Mediastinitis post revascularización miocárdica: impacto del cambio de profilaxis antibiótica en la fundación Cardioinfantil 2012 - 2013

INTRODUCCIÓN. La mediastinitis posterior a cirugía de revascularización miocárdica es una infección infrecuente, pero potencialmente fatal. En la Fundación Cardioinfantil se ha observado una tendencia al incremento de la misma en los últimos años, obligando a un cambio en las medidas de profilaxis antimicrobiana, pasando de cefalosporinas a vancomicina – gentamicina, sin embargo no se conoce aún el impacto de estas medidas. OBJETIVO: Determinar si el cambio de la profilaxis antibiótica en pacientes sometidos a revascularización miocárdica influye en una disminución de la incidencia de mediastinitis durante los años 2012 – 2013. METODOLOGÍA: Estudio de cohortes retrospectivo, evaluando la incidencia de mediastinitis post revascularización miocárdica, en pacientes expuestos a 2 diferentes tipos de profilaxis antimicrobiana (cefalosporinas vs vancomicina-gentamicina). Se describieron los patrones de susceptibilidad y resistencia de los patógenos encontrados en mediastinitis y la mortalidad de esta patología. RESULTADOS: Los patógenos más frecuentemente aislados en la mediastinitis fueron Staphylococcus aureus y Klebsiella pneumoniae, en la mayoría monomicrobiano. Se encontraron patógenos con perfiles de resistencia como betalactamasas de espectro extendido en Gram negativos y resistencia a la meticilina en cocos Gram positivos. El RR de mediastinitis del grupo expuesto a vancomicina-gentamicina respecto al grupo de cefalosporinas fue de 0,9 con IC 95% 0,28 – 3,28. CONCLUSIÓN: la epidemiologia microbiana de la mediastinitis no difiere de la reportada en otras series. La profilaxis antimicrobiana con vancomicina - gentamicina en pacientes sometidos a revascularización miocárdica, no redujo la incidencia de mediastinitis. Se propone regresar a la terapia de profilaxis con cefalosporinas.

Caracterización de las variantes anatómicas de las venas pulmonares en pacientes candidatos a aislamiento de venas pulmonares en Colombia

Introducción y objetivos: El conocimiento de la anatomía de las venas pulmonares y de la aurícula izquierda es fundamental para la planeación y prevención de posibles complicaciones durante la ablación de las venas pulmonares, procedimiento realizado para el manejo de la fibrilación auricular. Este estudio pretende caracterizar la anatomía (tamaño y forma) de las venas pulmonares y determinar las variantes anatómicas más comunes de las mismas. Métodos: Se analizaron 277 estudios de angioresonancia tridimensional y tomografía computarizada realizados previo al procedimiento de aislamiento de venas pulmonares. Se evaluaron los diámetros de la aurícula izquierda, de los ostia de las venas pulmonares y se determinaron la presencia de venas pulmonares comunes, accesorias y ramificaciones tempranas. Resultados: 75% de nuestros pacientes presentaron la anatomía normal de dos venas pulmonares derechas y dos izquierdas. En un 10,1% de los casos se encontraron venas supernumerarias y en un 11,2% se encontró un tronco común. En un 61% de los pacientes se encontraron ramas ostiales, las cuales en un 39,4% de los casos se presentaron en la vena pulmonar inferior derecha. Conclusiones: La evaluación de la morfología de la aurícula derecha y las venas pulmonares por medio de angioresonancia o tomografía computarizada, es necesaria para la realización de ablación por radiofrecuencia dada la alta frecuencia de variantes anatómicas y presencia de ramas ostiales.

