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Resumen Antecedentes y objetivo La cirugia minimamente invasiva de tumores benignos del oido medio es posible mediante el uso del endoscopio. La mejor iluminacion y la vision mas amplia que ofrece permiten el abordaje transcanal de estos raros tumores. El objetivo del presente trabajo es sintetizar los puntos clave de su diagnostico y tratamiento, a traves de una serie propia de casos. Materiales y metodos Estudio retrospectivo de tumores benignos de oido medio intervenidos exclusivamente por via transcanal endoscopica en un hospital universitario de tercer nivel, de adultos, entre junio de 2018 y junio de 2020. El seguimiento postoperatorio se realizo mediante otoendoscopia y audiometria. Resultados Fueron intervenidos durante el periodo de estudio 6 pacientes; 5 fueron mujeres y uno fue hombre, con una edad media de 57,8 anos (± 21,9). Cuatro tumores estaban en el oido izquierdo y 2 en el oido derecho. Estos incluian 4 paragangliomas timpanicos (3 de tipo I y uno de tipo II), un neurinoma de cuerda de timpano y un colesteatoma congenito. No hubo complicaciones postoperatorias graves. En el momento actual no se ha constatado recidiva tumoral en ninguno de los casos, con un seguimiento minimo de 7 meses. Conclusiones El presente estudio anade evidencia sobre la seguridad y eficacia de la cirugia transcanal endoscopica de oido, como tecnica minimamente invasiva, para el tratamiento de tumores benignos de oido medio confinados en la cavidad timpanica.

In the last decades, microbiology laboratories have undergone unprecedented technological changes which have revolutionized the diagnosis of infectious diseases. They have last generation technology which allows precise, rapid and effective diagnosis of a wide range of infectious diseases, while also providing valuable information on the antibiotic sensitivity/resistance of the causal microorganism, thereby notably reducing the morbidity and mortality of the patients and at the same time improving in-hospital patient management. Several studies have shown that with the increase in the use of rapid diagnostic techniques this technological advancement has a greater impact when accessibility to the microbiology laboratory is possible beyond the usual 7 h workday. This document discusses the need for clinical microbiology services to work 24 h a day, 7 days a week (24/7).

Introduction and aims: The primary aim was to explore the epidemiologic trend of pediatric inflammatory bowel disease in Latin America, and the secondary aims were to obtain an overview of the diagnostic/therapeutic focus of the members of the LASPGHAN and examine the relation of case frequency to year, during the study period. Materials and methods: Latin American pediatric gastroenterologists participated in an online survey, conducted through the SurveyMonkey platform, that investigated the yearly frequency of new inflammatory bowel disease patients within the time frame of 2005–2016, their disease variety, the gastrointestinal segments affected, and the diagnostic and treatment methods utilized. The correlation of new case frequency with each study year was evaluated. Results: A total of 607 patients were studied. The diagnoses were ulcerative colitis in 475 (78.3%) cases, Crohn’s disease in 104 (17.1%), and inflammatory bowel disease D unclassified in 28 (4.6%). The trend in ulcerative colitis was a lineal increase in the frequency of new cases related to each study year, with a significant correlation coefficient. Pancolitis was found in 67.6% of the patients. The diagnostic methods included clinical data, endoscopy, and biopsies in more than 99% of the cases, and imaging studies were indicated selectively. Drug regimens were limited to 5-aminosalicylic acid derivatives, azathioprine, 6-mercaptopurine, infliximab, and adalimumab. Conclusions: Pediatric inflammatory bowel disease in Latin America appears to have increased during the years included in the study period, with a predominance of moderate or severe ulcerative colitis. That lineal trend suggests the predictive likelihood of a gradual increase in the coming years, with possible epidemiologic and clinical implications. Resumen: Introducción y objetivos: El objetivo primario fue explorar la tendencia epidemiológica de la enfermedad intestinal inflamatoria pediátrica en América Latina; los secundarios, obtener una visión general del enfoque diagnóstico/terapéutico de miembros de la SLAGHNP y explorar la relación entre la frecuencia de casos y los años del período evaluado. Material y métodos: Se realizó una encuesta en línea a pediatras gastroenterólogos de América Latina con la plataforma SurveyMonkey. Se preguntó la frecuencia anual de pacientes nuevos de 2005 a 2016, su variedad, los segmentos del tubo digestivo afectados, los métodos de diagnóstico y el tratamiento utilizado. Se evaluó la correlación entre la frecuencia anual y los años de estudio. Resultados: Se estudió a 607 pacientes; el diagnóstico de colitis ulcerativa se realizó en 475 (78.3%), de enfermedad de Crohn en 104 (17.1%) y de enfermedad intestinal inflamatoria no clasificable en 28 (4.6%). La tendencia de colitis ulcerativa tuvo un incremento lineal con coeficiente de correlación significativo entre la frecuencia de casos nuevos y el año de estudio; 67.6% tuvieron pancolitis. Los métodos de diagnóstico incluyeron datos clínicos, endoscopia y biopsias en más del 99% de los casos; los estudios de imagen se indicaron de manera selectiva. Los esquemas farmacológicos se circunscribieron a derivados del ácido 5-aminosalicílico, azatioprina, 6-mercaptopurina, infliximab y adalimumab. Conclusiones: La enfermedad intestinal inflamatoria pediátrica en América Latina parece incrementarse en el período estudiado con predominio de formas moderadas o graves de colitis ulcerativa; esta tendencia lineal puede indicar la posibilidad predictiva de incremento gradual en la próxima década, lo que es probable que tenga implicaciones epidemiológicas y clínicas.

The mortality of septic shock remains high [Ann Intensive Care. 2017;7:19], so apart from usual therapy based on source control and antibiotics, some patients may need rescue therapies. Blood purification systems may play a role by facilitating the nonspecific removal of inflammatory mediators and microbiological toxins. There are different hemoadsorption systems, we describe in this case report the sequential use of Polymyxin B (PMX) endotoxin-adsorbing column (Toraymixin PMX-20R; Toray, Tokyo, Japan) and Cytosorb® (Cytosorbents Corp., New Jersey, USA).

Background The objective of this study was to evaluate the association of SYNTAX scores I, II, and residual with cardiovascular outcomes of patients undergoing coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) and compare both procedures in a long-term follow-up. Methods This is a retrospective single-center study from the MASS registry at the Heart Institute of the University of São Paulo, Brazil in which 969 patients with stable coronary artery disease undergoing CABG (559) or PCI (410) were included. We assessed the SYNTAX scores I, II and residual in both interventions. Clinical endpoints were the first occurrence of a composite of overall death, myocardial infarction, stroke, or repeat revascularization (MACCE) and the total occurrence of each component of MACCE. Results In the CABG sample, SSI had a median of 23 (IQR 17–29.5), median SSII of 25.4 (IQR 19.2–32.8), and median rSS of 2 (IQR 0–6.5); in PCI SSI had a median of 14 (IQR 10–19.1), median SSII of 28.7 (IQR 23–34.2), and median rSS of 4.7 (IQR 0–9). Total of 174 events were documented and CABG patients had a lower rate of MACCE (15.6% vs. 21.2%; adjusted HR 1.98; 95% CI 1.13–3.47; P = 0.016) and repeat revascularization (3.8% vs. 11.5%; adjusted HR 4.35; CI 95% 1.74–10.85; P = 0.002) compared with PCI. No SYNTAX score tertile found a difference in death rate between procedures. In a multivariate analysis, the rSS was an independent predictor for MACCE (HR 1.04; 95% CI 1.01–1.06; P = 0.001). Regarding death, the only independent predictors were ejection fraction and renal function. Conclusion Surgical revascularization resulted in a more complete revascularization and lower rates of major cardiac or cerebrovascular events in a long-term follow-up. Also, grading the incompleteness of revascularization through the residual SYNTAX score identified a higher event rate, suggesting that complete revascularization is associated with a better prognosis.

