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Introduction Streptococcus bovis/equinus complex (SBEC) is a major cause of infective endocarditis (IE), although its incidence varies greatly depending on the geographical area. The characteristics of IE caused by Streptococcus gallolyticus susp. gallolyticus are well known; there are hardly any descriptions of IE caused by other species or biotypes. Methods Retrospective cohort study, from 1990 to 2019, of all SBEC IE in adults in three Spanish hospitals, Lugo (LH), Barcelona (BH) and Ferrol (FH) where the population is mainly rural, urban and mixed, respectively. The incidence of IE was analyzed in 3 areas. Clinical characteristics of IE (277 cases, 258 biotyped) were compared according to SBEC species and biotypes. Results There are significant differences between the incidence of SBEC IE in HL (27.9/106) vs. HF and HB (8.8 and 7,1, respectively, p Conclusions IE due to SBEC has geographical variations in incidence and different clinical characteristics among biotypes. The association with CRC was high.

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 La amiloidosis hereditaria por transtirretina (ATTRv) es una enfermedad causada por mutaciones en el gen de la transtirretina que frecuentemente presenta afeccion cardiaca debido al deposito de amiloide en el miocardio. Nuestro objetivo es describir esta afeccion en una cohorte espanola. Metodos Estudio retrospectivo multicentrico de pacientes con ATTRv y afeccion cardiaca provenientes de centros espanoles. Se recogieron datos demograficos, clinicos y geneticos. Resultados En 26 centros se incluyo a 181 pacientes, el 65,2% varones, con una mediana de edad al diagnostico de 62 anos. Las mutaciones mas frecuentes fueron Val50Met (67,7%) y Val142Ile (12,4%). El principal motivo de consulta fue extracardiaco (69%), principalmente neurologico. La media de la fraccion aminoterminal del propeptido natriuretico cerebral (NT-proBNP) fue 2.145 ± 3.586 pg/ml. Lo mas caracteristico del electrocardiograma fueron el patron de seudoinfarto (25,9%) y el bloqueo auriculoventricular (25,3%). El grosor ventricular medio fue 15,4 ± 4,1 mm. El strain longitudinal estaba reducido en segmentos basales en el 29,4%. Se observo realce tardio subendocardico difuso en el 58,8%. En la gammagrafia habia captacion de grados 2-3 en un 75%. En el seguimiento, el 24,9% ingreso por insuficiencia cardiaca, el 34,3% preciso marcapasos y el 31,6%, trasplante hepatico. El 32,5% fallecio, principalmente por insuficiencia cardiaca (28,8%). Las mutaciones diferentes de Val50Met se asociaron en general con un peor pronostico. Conclusiones La ATTRv cardiaca en Espana tiene un espectro genetico y de afeccion heterogeneo. El pronostico es malo principalmente por las complicaciones cardiacas, por lo que son esenciales un diagnostico y un tratamiento precoces.

Introduction and objectives Hereditary transthyretin amyloidosis (hATTR) is a disease caused by mutations in the transthyretin gene that frequently shows cardiac involvement due to amyloid deposition in the myocardium. Our objective was to identify cardiac involvement in a Spanish cohort. Methods Retrospective multicenter study of patients diagnosed with hATTR with cardiac involvement from Spanish centers. We collected demographic, clinical, and genetic data. Results A total of 181 patients from 26 centers were included (65.2% men, with a median age at diagnosis of 62 years). The most frequent mutations were Val50Met (67.7%) and Val142Ile (12.4%). The main reason for consultation was extracardiac symptoms (69%), mainly neurological. The mean N-terminal pro-B-type natriuretic peptide level was 2145±3586 pg/mL. The most characteristic electrocardiogram findings were a pseudoinfarct pattern (25.9%) and atrioventricular block (25.3%). Mean ventricular thickness was 15.4±4.1mm. Longitudinal strain was reduced in basal segments by 29.4%. Late diffuse subendocardial enhancement was observed in 58.8%. Perugini grade 2 or 3 uptake was observed in 75% of scintigraphy scans. During follow-up, 24.9% of the patients were admitted for heart failure, 34.3% required a pacemaker, and 31.6% required a liver transplant. One third (32.5%) died during follow-up, mainly due to heart failure (28.8%). The presence of non-Val50Met mutations was associated with a worse prognosis. Conclusions HATTR cardiac amyloidosis in Spain shows heterogeneous genetic and clinical involvement. The prognosis is poor, mainly due to cardiac complications. Consequently early diagnosis and treatment are vital.

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

Background Major concerns years after the sleeve gastrectomy (SG) include weight regain, development of hiatal hernia (HH) and gastro esophageal reflux disease (GERD), with esophagitis and Barrett's esophagus (BE). Both problems could be related, and the incidence of asymptomatic patients is troubling. Goal To study the incidence of reflux symptoms, esophagitis, BE, hiatal hernia and asymptomatic pathology and their relationship with weight regain in patients 5 years after undergoing SG at different bariatric centers in Spain. Setting Public and private hospitals with bariatric surgery units. Patients and method Prospective, multicenter, non-randomized study involving 13 Spanish hospitals with a cumulative experience of 4500 patients having undergone the SG procedure and patients who had been subjected to the procedure at least 5 years previously along with preoperative gastroscopy. The clinical history, preoperative gastroscopy, and technical details of the SG were recorded. A specific clinical questionnaire was given that recorded the intake volume, perception of satiety and gastroesophageal reflux (GER) symptoms. Gastroscopy, pH-metry and manometry studies were carried out, and the data analyzed statistically. The study has been authorized by the official Spanish ethics committee "CEI/CEIm Hospital Universitario Gran Canaria Dr Negrin", with the code 2019-216-1. Results 105 patients who underwent SG and who had with at least 5 years of follow-up were included. All procedures were performed laparoscopically. The mean age of patients was 51.1 years and 70.5% were women. The mean characteristics of the SG procedure were a 37.2 French probe, at 4.6 cm from the pylorus, and a crura closure was performed in 5 cases. There were no major complications (Clavien Dindo> 3) or deaths. The average preoperative Body Mass Index (BMI) was 46.3 kg/m2, the minimum reached was 20.6 kg/m2, while the average after 5 years was of 34.5 kg/m2. The presence of GER, hiatal hernia and esophagitis symptoms went from 17.1%, 28.6% and 5.7%, respectively, before the SG to 76%, 30,5% and 31,4% respectively, 5 years after the procedure. Symptoms persisted over the years in 37,1% of cases and presented de novo in 52,8% of cases. 53% of manometries (n=27, total 51) and 64% of pH-metries (n=32, total 53) (DeMeester average score was 65) were pathological 5 years after the procedure. Concerning gastroscopies, 5 years after the procedure, HH was found in 33 patients (30,5% of total) and esophagitis in 32 patients (31,4% of total). 80 patients (76%) had GER symptoms, and 25 patients (24%) were asymptomatics. Only one patient (0,9%) developed BE. Conclusion Our study has confirmed a high rate of both “persistent” and “de novo” esophagitis and hiatal hernia, many of which were asymptomatic, 5 years after SG had been performed. Weight regain and a striking increase in gastric capacity are risk factors indicative of esophagitis, even when patients are asymptomatic. We consider a control gastroscopy and the preventive use of proton pump inhibitors (PPIs) necessary in these cases, regardless of symptoms. We recommend a control gastroscopy should be performed in all cases, regardless of symptoms, 5 years after SG. Further studies are needed to validate these recommendations.

Pertussis is a highly contagious, vaccine-preventable respiratory tract infection, with high morbidity and mortality and a particularly severe effect on newborns and infants under 2 months. The first pertussis vaccines were introduced in the 1940s. Since 1980, however, the incidence of cases has risen despite the extensive vaccination programmes and antibiotic adjuvant treatments available. Transition from the use of whole-cell vaccines to acellular vaccines and the antigenic modifications of Bordetella pertussis have contributed, among other factors, to a reduction in vaccine-acquired immunity and reemergence of the disease. Today, there are still unmet needs not covered by conventional prevention measures and existing antibiotic treatments. This review aims to update the available data, and to discuss which vaccine strategies might contribute to better disease control and prevention.

