OR: 1.001; CI 95%: 0.29–3.38) in the multivariable analysis. Conclusions: The addition of gentamicin to a regimen containing vancomycin or cloxacillin plus rifampicin in SPVE was not associated to better outcome.

In this work, we explore the interaction between some prototypical asphaltene and porphyrin molecules with a fully hydroxylated (0001) surface of α-quartz by means of theoretical calculations based on the density functional theory (DFT) under periodic boundary conditions. The influence of dispersion forces, adsorption geometries, and size of the side chain is analyzed. The inclusion of London dispersion forces is overriding as they increase the interaction by about 1 order of magnitude. All of the considered molecules strongly interact with the hydroxylated surface and prefer to adsorb in a parallel position instead of vertically. It is also found that adsorption energy always increases with larger side chains because dispersion interactions also augment. Interestingly, in the case of porphyrin, the less stable isomer in the gas phase is the preferred one after adsorption, which is substantiated by a differential stabilization induced by the surface. Finally, we present a comparative study of the adsorption of these model molecules in terms of energy per area unit and energy per interacting π electron.

Objective: To investigate the rate of colorectal neoplasms (CRNs) in patients who have Enterococcus faecalis infective endocarditis (EFIE) with available colonoscopies and to assess whether this is associated with the identification of a focus the infection. Patients and Methods: Retrospective analysis of data from a prospective multicenter study involving 35 centers who are members of the Grupo de Apoyo para el Manejo de la Endocarditis en Espana [Support Group for the Management of Infective Endocarditis in Spain] cohort. A specific set of queries regarding information on colonoscopy and histopathology of colorectal diseases was sent to each participating center. Four-hundred sixty-seven patients with EFIE were included from January 1, 2008, to December 31, 2017, from whom data on colonoscopy performance and results were available in 411 patients. Results: One hundred forty-two (34.5%) patients had a colonoscopy close to the EFIE episode. The overall rate of colorectal diseases was 70.4% (100 of 142), whereas the prevalence of CRN (advanced adenomas and colorectal carcinoma) was 14.8% (21 of 142), with no significant differences between the group of EFIE of unknown focus and that with an identified focus. Conclusion: Our study adds to prior evidence suggesting a much higher rate of CRN among patients with EFIE than in the general population of the same age and sex. In addition, our findings suggest that this phenomenon might take place both in EFIE with an unknown and an identified source of infection.

The correct description of crude oil/water interfaces is a very complex and an important task, particularly to the oil industry, whose main difficulty relies on understanding how the interfacial properties (i.e., interfacial tension and interfacial accumulation) of the system are affected by a very large number of components. To give some additional insight to the oil/water interfacial behavior, eleven oil/water mixtures (i.e., six binary, four ternary and a quaternary mixture) have been modeled through atomistic molecular dynamics simulations at laboratory conditions. All mixtures were built with a model oil based on dodecane, toluene, quinoline and a naphthenic acid, to represent the saturated, aromatic, basic resin and acid resin fractions, respectively. The results from this contribution show that interfacial tensions can be correlated to interfacial accumulation, which can be used as good starting point in predicting interfacial properties of oil mixtures. Additionally, the interfacial properties of mixtures behave similarly to the most polar pure oil/water interface, while all other compounds stay in the oil bulk as spectators. This behavior raises the question of whether using common n-alkane oils is a good enough approximation for modeling the interfacial properties of crude oils. (C) 2020 Elsevier B.V. All rights reserved.

