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Coastal retreat processes are usually associated with many anthropogenic actions, such as the regulation of river basins, the construction of hydraulic storm defence works in coastal areas and the building of housing on the beach. To all of this, we should also add the increase in sea levels due to the effect of climate change. The chosen area of study corresponds to the coastal area of the municipality of Guardamar del Segura, belonging to the Segura River Basin. The methodology applied in this study comprised the gathering of historical information, the extraction of data using GIS, the compiling of data using official organisations and the analysis of all these data from a geographical perspective. The obtained results show the chronology of the regulation works in the Segura Basin and their relationship with the reduction and negative trend in average ordinary flows (1940–2023) and the extraordinary, swelled flows recorded in the period 1994–2023. Furthermore, the coastlines from 1923 to 2023 were mapped, enabling us to determine the evolution of the coastline retreat processes experienced in the dune ridge of Guardamar del Segura and the increase in the frequency of impacts due to storms on Babilonia Beach. Finally, data on wind, waves and marine currents recorded at a gauging station were incorporated, enabling us to understand their impact on this coastal sector. The results obtained are discussed, and they indicate the need to incorporate data on sediment into the study in order to complete it. The conclusions reveal the existence of a relationship between all these anthropogenic elements in the beach erosion processes experienced in the village of Guardamar del Segura.

Background/Objectives: Inherited arrhythmogenic syndromes comprise a heterogenic group of genetic entities that lead to malignant arrhythmias and sudden cardiac death. Genetic testing has become crucial to understand the disease etiology and allow for the early identification of relatives at risk; however, it requires an accurate interpretation of the data to achieve a clinically actionable outcome. This is particularly challenging for the large number of rare variants obtained by current high-throughput techniques, which are mostly classified as of unknown significance. Methods: In this work, we present a new algorithm for the genetic interpretation of the remaining rare variants in order to shed light on their potential clinical implications and reduce the burden of unknown significance. Results: Our study illustrates the potential utility of our individualized comprehensive stepwise analyses focused on the rare variants associated with IAS, which are currently classified as ambiguous, to further determine their trends towards pathogenicity or benign traits. Conclusions: We advocate for personalized disease-focused population frequency data and family segregation analyses for all rare variants that remain ambiguous to further clarify their role. The current ambiguity should not influence medical decisions, but a potential deleterious role would suggest a closer clinical follow-up and frequent genetic data review for a more personalized clinical approach.

Background: The definition of patients with special needs (SNs) is used in the literature to refer to individuals with mental and physical disorders for whom the usual perioperative pathways are not applicable due to lack of cooperation, regardless of age. Studies in the literature recognize the appropriateness of general anesthesia for performing day surgery dental care in this type of patient. Objectives: The main objective was to assess the possible incidence of difficult airway management, understood as difficulty ventilating and/or intubating the patient. A secondary objective was to highlight the influence of general anesthesia on patient outcomes by testing the incidence of perioperative complications. Methods: The present retrospective, single-center, observational study involved 41 uncooperative patients aged between 3 and 17 undergoing dental surgery under general anesthesia. Data relating to airway management and general anesthesia present in the medical records were analyzed. Results: Tracheal intubation was successfully completed in all of the patients considered, and in no case did the patient have to be woken up because of difficulty in airway management. No perioperative complications attributable to anesthesia were found in any patients. Conclusions: From the present experience, it can be concluded that general anesthesia is a suitable option for performing dental care in pediatric subjects with special needs, and that although the peculiar perioperative management of these patients might increase the risk of possible anesthesia-related side effects, no complications have been encountered in any case.

Historical cartography is one of the principal tools used in correct flood adaptation and management based on territorial planning. In fact, Directive 2007/60/EC on the assessment and management of flood risks includes the analysis and inventory of historical floods in a river basin for assessing the flood hazard and risk existing in a geographical space. This study seeks to analyse the largest flood registered in the Segura basin, occurring on 14–15 October 1879, which attracted enormous interest on a national and international level. The methodology applied is based on the consultation of historical sources and historical cartography, and the elaboration of maps using GIS, enabling comparisons to be made with current flood zones. The results show that the Santa Teresa flood was very similar to the Spanish National Cartographic Systems for Flood Areas (SNCZI) map for a 500-year return period. Furthermore, it allows the identification of the sensitive points along the course of the river or those prone to burst banks or overflowing, which practically coincide with the current maps and modelling conducted by the official bodies. Furthermore, the buildings in the floodable area in the historical cartography have been counted and reconstructed on a GIS map and the SNCZI. Massive anthropic occupation through the construction of settlements and infrastructures (hospitals, schools, centers for the elderly, roads and railways) in the Guadalentín valley and the Segura River increases the risk of flooding in the study area, despite the numerous control and regulation works carried out in the Segura River basin.

Objectives The aim of this study is to investigate the effect of artificial intelligence (AI) and/or algorithms on drug management in primary care settings comparing AI and/or algorithms with standard clinical practice. Second, we evaluated what is the most frequently reported type of medication error and the most used AI machine type.Methods A systematic review of literature was conducted querying PubMed, Cochrane and ISI Web of Science until November 2021. The search strategy and the study selection were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Population, Intervention, Comparator, Outcome framework. Specifically, the Population chosen was general population of all ages (ie, including paediatric patients) in primary care settings (ie, home setting, ambulatory and nursery homes); the Intervention considered was the analysis AI and/or algorithms (ie, intelligent programs or software) application in primary care for reducing medications errors, the Comparator was the general practice and, lastly, the Outcome was the reduction of preventable medication errors (eg, overprescribing, inappropriate medication, drug interaction, risk of injury, dosing errors or in an increase in adherence to therapy). The methodological quality of included studies was appraised adopting the Quality Assessment of Controlled Intervention Studies of the National Institute of Health for randomised controlled trials.Results Studies reported in different ways the effective reduction of medication error. Ten out of 14 included studies, corresponding to 71% of articles, reported a reduction of medication errors, supporting the hypothesis that AI is an important tool for patient safety.Conclusion This study highlights how a proper application of AI in primary care is possible, since it provides an important tool to support the physician with drug management in non-hospital environments.

