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Aim To determinate molecular changes in the downstream epidermal growth factor receptor signaling pathway using serial liquid biopsies in patients with metastatic colorectal tumors (mCRC) under anti-angiogenic treatment. Patients and methods Determination of RAS mutation in primary tissue samples from colorectal tumors was performed in the 23 patients included in the study at diagnosis using quantitative-polymerase chain reaction. Sequential mutations were studied in circulating tumor (ct) DNA obtained from plasma samples. Results Twenty-three patients with RAS-mutated primary tumors were included. In the first ctDNA determination, 17 of these patients were found to have wild-type RAS status. Remarkably, three out of these 17 wild-type cases changed to RAS-mutated in subsequent ctDNA assays. Conclusion Serial liquid biopsies in patients with mCRC might be a useful tool for identifying changes in the RAS mutation status in patients who had undergone previous anti-angiogenic therapy. The understanding of these changes might help to better define the landscape of mCRC and be the path to future randomized studies.

Resumen Objetivo La tomografia de coherencia optica de dominio espectral (SD-OCT) es la herramienta de mayor utilidad para medir el grosor coroideo (GC). El GC puede estar aumentado tanto en las enfermedades oftalmologicas como en las sistemicas. No obstante, existen ciertas inquietudes en relacion con la reproducibilidad y la validez externa de la OCT. El objetivo de este estudio fue determinar la variabilidad interobservador e intraobservador de la medicion manual de la OCT. Metodos El GC fue medido de manera manual en la region central en 40 ojos de 21 sujetos (11 sanos y 10 con espondilitis anquilosante) utilizando RTVue-100 OCT (Optovue Inc., Fremont, CA, EE. UU.). Las mediciones fueron obtenidas por 9 oftalmologos independientes de 6 centros diferentes. Para determinar la variabilidad interobservador se utilizo el calculo del coeficiente de correlacion intraclase (CCI). Tambien la variabilidad intraobservador fue determinada en 2 de los oftalmologos. Resultados La media del GC subfoveal fue de 364,9 ± 85,1 μm (rango, 170-572). El CCI interobservador fue 0,823 (IC 95%, 0,749-0,888; p Conclusiones En este estudio la medicion manual del GC ha demostrado buena concordancia. Los resultados sugieren que la medicion manual con la OCT es un metodo valido para los estudios multicentricos.

Aim To evaluate whether positron-emission tomography/computed tomography with 68Ga-PSMA (68Ga-PSMA PET/CT) influences the therapeutic management of patients with primary or recurrent prostate cancer (PCa). Background Although 68Ga-PSMA PET/CT is one of the best options for staging or restaging patients with PCa, its availability is still very limited in Spain. The present study reports the results of the first group of patients in Spain who underwent 68Ga-PSMA PET/CT imaging. Materials and methods All patients (n = 27) with a histological diagnosis of PCa who underwent 68Ga-PSMA PET/CT prior to the definitive treatment decision at the only centre with this technology in Spain during 2017–2018 were included. Two nuclear medicine physicians and a radiologist reviewed the imaging studies. The clinical impact was assessed from a theoretical perspective, based on the treatment that would have been applied if no data from the 68Ga-PSMA PET/CT were available. Results Most patients (n = 26; 96%) had persistent disease or biochemical recurrence after radical prostatectomy, radiotherapy, or combined treatment. One patient underwent 68Ga-PSMA PET/CT imaging to stage high-risk PCa. Overall, 68Ga-PSMA PET/CT was positive in 19 patients (70.4%). In 68.75% of these patients, none of the other imaging tests—MRI, CT, or bone scans—performed prior to the 68Ga-PSMA PET/CT were able to detect the presence of cancerous lesions. Overall, the findings of the 68Ga-PSMA PET/CT led to a modification of the therapeutic approach in 62.96% of the patients in the study. Conclusions 68Ga-PSMA PET/CT alters the therapeutic approach in a substantial proportion of patients with PCa. Sin financiación No data JCR 2020 0.367 SJR (2020) Q3, 253/354 Oncology No data IDR 2020 UEM

Dimethyl fumarate (DMF) tolerability and safety in multiple sclerosis (MS) has been analyzed in randomized clinical trials. Real-life studies are needed to assess possible harms of this therapy in a wider MS population. To evaluate DMF tolerability, safety and persistence in MS in a real-world setting. We conducted a multicenter prospective study of patients who started DMF, attended in 16 public hospitals of Spain. A specific database was elaborated to collect data on most frequent adverse events (AE). Regression models were used to analyze the effect of demographic and clinical characteristics on risk of AEs and DMF discontinuation. We collected data of 886 patients (2681 patients/years-exposition) with median 39.5 (IQR 23, 51.5) months on DMF exposure; 25.3% were treatment naive and 74.7% switched to DMF from other disease-modifying therapies. DMF was discontinued in 29.9% of patients, in 13.2% due to AEs and in 13.5% to inefficacy. AEs were experienced by 71.2%, being flushing the most frequent (44.1%), 5.4% developed grade III lymphopenia, without cases of grade IV. Females showed a higher risk of flushing and gastroenteric symptoms (OR 1.49, p = 0.011; OR 1.69, p = 0.001, respectively); lymphopenia was associated with older age (OR 1.04, p

Objectives:There is evidence that the menopausal transition in women is accompanied by changes in themetabolic profile. We evaluated the lipid profile during the perimenopause to postmenopause transition and itsassociation with menopausal status.Methods:This is a retrospective observational study of laboratory studies from women presenting to thegynecology unit of Hospital Quiro ́ n Salud, Madrid (2007-2018) with irregular menstruation, amenorrhea ormenopausal symptoms. Inclusion criteria were one or more blood samples with determinations of fasting glucoseand lipids (total cholesterol, low-density lipoprotein cholesterol [LDL-c], high-density lipoprotein cholesterol[HDL-c] and triglycerides [TGs]) from women with a menopause diagnosis recorded in the hospital database. Thedeterminations were classified as perimenopausal or postmenopausal based on the date of last menstruation.Results:In total, 13,517 laboratory studies (3,073 perimenopausal and 10,444 postmenopausal) from 275 womenwere analyzed. Total cholesterol, LDL-c, and TG levels were significantly higher in postmenopausal women than inperimenopausal women, whereas HDL-c levels were significantly lower (P