Imposicions estructurals en el drenatge de la conca del riu Onyar (Girona)

The Onyar River basin is situated in the depression of la Selva. His origins are related to tectonic activity during Neogen in this region. In his evolution, we note a slowly and continuous downfall which directs the morphodinamical behaviour. In this sense, the drainage network has a directional trend towards the north, as consecuence of fault systems, and specially the N-S oriented one. A fault of this system has an important influence in the basin morphology, directs the drainage towards the north and avoids a closely drainage in the basin

Distribution of diatom communities in agricultural and mining watersheds of Southwest Spain

Els sistemes aquàtics continental representen un dels ecosistemes més amenaçats a nivell mundial, com a conseqüència de l'ús intensiu quel'home en fa. La conca del Guadiana no està lliure d'aquestes pressions antròpiques. Les grans infraestructures hidràuliques i l'escorrentia provinent de l'agricultura són només exemples dels greus problemes que pateix la conca. Aquests problemes es fan especialment palesos en la zona alta de la conca, on l'escassetat d'aigua no fa més que agreujar el problema.Tot això ha generat la necessitat urgent d'avaluar l'estat de conservació d'aquests ecosistemes aquàtics continentals, poder determinar la mesura i la magnitud de les pertorbacions que els estan afectant i així proposar mesures de gestió destinades a restaurar-ne la integritat ecològica. El principal objectiu que presenta aquest és determinar els patrons de distribució de les comunitats de algals (amb una menció especial en el grup de les diatomees) i de les seves causes en la conca del Guadiana i associades, amb la finalitat d'establir i proposar eines que permetin avaluar l'estat de conservació de les masses d'aigua d'aquestes conques.

Inundações urbanas na vila de Arouca : organização do escoamento superficial e áreas suscetíveis

As inundações urbanas, embora sejam um tema pouco estudado em Portugal, são um reflexo da intensificação da urbanização do território, facto que se tem acentuado no país (Oliveira, 2003). Com efeito, o objetivo deste artigo é compreender a dinâmica do escoamento superficial na área urbanizada da Vila de Arouca, mediante a identificação e análise do contributo que os elementos da malha urbana desempenham em todo esse processo. Por outro lado, analisa-se a evolução dos usos do solo nas últimas décadas, de forma a entender os efeitos que o incremento de áreas impermeabilizadas teve no reforço da componente superficial do escoamento. O inventário realizado sobre o escoamento superficial conduzido pelas vias da malha urbana, possibilitou a determinação dos locais mais problemáticos na área da vila e dos elementos expostos a este tipo de ocorrência. Assim, o estudo constitui um contributo para o ordenamento do território do município de Arouca, essencialmente, pela abordagem metodológica apresentada e pelos resultados obtidos.

Técnicas de reabilitação sem abertura de vala de redes de drenagem de águas residuais

O objectivo da presente dissertação consiste na apresentação de várias técnicas de reabilitação de redes de drenagem de águas residuais sem necessidade de abertura de vala. Para esse efeito efectuou-se um levantamento das técnicas de reabilitação de colectores sem abertura de vala actualmente existente no mercado, tendo-se identificado cinco técnicas diferentes, organizadas em dois grandes grupo: Técnicas de encamisamento (i.e., encamisamento pontual - «short liner» e contínuo com manga de fibras de feltro ou com manga de fibras de vidro) e técnicas de entubamento (i.e., entubamento simples - «sliplining» e com rebentamento por destruição da tubagem existente). As técnicas de reabilitação que foram desenvolvidas foram aplicadas a dois casos de estudo diferentes: um encamisamento contínuo com mangas de fibra de vidro (cura por radiação ultravioleta) para renovar o Emissário da Cadaveira, e um entubamento com rebentamento com tubos modelares pelo processo dinâmico, primeiro caso de entubamento realizado em Portugal para renovar um troço da rede de drenagem doméstica do novo Hospital de Cascais. A apresentação de casos de estudo foi fundamental para perceber o funcionamento das técnicas de reabilitação, e deu um aspecto técnico, essencial, a esta dissertação.

Simulating metals and mine discharges in river basins using a new integrated catchment model for metals: pollution impacts and restoration strategies in the Aries-Mures river system in Transylvania, Romania

The INtegrated CAtchment (INCA) model has been developed to simulate the impact of mine discharges on river systems. The model accounts for the key kinetic chemical processes operating as well as the dilution, mixing and redistribution of pollutants in rivers downstream of mine discharges or acid rock drainage sites. The model is dynamic and simulates the day-to-day behaviour of hydrology and eight metals (cadmium, mercury, copper, zinc, lead, arsenic, manganese and chromium) as well as cyanide and ammonia. The model is semi-distributed and can simulate catchments, sub-catchment and in-stream river behaviour. The model has been applied to the Roia Montan Mine in Transylvania, Romania, and used to assess the impacts of old mine adits on the local catchments as well as on the downstream Aries and Mures river system. The question of mine restoration is investigated and a set of clean-up scenarios investigated. It is shown that the planned restoration will generate a much improved water quality from the mine and also alleviate the metal pollution of the river system.

