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The objectives of this study are to establish the usefulness of lung ultrasound with a handheld device to predict the risk of developing heart failure with the need for mechanical ventilation (MV) in acute coronary syndrome (ACS). This is a prospective study of consecutive patients admitted because of ACS-type myocardial infarction, without data of HF at admission in a tertiary hospital, between February 2017 and February 2018. Lung ultrasounds were performed with a handheld cardiologic device in the first 24 h, and defined as echo-positive (PE+) when exams revealed 3 or more B-lines in 2 or more bilateral quadrants. We related this finding to the need for MV during admission. We included 119 patients (65.1 ± 12.8 year; 75.6% male, 24.4% female; 87.4% in Killip class I, 12.6% in Killip class II). Pulmonary echography was positive (PE+) in 21 patients (17.6%). The sensitivity of PE+ to predict MV was 93.3%, the specificity 93.3%, and the area under the curve 0.93. In Cox regression analysis adjusted by CRUSADE score and Killip class, PE+ patients had a hazard ratio of 64.55 (CI 7.87; 529.25, p 0.001) of needing MV. PE+ was associated with more frequent use of inotropes and mortality. Pulmonary ultrasonography with a handheld echocardiograph was predictive of severe heart failure and the need for mechanical ventilation in ACS with high specificity and sensitivity.

Introduction and Objective: To investigate whether reducing the use of ≥2 benzodiazepines and Z–drugs (BZD-Z) to ≤1 was associated with a decreased fall risk in polymedicated and elderly patients. Material and Methods: Prospective observational study to compare the fall risk in patients that remained taking 2 or more BZD-Z with those who tapered to 1 or none BZD-Z. Subjects were polymedicated patients, ≥65 years with concomitant use of ≥2 BZD-Z who received primary care in health centres. Main Measures: time to fall (Kaplan- Meier, Cox-regression model, multivariate analysis). Analyses was adjusted for confounder variables such as health problems and other treatments. Results: A total of 228 patients taking BZD-Z were followed during 1,085 days. Patients using ≥2 BZD-Z had 2.76 times (95%CI:1.34-5.68; p=0.006) greater risk of fall at any moment of the follow-up than those taking ≤1 BZD-Z. Antidepressants and oral corticosteroids were the other specific medication classes that showed a greater risk of fall:1.99 (95%CI:1.17-3.41; p=0.011) and 2.34 (95%CI:1.13-5.07; p=0.023), respectively. The Kaplan-Meier method revealed a significant increase of fall risk for patients continuously taking ≥2 BZD-Z compared with those intermittently taking ≥2 BZD-Z or taking ≤1 BZD-Z (p=0.008). Those patients concurrently using ≥2 BZD-Z and antidepressants showed a tendency to an increased fall risk (p

Resumen Objetivos Dada la importancia de la diabetes gestacional (DG) como problema de salud, nuestro objetivo en este trabajo ha sido analizar el rendimiento diagnostico de los diferentes criterios existentes en la actualidad (GEDE, OSullivan y Carpenter) tras la sobrecarga de 100 g de glucosa y estudiar la forma de aumentar su eficiencia. Material y metodos Realizamos una descriptiva de todas las variables. En la fase analitica del trabajo utilizamos la X2 de Pearson para ver si existian diferencias en el porcentaje de casos recogidos en cada centro de salud y el test de contraste de proporciones para estudiar las diferencias entre las prevalencias observadas. Confeccionamos modelos de regresion logistica binaria (RLB) utilizando como variable resultado el tener o no tener DG (SI/NO) y como predictoras las cuatro mediciones de la sobrecarga de 100 g de glucosa. Para decidir que modelo era mejor se tuvieron en cuenta el analisis stepwise atras - adelante (backward-forward) y la superficie de curva ROC generada por cada uno de ellos. Resultados Obtuvimos una muestra de 170 gestantes de seis centros de salud diferentes del Distrito Sanitario de Atencion Primaria de Sevilla (DSAP) que habian tenido un test de OSullivan positivo con una mediana de edad de 35 anos. Hubo diferencias significativas en las proporciones de prevalencia segun los criterios utilizados: Grupo Espanol de Diabetes y Embarazo (GEDE)/OSullivan p Conclusiones Sobre un diseno epidemiologico observacional, podemos afirmar que existen diferencias significativas en las proporciones de prevalencia observadas segun los criterios aplicados (p

Resumen: Introducción La pérdida neuronal/axonal progresiva se considera la causa más importante de discapacidad neurológica en la esclerosis múltiple (EM). El sistema visual está frecuentemente afectado en esta enfermedad y su accesibilidad a test funcionales y estructurales ha permitido que se convierta en un modelo para estudiar in vivo la patogenia de la EM. La ecografía orbitaria permite evaluar, de forma no invasiva y en tiempo real, las diversas estructuras de la órbita, incluido el nervio óptico. Material y métodos: Se ha llevado a cabo un estudio observacional ambispectivo en pacientes con EM recogiéndose datos evolutivos de la enfermedad. La ecografía orbitaria se realizó en todos los pacientes según el principio de mínima potencia necesaria (ALARA). También se recogieron los datos de tomografía de coherencia óptica (OCT) en aquellos que tenían realizadas ambas pruebas. El estudio estadístico se efectuó con el programa SPSS 22.0. Resultados: Se encontraron correlaciones estadísticamente significativas entre las medidas ecográficas y la progresión de la enfermedad (p = 0,041 para el ojo derecho y p = 0,037 para el ojo izquierdo), y la Expanded Disability Status Scale (EDSS) final en el seguimiento (p = 0,07 para el ojo derecho y p = 0,043 para el ojo izquierdo). No fue así para los datos referentes a brotes y a otras variables clínicas. Discusión: La medición del diámetro del nervio óptico por ecografía podría utilizarse como medida predictiva en la evolución de la EM, ya que la disminución del mismo se asocia con progresión clínica y mayor discapacidad, medidas con la EDSS. Abstract: Introduction: Progressive neuronal and axonal loss are considered the main causes of disability in patients with multiple sclerosis (MS). The disease frequently involves the visual system; the accessibility of the system for several functional and structural tests has made it a model for the in vivo study of MS pathogenesis. Orbital ultrasound is a non-invasive technique that enables various structures of the orbit, including the optic nerve, to be evaluated in real time. Material and methods: We conducted an observational, ambispective study of MS patients. Disease progression data were collected. Orbital ultrasound was performed on all patients, with power set according to the ‘as low as reasonably achievable’ (ALARA) principle. Optical coherence tomography (OCT) data were also collected for those patients who underwent the procedure. Statistical analysis was conducted using SPSS version 22.0. Results: Disease progression was significantly correlated with ultrasound findings (P = .041 for the right eye and P = .037 for the left eye) and with Expanded Disability Status Scale (EDSS) score at the end of the follow-up period (P = .07 for the right eye and P = .043 for the left eye). No statistically significant differences were found with relation to relapses or other clinical variables. Discussion: Ultrasound measurement of optic nerve diameter constitutes a useful, predictive factor for the evaluation of patients with MS. Smaller diameters are associated with poor clinical progression and greater disability (measured by EDSS).