Resumen Introduccion El diagnostico de la infeccion tuberculosa latente (ITL) mediante IGRA sigue generando debate. La experiencia empleando dos pruebas IGRA de manera simultanea es escasa. El objetivo de este estudio es comparar los resultados de dos versiones de QuantiFERON-TB Gold (In-Tube/Plus) con los de T-SPOT.TB y analizar la eficacia de esta estrategia dual (T-SPOT.TB + QTF) para el diagnostico de la ITL en poblacion con alguna condicion inmunosupresora. Metodos Estudio prospectivo (mayo 2015-junio 2017) que incluye 2.999 pacientes inmunodeprimidos y/o candidatos a terapias biologicas, a los que se les realizo de manera simultanea dos IGRA: grupo-1 (1.535 pacientes): T-SPOT.TB + QuantiFERON-TB Gold-In-Tube (QTF-GIT); grupo-2 (1.464 pacientes): T-SPOT.TB + QuantiFERON-TB Gold Plus (QTF-Plus). Resultados La concordancia entre QTF-GIT y T-SPOT.TB fue del 83,19% (κ = 0,532). Las proporciones de resultados positivos, negativos e indeterminados fueron, respectivamente: 14,33 vs. 17,06%; 82,41 vs. 74,46%; y 3,25 vs. 8,46%. La concordancia entre QTF-Plus y T-SPOT.TB fue del 87,56% (κ=0,609). Las proporciones de resultados positivos, negativos e indeterminados fueron, respectivamente: 15,02 vs. 15,36%; 82,92 vs. 79,37%; y 2,04 vs. 5,25%. Las discordancias entre T-SPOT.TB y QTF-Plus fueron del 12,43%, que implicaban que habia 103 pacientes positivos y otros 79 pacientes negativos a expensas exclusivamente de uno de los dos IGRA. Conclusiones Se evidencio una mayor concordancia entre QTF-Plus y T-SPOT.TB que entre QTF-GIT y T-SPOT.TB. Sin embargo, creemos que la proporcion de resultados discordantes entre T-SPOT.TB y QTF-Plus es lo suficientemente relevante clinicamente como para justificar el empleo simultaneo de dos IGRA en este grupo especifico de pacientes.

Introduction Gestational anaemia, which has specific haemoglobin (Hb) reference values in each trimester of gestation, increases the risk of maternal mortality and complications both in pregnancy and in the first months of the newborn's life. The objective of this study is to evaluate haemoglobin levels in pregnant women in our population, to determine the prevalence of gestational anaemia and to propose reference values specific to them. Material and methods Retrospective study of all blood counts requested in pregnancy and postpartum controls during 2019. Results 9995 gestation haemograms corresponding to 5507 pregnant women were reviewed. Of these, 1134 patients underwent complete follow-up in 2019. The prevalence data for anaemia were 1.8%, 11.8% and 13.2% in each trimester respectively, and the global prevalence in pregnancy was 22.6%. Regarding postpartum anaemia, its prevalence with respect to all pregnant women was 2.99%, increasing to 38.2% in those patients with complications during delivery. Conclusions The prevalence of gestational anaemia in our population is somewhat higher than in countries like ours. Therefore, there is room for improvement in our current clinical protocols. It is important to assess updating analytical controls with other more adequate parameters to determine iron reserves, as this is the main cause of anaemia.

Background: Recently, a specific methodology has been defined, using transperineal ultrasound, for the differential diagnosis of middle compartment prolapse [uterine prolapse (UP) or cervical elongation (CE) without UP] based on the difference in the pubis-uterine fundus distance at rest and with the Valsalva maneuver, with a cutoff point of 15 mm. The objective of this study was to validate the diagnostic utility of a ≥15 mm difference between the pubis-uterine fundus distance at rest and during the Valsalva maneuver to define UP in a multicenter study. Methods: This prospective multicenter observational study included 94 patients (UP =51; CE without UP =43). The clinical examination was based on the International Continence Society Pelvic Organ Prolapse Quantification (ICS POP-Q) system for assessing pelvic organ prolapse (POP) and patients were candidates for corrective surgery of the middle compartment of the pelvic floor (correction of UP or CE without UP). The ultrasound study was performed by transperineal ultrasound (B-mode) with the patient undergoing dorsal lithotomy. The distance evaluation was performed in relation to the posteroinferior pubic margin in the midsagittal plane, with reference to the uterine fundus (established as the most distal hyperechogenic) line from the pubis to the uterine fundus at rest and with the Valsalva maneuver. We defined UP detected using UP as a difference of ≥15 mm between the pubis-uterine fundus distance at rest and with the Valsalva maneuver. Agreement between the clinical and ultrasound diagnosis of UP was assessed using the Cohen kappa coefficient of agreement and its 95% CIs. Results: The ultrasound diagnosis of global UP at the three centers showed very good agreement, with a kappa index of 0.826 (0.71, 0.94). The agreement of ultrasound with the clinical diagnosis of UP using the ICS POP-Q system was very good for each of the hospitals [Hospital 1: 0.814 (0.64, 0.98), Hospital 2: 0.847 (0.64, 1) and Hospital 3: 0.824 (0.59, 1)]. Conclusions: A difference of ≥15 mm between the pubis-uterine fundus distance at rest and during the Valsalva maneuver for the diagnosis of UP presents very good agreement with the results of clinical evaluation with the ICS POP-Q system.

Objective To assess whether a sustained optimal haemoglobin value in the 3 months after admission for heart failure (HF) decompensation reduces morbidity and mortality during the 12 months after admission for acute HF. Patients and method Retrospective study of the 1408 patients older than 65 years included in the RICA registry divided into 3 groups: no anaemia (group A), recovered anaemia (group B), and persistent anaemia (group C), according to haemoglobin levels on admission, and 3 months after discharge. Kaplan-Meier curves were constructed, comparing the groups using the log-rank test and a Cox regression model was performed to analyse survival. Results 578 (41.1%), 299 (21.2%) and 531 (37.7%) were included in groups A, B and C, respectively. We recorded a total of 768 deaths and readmissions. There were 23 (4%), 12 (4%) and 49 (9.2%), (p=.001) individuals who died due to HF and 154 (27%), 73 (24%) and 193 (36%) (P Conclusions Persistent anaemia in the months after admission for HF increases morbidity and mortality in the subsequent year.

Surgical resection is the treatment of choice both for early-stage lung cancer and pulmonary metastatic disease. For patients with lung tumors who are not eligible for surgery, the minimally invasive modality of radiofrequency ablation (RFA) may be curative and, thus, should be considered. However, opinions regarding the optimal anesthetic technique for pulmonary RFA differ. Here the authors report their experience with the use of ultrasound-guided paravertebral block in minimally-sedated patients undergoing pulmonary RFA. This retrospective study was conducted at a single institution. The 17 consecutive patients underwent 19 pulmonary RFA procedures for primary lung tumor or lung metastases. In all patients, RFA was performed according to the protocol of the hospital. Anesthesia in patients receiving RFA for lung tumors consisted of a thoracic paravertebral block (TPVB), performed between T4 and T8, with minimal sedation. This approach allowed intraoperative communication with the patient and apnea pauses as needed. There were no complications after TPVB, which was well-tolerated by all patients. Only two patients required an alfentanil bolus during RFA because of pleuritic pain. No patient required conversion from sedation to general anesthesia. There were no episodes of hemodynamic instability or desaturation (SaO2 ≤95%), and excessive sedation prevented patient collaboration in only one patient. In conclusion, ultrasound-guided single-injection TPVB is a safe and effective anesthetic technique for high-risk patients undergoing RFA for a primary lung tumor or lung metastases.

Summary Objectives This study aims to evaluate the relationship between application of the MGDRx thermal eyebag and dry eye signs and symptoms in young and older subjects and to compare the results between the two groups. Methods Thirty young, healthily volunteers between 18 and 31 years of age (23.95 ± 3.94 years) and thirty older subjects between 61 and 90 years of age (77.97 ± 8.11 years) participated in this study. Ocular surface parameters were assessed using the Oculus Keratograph 5 M, following the guidelines of the Tear Film and Ocular Surface Dry Eye Workshop II Diagnostic Methodology report. Only subjects with a positive score on at least one questionnaire and an initial Non-Invasive Keratograph Break-Up Time (NIKBUT) under 10 seconds were included in the study. After thermal bag self-application in both eyes every day for 2 weeks, the protocol was carried out again. Lid massage was performed after lid warming. Compliance and degree of improvement were also assessed. Main results The young volunteer group showed an improvement in NIKBUT, lipid layer score, upper eyelid gland drop-out percentage and dry eye symptoms over the two week treatment period. Improvements in meibum quality, gland obstruction, telangiectasia scores, and dry eye symptoms were found in the older subjects. Mixed ANOVA revealed better NIKBUT and lipid layer values in the young subjects. Despite the treatment compliance being statistically higher in the older group than in the younger subjects (P = 0.002), there were no significant differences in subjective improvement between groups (P = 0.097). Conclusion Dry eye-related symptoms were improved after thermal bag application, while NIKBUT and lipid layer thickness were improved only in the younger subjects.