The coronavirus disease 2019, which is caused by severe acute respiratory syndrome coronavirus 2, was first identified in December 2019 in Wuhan, China, and has since spread rapidly, evolving into a full-blown pandemic. We would like to report our experience after 1 year of this pandemic in the surgical service of a district hospital in Spain. There have been many changes (including new protocols) that our service and the hospital have undergone, to adapt to the new situation. We believe that this experience can be useful for other professionals who have lived and are living a similar situation.

Introduction: Obesity is associated with nonalcoholic fatty liver disease (NAFLD) in children. Our aim was to analyze the association of dietary and sociodemographic factors with NAFLD in obese children and adolescents. Materials and methods: Thirty-three obese patients from 6-16 years of age were included in the present analytic cross-sectional study. Obesity was diagnosed with a body mass index z-score > 2 SD. NAFLD was estimated by liver ultrasound, serum amino transferases, and elastography. The sociodemographic variables were evaluated using validated questionnaires. Diet was estimated through two 24-h recall dietary surveys focused on the quantity of food energy, simple sugars, polyunsaturated fatty acids (PUFAs), and antioxidants. Results: Hepatic steatosis was identified by abdominal ultrasound in 13 patients (39.4%) and the serum alanine aminotransferase level was above the upper reference value in 54.2%. A higher educational level in both parents, greater monthly food expenditure, and a higher socioeconomic level were associated with NAFLD. Overall, simple sugar and saturated fat consumption was above the recommended daily intake, whereas vitamin E and PUFA consumption was below those parameters. Conclusions: NAFLD was identified in one-third of the cases. There was an association between NAFLD and sociodemographic variables. Both groups had an increased intake of simple sugars and a reduced intake of PUFAs. The selective occurrence of NAFLD could be related to a genetic predisposition that has been demonstrated in a Mexican population. Resumen: Introducción y objetivo: La obesidad se asocia con el hígado graso no alcohólico (HGNA) en niños. El objetivo fue explorar la asociación de factores dietéticos y sociodemográficos con el HGNA en niños y adolescentes obesos. Material y métodos: Treinta y tres pacientes obesos de 6-16 años fueron incluidos en este estudio transversal analítico. El diagnóstico de obesidad se realizó con puntuación z del índice de masa corporal > 2 DE. El HGNA se estimó con ultrasonido hepático, aminotransferasas séricas y elastografía. Las variables sociodemográficas se evaluaron con cuestionarios validados. La dieta se estimó mediante dos encuestas dietéticas por recordatorio de 24 horas enfocadas a la cantidad de energía, azúcares simples, ácidos grasos poliinsaturados (PUFAS) y antioxidantes. Resultados: En 13 pacientes (39.4%) se identificó esteatosis hepática por ultrasonido abdominal; 54.2% tuvieron una concentración sérica de alanina aminotransferasa por arriba de la referencia. El nivel educativo superior de ambos padres, el mayor gasto familiar mensual en alimentos y el mayor nivel socioeconómico se asociaron con HGNA. En el grupo total, el consumo de azúcares simples y grasas saturadas fue excesivo y el consumo de vitamina E y PUFAS estuvo por debajo del parámetro. Conclusiones: Se identificó HGNA en un tercio de los casos. Se demostró asociación entre HGNA y variables sociodemográficas. Ambos grupos tuvieron una ingesta aumentada de azúcares simples y disminuida de PUFAs. La ocurrencia selectiva de HGNA se podría relacionar a predisposición genética demostrada en población mexicana.

Introduction and objective T-14 and TAHSI are validated and reliable specific questionnaires which measure the quality of life in paediatric patients with adenotonsillar disease. The present study aims to compare the adapted and validated versions in Spanish of these two questionnaires (T-14-s and s-TAHSI) in order to assess the preferential use of either of them in our environment. Material and methods A multicentre prospective cross-sectional study was carried out between November 2015 and April 2016, to determine the possible correlation between these two instruments. Subjects aged from 2 to 16 years with indication for adenotonsillar surgery and healthy controls, were consecutively included. Parents or caregivers of these children completed T-14-s and s-TAHSI questionnaires initially, after 2–6 weeks and at 6 months after surgery. T-14-s and s-TAHSI scores of the entire sample were compared globally, patient and control subgroups were compared separately and finally, compared in the group of patients at 6 months from surgery, using Pearson correlation coefficient. The proportion of variability shared between both tests was calculated. Results A hundred subjects (50 cases and 50 controls) were studied. The overall correlation presented by both questionnaires was very high (.97) with a significance level of P Conclusion Quality of life questionnaires for paediatric patients with adenotonsillar pathology, T-14-s and s-TAHSI, showed high correlation and allows the equivalent use of both in our environment.

Resumen Introduccion y objetivo El T-14 y el TAHSI son cuestionarios especificos validados y fiables para medir la calidad de vida en pacientes pediatricos con patologia adenoamigdalar. El presente trabajo tiene como objetivo comparar las versiones adaptadas y validadas en lengua espanola de estos dos cuestionarios (T-14-s y s-TAHSI) con la finalidad de valorar la adopcion preferente de alguno de ellos en nuestro medio. Material y Metodos Para determinar la existencia de una correlacion entre ambos instrumentos, se realizo un estudio prospectivo transversal, multicentrico, entre noviembre de 2015 y abril de 2016. Se incluyeron consecutivamente sujetos de dos a 16 anos de edad con indicacion de cirugia adenoamigdalar y controles sanos. Los padres o tutores legales respondieron los cuestionarios T-14-s y s-TAHSI inicialmente, pasadas dos-seis semanas y a los seis meses de la cirugia. Se compararon las puntuaciones de T-14-s y s-TAHSI de toda la muestra globalmente, de los subgrupos de pacientes y controles por separado y, finalmente, del grupo de pacientes a los seis meses de la cirugia, mediante el coeficiente de correlacion de Pearson. Se calculo la proporcion de variabilidad compartida entre ambos test. Resultados Se estudiaron 100 sujetos (50 pacientes y 50 controles). La correlacion global que presentaron ambos cuestionarios fue muy alta (0,97), con un nivel de significacion de p Conclusion Los cuestionarios de calidad de vida para pacientes pediatricos con patologia adenoamigdalar, T-14-s y s-TAHSI, presentan una alta correlacion que permite el uso equivalente de ambos en nuestro medio.

