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Background: Spasticity is a frequent symptom of multiple sclerosis (MS), which may negatively influence daily living activities (ADL)., Objectives: To (1) explore the feasibility to conduct a structured interview by specialist nurses about limitations in ADL; (2) determine the percentage of people with MS (PwMS) with limitations in ADL related to spasticity; (3) to assess the knowledge about spasticity and describe its clinical features., Design: Observational, cross-sectional, multicentre study in 16 MS units of Catalonia (Spain). Participants were recruited from the outpatient facility and day-care hospital between July 2018 and June 2019 and met the following criteria: (1) age 18 or older, (2) diagnosis of MS according to McDonald criteria 2010 and (3) no clinical relapse in previous 30 days., Methods: Specialist nurses conducted a structured interview divided in two parts: the assessment of (1) limitations in the ADL and (2) the presence of spasticity and associated symptoms. The usefulness of this intervention was requested. This study met the STROBE reporting guidelines checklist for observational studies., Results: Three hundred sixty eight pwMS (244 women) with a mean age of 46 years and a median Expanded Disability Status Scale score of 2.5 (range, 0-8.5) were included. 262 (71%) pwMS had limitations in the ADL, and spasticity was reported as the most limiting symptom in 59 (23%). As a result of the interview, spasticity was observed in 199 (76%) participants; 47 (24%) of them were unaware that they had spasticity and 102 (51%) would not have reported it spontaneously. The level of the interview satisfaction was high (90%)., Conclusions: Spasticity is a complex and limiting symptom in MS. The structured interview conducted by specialist nurses is feasible and has good acceptance., Patient Contribution: Specialist nurses can be proactive in MS clinical assessment, which may help to detect symptoms with negative impact on quality of life., (© 2022 John Wiley & Sons Ltd.)

Purpose: To describe the characteristics and recurrence rates of primary periocular squamous cell carcinoma (SCC) in Spain., Methods: This retrospective study investigates the characteristics of primary periocular SCC at two tertiary centers in Spain from 2000 to 2020. Data were collected on demographics, skin phenotype, location, clinical and histological diagnosis, the commitment of surgical margins, recurrence, and risk factors. Multivariate analysis and risk factors were used to investigate recurrence rates, considering p  < 0.05 as statistically significant., Results: Over the 20-year studied period, 107 patients with primary periocular SCC were assessed. The mean age of SCC was 76.8 ± 12.8 years, 55 (50.9%) were females, and 105 (98.1%) had Fitzpatrick skin phenotype type II or III. SCC lesions affected less than 1/3 of the eyelid (56/52.3% cases), mainly the lower lid (42/39.3% lesions). Sixty (56.1%) cases were SCC differentiated, 76 (71%) had clear margins. Clinical diagnosis of SCC corroborated with histological in 84 (78.5%) cases and orbital involvement occurred in 18 (16.8%) cases. Recurrence was observed in 13 (12.1%) cases, occurring more in large tumors and undifferentiated subtype (53.8%), with committed margins (69.2%) ( p  = 0.001), being the commitment of margins a significant predictor for recurrence, although thickness was an independent predictor., Conclusion: Periocular SCC in Spain showed a similar pattern as in the world. The risk of recurrence is increased in undifferentiated and large periocular SCC, partially removed with committed margins.

Purpose: To determine the frequency of ocular conditions among patients presenting to an emergency department at a tertiary hospital in Spain., Methods: A retrospective, longitudinal analysis of all patients who presented to the ocular emergency department of Rio Hortega University Hospital, Valladolid, Spain, from 2013 to 2018 was performed. Data on demographics, ophthalmic examination, and diagnosis were collected. Diseases were classified according the International Classification of Diseases, Ninth Revision, Clinical Modification codes., Results: We had 20,822 patients, of which 10,878 (52.2%) were women. The main age categories were 45-65 years (7391 patients; 35.5%) and 15-45 years (5979 patients; 28.2%). Most of the patients (17,793; 85.5%) were discharged on the same day. Conjunctival pathology was the most common cause of presentation (4110; 19.7%), followed by corneal disorders (4025; 19.3%). Acute conjunctivitis was diagnosed in 2920 (14%) and ocular trauma in 2125 (10.2%) patients. Non-emergency ophthalmic conditions were diagnosed in 1581 (7.6%) patients. Retinal detachments and peripheral holes occurred more commonly in patients aged 45-65 years ( p  <0.001). Corneal or conjunctival disorders and lid inflammation ( p  <0.001) were more frequent in women, whereas men had higher incidences of trauma ( p  <0.001)., Conclusion: Most of our patients presented ocular surface diseases. Men were more vulnerable to trauma, mainly superficial foreign body. The majority of the patients presented with uncomplicated ocular conditions that would be managed more cost-effectively by primary health care providers. We advocate greater education of primary care physicians and patients in managing simple ocular emergencies to reduce the cases presenting to an emergency department of a tertiary hospital.