Resumen Objetivos Conocer la prevalencia de enfermedad renal cronica (ERC) y determinar los factores asociados al deterioro de la funcion renal en poblacion asistida en atencion primaria. Pacientes y metodo Estudio transversal y multicentrico realizado en los pacientes basales del estudio IBERICAN (identificacion de la poblacion espanola de riesgo cardiovascular y renal). Se considero ERC a un filtrado glomerular estimado (FGe) Resultados Se incluyeron 7.895 pacientes (edad media 57,9 ± 14,8 anos; 54,5% mujeres). El 14,4% (IC 95%: 13,6-15,1) presentaba ERC; en hombres un 16,1% (IC 95%: 14,9-17,3) y en mujeres un 12,9% (IC 95%: 11,9-14,0). Se observo un aumento continuo de la prevalencia con la edad (24,8% ≥ 65 anos) y con la agregacion de FRCV. Las variables que mas se asociaron a la probabilidad de padecer ERC fueron hipertrofia ventricular izquierda (OR: 1,95; p Conclusiones Catorce de cada 100 pacientes incluidos en el estudio IBERICAN presenta ERC. La prevalencia de ERC afecta a la cuarta parte de pacientes ≥ 65 anos y aumenta exponencialmente con la agregacion de FRCV.

In this paper, we deal with questions related to blockchains in complex Internet of Things (IoT)-based ecosystems. Such ecosystems are typically composed of IoT devices, edge devices, cloud computing software services, as well as people, who are decision makers in scenarios such as smart cities. Many decisions related to analytics can be based on data coming from IoT sensors, software services, and people. However, they are typically based on different levels of abstraction and granularity. This poses a number of challenges when multiple blockchains are used together with smart contracts. This work proposes to apply our concept of elasticity to smart contracts and thereby enabling analytics in and between multiple blockchains in the context of IoT. We propose a reference architecture for Elastic Smart Contracts and evaluate the approach in a smart city scenario, discussing the benefits in terms of performance and self-adaptability of our solution.

Native digital media use of self-destructive content for the dissemination of news is investigated. This new format, characterized by its ephemerality, has become fashionable within the most succes...

Diagnósticos sobre los integrantes de sectores productivos agrícolas proveen información para generar estrategias y políticas públicas que les fortalezcan, acordes a sus contextos. El objetivo del presente estudio fue describir y analizar a productores de café con base en aspectos sociales, productivos, económicos y su percepción sobre la cafeticultura. La información se obtuvo mediante entrevistas semiestructuradas realizadas entre noviembre de 2018 y marzo de 2019 a productores (n= 40) de la región Mixe, Oaxaca escogidos mediante un muestreo no probabilístico. La información se analizó con estadística descriptiva, análisis de conglomerados jerárquicos, prueba de Kruskal-Wallis, χ2 de Pearson y análisis de componentes principales. Los resultados mostraron que los productores desarrollan la cafeticultura con desventajas sociales, económicas y productivas donde la inversión en renovación de cafetal (χ2= 0), superficie en producción (χ2= 0), venta de café (χ2= 0), percepción sobre la cafeticultura como opción productiva (χ2= 0.001), edad de los productores (χ2= 0), años de experiencia (χ2= 0) y el grado de educación (χ2= 0) explican la conformación de productores inconformes (37.5%), indecisos (22.5%) y conformes (40%). Los productores presentan carencias sociales, productivas y económicas que se manifiestan en una cafeticultura de subsistencia, agroecosistemas que tienden a disminuir su agrobiodiversidad, con estrategia parcial de plagas y enfermedades, y estructuras comerciales deficientes que orillan a una percepción sobre esta actividad productiva donde la mayoría está inconforme e indecisa.

Short-chain fatty acids (SCFAs) can have pro- or anti-inflammatory properties, but their relationship with multiple sclerosis (MS) relapses during pregnancy remains unknown. This study aimed to explore SCFA profiles in MS patients during pregnancy and to assess their association with the appearance of relapses during pregnancy and postpartum.We prospectively included 53 pregnant MS patients and 21 healthy control women. Patients were evaluated during pregnancy and puerperium. SCFAs were measured by liquid chromatography-mass spectrometry.Sixteen patients (32%) had relapses during pregnancy or puerperium, and 37 (68%) did not. All MS patients showed significant increases in acetate levels during pregnancy and the postpartum period compared to non-MS women. However, propionate and butyrate values were associated with disease activity. Their values were higher in nonrelapsing patients and remained similar to the control group in relapsing patients. The variable that best identified active patients was the propionate/acetate ratio. Ratios of0.36 during the first trimester were associated with higher inflammatory activity (odds ratio = 165, 95% confidence interval = 10.2-239.4, p 0.01). Most nonrelapsing patients showed values of0.36, which were similar to those in healthy pregnant women.Low propionate/acetate ratio values during the first trimester of gestation identified MS patients at risk of relapses during pregnancy and the postpartum period.

Resumen Introduccion y objetivo La hipercolesterolemia familiar (HF) es el trastorno genetico mas frecuente asociado con enfermedad coronaria prematura debido a la presencia de cLDL incrementado desde el nacimiento. Se encuentra infradiagnosticada e infratratada. El objetivo primario del proyecto ARIAN es determinar el numero de pacientes diagnosticados de HF tras implantar un nuevo procedimiento de cribado desde el laboratorio. Material y metodos Este proyecto se ha disenado como un analisis retrospectivo mediante consulta al sistema informatico. Se seleccionaron de las bases de datos de laboratorio aquellas muestras de suero de pacientes ≥ 18 anos con cLDL directos o calculados > 250 mg/dl, desde el 1 de enero del 2017 hasta el 31 de diciembre del 2018. Una vez descartadas causas secundarias, se comunico al medico de Atencion Primaria solicitante la sospecha de que su paciente pudiera portar una HF y gestionar una cita prioritaria en la unidad de Lipidos. Todos aquellos pacientes con una puntuacion ≥ 6 puntos de los criterios de las Clinicas holandesas se les propuso un estudio genetico. Resultados El protocolo se presento a 55 laboratorios de forma individualizada. Hasta el dia 30 de diciembre del 2020, el numero centros que han remitido resultados es de 24. El numero de muestras analizadas hasta ese momento fue de 3.266.341, lo que representa un 34% de la poblacion atendida en esas areas de salud (9.727.434). Conclusiones La identificacion de nuevos sujetos con HF mediante esta nueva estrategia desde el laboratorio y su remision a las unidades de Lipidos debe incrementar el numero de pacientes tratados en las unidades de Lipidos y permitir iniciar cribados en cascada familiar.

Introduction: Patients with invasive pneumococcal disease (IPD) may require admission into paediatric intensive care units (PICU). The aim of this study is to analyse the epidemiological, clinical, and microbiological characteristics associated with IPD that may require admission to the PICU. Material and methods: A prospective study was conducted on cases of IPD diagnosed in three Paediatric Hospitals in Barcelona between January 2012 and June 2016. An analysis was made of the associations between the admission to PICU and the epidemiological, clinical, and microbiological variables. Results: A total of 263 cases with IPD were included, of which 19% (n = 50) required admission to PICU. Patients with septic shock (7; 100%), meningitis (16; 84.2%), and those with complicated pneumonia (23; 15.2%) were admitted to the PICU. The most frequent complications were pulmonary (35.2%) and neurological (39.5%). The ratio between admission and non-admission to PICU was 4.7 times higher in subjects with an underlying disease. The serotypes associated with PICU admission were 19A (23% of the total of this serotype), serotype 14 (20%), serotype 3 (17%), and serotype 1 (12.5%). Conclusions: IPD required PICU admission in cases of septic shock and meningitis, and less so with complicated pneumonia. The percentage of admissions is greater in children with an underlying disease. Admission into the PICU involves a longer stay, complications during the acute phase, as well as sequelae, particularly neurological ones. The serotypes of the patients that were admitted to PICU were predominantly vaccine serotypes. Resumen: Introducción: La enfermedad neumocócica invasora (ENI) puede requerir ingreso en la unidad de cuidados intensivos pediátricos (UCIP). El objetivo de este trabajo es analizar las características epidemiológicas, clínicas y microbiológicas asociadas a la ENI que predisponen el ingreso en la UCIP. Material y métodos: Estudio prospectivo de casos diagnosticados con ENI en tres hospitales pediátricos de Barcelona entre enero de 2012 y junio de 2016. Se analizaron las asociaciones entre el ingreso en la UCIP y las variables epidemiológicas, clínicas y microbiológicas. Resultados: Se incluyeron 263 casos con ENI. El 19% (n = 50) requirió ingreso en la UCIP. El 100% (7) de los pacientes con shock séptico, 84,2% (16) con meningitis y 15,2% (23) con neumonía complicada ingresaron en la UCIP. Las complicaciones más frecuentes fueron pulmonares (35,2%) y neurológicas (39,5%). La razón entre ingreso y no ingreso en la UCIP fue 4,17 veces mayor en los sujetos con enfermedad de base. Los serotipos asociados al ingreso en la UCIP fueron el 19A (23% del total de este serotipo), el 14 (20%), el 3 (17%) y el serotipo 1 (12,5%). Conclusiones: La ENI requiere ingreso en la UCIP en caso de shock séptico y meningitis, no así, de entrada, la neumonía complicada. El porcentaje de ingresos es mayor en los niños con enfermedad de base. El ingreso en la UCIP conlleva una estancia más prolongada, así como complicaciones durante la fase aguda y secuelas, sobre todo, neurológicas. Los serotipos de los pacientes que ingresaron en la UCIP fueron, predominantemente, serotipos vacunales.