1 recurso en línea (páginas 57-67)., La predicción de los modos de vibración de las moléculas o estructuras cristalinas basados en sus propiedades de simetría, nos permiten utilizar un poderoso método para caracterizar nuevos materiales. En el siguiente trabajo, se realizó el análisis modal teórico por medio del método de correlación, y se obtuvo los modos de vibración Raman opticamente activos para un sistema cristalino con estructura de tipo Hexagonal Wurzita. Utilizando la técnica de espectroscopia Raman, se registró el espectro de vibración Raman Stokes para un cristal de ZnO. A partir del análisis teórico y del espectro Raman registrado experimentalmente para el ZnO, se pudo observar y comparar el método teórico (método de correlación) con el experimental (técnica de espectroscopia Raman). Este análisis, sugiere que el método de correlación es preciso en la predicción de los modos de vibración de cualquier red cristalina, sin embargo, su poder se puede extender al usarse conjuntamente con los datos experimentales Raman en la caracterización de la calidad cristalina y estructural de nuevos materiales de interés tecnológico., The prediction of vibrational modes of the crystalline molecules or structures based on their properties of symmetry, allow us to use a powerful method to characterize new materials. In this work, the theoretical modal analysis was performed by the correlation method, and the optically active Raman vibration modes were obtained for a crystalline system with hexagonal Wurzite type structure. Using the Raman spectroscopy technique, the Raman Stokes vibration spectrum was obtained for a ZnO crystal. From the theoretical analysis and the experimentally recorded Raman spectrum for ZnO, it was possible to observe and compare the theoretical method (correlation method) with the experimental method (Raman spectroscopy technique). This analysis suggests that the correlation method is accurate in predicting the modes of vibration of any crystal lattice, which can be used in conjunction with the Raman experimental data in characterizing the crystalline and structural quality of new materials of technological interest., Bibliografía y webgrafía: páginas 66-67.

Background: There is little information concerning infective endocarditis (IE) in patients with bicuspid aortic valve (BAV) or mitral valve prolapse (MVP). Currently, IE antibiotic prophylaxis (IEAP) is not recommended for these conditions. Objectives: This study sought to describe the clinical and microbiological features of IE in patients with BAV and MVP and compare them with those of IE patients with and without IEAP indication, to determine the potential benefit of IEAP in these conditions. Methods: This analysis involved 3,208 consecutive IE patients prospectively included in the GAMES (Grupo de Apoyo al Manejo de la Endocarditis infecciosa en España) registry at 31 Spanish hospitals. Patients were classified as high-risk IE with IEAP indication (high-risk group; n = 1,226), low- and moderate-risk IE without IEAP indication (low/moderate-risk group; n = 1,839), and IE with BAV (n = 54) or MVP (n = 89). Results: BAV and MVP patients had a higher incidence of viridans group streptococci IE than did high-risk group and low/moderate-risk group patients (35.2% and 39.3% vs. 12.1% and 15.0%, respectively; all p < 0.01). A similar pattern was seen for IE from suspected odontologic origin (14.8% and 18.0% vs. 5.8% and 6.0%; all p < 0.01). BAV and MVP patients had more intracardiac complications than did low/moderate-risk group (50% and 47.2% vs. 30.6%, both p < 0.01) patients and were similar to high-risk group patients. Conclusions: IE in patients with BAV and MVP have higher rates of viridans group streptococci IE and IE from suspected odontologic origin than in other IE patients, with a clinical profile similar to that of high-risk IE patients. Our findings suggest that BAV and MVP should be classified as high-risk IE conditions and the case for IEAP should be reconsidered. Sin financiación 18.639 JCR (2018) Q1, 3/136 Cardiac & Cardiovascular Systems 9.280 SJR (2018) Q1, 1/365 Cardiology and Cardiovascular Medicine No data IDR 2018 UEM

Interfacial tension of some hydrocarbon/water systems, including a mixture of aliphatic and aromatic hydrocarbons, has been estimated on the basis of molecular dynamics simulations. The dependence of the interfacial properties on the salinity of the aqueous phase and the temperature has been simulated. Different concentrations in NaCl and CaCl2 up to 2 M have been used. It is found that, in all considered cases, interfacial tension increases with salt concentration. This effect depends on the preference of the salt ions for the bulk of the aqueous phase that, in turns, results in an increased difficulty for the water molecules to be at the interface. The influence of salinity is fundamentally electrostatic in origin and does not depends on the chemical nature of the salt cation. Finally, the impact of temperature on the dodecane/brine interfacial tension has also been inspected. A decreasing of the values of the interfacial tension is found in agreement, both in trend and magnitude, with experimental available data

