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Introduction Paediatric acquired brain injury (ABI) causes cognitive and behavioural difficulties and alters the course of child development. The ABI unit at Hospital Infantil Universitario Nino Jesus is the first within the public Spanish health system to provide comprehensive coverage to these patients and their families. Objective This study aims to show the working methodology followed with patients and their families, and to describe the clinical characteristics of the patients treated and the outcomes of treatment. Patients Fifty-three patients aged between three months and 16 and a half years received treatment. The conditions treated were brain tumours, stroke, traumatic brain injury, damage secondary to epilepsy surgery, and hypoxia. Methods All patients were evaluated at admission and at discharge. Treatments were adapted to each patient's difficulties and their severity, as well as to the patient's age. Families received individual and group therapy. Results Older age was associated with better cognitive recovery and shorter duration of treatment. Different conditions show differential impact on intelligence quotient and developmental quotient scores at the beginning of treatment, with hypoxia and encephalitis being associated with greatest severity. Intelligence quotient and developmental quotient scores and visual memory and attention scores at discharge improved significantly after the faceted neuropsychological treatment with respect to scores registered at admission. Conclusions The care of patients with ABI should include neuropsychological rehabilitation programmes and provide emotional support to the family so that they may actively participate in the recovery of the child or adolescent.

Familial hypokalaemic periodic paralysis (FHPP) is an uncommon genetic disease characterized by muscle weakness associated with hypokalaemia. Episodes are precipitated by drugs, stress, metabolic diseases, hypothermia or infection. We report the case of a 38-year-old pregnant women with FHPP who underwent epidural analgesia for labour. Pregnant women with FHPP require multidisciplinary management involving an anaesthesiologist, a gynaecologist and a paediatrician. It is important to maintain normothermia, prevent hyperventilation, monitor electrolytes, avoid glucose infusions and medications that cause hypokalaemia, and administer potassium supplements when required. Locoregional techniques should be preferred over general anaesthesia. Early epidural analgesia reduces the risk of pain that could trigger an episode of FHPP. In the case of general anaesthesia, drugs that can cause malignant hyperthermia should be avoided, and short-acting non-depolarizing neuromuscular blockers with blockade-depth monitoring should be used.

Resumen Introduccion y objetivo El abordaje mediante cirugia minimamente invasiva de la patologia de la glandula suprarrenal es el mas extendido hoy en dia, en donde la retroperitoneoscopia ocupa un lugar a tener muy en cuenta; sin embargo, la evolucion de estas tecnicas hacia abordajes todavia menos invasivos a traves de puerto unico es anecdotica. La finalidad de este trabajo es describir nuestra experiencia inicial en cirugia retroperitoneoscopica por puerto unico (SPORS) de la glandula suprarrenal centrandonos en los datos perioperatorios y dolor postoperatorio. Material y metodos Recogimos y analizamos los datos demograficos y operatorios de una serie de pacientes tratados mediante suprarrenalectomia mediante SPORS. Todos los procedimientos se realizaron mediante una unica incision subcostal de 3-4 cm a traves de un puerto multicanal. Se recogen diferentes datos quirurgicos como tiempo operatorio, sangrado, estancia o presencia de complicaciones. Empleamos la escala visual analogica (EVA) para la valoracion del dolor postoperatorio. Resultados Entre diciembre del 2018 y agosto del 2020, 6 pacientes con diferentes patologias suprarrenales fueron intervenidos en nuestro Departamento de forma consecutiva por el mismo cirujano mediante SPORS. Todas las cirugias se realizaron sin requerir colocacion de trocares accesorios o reconversion a cirugia abierta. El tiempo medio de las intervenciones fue de 91,6 ± 16,3 min, con un sangrado Conclusiones La suprarrenalectomia mediante SPORS es una tecnica factible y segura incluso en casos inicialmente adversos con buenos resultados cosmeticos y perioperatorios.

Mesenchymal stem cells (MSC) have received particular attention due to their ability to inhibit inflammation caused by cytokine storm induced by COVID-19. In this way some patients have been treated successfully. The aim of this study was to evaluate the safety and describe the clinical changes after IV administration of allogeneic human umbilical cord MSC (ahUCMSC), in patients with bilateral pneumonia caused by COVID-19, complicated with severe ARDS, as compassionate treatment. This was a pilot, open-label, prospective, longitudinal study. Five patients that did not improve in their clinical conditions after 48 hours of receiving the standard medical management used by the Medical Center and with persistent PaO2/FiO2 less than 100 mmHg were enrolled. ahUCMSC were infused IV, at dose of 1x106 per Kg of body weight over 15 minutes. Patients were monitored after the infusion to detect adverse event. Pa02/FiO2, vital signs, D-dimer, C reactive protein and total lymphocytes were monitored for 21 days after the infusion or until the patient was discharged from the hospital. Descriptive statistics were used with means or medians and standard deviation or interquartile range according to the type of variable. The Wilcoxon's rank-sum was used for stationary samples. Adverse events occurred in three patients and were easily and quickly controlled. Immediately after the infusion of ahUCMSC, constant rise of PaO2/FiO2 was observed in all patients during the first 7 days, with statistical significance. Three patients survived and were extubated on the ninth day post-infusion. Two patients died at 13 and 15 days after infusion. The infusion of ahUCMSC in patients with severe ARDS caused by COVID-19, was safe, and demonstrated its anti-inflammatory capacity in the lungs, by improving the respiratory function expressed by PaO2 / FiO2, which allowed the survival of 3 patients, with extubation at 9 days.

Objective To assess recent trends in prostate cancer incidence, survival and mortality in Spain using updated data. Subjects and method Prostate cancer mortality data have been obtained from the National Institute of Statistics (INE). Incidence cases have been obtained from the databases “Cancer Incidence in Five Continents (CI5)” and “European Cancer Information System”. Joinpoint regression models were used for trend analysis. The results show the duration (years) of each trend, as well as the Annual Percent Change (APC) for each of them. The direction and magnitude of recent trends (last 5 years available) were evaluated using the percentages of Average Annual Percent Change (AAPC). Results Incidence rates increased significantly from 16.4 in 1980 to 61.3 in 2014. The joinpoint analysis shows three periods: two initial periods of significant rise (1980−1990; 3.5% and 1990−2004; 8.4%) followed by a final one in which rates stabilize (2004−2014; −0.5%, non-significant). Mortality rates drop from 12.9 in 1980 to 7.9 in 2018, with an AAPC of −1.2% (p Conclusion Recent trends (last 5 years) show that mortality rates have decreased and incidence rates have stabilized or even decreased in some age groups.

Resumen Objetivo Evaluar las tendencias recientes de incidencia, supervivencia y mortalidad por cancer de prostata en Espana utilizando datos actualizados. Sujetos y metodo Las defunciones por cancer de prostata se han obtenido del Instituto Nacional de Estadistica (INE). Los casos incidentes se han obtenido de las bases de datos Cancer incidence in five continents (CI5) y European Cancer Information System. Para el analisis de tendencias se usaron modelos de regresion joinpoint. En los resultados se muestran los anos (periodo) que componen cada tendencia, asi como el porcentaje de cambio anual (PCA) para cada una de ellas. La direccion y magnitud de las tendencias recientes (ultimos 5 anos disponibles) se evaluaron mediante los porcentajes de cambio anual medio (PCAM). Resultados Las tasas de incidencia aumentaron de forma significativa, pasando de 16,4 en 1980 a 61,3 en 2014. El analisis joinpoint muestra 3 periodos: 2 iniciales de incrementos significativos (1980-1990; 3,5% y 1990-2004; 8,4%) seguidos de uno final en el que las tasas se estabilizan (2004-2014; −0,5%, no significativo). Las tasas de mortalidad descienden pasando de 12,9 en 1980 a 7,9 en el ano 2018, con un PCAM de −1,2% (p Conclusion Las tendencias recientes (ultimos 5 anos) muestran que las tasas de mortalidad han disminuido y que las tasas de incidencia se han estabilizado e incluso descendido en algunos grupos de edad.