Background: Lymphopenia is a major concern in MS patients treated with dimethyl-fumarate (DMF) as it increases the risk of progressive multifocal leukoencephalopathy. A pronounced reduction in absolute lymphocyte counts (ALCs) early after treatment initiation has been suggested to be associated with the occurrence of lymphopenia thereafter. Objectives: To identify risk factors for DMF-induced lymphopenia and evaluate whether the degree of decrease in the ALCs three months after initiation of DMF treatment is a predictor of the subsequent development of lymphopenia. Methods: In this real-world Spanish prospective multicenter study conducted in MS patients who started DMF between 2014 and 2019, we analyzed the association between DMF-related lymphopenia and the percentage of early ALCs decline using regression models, considering both, significant lymphopenia (grades 2 + 3) and severe lymphopenia (grade 3). The cutoff values of early ALCs declines were obtained using the ROC curve. Results: Among 532 MS patients treated with DMF, 193 (36.3%) developed any grade of lymphopenia. Older age and lower ALCs at treatment onset predicted the risk for lymphopenia but the best predictive risk factor was the reduction of ALCs within the three first months of treatment. Specifically, a reduction in ALCs≥21.2% was associated with a 6.5-fold higher risk of developing significant lymphopenia, and a decrease in ALCs≥40.2% with a 12.7-fold higher risk of developing severe lymphopenia. Conclusions: A pronounced reduction in ALCs early after initiation of DMF in MS patients is the best predictive risk factor for the subsequent development of significant lymphopenia. Sin financiación 4.808 JCR (2021) Q2, 64/212 Clinical Neurology 1.006 JCR (2021) Q1, 472/2489 Medicine (miscellaneous) No data IDR 2020 UEM

Introduction: There are some validated rating scales to assess severity of Essential tremor (ET), the most common cause of action tremor. Clinical evaluation through telematic consultations has been expanding in the last decade. Patients' self-assessment of tremor severity at home could constitute a useful tool in telemedicine. This paper aims to assess intrarater and interrater reliability of ET severity using Fahn-Tolosa Marin Tremor Rating Scale (FTMTRS) for patients' and neurologists' ratings. Material and methods: Patients were instructed on how to perform and rate the FTMTRS tasks. Supervised by neurologists, each patient performed one FTMTRS self-assessment at the hospital, which was rated in a blinded way by two neurologists, and six more self-assessments at home afterwards. Postural, intention and specific-tasks tremor were rated. A cumulative linked mixed model was used to assess intrarater and interrater reliability. Results: A total of 161 self-assessments from 19 patients were analyzed. Intrarater reliability of patients' self-ratings at home showed ICCs between 0.843 and 0.962. Interrater ICCs of neurologists' ratings were also excellent for all tremor types (0.903–0.987). Concordance between neurologists' and patients' assessments showed ICCs ranging from 0.407 to 0.824, with the higher agreement for writing/drawing-related tremor (0.824; CI 95% 0.634–0.989). Conclusions: The rating of ET severity from FTMTRS self-assessments performed by well-trained patients at home could be a suitable clinical measure to assess tremor in non-face-to-face medical consultations. The assessment of tremor during specific tasks could be the most efficient measure for the patient self-assessment at home. These results could be useful in telemedicine. Sin financiación 1.093 SJR (2021) Q1, 24/110 Geriatrics and Gerontology No data IDR 2020 4.402 JCR (2021) Q2, 76/212 Clinical Neurology 1.093 SJR (2021) Q1, 24/110 Geriatrics and Gerontology No data IDR 2021 UEM

Background and objectives Influenza vaccine is recommended for patients with autoimmune inflammatory rheumatic diseases who receive biological therapy. To evaluate if biological therapy impairs immunization after seasonal influenza vaccine. Material and methods Patients with inflammatory arthopathies, psoriasis, inflammatory bowel disease or connective tissue diseases who were receiving or were going to initiate biological therapy were included and vaccinated during 2014–2015 influenza season. ELISA was used to measure influenza antigen A and B antibodies, before and after vaccination. Demographic parameters, diagnosis and kind of treatment were recorded and their influence on the final serological status against influenza was studied. Results 253 subjects were analyzed. After vaccination, 77% of participants presented detectable antibodies against antigen A and 50.6% of them had detectable antibodies against antigen B. Final seropositivity rate against antigen B antibodies increased from baseline (50.6% vs 43.5%, p

Fundamentos: Una cuarta parte de los pacientes con fractura de cadera por fragilidad (FCF) son hombres, y estos presentan una mortalidad mayor que las mujeres. El objetivo de este trabajo es estudiar la mortalidad consecuencia de la FCF en hombres ≥65años, tanto intrahospitalaria como al año y a los 3años, y los posibles factores asociados. Material y métodos: Estudio observacional analítico de una cohorte histórica de 182 pacientes varones con FCF ≥65años ingresados en un servicio de Cirugía Ortopédica y Traumatología (COT) entre enero de 2009 y diciembre de 2014. Resultados: La mortalidad intrahospitalaria fue del 10,9% (6% en el servicio COT y 8,6% en el centro sociosanitario). Se encontró asociación entre la mortalidad intrahospitalaria y la edad (p=0,039). Veinte pacientes murieron durante su estancia en ambos hospitales. Cuarenta y dos (25,9%) murieron un año después y 95 (58,6%) murieron 3años después. La demencia/deterioro cognitivo se relacionó con un riesgo relativo de mortalidad a un año de 2,2, y de mortalidad a 3años de 1,6. Encontramos asociación entre la edad y la mortalidad y entre el índice de Barthel al inicio y la mortalidad en ambos períodos. Las causas más frecuentes de muerte fueron cardiovasculares (15,7%) y tumores (13,6%). Conclusiones: Los varones con FCF presentaron una mortalidad elevada tanto intrahospitalaria, como al año y a los 3años. El factor de riesgo más determinante de mortalidad al año es la demencia/deterioro cognitivo, y el de mortalidad a los 3años, la HTA. Background: A quarter of the patients with fragility hip fracture (FHF) are men, and they have higher mortality rates than women. The objective of this study is to analyse the mortality, as well as associated factors, due to FHF in men aged ≥65years, while in hospital and at one and three years of follow-up. Material and methods: An analytical observational study was conducted on a historical cohort of 182 male patients equal or older than 65 years that were admitted to an Orthopaedic Surgery and Traumatology (OST) Department between January 2009 and December 2014. Results: Within-hospital mortality was 10.9% (6% in the OST Department, and 8.6% in a Social-Health centre). A relationship (P=.039) was found between within-hospital mortality and age. A total of 20 patients died during their stay in both units, 42 (25.9%) died one year later, and 95 (58.6%) died three years later. Dementia/cognitive impairment was associated with a relative risk of one-year mortality of 2.2, and 1.6 of three-year mortality. An association was observed between age and mortality and between Barthel Index at baseline and mortality at both periods. The most frequent causes of death were cardiovascular (15.7%) and tumours (13.6%). Conclusions: Male patients with FHF showed high mortality rates in hospital, and at one-year and three-years follow-up. The most important risk factor of mortality was dementia/cognitive deterioration at one year, and high blood pressure at three years. Sin financiación No data JCR 2019 0.148 SJR (2019) Q3, 33/43 Family Practice No data IDR 2019 UEM