Dynamics of potassium leaching on a hillslope grassland soil

There have been only a few studies of potassium (K) losses from grassland systems, and little is known about their dynamics, especially in relation to nitrogen (N) management. A study was performed during the autumn and winter of 1999 and 2000 to understand the effects of N and drainage on the dynamics of K leaching on a hillslope grassland soil in southwestern England. Two N application rates were studied (0 and 280 kg N ha(-1) yr(-1)), both with and without the drainage. Treatments receiving N also received farmyard manure (FM). Higher total K losses and K concentrations in the leachates were found in the N + FM treatments (150 and 185% higher than in 0 N treatments), which were related to K additions in the FM. Drainage reduced K losses by 35% because of an increase in dry matter production and a reduction in overland and preferential flow. The pattern of change in K concentration in the leachates was associated with preferential flow at the beginning of the drainage season and with matrix flow later in winter, and was best described by a double exponential curve. Rainfall intensity and the autumn application of FM were the main determinants of K losses by leaching. The study provided new insights into the relationships between soil hydrology, rainfall, and K leaching and its implications for grassland systems.

Fe-sulphate-rich evaporative mineral precipitates from the Rio Tinto, southwest Spain

The soluble metal sulphate salts melanterite, rozenite, rhomboclase, szornolnokite, copiapite, coquimbite, hexahydrite and halotrichite, together with gypsum, have been identified, some for the first time oil the banks of the Rio Tinto, SW Spain. Secondary Fe-sulphate minerals call form directly from evaporating acid, sulphate-rich Solutions as a result of pyrite oxidation. Chemical analyses of mixtures of these salt minerals indicate concentrations of Fe (up to 31 wt.%), Mg (up to 4 wt.%), Cu (up to 2 wt.%) and Zn (up to wt.%). These minerals are shown to act as transient storage Cor metals and can store on average up to 10% (9.5 - 11%) and 22% (20-23%) Zn and Cu respectively, of the total discharge of the Rio Tinto during the summer period. Melanterite and rozenite precipitates at Rio Tinto are only found in association with very acidic drainage waters (pH <1.0) draining directly from pyritic waste piles. Copiapite precipitates abundantly oil the banks of the Rio Tinto by (1) direct evaporation of the river water; or (2) as part of a paragenetic sequence with the inclusion of minor halotrichite, indicating natural dehydration and decomposition. The natural occurrences are comparable with the process of paragenesis from the evaporation of Rio Tinto river water under laboratory experiments resulting in the formation of aluminocopiapite, halotrichite, coquimbite, voltaite and gypsum.

Hydrochemical variations and contaminant load in the Rio Tinto (Spain) during flood events

The aim of this work is to study the hydrochemical variations during flood events in the Rio Tinto, SW Spain. Three separate rainfall/flood events were monitored in October 2004 following the dry season. In general, concentrations markedly increased following the first event (Fe from 99 to 1130 mg/L; Q(max) = 0.78 m(3)/s) while dissolved loads peaked in the second event (Fe = 7.5 kg/s, Cu = 0.83 kg/s, Zn = 0.82 kg/s; Q(max) = 77 m(3)/s) and discharge in the third event (Q(max) = 127 m(3)/s). This pattern reflects a progressive depletion of metals and sulphate stored in the dry summer as soluble evaporitic salt minerals and concentrated pore fluids, with dilution by freshwater becoming increasingly dominant as the month progressed. Variations in relative concentrations were attributed to oxyhydroxysulphate Fe precipitation, to relative changes in the sources of acid mine drainage (e.g. salt minerals, mine tunnels, spoil heaps etc.) and to differences in the rainfall distributions along the catchment. The contaminant load carried by the river during October 2004 was enormous, totalling some 770 t of Fe, 420 t of Al, 100 t of Cu, 100 t of Zn and 71 t of Mn. This represents the largest recorded example of this flush-out process in an acid mine drainage setting. Approximately 1000 times more water and 1408 200 times more dissolved elements were carried by the river during October 2004 than during the dry, low-flow conditions of September 2004, highlighting the key role of flood Events in the annual pollutant transport budget of semi-arid and and systems and the need to monitor these events in detail in order to accurately quantify pollutant transport. (c) 2007 Elsevier B.V. All rights reserved.

