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Background: Infections related to non-surgical manipulation of the biliary tract (NSMBT) are common events despite periprocedural antibiotic prophylaxis (PAP). Since June 2017, our local protocol has indicated a 24-h regimen of intravenous piperacillin-tazobactam for this purpose., Objective: We aimed to describe the incidence and characteristics of NSMBT-related paediatric infections, define risk factors for their development, and analyse adherence to our PAP protocol., Materials and Methods: Epidemiological, clinical, and microbiological data were collected in consecutive NSMBT procedures performed in paediatric patients (<18 years) in our centre (2010-2019)., Results: 113 procedures in 37 patients, median age 4 years (IQR 1-8), were included. Main underlying diseases were biliary atresia (32%) and cancer (14%). Sixty-eight percent had undergone liver transplant and 70% hepaticojejunostomy. In 44 procedures (39%), the intervention was performed during the course of infection and previously prescribed antibiotic treatment was maintained. In the other 69, PAP was specifically indicated for NSMBT; antibiotic adequacy increased from 35% to 100% after June 2017. In total, 32 NSMBT-related infections (28%) occurred, mainly in the first 24h post-procedure (72%); no deaths happened. Causative pathogens were Gram-negative rods (64%), Gram-positive cocci (28%), and Candida spp. (8%). Main related risk factors were hepaticojejunostomy, biliary obstruction, and liver transplant., Conclusions: NSMBT in children entails a significant infection risk, even under antibiotic prophylaxis, being hepaticojejunostomy the main risk factor. Infectious complications mainly occurred immediately after the procedure. After establishing a PAP protocol, 100% of interventions received appropriate prophylaxis, decreasing antibiotic exposure time and potentially, the length of hospital stay., (Copyright © 2021 Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. Published by Elsevier España, S.L.U. All rights reserved.)

Background: Infections related to non-surgical manipulation of the biliary tract (NSMBT) are common events despite periprocedural antibiotic prophylaxis (PAP). Since June 2017, our local protocol has indicated a 24-h regimen of intravenous piperacillin-tazobactam for this purpose., Objective: We aimed to describe the incidence and characteristics of NSMBT-related paediatric infections, define risk factors for their development, and analyse adherence to our PAP protocol., Materials and Methods: Epidemiological, clinical, and microbiological data were collected in consecutive NSMBT procedures performed in paediatric patients (<18 years) in our centre (2010-2019)., Results: 113 procedures in 37 patients, median age 4 years (IQR 1-8), were included. Main underlying diseases were biliary atresia (32%) and cancer (14%). Sixty-eight percent had undergone liver transplant and 70% hepaticojejunostomy. In 44 procedures (39%), the intervention was performed during the course of infection and previously prescribed antibiotic treatment was maintained. In the other 69, PAP was specifically indicated for NSMBT; antibiotic adequacy increased from 35% to 100% after June 2017. In total, 32 NSMBT-related infections (28%) occurred, mainly in the first 24h post-procedure (72%); no deaths happened. Causative pathogens were Gram-negative rods (64%), Gram-positive cocci (28%), and Candida spp. (8%). Main related risk factors were hepaticojejunostomy, biliary obstruction, and liver transplant., Conclusions: NSMBT in children entails a significant infection risk, even under antibiotic prophylaxis, being hepaticojejunostomy the main risk factor. Infectious complications mainly occurred immediately after the procedure. After establishing a PAP protocol, 100% of interventions received appropriate prophylaxis, decreasing antibiotic exposure time and potentially, the length of hospital stay., (Copyright © 2021 Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction and Objectives: Within the paradigm shift of the last decade in the management of prostate cancer (PCa), perhaps the most relevant event has been the emergence of active surveillance (AS) as a mandatory strategy in low-risk disease. We carry out a critical review of the clinical, pathological and radiological improvements that allow optimizing AS in 2021., Material and Methods: Critical narrative review of the literature on improvement issues and controversial aspects of AS., Results: Adequate use of traditional criteria, optimized by enhanced biopsy and calculation of the prostate volume technique thanks to multiparametric magnetic resonance imaging (mpMRI) allow a better selection of patients for AS. This management should not be limited to patients under 60years of age, and patients with intermediate-risk PCa should be carefully selected to be included. Biopsies are still required in the follow-up, which can be personalized according to risk patterns. The pathologist must identify the cribriform or intraductal histology on biopsies in order to exclude these patients from AS, in the same way as with patients with alterations in DNA repair genes., Conclusions: Controversial indications such as the inclusion of patients from intermediate-risk groups, or the transition to active treatment due to exclusive progression in tumor volume, should be further optimized. It is possible that the future competition of tissue biomarkers, the refinement of objective parameters of mpMRI and the validation of PSA kinetics calculators may sub-stratify risk groups., (Copyright © 2020 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.)