Patients with early-stage non-small-cell lung cancer (NSCLC) are candidates for curative surgery; however, despite multiple advances in lung cancer management, recurrence rates remain high. Adjuvant chemotherapy has been demonstrated to significantly prolong overall survival (OS), but this benefit is modest and there is an urgent need for effective new therapies to provide a cure for more patients. The high efficacy of tyrosine kinase inhibitors (TKIs) against epidermal growth factor receptor-mutated (EGFR) in patients with advanced EGFR-mutated NSCLC has led to the evaluation of these agents in early stages of the disease. Multiple clinical trials have evaluated the safety and efficacy of EGFR TKIs as an adjuvant treatment, in patients with resected EGFR-mutated NSCLC, and shown that they significantly prolong disease-free survival (DFS), but this benefit does not translate to OS. Recently, an interim analysis of the ADAURA trial demonstrated that, surprisingly, osimertinib improved DFS. This led to the study being stopped early, leaving many unanswered questions about its potential effect on OS and its incorporation as a standard adjuvant treatment in this patient subgroup. These targeted agents are also being evaluated in locally-advanced disease, with promising results, although prospective studies with larger sample sizes are needed to confirm these results. In this article, we review the most relevant studies on the role of EGFR TKIs in the management of early-stage EGFR-mutated NSCLC.

Objective: Foot ulcers are a common complication of diabetes and are associated with an increase in lower limb amputation and death. Early referral to a specialised unit is recommended. The aim of this study was to assess the characteristics of new-patient referrals to specialised diabetes foot care units across Europe and to determine the factors involved in delayed referral. Method: In this prospective observational study, consecutive patients with a new foot ulcer presenting to nine diabetic foot centres in five European countries (France, Germany, Italy, Spain and the UK) were included. Results: Some 25% of the 332 patients included had presented with a foot ulcer >3 months before referral to the participating foot clinic. Compared with patients referred earlier, patients with a long time to referral (>3 months) were older (p=0.006) and had a less severe wound according to Infectious Diseases Society of America (IDSA) classification (p=0.003) and University of Texas classification (grade D=infection + peripheral artery disease, p=0.004). Conclusion: The proportion of patients with a diabetic foot ulcer (DFU) referred to a specialised unit >3 months after the beginning of the ulcer remained high throughout Europe. Patients with severe DFU were, however, referred more quickly by front line health professionals. Primary care professionals need to be made aware of the importance of early referral to a specialised unit in order to improve the management of foot disease in patients with diabetes. Declaration of interest: The authors have no conflicts of interest to declare.

Introduction: The number of patients with complex chronic conditions (CCC) has increased in the last 20 years or so. There is limited data as regards the prevalence of CCC in the paediatric population and its impact on hospital admissions. The main objectives of this study are to determine the proportion of CCC in the paediatric hospital population and compare them with other groups of patients admitted (acute and chronic). Patients and methods: A descriptive, retrospective study was carried out in a tertiary maternity-paediatric hospital (from December 2016 to November 2017). All patients admitted into the Paediatric Department were recruited with a fortnightly frequency. A series of demographic, clinical, and pregnancy data were collected. In order to identify the level of complexity of the patients, the Clinical Risk Group (CRG) was used, with 3 groups being created: acute, chronic, and CCC. Statistics analysis was performed using SPSS v24. Results: A total of 1433 patients were included. The proportion of CCC on the Paediatric Ward was 14.4%. The CCC were older patients, mainly admitted due to decompensation or progression of their underlying disease, had a longer admission time, and required support in the Paediatric Intensive Care Unit (PICU) more often than that of the other sub-groups. Just under half (44.7%) of the CCC were carriers of a technological device. Of the total of long stays (>1 month), 71.3% had CCC. Conclusions: Patients with CCC require long hospital stays, a greater need of intensive care, and use of technology. New approaches to treatment and follow-up need to be established. They should be cost-effective, and at the same time decrease the impact of the disease on the children and their family. Resumen: Introducción: En las últimas décadas se ha incrementado el número de pacientes crónicos complejos (PCC). Existen pocos datos referentes a la prevalencia de PCC en población pediátrica y su impacto en los ingresos hospitalarios. Los objetivos principales de este trabajo son determinar en nuestro medio la proporción de PCC en hospitalización pediátrica y compararlos con otros grupos de pacientes ingresados (agudos y crónicos). Pacientes y métodos: Estudio descriptivo retrospectivo realizado en un hospital materno-infantil terciario (de diciembre 2016 a noviembre 2017). Se reclutaron a todos los pacientes ingresados en el servicio de Pediatría con una periodicidad quincenal. Se recogieron una serie de variables demográficas, clínicas y de gestión. Para identificar el grado de complejidad de los pacientes se utilizó el sistema de clasificación Clinical Risk Group (CRG) y se crearon 3 grupos: agudos, crónicos y PCC. Para el análisis estadístico se usó SPSS v24. Resultados: Se incluyeron 1.433 pacientes. La proporción de PCC en planta de Pediatría fue del 14,4%. Los PCC fueron pacientes de mayor edad, ingresaron principalmente por descompensación o progresión de su enfermedad de base, estuvieron ingresados más tiempo y precisaron soporte en la Unidad de Cuidados Intensivos Pediátricos (UCIP) con mayor frecuencia que los otros subgupos. Un 44,7% de los PCC era portador de dispositivos tecnológicos. Del total de largas estancias (>1 mes), el 71,3% fue de PCC. Conclusiones: Los PCC requieren de estancias hospitalarias largas, mayor necesidad de cuidados intensivos y uso de tecnología. Es necesario plantear nuevos enfoques de tratamiento y seguimiento que sean costo-eficientes a la vez que disminuyan el impacto de la enfermedad en el niño y su familia.

INTRODUCTION AND OBJECTIVES According to the wavefront phenomenon described in the late 1970s, myocardial infarction triggered by acute coronary occlusion progresses with increasing duration of ischemia as a transmural wavefront from the subendocardium toward the subepicardium. However, whether wavefront progression of necrosis also occurs laterally has been disputed. We aimed to assess the transmural and lateral spread of myocardial damage after acute myocardial infarction in humans and to evaluate the impact of metoprolol on these. METHODS We assessed myocardial infarction in the transmural and lateral dimensions in a cohort of 220 acute ST-segment elevation myocardial infarction (STEMI) patients from the METOCARD-CNIC trial (Effect of Metoprolol in Cardioprotection During an Acute Myocardial Infarction). The patients underwent cardiac magnetic resonance imaging at 5 to 7 days and 6 months post-STEMI. RESULTS On day 5 to 7 post-STEMI cardiac magnetic resonance, there was a strong linear correlation between the transmural and lateral extent of infarction (delayed gadolinium enhancement) (r=-0.88; P

Objectives Thromboinflammation, resulting from a complex interaction between thrombocytopathy, coagulopathy, and endotheliopathy, contributes to increased mortality in COVID-19 patients. MR-proADM, as a surrogate of adrenomedullin system disruption, leading to endothelial damage, has been reported as a promising biomarker for short-term prognosis. We evaluated the role of MR-proADM in the mid-term mortality in COVID-19 patients. Methods A prospective, observational study enrolling COVID-19 patients from August to October 2020. A blood sample for laboratory test analysis was drawn on arrival in the emergency department. The primary endpoint was 90-day mortality. The area under the curve (AUC) and Cox regression analyses were used to assess discriminatory ability and association with the endpoint. Results A total of 359 patients were enrolled, and the 90-day mortality rate was 8.9%. ROC AUC for MR-proADM predicting 90-day mortality was 0.832. An optimal cutoff of 0.80 nmol/L showed a sensitivity of 96.9% and a specificity of 58.4%, with a negative predictive value of 99.5%. Circulating MR-proADM levels (inverse transformed), after adjusting by a propensity score including eleven potential confounders, were an independent predictor of 90-day mortality (HR: 0.162 [95% CI: 0.043-0.480]) Conclusions Our data confirm that MR-proADM has a role in the mid-term prognosis of COVID-19 patients and might assist physicians with risk stratification.

