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Primary neuroendocrine tumours of the kidney are rare, and their pathophysiology is uncertain; since their discovery in 1966, they have been described only a few times in the literature. We present a case of a well-differentiated neuroendocrine tumour of the kidney in an asymptomatic patient, which required a multidisciplinary approach by the hospital’s team, including precise surgical treatment and an effective radiopathological diagnosis. The patient underwent right radical nephrectomy. During follow-up, he remained asymptomatic, and no metastases or complications were identified.

Background Gastric cancer is worldwide the fourth more common cancer type by incidence, and the third by mortality. We analyzed three missense variants of TAS2R38 gene: rs713598 (A49P), rs1726866 (V262A), and rs10246939 (I296V). These variants and their combination in haplotypes (proline, alanine and valine/tasters or alanine, valine and isoleucine/nontasters) and diplotypes are responsible for individual differences in bitter perception. The single-nucleotide polymorphisms and the related phenotypes are known to be associated with susceptibility to Gram-negative bacterial infections, such as Helicobacter pylori, and with risk of various cancer types. An association between intermediate tasters (as defined by TAS2R38 diplotypes) and increased risk of gastric cancer was reported in a Korean population. Methods We analyzed 2616 individuals of Latin American origin, representing the whole spectrum of lesions from gastritis to gastric cancer. Results Comparing cancer cases vs. noncancers we observed a decrease in risk associated with heterozygous carriers of rs10246939 (P = 0.006) and rs1726866 (P = 0.003) when compared with homozygotes of the more common allele. Also, the analysis of diplotypes/phenotypes reflected the same association, with super-tasters showing a borderline increased risk of developing gastric cancer compared to medium-tasters [odds ratio (OR) = 1.63; 95% confidence interval (CI), 1.04-2.56; P = 0.033]. Also, nontasters showed an increased risk when compared to medium-tasters although not reaching statistical significance (OR = 1.58; 95% CI, 0.80-2.87; P = 0.203). We also tested the interactions between the TAS2R38 genotypes and H. pylori cagA status in a subset of samples and found no interaction. Conclusion In conclusion, our results suggest only a modest contribution of TAS2R38 gene genetic variability in gastric cancer etiology.

ObjetiveTo analyze the effects of the implementation of an ERAS program in patients undergoing pulmonary resection in a tertiary university hospital on the rates of complications and readmission and the length of stay.Methodsambispective cohort study, with a prospective arm of patients undergoing thoracic surgery within an ERAS program versus a retrospective arm of patients before the implementation of the protocol. We recluited 50 patients per arm. The primary outcome was the number of patients with 30-day surgical complications. Secondary outcome included ERAS adherence, no-surgical complications, mortality, readmission, reintervention rates, pain and hospital lenght of stay. We performed a multivariate logistic analysis to study the association of coutcomes with ERAS adherence.ResultsWe found no difference between the two groups in surgical complications [Standard 18 (36%) vs 12 (24%], p =0.19]. ERAS group was significantly lower only in its readmission rate [Standard 15 (30%) vs 6 (12%], p =0.03]. In multivariate analyses, ERAS adherence was the only factor associated with a reduction in surgical complications [OR (95%CI) = 0.02 (0.00, 0.59), p = 0.03] and length of stay [HR (95%CI) = 18.5 (4.39, 78.4), p < 0.001].ConclusionsERAS program was able to decrease the readmission rate at our centre significantly. The adherence to the ERAS protocol influenced the reduction of surgical complications and length of stay.

Background: Asthma is a chronic inflammatory condition of the airways with a complex pathophysiology. Stratification of asthma subtypes into phenotypes and endotypes should move the field forward, making treatment more effective and personalized. Eosinophils are the key inflammatory cells involved in severe eosinophilic asthma. Given the health threat posed by eosinophilic asthma, there is a need for reliable biomarkers to identify affected patients and treat them properly with novel biologics. microRNAs (miRNAs) are a promising diagnostic tool. Objective: The aim of this study was to identify serum miRNAs that can phenotype asthma patients. Methods: Serum miRNAs of patients with eosinophilic asthma (N=40) and patients with noneosinophilic asthma (N=36) were evaluated using next-generation sequencing, specifically miRNAs-seq, and selected miRNAs were validated using RT-qPCR. Pathway enrichment analysis of deregulated miRNAs was performed. Results: Next-generation sequencing revealed 15 miRNAs that were expressed differentially between eosinophilic and noneosinophilic asthma patients, although no differences were observed in the miRNome between atopic and nonatopic asthma patients. Of the 15 miRNAs expressed differentially between eosinophilic and noneosinophilic asthma patients, hsa-miR-26a-1-3p and hsa-miR-376a-3p were validated by RT-qPCR. Expression levels of these 2 miRNAs were higher in eosinophilic than in noneosinophilic asthma patients. Furthermore, expression values of hsa-miR-26a-1-3p correlated inversely with peripheral blood eosinophil count, and hsa-miR-376a-3p expression values correlated with FeNO values and the number of exacerbations. Additionally, in silico pathway enrichment analysis revealed that these 2 miRNAs regulate signaling pathways associated with the pathogenesis of asthma. Conclusion: hsa-miR-26a-1-3p and hsa-miR-376a-3p could be used to differentiate between eosinophilic and noneosinophilic asthma.

Resumen Objetivo Conocer el grado de implantacion de las practicas seguras con los medicamentos en los Servicios de Medicina Intensiva e identificar oportunidades de mejora. Diseno Estudio descriptivo multicentrico. Ambito Servicios de Medicina Intensiva. Participantes/procedimiento Cuarenta Servicios de Medicina Intensiva que voluntariamente cumplimentaron el «Cuestionario de autoevaluacion de la seguridad del uso de los medicamentos en los Servicios de Medicina Intensiva» entre marzo y septiembre del 2020. El cuestionario contiene 147 items de evaluacion agrupados en 10 elementos clave. Variables principales de interes Puntuacion media y porcentaje medio sobre el valor maximo posible en el cuestionario completo, en los elementos clave y en los items de evaluacion. Resultados La puntuacion media del cuestionario completo en los Servicios de Medicina Intensiva fue de 436,8 (49,2% del valor maximo posible). No se encontraron diferencias segun dependencia funcional, tamano del hospital y tipo de servicio. Los elementos clave referentes a la incorporacion de farmaceuticos en estos servicios, asi como a la competencia y la formacion de los profesionales en practicas de seguridad, mostraron los valores mas bajos (31,2% y 33,2%, respectivamente). Otros tres elementos clave relativos a la accesibilidad a la informacion sobre los pacientes y los medicamentos; a la estandarizacion, el almacenamiento y la distribucion de los medicamentos, y a los programas de calidad y gestion de riesgos mostraron porcentajes inferiores al 50%. Conclusiones Se han identificado numerosas practicas seguras efectivas cuyo grado de implantacion en los Servicios de Medicina Intensiva es bajo y que es preciso abordar para reducir los errores de medicacion en el paciente critico.

Introduction The ankylosed spine is prone to increased fractures risk even after minor trauma. The lower cervical spine is most frequently injured, and fractures of the ankylosed spine tend to precipitate spinal cord injury (SCI). The objective of the current study is to assess the incidence, management, and outcomes of patients with ankylosis of the spine sustaining a cervical fracture with associated SCI over a 7-year period. Material and methods Prospective cohort study. Patients referred to the institution with a cervical fracture associated with SCI on a background of AS or DISH from 2009 to 2017 were reviewed. Demographics, mechanism of injury, fracture type, neurological level of injury, time to surgery, surgical management, neurological status (AIS), spinal cord independence measure (SCIMIII) scale at admission and discharge, and hospital length of stay. In September 2019 the summative data was analyzed using NDI, VAS, SV-QLI/SCI and length of survival were analyzed for statistical significance. Pathological fractures and dementia were excluded. Results 1613 patients with traumatic SCI were admitted in this period of whom 37 (12 AS and 25 DISH) met the inclusion criteria (mean age 65 years AS; 67 DISH). Fracture-dislocation was the most frequent fracture type (33% AS patients, 24% DISH patients). C4 was the most common neurological level of injury. SCIMIII score at admission was 1 point and 59 at discharge. AIS at admission was A (50%). At time of discharge no patient had neurologically deteriorated. Post-discharge mortality was 58% in AS patients and 32% in DISH patients (p = 0.13). Conclusions Both AS and DISH patients have high levels of disability and mortality associated with trauma to the cervical spine. Despite their distinct clinical differences, in this cohort there were no statistically significant differences between AS and DISH patients regarding fracture type, SCIMIII, AIS, hospital stay, mortality, VAS, and SV-QLI/SCI after cervical fracture over 7 years follow-up.

