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Identifying tourists' preferences is essential for stakeholders to provide better products and services. Among the tools to classify such choices, expenditure segmentation is valuable for separating tourist groups with shared interests. The underlying idea of the (infinite) mixture model is that tourists spend on a specific activity depending on their preferences. However, the propensity to consume may be based on or influenced by the group to which the tourist belongs. Thus, such a tendency could increase depending on homogeneity or heterogeneity. This paper uses a compound distribution mixture to model the expenditure heterogeneity. The resulting mixture model derives from a multivariate Pareto (Lomax) distribution that is easy to implement and includes zero value in its support since it is empirically proven that a tourist's expenditure on some activity can be zero. Results show that once the spending on transport has been carried out, tourists prefer to spend more on food than other activities. Conditioned to the expense carried out on food, the mean expenditure on leisure activities is more significant than on transport. Finally, tourists would prefer to spend more on food than on transportation once they decide to spend on other activities.

Resumen: Objetivos: Resultados clínicos, radiológicos y funcionales de la primera serie española de pacientes intervenidos de artroplastia total de cadera (ATC) asistida mediante brazo robótico Mako® (Stryker) del Hospital Clínico San Carlos (HCSC) de Madrid. Material y métodos: Estudio descriptivo prospectivo que analiza los primeros 25 pacientes intervenidos de ATC asistida por robot (ATCaR) en el HCSC, con un seguimiento mínimo de 4 meses. Se evaluaron la demografía, los estudios de imagen (procesamiento Mako®, Rx y TAC), los parámetros clínicos, la funcionalidad (Harris modificada) y las complicaciones asociadas. Resultados: La edad media fue 67,2 años (min 47, max 88), siendo el 56% varones. El 88% corresponden a coxartrosis primaria, el 4% postraumática, el 4% secundaria a NAV y el 4% secundaria a choque femoroacetabular.El tiempo medio de cirugía fue de 116,9 minutos (min 92, max 150). La media de las cinco primeras intervenciones fue 122,6 minutos, y la de las cinco últimas, de 108,2 minutos. Como complicaciones intraoperatorias se cuantificaron 4 pérdidas de marcadores intraoperatorios.El tiempo de ingreso medio fue 4,4 días (min 3, max 7), con una disminución de hemoglobina posquirúrgica media de 3,08 ± 1,08 g/dl, requiriendo transfusión en el 12% de los casos. Se registran tres complicaciones médicas durante el ingreso, destacando un síndrome confusional con caída y fractura periprotésica AG1 no desplazada.El análisis del posicionamiento de los implantes registrados con sistema Mako® fueron 40,55 ± 1,53 grados de inclinación y 12,2 ± 3,6 grados de anteversión acetabular. El estudio de imagen posquirúrgico realizado a los pacientes, en concordancia con Mako®, muestra valores de inclinación acetabular de 41,2 ± 1,7 en Rx y versión acetabular de 16 ± 4,6 en TAC.La discrepancia de longitud de cadera varía de valores preoperatorios de −3,91 mm (DE: 3,9; min −12, max 3) a 1,29 mm (DE: 1,96) tras la cirugía registrados con Mako®, con un aumento de longitud de cadera medio de 5,64 mm (DE: 3,35). El estudio Rx simple demuestra una diferencia posquirúrgica en concordancia con Mako® entre ambas caderas de 0,5 ± 3,08 mm.El offset femoral nativo se mantuvo tras la cirugía con una diferencia pre y posquirúrgica de la cadera intervenida de 0,1 mm (DE: 3,7), registrado con Mako®.La puntuación Harris modificada preoperatoria fue de 41,6 ± 13,3, mejorando hasta valores postoperatorios de 74,6 ± 9,7 a los 4 meses.No se registraron complicaciones en el postoperatorio inmediato (4 meses). Conclusiones: La artroplastia total de cadera asistida por brazo robótico consigue una adecuada exactitud y reproducibilidad en el posicionamiento de los implantes y la dismetría de cadera posquirúrgica, sin aumentar las complicaciones asociadas a la técnica. El tiempo de cirugía, las complicaciones y los resultados funcionales a corto plazo son comparables a la técnica convencional de las grandes series publicadas previamente. Abstract: Objectives: Clinical, radiological and functional results of the first Spanish series of patients undergoing total hip arthroplasty assisted by Mako® (Stryker) robotic arm at the Hospital Clínico San Carlos (HCSC) in Madrid. Material and methods: Prospective and descriptive study analyzing the first 25 patients who underwent robotic-assisted THA at the HCSC, with a minimum follow-up of 4 months. Demographics, imaging studies (Mako® processing, Rx and CT), clinical parameters, functionality (modified Harris) and associated complications were evaluated. Results: Average age was 67.2 years (min 47, max 88), being 56% male population sample. 88% involves primary coxarthrosis, 4% post-traumatic coxarthrosis, 4% secondary avascular necrosis and 4% secondary femoroacetabular impingement.Average surgery time was 116.9 min (min 92, max 150). The average time of the first five surgeries was 122.6 min, and, regarding the last five interventions, it was 108.2 min. Found medical intraoperative complications were four intraoperative markers loss.Average admission time was 4.4 days (min 3, max 7), with an average postoperative hemoglobin decrease of 3.08 ± 1.08 g/dL, requiring a transfusion in 12% of the cases. Three medical complications have been registered in the meantime of the admission, with a relevant case of a confusional syndrome and a fall, which resulted in a non-displaced AG1 periprosthetic fracture.The analysis of the positioning of registered implants with Mako® system shows 40.55 ± 1.53 acetabular inclination degrees and 12.2 ± 3.6 acetabular anteversion degrees. The postoperative image study carried out on patients, are consistent with Mako® s results, as it shows an acetabular inclination of 41.2 ± 1.7 in Rx, as well as acetabular anteversion of 16 ± 4.6 in CT.Hip length variance ranges depending on preoperative values of 3.91 mm (SD: 3.9; min −12, max 3) to 1.29 mm (SD: 1.96) after surgery registered with Mako®, with an increase of an average hip length of 5.64 mm (SD: 3.35). Rx simple study results show a postoperative difference between both hips of 0.5 ± 3.08 mm, which is consistent with Mako® results.Native femoral offset was stable after surgery with a showing difference both pre and post operative of the intervened hip of 0.1 mm (SD: 3.7), registered with Mako®.Preoperatory modified Harris punctuation was 41.6 ± 13.3, improving to postoperative values of 74.6 ± 9.7 after four months since the surgery. No complications were registered in immediate postoperative (4 month). Conclusions: Total hip arthroplasty robot-assisted achieves an adequate precision and repeatability of the implant positioning and the postoperative hip dysmetry without showing an increase of associated complications to the technique applied. Surgery time, complications and functional results in a short-time period are similar to conventional techniques applied to great series previously published.

Abstract We realize a nationwide population-based retrospective study to analyze the characteristics and risk factors of fungal co-infections in COVID-19 hospitalized patients as well as describe their causative agents in the Spanish population in 2020 and 2021. Data were obtained from records in the Minimum Basic Data Set of the National Surveillance System for Hospital Data in Spain, provided by the Ministry of Health, and annually published with two years lag. The assessment of the risk associated with the development of healthcare-associated fungal co-infections was assessed using an adjusted logistic regression model. The incidence of fungal co-infection in COVID-19 hospitalized patients was 1.41%. The main risk factors associated were surgery, sepsis, age, male gender, obesity, and COPD. Co-infection was associated with worse outcomes including higher in-hospital and in ICU mortality, and higher length of stay. Candida spp. and Aspergillus spp. were the microorganisms more frequent. This is the first study analyzing fungal coinfection at a national level in hospitalized patients with COVID-19 in Spanish population and one of the few studies available that demonstrate that surgery was an independent risk factor of Aspergillosis coinfection in COVID-19 patients.