Objective The objectives of this paper were to determine weight status, eating, and alcohol drinking and smoking habits of university students, to determine the association between these variables with negative self-perception of their eating habits and to assess the risk of developing eating disorders. Method A cross-sectional study was carried out on 422 university students. The parameters analysed were: nutritional status, eating habits, alcohol/tobacco consumption, and risk of eating disorder. Logistic regression was applied to identify factors associated with a negative perception of eating habits. Results Out of the whole population that was analysed, 5% were underweight, 16% overweight and 4% obese. Fifty-five percent of the sample analysed did not consume five meals a day. The recommended foods for daily consumption were consumed below recommendations, while sausages/fatty meats, industrial pastries, lean meats, and fish were over-consumed. Overall, the population perceived their eating habits as good/very good (63%). Alcohol and tobacco consumption predominated at weekends. The girls were more image-conscious (80.6% vs. 66%) and fearful of gaining weight (52.5% vs. 23.9%). Almost 30% had a distorted perception of body image. There was a 12.8% risk of atypical anorexia nervosa and 4.7% of atypical bulimia nervosa. Conclusions College students led unhealthy lifestyles, mainly due to eating habits that do not conform to the establish recommendations. More than 17% are at risk of developing an atypical eating disorder. This information may be of interest in developing preventive actions.

Introduction:Graft is an alternative to native arteriovenous fistula to ensure permanent vascular access in hemodialysis patients. The most common complication is significant stenosis, which frequently causes thrombosis and graft loss. Periodic monitoring and surveillance with elective correction of stenotic lesions can prolong graft survival.Objective:To describe the effect of early diagnosis of significant stenosis on the rate of thrombosis and graft patency.Methods:Retrospective, observational study of a cohort of 86 prevalent patients undergoing hemodialysis with a graft as their vascular access. We applied a systematic follow-up protocol of 115 grafts based on various screening methods of monitoring (clinical monitoring, pre-pump arterial pressure, dynamic venous pressure, percentage of recirculation, and dose of dialysis) in conjunction with surveillance (normalized intra-access venous pressure and access flow). The annual rates of thrombosis, and primary, primary-assisted, and secondary patency were assessed.Results:The incidence of significant stenosis and thrombosis was 57.4% (65/115) and 39.0% (45/115), respectively. Of all screening procedures, normalized intra-access venous pressure was the best predictor of significant stenosis (hazards ratio, 7.71; 95% confidence interval, 3.06–19.46). The annual rate of thrombosis fluctuated from 0 to 0.26 thromboses/patient/year, with an average rate of 0.14 thromboses/patient/year. Primary, primary-assisted, and secondary patency were 74%/79%/82%, 50%/60%/66%, and 23%/35%/37% at 1, 2, and 5 years, respectively.Conclusion:The implementation of a systematic graft follow-up protocol combined with monitoring and surveillance enabled early diagnosis and elective correction of significant stenosis, prolonged graft patency, and a low thrombosis rate.

Introduction Advances in medicine have contributed to a higher average life expectancy, as well as an increasing number of chronic diseases patients. This longevity means that the assessment of the quality of life, particularly that related to vision, has become very relevant. Objective The validation of the translation and cross-cultural adaptation into Spanish of one of the most widely used vision-related quality of life questionnaires. It has sought to ensure that the Spanish version of the questionnaire was equivalent in semantic, conceptual, and technical content and criteria level, compared to its already validated English version. Method An analytical observational study was conducted using a cohort of patients, in whom their quality of life related to vision was analyzed. The study was developed in two steps; the first was the translation and cross-cultural adaptation to Spanish of the NEI VFQ-25 questionnaire. The second one was the psychometric study of the reliability and validity of the scale of the Spanish version. Results The analysis of the terms of reliability and validity showed that the translation and cross-cultural adaptation met the expected requirements and was well accepted by users. Conclusion There is now a possibility of having a Spanish validated questionnaire available to assess the quality of life related to vision in patients with chronic diseases, such as age-related macular degeneration.

Background and Aims There is a high prevalence of malnutrition (PEW) in patients on dialysis (HD-PD). There is no single tool to diagnose it, varying the percentage according to the one used. Aim To assess prevalence of malnutrition-inflammation by MIS scale (malnutrition-inflammation-score) in HD or PD patients of Spanish dialysis units. Method We evaluated 2937 patients on dialysis (HD+PD) in Spain were evaluated on the MIS scale strata (Kalantar-Zadeh 1999) also analyzing: Common data Age, sex, dialysis time, Charlson-I., RRF, albumin,prealbumin,Kt/V transferrin, CRP, DM , Specific-HD HD type, AVF or Catheter , Specific-PD PD-type, transport type. Statistical analysis with SPSS.23 software, using parametric and non-parametric test. Results We evaluate 2748 HD patients, median age 71 (RIC20), 65.90% male, median MIS 6 (RIC4), DM 36.91%, T in HD 36m (RIC54), FRR 35.44% , Charlson Index 7 (RIC4) and 186 in PD (62.96% men), median -age 62 (RIC 24), median-MIS 4 (RIC 2), T in PD of 18.5 m (RIC 23.5),DM 30.77%, FRR 79.89%, I Charlson 5 (RIC 4), In PDA 99pac-52.38%. Prevalence of global malnutrition (MIS>2) was 89% considering HD+DP and 50% when MIS>5 (table 1) In PD the higher normonutrides greater Kt/V in manual vs automatic not the malnourished ones. FRR significantly in greater % in normonutrides. No differences in malnutrition depending on carrier type. CRP sig major in MIS>2 and >5 In HD, Normo versus malnourished and with MIS>5 significant difference: HD type, CRP, HD Type, AVF vs catheter, age,sex. The prescription for Oral supplement was low and higher in HD 12.4% vs DP 6.3%. Conclusions 1.- There is a high prevalence of malnutrition on dialysis being higher in HD. 2.- In PD, FRR major and CRP minor in well-nourished versus malnourished. 3.- In HD: Normo versus malnourished and with MIS>5 significant difference: HD type, CRP,Charlson I. AVF vs catheter, age,sex. 4.- There is a percentage of malnourished patients with very low percentage of oral supplement.