Background Penetrating neck injuries represent 5–10% of all traumatic injuries, these bring with them a high rate of morbidity and mortality due to vital structures that could be injured in this area. The aim of this study was to determine the epidemiological and clinical characteristics of penetrating neck injuries. Methods This was a retrospective, unicentric and descriptive study that included all patients who underwent neck exploration surgery. Results A total of 70 neck exploration cases were reviewed, 34 (49%) didn’t had any injury. Thirty (43%) had at least one hard sign, 42 (60%) patients showed at least one soft sign. Statistical analysis showed only surgical time (252 ± 199.5 vs. 155 ± 76.4; p = 0.020) and transfusions (1.87 ± 3 vs. 0.4 ± 0.856; p = 0.013) were statistically significant. We report a mortality of 2 (3%) patients. Conclusions Our prevalence of neck surgical exploration without vascular injury was slightly higher (49% vs. 40%) than literature. We highlight the importance of not performing neck explorations in all patients who present a penetrating injury. We did not obtain differences between groups for hard signs and soft signs. We were not able to identify whether or not there would be an injury based on clinical characteristics. Imaging studies should be performed to avoid unnecessary neck explorations; however, depending on the clinical scenario some surgery cannot be avoided.

This study sheds light on the contingent effect that employee human capital may have on the relationship between family involvement and internationalisation via exporting —both in terms of entry mode (how to export) and degree (how much to export). We formulate several hypotheses by drawing mainly on arguments from the resource-based view and stewardship theory. The empirical setting is a large sample of Spanish manufacturing firms (family and non-family) operating between 1991 and 2016. Our results reveal that the positive (negative) relationship between family involvement and export intensity (direct exporting) is boosted (mitigated) at higher levels of employee human capital. Our findings thus provide statistical support for a positive and significant contingent approach to the effect human capital has on the connection between family involvement and internationalisation.

Background: Covid-19 infection and cancer are associated with an increased risk of thrombotic events. The aim of our study is to analyze the cumulative incidence of thrombosis in oncological patients with Covid-19 and detect differences with the non-cancer Covid-19 population. Methods: We retrospectively reviewed 1127 medical records of all admitted patients to ward of the Hospital Universitario Infanta Leonor (Madrid, Spain), including 86 patients with active cancer between March 5th, 2020 to May 3rd, 2020. We analyzed cumulative incidence of thrombosis and risk factors associated to the cancer patient’s cohort. Results: We diagnosed 10 thrombotic events in 8 oncological patients with a cumulative incidence of 9.3%. A statistically significant association was found regarding thrombosis and history of obesity (p=0,009). No differences related to cumulative incidence of thrombosis between both groups were detected (9.8%vs 5.80%) in our hospital (p = 0.25). Conclusion: No significant differences were observed in the cumulative incidence of thrombosis in the two study groups. The thrombotic effect of Covid-19 is not as evident in cancer patients and does not seem to be added to its prothrombotic activity.

Resumen Antecedentes y objetivo La coalicion tarsiana puede ser causa de dolor de medio-retropie en ninos mayores. El objetivo es analizar los tipos de coalicion tratados en nuestro centro hospitalario de 2010 a 2019 asi como el tratamiento realizado. Material y metodo Estudio observacional, descriptivo y retrospectivo de 18 pacientes con coalicion tarsiana, 8 mujeres y 10 hombres, de 11,9 ± 2,6 anos de edad. Se recogieron datos epidemiologicos, hallazgos clinicos y de pruebas de imagen y tratamiento realizado. Resultados Se revisaron 25 pies (38,8% bilaterales). El principal sintoma fue el dolor. Un 64% se asociaba a pie plano-valgo. El 52% se localizaba en la articulacion calcaneo-escafoidea, y un 40% en la calcaneo-astragalina. El tratamiento fue conservador en un 44,4% de los casos y quirurgico en el 56% (reseccion de la coalicion). Se produjo un solo caso de recidiva. Los resultados fueron mayoritariamente excelentes o buenos (88%) tras un periodo medio de seguimiento de 4 anos. Conclusiones El tipo de coalicion tarsiana diagnosticada con mayor frecuencia fue la localizada en la articulacion calcaneo-escafoidea seguida de la calcaneo-astragalina, pero puede aparecer en cualquier articulacion del pie. Casi la mitad respondieron bien al tratamiento conservador con resultados mayoritariamente buenos, pero el resto requirieron tratamiento quirurgico por persistencia de la clinica, cuyos resultados fueron excelentes en todos los casos excepto en uno que sufrio una recidiva. En los casos de coaliciones calcaneo-astragalinas asociadas a valgo severo de retropie, la correccion de esta deformidad, asociada o no a la reseccion de la coalicion, es recomendable.

Background Aortic stenosis is one of the most prevalent valve diseases but is rarely accompanied by tricuspid regurgitation. Our objective was to analyse the impact of tricuspid regurgitation severity and its surgical treatment on prognosis of patients undergoing aortic valve replacement. Methods Retrospective cohort study including all patients presenting with aortic stenosis with some degree of tricuspid regurgitation between 2001 and 2018. Patients were divided into groups according to the degree of tricuspid regurgitation. Results From a sample of 8,080 patients with aortic stenosis, 143 (1,8%) presented with more than trace tricuspid regurgitation. Among patients with mild, moderate, or severe tricuspid regurgitation, we observed no differences in 30-day (15,1 vs 14,8 vs 8,7%;p=0,727), 12-month (51,2 vs 56 vs 55%;p=0,892) or 5-year (64 vs 73,3 vs 66,7%;p=0,798) survival. Aortic valve replacement plus tricuspid annuloplasty, when compared with aortic valve replacement only was associated with longer ICU stay (9 vs 3 days;p=0,043) but not higher 30-day (0 vs 15,5%;p=0,112), 12-month (38,5 vs 54,3%;p=0,278) or 5-year mortality (57,1 vs 67.1%;p=0,594). Only history of liver disease and postoperative major morbidity were independent predictors of survival 30 days, 12 months and 5 years after surgery. Conclusions Severity of tricuspid regurgitation in patients with aortic stenosis was not associated with increased mortality. Tricuspid annuloplasty did not improve survival in this subset of patients but was associated with increased postoperative morbidity.