Purpose Survey of intravascular catheter management is an essential step in the control and prevention of catheter-related infection. In recent years, most surveillance studies only included catheters from intensive care units (ICUs). Data regarding the level of care and adherence to international guidelines in a whole general institution are scarce. Our objective was to evaluate the care situation of intravascular catheters in our adult units of a General Hospital. Methods We surveyed adults hospitalized in non-psychiatric/maternity wards. In a week, a nurse visited all the adult hospitalized patients. Data were registered in a protocol that included variables, such as no. of catheters, location of catheter, type of catheter, date of placement and the need of an indication of each catheter in the visit day. Results We included in the study a total of 753 adult patients. Of them, 653 (86.7%) had one or more inserted catheters at the moment of the study visit (total: 797 catheters). Of all the catheters, 144 (18.0%) were central venous catheters and 653 (81.9%) were peripheral lines. The hospitalization units where the patients were admitted were ICU, 52 (6.9%); and non-ICU, 601 (92.0%). There were 183 (22.9%) catheters with no need to remain in place in the day of the study. Overall, we found 464 (71.0%) patients with one or more opportunities for catheter care improvement. Conclusions A rapid survey of the care situation of intravascular catheters is feasible and easy to do with our methodology. The data show great opportunity for improvement, mainly in the non-ICU areas.

Background The impact of training programs on the care and maintenance of venous lines (VL) has been assessed mainly in patients admitted to the intensive care unit (ICU). Data on the impact of such programs in a whole general hospital are scarce. The objective of this study was to assess compliance with VL care after an extensive training program aimed at nurses caring for adult ICU and non-ICU patients. Methods We performed 2 point prevalence studies in a general hospital. A specialized nurse visited all hospitalized adult patients, performed a bedside inspection, and reviewed the nursing records for patients with a VL before and after a 1-year training program. The program included an interactive on-line teaching component and distribution of pocket leaflets and posters with recommendations on VL care. Results Data recorded for the first and second prevalence studies were as follows: number of patients visited, 753 vs. 682; total number of patients with ≥ 1 VL implanted on the visit day, 653 (86.7 %) vs 585 (85.8 %); catheters considered unnecessary on the study day, 183 (22.9 %) vs 48 (7.1 %) (p

La educación no es ajena a la dinámica del entorno empresarial ni a los constantes cambios de las condiciones del mercado, en el cual se debe afrontar la nueva demanda de profesionales. Las instituciones universitarias, en especial aquellas que imparten formación en administración o en negocios, están obligadas a generar procesos de actualización y desarrollo de tal manera que brinden a sus estudiantes una educación más acorde con las nuevas exigencias internacionales. Este documento analiza las tendencias de la formación en administración que ofrecen las universidades norteamericanas y las europeas en contraste con la oferta presente en Latinoamérica, y a partir de este diagnóstico sugiere algunas recomendaciones importantes que deben seguir las instituciones educativas de la región para consolidarse como líderes del mercado.

Objective To determine the frequency, etiology, and risk factors of ventilator-associated pneumonia (VAP) and purulent tracheobronchitis (TBX) in patients who have undergone heart surgery. To study the predictive role of systematic surveillance cultures. Design Prospective study. Setting Heart surgery intensive care unit. Patients Intubated heart surgical patients. Interventions Systematic tracheal aspirate and protected brush catheter cultures of all intubated patients. Measurements and Main Results Studied were the frequency of lower respiratory tract infection in ventilated patients and the role of surveillance cultures. The frequency of VAP was 7.87% (34.5 per 1,000 days of mechanical ventilation), and the criteria for purulent tracheobronchitis was fulfilled by 8.15% of patients (31.13 per 1,000 days of mechanical ventilation). After multivariate analysis, the variables independently associated with the development of respiratory tract infection were central nervous system disorder (relative risk [RR] = 4.7), ulcer disease (RR = 3.6), New York Heart Association score ≥3 (RR = 4), need for mechanical circulatory support (RR = 6.8), duration of mechanical ventilation >96 hrs (RR = 12.3), and reintubation (RR = 63.7). Mortality in our study was as follows: VAP patients, 57.1%; purulent tracheobronchitis patients, 20.7%; colonized patients, 11.5%; and noncolonized patients, 1.6%. Regular surveillance cultures were taken from all ventilated patients to assess the anticipative value of the cultures in predicting respiratory tract infection. A total of 1,626 respiratory surveillance samples were obtained. Surveillance cultures effectively predicted only one episode of VAP and one of tracheobronchitis. Conclusions Patients undergoing heart surgery have a high frequency of VAP. VAP is associated with a poor prognosis. In this study, surveillance cultures failed as an anticipative diagnostic method.

