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Introduction Thrombectomy in the carotid artery territory was recently shown to be effective up to 24 hours after symptoms onset. Methods We conducted a retrospective review of a prospective registry of patients treated at our stroke reference centre between November 2016 and April 2019 in order to assess the safety and effectiveness of mechanical thrombectomy performed beyond 6 hours after symptoms onset in patients with acute ischaemic stroke and large vessel occlusion in the carotid artery territory. Results Data were gathered from 59 patients (55.9% women; median age, 71 years). In 33 cases, stroke was detected upon awakening; 57.6% of patients were transferred from another hospital. Median baseline NIHSS score was 16, and median ASPECTS score was 8, with 94.9% of patients presenting > 50% of salvageable tissue. Satisfactory recanalisation was achieved in 88.1% of patients, beyond 24 hours after onset in 5 cases. At 90 days of follow-up, 67.8% were functionally independent; those who were not were older and presented higher prevalence of atrial fibrillation, greater puncture-to-recanalisation time, and higher NIHSS scores, both at baseline and at discharge. Conclusion In our experience, mechanical thrombectomy beyond 6 hours was associated with good 90-day functional outcomes. Age, NIHSS score, puncture-to-recanalisation time, and presence of atrial fibrillation affected functional prognosis. The efficacy of the treatment beyond 24 hours after onset merits study.

Resumen Introduccion La neuropatia hereditaria con paralisis sensible a la presion (NHPP) es una alteracion autosomica dominante, con episodios recurrentes de mononeuropatia en nervios susceptibles de compresion tipicos, con caracteristicas neurofisiologicas comunes. Sin embargo, se han comunicado otras presentaciones clinicas y neurofisiologicas. Metodos Analisis de caracteristicas clinicas y neurofisiologicas en una revision retrospectiva de 20 pacientes con NHPP confirmados geneticamente, de los cuales, 16 se estudiaron en nuestro servicio entre los anos 1996 y 2016. Resultados Ademas de las caracteristicas tipicas de la NHPP, encontramos formas atipicas como sintomas sensitivos recurrentes posicionales en 3 pacientes, polineuropatia sensitivo motora cronica en uno y mononeuropatia no evolutiva en otro. Dos pacientes empezaron en edad temprana, uno a los 7 anos, con lesion del ciatico popliteo externo y otro al nacer, con afectacion de plexo braquial. Las principales alteraciones de la conduccion nerviosa que se encontraron fueron: la disminucion de la velocidad de conduccion sensitiva con rangos del 84% en el sural y 94% en el mediano y peroneo superficial, descenso de la velocidad de conduccion motora del nervio cubital a traves del codo en el 97% y el incremento de la latencia distal motora del nervio mediano y ciatico popliteo externo en el 74%. Conclusion De acuerdo con los resultados, confirmamos la variabilidad clinica de la NHPP y encontramos los hallazgos mas frecuentes en la conduccion nerviosa, la disminucion generalizada de la velocidad de conduccion sensitiva, ademas de la afectacion motora principalmente en lugares susceptibles de compresion, y detectamos los casos tipicos, atipicos y asintomaticos de esta en entidad.

A 9-year-old 6-kg male castrated mixed-breed dog was admitted to the hospital as a second opinion for left-sided nephrectomy. Plain radiographs, ultrasound, excretory urography and retrograde urethrography revealed left-sided hydronephrosis and calculi in the bladder and urethra. The urethral calculi were hydropropulsed into the bladder and nephrectomy and cystotomy were performed. Three days after surgery, the patient showed preputial inflammation, pain and pollakiuria. Retrograde urethrography was repeated and extra-urethral leakage of contrast medium into the penile tissue was identified, followed by filling of the draining veins, reaching the caudal vena cava, with subsequent opacification of the right renal pelvis and ureter and opacification of a lymph node. The dog improved during hospitalisation and a retrograde urography performed 6 months after the initial surgery confirmed full recovery.

Background Moderate/severe cases of COVID-19 present a dysregulated immune system with T cell lymphopenia and a hyper-inflammatory state. This is a study protocol of an open-label, multi-center, double-arm, randomized, dose-finding phase I/II clinical trial to evaluate the safety, tolerability, alloreactivity, and efficacy of the administration of allogeneic memory T cells and natural killer (NK) cells in COVID-19 patients with lymphopenia and/or pneumonia. The aim of the study is to determine the safety and the efficacy of the recommended phase 2 dose (RP2D) of this treatment for patients with moderate/severe COVID-19. Methods In the phase I trial, 18 patients with COVID-19-related pneumonia and/or lymphopenia with no oxygen requirement or with an oxygen need of ≤ 2.5 liters per minute (lpm) in nasal cannula will be assigned to two arms, based on the biology of the donor and the patient. Treatment of arm A consists of the administration of escalating doses of memory T cells, plus standard of care (SoC). Treatment of arm B consists of the administration of escalating doses of NK cells, plus SoC. In the phase II trial, a total of 182 patients with COVID-19-related pneumonia and/or lymphopenia requiring or not oxygen supplementation but without mechanical ventilation will be allocated to arm A or B, considering HLA typing. Within each arm, they will be randomized in a 1:1 ratio. In arm A, patients will receive SoC or RP2D for memory T cells plus the SoC. In arm B, patients will receive SoC or RP2D for NK cells plus the SoC. Discussion We hypothesized that SARS-CoV-2-specific memory T-lymphocytes obtained from convalescent donors recovered from COVID-19 can be used as a passive cell immunotherapy to treat pneumonia and lymphopenia in moderate/severe patients. The lymphopenia induced by COVID-19 constitutes a therapeutic window that may facilitate donor engraftment and viral protection until recovery. Trial registration ClinicalTrials.govNCT04578210. First Posted : October 8, 2020

