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La relevancia que ha cobrado el litio en España como mineral estratégico debe tomarse en consideración para acelerar la transición energética de los modelos industriales; en particular, del automóvil. Los proyectos mineros o industriales requieren estabilidad, transparencia y participación de los ciudadanos para facilitar su aprobación. Para permitir el desarrollo de las Directivas europeas y aprovechar la oportunidad financiera europea es necesaria la cooperación activa entre empresas e instituciones gubernamentales. El marco legislativo español y las Comunidades Autónomas deben facilitar el desarrollo industrial sostenible sin desatender ni obstaculizar la justicia energética.

Peroxisomal biogenesis disorders (PBDs) are a heterogeneous group of genetic diseases. Multiple peroxisomal pathways are impaired, and very long chain fatty acids (VLCFA) are the first line biomarkers for the diagnosis. The clinical presentation of PBDs may range from severe, lethal multisystemic disorders to milder, late-onset disease. The vast majority of PBDs belong to Zellweger Spectrum Disordes (ZSDs) and represents a continuum of overlapping clinical symptoms, with Zellweger syndrome being the most severe and Heimler syndrome the less severe disease. Mild clinical conditions frequently present normal or slight biochemical alterations, making the diagnosis of these patients challenging. In the present study we used a combined WES and RNA-seq strategy to diagnose a patient presenting with retinal dystrophy as the main clinical symptom. Results showed the patient was compound heterozygous for mutations in PEX1. VLCFA were normal, but retrospective analysis of lysosphosphatidylcholines (LPC) containing C22:0–C26:0 species was altered. This simple test could avoid the diagnostic odyssey of patients with mild phenotype, such as the individual described here, who was diagnosed very late in adult life. We provide functional data in cell line models that may explain the mild phenotype of the patient by demonstrating the hypomorphic nature of a deep intronic variant altering PEX1 mRNA processing.

Old patients with hepatotoxicity have been scarcely studied in idiosyncratic drug-induced liver injury (DILI) cohorts. We sought for the distinctive characteristics of DILI in older patients across age groups. A total of 882 DILI patients included in the Spanish DILI Registry (33% ≥65 years) were categorized according to age: “young” (

Palliative sedation is used to relieve end-of-life refractory symptoms.The objective of this study was to describe the use of palliative sedation in patients who die in internal medicine departments.An observational, cross-sectional, retrospective, and multicenter clinical audit study was conducted in 145 hospitals in Spain and Argentina. Each hospital included the first 10 patients who died in the internal medicine department, starting on December 1, 2015.We included 1447 patients, and palliative sedation was administered to 701 patients (48.4%). Having a terminal illness (odds ratio [OR] 2.469, 95% CI 1.971-3.093, P 0.001) and the length of hospital stay (OR 1.011, 95% CI 1.002-1.021, P = 0.017) were independently associated with the use of palliative sedation. Consent was granted by the families of 582 (83%) patients. The most common refractory symptom was dyspnea, and the most commonly used drugs for sedation were midazolam (77%) and morphine (89.7%). An induction dose was administered in 25.7% of the patients. Rescue doses were scheduled for 70% of the patients, and hydration was maintained in 49.5%. Pain was more common in patients with cancer, whereas dyspnea was more common in those without cancer. Rescue doses were used more often for the patients with cancer (77.8% vs. 67.7%, P = 0.015). Monitoring the palliative sedation with a scale was more frequent in the patients with cancer (23.7% vs. 14.3%, P = 0.008).Palliative sedation is used more often for terminal patients. There are differences in the administration of palliative sedation between patients with and without cancer.

El avance de las nuevas tecnologías y de la información ha permitido que el teletrabajo sea cada vez un método más factible y utilizado en las empresas. Implica comodidad y versatilidad al evitar el desplazamiento a un entorno común de trabajo y desempeñar las mismas funciones que pueden realizarse desde casa o desde un tercer espacio, es decir, utilizar un espacio efectivo para ello. Este proyecto analiza la nueva normativa y regularización que se adopta tras la pandemia del COVID-19, los cambios que se han producido y comprenderemos por qué ha aumentado significativamente el porcentaje de empresas que han decidido seguir con este sistema de trabajo.Además, se profundiza en los riesgos psicosociales que pueden desarrollarse a causa del teletrabajo y analizaremos cuáles son los que más comunes. Todo ello lo realizaremos por medio de una encuesta que será contestada por personas de diferente edad, sexo, estado civil, situación familiar y laboral, para poder contrastar información y llegar a una conclusión.

