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Introduction and Objectives: Cognitive impairment-dementia is an increasing health concern with a major economic and social impact. This study aims to examine how it is currently approached in primary care practices in the Autonomous Community of Galicia, Spain. Methods: A working group was formed between two scientific societies, which developed a survey that was sent online to 2206 primary care doctors, subsequently analysing the responses received. Results: A total of 124 primary care doctors (5.3%) responded to the survey, 69.4% of which were women, with a mean age of 54 years. Out of these doctors, 92 (80%) have been working for more than 10 years, 30 (24.2%) have never received any training on the topic of study and only 31 (25%) have received some training in the last 5 years. The initial complaint derives from close relatives (76.6%) and this complaint usually entails memory problems (59.7%). The screening test used by 77.4% of the professionals is the MMSE with a higher prevalence among younger doctors (p-value 0.04). In the case of suspected cognitive impairment, doctors perform a cognitive assessment scale (96%), order a blood test (83.9%) and perform functional assessment scales (77.4%). They do so on a scheduled basis (79%). In total, 42.7% recognise that they reach the diagnosis in moderate dementia stages, hindered as a result of care-based reasons (66.9%). Doctors have difficulties in detecting the pathology associated with cognitive impairment in 52.4% of cases. In dementia management, 66.1% have difficulties in providing caregiver support and 42.7% with pharmacological treatment. In cases of advanced dementia, the problem is the lack of support from social services (47.6%), hospital specialists (45.2%) and the difficulty of pharmacological treatment (43.5%). Conclusions: Primary care doctors report that the main barriers in the care for cognitive impairment-dementia are: training, healthcare organization, social, management of specific dementia treatments and associated pathologies and coordination with hospital care. Key words: Primary care, cognitive impairment, dementia, screening, survey, attitudes [ABSTRACT FROM AUTHOR]

Introduction: Experience in the use of diagnostic and/or therapy of endoscopic retrograde cholangiopancreatography (ERCP) in children is limited. This is due to the underdiagnosis of pancreaticobiliary disease in the pediatric population and specialist personnel in this procedure., Objective: To determine the safety and success rate of ERCP in children at Hospital Fundación Santa Fe de Bogotá between January 2007 and June 2015., Methodology: This was an observational, descriptive, retrospective case series study of patients under 18 years, who underwent ERCP between January 2007 and June 2015. The following variables were analyzed: indication, duration, type of procedure, rate of success, and complications., Results: A total of 30 patients were included, in whom 65 ERCP procedures were performed. Successful cannulation was achieved in 52 of the 65 procedures (80%). Among the complications that occurred, there were four cases of pancreatitis (6.2%), two cases of bleeding (3.1%), and one case of bacteremia (1.5%), and in most cases (58 in total, 89.2%), there were no complications., Discussion: The pediatric gastroenterology group of the Fundación Santa Fe de Bogotá has obtained good results in performing ERCP in the pediatric population with a success rate of 80% associated with a null mortality rate. There is enough literature available to conclude that performing ERCP in the pediatric population maintains an adequate success rate and a low complication rate. In all the studies evaluated, a null mortality rate was found, so it is considered that this procedure is safe in patients under 18 years of age., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Gómez et al.)

Background: Pistachio (Pistacia vera L.) is a commercially important tree in the Mediterranean basin, where there is a considerable increase in cultivation, especially in Spain. Because of its recent introduction as a crop in the country (1980s), studies on the pests of pistachio in Spain are still rare. Here, we studied the leaf beetle Labidostomis lusitanica (Coleoptera: Chrysomelidae), which was observed on pistachio and might become a serious pest under the expanding Spanish pistachio fields. Because early detection of pests is extremely important to properly plan control strategies, we (i) updated the information on the distribution of the species through samplings and surveys, and (ii) modelled its potential distribution., Results: Currently, L. lusitanica occurs across the whole Iberian Peninsula, especially in its southern and eastern parts, with adults on flight roughly from late April to early June. Analysis of climatic niches showed that L. lusitanica prefers dry and hot areas, which are conditions found especially in the central-southern parts of the Iberian Peninsula. Such highly suitable areas for this pest overlap considerably with the suitable areas for pistachio cultivation. Surveys of pistachio growers weakly suggested a higher pest attack probability, but, unexpectedly, a lower perceived impact in very suitable areas for L. lusitanica, suggesting that other factors may shape its pest potential in a complex way., Conclusion: In line with what has been observed for other Labidostomis species on pistachio in other Mediterranean countries, L. lusitanica has a good potential to harm pistachio production in Spain, claiming for further investigations and prevention strategies. © 2021 The Authors. Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry., (© 2021 The Authors. Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.)