espanolObjetivo. El objetivo del estudio es identificar los factores de riesgo asociados a infecciones por Pseudomonas aeruginosa resistente a antibioticos carbapenemicos (PARC) y Acinetobacter baumannii resistente a antibioticos carbapenemicos (ABRC) en pacientes adultos a traves de una revision sistematica de la literatura, clasificarlos segun su nivel de importancia y exponer las recomendaciones en el entorno espanol de un panel de expertos. Material y metodos. Se llevo a cabo una revision sistematica de la literatura para identificar los factores de riesgo asociados a PARC o ABRC y posteriormente evaluar cada factor de riesgo por un panel de expertos basandose en la evidencia disponible y su experiencia en la practica clinica. Resultados. Se identificaron 593 articulos incluyendose 29 para PARC y 23 para ABRC. Se identificaron 38 factores de riesgo asociados a PARC y 36 factores de riesgo asociados a ABRC. Tras su evaluacion, para PARC, se clasificaron en: 11 importantes, 10 moderadamente importantes y 15 poco importantes; y para ABRC, 9 importantes, 5 moderadamente importantes y 19 poco importantes. Para ambos patogenos, los factores de riesgo importantes estuvieron relacionados con el uso previo de antibioticos y la hospitalizacion. Conclusion. Se han identificado los principales factores de riesgo asociados a PARC y ABRC mediante una revision de la evidencia disponible. Sin embargo, son necesarios estudios adicionales prospectivos que permitan identificar los pacientes con infecciones por dichos patogenos. EnglishObjective. The aim of the study is to identify risk factors associated to infections caused by carbapenem-resistant Pseudomonas aeruginosa (CRPA) and carbapenem-resistant Acinetobacter baumannii (CRAB) in adult patients through a systematic literature review, classify them according to their importance and provide recommendations by experts in the Spanish context. Material and methods. We developed a systematic literature review to identify risk factors associated to CRPA or CRAB infections and they were evaluated and discussed by a multidisciplinary panel of experts. Results. There were included 29 studies for P. aeruginosa and 23 for A. baumannii out of 593 identified through systematic literature review. We identified 38 risk factors for P. aeruginosa and 36 for A. baumannii. After risk factor evaluation by the panel of experts, results for CRPA were: 11 important, 10 slightly important and 15 unimportant risk factors; and for CRAB were: 9 important, 5 slightly important and 19 unimportant risk factors. For both pathogens, previous use of antibiotics and hospitalization were important risk factors. Conclusion. We could identify the main risk factors associated to CRPA and CRAB through literature review. There is a need for developing additional studies with higher levels of evidence to identify sooner and better infected patients through associated risk factors.

We report on a patient with refractory Myasthenia gravis with acetylcholine receptor antibodies with two prior myasthenic crises suffering from COVID-19 with rapid evolving weakness and respiratory failure. Respiratory failure developed and prolonged mechanical ventilation was necessary. After plasmapheresis, residual, severe generalized and bulbar weakness persisted. Complement inhibition with eculizumab was, therefore, introduced and lead to rapid recovery. In refractory myasthenic crisis individualised therapies could be successful.

Twenty-five eyes of 25 patients with bipolar disorder and 74 eyes of 74 healthy controls underwent retinal measurements of retinal nerve fiber layer (RNFL) and ganglion cell layer (GCL) thickness. Measurements were obtained using the Spectralis-OCT device with the new Posterior Pole protocol which assesses the macular area by analyzing retinal thickness in a grid of 64 (8*8) cells.Significant differences (Posterior Pole OCT protocol is a useful tool to assess changes in the inner retinal layers in bipolar disorder. These observed changes, especially those affecting the GCL, may be associated with disease evolution and may be predictive of the presence of the disease. OCT data could potentially be a useful tool for clinicians to diagnose and monitor BD patients.

The aim of the study was to analyze the epidemiological and clinical changes in EFIE. All definite IE episodes treated at a referral center between 2007 and 2018 were registered prospectively, and a trend test was used to study etiologies over time. EFIE cases were divided into three periods, and clinical differences between them were analyzed. All episodes of E. faecalis monomicrobial bacteremia (EFMB) between 2010 and 2018 and the percentage of echocardiograms performed were retrospectively collected. Six hundred forty-eight IE episodes were studied. We detected an increase in the percentage of EFIE (15% in 2007, 25.3% in 2018, P = 0.038), which became the most prevalent causative agent of IE during the last study period. One hundred and eight EFIE episodes were analyzed (2007–2010, n = 30; 2011–2014, n = 22; 2015–2018, n = 56). The patients in the last period were older (median 70.9 vs 66.5 vs 76.3 years, P = 0.015) and more frequently had an abdominal origin of EFIE (20% vs 13.6% vs 42.9%, P = 0.014), fewer indications for surgery (63.3% vs 54.6% vs 32.1%, P = 0.014), and non-significantly lower in-hospital mortality (30% vs 18.2% vs 12.5%, P = 0.139). There was an increase in the percentage of echocardiograms performed in patients with EFMB (30% in 2010, 51.2% in 2018, P = 0.014) and EFIE diagnoses (15% in 2010, 32.6% in 2018, P = 0.004). E. faecalis is an increasing cause of IE in our center, most likely due to an increase in the percentage of echocardiograms performed. The factors involved in clinical changes in EFIE should be thoroughly studied.

Introduction Obesity is a chronic disease of multifactorial origin characterized by excess weight and excess fat accumulation, and whose etiology includes intrinsic (genetic, physiological, and metabolic) and extrinsic (social and cultural) factors. Fat accumulation is caused by a prolonged imbalance in the energy balance influenced, among other factors, by adaptive thermogenesis, which is triggered by cold environmental conditions, or by hypercaloric intake. Thermogenesis is regulated by the sympathetic nervous system (SNS) and occurs in the muscle and brown adipose tissue (BAT). There are adrenergic receptors in BAT, including the beta-3 adrenergic receptor (ADRB3), the main receptor for the regulation of thermogenesis. The presence in heterozygosis of a SNP-type polymorphism in the ADRB3 gene (Trp64Arg; rs4994) is associated with lower lipolytic activity, a predisposition to obesity, and resistance to weight loss. The objective of this study was to analyze through a systematic review the weight loss program most appropriate for carriers. Methods A retrospective study of published papers on rs4994 polymorphism in the SNP and PubMed databases was conducted. Results Most published studies suggest the presence of obesity and resistance to weight loss in carriers, and report significant improvements in anthropometric parameters when patients receive fat-rich hypocaloric diets. Conclusions Based on these conclusions, specific nutritional and physical exercise guidelines are proposed for individuals carrying the Trp64Arg allele.