Objective To analyze the anatomic characteristics of the left atrium and pulmonary veins in individuals undergoing ablation for atrial fibrillation and to identify possible anatomic factors related with recurrence. Material and methods We retrospectively reviewed the CT angiography studies done to plan radiofrequency ablation for atrial fibrillation in 95 patients (57 men; mean age, 65 ± 10 y). We reviewed the anatomy of the pulmonary veins and recorded the diameters of their ostia as well as the diameter and volume of the left atrium. We analyzed these parameters according to the type of arrhythmia and the response to treatment. Results In 71 (74.7%) patients, the anatomy of the pulmonary veins was normal (i.e., two right pulmonary veins and two left pulmonary veins). Compared to patients with paroxysmal atrial fibrillation, patients with persistent atrial fibrillation had slightly larger diameter of the left pulmonary veins (left superior pulmonary vein 17.9 ± 2.6 mm vs. 16.7 ± 2.2 mm, p = 0.04; left inferior pulmonary vein 15.3 ± 2 mm vs. 13.8 ± 2.2 mm, p = 0.009) and larger left atrial volume (91.9 ± 24.9 cm3 vs. 70.7 ± 20.3 mm3, p = 0.001). After 22.1 ± 12.1 months’ mean follow-up, 41 patients had sinus rhythm. Compared to patients in whom the sinus rhythm was restored, patients with recurrence had greater left atrial volume (81.4 ± 23.0 mm3 vs. 71.1 ± 23.2 mm3, p = 0.03). No significant differences in pulmonary vein diameters or clinical parameters were observed between patients with recurrence and those without. Conclusion The volume of the left atrium is greater in patients with persistent atrial fibrillation and in those who do not respond to ablation.

Resumen Antecedentes y objetivo Los enterococos son una causa frecuente de infecciones del tracto urinario (ITU). Este trabajo pretende definir los factores de riesgo asociados con las ITU causadas por enterococos y determinar su mortalidad global y los factores de riesgo predictivos. Materiales y metodos Se llevo a cabo un estudio retrospectivo sobre las ITU bacteriemicas por enterococos en pacientes hospitalizados. Se compararon 106 sujetos hospitalizados por ITU bacteriemicas por enterococos con una muestra aleatoria de 100 pacientes hospitalizados por ITU bacteriemicas por otras enterobacterias. Resultados Se analizo un total de 106 sujetos hospitalizados por ITU por enterococos, 51 de ellos con hemocultivos positivos concomitantes. La distribucion por especies fue: 83% por Enterococcus faecalis (E. faecalis) y 17% por Enterococcus faecium (E. faecium). La puntuacion media en el indice de comorbilidad de Charlson fue de 5,9 ± 2,9. Al comparar las ITU bacteriemicas por enterococos con las causadas por otras enterobacterias se identificaron los siguientes factores predictivos independientes de ITU bacteriemicas por enterococos: sexo masculino, uropatia obstructiva, infeccion nosocomial, canceres de vias urinarias y tratamiento antibiotico previo. En conjunto, la mortalidad hospitalaria fue del 16,5% y se asocio con una mayor puntuacion de la escala para la evaluacion del dano organico secuencial (SOFA) (> 4), a enfermedades concomitantes graves, como inmunodepresion, hemopatia maligna y nefrostomia, y a la especie E. faecium y su patron de resistencia a la ampicilina o la vancomicina (p 0,05). Conclusiones Los enterococos son una causa frecuente de ITU complicadas en pacientes con factores de riesgo. La elevada mortalidad vinculada con la severidad de la infeccion y el grado de comorbilidad podrian justificar un tratamiento empirico en pacientes de riesgo.

Aims: Dilated cardiomyopathy (DCM) associated with dystrophin gene (DMD) mutations in individuals with mild or absent skeletal myopathy is often indistinguishable from other DCM forms. We sought to describe the phenotype and prognosis of DMD associated DCM in DMD mutation carriers without severe skeletal myopathy. Methods and results: At 26 European centres, we retrospectively collected clinical characteristics and outcomes of 223 DMD mutation carriers (83% male, 33 ± 15 years). A total of 112 individuals (52%) had DCM at first evaluation [n = 85; left ventricular ejection fraction (LVEF) 34 ± 11.2%] or developed DCM (n = 27; LVEF 41.3 ± 7.5%) after a median follow-up of 96 months (interquartile range 5–311 months). DCM penetrance was 45% in carriers older than 40 years. DCM appeared earlier in males and was independent of the type of mutation, presence of skeletal myopathy, or elevated serum creatine kinase levels. Major adverse cardiac events (MACE) occurred in 22% individuals with DCM, 18% developed end-stage heart failure and 9% sudden cardiac death or equivalent. Skeletal myopathy was not associated with survival free of MACE in patients with DCM. Decreased LVEF and increased left ventricular end-diastolic diameter at baseline were associated with MACE. Individuals without DCM had favourable prognosis without MACE or death during follow-up. Conclusions: DMD-associated DCM without severe skeletal myopathy is characterized by incomplete penetrance but high risk of MACE, including progression to end-stage heart failure and ventricular arrhythmias. DCM onset is the major determinant of prognosis with similar survival regardless of the presence of skeletal myopathy.

Brachial plexus injury is a lesion that results in loss of function of the arm, and there are multiple ways of surgically approaching its treatment. Controlled trials that compare all surgical repair strategies and their clinical outcomes have not been performed. A systematic review was conducted to identify all articles that reported clinical outcomes in different surgeries (nerve transfer, nerve graft, neurolysis, end-to-end, multiple interventions, and others). Advanced search in PubMed was performed using the Mesh terms “brachial plexus injury” as the main topic and “surgery” as a subtopic, obtaining a total of 2153 articles. The clinical data for eligibility extraction was focused on collecting motor, sensory, pain, and functional recovery. A statistical analysis was performed to find the superior surgical techniques in terms of motor recovery, through the assessment of heterogeneity between groups, and of relationships between surgery and motor recovery. The frequency and the manner in which clinical outcomes are recording were described. The differences that correspond to the demographics and procedural factors were not statistically significant among groups (p > 0.05). Neurolysis showed the highest proportion of motor recovery (85.18%), with significant results between preoperative and post-operative motor assessment (p = 0.028). The proportion of motor recovery in each group according to the surgical approach differed significantly (X2 = 82.495, p = 0.0001). The motor outcome was the most reported clinical outcome (97.56%), whereas the other clinical outcomes were reported in less than 15% of the included articles. Unexpectedly, neurolysis, a technique displaced by new surgical alternatives such as nerve transfer/graft, demonstrated the highest proportion of motor recovery. Clinical outcomes such as pain, sensory, and functional recovery were infrequently reported. These results introduce the need to re-evaluate neurolysis through comparative clinical trials, as well as to standardize the way in which clinical outcomes are reported.