Resumen Introduccion Nuestro trabajo tiene como objetivo aumentar la eficiencia del cribado de aneuploidias del primer trimestre de la gestacion mediante la creacion de modelos predictivos que sirvan para identificar gestantes en riesgo de desarrollar sobrepeso u obesidad en el tercer trimestre e instaurar medidas preventivas de obesidad a partir de ellos. Metodos Estudio observacional de tipo ambispectivo realizado en atencion primaria, en el que se han recogido un total de 380 registros correspondientes a otros tantos embarazos. Se han muestreado 6 centros de salud con las variables siguientes: edad en la gestacion, proteina A placentaria asociada al embarazo (PAPP-A) (mU/ml), gonadotropina corionica humana (b-HCG) (ng/ml), semana de recogida de la muestra para el cribado de primer trimestre, indice de masa corporal (IMC) a las 12 y a las 28 semanas de gestacion, TSH a las 12 semanas de gestacion, presion arterial sistolica (PAS), presion arterial diastolica (PAD) y presion arterial media (PAM) a las 12 y a las 28 semanas de gestacion. Se recodifico la variable IMC a las 28 semanas, clasificando a las embarazadas en peso normal (IMC Resultados Las medianas de la PAPP-A y de b-HCG medidas en el primer trimestre son menores de manera progresiva en los grupos de gestantes con normopeso, sobrepeso y obesidad observadas en el tercer trimestre. Estos valores son predictores del peso en el tercer trimestre (regresion logistica ordinal) (PAPP-A: p = 0,022; b-HCG: p = 0,002). Ninguna gestante desarrollo preeclampsia. Las PAS, PAD y PAM en el tercer trimestre fueron significativamente diferentes (ANOVA de varios factores; p Discusion La regresion logistica ordinal demuestra que la disminucion de los valores observada de PAPP-A y de b-HCG en el primer trimestre es predictora del grado de obesidad de forma significativa y gradual en una muestra de gestantes normotensas. No hemos querido confeccionar un modelo de regresion ordinal incluyendo el IMC de las 12 semanas por la colinealidad interna que aportaria al estar basada la variable resultado en el. El efecto predictor de la b-HCG es mas homogeneo que el de la PAPP-A para el estado de sobrepeso y obesidad.

The objective was to quantify oxidative stress resulting from ischemia during the donation process, using malondialdehyde (MDA) measurement, and its modulation by the administration of melatonin. We designed a triple-blind clinical trial with donors randomized to melatonin or placebo. We collected donors by donation after brain death (DBD) and controlled donation after circulatory death (DCD), the latter maintained by normothermic regional perfusion (NRP). Melatonin or placebo was administered prior to donation or following limitation of therapeutic effort (LTE). Demographic variables and medical history were collected. We also collected serial measurements of MDA, at 60 and 90 min after melatonin or placebo administration. A total of 53 donors were included (32 from DBD and 21 from DCD). In the DBD group, 17 donors received melatonin, and 15 placebo. Eight DCD donors were randomized to melatonin and 13 to placebo. Medical history and cause for LTE were similar between groups. Although MDA values did not differ in the DBD group, statistical differences were observed in DCD donors during the 0-60 min interval: -4.296 (-6.752; -2.336) in the melatonin group and -1.612 (-2.886; -0.7445) in controls. Given the antioxidant effect of melatonin, its use could reduce the production of oxidative stress in controlled DCD., This research was funded by Mutua Madrileña Foundation. Code AP166562017. Melatonin administration as a therapeutic strategy against tissue ischemia in deceased donors, and its assessment using biomarkers for oxidative stress and microRNAs. STUDY ID: ISRCTN66157570.

[ES] Fundamentos: Según el Consorcio Internacional para la Investigación de Enfermedades Raras (IRDiRC) el diagnóstico de una enfermedad rara (ER) conocida debería hacerse en el plazo de un año. El objetivo de esta revisión sistemática fue identificar las evidencias científicas sobre el tiempo que transcurre hasta obtener el diagnóstico en pacientes con ER y conocer si se produce retraso, conforme al objetivo del IRDiRC (más de un año). Métodos: Se realizó una revisión sistemática según criterios PRISMA en las bases de datos PubMed, Scopus y Web of Science (WoS). Se valoró la calidad de los estudios incluidos conforme a la declaración STROBE. Resultados: Se incluyeron 17 artículos orientados a ER específicas, principalmente metabólicas, neurológicas y trastornos que afectan a la inmunidad. Los diseños fueron fundamentalmente transversales, aunque también se incluyeron dos de cohorte retrospectivos. La mayoría de los estudios reflejan que se emplea más de un año en obtener el diagnóstico de estas ER. Conclusiones: La literatura científica que cuantifica el tiempo hasta el diagnóstico en ER es aún escasa y ningún estudio se orienta a estas enfermedades en su conjunto. Según el objetivo del IRDiRC, existe un evidente retraso en el diagnóstico de ER, ya que en la mayoría de los casos se requiere de un tiempo superior a un año. Por tanto, son necesarios nuevos avances en campo de las ER para contribuir a la reducción del tiempo desde la aparición de los síntomas hasta el diagnóstico adecuado [EN] Background: The aims of the International Consortium for Rare Diseases Research (IRDiRC) include that the diagnosis of a known rare disease (RD) must be made within a year. The objective of this systematic review was to identify the scientific evidence about the time to diagnosis in patients affected by RDs and also to know if there is a diagnostic delay (more than one year) according to the objective set by the IRDiRC. Methods: A systematic review was carried out according to PRISMA criteria in the PubMed, Scopus and Web of Science (WoS) databases. The quality of the articles was assessed using the STROBE statement. Results: 17 articles were included. They were devoted to specific RDs, most of them metabolic diseases, neurological and disorders that affect immunity. The study designs were mainly cross-sectional, and two retrospective cohorts were also included. Most articles showed that it takes more than a year to get a diagnosis for these RDs. Conclusions: Scientific literature quantifying the time to diagnosis is still scarce and no study addresses RDs as a whole. In most cases, it takes more than one year to obtain a diagnosis of a RD, so there is an obvious delay according to the objective set by the IRDiRC. Therefore, new advances in the RD field are necessary to reduce the time from the onset of symptoms to the accurate diagnosis. Sí

Acid mining drainage has a serious impact on the environment. Forward osmosis allows the concentration of acid mine waters to favor the formation of enrichment sludges and subsequent selective metal precipitation. In this work, a methodology was proposed to treat mining effluents from the Iberian Pyrite Belt. Forward osmosis experiments were performed using different osmotic pressures from 0.5M to 2.5M NaCl to evaluate water fluxes and recovery. The water recovery obtained was in the range of 50-80%, and the flux remained above 5 (L•m−2•h−1). Four combined processes were modelled to determine the feasibility of eliminating water and precipitating metals. Furthermore, a new hybrid membrane process was proposed to recover at least 75% of water with recovery yields of Al, Fe, Cu, Zn and Mn of greater than 70%. A water production cost of 2.01 $/m3 and a specific energy consumption of 8.03 kWhe/m3 were estimated for the hybrid process.

The aims of the International Consortium for Rare Diseases Research (IRDiRC) include that the diagnosis of a known rare disease (RD) must be made within a year. The objective of this systematic review was to identify the scientific evidence about the time to diagnosis in patients affected by RDs and also to know if there is a diagnostic delay (more than one year) according to the objective set by the IRDiRC.A systematic review was carried out according to PRISMA criteria in the PubMed, Scopus and Web of Science (WoS) databases. The quality of the articles was assessed using the STROBE statement.17 articles were included. They were devoted to specific RDs, most of them metabolic diseases, neurological and disorders that affect immunity. The study designs were mainly cross-sectional, and two retrospective cohorts were also included. Most articles showed that it takes more than a year to get a diagnosis for these RDs.Scientific literature quantifying the time to diagnosis is still scarce and no study addresses RDs as a whole. In most cases, it takes more than one year to obtain a diagnosis of a RD, so there is an obvious delay according to the objective set by the IRDiRC. Therefore, new advances in the RD field are necessary to reduce the time from the onset of symptoms to the accurate diagnosis.Según el Consorcio Internacional para la Investigación de Enfermedades Raras (IRDiRC) el diagnóstico de una enfermedad rara (ER) conocida debería hacerse en el plazo de un año. El objetivo de esta revisión sistemática fue identificar las evidencias científicas sobre el tiempo que transcurre hasta obtener el diagnóstico en pacientes con ER y conocer si se produce retraso, conforme al objetivo del IRDiRC (más de un año).Se realizó una revisión sistemática según criterios PRISMA en las bases de datos PubMed, Scopus y Web of Science (WoS). Se valoró la calidad de los estudios incluidos conforme a la declaración STROBE.Se incluyeron 17 artículos orientados a ER específicas, principalmente metabólicas, neurológicas y trastornos que afectan a la inmunidad. Los diseños fueron fundamentalmente transversales, aunque también se incluyeron dos de cohorte retrospectivos. La mayoría de los estudios reflejan que se emplea más de un año en obtener el diagnóstico de estas ER.La literatura científica que cuantifica el tiempo hasta el diagnóstico en ER es aún escasa y ningún estudio se orienta a estas enfermedades en su conjunto. Según el objetivo del IRDiRC, existe un evidente retraso en el diagnóstico de ER, ya que en la mayoría de los casos se requiere de un tiempo superior a un año. Por tanto, son necesarios nuevos avances en campo de las ER para contribuir a la reducción del tiempo desde la aparición de los síntomas hasta el diagnóstico adecuado.