ZusammenfassungAnatomische Resektionsverfahren sind unverändert etablierter Standard in der kurativen Behandlung des nichtkleinzelligen Lungenkarzinoms in den Stadien I – III und einiger kleinzelliger Lungenkarzinome.Die Angaben in der Literatur zur Letalität sowie den Komplikationsraten der Resektionsverfahren schwanken jedoch erheblich. Eine Variable, die das Operationsergebnis maßgeblich beeinflusst, ist die Auswahl der Kandidaten für eine Resektion sowie die Bestimmung des Umfangs der Resektion auf dem Boden einer adäquaten Durchführung und Interpretation einer umfassenden mehrdimensionalen präoperativen Evaluation. Elemente dieser Evaluation sind entsprechend verfügbarer Daten und Leitlinien: der ECOG-Score; kardiales Assessment, ggf. zerebrovaskuläres Assessment; pulmonales Assessment, ggf. mit Ergebnissen der Split-Funktionsanalysen, jeweils ggf. nach Therapie bzw. Adjustierung einer Therapie; bei Patienten über 70 Jahren: Score zur allgemeinen Funktionalität (IADL).Im Rahmen dieser Evaluation ergeben sich demnach 3 verschiedene Risikogruppen: Patienten mit einem geringen Risiko für intra- und postoperative Komplikationen und Letalität; Patienten mit einem entsprechend erhöhten Risiko; Patienten, die als inoperabel eingeschätzt werden.Um eine autonome Entscheidung des Patienten über die optimale Therapie auf dem Hintergrund definierter Risiken zu ermöglichen, ist zudem auch die Kenntnis des Patienten, seiner Präferenzen und Wertmaßstäbe sowie seiner familiären und sozialen Einbindung unverzichtbar.

The aim of this study was to evaluate the association between biomass formation and the clinical characteristics and prognosis of Staphylococcus aureus infective endocarditis (IE).We prospectively studied 209 S. aureus strains causing IE. Biomass formation was examined using the crystal violet assay and quantified spectrophotometrically. The average (SD) optical density of the biomass was compared for each clinical, microbiological (methicillin-resistance, vancomycin MIC≥1.5μg/ml) and molecular (clonal complex, agr type and agr dysfunction) variable according to their presence or absence. The primary clinical endpoints studied were in-hospital death, severe sepsis, persistent bacteraemia, symptomatic peripheral embolisms and prosthetic valve IE.Mean age was 66.1 years, 61.5% of patients were male and the median age-adjusted Charlson comorbidity index was 5 points (IQR 3-8). In-hospital mortality was 37.3%. Strains belonging to CC5 and CC22 had optical biomass densities [mean (SD) 1.573 (1.14) vs 0.942 (0.98) p0.001 and 1.720 (0.94) vs 1.028 (1.04) p=0.001, respectively]. Strains belonging to CC5 and CC22 had significantly higher optical biomass densities [1.369 (1.18) vs 0.920 (0.93) p=0.008]. No statistically significant differences were found in the clinical endpoints studied.High biomass production was associated with CC5 and CC22 but not with higher hospital mortality, septic complications, type of endocarditis, methicillin-resistance, elevated vancomycin MIC or agr dysfunction.

Lung cancer is one of the deadliest cancers in the world. Its histological classification depends on early diagnosis and successful treatment. Therefore, having specific biomarkers for a quick sorting widens the successful output of lung cancer treatment. High-throughput sequencing (RNA-seq) was performed of small cohorts of BioBanco samples from healthy and tumour cells from lung adenocarcinoma (LUAD) and squamous cell carcinoma of the lung (lSCC). RNA-seq samples from small cell lung cancer (SCLC) were downloaded from databases. A bioinformatic workflow has been programmed for the identification of differentially expressed genes (DEGs). A total of 4777 DEGs were differentially expressed in SCLC, 3676 DEGs were in lSCC, while the lowest number of DEGs, 2819, appeared in LUAD. Among them, 945 DEGs were common to the three histological types. Once validated their expression profile and their survival predictive capacity in large, public cohorts, three DEGs can be exclusively considered as diagnostic biomarkers, three as prognosis biomarkers, and other three exhibit both diagnosis and prognosis capabilities. This prospective study presents evidences for the diagnostic and prognostic capabilities of expression changes in CAPN8-2, TMC5 and MUC1 in LUAD, while they are non-significant in SCLC and lSCC. Their translation to clinical practice is proposed.

Resumen Objetivos Analizar el riesgo de fractura calculado por FRAX® y la frecuencia de alto riesgo de fractura en la poblacion general en Espana. Metodos EPISER2016 es un estudio transversal multicentrico de base poblacional de la prevalencia de las enfermedades reumaticas en poblacion adulta en Espana. Un total de 3.154 sujetos de edad igual o superior a 40 anos (1.184 hombres y 1.970 mujeres) se seleccionaron mediante muestreo aleatorio estratificado. Las preguntas relacionadas con los factores de riesgo de fractura se realizaron mediante encuesta telefonica. El riesgo de fractura principal (RFP) y de cadera (RFC) se calcularon con la version espanola de la herramienta FRAX®, sin la inclusion de la densidad mineral osea. Para definir alto riesgo de fractura, se utilizaron los umbrales RFP ≥ 20%, RFP ≥ 10%, RFP ≥ 7,5% y RFC ≥ 3%. Resultados La mediana (rango intercuartilico) del RFP fue 2,61% (1,55-6,34%) en mujeres y 1,67% (1,15-2,87%) en hombres; la del RFC fue 0,39% (0,14-1,86%) y 0,18% (0,07-0,77%). El 3,83% de las mujeres y ningun hombre tenian un RFP ≥ 20%; el 15,71% y el 1,14% tenian un RFP ≥ 10%; el 20,62% y el 2,21%, un RFP ≥ 7,5%; y el 19,27% y el 8,05%, un RFC ≥ 3%. En las mujeres de 65 anos o mas, el RFC fue alto en el 58,09%. Conclusiones EPISER2016 nos ha permitido conocer el riesgo de fractura calculado por FRAX® y la prevalencia de alto riesgo de fractura en la poblacion general segun los diversos umbrales utilizados en Espana.

The Spanish Antibiogram Committee (Comité Español del Antibiograma, COESANT) presents in this document a simple "roadmap" or decalogue of recommendations, with a view to facilitating the transition from the Clinical and Laboratory Standards Institute (CLSI) to the European Committee on Antimicrobial Susceptibility Testing (EUCAST) antimicrobial susceptibility testing regulations to the Clinical Microbiology Spanish laboratories that still use the CLSI guidelines. The objectives are to adapt the closer European regulations to the Spanish clinical and epidemiological reality and to fully implement the EUCAST recommendations in all microbiology laboratories in Spain.

We aimed to conduct an updated review on the pathophysiology, diagnosis, and nutritional intervention of CCLD and secondary malnutrition in infants. Protein-energy malnutrition, impaired linear growth, fat-soluble vitamin deficiencies, and hepatic osteodystrophy can occur in up to 80% of cases. The proposed pathophysiological mechanisms include insufficient energy intake, lipid- and fat-soluble vitamin malabsorption, increased energy expenditure, altered intermediate metabolism, hormonal dysregulation, and systemic inflammation. The current approach to diagnosis is the identification of the deviation of growth parameters, body composition, and serum concentration of micronutrients, which determines the type and magnitude of malnutrition. Currently, liver transplantation is the best therapeutic alternative for the reversal of nutritional impairment. Early and effective portoenteroanatomosis can extend survival in patients with biliary atresia. Medical and dietary interventions in some storage and metabolic diseases can improve liver damage and thus the nutritional status. A proportion of patients with biliary atresia have fat-soluble vitamin deficiencies despite receiving these vitamins in a water-soluble form. With aggressive enteral nutrition, it may be possible to increase fat stores and preserve muscle mass and growth. The nutritional issues identified in the pre- and post-transplantation stages include muscle mass loss, bone demineralization, growth retardation, and obesity, which seems to correspond to the natural history of CCLD. Due to the implications for the growth and development of infants with CCLD with this complex malnutrition syndrome, innovative projects are required, such as the generation of prediction and risk models, biomarkers of growth and body composition, and effective strategies for nutritional prevention and intervention.

