Sanidad Militar

Control of legionellosis

Comments on the editorial "Zoonoses: basis and foundation of the One Health initiative"

The influence of work-family balance on the mental health of military emergency unit personnel

RESUMEN En este estudio se ha tratado de analizar la influencia de la interrelación familia-trabajo con el estrés percibido y la salud mental general del personal interviniente en emergencias. Además, se ha explorado si una variable propiamente psicológica como la autoeficacia percibida, ejercía algún tipo de efecto mediador entre las relaciones del eje familia-trabajo con las variables de resultado, el estrés y la salud mental general. Para ello, se han aplicado una serie de cuestionarios a una muestra de 460 intervinientes de la Unidad Militar de Emergencias, cuyos datos se han analizado posteriormente a través de técnicas de regresión lineal y estudio de mediación con PROCESS. Los resultados nos indican que existe una relación significativa directa entre la interrelación familia-trabajo, respecto al estrés y la salud mental general percibida por el personal de emergencias. No se ha encontrado evidencia de que la variable autoeficacia percibida ejerza ningún tipo de efecto mediador entre la interrelación familia-trabajo y las variables de resultado. En conclusión, se debe seguir investigando en las variables psicológicas que puedan mitigar el estrés generado en el personal de emergencias, proveniente de su ámbito familiar, ya que ha quedado demostrado que este tiene una relación significativa entre ambos conceptos y que puede tener consecuencias en la salud mental general de los intervinientes.

ABSTRACT In this research we tried to analyze the influence of the family-work interrelationship with perceived stress and the general mental health of staff involved in emergencies. In addition, it has been explored whether a specific psychological variable such as perceived self-efficacy exerted some kind of mediating effect between the family-work axis relationships with outcome variables, stress and general mental health. To this end, a series of questionnaires were applied to a sample of 460 participants from the Emergency Military Unit, whose data were subsequently analyzed through linear regression techniques, and mediation study with PROCESS. Results indicate that there is a significant direct relationship between family-work interrelationship, with respect to stress and general mental health perceived by emergency staff. No evidence has been found that perceived the self-efficacy variable exerts any kind of mediating effect between family-work interrelation and outcome variables. In conclusion, further research should be carried out on psychological variables that can mitigate the stress generated by emergency personnel, from their family environment. It has been shown that this has a significant relationship between the two concepts and that it can have consequences on the general mental health of the participants.

In vitro evaluation of the efficacy of fresh, temperatured and frozen platelets. Possible employment in the military environment

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SUMMARY Introduction. Exsanguinating hemorrhage is the first preventable cause of death for combatants in armed conflicts, thus making the possibility of transfusing blood components early an absolutely essential benefit during health care for casualties generated in military operations. Throughout the numerous conflicts that have occurred during the past century, there have been important changes in the hemotherapy treatment of casualties along with an evolution of the health doctrine regarding this issue. In some massive transfusion protocols, the diagnostic technique of thromboelastometry (TE) has been used. TE is a test that shows the viscoelastic properties of blood from clot formation to fibrinolysis, evaluates platelet function and correlates quickly with the physiological process of hemostasis. The main objective of this study is the evaluation in vitro of the hemostatic capacity of the various cold, frozen and fresh platelet concentrates through standardized coagulation tests and thromboelastometry, clarifying whether the contribution to the clot is significantly improved with cold platelet pools (preserved at 4ºC), compared to fresh and frozen platelets. It is also intended to determine what advantages would be the incorporation of cold platelets in transfusion medicine performed in the military environment. Material and methods. An experimental study was designed to compare cold (refrigerated), frozen and fresh (conventional) platelets in vitro, analyzing their performance and effectiveness through systematic blood analysis, routine laboratory coagulation mechanisms (Prothrombin Time, Prothrombin Activity, Cephalin and Fibrinogen) and Rotational Thromboelastometry (ROTEM). A sample of 20 healthy patients was recruited, after informing them in writing and obtaining the mandatory informed consent, they donated 6 tubes with 10 ml citrate. of blood per patient. For the comparison, the data collected from the performance of the ROTEM between baseline and experimental samples (after platelet transfusion) were normally distributed and analyzed using the paired Student’s t-test and were analyzed by multiple linear regression, adjusting and not adjusting according to the platelet count. Approval was obtained from the Drug Research Ethics Committee and the hospital research committee. Results. The mean of the EXTEM CT parameter is significantly lower in the sample with frozen platelets compared to that of tempered and normal platelets. The mean of the EXTEM CFT parameter is significantly lower in the sample with normal platelets compared to that of frozen platelets. The mean of the EXTEM CFT parameter is significantly lower in the sample with frozen platelets compared to that of tempered platelets. The mean of the Platelet Index parameter is significantly higher in the sample with normal platelets compared to that of tempered platelets. The mean of the MCE PI parameter is significantly higher in the sample with tempered platelets compared to that of frozen platelets. Conclusion. After evaluating the hemostatic capacity in vitro using standardized coagulation tests and thromboelastometry, tempered platelets significantly improve the maximum elasticity of the clot in relation to platelet count compared to frozen platelets, but not compared to fresh platelets. The incorporation of tempered platelets in transfusion medicine in the military environment would be another treatment alternative for discharge with exsanguinating hemorrhage and would provide logistical advantages by increasing the shelf life of standard platelets from seven to twenty-one days and simplifying processing, transportation and Reconstitution of the blood component to the liquid medium as it is not necessary to freeze it.