The use of earth observation techniques to improve catchment-scale pollution predictions

Remote sensing can potentially provide information useful in improving pollution transport modelling in agricultural catchments. Realisation of this potential will depend on the availability of the raw data, development of information extraction techniques, and the impact of the assimilation of the derived information into models. High spatial resolution hyperspectral imagery of a farm near Hereford, UK is analysed. A technique is described to automatically identify the soil and vegetation endmembers within a field, enabling vegetation fractional cover estimation. The aerially-acquired laser altimetry is used to produce digital elevation models of the site. At the subfield scale the hypothesis that higher resolution topography will make a substantial difference to contaminant transport is tested using the AGricultural Non-Point Source (AGNPS) model. Slope aspect and direction information are extracted from the topography at different resolutions to study the effects on soil erosion, deposition, runoff and nutrient losses. Field-scale models are often used to model drainage water, nitrate and runoff/sediment loss, but the demanding input data requirements make scaling up to catchment level difficult. By determining the input range of spatial variables gathered from EO data, and comparing the response of models to the range of variation measured, the critical model inputs can be identified. Response surfaces to variation in these inputs constrain uncertainty in model predictions and are presented. Although optical earth observation analysis can provide fractional vegetation cover, cloud cover and semi-random weather patterns can hinder data acquisition in Northern Europe. A Spring and Autumn cloud cover analysis is carried out over seven UK sites close to agricultural districts, using historic satellite image metadata, climate modelling and historic ground weather observations. Results are assessed in terms of probability of acquisition probability and implications for future earth observation missions. (C) 2003 Elsevier Ltd. All rights reserved.

Estimating soil water fluxes from soil water records obtained using dielectric sensors

Accurate estimation of the soil water balance (SWB) is important for a number of applications (e.g. environmental, meteorological, agronomical and hydrological). The objective of this study was to develop and test techniques for the estimation of soil water fluxes and SWB components (particularly infiltration, evaporation and drainage below the root zone) from soil water records. The work presented here is based on profile soil moisture data measured using dielectric methods, at 30-min resolution, at an experimental site with different vegetation covers (barley, sunflower and bare soil). Estimates of infiltration were derived by assuming that observed gains in the soil profile water content during rainfall were due to infiltration. Inaccuracies related to diurnal fluctuations present in the dielectric-based soil water records are resolved by filtering the data with adequate threshold values. Inconsistencies caused by the redistribution of water after rain events were corrected by allowing for a redistribution period before computing water gains. Estimates of evaporation and drainage were derived from water losses above and below the deepest zero flux plane (ZFP), respectively. The evaporation estimates for the sunflower field were compared to evaporation data obtained with an eddy covariance (EC) system located elsewhere in the field. The EC estimate of total evaporation for the growing season was about 25% larger than that derived from the soil water records. This was consistent with differences in crop growth (based on direct measurements of biomass, and field mapping of vegetation using laser altimetry) between the EC footprint and the area of the field used for soil moisture monitoring. Copyright (c) 2007 John Wiley & Sons, Ltd.