La realización del ejercicio es uno de los mayores beneficios para la salud. Sin embargo, a nivel sistémico puede resultar perjudicial dependiendo del grado de intensidad con que practiquen los deportistas. El entrenamiento de alta resistencia implica un entrenamiento exhaustivo que puede resultar en síntomas gastrointestinales con manifestaciones sistémicas como el desencadenamiento del proceso inflamatorio, progresión del estrés oxidativo y modificación de la microbiota intestinal. Actualmente, los deportistas consumen productos comerciales para contrarrestar estos efectos. Sin embargo, existen alternativas terapéuticas naturales como el consumo de fuentes ricas en fibra dietética y polifenoles. El uso de estas fuentes puede mejorar los síntomas reduciendo los procesos oxidativos sistémicos, protección intestinal y aumento en el rendimiento deportivo. Esta revisión se centra en los mecanismos sistémicos modificados por la realización de ejercicios de alta resistencia, la influencia del consumo de fuentes naturales como fibra y compuestos polifenólicos como una alternativa terapéutica por reducir los síntomas intestinales y procesos sistémicos negativos favoreciendo la salud intestinal.

Background OXA-48 is an Ambler class D β-lactamase that hydrolyses penicillin and imipenem but has poor hydrolytic activity against cephalosporins. However, very few clinical experiences of treating extended-spectrum β-lactamase (ESBL)-negative OXA-48 producers with cephalosporins have been published. Objectives The aim of this study was to report clinical experience of infections due to ESBL-negative OXA-48-producing Klebsiella pneumoniae (K. pneumoniae) treated with cephalosporins. Patients and methods A retrospective study was conducted at Vall d’Hebron University Hospital, in Barcelona (Spain). It reviewed all microbiological isolates of OXA-48-producers that did not co-produce ESBL from May 2014 to May 2017, and included only clinical strains of patients treated with a cephalosporin for ≥72 h. Results From the 75 isolations of OXA-48 producers, there were 17 isolations of ESBL-negative OXA-48-producing K. pneumoniae. Three patients were treated with cephalosporins with successful outcomes: a pneumonia in a neutropenic patient treated with cefepime and amikacin; an acute focal nephritis of a renal graft treated with ceftriaxone; and an intrabdominal post-surgical infection treated with cefepime in combination with tigecycline at the beginning, and ciprofloxacin afterwards. Conclusions Cephalosporins could be an alternative treatment in selected patients with ESBL-negative OXA-48-producing K. pneumoniae infections, especially to avoid carbapenem use. However, it remains unknown if they should be given in combination.

BACKGROUND Despite the powerful myocardial protection of ischemic preconditioning (IP) observed in experimental studies, it remains a challenge to observe such protection in humans. Thus, the aim of this study was to evaluate the possible effects of IP on clinical outcomes in patients with coronary artery disease (CAD). PATIENTS AND METHODS In this cohort study, patients with multivessel CAD, preserved systolic ventricular function, and stable angina were prospectively selected. They underwent two sequential exercise stress tests (EST) to evaluate IP presence. IP was considered present if patients had an improvement in the time to the onset of 1.0-mm STsegment deviation in the second EST. The primary end point was the composite rate of cardiac death, nonfatal myocardial infarction, or revascularization during 1-year follow-up. Patients with (IP+) and without (IP-) the cardioprotective mechanism were compared regarding clinical end points. RESULTS A total of 229 patients completed EST and had IP evaluated: 165 (72%) were IP+ and 64 (28%) were IP - patients. Of these, 218 patients had complete follow-up. At 1-year, event-free survival regarding the primary end point was 95.5 versus 83.6% (P = 0.0024) and event-free survival regarding cardiac death or myocardial infarction was 99.4 versus 91.7% (P=0.0020), respectively, in IP + and IP - groups. The unadjusted hazard ratio (IP + /IP-) for the primary end point was 4.63 (1.52-14.08). After multivariate analysis, IP was still significantly associated with better clinical outcomes (P = 0.0025). CONCLUSION This data suggest that IP may contribute to better clinical outcomes in patients with ischemic heart disease.

To evaluate visual and retinal changes in patients with bipolar disorder. To analyze the correlation between structural changes and visual function parameters.Thirty patients with bipolar disorder and 80 healthy controls underwent visual function evaluation with Early Treatment Diabetic Retinopathy Study charts at 100%, 2.50%, and 1.25% contrast, Pelli-Robson chart, and color vision Farnsworth and Lanthony tests. Analysis of the different retinal layers was performed using Spectralis optical coherence tomography with automated segmentation software. Correlation analysis between structural and functional parameters was conducted.Patients with bipolar disorder presented worse color vision compared with controls (Lanthony's index, P = 0.002). Full macular thickness, the retinal nerve fiber layer (RNFL), ganglion cell layer, and inner plexiform layer were reduced in patients compared with healthy individuals (P0.005). The inner nuclear layer was significantly thickened in patients (P0.005). Peripapillary RNFL thickness was reduced in all temporal sectors (P0.005). Significant correlations were found between visual acuity and the RNFL thickness, the Pelli-Robson score and the inner plexiform layer, and between the Lanthony's color index and the ganglion cell layer thickness.Patients with bipolar disorder present quantifiable thinning of the macular RNFL, ganglion cell layer, and inner plexiform layer, as well as in the peripapillary RNFL thickness, and increasing thinning in the inner nuclear layer.

Objective The objectives of this paper were to determine weight status, eating, and alcohol drinking and smoking habits of university students, to determine the association between these variables with negative self-perception of their eating habits and to assess the risk of developing eating disorders. Method A cross-sectional study was carried out on 422 university students. The parameters analysed were: nutritional status, eating habits, alcohol/tobacco consumption, and risk of eating disorder. Logistic regression was applied to identify factors associated with a negative perception of eating habits. Results Out of the whole population that was analysed, 5% were underweight, 16% overweight and 4% obese. Fifty-five percent of the sample analysed did not consume five meals a day. The recommended foods for daily consumption were consumed below recommendations, while sausages/fatty meats, industrial pastries, lean meats, and fish were over-consumed. Overall, the population perceived their eating habits as good/very good (63%). Alcohol and tobacco consumption predominated at weekends. The girls were more image-conscious (80.6% vs. 66%) and fearful of gaining weight (52.5% vs. 23.9%). Almost 30% had a distorted perception of body image. There was a 12.8% risk of atypical anorexia nervosa and 4.7% of atypical bulimia nervosa. Conclusions College students led unhealthy lifestyles, mainly due to eating habits that do not conform to the establish recommendations. More than 17% are at risk of developing an atypical eating disorder. This information may be of interest in developing preventive actions.

