Owing to their capacity for rapid response, members of the Spanish Guardia Civil constitute a key resource for out-of-hospital cardiopulmonary resuscitation, particularly in rural or hard-to-reach areas. This study aimed to evaluate cardiopulmonary resuscitation technical quality following a training intervention and to examine its association with anthropometric variables. A quasi-experimental study with repeated measures and no control group was conducted in 41 members of the Rapid Intervention Section. Sociodemographic, anthropometric, and cardiopulmonary resuscitation quality variables were collected, including a composite total score (0-100 points) derived from compression quality, chest compression fraction, and ventilation performance. The simulation-based intervention, performed using a manikin, followed European Resuscitation Council guidelines. Only one participant was a woman. Median BMI was 27.4 kg/m², and 70.7% of participants had a body fat percentage =25%. Post-intervention, significant improvements were observed in median total score (64 to 93 points), proportion of correct ventilations (33% to 90%), compression/ventilation ratio (12.2% to 46.3%), and mean compression rate (134 to 109/min). Height was negatively associated with post-intervention performance (ß = -1.024; p = 0.001). The training intervention significantly improved cardiopulmonary resuscitation quality. Height was inversely associated with performance, whereas body fat percentage showed no significant association. These findings should be interpreted with caution given the study design limitations.

Standard dosing of linezolid regimen frequently results in suboptimal exposure in critically ill patients. This study aimed to analyze the association between dosing regimens (total daily dose and infusion duration) and the probability of achieving pharmacokinetic/pharmacodynamic targets, as well as their microbiological and clinical impact. A retrospective observational study was conducted in critically ill patients admitted to intensive care units who underwent therapeutic drug monitoring of linezolid between May 2021 and December 2023. Achievement of pharmacokinetic/pharmacodynamic targets (Cmin: 2-7 mg/L, AUC: 0-24/MIC: 80-120 mg*h/L, and T>MIC =85%) was evaluated according to the initial regimens (1,200 or 1,800 mg/day) and infusion duration (1 or 3 hours). Risk subgroups included obesity, augmented creatinine clearance, renal replacement therapy, and age <65 years. Seventy patients were included. At the first monitoring, only 18.6% achieved all three pharmacokinetic/pharmacodynamic targets and 40% achieved the Cmin target. No statistically significant differences were observed in target attainment according to dose or infusion duration, including within risk subgroups. However, the 1,800 mg/day regime showed a numerically higher proportion of patients achieving the Cmin target (54.5% vs. 37.3%). No significant differences in microbiological or clinical outcomes were observed between patients with Cmin within the target range and those outside it. Fewer than 20% of critically ill patients achieve all pharmacokinetic/pharmacodynamic targets with the initial regimen. These findings support the need for individualized dosing and therapeutic drug monitoring to optimize linezolid treatment in this population, particularly in high-risk patients.

Bezoars are an uncommon cause of intestinal obstruction and may be managed using several approaches. Because recurrence can occur, invasive or surgical treatments should not be considered first-time when conservative options are feasible. We report the case of a 67-year-old man with a previously asymptomatic giant gastric phytobezoar who developed subocclusive symptoms. A review of the literature was performed to evaluate available treatment strategies, as no standard therapy exists to date for giant bezoars. A conservative approach was selected using an oral enzyme complex (Digeston Plus®) containing digestive enzymes and probiotic bacteria. The patient completed a three-month treatment course, leading to symptom resolution and near-complete dissolution of the bezoar without the need of invasive intervention.

Fahr's syndrome is a rare neurological disease characterized by bilateral intracranial calcifications associated with disturbances in calcium-phosphate metabolism, most commonly due to hypoparathyroidism. We report a 56-year-old man presenting with generalized seizures and behavioral changes. Laboratory evaluation revealed severe hypocalcemia, hyperphosphatemia, and low parathyroid hormone levels. Brain computed tomography demonstrated symmetrical calcifications involving the basal ganglia and other subcortical structures, consistent with Fahr's syndrome. Diagnosis was established through the integration of clinical features, biochemical abnormalities, and neurological findings, after excluding alternative causes of intracranial calcifications, including infectious, autoimmune, and genetic conditions. Management focused on prompt correction of hypocalcemia and long-term metabolic control with close biochemical monitoring. Early recognition of hypoparathyroidism is essential to prevent neurological complications and improve outcomes. This case highlights the pivotal role of laboratory assessment in the diagnosis and management of Fahr´s syndrome.

