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Introducción: el dolor postoperatorio en el niño constituye una entidad especial ya que en el influyen varios factores, por tanto es una experiencia no esperada por el niño y más difícil de tratar. Objetivos: evaluar y comparar la duración y calidad de la analgesia postoperatoria caudal así como la estabilidad hemodinámica y los efectos adversos entre bupivacaína-buprenorfina contra bupivacaína. Material y método: ensayo clínico controlado, prospectivo, longitudinal y comparativo; se estudian 40 pacientes de 1 a 7 años, para cirugía ortopédica bajo bloqueo caudal en el HTO No 21 de Monterrey, Nuevo León, de mayo 2009 a enero 2010. Se asignan en forma aleatoria a dos grupos: grupo A bupivacaína 0,25% 1,4 ml/kg y grupo B se le administrará bupivacaína al 0,25% 1,4 ml/kg adicionada de 1 μg/kg de buprenorfina. La intensidad del dolor postoperatorio se medirá a través del EVA, NIPS Y CRIES a las 2, 4, 6, 12 y 24 horas posteriores. Análisis estadístico: T de Student, U de Mann-Whitney; y prueba de Chi cuadrado. Resultados: el tiempo de administración del primer analgésico posterior a cirugía fue más corto en el grupo A (5,33 vs. 8,46 horas), con una diferencia a favor del grupo B (p < 0,05). Las dosis de rescate fueron menores para el grupo experimental (22 vs. 17, p < 0,05). Los efectos secundarios fueron mínimos los más significativos fueron la retención urinaria, náusea y vómito. Conclusión: la mezcla de buprenorfina-bupivacaína, en niños produce un mayor tiempo libre de dolor post operatorio, con reducción de las dosis de analgésicos de rescate en las primeras 24 horas.

En aquest article es parlarà sobre el projecte d’implantació del sistema de gestió de qualitat en centres educatius (FPQ). El nostre centre educatiu va començar aquest projecte el curs 2003/2004 i ara mateix acaba de passar una auditoria externa feta per l’empresa AENOR per obtenir la certificació de qualitat basada en la norma UNE-EN ISO 9001:2000., En este artículo hablaremos del proyecto de implantación del sistema de gestión de calidad en centros educativos (FPQ). Nuestro centro comenzó este proyecto en el curso 2003/2004 i en estos momentos acaba de pasar una auditoría externa realizada por la empresa AENOR para obtener la certificación de calidad basada en la norma UNE-EN ISO 9001:2000.

Instituto de Estudios Zamoranos Florián de Ocampo, Ayuda a la Investigación, [ES] Este trabajo representa una primera aportación a la investigación de las anomalías geoquímicas del noroeste de la provincia de Zamora y de su posible relación con la alta incidencia de fallecimientos a causa de cáncer gástrico. A través del seguimiento epidemiológico de los fallecimientos a causa de cáncer en quince localidades del noroeste de Zamora (Codesal, Ferreras de Abajo, Ferreras de Arriba, Folgoso, Linarejos, Manzanal de Arriba, Otero de Bodas, Pedroso de la Carballeda, Sagallos, Sandín, Santa Cruz de los Cuérragos, Sarracín de Aliste, Val de Santa María, Villanueva de Valrojo y Villardeciervos), se ha comprobado que de los 639 fallecimientos que tuvieron lugar entre 1975 y 1989, 170 lo fueron por cáncer (26.7 %) y de éstos, 75 sucedieron a causa de cáncer gástrico (11.7 % sobre el número de fallecimientos totales y 44% sobre el número de fallecimientos por cáncer). En una primera aproximación, en vistas a la determinación de las posibles causas de esta situación, se ha realizado un estudio geoquímico básico del área de Ferreras de Arriba y localidades más cercanas (perfiles radiométricos, análisis de sedimentos de arroyo y aguas), donde la incidencia de fallecimientos a causa de cáncer gástrico es especialmente elevada. Este estudio muestra como hechos más significativos que: (i) en esta zona los contenidos de elementos químicos potencialmente tóxicos (arsénico, cromo, plomo, selenio, etc.) son bajos y no parecen representar ningún peligro para la salud humana; y (ii) existe un déficit notable en elementos químicos convenientes no sólo para la salud humana, sino también para el desarrollo adecuado de animales y plantas (calcio, cloruros, fluoruros, magnesio, etc.). Ello queda reflejado con claridad en la composición química y otros parámetros de las aguas de la zona estudiada