Background Therapeutic drug monitoring of infliximab in Crohn’s disease is necessary to optimize treatments. However, infliximab serum levels are not well defined. The aim of the study was to find our cut-off of infliximab serum levels in Crohn’s disease patients in remission in clinical practice. Furthermore, we tried to identify other predictors of long-term benefit of infliximab therapy. Methods Observational, retrospective and single-center study of patients diagnosed with Crohn’s disease on maintenance therapy with infliximab from January 2019 to July 2020. Infliximab trough levels and antibodies to infliximab were measured at least three times, after 6 months of treatment. The tests were performed using enzyme linked immunosorbent assay. Clinical remission was defined using the Harvey Bradshaw index ≤4. The interpretation of data was by ROC analysis. Results 105 Crohn’s disease patients were included in the study, 57.1% men, with a median age at diagnosis of 26 years. The rest of the characteristics are in table 1. The best infliximab level cut-off point classifying patients in clinical remission was 4 μg/ml with an area under the curve of 0.801 (figure 1 and 2). Median infliximab trough levels were significantly higher when patients achieved clinical remission [4.8 (3–8) μg/ml] versus [0.59 (0.1–2.4) μg/ml]. In the multivariate analysis we observed that the variables age, time on infliximab treatment and time of disease evolution were associated with non-remission (table 2). Conclusion Infliximab levels are an objective parameter related to clinical remission in maintenance therapy in patients with Crohn’s disease. Our cut-off point associated with clinical remission was 4 μg/ml.

Recognized the value of gestational diabetes (GD) as a health problem, our aim in this work has been to analyze the diagnostic performance of the different today's existing criteria (GEDE, O'Sullivan and Carpenter) after the overload of 100 g of glucose and revise how to increase its efficiency.We carried out a description of all the variables. In the analytical phase of the work, we used Pearson's Chi square to see if there were differences in the percentage of cases collected in each health center and the proportions contrast test to study the differences between the experimental prevalence. We completed binary logistic regression models using as result variable having or not having gestational diabetes (yes/no) and as predictors the four measurements of the curve with 100 g of glucose overload. To decide which model was better, the stepwise backward-forward analysis and the surface of the ROC curve generated by each of them were considered.We obtained a sample of 170 pregnant women from six different Primary Care Area of Seville health centers who had shown a positive O'Sullivan test with a median age of 35 years. There were significant differences in the prevalence proportions according to the criteria used: GEDE/O'Sullivan p0.001; GEDE/Carpenter p0.001. Logistic models with three and four predictor variables were equal in discriminatory diagnostic capacity when the GEDE criteria were used (area under the ROC curve = 0.96, 95% CI: 0.93-0.98). The back-forward stepwise analysis stayed with the three-variable model as the most parsimonious. The same did not occur when applying the other two criteria.Regarding an observational design, we state that there are significant differences in the prevalence proportions observed according to the criteria applied (p0.001) and we can also support that using the GEDE criteria, the taking of the third hour could be dispensed with, based on Bayesian criteria and the application of the ROC curve analysis.

In this work, a comprehensive discussion of forward osmosis membrane technology is presented. Forward osmosis is an interesting and promising system to concentrate multiple kind of solutions in different industrial areas as an alternative solution to classical water evaporation. Therefore, the number of publications and works related to this topic has considerably increased in the last years. Several aspects of forward osmosis have been discussed such as membrane fouling, concentration polarization phenomena, the different available draw solutions and the industrial applications in which forward osmosis has been applied. Cellulose triacetate membranes and thin-film composite membranes are the most employed nowadays. Chemical industry, desalination of drinking water, food industry and pharmaceutical industry are analyzed in deep since these are the most studied areas for forward osmosis application. Herein, the potential of forward osmosis for a sustainable industrial growth is widely proved in every sense.

Background The development of heart failure (HF) is a factor of poor prognosis in patients admitted due to acute coronary syndrome (ACS). Research question The aim of this study is to establish the usefulness of lung ultrasound (LU) to predict patients at risk of developing HF and the need for mechanical ventilation. Methods Prospective study with consecutive inclusion of patients with ACS type infarction without HF on admission and admitted to our centre between February 2017 and 2018. A lung ultrasound was performed in the first 24 hours, considering it positive when they presented 3 or more B lines in two or more quadrants of bilateral form. The result was related to the need for mechanical ventilation. Results We included 119 patients (65.1±12.8 years, 75.6% men), 12.6% presented a need for mechanical ventilation. Patients with a positive LU adjusted for a history of atrial fibrillation and the Killip-Kimball class have a risk 72.79 [95% CI: (9.21, 575.28)] times higher than needing mechanical ventilation at any time of the follow-up Adjusted for sex and heart rate, the result is 101.28 [95% CI: (12.83, 799.15); p=0.00005] times more risk of needing mechanical ventilation at any time of follow-up. Conclusions LU has a high positive predictive value for the development of severe HF and the need for mechanical ventilation, in patients admitted for ACS. Our findings suggest that LU should be incorporated in the initial stratification of patients with ACS. Survival analysis mechanical ventilation Funding Acknowledgement Type of funding source: None

This paper presents a comprehensive list of Carbon Capture and Utilization technologies and applications, ranging from lab-scale R&D activities reported in academic papers to commercially establish...

Cerebral damage secondary to the vasospasm due to subarachnoid hemorrhage (SAH) is an important cause of morbid-mortality. We propose the use of the PET tracer [18F]Fluoromisonidazole to visualize the hypoxia due to the vasospasm. On the other hand [18F]Fluoromisonidazole synthesis process was optimized, avoiding HPLC purification using SPE cartridges instead, and reducing some synthesis steps. [18F]Fluoromisonidazole in vitro stability was tested for ten hours, and in vivo PET/CT images showed higher cerebral uptake in hemorrhagic animals than in control rats., This research was in part supported by Spanish Regional Government of Andalusia with the research Grant PI-0136-2012 CSBS 2012 entitled “New therapeutic targets in spontaneous subarachnoid hemorrhage.” Andalusian Health System and also by the research Grant CTS 2482 entitled “Integration of the image PET/CT in a precision and Adaptive radiotherapy planning”. Spanish Regional Government of Andalusia.

Cerebral vasospasm, one of the main complications of subarachnoid hemorrhage (SAH), is characterized by arterial constriction and mainly occurs from day 4 until the second week after the event. Urotensin-II (U-II) has been described as the most potent vasoconstrictor peptide in mammals. An analysis is made of the serum U-II concentrations and mRNA expression levels of U-II, urotensin related peptide (URP) and urotensin receptor (UT) genes in an experimental murine model of SAH.An experimental study was carried out.Experimental operating room of the Biomedicine Institute of Seville (IBiS), Virgen del Rocío University Hospital (Seville, Spain).96 Wistar rats: 74 SAH and 22 sham intervention animals.Day 1: blood sampling, followed by the percutaneous injection of 100μl saline (sham) or blood (SAH) into the subarachnoid space. Day 5: blood sampling, followed by sacrifice of the animals.Weight, early mortality, serum U-II levels, mRNA values for U-II, URP and UT.Serum U-II levels increased in the SAH group from day 1 (0.62pg/mL [IQR 0.36-1.08]) to day 5 (0.74pg/mL [IQR 0.39-1.43]) (p0.05), though not in the sham group (0.56pg/mL [IQR 0.06-0.83] day 1; 0.37pg/mL [IQR 0.23-0.62] day 5; p=0.959). Between-group differences were found on day 5 (p0.05). The ROC analysis showed that the day 5 serum U-II levels (AUC=0.691), URP mRNA (AUC=0.706) and UT mRNA (AUC=0.713) could discriminate between sham and SAH rats. The normal serum U-II concentration range in rats was 0.56pg/mL (IQR 0.06-0.83).The urotensinergic system is upregulated on day 5 in an experimental model of SAH.