La dactilitis sarcoidea es una manifestación infrecuente, observándose en un 0,2% de los casos de sarcoidosis. Suele cursar con la presencia de tumefacción en los dedos de las manos o los pies, afectando principalmente a las falanges medias y, en menor frecuencia, a las falanges distales.

Anaemia is defined by the presence of haemoglobin (Hb) levels

Resumen Introduccion y objetivos Segun las guias de muerte subita, se debe considerar un desfibrilador automatico implantable (DAI) para los pacientes con miocardiopatia dilatada debida a variantes en el gen de la lamina (LMNA) con al menos 2 factores: varones, fraccion de eyeccion del ventriculo izquierdo (FEVI) Metodos Se evaluo la relacion entre factores de riesgo y eventos cardiovasculares en una cohorte de 140 portadores de variantes en LMNA (54 probandos, 86 familiares, edad ≥ 16 anos). Se considero: a) evento arritmico mayor (EAM) si hubo descarga apropiada del DAI o muerte subita, y b) muerte por insuficiencia cardiaca, incluidos los trasplantes. Resultados Se identificaron 11 variantes nuevas y 21 previamente publicadas. La FEVI Conclusiones En el registro REDLAMINA, los unicos 2 predictores asociados con EAM fueron la TVNS y la FEVI

Aims: The paper has introduced an algorithmic modification of M.L.Das's previous work done of " IoT Mutual Authentication". Background: IoT has proven that if there exists a thing on the earth then it is bound to be connected to the internet to tell its feature on its own. IoT plays a remarkable role in all aspects of our daily lives it covers entertainment, sports, healthcare, education, security, automobiles, industrial as well as home appliances and many more real time applications. To ease our everyday activities, it reinforcing the way people interact with their surroundings. This holistic view brings some major concerns in terms of security and privacy. Objective: The objective of the work is to increase security and protect the algorithm from various attackers so to use with real time application. Methods: In this we have used XoR (Exclusive OR) operation and because of this we can protect the algorithm from DoS attacks, bypass attack, intruder attack and allow user to change password. Conclusion: The proposed work has secured all the connected IoT devices to work inde-pendently and secured because every device has to verify at each step in the IoT system before initiating its operation.

La malformación de Dandy Walker (DW) es una malformación cerebelosa asociada a múltiples déficits cognitivos, alteraciones psicopatológicas y alteraciones motoras. Presentamos el caso de un paciente afectado de esta malformación y derivado a la unidad de salud mental infantil por presentar psicopatología asociada. Realizamos una revisión sobre la epidemiología, la clínica, el pronóstico y la comorbilidad propia de esta malformación así como sobre la psicopatología asociada a la patología cerebelosa en su conjunto, incluyendo el síndrome cerebeloso cognitivo-afectivo de Shamahmann y Sherman. Por último, incluimos la descripción del caso y establecemos el diagnóstico diferencial a partir de la historia del paciente, la exploración del estado mental y el análisis de las exploraciones complementarias (radiológicas y neuropsicológicas).

Background Here, we assess the efficacy and safety of direct antiviral agents (DAAs) in a real-world cohort of co-infected individuals, and evaluate the consistency between clinical practice and guideline recommendations. Methods Multicenter, prospective cohort study of HIV/HCV co-infected patients followed-up in nine sites in Spain. All patients with detectable HCV-RNA naive to second-generation DAAs were enrolled. The primary endpoint was the assessment of sustained virological response at week 12 (SVR12). We performed intention-to-treat (ITT), per-protocol (PP), and multivariable analyses to identify factors associated with therapeutic failure. We compared the DAAs we administered to available guideline recommendations. Schemes not perfectly adjusted to the recommendations were defined as sub-optimal. Results Overall, 316 patients (82.1% male) received a total of 330 treatments. Of these, 43.9% were cirrhotic and 40.6% were treatment-experienced. In the ITT and PP analyses, SVR12 was achieved in 90.9% [95% confidence interval (CI) 87.3-93.6] and 93.7% (95% CI 90.5-95.6), respectively. Only alcohol abuse [odds ratio (OR): 0.33; 95% CI 0.138-0.789, P = 0.013] and a higher basal bilirubin level (OR: 0.595; 95% CI 0.416-0.851, P = 0.004) were independently associated to therapeutic failure. A progressive decrease in the proportion of sub-optimal treatments was observed over time, from 75% in 2014 to 0% in 2018. Being treated with a sub-optimal regimen was not associated with failure. Conclusion Despite numerous difficulties in treatment access and in adaptation to the changing guidelines, we detected no differences among the DAAs used, nor did we detect a lower efficacy when the chosen treatment was not optimal.

Venous thromboembolic disease (VTED) is a common and clinically important complication in patients with cancer, contributing to its mortality and morbidity. Direct oral anticoagulant agents (DOACs), including direct thrombin inhibitors and direct factor Xa inhibitors, are as effective as vitamin K antagonists for the treatment of VTED and are associated with less frequent and severe bleeding. They have advantages over low-molecular-weight heparin, but comparative long-term efficacy and safety data are lacking for these compounds. Recent randomized clinical trials suggest a role for DOACs in the treatment of VTED in patients with cancer. This review will discuss the existing evidence and future perspectives on the role of DOACs in the treatment of VTE based on the current evidence about their overall efficacy and safety and the limited information in patients with cancer; in addition, we will briefly review their pharmacokinetic properties with special reference to potential interactions.

Resumen El sindrome de sensibilidad quimica multiple es un trastorno cronico poco conocido que ocasiona multiples sintomas en diversos aparatos y sistemas del organismo tras la exposicion a agentes quimicos a muy bajas concentraciones consideradas no perjudiciales para la poblacion. Se trata de un proceso de instauracion solapada y progresiva que afecta de forma mayoritaria a mujeres de mediana edad. En 1987 Cullen propone el termino de SQM, no siendo hasta 1999 cuando se llega a un consenso para su diagnostico basado en los criterios de Nethercott, los cuales son publicados por Bartha. En Espana se reconoce la enfermedad en el ano 2014 incluyendose en el CIE-9-MC con el codigo 995, dentro del acapite de alergias no especificadas. Una actualizacion posterior en el ano 2016 del CIE-10-MC la clasifica con el codigo T78.40. Su etiopatogenia a dia de hoy es desconocida, por lo que la OMS no la ha reconocido como enfermedad, pero se cree que podrian participar factores geneticos, alergenicos, quimicos y anatomicos. Se trata de una enfermedad neurologica, con factores de predisposicion claros, que empeora al hacer sobreesfuerzos fisicos o ante estresores psicologicos minimos, asi como por exposicion a factores quimicos y ambientales. Su diagnostico es fundamentalmente clinico y a dia de hoy no tiene un tratamiento especifico. Exponemos el caso de una gestante afecta de esta patologia, asi como las medidas llevadas a cabo de forma multidisciplinar en el manejo del parto y puerperio inmediato.