2009-2019: evolution of the epidemiology of sports injuries in the Armed Forces

RESUMEN Introducción: Las lesiones músculo-esqueléticas son la principal causa de bajas consideradas no de combate en las Fuerzas Armadas. Es fundamental recoger y analizar datos sobre las mismas para determinar los factores de riesgo. Esto debería traducirse en el desarrollo de una planificación adecuada de la preparación física, que permita la prevención, la recuperación del personal lesionado y el cumplimiento de los cometidos asignados a cada puesto táctico. Material y método. Diseño epidemiológico observacional de tipo descriptivo, transversal y retrospectivo, extrayendo de las estadísticas oficiales publicadas por el Ministerio de Defensa datos sobre accidentes sufridos por el personal militar entre los años 2009 y 2019, entre los que se incluyen los ocasionados por la práctica deportiva. Resultados. Las lesiones debidas a la realización de actividades deportivas suponen aproximadamente un 50 % de los accidentes sufridos por los militares. Los afectados mayoritariamente son el personal de tropa y marinería (85 %), sobre todo del Ejército de Tierra (86 %). Las lesiones más frecuentes son traumáticas (en torno al 65 %), si bien de carácter leve. El mayor número de sucesos ocurren en instrucción y en preparación física; la carrera, la gimnasia y las pruebas de valoración de la condición física (con un 65 % del total) son las tareas más lesivas. Conclusiones. Aunque el número absoluto de lesionados ha disminuido a lo largo de la década analizada, la tendencia y la frecuencia relativa de casos apenas ha variado, por lo que deberían revisarse la metodología del entrenamiento y el mecanismo de recogida de datos.

ABSTRACT Introduction: Musculoskeletal injuries are the main cause of non-combat casualties in the Armed Forces. It is essential to collect and analyze data on them to determine risk factors. This should translate into the development of adequate physical preparation planning, which allows prevention, recovery of injured personnel and the fulfillment of the tasks assigned to each tactical position. Material and method. Descriptive, cross-sectional and retrospective observational epidemiological design, extracting from the official statistics published by the Ministry of Defense data on accidents suffered by military personnel between 2009 and 2019, including those caused by sport practice. Results. Injuries due to sports activities account for approximately 50 % of the accidents suffered by the military. Those most affected are the enlisted service members (85 %), especially in the Army (86 %). The most frequent injuries are traumatic (around 65 %), although with a minor nature. The largest number of events occur in instruction and physical preparation; running, gymnastics and tests to assess physical condition (with 65 % of the total) are the most damaging tasks. Conclusions. Although the absolute number of injured has decreased throughout the decade analyzed, the trend and relative frequency of cases has hardly changed, in this sense the training methodology and the data collection mechanism should be reviewed.