In the present paper the feasibility of using direct contact membrane distillation for the concentration of glycol from used coolant liquids is analyzed. Membrane distillation experiments were performed with water–ethylene glycol mixtures, using a tangential flow cell, various membranes and different temperatures. The experiments show that the membranes reject almost completely the glycol and effective concentration is achieved. This result is expected, since the vapor pressure of glycol is negligible, compared to that of water, at the temperatures employed in the experiments. On the other hand, the effects of both temperature and concentration polarization were very important, and a specific computer code was developed in order to take them into account. From the computer code, values are obtained for the permeability of the membrane, and for the heat and mass transfer coefficients of the boundary layers. The values obtained agree with those of other literature sources and with the theoretical expectations.

The use of membrane distillation in the concentration of protein solutions is proposed. Semidilute BSA solutions (concentrations ranging between 40 and 100%), at pH 7 were employed. Transmembrane volume fluxes and evolution of the BSA concentration were measured at different conditions. Temperatures ranged between 20 and 38°C. The filtration cell was operated at laminar regime with tangential velocities of 579 and 89cm-s°. Special attention was devoted to analysis of the temperature polarization and fouling effects. The results obtained show that fouling effects are practically absent in membrane distillation operations with BSA solutions, at least for concentrations up to 10% w/w and in the range of crossflow velocities employed. This may be due to the fact that the transmembrane fluxes are below the value of the critical flux for fouling.

Background Lock-therapy with antimicrobials has been used for the treatment and prevention of catheter-related bloodstream infections (CR-BSI). Experiences with Ethanol-Locks (E-locks) have included therapeutic interventions with variable results. Patients undergoing Major Heart Surgery (MHS) are a high-risk population for CR-BSI.The aim of this study was to assess the efficacy and tolerance to E-Locks in the prevention of CR-BSI of patients undergoing MHS. Methods and Findings This is an academic, prospective, randomized, non-blinded and controlled clinical trial assessing the incidence of CR-BSI of patients with E-locks (E-lock) and the tolerance to the procedure in comparison with patients receiving conventional catheter-care (CCC). Patients undergoing MHS with intravascular catheters for more than 48 hours were randomly assigned into treatment or control group by a computer-generated list of randomly assigned numbers. In the treatment group, all their catheter lumens were locked with an ethanol solution at 70% for two hours, every three days (E-Locks). The control group received conventional catheter-care (CCC). Overall, 200 patients with 323 catheters were included in the study, which was stopped after 10 months due to adverse events. Of them, 179 catheters (113 patients) had E-Locks and 144 catheters (87 patients) were CCC. Euroscore Surgical Risk in both groups was 4.04 vs 4.07 p = 0.94 respectively. The results for the E-Locks and CCC were as follows: Incidence of CR-BSI/1000 days of exposure 2.1 vs 5.2 (p = 0.33), catheter tip colonization 14 (7.8%) vs 6 (4.2%) patients (p = 0.17), median length of hospital stay, 15 vs 16 days (p = 0.77). Seven patients (6.19%), all in the ethanol branch, had to discontinue the trial due to intolerance or adverse events. Conclusions We do not recommend prophylaxis of CR-BSI with ethanol-lock on a routine basis in patients undergoing Major Heart Surgery. Trial Registration Clinical Trials.gov NCT01229592

Summary Aspiration of subglottic secretions (ASS) is recommended in patients requiring mechanical ventilation for ≥48h. We assessed the impact of the introduction of ASS routinely in all patients after major heart surgery in an ecological study comparing ventilator-acquired pneumonia (VAP) incidence, days of mechanical ventilation, and cost of antimicrobial agents before and after the implementation of ASS. Before and after the intervention the results (per 1000 days) were: VAP incidence, 23.92 vs 16.46 ( P = 0.04); cost of antimicrobials, €71,384 vs €63,446 ( P = 0.002); and days of mechanical ventilation, 507.5 vs 377.5 ( P = 0.009). From the moment of induction of anaesthesia all patients undergoing major heart surgery should routinely receive ASS.