Resumen Introduccion y objetivos Esta establecido que la necrosis secundaria a una oclusion coronaria se inicia en el subendocario y progresa hacia el subepicardio. Sin embargo, hay controversia sobre la posibilidad de que la onda de progresion del infarto sea lateral, ademas de transmural, y es el objetivo de este trabajo. Metodos Se estudio la extension del infarto en las dimensiones transmural y lateral en 220 pacientes con infarto agudo de miocardio del ensayo METOCARD-CNIC (Efecto del metoprolol en la cardioproteccion durante un infarto agudo de miocardio). Los pacientes se sometieron a 2 resonancias magneticas. Resultados En la resonancia de los dias 5-7 posinfarto, se encontro una fuerte correlacion lineal entre las extensiones transmural y lateral del infarto (realce tardio de gadolinio) (r = -0,88; p Conclusiones Nuestros hallazgos cuestionan el dogma de que la progresion del infarto solo se produce en sentido transmural. Mostramos que el infarto progresa de forma circunferencial (en sentido tanto transmural como lateral). Esto implica que las terapias cardioprotectoras pueden asociarse con miocardio salvado en los bordes laterales del infarto. Este estudio ha sido registrado en ClinicalTrial.gov (Identificador: NCT01311700).

La investigación tuvo por objetivo diseñar un sistema computacional Web-App para el registro de datos in situ y para la estimación del almacenamiento de carbono aéreo en parcelas de café en Huatusco, Veracruz, México. Lo anterior se planteó por las necesidades de los productores para automatizar los cálculos de captura de CO2 que sirven en la contribución de la mitigación del cambio climático. El software se elaboró en el Campus Montecillo del Colegio de Postgraduados de febrero a octubre de 2020 a través de la propuesta de la metodología PADPEEM y probado con los datos obtenidos en algunos cultivos de café en Huatusco en enero de 2020. En los resultados se mostró el sistema CarbonoCafé, su arquitectura, mapa de navegación e interfaces. El sistema CarbonoCafé será de impacto en la reducción de recursos humanos, económicos y de tiempo, para el cálculo de carbono aéreo in situ. Además, contiene bases de datos que se pueden consultar desde cualquier computadora o teléfono móvil.

There are insufficient data regarding risk scores validation in patients with diabetes mellitus and non-ST elevation acute coronary syndrome (NSTEACS). We performed a diabetes mellitus-specific analysis of cardiovascular outcomes after NSTEACS. We tested the predictive power of the Global Registry of Acute Coronary Events (GRACE) and PREdicting bleeding Complications In patients undergoing Stent implantation and subsEquent Dual Anti-Platelet Therapy (PRECISE-DAPT) scores.This work is a retrospective analysis that included 7,415 consecutive NSTEACS patients from two Spanish Universitarian hospitals between the years 2003 and 2017. The area under the ROC curve among with and without diabetes mellitus patients was calculated, to evaluate the predictive power of both scores. RESULTS: Among the study participants, 2124 patients (28.0%) were diabetic. The median follow-up was 54,3 months (IQR 24,7-80,0 months). Diabetic patients were more women (30.5% vs. 25.7%) and older (70.0 ± 10.8 vs. 65.3 ± 13.2 years old); they had higher GRACE (146 ± 36 vs. 137 ± 36), PRECISE-DAPT (15 ± 7 vs. 18 ± 9) at admission. Early invasive coronary angiography (≤ 24 h after admission) was performed more frequently in non-diabetic. We tested the predictive power of the GRACE and PRECISE-DAPT risk scores among diabetic and non-diabetic. PRECISE-DAPT risk score showed a good predictive power for all-cause mortality, cardiovascular mortality and MACE in diabetic admitted with NSTEACS, without differences compared to non-diabetic.PRECISE-DAPT risk score has an appropriate predictive power in diabetic patients admitted with NSTEACS compared to non-diabetic NSTEACS. However, GRACE would be predictive worse in diabetic during long-term follow-up in a large contemporary registry.

Severe hypercholesterolaemia is a major cardiovascular risk factor. Early detection and treatment can reduce the incidence of cardiovascular disease. Given the high prevalence of hypercholesterolaemia in Andalusia, the development of a screening strategy for its detection in Primary Care may be an efficient measure. Objective To identify patients in Primary Care with severe hypercholesterolaemia that may increase their cardiovascular risk by reviewing LDL-cholesterol results in computerised laboratory systems. Material and methods Observational, retrospective, multi-centre study in 16 hospitals in Andalusia and Ceuta. Anonymous analytical data were acquired from the different laboratory computer systems for the year 2018, and exclusively from Macarena Hospital for the year 2019. Results From a total of 1,969,035 determinations on ≥18 years old, 2791 patients (0.14%) were detected with LDL-cholesterol >250 mg/dl and from a total of 2.327.211 determinations studied in children under 18 years old, 3804 patients (0.16%) were detected with LDL-cholesterol >135 mg/dl. The highest incidence of possible genetic hypercholesterolaemia in adults corresponded to the province of Seville with 23.6 cases/1000 determinations, while in minors, the highest incidence corresponded to the province of Cadiz with 75 possible cases/1000 determinations. A geographical triangle of greater prevalence is observed between the provinces of Seville, Huelva and Cadiz. Conclusions The development of a screening strategy using a computerised review of LDL-cholesterol in Primary Care detects a large number of subjects with severe hypercholesterolaemia that could benefit from an early intervention.

The main objective was to compare the meaning of soluble angiotensin-converting enzyme-2 (sACE2) plasma levels modulation on the prognosis of two cohorts of heart failure (HF) and acute coronary syndrome (ACS). We conducted an observational clinical study where sACE2 was measured in two cohorts of HF or ACS (102 patients each), matched by age and gender. The primary endpoint (cardiac death) and the secondary endpoints (non-fatal myocardial infarction or HF readmission) were registered during a 5-year follow-up period. Association with pharmacotherapy was studied, and the effects of cardiovascular drugs on ACE isoforms expression were analysed in human umbilical vein endothelial cells (HUVEC) in vitro. The levels of sACE2 were significantly higher in the HF than ACS cohort. sACE2 was inversely related with the leukocytes number and directly with urea levels. In the ACS cohort, sACE2 was associated with age and glycaemic parameters, but in the HF cohort, the association was with N-terminal pro-B-type natriuretic peptide. The levels of sACE2 were related to long-term prognosis and confirmed as a non-independent predictor in the HF cohort. Soluble ACE2 was higher in patients treated with angiotensin receptors blockers and β-blockers, accordingly with losartan and metoprolol upregulation of ACE1 and ACE2 in HUVECs. Plasma levels of sACE2 were higher in HF than in ACS, independently of age and gender, and were related to long-term cardiac death in the HF cohort. Losartan and metoprolol, but not enalapril, upregulated ACE expression in endothelial cells, accordingly with higher levels of sACE2 in patients using these drugs. Supplementary Information The online version contains supplementary material available at 10.1007/s00109-021-02129-4.

Resumen Introduccion y objetivos El objetivo es evaluar la interaccion entre carga de comorbilidad y beneficio de la revascularizacion en ancianos con sindrome coronario agudo sin elevacion del ST (SCASEST). Metodos Estudio retrospectivo que incluyo a 7.211 pacientes de edad ≥ 70 anos y procedentes de 11 registros de SCASEST espanoles. Se evaluaron 6 comorbilidades (diabetes mellitus, arteriopatia periferica, enfermedad cerebrovascular, enfermedad pulmonar cronica, insuficiencia renal y anemia). Se calculo una puntuacion de propension para comparar el efecto de la revascularizacion frente al tratamiento conservador. El objetivo fue la mortalidad a 1 ano. Resultados Al ano habian fallecido 1.090 pacientes (15%). La frecuencia de revascularizacion durante la hospitalizacion fue del 60%. La revascularizacion se asocio con menor mortalidad, cuya magnitud no cambio al anadir al modelo las comorbilidades (HR = 0,61; IC95%, 0,53-0,69; p = 0,0001). Sin embargo, los efectos de la revascularizacion se atenuaron en los pacientes con insuficiencia renal, arteriopatia periferica y enfermedad pulmonar cronica (para la interaccion, p = 0,004, p = 0,007 y p = 0,03 respectivamente), mientras que no se modificaron con la diabetes mellitus, la anemia o la enfermedad cerebrovascular (p = 0,74, p = 0,51 y p = 0,28). Los beneficios de la revascularizacion disminuyeron gradualmente segun aumentaba el numero de comorbilidades (de HR = 0,48; IC95%, 0,39-0,61 con 0 comorbilidades hasta HR = 0,83; IC95%, 0,62-1,12 con 5 o mas comorbilidades; omnibus, p = 0,016). Los resultados fueron identicos con el modelo de la puntuacion de propension o cuando se utilizo la intervencion de cateterismo cardiaco como variable de exposicion. Conclusiones La revascularizacion durante el ingreso mejoro independientemente de las comorbilidades la mortalidad a 1 ano de una poblacion anciana con SCASEST. No obstante, el beneficio se redujo de manera progresiva segun aumentaba la carga de comorbilidades. La insuficiencia renal, la arteriopatia periferica y la enfermedad pulmonar cronica son las comorbilidades que mas contrarrestaron los potenciales beneficios de la revascularizacion.

