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Abstract The demersal fish orange roughy (Hoplostethus atlanticus) can live for up to 250 years, twenty times more than its congener silver roughy (Hoplostethus mediterraneus). Studies of Hoplostethus have focused mainly on its ecology and conservation due to its vulnerability to commercial fishing. In this work, we present the de novo genomes of orange and silver roughies and explore the genomic mechanisms that could contribute to such differential longevities. Using comparative genomics on a list of more than 400 genes, we identified gene candidates with differential residue changes in Hoplostethus that are related to genomic instability, disabled macroautophagy and intercellular communication. We hypothesized that these mechanisms could have been selected as adaptations to the deep environment and, as an epiphenomenon of these mechanisms, may have contributed to an extension of the lifespan of H. atlanticus.

Introducción: La candidemia es una enfermedad que se ha incrementado en el medio hospitalario. Afecta con frecuencia a pacientes asistidos en las unidades de atención al grave, con predominio de aislados sensibles a los antifúngicos disponibles. Las especies del complejo Candida parapsilosis son las responsables, en gran medida, de causar infecciones graves. Objetivo: Caracterizar a pacientes hospitalizados con candidemia desde el punto de vista clínico y microbiológico. Métodos: Estudio observacional, descriptivo y transversal en 234 pacientes, con diagnóstico presuntivo de candidemia. Se caracterizaron los aislados recuperados por métodos microbiológicos fenotípicos. Se analizaron las variables clínicas: Resultados de los hemocultivos, grupo poblacional y fallecidos por candidosis y las microbiológicas: Aislados en las muestras positivas y perfil de susceptibilidad a los antifúngicos. Como medidas resumen para el análisis de los datos se utilizaron frecuencias absolutas y porcentajes. Resultados: Se confirmaron 51 pacientes con candidemia en las unidades de atención al grave (21,79 %); el 52,94 % en neonatos. Predominaron las especies no albicans, como el complejo Candida parapsilosis (80,39 %) y Candida tropicalis (9,80 %). Los antifúngicos más activos fueron anfotericina B y 5-fluorocitosina. La mortalidad global fue de 25,49 %. Conclusiones: Los pacientes hospitalizados con candidemia se caracterizan por ser de edad neonatal, con el complejo Candida parapsilosis, de elevada sensibilidad a los antifúngicos y alto índice de mortalidad.

Abstract Eutrophication is a main threat to continental aquatic ecosystems. Prevention and amelioration actions have been taken under the assumption of a stable climate, which needs reconsideration. Here, we show that reduced precipitation can bring a lake ecosystem to a more productive regime even with a decline in nutrient external load. By analyzing time series of several decades in the largest lake of the Iberian Peninsula, we found autocorrelated changes in the variance of state variables (i.e., chlorophyll and oxygen) indicative of a transient situation towards a new ecosystem regime. Indeed, exceptional planktonic diatom blooms have occurred during the last few years, and the sediment record shows a shift in phytoplankton composition and an increase in nutrient retention. Reduced precipitation almost doubled the water residence time in the lake, enhancing the relevance of internal processes. This study demonstrates that ecological quality targets for aquatic ecosystems must be tailored to the changing climatic conditions for appropriate stewardship.

Introduction: A part of the admissions to the intensive care unit are made up of adults in middle age (between 40 and 59 years old). Objectives: Characterize the mature adult admitted to the intensive care unit. Methods: Observational, descriptive and cross-sectional study, in the intensive care unit with a series of 1214 patients. The following were studied: age, sex, type of admission, APACHE II upon admission, mechanical ventilation, length of stay, mortality and direct cause of death. Statistical methods: Frequency distributions, measures of central tendency, chi-square tests and Student's t test; 5 % significance level was stated. Results: The mean age was 50.9 ± 5.3 years. The age group 50-59 years (61.9 %) and the male sex (60.0 %) predominated. 55.3 % were discharged alive. There was a significant difference between the mean ages between those who died and those who were discharged alive (p< 0.0001). Clinical admission was awarded the highest number of admissions (65.0 %). The mean APACHE II value was 14.5 ± 7.6; in the deceased it was higher (20.0 vs. 10.0). 58.5 % of patients did not receive mechanical ventilation. The average stay was 6.6 days, longer in those who died (7.8 vs. 5.6). The main cause of death was severe cerebral edema (22.6 %). Conclusions: The age group 50-59 years predominates, the male sex, the cause of admission was clinical, the APACHE II value = 15 points, the stay = 7 days, requiring MV and being discharged alive; the direct cause of death is intense cerebral edema.

Healthcare workers (HCW) have been the professional category most exposed to SARS-CoV-2. The pandemic’s impact on HCW was analyzed in terms of COVID-19-related temporary disability (TD) between February 15th, 2020 and May 1st, 2021. TDs in HCW for COVID-19 infection or quarantine were described. TD quarantine/infection ratios and TDs per 100,000 affiliated HCW were compared with the cumulative incidence (CI) of COVID-19 cases notified to the National Network of Epidemiological Surveillance. TDs rates by economic activity and occupation were computed. A total of 429,127 TDs were recorded, 36,6% for infection. Three-quarters (76%) were women. The median TD quarantine/infection ratio was 2.5 (Interquartile range [IQR] 1.5–3.9). TDs rates in HCW were always above the CI except for the last two months of the fourth wave. Hospital activities accounted for 84% of TDs and showed the highest TD rate for infection (8,279/100,000). Nursing professionals and midwifery, Physicians, and Nursing assistants accounted for 26, 18 and 17 % of the conceded TD respectively, whereas the highest TDs rates were registered among Nursing assistants, Nursing professionals and Physicians: 7,426, 6,925 and 5,508/100,000, respectively. The results indicate the high impact of COVID-19 on HCW in Spain and it’s inequalities. They also confirm that TDs represent a complementary source of information for epidemiological and public health surveillance and could provide an early warning of new emerging infections.

Introduction: The presence of genital mycoplasmas in the respiratory tract of the newborns has been associated with significant perinatal morbidities and mortality. Objective: Relating clinical-epidemiological variables to Ureaplasma/Mycoplasma, determine frequency of isolated and the coinfection in positive respiratory samples from newborns. Methods: Descriptive, cross-sectional study of a series of cases in 98 hospitalized newborns. 94 pharyngeal swabs and 4 bronchial secretions were microbiologically analyzed by Multiplex-PCR for the identification of Ureaplasma/Mycoplasma species and other clinical variables were obtained such as history of preterm birth, low weight, premature rupture of membranes of 18 hours or more, with connatal bronchopneumonia or without antimicrobial treatment. As a summary measure, absolute and relative frequencies and a test of independence based on the ji square distribution were used. Results: Of the 4 newborns with connatal bronchopneumonia, 50 % were positive for Mycoplasma genitalium and Mycoplasma hominis interchangeably. Likewise, 19.54 % of the newborn underweight and the 13.79 % of the preterm they had these bacteria's presence. There was no statistical significance between the clinical variables and these results. 7 isolates of Ureaplasma urealitycum and Mycoplasma hominis, 4 of Ureaplasma parvum and 3 of Mycoplasma genitalium were identified. Coinfection with other bacteria was obtained in 8 clinical samples. Conclusions: There was no relationship between clinical-epidemiological variables and genital mycoplasma. Ureaplasma and Mycoplasma species were identified in respiratory samples from hospitalized newborns, as well as coinfection between several microorganisms.