Objectives (1) To systematically and critically review the evidence on the characteristics, efficacy and safety of glucocorticoids (CS) in rheumatoid arthritis (RA); (2) to generate practical recommendations. Methods A systematic literature review was performed through a sensitive bibliographic search strategy in Medline, Embase and the Cochrane Library. We selected randomized clinical trials that analyzed the efficacy and/or safety of CS in patients with RA. Two reviewers performed the first selection by title and abstract. Then 10 reviewers selected the studies after a detailed review of the articles and data collection. The quality of the studies was evaluated with the Jadad scale. In a nominal group meeting, based on the results of the systematic literature review, related recommendations were reached by consensus. Results A total of 47 articles were finally included. CS in combination with disease-modifying antirheumatic drugs help control disease activity and inhibit radiographic progression, especially in the short-to-medium term and in early RA. CS can also improve function and relieve pain. Different types and routes of administration are effective, but there is no standardized scheme (initial dose, tapering and duration of treatment) that is superior to others. Adverse events when using CS are very frequent and are dose-dependent and variable severity, although most are mild. Seven recommendations were generated on the use and risk management of CS. Conclusions These recommendations aim to resolve some common clinical questions and aid in decision-making for CS use in RA.

Resumen Las anomalias en el equilibrio acido-base son problemas clinicos comunes, y pueden tener efectos perjudiciales en la funcion celular y ser el indicio de varios trastornos. Por lo tanto, es importante para el clinico, el hacer un diagnostico preciso de los trastornos acido-base presentes para un tratamiento adecuado. Se han propuesto 3 enfoques para evaluar los trastornos acido-base: un enfoque centrado en el bicarbonato, el enfoque de Stewart y el enfoque de exceso de base. Aunque los 2 ultimos tienen muchos adeptos, solo discutiremos el enfoque centrado en el bicarbonato. Este enfoque es mas facil de utilizar desde el punto de vista clinico, tiene una evaluacion fisiologica del trastorno acido-base, presenta una logica facilmente comprensible para evaluar la gravedad y proporciona, ademas, una base mas solida para el desarrollo de terapias efectivas. Por lo tanto, nuestro trabajo se limitara a un examen en profundidad de esta teoria. En esta revision, primero se introduciran nuevos conceptos importantes; sus beneficios y discusion de sus limitaciones; y luego se mostrara su utilizacion para analizar casos reales. Se ha generado un algoritmo para abordar de forma sistematica el analisis que incorpora estos nuevos conceptos.

Kearns-Sayre syndrome is a mitochondrial myopathy characterized by ophthalmoplegia, pigmentary retinopathy and cardiac conduction abnormalities. This article describes the clinical management of a 50-year-old patient with Kearns-Sayre syndrome who underwent subarachnoid anesthesia for a traumatic femoral fracture surgery.

Resumen El sindrome de Kearns-Sayre constituye una miopatia mitocondrial que cursa con oftalmoplejia, retinopatia pigmentaria y alteraciones de la conduccion cardiaca. Presentamos el caso de un paciente de 50 anos de edad con sindrome de Kearns-Sayre intervenido de una fractura de femur con anestesia subaracnoidea.

Introduction/Background* Enhanced recovery after surgery (ERAS) programs in advanced ovarian cancer (AOC) surgery have been developed in the last few years. The PROFAST randomized controlled trial showed that ERAS was associated with a decrease on length of stay and readmission. Here, we present the results of a secondary outcome, cost analysis, of the PROFAST trial. Methodology The PROFAST trial was a prospective, interventional randomized clinical trial that enrolled women undergoing surgery for either suspected or diagnosed advanced ovarian cancer, at a reference hospital in gynecologic oncology in Barcelona (Spain). Patients were treated following either an ERAS protocol or conventional management (CM) protocol. The primary outcome was to evaluate reduction in length of stay (LOS). One of the secondary outcomes was to perform cost analysis betweem both groups. Cost estimations were performed by two strategies: gross counting (cost of inpatient care, intensive care unit and surgery care), and microcosting (costs associated to image testing and laboratory). In both cases, costs were based on 2014 cost data. A sensitivity analysis of cost savings in different scenarios was performed. This trial was registered at ClinicalTrials.gov (NCT02172638). Result(s)* From June 2014 to March 2018, 110 women were recruited, of which eleven were excluded. The ERAS group comprised 50 patients, and the CM group, 49 patients. LOS. Although mean overall cost per patient was higher in ERAS vs CM (14347 € vs 12597€), ERAS cost distribution was skewed by two patients that accounted for 48% of total intensive care unit costs. Comparing median costs, ERAS costs were significantly lower than CM costs (7642€/patient vs 8594€/patient, P=.0275). Decrease in hospital readmission rates led to higher readmission costs in the CM group (Total costs 6126€ v 125725€, P=.028). Sensitivity analysis showed that, in the worst predicted scenario (median LOS corresponding to 12 days), 1146 €/patient would be saved if ERAS protocols were applied. Conclusion* Besides of achieving lower LOS and fewer readmission rates, implementation of an ERAS program in AOC surgery leads to valuable hospital savings. Therefore, ERAS should be the standard practice for AOC surgeries.

The purpose of the present study was to develop a narrative review of the available evidence of mirabegron efficacy in three scenarios: as a medical expulsive therapy; as a medical treatment to increase a successful access to stones before ureteroscopy, and management of double-J stent-related symptoms. Only two original studies have evaluated its use as a medical expulsive therapy, with contradictory results in terms of stone expulsion rate; however, both demonstrated a better pain control in the mirabegron group. One randomized controlled trial (RCT) found a higher successful access to ureteral stones when mirabegron was administered 1 week before the ureteroscopy. And two RCTs demonstrated its efficacy in diminishing discomfort related with double-J stent. There is a promising role for the use of mirabegron in the arsenal of urolithiasis treatment, even as a medical expulsive therapy, before ureteroscopy surgery, to increase the successful access to the stones and after the placement of ureteral catheter to reduce the related symptoms. However, larger-scaled prospective double-blinded RCTs are needed before it can be used with these purposes in the clinical scenario.