The potential presence of spore-forming bacteria related to the Bacillus cereus group in Mexican chili powder elaborated from Capsicum annuum L. is of commercial and clinical interest, because chili powder is an essential spice in the Mexican diet and in diets around the globe. To facilitate detection and isolation of members of this group of spore-forming bacteria from Mexican chili powder samples, we identified colonies that grew on agar medium selective for Bacillus cereus sensu lato, supplemented with polymyxin B (10 µg/mL) and ampicillin (10 to 100 µg/mL). The presumptive B. cereus ( s.l. ) isolates were tested using a tRNA Cys -PCR-based approach and the results identified species related phylogenetically to B. cereus , B. thuringiensis, and B. toyonensis . Their toxigenic potential was assessed by serological tests to detect enterotoxins (Nhe and Hbl) and by PCR targeting the hemolysin BL ( hbl ) component C ( hblC ) and non-hemolytic enterotoxin component A ( nheA ). The antibiotic profiles of the isolates showed a high resistance to β-lactams (100% of the isolates), trimethoprim-sulfamethoxazole (100%), tetracycline (90%), erythromycin (77%), clindamycin (74%), and chloramphenicol (42%). Our results indicate the presence of B. cereus s.l. with toxigenic characteristics in Mexican chili powder. Because of the potential for these organisms to cause disease through their production of various toxins, and resistance to antibiotics, we recommend that a microbiological risk assessment must be considered in the Mexican regulatory requirements.

Narrative review: skin tear, laceration or skin avulsion? The current definitions for skin tear, laceration and skin avulsion do not provide a clear and evident differentiation between them in clinical practice, as their descriptions vary from author to author. Most of the literature uses these terms to refer to lacerations, but in practice, they can also mean skin avulsions, skin tears and pretibial lacerations, creating confusion among health professionals. This narrative review aims to provide the authors' views to help reach a precise definition for such terms and avoid further confusion in clinical practice.

American foulbrood (AFB) caused by Paenibacillus larvae is the most destructive honeybee bacterial disease and its dissemination via commercial bee pollen is an important mechanism for the spread of this bacterium. Because Mexico imports bee pollen from several countries, we developed a tRNA Cys -PCR strategy and complemented that strategy with MALDI-TOF MS and amplicon-16S rRNA gene analysis to evaluate the presence of P. larvae in pollen samples. P. larvae was not detected when the tRNA Cys -PCR approach was applied to spore-forming bacterial colonies obtained from three different locations and this result was validated by bacterial identification via MALDI-TOF MS. The genera identified in the latter analysis were Bacillus (fourteen species) and Paenibacillus (six) species. However, amplicon-16S rRNA gene analysis for taxonomic composition revealed a low presence of Paenibacillaceae with 0.3 to 16.2% of relative abundance in the commercial pollen samples analyzed. Within this family, P. larvae accounted for 0.01% of the bacterial species present in one sample. Our results indicate that the tRNA Cys -PCR, combined with other molecular tools, will be a useful approach for identifying P. larvae in pollen samples and will assist in controlling the spread of the pathogen.

In the article mentioned above an author's name was misspelled.

Multidrug-resistant microorganisms are of great concern to public health. Genetic mobile elements, such as plasmids, are among the most relevant mechanisms by which bacteria achieve this resistance. We obtained an Escherichia coli strain CM6, isolated from cattle presenting severe diarrheic symptoms in the State of Querétaro, Mexico. It was found to contain a 70kb plasmid (pMEX01) with a high similarity to the pHK01-like plasmids that were previously identified and described in Hong Kong. Analysis of the pMEX01 sequence revealed the presence of a bla CTX-M-14 gene, which is responsible for conferring resistance to multiple β-lactam antibiotics. Several genes putatively involved in the conjugative transfer were also identified on the plasmid. The strain CM6 is of high epidemiological concern because it not only displays resistance to multiple β-lactam antibiotics but also to other kinds of antibiotics., (Published by Elsevier Editora Ltda.)

Fulminant hepatic failure without liver transplantation is associated with a high mortality rate (80-100 per cent). Some 254 liver transplantations were performed on 202 patients between April 1986 and February 1992. Of these, 26 patients had fulminant hepatic failure. The median age was 31.5 (range 3-60) years. Reduced-size grafts were used in seven patients. The preoperative mortality rate was six of 26 patients, and five patients died during follow-up. Ten patients underwent retransplantation and two a second retransplant. The overall mortality rate was 16 of 26 and actuarial survival rate was 62.7 per cent at 12 months and 48.7 per cent at 36 months. The preoperative mortality rate is relatively high but liver transplantation is currently recommended as a last-resort treatment for patients with fulminant hepatic failure in the absence of response to medical treatment.