Objective To assess the predictive value of four cardiovascular (CV) risk algorithms for identifying high-risk psoriatic arthritis (PsA) patients.Methods Evaluation of patients with PsA enrolled in the Spanish prospective project CARdiovascular in RheuMAtology. Baseline data of 669 PsA patients with no history of CV events at the baseline visit, who were followed in rheumatology outpatient clinics at tertiary centres for 7.5 years, were retrospectively analysed to test the performance of the Systematic Coronary Risk Assessment (SCORE), the modified version (mSCORE) European Alliance of Rheumatology Associations (EULAR) 2015/2016, the SCORE2 algorithm (the updated and improved version of SCORE) and the QRESEARCH risk estimator version 3 (QRISK3).Results Over 4790 years of follow-up, there were 34 CV events, resulting in a linearised rate of 7.10 per 1000 person-years (95% CI 4.92 to 9.92). The four CV risk scales showed strong correlations and all showed significant associations with CV events (p

Abstract The development of novel advanced nanomaterials (NMs) with outstanding characteristics for their use in distinct applications needs to be accompanied by the generation of knowledge on their potential toxicological impact, in particular, that derived from different occupational risk exposure routes, such as inhalation, ingestion, and skin contact. The harmful effects of novel graphene-metal oxide composites on human health are not well understood, many toxicological properties have not been investigated yet. The present study has evaluated several toxicological effects associated with graphene decorated with manganese oxide nanoparticles (GNA15), in a comparative assessment with those induced by simple graphene (G2), on human models representing inhalation (A549 cell line), ingestion (HT29 cell line) and dermal routes (3D reconstructed skin). Pristine and degraded forms of these NMs were included in the study, showing to have different physicochemical and toxicological properties. The degraded version of GNA15 (GNA15d) and G2 (G2d) exhibited clear structural differences with their pristine counterparts, as well as a higher release of metal ions. The viability of respiratory and gastrointestinal models was reduced in a dose-dependent manner in the presence of both GNA15 and G2 pristine and degraded forms. Besides this, all NMs induced the production of reactive oxygen species (ROS) in both models. However, the degraded forms showed to induce a higher cytotoxicity effect. In addition, we found that none of the materials produced irritant effects on 3D reconstructed skin when present in aqueous suspensions. These results provide novel insights into the potentially harmful effects of novel multicomponent NMs in a comprehensive manner. Furthermore, the integrity of the NMs can play a role in their toxicity, which can vary depending on their composition and the exposure route.

IntroductionDuring the COVID-19 pandemic, a set of social measures were adopted for the preservation of business activity and the protection of workers. One of these measures was issuing the Temporary Disability (TD) for COVID-19 cases, close contacts, and especially vulnerable workers.ObjetiveThis study analyzes whether the TD registry could be used as a complementary source to traditional epidemiological surveillance.MethodsA longitudinal study of time series was carried out with a cross-correlation analysis of TD and COVID-19 cases reported to the National Epidemiological Surveillance Network (RENAVE). The analysis included six pandemic waves between 10/03/2020 and 31/12/2021 in Spain. Cross-correlation coefficients (r) were calculated using a time lag of -14 days.ResultsDuring the study period, 2,253,573 TD processes were recorded in Spain and 4,894,802 COVID-19 cases were reported to RENAVE. Significant positive correlations were observed at time lags of -7, -10, and -14, indicating that TD notification preceded RENAVE notification. In the first and sixth pandemic waves, TD notification preceded RENAVE by 12 and 7 days, respectively. Negative correlations between the two series were observed in the second and fourth waves, coinciding with a lower number of reported cases. In the third and fifth waves, TD notification also preceded RENAVE (lags -1, -5 and -14, -7, respectively).ConclusionsThe results confirm the usefulness of TD registry as a complementary system to traditional epidemiological surveillance in Spain, by detecting COVID-19 cases in the 7, 10, and 14 days prior. A better positive correlation is observed in waves where more cases were reported.

Stevia rebaudiana Bertoni water extracts have been used as a natural sweetener and customary medicine by the indigenous inhabitants of South America for several hundred years. This plant was sent to Europe in the 16th century and was described by Peter Jacob Esteve in Spain. Recently the food industry has started to employ S. rebaudiana as sweetener using its glycosides after purification. Advertisement claims that Stevia glycosides is good for controling body mass and reducing glycemia. This study's objective was to evaluate the effect of S. rebaudiana leaf extract on Wistar rats as animal model to prove its effectiveness on body mass control, glycemia reduction, and other biochemical parameters. Three groups were randomly formed with 24 males and 24 females: A blank group without any sweetener, a control group drinking water with 10% glucose, and the test group ingesting a 0.94% water extract of S. rebaudiana. Body mass measurements as well as food and drink consumption were daily performed. The experiment lasted 120 days after the specimens were weaned and got used to eating solid food. Euthanasia was done and blood serum was collected to evaluate the following biochemical parameters: Glucose, triglycerides, cholesterol, insulin, glucagon, leptin, ghrelin, and glucose-dependent insulinotropic peptide, GIP. Results indicated that only female rats had statistical differences in body mass gain. No relevant effects either positive or negative were found in the biochemical parameters measured. The crude extracts of S. rebaudiana did not show any relevant changes in biochemical and hormonal profiles, changes nor body mass with respect to the blank and control groups of young and healthy rats in the age range of infancy to youth. According to the results obtained, the therapeutic properties that have been associated to S. rebaudiana consumption especially for body mass control and glycemia reduction, did not occur in young and healthy male and female rats in equivalent age to infants, young children, and youths.

Introducción: Se considera población adulta joven a los grupos etarios hasta 35 años de edad, otros señalan la edad comprendida entre los 20 y 40 años. Objetivos: Determinar la mortalidad y morbilidad del adulto joven ingresado en la unidad de cuidados intensivos. Métodos: Estudio observacional, descriptivo, transversal en una serie de 623 pacientes. Las variables estudiadas fueron: edad, sexo, tipo de ingreso, APACHE II al ingreso, ventilación mecánica, estadía, mortalidad y causa directa de muerte. Los métodos estadísticos utilizados fueron las distribuciones de frecuencias, medidas de tendencia central, y las pruebas inferenciales ji cuadrado y t de Student. Se consideró como nivel de significación el 5 %. Resultados: Predominó el grupo de edad 19-29 años (53,9 %) y el sexo masculino (64,7 %). La razón sexo masculino/femenino fue de 1,8:1,0. Egresaron vivos el 75,9 % de los pacientes. El ingreso de tipo clínico se adjudicó el mayor número de pacientes (45,1 %). La media del valor del APACHE II fue superior en los fallecidos (18,9 vs. 7,6). No recibieron ventilación mecánica el 54,1 % de los pacientes. La estadía media fue más prolongada en los fallecidos (10,5 vs. 6,5 días) y la principal causa de muerte fue la bronconeumonía bacteriana (22,2 %). Conclusiones: Los adultos jóvenes en cuidados intensivos es más probable que evolucionen de forma satisfactoria y egresen vivos. La principal causa de muerte es la bronconeumonía bacteriana.