Purpose This study aimed to develop and validate new metrics to objectively assess the lipid layer thickness (LLT) through the analysis of grey intensity values obtained from the Placido disk pattern reflected onto the tear film. Methods Ocular surface parameters were measured using Oculus Keratograph 5 M in 94 healthy volunteers (43.8 ± 26.8 years). Subjects’ LLT was subjectively classified into 4 groups using an interferometry-based grading scale. New metrics based on the intensity of the Placido disk images were calculated and compared between groups. The repeatability of the new metrics and their diagnostic ability was analysed through receiver operating characteristics (ROC) curves. The level of agreement between the new objective tool and the existing subjective classification scale was analysed by means accuracy, weighted Kappa index and F-measure. Results Mean pixel intensity, median pixel intensity and relative energy at 5.33 s after blinking achieved the highest performance, with a correlation with LLT between r = 0.655 and 0.674 (p F-measure between 0.86 and 0.87. Conclusion The analysis of grey intensity values in videokeratography can be used as an objective tool to assess LLT. These new metrics could be included in a battery of clinical tests as an easy, repeatable, objective and accessible method to improve the detection and monitoring of dry eye disease and meibomian gland dysfunction.

Background Breast cancer survivors (BCS) face several symptoms and are at higher risk of weight gain following diagnosis. Current literature shows that both exercise and diet play a key role in recovery of BCS. However, there is a gap between current guidelines and the real-world context. The aim of this article is to describe the process behind a free, not-for-profit community-based therapeutic exercise and education programme (TEEP) for BCS in the clinical setting. Methods The “Onco-Health Club” (OHC) consists of therapeutic exercise (TE) intervention aimed at ameliorating cancer-related fatigue (CRF) and improving QoL and physical function. TE is supplemented with nutritional education, providing information about the Mediterranean diet. To this end, patients are recruited from an oncologist and are referred to a physiotherapist and a nutritionist for baseline assessment. TEEP consists of a 3-month intervention, delivered twice a week in a group format with 1 h of TE and 30 min of nutritional education. BCS then have a final assessment and are advised to continue with a healthy lifestyle. Data about referral, compliance and assessment were collected. Results From May 2017 to February of 2020, a total of 158 patients were recruited from 8 cohorts and 142 initially started the OHC. From 119 that joined the program, 96 patients were considered to have finished it with good adherence (assistance > 80%). BCS significantly improved their QoL, as well as upper and lower limb’s function, and increased their level of physical activity. CRF tended to decrease (p = 0.005). Conclusions This study obtained data on recruitment, compliance, and possible limitations of these kinds of programmes in a real-world context. Further research is needed in order to optimize patient engagement and compliance, as well as to determine the transferability of these programmes in the clinical setting. Trial registration NCT03879096, Registered 18th March 2019. Retrospectively registered.

Introducción. La tormenta tiroidea es una afectación orgánica severa que se produce por la liberación de triyodotironina (T3) y tiroxina (T4). Su incidencia es de 0.20 casos por cada 100 000 habitantes y puede conllevar a una mortalidad de hasta el 30%. Esta es una entidad refractaria para la cual existen pocas opciones terapéuticas, siendo la terapia de intercambio plasmático una estrategia potencialmente útil para su manejo. Presentación del caso. Paciente femenina de 17 años quien ingresó al servicio de urgencias de una institución de tercer nivel de atención por un cuadro clínico de aproximadamente 25 días de evolución consistente en palpitaciones, disnea en reposo, ortopnea, dolor torácico y abdominal, astenia, adinamia, mareo, cefalea y deposiciones líquidas; como antecedentes presentaba hipertiroidismo en manejo ambulatorio. Dada la sintomatología y gracias a que se obtuvo un puntaje de 65 en la escala de Burch-Wartofsky, se diagnosticó tormenta tiroidea, se dio orden de hospitalización y se inició manejo farmacológico, con el cual no se logró una mejoría. Al tercer día de hospitalización la joven presentó deterioro clínico continuo y un episodio convulsivo, por lo que se consideró tormenta tiroidea refractaria que fue tratada satisfactoriamente con terapia de intercambio plasmático como terapia puente previo a tiroidectomía total de urgencia. Conclusión. La terapia de intercambio plasmático permite una rápida remoción de las hormonas tiroideas y, aunque su implementación no es ampliamente difundida por las guías de práctica clínica, existe evidencia que demuestra una disminución en el riesgo de complicaciones perioperatorias y una evolución exitosa tras su uso como terapia puente previo a tiroidectomía en pacientes con tormenta tiroidea refractaria.

Left ventricular noncompaction (LVNC) is a heterogeneous entity with uncertain prognosis. This study sought to develop and validate a prediction model of major adverse cardiovascular events (MACE) and to identify LVNC cases without events during long-term follow-up. This is a retrospective longitudinal multicenter cohort study of consecutive patients fulfilling LVNC criteria by echocardiography or cardiovascular magnetic resonance. MACE were defined as heart failure (HF), ventricular arrhythmias (VAs), systemic embolisms, or all-cause mortality. A total of 585 patients were included (45 ± 20 years of age, 57% male). LV ejection fraction (LVEF) was 48% ± 17%, and 18% presented late gadolinium enhancement (LGE). After a median follow-up of 5.1 years, MACE occurred in 223 (38%) patients: HF in 110 (19%), VAs in 87 (15%), systemic embolisms in 18 (3%), and 34 (6%) died. LVEF was the main variable independently associated with MACE (P < 0.05). LGE was associated with HF and VAs in patients with LVEF >35% (P < 0.05). A prediction model of MACE was developed using Cox regression, composed by age, sex, electrocardiography, cardiovascular risk factors, LVEF, and family aggregation. C-index was 0.72 (95% confidence interval: 0.67-0.75) in the derivation cohort and 0.72 (95% confidence interval: 0.71-0.73) in an external validation cohort. Patients with no electrocardiogram abnormalities, LVEF ≥50%, no LGE, and negative family screening presented no MACE at follow-up. LVNC is associated with an increased risk of heart failure and ventricular arrhythmias. LVEF is the variable most strongly associated with MACE; however, LGE confers additional risk in patients without severe systolic dysfunction. A risk prediction model is developed and validated to guide management. The project was partially funded by a grant from the Catalan Society of Cardiology (Barcelona, Spain). Hospital Universitario Virgen de la Arrixaca (Murcia, Spain) was supported by a grant from the Foundation Marató TV3 (218/C/2015) (Barcelona, Spain). Hospital Universitario y Politécnico La Fe (Valencia, Spain) was partially supported by Fondo Europeo de Desarrollo Regional (“Unión Europea, Una forma de hacer Europa”) (Madrid, Spain) and the Instituto de Salud Carlos III (La Fe Biobank PT17/0015/ 0043) (Madrid, Spain). Dr Guala was supported by funding from the Spanish Ministry of Science, Innovation and Universities (IJC2018-037349-I) (Madrid, Spain). Dr La Mura was supported by a research grant from the Cardiopath PhD program (Naples, Italy). Prof de la Pompa was supported by grants PID2019-104776RB-I00 and CB16/11/00399 (CIBER CV) from the Spanish Ministry of Science, Innovation and Universities. Dr Bayes-Genis was supported by grants from CIBER Cardiovascular (CB16/11/00403 and 16/11/00420) (Madrid, Spain) and AdvanceCat 2014-2020 (Barcelona, Spain); and has received advisory board and lecture fees from Novartis, Boehringer Ingelheim, Vifor, Roche Diagnostics, and Critical Diagnostics. Dr Pontone has received speaker honorarium and/or institutional research grants from GE Healthcare, Bracco, Boehringer Ingelheim, and HeartFlow. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Sí

A novel thermal energy storage and recovery system is proposed as a modification to existing photovoltaic modules with the objective to improve the solar energy collector overall efficiency. Integrating a phase change material in the hybrid module (PVT-PCM), a lower and stable operating temperature is achieved. The baseline for the experimental comparison is established by an experimental campaign that includes simultaneous operation of a hybrid PVT-PCM module and a traditional photovoltaic (PV) module. Both photovoltaic modules used are from the same manufacturer, model, and technical specifications. Before the modification to a hybrid PVT-PCM module, a difference in electrical performance between the photovoltaic modules is quantified to determine the factual effect of the modification. After the modification, the daily electrical efficiency of the hybrid PVT-PCM increased a 7.43% with respect to the traditional PV module. In addition, the daily hybrid efficiency of the PVT-PCM module reaches 31.35%, while the daily electrical efficiency of the PV module is 13.12%, which translates to a total increase of 20.45% in the capability to extract useful energy from the sun for the PVT-PCM module.

