Search

We conducted a multicentre study of 1844 patients from 42 Spanish intensive care units, and analysed the clinical characteristics of brain death, the use of ancillary testing, and the clinical decisions taken after the diagnosis of brain death. The main cause of brain death was intracerebral haemorrhage (769/1844, 42%), followed by traumatic brain injury (343/1844, 19%) and subarachnoid haemorrhage (257/1844, 14%). The diagnosis of brain death was made rapidly (50% in the first 24 h). Of those patients who went on to die, the Glasgow Coma Scale on admission was ≤ 8/15 in 1146/1261 (91%) of patients with intracerebral haemorrhage, traumatic brain injury or anoxic encephalopathy; the Hunt and Hess Scale was 4-5 in 207/251 (83%) of patients following subarachnoid haemorrhage; and the National Institutes of Health Stroke Scale was ≥ 15 in 114/129 (89%) of patients with strokes. Brain death was diagnosed exclusively by clinical examination in 92/1844 (5%) of cases. Electroencephalography was the most frequently used ancillary test (1303/1752, 70.7%), followed by transcranial Doppler (652/1752, 37%). Organ donation took place in 70% of patients (1291/1844), with medical unsuitability (267/553, 48%) and family refusal (244/553, 13%) the main reasons for loss of potential donors. All life-sustaining measures were withdrawn in 413/553 of non-donors (75%). [ABSTRACT FROM AUTHOR]

Two spent mushroom substrates (fresh, F-SMS, and composted in aerobic conditions, C-SMS) were annually applied for 4 yr at two different rates (8 and 25 Mg ha-1 as dry matter) to a vineyard soil (Typic Haploxerept) located near Logroño (Ebro Valley, La Rioja, Spain). Soil samples were collected at three depths (0-5, 5-15 and 15-25 cm), and analyzed for soil organic carbon (SOC), water-soluble carbon (WSC), potentially mineralizable nitrogen (PMN), Due to image rights restrictions, multiple line equation(s) cannot be graphically displayed. and exchangeable Due to image rights restrictions, multiple line equation(s) cannot be graphically displayed. , microbial biomass carbon (MBC), soil C02 evolution (SR), β-glucosidase activity (CLU) and soil mean weight diameter (MWD) of aggregates and water-stable aggregates (WSA). The highest rate of F-SMS and C-SMS (25 Mg ha-1) increased SOC, total nitrogen ( Total N), and labile organic forms (WSC and PMN) at 0- to 5- and 5- to 15-cm soil depth and microbiological activity (MBC and GLU) at 5- to 15-cm soil depth. There were no differences in soil C02 emissions between F-SMS and C-SMS amendments. Applications of SMS did not increase the soil aggregation but increased the content of inorganic N in the soil surface (0- to 5-cm depth) layer. Factor analysis showed the positive relationship between labile organic matter fractions and N availability. Finally, application of SMS to semiarid vineyard soils facilities SMS recycling with simultaneous improvement in soil quality indicators related to labile organic matter and microbiologic activity. However, increased PMN and soil Due to image rights restrictions, multiple line equation(s) cannot be graphically displayed. indicate a potential risks for N leaching from SMS amendments that should be further evaluated. INSET: 1. [ABSTRACT FROM AUTHOR]

We studied effects of phosphogypsum (PG) rates ranging from 1.4 to 84.2 Mg ha-1 applied to the Ap horizon of a plinthic Palexerult on the ionic composition of the soil solution, as well as their impact on biomass production in wheat [Triticum aestivum (L.), cv. Jabato]. Similar soil samples were treated with highly pure gypsum (G) or the industrial byproduct red gypsum (G) at rates equivalent to PG applications of 4.2 and 33.7 Mg ha-1 for comparison with the action of PG. All treatments increased the Ca, Mg, K, Na, and SO4 concentrations to the same extent; however, RG at high rates (30.6 Mg ha-1) raised the Na and Mg concentrations more markedly than did the other two amendments. Phosphogypsum provided the greatest increases in F, Al, and Si, the last two as a result of the corrosive effects of F on soil silicates; the increases were all proportional to the applied PG rate, and as a result, the higher PG rates increased the activities of all Al ionic species relative to G, RG, and the control. Application of G and RG at rates equivalent to PG applications of 4.2 and 33.7 Mg ha-1 increased biomass production compared with the control. Phosphogypsum increased biomass production at lower rates (0- 16.8 Mg ha-1), but biomass was virtually zero at rates above 67.3 Mg ha-1. The highest PG rates increased plant Al and F contents, the last reaching toxic levels for cattle. [ABSTRACT FROM AUTHOR]