(Objective: Aspiration of endotracheal secretions is a major step in the prevention of ventilatorassociated pneumonia (VAP). We compared conventional and continuous aspiration of subglottic secretions (CASS) procedures in ventilated patients after major heart surgery (MHS). Materials and methods: Randomized comparison during a 2-year period. Results: A total of 714 patients were randomized (24 patients were excluded from the study; 359 CASS patients; 331 control subjects). The results for CASS patients and control subjects (per protocol and intention-to-treat analysis) were as follows: VAP incidence, 3.6% vs 5.3% (p 0.2) and 3.8% vs 5.1%, respectively; incidence density, 17.9 vs 27.6 episodes per 1,000 days of mechanical ventilation (MV) [p 0.18] and 18.9 vs 28.7 episodes per 1,000 days of MV, respectively; hospital antibiotic use in daily defined doses (DDDs), 1,213 vs 1,932 (p 48 h, the comparisons of CASS patients and control subjects were as follows: VAP incidence, 26.7% vs 47.5% (p 0.04), respectively; incidence density, 31.5 vs 51.6 episodes per 1,000 days of MV, respectively (p 0.03); median length of ICU stay, 7 vs 16.5 days (p 0.01), respectively; hospital antibiotic use, 1,206 vs 1,877 DDD (p < 0.001), respectively; Clostridium difficileassociated diarrhea, 6.7% vs 12.5% (p 0.3), respectively; and overall mortality rate, 44.4% vs 52.5% (p 0.3), respectively. Reintubation increased the risk of VAP (relative risk [RR], 6.07; 95% confidence interval [CI], 2.20 to 16.60; p < 0.001), while CASS was the only significant protective factor (RR, 0.40; 95% CI, 0.16 to 0.99; p 0.04). No complications related to CASS were observed. The cost of the CASS tube was 9 vs 1.5 € for the conventional tube. Conclusions: CASS is a safe procedure that reduces the use of antimicrobial agents in the overall population and the incidence of VAP in patients who are at risk. CASS use should be encouraged, at least in patients undergoing MHS. (CHEST 2008; 134:938–946) Abbreviations: APACHE acute physiology and chronic health evaluation; CASS continuous aspiration of subglottic secretions; CDAD Clostridium difficile-associated diarrhea; CI confidence interval; DDD daily defined dose; ETA endotracheal aspiration; ETT endotracheal tube; EuroSCORE European System for Cardiac Operative Risk Evaluation; IQR interquartile range; MHS major heart surgery; MV mechanical ventilation; RR relative risk; VAP ventilator-associated pneumonia

Staphylococcus aureus is the main cause of surgical site infection (SSI) after major heart surgery (MHS), with the patient's endogenous flora as the principal source. However, the influence of nasal carriage of S. aureus on the development of SSI after MHS has not been established and Centers for Disease Control and Prevention guidelines do not make a recommendation for or against decolonisation. We performed a one-year observational study in which patients undergoing MHS were screened for nasal carriage of S. aureus before surgery. Cases of SSI were recorded and the risk factors of patients with and without SSI were analysed. During the study period, 357 patients were included in the protocol. Ninety-six patients (27%) were found to be nasal carriers of S. aureus and nine (9.4%) of these had meticillin-resistant (MRSA) strains. The overall incidence of SSI was 6.4%, with 4.2% for mediastinitis and 2.2% for superficial SSI. Nasal carriers of S. aureus had a significantly higher incidence of SSI than non-carriers (12.5% vs 5%, P = 0.01). Among MRSA carriers, the incidence of SSI reached 33% (P < 0.001). S. aureus was responsible for 64% of SSIs. Multivariate analysis showed that the independent factors for SSI were S. aureus nasal carriage [relative risk (RR): 3.1; 95% confidence interval (CI): 1.4-7.3; P = 0.009], reoperation (RR: 3.1; 95% CI: 1.8-19.2; P = 0.04) and diabetes mellitus (RR: 5.9; 95% CI: 1.8-19.2; P = 0.003). Nasal carriage of S. aureus significantly increases the rate of nosocomial SSI after MHS and decolonisation strategies should be implemented in this population. © 2007 The Hospital Infection Society.