In the forensic medicine field, molecular autopsy is the post-mortem genetic analysis performed to attempt to unravel the cause of decease in cases remaining unexplained after a comprehensive forensic autopsy. This negative autopsy, classified as negative or non-conclusive, usually occurs in young population. In these cases, in which the cause of death is unascertained after a thorough autopsy, an underlying inherited arrhythmogenic syndrome is the main suspected cause of death. Next-generation sequencing allows a rapid and cost-effectives genetic analysis, identifying a rare variant classified as potentially pathogenic in up to 25% of sudden death cases in young population. The first symptom of an inherited arrhythmogenic disease may be a malignant arrhythmia, and even sudden death. Early identification of a pathogenic genetic alteration associated with an inherited arrhythmogenic syndrome may help to adopt preventive personalized measures to reduce risk of malignant arrhythmias and sudden death in the victim’s relatives, at risk despite being asymptomatic. The current main challenge is a proper genetic interpretation of variants identified and useful clinical translation. The implications of this personalized translational medicine are multifaceted, requiring the dedication of a specialized team, including forensic scientists, pathologists, cardiologists, pediatric cardiologists, and geneticists.

BackgroundThere currently is no evidence that COVID-19 has had an impact on the rates of psychological abuses occurring when a minor witnesses interpersonal violence.AimOur aim was to describe the accesses of the last four years to the Emergency Department of a tertiary hospital (Careggi University Hospital—Florence, Italy) due to this issue and then to evaluate whether the COVID-19 has had an impact on this trend.MethodsWe collected data regarding cases of abuse in which at least a minor had reportedly witnessed the event. Medical records stored between January 1, 2018 to January 1, 2022 were analyzed, extracting sex, age and nationality of the victim; sex of the perpetrator and relationship with the victim; known previous episodes of abuse in the medical history of the victim; setting of the abuse (domestic vs. non-domestic); type of abuse (physical, psychological, sexual); whether the perpetrator was under the influence of alcohol/drugs; whether the victim was hospitalized; prognosis of the victim; number, relation with the victim and involvement in the abuse (as co-victim) of the minor(s) who witnessed the abuse.ResultsA total of 167 eligible cases were registered. 69% of victims had previous episodes of abuse. The perpetrators were all known and mainly males (96%).The abuses were mainly domestic (79%). In 74% of the cases only a type of violence was perpetrated. In 12% of the cases, the minors were also victims of physical abuse. No statistically significant relationships were found between the start of the COVID-19 pandemic and the changes in the number of cases of domestic abuse (p = 0.07), physical abuse (p = 0.62), psychological abuse (p = 0.83) or sexual abuse (p = 0.88). However, during the institutional lockdown in Italy (March-May 2022) only two cases occurred – a number that did not allow period-specific statistical inference.ConclusionsEmpowering the hospital policies specifically aimed at identifying and protecting the victims of violence/witnessed violence remains a critical goal from both a public health and medico-legal point of view.

Purpose of the studyTo assess perception, awareness, and attitudes regarding the medico-legal relevance of child maltreatment and management of pediatric patients during the COVID-19 pandemic in a cohort of medicine and surgery students, with a particular focus on child safety and maltreatment.MethodsA cross-sectional, web-based survey was conducted through an anonymous questionnaire on the personal websites of Università Cattolica del Sacro Cuore medical students.ResultsThe study included 1,166 participants, the majority of whom were experienced with child maltreatment and defensive medicine; only a small percentage was aware of the government's efforts to prevent child maltreatment and safeguard vaccination physicians. Moreover, there was no agreement on the use of telemedicine for non-serious pediatric patients or on the consequences it might have on their health. Finally, the detrimental impacts of lockdown on children's mental health are a major worry.ConclusionsKnowledge of these themes is mainly implemented by deepening these concepts during the undergraduate studies since a high level of knowledge on child maltreatment and on the management of COVID-19 pandemic was significantly associated with clinical years of course. Specific seminars analyzing telemedicine and legislative protections concerning minors and those concerning vaccination doctors should be included in the study plan to raise awareness these concepts.

Introduction/purposeSince a significant proportion of SARS-CoV-2 infections occur within healthcare facilities, a multidisciplinary approach is required for careful and timely assessment of the risk of infection in asymptomatic patients or those whose COVID-19 diagnosis has not yet been made. The aim of this study was to investigate whether an adaptative model based on microbiological testing can represent a valid risk management strategy.Material and methodsWe collected data from the risk management unit database of a 1,550-bed tertiary hospital (Fondazione Policlinico Gemelli IRCCS, Rome, Italy) concerning pediatric admissions to the Emergency Department (ED) from 1 March 2020 to 31 December 2021. The study period was subdivided in period A and period B according to the technique used for the microbiological screening, respectively reverse-transcription polymerase chain reaction (RT-PCR) and antigen-detection test.ResultsIn Period A, 426 children (mean age: 6 years) underwent microbiological screening at the ED. The total number of molecular tests performed was 463. 459/463 tested negative at the molecular test. In Period B, 887 children (mean age: 6 years) underwent microbiological screening in the ED. The total number of molecular tests performed was 1,154. 1,117/1,154 tested negative at the molecular test. Neither in Period A nor in Period B hospital-acquired SARS-CoV-2 infections were reported.Discussion and conclusionDespite high volumes, no cases of hospital-acquired SARS-CoV-2 infection have been reported. SARS-CoV-2 antigen-based tests can be used as a first-line option as they provide rapid results compared to RT-PCR, reducing the risk of infection in ED waiting rooms.