The aim of this study was to analyze how the consumption of medication over time affects the survival rate in patients with a coronary event and whether there is a gender difference.The study included 804 patients admitted to 4 hospitals with a coronary event during 2007. Monitoring after coronary event was carried out during 2007 and every 6 months in the subsequent 2 years (2008 and 2009) throughout the review of the clinical history of the patient. The main outcome was the analysis of mortality after the coronary event. Kaplan-Meier survival curves were plotted to calculate the time to death, comparing women versus men for 4 medication groups: aspirin, statins, β-blockers, and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEIs/ARBs). A Cox regression model was used for the final mortality analysis.During the follow-up time, 172 deaths were assessed. Each month of treatment with aspirin, statins, β-blockers, or ACEI/ARB was associated with a decrease in mortality between 13.0% and 0.5% (univariate analysis). The Kaplan-Meier method revealed a significant reduction in mortality after the coronary event for each month of treatment with aspirin (men), statins (men), and β-blockers (both men and women). No significant effect in survival was observed in either gender with ACEI/ARB treatment. The final multivariable model (Cox regression) showed that the taking of aspirin, statins, β-blockers, or ACEI/ARB is able to reduce mortality rates up to 7.0% (aspirin) throughout each month of treatment after a coronary event without any influence of gender.Aspirin, statins, β-blockers, and ACEI/ARB revealed a protective character with each month of treatment throughout the follow-up period, in terms of risk reduction of death. Aspirin and statins showed the maximum benefit, followed by ACEI/ARB and β-blockers.

Atlantic Copper is a copper cathode producer located in Spain. One of the most important steps in the production process is electrorefining, and this is strongly influenced by elements dissolved in the electrolyte. The presence of some metals or semi-metals, such as As, Sb or Bi, adversely affects the current efficiency and quality of the cathodes. Therefore, it is very important to control the level of such impurities in the electrolyte. This paper describes the study of the separation of Sb and Bi from a real electrolyte by means of ion-exchange columns (using aminophosphonic resins). Possible variations of the composition of the electrolyte were considered, because the presence of Fe(III) could poison the resins. Thus, the main result of the work is a complete operating protocol (load + elution + regeneration) of ion-exchange columns. Different alternatives to resin regeneration are also described in order to adapt the designed installation to the variability of Sb, Bi and Fe impurity levels in the electrolyte.

[ES] Introducción: La parada cardiorrespiratoria (PCR) presenta múltiples morbilidades secundarias, especialmente las neurológicas, por tanto es necesario un correcto manejo posparada. El objetivo de este trabajo consiste en analizar las características y los resultados de pacientes sometidos a hipotermia tras una PCR extrahospitalaria resucitada. Material y métodos: Realizamos un estudio prospectivo observacional de dos años, donde se incluyeron pacientes que ingresaron en nuestra unidad mayores de 18 años y con PCR prolongada extrahospitalaria resucitada, en los cuales se realizó un protocolo consensuado de cuidados posresucitación e hipotermia terapéutica. Resultados: Se incluyeron 33 pacientes. Se observó una media de 31,6 min de tiempo de PCR. Un 32,3% presentaron encefalopatía hipóxico-anóxica, siendo más frecuente en fumadores (p = 0,04), y con mayores tiempos de PCR (p= 0,049). También el 66,7% de los pacientes presentaron mayores datos de hipoperfusión (p = 0,049). Conclusión: Observamos que la hipotermia podría ser un instrumento útil en el manejo de las PCR extrahospitalarias. Además, encontramos que el pronóstico neurológico se asocia más a factores no modificables., [EN] Introduction: Cardiac arrest have secondary co-morbidities, especially neurological outcome. Due to this cirumstances is mandatory to optimized postcardiac arrest management. The objective of this research is to analyze patient's characteristics and outcome after out-hospital cardiac arrest in patients that have undergone therapeutic hypothermia. Matherial and methods: We conducted a prospective observational study during a two-year period. We included resuscitated patients over eighteen years old who were admitted in to our intensive care unit. These patients had undergone prolonged resuscitation measures and were included in an implemented post-resuscitation protocol which included therapeutic hypothermia. Results: Thirty-three patients were analyzed. The median time of cardiopulmonary resuscitation was 31.6 minutes. We observed hypoxic/anoxic encephalopathy in 32.3% of cases. This prognosis was associated in those who smoked (p = .04) and with longer time of cardiac arrest (p = .049). Also, the 66.7% of the patients showed a higher incidence of hypoperfusion (p = .049). Conclusion: In our series hypothermia could be a useful tool in post-resucitation cardiac arrest managment. We also found that the neurological prognosis was associated to non-modifiable risk factors.

Despite the World Health Organization considering it important to promote physical activity as part of a healthy lifestyle, the official data show an increase in the percentage of physical inactivity, which has brought about the development of strategies at different levels (national and international) to reverse this trend. For the development of these strategies, it is relevant to know what the determinants of physical activity (at leisure and at work) are. Therefore, this is going to be analysed in the autochthonous young adults from Seville. A cross-sectional survey of their health behaviours was carried out. The sample was selected through a proportionally stratified random sampling procedure. From the results, we highlight that the general perceived health status is good and that most physical activity is performed during leisure time. However, a majority of the population analysed reported overweight or obesity. Participants with a low perceived health status, those who have low social support from their family and friends, and those who do not smoke are the ones who have more probability of engaging in physical activity during their leisure time. However, gender, education level, and alcohol consumption are revealed as determinants of the intensity of physical activity at work. In this regard, men and/or participants with a low level of studies are those who carry out more physically demanding activities at work.

Trabajo presentado en el 17th Euro Fed Lipid Congress And Expo (Oils, fats, and lipids. Driving science and technology to new horizons), celebrado en Sevilla del 20 al 23 de octubre de 2019., Diabetes, one of the most prevalent chronic diseases, represents a major public health problem worldwide. In 2017, there were 425 million diabetic people in 2017, and a significant increase in the prevalence is expected in the next years, estimating that the number of diabetics in the world will achieve 629 million in 2045. An essential topic of diabetes approach is prevention, especially in people at high risk. Oleanolic acid (OA), a natural component of olive (Olea europaea L.), has demonstrated antidiabetic action in vitro and in experimental animals. However, a similar action had not been proved in humans. The PREDIABOLE (PREvention of DIABetes with OLEanolic acid) Study is a randomised and controlled trial, entirely performed in primary care, designed to assess whether the regular intake of an OA-enriched olive oil is effective in the prevention of diabetes. Diabetes is preceded by a period of dysglycemia, known as prediabetes, in which plasma glucose is higher than normal but not meet the criteria for diabetes. Prediabetes is defined by impaired fasting glucose (IFG), and/or impaired glucose tolerance (IGT) and/or a glycated hemoglobin (HbA1C) in the range 5.7¿6.4% (39¿47 mmol/mol). Prediabetes is associated with obesity, dyslipidemia and hypertension. Compared to euglycemics, people with both IFG and IGT have 20-fold higher risk of developing type 2 diabetes at short time. Therefore, they are ideal target population to investigate new preventive strategies against diabetes. In PREDIABOLE, prediabetic individuals (IFG + IGT) of both sex (176 patients, 30-80 years old) were randomised to receive OA-enriched olive oil (equivalent-dose 30 mg OA/day) (intervention group; IG) or the same oil not enriched (control group; CG). The main outcome was the incidence of new onset type 2 diabetes in both groups. After a median 27.5 months of follow-up, 48 new diabetes cases occurred, 31 in the CG and 17 in the IG. Multivariate adjusted hazard ratio was 0.45 (95% CI, 0.24-0.83) for the IG when compared with the CG. Intervention-related adverse effects were not reported. In conclusion, the PREDIABOLE Study demonstrates that the intake of an OA-enriched olive oil results in a substantial risk reduction of developing type 2 diabetes in prediabetic patients. Furthermore, this dietary intervention is well accepted by the population and also safe and palatable, showing high potential to be long-term sustainable. The burst of diabetes prevalence demands urgent measures delaying or avoiding the appearance of the disease. In this scenario, the use of OA-enriched functional foods is an interesting strategy. Nevertheless, further research is needed to consolidate the evidence of PREDIABOLE and to extend the use of OA in the design of new foods and drugs. Clinical Trial Registration: Current Controlled Trials number ISRCTN03372660