Introduction and objectives Despite evidence of a reduction in the incidence and mortality of acute coronary syndrome (ACS), some studies have highlighted differences in outcomes between men and women. We aimed to explore sex differences in the management and treatment of patients with ACS in Spain. Methods This ecological cross-sectional study combined ACS data from 10 Spanish registries (54 centres). Meta-regression analysis was performed using aggregated data of baseline characteristics, interventional procedures, treatments, and events that occurred during hospitalization and one-year follow-up. Results Aggregated data from 34 605 patients (75.1% men) was included. ST-segment elevation myocardial infarction was the most frequent diagnosis (58.9%) and almost 80% of patients were Killip Class I. Compared to men, women were older (mean age: 71.0 vs 63.3 years) and presented higher rates of hypertension (68.1% vs 51.7%) and diabetes (37.7% vs 26.5%). Women were also less likely to undergo percutaneous coronary interventions, revascularization surgery, and to receive drug-eluting stents during hospitalization. Regarding to antiplatelet therapy, even though indicated, 23.1% of women were not treated with P2Y12 inhibitors (vs 14.2% of men; P 60%). Significantly higher in-hospital (5.4% vs 3.7%) and 1-year (8.2% vs 4.9%) mortality was observed among women compared to men, which was mainly attributed to cardiovascular causes. Conclusions Despite older age and unfavourable risk profile, female ACS patients seem to be suboptimally treated with P2Y12 inhibitors. To reduce mortality associated with ACS, improved prevention and optimized therapeutic approaches are needed.

Introduction Multiple sclerosis (MS) is an immunological, degenerative and chronic neurological disease that is frequently diagnosed in young adults. Medical care might be challenging as MS symptoms are heterogenic and sometimes medical-care team requirements might not meet MS patients’ needs. Objectives To learn the experience of patients and their caregivers of the medical care received in the Gregorio Maranon Hospital Demyelinating Unit. Method we designed a focus group with 26 participants incidentally recruited from the Gregorio Maranon Hospital Demyelinating Unit: 8 with low physical disability, 8 with high physical disability and 10 caregivers. Information was collected regarding three main topics: information, clinical care and medical team. Results High satisfaction was found among all participants with most of the medical care and with the professionals of the MS Unit. They agreed with the interventions they were offered but they considered that physical rehabilitation and psychological support must be offered, not only to MS patients but also to their caregivers and family. They also asked to emphasize transdisciplinary care. Conclusions This information defined the aspects of medical care that participants perceived as quality-care and the goals the Unit needs to achieve in the future.

Background The relationship of host immune response and viral replication with health outcomes in patients with COVID-19 remains to be defined. We aimed to characterize the medium and long-term clinical, virological, and serological outcomes after hospitalization for COVID-19, and to identify predictors of long-COVID. Methods Prospective, longitudinal study conducted in COVID-19 patients confirmed by RT-PCR. Serial blood and nasopharyngeal samples (NPS) were obtained for measuring SARS-CoV-2 RNA and S-IgG/N-IgG antibodies during hospital stay, and at 1, 2, and 6 months post-discharge. Genome sequencing was performed where appropriate. Patients filled out a COVID-19 symptom questionnaire (CSQ) at 2-month and 6-month visits, and those with highest scores were characterized. Results Of 146 patients (60% male, median age 64 years) followed-up, 20.6% required hospital readmission and 5.5% died. At 2 months and 6 months, 9.6% and 7.8% patients, respectively, reported moderate/severe persistent symptoms. SARS-CoV-2 RT-PCR was positive in NPS in 11.8% (median Ct = 38) and 3% (median Ct = 36) patients at 2 months and 6 months, respectively, but no reinfections were demonstrated. Antibody titers gradually waned, with seroreversion occurring at 6 months in 27 (27.6%) patients for N-IgG and in 6 (6%) for S-IgG. Adjusted 2-month predictors of the highest CSQ scores (OR [95%CI]) were lower peak S-IgG (0.80 [0.66–0.94]) and higher WHO severity score (2.57 [1.20–5.86]); 6-month predictors were lower peak S-IgG (0.89 [0.79–0.99]) and female sex (2.41 [1.20–4.82]); no association was found with prolonged viral RNA shedding. Conclusions Long-COVID is associated with weak anti-SARS-CoV-2 antibody response, severity of illness, and female gender. Late clinical events and persistent symptoms in the medium and long term occur in a significant proportion of patients hospitalized for COVID-19. Supplementary Information The online version contains supplementary material available at 10.1007/s10875-021-01083-7.

Background More than 20% of hospitalized patients with COVID-19 demonstrate ARDS requiring ICU admission. The long-term respiratory sequelae in such patients remain unclear. Research Question What are the major long-term pulmonary sequelae in critical patients who survive COVID-19? Study Design and Methods Consecutive patients with COVID-19 requiring ICU admission were recruited and evaluated 3 months after hospitalization discharge. The follow-up comprised symptom and quality of life, anxiety and depression questionnaires, pulmonary function tests, exercise test (6-min walking test [6MWT]), and chest CT imaging. Results One hundred twenty-five patients admitted to the ICU with ARDS secondary to COVID-19 were recruited between March and June 2020. At the 3-month follow-up, 62 patients were available for pulmonary evaluation. The most frequent symptoms were dyspnea (46.7%) and cough (34.4%). Eighty-two percent of patients showed a lung diffusing capacity of less than 80%. The median distance in the 6MWT was 400 m (interquartile range, 362-440 m). CT scans showed abnormal results in 70.2% of patients, demonstrating reticular lesions in 49.1% and fibrotic patterns in 21.1%. Patients with more severe alterations on chest CT scan showed worse pulmonary function and presented more degrees of desaturation in the 6MWT. Factors associated with the severity of lung damage on chest CT scan were age and length of invasive mechanical ventilation during the ICU stay. Interpretation Three months after hospital discharge, pulmonary structural abnormalities and functional impairment are highly prevalent in patients with ARDS secondary to COVID-19 who required an ICU stay. Pulmonary evaluation should be considered for all critical COVID-19 survivors 3 months after discharge.

Sepsis-associated encephalopathy (SAE) is a neurological complication of sepsis, characterized by brain dysfunction without any direct central nervous system infection. The diagnosis of SAE is currently a challenge. In fact, problems in making a diagnosis of SAE cause a great variability of incidence that can reach up to 70% of all septic patients. Even more, despite SAE is the most frequent type of encephalopathy occurring in critically ill patients, the molecular mechanisms that guide its progression have not been completely elucidated. On the other hand, miRNAs have proven to be excellent biomarkers for both diagnosis and prognosis, especially in brain pathologies because of their small size they can cross the blood-brain barrier easier than other biomolecules. The identification of new miRNAs as biomarkers may help to improve SAE diagnosis and prognosis and also to design new therapies for this clinical manifestation that produces diffuse cerebral dysfunction. This review is focused on SAE physiopathology and the need to have clear criteria for its diagnosis; thus, this work postulates some miRNA candidates to be used for SAE biomarkers because of their role in both, neurological damage and sepsis.