Livestock is an activity of the primary sector that mostly affects the microbiological quality compromising the potential uses of water. Due to the current and future demand, it is essential to generate baselines of water resources, evaluate risks, and design conservation strategies. The aim of the work was to study the microbiological water quality through indicator microorganisms such as coliform group, Escherichia coli, and aerobic sulfite reducers (ASR) in a temperate stream from Pampas ecoregion affected mainly by extensive livestock activities. A third-order stream, namely Santa Barbara (Entre Rios, Argentina) was studied during an annual period (2013). The highest coliform counts occurred during the sampling with higher temperatures, organic matter, and total phosphorus. The frequency of the presence of E. coli and ASR bacteria was high during winter and correlated negatively with the hydrometric level of the Gualeguaychu river and the rains. It was observed that the total and thermotolerant coliform values were very similar, which indicates that most of the coliforms were associated with a fecal origin of the livestock activities that develop in the sub-basin. Moreover, the results indicated a high risk to health due to microbiological contamination. We conclude that it is necessary to implement sustainable management techniques to reduce the impact of the livestock on the aquatic ecosystem.

Objective Our objectives were to study the association between epidural analgesia and risk of severe perineal laceration (SPL), and identify additional risk factors for SPL. This multicentre study consisted of an analysis of data from the MidconBirth Phase I Database, on the use of EA and perineal results during childbirth. (World Health Organization, International Clinical Trials Registry Platform, 2016: http://apps.who.int/trialsearch/Trial2.aspx?TrialID=ISRCTN17833269). Methods We conducted a prospective study of pregnant women at term between July 2016 and July 2017 in 30 public maternity hospitals in Catalonia, Spain. Inclusion criteria were an uncomplicated singleton pregnancy, in cephalic presentation and vaginal birth. Data was analysed separately for instrumental births and spontaneous vaginal births, as the former is more frequently associated with episiotomy and more perineal lacerations. Risk factors as well as protective factors in each cohort of women (instrumental and spontaneous vaginal birth), were identified. Multivariate logistic regression model was performed to study the association between epidural analgesia and SPL to identify potential confounders. Odds ratios (OR), using 95% confidence intervals (CI) were constructed. Findings During the study period, 5497 eligible women gave birth, 77.46% of them received epidural analgesia. SPL occurred in 1.63% of births. The univariate analysis showed births with epidural analgesia had significantly higher rates of inductions, augmentation of labour, lithotomy position for birth and episiotomy. However, this association disappeared when the variable "type of vaginal birth" was introduced. In multivariate logistic regression, nulliparity was the major predictor for SPL (OR: 0.17; CI 95%: 0.08–0.34, p: 0.000). Key conclusions Epidural analgesia was not associated with SPL once confounding factors were included. Other interesting factors associated with SPL were identified. Implications for practice This paper identifies important practice areas which contribute to SPL and which have the potential to be rectified. It offers evidence on the role that EA plays on pelvic floor injuries and it adds to existing evidence about the disadvantages of using the lithotomy position for birth, especially in relation to SPL. It highlights the need for practice change in Catalonia from what can be considered a medical model of care to one more aligned with the midwifery philosophy of care through the development of clinical guidelines. It also signals the need to provide women with evidence base upon which to make informed choices on the use of EA, specifically in relation to SPL.

Airway obstruction with increased airway resistance in asthma, commonly caused by smooth muscle constriction, mucosal edema and fluid secretion into the airway lumen, may partly be due to a poor function of pulmonary surfactant. Surfacen®, a clinical pulmonary surfactant, has anti-inflammatory action, but its effect on asthma has not been studied. This work aimed to evaluate the effect of Surfacen® in a murine allergen-induced acute asthma model, using house dust mite allergens. In a therapeutic experimental setting, mice were first sensitized by being administered with two doses (sc) of Dermatophagoides siboney allergen in aluminum hydroxide followed by one intranasal administration of the allergen. Then, sensitized mice were administered with aerosol of hypertonic 3% NaCl, Salbutamol 0.15 mg/kg, or Surfacen® 16 mg in a whole-body chamber on days 22, 23, and 24. Further, mice were subjected to aerosol allergen challenge on day 25. Surfacen® showed bronchial dilation and inhibition of Th2 inflammation (lower levels of IL-5 and IL-13 in broncoalveolar lavage) which increased IFN-γ and unchanged IL-10 in BAL. Moreover, Sufacen® administration was associated with a marked inhibition of the serum specific IgE burst upon allergen exposure, as well as, IgG2a antibody increase, suggesting potential anti-allergy effects with inclination towards Th1. These results support also the effectiveness of the aerosol administration method to deliver the drug into lungs. Surfacen® induced a favorable pharmacological effect, with a bronchodilator outcome comparable to Salbutamol, consistent with its action as a lung surfactant, and with an advantageous anti-inflammatory and anti-allergic immunomodulatory effect.

Low-dose computed tomography (LDCT), an accepted U.S. screening tool for early lung cancer detection, is not widely-used in Puerto Rico. We investigated knowledge and attitudes about LDCT in focus groups of primary care physicians (PCP) and individuals at high risk for lung cancer (HRI) in Puerto Rico. Transcribed/translated audio-recorded discussions were analyzed with the constant comparison method. Both groups had limited knowledge about LDCT and concerns regarding insurance coverage. Most HRIs had never had a provider recommend LDCT and believed that having symptoms was necessary to obtain LDCT screening. Perceived barriers included fears about results and the procedure; a perceived benefit was having early detection and possibly being cured. Few PCPs had ever recommended LDCT to a patient, with those who had basing their decision on symptoms/smoking history but having challenges with insurance. More education on LDCT is needed among HRIs, and U.S. Preventive Services Task Force guidelines should be widely distributed to encourage physician recommendations.

The minimally invasive surgical approach to adrenal gland pathology is the most widely used nowadays, and retroperitoneoscopy occupies a relevant place. However, the evolution of these techniques towards even less invasive surgery through single-port access is anecdotal. The aim of this work is to describe our initial experience in single-port retroperitoneoscopic surgery (SPORS) of the adrenal gland focusing on perioperative data and postoperative pain.We collected and analyzed the demographic and operative data of a series of patients undergoing adrenalectomy through SPORS. All procedures were performed through a single 3-4 cm subcostal incision with a multichannel port. Surgical data such as operative time, bleeding, length of stay and presence of complications were collected. We used the visual analog scale (VAS) for postoperative pain assessment.From December 2018 to August 2020, 6 patients with different types of adrenal pathology underwent consecutive surgeries in our Department by the same surgeon using SPORS. All surgeries were performed without requiring accessory trocar placement or reconversion to open surgery. The mean operative time was 91.6 ± 16.3 min, with150 mL bleeding, mean length of stay of 35.8 ± 13.3 h and postoperative pain of VAS ≤3 (median 0.5). The mean size of specimens was 57.8 ± 18 mm. No complications were reported according to the Clavien-Dindo scale.Even in initially adverse cases, SPORS adrenalectomy is a feasible and safe technique with good cosmetic and perioperative results.

Neonatal screening for innate metabolism disorders was instituted more than 50 years ago. In Latin America, countries like Uruguay, Costa Rica, Chile, Brazil, and Colombia have implemented this public health measurement in a sustained fashion. Technology for detecting these conditions has been steadily progressing, achieving a good cost/effectiveness ratio, so access for such test is practically universal. Intracellular cobalamin metabolism disorders constitute a heterogeneous group that is subdivided in three biochemical phenotypes. We report the first patient in Peru with a late diagnosis of a homozygous c.394 C>T variant in the MMACHC gene, which belongs to the cbIC complementation group, which leads to methyl-malonic aciduria and homocystinuria, characterized by low height, retardation of psychomotor development, seizures, megaloblastic anemia, and variable thrombocytopenia and neutropenia. Also, homocysteine levels are high, there is methyl-malonic academia, and there is a paradoxical vitamin B12 increase in peripheral blood. This paper emphasizes the importance of making a timely diagnosis of potentially treatable conditions, avoiding or reducing the severity of the implied phenotype, with the implementation of new technologies in our country.