Objectives: Clinical, radiological and functional results of the first Spanish series of patients undergoing total hip arthroplasty assisted by Mako® (Stryker) robotic arm at the Hospital Clínico San Carlos (HCSC) in Madrid. Material and methods: Prospective and descriptive study analyzing the first 25 patients who underwent robotic-assisted THA at the HCSC, with a minimum follow-up of 4 months. Demographics, imaging studies (Mako® processing, Rx and CT), clinical parameters, functionality (modified Harris) and associated complications were evaluated. Results: Average age was 67.2 years (min 47, max 88), being 56% male population sample. 88% involves primary coxarthrosis, 4% post-traumatic coxarthrosis, 4% secondary avascular necrosis and 4% secondary femoroacetabular impingement.Average surgery time was 116.9 min (min 92, max 150). The average time of the first five surgeries was 122.6 min, and, regarding the last five interventions, it was 108.2 min. Found medical intraoperative complications were four intraoperative markers loss.Average admission time was 4.4 days (min 3, max 7), with an average postoperative haemoglobin decrease of 3.08 ± 1.08 g/dl, requiring a transfusion in 12% of the cases. Three medical complications have been registered in the meantime of the admission, with a relevant case of a confusional syndrome and a fall, which resulted in a non-displaced AG1 periprosthetic fracture.The analysis of the positioning of registered implants with Mako® system shows 40.55 ± 1.53 acetabular inclination degrees and 12.2 ± 3.6 acetabular anteversion degrees. The postoperative image study carried out on patients, are consistent with Mako® results, as it shows an acetabular inclination of 41.2 ± 1.7 in Rx, as well as acetabular anteversion of 16 ± 4.6 in CT.Hip length variance ranges depending on preoperative values of 3.91 mm (SD: 3.9; min −12, max 3) to 1.29 mm (SD: 1.96) after surgery registered with Mako®, with an increase of an average hip length of 5.64 mm (SD: 3.35). Rx simple study results show a postoperative difference between both hips of 0.5 ± 3.08 mm, which is consistent with Mako® results.Native femoral offset was stable after surgery with a showing difference both pre and post operative of the intervened hip of 0.1 mm (SD: 3.7), registered with Mako®.Preoperatory modified Harris punctuation was 41.6 ± 13.3, improving to postoperative values of 74.6 ± 9.7 after four months since the surgery. No complications were registered in immediate postoperative (4 months). Conclusions: Total hip arthroplasty robot-assisted achieves an adequate precision and repeatability of the implant positioning and the postoperative hip dysmetry without showing an increase of associated complications to the technique applied. Surgery time, complications and functional results in a short-time period are similar to conventional techniques applied to great series previously published. Resumen: Objetivos: Resultados clínicos, radiológicos y funcionales de la primera serie española de pacientes intervenidos de artroplastia total de cadera (ATC) asistida mediante brazo robótico Mako® (Stryker) del Hospital Clínico San Carlos (HCSC) de Madrid. Material y métodos: Estudio descriptivo prospectivo que analiza los primeros 25 pacientes intervenidos de ATC asistida por robot (ATCaR) en el HCSC, con un seguimiento mínimo de 4 meses. Se evaluaron la demografía, los estudios de imagen (procesamiento Mako®, Rx y TAC), los parámetros clínicos, la funcionalidad (Harris modificada) y las complicaciones asociadas. Resultados: La edad media fue de 67,2 años (min 47, máx 88), siendo el 56% varones. El 88% corresponden a coxartrosis primaria, el 4% postraumática, el 4% secundaria a necrosis avascular (NAV) y el 4% secundaria a choque femoroacetabular.El tiempo medio de cirugía fue de 116,9 min (min 92, máx 150). La media de las 5 primeras intervenciones fue de 122,6 min, y la de las 5 últimas, de 108,2 min. Como complicaciones intraoperatorias se cuantificaron 4 pérdidas de marcadores intraoperatorios.El tiempo de ingreso medio fue de 4,4 días (min 3, máx 7), con una disminución de hemoglobina posquirúrgica media de 3,08 ± 1,08 g/dl, requiriendo transfusión en el 12% de los casos. Se registran 3 complicaciones médicas durante el ingreso, destacando un síndrome confusional con caída y fractura periprotésica AG1 no desplazada.El análisis del posicionamiento de los implantes registrados con sistema Mako® fueron 40,55 ± 1,53 grados de inclinación y 12,2 ± 3,6 grados de anteversión acetabular. El estudio de imagen posquirúrgico realizado a los pacientes, en concordancia con Mako®, muestra valores de inclinación acetabular de 41,2 ± 1,7 en Rx y versión acetabular de 16 ± 4,6 en la TAC.La discrepancia de longitud de cadera varía de valores preoperatorios de −3,91 mm (DE: 3,9; min −12, máx 3) a 1,29 mm (DE: 1,96) tras la cirugía registrados con Mako®, con un aumento de longitud de cadera medio de 5,64 mm (DE: 3,35). El estudio de Rx simple demuestra una diferencia posquirúrgica en concordancia con Mako® entre ambas caderas de 0,5 ± 3,08 mm.El offset femoral nativo se mantuvo tras la cirugía con una diferencia pre y posquirúrgica de la cadera intervenida de 0,1 mm (DE: 3,7), registrado con Mako®.La puntuación Harris modificada preoperatoria fue de 41,6 ± 13,3, mejorando hasta valores postoperatorios de 74,6 ± 9,7 a los 4 meses.No se registraron complicaciones en el postoperatorio inmediato (4 meses). Conclusiones: La artroplastia total de cadera asistida por brazo robótico consigue una adecuada exactitud y reproducibilidad en el posicionamiento de los implantes y la dismetría de cadera posquirúrgica, sin aumentar las complicaciones asociadas a la técnica. El tiempo de cirugía, las complicaciones y los resultados funcionales a corto plazo son comparables a la técnica convencional de las grandes series publicadas previamente.

En este artículo se reflexiona sobre la reciente ley aprobada por el Congreso de los Diputados conocida como Ley 4/2023 para la igualdad real y efectiva de las personas trans y para la garantía de los derechos de las personas LGTBI (BOE-A-2023-5366, 2023). Se analizan inicialmente los artículos que más polémica han causado en el ámbito social, que son los relativos a la rectificación registral (Art. 43-51), y posteriormente los que hacen referencia directa o indirectamente a aspectos sanitarios; 1) el que prohíbe de métodos, programas o las llamadas terapias de conversión (Art. 17), 2) los que definen cómo debe ser en términos generales la atención sanitaria (Art. 56-59), y 3) finalmente el único artículo que menciona a los menores (Art 70). Se comenta que el término utilizado de persona trans, al englobar un amplio abanico de diversidades sexuales, variantes y expresiones de género, incluye tanto a personas que necesitan una atención médica como a otras que no. Se plantea que la rectificación registral acorde con esta ley 2023 al no precisar ningún requisito para su inscripción, ofrece menos garantías que la legislación ya existente de marzo 2007. Se considera que las directrices de la nueva ley se están traduciendo en una toma de decisiones por parte del usuario sin disponer de una valoración o diagnóstico por el equipo de profesionales que atienden el caso. Se destaca que la ley no incluye ninguna referencia a la atención por salud mental. Y en conjunto, se concluye que el texto aprobado, en el ámbito sanitario, puede mermar la calidad de la asistencia integral, sobre todo en menores, o personas con identidades complejas, dudosas, o con comorbilidades, que pueden generar discrepancia entre el criterio del profesional y la opinión del usuario.