Introduction: In Cuba, cerebrovascular diseases (CVD) are very common non-communicable chronic conditions. Objectives: Characterize patients from intensive care unit with a pathological diagnosis of CVD. Methods: Observational, descriptive and transversal study in a sample of 176 patients. Variables: Age (19-39 years, 40-59 years, 60-100 years), sex, type of CVD (hemorrhagic, ischemic), APACHE II scale (= 15, > 15 score) and Glasgow coma on admission (= 8, > 8 score), mechanical ventilation (yes, no), length of stay (= 7, > 7 days) and direct cause of death. Frequencies, measures of central tendency, chi-square and Student's t tests (significance level of 5%) were calculated. Results: Hemorrhagic cerebrovascular disease, male sex (52.8%) and the age group of 60-100 years (64.8%) predominated. The mean age was 63.8 years. The average value of the APACHE II and Glasgow scales was 21.6 and 6.5. 97.6% received mechanical ventilation. The mean stay was 7.0 days. Severe cerebral edema was the main cause of direct death (79.3%). Conclusions: There is a predominance of hemorrhagic CVD, in male patients, aged 60-100 years, APACHE II score > 15, Glasgow score = 8, ventilated patients, stay = 7 days and intense cerebral edema.

Abstract In the present study, a comparative human toxicity assessment between newly developed Mn3O4 nanoparticles with enhanced electrochemical properties (GNA35) and their precursor material (Mn3O4) was performed, employing different in vitro cellular models representing main exposure routes (inhalation, intestinal and dermal contact), namely the human alveolar carcinoma epithelial cell line (A549), the human colorectal adenocarcinoma cell line (HT29), and the reconstructed 3D human epidermal model EpiDerm. The obtained results showed that Mn3O4 and GNA35 harbour similar morphological characteristics, whereas differences were observed in relation to their surface area and electrochemical properties. In regard to their toxicological properties, both nanomaterials induced ROS in the A549 and HT29 cell lines, while cell viability reduction was only observed in the A549 cells. Concerning their skin irritation potential, the studied nanomaterials did not cause a reduction of the skin tissue viability in the test conditions nor interleukin 1 alpha (IL- 1 α) release. Therefore, they can be considered as not irritant nanomaterials according to EU and Globally Harmonized System of Classification and Labelling Chemicals. Our findings provide new insights about the potential harmful effects of Mn3O4 nanomaterials with different properties, demonstrating that the hazard assessment using different human in vitro models is a critical aspect to increase the knowledge on their potential impact upon different exposure routes.

Introducción: la cromoblastomicosis es una micosis subcutánea, crónica, causada por un grupo de hongos dematiáceos; Fonsecaea pedrosoi es de los agentes etiológicos más frecuentes, está presente en climas tropicales, de abundante vegetación. El diagnóstico se basa en tres pilares fundamentales: el clínico-epidemiológico, el de Anatomía Patológica y el microbiológico. Objetivo: describir el diagnóstico etiológico y las variables epidemiológicas de interés de la enfermedad en la Provincia de Villa Clara durante el período de 2003 a 2018. Métodos: estudio descriptivo, transversal en una población de 47 pacientes. Como medida de resumen se utilizaron las frecuencias absolutas y relativas y para la exploración espaciotemporal la técnica de Kulldorff. Resultados: del total de pacientes al 19% se le realizaron estudios micológicos en los que se aislaron las especies Fonsecaea pedrosoi, Cladophialophora carrionii y Phialophora verrucosa. En el Municipio de Manicaragua se identificó un conglomerado espacial verdadero de alta tasa de incidencia. Fue 2,12 veces más frecuente en hombres que en mujeres. Conclusiones: en la provincia no existe integración clínica, anatomopatológica y microbiológica para el diagnóstico de la cromoblastomicosis; al menos tres agentes etiológicos conocidos, Fonsecaea pedrosoi, Cladophialophora carrionii y Phialophora verrucosa, fueron causa de la enfermedad durante el período estudiado. El Municipio montañoso de Manicaragua constituye un área geográfica de alto riesgo en la provincia. El sexo más afectado por la enfermedad fue el masculino.

GroEL is a chaperonin that helps other proteins fold correctly. However, alternative activities, such as acting as an insect toxin, have also been discovered. This work evaluates the chaperonin and insecticidal activity of different GroEL proteins from entomopathogenic nematodes on G. mellonella. The ability to synergize with the ExoA toxin of Pseudomonas aeruginosa was also investigated. The GroELXn protein showed the highest insecticidal activity among the different GroELs. In addition, it was able to significantly activate the phenoloxidase system of the target insects. This could tell us about the mechanism by which it exerts its toxicity on insects. GroEL proteins can enhance the toxic activity of the ExoA toxin, which could be related to its chaperonin activity. However, there is a significant difference in the synergistic effect that is more related to its alternative activity as an insecticidal toxin.

Abstract The purpose of our study was to develop a predictive model to rule out pheochromocytoma among adrenal tumours, based on unenhanced computed tomography (CT) and/or magnetic resonance imaging (MRI) features. We performed a retrospective multicentre study of 1131 patients presenting with adrenal lesions including 163 subjects with histological confirmation of pheochromocytoma (PHEO), and 968 patients showing no clinical suspicion of pheochromocytoma in whom plasma and/or urinary metanephrines and/or catecholamines were within reference ranges (non-PHEO). We found that tumour size was significantly larger in PHEO than non-PHEO lesions (44.3 ± 33.2 versus 20.6 ± 9.2 mm respectively; P

Introducción: a escala mundial se ha observado la aparición de cepas de Pseudomonas aeruginosa multirresistentes durante las últimas décadas. Este patógeno oportunista, relacionado ampliamente con infecciones asociadas a la asistencia sanitaria, produce mecanismos de resistencia a diversos antibióticos. Objetivo: enumerar factores de riesgo conocidos de los pacientes y describir el patrón de resistencia de Pseudomonas aeruginosa frente a los antimicrobianos. Métodos: estudio descriptivo, transversal realizado en el Servicio de Angiología del Hospital “Camilo Cienfuegos” de Sancti Spíritus entre el primero de julio y el 31 de diciembre de 2017 de aislamientos de Pseudomonas aeruginosa en muestras purulentas de pacientes con infecciones asociadas a la asistencia sanitaria. La población fue de 47 muestras. Se utilizó el sistema automatizado Vitek® 2 Compact para confirmar el diagnóstico y determinar la susceptibilidad antimicrobiana ante 13 antibióticos probados. Resultados: los principales factores de riesgo conocidos encontrados en los pacientes fueron la diabetes mellitus tipo 2 y la insuficiencia arterial crónica. La resistencia se mantuvo a antibióticos B-lactámicos, incluidos los carbapenémicos en más de un 50%; sin embargo, se mantuvieron niveles bajos de resistencia a aminoglucósidos, fluoroquinolonas, tigeciclina y colistina. Conclusiones: la diabetes mellitus tipo 2 fue el principal factor de riesgo en pacientes ingresados en la Sala de Angiología para contraer una infección asociada a la asistencia sanitaria por Pseudomonas aeruginosa, los B-lactámicos presentaron una alta resistencia y la colistina puede ser una posible opción de tratamiento.