This paper shows an experience of the practical implementation of the Quadruple Helix-Based Innovation Model of Reference Sites of the European Commission through the Design Thinking method. This method establishes that, in order to successfully achieve the design of a digital solution, five unavoidable phases must be covered: empathize, define, ideate, prototype and test. The process was approached using the research action design. Qualitative data collection and analysis techniques were applied in each phase: qualitative meta-synthesis, focus groups, biographical interviews, professional and community forums and techniques of prototyping and testing with users. The systematic application of this method has facilitated the consolidation of a cooperative work model in which the main key agents in active and healthy ageing interact. Thus, products and services have been developed to better meet the needs of the users, making them an active part of the creation process., (Copyright © 2018 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

INTRODUCCIóN: Adherence to guidelines on the periendoscopic management of antiplatelet therapy (APT) has not been analyzed in detail. Our aim was to assess adherence to guidelines in patients referred to our Endoscopy Unit on a case-by-case basis, describing in detail the detected deviations and identifying areas of improvement., Patients and Methods: Cross-sectional study of outpatients consecutively scheduled for an unsedated upper or lower gastrointestinal endoscopy between January and June 2015. Patients on anticoagulant therapy were excluded., Results: 675 patients were evaluated, including 91 (13.5%) patients on APT [upper GI endoscopy 25 (27.5%), lower GI endoscopy 66 (72.5%)]. Contrary to the clinical guidelines, aspirin was discontinued in 25 of the 77 patients previously prescribed the drug (32.5%) but this modification was patient's own decision in 11 cases. Most of the apparent deviations in the management of clopidogrel and dual antiplatelet therapy (DAPT) were not true non-adherence cases. The Primary Care physician modified an APT prescribed by another physician in 8 of 9 cases (88.9%), always in cases with aspirin. No relationship was found between the endoscopic procedure's predicted risk of bleeding or the patient's thrombotic risk and modification of therapy., Discussion: In many patients, the peri-procedural management of APT goes against current guidelines, but some of these inconsistencies cannot be considered true deviations from practice. Identified areas for improvement are increasing patient awareness about APT, disseminating the guidelines in Primary Care, and underscoring the significance of thrombotic risk related to APT withdrawal., (Copyright © 2019 Elsevier España, S.L.U. All rights reserved.)

Objective: Collect and analyze all the described cases of optic neuropathy associated with linezolid., Method: A systematic review of cases was carried out through a search in PubMed-Medline, Embase and ScienceDirect, between September 2002 and April 2018. The demographic, clinical and ophthalmology  characteristics of each patient were evaluated., Results: A total of 33 cases from 26 independent articles were analyzed. The mean age was 44.97 ± 21.40 years (range: 6-79) and 16  (50%) of 32 cases were women. The duration of treatment with linezolid  until onset of symptoms was greater than 28 days in 29 (90.6%) of 32  documented cases. The mean time of exposure to onset of symptoms was 8.5 ± 8.6 months (range: 0.33-50). A total of 12 of 26 adult patients  received linezolid 600 mg/24 h, starting. In 30 (90.9%) patients loss of  visual acuity was documented. Linezolid was withdrawn in all cases once the diagnosis was confirmed, with clinical improvement in 31 (93.9%) cases. Conclusions: Optic neuropathy is a reversible complication related to the  prolonged use of linezolid and regardless of the dose. We recommend follow- up in patients with long treatments (&gt; 28 days) and ophthalmological exploration in those with visual alterations for the early  diagnosis of neuropathy and early withdrawal of linezolid., (Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.)

Background and Objective: The relationship between atherothrombotic cardiovascular disease (ATCD) and localised infections in teeth, including caries and chronic apical periodontitis (CAP) has not been studied much and is not well defined., Method: A systematic search was performed using the scientific databases PubMed and Medline from 1989 to 2016., Results: A significant relationship was observed with ATCD in 10 out of 10 studies addressing the degree of oral hygiene, in 14 of 17 that included loss of teeth, in 6 of 12 that analysed caries and in 11 of 15 that included CAP. However, there was a huge methodological heterogeneity., Conclusions: It can be concluded that there is an association between CAP and ATCD. Patients with ATCD present a worse oral hygiene status and fewer teeth., (Copyright © 2017 Elsevier España, S.L.U. All rights reserved.)