Resumen Antecedentes El estres laboral, el miedo a infectarse y la falta de medios para combatir la pandemia de la COVID-19, sumados a la situacion de reclusion domiciliaria, podrian provocar un fuerte impacto en la salud mental. El objetivo fue determinar el nivel de ansiedad a traves del cuestionario State-Trait Anxiety Inventory (STAI), realizado por los profesionales de una sala de partos que atendieron a embarazadas COVID-19 positivas. Material y metodos Estudio descriptivo transversal en un area obstetrica de Barcelona desde el 14 de marzo al 24 de mayo de 2020. Poblacion de estudio: personal sanitario mayor de 18 anos, sin trastornos de ansiedad diagnosticados antes de la pandemia. Los principales parametros a estudiar fueron el nivel de «ansiedad estado» y «ansiedad rasgo», segun el cuestionario STAI. Se realizo una estadistica descriptiva e inferencial. El nivel de significacion estadistica utilizado fue p Resultados Setenta y siete profesionales participaron en este estudio. La puntuacion media para la «ansiedad estado» fue de 26,3 puntos (valor p = 0,067) y para la «ansiedad rasgo» de 14,3 puntos (valor p = 0,091). Se observo que los profesionales que tienen hijos (valor p = 0,048) y los profesionales que manifestaron haber disminuido sus ingresos economicos familiares (valor p = 0,026) mostraron puntuaciones medias mas altas de «ansiedad estado». Se observo una asociacion positiva entre los anos de experiencia laboral y el nivel de «ansiedad estado», observandose diferencias estadisticamente significativas, valor p = 0,030. Conclusiones Los profesionales que habian sufrido una reduccion de sus ingresos, junto con los que vivian con hijos fueron los que presentaron mayores puntuaciones de «ansiedad estado».

Objectives: This study sought to describe the incidence, determinants, and prognostic impact of cardiogenic shock (CS) in takotsubo syndrome (TTS).Background: TTS can be associated with sev...

Background: Carpal tunnel syndrome is the most common peripheral neuropathy. It is characterised by the compression of the median nerve in the carpal tunnel. It presents a high prevalence and is a disabling condition from the earliest stages. Severe cases are usually treated surgically, while conservative treatment is recommended in mild-to-moderate cases. The aim of this systematic review is to present the conservative treatments and determine their effectiveness in mild-to-moderate cases of carpal tunnel syndrome in the last 15 years. Methods: A systematic review was performed according to PRISMA criteria. We used the Medline, PEDro, and Cochrane databases to find and select randomised controlled clinical trials evaluating the effects of conservative treatment on the symptoms and functional ability of patients with mild-to-moderate carpal tunnel syndrome; 32 clinical trials were included. There is evidence supporting the effectiveness of oral drugs, although injections appear to be more effective. Splinting has been shown to be effective, and it is also associated with use of other non-pharmacological techniques. Assessments of the use of electrotherapy techniques alone have shown no conclusive results about their effectiveness. Other soft tissue techniques have also shown good results but evidence on this topic is limited. Various treatment combinations (drug and non-pharmacological treatments) have been proposed without conclusive results. Conclusions: Several conservative treatments are able to relieve symptoms and improve functional ability of patients with mild-to-moderate carpal tunnel syndrome. These include splinting, oral drugs, injections, electrotherapy, specific manual techniques, and neural gliding exercises as well as different combinations of the above. We have been unable to describe the best technique or combination of techniques due to the limitations of the studies; therefore, further studies of better methodological quality are needed. Resumen: Introducción: El Síndrome del Túnel Carpiano [STC] es la neuropatía periférica más común. Consiste en la compresión del nervio mediano a nivel de túnel carpiano. Tiene una alta prevalencia y genera una situación muy discapacitante desde las primeras fases. En los casos graves el tratamiento suele ser quirúrgico, mientras que en los leves y moderados el tratamiento es conservador. El objetivo de esta revisión es conocer los tratamientos conservadores, así como su efectividad, en pacientes con STC leve y moderado, en los 15 últimos años. Desarrollo: Se realizó una revisión sistemática según los criterios de PRISMA. Se emplearon las bases de datos Medline, PEDro y Cochrane. Se seleccionaron aquellos ensayos clínicos controlados y aleatorizados que analizasen los efectos del tratamiento conservador sobre los síntomas y la función en pacientes con STC leve o moderado. Se incluyeron 32 ensayos clínicos. Existe evidencia sobre la efectividad de los fármacos orales aunque las infiltraciones parecen ser más efectivas. El uso de férulas ha mostrado ser efectiva y asociada a otras técnicas no farmacológicas también. Las técnicas de electroterapia no han mostrado resultados concluyentes sobre la efectividad de forma aislada. Otras técnicas de tejido blando también han mostrado buenos resultados pero es escasa la evidencia en este campo. También se han propuesto varias combinaciones de tratamiento farmacológico con no farmacológico sin resultados concluyentes. Conclusiones: Existen varios tratamientos conservadores capaces de mejorar los síntomas y la función de los pacientes con STC leve y moderado. Éstos incluyen el uso de férulas, fármacos orales, infiltraciones, técnicas de electroterapia, técnicas manuales específicas y ejercicios de deslizamiento neural, así como la combinación de varias de ellas. No ha sido posible describir la mejor técnica o combinación de técnicas debido a las limitaciones de los estudios, por lo que es necesario realizar más estudios con una calidad metodológica adecuada. Keywords: Carpal tunnel syndrome, Median neuropathy, Physiotherapy modalities, Review, Treatment outcomes, Palabras clave: Síndrome del túnel carpiano, Neuropatía del nervio mediano, Técnicas de fisioterapia, Revisión, Resultados

The objective was to compare the performance of the updated Charlson comorbidity index (uCCI) and classical CCI (cCCI) in predicting 30-day mortality in patients with Staphylococcus aureus bacteraemia (SAB). All cases of SAB in patients aged ⩾14 years identified at the Microbiology Unit were included prospectively and followed. Comorbidity was evaluated using the cCCI and uCCI. Relevant variables associated with SAB-related mortality, along with cCCI or uCCI scores, were entered into multivariate logistic regression models. Global model fit, model calibration and predictive validity of each model were evaluated and compared. In total, 257 episodes of SAB in 239 patients were included (mean age 74 years; 65% were male). The mean cCCI and uCCI scores were 3.6 (standard deviation, 2.4) and 2.9 (2.3), respectively; 161 (63%) cases had cCCI score ⩾3 and 89 (35%) cases had uCCI score ⩾4. Sixty-five (25%) patients died within 30 days. The cCCI score was not related to mortality in any model, but uCCI score ⩾4 was an independent factor of 30-day mortality (odds ratio, 1.98; 95% confidence interval, 1.05–3.74). The uCCI is a more up-to-date, refined and parsimonious prognostic mortality score than the cCCI; it may thus serve better than the latter in the identification of patients with SAB with worse prognoses.