Objective In this review we try to update the new procedures applicable in the microbiological diagnosis of bacteriemia and fungemias. Method Review of scientific literature. Results and conclusions After defining the process and indicating its fundamental principles, the main biomarkers used in clinical practice are reviewed. Subsequently, the particularities of the pre-analytical phase (collection and transport of samples) are highlighted and the steps to follow for the microbiological identification by classical methods are detailed, based on the culture of the blood samples. In the following section, we review the diagnostic methods not culture based, including those that detect the presence of the genome of the microorganism and those based on the study of proteome by mass spectrometry. The last section describes the procedures more frequently used for the study of antibiotic susceptibility, both by phenotypic and genotypic methods.

ObjectiveWe aimed to study the correlation between neck circumference (NC) and anthropometric adiposity indicators, and to determine cut-off points of NC for both sexes to identify elevated central adiposity in schoolchildren in western Mexico.DesignCross-sectional study.SettingRural settings in western México.ParticipantsChildren from a convenience sample of six schools in Acatlán, Jalisco, Mexico (n1802).ResultsNC showed a strong positive correlation with all anthropometric adiposity indicators in both sexes, which were notably higher in boys regardless of age. Noteworthy, waist circumference displayed the highest significant correlation when analysed by both age and sex. As age increased, NC cut-off points to identify elevated central adiposity ranged from 25·7 to 30·1 cm for girls and from 27·5 to 31·7 cm for boys.ConclusionsNC could be used as a simple, inexpensive and non-invasive indicator for central obesity assessment in Mexican schoolchildren.

Aim: To identify and discuss the efficacy of dietary interventions, antioxidant supplementation, physical activity, and nutritional and psychologic counseling in the treatment of children and adolescents with non alcoholic fatty liver disease associated with obesity. Materials and methods: A scoping review of studies on nutritional and educational interventions and physical activity in pediatric patients with non alcoholic fatty liver disease was conducted. A search for randomized clinical trials or quasi-experimental studies published up to December 2017 was carried out, utilizing seven databases (Medline, EBSCO, OVID, Science Direct, JSTOR, Wiley, and Biblioteca Digital UDG). Results: From a total of 751 articles, 729 were excluded due to the criteria of age, design, language, diagnostic method, and outcome variables. The analysis included 22 articles. The most frequently used intervention variables were diet and physical activity. The interventions had different durations, but most were carried out for one year. Some authors employed ascorbic acid, vitamin E, or omega-3 fatty acid supplementation. There were varying degrees of improvement in the variables analyzed in the majority of the studies, such as a decrease in ALT levels, a reduced frequency of steatosis determined through imaging studies, and a decrease in body mass index. Conclusions: The dietary interventions, omega-3 fatty acid supplementation, physical activity, and nutritional and psychologic counseling were identified as efficacious measures in the treatment of non alcoholic fatty liver disease associated with obesity in children and adolescents, according to biochemical or imaging study indicators, within the time frame of the intervention. Resumen: Objetivo: Identificar y discutir la eficacia de intervenciones nutricias, suplementación de antioxidantes, actividad física y consultoría nutricia y psicológica en el tratamiento de niños y adolescentes con hígado graso no alcohólico asociado a obesidad. Material y métodos: Se realizó una revisión sistemática de estudios de intervención nutricia, educativa y con actividad física en pacientes pediátricos con hígado graso no alcohólico. Se revisaron siete bases de datos (Medline, EBSCO, OVID, Science Direct, JSTOR, E, Wiley y Biblioteca Digital UDG) para la búsqueda de ensayos clínicos aleatorizados o cuasiexperimentales publicados hasta diciembre de 2017. Resultados: De un total de 751 artículos se excluyeron 729 por criterios como edad, diseño, idioma, método de diagnóstico y variables de desenlace; el análisis se realizó con 22 trabajos. Las variables de intervención empleadas con mayor frecuencia fueron la dieta y la actividad física por tiempo variable, en la mayor parte de los trabajos durante un año. Algunos autores suplementaron con ácido ascórbico, vitamina E o ácidos grasos omega-3. En la mayor parte de los trabajos evaluados se consiguieron grados variables de mejoría de las variables evaluadas como disminución de niveles de ALT, disminución de la frecuencia de esteatosis por estudios de imagen y disminución del índice de masa corporal. Conclusiones: Las intervenciones dietéticas, la suplementación de ácidos grasos omega-3, la actividad física y la consejería nutricia y psicológica se identificaron como medidas eficaces en el tratamiento del hígado graso no alcohólico asociado a obesidad en niños y adolescentes de acuerdo a indicadores bioquímicos o de imagen durante el período de la intervención. Keywords: Nonalcoholic fatty liver disease, Childhood obesity, Diet, Physical activity, Antioxidants, Palabras clave: Hígado graso no alcohólico, Obesidad infantil, Dieta, Actividad física, Antioxidantes

Resumen Objetivos Describir la metodologia del estudio de prevalencia de las enfermedades reumaticas en la poblacion adulta en Espana, EPISER 2016, asi como sus fortalezas y limitaciones. El objetivo del proyecto es estimar la prevalencia de artritis reumatoide (AR), artropatia psoriasica (APs), espondilitis anquilosante (EA), lupus eritematoso sistemico (LES), sindrome de Sjogren (SS), artrosis (de rodilla, cadera, manos, columna cervical y lumbar), fibromialgia, gota y fractura osteoporotica clinica. Material y metodo Estudio transversal multicentrico de base poblacional en el que participan 45 municipios de las 17 comunidades autonomas. La poblacion de referencia esta compuesta por adultos de 20 o mas anos residentes en Espana. La recogida de informacion se llevara a cabo mediante encuesta telefonica empleando el sistema Computer Assisted Telephone Interview (CATI). Las sospechas diagnosticas y los diagnosticos autorreferidos seran estudiadas por reumatologos del hospital de referencia de los municipios seleccionados. Analisis estadistico: se calcularan las prevalencias de enfermedades reumaticas mediante estimadores y sus IC del 95%. Se calcularan factores de ponderacion en funcion de la probabilidad de seleccion en cada una de las etapas del muestreo. Se tendra en cuenta la distribucion de la poblacion en Espana segun datos del Instituto Nacional de Estadistica. Conclusiones Los cambios sociodemograficos y en habitos de vida durante los ultimos 16 anos justifican la realizacion de EPISER 2016. El estudio ofrecera datos actualizados de prevalencia en AR, EA, APs, LES, SS, artrosis, fibromialgia, gota y fractura osteoporotica clinica. Los resultados permitiran comparar los datos con estudios de otros paises y con el EPISER 2000.