ABSTRACT Introduction and objectives: Transcatheter aortic valve implantation (TAVI) has proven safe and effective in low-to-high risk patients, but emergency procedures have been excluded from the landmark trials. We aimed to assess the current outcomes and main factors conditioning the prognosis during emergency TAVI. Methods: A systematic search in PubMed and Google Scholar was conducted for all studies comparing elective vs emergency TAVI. Searched terms were “emergency” and/or “urgent”, “elective”, and “transcatheter valve replacement” and/or “heart failure” and/or “cardiogenic shock”. Emergency TAVI was considered as any unscheduled TAVI performed to treat refractory heart failure or cardiogenic shock. A random-effects model was used. Results: A total of 7 studies with 84 427 TAVI patients were included (14 241 emergency procedures; 70 186 elective TAVIs). Emergency cases presented higher risk scores (logistic EuroSCORE 65.9% ± 21% vs 29.4% ± 18%, P < .001; Society of Thoracic Surgeons Risk Score 29.4% ± 27.4% vs 13.7% ± 11.6%, P < .001). More advanced heart disease was observed with deterioration of left ventricular (LV) function (39.5% ± 17.8% vs 52.5% ± 12.8%; P < .001) and larger LV end-diastolic diameters (55 ± 9 mm vs 48 ± 7 mm; P < .001) despite similar aortic valve areas and gradients. Elective TAVIs presented a greater success rate (93.6% vs 92.5%; odds ratio [OR] = 0.84; 95%CI, 0.74-0.95; P = .005), less acute kidney injury, and a lower need for dialysis and mechanical circulatory support. Overall, non-emergency cases had lower in-hospital (3.3% vs 5.7%; P < .001), 30-day (4.4% vs 8.8%; P < .001) and 1-year mortality rates (19.7% vs 34.75%; P = .0001). The main determinants of mortality were need for new dialysis (OR = 2.26; 95%CI, 1.84-2.76; P < .001) or mechanical circulatory support (OR = 2.55; 95%CI, 1.14-5.67; P < .001). Conclusions: Emergency TAVI recipients presented worse baseline risk and more advanced cardiac disease that determined greater in-hospital, 30-day, and 1-year mortality rates. The early identification of patients at risk for requiring mechanical circulatory support or dialysis may contribute to a better indication of TAVI in emergency scenarios.

Resumen Introducción: Las agresiones en el ámbito sanitario son un problema creciente en la sociedad actual que pueden ocasionar patología que afecta a la esfera psíquica. Objetivo: El objetivo de esta revisión es conocer si los profesionales sanitarios que reciben agresiones de la ciudadanía acaban desarrollando problemas de carácter psicosocial. Métodos: Revisión sistemática realizada a partir de las bases de datos MEDLINE (mediante Pubmed), SCIELO (Scientific Electronis Library Online), Scopus, Web of Science y LILACS (Literatura Latinoamericana y del Caribe en CC de la Salud). La búsqueda de la ecuación fue realizada con los descriptores “Workplace violence”, “Aggression”, “Medical staff”, “Occupational stress”, “Psychosocial impact” y “Personnel burnout”. El único filtro que se utilizó fue el de “fecha de publicación”, tomando aquellos artículos a partir del año 2000. Resultados: Se obtuvieron 57 referencias de las cuales al aplicar los criterios de inclusión y exclusión, dieron como resultado 13 artículos. Los artículos que se han utilizado tratan sobre la relación que puede existir entre las agresiones al personal sanitario y el impacto psicosocial que tienen en el mismo. Conclusiones: Las agresiones son un fenómeno muy prevalente en el mundo pero a pesar de ello, día de hoy no existen muchos estudios que investiguen la relación de los efectos psicosociales con las agresiones. Es por ello que creemos necesario que se hagan más estudio al respecto. Además, es necesario promover programas de prevención de agresiones entre el sanitario para disminuir la incidencia, así como campañas para la población.

Introduction: Bacillary dysentery was described in the Ebers papyri 2000 years before our era by Hippocrates, Father of Medicine, in the 5th century. It is one of the most important causes of medical care in the presence of unfavorable hygienic conditions. Objective: to characterize the antimicrobial resistance of Shigella strains isolated in children attended at the University Pediatric Hospital “José Luis Miranda” in the period from January to December 2018. Methods: a cross-sectional descriptive study was performed. The 25 Shigella strains selected by non-probabilistic purposive sampling were used for the investigation. Descriptive statistical methods were used. The ethical norms established in the context and the bioethical principles of autonomy, beneficence, non-maleficence and justice were taken into account. Results: the most representative serogroup in the sample was Shigella sonnei, with 19 strains, for 76% of the total number of isolates in the year. 84% of the strains were Shigella sonnei. Eighty-four percent of the strains were resistant to nalidixic acid. It was found that 16% of the isolated strains were resistant to three or more antibiotics, therefore, they were considered multidrug resistant. Conclusions: ciprofloxacin was sensitive to all the strains under study. Multidrug resistance was found in a small, although not ligible, percentage of the samples, which highlights the need to maintain active surveillance of this health problem.

Introduction: invasive mycoses caused by Candida spp remain the most diagnosed in neonatal, pediatric and adult patients hospitalized in intensive care rooms at the provincial level. Objective: to identify the main type of sample by age group and Candida species by type of sample in neonates and children under 18 years. Method: a descriptive, cross-sectional study on the isolates of Candida spp in blood cultures, urine cultures, cerebrospinal fluid, endotracheal tube and catheter tip obtained from neonatal, pediatric and adult patients hospitalized in serious care rooms in the five provincial hospitals of Villa Clara between on January 1, 2018 until August 31, 2019. The sample was 114 positive isolates. Absolute, relative, percent, and statistical frequency distributions were obtained as Pearson's chi-square. Results: adults provided higher numbers of positive isolates, followed by neonates and pediatric age, mainly in 2018. Blood samples, followed by urine samples in neonates and pediatric patients were the most diagnosed; in adults it was the other way around. In neonates Candida tropicalis and Candida spp were the most isolated species, without statistical significance, in pediatric patients were Candida spp and Candida krusei, both with statistical significance in blood cultures and catheter tip. Conclusions: invasive candidiasis was diagnosed in the three age groups, mainly in blood and urine, and with variability in Candida species.

Introduction: cervicovaginal infections represent 20% of the gynecological consultation. Objective: to determine the etiology of cervicovaginal infections in outpatients with gynecological symptoms who went to the Hospital. Methods: a descriptive, cross-sectional study was carried out. The sample of 222 patients with symptoms was taken from the gynecology office of the Mariana Grajales Gynecological Hospital of Santa Clara, from January 1, 2016 to December 31, 2018. The information was recorded in a computerized database as Microsoft Excel 2013 and absolute, relative frequencies and percentage were determined. Results: the most frequent symptoms were abnormal vaginal discharge, pruritus, burning and pain under belly. The frequency of Candida spp, bacterial vaginosis, Ureaplasma spp and Chlamydia trachomatis were higher, while Mycoplasmas hominis and Ureaplasma spp, Mycoplasma hominis and Trichomonas vaginalis coinfection were present in lesser percent. Conclusions: Candida spp and bacterial vaginosis were the most frequent causes of cervicovaginal infections.

The objective of the study is to analyze the impact of violence on women's health and the feelings generated during the period of exposure to violence. This is a qualitative study with an interpretative phenomenological design in which 16 women participated-4 through interviews and 12 through stories. The data obtained were analyzed using the Colaizzi approach. The results were structured into 3 themes according to how the women interpreted their experiences. The themes were physical consequences: visible traces; psychological consequences: stormy days and sunny days; and social consequences: from loneliness to a new world. In conclusion, the women in this study considered all those (very diverse) physical pathologies to be important. They encompassed a series of psychological disorders that lasted over time, causing considerable suffering and complicating the participants' ability to relate to the rest of society, especially men. Similarly, the participants identified a series of positive consequences when they left the traumatic situation empowered after overcoming gender-based violence.