Introduction: The objective of this survey is to find out the cumulated experience and the current situation of video-assisted thoracic surgery (VATS) for anatomical lung resections in Spain., Methods: This is a descriptive study performed from two independent surveys designed through the Survey Monkey ® web platform. The first survey was aimed at 53 thoracic surgery departments from the public and state-assisted national health system. The second survey, of a personal nature, was directed at 315 thoracic surgeons in active service, including physicians at their residency program. The surveys were kept operative from 18/11/2014 to 15/01/2015., Results: The first survey was answered by 32 (60%) departments and the second by 167 (53%) professionals. A total of 29 (91%) of the thoracic surgery departments represented recognized having some level of experience in this technique. However, a great proportion of departments, 15 (52%), counted less than 100 procedures and the cumulated time of experience was lower than 5 years in 19 (66%) departments. Among all the individual respondents, 126 (77%) admitted having performed the procedure at some point. Of those without any experience, at least 36 (95%) of them recognized that future training in this technique is one of their future professional objectives., Conclusions: Waiting for future prospective national registries contribute further information about the expansion of this technique in our country, the results of the current survey show, up to now, the best reflection of clinical practice and opinion of the surgeons involved in the development of VATS., (Copyright © 2016 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction and Objectives: The seventh edition of the TNM classification, together with undeniable advantages, has limitations. The International Association for the Study of Lung Cancer (IASLC) Staging Committee has designed an international prospective study to improve this classification. A group of thoracic surgeons and pulmonologists was established in the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) Oncology area, and created a registry of new lung cancer (LC) cases to participate in this project. The aim of this paper is to describe the main characteristics of the patients included., Materials and Methods: Prospective, observational, multicentre, multiregional data collection (epidemiological, clinical, therapeutic and, especially, anatomical extension) study, according to the IASLC protocol, to analyse its prognostic value., Results: Two thousand, four hundred and nineteen patients (83.6% men) from 28 hospitals were included. Ninety-six percent of the men and 54% of the women were smokers or ex-smokers. Chest/abdominal computed tomography (CT) scanning was performed in over 90% and positron emission tomography (PET)/CT scanning in 51.5% of cases. Among the 1035 patients who underwent surgery, 77% had early stages (ia to iib), and 61.6% of those treated using other methods had stage iv. Respiratory comorbidity was higher in men (47.9% versus 21.4%). The most common histological subtype was adenocarcinoma (34%), especially in non-smoking women (69.5%)., Conclusions: The proportion of women and adenocarcinomas, as well as those resected at an early stage, increased among LC cases in Spain., (Copyright © 2013 SEPAR. Published by Elsevier Espana. All rights reserved.)

Pneumocephalus resulting from a subarachnoid-pleural fistula following resection of a pulmonary neoplasm is a very rare postoperative complication: we have found only 17 cases in the literature. We report the case of a 65-year-old man diagnosed with a superior sulcus tumor who underwent a left upper lobectomy and costal resection following neoadjuvant radiation therapy. Soon after surgery, the patient developed a subarachnoid-pleural fistula and pneumocephalus that required reoperation and drainage. Recurrence was suspected when chronic aseptic meningitis developed. Another thoracotomy was required to resolve the complication.

Objective: To compare the frequency and characteristics of post-vaccination reactions, between on the one hand the simultaneous administration of the Oral Antipolio (OP), the Triple Virus (TV) and the Anti-Diphtheria and Anti-Tetanus (DT) vaccines; and on the other hand, their administration in sequence., Design: Prospective study with interventions, with a non-random, non-blind determination. SITE. Survey covering the mothers of infants vaccinated at 24 vaccination centres in Mála province., Participants: 490 infants vaccinated during their second year of life. 263 had the vaccines administered simultaneously and 227 in sequence., Interventions: Simultaneous administration of the TV, OP and DT vaccines at 15 months; as against the administration of TV at 15 months, followed by OP and DT at 18 months., Main Results: 78 infants (29.66%) suffered a reaction that could be attributed to the vaccination after the simultaneous administration of TV, OP and DT; and 86 infants (37.88%) after one of the two occasions of vaccination in the administration in sequence: 27.31% after the TV, 17.18% after the OP-DT and 6.62% after both., Conclusions: The safety of simultaneous administration, taken together with data coming from other studies on its immunogenic effectiveness, reaffirms the usefulness of simultaneous administration of TV, OP and DT vaccines at 15 months, as a strategy to improve vaccine coverage of infants in their second year of life.