Effectiveness of a program to promotion of healthy habits in military personnel of the navy with overweight and obesity

RESUMEN Antecedentes y objetivos: el sobrepeso y obesidad en personal de la Armada puede provocar pérdida de aptitud para el servicio y complicaciones en la participación de misiones. El objetivo principal de este estudio pretende demostrar que una intervención basada en la promoción de hábitos saludables durante doce meses, pudo disminuir el índice de masa corporal (IMC) y mejorar parámetros bioquímicos en personal con obesidad o sobrepeso. Material y métodos: estudio cuasi-experimental, longitudinal, correlacional y comparativo (pre-test y post-test), durante doce meses, con dos grupos, intervención (GI) y control (GC). La muestra compuesta por 42 militares (n=21 por grupo), con IMC superior a 28 kg/m2. Se ejecutó en dos periodos: el primero a bordo de una fragata durante una misión; el segundo desde el final de la misión hasta completar doce meses. Se realizaron 18 sesiones personalizadas enfocadas a fomentar hábitos saludables en la dieta y favorecer la actividad física. Se monitorizaron variables antropométricas y bioquímicas en el GI. Del GC se obtuvieron los datos de IMC al inicio y final del estudio. Resultados: se produjo una disminución de la media del IMC de 33,71 kg/m2 a 30,91 kg/m2 en el GI; la adherencia fue consistente (90,5 %). A partir de los seis meses se observó un descenso en el número de participantes del GI (76,2 %) y un aumento del IMC con respecto a los valores obtenidos en la primera mitad (de 30,91 a 31,82 kg/m2). Se demostró una disminución del IMC al final de la intervención (p<0,005). Se evidencia una mejora de HDL-colesterol (p<0,04) y de triglicéridos (p<0,029) estadísticamente significativa. No se apreciaron cambios significativos en el GC. Conclusiones: el efecto de la intervención basada en la promoción de hábitos de vida saludables disminuye el IMC en personal afecto de sobrepeso y obesidad y mejora determinados parámetros bioquímicos relacionados con esta.

SUMMARY Antecedent and objectives: overweight and obesity in Navy personnel can cause loss of physical aptitude and complications in the development of missions. The main objective is to demonstrate that an intervention based on the promotion of healthy habits for 12 months, can reduce the Body Mass Index (BMI) and improve biochemical parameters in personnel affected by overweight or obesity. Material and Methods: quasi-experimental study, correctional, longitudinal, correctional and comparative (pre-test and post-test) for 12 months, with two groups, intervention (IG) and control (CG). The sample included 42 military personnel (n=21 per group), with a BMI higher than 28 kg/m2. It was carried out in two periods: the first period was carried out on board a frigate, taking advantage of its participation during a mission; the second since the end of the mission until completing the 12 months. 18 personalized sessions were held, focused on promoting healthy habits in both diet and promote physical activity. Anthropometric and biochemical dates were monitored in the IG. In the CG, BMI data were obtained at the beginning and end of the study. Results: During the first period, in the IG there was a decrease in BMI of 33,71 to 30,91 kg/m2 (p<0.05); Adherence is consistent (90,5 %). After 6 months a decrease in the number of participants (76,2 %) and an increase in BMI with respect to the values of the first half (from 30,91 kg/m2 to 31,82 kg/m2) were observed. A decrease in BMI was demonstrated at the end of the intervention. There is an improvement in HDL-cholesterol (p<0.04) and triglycerides (p<0.029). No significant changes were seen in GC. Conclusions: the effect of the nursing intervention based on the promulgation of healthy life habits decreases the BMI in personnel affected by overweight and obesity and improves certain biochemical parameters related to this.

Prevalence of legionella species in water supply facilities of Spain: a systematic review and meta-analysis