During the Covid-19 health emergency, telemedicine was an essential asset through which health systems strengthened their response during the critical phase of the pandemic. According to the post-pandemic economic reform plans of many countries, telemedicine will not be limited to a tool for responding to an emergency condition but it will become a structural resource that will contribute to the reorganization of Healthcare Systems and enable the transfer of part of health care from the hospital to the home-based care. However, scientific evidences have shown that health care delivered through telemedicine can be burdened by numerous ethical and legal issues. Although there is an emerging discussion on patient safety issues related to the use of telemedicine, there is a lack of reseraches specifically designed to investigate patient safety. On the contrary, it would be necessary to determine standards and specific application rules in order to ensure safety. This paper examines the telemedicine-risk profiles and proposes a position statement for clinical risk management to support continuous improvement in the safety of health care delivered through telemedicine.

Undiagnosed interventricular anatomic variants are not usually associated with sudden death or other cardiac conditions. We present images of a sieve-like interventricular fruste septal anatomic variant that was associated with sudden death in an otherwise healthy 48-year-old man.

Several authors worldwide have reported a significant decrease in hospital admissions for acute coronary syndromes (ACSs) during the most recent months of the COVID-19 outbreak. The causes of this pattern and its impact on patients and hospital management have been studied. We conducted a monocentric, observational, retrospective study aimed at evaluating consecutive patients discharged from our local network with a diagnosis of ACS from the 20th of February 2020 to the 30th of April 2020. 201 patients with ACS were included in the analysis. The number of patients with NSTE (Non-ST elevation)-ACS dropped from 84 (65%) in 2019 to 21 (44.4%) in 2020 (62% reduction, p < 0.01), while more patients with a diagnosis of STEMI were admitted in 2020. 38 composite events were observed in 2020, while only 34 patients were free from events. Conversely, in the 2019 ACS group, 37 events were recorded, while 92 patients did not develop any events (RR 1.82; 1.29- 2.6 95% CI; p< 0.01). Delay in diagnosis and treatment of patients with ACS has a significant impact on public health costs and sustainability of care, since it is associated with a significant increase in short-term complications and deaths. Public health messaging and proper healthcare services organization should play a crucial role in adjusting the system to the new needs of public health.

Introduction In primary care, almost 75% of outpatient visits by family doctors and general practitioners involve continuation or initiation of drug therapy. Due to the enormous amount of drugs used by outpatients in unmonitored situations, the potential risk of adverse events due to an error in the use or prescription of drugs is much higher than in a hospital setting. Artificial intelligence (AI) application can help healthcare professionals to take charge of patient safety by improving error detection, patient stratification and drug management. The aim is to investigate the impact of AI algorithms on drug management in primary care settings and to compare AI or algorithms with standard clinical practice to define the medication fields where a technological support could lead to better results.Methods and analysis A systematic review and meta-analysis of literature will be conducted querying PubMed, Cochrane and ISI Web of Science from the inception to December 2021. The primary outcome will be the reduction of medication errors obtained by AI application. The search strategy and the study selection will be conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the population, intervention, comparator and outcome framework. Quality of included studies will be appraised adopting the quality assessment tool for observational cohort and cross-sectional studies for non-randomised controlled trials as well as the quality assessment of controlled intervention studies of National Institute of Health for randomised controlled trials.Ethics and dissemination Formal ethical approval is not required since no human beings are involved. The results will be disseminated widely through peer-reviewed publications.

Sepsis is one of the leading causes of death even in the tertiary hospitals of Western Countries and sepsis-related in-hospital mortality contributes to define hospital performance and quality of care. A better understanding of its epidemiological and pathological characteristics seems the key to tailor public health interventions aimed at reducing its incidence, morbidity and mortality. A retrospective analysis of 109 autoptic cases of inpatients that acquired sepsis in a tertiary hospital was performed. In particular, we identified and analysed the recurrent anamnestic/clinical factors and histopathological features. The most common continuous foci were due to respiratory infections. Subendocardial myocardial ischaemia was the clinical cause of death in 56.8% of the study population. An inflammatory infiltrate was identified in specimens of the lung (28.4%), liver (28%), heart (23.5%) and kidneys (15%). Common findings were arteriosclerosis and atherosclerosis (57%), steatosis (24.5%), diffluent spleen (18%) and colliquation of adrenal glands (16.6%). The comorbidities and the autoptic features founded are consistent with the previous evidences in sepsis field. Clinical autopsy is certainly a useful tool to collect data on sepsis, but we did not find any feature that can be considered specific or sensitive for the diagnosis of sepsis. More efforts should be made in the direction of a multidisciplinary approach to in-hospital sepsis autopsies to grant pathologists a key role in the management of claims and clinical risk.

Artificial intelligence needs big data to develop reliable predictions. Therefore, storing and processing health data is essential for the new diagnostic and decisional technologies but, at the same time, represents a risk for privacy protection. This scoping review is aimed at underlying the medico-legal and ethical implications of the main artificial intelligence applications to healthcare, also focusing on the issues of the COVID-19 era. Starting from a summary of the United States (US) and European Union (EU) regulatory frameworks, the current medico-legal and ethical challenges are discussed in general terms before focusing on the specific issues regarding informed consent, medical malpractice/cognitive biases, automation and interconnectedness of medical devices, diagnostic algorithms and telemedicine. We aim at underlying that education of physicians on the management of this (new) kind of clinical risks can enhance compliance with regulations and avoid legal risks for the healthcare professionals and institutions.