Endocranial lesions: their distribution and aetiology

Reactive new bone on the endocranial surface of the skull in non-adults has recently received a lot of attention in the palaeopathological literature. These features appear as layers of new bone on the original cortical surface, expanding around meningeal vessels, as isolated plaques, 'hair-on-end' extensions of the diploe or, as 'capillary' impressions extending into the inner lamina of the cranium. These lesions are commonly found on the occipital bone, outlining the cruciate eminence, but have also been recorded on the parietal and frontal bones, and appear to follow the areas of venous drainage. Although recognized as resulting from haemorrhage or inflammation, their precise aetiology is still a matter of controversy. This paper outlines their possible causes and examines their nature and distribution in a group of non-adults from four archaeological sites in England. It is recommended that, when recording these lesions in the future, additional skeletal pathologies, the age of the child, and nature and distribution of the lesions also be taken into account. Copyright (C) 2004 John Wiley Sons, Ltd.

Competition in tree row agroforestry systems. 3. Soil water distribution and dynamics

The purpose of this study was to test the hypothesis that soil water content would vary spatially with distance from a tree row and that the effect would differ according to tree species. A field study was conducted on a kaolinitic Oxisol in the sub-humid highlands of western Kenya to compare soil water distribution and dynamics in a maize monoculture with that under maize (Zea mays L.) intercropped with a 3-year-old tree row of Grevillea robusta A. Cunn. Ex R. Br. (grevillea) and hedgerow of Senna spectabilis DC. (senna). Soil water content was measured at weekly intervals during one cropping season using a neutron probe. Measurements were made from 20 cm to a depth of 225 cm at distances of 75, 150, 300 and 525 cm from the tree rows. The amount of water stored was greater under the sole maize crop than the agroforestry systems, especially the grevillea-maize system. Stored soil water in the grevillea-maize system increased with increasing distance from the tree row but in the senna-maize system, it decreased between 75 and 300 cm from the hedgerow. Soil water content increased least and more slowly early in the season in the grevillea-maize system, and drying was also evident as the frequency of rain declined. Soil water content at the end of the cropping season was similar to that at the start of the season in the grevillea-maize system, but about 50 and 80 mm greater in the senna-maize and sole maize systems, respectively. The seasonal water balance showed there was 140 mm, of drainage from the sole maize system. A similar amount was lost from the agroforestry systems (about 160 mm in the grevillea-maize system and 145 mm in the senna-maize system) through drainage or tree uptake. The possible benefits of reduced soil evaporation and crop transpiration close to a tree row were not evident in the grevillea-maize system, but appeared to greatly compensate for water uptake losses in the senna-maize system. Grevillea, managed as a tree row, reduced stored soil water to a greater extent than senna, managed as a hedgerow.

Solute movement through intact columns of cryoturbated Upper Chalk

Cryoturbated Upper Chalk is a dichotomous porous medium wherein the intra-fragment porosity provides water storage and the inter-fragment porosity provides potential pathways for relatively rapid flow near saturation. Chloride tracer movement through 43 cm long and 45 cm diameter undisturbed chalk columns was studied at water application rates of 0.3, 1.0, and 1.5 cm h(-1). Microscale heterogeneity in effluent was recorded using a grid collection system consisting of 98 funnel-shaped cells each 3.5 cm in diameter. The total porosity of the columns was 0.47 +/- 0.02 m(3) m(-3), approximately 13% of pores were >15 mu m diameter, and the saturated hydraulic conductivity was 12.66 +/- 1.31 m day(-1). Although the column remained unsaturated during the leaching even at all application rates, proportionate flow through macropores increased as the application rate decreased. The number of dry cells (with 0 ml of effluent) increased as application rate decreased. Half of the leachate was collected from 15, 19 and 22 cells at 0.3, 1.0, 1.5 cm h(-1) application rates respectively. Similar breakthrough curves (BTCs) were obtained at all three application rates when plotted as a function of cumulative drainage, but they were distinctly different when plotted as a function of time. The BTCs indicate that the columns have similar drainage requirement irrespective of application rates, as the rise to the maxima (C/C-o) is almost similar. However, the time required to achieve that leaching requirement varies with application rates, and residence time was less in the case of a higher application rate. A two-region convection-dispersion model was used to describe the BTCs and fitted well (r(2) = 0.97-0-99). There was a linear relationship between dispersion coefficient and pore water velocity (correlation coefficient r = 0.95). The results demonstrate the microscale heterogeneity of hydrodynamic properties in the Upper Chalk. Copyright (C) 2007 John Wiley & Sons, Ltd.