Background Suspicion of catheter-related bloodstream infection (CR-BSI) leads frequently to unnecessary catheter withdrawals, and many catheter-tip cultures yield negative results. The objective of this study was to compare the yield of 3 microbiological procedures to assess CR-BSI without catheter withdrawal. Methods The study was prospectively performed in a group of patients without neutropenia or blood disorders who were admitted to the intensive care unit during a 37-month period with sepsis suspected on clinical grounds and who had central venous catheters inserted for >48 h. The microbiological procedures compared were semiquantitative cultures from hub and skin (superficial), differential quantitative blood cultures, and differential time to positivity between cultures of blood obtained from catheter hubs and peripheral blood. Results Of the 204 episodes of suspected CR-BSI included in the study, 28 were confirmed to be CR-BSI. We obtained the following results for sensitivity, specificity, positive and negative predictive values, and accuracy: superficial cultures, 78.6%, 92.0%, 61.1%, 96.4%, and 90.2%, respectively; differential quantitative blood cultures, 71.4%, 97.7%, 83.3%, 95.6%, and 94.1%, respectively; and differential time to positivity, 96.4%, 90.3%, 61.4%, 99.4%, and 91.2%, respectively. Conclusions CR-BSI can be assessed without catheter withdrawal in patients without neutropenia or blood disorders who have catheters inserted for a short time and are hospitalized in the intensive care unit. Convenience, use of resources, and expertise should determine the technique of choice in different medical contexts. Because of ease of performance, low cost, and wide availability, we recommend combining semiquantitative superficial cultures and peripheral vein blood cultures to screen for CR-BSI, leaving differential quantitative blood cultures as a confirmatory and more specific technique.

The aim of the study was to assess of the role of intraoperative cultures taken at the end of major heart surgery (MHS) in the prediction of postoperative mediastinitis (PM) in patients undergoing MHS over a 6-month period in a tertiary university hospital. Just before wound closure, a sample of the sternal border was taken, swabbing back and forth the sternal border and the subcutaneous tissues. A second sample was taken after irrigation of the deep mediastinal structures with 10 mL of Ringer lactate. Swabs were processed semiquantitatively and the mediastinal fluid with a quantitative technique. The observation of one or more colonies per plate was considered a positive culture. Cultures obtained at the end of 229 surgical interventions (227 patients) were positive with the semiquantitative or with the quantitative procedures in 31.0% (95% confidence interval [CI], 25.1-37.4%) and 34.5% (95% CI, 28.4-41.0%) of the times, respectively (P = NS). The number of microorganisms isolated in the wound swab or mediastinal fluid was 91 and 110, respectively. Of the 227 patients, 7 developed an episode of PM (3.1%; 95% CI, 1.2-6.2%) after a median time of 11 days (range, 5-19 days). The microorganisms causing the 7 cases of mediastinitis were not isolated in the intraoperative cultures in any of the cases. The value of intraoperative cultures as a test for prediction of PM depending on the breakpoint chosen were as follows: sensitivity (0%), specificity (66.2-97.3%), and positive (0%) and negative predictive values (96.8-98.0%). We recommend against surveillance cultures taken intraoperatively in patients undergoing MHS.