Background: The disposable bronchoscope is an excellent alternative to face the problem of SARS-CoV-2 and other cross infections, but the bronchoscopist's perception of its quality has not been evaluated., Methods: To evaluate the quality of the Ambu-aScope4 disposable bronchoscope, we carried out a cross-sectional study in 21 Spanish pulmonology services. We use a standardized questionnaire completed by the bronchoscopists at the end of each bronchoscopy. The variables were described with absolute and relative frequencies, measures of central tendency and dispersion depending on their nature. The existence of learning curves was evaluated by CUSUM analysis., Results: The most frequent indications in 300 included bronchoscopies was bronchial aspiration in 69.3% and the median duration of these was 9.1 min. The route of entry was nasal in 47.2% and oral in 34.1%. The average score for ease of use, image, and aspiration quality was 80/100. All the planned techniques were performed in 94.9% and the bronchoscopist was satisfied in 96.6% of the bronchoscopies. They highlighted the portability and immediacy of the aScope4TM to start the procedure in 99.3%, the possibility of taking and storing images in 99.3%. The CUSUM analysis showed average scores > 70/100 from the first procedure and from the 9th procedure more than 80% of the scores exceeded the 80/100 score., Conclusions: The aScope4™ scored well for ease of use, imaging, and aspiration. We found a learning curve with excellent scores from the 9th procedure. Bronchoscopists highlighted its portability, immediacy of use and the possibility of taking and storing images.

Introduction: We analysed the neurological complications of patients with severe SARS-CoV-2 infection who required intensive care unit (ICU) admission., Patients and Methods: We conducted a retrospective, observational, descriptive study of consecutive patients admitted to the ICU due to severe respiratory symptoms secondary to SARS-CoV-2 infection between 1 April and 1 June 2020., Results: We included 30 patients with neurological symptoms; 21 were men (72.40%), and mean age (standard deviation [SD]) was 57.41 years (11.61). The mean duration of ICU stay was 18.83 days (14.33). The neurological conditions recorded were acute confusional syndrome in 28 patients (93.33%), neuromuscular disease in 15 (50%), headache in 5 (16.66%), cerebrovascular disease in 4 (13.33%), and encephalopathies/encephalitis in 4 (13.33%). CSF analysis results were normal in 6 patients (20%). Brain MRI or head CT showed alterations in 20 patients (66.6%). EEG was performed in all patients (100%), with 8 (26.66%) showing abnormal findings. In 5 of the 15 patients with clinical myopathy, diagnosis was confirmed with electroneuromyography. We found a correlation between older age and duration of ICU stay (P=.002; 95%CI: 4.032-6.022; OR: 3,594)., Conclusions: Severe COVID-19 mainly affects men, as observed in other series. Half of our patients presented acute myopathy, and almost all patients left the ICU with acute confusional syndrome, which fully resolved; no correlation was found with EEG or neuroimaging findings. Older age is associated with longer ICU stay., (Copyright © 2020 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: REM sleep behaviour disorder (RBD) is characterised by violent behaviours (screaming, kicking, vivid dreams) during REM sleep. It has a prevalence of 1% to 2% of the general population and is especially frequent in men and the population older than 60. In the last decade, RBD has been suggested to be a prodrome of neurodegenerative disease. We analysed associated neurological diseases and responses to drug treatment in 33 patients with RBD treated in the multidisciplinary sleep disorders unit at Hospital Infanta Sofía., Patients and Methods: We conducted an observational descriptive retrospective analysis of patients diagnosed with RBD and treated in our multidisciplinary sleep disorders unit between October 2012 and December 2015. We recorded age, sex, associated diseases, and treatments administered to these patients., Results: A total of 365 patients were attended at our unit, including 33 with RBD: 13 women (40%) and 20 men (60%). Mean age was 62.72 years. An associated disorder was identified in 48%, with the most common being mild cognitive impairment (69%). The percentage of patients with RBD and an associated disorder among patients older than 60 was 68%. Eighty-two percent of the patients required treatment. The most commonly used drug was clonazepam (76%), followed by melatonin (9%), gabapentin (6%), and trazodone (3%)., Discussion: In our series, 48% of the patients had an associated disorder. The likelihood of detecting an associated disorder increases with patients' age. The vast majority of patients required drug treatment due to symptom severity; the most frequently administered drug was clonazepam (76%)., (Copyright © 2017 The Author(s). Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction and Objectives: The number of heart-transplant recipients exceeding 20 years of follow-up is steadily increasing. However, little is known about their functional status, comorbidities, and mortality. Identifying the predictors of prolonged survival could guide the selection of candidates for the low number of available donors., Methods: Functional status, morbidities, and mortality of heart-transplant patients between 1984 and 1992 were analyzed. To identify predictors of 20-year survival, a logistic regression model was constructed using the covariates associated with survival in the univariate analysis., Results: A total of 39 patients who survived 20 years (26% of patients transplanted before 1992) were compared to 90 recipients from the same period who died between 1 and 20 years post-transplantation. Major complications were hypertension, renal dysfunction, infections, and cancer. After a mean follow-up of 30 months, 6 survivors had died, yielding a mortality rate of 6% per year (vs 2.5%-3% in years 1-19). Causes of mortality were infection (50%), malignancy (33%), and allograft vasculopathy (17%). Long-term survivors were younger and leaner, and had nonischemic cardiomyopathy and lower ischemic time. Logistic regression identified recipient age <45 years (odds ratio=3.9; 95% confidence interval, 1.6-9.7; P=.002) and idiopathic cardiomyopathy (odds ratio=3; 95% confidence interval, 1.4-7.8; P=.012) as independent predictors for 20-year survival., Conclusions: One fourth of all heart-transplant patients in our series survived >20 years with the same graft, and most enjoy independent lives despite significant comorbidities. Recipient age <45 years and idiopathic cardiomyopathy were associated with survival beyond 2 decades. These data may help decide donor allocation., (Copyright © 2013 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.)