La Ley de Costas 2/2013 extiende las concesiones de las construcciones que ocupan el dominio público marítimo terrestre (DPMT) hasta un máximo de 75 años, lo que supone una falta de visión ante los efectos del cambio climático asociados al incremento del nivel del mar y la mayor recurrencia de los temporales marítimos. El presente trabajo realiza un diagnóstico sobre el problema de la ocupación de la franja costera en el litoral sur de la provincia de Alicante. Se analizan los efectos de la borrasca Gloria (enero de 2020), el grave problema de regresión de las playas y el riesgo de inundación en las viviendas que ocupan el DPMT. Los resultados muestran el grave riesgo de inundación que presentan las playas de Babilonia, La Mata, Las Villas y El Mojón. Se realizan propuestas en diferentes materias que permitirían la recuperación de las playas con el grave problema de la regresión y la adaptación al cambio climático.

Purpose: To evaluate the usefulness of studying vital injuries at the sternal head insertion of the sternocleidomastoid muscle in the medico-legal assessment of death by hanging. Materials and Methods: Study material was obtained from eight bodies of people who died from hanging. The control group included as many specimens collected from people who died from traumatic causes other than hanging (precipitation from medium to large heights and traffic accidents). The structures under study were examined histologically with a BX-51 light microscope (Olympus). An analysis of the extravasated erythrocytes was performed by counting the number per mm2 in the histologic section on 10 HPF (400×), and Student’s t-test for a comparison of the averages was applied for all parametric values. The authors noted that the key finding, indicative of the subject’s viability at the time of discontinuation, was the presence of recent hemorrhagic infiltrate (in the absence of hemosiderin) at the tendon insertion of the sternocleidomastoid muscle and the proximal part of the muscle itself. Results: All specimens tested were positive for the presence of hemorrhagic infiltrate at the portions tested in a statistically significant manner. In contrast, in the control cases there was no or, where present, no statistically significant (p < 0.05) presence of recent hemorrhagic infiltrate. The limitation of the study is the low number of samples examined. In any case, the results obtained are strongly indicative of the possibility of using this type of forensic pathological investigation in cases where there is a doubt in terms of a differential diagnosis between hanging (suicidal type) and suspension of a corpse in a simulation of hanging.

At the onset of the SARS-CoV-2 pandemic, individual and social measures were strengthened through restrictive non-pharmaceutical interventions, labelled with the term “lockdown”. In Italy, there were two lockdowns (9 March 2020–3 May 2020 and 3 November 2020–27 March 2021). As part of preventive measures, healthcare workers and the administrative staff population of Policlinico A. Gemelli underwent nasopharyngeal swab tests from 1 March 2020 to 9 February 2022, a long time interval that includes the two aforementioned lockdowns. The population included 8958 people from 1 March 2020 to 31 December 2020; 8981 people from 1 January 2021 to 31 December 2021; and 8981 people from 1 January 2022 to 9 February 2022. We then analysed pseudo-anonymized data, using a retrospective observational approach to evaluate the impact of the lockdown on the incidence of SARS-CoV-2 infections within the population. Given the 14 day contagious period, the swab positivity rate (SPR) among the staff decreased significantly at the end of the first lockdown, every day prior to 18 May 2020, by 0.093 (p < 0.0001, CI = (−0.138–−0.047)). After the fourteenth day post the end of the first lockdown (18 May 2020), the SPR increased daily at a rate of 0.024 (p < 0.0001, 95% CI = (0.013–0.034)). In addition, the SPR appeared to increase significantly every day prior to 17 November 2020 by 0.024 (p < 0.0001, CI = (0.013–0.034)). After the fourteenth day post the start of the second lockdown (17 November 2020), the SPR decreased daily at a rate of 0.039 (p < 0.0001, 95% CI = (−0.050–−0.027)). These data demonstrate that, in our Institution, the lockdowns helped to both protect healthcare workers and maintain adequate standards of care for COVID and non-COVID patients for the duration of the state of emergency in Italy.

La rambla de Abanilla es un curso fluvial del sureste ibérico, generalmente seco, que se reactiva en momentos de precipitaciones intensas, generando anegaciones en su tramo final, en la Vega Baja del Segura (Alicante). El objetivo de esta investigación es determinar el grado de peligrosidad existente en los municipios del tramo bajo que fueron afectados en el episodio de septiembre de 2019. Se realiza una modelización del cauce y una serie mapas temáticos, cuyo resultado ha sido una cartografía de peligrosidad de inundación. Los resultados obtenidos muestran un nivel elevado de peligrosidad en el curso final del cauce (mayor que el realizado en la cartografía oficial existente SNCZI y PATRICOVA). Se analizan las propuestas que se han ido planteando tras cada evento de inundación por parte de diferentes organismos, y se proponen una serie de actuaciones para reducir la peligrosidad en los diferentes tramos de la rambla de Abanilla. La recuperación de sistemas tradicionales de riego se presenta como una posibilidad para reducir caudales de crecida y transformar el riesgo en un recurso, además de ser una medida de adaptación en el actual contexto de cambio climático.

ABSTRACT: Background: Accurate interpretation of rare genetic variants is a challenge for clinical translation. Updates in recommendations for rare variant classification require the reanalysis and reclassification. We aim to perform an exhaustive re-analysis of rare variants associated with inherited arrhythmogenic syndromes, which were classified ten years ago, to determine whether their classification aligns with current standards and research findings. Methods: In 2010, the rare variants identified through genetic analysis were classified following recommendations available at that time. Nowadays, the same variants have been reclassified following current American College of Medical Genetics and Genomics recommendations. Findings: Our cohort included 104 cases diagnosed with inherited arrhythmogenic syndromes and 17 post-mortem cases in which inherited arrhythmogenic syndromes was cause of death. 71.87% of variants change their classification. While 65.62% of variants were classified as likely pathogenic in 2010, after reanalysis, only 17.96% remain as likely pathogenic. In 2010, 18.75% of variants were classified as uncertain role but nowadays 60.15% of variants are classified of unknown significance. Interpretation: Reclassification occurred in more than 70% of rare variants associated with inherited arrhythmogenic syndromes. Our results support the periodical reclassification and personalized clinical translation of rare variants to improve diagnosis and adjust treatment. Funding: Obra Social ''La Caixa Foundation'' (ID 100010434, LCF/PR/GN16/50290001 and LCF/PR/GN19/50320002), Fondo Investigacion Sanitaria (FIS PI16/01203 and FIS, PI17/01690), Sociedad Española de Cardiología, and “Fundacio Privada Daniel Bravo Andreu”. Keywords: Sudden cardiac death, Arrhythmias, Pathogenicity, Genetics