Resumen Raramente se reporta la acidosis metabolica resistente de riesgo debido a cetoacidosis no diabetica por inanicion a corto plazo. La cetoacidosis grave debida a inanicion es una situacion infrecuente y lo es mas aun durante el embarazo con situacion clinica estresante concomitante. Este informe de un caso presenta a una mujer no diabetica ingresada en cuidados intensivos debido a insuficiencia respiratoria tipo 1 durante el tercer trimestre de embarazo, con acidosis metabolica grave resistente a tratamiento medico. Diagnosticamos a la paciente de cetoacidosis por inanicion, basandonos en su historia y la ausencia de otras causas de acidosis metabolica con anion gap elevado, tras la realizacion de un analisis riguroso de su trastorno acido-base.

Recibido: 4 feb. 2018 Aceptado: 16 may. 2018 Introducción: La implementación de cualquier protocolo de atención en salud, requiere de la sinergia de esfuerzos de autoridades que velene implementen el sistema, de los recursos materiales destinados para su desarrollo y del ser humano para operacionalizarlo. Objetivos: El objetivo del estudio fue evaluar los tratamientos antituberculosos acortados en pacientes ingresados en el Hospital San Vicente, diagnosticados como casos nuevos y/oretratamientos del 1 de enero al 31 de diciembre del año 2015. Metodología: Del total de 304 pacientes ingresados con diagnóstico de Tuberculosis, setomó una muestra de investigación de 110 pacientes que cumplieran con diagnóstico exclusivo de tuberculosis pulmonar e iniciaran tratamientos contemplados estrictamente en Plan “A” y Plan “B”. Resultados: Se registraron de acuerdo a categorías: Curado en el 65% de los pacientes, quedando muy pordebajo de la norma nacional del 85%. Tratamiento Completo en el 8%, alto, en relación a la norma del 2%. Alta tasa de abandono del 17% en comparación al 6% establecido. Se observó una tasa de abandono recuperado que continuaron tratamiento del 6% y una tasa de fallecidos global de 9.72%. Conclusiones: La eficacia del tratamiento expresada en la tasa de curación, iniciada en el Hospital San Vicente es alta pero no cumple con la meta de la norma nacional del 85% en la fase complementaria en las áreas de salud ambulatorias por una elevada tasa de abandonos y fallecidos.

Upgraded metallurgical-grade silicon (UMG Si) solar cells with different ranges of efficiencies were characterized through electroluminescence imaging (ELi) and light-beam induced current (LBIC) measurements. The results showed a good correlation between the EL intensity and the efficiency of the solar cells. ELi images gave a bright contrast at the defects, grain boundaries and intragrain defects, and dark contrast inside the grain bodies. Metallic impurities are much more present in some cells due to the directional solidification of the Si ingot. Local short-circuit current mapping with LBIC measurements revealed a bright zone in the neighborhoods of the defects due to the depletion of impurities. Internal quantum efficiencies (IQE) and effective diffusion lengths (Leff) were calculated using different excitation wavelengths. High resolution LBIC measurements revealed micrometric clusters of impurities around intragrain defects, Spanish MINECO project, ref. ENE2014-56069-C4-4-R and “Junta de Castilla y León (Spain)” project number VA081U16

The speckled flounder Paralichthys woolmani is a flatfish species found in Ecuadorian coastal waters, consumed by local coastal communities and likely an excellent candidate for aquaculture production in indoor facilities. This study describes the early development and culture technique of P. woolmani under experimental conditions. Broodstocks were obtained from the wild and kept under laboratory conditions for this study. A total of four effective spontaneous spawns were registered at water temperature of 24.1°C, resulting in 1.3 million eggs and 129.2 thousand newly hatched larvae. Larval pelagic life lasted 28 days post hatch. Survival at benthic juvenile stage ranged 0.3%–46.9%. Pseudoalbinism was present in all juvenile batches. However, different pigmentation patterns in juveniles were recovered with addition of semi‐moist diet. There was no presence of ectoparasites or abnormal eye migration. At 370 days post hatch, flatfish reached 294.6 ± 86.9 g of body weight. These results can be of practical use for optimizing culture conditions to increase the yield of P. woolmani in captivity.

Background Colon immune dysregulation results in a chronic inflammatory response typical of IBD and mainly driven by T-cell response to microbial antigens. Interestingly, stress can trigger or modulate inflammation and even modify the clinical course of IBD. Sphingosine 1-phosphate (S1P) increase in tissues is involved in T-cell recruitment and different compounds acting on S1P signaling are currently under clinical trials to test their ability to impact IBD progression, including sphingosine kinase 2 (Sphk2) inhibitors. Methods Male C57BL/6NJ and Sphk2-/- mice were randomly assigned to 4 experimental groups: Control WT (n=5), Control Sphk2-/- (n=5), Stress WT (n=8), and Stress Sphk2-/- (n=8). A sub-chronic stress mixed model based on immobilization and ultrasound exposure for 2h during 4 days was used. A set of tissue and biochemical assays was performed to evaluate stress and immune responses, S1P pathways, and epithelial barrier integrity. Results Stress caused weight loss and corticosterone upregulation regardless of the genotype. S1P was increased in the colon of stressed mice due to a decrease in its degradation enzymes and Sphk2, leading to an immune dysregulation reflected by an upregulation of TLR4 pathway, an inhibition of anti-inflammatory mechanisms – 15-lipoxygenase, N-formyl-peptide receptor 2 and Liver X Receptor – a decrease in IgA+ and a decrease in IgM+ B-cells and plasmablasts, and a Th17 polarization. Sphk2 deletion did not affect inflammatory processes but could interfere with Th17 response. Moreover, Sphk2-/- mice showed lower expression levels of claudins 3, 4, 5, 7, and 8 that could be related to structural abnormalities relevant to IBD. Stress exposure also decreased some of these claudins and increased intestinal permeability, but a synergistic effect between stress and genotype for permeability was not detected. Conclusion Sub-chronic stress induced colon S1P increase, immune dysregulation and increased intestinal permeability. Sphk2 deletion is involved in structural abnormalities and Th17 response but did not aggravate the inflammatory processes exerted by stress.

To analyze whether immune-mediated diseases (IMDs) occurs in sarcoidosis more commonly than expected in the general population, and how concomitant IMDs influence the clinical presentation of the disease.We searched for coexisting IMDs in patients included in the SARCOGEAS-cohort, a multicenter nationwide database of consecutive patients diagnosed according to the ATS/ESC/WASOG criteria. Comparisons were made considering the presence or absence of IMD clustering, and odds ratios (OR) and their 95% confidence intervals (CI) were calculated as the ratio of observed cases of every IMD in the sarcoidosis cohort to the observed cases in the general population.Among 1737 patients with sarcoidosis, 283 (16%) patients presented at least one associated IMD. These patients were more commonly female (OR: 1.98, 95% CI: 1.49-2.62) and were diagnosed with sarcoidosis at an older age (49.6 vs. 47.5years, P0.05). The frequency of IMDs in patients with sarcoidosis was nearly 2-fold higher than the frequency observed in the general population (OR: 1.64, 95% CI: 1.44-1.86). Significant associations were identified in 17 individual IMDs. In comparison with the general population, the IMDs with the strongest strength of association with sarcoidosis (OR5) were common variable immunodeficiency (CVID) (OR: 431.8), familial Mediterranean fever (OR 33.9), primary biliary cholangitis (OR: 16.57), haemolytic anemia (OR: 12.17), autoimmune hepatitis (OR: 9.01), antiphospholipid syndrome (OR: 8.70), immune thrombocytopenia (OR: 8.43), Sjögren syndrome (OR: 6.98), systemic sclerosis (OR: 5.71), ankylosing spondylitis (OR: 5.49), IgA deficiency (OR: 5.07) and psoriatic arthritis (OR: 5.06). Sex-adjusted ORs were considerably higher than crude ORs for eosinophilic digestive disease in women, and for immune thrombocytopenia, systemic sclerosis and autoimmune hepatitis in men.We found coexisting IMDs in 1 out of 6 patients with sarcoidosis. The strongest associations were found for immunodeficiencies and some systemic, rheumatic, hepatic and hematological autoimmune diseases.