Background: This study was undertaken to analyse the OA1 gene (GPR143) and its involvement in a Spanish family presenting with nystagmus, a common symptom of X-linked ocular albinism (XLOA)., Methods: DNA samples from the index case and eight relatives were analysed by multiplex ligation-dependent probe amplification (MLPA). Sequence analysis and restriction assay were used to confirm the results. In addition, an analysis of a STR located in intron 1 of the OA1 gene (OA-CA) was performed., Results: The father of the proband presented with nystagmus, a feature consistent with XLOA. Mutation screening by multiplex ligation-dependent probe amplification and sequence analysis of the exon 2 of the OA1 gene led to the identification of the novel p.Glu129fsX35 (g.5815delA) mutation in two affected males and four carrier females. Three relatives were found to be non-mutated. The deletion detected resulted in a truncated protein 35 codons downstream and generated a new restriction site for the XcmI endonuclease. Additionally, microsatellite analysis showed co-segregation with the disease in the family., Conclusions: A novel deletion in the OA1 gene was identified in a Spanish family with ocular albinism. The mutation detected is likely a loss-of-function alteration. To the best of our knowledge, we describe the first Spanish family known to present with XLOA due to mutations in the OA1 gene.

Introduction: Adequate antibiotic use clearly influences the development of bacterial resistance, adverse events and healthcare costs. Studies of drug usage allow us to detect deviations in antibiotic use., Material and Methods: Antibiotic use during the period 1998-2002 was analyzed using data provided by management software applications. The prescription of restricted-use antibiotics during years 2001 and 2002 was analyzed by selecting patients according to the information available in the unit-dose drug distribution area database at the pharmacy department., Results: Antibiotic use increased from 78 to 100 DDD during the period of time studied. The use of new quinolones has displaced macrolides. Two thirds of piperacillin --tazobactam prescriptions are for surgical patients., Conclusions: 1. Changes in the pattern of antibiotic use have been detected. 2. The relative weight of restricted-use antibiotics has increased. 3. This study allows a prioritization of intervention areas.

Background and Aim of the Work: Almost no epidemiological data are available on a worldwide basis on the prevalence, incidence or relative frequency of interstitial lung diseases (ILD). We report the results of a registration of ILD by 23 centers of pulmonary medicine in Spain over one year (from October 2000 to September 2001)., Methods: A standardized questionnaire was sent to the centers, together with guidelines for classification and diagnostic evaluation. This questionnaire included questions about the explorations performed to establish the diagnosis., Results: A total of 511 cases were registered. The mean age of the patients was 61 +/- 0.7 (x +/- SEM) yrs. The male to female ratio was 1.2:1. The estimated incidence of ILD was 7.6 per 100,000/year. The most frequent disease was idiopathic pulmonary fibrosis (38.6%), followed in decreasing order by sarcoidosis (14.9%), cryptogenic organizing pneumonia (10.4%), ILD associated with collagen vascular diseases (9.9%) and hypersensitivity pneumonitis (6.6%). In 5.1% of cases ILD was unclassified. HRCT scan was performed in 91.9% of cases, bronchoalveolar lavage in 67.9%, transbronchial lung biopsy in 59.9%, and surgical lung biopsy in 22.7%., Conclusions: This registration provides interesting information on the occurrence of ILD in Spain and on the procedures used to establish the diagnosis.