Follicular cysts develop from the enamel epithelium of an un-erupted tooth. Two cases of extremely large and extended follicular cysts related to the upper impacted third molars in young patients and treatments are described. Case 1 Female, aged 16 with swelling of the right cheek and oral vestibule, right exophthalmos and diplopia. Spiral Computed Tomography (CT) showed a massive lesion occupying the maxillary sinus with extension into the pterygo-maxillary space, due to the destruction of the posterior antral bone wall. Above the lesion was compressing the orbital floor. Transantral surgical excision was performed approaching to the pterygo-maxillary space and orbital structure also using the operating microscope. 5-years follow-up shows good restoring of the involved structures without relapse. Case 2 - Female, aged 22, with swelling of the left cheek and oral vestibule, left nasal obstruction, orbital pain and diplopia. Spiral CT-MR integrated study allowed a very accurate analysis: the lesion occupied the entire maxillary sinus, the pterygo-maxillary space, the left nasal cavity, ethmoidal structures with posterior orbital compression. Transantral surgical excision was performed approaching to the pterygo-maxillary space; nasal-ethmoidal and orbital structures were approached by endoscopic technique. Follow-up shows good clinical, anatomical and functional conditions. Histological examination confirmed in both cases the diagnosis of follicular cyst. Giant follicular cysts require an accurate preoperative study due to the delicate structures that may be involved. In the reported cases, the operating microscope and endoscopic surgical procedures were needed in the delicate surgical steps to perform the detachment in deep areas.

Insanity defense is sometimes invoked in criminal cases, and its demonstration is usually based on a multifactorial contribution of behavioural, clinical, and neurological elements. Neuroradiological evidence of structural alterations in cerebral areas that involve decision-making and moral reasoning is often accepted as a useful tool in these evaluations. On the other hand, the genetic predisposition to anti-social behavior is still controversial. In this paper, we describe two cases of violent crimes committed by young carriers of genetic variants associated with personality disorder; both the defendants claimed to be insane at the time of the crime. We discuss these cases and review the scientific literature regarding the relationship between legal incapacity/predisposition to criminal behavior and genetic mutations. In conclusion, despite some genetic variants being able to influence several cognitive processes (like moral judgement and impulse control), there is currently no evidence that carriers of these mutations are, per se, incapable of intentionally committing crimes.

Energy system models for the analysis of future scenarios are mainly driven by the set of energy service demands that define the broad outlines of socio-economic development throughout the model time horizon. Here, the long-term effects of the COVID-19 pandemic on the drivers of the industrial production in six energy-intensive subsectors are addressed using Vector AutoRegressive models. The model results are computed either considering or not considering the effects of the pandemic. The comparison to established pre-pandemic trends allows for validating the robustness of the selected model. The anticipated effect of the pandemic to 2040 shows a long-term reduction by 3% to 10%, according to the different subsector, in the industrial energy service demand. When the computed service demands are used as input to the TIMES-Italy model, which shows good capability to reproduce the energy consumption of the industrial sectors in the period 2006–2020, the impact of the pandemic on energy consumption forecasts can be assessed in a business-as-usual scenario. The results show how the long-term effects of the shock caused by the pandemic could lead, by 2040, to a total industrial energy consumption 5% lower than what was foreseen before the pandemic, while the energy mix remains almost unchanged.

Existe una tentación de rememorar acontecimientos de trascendencia mundial por el mismo hecho conmemorativo, como una forma de historiar a través de las efemérides. Y el año 2017 invita a hacerlo con las Revoluciones Rusas de febrero y octubre de 1917. La realización de congresos internacionales, es otra muestra de lo que se va a producir este año en cuanto a la problemática de debate, actualización e intercambio de ideas, tanto desde la perspectiva historiográfica como posiblemente también en la profundización de algunas líneas de análisis que aún no han sido lo suficientemente abordadas o la puesta en tensión de algunas otras que se han dado por cristalizadas, pero que sin embargo deberán ser revisadas.Así con el aniversario en marcha y con la realización del Congreso Internacional a 100 años de la Revolución Rusa en Rosario buscamos poner en debate el estudio del proceso revolucionario ruso, o tal vez contribuir al inicio de una posible revisión necesaria del mismo.

En 1917 los soviets de obreros y soldados y las organizaciones revolucionarias encabezadas por el Partido Bolchevique, provocaron un vuelco sustancial en la vida política rusa al comenzar a controlar el poder político en los principales núcleos urbanos del país, poniendo fin a la experiencia del Gobierno provisional que había continuado con la presencia rusa en la Guerra Mundial, abriendo así la posibilidad de una primera fase en la construcción del socialismo. Sin embargo, la Guerra civil que se cernió sobre el territorio del ex imperio zarista y que enfrento a los ejércitos de las fuerzas revolucionarias contra los bolsones de resistencia contrarrevolucionaria a partir de 1918, terminó de agotar las fuerzas productivas de una incipiente industria. Al término de la contienda, la desesperada situación de la economía soviética desbrozó el camino para que se intentaran implementar una serie de experiencias de planificación de la producción en el marco de la Nueva Política Económica (NEP) que contemplaba el desarrollo de la industrialización gradual, pero basada en el indispensable aumento de la productividad y la racionalización de la organización productiva fabril. La incidencia de las ideas organizacionales de Taylor, que ya habían influido en la dirigencia bolchevique en los años de la guerra civil como formas de reorganización racional de la producción, fueron introducidos en las directivas de los organismos de planificación con cierto grado de eficacia. El trabajo intenta relevar los trazos generales de esta implementación en las fábricas, sus dificultades de traslación al ámbito productivo, y, por último, los debates y disidencias que su implementación ocasionó en la sociedad soviética. Palabras clave: Revolución Rusa; Industrialización; Organización científica del trabajo; taylorismo

Reseña de Enzo Traverso, Melancolía de izquierda. Marxismo, historia y memoria, México: FCE, 2018, 416 pgs.