OBJECTIVES: The aim of this study was to examine the incidence of coronavirus disease 2019 (COVID-19) among patients with immunomediated inflammatory diseases (IMIDs) treated with biologic or targeted synthetic disease-modifying antirheumatic drugs (bDMARDs and tsDMARDs) and to evaluate the influence of either IMIDs or related therapies on the incidence and evolution of COVID-19. METHODS: This observational, cross-sectional study was conducted from January 31, 2020, to May 15, 2020. Data of 902 patients were obtained from clinical records in hospitals, primary care units, and community pharmacies. Inclusion criteria were adults with IMIDs treated with bDMARDs or tsDMARDs who started therapy 3 months prior to study commencement. Patients with poor adherence to treatments were excluded. COVID-19 was classified as "definitive" (severe acute respiratory syndrome coronavirus 2 polymerase chain reaction [PCR]-positive), "possible" (characteristic symptoms and negative PCR), and "suspected" (characteristic symptoms but PCR not performed). RESULTS: COVID-19 was diagnosed in 70 patients (11 definitive, 19 possible, and 40 suspected). The cumulative incidence of definitive COVID-19 was 1.2%. When considering all cases, the incidence was 7.8%. Patients on biosimilars tumor necrosis factor blockers were more likely to have a diagnosis of COVID-19 (odds ratio, 2.308; p < 0.001). Patients on anti-B-cell therapies had a lower incidence of infections (p = 0.046). Low rates of hospitalization (14.3%), pneumonia (14.3%), death (2.9%), or thrombosis (2.9%) were observed, and 94.3% of patients recovered. CONCLUSIONS: The cumulative incidence of confirmed cases of COVID-19 was similar to the general population, with generally low hospitalization, intensive care management, and mortality rates. COVID-19 incidence was less frequent in patients with more severe immunosuppression.

Patients with different autoimmune inflammatory diseases (AIID) on biological therapy are at risk of pneumococcal disease. Adults with inflammatory arthropathies, connective tissue diseases, psoriasis, or inflammatory bowel disease on biological therapy such as anti-TNFα, rituximab, tocilizumab, abatacept, or anakinra were included in this study. Patients completed a protocol combining the pneumococcal vaccines PCV13 and PPV23. Immune response against pneumococcal serotypes 1, 3, 7F, 14, 19A, and 19F were assessed evaluating functional antibodies by an opsonophagocytosis killing assay (OPKA). In this study, 182 patients with AIID completed the sequential vaccination protocol. Patients on etanercept tended to achieve OPKA titers against a larger number of serotypes than the rest of patients on other biological therapies, while adalimumab was associated to a lower number of serotypes with OPKA titers. Rituximab was not associated with a worse response when compared with the rest of biological agents. Not glucocorticoids, nor synthetic disease-modifying antirheumatic drugs, interfered with the immune response. OPKA titers against serotype 3 which is one of the most prevalent, was obtained in 44% of patients, increasing up to 58% in those on etanercept. Hence, almost 50% of patients on biological therapy achieved functional antibodies after the administration of a complete pneumococcal vaccination protocol. Ministerio de Economía, Industria y Competitividad, Gobierno de España (SAF2017-83388) Sociedad de Reumatología de la Comunidad de Madrid (SORCOM)/ MSD (204151) Pfizer (14151) 4.961 JCR (2021) Q2, 77/161 Immunology 1.004 SJR (2021) Q1, 26/153 Drug Discovery No data IDR 2021 UEM

Objective: The aim of this review was to analyze the effectiveness of workplace exercise interventions on body composition (BC). Data Source: Studies published in PubMed, Scopus, SPORTDiscus, Web of Science, CINAHL and PsycINFO, from the earliest time point until 8 July 2020. Study Inclusion and Exclusion Criteria: Inclusion criteria were worksite interventions, in adults, Randomized Controlled Trials (RCTs), real exercise practice, and measuring BC outcomes. Exclusion criteria were full-text non-available, abstract not in English, and exercise protocol missing. Data Extraction: 157 studies were retrieved and assessed for inclusion by 2 independent reviewers, who also used the Cochrane’s Collaboration Tool to assess study quality and risk of bias. Data Synthesis: We performed a meta-analysis to determine the effect size of the interventions on BC outcomes reported in at least 5 studies. Results: Twelve RCTs were included (n = 1270, 66% women), quality of studies being low to high (25% moderate, 67% high). Interventions achieved a statistically significant decrease in waist circumference (SMD = 0.24; 95% confidence interval (CI): 0.06 to 0.41; p = 0.008), total mass fat (SMD = 0.21; 95%CI: 0.00 to 0.41; p = 0.047), and body adiposity index (SMD = 0.20; 95%CI: 0.00 to 0.41; p = 0.049). No changes were observed in body weight (SMD = 0.08 95%CI: −0.02 to 0.18; p = 0.128). Additionally, muscle mass increased in interventions that included strength training. There were no adverse events reported. Conclusion: The most effective workplace exercise interventions to improve BC combined supervised, moderate-intensity aerobic and strength training, for at least 4 months.

Recent studies in Spain have shown that males, younger workers, and people involved in manual jobs had the highest risk of suffering a work-related eye injury (WREI). This study aims to assess the predictors of sick leave associated with WREI and to compare them with risk factors of initial injury. A retrospective and descriptive study of WREI that causes sick leave of one or more days among workers from an insurance labor mutual company in Spain was conducted over a period from 2008 to 2018. The variables of the study were sex, age, occupation, and type of injury. A total of 9352 (18.6% of 50,265 WREI) cases and 113,395 total days of sick leave were observed, with an estimated EUR 4,994,009.59 of associated labor cost. The main predictors of sick leave related to WREI were found to be female (highest incidence, 25.9 (95% CI (24.8–27.1))), &gt, 55 years of age (highest incidence, 20.5 (95% CI (19.3–21.7))), not working in the industry (lowest incidence, 13.8 (95% CI (13.3–14.2))), and not suffering “other disorders of conjunctiva” (lowest incidence, 5.7 (95% CI (4.7–6.8))). The consequences associated with WREI are worse for female and older workers, despite the main risk of suffering WREI being observed in males and younger workers.

This article belongs to the Special Issue Molecular Approaches to Food Allergy Diagnosis, Treatment and Identification of Allergens., Oral food challenge (OFC) remains the gold standard for the diagnosis of food allergies. However, this test is not without risks, given that severe allergic reactions can be triggered while it is conducted. The purpose of this study is to identify potential demographic variables, clinical characteristics of the patients and biomarkers that may be associated with severe reactions during the hazelnut oral challenge test. The sample included 22 children allergic to hazelnut who underwent a tree nut skin prick test (SPT), specific IgE (sIgE) to hazelnut, component-resolved diagnosis (CRD) with different hazelnut allergens (Cor a 1, Cor a 8, Cor a 9, Cor a 11, Cor a 14), and a single-blind placebo-controlled challenge with hazelnut. A statistically significant relationship was found between the severity of the reaction and the highest values of sIgE to hazelnut, Cor a 11 and Cor a 14, cumulative symptom-triggering dose and sunflower seed sensitization. The use of the CRD is a useful tool to identify patients at higher risk of developing a severe reaction. In this pediatric population sample from Spain, storage proteins were confirmed to be most involved in hazelnut allergy and the development of severe reactions., This research was funded by SEAIC Foundation of the Spanish Society of Allergy and Clinical Immunology.