Abstract Renewable energy sources are key to achieve the transition toward clean energy system. Among them, the geothermal energy has a production whose effectiveness requires sufficient understanding of the temperature distribution and fluid circulation at depth, as well as of the lithological and petrophysical properties of the crust. The focus of this paper is twofold: first, we summarize the main advances in the development of new methodologies and numerical codes to characterize the properties of the thermal lithosphere in terms of its, temperature, density and composition; second, based on the compilation of available thermal modelling results, we present the depth of the thermal Lithosphere–Asthenosphere Boundary (LAB) of the Iberian Peninsula and the temperature distribution at crustal depths of 5, 10, and 20 km, in addition to at Moho level. At 5 km depth, the temperature is above 110 °C with local anomalies (> 130 °C) located in the Iberian Massif and Cenozoic volcanic provinces. A similar pattern is observed at 10 and 20 km depth, where temperatures are above 190 °C and 350 °C, respectively. At 20 km depth, anomalies above > 500 °C, delineate the SE and NE Cenozoic volcanic provinces. At Moho depths, temperature ranges from 450 to 800 °C with hot regions mainly located along the Iberian Massif and the SE and NE volcanic provinces. The compiled results do not show any lithospheric anomaly that could give rise to high temperatures at shallow depths, but they do show an acceptable exploitation potential at intermediate depths. With regard to the direct use of district and greenhouse heating and for industrial processes, the potential is great throughout the Peninsula, the main challenges being the availability of groundwater and drilling costs.

Introduction CADASIL (Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy) is a cerebrovascular disease, tht appears in 1.98/100,000. It´s caused by a mutation of the Notch3 gene and is characterized by accumulation of granular osmiophilic material in the middle layer of the small and median sized cerebral arteries. Sypmtoms are migraine, recurrent cerebral ischemic episodes, dementia, neuropsychiatric disorders (anosognosia, character disorders, apathy and cognitive impairment). It usually appears between 30-60 years, although there is an important variability. There is no curative treatment, only palliative. Objectives Clinical review of anosognosia and its presence in CADASIL disease. Methods Clinical case and literatura review. Results We presented the clinical case of a 68-year-old man, who was diagnosed with CADASIL after a stroke 3 years earlier. In his family, his brother was diagnosed also with CADASIL. The patient had previously presented disturbances in impulse control (hyperorality) and important executive failures. He currently presented anosognosia, deficits in verbal memory, spatial perception and executive functions, in addition to behavioral alterations and apathy. Due to these deficits he was prohibited from certain activities (driving, hunting). The patient was not aware of these deficits and becouse of his “no knowledge of his illness”, he disagreed with these prohibitions, so he showed rage and anger at the impotence of not understanding why certain actions are prohibited. In the consultation, mnesic errors and in naming objects were also objectified, for which it was recommended to carry out cognitive stimulation on a daily basis. In addition, he presented failures of sphincter incontinence, especially of urine and occasionally also of the anal sphincter. He had previously had episodes of myoclonus or fasciculations. A genetic study by massive sequencing confirmed the heterozygous presence of the pathogenic variant c.1819C>T p.(Arg607Cys) in the NOTCH3 gene, a CADASIL disease. Conclusions The anosognosia that many patients with CADASIL disease present constitutes a problem because it contributes to the delay in consultation and, therefore, the delay in the adequate diagnostic approach, therapeutic possibilities and family genetic counseling. Due in part to anosognosia, CADASIL is considered an underdiagnosed entity. Due to the lack of awareness and the consequent lack of recognition of the deficit, these people are often seen as stubborn and difficult to deal with by people in their immediate environment. In addition, there is general difficulty in the rehabilitation process, since patients do not think the neccesity to be treated. This can generate frustration and despair both in their relatives and in the health personnel. For all these reasons, both in anosognosia and in CADASIL disease, adequate psychological support is needed for both those affected and their families. Disclosure of Interest None Declared

Introduction Hyperammonemic encephalopathy is an unusual but fatal consequence of patients being treated with valproic acid (VPA). The most relevant clinical features in cases of valproic acid-induced hyperammonemia include confusion, lethargy, vomiting, and increased seizure frequency and may progress to stupor, coma, and lead to death in isolated cases. The causes are not fully elucidated, but studies suggest alterations in liver and kidney function with abnormalities in the urea cycle causing increased ammonium levels. Objectives Clinical review and treatment approach for VPA-induced hyperammonemia encephalopathy. Methods Clinical case and literature review. Results A 23 - years - old male, admitted to the psychiatric unit for a psychotic episode in the context of drug use and associated affective symptoms. Treatment with antipsychotic (Risperidone 6mg per day) and mood stabilizer (valproic acid up to 1000/mg per day) was prescribed. After ten days of treatment, the patient started with low level of awareness and abnormal behaviour. Neurological examination showed marked somnolence, dysarthric language, unstable gait and behavioral alterations. In the physical examination the constants are stable with discrete tachycardia. Laboratory tests revealed hyperammonemia (609μg/dL), with normal liver function and serum concentration of total valproic acid was therapeutic (69mg/L). Brain computed tomography (CT) revealed no significant anomalies. Doctors initiated treatment with daily cleansing enema and VPA was suspended immediatly. After forty-eight hours the patient’s mental status gradually improved back to baseline and the ammonium levels were normalized in medical tests. Conclusions Valproate-induced hyperammonemic encephalopathy is an unusual but serious complication. It is often underdiagnosed, with an unclearly incidence. The consequences of undertreatment can be potentially deadly. Clinical suspicion should be established in all patients with decreased level of consciousness in patients receiving VPA. Hyperammonemia can be asymptomatic in half of the cases and can occur in people with normal therapeutic doses and normal serum valproate levels. The mechanism of VPA-induced hyperammonemic encephalopathy is unclear. At present, it is thought to be primarily due to propionic acid, a metabolite of VPA, which inhibits an enzyme necessary for the elimination of ammonia in the urea cycle. In addition, VPA can raise plasma ammonia levels through interaction with carnitine, leading to increased renal excretion of carnitine. In terms of treatment, the main recommendations agree that discontinuation of valproate is the most effective therapy, followed by administration of lactulose to reduce ammonium levels. Carnitine supplementation may be useful in the following cases: for seizure disorders in children at risk of developing carnitine deficiency, in VPA poisoning and in VPA-induced hepatotoxicity. Disclosure of Interest None Declared

Background Stratification of the severity of infection is currently based on the Sequential Organ Failure Assessment (SOFA) score, which is difficult to calculate outside the ICU. Biomarkers could help to stratify the severity of infection in surgical patients. Methods Levels of ten biomarkers indicating endothelial dysfunction, 22 indicating emergency granulopoiesis, and six denoting neutrophil degranulation were compared in three groups of patients in the first 12 h after diagnosis at three Spanish hospitals. Results There were 100 patients with infection, 95 with sepsis and 57 with septic shock. Seven biomarkers indicating endothelial dysfunction (mid‐regional proadrenomedullin (MR‐ProADM), syndecan 1, thrombomodulin, angiopoietin 2, endothelial cell‐specific molecule 1, vascular cell adhesion molecule 1 and E‐selectin) had stronger associations with sepsis than infection alone. MR‐ProADM had the highest odds ratio (OR) in multivariable analysis (OR 11·53, 95 per cent c.i. 4·15 to 32·08; P = 0·006) and the best area under the curve (AUC) for detecting sepsis (0·86, 95 per cent c.i. 0·80 to 0·91; P

El objetivo del estudio fue determinar mediante un análisis de la edafo-climo-toposecuencia la distribución de los suelos en la subcuenca del río Mira, utilizando geoinformación (geomorfología, suelos, cobertura de las tierras), generada por el Instituto Espacial Ecuatoriano y SIGTIERRAS, y utilizando un Sistema de Información Geográfica para el procesamiento de los datos. Mediante el enfoque analítico, se elaboró el mapa geopedológico, determinando 16 unidades de paisaje producto de la agrupación de factores formadores del suelo. La ceniza volcánica es el material del cual se han desarrollado los suelos y dependiendo de su altitud presentan diferentes características: en zonas altas (>3200 m s. n. m.) presentan la mayor acumulación de materia orgánica (confiriendo coloraciones oscuras); en zonas intermedias (1600 a 3200 m s. n. m.) se pueden observar suelos con mayor evolución pedogenética, meteorización de arcillas, ricos en materia orgánica, de color pardo oscuro y elevada saturación de bases; y en zonas bajas (