Background: Several studies have reported positive efficacy outcomes for patients with inflammatory bowel disease treated with CT-P13, an infliximab biosimilar. Data from follow-up periods longer than 1 year are still scarce. Here, we assessed the long-term efficacy data, loss of response and safety after switching from infliximab to CT-P13 in patients with inflammatory bowel disease. Methods: This was a prospective single-center observational study involving patients with moderate-to-severe Crohn’s disease and ulcerative colitis switched from infliximab to CT-P13 treatment and reviewed up to 24 months. Efficacy and loss of response were measured using the Harvey–Bradshaw (HB) index and partial Mayo score for patients with Crohn’s disease and ulcerative colitis respectively. C-reactive protein, infliximab drug levels, adverse events and antidrug antibodies were also monitored throughout the study. Results: A total of 64 patients with Crohn’s disease and 36 patients with ulcerative colitis were included. Most of them (72%) remained on CT-P13. Overall, 28% of patients discontinued the therapy due to loss of response, adverse events or long-lasting clinical remission. Remission at 18 and 24 months occurred in 69.9% and 68.5% of patients, respectively. Dose increase was performed in 22% of patients, with remission being reached in 60% of them. HB index, partial Mayo score, C-reactive protein and infliximab drug levels did not show significant changes. Serious adverse events were reported in 14% of patients. Overall, two patients developed low levels of antidrug antibodies. Conclusions: Most of the patients switching from original infliximab were maintained on CT-P13 at 2 years of follow up with a good profile of efficacy and safety.

26 Páginas.-- 3 Tablas.-- 2 Figuras, Aim To assess whether the regular intake of an oleanolic acid (OA)‐enriched olive oil is effective in the prevention of diabetes. Methods In the PREDIABOLE study, prediabetic individuals (impaired fasting glucose and impaired glucose tolerance) of both sexes (176 patients, aged 30‐80 years) were randomized to receive 55 mL/day of OA‐enriched olive oil (equivalent dose 30 mg OA/day) [intervention group (IG)] or the same oil not enriched [control group (CG)]. The main outcome was the incidence of new‐onset type 2 diabetes in both groups. Results Forty‐eight new diabetes cases occurred, 31 in the CG and 17 in the IG. The multivariate‐adjusted hazard ratio was 0.45 (95% CI, 0.24‐0.83) for the IG compared with the CG. Intervention‐related adverse effects were not reported. Conclusions The intake of OA‐enriched olive oil reduces the risk of developing diabetes in prediabetic patients. The results of the PREDIABOLE study promote the use of OA in new functional foods and drugs for the prevention of diabetes in individuals at risk of developing it., The authors especially thank the ACESUR Group (Dos Hermanas, Seville, Spain), which donated all the commercial olive oil for the trial. This collaborator had no role in the design, collection, analysis or interpretation of the data or in the decision to submit the manuscript for publication. The authors also express their gratitude to Dr. Alberto Gil‐Peralta, Neurology Service of the Virgen del Rocío University Hospital (Seville, Spain), for the critical reading of the manuscript and his helpful comments. CIBEROBN is an initiative of Instituto de Salud Carlos III (ISCIII), Madrid, Spain. The PREDIABOLE study was supported by the official funding agency for biomedical research of the Spanish Government, ISCIII, through the Fondo de Investigación para la Salud (FIS), which is co‐funded by the European Regional Development Fund, including the following projects: PI10/00913 (led by J.M.S.‐L.) and PI10/01415 (led by J.A.C.). The study was also supported by a grant of Consejería de Salud de la Junta de Andalucía (PI‐0037/2008, led by J.M.S.‐L.). None of the funding sources took part in the design, collection, analysis or interpretation of the data or in the decision to submit the manuscript for publication.

BACKGROUND Venous thromboembolism (VTE) is a common, potentially fatal complication after traumatic brain injury (TBI). The objective was to evaluate the effectiveness and safety of pharmacologic VTE prophylaxis in moderate to severe TBI patients, and its use in hospitals. DATA SOURCES A systematic review of the literature was conducted using Medline, Embase, Central database, Google scholar, and the SciELO from 1966 to 2014. STUDY SELECTION & DATA EXTRACTION All studies providing information on the following variables-use of VTE prophylaxis (both pharmacological and nonpharmacological), initiation of treatment, application of specific protocols, rates of VTE and hemorrhagic progression of the traumatic brain injury on computed tomographic scan-were included. The random effects model was used to calculate pooled effect estimates. Heterogeneity among studies was assessed using the Cochran Q homogeneity test. A forest plot was constructed, and aggregate odds ratio was computed. Potential publication bias was evaluated using funnel plots. METHODS & MAIN RESULTS A total of 12 retrospective observational studies were identified, totaling 8,747 patients. Six studies (3,325 patients) were used to analyze the safety and five (2,105 patients) to analyze the effectiveness of pharmacological versus nonpharmacological prophylaxis, without considering the timing of treatment. Four studies (1,371 patients) were used to evaluate early versus late pharmacologic prophylaxis, with results favoring early administration (odds ratio, 0.46; 95% confidence interval, 0.24-0.88; p < 0.05; I, 46%) and showing no significant differences regarding safety. Three studies (4,133 patients), used to analyze VTE prophylaxis protocols, showed significant heterogeneity (p < 0.01). CONCLUSION When we compared mechanical and pharmacological prophylaxis, the results were heterogeneous; and thus, their potential differences could not be assessed. In some studies, the introduction of prophylaxis protocols in neurocritical patient care improved their effectiveness. Early pharmacologic prophylaxis, in the first 72 hours after TBI, was more effective than late, when there was no hemorrhagic progression within 24 hours after injury; no significant differences were found regarding safety. LEVEL OF EVEDINCE Systematic review/meta-analysis, level III.

To determine temporal profile and prognostic ability of S100B protein and neuron-specific enolase (NSE) for prediction of short/long-term mortality in patients suffering from severe traumatic brain injury (sTBI).Ninety-nine patients with sTBI were included in the study. Blood samples were drawn on admission and on subsequent 24, 48, 72, and 96 h.15.2% of patients died in NeuroCritical Care Unit, and 19.2% died within 6 months of the accident. S100B concentrations were significantly higher in patients who died compared to survivors. NSE levels were different between groups just at 48 h. In the survival group, S100B levels decreased from 1st to 5th sample (p 0.001); NSE just from 1st to 3rd (p 0.001) and then stabilized. Values of S100B and NSE in non-survival patients did not significantly vary over the four days post sTBI. ROC-analysis showed that all S100B samples were useful tools for predicting mortality, the best the 72 h sample (AUC 0.848 for discharge mortality, 0.855 for six-month mortality). NSE ROC-analysis indicated that just the 48-h sample predicted mortality (AUC 0.733 for discharge mortality, 0.720 for six-month mortality).S100B protein showed higher prognostic capacity than NSE to predict short/long-term mortality in sTBI patients.