Objectives to determine the safety and effect of intravenous iron sucrose on functional outcomes, delirium, nosocomial infections and transfusion requirements in older patients with hip fracture. Design single-centre randomised, double-blind, placebo-controlled clinical trial. Setting and participants orthogeriatric share care service at an academic tertiary care hospital. A total of 253 patients were recruited: 126 patients were assigned to intravenous iron and 127 to placebo. Methods on days 1, 3 and 5 after admission, the iron group received 200 mg Venofer® (iron sucrose) in 100 ml saline and the placebo group 100 ml saline. The primary outcome was absolute functional gain, considered as Barthel index (BI) at discharge minus BI on admission. Secondary outcomes included incidence of postoperative delirium according to the confusion assessment method, proportion of patients recovering prior functional status at 3 months, postoperative transfusion requirements, haemoglobin at 3 months, incidence of nosocomial infections and safety. Results the median participant age was 87 (interquartile range, 82.5–91.5) years. Most patients were female (72.7%), and the median previous BI was 81(59–95). No significant effect of intravenous iron was observed for the primary outcome: the median AFG score was 17.1 points (4.8–23.3) in the intravenous iron group and 16 points (6–26) in the placebo group (P = 0.369). No significant treatment effects were observed for other functional outcomes or secondary end points. Conclusion while we found no impact of intravenous iron sucrose on functional recovery, incidence of postoperative delirium, transfusion requirements, haemoglobin at 3 months, mortality and nosocomial infections rates in older patients with hip fracture, we did find that the intervention was safe.

Dimethyl fumarate (DMF) has demonstrated efficacy in phase III studies. However, real-world data are still limited.The objective of this study was to describe the profile of patients who receive DMF and to assess the effectiveness of DMF regarding relapses, disability progression, magnetic resonance imaging activity, and NEDA (No Evidence Disease Activity)-3 status in a Spanish population in a real-world setting.We conducted a multicenter prospective study of patients who started DMF between 2014 and 2019 in Spain. Three subgroups were considered: naïve, switch to DMF because of inefficacy, and switch to DMF because of adverse effects. The effects of DMF on clinical and radiological measures were evaluated.Among 886 patients, 25.3% were naïve, 28.8% switched because of adverse effects, and 45.9% because of inefficacy. Median follow-up was 38.9 (interquartile range 22.6-41.8) months. Annualized relapse rates were 0.15, 0.10, and 0.10 at 12, 24, and 36 months respectively, and 77.7% of patients were relapse free at month 42. At 12, 24, and 42 months, 96.1%, 87.4%, and 79.7% of patients were progression free, respectively. The number of T1 gadolinium-enhancement (T1Gd+) lesions was 0.19, 0.14, and 0.18 at 12, 24, and 36 months. NEDA-3 status at month 42 was maintained by 49.8% of patients. Relapsing was associated with higher annualized relapse rates the year before (hazard ratio 1.34, p0.001) and to the inefficacy switch vs naïve group (hazard ratio 1.76, p = 0.003). A higher baseline Expanded Disability Status Scale score was associated with disability progression (hazard ratio 1.15, p = 0.003) and more T1Gd+ lesions (hazard ratio 1.07, p0.001) with radiological progression. A higher baseline Expanded Disability Status Scale score, a larger number of T1Gd+ lesions, and a switch because of inefficacy (vs adverse events) were all risk factors for losing NEDA-3 status. DMF was discontinued in 29.9% of patients, in 13.5% because of inefficacy.Our findings confirm the sustained effectiveness of DMF on the clinical and radiological activity of multiple sclerosis in a real-world setting, both in naïve patients and in those switching from other multiple sclerosis therapies.

Background The COVID-19 outbreak challenges the Spanish health system since March 2020. Some available therapies (antimalarials, antivirals, biological agents) were grounded on clinical case observations or basic science data. The aim of this study is to describe the characteristics and impact of different therapies on clinical outcomes in a cohort of severe COVID-19 patients. Methods In this retrospective, single-center, observational study, we collected sequential data on adult patients admitted to Hospital Universitario Quironsalud Madrid. Eligible patients should have a microbiological (positive test on RT-PCR assay from a nasal swab) or an epidemiological diagnosis of severe COVID-19. Demographic, baseline comorbidities, laboratory data, clinical outcomes, and treatments were compared between survivors and non-survivors. We carried out univariate and multivariate logistic regression models to assess potential risk factors for in-hospital mortality. Findings From March 10th to April 15th, 2020, 607 patients were included. Median age was 69 years [interquartile range, {IQR} 22; 65% male). The most common comorbidities were hypertension (276 [46·94%]), diabetes (95 [16·16%]), chronic cardiac (133 [22·62%]) and respiratory (114 [19·39%]) diseases. 141 patients (23·2%) died. In the multivariate model the risk of death increased with older age (odds ratio, for every year of age, 1·15, [95% CI 1·11 - 1·2]), tocilizumab therapy (2·4, [1·13 - 5·11]), C-reactive protein at admission (1·07, per 10 mg/L, [1·04 - 1·10]), d-dimer > 2·5 μg/mL (1·99, [1·03 - 3·86]), diabetes mellitus (2·61, [1·19 - 5·73]), and the PaO2/FiO2 at admission (0·99, per every 1 mmHg, [0·98 - 0·99]). Among the prescribed therapies (tocilizumab, glucocorticoids, lopinavir/ritonavir, hydroxychloroquine, cyclosporine), only cyclosporine was associated with a significant decrease in mortality (0·24, [0·12 - 0·46]; p

ObjectiveTo describe the epidemiological characteristics and trends of work-related eye injuries (WREIs) in Spain over a 10-year period by sex, age and occupational sector.Design and settingsA descriptive, retrospective and longitudinal study based on data from workers insured by a labour insurance company in Spain from 2008 to 2018 was presented. The study considered the ratio of the number of WREI per 100 000 population and the relative risk of suffering an ocular injury. WREIs were characterised by sex, age and occupational sector of injured workers.Primary and secondary outcome measuresRatio of the number of WREI.ParticipantsIn Spain, all workers are insured by a labour insurance company that provides cover in the event of work-related accidents. In this study, we have included all workers insured by one of these insurance companies, IBERMUTUA, with workers in all areas of Spain.ResultsThe study included 50 265 WREI in the company over the 10-year period. Most of the injuries occurred in males (44 445; 88.4%), in 35–44 age group (15 992; 31.8%) and in industry workers (18 899; 42.6%). The average incidence was 429.75 per 100 000 workers insured and 4273.36 per 100 000 IBERMUTUA accidents (related and not related to eyes). Males, 16–24 age group and industry occupational sector group, have the highest incidence for WREI. The incidence of WREI decrease over the study period in all variables. Males have 6.56 (95% CI 6.38 to 6.75) times more risk of suffering WREI than females. 16–24 age group have 1.77 (95% CI 1.71 to 1.83) times more risk than in the group of workers older than 55. Finally, industry workers have 7.73 (95% CI 7.55 to 7.92) times more risk than services workers.ConclusionsThe risks of suffering WREI is higher for males, younger and less experienced workers, and for those who works in a manual task.