Purpose To investigate the factors associated with persistent serous retinal detachment in highly myopic eyes with inferior posterior staphyloma. Methods A total of 27 highly myopic patients (44 eyes) with an inferior posterior staphyloma were recruited. Serous retinal detachment was investigated; 13 eyes had persistent sub-macular fluid (study group), and 31 eyes lacked sub-macular fluid (control group). All patients underwent complete ophthalmologic examinations, including axial length measurement and fluorescein angiography (FA). Triton Deep Range Imaging (DRI) optical coherence tomography (OCT) (Topcon Corp., Tokyo, Japan) scans through the fovea measured choroidal thicknesses, macular bend height, and vitreoretinal interface factors. Results Of the 44 eyes, 13 had neurosensory retinal detachment and 31 did not. No significant differences were found in any of the studied variables (age, gender, spherical equivalence, axial length, vitreomacular traction, epiretinal membrane, internal limiting membrane detachment), except a higher macular bend height (P = .01), and a reduced macular choroidal thickness (P = .02), which were associated with the risk of serous retinal detachment. No statistically significant differences in best-corrected visual acuity (BCVA) were observed between the study and control groups. Serous retinal detachment always occurred at the bisected retinal pigment epithelium of the macula corresponding to the upper edge of the staphyloma, and was characterised by multiple hyperfluorescent granular patches on fluorescein angiography. Conclusions A higher macular bend height and a reduced macular choroidal thickness may be important factors in the development of serous retinal detachment in patients with inferior posterior staphyloma.

Patients with cancer are among the most vulnerable populations in the aftermath of a disaster. They are at higher risk of medical complications and death due to the collapse of or disruptions in the health care system, the community infrastructure, and the complexity of cancer care. The United Nations' Sendai Framework for Disaster Reduction states that people with life-threatening and chronic diseases should be considered in disaster plans to manage their risks. With extreme weather or disasters becoming more intense and frequent and with the high burden of cancer in the United States and its territories, it is important to develop region-specific plans to mitigate the impact of these events on the cancer patient population. After Hurricanes Irma and Maria hit Puerto Rico and the U.S. Virgin Islands in 2017, the need to develop and implement such plans for patients with cancer was evident. We describe ongoing efforts and opportunities for disseminating and implementing emergency response plans to maintain adequate cancer care for patients during and after disasters. While plans for patients with cancer should be housed within the emergency support function infrastructure of each jurisdiction, the Centers for Disease Control and Prevention's Comprehensive Cancer Control Plans provide excellent community-centered mechanisms to support these efforts.

Background Cardiovascular disease has a negative impact on the vital prognosis of patients with chronic obstructive pulmonary disease (COPD), where dyslipidaemia (DLP) and arterial hypertension (AHT) are considered the most prevalent risk factors. The objective of this study was 1) to assess the relationship between diagnosed DLP and cardiovascular disease in COPD patients and compare it with other known cardiovascular risk factors and 2) to determine the relationship between the different cardiovascular comorbidities and the severity groups according to the GOLD 2017 classification. Methods A cross-sectional, observational study was performed in 454 outpatients with COPD during their follow up. We calculated the prevalence of each of the cardiovascular comorbidities and the probability of each of the cardiovascular risk factors to occur jointly with a vascular disease (RRij). Results A total of 66.7% of the patients had DLP, whereby DLP was related to cerebrovascular accidents (CVA) (RRij 1.36, p = 0.0054), chronic kidney disease (CKD) (RRij 1.34, p = 0.00023), and peripheral arterial disease (PAD) (RRij 1.38, p = 0.00015). AHT was mostly related to CVA (RRij 1.41, p = 0.0014) and CKD (RRij 1.42, p Conclusion DLP was related to CVA, CKD, and PAD. AHT and T2DM are the conditions that mostly relate to HF and CVA.

Objectives To describe the epidemiological, clinical and microbiological characteristics and mortality of patients with Candida bloodstream infection and systemic autoimmune diseases. Methods We performed a retrospective multicenter study of candidemia in adults with systemic autoimmune diseases between 2010 and 2016. Results Among 1040 patients with candidemia, 36 (3.5%) had a systemic autoimmune disease. The most common systemic autoimmune disease was rheumatoid arthritis (27.8%). The most common species was Candida albicans (66.7%). Twenty-two (61.1%) patients received a corticosteroid therapy and nine (25%) received an immunosuppressive therapy at the time of candidemia. The mortality rate was 27.8%. Conclusions Systemic autoimmune diseases are not common in patients with candidemia. The unadjusted mortality rate was comparable to other candidemia studies in the general population.

Resumen Introduccion La enfermedad cardiovascular tiene un impacto negativo en el pronostico vital de los pacientes con enfermedad pulmonar obstructiva cronica (EPOC), siendo la dislipidemia (DLP) y la hipertension arterial (HTA) los factores de riesgo mas prevalentes. El objetivo del estudio fue: 1) evaluar la relacion existente entre el diagnostico de DLP y la presencia de enfermedad cardiovascular en pacientes con EPOC, y compararlo con otros factores conocidos de riesgo cardiovascular; y 2) determinar la relacion entre las diferentes comorbilidades cardiovasculares y los grupos de gravedad segun la clasificacion GOLD 2017. Metodos Estudio observacional transversal de 454 pacientes con EPOC en seguimiento ambulatorio. Se calculo la prevalencia de cada una de las comorbilidades cardiovasculares y el riesgo de que cada uno de los factores de riesgo cardiovascular se presentase conjuntamente con una enfermedad vascular (RRij). Resultados El 66,7% de los pacientes eran dislipidemicos. La DLP mostro una mayor relacion con la presencia de accidentes cerebrovasculares (ACV) (RRij 1.36; p = 0,0054), enfermedad renal cronica (ERC) (RRij 1.34; p = 0,00023) y arteriopatia periferica (AP) (RRij 1.38; p = 0,00015); la HTA se relaciono mayormente con ACV (RRij 1,41; p = 0,0014) y ERC (RRij 1,42; p Conclusion La DLP se relaciono con la presencia de ACV, ERC y AP. La HTA y DMT2 se relacionaban mayoritariamente con IC y ACV.