RESUMEN Antecedentes. Las especies de Legionella tienen su hábitat natural o reservorio primario en las aguas dulces superficiales de lagos, ríos, estanques y aguas termales, desde donde a través de los sistemas de suministro colonizan el agua de consumo. El presente estudio pretende investigar la prevalencia de Legionella en instalaciones de agua de consumo de España. Métodos. Se realizó una revisión sistemática mediante la búsqueda en bases de datos electrónicas de información científica de estudios observacionales sobre contaminación de agua de consumo por Legionella, con resultados de análisis de muestras de agua obtenidos entre enero de 2001 y abril de 2021. Se efectuó meta-análisis mediante el software MetaXL© en la hoja de cálculo Microsoft Excel. Resultados. Se seleccionaron un total de 21 estudios. La prevalencia de Legionella en España fue de 21,8 % (IC 95 %: 15,0-29,6). La especie más comúnmente aislada fue L. pneumophila serogrupos 2-15 (44,4 %, IC 95 %: 29,5-59,8). Los valores más altos se hallaron en puntos terminales de las redes de agua caliente sanitaria (31,7 %, IC 95 %: 21,6-42,9), y en las comunidades autónomas de Aragón (24,7 %, IC 95 %: 8,8-44,9) y Cataluña (21,3 %, IC 95%: 4,4-44,8). Conclusiones. La prevalencia global de Legionella obtenida puede compararse con los estudios de otros autores, siendo en líneas generales cercana a la obtenida a nivel mundial, con variaciones en relación a otros países. Las instalaciones con mayor prevalencia han resultado ser las de mayor riesgo de proliferación y dispersión de la bacteria según la normativa vigente, y aquellas situadas en la mitad oriental de España.

SUMMARY Background. Legionella species have their natural habitat or primary reservoir in the fresh surface waters of lakes, rivers, ponds and hot springs, from where they colonize drinking water through supply systems. The present study aims to investigate the prevalence of Legionella in drinking water facilities in Spain. Methods. A systematic review was performed by searching in electronic databases of scientific information for observational studies on contamination of drinking water by Legionella, with results of analysis of water samples obtained between January 2001 and April 2021. Meta-analysis was carried out using the MetaXL© software in the Microsoft Excel spreadsheet. Results. A total of 21 studies were selected. The prevalence of Legionella in Spain was 21.8 % (95 % CI: 15.0-29.6). The most commonly isolated species were L. pneumophila serogroups 2-15 (44.4 %, 95 % CI: 29.5-59.8). The highest values were found at terminal points of the sanitary hot water networks (31.7 %, 95 % CI: 21.6-42.9), and in the autonomous regions of Aragon (24.7 %, 95 % CI: 8.8-44.9) and Catalonia (21.3 %, 95 % CI: 4.4-44.8). Conclusions. The overall prevalence of Legionella obtained can be compared to studies performed by other authors, being in general terms close to that obtained worldwide, with variations in relation to other countries. The facilities with the highest prevalence have turned out to be those with the highest risk of proliferation and dispersal of the bacteria according to current regulations, and those located in the eastern half of Spain.

Storm «Philomena»: trench foot in peacetime in Spain

RESUMEN El pie de trinchera es considerada la lesión militar más frecuente no relacionada con el combate y conocemos de su existencia desde tiempos de Napoleón. Sin embargo, esta vasoneuropatía sigue siendo una condición poco conocida y, por ende, un desafío diagnóstico. Con la presentación de dos casos clínicos atendidos en nuestro hospital durante la borrasca Filomena, ocurrida en España en enero del 2021, con Madrid como una de las zonas más afectadas, pretendemos aportar un poco más de conocimiento, en aras de mejorar la identificación de los casos y el correcto manejo terapeútico que, a buen seguro, mejorará el pronóstico de nuestros pacientes, sin olvidar las medidas preventivas. En nuestra experiencia ha sido determinante un riguroso estudio diagnóstico (vascular y electroneurofisiológico) y el tratamiento vasodilatador con bloqueo ciático poplíteo, inhibidores de la 5 fosfodiesterasa y calcioantagonistas dihidropiridínicos.

ABSTRACT Trench foot is considered the most common non-combat related military injury and we have known of its existance since Napoleon’s time. However, this vasoneuropathy remains a poorly understood condition and, therefore, a diagnostic challenge. With the report of 2 clinical cases treated in our hospital during Filomena storm, which occurred in Spain in January 2021, with Madrid as one of the most affected areas, we intend to contribute a little more knowledge, in order to improve cases identification and the correct management that, surely will improve our patients prognosis, without forgetting preventive measures. In our experience, a rigorous diagnostic study (vascular and electroneurophysiological) and a vasodilatador treatment with sciatic popliteal block, 5-phosphodiesterase inhibitors and dihydropyridine calcium antagonists have been decisive.