Resumen Introduccion y objetivos El estudio de las cardiopatias familiares implica realizar pruebas diagnosticas, a veces molestas, a familiares asintomaticos. El objetivo de este proyecto es cuantificar el rechazo a dichas pruebas y recomendaciones terapeuticas. Metodos Se evaluo a 1.992 familias consecutivas con cardiopatias familiares para analizar el rechazo al cribado familiar. Se evaluo a 1.539 (recomendacion de cardiorresonancia) y 837 (recomendacion de test de provocacion farmacologica). Se evaluo a 395 pacientes con indicacion de desfibrilador automatico implantable (DAI) y 402 con indicacion de anticoagulacion, para estudiar el rechazo de los tratamientos. Resultados El 28% de las familias a las que se recomienda estudio por sospecha de cardiopatia familiar no acuden; el rechazo es menor si hay antecedentes familiares de muerte subita. El 23% no se sometio a la resonancia; los 2 motivos mas alegados son citacion imposible (53%) y claustrofobia (18%). Las personas de mas edad, las mujeres, los sintomaticos, los individuos con arritmias y los familiares rechazaron mas la prueba. El 19% no se hizo el test de provocacion farmacologica por temor (46%) o citacion imposible (25%). Los individuos de mas edad, los asintomaticos, aquellos con antecedente de arritmias, los familiares y aquellos con estudio genetico positivo lo rechazaron en mayor proporcion. Solo una minoria de pacientes rechazaron los tratamientos (el 5,1% el DAI y el 2,5% la anticoagulacion). La tasa de muerte subita entre los que rechazaron el DAI fue alta (el 4,5% al ano). Conclusiones Una quinta parte de las personas que acuden al cribado de cardiopatias familiares rechazan la realizacion de pruebas mas sofisticadas y molestas. Se identifican varios predictores independientes asociados con el rechazo. Solo una minoria de pacientes en alto riesgo rechazan los tratamientos como la anticoagulacion o el implante de DAI.

Introduction and objectives Coronary heart disease is the leading cause of heart failure (HF). The aim of this study was to assess the risk of readmission for HF in patients with acute coronary syndrome without previous HF or left ventricular dysfunction. Methods Prospective study of consecutive patients admitted for acute coronary syndrome in 2 institutions. Risk factors for HF were analyzed by competing risk regression, taking all-cause mortality as a competing event. Results We included 5962 patients and 567 (9.5%) experienced at least 1 hospital readmission for acute HF. Median follow-up was 63 months and median time to HF readmission was 27.1 months. The cumulative incidence of HF was higher than mortality in the first 7 years after hospital discharge. A higher risk of HF readmission was associated with age, diabetes, previous coronary heart disease, GRACE score > 140, peripheral arterial disease, renal dysfunction, hypertension and atrial fibrillation; a lower risk was associated with optimal medical treatment. The incidence of HF in the first year of follow-up was 2.73% and no protective variables were found. A simple HF risk score predicted HF readmissions risk. Conclusions One out of 10 patients discharged after an acute coronary syndrome without previous HF or left ventricular dysfunction had new-onset HF and the risk was higher than the risk of mortality. A simple clinical score can estimate individual risk of HF readmission even in patients without previous HF or left ventricular dysfunction.

Beta-blockers, angiotensin-converting enzyme inhibitors (ACE inhibitors), angiotensin-II-receptor-blockers (ARB), and mineralocorticoid-receptor antagonists decrease mortality and heart failure (HF) hospitalizations in HF patients with reduced left ventricular ejection fraction. The effect is dose-dependent. Careful titration is recommended. However, suboptimal doses are common in clinical practice. This study aimed to compare the safety and efficacy of dose titration of the aforementioned drugs by HF nurses vs HF cardiologists.ETIFIC was a multicenter (n=20) noninferiority randomized controlled open label trial. A total of 320 hospitalized patients with new-onset HF, reduced ejection fraction and New York Heart Association II-III, without beta-blocker contraindications were randomized 1:1 in blocks of 4 patients each stratified by hospital: 164 to HF nurse titration vs 156 to HF cardiologist titration (144 vs 145 analyzed). The primary endpoint was the beta-blocker mean relative dose (% of target dose) achieved at 4 months. Secondary endpoints included ACE inhibitors, ARB, and mineralocorticoid-receptor antagonists mean relative doses, associated variables, adverse events, and clinical outcomes at 6 months.The mean±standard deviation relative doses achieved by HF nurses vs HF cardiologists were as follows: beta-blockers 71.09%±31.49% vs 56.29%±31.32%, with a difference of 14.8% (95%CI, 7.5-22.1), P.001; ACE inhibitors 72.61%±29.80% vs 56.13%±30.37%, P.001; ARB 44.48%±33.47% vs 43.51%±33.69%, P=.93; and mineralocorticoid-receptor antagonists 71%±32.12% vs 70.47%±29.78%, P=.86; mean±standard deviation visits were 6.41±2.82 vs 2.81±1.58, P.001, while the number (%) of adverse events were 34 (23.6) vs 30 (20.7), P=.55; and at 6 months HF hospitalizations were 1 (0.69) vs 9 (5.51), P=.01.ETIFIC is the first multicenter randomized trial to demonstrate the noninferiority of HF specialist-nurse titration vs HF cardiologist titration. Moreover, HF nurses achieved higher beta-blocker/ACE inhibitors doses, with more outpatient visits and fewer HF hospitalizations. Trial registry number: NCT02546856.

Resumen Introduccion y objetivos La cardiopatia isquemica es la primera causa de insuficiencia cardiaca. Nuestro objetivo es analizar el riesgo de insuficiencia cardiaca tras un sindrome coronario agudo en pacientes sin insuficiencia cardiaca previa ni disfuncion ventricular izquierda. Metodos Estudio prospectivo de pacientes consecutivos ingresados por sindrome coronario agudo en 2 hospitales. La incidencia de insuficiencia cardiaca se analizo considerando la muerte como evento competitivo. Resultados Se incluyo a 5.962 pacientes, y 567 (9,5%) tuvieron al menos 1 reingreso por insuficiencia cardiaca aguda. La mediana de seguimiento fue 63 meses y la mediana de tiempo hasta el reingreso por insuficiencia cardiaca 27,1 meses. La incidencia acumulada de insuficiencia cardiaca fue superior que la de muerte en los primeros 7 anos tras el alta. La edad, la diabetes, la cardiopatia isquemica previa, una escala GRACE > 140, la enfermedad arterial periferica, la disfuncion renal, la hipertension arterial y la fibrilacion auricular se asociaron con mayor riesgo de reingreso por insuficiencia cardiaca; el tratamiento medico optimo se asocio con menor riesgo. La incidencia de insuficiencia cardiaca en el primer ano fue del 2,73% y no se hallaron variables protectoras. Una sencilla escala de riesgo de insuficiencia cardiaca predijo el riesgo de reingreso por insuficiencia cardiaca. Conclusiones Uno de cada 10 pacientes dados de alta tras un sindrome coronario agudo sin haber tenido antes insuficiencia cardiaca o disfuncion ventricular sufrio insuficiencia cardiaca de novo y el riesgo es superior que el de muerte. Una sencilla escala clinica permite estimar el riesgo individual de reingreso por insuficiencia cardiaca, incluso en pacientes que no han tenido antes insuficiencia cardiaca ni disfuncion ventricular izquierda.

Resumen Introduccion y objetivos Los bloqueadores beta, inhibidores de la enzima de conversion de la angiotensina (IECA), antagonistas de los receptores de la angiotensina II (ARA-II) y antagonistas de receptores mineralocorticoides, disminuyen mortalidad y hospitalizaciones por insuficiencia cardiaca (IC) en pacientes con IC y fraccion de eyeccion del ventriculo izquierdo reducida. Efecto dosis-dependiente. Se recomienda titulacion cuidadosa. Sin embargo, las dosis suboptimas son habituales. Se comparo eficacia y seguridad de la titulacion de farmacos enfermeras de IC frente a cardiologos de IC. Metodos ETIFIC fue un ensayo de no inferioridad, multicentrico (20), abierto, controlado y aleatorizado. 320 pacientes hospitalizados con IC de debut, fraccion de eyeccion reducida y New York Heart Association II-III. Sin contraindicacion para bloqueadores beta, fueron aleatorizados 1:1, estratificados en bloques de 4 pacientes/hospital, 164 a titulacion de enfermeras de IC frente a 156 cardiologos de IC (analizados 144 frente a 145). El objetivo principal fue la dosis relativa media (% de dosis objetivo) de bloqueadores beta alcanzada a 4 meses. Los objetivos secundarios fueron: la dosis relativa media de IECA, ARA-II y antagonistas de receptores mineralocorticoides, variables asociadas, eventos adversos y resultados clinicos a 6 meses. Resultados La dosis relativa media ± desviacion estandar alcanzada por enfermeras de IC frente a cardiologos de IC: bloqueadores beta 71,09 ± 31,49% frente a 56,29 ± 31,32%, diferencia 14,8% (IC95%, 7,5-22,1); p Conclusiones ETIFIC es el primer ensayo aleatorizado multicentrico que prueba la no inferioridad de titulacion de farmacos por enfermeras de IC frente a cardiologos de IC. Las enfermeras especialistas consiguieron mayores dosis de bloqueadores beta/IECA con mas visitas y menos hospitalizaciones por IC. Registro del ensayo: NCT02546856.