Introduction The close association among thyroid metabolism, mood disorders and behavior has long been known. The role of basal thyroid axis in antidepressant treatment response is less known. Objectives The aim of the present study was to study the association of basal serum thyrotropin (TSH) levels, with antidepressant treatment response in major depressive disorder. Methods Thirty-one depressed adult outpatients were included. Major depressive episode was diagnosed through the MINI (DSM-IV-TR) interview. Clinical symptomatology and blood samples were assessed at baseline, and at 4- and 8-weeks of either escitalopram or sertraline. Treatment response was defined by an improvement ≥50% in MADRS scores at 4-, and 8-weeks. Basal TSH levels were included in a linear regression model as predictor of treatment response. Results Twenty-seven patients finished 8-weeks of treatment. Response to treatment was of 74% at 4-weeks, and 63% at 8-weeks of antidepressant treatment. Basal median TSH levels were between normal ranges (M+SD=1.85+1,02 mlU/L). Basal TSH levels not correlated with basal MADRS scores, but with higher MADRS scores at week-4 (r=0,415, p=0,031) and at week-8 (r=0,392, p=0,043). Moreover, less baseline TSH levels trend to be a significant good predictor for treatment response at 4-weeks (R2=.116, p=.083); and a good predictor at 8-weeks treatment (R2=.147, p=.049). Conclusions Baseline TSH levels even within the normal range may play a role in predicting antidepressant response. Disclosure No significant relationships.

Background: Tuberculous meningitis (TBM) occurs in 1–5% of cases of tuberculosis. Without early treatment, mortality and permanent disability rates are high. Methods: A retrospective study performed at a tertiary hospital in Madrid (Spain) to describe clinical, diagnostic, and therapeutic aspects of TBM and analyze epidemiological trends over forty years, divided into two intervals (1979−1998 and 1999−2018). Results: Overall, TBM was diagnosed in 65 patients (1.8% of new tuberculosis diagnoses), 48 in the first period and 17 in the second one. Median age at diagnosis increased from 38.5 to 77 years (p = 0.003). The proportion of non-HIV immunosuppressed patients increased (from 2.1% to 29.4%, p < 0.001), while the percentage of patients with a history of drug-abuse decreased (from 33.3% to 5.9%, p = 0.027). The median time between the onset of neurological symptoms and lumbar puncture increased from seven to 15 days (p = 0.040). The time between the onset of symptoms and the initiation of tuberculostatic treatment also increased from eleven to 18 days (p = 0.555). Results from image, biochemical, and microbiological tests showed no differences between both periods. A decreasing trend was observed in survival rates at 1-week (from 97.9% to 64.7%, p < 0.001), 1-month (from 91.7% to 58.8%, p = 0.002) and 1-year (from 85.4% to 47.1%, p = 0.002) after TBM diagnosis. Conclusions: The profile of patients diagnosed with TBM has changed from a young HIV-infected patient with a history of drug addiction to an elderly patient with non-HIV immunosuppression. Diagnosis and start of treatment both experienced a noticeable delay in the second period, which could help explain the increase in mortality observed across the two periods.

Abstract Background Congenital heart disease (CHD) is the most prevalent congenital malformation affecting 1 in 100 newborns. While advances in early diagnosis and postnatal management have increased survival in CHD children, worrying long-term outcomes, particularly neurodevelopmental disability, have emerged as a key prognostic factor in the counseling of these pregnancies. Methods Eligible participants are women presenting at 20 to

Spinal teratomas that occur in adulthood are rare. The most accepted theory is that of a disembryogenic origin, but in this case we present the theory of misplaced germ cells.We present a 54-year-old male with saddle hypoesthesia, 3/5 paraesthesia of the lower extremities, urinary incontinence, loss of anal sphincter tone, and patellar and achilles hyporeflexia, of 10 months’ evolution. The MRI showed a heterogeneous, cystic and solid intramedullary lesion with defined edges. Laminoplasty surgery of L2 to L4 and complete resection of the lesion was performed. The histopathological study found a mature teratoma.The incidence of intraspinal teratomas is very low. There are two theories: the disembryogenic theory (most accepted) and the misplaced germ cell theory (our case). This pathogenesis of teratoma formation involves a niche of pluripotent cells from the primitive knot or a caudal cell mass that may precede the formation of a dysraphism. In this modified theory, teratoma growth sometimes causes disruption of the development field and dysraphism. Resumen: Los teratomas espinales, son raros que se presenten en edad adulta. La teoría más aceptada es disembriogénica, pero en este caso exponemos la teoría de células germinales del fuera de lugar.Presentamos un masculino de 54 años, de 10 meses de evolución con hipoestesia en silla de montar, parestesia miembros pélvicos 3/5, incontinencia urinaria, tono de esfínter anal ausente, hiporeflexia patelar y aquilea. RMN lumbar muestra lesión tumoral heterogénea intramedular, quística y solida, bordes definidos. Se realiza cirugía de laminoplastia de L2-L4 y resección total de lesión tumoral, con resultado del estudio histopatológico de Teratoma maduro. La incidencia de teratomas intraespinales es muy baja. Existen 2 teorías: teoría disembiogénica (más aceptada) y teoría de células germinales fuera de lugar (nuestro caso). Esta patogénesis de formación de teratoma tiene nicho de células pluripotentes a partir de nodos de Hensen o masa celular caudal que puede preceder a la formación de disrafismo. Esta teoría modificada, del crecimiento de teratoma a veces causa interrupción del campo del desarrollo y disrafismo. Keywords: Teratoma, Spinal tumour, Mollaret's meningitis, Aseptic meningitis, Intradural, Misplaced germ cell theory, Palabras clave: Teratoma, Tumour espinal, Meningitis Mollaret, Meningitis aséptica, Intradural, Teoría de las células germinales fuera de lugar

Background: Special attention is required when considering any educational intervention aimed at its promotion and development. Our objective is to conduct an umbrella review of systematic reviews that gather evidence from relationships and sex education programmes tailored for individuals with intellectual disabilities. Methods: The protocol was developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses Protocol. Systematic reviews were identified through a search in Web of Science, SCOPUS and PsychINFO, using the descriptors: 'intellectual disab*' AND 'sex*'AND 'systematic'. Findings: The results of the nine reviews included in the meta-review yield relevant outcomes related to 50 sex education interventions carried out with people with intellectual disabilities. This provided the opportunity to delve into the characteristics of these interventions to ascertain the accomplishments achieved to date. Conclusions: The findings serve as foundation to propose and promote new research on this important area of life, addressing the inequalities identified concerning the sexuality and affective-sexual education of people with intellectual disabilities. It offers valuable information for the educational, social and healthcare fields, facilitating the design of more effective and rights-respecting initiatives.

Post-fire management should be based on a proper evaluation of fire damage (burn severity), mainly for Large Fires (>500 ha). Several methodologies have been developed based on remote sensing information validated with fieldwork. The most widespread techniques was the assessment of fire severity indices obtained from remote sensing. It allow a quick assessment of large areas at affordable costs, although the analysis of soil burn severity and the degree of agreement with the ground truth is not fully reliable. Our study case was the Donceles fire (summer 2012, Hellín, Albacete). The post-fire restoration planning, emergency actions, was based on cartographic information of burn severity. To optimize results in a short time and low budget, we applied methodologies in a similar way other similar fires in the Mediterranean peninsular area. We assessed burn severity by using spectral indices (NDVI, dNBR, RdNBR and RBR) and images from Landsat-7 (including banded) and Deimos-1. For each index, we developed both supervised and unsupervised classifications, using field data as training areas. The highest overall reliability values were found for dNBR (79%) and NBR (71%), obtaining low values with RdNBR. In all cases, the reliability was higher using the supervised classification, so using real-ground data to identify the categories of severity to be discriminated. We conclude the need to extend fire studies in our area to improve the reliability of the fire severity assessment obtained from spectral indexes, thus establishing a protocol of data collection and standard methodology of calculation adapted to the characteristics of the region.