Introducción: La amenorrea secundaria es la ausencia de sangrado durante más de tres meses seguidos después de la menarquia. Esta alteración menstrual es causada en muchas ocasiones por una baja disponibilidad energética junto a un alto nivel de entrenamiento, y puede ser síntoma del síndrome de deficiencia energética en el deporte. Objetivos: Los objetivos del presente trabajo han sido describir la presencia de alteraciones del ciclo menstrual en una muestra de mujeres atletas de élite y proponer un programa de actuación, información y sensibilización para entrenadores. Material y métodos: Se realizó una encuesta sobre las alteraciones menstruales en una muestra de 30 atletas de alto rendimiento de diferentes disciplinas de atletismo (carreras y saltos). Basándose en la encuesta realizada a las atletas se creó un programa de actuación, sensibilización y prevención de las alteraciones menstruales para entrenadores de atletismo. Resultados: Se observó a través de la encuesta realizada que 22 de las atletas encuestadas habían presentado alguna alteración menstrual (amenorrea, oligomenorrea y/o polimenorrea) a lo largo de los últimos veinte meses. Los resultados mostraron la presión que sienten por mantener una apariencia delgada y la utilización de algún método para bajar de peso a lo largo de su carrera deportiva. Por ello, es importante la creación de un programa de información para entrenadores. Conclusiones: Las alteraciones del ciclo menstrual están presentes en el atletismo de alto rendimiento y los entrenadores no parecen atender adecuadamente este problema, por ello hay que concienciar a los profesionales del deporte sobre esta problemática.

[Background & Aims] Prospective drug-induced liver injury (DILI) registries are important sources of information on idiosyncratic DILI. We aimed to present a comprehensive analysis of 843 patients with DILI enrolled into the Spanish DILI Registry over a 20-year time period., [Methods] Cases were identified, diagnosed and followed prospectively. Clinical features, drug information and outcome data were collected., [Results] A total of 843 patients, with a mean age of 54 years (48% females), were enrolled up to 2018. Hepatocellular injury was associated with younger age (adjusted odds ratio [aOR] per year 0.983; 95% CI 0.974–0.991) and lower platelet count (aOR per unit 0.996; 95% CI 0.994–0.998). Anti-infectives were the most common causative drug class (40%). Liver-related mortality was more frequent in patients with hepatocellular damage aged ≥65 years (p = 0.0083) and in patients with underlying liver disease (p = 0.0221). Independent predictors of liver-related death/transplantation included nR-based hepatocellular injury, female sex, higher onset aspartate aminotransferase (AST) and bilirubin values. nR-based hepatocellular injury was not associated with 6-month overall mortality, for which comorbidity burden played a more important role. The prognostic capacity of Hy’s law varied between causative agents. Empirical therapy (corticosteroids, ursodeoxycholic acid and MARS) was prescribed to 20% of patients. Drug-induced autoimmune hepatitis patients (26 cases) were mainly females (62%) with hepatocellular damage (92%), who more frequently received immunosuppressive therapy (58%)., [Conclusions] AST elevation at onset is a strong predictor of poor outcome and should be routinely assessed in DILI evaluation. Mortality is higher in older patients with hepatocellular damage and patients with underlying hepatic conditions. The Spanish DILI Registry is a valuable tool in the identification of causative drugs, clinical signatures and prognostic risk factors in DILI and can aid physicians in DILI characterisation and management., [Lay summary] Clinical information on drug-induced liver injury (DILI) collected from enrolled patients in the Spanish DILI Registry can guide physicians in the decision-making process. We have found that older patients with hepatocellular type liver injury and patients with additional liver conditions are at a higher risk of mortality. The type of liver injury, patient sex and analytical values of aspartate aminotransferase and total bilirubin can also help predict clinical outcomes., The present study has been supported by grants of Instituto de Salud Carlos III cofounded by Fondo Europeo de Desarrollo Regional – FEDER (contract numbers: PI19/00883, PI16/01748, PI18/00901, PI18/01804, PI-0285-2016, PI-0274-2016, PI-0310-2018, PT17/0017/0020) and Agencia Española del Medicamento. CIBERehd and Plataforma ISCIII Ensayos Clinicos are funded by Instituto de Salud Carlos III. MRD holds a Joan Rodes (JR16/00015)/Acción B clinicos investigadores (B-0002-2019) and JSC a Rio Hortega (CM17/00243) research contract from ISCIII and Consejería de Salud de Andalucía.

Osteoporosis is a highly prevalent disease with important consequences. The most widely used drugs to control this disease are bisphosphonates but their prolonged use is associated with the risk of atypical fractures. We report the cases of two patients under bisphosphonate treatment with bilateral atypical femoral fractures. In one patient the fractures occurred simultaneously, unprovoked by trauma, and in the other, they occurred as delayed fractures after mild trauma. In both cases, the fractures were preceded by pain. The fractures were treated with intramedullary nailing and bisphosphonate withdrawal with good outcomes. Although bisphosphonates have demonstrated effectiveness in preventing frailty-related fractures, their prolonged use has paradoxically been associated with atypical fractures. These fractures are usually preceded by pain. Consequently, when faced with this clinical picture, physicians should request imaging studies that could show incomplete fractures that could benefit from prophylactic nailing before becoming complete fractures.