The consumption of contaminated water is a major cause of acute diarrheal disease (ADD), particularly in rural areas where treatment and control are limited. The aim of this study was to characterize the epidemiological situation and microbiological risk linked to water consumption in the rural area near the capital of Colombia. A cross-sectional study was carried out using secondary data analysis about water quality records and survey information. We described the epidemiological situation of ADD in the municipality and we estimated the risk of ADD by enterotoxigenic E. coli (ETEC) from drinking water in that region using Quantitative Microbial Risk Assessment (QMRA). During the study period, 1318 cases of ADD were reported, with 33% in children under 5. For all zones evaluated the risk exceeds commonly used acceptable risk levels. Inadequate protocols for thermal treatment and subsequent storage increase the risk of illness. The study highlights the need to strengthen intersectoral work, improve water infrastructure, and implement protocols and education about the management of drinking water to reduce health risks.

Resumen Objetivo Evaluar la sintomatologia clinica residual que puedan presentar los supervivientes de un fracaso multiorganico (FMO) tras su alta de la Unidad de Cuidados Intensivos (UCI) e identificar aquellos factores que puedan estar asociados. Material y metodos Fueron seleccionados de forma consecutiva en el estudio un total de 545 pacientes adultos con FMO a su ingreso. Se realizo una encuesta a los 6 y 12 meses tras el alta de una UCI medico-quirurgica en Espana. Se realizo una encuesta telefonica sobre los sintomas clinicos presentes al alta de UCI. Resultados Se realizo seguimiento a un total de 266 pacientes supervivientes al FMO; un 62,2% eran varones, la edad media fue de 60 ± 18 anos y un 67,8% eran pacientes medicos. Los sintomas mas comunes presentados tras el alta hospitalaria fueron astenia (173; 76%), alteraciones en el sueno (112; 50%) y depresion (109; 48%). Conclusiones El seguimiento revelo la presencia frecuente de sintomas clinicos «residuales» que persistieron al menos un ano; de forma mas notable, la artromialgia y la astenia. La presencia de sintomas depresivos tras los primeros 6 meses del alta poshospitalaria tambien fue comun entre los pacientes supervivientes de FMO. La duracion de la sintomatologia se relaciono principalmente con una situacion basal pobre a los 6 y 12 meses, un ingreso hospitalario largo y una puntuacion de gravedad alta al ingreso en la UCI.

The aim of this work is to show the Optical Wireless Link to intraSpacecraft Communications (OWLS) technology as a platform technology for space missions, and more specifically its use within the On-Board Communication system of OPTOS satellite. OWLS technology was proposed by Instituto Nacional de Tecnica Aeroespacial (INTA) at the end of the 1990s and developed along 10 years through a number of ground demonstrations, technological developments and in-orbit experiments. Its main benefits are: mass reduction, flexibility, and simplification of the Assembly, Integration and Tests phases. The final step was to go from an experimental technology to a platform one. This step was carried out in the OPTOS satellite, which makes use of optical wireless links in a distributed network based on an OLWS implementation of the CAN bus. OPTOS is the first fully wireless satellite. It is based on the triple configuration (3U) of the popular Cubesat standard, and was completely built at INTA. It was conceived to procure a fast development, low cost, and yet reliable platform to the Spanish scientific community, acting as a test bed for space born science and technology. OPTOS presents a distributed OBDH architecture in which all satellite’s subsystems and payloads incorporate a small Distributed On-Board Computer (OBC) Terminal (DOT). All DOTs (7 in total) communicate between them by means of the OWLS-CAN that enables full data sharing capabilities. This collaboration allows them to perform all tasks that would normally be carried out by a centralized On-Board Computer.

Nowadays, the strong relationship between diet and health is well known. Although the primary role of diet is to provide nutrients to fulfill metabolic requirements, the use of foods to improve health and the state of well-being is an idea increasingly accepted by society in the last three decades. During the last years, an important number of scientific advances have been achieved in this field and, although in some situations, it is difficult to establish a distinction between "harmful" and "good" bacteria, experts agree in classifying the genera Bifidobacterium and Lactobacillus as beneficial bacteria. Thus, several strategies can be used to stimulate the proliferation of these beneficial intestinal bacteria, being one of them the consumption of prebiotics. The development of new prebiotics, with added functionality, is one of the most serious challenges shared not only by the scientific community but also by the food industry. The objective of this work was to evaluate the potential prebiotic effect of red and white grape residues, both obtained during the winemaking process. For such purpose, an in vitro study with pure cultures of Lactobacillus and Bifidobacterium was first conducted. Secondly, a study with mixed cultures using human fecal inocula was carried out in a simulator of the distal part of the colon. The obtained results showed an increase in the Lactobacillus and Bifidobacterium population, indicating that these ingredients are serious candidates to be considered as prebiotics.

Clinical case A 49-year-old woman experienced a local relapse of a primary follicular lymphoma (FL) of the conjunctiva. She received 4 weekly intra-lesional injections followed by 6 monthly injections of rituximab (6 mg/ml). A clinical response was achieved after first injection. No adverse ocular event or signs of lymphoma relapse were seen after 10 months of follow-up. Discussion Intralesional administration of rituximab for treating primary FL of the conjunctiva was an effective and safe therapeutic option; therefore it could be an alternative to other conventional treatments, such as radiotherapy or chemotherapy.

Objective To report the outcomes of surgical treatment of lower limb fractures in patients with chronic spinal cord injuries. Material and method A total of 37 lower limb fractures were treated from 2003 to 2010, of which 25 fractures were treated surgically and 12 orthopaedically. Results Patients of the surgical group had better clinical results, range of motion, bone consolidation, and less pressure ulcers and radiological misalignment. No differences were detected between groups in terms of pain, hospital stay, and medical complications. Discussion There is no currently consensus regarding the management of lower limb fractures in patients with chronic spinal cord injuries, but the trend has been conservative treatment due to the high rate of complications in surgical treatment. Conclusions Chronic spinal cord injuries patients with lower limb fractures who are treated surgically achieved a more reliable consolidation, practically a free range of motion, low rate of cutaneous complications, and pain associated with the fracture. This allows a quick return to the previous standard of living, and should be considered as an alternative to orthopaedic treatment in these patients.