Antecedentes: El uso crónico de antiinflamatorios no esteroideos (AINE) puede provocar complicaciones en el tracto gastrointestinal. Para prevenirlas, se recomienda el uso de inhibidores de la bomba de protones (IBP) en los enfermos de alto riesgo. Objetivo: Evaluar las medidas de gastroprotección en personas que usan AINE en forma crónica. Material y métodos: Estudio descriptivo y transversal. Se revisaron los expedientes clínicos de los enfermos que acudían a la consulta externa de reumatología durante 4 meses y se eligieron a los que utilizaban AINE de forma crónica. Se buscaron intencionadamente las medidas de gastroprotección de acuerdo con las recomendaciones publicadas por el Colegio Americano de Gastroenterología. Resultados: Se incluyó a 417 pacientes (347 mujeres; edad promedio= 48.12 ± 14.2 años). El diagnóstico más frecuente fue artritis reumatoide (65%). Nueve pacientes (2.1%) tenían historia de úlcera péptica. Cuarenta y ocho (11.5%) enfermos tenían 65 años o más. Veintiséis (6.2%) tomaban AINE y aspirina, y 130 (31.2%) AINE con esteroides. En 53 casos (12.7%) se conocía el estatus de infección por Helicobacter pylori que fue positivo en solo 9 (16%). En 211 casos se estableció algún riesgo para toxicidad gastrointestinal y solo 65 (30.8%) recibía gastroprotección. En cambio, 31 (15%) lo recibieron sin ninguna indicación. Conclusión: La profilaxis con IBP en usuarios crónicos de AINE se emplea de manera inadecuada. En su mayoría no se indica (69.2%) y en otras se utiliza sin justificación (15%).

Introduction and aims: The chronic use of nonsteroidal anti-inflammatory drugs (NSAIDs) can cause complications in the gastrointestinal tract. The use of proton pump inhibitors (PPIs) is recommended in high-risk patients to prevent them. Objective: The aim of this article was to evaluate the gastroprotection measures taken in persons with chronic NSAID use. Materials and methods: A descriptive cross-sectional study was conducted. The clinical records were reviewed of patients seen as outpatients at the Rheumatology Department over a 4-month period, choosing those with chronic NSAID use, and intentionally looking for gastroprotection measures according to the recommendations published by the American College of Gastroenterology. Results: A total of 417 patients (347 women; mean age: 48.12 ± 14.2 years) were included. The most frequent diagnosis was rheumatoid arthritis (65%). Nine patients (2.1%) had a history of peptic ulcer, 48 (11.5%) patients were 65 years of age or older, 26 (6.2%) patients took NSAIDs and aspirin, and 130 (31.2%) took NSAIDs with steroids. Tests for Helicobacter pylori infection were done in just 53 cases, and there were positive results in only 9 (16%). Some risk for gastrointestinal toxicity was established in 211 cases and only 65 (30.8%) received gastroprotection. In contrast, 31 (15%) patients received gastroprotection when there was no indication for it. Conclusion: Prophylaxis with PPIs in chronic NSAID users was inadequately employed. It was not prescribed in the majority of patients (69.2%) and it was used with no justification in others (15%).

Background: Our study was designed to assess the effects of GHD on nutritional and metabolic parameters, brain natriuretic peptide (BNP) levels, and left ventricular mass (LVM) in prepubertal children and after short-term GH replacement therapy.Materials and Methods: This prospective study enrolled 81 children. We compared 40 GHD children (16 males and 24 females) to 41 healthy children (control group) (18 males and 23 females). All subjects were at Tanner Stage I (aged 7–11 years). At the baseline, a blood sample was drawn and echocardiographic images were obtained. These tests were repeated on the GHD subjects after 6 months of GH replacement therapy. Body surface, weight, size, blood pressure, heart rate, glucose, insulin, HOMA-IR, HOMA-β, QUICKI, cholesterol, HDLc, LDLc, triglycerides, IGF1, and IGFBP3 were measured. Indexed LVM, diastolic and systolic diameter (dD-sD), diastolic and systolic LV function, isovolumic relaxation time, right ventricle function, and BNP levels were obtained through echocardiography. These parameters were correlated to growth factors. Data were analyzed using Student's t-test or U-Mann–Whitney-test and Pearson's correlation, considering p < 0.05 to be significant.Results: Indexed LVM was smaller in GHD patients than in controls, whereas diastolic and systolic functions, BNP, metabolic, and nutritional profiles were similar. After treatment, nutritional and metabolic profiles significantly improved, though diastolic and systolic functions did not seem to have changed. There was a significant increase in LVM. Indexed LVM was similar to that of controls. Significant correlations were obtained between LVM-IGF1 and sD-IGFBP3.Conclusions: GHD in childhood is associated with a lower indexed LVM. In the short-term, GH increases the indexed LVM, while maintaining normal systolic and diastolic functions, BNP, and an improved lipid profile.

The prevalence of cow's milk protein allergy (CMPA) has increased in recent years, and is associated with antimicrobial use during the perinatal period, prematurity, the type of childbirth, and the decrease in breastfeeding. The aim of this study was to analyze whether there is any association between these factors and the development of CMPA. Material and methods: A retrospective, comparative, cross-sectional, observational study was conducted by reviewing the case records of 101 children diagnosed with CMPA and seen at the Department of Gastroenterology and Nutrition of the Instituto Nacional de Pediatría within the time frame of January 2012 and August 2013. The following variables were included: age, sex, weeks of gestation, history of maternal infection and antimicrobial use during the pregnancy, type of delivery, and feeding with human milk, and its duration. Likewise, the case records of 90 children were reviewed as a control group on not having CMPA or any other allergy. The chi-square test was used for proportions, and the Mann-Whitney U test was used for comparing means in the statistical analysis. Results: The factors associated with CMPA were the use of antimicrobials during gestation and breastfeeding duration in months. Both factors were statistically significant (P

La alergia a las proteínas de la leche de vaca se ha incrementado en los últimos años, asociado al uso de antimicrobianos en el periodo perinatal, prematuridad, el tipo de nacimiento y la disminución de la lactancia materna. El objetivo de este estudio fue analizar si existe alguna asociación entre estos factores y el desarrollo de alergia a las proteínas de la leche de vaca (APLV). Material y métodos: Estudio comparativo, retrospectivo, transversal, observacional. Se revisaron los expedientes de 101 niños con diagnóstico de APLV que asistieron al Departamento de Gastroenterología y Nutrición del INP de enero de 2012 a agosto de 2013. Se incluyeron las siguientes variables: edad, sexo, semanas de gestación, antecedente de infecciones y uso de antimicrobianos en la madre durante el embarazo, tipo de parto, alimentación con leche materna y duración de la misma. Así mismo se revisaron los expedientes de 90 niños como grupo control sin APLV ni otro tipo de alergias. Para el análisis estadístico se utilizo prueba de Chi cuadrado para proporciones o U-Mann-Whitney en el caso de comparación de medias. Resultados: Se encontró que los factores asociados a APLV fueron el uso de antimicrobianos en la etapa gestacional y la duración en meses de la lactancia materna; en todos ellos existió una diferencia estadísticamente significativa (p