Objective: To determine the incidence, clinical approach, diagnostic delay and survival for bronchogenic carcinoma (BC) in the public health area of A Coruña (Spain)., Patients and Method: This was a retrospective study of patients with a diagnosis of BC made in 1995 and 1996 in a health care area with 509,000 inhabitants. For analysis we gathered demographic, clinical and cyto-histologic data and analyzed diagnostic delay, extension of disease and time of death. Crude, age-specific and age-standardized incidences were calculated., Results: BC was diagnosed in 378 patients (95% men and 5% women). The crude incidence was 37 per 100,000 inhabitants (73.7 per 100,000 men and 3 per 100,000 women) and the age-standardized incidence was 21.7 per 100,000. Diagnosis was by cyto-histology in 87% of the cases, and the most frequent biopsy finding was epidermoid carcinoma. Diagnosis was by clinical or radiologic findings for 13.7%, and patients in that group were older and had greater comorbidity. No symptoms were present in 13% and in those patients diagnosis was earlier, with non-small BC predominating and 60% treated surgically. The diagnostic delay (time from the first symptom to histologic confirmation) was 2.5 months (median, 2.1), and length of delay did not affect survival. Surgery was performed in 23% of the patients with non-small BC. The median survival was 7.1 months (5.2 months for patients who were not treated surgically, and 37.6 for those who were)., Conclusions: The incidence of BC in men in our study is consistent with that reported for other Spanish regions, although the incidence we observed for women is much lower. Diagnostic delay did not affect survival. The percentage of patients with surgical-stage disease is very low and survival is very short. These findings support the need for early diagnosis.

Objectives: To analyze the relation between perinatal variables (gestational, neonatal, demographic, and social) at time of delivery. To evaluate differences between rural and urban areas --and differences between social status within these areas-- as an approach to studying health inequality. To identify variables associated with the risk of prematurity and low birth weight from onset of pregnancy., Methods: A retrospective study was made of deliveries in a 4-year period (1993-1996) in a health-care district of the province of Cáceres (Spain) (population: 176,511 inhabitants). Data were obtained from hospital records (N = 5922 deliveries). Gestational (mother's age, multiparity), neonatal (sex, birth weigh, weeks of gestation, twin birth), and sociodemographic variables (mother's place of residence and social rank) were studied. A logistical regression analysis was made to identify the main risk factors., Results: The percentage of infants with birth weight less than 2800 g (16.92%) or less than 2500 g (7.80%), and of preterm births (6.16%) in the health-care district of Cáceres were higher than those reported for other studies made in Spain and elsewhere. The risk of low birth weight (<2800 g) was greater for twin births (OR = 16.50; IC 95%: 9.67-28.15); female infants (OR = 1.36; IC 95%: 1.19-1.56), adolescent mothers (<20 years: OR = 1.54; IC 95%: 1.14-2. 09), older mothers (>35 years: OR = 2.12; IC 95%: 1.41-3.17), and first pregnancies (OR = 1.25, IC 95%: 1.09-1.44). The mother's social status was a risk factor for urban marginal groups compared with non-marginal groups (OR = 1.43, IC 95%: 1.12-1.82). The risk of preterm birth depended mainly on the mother's age and was greater in adolescents (OR = 1.84, IC 95%: 1.17-2.89) and older women (OR = 3. 08, IC 95%: 1.81-5.24), as well as for twin births (OR = 10.47; IC 95%: 6.49-16.89). Women in marginal urban groups had the highest rates of multiple pregnancies and adolescent pregnancies. Women in non-marginal urban areas had the highest rate of first pregnancies in older women. Women in rural areas showed intermediate characteristics., Conclusions: The percentage of low-birth-weight or preterm newborns and of adolescent mothers was greater in women of lower socioeconomic level. The greatest differences in perinatal variables were observed in urban areas (marginal vs. non-marginal groups) and between regions and countries.