Objective: To compare visual quality in patients implanted with Tecnis® monofocal (ZCB00) and multifocal (ZMB00) intraocular lenses taking into account their optical quality measured in vitro with an eye model. Methods: In total, 122 patients participated in this study: 44 implanted with monofocal and 78 with multifocal intraocular lenses. Measurements of visual acuity and contrast sensitivity were performed. The optical quality of the intraocular lenses was evaluated in three image planes (distance, intermediate and near) using an eye model on a test bench. The metric considered was the area under the curve of the modulation transfer function. Results: Optical quality at the far focus of the monofocal intraocular lens (area under the curve of the modulation transfer function = 66.97) was considerably better than that with the multifocal lens (area under the curve of the modulation transfer function = 32.54). However, no significant differences were observed between groups at the distance-corrected visual acuity. Distance-corrected near vision was better in the multifocal (0.15 ± 0.20 logMAR) than that in the monofocal group (0.43 ± 0.21 logMAR, p Conclusion: Patients implanted with multifocal ZMB00 achieved a distance visual acuity similar to those implanted with monofocal ZCB00, but showed significantly better intermediate and near visual acuity. A correlation was found between intraocular lenses’ optical quality and patients’ visual acuity. Contrast sensitivity was very similar between the multifocal and monofocal groups.

Background and objective: Treatments that require the introduction of external gas into the non-invasive ventilation (NIV) circuit, such as aerosol and oxygen therapy, may influence the performance of the ventilator trigger system. The aim of the study was to determine the presence and type of asynchronies induced by external gas in the NIV circuit in a bench model and in a group of patients undergoing chronic NIV.Methods: Bench study: Four ventilators (one with two different trigger design types) and three gas sources (continuous flow at 4 and 9 l/min and pulsatile flow at 9 l/min) were selected in an active simulator model. The sensitivity of the trigger, the gas introduction position, the ventilatory pattern and the level of effort were also modified.Clinical study: The same ventilators and gas conditions were used in patients undergoing chronic NIV.Results: Bench: The introduction of external gas caused asynchronies in 35.9% of cases (autotriggering 73%, ineffective effort 27%). Significant differences (p

Objectives To evaluate the association between compliance with previously published quality indicators (QIs) for the management of Staphylococcus aureus bacteraemia (SAB) and 30-day mortality. Methods We conducted a post hoc analysis of all adult patients with SAB who were hospitalized at a Spanish university hospital between 2013 and 2018. We evaluated the compliance with 7 QIs of SAB management (i.e., Infectious Diseases consultation, follow-up blood cultures, early source control, echocardiography, early cloxacillin or cefazolin, vancomycin monitoring, and appropriate treatment duration). The QIs compliance rate was considered good if ≥75% of the QIs recommended in each patient were performed. We studied the impact of different risk factors (including QIs compliance) on 30-day all-cause mortality adjusting by multivariable modeling and propensity-matched analysis. Results We included 441 patients with SAB. The QIs compliance rate was ≥75% in 361 patients (81.9%). A total of 95 patients (21.5%) died within 30 days after the index blood culture. In the multivariable model, the variables associated with 30-day mortality were: age (OR, 1.1; 95% CI, 1.0–1.1), Charlson comorbidity index (OR, 1.2; 95% CI, 1.1–1.4), persistent bacteraemia >72 h (OR, 6.0; 95% CI, 3.2–11.5), infective endocarditis (OR, 2.8; 95% CI, 1.2–6.7), and SAB of unknown source (OR, 3.3; 95% CI, 1.5–7.1). We did not find an association between a global QIs compliance rate of ≥75% or any individual QI with 30-day mortality. Conclusions SAB 30-day mortality remains high despite good adherence to previously published QIs for the management of SAB. Future research should focus on additional factors to further improve SAB-related mortality.

Introduction: Elevated plasma α-klotho (αKl) protects against several ageing phenotypes and has been proposed as a biomarker of a good prognosis for different diseases. The beneficial health effects of elevated plasma levels of soluble αKl (SαKl) have been likened to the positive effects of exercise on ageing and chronic disease progression. It has also been established that molecular responses and adaptations differ according to exercise dose. The aim of this study is to compare the acute SαKl response to different exercise interventions, cardiorespiratory, and strength exercise in healthy, physically active men and to examine the behavior of SαKl 72h after acute strength exercise.Methods: In this quasi-experimental study, plasma SαKl was measured before and after a cardiorespiratory exercise session (CR) in 43 men, and strength exercise session (ST) in 39 men. The behavior of SαKl was also examined 24, 48, and 72h after ST.Results: Significant differences (time×group) were detected in SαKl levels (p=0.001; d=0.86) between CR and ST. After the ST intervention, SαKl behavior varied significantly (p=0.009; d=0.663) in that levels dropped between pre- and post-exercises (p=0.025; d=0.756) and were also significantly higher compared to pre ST values at 24h (p=0.033; d=0.717) and at 48h (p=0.015; d=0.827).Conclusions: SαKl levels increased in response to a single bout of cardiorespiratory exercise; while they decreased immediately after strength exercise, levels were elevated after 24h indicating different klotho protein responses to different forms of exercise.

Higher rates of severe COVID‐19 have been reported in kidney transplant recipients (KTRs) compared to non‐transplant patients. We aimed to determine if poorer outcomes were specifically related to chronic immunosuppression or underlying comorbidities. We used a 1:1 propensity score‐matching method to compare survival and severe disease‐free survival (defined as death and/or need for intensive care unit (ICU)) incidence in hospitalized KTRs and non‐transplant control patients between 26 February and 22 May 2020. Patients were matched for risk factors of severe COVID‐19: age, sex, body mass index, diabetes mellitus, preexisting cardiopathy, chronic lung disease and basal renal function. We included 100 KTRs (median age [interquartile range (IQR)]) 64.7 years (55.3‐73.1) in 3 French transplant centers. After a median follow‐up of 13 days (7‐30), transfer to ICU was required for 34 patients (34%) and death occurred in 26 patients (26%). Overall, 43 patients (43%) developed a severe disease during a median follow‐up of 8.5 days (2‐14). Propensity score matching to a large French cohort of 2017 patients hospitalized in 24 centers, revealed that survival was similar between KTRs and matched non‐transplant patients with respective 30‐days survival of 62.9% and 71% (p=0.38) and severe disease‐free 30‐days survival of 50.6% and 47.5% (p=0.91). These findings suggest that severity of COVID‐19 in KTRs is related to their associated comorbidities and not to chronic immunosuppression.

Neck circumference was studied for the first time in a pediatric population in 2010. Since then, various countries have proposed cutoff values to identify overweight, obesity, and metabolic syndrome. However, no reference values have been established for the Mexican child population. The aim of this study is to provide percentile reference values for the neck circumference of Mexican schoolchildren. Only normal-weight schoolchildren aged 6–11 years were included. Percentiles and growth charts were constructed based on the “Generalized Additive Model for Location, Scale and Shape” (GAMLSS). A total of 1059 schoolchildren (52.9% female) was evaluated. Weight, height, and BMI values were higher for males, however, this difference was not statistically significant. The 50th percentile for females was 24.6 cm at six years old and 28.25 cm at 11 years old, and for males, it was 25.75 cm and 28.76 cm, respectively. Both males and females displayed a pronounced increase in neck circumference between 10 and 11 years of age. The greatest variability was found in the 11-year-old group, with an increase of 5.5 cm for males and 5.4 cm for females. This study presents the first reference values for neck circumference for a Mexican child population.