Resumen: Introducción: El análisis instrumental de marcha (AIM) es una tecnología de uso creciente en la evaluación de trastornos motores infantiles. La evaluación de pacientes requiere una base de referencia de normalidad, pero existen pocas referencias infantiles españolas. Objetivo: Descripción de 16 variables de marcha de relevancia clínica en una muestra de referencia de escolares sanos. Estudio de sus relaciones lineales y asimetrías izquierda-derecha. Sujetos y métodos: Se midieron con AIM 16 variables de marcha en escolares sanos (n = 27, 5-13 años). Se estudiaron las asimetrías en cada variable (t de Student, muestras dependientes) y sus intervalos de confianza (95% de la media de diferencia estandarizada derecha menos izquierda, dz). Se representaron los valores y las asociaciones entre variables mediante «heatmap». Resultados: Se aportan tablas de normalidad para 16 variables del ciclo de marcha. Son significativamente asimétricos los valores medios de flexión mínima de cadera (dz: 0,25 IC del 95%, 0,11-0,39) y de máxima abducción de cadera en el balanceo (dz: -1,05 IC del 95%, –1,71; –0,27). Existen asociaciones funcionales entre las variables de marcha. Conclusiones: Presentamos una muestra de normalidad de escolares españoles donde se observan asimetrías entre los lados izquierdo y derecho y organización funcional entre sus variables. Abstract: Introduction: Instrumental gait analysis is an emerging technology used increasingly to evaluate motor disorders in children. Normal reference data is necessary in order to evaluate patients, but there are few reference resources for the Spanish paediatric population. Objective: We aim to describe the values of 16 clinically relevant gait variables in healthy Spanish schoolchildren, and identify any linear associations or left-right asymmetries. Subjects and methods: The values of 16 gait variables were determined in schoolchildren (n = 27, aged 5-13 years) using instrumental gait analysis. We analysed asymmetries for each variable (Student's t-test for dependent samples) and calculated their confidence intervals (95% of the standardised difference in right and left means [SMD]). Values and associations between variables were represented using a heat map. Results: Our project presents normal values tables for 16 variables in the gait cycle. Significant asymmetries were detected in the mean values for minimum hip flexion (SMD: 0.25 95% CI, 0.11-0.39) and peak hip abduction in swing (SMD: −1.05 95% CI: −1.71- − 0.27). Functional associations among gait variables are present. Conclusions: We present a reference dataset for Spanish school-aged children in which left-right asymmetries and functional associations may be observed for different variables. Palabras clave: Análisis multivariante, Marcha, Niño, Salud, Movimiento, Keywords: Multivariate analysis, Gait, Children, Health, Movement

Introduction: Instrumental gait analysis is an emerging technology used increasingly to evaluate motor disorders in children. Normal reference data is necessary in order to evaluate patients, but there are few reference resources for the Spanish paediatric population. Objective: We aim to describe the values of 16 clinically relevant gait variables in healthy Spanish schoolchildren, and identify any linear associations or left–right asymmetries. Subjects and methods: The values of 16 gait variables were determined in schoolchildren (n = 27, aged 5–13 years) using instrumental gait analysis. We analysed asymmetries for each variable (Student's t-test for dependent samples) and calculated their confidence intervals (95% of the standardised difference in right and left means [SMD]). Values and associations between variables were represented using a heat map. Results: Our project presents normal values tables for 16 variables in the gait cycle. Significant asymmetries were detected in the mean values for minimum hip flexion (SMD: 0.25; 95% CI: 0.11–0.39) and peak hip abduction in swing (SMD: −1.05; 95%: CI −1.71 to −0.27). Functional associations among gait variables are present. Conclusions: We present a reference dataset for Spanish school-aged children in which left–right asymmetries and functional associations may be observed for different variables. Resumen: Introducción: El análisis instrumental de marcha (AIM) es una tecnología de uso creciente en la evaluación de trastornos motores infantiles. La evaluación de pacientes requiere una base de referencia de normalidad, pero existen pocas referencias infantiles españolas. Objetivo: Descripción de 16 variables de marcha de relevancia clínica en una muestra de referencia de escolares sanos. Estudio de sus relaciones lineales y asimetrías izquierda-derecha. Sujetos y métodos: Se midieron con AIM 16 variables de marcha en escolares sanos (n = 27, 5–13 años). Se estudiaron las asimetrías en cada variable (t de Student, muestras dependientes) y sus intervalos de confianza (95% de la media de diferencia estandarizada derecha menos izquierda, dz). Se representaron los valores y las asociaciones entre variables mediante “heatmap”. Resultados: Se aportan tablas de normalidad para 16 variables del ciclo de marcha. Son significativamente asimétricos los valores medios de flexión mínima de cadera (dz: 0,25; IC del 95%: 0,11–0,39) y de máxima abducción de cadera en el balanceo (dz: −1,05; IC del 95%: −1,71, −0,27). Existen asociaciones funcionales entre las variables de marcha. Conclusiones: Presentamos una muestra de normalidad de escolares españoles donde se observan asimetrías entre los lados izquierdo y derecho y organización funcional entre sus variables. Keywords: Multivariate analysis, Gait, Children, Health, Movement, Palabras clave: Análisis multivariante, Marcha, Niño, Salud, Movimiento

We evaluated the clinical, parasitological and immunological effects of a Venezuelan strain of Trypanosoma evansi (T. evansi) throughout in experimentally inoculated rabbits over the course of infection and compared them with the same aspect in healthy animals. Body temperature was recorded in degrees Celsius, animal weight in kilograms, serum proteins in g/dl using a refractometer, haematocrit percentage by capillary centrifugation and the anti-T. evansi IgG titer by indirect ELISA immunoassay, from both infected animals and controls for 95 days. Infected animals showed a higher body temperature, total serum protein and anti- T. evansi antibody titer, and a lower haematocrit and weight gain than controls. These differences were related to the presence of the parasites in the blood as detected micro-haematocrit centrifugation technique (MHCT) and direct microscopic examination (DME). This study confirms the usefulness of rabbits as a model for the study of trypanosomosis; the clinical features of the disease can be observed and the three characteristic stages, prepatent period, acute and chronic phase clearly defined over the course of the infection.

Resumen: Objetivo: Evaluar el patrón de pacientes a los que se realiza monitorización prolongada Video-EEG en un centro especializado en epilepsia y valorar la utilidad de dicha técnica en la epilepsia farmacorresistente. Métodos: Se realizó el estudio y análisis prospectivo de la monitorización de 100 pacientes consecutivos con epilepsia farmacorresistente correspondientes a un solo centro. Se analizaron los datos demográficos de la serie, el tiempo trascurrido hasta la primera crisis, las maniobras de provocación de crisis y el rendimiento de la prueba (utilidad del test, cambio de actitud, mejoría en el ajuste farmacológico y mejoría quirúrgica). Se realizó un subanálisis en diferentes grupos diagnósticos. Resultados: El estudio se realizó fundamentalmente en población joven (34,4 años) y la media de horas trascurridas hasta la primera crisis fue de 30, requiriendo en la mayoría de pacientes (90%) retirar la medicación antiepiléptica. Pese a ello, no se produjo ningún caso de status epiléptico. La utilidad del test fue elevada en todos los grupos permitiendo cambiar el manejo de los pacientes en un 65%, lo cual se tradujo en mejorías tanto a nivel farmacológico como quirúrgico. Conclusión: La monitorización prolongada Video-EEG es una técnica adecuada para el estudio de pacientes con una epilepsia farmacorresistente, siendo el mayor problema en nuestro medio su difícil accesibilidad. Abstract: Objective: To evaluate the characteristics of patients on whom long-term Video-EEG monitoring is performed in a specialist centre and to assess its suitability to study refractory epilepsy patients. Methods: A prospective analysis and study of Video-EEG monitoring was performed in a series of 100 refractory epilepsy patients from a single centre. The analysis included demographic data, the time until the first seizure, the methods used to provoke seizures, and the outcome (usefulness, change in the management, pharmacological and surgical improvement). A subgroup analysis based on diagnosis was performed. Results: The study was performed mainly on young people (mean 34.4 years) and the first seizure appeared in a mean of 30 hours, requiring most of the patients to withdraw the medication. Nevertheless, there were no cases of status epilepticus. The usefulness of the test was high in all the groups. The management was changed in 65% of the patients with pharmacological and surgical improvement. Conclusion: Long-term Video-EEG monitoring is a suitable test to study refractory epilepsy patients. The main problem in our country is accesibility. Palabras clave: Video-EEG, Farmacorresistente, Epilepsia, Cirugía, Keywords: Video-EEG, Refractory, Epilepsy, Surgery