Purpose Information regarding patients' needs, fears and experiences/perceptions in the perioperative setting is limited. Through two focus groups, we explored the needs, fears and experiences of patients who had recently undergone, or were scheduled for, surgery under general anaesthesia, with regard to the entire perioperative process. Materials and Methods Adults were invited to participate in a focus group if they had (a) undergone abdominal or gynaecological surgery with general anaesthesia in the past 4 months (focus group 1) or (b) been indicated for abdominal or gynaecological surgery and were waiting for the assigned surgery date (focus group 2). Discussions were audio recorded and, through thematic analysis, patients' needs and experiences/perceptions regarding perioperative surgical stages were obtained/coded. Analysis of code co-occurrence was performed using a codes matrix. Results Focus groups consisted of 13 females, 1 male (50% aged >45 years). The immediate postoperative period generated the highest number of co-occurrences, followed by the indication of surgery. The most frequent code was the need for information, especially at the indication of surgery, the pre-anaesthesia clinic and in the postoperative period. Fears were described particularly at the indication of surgery, the waiting period, the surgical room, anaesthesia induction and the postoperative period, particularly after hospital discharge; pain was cited most commonly in the postoperative period. Stress/anxiety and emotional impact were also cited in the postoperative period including home arrival. Conclusion Information collected in these patients' focus groups should inform future research and healthcare planning. Patients demand receiving more comprehensive and understandable information and more involvement in several steps; this could reduce fears and stress/anxiety described across the perioperative process. Importantly, findings also extend to the postoperative period and home arrival.

Background The shipping industry has grown spectacularly during the last 50 years transporting nowadays, approximately, the 80–90% of goods worldwide. However, maritime transport remains a highly inefficient industry. Only in the last 10–15 years has the industry started studying how to optimize navigation speeds and digitization is just entering ports. Consequently, institutions like the International Maritime Organization (IMO) are pressing towards the adoption of measures that increase the industry efficiency, like Just-In-Time (JIT) operations. Methods and Results This paper shows why the Sea Traffic Management (STM) concept, based on stakeholder collaboration, is a JIT enabler. To do so, we analyze 1 year of navigation data of 33 ships, estimating the impact of JIT barriers on shipping and showing the benefits that the adoption of STM, with different maturity levels, could provide to the industry. Our evaluation shows that, only for containerships, STM can help reducing by 15–23% of fuel consumption and GHG emissions.

We present the case of a 17-year-old male patient with a history of cocaine use who consulted for chest pain and dyspnoea. A pneumomediastinum is defined as the irruption of air in the mediastinal space, and is associated with different causes, including addiction to inhaled drugs. It occurs in people with predisposing factors and the presence of precipitating factors such as consumption of inhaled drugs. X-ray and computed tomography of the thorax are very useful tools in guiding the diagnosis. The low incidence of this pathology represents a difficult diagnosis for the doctor, although in some characteristic work environments a high level of suspicion is necessary.

OBJECTIVE To evaluate the progression of liver stiffness after treatment with direct antiviral agents (DAAs), to identify predictive factors of fibrosis regression and to analyze the changes of scores AST-to-platelet ratio index (APRI) and Fibrosis-4 (FIB-4) after treatment. DESIGN Multicenter prospective cohort study of HIV/HCV co-infected patients conducted within the GECMEI cohort, Spain. METHODS Individuals were eligible if they were willing to start DAAs and underwent two transient elastographies: at baseline and after the end of treatment (EOT). All patients with detectable HCV RNA naive to DAAs were consecutively enrolled from nine medical hospitals. Liver stiffness results were categorized in four Metavir stages (F1: 12.4 kPa). The APRI and FIB-4 scores were calculated at baseline, EOT and 12 weeks after EOT. RESULTS One hundred and seventy-eight patients were examined throughout a follow-up of 16.3 months (IQR: 12.5-25). The median of liver stiffness decrease was 2.6 kPa (IQR: 0-6.3). A greater improvement was observed in F3-F4 compared with F1-F2, (6.4 vs. 0.91 kPa, P

Summary: Heat stress is a major problem in the poultry industry, especially during summer months and when birds are raised under high-density conditions. Previous studies have reported that vitamin C or electrolyte supplementation could palliate the effects of heat stress in broiler chickens. The present study evaluated the effect of a mineral and vitamin mix (AHS) added to drinking water on the performance of broiler chickens. In total, 1,824 one-day-old birds were randomly allocated to 48 pens. Maximum animal density was 26.5 kg/m2. The control group received no additive; AHS-1 and -2 groups received the AHS mix at a concentration of 1 and 2 kg/1,000 L in drinking water, respectively; and the Vit-C group received vitamin C in drinking water at 200 g/1,000 L. All birds were fed the same diets based on a 3-phase feeding program; feed and water were given on ad libitum basis. To mimic heat stress conditions, temperature in the barn was raised to 35 C from 08:00 to 14:00 h each day. For the overall growing period (0 to 35 D), adding AHS to drinking water increased final BW, ADG, and ADFI linearly (PLinear 0.10). No significant effect on mortality were found (8.77%; P > 0.10). Relative to control, all the treatments tested reduced (P < 0.05) corticosterone concentration in blood serum. In conclusion, the combined use of supplementary levels of minerals and vitamins could alleviate the effects of heat stress on broilers chickens.

espanolLa afectacion hepatica en el contexto de un proceso infeccioso sistemico constituye un problema clinico frecuente, cuyo espectro comprende desde alteraciones analiticas con escasa expresion clinica hasta cuadros graves de hepatitis fulminante. La frecuencia con la que se presenta varia en funcion del estado de inmunocompetencia del huesped y del espacio geografico en el que nos encontremos. La etiologia de la enfermedad hepatica de origen infeccioso es variable, pudiendo estar implicadas bacterias, virus, hongos y parasitos. En esta actualizacion, se revisa la implicacion hepatica en el seno de las infecciones sistemicas por microorganismos no propiamente considerados germenes hepatotropos, incidiendo en las peculiaridades relevantes de cara al diagnostico y tratamiento en cada una de ellas. EnglishLiver involvement in systemic infectious disorder is a frequent condition, whose clinical spectrum ranges from subclinical biochemical change to even fulminant hepatic failure. Incidence varies depending on immunocompetence status and geographic situation of patient. Etiology of infectious liver disease is variable, bacteria, viruses, fungi and parasites can be involved. Current update reviews liver involvement in systemic infectious diseases caused by non-hepatotropic microorganisms, focusing on relevant peculiarities of each one facing the diagnosis and treatment.