Cardiac ascites accounts for approximately 5% of ascites cases and is typically characterized by high protein concentration, which is thought to confer protection against spontaneous bacterial peritonitis. Nevertheless, spontaneous bacterial peritonitis may develop in the setting of advanced heart failure due to intestinal congestion and impaired perfusion. We present the case of a 65-year-old male with advanced heart failure, a left ventricular ejection fraction of 19%, severe tricuspid regurgitation, and pulmonary hypertension, who presented with dyspnoea and progressive abdominal distension. Imaging excluded portal hypertension and cirrhosis. Ascitic fluid analysis revealed a protein concentration of 3.5 g/dL, a serum-ascites albumin gradient of 2.2 g/dL, and 89% polymorphonuclear cells, confirming spontaneous bacterial peritonitis. The patient responded favourably to antibiotic therapy. Although uncommon, spontaneous bacterial peritonitis should be considered in cardiac ascites, as prompt recognition and treatment are crucial to reduce morbidity and mortality.

The aim of this study was to examine the psychometric properties of the Observational Gait Scale for Individuals with Lower Limb Amputation, including intra- and inter-rater reliability, minimal detectable change, and construct validity. An observational study was conducted in individuals with unilateral lower limb amputation. Gait was recorded under standardized conditions and independently assessed by two trained evaluators using the Observational Gait Scale for Individuals with Lower Limb Amputation, which comprised two sections: 1 - assessment of kinematic gait patterns focused on joint mobility, and 2 - assessment of spatiotemporal parameters. Intraclass correlation coefficient, Bland-Altman plots and Pearson's correlation with the Houghton Scale were used. Thirty-seven participants were included, 56.8% women and mean age 45.6 years (SD=13.8). Intra-rater reliability was excellent for the total score (ICC = 0.996), section 1 (ICC = 0.988), and section 2 (ICC = 0.995) with an MDC95 of 0.12 points. Inter-rater reliability was also excellent (total ICC = 0.987; section 1 = 0.966; section 2 = 0.986), with an MDC95 of 0.36 points. Bland-Altman analysis showed narrow limits of agreement (±1.4 points intra-rater and ±2.28 points inter-rater). Construct validity was strong and statistically significant (r= -0.773; p <0.001). The Observational Gait Scale for Persons with Lower Limb Amputation is a reliable and valid tool for assessing an objective and structured evaluation of gait patterns in individuals with unilateral lower limb amputation. Its design, excellent reliability and strong construct validity support its use in both clinical practice and research.

The International Agency for Research on Cancer classifies night shift work as Group 2A, a probable human carcinogen. This study updates the evidence on the association between night shift work and the risk of breast and prostate cancer. Searches were conducted in PubMed and Web of Science. Case-control and cohort studies were included if they assessed night work as a risk factor for breast or prostate cancer, had =100 participants, provided full text in English or Spanish, scored =6 on the Newcastle-Ottawa Scale, and reported relative risks or odds ratio with 95% confidence interval. Heterogeneity and study quality were evaluated. Data synthesis followed PRISMA guidelines. Twenty-one studies including 586,890 participants were analysed. For breast cancer, significant association were found only in cohort studies, both overall (RR=0.82; 95%CI: 0.67-0.99; I2=91%) and for <10 years of night work (RR=0.75; 95% CI: 0.68-0.82; I2=0%). Average study quality was acceptable (score 7), although heterogeneity was substantial. For prostate cancer, case-control studies reported an OR of 1.14 (95%CI; 1.02-1.27; I2=25%). For exposures =10 years, both RR (2.20; 95%CI: 1.35-3.59) and OR (1.16; 95%CI: 1.03-1.30) were significant. Overall quality was moderate (score 6) with low heterogeneity (25%). Weak associations between night shift work and prostate cancer are observed in case-control studies and among individuals with =10 years of exposure, but no consistent association was found for breast cancer. These findings remain inconclusive and highlight the need for further research.

This study aims to evaluate hand hygiene performance among nursing students and to explore their reflections following an innovative educational intervention. A simulation-based study was conducted with undergraduate nursing students using a mixed-methods design: a quantitative cross-sectional component to evaluate the effectiveness of the intervention and a qualitative exploratory component using reflective writing. Hand hygiene was performed with a hydroalcoholic solution containing ionizing agent that fluoresce under ultraviolet light. A portable ultraviolet device was used to visualize clean and missed areas. The time spent and the percentage of clean surface area were recorded. After reviewing the initial results, the handwashing procedure was repeated, and both time and clean surface area were compared. Participants then answered open-ended written questions about their experience. Thirty students participated in the quantitative component and sixty in the qualitative component. The most difficult areas to clean were the fingertips, palms, and thumbs. The second handwashing attempt was 2.6 seconds longer (p=0.012), increased the median clean surface area by 9% (p=0.006), and raised the proportion of students achieving =70% cleanliness from 36.7% to 66.7%. Students reported notable benefits, including heightened awareness of personal errors, visual learning, and reinforced understanding of proper technique. This visual and hands-on educational strategy effectively increases student awareness of key aspects of hand hygiene and may contribute to reducing iatrogenic nosocomial infections.