To assess the utility of C-reactive protein (CRP) and procalcitonin (PCT) as biomarkers of infection in patients with severe burn injury.The present study included severe burn injury patients consecutively admitted to the Virgen del Rocío University Hospital (Andalucia, Spain) intensive care unit during a 12-month period. The variables of interest were: age, sex, mechanism of injury, percentage of burned body surface area, the Abbreviated Burn Severity Index (ABSI) and the absence/presence of sepsis. The authors analyzed serum levels of CRP and PCT at admission and every 48 h thereafter until intensive care unit discharge or death. Each determination was considered to be a sample or unit of analysis.A total of 157 determinations were analyzed from 17 severe burn injury patients. Fifty-four samples were considered to be septic, 25 of which corresponded to the first day of a new onset of sepsis. The mean duration of these symptoms was four days (interquartile range two to five days). Significant differences were found in the distributions of CRP and PCT values between sepsis and no-sepsis samples. Analysis of the changes in these biomarkers over time showed that PCT increase (ΔPCT) differentiated these diagnoses, whereas CRP increase (ΔCRP) did not. ROC curve analysis revealed that ΔPCT could predict positive sepsis samples (area under the curve 0.75 [95% CI 0.58 to 0.90]; P=0.003).These preliminary results showed that PCT had a better discriminatory capacity than CRP for identifying infectious processes in patients with severe burn injury. A larger sample size would be needed to confirm these results.Évaluer l’utilité de la protéine C réactive (PCR) et de la procalcitonine (PCT) comme biomarqueurs de l’infection chez des grands brûlés.La présente étude portait sur des grands brûlés admis consécutivement à l’unité de soins intensifs de l’hôpital universitaireAu total, les auteurs ont analysé 157 déterminants chez 17 grands brûlés. Cinquante-quatre échantillons étaient considérés comme septiques, dont 25 correspondaient au premier jour d’apparition du sepsis. Les symptômes duraient en moyenne quatre jours (plage interquartile de deux à cinq jours). Les auteurs ont constaté des différences importantes dans la répartition des valeurs de PCR et de PCT entre les échantillons de sepsis et sans sepsis. L’analyse des changements de ces biomarqueurs au fil du temps a révélé que l’augmentation de la PCT (ΔPCT) distinguait ces diagnostics, contrairement à l’augmentation de la PCR (ΔPCR). L’analyse de la courbe ROC a révélé que la ΔPCT pouvait prédire des échantillons de sepsis positifs (aire sous la courbe de 0,75 [95% IC 0,58 à 0,90]; P=0,003).Les résultats préliminaires démontrent que la PCT avait une meilleure capacité discriminatoire que la PCR pour dépister les processus infectieux chez des grands brûlés. Il faudrait un plus gros échantillon pour confirmer ces résultats.

To assess the prognostic value of APACHE II and SAPS II scales to predict brain death evolution of neurocritical care patients.Retrospective observational study performed in a tertiary hospital. Include 508 patients over 16 years old, hospitalized in ICU for at least 24 hours. The variables of interest were: demographic data, risk factors, APACHE II, SAPS II and outcome.Median age: 41 years old (IR: 25-57). Males: 76.2%. Most frequent reason for admission: trauma (55.3%). Medians: Glasgow Coma Scale (GCS), 10 points; APACHE II, 13 points; SAPS II, 31 points; and ICU stay, 5 days. Mortality in the ICU was 28.5% (n = 145) of whom 44 (8.7%) evolved to brain death. Univariate logistic regression analysis showed that GCS, APACHE II and SAPS II scores, as well as ICU stay days behaved as predictors of brain death evolution. However, the multivariate analysis performed including APACHE II and SAPS II scores showed that only APACHE II maintained statistical significance, despite the good discrimination of both scores.Transplant coordinators might use the APACHE II score as a tool to detect patients at risk of progression to brain death, minimizing the loss of potential donors.APACHE II y SAPS II como predictores de evolucion a muerte encefalica en pacientes neurocriticos.Objetivo. Evaluar si las escalas pronosticas APACHE II (Acute Physiology and Chronic Health Evaluation II) y SAPS II (Simplified Acute Physiology Score II) son capaces de predecir la evolucion a muerte encefalica en pacientes neurocriticos. Pacientes y metodos. Estudio retrospectivo, observacional, realizado en un hospital de tercer nivel. Se incluyo a 508 pacientes mayores de 16 años, ingresados con patologia neurocritica aguda, con estancia en la unidad de cuidados intensivos de al menos 24 horas. Las variables de interes fueron: datos demograficos, factores de riesgo, APACHE II, SAPS II y resultado pronostico. Resultados. Mediana de edad: 41 años (rango intercuartilico: 25-57). Varones: 76,2%. Motivo de ingreso mas frecuente: traumatismo (55,3%). Medianas: escala de coma de Glasgow (GCS), 10 puntos; APACHE II, 13 puntos; SAPS II, 31 puntos; y estancia en cuidados intensivos, cinco dias. La mortalidad en la unidad de cuidados intensivos fue de 145 (28,5%). De ellos, 44 (8,7%) evolucionaron a muerte encefalica. El analisis de regresion logistica univariante mostro que la GCS, las escalas APACHE II y SAPS II, y los dias de estancia en la unidad de cuidados intensivos se comportaron como variables predictoras de evolucion a muerte encefalica. Sin embargo, en el analisis multivariante realizado con APACHE II y SAPS II, se evidencio que solo APACHE II mantiene significacion estadistica, a pesar de la buena discriminacion de ambas escalas. Conclusion. Los coordinadores de trasplantes podrian usar la escala APACHE II como una herramienta para detectar pacientes con riesgo de evolucion a muerte encefalica, minimizando la perdida de potenciales donantes.

The aim of this study was to validate the S100B protein as a diagnostic tool for ruling out the presence of intracranial lesion (IL) after mild traumatic brain injury (mTBI). Subjects with a Glasgow Coma Scale (GCS) score of 15 and at least one neurological symptom post-trauma were selected from a large Spanish cohort.A number of 260 patients with mTBI were enrolled. Blood samples were extracted within 6 h and CT scan performed within 24 h post-injury. Blood samples were also drawn from 18 healthy subjects.CT scan revealed the presence of IL in 22 patients (8.5%). Patients with mTBI had higher S100B serum levels (p = 0.008) than the healthy subjects (p 0.001). The ROC analysis of S100B discriminated between patients with and without IL (AUC: 0.671; 95%CI: 0.574-0.769; p = 0.008). The multivariate analysis identified male gender (OR: 5.39; 95%CI: 1.45-20.10; p = 0.012), age 65 (OR: 2.97; 95%CI: 1.04-8.44; p = 0.041) and S100B level0.10 µg/L (OR: 7.93; 95%CI: 1.03-60.76; p = 0.046) as independent risk factors for IL in patients with mTBI.Measurement of S100B within 6 h of mTBI accurately predicts risk of IL in patients with a GCS score of 15 and at least one neurological symptom.

Resumen Introduccion El objetivo de este estudio es el analisis del impacto de los trastornos asociados al consumo de alcohol (TCA) en las neumonias neumococicas adquiridas en la comunidad (NNAC), en terminos de exceso de mortalidad intrahospitalaria, prolongacion de estancias y sobrecostes. Material y metodos Estudio observacional retrospectivo de una muestra de pacientes que presentaron NNAC recogidos en los conjuntos minimos basicos de datos de 87 hospitales espanoles durante el periodo 2008-2010. Se calculo la mortalidad, la prolongacion de estancias y los sobrecostes atribuibles a los TCA controlando mediante analisis multivariado de la covarianza variables como la edad y el sexo, el tipo de hospital, los trastornos adictivos y las comorbilidades. Resultados Se estudiaron 16.202 ingresos urgentes por NNAC de 18 a 74 anos de edad, entre los cuales hubo 2.685 pacientes con TCA. Los ingresos con NNAC y TCA fueron predominantemente varones, con mayor prevalencia de trastornos por tabaco y drogas y con indices de comorbilidad de Charlson mas elevados. Los pacientes con NNAC y TCA presentaron importantes excesos de mortalidad (50,8%; IC 95%: 44,3-54,3%), prolongacion indebida de estancias (2,3 dias; IC 95%: 2,0-2,7 dias) y sobrecostes (1.869,2 €; IC 95%: 1.498,6-2.239,8 €). Conclusiones De acuerdo con los resultados de este estudio, los TCA en pacientes con NNAC aumentan significativamente la mortalidad, la duracion de la estancia hospitalaria y sus costes.