OBJECTIVE To determine the effectiveness of a brief intervention in increasing influenza vaccination coverage compared with the usual advice in people who refuse it, and to record the main reasons for refusing to be vaccinated. METHOD A cluster randomized clinical trial was conducted in which the study population was individuals with high risk factors who initially had refused to be vaccinated against influenza. Professionals (doctors and nurses) who voluntarily accepted to participate were assigned randomly to the intervention group (brief intervention) and the control group (usual advice). RESULTS 57 professionals recruited 524 people who had previously declined the influenza vaccination (271 in the control group and 253 in the intervention group). Brief intervention showed its effectiveness with an odds ratio of 2.48 (1.61-3.82; p

Resumen Introduccion La hemodialisis domiciliaria (HDD) esta especialmente implementada en la Comunidad Valenciana en comparacion con el resto del territorio nacional, con una prevalencia de 13,4 pacientes pmp a diciembre de 2018. Realizamos una valoracion de las caracteristicas de los pacientes y de la supervivencia global y tecnica del paciente en HDD en funcion del momento historico de inicio y de su procedencia. Material y metodos Pacientes incluidos en el Registro de Enfermos Renales de la Comunidad Valenciana desde que se reportan datos al mismo hasta diciembre de 2020. Estudio descriptivo y retrospectivo, calculando supervivencia global (evento combinado muerte-fallo tecnico, censurando trasplante) y supervivencia tecnica (evento fallo tecnico, censurando muerte y trasplante). Comparamos la supervivencia de la tecnica en funcion de era de inicio: antigua (1976-2000) vs. moderna (2001-2020), y en funcion de la modalidad de procedencia. Realizamos regresion de Cox uni- y multivariante en el total de la serie tanto para supervivencia global como tecnica. Resultados Doscientos treinta y seis pacientes en HDD (611,4 pacientes-ano de seguimiento), edad media 49,7 ±16,3 anos; tiempo terapia renal sustitutiva previa 0,2 anos de mediana. Los ratios de trasplante, muerte y fallo tecnico fueron 13,2; 4,4 y 7 eventos por 100 pacientes-ano respectivamente. En la comparacion por eras segun inicio en HDD, antigua (n = 57) vs. moderna (n = 179) fue estadisticamente significativa la edad (37,5 vs. 53,5 anos), la DM (3,5 vs. 13,4%) y la nefropatia tubulointersiticial cronica (24,6 vs. 8,9%) como causa de enfermedad renal cronica. Hubo en la era moderna mayor probabilidad de provenir de consulta externa (33,3 vs. 48,6%) y de dialisis peritoneal (1,8 vs. 12,8%) con significacion estadistica. En era antigua un unico hospital centralizaba el 57,9% de los pacientes, y en era moderna entre 2 hospitales centralizaban el 55,8% de los pacientes. La supervivencia global en era antigua fue del 83,7% al ano, del 77,4% a 2 anos y del 61% a 5 anos; y en era moderna del 87,3% al ano, del 83% a 2 anos y del 47,8% a 5 anos (Log Rank: 0,521). La supervivencia tecnica en era antigua fue 85,4% al ano, 79% a 2 anos y 64,1% a 5 anos; y en era moderna 91,4% al ano, 88,5% a 2 anos y 74,5% a 5 anos (Log Rank: 0,195). No hubo diferencias estadisticas en la comparacion en funcion de la procedencia. En la regresion de Cox fueron estadisticamente significativos para supervivencia global la edad y estar diagnosticado de cardiopatia, enfermedad vascular o neoplasia activa, y para la supervivencia tecnica hepatopatia o problema social, tanto en analisis univariante como en multivariante. Conclusion En la era moderna existe un incremento considerable de pacientes en HDD en la Comunidad Valenciana. Hubo un efecto centro en el desarrollo de los programas de HDD, la mayoria de los pacientes dependian de pocos centros asistenciales. Los pacientes fueron de mayor edad y mayor comorbilidad en la era moderna, pese a ello sin afectar ni la supervivencia tecnica y ni global de la HDD.

There is consensus, both in academia and in the business world, that one of the main resources of a company is the incorporation of technology and, along with this, its capacity to generate innovation. Therefore, knowing the development of a company’s research becomes essential. The aim of this work is to develop a bibliometric analysis of the literature published in the Web of Science database to analyze the advances and trends in the development of research. The methodology analyzed bibliometric quantity and quality indicators using Bibliometrix, VOSviewer, and SciMAT software. The results show the evolution of the topic as well as recognition of the different lines along which research has organized the debate.

Background: The association between heart rate (HR) and pulmonary embolism (PE) outcomes has not been well studied. Furthermore, optimal cutoffs to identify low-risk and intermediate- to high-risk patients are not well known. Research Question: Does an association exist between baseline HR and PE outcome across the continuum of HR values? Study Design and Methods: The current study included 44,331 consecutive nonhypotensive patients with symptomatic PE from the Registro Informatizado de la Enfermedad TromboEmbólica registry between 2001 and 2021. Outcomes included 30-day all-cause and PE-specific mortality. We used hierarchical logistic regression to assess the association between admission HR and outcomes. Results: A positive relationship was found between admission HR and 30-day all-cause and PE-related mortality. Considering an HR of 80 to 99 beats/min as a reference, patients in the higher HR strata showed higher rates of all-cause death (adjusted OR, 1.5 for HR of 100-109 beats/min; adjusted OR, 1.7 for HR of 110-119 beats/min; adjusted OR, 1.9 for HR of 120-139 beats/min; and adjusted OR, 2.4 for HR of ≥ 140 beats/min). Patients in the lower strata of HR showed significantly lower rates of 30-day all-cause mortality compared with the same reference group (adjusted OR, 0.6 for HR of 60-79 beats/min; and adjusted OR, 0.5 for HR of < 60 beats/min). The findings for 30-day PE-related mortality were similar. For identification of low-risk patients, a cutoff value of 80 beats/min (vs 110 beats/min) increased the sensitivity of the simplified Pulmonary Embolism Severity Index (sPESI) from 93.4% to 98.8%. For identification of intermediate- to high-risk patients, a cutoff value of 140 beats/min (vs 110 beats/min) increased the specificity of the Bova score from 93.2% to 98.0%. Interpretation: In nonhypotensive patients with acute symptomatic PE, a high HR portends an increased risk of all-cause and PE-related mortality. Modifying the HR cutoff in the sPESI and the Bova score improves prognostication of patients with PE.

There is currently a degree of divergence among the main clinical practice guidelines on the management of risk factors for peripheral arterial disease (PAD). This project aims to gain understanding of the management of PAD risk factors in clinical practice and to reach a multidisciplinary consensus on the strategies to be followed in order to optimize its identification, treatment, and follow-up.A multidisciplinary consensus following the Delphi methodology.Professionals (n = 130) with extensive experience in PAD participated in this consultation. The results suggest that in order to optimize the control of risk factors, efforts should be aimed at: (1) promoting the involvement and awareness of all specialists in the identification of and screening for the disease; (2) guaranteeing the possibility of evaluating the ankle-brachial index (ABI) in all the medical specialties involved; (3) promoting strategies for patients to quit smoking through the use of drugs, programs, or referrals to specialized units; (4) promoting an appropriate Mediterranean-based diet and the prescription of daily exercise; (5) raising awareness of the importance of ensuring LDL cholesterol values below 70 mg/dL, especially in symptomatic but also in asymptomatic patients (55 mg/dL following the publication of the ESC/EAS guide); (6) recommending the use of antiplatelet therapy in asymptomatic patients with diabetes mellitus (DM) and/or a pathological ABI; and (7) protocolizing the annual evaluation of ABI in high-risk patients.This document presents the 22 agreed-upon strategies which are intended to help professionals optimize multidisciplinary management of PAD risk factors.

Circulating tumor mast cells (CTMCs) have been identified in the blood of a small number of patients with advanced systemic mastocytosis (SM). However, data are limited about their frequency and prognostic impact in patients with MC activation syndrome (MCAS), cutaneous mastocytosis (CM) and nonadvanced SM. We investigated the presence of CTMCs and MC-committed CD34+ precursors in the blood of 214 patients with MCAS, CM, or SM using highly sensitive next-generation flow cytometry. CTMCs were detected at progressively lower counts in almost all patients with advanced SM (96%) and smoldering SM (SSM; 100%), nearly half of the patients (45%) with indolent SM (ISM), and a few patients (7%) with bone marrow (BM) mastocytosis but were systematically absent in patients with CM and MCAS (P < .0001). In contrast to CTMC counts, the number of MC-committed CD34+ precursors progressively decreased from MCAS, CM, and BM mastocytosis to ISM, SSM, and advanced SM (P < .0001). Clinically, the presence (and number) of CTMCs in blood of patients with SM in general and nonadvanced SM (ISM and BM mastocytosis) in particular was associated with more adverse features of the disease, poorer-risk prognostic subgroups as defined by the International Prognostic Scoring System for advanced SM (P < .0001) and the Global Prognostic Score for mastocytosis (P < .0001), and a significantly shortened progression-free survival (P < .0001) and overall survival (P = .01). On the basis of our results, CTMCs emerge as a novel candidate biomarker of disseminated disease in SM that is strongly associated with advanced SM and poorer prognosis in patients with ISM.