Producción Científica, Background: Saccharomyces cerevisiae is well known in the baking and brewing industry and is also used as a probiotic in humans. However, it is a very uncommon cause of infection in humans. Methods: During the period of 15–30 April 2003, we found 3 patients with S. cerevisiae fungemia in an intensive care unit (ICU). An epidemiological study was performed, and the medical records for all patients who were in the unit during the second half of April were assessed. Results: The only identified risk factor for S. cerevisiae infection was treatment with a probiotic containing Saccharomyces boulardii (Ultralevura; Bristol-Myers Squibb). This probiotic is used in Europe for the treatment and prevention of Clostridium difficile–associated diarrhea. The 3 patients received the product via nasograstric tube for a mean duration of 8.5 days before the culture result was positive, whereas only 2 of 41 control subjects had received it. Surveillance cultures for the control patients admitted at the same time did not reveal any carriers of the yeast. Strains from the probiotic capsules and the clinical isolates were identified as S. cerevisiae, with identical DNA fingerprinting. Discontinuation of use of the product in the unit stopped the outbreak of infection. A review of the literature identified another 57 cases of S. cerevisiae fungemia. Overall, 60% of these patients were in the ICU, and 71% were receiving enteral or parenteral nutrition. Use of probiotics was detected in 26 patients, and 17 patients died. Conclusions: Use of S. cerevisiae probiotics should be carefully reassessed, particularly in immunosuppressed or critically ill patients., Red Española de Investigación en Patología Infecciosa (REIPI-C03/14)

Hub colonization and subsequent intraluminal progression due to frequent opening and manipulation of intravenous systems is the cause of many catheter-related infections (CRI). A prospective, comparative, randomized study was performed to assess a new closed-needleless hub device (CLAVE) compared with conventional open systems (COS). End-points were hub and skin colonization, catheter tip colonization, catheter-related bloodstream infection (CRBSI) and number of accidental needlesticks. All cultures were processed following standard semiquantitative microbiological techniques. The study involved patients who underwent heart surgery over an 11-month period in a post-surgical ICU. During the study period, 352 patients underwent major heart surgery and 1774 catheters were inserted. Overall, 865 catheters in 178 patients were allocated to the CLAVE system and 909 catheters in 174 patients to COS. The groups were similar regarding underlying conditions and risk factors for infection. Comparison of endpoint results in CLAVE and COS groups was as follows: incidence density per 1000 catheter-days of tip colonization: 59.2 versus 83.6 (P=0.003); of hub colonization: 7.56 versus 24.66 (P=0.0017); of skin colonization: 41.5 versus 58.9 (P=0.038); and of CRBSI 3.78 versus 5.89 (P=0.4). There was one accidental needlestick and one catheter-related prosthetic endocarditis in the COS group. Multivariate analysis showed that CLAVE use was an independent protective factor for tip colonization. CLAVE offered significant protection from catheter-tip and hub colonization.

Introduction Ventilator-associated pneumonia (VAP) is the most frequent infection in patients admitted to intensive care units. The efficacy of individual measures for the prevention of VAP is well documented, and data on the impact of implementing bundle measures have usually been reported from studies in which several measures are implemented simultaneously in the general intensive care unit (ICU). The objective of our work was to evaluate the impact of four sequentially implemented measures for preventing VAP in a major heart surgery ICU. The measures were a specific training program, aspiration of subglottic secretions (ASSs), introduction of an inclinometer to improve the semirecumbent position, and reinforcement of oral care with chlorhexidine. Methods We compared rates of VAP, days on mechanical ventilation (MV), and cost of antimicrobial agents before and during implementation. Results We collected data from 401 patients before the intervention and from 1,534 patients during the intervention. Both groups were comparable. No significant differences in EuroSCORE were observed between the patients of both periods (6.4 versus 6.3; P = 0.7). The rates of VAP (episodes/1,000 days of ventilation) were, respectively, 23.9 versus 13.5 (P = 0.005). Mean number of days of MV/1,000 days of stay was 507 versus 375 (P = 0.001), and the cost of antimicrobial therapy (Euros/1,000 days of stay) was €70,612 versus €52,775 (P = 0.10). The main effect of sequential application of preventive measures in time achieved a relative-rate reduction of VAP of 41% (IRR, 0.41; 95% CI, 0.28 to 0.62). The mortality rate before and during the intervention was 13.0% and 10.2%, respectively. VAP rate was most significantly reduced by training and the use of the inclinometer. Conclusions A sequentially applied bundle of four preventive measures reduces VAP rates, days of MV, and the cost of antimicrobial therapy in patients admitted to the major heart surgery ICU. Trial registration Clinical Trials.gov: NCT02060045. Registered 4 February 2014.