BackgroundThe role of bronchoscopy in coronavirus disease 2019 (COVID-19) is a matter of debate.Patients and methodsThis observational multicentre study aimed to analyse the prognostic impact of bronchoscopic findings in a consecutive cohort of patients with suspected or confirmed COVID-19. Patients were enrolled at 17 hospitals from February to June 2020. Predictors of in-hospital mortality were assessed by multivariate logistic regression.ResultsA total of 1027 bronchoscopies were performed in 515 patients (age 61.5±11.2 years; 73% men), stratified into a clinical suspicion cohort (n=30) and a COVID-19 confirmed cohort (n=485). In the clinical suspicion cohort, the diagnostic yield was 36.7%. In the COVID-19 confirmed cohort, bronchoscopies were predominantly performed in the intensive care unit (n=961; 96.4%) and major indications were: difficult mechanical ventilation (43.7%), mucus plugs (39%) and persistence of radiological infiltrates (23.4%). 147 bronchoscopies were performed to rule out superinfection, and diagnostic yield was 42.9%. There were abnormalities in 91.6% of bronchoscopies, the most frequent being mucus secretions (82.4%), haematic secretions (17.7%), mucus plugs (17.6%), and diffuse mucosal hyperaemia (11.4%). The independent predictors of in-hospital mortality were: older age (OR 1.06; pConclusionBronchoscopy may be indicated in carefully selected patients with COVID-19 to rule out superinfection and solve complications related to mechanical ventilation. The presence of haematic secretions in the distal bronchial tract may be considered a poor prognostic feature in COVID-19.

Background and importance Management of immunosuppression in recipients of solid organ transplantation (SOT) is challenging Drugs used in COVID-19 involve drug-drug interactions (DDIs) with immunosuppressants Aim and objectives To describe DDIs in hospitalised SOT recipients (SOTr) and to analyse DDI management and their clinical impact Material and methods A retrospective single centre study was conducted in SOTr with COVID-19 hospitalised from 11 March to 25 April Clinical data and pharmacotherapy were recorded from admission up to 28 days or discharge Lexicomp was used to detect and categorise DDIs according to: risk level (X: avoid combination;D: consider therapy modification;C: monitor therapy;B: no action needed), reliability rating and severity 46 patients were included: 33 (71 7%) men, aged 62 7 ±12 6 (mean±SD) years They had received kidney (30;56 2%), lung (13;28 3%) or liver (3;6 5%) transplants Results Immunosuppression at admission: tacrolimus (41;89 1%), mycophenolate mofetil/mycophenolate sodium (28;60 9%), prednisone (39;84 8%), everolimus (7;15 2%), sirolimus (7;15 2%) and cyclosporine (1;2 2%) 106 DDIs affecting 42 (91 3%) patients were detected (patients could have >1 DDI) DDIs were classified as confirmed (18;39 1%) or potential (33;71 7%) Immunosuppressants with DDIs: tacrolimus (65;61 3%), everolimus (12;11 3%), sirolimus (6;5 7%), methylprednisolone (12;11 3%), prednisone (10;9 4%) and mycophenolate (1;0 9%) Drugs for COVID-19 with DDIs: lopinavir/ritonavir (45;42 5%), azithromycin (32;30 2%), tocilizumab (15;14 2%), darunavir/cobicistat (10;9 4%), and hydroxychloroquine (4;3 8%) DDIs were risk X (6;5 6%), risk D (42;40 8%), risk C (57;53 7%) and risk B (1;0 9%) The reliability rate of DDIs was excellent (0 9%), good (52 8%) and fair (44 3%) Severity was low, moderate and major in 6 6%, 84 9% and 8 5% of cases, respectively Immunosuppression was withheld in 33 (71 7%) patients due to DDIs 36 (87 7%) of 41 patients receiving tacrolimus had 65 DDIs;tacrolimus was withdrawn in 22 (61 1%), reduced in 18 (50%) and increased in 4 (11 1%) cases Seven patients receiving everolimus had 12 DDIs and 4 patients with sirolimus had 6 DDIs;immunosuppressant was stopped in all cases Tacrolimus levels were supratherapeutic (>10 ng/mL) in 8 (25%) patients at admission, 13 (43 3%;n=30) at 48 hours, 10 (31 3%, n=32) at 7 days and 2 at 14 days (17 7%, n=28) No graft rejection was detected Mean creatinine serum concentration was 2 2 mg/dL at admission and 2 6 mg/ dL 7 days later Two cases of acute kidney failure were attributable to tacrolimus intoxication Conclusion and relevance DDIs were highly prevalent in hospitalised SOTr with COVID-19 Pharmaceutical care is critical to promptly detect and manage DDIs in SOTr

Background and importance Direct oral anticoagulants (DOAC) were moderately used in the primary care (PC) setting due to their associated risks in elderly and their high cost. In contrast, acenocumarol was much more common in Catalonia, even though it requires intense monitoring. During the SARS-CoV-2 pandemic, the use of DOAC has been encouraged to reduce patient medical visits. Aim and objectives To analyse the change in DOAC use in our area and to evaluate prescription appropriateness. Material and methods This cross sectional study analysed the use of DOAC in a PC population in Barcelona in September 2020. The results were compared with historical data from December 2018. Demographic variables (age, gender), pharmacotherapeutic data (drugs, dose, frequency) and clinical data (glomerular filtration (GF), international normalised ratio (INR), CHA2DS2-VASc score) were obtained from the electronic medical record (September 2020). Prescription appropriateness was evaluated according to the drugs’ summary of product characteristics. Results The study included 351 732 patients in 2018 and 364 350 in 2020; 9194 (2.65%) and 10 017 (2.75%) of the patients were treated with oral anticoagulants (OA), respectively. Prevalence of OA use: 2018: acenocumarol 5734 (62.4%), warfarin 133 (2.3%), apixaban 1006 (10.9%), edoxaban 309 (3.4%), dabigatran 532 (5.8%) and rivaroxaban 1480 (16.1%). 2020: acenocumarol 3804 (38.0%), warfarin 157 (1.6%), apixaban 1875 (18.7%), edoxaban 959 (9.6%), dabigatran 712 (7.1%) and rivaroxaban 2510 (25.1%). Comparison of prevalence between 2018 and 2020: Decrease in acenocumarol (62.4% vs 38.0%, p No change in warfarin (1.45% vs 1.6%, p Increase in DOAC (36.2% vs 60.5%, p DOAC prescription appropriateness in 2020 (among 6056 patients): The main indication was atrial fibrillation (5881 patients, 97.1%). 373 men had CHA2DS2–VASc Frequency of contraindications: peptic ulcer (1603; 26.5%), valvulopathy (1060; 17.5%) and renal failure (76; 1.3%). 2433 (40.2%) patients had at least one contraindication. Dose was not appropriately reduced in 526 patients (8.7%). Conclusion and relevance DOAC use increased notably in our PC area during the SARS-CoV-2 pandemic. We found that 40.2% of patients treated with DOAC had at least one contraindication for the treatment. Interventions should be done to improve DOAC prescription and ensure patient safety. References and/or acknowledgements Conflict of interest No conflict of interest