Resumen Objetivo Valorar la interpretacion de ApnealinkTM® (AL) por medicos de atencion primaria (MAP), y la alcanzada mediante poligrafia respiratoria (PGR) en la Unidad de Sueno Hospitalaria (USH) en pacientes con alta probabilidad de sindrome de apnea e hipopnea del sueno (SAHS). Metodos Se recogen aleatoriamente, durante tres meses, pacientes seleccionados en USH para estudio mediante PGR, con elevada probabilidad de SAHS que aceptaron repetir estudio mediante AL. La USH corregia la PGR segun normativa SEPAR; el MAP corregia el AL y planteaba manejo. Se analizaron los pacientes con estudios validos(tiempo registro ≥ 240 min) para ambos dispositivos, comparandose resultados. Se considero el estudio AL automatico y corregido, considerando un indice de desaturacion de oxihemoglobina (ODI) al 4% (ODI 4%), (AL 4%) y al 3% (ODI 3%), (AL 3%). Cuando ODI 4% era ≥ 12/h, se establecio diagnostico SAHS moderado/grave, suponiendo un IAH ≥ 15/h. Para interpretar AL con ODI 3% y tratamiento, se siguieron criterios SEPAR. Se compararon los resultados para las mismas variables del AL frente a PGR. Resultados Se incluyeron 43 pacientes validos para AL, 45 para PGR y 41 validos para ambos estudios. El estudio AL 4% mostro 27 (62,8%) positivos (OR 5,5, p Se compararon los resultados para las mismas variables del AL frente a PGR. Conclusiones Existe equivalencia entre las decisiones del MAP y la USH. El AL seria un buen metodo diagnostico de SAHS en atencion primaria, en pacientes seleccionados con alta probabilidad de SAHS.

Trifluridine/tipiracil is currently approved for metastatic colorectal cancer (mCRC) refractory to available therapies. However, there is no consensus on factors that predict treatment outcomes in daily practice. We assessed the early clinical experience with trifluridine/tipiracil in Spain and potential survival markers. This was a retrospective cohort study of mCRC patients who participated in the trifluridine/tipiracil early clinical experience programme in Spain. The primary outcome was overall survival (OS). Associations between OS and patient characteristics were assessed using multivariate Cox regression analyses. A total of 379 patients were included in the study. Trifluridine/tipiracil was administered for a median of 3.0 cycles and discontinued mainly due to disease progression (79.2%). The median OS was 7.9 months, with a 12-month OS rate of 30.5%. Cox analyses revealed that the following variables independently enhanced OS: ≤2 metastatic sites, no liver metastasis, alkaline phosphatase &lt, 300 IU, trifluridine/tipiracil dose reductions, and neutrophil/lymphocyte ratio &lt, 5. Grade ≥ 3 toxicities were reported in 141 (37.2%) patients, including mainly afebrile neutropaenia (23.2%), anaemia (12.1%), and thrombocytopaenia (5.3%). This study supports the real-life efficacy and safety of trifluridine/tipiracil for refractory mCRC and identifies tumour burden, liver metastasis, alkaline phosphatase, dose reductions, and neutrophil/lymphocyte ratio as survival markers.

Resumen Introduccion Las infecciones por Chlamydia trachomatis (CT) son un problema de salud publica por su alta incidencia y consecuencias sobre la salud reproductiva. Nuestro objetivo es describir las caracteristicas sociodemograficas, conductuales y clinicas de los pacientes con infeccion por CT para adaptar las intervenciones preventivas a los grupos con mayor riesgo. Metodos Serie de casos prospectiva de todos los pacientes diagnosticados de CT entre septiembre del 2016 a enero del 2019 en las consultas de referencia para infecciones de transmision sexual (ITS) de Osakidetza en Bizkaia. Resultados Aceptaron participar 847 pacientes (88,2%): 41% mujeres, 33,8% varones heterosexuales y 25% hombres que tenian sexo con hombres (HSH); 33% eran inmigrantes y 26% menores de 25 anos (33% entre las mujeres). Un 20% utilizaba siempre preservativo. Un 36% habia tenido ITS anteriormente y 28% tenia otra ITS simultanea. El 55% de las infecciones fueron asintomaticas (70% entre las mujeres). El recto fue la localizacion mas frecuente entre los HSH (69,5%), seguida de la uretra (31,4%) y la faringe (14,5%). En las mujeres, la infeccion afecto principalmente el cervix (86,5% de los casos), seguido del recto (17,6%) y la faringe (13,8%). Se estudio a los contactos del 58% de los pacientes. La tasa de reinfeccion a las cuatro semanas fue del 17% entre aquellos con criterios para realizar un test de cura. Conclusion Estos resultados justifican la implantacion de cribados oportunistas en mujeres menores de 25 anos e inmigrantes jovenes de ambos sexos, con toma de muestras genitales y extra-genitales, y el establecimiento de guias apropiadas para la notificacion de contactos.

It is crucial to assess the levels of protection generated by natural infection or SARS-CoV-2 vaccines, mainly in individuals professionally exposed and in vulnerable groups. Measuring T-cell responses may complement antibody tests currently in use as correlates of protection. Our aim was to assess the feasibility of a validated assay of T-cell responses.Twenty health-care-workers (HCW) were included. Antibody test to SARS-CoV-2 N and S-proteins in parallel with a commercially available whole-blood-interferon-gamma-release-assay (IGRA) to S-peptides and two detection methods, CLIA and ELISA were determined.IGRA test detected T-cell responses in naturally exposed and vaccinated HCW already after first vaccination dose. The correlation by the two detection methods was very high (Whole-blood-IGRA-tests amenable to automation and constitutes a promising additional tool for measuring the state of the immune response to SARS-CoV-2; they are applicable to large number of samples and may become a valuable correlate of protection to COVID-19, particularly for vulnerable groups at risk of being re-exposed to infection, as are health-care-workers.Es fundamental evaluar los niveles de protección inmune en infectados o tras la vacunación frente a SARS-CoV-2. La cuantificación de la respuesta inmune celular T puede complementar la determinación de anticuerpos. Evaluamos la viabilidad de un ensayo comercial validado de respuesta celular T específica frente a SARS-CoV-2.Se incluyeron veinte trabajadores sanitarios (TS). Medimos anticuerpos contra las proteínas N y S de SARS-CoV-2 y realizamos el ensayo de liberación de interferón-gamma (IFNγ) en sangre completa (IGRA) frente a péptidos de la proteína S. IFNγ se determinó mediante dos métodos de detección: CLIA y ELISA.IGRA detectó respuesta celular T en TS tanto infectados como vacunados. La correlación de los dos métodos de detección de IFNγ fue muy alta (R 0,8) y la sensibilidad y la especificidad variaron entre 100 y 86% y 100-73% respectivamente. Hubo una concordancia muy alta entre los niveles de anticuerpos específicos y el ensayo IGRA aunque la correlación cuantitativa fue relativamente baja. En el grupo de infectados, una dosis de vacuna fue suficiente para alcanzar el «plateau» de respuesta inmune. IGRA fue claramente positivo en un profesional vacunado inmunosuprimido que presentaba anticuerpos contra la proteína S negativos.IGRA frente a péptidos de la proteína-S es susceptible de automatización y constituye una herramienta prometedora para medir la respuesta inmune celular frente a SARS-CoV-2; es aplicable a un gran número de muestras y puede servir para valorar la protección, particularmente en los grupos vulnerables en riesgo de volver a exponerse a la infección, como los TS.