Palmoplantar erythrodysesthesia after perioperative treatment with chemotherapy

RESUMEN La eritrodisestesia palmoplantar es una reacción adversa que se asocia a la administración de docetaxel y fluoropirimidinas. La actividad de la enzima dihidropirimidina deshidrogenasa (DPD) determina la tasa de catabolismo del 5-Fluorouracilo (5-FU) y está sujeta a variabilidad interindividual y polimorfismo genético. Por tanto, los pacientes con deficiencia de DPD presentan un mayor riesgo de toxicidad. Presentamos el caso de un paciente tratado con docetaxel, oxaliplatino y 5-FU (esquema FLOT) que presentó toxicidad cutánea moderada y del que se sospechó deficiencia de DPD.

SUMMARY Palmoplantar erythrodysesthesia is an adverse event associated with the administration of docetaxel and fluoropyrimidines. The activity of the enzyme dihydropyrimidine dehydrogenase (DPD) determines the rate of catabolism of 5-Fluorouracil (5-FU) and is subject to interindividual variability and genetic polymorphism. Therefore, patients with DPD deficiency present an increased risk of toxicity. We present the case of a patient treated with docetaxel, oxaliplatin and 5-FU (FLOT scheme) who presented moderate skin toxicity and who was suspected of DPD deficiency.

Positive assessment of drugs: July, September and October of 2022

RESUMEN Se reseñan los medicamentos evaluados y con dictamen positivo por comisión de expertos de la Agencia Europea del Medicamento, hechos públicos en julio, septiembre y octubre de 2022 y considerados de mayor interés para el profesional sanitario. Se trata de opiniones técnicas positivas que son previas a la autorización y puesta en el mercado del medicamento.

SUMMARY: The drugs assessed by the European Medicines Agency made public in July, September and October of 2022, and considered of interest to the healthcare professional, are reviewed. These are positive technical reports prior to the authorization and placing on the market of the product.

Promotion of mental health during the pandemic, actions carried out at the Defense Preventive Medicine Institute

RESUMEN En la situación de pandemia por COVID-19 la salud pública y la medicina preventiva han pasado a primera línea de actuación. En este marco la salud mental ha resultado muy afectada. Sanitarios y población general han sufrido las consecuencias del aislamiento y la desinformación, entre otros. Desde el Instituto de Medicina Preventiva Capitán médico Ramón y Cajal se han desarrollado varias acciones de promoción de la salud, en las que el abordaje psicológico se ha tenido muy en cuenta. Durante este tiempo, se han seguido las líneas estratégicas de comunicación propuestas por la Organización Mundial de la Salud. Igualmente, con el objetivo de apoyar la labor de los profesionales sanitarios de los ejércitos se han diseñado diversas guías, infografías y otros materiales difundidos a través de la web del instituto. Se ha dedicado una especial atención a la fatiga pandémica para reforzar las medidas de prevención y vencer el cansancio frente a la pandemia, con el fin de cambiar la disminución de la percepción de riesgo. Todas estas acciones tienen como objetivo final mantener las condiciones psicofísicas del personal militar en un estado óptimo para desarrollar las misiones encomendadas.

SUMMARY In the situation of the COVID-19 pandemic, public health and preventive medicine have come to the forefront of action. In this framework, mental health has been greatly affected, health workers and the general population have suffered the consequences of isolation and misinformation, among others. From the Institute of Preventive Medicine Capitán médico Ramón y Cajal, several health promotion actions have been developed in which the psychological approach has been taken into account. During this time, the strategic lines of communication proposed by the World Health Organization have been followed. Likewise, with the aim of supporting the work of health professionals in the Armed Forces, various guides, infographics and other material have been designed and disseminated through the Institute’s website. Special attention has been devoted to pandemic fatigue to reinforce prevention measures and overcome fatigue in the face of the pandemic, in order to change the decrease in risk perception. All these actions have the final objective of maintaining the psychophysical conditions of military personnel in an optimal state to carry out the entrusted missions.