Introduction The aim of this study was to investigate the impact of alcohol use disorders (AUD) on community-acquired pneumococcal pneumonia (CAPP) admissions, in terms of in-hospital mortality, prolonged stay and increased hospital spending. Methods Retrospective observational study of a sample of CAPP patients from the minimum basic datasets of 87 Spanish hospitals during 2008–2010. Mortality, length of hospital stay and additional spending attributable to AUD were calculated after multivariate covariance analysis for variables such as age and sex, type of hospital, addictions and comorbidities. Results Among 16,202 non-elective admissions for CAPP in patients aged 18–74 years, 2685 had AUD. Patients admitted with CAPP and AUD were predominantly men with a higher prevalence of tobacco or drug use disorders and higher Charlson comorbidity index. Patients with CAPP and AUD had notably higher in-hospital mortality (50.8%; CI 95%: 44.3–54.3%), prolonged length of stay (2.3 days; CI 95%: 2.0–2.7 days) and increased costs (1869.2 €; CI 95%: 1498.6–2239.8 €). Conclusions According to the results of this study, AUD in CAPP patients was associated with increased in-hospital mortality, length of hospital stay and hospital spending.

Objective To analyze mortality and functional outcome in patients with severe spontaneous intracerebral hemorrhage (ICH), and identify the clinical characteristics, radiological findings and therapeutic procedures predictive of mortality in the Intensive Care Unit (ICU) and during hospitalization, as well as of poor functional results at 6 months. Design A prospective, observational study was carried out. Setting Neurocritical Care Unit of a university hospital. Patients Patients diagnosed with ICH were included over a period of 23 months. Variables of interest Demographic characteristics, cardiovascular risk factors, regular medication, laboratory test parameters, cranial CT findings, therapeutic procedures and outcome data. Intervention None. Results A total of 186 patients with ICH met the inclusion criteria. Surgery to evacuate ICH was performed in 25.8% of the patients. The mortality rate was 46.7%. The modified Rankin score at 6 months was 5 (RI: 4.6). Multivariate Cox regression analysis showed the presence of diabetes, prior anticoagulation, as well as APACHE II severity and the type of bleeding on the cranial CT scan to be predictors of mortality and poor functional outcomes. On the other hand, neurosurgical procedures and intracranial pressure (ICP) monitoring were associated with better outcomes. Conclusion The presence of comorbidities such as diabetes, or previous anticoagulation, as well as the CT findings were associated to poorer outcomes. In contrast, ICP monitoring and early neurosurgery were predictive of longer survival and better functional outcomes.

Resumen Objetivo Evaluar la mortalidad y el resultado funcional final de los pacientes con hemorragia intraparenquimatosa espontanea grave (HIP). Determinar las caracteristicas clinicas, radiologicas y terapeuticas con mayor poder predictivo sobre la mortalidad en la Unidad de Cuidados Intensivos (UCI) y durante el ingreso hospitalario, asi como sobre los malos resultados funcionales a los 6 meses. Diseno Estudio prospectivo, observacional. Ambito UCI de un hospital universitario. Pacientes Durante 23 meses se incluyo a aquellos pacientes con diagnostico de HIP. Variables de interes Datos demograficos, factores de riesgo cardiovascular, medicacion habitual, datos de laboratorio, tomografia craneal (TC), neuromonitorizacion, manejo terapeutico y evaluacion pronostica. Intervencion Ninguna. Resultados Se incluyo a un total de 186 pacientes. En el 25,8% se realizo evacuacion quirurgica de la HIP. La mortalidad fue del 46,7%. La mediana del Rankin modificado a los 6 meses fue de 5 (RI: 4;6). El analisis multivariante de regresion de Cox mostro que la presencia de diabetes, tratamiento previo con anticoagulantes, la gravedad segun APACHE II y el tipo de hemorragia en la TC de craneo se comportaron como variables predictoras de mortalidad y malos resultados funcionales, mientras que la realizacion de procedimientos neuroquirurgicos y la monitorizacion de la presion intracraneal (PIC) asociaron una mayor supervivencia y mejores resultados. Conclusion La presencia de comorbilidades, como la diabetes o el tratamiento previo con anticoagulantes, asi como los hallazgos de la TC se asociaron a peores resultados. Por contra, el marcador de mayor supervivencia y mejor resultado funcional era la monitorizacion de la PIC, asi como la cirugia precoz.

Progressive neuronal and axonal loss are considered the main causes of disability in patients with multiple sclerosis (MS). The disease frequently involves the visual system; the accessibility of the system for several functional and structural tests has made it a model for the in vivo study of MS pathogenesis. Orbital ultrasound is a non-invasive technique that enables various structures of the orbit, including the optic nerve, to be evaluated in real time.We conducted an observational, ambispective study of MS patients. Disease progression data were collected. Orbital ultrasound was performed on all patients, with power set according to the 'as low as reasonably achievable' (ALARA) principle. Optical coherence tomography (OCT) data were also collected for those patients who underwent the procedure. Statistical analysis was conducted using SPSS version 22.0.Disease progression was significantly correlated with ultrasound findings (P=.041 for the right eye and P=.037 for the left eye) and with Expanded Disability Status Scale (EDSS) score at the end of the follow-up period (P=.07 for the right eye and P=.043 for the left eye). No statistically significant differences were found with relation to relapses or other clinical variables.Ultrasound measurement of optic nerve diameter constitutes a useful, predictive factor for the evaluation of patients with MS. Smaller diameters are associated with poor clinical progression and greater disability (measured by EDSS).

Two cases of metanephric adenoma are presented, a rare benign renal tumor, and a literature review is done under the current WHO classification (2016).Standard histopathological study was performed with hematoxylin-eosin and immunohistochemistry to analyze the expression of WT, Vimentin, Racemase, CK7, CD10 and RCC.Neoplasms of 3 and 4.5 cm, histologically, exhibiting tubulopapillary architecture. There was no evidence of significant nuclear atypia and mitotic figures. Immunohistochemical study showed positive immunoreaction for WT1 and Vimentin in tumor cells.Two new cases of metanephric adenoma are presented and a review of the literature was performed in order to discuss the prognosis and differential diagnosis of metanephric adenoma. This is a rare tumor and its diagnosis lies on its morphology and its immunohistochemical profile.

Background In all organ transplantation programs, election of the proper protocol relies primarily on the professionals involved in the detection of potential donors. The objective of our study was to assess the impact of a series of prehospital training sessions, as well as to develop several positive feedback strategies within the uncontrolled organ donation after circulatory death (uDCD) program in our city. Methods A before–after intervention study was carried out in 3 steps. First, professionals enrolled in the Emergency Health Services Agency-061 (EPES-061) program underwent specific training to identify potential donors. Second, a specific logotype was designed to alert emergency health care professionals that in cases where cardiopulmonary resuscitation was ineffective and after treatment of all potentially reversible causes, the “chain of survival” should be considered a “chain of opportunities.” Third, a positive feedback strategy was put in place, whereby each time a donation was procured, the EPES-061 personnel that had identified the potential donor were notified by phone and in a personal letter. Results The mean age for donors was 50.5 years of age (interquartile range 37–52.5), and 89.5% of all donations came from male subjects. Positive feedback letters and phone calls, including information on final outcome, were provided to the appropriate personnel in 100% of the cases. Postintervention information showed an increase in both eligible and utilized donors. Conclusions Interventions outside the hospital setting that facilitate optimal implementation of the uDCD program are an essential part of this strategy to increase the donor pool and make the wait shorter for transplant patients.

The slow progression of chronic hepatitis C (CHC) infection requires long observation periods to detect clinical changes. We compare the incidence of clinical events, hepatocellular carcinoma (HCC), overall mortality, liver-related mortality, and fibrosis progression between patients with a sustained virological response (SVR) and nonresponders (NR) after a 13-year follow-up period.One hundred and eighty-two CHC patients, who received interferon and ribavirin treatment between 1996 and 2000, were included. Clinical events were evaluated during follow-up. At the end of follow-up, transient elastography was used to assess fibrosis progression.Of the 182 patients, 46.7% (n=85) achieved an SVR. Twenty-seven patients developed hepatic decompensation (one SVR) and 15 developed HCC (three SVR). Twenty-nine patients died (eight SVR). Twelve of the 29 deaths were liver related (two SVR). Independent factors associated with hepatic decompensation were NR to treatment [hazard ratio (HR)=23.35; 95% confidence interval (CI): 2.90-189.25; P=0.003], advanced fibrosis at baseline (HR=9.11; 95% CI: 4.13-20.09), and treatment delay after diagnosis (HR=1.02; 95% CI: 1.00-1.03; P=0.012). Only the latter two were associated with HCC development and liver-related mortality. An assessment of liver fibrosis was performed on 125 patients (66 SVR). Fibrosis values were significantly lower in SVR patients, showing less progression to advanced stages of fibrosis [SVR: 6.6 (2.8); 95% CI: 5.8-7.3] than NR [NR: 14.0 (11.1); 95% CI: 11.1-16.9; P0.001].In patients with CHC, SVR is durable and reduces clinical events. The risk of HCC development is lower, but not eliminated. Sustained responders showed fibrosis stabilization or improved fibrosis values.