Resumen Introduccion Las complicaciones infecciosas presentan un papel destacado en la duodenopancreatectomia. Su incidencia aumenta en casos con drenaje biliar preoperatorio (DBP), por el mayor riesgo de bacterobilia. Se presenta un estudio con el objetivo de valorar un protocolo de antibioterapia guiado por una tincion de gram intraoperatoria de liquido biliar. Metodos Estudio retrospectivo en el que se analiza la incidencia de complicaciones infecciosas entre dos grupos de 25 pacientes, consecutivos en el tiempo, intervenidos de duodenopancreatectomia. En el grupo 1 se administro profilaxis con cefazolina en pacientes sin DBP y antibioterapia durante cinco dias con piperacilina-tazobactam en casos con DBP. En el grupo 2 se realizo tincion de gram intraoperatoria de bilis de forma sistematica. Si no se detectaban microorganismos, la antibioterapia se limitaba a profilaxis con cefazolina. Si se apreciaba bacterobilia, se administraba antibioterapia dirigida durante cinco dias. Resultados La incidencia de infeccion organo-cavitaria fue del 24% en el grupo 1 y del 4% en el 2 (p=0,04) y la incidencia de sepsis fue del 32% en el primer grupo y del 4% en el segundo (p=0,01). No se apreciaron diferencias en el resto de variables de morbimortalidad. Los microorganismos mas prevalentes en bilis fueron Enterococcus spp y Klebsiella spp. En cultivos postoperatorios, aunque tambien fueron los mas frecuentes en el grupo 1 (28 y 24%), solo aparecieron en el 4% de los casos del grupo 2 (p Conclusion La tincion de gram intraoperatoria de bilis podria ser util para dirigir la antibioterapia en la duodenopancreatectomia y contribuir a reducir las complicaciones infecciosas.

BACKGROUND: In taekwondo the ability to repeat high-intensity efforts is characteristic of the sport. The Frequency speed of kick test (FSKT) is frequently used to assess this ability, although its influence on aerobic capacity and dynamic strength characteristics has received less attention in the literature. OBJECTIVE: To examine the relationship between specific high-intensity intermittent efforts with aerobic capacity and slow stretch-shortening cycle utilization in taekwondo athletes. METHODS: Nineteen taekwondo male athletes were assessed by squat jump (SJ), countermovement jump (CMJ), 20-meter shuttle run (20MSR), and frequency speed of kick test multiple (FSKTMULT). From the FSKTMULT, total kicks and kick decrement index [KDI] were calculated. Additionally, from both jump tests, the slow stretch-shortening cycle utilization (Slow SSC Utilization) was determined from the eccentric utilization ratio [EUR], pre-stretch augmentation [PSA], and reactive strength index [RSI]. RESULTS: There were positive and significant correlations between total kicks with 20MSR (r= 0.85; p= 0.00) and SJ (r= 0.66; p< 0.05). The multiple regression model demonstrated that total kicks where significantly influenced by 20MSR (R2= 71%; p= 0.00). Additionally, only EUR and RSI explained total kicks performance to a greater proportion (R2= 76%). CONCLUSIONS: The FSKTMULT total kicks performance is positively correlated and influenced by aerobic capacity and slow SSC utilization.

Resumen Introduccion y objetivos Se han desarrollado puntuaciones multiparametricas para una mejor estratificacion del riesgo en el sindrome de Brugada (SBr). Nuestro objetivo es validar 3 abordajes multiparametricos (las escalas Delise, Sieira y Shanghai BrS) en una cohorte de pacientes con sindrome de Brugada y estudio electrofisiologico (EEF). Metodos Pacientes diagnosticados de SBr y con un EEF previo entre 1998-2019 en 23 hospitales. Se utilizaron analisis mediante estadistico C y modelos de regresion de riesgos proporcionales de Cox. Resultados Se incluyo en total a 831 pacientes con una media de edad de 42,8 ± 13,1 anos; 623 (75%) eran varones; 386 (46,5%) tenian patron electrocardiografico (ECG) tipo 1; 677 (81,5%) estaban asintomaticos y 319 (38,4%) tenian un desfibrilador automatico implantable. Durante un seguimiento de 10,2 ± 4,7 anos, 47 (5,7%) sufrieron un evento cardiovascular. En la cohorte total, un ECG tipo 1 y sincope fueron predictivos de eventos arritmicos. Todas las puntuaciones de riesgo se asociaron significativamente con los eventos. Las capacidades discriminatorias de las 3 escalas fueron discretas (particularmente al aplicarlas a pacientes asintomaticos). La evaluacion de las puntuaciones de Delise y Sieira con diferente numero de extraestimulos (1 o 2 frente a 3) no mejoro sustancialmente el indice c de prediccion de eventos. Conclusiones En el SBr, los factores de riesgo clasicos como el ECG y el sincope previo predicen eventos arritmicos. El numero de extraestimulos necesarios para inducir arritmias ventriculares influye en las capacidades predictivas del EEF. Las escalas que combinan factores de riesgo clinico con EEF ayudan a identificar las poblaciones con mas riesgo, aunque sus capacidades predictivas siguen siendo discretas tanto en poblacion general con SBr como en pacientes asintomaticos.

Introduction Multiple sclerosis (MS) is an inflammatory, demyelinating, and neurodegenerative disease that affects the central nervous system. Adherence to treatment is essential to modify the course of the disease. Cognitive impairment affects up to 70% of these patients and is a limitation for administration and adherence to treatment. Objective The main objective was to assess the degree of adherence to treatment in patients with MS and cognitive impairment. Secondary objectives were to describe the tools that can influence adherence to treatment and to evaluate the effectiveness of the technological devices used to alert the patient that he/she must self-inject. Method The method consisted of a descriptive, retrospective, and cross-sectional pilot study. It was carried out in the MS clinic of the Torrecardenas University Hospital from December 2018 to September 2019. The sample included 20 patients diagnosed with MS currently treated with immunomodulatory injectable drugs for at least 6 months. The Symbol Digit Modalities Test (SDMT) was used to assess cognitive impairment and to determine adherence, patients answered the Morisky-Green test (MG). Results Twenty patients (8 men and 12 women) were included over 10 months with MS and cognitive impairment (SDMT score less than 50th percentile). Regarding gender-differentiated adherence, 75% of men were not adherent to treatment; by contrast, 66.6% of women were com-pliant with the dosage schedule. There were no statistically significant differences in terms of differentiated adherence by type of treatment. The main methods used to promote adherence were: 10% calendar, 20% family members, and 30% alarms as reminder. Discussion and conclusion Adherence results show a predominance of adherence in women, even with cognitive impairment. This reinforces our initial hypothesis that relates good therapeutic adherence to lesser progression of cognitive impairment in MS. As a preventive measure, we would like to emphasize the importance of the role of the nursing team in detecting cognitive impairment and in assessing adherence to treatment.

Resumen Introduccion Los pacientes hospitalizados con enfermedades reumaticas o autoinmunes sistemicas (ERAS) generan gran impacto en terminos clinicos. Objetivos Caracterizar a la poblacion y estimar factores de riesgo asociados con la presencia de desenlaces adversos en pacientes evaluados hospitalariamente por reumatologia en la Clinica Imbanaco durante los anos 2013-2019. Metodologia Se analizo una cohorte historica de pacientes hospitalizados que fueron evaluados por reumatologia. La poblacion se clasifico asi: grupo 1, pacientes con ERAS diagnosticada de novo; grupo 2, pacientes con ERAS diagnosticada conocida; grupo 3, pacientes sin ERAS diagnosticada; y grupo 4, pacientes con sospecha no confirmada de ERAS. Se definio un desenlace adverso compuesto si se presento al menos uno de los siguientes casos: 1) mortalidad hospitalaria; 2) ingreso a la unidad de cuidado intensivo; 3) infeccion intrahospitalaria; 4) reingreso. Resultados En un total de 327 eventos de hospitalizacion (307 pacientes), la mediana de edad fue 48 (34-63) anos y 222 (72,3%) fueron mujeres. El desenlace adverso compuesto se presento en 136 (41,5%) eventos. El grupo 2 tuvo mayor numero de desenlaces adversos (61/128; 47,6%). Las variables asociadas con peores resultados fueron: diagnostico inicial cardiovascular (OR = 4,63; IC: 1,60-13,43; p = 0,005), mayor estancia hospitalaria (OR = 1,04; IC: 1,01-1,07; p = 0,005) y tener una especialidad tratante diferente a medicina interna (OR = 2,79; IC: 1,26-6,17; p = 0,011). El sexo masculino (OR = 0,29; IC: 0,12-0,66; p = 0,004), pertenecer a un regimen especial de salud (OR = 0,39; IC: 0,15-0,99; p = 0,047) y tener hemoglobina > 11,4 g/dL (OR = 0,82; IC: 0,69-0,99; p = 0,039) fueron factores asociados con menor oportunidad de desarrollar el desenlace compuesto. Conclusiones En esta cohorte historica se encontro que porcentualmente el grupo de pacientes con ERAS diagnosticadas conocidas presentaron mayor numero de desenlaces adversos, entre los que se destacan para el mismo grupo, el ingreso a UCI y el reingreso hospitalario.