Introduction: COPD is characterized by limitation of the airflow, progressive, partially reversible and associated to an abnormal inflammatory responsive of the lungs. Objective: To characterize patients with COPD admitted at the Intensive Care Unit. Methods: A descriptive, retrospective study was carried out in a series of 347 patients with chronic obstructive pulmonary disease admitted to intensive care. The variables age, sex, cause of admission, discharge status, APACHE II scale value at admission, invasive mechanical ventilation, tracheostomy, and direct cause of death according to autopsies performed were studied. Absolute and relative frequency distributions, measures of central tendency, and for comparison, the chi-square and Student's t tests were calculated, with a significance level of 5%. Results: The mean age was of 72,1 ± 8,2 years. The female sex (52.7%) and the age group of 60-79 years (67.1%) predominated. The female / male sex ratio was 1.1: 1.0. 64.8% of the patients were discharged dead. There were significant differences between the mean age of the deceased and the living (p = 0.001). The cause of clinical admission had the highest number of admissions (86.7%). The mean APACHE II value was higher in the deceased (21.0 vs. 15.2). 81.3% of the patients received mechanical ventilation, and 17.3% underwent a tracheostomy. The main cause of death was bacterial bronchopneumonia (67.2%). Conclusions: Patients with chronic obstructive pulmonary disease admitted to the intensive care unit have high mortality and it is associated with three main direct causes of death: bacterial bronchopneumonia, pulmonary thromboembolism and septic shock.

Introduction: Penile traction therapy (PTT) aims to non-surgically reduce curvature, enhance girth, and recover lost length. Available clinical practice guidelines however lack clear recommendations regarding their use. Aim: To present a comprehensive review and recommendation regarding the available evidence to the use of PTT in Peyronie's disease (PD). Methods: A systematic literature search was performed on Pubmed and Medline for relevant studies from all times until 2019. Studies of PTT (monotherapy and in combination) in patients with PD with any documented degree of curvature and in either the acute or chronic phase of the disease were included. Full texts not published in English language were excluded. Main outcomes measures: Several scenarios, including preclinical data have been investigated. For each topic covered evidence was analyzed and expert opinion was stated. Results: The paucity of high-level studies precluded any strong recommendations, however, specific statements on this topic, summarizing the ESSM position, were provided. The available data about the use of PTT in PD are still poor, and the impact of this therapy for the treatment of PD has not been clearly stablished. Available data in the clinical setting are still poor, and the impact of these devices on PD evolution has not been clearly established. Conclusion: PTT seems to be a valid treatment option for PD, although there is not enough evidence to give any definitive recommendation in any clinical scenario. García-Gómez B, Aversa A, Alonso-Isa M et al. The Use of Penile Traction Devices for Peyronie's Disease: Position Statements from the European Society for Sexual Medicine. Sex Med 2021;9:100387.

Se trata de una paciente de 54 años que comenzó con una lesión en la vulva a nivel de la cicatriz de la rafia desde hace cuatro años aproximadamente que evolucionó a un absceso, para lo que llevó tratamiento en varias ocasiones, sin mejoría, por lo que continuó con sangrado y dolor en la región de la vulva. Decidió acudir a la Consulta ginecológica del Hospital “Mariana Grajales” de Santa Clara y se le diagnosticó lesión en horquilla vulvar de 3cm, sobreelevada, de bordes indurados y ulcerada. Por las características clínicas de la lesión se decidió su ingreso en la Sala de Ginecología y se le realizó una vulvectomía con linfadenectomía inguinal bilateral. El diagnóstico histológico consistió en un siringocistadenocarcinoma papilífero ulcerado infiltrante de la vulva. El siringocistadenocarcinoma papilífero es un tumor anexial maligno derivado de las glándulas sudoríparas extremadamente infrecuente. Se localiza, predominantemente, en la cabeza y el cuello y puede desarrollarse de un siringocistadenoma papilífero o de un nevo sebáceo de Jadassohn; su localización en la vulva es infrecuente.

Introducción: La bacteriemia es la infección caracterizada por la presencia de bacterias en la sangre, fenómeno frecuente en el medio hospitalario y más en las unidades de cuidados intensivos. Objetivo: Determinar las características clínicas y epidemiológicas de pacientes con bacteriemias en la unidad de cuidados intensivos. Métodos: Estudio descriptivo, en la unidad de cuidados intensivos del Hospital Militar Central "Dr. Carlos J. Finlay", durante los años 2016 y 2017. De 397 pacientes con bacteriemia, fueron incluidos quienes tenían 18 años o más de edad, con ingreso en cuidados intensivos durante 48 horas o más y con hemocultivos positivos. Resultados: Hemocultivos; resultaron positivos 143 (5,75 %). Pacientes: el 37,1 % resultó mayor de 60 años. Fueron bacteriemias secundarias el 87,41 %, el foco de infección más frecuente fue el catéter venoso central (44,05 %) y el sistema respiratorio (40,55 %). Los gérmenes que crecieron en los hemocultivos fueron Estafilococo coagulasa positivo (23,77 %) seguido del Acinetobacter (16,78 %). Fueron monomicrobianos 103 cultivos y 40 polimicrobianos. Hubo shock séptico en 54 pacientes (37,76 %) y fallecieron 47. La mortalidad global fue de 32,86 %. Conclusiones: La incidencia de bacteriemias secundarias fue superior a las primarias, así como las monomicrobianas sobre las polimicrobianas. El foco de infección más frecuente fue el sistema respiratorio y los factores de riesgo presentes fueron: nutrición parenteral, diabetes mellitus, neoplasia y edad superior a los 60 años. El germen más frecuente fue el estafilococo coagulasa positivo. La incidencia de shock séptico y la mortalidad fueron elevadas.

AimTo determine whether healthcare workers (HCW) hospitalized in Spain due to COVID-19 have a worse prognosis than non-healthcare workers (NHCW).MethodsObservational cohort study based on the SEMI-COVID-19 Registry, a nationwide registry that collects sociodemographic, clinical, laboratory, and treatment data on patients hospitalised with COVID-19 in Spain. Patients aged 20-65 years were selected. A multivariate logistic regression model was performed to identify factors associated with mortality.ResultsAs of 22 May 2020, 4393 patients were included, of whom 419 (9.5%) were HCW. Median (interquartile range) age of HCW was 52 (15) years and 62.4% were women. Prevalence of comorbidities and severe radiological findings upon admission were less frequent in HCW. There were no difference in need of respiratory support and admission to intensive care unit, but occurrence of sepsis and in-hospital mortality was lower in HCW (1.7% vs. 3.9%; p = 0.024 and 0.7% vs. 4.8%; pConclusionsHospitalized COVID-19 HCW had fewer comorbidities and a better prognosis than NHCW. Our results suggest that professional exposure to COVID-19 in HCW does not carry more clinical severity nor mortality.

Introduction Scabies is a neglected disease stablished worldwide with a fairy well determined incidence. In high-income countries, it often causes outbreaks affecting the residents and staff of institutions and long-term facilities, usually hard to detect and control due to the difficult diagnosis and notification delay. This study aim at characterizing the affected population, geographical distribution, and evolution of scabies in Spain from 1997–2019 as well as to describe the main environments of transmission using different data sources. Methods We carried out a nationwide retrospective study using four databases, which record data from different perspectives: hospital admissions, patients attended at primary healthcare services, outbreaks, and occupational diseases. We described the main characteristics from each database and calculated annual incidences in order to evaluate temporal and geographical patterns. We also analyzed outbreaks and occupational settings to characterize the main transmission foci and applied Joinpoint regression models to detect trend changes. Results The elderly was the most frequent collective among the hospital admitted patients and notified cases in outbreaks, while children and young adults were the most affected according to primary care databases. The majority of the outbreaks occurred in homes and nursing homes; however, the facilities with more cases per outbreak were military barracks, healthcare settings and nursing homes. Most occupational cases occurred also in healthcare and social services settings, being healthcare workers the most common affected professional group. We detected a decreasing trend in scabies admissions from 1997 to 2014 (annual percentage change -APC- = -11.2%) and an increasing trend from 2014 to 2017 (APC = 23.6%). Wide geographical differences were observed depending on the database explored. Discussion An increasing trend in scabies admissions was observed in Spain since 2014, probably due to cutbacks in social services and healthcare in addition to worsen of living conditions as a result of the 2008 economic crisis, among other reasons. The main transmission foci were healthcare and social settings. Measures including enhancing epidemic studies and national registries, reinforcing clinical diagnosis and early detection of cases, hygiene improvements and training of the staff and wide implementation of scabies treatment (considering mass drug administration in institutions outbreaks) should be considered to reduce the impact of scabies among most vulnerable groups in Spain.