Resumen Se presenta el caso de una mujer de 46 anos de edad sin antecedentes de interes quien, tras una intervencion de histerectomia abdominal con anestesia raquidea, presento en el postoperatorio hipoestesia en la cara anterior del muslo, paresia cuadricipital y abolicion del reflejo rotuliano, sin otras manifestaciones asociadas. Inicialmente dicho cuadro clinico fue achacado a la tecnica anestesica. Sin embargo, las exploraciones complementarias posteriores llevadas a cabo con tomografia computarizada, resonancia magnetica y electromiografia descartaron que la tecnica anestesica fuera la responsable del cuadro clinico que presentaba la paciente, que fue diagnosticada de neuropatia femoral secundaria a la tecnica quirurgica realizada. Como resultado, la evolucion del cuadro clinico fue satisfactoria. Dicha clinica cedio al cabo de 6 meses de tratamiento rehabilitador y de la administracion oral de complejo vitaminico B. Como conclusion, cabe decir que la cirugia en la parte baja del abdomen tambien puede producir lesiones en el nervio femoral, complicacion que a veces se asume como consecuencia de las tecnicas de anestesia raquidea.

Summary Background Faecal microbiota transplantation (FMT) is a highly effective approach for refractory and recurrent Clostridioides difficile infection (CDI). Despite its excellent efficacy, FMT is not yet a routine procedure in most centres. There is very little experience with FMT based on lyophilized capsules, and data from European institutions are lacking. This article describes our experience with FMT to treat recurrent CDI using lyophilized oral capsules. Methods A prospectively recorded single-centre case series of patients with recurrent CDI who underwent FMT between January 2018 and May 2019 were analysed. The primary outcome was defined as resolution of CDI without recurrences over a two-month period. Overall resolution was defined as resolution of diarrhoea without recurrence of CDI within two months after a further cycle of FMT. The FMT process involved oral ingestion of four or five lyophilized capsules in a single dose. All stool donors were rigorously screened. Findings FMT was performed in 32 patients. Primary cure was achieved in 81.3% of patients, and the overall cure rate was 87.5%. FMT via lyophilized capsules was well tolerated. No FMT procedure-related adverse events and no further complications were observed for lyophilized-capsule FMT. Conclusions This initial clinical experience suggests that FMT based on oral lyophilized preparations is a safe, well-tolerated, and highly effective treatment for recurrent CDI. Administration of oral lyophilized capsules seems feasible in hospital routine and will enable FMT to be more widely used.

Background: The prevalence of binge drinking has risen in recent years. It is associated with a range of neurocognitive deficits among adolescents and young emerging adults who are especially vulnerable to alcohol use. Attention is an essential dimension of executive functioning and attentional disturbances may be associated with hazardous drinking. The aim of the study was to examine the oscillatory neural dynamics of attentional control during visual target detection in emerging young adults as a function of binge drinking. Method: In total, 51 first-year university students (18 ± 0.6 years) were assigned to light drinking (n = 26), and binge drinking (n = 25) groups based on their alcohol consumption patterns. A high-density magnetoencephalography signal was combined with structural magnetic resonance imaging in an anatomically constrained magnetoencephalography model to estimate event-related source power in a theta (4–7 Hz) frequency band. Phase-locked co-oscillations were further estimated between the principally activated regions during task performance. Results: Overall, the greatest event-related theta power was elicited by targets in the right inferior frontal cortex and it correlated with performance accuracy and selective attention scores. Binge drinkers exhibited lower theta power and dysregulated oscillatory synchrony to targets in the right inferior frontal cortex, which correlated with higher levels of alcohol consumption. Conclusions: These results confirm that a highly interactive network in the right inferior frontal cortex subserves attentional control, revealing the importance of theta oscillations and neural synchrony for attentional capture and contextual maintenance. Attenuation of theta power and synchronous interactions in binge drinkers may indicate early stages of suboptimal integrative processing in young, highly functioning binge drinkers, Study was supported by the projects SPI/2010/134 and SPI/2010/051 from the Spanish Ministry of Health and Social Politics (National Plan of Drugs), and the National Institutes of Health, (R01-AA016624). Eduardo López-Caneda was supported by the Postdoctoral Fellowship of the Portuguese Foundation for Science and Technology SFRH/BPD/109750/2015

The extraction of feather keratin biopolymer structures was studied using chicken feathers as a biomass material by the cold acid hydrolysis reaction; the recrystallization stage was performed using microwave or ultrasound irradiation, and conduction heating was used as a reference. The microwave or ultrasound irradiation modified the texture and the morphology of the obtained materials, and they can be controlled depending on the time exposure and the power of the irradiation; this has high relevance in the design of new materials to obtain nanostructures depending on the specific application. It was found that the microwave irradiation promotes the growth of the beta sheet over the alpha helix, and in the case of ultrasound irradiation, the growth is reversed being similar to the conduction heating; the porosity properties remain invariant, modifying the particle sizes depending on the exposure time and power of irradiation. Therefore, the feather keratin biopolymer, when modified by microwaves and ultrasound in the recrystallization stage, is a fibrous protein that has good mechanical, structural, morphological, and thermal properties with potential applications such as development of biocompatible materials with cellular interaction and in catalysis as catalytic and enzymatic support to mention just a few.

Background:Prognosis of non-infectious refractory uveitis has improved markedly with biologic therapy (BT) (1-5). Most data are with monoclonal anti-TNF drugs, especially Adalimumab (ADA) and Infliximab (IFX). However, there is not enough evidence for the use of Certolizumab Pegol (CZP).Objectives:To evaluate the efficacy and safety of CZP in refractory uveitis secondary to Immune-Mediated Inflammatory Diseases (IMID).Methods:Multicenter study of 71 patients with uveitis due to IMID refractory to glucocorticoids and conventional immunosuppressants. Efficacy was assessed with the following ocular parameters: best corrected visual acuity (BCVA), anterior chamber cells, vitritis, macular thickness and presence of retinal vasculitis. These outcomes were compared between baseline, 1st week, 1st and 6th month, and 1st and 2nd year. Statistical analysis was performed with IBM SPSS Statistics v.23.Results:71 patients/100 affected eyes (29 men/42 women) with mean age of 40.0±11.3 years were studied. Underlying IMIDs were: spondyloarthritis (n=38), Behçet (10), psoriatic arthritis (8), Crohn disease (3), sarcoidosis (2), JIA (1), reactive arthritis (1), rheumatoid arthritis (1), relapsing polychondritis (1), TINU (1), pars planitis (1), Birdshot (1) and idiopathic uveitis (3). Uveitis pattern was anterior (n=55), posterior (6), panuveitis (6) and intermediate (4).Prior to CZP, patients had received: methotrexate (37), sulfasalazine (26), azathioprine (14), cyclosporine (10), leflunomide (3), mycophenolate mofetil (3) and cyclophosphamide (1). Previous BT was administered in 48 (67.6%) patients, with a mean of 1.4±1.3 drugs per patient as follows: ADA (n=56), IFX (27), golimumab (14), tocilizumab (5) and etanercept (3). Pregnancy was the reason for prescribing CZP in 19 patients. CZP was administered in monotherapy (n=39) or combined with conventional immunosuppressants (n=32).After a mean follow-up of 27.1±21.1 months, most of the ocular variables showed a rapid and significantly improvement (Table 1). A decrease in the median number [IQR] of flares of uveitis before and after CZP, (3 [1-4] vs. 0 [0-1], pConclusion:CZP seems to be effective and safe in patients with refractory uveitis due to IMID.References:[1]Martín-Varillas JL, et al. Ophthalmology 2018; 125:1444-1451. doi: 10.1016/j.ophtha.2018.02.020.[2]Atienza-Mateo B, et al. Arthritis Rheumatol 2019; 71:2081-2089. doi: 10.1002/art.41026.[3]Santos-Gómez M, et al. Clin Exp Rheumatol 2016; 34(6 Suppl 102):S34-S40. PMID: 27054359[4]Vegas-Revenga N, et al. Am J Ophthalmol 2019; 200:85-94. doi: 10.1016/j.ajo.2018.12.019[5]Calvo-Río V, et al. Clin Exp Rheumatol. 2014; 32 (4 Suppl 84):S54-7. PMID: 25005576Table 1.Baseline1stweek1stMonth6thMonth1styear2ndyearBCVA (mean±SD)0.68±0.270.72±0.27*0.79±0.25*0.84±0.24*0.85±0.25*0.87±0.22*Improvement in AC Cells, n (%)Patients with AC cells at baseline (n=48)-21 (43.7)30 (62.5)*41 (85.4)*48 (100)*48 (100)*Improvement in Vitritis, n (%)Patients with vitritis at baseline (n=13)-3 (23.1)8 (61.5)*11 (84.6)*13 (100)*13 (100)*OCT (µ) (mean±SD)292.5±47.7294±47.4286.7±41.9*274.7±38.7*272.8±38.9*266.31±36.2*Choroiditis; affected eyes, n, (%)3 (4.2)3 (4.2)2 (2.8)2 (2.8)1 (1.4)0 (0)Retinal Vasculitis; affected eyes, n, (%)2 (2.8)0 (0)1 (1.4)0 (0)0 (0)0 (0)*pDisclosure of Interests:None declared