OBJECTIVE Choroidal thickness (CT) has been evaluated as a marker of systemic inflammation in ankylosing spondylitis (AS). This study evaluates the CT of AS patients before and after 6 months of biological treatment. METHODS This longitudinal multicenter study evaluated CT in 44 AS patients. The correlations between CT and C-reactive protein (CRP) with disease activity indices were calculated. The concordance between CT and CRP was determined. We assessed factors associated with response to treatment. Clinically important improvement was defined as a decrease in Ankylosing Spondylitis Disease Activity Score of 1.1 points or greater. RESULTS Forty-four eyes in patients aged 18 to 65 years were included. Mean CT values were significantly higher at baseline than after 6 months of treatment (baseline: 355.28 ± 80.46 μm; 6 months: 341.26 ± 81.06 μm; p < 0.001). There was a 95% concordance between CT and CRP at baseline and 6 months. Clinically important improvement was associated with lower baseline CT and age as independent factors (odds ratios, 0.97 [95% confidence interval, 0.91-0.93; p = 0.009] and 0.81 [95% confidence interval, 0.7-0.95; p = 0.005]), with baseline CT of less than 374 μm (sensitivity 78%, specificity 78%, area under the curve 0.70, likelihood ratio 3.6). CONCLUSIONS Choroidal thickness decreased significantly after 6 months of biological treatment in all treatment groups. Choroidal thickness and CRP had a 95% concordance. A high CT was associated with a risk of biological treatment failure. Choroidal thickness can be considered a useful biomarker of inflammation and a factor associated with response to treatment in AS.

Background: Several studies show a high percentage of eye injuries related to work compared to other origins. However, there are few studies that describe work-related eye injuries. Methods: A descriptive, retrospective, and longitudinal study that describes the characteristics of work-related eye injuries in a group of insured workers. Eye injuries were classified according to the International Classification of Diseases (ICD-10) and analyzed over 10 years (2008&ndash, 2018). Results: Keratitis and conjunctivitis were the most prevalent injuries (26,674 (53.1%) and 15,906 (31.6%)). Keratitis and conjunctivitis also show the highest percentage of injury incidence per 100,000 insured workers in both sexes, any age group, and any occupation. The analysis of the cumulative percentage change and average annual percent change in incidences over ten years shows a decrease in the incidences of all injuries, except for other disorders of the eye and anexa. Conclusions: Most of the work-related eye injuries affect the most exposed eye structures in any line of work: the cornea and conjunctiva. Suitable protection of these eye structures will decrease the number of cases of work-related eye injuries.

Background and objective Ankylosing spondylitis (AS) is an inflammatory disease, and choroidal thickness (CT) has been proposed and evaluated as a potential marker of systemic inflammation associated with AS and other inflammatory diseases. This study compared CT measurements taken from patients with severe AS disease activity without eye inflammation with those taken from healthy subjects. Methods This cross-sectional, multicenter study compared CT in 44 patients with high AS disease activity, and no history of eye inflammation with CT in 44 matched healthy subjects aged between 18 and 65 years. In the AS group, the correlation between CT and C-reactive protein, human leukocyte antigen (HLA) B27 positivity, disease duration, and disease activity was calculated. Results Mean CT values of patients with AS were significantly higher in the right eye, the left eye, and the thickest choroid eye. The right eye mean CT was 338.3 ± 82.8 μm among patients with AS and 290.5 ± 71.2 μm among healthy subjects (p = 0.005). The left eye mean CT was 339.5 ± 84.7 μm for patients with AS and 298.4 ± 68.9 μm for healthy subjects (P = 0.015). The thickest choroid eye CT was 358.4 ± 82.1 μm among patients with AS and 314.1 ± 65.2 μm among healthy subjects (P = 0.006). We did not find a significant correlation between CT and disease activity, C-reactive protein, human leukocyte antigen B27 positivity, or disease duration. Conclusions Patients with active AS but without a history of eye inflammation had a thicker choroid than healthy subjects. This finding suggests that CT is a marker of systemic inflammation in patients with inflammatory disease, regardless of known eye symptoms.

To analyze the differences in work-related eye injury trends among the different Autonomous Communities in Spain.This was a descriptive, retrospective and longitudinal study based on a Social Security-affiliated mutual insurance company work injury and illness database for the period 2008-2018 that included all Spanish Autonomous Communities. Accidents that caused an injury to any ocular structure were analysed, and both the incidence of work-related eye-injuries per 100 000 insured workers and the relative risk of suffering an eye injury were compared.We observed a general decrease in work-related eye injuries in all of the communities, although with two distinct time periods. The annual percentage change decrease occurred in all communities until 2013. From 2013 to 2018, however, this decreasing trend was only observed in Asturias, Castilla-La Mancha, Canary Islands, Madrid, Murcia and Navarra. Castilla-La Mancha was the Autonomous Community with the highest incidence (886.56/100.000), as well as the highest relative risk of suffering an eye injury (RR 2.66; IC 95% 2.58 - 2.75). At the other end, the lowest incidence (82.25/100.000) and RR (RR 0.247; IC 95 % 0.22 - 0.28) were observed in Catalonia.We observed a statistically significance decrease in the incidence and relative risk of work-related eye injuries in all Autonomous Communities over the study period, although this trend changed from 2013 onward.Analizar las diferencias en la evolución de las lesiones oculares en el trabajo entre las comunidades autónomas en España. MÉTODOS: Se llevó a cabo un estudio descriptivo, retrospectivo y longitudinal de los accidentes laborales y las enfermedades profesionales de una Mutua Colaboradora de la Seguridad Social entre las diferentes comunidades autónomas españolas en el intervalo de tiempo de 2008-2018. Se analizaron aquellos accidentes que provocaron lesión en alguna estructura ocular, comparándose la incidencia por cada 100 000 asegurados y el riesgo relativo (RR) de sufrir una lesión ocular en el trabajo.Se observó una disminución en la evolución de la incidencia de lesiones oculares en el trabajo en todas las comunidades, aunque con dos periodos diferenciados. El porcentaje de cambio anual disminuye en todas las comunidades hasta el 2013, pero entre 2013-2018 esta tendencia sólo se mantiene en Asturias, Castilla-La Mancha, Islas Canarias, Madrid, Murcia y Navarra. Castilla- La Mancha fue la comunidad autónoma con mayor incidencia (886.56/100 000) y riesgo relativo de sufrir una lesión ocular (RR 2.66; IC 95% 2.58 – 2.75), mientras Cataluña presentó la menor incidencia (82.25) y riesgo relativo (RR 0.25; IC 95 % 0.22 – 0.28).Durante el periodo 2008-2018 se produce una disminución en la incidencia de lesiones oculares en el trabajo en todas las comunidades autónomas con un cambio de tendencia a partir del año 2013.