Objective: To evaluate the characteristics of patients on whom long-term Video-EEG monitoring is performed in a specialist centre and to assess its suitability to study refractory epilepsy patients. Methods: A prospective analysis and study of Video-EEG monitoring was performed in a series of 100 refractory epilepsy patients from a single centre. The analysis included demographic data, the time until the first seizure, the methods used to provoke seizures, and the outcome (usefulness, change in the management, pharmacological and surgical improvement). A subgroup analysis based on diagnosis was performed. Results: The study was performed mainly on young people (mean 34.4 years) and the fi rst seizure appeared in a mean of 30 hours, requiring most of the patients to withdraw the medication. Nevertheless, there were no cases of status epilepticus. The usefulness of the test was high in all the groups. The management was changed in 65% of the patients with pharmacological and surgical improvement. Conclusion: Long-term Video-EEG monitoring is a suitable test to study refractory epilepsy patients. The main problem in our country is accesibility Resumen: Objetivo: Evaluar el patrón de pacientes a los que se realiza monitorización prolongada Video-EEG en un centro especializado en epilepsia y valorar la utilidad de dicha técnica en la epilepsia farmacorresistente. Métodos: Se realizó el estudio y análisis prospectivo de la monitorización de 100 pacientes consecutivos con epilepsia farmacorresistente correspondientes a un solo centro. Se analizaron los datos demográfi cos de la serie, el tiempo trascurrido hasta la primera crisis, las maniobras de provocación de crisis y el rendimiento de la prueba (utilidad del test, cambio de actitud, mejoría en el ajuste farmacológico y mejoría quirúrgica). Se realizó un subanálisis en diferentes grupos diagnósticos. Resultados: El estudio se realizó fundamentalmente en población joven (34,4 años) y la media de horas trascurridas hasta la primera crisis fue de 30, requiriendo en la mayoría de pacientes (90%) retirar la medicación antiepiléptica. Pese a ello, no se produjo ningún caso de status epiléptico. La utilidad del test fue elevada en todos los grupos permitiendo cambiar el manejo de los pacientes en un 65%, lo cual se tradujo en mejorías tanto a nivel farmacológico como quirúrgico. Conclusión: La monitorización prolongada Video-EEG es una técnica adecuada para el estudio de pacientes con una epilepsia farmacorresistente, siendo el mayor problema en nuestro medio su difícil accesibilidad. Keywords: Video-EEG, Refractory, Epilepsy, Surgery, Palabras clave: Video-EEG, Farmacorresistente, Epilepsia, Cirugía

Background: the efficacy of combination therapy with peginterferon plus ribavirin to eradicate viral infection in patients with chronic hepatitis C (CHC) is well established; moreover, it is able to arrest or even reverse liver fibrosis. Aims: to analyze the measurements of hepatic stiffness as an index of liver fibrosis using transient elastography (TE) in patients who underwent a sustained virological response (SVR) during long-term follow-up; comparing the changes in the severity of fibrosis with non-responders patients. Material and methods: after hepatic fibrosis was studied in three patients with CHC who underwent a SVR during long-term follow up, a prospective study was initiated in 24 patients with CHC who received combination therapy to compare the evolution of fibrosis in those with SVR and those who were non-responders. The genotype of hepatitis C virus (HCV) and the degree of viremia were determined. METAVIR scoring system was used for liver fibrosis. Hepatic stiffness was measured by TE. Results: of the initial three patients pre-treatment liver biopsies revealed active disease and fibrosis (stage 3) in two and mild fibrosis (stage 1) in one. After several years of follow up serum AST/ALT levels were normal and HCV RNA was undetectable in each case; in contrast to the baseline histological assessments of fibrosis, values for hepatic stiffness (3.4-6.9 KPa) were compatible with an absence of any appreciable hepatic fibrosis. In the prospective study, 8 patients underwent a SVR and 16 were non-responders. TE indicated that the severity of hepatic fibrosis in the SVR group improved in 7 (88%) patients, whereas in the non-responder it improved in only 4 (25%) (p < 0.05). The difference between development of severe fibrosis (F ≥ 3) in responders and non-responders was not significant (p = 0.23), possibly due to the small sample size. Conclusions: regression of hepatic fibrosis appears to be common in patients with CHC who undergo a SVR. TE is a simple non-invasive technique that enables multiple assessments of the severity of hepatic fibrosis to be made efficiently during long-term follow-up of patients with CHC who receive combination antiviral therapy.

Newcastle disease virus (NDV) is the causative agent of an economically important disease, which affects all species of birds worldwide. Current vaccination programs for NDV include the use of either low-virulent live-virus vaccines or inactivated vaccines to induce protective immunity while producing minimal adverse effects in birds. In order to further characterize the immune response elicited by live virus and inactivated NDV conventional vaccines in chickens, we evaluated the presence of specific antibodies in different secretions and in tissue culture supernatants of immunized birds. To this end, we analyzed all the samples by ELISA, using an indirect assay set up in the laboratory. Specific anti-NDV IgG antibodies were detected in tracheal and cloacal swabs and tracheal and intestinal washes of immunized animals. We also found specific anti-NDV IgG antibodies in tracheal and intestinal tissue culture supernatants, indicating that the IgG found in swabs and washes was not transudated from serum or, at least, was not all transudated from serum. Knowledge about the mechanisms involved in the immune response of chickens to different NDV vaccines should increase our understanding of the mucosal response against the virus and, eventually, provide new useful information for the development and evaluation of synthetic vaccines.

Diffuse large B-cell lymphoma is the most common form of lymphoma. It usually begins in the lymph nodes; up to 40% may have an extranodal presentation. According to a definition of primary extranodal lymphoma with presentation only in extranodal sites, there are reports of large B-cell lymphomas limited to liver or spleen as separate entities, and to date there have been only three documented cases of primary hepatosplenic presentation. This paper reports a fourth case. Due to a review of the literature and the clinical course of the case reported, we conclude that primary hepatosplenic large B-cell lymphoma has been found predominantly in females older than 60 years. The patients reported had

