Incidence and predictors of sternal surgical wound infection in cardiac surgery: A prospective study

Sternal surgical wound infection (SSWI) in cardiac surgery is associated with increased morbidity. We investigated the incidence of SSWI, the main germs implicated and predictors of SSWI. Prospective study including patients undergoing full median sternotomy between January 2017 and December 2019. Patients were followed-up for 3 months after hospital discharge. All sternal wound infections up to 90 days after discharge were considered SSWI. 1004 patients were included. During follow-up, 68 (6.8%) patients presented SSWI. Patients with SSWI had a higher incidence of postoperative renal failure (29.4% vs 17.1%, P = .007), a higher incidence of early postoperative reoperation for non-infectious causes (42.6% vs 9.1%, P < .001), longer ICU stay (3 [2–9] days vs 2 [2–4] days, P = .006), and longer hospital stay (24.5 [14.8–38.3] days vs 10 [7–18] days, P < .001). Gram-positive germs were presented in 49% of the cultures, and gram-negative bacteria in 35%. Early reoperation for non-infectious causes (OR 4.90, 95% CI 1.03–23.7), and a longer ICU stay (OR 1.37 95% CI 1.10–1.72) were independent predictors of SSWI. SSWI is rare but leads to more postoperative complications. The need for early reoperation because of non-infectious cause and a longer ICU stay were independently associated with SSWI.     

Effect of Sex Differences on Computed Tomography Findings in Adults With Cystic Fibrosis: A Multicenter Study

BackgroundThe survival of women with cystic fibrosis (CF) is lower than that of men by approximately 5 years. While various factors have been put forward to account for this discrepancy, no specific reasons have been established. Our hypothesis was that anatomical-structural involvement is more pronounced in women with CF than in men and that this is reflected in thoracic HRCT findings.Material and methodsWe performed a prospective multicentre study, in which adult patients were consecutively included over 18 months. Chest HRCT was performed, and findings were scored by 2 thoracic radiologists using the modified Bhalla system. We also studied respiratory function, applied the CFQR 14+ questionnaire, and collected clinical variables.ResultsOf the 360 patients followed up in the participating units, 160 were eventually included. Mean age was 28 years, and 47.5% were women. The mean ± SD global score on the modified Bhalla score was 13.7 ± 3.8 in women and 15.2 ± 3.8 in men (p = 0.024). The highest scores were observed for sacculations, bronchial generations, and air trapping in women. Women had lower BMI, %FEV₁, %FVC, and %DLCO. Similarly, the results for the respiratory domain in CFQR 14+ were worse in women, who also had more annual exacerbations.ConclusionsThis is the first study to provide evidence of the implication of sex differences in HRCT findings in patients with CF. Women with CF present a more severe form of the disease that results in more frequent exacerbations, poorer functional and nutritional outcomes, deterioration of quality of life, and greater structural damage.     

Relationship between oxidative and occupational stress and aging in nurses of an intensive care unit

Stressful conditions lead to formation of excessive reactive oxygen species (ROS) and cause oxidative stress and aging. The aim of this study was to determine superoxide dismutase (SOD) and catalase (CAT) activity, and malondialdehyde (MDA) levels in nurses of a hospital intensive care unit according to demographic and occupational parameters, and to analyse the relationship with aging. Thirty-two nurses working in an intensive care unit and 35 aged-matched healthy individuals of both sexes as a control group were surveyed. No significant variations with respect to sex were detected in SOD, CAT, MDA and burnout levels. MDA levels increased with age in both the control group and the nurses, and we observed significant differences in MDA levels between the control group and nurses for all age groups. Significant variations in MDA levels were detected between single (286.12 ± 8.41) and married (318.82 ± 6.02), people, between those who frequently practice some kind of sport (281.41 ± 7.32) and those who never participate in sport (298.24 ± 8.11) ,and between those who frequently eat fruit and greens (289.75 ± 8.41) and those who never eat them (315.12 ± 7.21). Significant differences were detected between smokers and nonsmokers in SOD, CAT and MDA, but not for alcohol, coffee, tea or cola consumption. Higher SOD activity and MDA levels were detected in nurses on evening and night shifts (P < 0.01); these nurses also scored significantly higher on burnout subscales. These results suggest that: (1) occupational stress increases oxidative stress levels as a response to elevated ROS generation; (2) occupational stress increases MDA levels as a response to an elevation in free radical generation and can lead to aging; (3) working evening and night shifts increases oxidative and burnout levels. It is evident that preventive changes in job conditions and lifestyle are necessary to improve the quality of life of nurses who work in intensive care units.     

El modelo de autogestión en la agenda de consultas sucesivas en reumatología

IntroductionThe rheumatology service of Ciudad Real Hospital, located in an autonomous community of that same name that is nearly in the center of Spain, implemented a self-management model of successive appointments more than 10 years ago. Since then, the physicians of the department schedule follow-up visits for their patients depending on the disease, its course and ancillary tests.The purpose of this study is to evaluate and compare the self-management model for successive appointments in the rheumatology service of Ciudad Real Hospital versus the model of external appointment management implemented in 8 of the hospital's 15 medical services.Material and methodsA comparative and multivariate analysis was performed to identify variables with statistically significant differences, in terms of activity and/or performance indicators and quality perceived by users. The comparison involved the self-management model for successive appointments employed in the rheumatology service of Ciudad Real Hospital and the model for external appointment management used in 8 hospital medical services between January 1 and May 31, 2016.ResultsIn a database with more than 100,000 records of appointments involving the set of services included in the study, the mean waiting time and the numbers of non-appearances and rescheduling of follow-up visits in the rheumatology department were significantly lower than in the other services. The number of individuals treated in outpatient rheumatology services was 7,768, and a total of 280 patients were surveyed (response rate 63.21%). They showed great overall satisfaction, and the incidence rate of claims was low.ConclusionOur results show that the self-management model of scheduling appointments has better results in terms of activity indicators and in quality perceived by users, despite the intense activity. Thus, this study could be fundamental for decision making in the management of health care organizations.     