Sudden death (SD) is defined as the unexpected natural death occurred within an hour after the onset of symptoms or from the last moment the subject has been seen in a healthy condition. Brugada syndrome (BrS) is one of the most remarkable cardiac causes of SD among young people. We report the case of a 20-year-old man who suddenly died after reportedly having smoked cannabis. Autopsy, toxicology, and genetic testing were performed. Autopsy found a long and thick myocardial bridging (MB) at 2 cm from the beginning of the left anterior descending coronary artery. Furthermore, at the histopathological examination, fibrosis and disarray in myocardial area above the MB, fatty tissue in the right ventricle and fibrosis of the sino-atrial node area were found. Toxicology testing was inconclusive, while genetic testing found a rare missense variant of the TTN gene, classified as likely benign, and a variant of unknown significance in the SLMAP gene (a gene that can be associated with BrS). Hence, despite several atypical features were found, no inference on the cause of the death could be made under current evidence.

Abusive head trauma (AHT) represents a commonly misdiagnosed condition. In fact, there is no pathognomonic sign that allows the diagnosis in children. Therefore, it is such an important medico-legal challenge to evaluate reliable diagnostic tools. The aim of this review is to evaluate the current scientific evidence to assess what the best practice is in order to diagnose AHT. We have focused particularly on evaluating the importance of circumstantial evidence, clinical history, the use of postmortem radiological examinations (such as CT and MRI), and the performance of the autopsy. After autopsy, histological examination of the eye and brain play an important role, with attention paid to correlation with symptoms found in vivo.

Reseña de Marcello Musto (ed.) y otros, De regreso a Marx: nuevas lecturas y vigencia en el mundo actual, Buenos Aires: Octubre Editorial, 2015, 432 pgs.

Sudden unexpected death in epilepsy is an unpredicted condition in patients with a diagnosis of epilepsy, and autopsy does not conclusively identify cause of death. Although the pathophysiological mechanisms that underlie this entity remain unknown, the fact that epilepsy can affect cardiac function is not surprising. The genetic factors involving ion channels co-expressed in the heart and brain and other candidate genes have been previously described. In the present study, 20 epilepsy patients with personal or family history of heart rhythm disturbance/cardiac arrhythmias/sudden death were sequenced using a custom re-sequencing panel. Twenty-six relatives were genetically analysed to ascertain the family segregation in ten individuals. Four subjects revealed variants with positive genotype-phenotype segregation: four missense variants in the CDKL5, CNTNAP2, GRIN2A and ADGRV1 genes and one copy number variant in KCNQ1. The potential pathogenic role of variants in new candidate genes will need further studies in larger cohorts, and the evaluation of the potential pathogenic role in the cardio-cerebral mechanisms requires in vivo/in vitro studies. In addition to family segregation, evaluation of the potential pathogenic roles of these variants in cardio-cerebral mechanisms by in vivo/in vitro studies should also be performed. The potential pathogenic role of variants in new candidate genes will need further studies in larger cohorts.

Reseña de Martín Cortés, Un nuevo marxismo para América Latina. José Aricó: traductor, editor, intelectual, Buenos Aires: Siglo XXI, 2015, 264 pgs.

En los años de la Primera Guerra Mundial, el modelo agroexportador argentino se resintió y mostró signos de una profunda recesión.Entre los sectores estratégicos estrechamente vinculados al funcionamiento del modelo con dificultades para la reinversión de capital se encontraban las empresas ferrocarrileras. A mediados de 1917, en la salida del ciclo recesivo,los obreros descalificados y mal remunerados de los astilleros y talleres de la empresa Central Argentino, con centro en Rosario y Pérez, comenzaron un conflicto contra la disminución de los días de trabajo. El artículo reflexiona sobre la composición de clase de los trabajadores en conflicto, el ciclo de alzas y bajas de la lucha y las divergencias en las líneas político-gremiales que intervinieron en la misma.

Gonzalo Pérez Álvarez, Patagonia. Conflictividad social y neoliberalismo. El noroeste de Chubut (1990-2005), Buenos Aires, Imago Mundi, 2013, 358 págs.

Reseña de Alejandro Jasinski, Revuelta obrera y masacre en La Forestal. Sindicalización y violencia empresaria en tiempos de Yrigoyen, Biblos, Buenos Aires, 2013, 278 págs.