espanolLas alteraciones hepaticas aparecen aproximadamente en el 3% de las gestaciones. La gravedad de estos procesos es variable, desde alteraciones analiticas asintomaticas hasta enfermedades graves con alta morbimortalidad. Por ello, es importante estudiar a cualquier gestante con sospecha de hepatopatia de forma precoz y reconocer los procesos potencialmente graves para iniciar las medidas terapeuticas necesarias. Dentro de las hepatopatias que pueden presentarse durante el embarazo se reconocen dos grandes grupos: enfermedades propias de la gestacion que no aparecen en otros contextos clinicos y enfermedades hepaticas que coinciden temporalmente con el embarazo. Este ultimo grupo engloba tanto hepatopatias agudas como enfermedades hepaticas cronicas. En ambos casos, debe tenerse en cuenta que la gestacion puede modificar el curso clinico habitual de la enfermedad, en ocasiones con importantes implicaciones pronosticas. EnglishLiver disorders appears approximately in 3% of pregnancies. Severity is variable and goes from asymptomatic to severe diseases with high morbi-mortality. Thus, early study of any pregnant woman suspected of liver disease has to be carried out, and potentially severe conditions have to be recognized in order to initiate therapeutic measures. We identify two large groups of liver diseases during pregnancy: gestational diseases not developed in other clinical contexts and liver diseases coinciding with pregnancy. The last group encompass both acute liver diseases as well as chronic liver diseases. In both cases, it is necessary to take in to account that pregnancy can modify the usual clinical course of the disease, with important prognostic implications at times.

espanolLa insuficiencia hepatica aguda grave (fallo hepatico agudo o fulminante) es una entidad poco frecuente caracterizada por un deterioro de la funcion hepatica en pacientes sin hepatopatia previa conocida, que se manifiesta por la presencia de coagulopatia de origen hepatico, ictericia y alteracion variable del nivel de consciencia (encefalopatia hepatica). La etiologia del cuadro es muy variable, desde causas mas frecuentes como hepatotoxicidad por diversas sustancias (como paracetamol) o la hepatitis isquemica o virica, hasta otras mucho menos habituales como la enfermedad de Wilson o el sindrome de Budd-Chiari. En otros casos (hasta el 40%) no se consigue identificar la causa desencadenante. Sin tratamiento, el pronostico de estos pacientes es pobre, con una mortalidad libre de trasplante incluso superior al 90% en algunos casos, por lo que el reconocimiento a tiempo del cuadro y su manejo de forma precoz resultan fundamentales. Ademas de medidas generales de soporte, debera iniciarse el tratamiento especifico de la causa (si esta se conoce) siempre que se disponga del mismo. Sin embargo, en muchos casos, ya sea por desconocimiento de la causa desencadenante, ausencia de tratamiento etiologico o de mejoria del paciente a pesar de la instauracion del mismo, el trasplante hepatico urgente sera la unica solucion posible para estos pacientes EnglishSevere acute liver failure (acute or fulminant hepatic failure) is a rare disorder characterized by hepatic function deterioration in patients without previous liver disease; it leads to hepatic coagulopathy, jaundice and hepatic encephalopathy (loss of consciousness in variable degree). Etiology varies from hepatoxicity (drug-induced injure, for example paracetamol) the commonest, to ischemic or viral hepatitis; including other causes much less frequent (Wilson's disease and Budd-Chiari syndrome). Triggering cause is not identified in other cases (up to 40%). Without treatment prognosis is poor, and transplant free mortality can exceed 90%; so, on-time diagnosis and early management are mandatory. Together with support measures, cause-specific treatment has to be stablished (if cause is known and treatment is available). However, urgent hepatic transplantation is the only possible treatment for such patients (unknowing triggering cause, etiologic treatment not available or lack of treatment response)

The current COVID-19 pandemic demands the rapid development of vaccines and the rapid evaluation of drugs to combat SARS-CoV-2. The urgency of the former ended up in the rapid approval of several vaccines under an emergency use. Despite this, for the latter there is still limited information that successfully demonstrates the efficacy of a particular drug against SARS-CoV-2. Therefore this chapter is intended to summarize antiviral drugs with activity against enveloped viruses (including SARS-CoV-2) that have been further evaluated as cargo of DDS (drug delivery systems). To the best of our knowledge, drugs with activity against SARS-CoV-2 have not been evaluated as part of DDS. The activity of some drugs against COVID-19 has been demonstrated with experiments or computational studies. The antiviral drugs presented are chloroquine, ivermectin, lopinavir/ritonavir, ribavirin, and sofosbuvir. Small interfering RNA (siRNA) is also presented since several DDS carrying siRNA have been evaluated against enveloped viruses. Dexamethasone is a special case that is also presented here as antiinflammatory agent since it is currently used in the treatment of COVID-19. The materials used to produce DDS are diverse and include gelatin, poly(l-lactide), poly(lactic acid), poly(lactic-co-glycolic acid), liposomes, mesoporous silica, and chitosan.

SARS-CoV2 infection has devastating consequences on healthcare systems and has caused 3 million deaths by April 2021. Identifying patients at risk of death is a priority. Moderate–severe COVID-19 cases seem to associate a cytokine release that follows endothelial injury, triggering a hyperinflammatory and procoagulant state in which leukocytes and platelets are protagonists. Our group has published some reports about the usefulness of the hemogram in COVID-19. Hemogram-derived ratios, mainly the neutrophil-to-lymphocyte ratio (NLR) and the novelty neutrophil-to-platelet ratio (NPR), obtained on admission and their rate of change during hospitalization, can easily detect patients with high risk of mortality. Hemogram is a tool available to all hospitals and analyzing the hemogram-derived ratios would provide much more information than could be extracted by evaluating the counts in isolation. We now know that in COVID-19 it is essential to start early anti-inflammatory treatment when patient deteriorates and the hemogram could be a good indicator of this situation. More comprehensive studies are needed to determine how useful these hemogram-derived ratios and prognostic scores are. In the next chapter we will present information related to this aspect as well as our group’s research on the usefulness of the hemogram in COVID-19.