Polymorphisms in the Hypoxia Inducible Factor 1-α and the Impact on the Prognosis of Early Stages of Oral Cancer

Background  Hypoxia-inducible factor-1 (HIF-1) is the key regulator of cellular responses to hypoxia and presumably plays a central role in the control of tumor growth. Polymorphisms or mutations increasing its activity and stability in vitro under normoxia have recently been identified. In this study, we aimed to investigate the effect of C1772T and G1790A single nucleotide polymorphisms (SNPs), located within the exon 12 of HIF-1α on the prognosis of early stages of oral squamous cell carcinoma (OSCC). Methods  The frequency of C1772T and G1790A polymorphisms was determined by PCR-RFLP in 139 DNA samples from healthy volunteers and 74 patients with surgically treated T1/2 N0 OSCC. The impact of HIF-1α SNPs on tumor size, invasive depth, pathological features, and histological grade was studied. Correlations between genotype and relapse and/or disease-specific survival were evaluated by Kaplan-Meier analysis and log-rank test. Results  Concerning G1790A SNP, the frequencies of GA heterozygous and AA variant homozygous genotypes were significantly higher in patients than in healthy volunteers (32.8% vs. 6.5% and 4.7% vs. none, respectively) (P < .0001). Also, the presence of the variant allele A was associated to disease-relapse (P = .02) and shorter disease-free survival (P = .04). The genotype distribution of C1772T did not diverge between patients and healthy subjects, and no differences were observed with respect to disease-free or overall survival. Conclusions  Our results suggest that G1790A polymorphism in the HIF-1α gene might confer susceptibility to OSCC and could be a marker of disfavorable prognosis at early stages.     

Ocular necrotizing fasciitis due to Pseudomonas aeruginosa in a non-neutropenic patient

Eyelid necrosis is a very rare disease, usually secondary to trauma or infections. Pseudomonas aeruginosa (PA) eyelid necrosis remains principally a clinical diagnosis and it is often missed early in its presentation because of the difficulty in differentiating it from more common soft tissue infections. However, when the diagnosis is made we must act quickly due to the fatal evolution if not handled properly. We present the case of a non-neutropenic 53-year-old male patient with a history of alcoholism, smoking habit and lung cancer under chemotherapy treatment who developed ocular necrotizing fasciitis due to PA with perforation of his left eye and severe bilateral sclera ischemia despite intensive antibiotic treatment and surgical debridement.     

Functional capacity for daily living activities among senior citizens attending Community Centers in the city of Zaragoza, Spain, 2005

BACKGROUND: To study the dependence related to aging is of particular interest in Aragon, where the population is one of the most aged in Spain. The objective of this study is that of quantifying the degree of functional dependence for daily living activities (DLA) and identifying the personal traits related thereto among individuals age 65 and above who are living at home and attend Community Centers in the city of Zaragoza. METHODS: Cross-sectional study with 380 individuals selected by two-stage sampling. The OARS-MFAQ questionnaire was used by way of personal interviews, analyzing questions which assess the functional capacity to carry out the DLA's and their scoring (dependent variable), sociodemographic variables, self-assessed health condition and actual and hypothetical informal help (independent variables). The chi-square was used for evaluating classified residual data (p<0.05) and multiple correspondence analyses. RESULTS: A total of 9.6% of the subjects showed "major/total dependence", this percentage increasing to 15.5% and 18.7% for those individuals above age 75 and 80, respectively. The "minor/moderate dependence" is related to being a female (p<0.01), health condition self-assessed as poor-passable (p<0.0001), being a widow(er) (p<0.01), having no elementary school education (p<0.01). CONCLUSIONS: Those individuals who are more elderly, females, widow/widowers, having a lesser degree of education and worse self-assessed health condition are more dependent. Practically one out of every ten non-institutionalized individuals 65 years of age or over shows a severe deterioration of their functional capacity. Extrapolating, nearly 11,000 individuals in the city of Zaragoza would require daily help for the DLA's or should stay institutionalized.     

Glucagon and insulin response to dietary carbohydrate in rainbow trout (Oncorhynchus mykiss)

The effects of high carbohydrate (CH) diets on circulating levels of insulin and glucagon were studied in rainbow trout (Oncorhynchus mykiss). Fish (76.87 +/- 8.11 g) were fed for 60 days with three isocaloric diets: control (C) (12% CH), W (28% CH mainly from wheat), and S (28% CH from wheat plus gelatinized starch). After the diet treatment, trout fed the enriched CH diets showed a higher hepatosomatic index and liver glycogen content than controls. In addition, plasma glucose levels were also higher but, on the contrary, circulating insulin levels were greater in the control group. After the period of diet adaptation, fish were sampled 3, 6, 9, and 24 h after food administration. Glycemia levels correlated with the dietary carbohydrate content, and were minimum in controls (from 96.02 +/- 3.77 to 118.97 +/- 6.08 mg/100 ml), followed by W group (from 124.60 +/- 7.46 to 172.19 +/- 11.36 mg/100 ml) and maximum in the S group (from 133.51 +/- 9.36 to 217.88 +/- 13.36 mg/100 ml). Postprandial glucagon profiles showed an inverse relationship with glycemia, indicating that the ingestion of glucose inhibits glucagon secretion. There were no significant differences in postprandial insulin levels between groups except for W group, which presented lower levels of circulating insulin 9 h after feeding. These results indicate that in trout fed a CH diet glucose affects the secretion of glucagon more than insulin during the postprandial period.