Background Data on the benefits of cardiac resynchronization therapy (CRT) in patients with severe heart failure symptoms are limited. We investigated the relative effects of CRT in patients with ambulatory New York Heart Association (NYHA) IV versus III functional class at the time of device implantation. Methods and Results In this meta‐analysis, we pooled patient‐level data from the MIRACLE (Multicenter InSync Randomized Clinical Evaluation), MIRACLE‐ICD (Multicenter InSync Implantable Cardioversion Defibrillation Randomized Clinical Evaluation), and COMPANION (Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure) trials. Outcomes evaluated were time to the composite end point of the first heart failure hospitalization or all‐cause mortality, and time to all‐cause mortality alone. The association between CRT and outcomes was evaluated using a Bayesian hierarchical Weibull survival regression model. We assessed if this association differed between NYHA III and IV groups by adding an interaction term between CRT and NYHA class as a random effect. A sensitivity analysis was performed by including data from RAFT (Resynchronization‐Defibrillation for Ambulatory Heart Failure). Our pooled analysis included 2309 patients. Overall, CRT was associated with a longer time to heart failure hospitalization or all‐cause mortality (adjusted hazard ratio [aHR], 0.79 [95% credible interval [CI], 0.64–0.99]; posterior probability or P=0.044), with a similar association with time to all‐cause mortality (aHR, 0.78 [95% CI, 0.59–1.03]; P=0.083). Associations of CRT with outcomes were not significantly different for those in NYHA III and IV classes (ratio of aHR, 0.72 [95% CI, 0.30–1.27]; P=0.23 for heart failure hospitalization/mortality; ratio of aHR, 0.70 [95% CI, 0.35–1.34]; P=0.27 for all‐cause mortality alone). The sensitivity analysis, including RAFT data, did not show a significant relative CRT benefit between NYHA III and IV classes. Conclusions Overall, there was no significant difference in the association of CRT with either outcome for patients in NYHA functional class III compared with functional class IV.

Climate change is one of the most important problems facing society in the 21st century. Despite the uncertainty about the behaviour of rainfall due to climate change, what is clear is that average rainfall has been reduced in the inland areas and headwaters of Spain's river basins. The Tagus basin is one of the most affected, with implications for the Jucar and Segura basins. The working hypothesis is to corroborate with the data collected on the effects of climate change on the TTS. To this end, the following methodology has been applied: (a) analysis in the headwaters of the Tagus, using data on precipitation, surface runoff and reservoir water; (b) analysis of the resources of the Segura basin (supply and demand), based on the basin organisation's own data; (c) construction of a water balance adjusted to the Bajo Segura district (Alicante), a user of the water transferred for agricultural use. Likewise, the data provided by the basin organisation have made it possible to corroborate the data on consumption and allocation of the corresponding volumes of water. The results obtained make it possible to put forward a novel proposal in the scientific field related to hydrological planning based on the principles of sustainability. [ABSTRACT FROM AUTHOR]

Background and aimsCOVID-19 vaccination has proved to be effective to prevent symptomatic infection and severe disease even in immunocompromised patients including liver transplant patients. We aim to assess the impact of COVID-19 vaccination on the mortality and development of severe and critical disease in our center.MethodsA retrospective cohort study of LT patients in a reference center between March 2020 and February 2022. Demographic data, cirrhosis etiology, time on liver transplantation, immunosuppressive therapies, and vaccination status were recorded at the time of diagnosis. Primary outcome was death due to COVID-19, and secondary outcomes included the development of severe COVID-19 and intensive care unit (ICU) requirement.Results153 of 324 LT recipients developed COVID-19, in whom the main causes of cirrhosis were HCV infection and metabolic-associated fatty liver disease. The vaccines used were BNT162b2 (48.6%), ChAdOx1 nCoV-19 (21.6%), mRNA-1273 vaccine (1.4%), Sputnik V (14.9%), Ad5-nCoV-S (4.1%) and CoronaVac (9.5%). Case fatality and ICU requirement risk were similar among vaccinated and unvaccinated LT patients (adjusted relative case fatality for vaccinated versus unvaccinated of 0.68, 95% CI 0.14-3.24, p = 0.62; adjusted relative risk [aRR] for ICU requirement of 0.45, 95% CI 0.11-1.88, p = 0.27). Nonetheless, vaccination was associated with a lower risk of severe disease (aRR for severe disease of 0.32, 95% CI 0.14-0.71, p = 0.005).ConclusionsVaccination reduces the risk of severe COVID-19 in LT patients, regardless of the scheme used. Vaccination should be encouraged for all.

Background: Iron overload is frequent in patients with chronic liver disease, associated with shorter survival after liver transplantation in patients with hereditary hemochromatosis. Its effect on patients without hereditary hemochromatosis is unclear. The aim of the study was to study the clinical impact of iron overload in patients who underwent liver transplantation at an academic tertiary referral center. Methods: We performed a retrospective cohort study including all patients without hereditary hemochromatosis who underwent liver transplantation from 2015 to 2017 at an academic tertiary referral center in Mexico City. Explant liver biopsies were reprocessed to obtain the histochemical hepatic iron index, considering a score >- 0.15 as iron overload. Baseline characteristics were compared between patients with and without iron overload. Survival was estimated using the Kaplan-Meier method, compared with the log-rank test and the Cox proportional hazards model. Results: Of 105 patients included, 45% had iron overload. Viral and metabolic etiologies, alcohol consumption, and obesity were more frequent in patients with iron overload than in those without iron overload (43% vs. 21%, 32% vs. 22%, p = 0.011; 34% vs. 9%, p = 0.001; and 32% vs. 12%, p = 0.013, respectively). Eight patients died within 90 days after liver transplantation (one with iron overload). Complication rate was higher in patients with iron overload versus those without iron overload (223 vs. 93 events/100 personmonths; median time to any complication of 2 vs. 3 days, p = 0.043), without differences in complication type. Fatality rate was lower in patients with iron overload versus those without iron overload (0.7 vs. 4.5 deaths/100 person-months, p = 0.055). Conclusion: Detecting iron overload might identify patients at risk of early complications after liver transplantation. Further studies are required to understand the role of iron overload in survival.