Resumen Trichophyton benhamiae es un dermatofito zoofílico. Puede causar tinea corporis, tinea faciei y tinea capitis. Se caracteriza por producir lesiones inflamatorias, sobre todo en niños. El objetivo de esta publicación es describir 7 casos clínicos de pacientes pediátricos atendidos entre julio del 2019 y enero del 2020 en nuestra institución. A los pacientes se les solicitó estudio micológico convencional, con posterior confirmación con MALDI-TOF MS y secuencia-ción del ADN ribosomal. Se aisló e identificó T. benhamiae como agente etiológico; el nexo epidemiológico fue el contacto con cobayos. Estas son las primeras descripciones de infecciones causadas por T. benhamiae en Argentina. Al realizar estudios micológicos convencionales, este agente puede confundirse con otros dermatofitos, por lo tanto, se requieren herramientas como MALDI-TOF MS o la secuenciación para llegar a un diagnóstico definitivo. Es importante contar con datos epidemiológicos, como el contacto con mascotas no tradicionales, para una presunción diagnóstica adecuada.

Objective: During its first year, the AWARE study assessed disease activity, patient quality of life (QOL), and treatment patterns in chronic urticaria (CU) refractory to H1-antihistamines (H1-AH) in clinical practice. Methods: We performed an observational, prospective (24 months), international, multicenter study. The inclusion criteria were age ≥18 years and H1-AH–refractory CU (>2 months). At each visit, patients completed questionnaires to assess disease burden (Urticaria Control Test [UCT]), disease activity (7 day-Urticaria Activity Score [UAS7]), and QOL (Dermatology Life Quality index [DLQI], Chronic Urticaria Quality of Life Questionnaire [CU-Q2oL], and Angioedema Quality of Life Questionnaire [AE-QoL]). We present data for Spain. Results: The study population comprised 270 evaluable patients (73.3% female, mean [SD] age, 48.9 [14.7] years). At baseline, 89.3% were prescribed a CU treatment. After 1 year, first- and second-line treatments became less frequent and third-line treatments became more frequent. At baseline, 47.0% of patients experienced angioedema; at 1 year, this percentage had fallen to 11.8%. The mean (SD) AE-QoL score decreased from 45.2 (28.7) to 24.0 (25.8). The mean (SD) UCT score decreased from 7.0 (4.5) to 12.1 (4.1). According to UAS7, 38.2% of patients reported absence of wheals and itch in the previous 7 days at 1 year compared with 8.3% at baseline. The mean (SD) DLQI score decreased from 8.0 (7.4) to 2.8 (4.6). At the 1-year visit, the percentage of patients reporting a high or very high impact on QOL fell from 29.9% to 9.6%. Conclusions: H1-AH–refractory CU in Spain is characterized by absence of symptoms and a considerable impact on QOL. Continuous follow-up of CU patients and third-line therapies reduce disease burden and improve patients’ QOL.

El grupo de investigación EDUTIC de la Vicerrectoría de Educación Virtual de la Universidad de Boyacá se encuentra desarrollando el proyecto “Estudio Comparativo entre Plataformas Virtuales Libres y la Plataforma Virtual Propietaria de la Universidad de Boyacá”. El objetivo planteado es identificar la plataforma virtual libre que se ajuste a las políticas del modelo pedagógico virtual de la Universidad de Boyacá con el fin de mejorar los servicios académicos que se ofrecen. El proyecto se sustenta en los modelos de calidad de software planteados en la ingeniería del software, así como en la revisión de los estándares de calidad definidos para la formación académica a través de e-learning y b-learning. Como resultado hasta el momento se ha logrado construir un conjunto de formatos de evaluación de LMS, los cuales se han agrupado en tres dimensiones: la dimensión del modelo pedagógico, la dimensión del usuario, y la dimensión técnica.

This article examines the contribution of streaming platforms in providing financial investment ‐ in the form of co-productions, commissions and acquisitions of audio-visual content ‐ as well as capital returns to local audio-visual producers. It will focus on the North American region, particularly on Mexico and Canada, as gravitating around stronger US audio-visual companies. Studies of traditional audio-visual windows in the countries studied have pointed out the undercapitalization of independent content producers due to financial structures and capital return models that are disadvantageous to them. This article questions: what is streaming’s contribution, as a new commercialization window, to the capitalization of local independent producers? The research conducted a qualitative study of interviews with film producers and distributors as well as an industrial analysis based on previous studies, media and business reports. The research has found that streaming tends to provide: (1) equal or slightly less returns than what the DVD window used to offer; and (2) equal or more generous figures than those delivered by TV and cinema exhibition windows. Furthermore, streaming has promoted a burgeoning production activity ‐ adding to the production from traditional players (film and TV). These are benefits that should not be overlooked. However, streaming has not altered independent producers’ disadvantageous position: (1) revenue shares are still relatively small; (2) licences represent small percentages of what content costs to make; (3) commissioning and co-production budgets are fairly close to production costs; and (4) the boom of platforms’ original production is actually a battle among large corporations to control intellectual property (IP). All the above keep hindering the financial capacity of local independent producers.

Resumen Introduccion y objetivos El acceso transaxilar (ATx) se ha convertido en el acceso alternativo al transfemoral (ATF), mas utilizado en pacientes sometidos a implante percutaneo de valvula aortica (TAVI). El objetivo principal de este estudio es comparar la mortalidad total hospitalaria y a los 30 dias de los pacientes incluidos en el registro espanol de TAVI a los que se trato por acceso ATx frente a ATF. Metodos Se analizo a todos los pacientes incluidos en el registro espanol de TAVI tratados por ATx o ATF. Los eventos hospitalarios y a los 30 dias de seguimiento se definieron segun las recomendaciones de la Valve Academic Research Consortium. Se evaluo el impacto de la via de acceso mediante emparejamiento por puntuacion de propension segun las caracteristicas clinicas y ecograficas. Resultados Se incluyo a 6.603 pacientes, 191 (2,9%) tratados por ATx y 6.412 con ATF. Despues del ajuste (grupo de ATx, n = 113; grupo de ATF, n = 3.035), el exito del dispositivo fue similar entre ambos grupos (el 94% en el grupo de ATx frente al 95% en el de ATF; p = 0,95); sin embargo, se observo un incremento en la tasa de infarto agudo de miocardio (OR = 5,3; IC95%, 2,0-13,8; p = 0,001), complicaciones renales (OR = 2,3; IC95%, 1,3-4,1; p = 0,003) e implante de marcapasos (OR = 1,6; IC95%, 1,01-2,6; p = 0,03) en el grupo de ATx comparado con el de ATF. De mismo modo, la mortalidad hospitalaria y a los 30 dias fueron superiores en el grupo de ATx (respectivamente, OR = 2,2; IC95%, 1,04-4,6; p = 0,039; y OR = 2,3; IC95%, 1,2-4,5; p = 0,01). Conclusiones El ATx se asocia con un aumento en la mortalidad total tanto hospitalaria como a los 30 dias frente al ATF. Ante estos resultados, el ATx debe considerarse solo en caso de que el ATF no sea posible.