The pandemic has badly affected the most diverse career stage in UK Earth sciences: early career researchers. Disrupted careers must be rescued with contingency plans, remote networks, a focus on mental health and mentor support if we are to retain diversity and talent.

The aim of this study was the quantification of Sphingosine-1-phosphate (S1P) in periodontal pockets of patients with periodontitis. This is an observational, descriptive, case-control study. Thirty subjects were selected: 15 controls and 15 cases. A periodontal study was conducted following the parameters of AAP 2017 for the diagnosis of periodontal diseases. A sample of saliva and gingival crevicular fluid was obtained from each subject and then analyzed with the Human S1P Elisa kit (MyBioSource #MBS2516132) accordingly to the manufacturer's instructions, in order to verify the presence of S1P and quantify it´s concentration when founded. Results showed a significant difference (p=0.05) between cases and controls. In the case of saliva samples, the concentration of S1P was higher than the ones found in the control group (72.94 ng/mL and 45.12 ng/mL). For GCF, a higher amount of S1P was found in patients with POD (20.09 ng/mL and 15.20 ng/mL). This work raises a possible route of bone metabolism, inflammatory process, and identification of periodontitis through oral quantification of S1P, however, future studies are needed. Resumen El propósito de este estudio fue la cuantificación de Esfingosina-1-Fosfato (S1P) en las bolsas periodontales de pacientes con periodontitis. Estudio observacional, descriptivo de casos y controles. 30 sujetos fueron seleccionados de los cuales 15 controles y 15 casos. Se realizó un estudio periodontal completo siguiendo los parámetros establecidos por la AAP en 2017 para el diagnóstico de las enfermedades periodontales. Se tomaron muestras de saliva y de líquido crevicular gingival de cada sujeto estudiado y se analizaron con el ELISA kit humano para S1P (MyBiosource #MBS2516132) y de acuerdo con las instrucciones del fabricante, se realizó para cuantificar la presencia d S1P en las muestras estudiadas. Los resultados mostraron diferencia significativa (p=0.05) entre casos y controles. En el caso de las muestras de saliva, la concentración de S1P en controles fue mayor (72.94 ng/mL y 45.12 ng/mL). Para Líquido crevicular gingival, se encontró mayor cantidad de S1P en los pacientes con periodontitis (20.09 ng/mL y 15.20 ng/mL). Este estudio plantea una posible ruta de metabolismo óseo, proceso inflamatorio e identificación de la Periodontitis a través de la cuantificación oral de S1P, sin embargo se necesitan estudios futuros.

Resumen: Antecedentes y objetivo: La actualización de las series estándar de pruebas epicutáneas debe basarse en datos objetivos de frecuencia de sensibilización de los alérgenos que componen cada batería. La última renovación de la batería estándar española se realizó en 2016 y de la europea en 2019, quedando pendiente valorar la inclusión de alérgenos emergentes. Material y método: Desarrollamos un estudio observacional, prospectivo y multicéntrico de los pacientes consecutivos del registro del Grupo Español de Investigación en Dermatitis y Alergia Cutánea sometidos a pruebas epicutáneas con hidroperóxido de linalool, hidroperóxido de limoneno, 2-hidroxi-etil-metacrilato, benzisotiazolinona, octilisotiazolinona, mezcla textil, metabisulfito sódico, propóleo, bronopol, mezcla de compuestas II, diazolidinil urea, imidazolidinil urea, decil glucósido y lauril glucósido, durante los años 2019 y 2020. Resultados: Se analizó una muestra de 4.654 pacientes estudiados con diazolidinil urea, imidazolidinil urea y bronopol, y de 1.890 pacientes con el resto de los alérgenos. El índice MOAHLFA fue: M 30%, O 18%, A 15%, H 29%, L 6,5%, F 23%, A 68%. Siete alérgenos mostraron una frecuencia de sensibilización mayor del 1%: hidroperóxido de linalool, 2-hidroxi-etil-metacrilato, benzisotiazolinona, hidroperóxido de limoneno, mezcla textil, metabisulfito sódico y propóleo. Tres alérgenos mostraron una frecuencia de relevancia presente superior al 1%: hidroperóxido de linalool, 2-hidroxi-etil-metacrilato e hidroperóxido de limoneno; para benzisotiazolinona y mezcla textil, esta frecuencia fue de entre el 0,9 y el 1%. Conclusiones: Nuestros resultados indican que debería valorarse la inclusión de siete nuevos alérgenos en la batería estándar española. Estos resultados podrían contribuir a la próxima actualización de la batería basal europea. Abstract: Background: Standard patch test series must be updated using objective data on allergen sensitization. The Spanish standard series was last updated in 2016 and the European series in 2019, and the inclusion of several emerging allergens needs to be evaluated. Material and methods: We conducted a prospective, observational, multicenter study of consecutive patients from the registry of the Spanish Contact Dermatitis and Skin Allergy Research Group (GEIDAC) who were patch tested in 2019 and 2020 with linalool hydroperoxide, limonene hydroperoxide, 2-hydroxyethyl-methacrylate, benzisothiazolinone, octylisothiazolinone, textile dye mix (TDM), sodium metabisulfite, propolis, bronopol, Compositae mix II, diazolidinyl urea, imidazolidinyl urea, decyl glucoside, and lauryl glucoside. Results: We analyzed data for 4654 patients tested with diazolidinyl urea, imidazolidinyl urea, and bronopol, and 1890 tested with the other allergens. The values for the MOAHLFA index components were 30% for male, 18% for occupational dermatitis, 15% for atopic dermatitis, 29% for hand, 6.5% for leg, 23% for face, and 68% for age > 40 years. Sensitization rates above 1% were observed for 7 allergens: linalool hydroperoxide, 2-hydroxyethyl-methacrylate, benzisothiazolinone, limonene hydroperoxide, TDM, sodium metabisulfite, and propolis. Three allergens had a current relevance rate of over 1%: linalool hydroperoxide, 2-hydroxyethyl-methacrylat, and limonene hydroperoxide. Benzisothiazolinone and TDM had a relevance rate of between 0.9% and 1%. Conclusions: Our results indicate that 7 new allergens should be considered when extending the Spanish standard patch test series. The data from our series could be helpful for guiding the next extension of the European baseline series.