We have performed 284 OLT and from 1990 we accept donors older than 50 years. We analyzed 100 consecutive OLT from 1990 in relation to donor age and we divided them in three groups: A) 10 liver transplants with donors < 16 years old; B) 76 liver transplants with donors between 16 and 49 years old, and C) 14 liver transplants with donors > 49 years old. The follow-up was more than 6 months. The liver preservation was carried out with Belzer solution and the immunosuppression was performed with cyclosporine A, corticoids and azathioprine. The C group donors were more stable haemodynamically (less dopamine dosage-p < 0.001- and less hours with arterial hypotension-p < 0.05-) and they died less of craneoencephalic traumatism than A group donors (p < 0.01). The C group donors didn't have more frequence of liver esteatosis or greater graft harvest lesions (p = n.s.). The cold ischaemia time was greater in C group vs A (p < 0.05) and its pretransplant clinical status was more serious than in A and B groups (p < 0.05). There were no significant differences between groups in relation to recipient status, frequence of hepatic artery or portal vein thrombosis, frequence of acute rejection, chronic rejection or biochemical graft evolution at first month. There were more primary graft non functions in B vs A (p < 0.05) and retransplants in B vs A and C (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Among a total of 220 liver transplants, reduced-size liver was used in 21 cases due to discrepancies in size between recipient and donors in 19 patients. In the case of two adult patients suffering from fulminant hepatic failure and in a critical condition, only one donor organ became available, so that the graft was divided to give the two recipients an equal opportunity. The two patients with fulminant hepatic failure were admitted to the ICU requiring mechanical respiration almost at the same time. Hepatitis serologies were HBcAb+, HBsAb+, and VCA+ in one and negative in the second. They had different blood groups (A.Rh+, O.Rh-), and the only donor available was located in Milan, Italy. The graft perfused with UW. was divided into two (right side, segments IV, V, VI, VII, and VIII, and left side, segments I, II and III). The recipients were transplanted 50 and 48 hours after admission. The cold ischemia time was 7.10 and 16.50 hours. The first patient, who received the right lobe, was extubated at 48 hours and discharged on the 40th postransplant day. The second patient remained unconscious with progressive deterioration; an EEG on the 4th day revealed absence of higher cortical function.

A retrospective review is presented of neurologic complications in our first 143 consecutive adult patients (208 liver transplants in 143 adults and 18 children) undergoing liver transplantation. Nineteen (13.2%) of the 143 patients developed neurologic complications in the postoperative period. Immunosuppression was initiated intraoperatively with steroids with the addition of azathioprine on Day 1 and cyclosporine, adjusted by RIA to a level of 400-600 ng/ml, on Day 2 post-transplantation. Azathioprine is discontinued in the third month. Fourteen of the 19 patients (73.6%) presented with CNS complications characterized by: diffuse multifactorial encephalopathy (5 patients); leukoencephalopathy (2 patients) which required temporary (1 case) or permanent (1 case) discontinuation of cyclosporine A; hemorrhage (in 2 cases due to arterial hypertension and coagulopathy and another due to unknown causes); ischemic/anoxic injury secondary to cardiorespiratory arrest (2 patients) or arteriothrombosis (1 patient); and myelopathy (1 patient) due to vertebral compression (T10-T11) secondary to osteoporosis. The diagnostic studies most often employed were computed tomographic (CT) (85.7%) and electroencephalography (EEG) (42.8%). Five of 19 patients (26.3%) suffered peripheral nervous system (PNS) complications: 1 patient with reversible Claude-Bernard-Horner Syndrome caused by central venous catheterization during anesthesia; 2 patients with peroneal nerve palsy due to compression below the knees by operating room table supports; 1 patient with an irreversible lesion of the right recurrent laryngeal nerve secondary to prolonged intubation and central venous catheterization; and 1 patient with a reversible lesion of the left brachial plexus secondary to inadvertant hyperextension of the upper extremity on the O.R. table due to the need for dialysis and catheterization of the axillary vein for veno-venous bypass.(ABSTRACT TRUNCATED AT 250 WORDS)

We present the results we obtained during the last 12 years with transhiatal esophagectomy. Two hundred and eighty-three patients were operated on using this procedure; 171 of them underwent the operation for cancer of the esophagus, 73 for cancer of the cardia, and 11 for cancer of the hypopharynx. The tumor stage, the operative technique, and the type of esophageal replacement (stomach: 62.9%; colon: 37.1%) are described. Overall operative mortality was 5.6%, mainly as a result of respiratory insufficiency. Long-term survival was 11.9% at five years for cancer of the esophagus, much lower than the 48.3% for cancer of the cardia.

A retrospective study on 834 newborns of low birth weight, 2,500 grs., or less over a total of 19,869 live newborns during the year 1973 is presented. They are divided into low birth weight compatible with gestational age and low birth weight for gestational age when birth weight is lower than 10th percentile of Lubchenco's chart. Each of these groups is subdivided in three parts: First part refers to coincidence of frequence of different ethiologic factors or causes of low birth weight (maternal, gestational, placental and termination of pregnancy). The second part has its object in the clinical appraisal of the state at birth of these low birth weight newborns (fetal-obstetric evaluation of Velasco-Cándano, neonatal Apgar scoring, respiratory evaluation by Silvermann-Andersen and evaluation of external maturaty according to Usher). Third part of the study relates the morbility-mortality rate, need for admission, presence of congenital anomalies and autopsy findings in each of these groups of low birth weight newborns. Relation among all these estimated parameters is made presenting some conclusions reached.