Hemos desarrollado el programa NUTRISOL, un programa informático destinado al análisis de la ingesta alimentaria mediante la transformación de alimentos a nutrientes. Ha sido elaborado bajo el sistema operativo Windows®, usando el entorno Visual Basic® 6.0. En su elaboración se han usado las tablas de composición de alimentos del CSIC y medidas domésticas de alimentos de uso común en España, siendo posible modificarlas y actualizarlas. También se presentan diversas dietas y datos antropométricos de referencia. Los resultados que aporta pueden procesarse con la mayoría de los programas estadísticos. El programa ofrece tres módulos: 1) Epidemiología nutricional, en el que se pueden crear o abrir bases de datos, gestionar muestras, gestionar la ingesta, consultar contenido de nutrientes y exportar datos para tratarlos con programas estadísticos. 2) Análisis de dietas y recetas, en el que además se pueden crear o modificar las existentes y exportarlas. 3) Solicitud de distintas dietas para patologías prevalentes. También se ofrece un apartado de herramientas independientes en el que se pueden modificar las tablas originales, calcular las necesidades energéticas, las ingestas recomendadas e índices antropométricos. En conclusión, el programa NUTRISOL es una aplicación que funciona en ordenadores tipo PC-compatibles con mínimo equipamiento, con una interfaz "amigable", de uso sencillo, que se puede adaptar a cualquier región, de acceso gratuito y que ha demostrado su utilidad y fiabilidad en distintos estudios epidemiológicos. Además, puede ser un instrumento eficiente para la educación nutricional, la nutrición hospitalaria y la promoción de la salud.We have developed the computer programme NUTRISOL, a nutritional programme destined to analysis of dietary intake by means of the food transformation to nutrient. It has been performed under Windows® operative system, using Visual Basic® 6.0. It is presented in a CD-Rom. We have used the Spanish CSIC Food Composition Table and domestic food measures commonly used in Spain which could be modified and updated. Diverse kind of diets and reference anthropometric data are also presented. The results may be treated using various statistical programmes. The programme contains three modules: 1) Nutritional epidemiology, which allows to create or open a data base, sample management, analyse food intake, consultation of nutrient content and exportation of data to statistical programmes. 2) Analyses of diets and recipes, creation or modification of new ones. 3) To ask different diets for prevalent pathologies. Independent tools for modifying the original tables, calculate energetic needs, recommend nutrient intake and anthropometric indexes are also offered. In conclusion, NUTRISOL Programme is an application which runs in PC computers with minimal equipment in a friendly interface, of easy use, freeware, which may be adapted to each country, and has demonstrated its usefulness and reliability in different epidemiologic studies. Furthermore, it may become an efficient instrument for clinical nutrition and health promotion.

Capital natural y funciones de los ecosistemas: explorando las bases ecológicas de la economía. La naturaleza es a la vez fuente de recursos y sumidero de los residuos generados por el sistema económico. Otros beneficios se obtienen directamente de los ecosistemas sin pasar por procesos de transformación ni por los mercados, como en el caso del aire limpio. Así, la buena salud de la economía y el bienestar humano están en el largo plazo supeditados al mantenimiento de la integridad y la resiliencia de los ecosistemas que la engloban. El que la teoría económica estándar haya ignorado este hecho, ha sido identificado como una causa fundamental de la actual crisis ecológica. Aproximaciones como la economía ecológica y ambiental tratan de poner coto a este tipo de carencias analíticas, desarrollando conceptos y formas de contabilidad que incorporen el papel de la naturaleza y los costes ecológicos derivados del crecimiento económico. Conceptos como el capital natural o las funciones y servicios de los ecosistemas están jugando un papel fundamental en la articulación de una nueva forma de entender la economía. Este artículo ofrece una breve revisión de dichos conceptos y discute posibles aproximaciones para medir su importancia (valor).

El bastidor de los equipos móviles es un elemento que se diseña para no ser reparado, o sea, es el elemento que caracterizala durabilidad del equipo. Para garantizar la resistencia, rigidez y durabilidad del mismo es necesario el empleo de técnicasmodernas de cálculo que permitan su perfeccionamiento desde las etapas de diseño; el Método de los Elementos Finitos(MEF) es una poderosa herramienta de cálculo que goza, a partir de la difusión de potentes ordenadores personales y dediferentes sistemas profesionales de análisis, de gran uso entre los especialistas de cálculo. El presente trabajo trata sobre elanálisis del bastidor principal de la cosechadora cubana de caña de azúcar, modelo KTP-2M, utilizando las técnicas delMEF, con el fin de realizar las necesarias modificaciones que garanticen la resistencia y la rigidez en la parte trasera delbastidor con un menor uso de metal.Palabras claves: Elemento finito, bastidor, cosechadora de caña, resistencia mecánica._____________________________________________________________________________Abstract.The frame for mobile equipment’s is designed to be never repaired. For the higher level of strength, rigidity and durabilityof the frame is necessary the use of new calculation techniques during the first design stage. This work deals with the mainframe analysis of the Cuban sugar cane combine harvester KTP-2M model, using the Finite Element Method in order tomodify the frame assuring the strength and increasing the rigidity in the rear side and using less quantity of metal.Key words: Finite Element, sugar cane combine-harvester, mechanical strength, main frame.

Introduction: detection of early-stage colorectal carcinoma (CRC) -( Dukes' A or B)- provides better survival rates in these patients. Thus, the effectiveness of screening programs in asymptomatic patients or of early diagnosis in symptomatic individuals has been postulated. The aim of this study was to establish whether a delay in diagnosis or other factors are related to CRC stage. Patients and methods: a retrospective study was performed on 96 patients with CRC. Age at diagnosis, gender distribution, intestinal disorders, diagnosis delay, primary sign and -regarding CRC- localization, stage (Dukes') and grade of differentiation (well differentiated; non-well differentiated; poorly differentiated) were recorded. Results: diagnosis delay was 185 ± 190 days. Patients delay in obtaining a diagnosis was 119 ± 158 days. In 40% of patients CRC was diagnosed at an early stage (Dukes' A or B), and in 13% CRC was poorly differentiated. The only factor with an independent effect on Dukes' stage was tumor differentiation (p: 0.0012). Distal location was associated with less advanced tumors without statistical significance (p: 0.156). Conclusion: based on the presented data, a greater effort regarding screening programs for healthy people seems warranted, as improved survival has been demonstrated when diagnosis delay is reduced, particularly in patients with the highest mean delay.Introducción: el diagnóstico precoz del cáncer colorrectal (estadios A y B de Dukes) consigue mejorar las tasas de supervivencia de estos pacientes. Con este objetivo se ha propuesto como estrategia acelerar el diagnóstico de enfermos sintomáticos o realizar cribados en enfermos asintomáticos. El objetivo de este trabajo es identificar los factores que influyen en la extensión tumoral del carcinoma colorrectal, especialmente la demora en el diagnóstico. Material y métodos: estudio prospectivo de una serie de 99 pacientes diagnosticados de carcinoma colorrectal en los que se analizaron las variables: edad, sexo, habito intestinal, ingesta de laxantes, signo o síntoma de presentación, localización tumoral, grados de Dukes, diferenciación histológica y demora diagnóstica definida como el tiempo transcurrido desde el comienzo de los síntomas hasta el diagnóstico endoscópico del tumor. Resultados: el 40% de los enfermos presentaban al momento del diagnóstico un estadio A o B de Dukes. Un 15% de los tumores eran de grado histológico "bien diferenciado' y un 13% "mal diferenciado'. La demora diagnóstica global fue de 185 ± 190 días de los que 119 ± 158 días se debieron al retraso del enfermo en acudir al médico. La única variable que influyó significativamente sobre la extensión tumoral fue el grado de diferenciación (p < 0,05). La localización distal se asoció a menor extensión sin alcanzar significación estadística (p = 0,1). Conclusión: de acuerdo a los datos presentados, parece razonable dirigir fundamentalmente nuestros esfuerzos hacia programas de cribado poblacional que han demostrado reducir significativamente la mortalidad, en lugar de tratar reducir una demora diagnostica que depende fundamentalmente del enfermo.

Se propone un modelo bidimensional para realizar simulaciones computacionales de irregularidades de concentración electrónica, en un rango extendido de altitud centrado en la base de la capa F, e incluyendo la dependencia de las frecuencias de colisiones y de recombinación, con la densidad. El modelo se prueba con diferentes amplitudes de perturbación en una franja limitada. Se encuentra que las amplitudes en un rango medio son más efectivas como efecto desestabilizante. Todos los resultados confirman la predicción de Rayleigh-Taylor hidrodinámica. doi: https://doi.org/10.22201/igeof.00167169p.2005.44.4.238

A bidimensional model is proposed to perform computer simulations of enhanced electron concentration irregularities, in an extended altitude range centered at the bottom of the F layer, and including the dependence of collision and recombination frequencies on density. The model is tested with different perturbation amplitudes in a limited fringe. We find that amplitudes in a medium range are more effective as a destabilising effect. All results confirm the hydrodynamic Rayleigh-Taylor prediction.