Aim: to study a sample of patients with morbid obesity who are on the waiting list for a surgical intervention, to establish various scores of surgical risk (Possum and severity score), and to assess potential criteria for list prioritization. Design: we calculated physiological and surgical Possum scores for every patient, and analysed comorbidities and other associated factors to calculate the severity score. Likewise, we calculated the predictive rates of morbimortality. Differences between associated comorbidities in body mass index (BMI) were also analyzed. The correlation between Possum score, prediction rates, and severity score were analyzed. Patients: fifty-two patients on the surgical waiting list in our institution (San Juan University Hospital, Reus) from 26/4/02 to 5/03/04. Results: the mean qualitative score is significantly higher in the female sex. Invalidating arthropathy and socio-occupational and/or psychiatric criteria are significantly higher in women. There is a significant correlation between the severity score and Possum score. Age does not correlate with any of the variables studied. Conclusions: possum scores are significantly related to BMI, particularly in terms of morbidity rates. The degree of correlation between the Possum score and the qualitative score tells how useful the latter is to cover other determinant factors in the severity of this condition. Socio-occupational and psychiatric criteria, and invalidating arthropathy are the main variables to be taken into account for postsurgical prediction, and are directly related to BMI degree.Objetivo: estudio de una muestra de pacientes afectos de obesidad mórbida y en lista de espera para intervención quirúrgica, determinar el riesgo quirúrgico según diferentes scores (Possum y score de gravedad) y valorar los posibles criterios en la priorización de dicha lista. Diseño: cálculo del Possum fisiológico y quirúrgico para cada paciente y análisis de las comorbilidades y otros factores asociados para el cálculo del score de gravedad. Cálculo de los ratios predictivos de morbi-mortalidad. Análisis de las diferencias observadas, según el índice de masa corporal (IMC), de las comorbilidades asociadas. Análisis del grado de correlación entre el Possum, los ratios de predicción y el score de gravedad. Pacientes: Cincuenta y dos pacientes incluidos en la lista de espera quirúrgica de nuestro centro (Hospital Universitario San Joan de Reus) durante el periodo del 26/4/02 al 5/03/04. Resultados: el score cualitativo tiene una media superior significativa en el sexo masculino. La artropatía invalidante y los criterios socio-laborales y/o psiquiátricos son significativamente superiores en el sexo femenino. Existe una correlación significativa entre el score de gravedad y el Possum. La edad no se correlaciona en nuestra serie con ninguna de las variables estudiadas. Conclusiones: los valores del Possum están relacionados significativamente con el IMC, en especial en base al ratio de morbilidad. El grado de correlación entre el Possum y el score cualitativo nos indica la utilidad de este para cubrir otros factores determinantes en la gravedad de esta patología. Los criterios socio-laborales y psiquiátricos y la artropatía invalidante, son las principales variables a tener en cuenta en la predicción postquirúrgica, estando directamente relacionados con el grado de IMC.

Background/aims: evidence of gender-related differences in gastric emptying have been reported in the literature. Usually, those researches have focusing only with solid or liquid meal and invasive techniques. The objective of this study was to know the differences in the half time of gastric emptying and frequency of peristaltic contractions measured with magnetogastrography (MGG) on healthy subjects, using a semi-solid test meal. Methods: the study was carried out in 16 healthy subjects without gastrointestinal disease history, they were divided in two groups, 8 male and 8 female. A test meal composed by 250 ml of yogurt and 3 grs of magnetite (Fe3O4), was employed. Results: the gastric emptying half times were found to be 32.3±10.8 and 36.0±6.7 minutes, for men and women, respectively. Magnetogastrography modality presented in this study is a useful technique to measure the gastric emptying and the peristaltic contractions frequency. The studies were performed in healthy subjects without side effects. Using this technique a significant statistical difference (p0.05) on gastric emptying from healthy volunteers was obtained between men and women. Conclusions: a contribution of this study was to demonstrate the feasibility of magnetogastrography to analyze gender differences in the gastric emptying half time using a semi-solid test meal.

Introduction: A dysregulated inflammatory response, known as “cytokine storm”, plays an important role in the pathophysiology of coronavirus 2019 disease (COVID-19). Identifying patients with a dysregulated inflammatory response and at high risk for severe respiratory failure, organ dysfunction, and death is clinically relevant, as they could benefit from the specific therapies, such as cytokine removal by hemoadsorption. This study aimed to evaluate cytokine hemoadsorption as rescue therapy in critically ill patients with SARS-CoV-2 pneumonia, severe respiratory failure refractory to prone positioning, and hypercytokinemia.Methods: In this single center, observational and retrospective study, critically ill patients with SARS-CoV-2 pneumonia, severe acute respiratory failure, and hypercytokinemia were analyzed. All the patients underwent cytokine hemoadsorption using CytoSorb® (Cytosorbents Europe, Berlin, Germany). The indication for treatment was acute respiratory failure, inadequate clinical response to the prone position, and hypercytokinemia.Results: Among a total of 343 patients who were admitted to the intensive care unit (ICU) due to SARS-CoV-2 infection between March 3, 2020 and June 22, 2020, six patients received rescue therapy with cytokine hemoadsorption. All the patients needed invasive mechanical ventilation and prone positioning. A significant difference was found in the pre- and post-treatment D-dimer (17,868 mcg/ml [4,196–45,287] vs. 4,488 mcg/ml [3,166–17,076], p = 0.046), C-reactive protein (12.9 mg/dl [10.6] vs. 3.5 mg/dl [2.8], p = 0.028), ferritin (1,539 mcg/L [764–27,414] vs. 1,197 ng/ml [524–3,857], p = 0.04) and interleukin-6 (17,367 pg/ml [4,539–22,532] vs. 2,403 pg/ml [917–3,724], p = 0.043) levels. No significant differences in the pre- and post-treatment interleukin-10 levels (22.3 pg/ml [19.2–191] vs. 5.6 pg/ml [5.2–36.6], p = 0.068) were observed. Improvements in oxygenation (prehemoadsorption PaO2/FIO2 ratio 103 [18.4] vs. posthemoadsorption PaO2/FIO2 ratio 222 [20.9], p = 0.029) and in the organ dysfunction (prehemoadsorption SOFA score 9 [4.75] vs. posthemoadsorption SOFA score 7.7 [5.4], p = 0.046) were observed. ICU and in-hospital mortality was 33.7%.Conclusions: In this case series, critically ill patients with COVID-19 with severe acute respiratory failure refractory to prone positioning and hypercytokinemia who received adjuvant treatment with cytokine hemoadsorption showed a significant reduction in IL-6 plasma levels and other inflammatory biomarkers. Improvements in oxygenation and SOFA score were also observed.