Introduction: The admission of patients of fourth age in intensive care units has increased in the last years. Objectives: To determinate the mortality and morbidity of the patients of the fourth age. Methods: A retrospective and descriptive study. The series consisted of 703 patients. Variables: age, sex, cause of admitted, stay, APACHE II, mechanical ventilation, status of issue, direct cause of death. The statistical methods used were the absolute and relative frequency distributions, measures of central tendency, as well as the Chi-square and Student´s t tests. A significant level of 5% was considered. Results: The average age was 84.2 ± 3.2 years. Females (57. 7 %) and the 75-79 years age group (46, 8 %) predominated. The ratio of women/men was 1. 09/1. 0. Over half of the patients died on discharge (60. 7 %). There were not significant differences between average ages of deceased and the living patients (80. 7 vs 80. 4 years). The clinical admission showed the highest number of patients (69. 7%). The mean of APACHE II was 20. 1, being higher in patients dead that in the ones alive (23. 0 vs 15. 5). The average stay was 5.7 days, longer in the deceased patients (6. 7 vs 4. 3). 71.5% of patients received mechanical ventilation. The main direct cause of death was bacterial bronchial pneumonia (36. 9 %). Conclusions: the patient of fourth age admitted to the intensive care unit has higher mortality and high percentage require mechanical ventilation.

Objective: Characterization of alcoholic patients with admitted at the Intensive Care Unit. Method: A descriptive and retrospective study. The final sample was 123 patients. The statistical methods for the study included absolute and relative frequency distributions, central tendency measures, Chi-square and Student´s t tests. Results: Average age was of 58, 5 ± 12,4 years old. The 40-59 (48, 8 %) prevailed as well as Males (92, 7 %). The proportion of male/female sex was of 12, 7:1, 0. More than half of the patients died (56, 1 %). The media age of this group was lightly high to that of the alive discharged patients (60,0 vs 56,6 years old). The clinic admittance cause was most frequent (67, 5 %). The mean of APACHE II value was 18, 1 and it was higher in the diseased than in the survivors (22, 0 vs 13, 1). Most patients ventilated (71, 5 %). The main stay was 6, 9 days, more extended in the dead (8, 1 vs 5, 4). The main causes of death were bacterial bronchopneumonia (28, 6 %). Conclusion: Patients with antecedent of alcoholism have high mortality.

ObjectivesTo demonstrate how data-driven variability methods can be used to identify changes in disease recording in two English electronic health records databases between 2001 and 2015.DesignRepeated cross-sectional analysis that applied data-driven temporal variability methods to assess month-by-month changes in routinely collected medical data. A measure of difference between months was calculated based on joint distributions of age, gender, socioeconomic status and recorded cardiovascular diseases. Distances between months were used to identify temporal trends in data recording.Setting400 English primary care practices from the Clinical Practice Research Datalink (CPRD GOLD) and 451 hospital providers from the Hospital Episode Statistics (HES).Main outcomesThe proportion of patients (CPRD GOLD) and hospital admissions (HES) with a recorded cardiovascular disease (CPRD GOLD: coronary heart disease, heart failure, peripheral arterial disease, stroke; HES: International Classification of Disease codes I20-I69/G45).ResultsBoth databases showed gradual changes in cardiovascular disease recording between 2001 and 2008. The recorded prevalence of included cardiovascular diseases in CPRD GOLD increased by 47%–62%, which partially reversed after 2008. For hospital records in HES, there was a relative decrease in angina pectoris (−34.4%) and unspecified stroke (−42.3%) over the same time period, with a concomitant increase in chronic coronary heart disease (+14.3%). Multiple abrupt changes in the use of myocardial infarction codes in hospital were found in March/April 2010, 2012 and 2014, possibly linked to updates of clinical coding guidelines.ConclusionsIdentified temporal variability could be related to potentially non-medical causes such as updated coding guidelines. These artificial changes may introduce temporal correlation among diagnoses inferred from routine data, violating the assumptions of frequently used statistical methods. Temporal variability measures provide an objective and robust technique to identify, and subsequently account for, those changes in electronic health records studies without any prior knowledge of the data collection process.

INTRODUCTION:Pressure ulcers (PUs) nowadays are a major health problem in society, associated with increased morbidity and increased health care costs. The incidence of HAPU is an indicator of health care quality. OBJECTIVE:To describe the profile of patients with minimal risk on the Norton-MI scale who developed PUs during hospitalization, and to identify the incidence of hospital-acquired pressure ulcers (HAPU). METHODS:Retrospective cohort study conducted between 2014 and 2017. STUDY POPULATION:Patients over 18 years of age classified as "minimum risk" according to Norton-MI, admitted to acute hospital units of the Severo Ochoa University Hospital-Madrid-Spain. Patients were classified as patients with hospital-acquired pressure ulcers (PWHAPU) if they developed one or more new PU during their hospitalization. VARIABLES:Sociodemographic variables, hospitalization units, Morton-MI score and characteristics of the risk factors of HAPU were studied. RESULTS:The risk of PU was evaluated in 5530 patients, being 1260 patients classified as "minimum risk", with a median of 16 points in the Norton-MI scale. The average age was 76 years old and 52.5% were women. Principal causes of admission: traumatological pathologies (20.8%) and cardiovascular pathologies (20%). 129 HAPU were diagnosed in 112 patients, implying an incidence of HAPU of 8.89% (CI95%: 7.44-10.59). 106 PWHAPU (94.6%) presented up to 6 risk factors. The excess pressure and altered skin sensibility were identified as statistically significant risk factors as predictive factors of HAPU. In terms of severity, 55% of the HAPU were category I and 42.6% were category II, mainly with anatomical sacro-coxygeal location. In 65.2% of the patients the HAPU appeared in the first week of hospitalization. CONCLUSION:In our study the incidence of HAPU in patients classified as minimum risk with Norton-MI scale was 8.89%. This elevated risk suggests for future investigations to develop new validity studies of the Norton-MI scale and to maintain a continuo training of professionals in the knowledge of PU risk assessment scales for their safe application in the patients, since it directs the practice of care in the prevention of PUs. It would be advisable to specially control the risk of PUs in care units, mainly in the first week of their hospital stay to minimize the HAPU incidence.