Objective To identify the prevalence and risk factors of diabetic retinopathy (DR) among rural inhabitants included in a tele-ophthalmology program. To analyze diagnostic accuracy among primary care physicians, concordance with ophthalmologists, and financial savings. Material and methods An observational randomized study was conducted on 394 patients included in a tele-ophthalmology program (from January 2010 to January 2015). An analysis was performed on the clinical characteristics, DR findings in retinography images, and correspondence between the request for a second interpretation by an ophthalmologist, and previously established criteria for it: presence of moderate to severe DR, vision loss, poor image quality and/or intraocular pressure >22 mmHg. Statistical analysis was performed using the SPSS program (Student t and χ 2 tests). Results DR prevalence was 12.1%. Patients with glycosylated hemoglobin values >7.68% or those treated with a combination of insulin and oral antidiabetic drugs showed a higher risk of DR ( P Conclusions Tele-ophthalmology programs are a useful tool in DR screening. Primary care physicians are able to distinguish patients who need specialist care, avoiding unnecessary referrals to ophthalmologists, and saving costs.

Introduction: In recent decades, mortality rates for cerebrovascular diseases (CVD) have declined significantly in many countries. This study analyses changes in CVD mortality rates in Spain (1980-2011) to determine if previously observed trends remain. Patients and methods: Data on CVD mortality rates and the population data needed for the analysis were provided by Spain's National Statistics Institute. We calculated age-specific mortality rate, age-standardised overall mortality, and age-truncated mortality (35-64 years) using the direct method and standard European population structure. Joinpoint analysis was used to estimate the percentage of annual change in rates and identify significant changes in trends. Results: CVD mortality rate decreased considerably and continuously over the last 32 years in all age groups and in both sexes in Spain. For both sexes, joinpoint analysis identifies a final period with more marked decline: 2005-2011 in women (−6.3%) and 2007-2011 in men (−7.2%). Conclusions: CVD mortality rates displayed a marked and continuous decline in Spain between 1980 and 2011. Due to the ageing of the population, doctors expect an increase in CVD prevalence and therefore its magnitude in terms of disability and healthcare costs, which poses a challenge to our health system. Resumen: Introducción: En las últimas décadas las tasas de mortalidad por enfermedades cerebrovasculares (ECV) han descendido de forma importante en muchos países. En este estudio se analizan los cambios recientes en la evolución de la mortalidad por ECV en España (1980-2011) para verificar si las tendencias observadas previamente continúan. Pacientes y métodos: Los datos de mortalidad por ECV y las poblaciones necesarias para el cálculo de los indicadores fueron facilitados por el Instituto Nacional de Estadística. Se calcularon las tasas específicas por grupos de edad y estandarizadas globales y truncadas (35-64 años) mediante el método directo (población estándar europea). Mediante análisis de regresión «joinpoint» estimamos el porcentaje de cambio anual de las tasas e identificamos puntos de cambio significativos en la tendencia. Resultados: La mortalidad por ECV se ha reducido de forma contundente y sostenida en los últimos 32 años en todos los grupos de edad y sexo en España. En ambos sexos el análisis joinpoint identifica un periodo final de mayor descenso (2005-2011 [−6,3%] en mujeres y 2007-2011 en varones [−7,2%]). Conclusiones: Existe un marcado y continuo descenso en la mortalidad por ECV en España (1980-2011). Teniendo en cuenta el proceso de envejecimiento de la población, es esperable un incremento de la prevalencia y, por ello, de la magnitud de las ECV medida en términos de discapacidad y costes de salud, lo que representará un gran reto para nuestro sistema sanitario. Keywords: Regression analysis, Cerebrovascular diseases, Epidemiology, Spain, Mortality, Trends, Palabras clave: Análisis de regresión, Enfermedad cerebrovascular, Epidemiología, España, Mortalidad, Tendencia

Objective To evaluate the usefulness of surgical complexity classification index (SCCI) to predict the degree of surgical difficulty in cataract surgery. Material and methods This retrospective study includes data collected between January 2013 and December 2014 from patients who underwent cataract extraction by phacoemulsification at our hospital. A sample size of 159 patients was obtained by simple random sampling ( p = 0.5, 10% accuracy, 95% confidence). The main variables were: recording and value of SCCI in electronic medical record (EMR), presence of exfoliation syndrome (XFS), criteria for inclusion in surgical waiting list (SWL), and functional results. SCCI was classified into 7 categories (range: 1–4) according to predictors of technical difficulty, which was indirectly estimated in terms of surgical time (ST). All statistical analyses were performed using SPSS v15.0 statistical software. Results Prevalence of XFS was 18.2% (95%CI: 11.9–24.5). In terms of quality indicators in the cataract surgery process, 96.8% of patients met at least one of the criteria to be included in SWL, and 98.1% gained ≥2 Snellen lines. The SCCI was recorded in EMR of 98.1% patients, and it was grouped for study into 2 categories: high and low surgical complexity. Statistically significant differences in the distribution of ST were found depending on the assigned SCCI ( p p Conclusions The SCCI enables to estimate the degree of surgical complexity in terms of ST in cataract surgery, which is especially useful in those areas with high prevalence of XFS, because of the higher theoretical risk of surgical complications.

Clinical case A 77-year-old patient had uneventful cataract surgery in the right eye under peribulbar anaesthesia. The next day, a severe and progressive eyelid swelling was noted, caused by an unknown allergic reaction to povidone–iodine. The allergic signs dissapeared by the fifth day, but amaurosis and a cherry-red spot were detected. Doppler ultrasound and CT angiography confirmed an 80% ipsilateral internal carotid artery stenosis. Discussion Retinal vascular occlusion after orbital loco-regional anaesthesia is rare. When this complication occurs, carotid disease, and local or systemic factors, should be evaluated.