Update on chest drainage management

RESUMEN: La acumulación de aire y/o líquido en el espacio pleural conlleva un incremento de la morbimortalidad. El drenaje pleural permite la evacuación del contenido anormal de la cavidad pleural, con la consiguiente reexpansión pulmonar y estabilización cardiorrespiratoria. La complejidad cada vez mayor de los enfermos ingresados en el hospital hace frecuente en la práctica clínica la necesidad de colocación de un drenaje torácico. Tanto la colocación como los cuidados deben ser realizados por personal entrenado. La presente revisión no tiene como objetivo describir la patología pleural sino demostrar de una forma didáctica y práctica las pautas básicas para la colocación y el manejo adecuado de los sistemas de drenaje pleural al personal sanitario para contribuir a mejorar la seguridad de la práctica clínica. Entre los mayores avances destacan la introducción de la ecografía torácica y la utilización de nuevas técnicas de drenaje.

SUMMARY Accumulation of air and/or liquid in the pleural cavity leads to an increase in morbidity and mortality. Chest drainage allows the evacuation of the abnormal content of the pleural cavity, with the consequent lung expansion and cardiorespiratory stability. The increased patient-related complexity in hospitals often carries to place chest drainage in clinical practice. Both placement and care must be performed by a highly trained staff. The objective of this review is not to describe pleural pathology, but to demonstrate in a didactic and practical way the basic guidelines for placement and management of chest drainage systems for healthcare professionals to improve workplace safety. Among the greatest advances are the introduction of chest ultrasound and the use of new drainage techniques.

Unexpected kidney finding in a patient with anemia and weight loss

SUMMARY 57-year-old woman with autism spectrum disorder and secondary epileptic seizures. A CT of abdomen is requested due to anemia and weight loss. The patient did not refer urinary symptoms. She was admitted four months to Internal Medicine Service, due to urinary sepsis, where Morganela morgani was isolated, and bacteremia, with Staphylococcus epidermidis isolation. In the CT performed, we found an increase in the size of the right kidney, with loss of corticomedullary differentiation and replacement of a destroyed renal parenchyma by low-attenuation masses that corresponds to the dilated calyces. A staghorn stone with involvement of the peripelvic fat was also described.

Military surgeons who created cardiac surgery, regardless of their military activity

RESUMEN La cirugía cardiaca surgió como especialidad quirúrgica a mediados del siglo XX, gracias a la incorporación de la máquina de corazón-pulmón por John Gibbon y la empresa IBM en Filadelfia (EE. UU.). Esto permitió realizar intervenciones a corazón abierto en la mayoría de países desarrollados. Décadas antes, algunos cirujanos trataron de curar a sus pacientes con ingeniosas operaciones a corazón cerrado. Durante la II Guerra Mundial, varios cirujanos militares desempeñaron un papel decisivo en el desarrollo de esta moderna cirugía, incorporando ingeniosas técnicas quirúrgicas para salvar a numerosos soldados heridos en el frente de batalla, entre ellos destacan Dwight E. Harken y C. Walton Lillehei, considerados «padres de la cirugía cardiaca». Importantes logros surgieron de estos pioneros, al margen de su actividad castrense, como las unidades de cuidados intensivos, las primeras valvuloplastias mitrales y prótesis valvulares cardiacas, los marcapasos implantables, o la utilización de la hipotermia moderada en las operaciones a corazón abierto. Las importantes aportaciones de estos admirables cirujanos, constituyeron los ladrillos con los que se construyó la cirugía cardiaca moderna.

SUMMARY In the mid-twentieth century, cardiac surgery emerged thanks to John Gibbon & IBM Company heart-lung machine incorporation in Philadelphia, USA, allowing open heart surgery to be carry out, which was soon possible in most developing countries. However, a few years before, some surgeons tried to cure their patients with ingenious closed-heart surgical techniques. During World War II, several military surgeons landed a decisive role in the development of this surgery by incorporating some surgical techniques that saved the life of numerous soldiers on the battlefront, among them Dwight E. Harken and C. Walton Lillehei, worldwide considered «fathers of cardiac surgery». Several important achievements emerged later, from these pioneers, regardless of their military activity, such as the intensive care units, the first mitral valvuloplasties and mechanical artificial heart valves, the implantable cardiac pacemakers, or the use of moderate hypothermia in open heart surgery. The important contributions of these admirable surgeons constituted the building blocks on which modern cardiac surgery was built.