Dimethyl fumarate (DMF) tolerability and safety in multiple sclerosis (MS) has been analyzed in randomized clinical trials. Real-life studies are needed to assess possible harms of this therapy in a wider MS population.To evaluate DMF tolerability, safety and persistence in MS in a real-world setting.We conducted a multicenter prospective study of patients who started DMF, attended in 16 public hospitals of Spain. A specific database was elaborated to collect data on most frequent adverse events (AE). Regression models were used to analyze the effect of demographic and clinical characteristics on risk of AEs and DMF discontinuation.We collected data of 886 patients (2681 patients/years-exposition) with median 39.5 (IQR 23, 51.5) months on DMF exposure; 25.3% were treatment naïve and 74.7% switched to DMF from other disease-modifying therapies. DMF was discontinued in 29.9% of patients, in 13.2% due to AEs and in 13.5% to inefficacy. AEs were experienced by 71.2%, being flushing the most frequent (44.1%), 5.4% developed grade III lymphopenia, without cases of grade IV. Females showed a higher risk of flushing and gastroenteric symptoms (OR 1.49, p = 0.011; OR 1.69, p = 0.001, respectively); lymphopenia was associated with older age (OR 1.04, p 0.001), and a higher EDSS with lymphopenia (OR 1.10, p = 0.035) and DMF withdrawal (HR 1.43, p = 0.012). No safety problems were reported.Our findings confirm good tolerability and safety of DMF in real-world setting and suggest that women have an increased risk of AEs and higher baseline disability involves greater risk of drug discontinuation.

Aim:We aimed to investigate the impact of delirium on short-term outcomes in hip fracturepatients. Special attention was given to patients with delirium and dementia.Methods:A prospective observational cohort study was carried out in hip fracture patientsaged≥70 years who were admitted to a hospital unit where a multicomponents approach todelirium is established for all patients. Our population was split into delirium (n= 212) andnon-delirium cohort (n= 171) according to the Confusion Assessment Method. Patients witha previous diagnosis of dementia in an outpatient appointment were also assessed within thedelirium cohort. The utility of the rehabilitation was measured with the Absolute FunctionalGain index.Results:A total of 383 patients were entered into the study. The median age was 86 years,and most patients were women (78.8%). Delirium patients were older, presented a lower pre-vious Barthel Index (BI), had higher rates of dementia and came more frequently from nursinghomes. Comparative analysis did not show differences in mortality, complications, length ofstay or walking ability between the cohorts. However, lower BI on discharge, lower AbsoluteFunctional Gain and the presence of nosocomial infections were found more frequently inthe delirium cohort. In multivariate analysis, only the BI on discharge (P= 0.010) was lower indelirium patients. Within the delirium cohort, those suffering from dementia had worse BI ondischarge (P= 0.017) and lower Absolute Functional Gain (P= 0.019).Conclusions:Delirium was not associated with mortality, walking ability, length of stay andclinical complications in hip fracture patients. BI on discharge was the only short-term out-come affected. In the delirium cohort, those suffering from dementia showed worse rehabili-tation results. Sin financiación 2.730 JCR (2020) Q2, 15/36 Gerontology 0.823 SJR (2020) Q1, 10/41 Gerontology No data IDR 2020 UEM

Background: Dimethyl fumarate (DMF) has demonstrated efficacy in phase III studies. However, real-world data are still limited. Objective: The objective of this study was to describe the profile of patients who receive DMF and to assess the effectiveness of DMF regarding relapses, disability progression, magnetic resonance imaging activity, and NEDA (No Evidence Disease Activity)-3 status in a Spanish population in a real-world setting. Methods: We conducted a multicenter prospective study of patients who started DMF between 2014 and 2019 in Spain. Three subgroups were considered: naïve, switch to DMF because of inefficacy, and switch to DMF because of adverse effects. The effects of DMF on clinical and radiological measures were evaluated. Results: Among 886 patients, 25.3% were naïve, 28.8% switched because of adverse effects, and 45.9% because of inefficacy. Median follow-up was 38.9 (interquartile range 22.6-41.8) months. Annualized relapse rates were 0.15, 0.10, and 0.10 at 12, 24, and 36 months respectively, and 77.7% of patients were relapse free at month 42. At 12, 24, and 42 months, 96.1%, 87.4%, and 79.7% of patients were progression free, respectively. The number of T1 gadolinium-enhancement (T1Gd+) lesions was 0.19, 0.14, and 0.18 at 12, 24, and 36 months. NEDA-3 status at month 42 was maintained by 49.8% of patients. Relapsing was associated with higher annualized relapse rates the year before (hazard ratio 1.34, p < 0.001) and to the inefficacy switch vs naïve group (hazard ratio 1.76, p = 0.003). A higher baseline Expanded Disability Status Scale score was associated with disability progression (hazard ratio 1.15, p = 0.003) and more T1Gd+ lesions (hazard ratio 1.07, p < 0.001) with radiological progression. A higher baseline Expanded Disability Status Scale score, a larger number of T1Gd+ lesions, and a switch because of inefficacy (vs adverse events) were all risk factors for losing NEDA-3 status. DMF was discontinued in 29.9% of patients, in 13.5% because of inefficacy. Conclusions: Our findings confirm the sustained effectiveness of DMF on the clinical and radiological activity of multiple sclerosis in a real-world setting, both in naïve patients and in those switching from other multiple sclerosis therapies. Sin financiación 5.754 JCR (2020) Q1, 36/208 Clinical Neurology 1.565 SJR (2020) Q1, 61/372 Neurology (clinical) No data IDR 2020 UEM