Background: Dysphagia is the most frequent symptom in patients diagnosed with esophageal cancer. Self-expanding metal stents (SEMS) are the current palliative treatment of choice for dysphagia in patients with non-curable esophageal cancer. This study aimed to evaluate the efficacy and adverse events (AEs) of different types of SEMS for palliation of dysphagia. Methods: We performed a retrospective cohort study of patients with advanced esophageal cancer and SEMS placement for dysphagia palliation in a tertiary care center. The primary outcome was the clinical success defined as an improvement in dysphagia (reduction of at least 2 points in the Mellow–Pinkas scoring system for dysphagia) after SEMS placement. Results: Between January 1999 and May 2020, 295 patients with esophageal cancer were identified. Among them, 75 had a SEMS placement for dysphagia palliation. The mean age of the patients was 61.3 years (standard deviation: 13.4), 69 patients (92%) were men, and the mean Mellow–Pinkas scoring for dysphagia pre- and post-SEMS placement were 3.1 and 1.4 (change from baseline −1.7), respectively. Technical success and clinical success were achieved in 98.6% and 58.9%, respectively. AEs were identified in 35/75 patients (46.7%), and SEMS migration was the most frequent AE in 22/75 patients (29.3%). There were no significant differences in improvement in dysphagia ( p = 0.054), weight changes ( p = 0.78), and AE ( p = 0.73) among fully covered SEMS (fc-SEMS) and partially covered SEMS (pc-SEMS). The median follow-up was 89 days (interquartile range: 29–221). Conclusion: SEMS placement was associated with a rapid improvement in dysphagia, high technical success, and a modest improvement in dysphagia with no major AE among fc-SEMS and pc-SEMS.

Objective. To characterize the impact of Mexico’s Co­vid-19 vaccination campaign of older adults. Materials and methods. We estimated the absolute change in sympto­matic cases, hospitalizations and deaths for vaccine-eligible adults (aged >60 years) and the relative change compared to vaccine-ineligible groups since the campaign started. Re­sults. By May 3, 2021, the odds of Covid-19 cases among adults over 60 compared to 50-59 year olds decreased by 60.3% (95%CI: 53.1, 66.9), and 2 003 cases (95%CI: 1 156, 3 130) were avoided. Hospitalizations and deaths showed similar trends. Conclusions. Covid-19 events decreased after vaccine rollout among those eligible for vaccination.

Abstract Background The COVID-19 pandemic has brought unprecedented changes to medical education. However, no data are available regarding the impact the pandemic may have on medical training in Mexico. The aim of our study was to evaluate and identify the medical school students’ perceptions of the changes in their clinical training due to the pandemic in Mexico. Methods This was a cross-sectional study where a previous validated online survey was translated and adapted by medical education experts and applied to senior medical students from March to April of 2021. The 16-item questionnaire was distributed online combining dichotomous, multiple-choice, and 5-point Likert response scale questions. Descriptive and multivariate analyses were performed to compare the student’s perceptions between public and private schools. Results A total of 671 responses were included in the study period. Most participants were from public schools (81%) and female (61%). Almost every respondent (94%) indicated it was necessary to obtain COVID-19 education, yet only half (54%) received such training. Students in private schools were less likely to have their clinical instruction canceled (53% vs. 77%, p = 0.001) and more likely to have access to virtual instruction (46% vs. 22%, p = 0.001) when compared to students from public schools. Four out of every five students considered their training inferior to that of previous generations, and most students (82%) would consider repeating their final year of clinical training. Conclusions The impact of the COVID-19 on medical education in Mexico has been significant. Most final-year medical students have been affected by the cancellation of their in-person clinical instruction, for which the majority would consider repeating their final year of training. Efforts to counterbalance this lack of clinical experience with virtual or simulation instruction are needed.

Background and Aims: Metabolic-associated fatty liver disease (MAFLD) is a leading cause of chronic liver disease. Nowadays, the prevalence of MAFLD in Mexico is unknown with no screening point-of-care tools. We aimed to estimate the prevalence of MAFLD in Mexico and to develop a score for MAFLD screening. Methods: We conducted a cross-sectional study in 5 Mexican states, including adult subjects evaluated in checkup campaigns. Subjects underwent a liver ultrasound to look for hepatic steatosis. Based on the most clinically relevant variables associated with MAFLD, we developed the MAFLD-screening score (MAFLD-S). Discrimination and calibration of the score were evaluated using the area under the ROC curve and observed vs predicted plots, respectively. Results: We included 3357 participants (60% female, mean age 47 ± 12 years). Fifty-two percent had hepatic steatosis, and 47% met MAFLD criteria. Subjects with MAFLD were older (48 ± 11 vs 45 ± 13 years, P < .001), were more frequently males (43% vs 36%, P < .001), and had a higher body mass index (31.6 + 4.9 vs 25.6 + 3.8 kg/m2, P < .001) than subjects without MAFLD. The MAFLD-S includes age, body mass index, gender, diabetes, hypertension, and dyslipidemia and has an area under the curve of 0.852, 95% CI = 0.828–0.877, with a sensitivity of 78.8% and a specificity of 82.8% for the optimal cutoff. Using data from the National Health and Nutrition Survey 2018–2019, we predicted a MAFLD national prevalence of 49.6%. Conclusion: Nearly half of the Mexican population has MAFLD, representing a present and future challenge. With external validation, the MAFLD-S could be a valuable and practical screening tool.

Background: Early post-liver transplant (LT) acute kidney injury (AKI) has been associated with worse short-term and long-term outcomes, but the incidence and risk factors in our population are unknown. Methods: We designed a prospective, singlecenter, longitudinal cohort study to determine the incidence of AKI during the immediate postoperative period of LT, and to identify the risk factors associated with AKI after LT. Pre-operative and intraoperative variables were analyzed to determine if there was any correlation with the development of post-operative AKI. Results: Eighty-six patients were included in the final analysis; from them, 45 (52%) developed AKI in the following 30 days after LT. The presence of hepatic encephalopathy prior to LT was the factor most strongly associated with the development of AKI (Relative Risk 3.67, 95% Confidence Interval 1.08-8.95). Other factors associated with AKI development were male gender and a higher serum lactate during surgery. Conclusion: AKI was a frequent complication that significantly worsened the prognosis of LT recipients and was associated with an increased 30-day mortality rate. The presence of hepatic encephalopathy strongly predicted the development of severe AKI.