Introduction: Two-stage exchange is the gold standard in the surgical management of prosthetic joint infection (PJI). However, perioperative reinfections (RePJI) can occur to newly inserted prosthesis, which highlights the importance of an adequate antibiotic prophylaxis, although there is scarce evidence in this field. Our objective was to evaluate the characteristics of RePJI, its prognosis and the antibiotic prophylaxis that is commonly used in second-stage surgery., Methods: Multicentric retrospective observational study in Spanish hospitals including patients with RePJI between 2009 and 2018., Results: We included 92 patients with RePJI from 12 hospitals. The most frequent isolated microorganism was Staphylococcus epidermidis in 35 cases (38.5%); 61.1% of staphylococci were methiciliin-resistant. In 12 cases (13%), the same microoganism causing the primary PJI was isolated in RePJI. When comparing with the microbiology of primary PJI, there were more cases caused by Gram-negative bacteria (the most frequent was Pseudomonas spp.) and less by Gram-positive bacteria. Failure occured in 69 cases (75%). There were 43 different courses of antibiotic prophylaxis after the second-stage surgery; the most frequent was a unique preoperative cefazolin dose, but most patients received prophylaxis before and after the second-stage surgery (61 cases)., Conclusions: The most frequent microorganisms in RePJI are coagulase-negative staphylococci, although Gram-negative bacteria, especially Pseudomonas spp. are also common. There is a significant heterogeneity in antibiotic prophylaxis for a second-stage surgery. ReIPJI treatment has a high failure rate., (Copyright © 2023 Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction: After two-stage exchange due to prosthetic joint infection (PJI), the new prosthesis carries a high risk of reinfection (RePJI). There isn`t solid evidence regarding the antibiotic prophylaxis in 2nd-stage surgery. The objective of this study is to describe what antibiotic prophylaxis is used in this surgery and evaluate its impact on the risk of developing RePJI., Methods: Retrospective multicenter case-control study in Spanish hospitals. The study included cases of PJI treated with two-stage exchange and subsequently developed a new infection. For each case, two controls were included, matched by prosthesis location, center, and year of surgery. The prophylaxis regimens were grouped based on their antibacterial spectrum, and we calculated the association between the type of regimen and the development of RePJI using conditional logistic regression, adjusted for possible confounding factors., Results: We included 90 cases from 12 centers, which were compared with 172 controls. The most frequent causative microorganism was Staphylococcus epidermidis with 34 cases (37.8%). Staphylococci were responsible for 50 cases (55.6%), 32 of them (64%) methicillin-resistant. Gram-negative bacilli were involved in 30 cases (33.3%), the most common Pseudomonas aeruginosa. In total, 83 different antibiotic prophylaxis regimens were used in 2nd-stage surgery, the most frequent a single preoperative dose of cefazolin (48 occasions; 18.3%); however, it was most common a combination of a glycopeptide and a beta-lactam with activity against Pseudomonas spp (99 cases, 25.2%). In the adjusted analysis, regimens that included antibiotics with activity against methicillin-resistant staphylococci AND Pseudomonas spp were associated with a significantly lower risk of RePJI (adjusted OR = 0.24; 95% IC: 0.09-0.65)., Conclusions: The lack of standardization in 2nd-satge surgery prophylaxis explains the wide diversity of regimens used in this procedure. The results suggest that antibiotic prophylaxis in this surgery should include an antibiotic with activity against methicillin-resistant staphylococci and Pseudomonas., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Abstract: We compared Spanish autonomous communities' regulations affecting the use of semiautomatic external defibrillators (semi-AEDs), including requirements for training and providing devices outside health care settings. We analyzed differences in the development of regulations across the different geographic areas. Regulations published in the official bulletins of Spain's 17 autonomous communities and 2 autonomous cities in effect in May 2019 were reviewed to extract directives affecting training, authorized use, and the provision of semi-AEDs outside health care centers. We found that both doctors and nurses are authorized to use the devices in most communities, with the exception of Murcia, where only doctors may use them. Fourteen communities also authorize emergency responders to operate semi-AEDs. Other individuals must call for emergency help before using one, and specific rules vary by community. In the Basque Country anyone may use them, but in other communities, only individuals who have taken a training course on how to use a semi-AED may. The duration of training programs varies from 4 to 9 hours in different parts of Spain, and retraining is required at intervals that vary from 1 to 3 years. However, in 11 communities any citizen may use a semi-AED in an emergency in which authorized persons are not present (after first calling for emergency responders). Eleven autonomous communities regulate the required provision of semi-AEDs outside health care centers. We conclude that although Spain's autonomous communities have regulations in place for the use of these devices, the regulatory map is highly diverse. Therefore, we think that harmonization is desirable in the interest of unifying criteria and encouraging the use of semi-AEDs when they are needed.

Observational study of patients on hemodialysis (HD) in FMC® Spain clinics over the years 2009 and 2010. The data were collected from the EuClid® database, implemented in the clinics of FMC®, which complies with the following feature: record online, compulsory, conducted in patients incidents and that it covers the entire population on HD in these clinics. Its aim is to understand the characteristics of patients and treatment patterns, comparing them with other studies described in the literature and in order to improve their prognosis and quality of life. Include 2637 incidents patients and 4679 prevalent, which makes a total of 7316 patients. In prevalent patients: 24.4% were diabetic; 76.3% had cardio-vascular disease (CVD) and 13.4% cancer. Among the incidents, these percentages were: 33.5% diabetic; 80.6% had CVD and 12.6% cancer. The prevalent patients had such as vascular access: FAV 68.5%, prosthesis 5.6%, permanent catheter 23.7% and 2.3% temporary catheter. The average of the duration of the sessions of HD was 230 minutes. 23.2% of the prevalent patients were on on-line hemodiafiltration. These patients hospitalization rates were 0.46 hospitalizations per incident patient per year and 0.52 per prevalent patient per year. The annual gross mortality rate was 12%. The mortality of the patients in this study HD is smaller than these of the Spanish Registry of Dialysis and Transplant (GRER). The result of morbidity and mortality of the FMC clinics of Spain can, therefore, be as good compared with these of the GRER and other international series. That does not mean that there are not areas of improvement as the increase in the time of dialysis, the percentage of patients on on-line hemodiafiltration convective techniques and the percentage of FAV.