Applied immunology; Predictive markers; Viral infection Immunologia aplicada; Marcadors predictius; Infecció viral Inmunología aplicada; Marcadores predictivos; Infección viral Quantitative or qualitative differences in immunity may drive clinical severity in COVID-19. Although longitudinal studies to record the course of immunological changes are ample, they do not necessarily predict clinical progression at the time of hospital admission. Here we show, by a machine learning approach using serum pro-inflammatory, anti-inflammatory and anti-viral cytokine and anti-SARS-CoV-2 antibody measurements as input data, that COVID-19 patients cluster into three distinct immune phenotype groups. These immune-types, determined by unsupervised hierarchical clustering that is agnostic to severity, predict clinical course. The identified immune-types do not associate with disease duration at hospital admittance, but rather reflect variations in the nature and kinetics of individual patient’s immune response. Thus, our work provides an immune-type based scheme to stratify COVID-19 patients at hospital admittance into high and low risk clinical categories with distinct cytokine and antibody profiles that may guide personalized therapy. This work was supported by Health Holland LSHM20056 grant (PDK), in part from the European Union’s Horizon 2020 research and innovation program under grant agreement No 779295 (PDK), in part supported by the Erasmus foundation (BJAR), grant PI20/00416 from the Instituto de Salud Carlos III (RPB) and the European Regional Development Fund (ERDF) (RPB).

Background SARS-CoV-2 infection portends a broad range of outcomes, from a majority of asymptomatic cases to a lethal disease. Robust correlates of severe COVID-19 include old age, male sex, poverty, and co-morbidities such as obesity, diabetes, and cardiovascular disease. A precise knowledge of the molecular and biological mechanisms that may explain the association of severe disease with male sex is still lacking. Here, we analyzed the relationship of serum testosterone levels and the immune cell skewing with disease severity in male COVID-19 patients. Methods Biochemical and hematological parameters of admission samples in 497 hospitalized male and female COVID-19 patients, analyzed for associations with outcome and sex. Longitudinal (in-hospital course) analyses of a subcohort of 114 male patients were analyzed for associations with outcome. Longitudinal analyses of immune populations by flow cytometry in 24 male patients were studied for associations with outcome. Results We have found quantitative differences in biochemical predictors of disease outcome in male vs. female patients. Longitudinal analyses in a subcohort of male COVID-19 patients identified serum testosterone trajectories as the strongest predictor of survival (AUC of ROC = 92.8%, p < 0.0001) in these patients among all biochemical parameters studied, including single-point admission serum testosterone values. In lethal cases, longitudinal determinations of serum luteinizing hormone (LH) and androstenedione levels did not follow physiological feedback patterns. Failure to reinstate physiological testosterone levels was associated with evidence of impaired T helper differentiation and augmented circulating classical monocytes. Conclusions Recovery or failure to reinstate testosterone levels is strongly associated with survival or death, respectively, from COVID-19 in male patients. Our data suggest an early inhibition of the central LH-androgen biosynthesis axis in a majority of patients, followed by full recovery in survivors or a peripheral failure in lethal cases. These observations are suggestive of a significant role of testosterone status in the immune responses to COVID-19 and warrant future experimental explorations of mechanistic relationships between testosterone status and SARS-CoV-2 infection outcomes, with potential prophylactic or therapeutic implications., This study was funded by grants from the Ministerio de Ciencia e Innovación (RTI2018-096055-B-I00), Consejo Superior de Investigaciones Científicas’ COVID-19 Research Fund (CSIC-COV19-006, CSIC-COV19-201), Agència de Gestió d’Ajuts Universitaris i de Recerca (2020PANDE00048 and 2017SGR 1411 GRC), and Plan Nacional de I+D (PID-107139RB-C21) and Instituto Nacional de la Salud Carlos III (PI18/00346 and COVID-19_00416).