This study was implemented to assess the Sessile Bioindicators in Permanent Quadrats (SBPQ) underwater environmental alert method. The SBPQ is a non-invasive and low-cost protocol; it uses sessile target species (indicators) to detect environmental alterations (natural or anthropic) at either the local or global (i.e., climate change) scale and the intrusion of invasive species. The SBPQ focuses on the monitoring of preselected sessile and sensitive benthic species associated with rocky coralligenous habitats using permanent quadrats in underwater sentinel stations. The selected target species have been well documented as bioindicators that disappear in the absence of environmental stability. However, whether these species are good indicators of stability or, in contrast, suffer variations in long-term coverage has not been verified. The purpose of this study was to assess the part of the method based on the hypothesis that, over a long temporal series in a highly structured and biodiverse coralligenous assemblage, the cover of sensitive sessile species does not change over time if the environmental stability characterising the habitat is not altered. Over a ten-year period (2005-2014), the sublittoral sessile biota in the Straits of Gibraltar Natural Park on the southern Iberian Peninsula was monitored at a 28 m-deep underwater sentinel stations. Analyses of the coverages of target indicator species (i.e., Paramuricea clavata and Astroides calycularis) together with other accompanying sessile organisms based on the periodic superimposition of gridded images from horizontal and vertical rocky surfaces allowed us to assess the effectiveness of the method. We conclude that no alterations occurred during the study period; only minimal fluctuations in cover were detected, and the method is reliable for detecting biological changes in ecosystems found in other geographical areas containing the chosen indicator species at similar dominance levels.

Background and purposeGenetic classifications are crucial for understanding the heterogeneity of glioblastoma. Recently, perfusion MRI techniques have demonstrated associations molecular alterations. In this work, we investigated whether perfusion markers within infiltrated peripheral edema were associated with proneural, mesenchymal, classical and neural subtypes.Materials and methodsONCOhabitats open web services were used to obtain the cerebral blood volume at the infiltrated peripheral edema for MRI studies of 50 glioblastoma patients from The Cancer Imaging Archive: TCGA-GBM. ANOVA and Kruskal-Wallis tests were carried out in order to assess the association between vascular features and the Verhaak subtypes. For assessing specific differences, Mann-Whitney U-test was conducted. Finally, the association of overall survival with molecular and vascular features was assessed using univariate and multivariate Cox models.ResultsANOVA and Kruskal-Wallis tests for the maximum cerebral blood volume at the infiltrated peripheral edema between the four subclasses yielded false discovery rate corrected p-values of ConclusionsHigher relative cerebral blood volume at infiltrated peripheral edema is associated with proneural glioblastoma subtype suggesting underlying vascular behavior related to molecular composition in that area.

Abstract Background Sex differences are important epidemiological factors that impact in the frequency and severity of infectious diseases. A clear sexual dimorphism in bacterial infections has been reported in both humans and animal models. Nevertheless, the molecular mechanisms involved in this gender bias are just starting to be elucidated. In the present article, we aim to review the available data in the literature that report bacterial infections presenting a clear sexual dimorphism, without considering behavioral and social factors. Main body The sexual dimorphism in bacterial infections has been mainly attributed to the differential levels of sex hormones between males and females, as well as to genetic factors. In general, males are more susceptible to gastrointestinal and respiratory bacterial diseases and sepsis, while females are more susceptible to genitourinary tract bacterial infections. However, these incidences depend on the population evaluated, animal model and the bacterial species. Female protection against bacterial infections and the associated complications is assumed to be due to the pro-inflammatory effect of estradiol, while male susceptibility to those infections is associated with the testosterone-mediated immune suppression, probably via their specific receptors. Recent studies indicate that the protective effect of estradiol depends on the estrogen receptor subtype and the specific tissue compartment involved in the bacterial insult, suggesting that tissue-specific expression of particular sex steroid receptors contributes to the susceptibility to bacterial infections. Furthermore, this gender bias also depends on the effects of sex hormones on specific bacterial species. Finally, since a large number of genes related to immune functions are located on the X chromosome, X-linked mosaicism confers a highly polymorphic gene expression program that allows women to respond with a more expanded immune repertoire as compared with men. Conclusion Notwithstanding there is increasing evidence that confirms the sexual dimorphism in certain bacterial infections and the molecular mechanisms associated, further studies are required to clarify conflicting data and to determine the role of specific hormone receptors involved in the gender bias of bacterial infections, as well as their potential as therapeutic targets.

Introducción: el intento suicida, también denominado parasuicidio, tentativa de suicidio, definido como aquel acto sin resultado de muerte en que un individuo, se hace daño a sí mismo. Objetivo: describir el comportamiento del intento suicida en el municipio de Guantánamo, en el nonestre enero-septiembre de 2016. Método: se realizó un estudio descriptivo. Los datos obtenidos se le fue solicitado al Departamento de Estadística de la Dirección Provincial de Salud. El universo fue de 254 pacientes y se selección un amuestre de 186 a través del muestre simple aleatorio. Se utilizó para el procesamiento de la información el Microsoft Excel donde se obtuvo el porcentaje según cantidad de datos, los resultados se expusieron en tablas. Resultados: durante el nonestre el tercer trimestre fue el que mayor aportó paciente con intento suicida, el municipio que más casos reportó fue Guantánamo, siendo el sexo femenino el de mayor incidencia, las edades entre 25-59 años y los meses de agosto y abril respectivamente, los meses que mayor número de paciente se registró fue septiembre, abril y agosto, respectivamente. Conclusiones: es de vital importancia poner atención al tema en cuestión, dándoles mayor atención a los jóvenes, además de estudiar las causas de las incidencias del sexo femenino que están adoptando la posición de atentar contra su vida.

Según las estadísticas oficiales, los hombres sufren más enfermedades profesionales (EEPP) que las mujeres. No obstante, hay que tener presente su desigual distribución y participación en el mundo laboral. El objetivo de este estudio fue valorar cómo afecta el sexo al reconocimiento de EEPP en España, identificando posibles factores de interacción/confusión. Métodos: Se estudió la incidencia de las EEPP declaradas a través del Parte Oficial durante el período de 1999 al 2009, proporcionados por la Subdirección General de Estadísticas Sociales y Laborales del Ministerio de Empleo y Seguridad Social. Las variables incluidas fueron: año de declaración, sexo, edad, ocupación y actividad económica de la empresa. Se calcularon tasas y riesgos relativos (RR) crudos de EEPP por cada variable. Se estimaron los RR ajustados mediante análisis bivariable y multivariante de Poisson. Resultados: Durante 1999-2009 se notificaron en España 243.310 EEPP, con una razón de tasas hombres/mujeres de 1,07. Hubo correlación entre la ocupación y la actividad de la empresa, por lo que se analizaron las EEPP según estas variables por separado. Por ocupación, los hombres presentaron un RR crudo de 1,067 (IC95%:1,058-1,076) frente a las mujeres, mientras que al ajustar por todas las variables del modelo el RR fue de 0,507 (IC95%:0,502-0,512). Por actividad, el sentido del riesgo también se invirtió en el análisis ajustado para el sexo (RRc=1,065, IC95%:1,056-1,074 frente a 0,632, IC95%:0,626-0,638). Conclusiones: Aunque las tasas crudas de EEPP son inferiores en mujeres que en hombres durante el periodo 1999-2009 en España, al ajustar estas tasas por la actividad de la empresa o la ocupación del trabajador, la edad y el año de declaración, los RR pasan a ser casi un 50% superiores en mujeres que en hombres para la mayoría de ocupaciones y tipos de actividad de la empresa.