BACKGROUND The aim of this work was to validate the IMPACT (International Mission for Prognosis and Analysis of Clinical Trials in TBI) model in a Spanish cohort of patients with moderate-severe TBI (traumatic brain injury). SETTING Two level I neurotrauma centers. PARTICIPANTS Patients admitted to these hospitals between 2011 and 2014 with a diagnosis of TBI and a Glasgow Coma Scale score of 12 or less. DESIGN Prospective observational study. MAIN MEASURES We collected prospectively the clinical variables included in the IMPACT models. Outcome evaluation was prospectively done at 6-month follow-up according to the Glasgow Outcome Scale. RESULTS A total of 290 patients were included in the study. Forty-seven patients (16.2%) died within 6 months post-TBI, and 74 patients (25.5%) had an unfavorable outcome. The Hosmer-Lemeshow test revealed that there was no difference between observed and predicted outcomes; hence, the 3 models displayed adequate calibration for predicting 6-month mortality or unfavorable outcome. The receiver operating characteristic curve indicated that the 3 models (Core, Extended, and Lab) could accurately discriminate between favorable and unfavorable outcomes, as well as between survival and mortality (P < .001). CONCLUSION The IMPACT model validates prediction of 6-month outcomes in a Spanish population of moderate-severe TBI. IMPACT Lab model is the one that presents a higher discriminative capacity. These results encourage the implementation of the IMPACT model as a prognostic tool in the management of patients with TBI.

[ES] Objetivo: El vasoespasmo cerebral, una de las principales complicaciones secundarias a hemorragia subaracnoidea (HSA), se caracteriza por una constricción arterial que tiene lugar principalmente entre el día 4 y la segunda semana. La urotensina-II (U-II) ha sido definida como el péptido con mayor capacidad vasoconstrictora en mamíferos. Quisimos analizar los niveles séricos de U-II, así como los niveles de expresión de los genes de U-II, péptido relacionado con urotensina y receptor de urotensina, en un modelo murino experimental de HSA., Diseño: Estudio experimental., Ámbito: Quirófano experimental del Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío., Participantes: Noventa y seis ratas Wistar: 74 con inyección percutánea de sangre (HSA), 22 con inyección percutánea de 100 μL de salino (Sham)., Intervenciones: Día 1: extracción de muestras de sangre. Posteriormente, inyección percutánea de 100 μL de salino (Sham) o de sangre (HSA) en el espacio subaracnoideo. Día 5: extracción de muestras de sangre y sacrificio del animal., Principales variables de interés: Peso, mortalidad precoz, niveles séricos de U-II, valores de ARNm de U-II, péptido relacionado con urotensina y receptor de urotensina., Resultados: Observamos un incremento en los niveles de U-II sérica en el grupo HSA desde el día 1 (0,62 pg/mL [RI 0,36-1,08]) al día 5 (0,74 pg/mL [RI 0,39-1,43]) (p < 0,05); pero no observamos tal diferencia en el grupo Sham (0,56 pg/mL [RI 0,06-0,83] día 1; 0,37 pg/mL [RI 0,23-0,62] día 5) (p = 0,959). Se encontraron diferencias en los niveles de U-II entre ambos grupos al quinto día (p < 0,05). El análisis de curvas ROC demostró que la U-II sérica al quinto día (AUC = 0,691), ARNm de péptido relacionado con urotensina (AUC = 0,706) y ARNm de receptor de urotensina (AUC = 0,713) podían discriminar entre ratas Sham y HSA. Además, definimos un rango de normalidad para los niveles de U-II séricos en ratas: 0,56 pg/mL (RI 0,06-0,83)., Conclusión: Este estudio demuestra por primera vez que el sistema urotensinérgico ve incrementada su expresión en el quinto día en un modelo de HSA., [EN] Objective: Cerebral vasospasm, one of the main complications of subarachnoid hemorrhage (SAH), is characterized by arterial constriction and mainly occurs from day 4 until the second week after the event. Urotensin-II (U-II) has been described as the most potent vasoconstrictor peptide in mammals. An analysis is made of the serum U-II concentrations and mRNA expression levels of U-II, urotensin related peptide (URP) and urotensin receptor (UT) genes in an experimental murine model of SAH., Design: An experimental study was carried out., Setting: Experimental operating room of the Biomedicine Institute of Seville (IBiS), Virgen del Rocío University Hospital (Seville, Spain)., Participants: 96 Wistar rats: 74 SAH and 22 sham intervention animals., Interventions: Day 1: blood sampling, followed by the percutaneous injection of 100 μl saline (sham) or blood (SAH) into the subarachnoid space. Day 5: blood sampling, followed by sacrifice of the animals., Main variables of interest: Weight, early mortality, serum U-II levels, mRNA values for U-II, URP and UT., Results: Serum U-II levels increased in the SAH group from day 1 (0.62 pg/mL [IQR 0.36–1.08]) to day 5 (0.74 pg/mL [IQR 0.39–1.43]) (p < 0.05), though not in the sham group (0.56 pg/mL [IQR 0.06–0.83] day 1; 0.37 pg/mL [IQR 0.23–0.62] day 5; p = 0.959). Between-group differences were found on day 5 (p < 0.05). The ROC analysis showed that the day 5 serum U-II levels (AUC = 0.691), URP mRNA (AUC = 0.706) and UT mRNA (AUC = 0.713) could discriminate between sham and SAH rats. The normal serum U-II concentration range in rats was 0.56 pg/mL (IQR 0.06–0.83)., Conclusion: The urotensinergic system is upregulated on day 5 in an experimental model of SAH.

Resumen Objetivo Analizar las caracteristicas de la poblacion que recibe tratamiento antibiotico y valorar la adecuacion de estos tratamientos a sus indicaciones. Metodos Diseno: estudio descriptivo transversal de prescripcion-indicacion. Emplazamiento Un distrito de atencion primaria en Andalucia. Participantes Pacientes adscritos a claves medicas del distrito. Se selecciono una muestra por muestreo aleatorizado simple (nivel de confianza: 95%; precision: 5%) de pacientes con prescripciones de antimicrobianos en 2009. Variable principal: adecuacion de la prescripcion de antibioticos a las recomendaciones de las guias locales. Los datos fueron obtenidos a traves del sistema de facturacion de recetas y la historia de salud digital. Resultados El 25% de la poblacion del area recibio antibioticos durante 2009. La muestra (1.266 pacientes) presento las siguientes caracteristicas: el 57.9% eran mujeres, con una media de edad de 41 (± 1) anos. El 39,3% eran pensionistas. La adecuacion del tratamiento antibiotico fue del 19,9%, sin que se observaran diferencias de genero. Se obtuvieron diferencias estadisticamente significativas relacionadas con la edad, y los mayores de 65 anos fueron el grupo de pacientes con mayor porcentaje de inadecuacion. Los principales motivos de inadecuacion fueron: no presentar registro de infeccion (44,5%), duracion del tratamiento erronea (15,5%) y antibiotico incorrecto (11,5%). Conclusion Existe un alto grado de inadecuacion en la prescripcion de antibioticos en atencion primaria. El alto grado de infra-registro, principalmente en pacientes de edades superiores, seguido de la utilizacion de pautas y tipo de antibioticos erroneos constituyen los principales motivos de inadecuacion.