Neuroleptic malignant syndrome is a rare medical emergency associated with the use of antipsychotics and other antidopaminergic drugs. There is no specific test, and diagnosis is based on high clinical suspicion and good differential diagnosis. A clinical picture consistent with hyperthermia, muscle rigidity, altered level of consciousness, together with signs of rhabdomyolysis in analytical studies and a history of taking neuroleptic drugs are the key elements in the detection of this entity. Due to its low incidence and potential mortality, it is essential to publish case reports of neuroleptic malignant syndrome in order to raise awareness of this entity and facilitate diagnostic suspicion when encountering a patient with compatible symptoms. The following is the case of a 79 year old patient with chronic alcohol consumption as the only history of interest, who was given a single dose of haloperidol after an episode of delirium in the postoperative period of conventional trauma surgery. She subsequently developed a picture of progressive deterioration of the level of consciousness, diaphoresis, generalized muscle rigidity, hyperthermia, together with severe metabolic acidosis, hyperlacticaemia, rhabdomyolysis, hypertransaminasemia and hypocalcemia. After ruling out other entities compatible with the clinical picture, neuroleptic malignant syndrome was given as the main diagnostic hypothesis. Diagnosis was confirmed after clinical and analytical improvement following treatment with dantrolene. The patient was discharged from hospital with no sequelae a few days after onset of the condition.

Introduction Although minimally invasive surgery is becoming the standard technique in gastrointestinal surgery, implementation for small bowel neuroendocrine neoplasms (SB-NEN) is lagging behind. The aim of this international survey was to gain insights into attitudes towards minimally invasive surgery for resection of SB-NEN and current practices. Methods An anonymous survey was sent to surgeons between February and May 2021 via (neuro)endocrine and colorectal societies worldwide. The survey consisted of questions regarding experience of the surgeon with minimally invasive SB-NEN resection and training. Results A total of 58 responses from five societies across 20 countries were included. Forty-one (71%) respondents worked at academic centers. Thirty-seven (64%) practiced colorectal surgery, 24 (41%) endocrine surgery and 45 (78%) had experience in advanced minimally invasive surgery. An open, laparoscopic or robotic approach was preferred by 23 (42%), 24 (44%), and 8 (15%) respondents, respectively. Reasons to opt for a minimally invasive approach were mainly related to peri-operative benefits, while an open approach was preferred for optimal mesenteric lymphadenectomy and tactile feedback. Additional training in minimally invasive SB-NEN resection was welcomed by 29 (52%) respondents. Forty-three (74%) respondents were interested in collaborating in future studies, with a cumulative median (IQR) annual case load of 172 (86-258). Conclusions Among respondents, 69% applies minimally invasive surgery for resection of SB-NEN. Arguments for specific operative approaches differ, and insufficient training in advanced laparoscopic techniques seems to be a barrier. Future collaborative studies can provide better insight in selection criteria and optimal technique.

BACKGROUND Invasive pneumococcal disease (IPD) is the most important bacterial infection in young children, and the introduction of pneumococcal conjugate vaccines has changed its presentation. This study compared the incidence, characteristics and serotype distribution of IPD before and after the introduction of the pneumococcal conjugate vaccine (PCV13). METHODS Prospective enrolment of patients with IPD aged less than 60 months and admitted to either of 2 tertiary care hospitals between January 2007 and December 2009 (pre-PCV13 period) and January 2012 and June-2016 (PCV13 period). RESULTS We identified 493 cases, 319 in the pre-PCV13 period and 174 in the PCV13 period. The incidence of IPD decreased from 89.7 to 34.4 casos per 100 000 habitantes ( -62%; P

Pathological response to neoadjuvant therapy with chemotherapy vs chemoradiotherapy in stage III NSCLC. Contribution of IASLC recommendations

Background While ptosis is a well-known consequence of glaucoma surgery, some isolated case reports point to the possibility of upper eyelid retraction occurring after glaucoma surgery. This study aims to analyze the occurrence of ptosis and eyelid retraction after glaucoma surgery and to evaluate factors contributing to these palpebral fissure changes. Methods Cross-sectional study including 100 eyes of 100 patients that had undergone unilateral glaucoma surgery. Upper eyelid height in the operated eye was measured by digital photography and compared with the fellow, non-operated eye. The main outcome was to determine if ptosis or retraction occurred in the operated eye in comparison with the fellow eye. The secondary outcome was to determine if any variable was associated with ptosis or retraction. A clinically significant difference (either toward ptosis or retraction) was defined as a difference ≥1 mm between both eyes. Results Of 100 eyes included 81 (81%) showed no change in eyelid height (−0.133 mm ± 0.496), 11 (11%) showed ptosis (−1.348 mm ± 0.387) and 8 eyes (8%) showed retraction (1.705 ± 0.634). A statistically significant relation was found between ptosis and pseudoexfoliation glaucoma (p = 0.003). A trend toward lower postoperative IOP and higher conjunctival blebs was found in eyes with postoperative eyelid retraction. Conclusions Eyelid retraction was present in 8% of patients and ptosis in 11%. Patients with eyelid retraction showed around a 3 mmHg lower postoperative IOP than eyes without retraction. The presence of pseudoexfoliation may be a risk factor for this complication. A prospective study with a large number of patients would be required to confirm these results.

Background Refractory obsessive-compulsive disorder (OCD) among adults is the first psychiatric indication of deep brain stimulation (DBS) to receive an FDA Humanitarian Device Exemption (HDE). Given the HDE approval and encouraging evidence that has since emerged, exploration of DBS for OCD may expand to adolescents in the future. More than 100,000 adolescents in the U.S. suffer from refractory OCD, and there is already a precedent for the transition of DBS in adults to children in the case of dystonia. However, the risk-benefit analysis of pediatric DBS for OCD may be more complex and raise different ethical questions compared to pediatric DBS for dystonia. Objective This study aimed to gain insight into pressing ethical issues related to using DBS in adolescents with OCD. Methods Semi-structured interviews were conducted with clinicians (n = 25) caring for pediatric patients with refractory OCD. Interview transcripts were coded with MAXQDA 2018 software and analyzed using thematic content analysis to identify emergent themes. Results Five central themes were identified in clinician responses, three of which were exacerbated in the pediatric DBS setting. Clinicians expressed concerns related to conditions of decision-making including adolescents' capacity to assent (80%), the lack of evidence about the outcomes and potential unknown effects of using DBS in adolescents with OCD (68%), and the importance of exhausting other treatment options before considering DBS (20%). Conclusions Strategies to address clinician concerns include implementation of validated decision support tools and further research into the outcomes of pediatric DBS for OCD to establish clear guidelines for patient selection.