Fundamentos: En algunas comunidades autónomas (CCAA) existen diver - sas iniciativas para conocer la comunicación de las sospechas de enfermedades profesionales (EP) a las autoridades sanitarias. El objetivo de este trabajo fue des - cribir el grado de desarrollo y características de los sistemas puestos en marcha desde las administraciones sanitarias a nivel autonómico. Métodos : Se realizó un estudio descriptivo transversal para conocer los sis - temas de información y vigilancia de las enfermedades laborales, marco legal, institución responsable y disponibilidad de la información. Se celebró una reu - nión y se diseñó una encuesta que se remitió a todas las CCAA y ciudades autó - nomas. Se recogió información sobre si existían o no normas reguladoras, asig - nación de recursos humanos, los profesionales responsables de la notificación, la cobertura y el número de sospechas de EP recibidas, tramitadas y reconocidas. Resultados : Respondieron 17 CCAA y 1 ciudad autónoma. Tenían desarro - llados sistemas de comunicación de sospecha de EP 10 de ellas, de los cuales 3 se apoyaban en una norma legal autonómica específica. Los profesionales respon - sables de la notificación fueron médicos/as de los servicios públicos de salud, de los servicios de prevención y 2 de las inspecciones sanitarias. 7 CCAA disponían de aplicación informática para dar soporte al sistema. La tasa de reconocimiento de EP de las sospechas tramitadas fue del 53% en el País Vasco, del 41% en Castilla-La Mancha, del 36% en Murcia, del 32,6% en la Comunidad Valenciana y 31 % en La Rioja. Conclusiones: El estudio pone de manifiesto un desarrollo desigual de los sistemas de declaración de sospecha de EP en España. Aunque la tendencia es po - sitiva, so lo la mitad de las CCAA tienen algún sistema de comunicación aunque no todos disponen de una aplicación informática para gestionarlo, obteniéndose tasas de reconocimiento de EP desiguales entre las comunidades autónomas.

Myocardial infarction has been carefully studied in numerous experimental models. Most of these models are based on electrophysiological and functional data, and pay less attention to histological discoveries. During the last decade, treatment using advanced therapies, mainly cell therapy, has prevailed from among all the options to be studied for treating myocardial infarction. In our study we wanted to show the fundamental histological parameters to be evaluated during the development of an infarction on an experimental model as well as treatment with mesenchymal stem cells derived from adipose tissue applied intra-lesionally. The fundamental parameters to study in infarcted tissue at the histological level are the cells involved in the inflammatory process (lymphocytes, macrophages and M2, neutrophils, mast cells and plasma cells), neovascularization processes (capillaries and arterioles) and cardiac cells (cardiomyocytes and Purkinje fibers). In our study, we used intramyocardial injection of mesenchymal stem cells into the myocardial infarction area 1 hour after arterial occlusion and allowed 1 month of evolution before analyzing the modifications on the normal tissue inflammatory infiltrate. Acute inflammation was shortened, leading to chronic inflammation with abundant plasma cells and mast cells and complete disappearance of neutrophils. Another benefit was an increase in the number of vessels formed. Cardiomyocytes and Purkinje fibers were better conserved, both from a structural and metabolic point of view, possibly leading to reduced morbidity in the long term. With this study we present the main histological aspects to be evaluated in future assays, complementing or explaining the electrophysiological and functional findings.

In this work we present a methodology able to use harmonized PET/CT imaging in dose painting by number (DPBN) approach by means of a robust and accurate treatment planning system. Image processing and treatment planning were performed by using a Matlab-based platform, called CARMEN, in which a full Monte Carlo simulation is included. Linear programming formulation was developed for a voxel-by-voxel robust optimization and a specific direct aperture optimization was designed for an efficient adaptive radiotherapy implementation. DPBN approach with our methodology was tested to reduce the uncertainties associated with both, the absolute value and the relative value of the information in the functional image. For the same H&N case, a single robust treatment was planned for dose prescription maps corresponding to standardized uptake value distributions from two different image reconstruction protocols: One to fulfill EARL accreditation for harmonization of [18F]FDG PET/CT image, and the other one to use the highest available spatial resolution. Also, a robust treatment was planned to fulfill dose prescription maps corresponding to both approaches, the dose painting by contour based on volumes and our voxel-by-voxel DPBN. Adaptive planning was also carried out to check the suitability of our proposal. Different plans showed robustness to cover a range of scenarios for implementation of harmonizing strategies by using the highest available resolution. Also, robustness associated to discretization level of dose prescription according to the use of contours or numbers was achieved. All plans showed excellent quality index histogram and quality factors below 2%. Efficient solution for adaptive radiotherapy based directly on changes in functional image was obtained. We proved that by using voxel-by-voxel DPBN approach it is possible to overcome typical drawbacks linked to PET/CT images, providing to the clinical specialist confidence enough for routinely implementation of functional imaging for personalized radiotherapy.

ObjectiveTo evaluate the effects of Process-Reengineering interventions on the Electronic Health Records (EHR) of a hospital over 7 years.Materials and methodsTemporal Variability Assessment (TVA) based on probabilistic data quality assessment was applied to the historic monthly-batched admission data of Hospital La Fe Valencia, Spain from 2010 to 2016. Routine healthcare data with a complete EHR was expanded by processed variables such as the Charlson Comorbidity Index.ResultsFour Process-Reengineering interventions were detected by quantifiable effects on the EHR: (1) the hospital relocation in 2011 involved progressive reduction of admissions during the next four months, (2) the hospital services re-configuration incremented the number of inter-services transfers, (3) the care-services re-distribution led to transfers between facilities (4) the assignment to the hospital of a new area with 80,000 patients in 2015 inspired the discharge to home for follow up and the update of the pre-surgery planned admissions protocol that produced a significant decrease of the patient length of stay.DiscussionTVA provides an indicator of the effect of process re-engineering interventions on healthcare practice. Evaluating the effect of facilities' relocation and increment of citizens (findings 1, 3-4), the impact of strategies (findings 2-3), and gradual changes in protocols (finding 4) may help on the hospital management by optimizing interventions based on their effect on EHRs or on data reuse.ConclusionsThe effects on hospitals EHR due to process re-engineering interventions can be evaluated using the TVA methodology. Being aware of conditioned variations in EHR is of the utmost importance for the reliable reuse of routine hospitalization data.

Type 2 diabetes mellitus is a complex metabolic disease and its pathogenesis involves abnormalities in both peripheral insulin action and insulin secretion. Previous in vitro data showed that insulin receptor isoform A, but not B, favours basal glucose uptake through its specific association with endogenous GLUT1/2 in murine hepatocytes and beta cells. With this background, we hypothesized that hepatic expression of insulin receptor isoform A in a mouse model of type 2 diabetes could potentially increase the glucose uptake of these cells, decreasing the hyperglycaemia and therefore ameliorating the diabetic phenotype. To assure this hypothesis, we have developed recombinant adeno-associated viral vectors expressing insulin receptor isoform A (IRA) or isoform B (IRB) under the control of a hepatocyte­-specific promoter. Our results demonstrate that in the long term, hepatic expression of IRA in diabetic mice is more efficient than IRB in ameliorating glucose intolerance. Consequently, it impairs the induction of compensatory mechanisms through beta cell hyperplasia and/or hypertrophy that finally lead to beta cell failure, reverting the diabetic phenotype in about 8 weeks. Our data suggest that long-term hepatic expression of IRA could be a promising therapeutic approach for the treatment of type 2 diabetes mellitus.

SUMMARY The whole-body iodine-131 scintigraphy is an imaging technique in monitoring patients with a history of thyroid cancer. Although the rate of false positives is negligible, it is not nonexistent. We report the case of an intervened and treated patient for thyroid cancer with good clinical and biochemical response. Scintigraphic findings were consistent with unsuspected bone metastasis. Fused SPECT/CT data allowed accurate diagnosis of giant diaphragmatic hernia associated with intrathoracic stomach, a very rare pathology that can lead to false positive results.