Massive vaccination offers great promise for halting the global COVID-19 pandemic. However, the limited supply and uneven vaccine distribution create an urgent need to optimize vaccination strategies. We evaluate SARS-CoV-2-specific antibody responses after Sputnik V vaccination of healthcare workers in Argentina, measuring IgG anti-spike titers and neutralizing capacity after one and two doses in a cohort of naive or previously infected volunteers. By 21 days after receiving the first dose of the vaccine, 94% of naive participants develop spike-specific IgG antibodies. A single Sputnik V dose elicits higher antibody levels and virus-neutralizing capacity in previously infected individuals than in naive ones receiving the full two-dose schedule. The high seroconversion rate after a single dose in naive participants suggests a benefit of delaying administration of the second dose to increase the number of people vaccinated. The data presented provide information for guiding public health decisions in light of the current global health emergency., Graphical abstract, Rossi et al. provide data on antibody responses to Sputnik V vaccine in naive and previously infected volunteers. This study shows a high seroconversion rate following the first dose in naive individuals. In seropositive participants, a single dose of Sputnik V elicits a fast and robust antibody response without apparent benefit from a second dose.

Background Post-marketing data are required to confirm the durability and the long-term benefit and safety of UST in CD in clinical practice. Our aims were: (1) to evaluate the retention rate of UST in CD patients and to identify predictive factors of UST discontinuation; (2) to assess UST short-term effectiveness; (3) to analyse the durability of the response to UST in the long-term; and (4) to evaluate the safety of UST in clinical practice. Methods Retrospective, multicentre study (>60 centres). Patients with active CD [(Harvey–Bradshaw (HBI) >4)] that received at least one dose of UST intravenously before July 2018 were included. Clinical activity plus biochemical parameters were assessed at every UST administration. Clinical remission was defined as HBI score ≤4, and clinical response as a decrease in HBI ≥3 points. Loss of efficacy was defined as reappearance of symptoms that led to intensify the treatment dose, add another medication to control CD, switching or surgery in patients with short-term remission. The retention rate of UST treatment and the cumulative incidence of loss of efficacy were evaluated by survival curves, and predictive factors were assessed by Cox-regression. The short-term response was evaluated at week 8 and after the induction (week 16). Factors associated with short-term remission were assessed by multivariate analysis. Adverse events were recorded. Data quality was assured by remote monitoring. Results 331 CD patients have been included up to date (Table 1). The incidence rate of UST discontinuation was 15% per patient-year of follow-up: 8%, 13% and 20% at 6, 12 and 18 months (Figure 1). Previous surgery was the only factor associated with a higher risk of UST discontinuation [Hazard ratio (HR) = 2.03, 95% confidence interval (CI) = 1.1–3.6]. Short-term efficacy is shown in Figure 2. Previous surgery (OR = 0.3, 95% CI = 0.2–0.6) and higher HBI score at baseline (OR = 0.8, 95% CI=0.8–0.9) were associated with an impaired response to UST at week 16. The cumulative incidence of loss of response was 32% per-patient-year of follow-up (Figure 3); A higher HBI score at baseline was associated with a higher risk of losing response (HR = 1.2, 95% CI = 1.1–1.3). Neither the concomitant treatment with immunosuppressants nor the number of previous biologics were associated with UST short- and long-term benefit. Thirty adverse events were reported in 25 (7%) patients (Table 2). Conclusion Sustain is the largest real clinical practice study of UST to treat CD patients with the longest follow-up reported to date. UST was demonstrated to be effective in real-world use in the short and long run. Safety was consistent with the known profile of UST.

Introduction: Collecting duct carcinomas (CDC), also known as Bellini’s tumors, are a rare and aggressive subtype of renal cell carcinoma. Therefore, there are very few data about their management, and there is no standard therapy for this malignancy. We report the outcome of CDC patients treated on institutions belonging to the ‘Grupo Centro’ of Genitourinary Tumors, a novel networking cooperative group in Spain. Material and Methods: Patients with CDC diagnosed between 1995 and 2015 were included. They had to have an appropriate follow-up, as well as available tissue for further correlative studies. Demographic baseline features and therapy outcomes were collected in a retrospective fashion. Approval for this data collection was obtained from a central ethical committee. Results: A total of 43 patients were analysed, with a median overall survival (OS) of 14 months (95% CI: 9.2–18.8 months). 29 of them (67.4%) were diagnosed as localized disease, and 14 (32.6%) as metastatic disease. For the subgroup of patients diagnosed without metastases, median relapse-free survival (RFS) is 22 months (95% CI: 12.4–35.6 months), and median OS, 53 months (95% CI: 35.5–84.3 months). For the subgroup of patients with metastatic disease, median OS is 6 months (95% CI: 4.1–7.8 months). 16 patients (55.2%) with stage IV disease received systemic therapy, mainly platinum-based chemotherapy, with a response rate of 12.5% and a median progression-free survival (PFS) of 2 months. Conclusions: CDC of the kidney is a malignancy with poor prognosis and few responses to therapy. Median OS of our group in the metastatic setting is similar to what has been observed in previous series. There is a clear need to improve the armamentarium we have for the systemic approach of patients with advanced CDC.

Resumen El DSM-5 ha incluido una nueva clasificacion llamada «trastornos de sintomas somaticos y trastornos relacionados» que sustituye a los antiguos trastornos somatomorfos que englobaban: trastorno de somatizacion, trastorno por dolor, hipocondria y trastorno conversivo. Las personas con este tipo de trastornos acuden en busca de ayuda a Atencion Primaria y otros entornos medicos y, con menor frecuencia, al ambito de salud mental, generando un alto consumo de recursos para el sistema publico. El origen de estos trastornos no esta bien definido, aunque se han encontrado tanto causas biologicas como psicologicas, teniendo en cuenta la experiencia biografica y los rasgos de personalidad del paciente. En el diagnostico es necesario descartar la presencia de patologia medica subyacente a traves de una exploracion minuciosa y de la realizacion de pruebas complementarias. El tratamiento combina estrategias para el manejo del paciente con intervenciones terapeuticas especificas (medidas farmacologicas y psicoterapeuticas).