Mª del Carmen Álamo,1 Sebastian Ochenduszko,2 Guillermo Crespo,3 Mónica Corral,4 Juana Oramas,5 Pilar Sancho,6 Javier Medina,7 Fernando Garicano,8 Pedro López,9 Begoña Campos Balea,10 Analia Rodríguez Garzotto,11 Eva Muñoz-Couselo12,13 1Oncology Department, Hospital Universitario Virgen Macarena, Sevilla, Spain; 2Oncology Department, Hospital Universitario Dr. Peset, Valencia, Spain; 3Oncology Department, Hospital Universitario de Burgos, Burgos, Spain; 4Oncology Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain; 5Oncology Department, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain; 6Oncology Department, Hospital Universitario Virgen del Rocío, Sevilla, Spain; 7Oncology Department, Hospital Universitario Virgen de la Salud, Toledo, Spain; 8Oncology Department, Hospital de Galdakao, Bizkaia, Spain; 9Oncology Department, Complejo Hospitalario General de Jaén, Jaén, Spain; 10Oncology Department, Hospital Lucus Augusti, Lugo, Spain; 11Medical Department and Strategy, Roche S.A, Madrid, Spain; 12Oncology Department, Hospital Universitario Vall d´Hebron, Barcelona, Spain; 13VHIO Vall d’Hebron Institute on Oncology, Barcelona, SpainCorrespondence: Eva Muñoz-CouseloOncology Department, Hospital Universitario Vall d´Hebron, Passeig de la Vall d’Hebron, 119, Barcelona, 08035, SpainEmail emunoz@vhio.netBackground: The combination of BRAF and MEK inhibitors delays the onset of resistance and provides more sustained and dramatic responses in comparison with a BRAF inhibitor in monotherapy. The objective of the study was to evaluate the effectiveness of the combination therapy with vemurafenib/cobimetinib in terms of durability, and to describe differential characteristics in patients associated to durable responses in real-world settings.Patients and Methods: Retrospective, observational, cross-sectional, multicenter study involving 41 patients with advanced melanoma harboring a BRAFV600 mutation who initiated a combination therapy with vemurafenib/cobimetinib between May 2018 and March 2019. Participants were differentiated regarding the durability of the response: durable (complete response, CR, or a partial response, PR, for at least 12 months) and non-durable (stable disease, SD, progressive disease, PD, or CR/PR < 12 months). Secondary endpoints included treatment adherence, labor productivity, anxiety/depression, and safety profile.Results: During the combination therapy, 12 patients (29.3%) had a CR, 19 a PR (46.3%), 5 showed SD (12.2%), and 5 had PD. A total of 12 patients (29.3%) were considered as achieving a durable response and 29 (70.7%) as a non-durable one. Practically all sociodemographic and clinical characteristics were similar between patients. Body mass index was the only differential factor (with higher body mass index achieving a non-durable response). The treatment adherence was 100% in patients with durable response and 66.7% in those with non-durable.Conclusion: The combination treatment with vemurafenib/cobimetinib results in an important impact on long-term survival, leading to a steady CR in one-third of the patients.Keywords: vemurafenib, cobimetinib, BRAF, metastatic melanoma, durable response, clinical practice

Resumen Objetivo Evaluar el uso de la terapia con beneficio cardiovascular en pacientes con DM tipo 2 previo al ingreso en servicios de medicina interna. Metodos Estudio transversal en un dia de los pacientes con DM tipo 2 hospitalizados en servicios de medicina interna. Se recogieron variables demograficas y antropometricas, datos de laboratorio y utilizacion de farmacos antihiperglucemiantes. La variable desenlace fue la proporcion y los determinantes de uso de inhibidores del cotransportador sodio-glucosa 2 (iSGLT2) y de agonistas del receptor del peptido similar al glucagon tipo 1 (AR-GLP1). Resultados Se incluyeron 928 pacientes pertenecientes a 74 hospitales. La edad media fue 78,9 anos (DE: 10,86), un 50% varones. Un total de 557 (60%) presentaba cardiopatia isquemica, 189 (20,4%) enfermedad cerebrovascular, 293 (31,6%) insuficiencia cardiaca, 274 (29,5%) enfermedad renal cronica y 129 (13,9%) enfermedad arterial periferica. Los antihiperglucemiantes utilizados previo al ingreso fueron: sulfonilureas (5.7%), biguanidas (49.1%), inhibidores de la alfa-glucosidasa (0,2%), pioglitazona (0%), iDPP4 (39%), iSGLT2 (5,8%), AR-GLP1 (2,6%) y analogos de insulina basal (24%). La edad mayor de 75 anos fue el factor determinante principal para no utilizar iSGLT2 (OR ajustada 0,28; intervalo de confianza al 95%: 0,10-0,74; p = 0,039) o AR-GLP1 (OR ajustada 0,09; intervalo de confianza al 95%: 0,02-0,46; p = 0,006). Discusion Una gran proporcion de pacientes ancianos con DM tipo 2 de muy alto riesgo cardiovascular no recibe terapia antihiperglucemiante con farmacos de probado beneficio cardiovascular. El tratamiento mas frecuentemente utilizado fue metformina e iDPP4. Existe un margen de mejora en el tratamiento en esta poblacion de muy alto riesgo.

To report the case of a pregnant woman with mirror syndrome associated with non-compaction cardiomyopathy in the mother and the fetus, in which antenatal medical treatment provided to the mother resulted in a favorable perinatal maternal outcome.A 16-year old primigravida with 33 weeks of gestation referred from a Level I institution to a private Level IV center in Medellín, Colombia, because of a finding of fetal hydrops on obstetric ultrasound. During hospitalization, the patient showed clinical and ultrasonographic signs of heart failure (dyspnea, edema and hypoxemia), with the diagnosis of hydrops fetalis (mirror syndrome) also confirmed. Diuretic treatment with furosemide was initiated in the mother, with subsequent improvement of the maternal condition as well as of the fetal edema. During the subacute postpartum period in the hospital, the presence of non-compaction cardiomyopathy was confirmed on cardiac nuclear magnetic resonance imaging in both the mother and the newborn. After discharge in adequated condition, they were included in the cardiovascular follow-up program for heart failure and congenital heart disease, respectively.A case of mirror syndrome associated with maternal and fetal non-compaction cardiomyopathy is presented. There is a limited number of reports on mirror syndrome due to cardiac anomalies (maternal and fetal), with weak treatment descriptions, pointing to the need for research in this area. It would be important to consider the diagnosis of non-compaction cardiomyopathy in fetuses with hydrops unrelated to isoimmunization or cardiac dysfunction, and approach these cases from a multi-disciplinary perspective.reportar el caso de una gestante con síndrome en espejo asociada a miocardiopatía no compactada, tanto en la madre como el feto, en los que el tratamiento médico antenatal en la madre llevó a un resultado materno perinatal favorable.se describe el caso de una primigestante de 16 años, con 33 semanas de embarazo, remitida desde una institución de primer nivel de atención a una institución privada de cuarto nivel en la ciudad de Medellín, Colombia, por presentar feto con hidropesía en ultrasonido obstétrico de control. Durante la hospitalización, la paciente presentó signos clínicos y ecocardiográficos de falla cardiaca (disnea, edema e hipoxemia), a la vez que se confirmó el diagnóstico de Hydrops fetalis (síndrome en espejo). Se instauró tratamiento diurético con furosemida en la madre, logrando mejoría del cuadro materno y del edema fetal. En el puerperio mediato hospitalario se confirmaron la presencia de miocardiopatía no compactada en la resonancia magnética nuclear cardiaca, tanto de la madre como del recién nacido. Ambos egresaron en adecuadas condiciones y fueron vinculados al programa de seguimiento cardiovascular: falla cardiaca y de cardiopatía congénitas, respectivamente.se presenta un caso de síndrome en espejo asociado a miocardiopatía no compactada materna y fetal. Es limitado el número de reportes de síndrome en espejo por anomalías cardiacas (maternas y fetales) y pobre la descripción de los tratamientos realizados que surgen como temas a investigar. Sería importante considerar el diagnóstico de MNC en fetos con hidropesía no asociados a isoinmunización y con disfunción cardiaca, así como su atención por equipos multidisciplinarios.

La linfocitopenia T CD4 idiopática (LCI) es un síndrome clínico inusual que se caracteriza por un déficit de células T CD4+ circulantes en ausencia de infección por VIH u otra condición de inmunosupresión. Los pacientes con dicha enfermedad pueden presentarse asintomáticos o con infecciones oportunistas, las más frecuentes son por criptococo, micobacterias o virales como herpes zoster. Presentamos el caso de un hombre de 32 años, sin antecedentes, en quien se descartó infección por retrovirus, con recuento de linfocitos T CD4+ menor a 300 células/m3; se diagnosticó LCI posterior al diagnóstico de criptococomas cerebrales mediante hallazgos imagenológicos los cuales fueron congruentes con estudios microbiológicos.