Objective: We review a series of 240 patients treated surgically for pulmonary hydatid cyst in our center between 1966 and 1988, assessing the results with our surgical technique, which involves a novel needle aspiration device designed by Professor D. Figuera, and postoperative treatment protocol., Patients and Methods: The majority (60.4%) of the patients were from areas endemic for hydatid disease. The mean age of the patients at the time of the surgical procedure was 31.5 +/- 7.2 years (range: 4-70 years). A trocar-suction device was used for the needle aspiration of 276 (92%) of the 300 cysts encountered in the 240 patients. The remaining 24 cysts were removed integrally by means of different surgical techniques such as cyst enucleation, lobectomy, segmentectomy and atypical pulmonary resection. The residual cavity was treated by pericystectomy and eversion to the pleural surface in 238 cases (86.2%) and by capitonnage in 38 (13.7%). High vacuum suction (-30 cm H2O) was employed in every case. Depending on when the procedure was performed, the patients were treated with mebendazole or albendazole according to the protocol designed by Bekhti., Results: Clinical assessment of the symptoms and plain chest X-ray led to the correct diagnosis in 228 cases (95%). In six (2.5%), imaging studies such as ultrasonography, computed tomography and nuclear magnetic resonance were required, and in the remaining six cases (2.5%), the diagnosis was established intraoperatively or in the subsequent histopathological study. One hundred and seventy patients (70.8%) presented a solitary lung cyst, while the remaining 70 (29.2%) were found to have multiple cysts in one or more lobes of one or both lungs. In addition, 45 patients (18.7%) presented hepatic cysts and 25 (10.4%) had cysts in other locations. After 18 years of follow-up, the survival rate was 94.6%. Of the surviving patients, 98.3% were free of pulmonary hydatid disease and 95.1% were free of hydatid disease., Conclusions: The trocar-suction device employed here for needle aspiration of hydatid cysts has demonstrated its efficacy in preventing the rupture of the cyst and its possible dissemination. With its use, the parasite is eradicated and the residual cavity can be excised.

Objective: To analyse the lipid profile of the infant and young population of our province, and to compare our findings with those of other similar Spanish studies., Design: A cross-sectional descriptive study., Setting: School population from 2 to 16 years old in the province of Cáceres (N = 91083)., Participants: A representative and proportional sample of 2150 children, with the two sexes at 50%., Interventions: The total cholesterol (TC), HDL-C (enzymatic technique) and LDL-C (Friedewald formula) were determined., Results: The mean values of TC, LDL-C and HDL-C (mean +/- SD) were 182.77 +/- 28.96, 114.19 +/- 26.54 and 57.31 +/- 13.97, respectively. Comparison of our lipid figures by age and sex with those of other Spanish studies (Fuenlabrada, Niño Jesús, Navarra and RICARDIN) and with the North American LRCP showed, in general, higher means of TC and LDL-C and/or lesser HDL-C levels in our population., Conclusions: Comparison with earlier studies shows that children from Cáceres have a more atherogenic lipid profile. Social and methodological differences may have affected the results. However, we think that, given the time elapsed since previous studies, the differences found may reflect progressive changes in the Spanish diet towards higher consumption of saturated fats.

Background: The lipid factor is currently considered to be the main agent responsible for cardiovascular risk in young individuals. This is already present during infancy in proportions that give rise to concern, and is growing, as has would seem to have been shown by several national studies. This study analyses the prevalence of hyperlipidemia in children within the province of Caceres according to several different criteria, and describes changes according to age groups and sex, comparing the overall results with those of other national studies., Methods: A cross-sectional descriptive study of a representative and proportional sample of 2,150 children aged 2 to 6 years old in the province of Caceres (N = 91,083). The following were determined: total cholesterol, fractions, apolipoproteins and risk coefficients (enzymatic technique)., Results: 27.9% of children presented total cholesterol values of > 200 mg/dl; 7.5% of females and 4.7% of males had figures of more than 230 mg/dl. Levels of C-LDL > 130 mg/dl appear in 26.4%, Apo-B > 75 mg/dl in 65.5% and C-NO-HDL > 165 in 8.4%. C-HDL- < 35 mg/dl was found in 3.3% of individuals, while Apo-A < 100 mg/dl was only found in 0.3%. The ratios between CT/HDL > 3.5 and LDL/HDL > 2.2 were found to be 36.1% and 39.8%, respectively. The prevalence of hyperlipidemia is higher in females and pre-puberty stages., Conclusions: Overall, and independently of the criteria used, the proportion of cases of hyperlipidemia is high, and is above the levels cited in other Spanish studies. The prevalence of hyperlipidemia is highest in females before puberty, who display the most discriminatory risk coefficients, and best identify the change in the lipid profile at puberty.