Background: The optimal induction treatment in potentially-resectable stage IIIA-N2 NSCLC remains undefined. Aim: To compare neoadjuvant high-dose chemoradiotherapy (CRT) to neoadjuvant chemotherapy (CHT) in patients with resectable, stage IIIA-N2 non-small-cell lung cancer (NSCLC). Methods: Retrospective, multicentre study of 99 patients diagnosed with stage cT1-T3N2M0 NSCLC who underwent neoadjuvant treatment (high-dose CRT or CHT) followed by surgery between January 2005 and December 2014. Results: 47 patients (47.5%) underwent CRT and 52 (52.5%) CHT, with a median follow-up of 41 months. Surgery consisted of lobectomy (87.2% and 82.7%, in the CRT and CHT groups, respectively) or pneumonectomy (12.8% vs. 17.3%). Nodal downstaging (to N1/N0) and Pathologic complete response (pCR; pT0pN0) rates were significantly higher in the CRT group (89.4% vs. 57.7% and 46.8% vs. 7.7%, respectively; p < 0.001)). Locoregional recurrence was significantly lower in the CRT group (8.5% vs. 13.5%; p = 0.047) but distant recurrence rates were similar in the two groups. Median PFS was 45 months (CHT) vs. "not reached" (CRT). Median OS was similar: 61 vs. 56 months (p = 0.803). No differences in grade ≥3 toxicity were observed. On the Cox regression analysis, advanced pT stage was associated with worse OS and PFS (p < 0.001) and persistent N2 disease (p = 0.002) was associated with worse PFS. Conclusions: Compared to neoadjuvant chemotherapy alone, a higher proportion of patients treated with preoperative CRT achieved nodal downstaging and pCR with better locoregional control. However, there were no differences in survival. More studies are needed to know the optimal treatment of these patients. Sin financiación No data JCR 2020 0.367 SJR (2020) Q3, 253/354 Oncology No data IDR 2020 UEM

Spectral-domain optical coherence tomography (SD-OCT) is the most useful tool to measure choroidal thickness (CT). CT may be increased in ocular and systemic diseases. However, there are concerns relating reproducibility and external validity of OCT. The aim of this study was to assess the inter-observer and intra-observer variability of manual OCT measurements.CT was manually measured in the central choroid of 40 eyes from 21 subjects (11 healthy and 10 with ankylosing spondylitis) using RTVue-100 OCT (Optovue Inc., Fremont, CA, EE.UU.). Measurements were performed by 9 independent ophthalmologists from 6 different centers. To assess the inter-observer variability, the intra-class correlation coefficient (ICC) method was calculated. Also, intra-observer variability was assessed in 2 of the ophthalmologists.The mean subfoveal CT was 364.9±85.1μm (range, 170 to 572). The inter-observer ICC was 0.823 (CI 95%, 0.749 to 0.888, p0.001). The intra-observer ICCs were 0.885 (CI 95%, 0.783 to 0.939, p0.001) and 0.925 (CI 95%, 0.859 to 0.960. p0.001).In this study, manual measurements of CT with OCT showed a good concordance. These results suggest that manual OCT is a valid tool for multicenter studies.

Patient blood management (PBM) performs multidisciplinary strategies to optimize red blood cell (RBC) transfusion. Orthogeriatric share care models (surgeon and geriatrician manage the patient together from admission) have the goal of improving outcomes in hip fracture patients. MATERIAL AND METHODS: A prospective observational study was conducted. Patients aged ≥70 years undergoing hip fracture (HF) surgery were consecutively included. When admitted on the orthogeriatric service a PBM protocol was applied based on: perioperative antithrombotic management, intravenous iron sucrose administration and restrictive transfusion criteria. Risk factors, clinical and functional effects of transfusion and its requirements were assessed to audit our model. RESULTS: A total of 383 patients participated (women, 78.8%; median age, 86 (82-90) years). 210 patients (54.8%) were transfused. Age (OR = 1.055, 95% CI 1.017-1.094; p = 0.004) and Hemoglobin (Hb) level on admission (OR = 0.497, 95% CI 0.413-0.597; p

Background/objective: Two functional networks are proposed as neuronal support for the complex processes of memory: the anterior temporal and the medial posterior systems. We examined the atrophy of hippocampus (HC) and of those areas constituting the two functional memory systems in multiple sclerosis (MS) patients with low disability. Methods: Episodic memory (EM) was assessed in 88 relapsing MS patients and in 40 healthy controls using Wechsler Memory Scale III (Spanish adaptation). FreeSurfer software was used to calculate normalized volume of total cortex, grey matter, white matter, subcortical grey matter (thalamus and striatum), HC and both the anterior temporal (entorhinal, ventral temporopolar, lateral orbitofrontal, amygdala) and posterior medial systems (thalamus, parahippocampal, posterior cingulate, precuneus, lateral parietal and medial prefrontal). Linear regression analysis was used to identify predictors of memory performance. Results: Total grey matter and cortex volumes correlated with all subtypes of EM, and the precuneus volume correlated with overall, immediate and delayed memories. Univariant regression analysis identified an association between the volumes of the posterior medial memory network regions and EM scores. The volume of the left precuneus area was the unique and independent predictor for all EM subtypes except for visual memory, for which left HC volume was also an independent predictor. Conclusion: Left precuneus volume was the best predictor of memory in relapsing MS patients with low disability and mild deficits in EM. Sin financiación 4.204 JCR (2018) Q1, 41/199 Clinical Neurology 1.432 SJR (2018) Q1, 66/378 Neurology (clinical) No data IDR 2018 UEM

To evaluate the response to hepatitis B virus (HBV) vaccine in patients on biological therapy. Adults with autoimmune inflammatory diseases on biological therapy such as anti-TNFα, rituximab, tocilizumab, abatacept, or anakinra were included. Hepatitis B surface antibody (anti-HBs) was measured by ELISA before and after vaccination. Seroconversion was considered when an anti-HBs titer 10 mIU/mL was achieved. The effect of treatment on the immunoprotective state was studied. The response was compared with that obtained in patients on synthetic disease modifying anti-rheumatic drugs (DMARDs) and healthy controls. A total of 187 patients on biologicals, 48 on synthetic DMARDs, and 49 on healthy controls were analyzed. More than 80% of patients on biologics responded to the vaccine but required more boosters and second vaccine series. Patients who achieved seroconversion were younger than those who did not (47.10 ± 12.99 vs. 53.18 ± 10.54 years, p = 0.012). Being on etanercept or golimumab was associated with seroconversion, while being on rituximab was not. Seroconversion was achieved in 93.75% of patients on synthetic DMARDs and 97.96% of healthy controls. The seroconversion rate in the biologics group was lower than in the synthetic DMARD group (p = 0.043) and tended to be lower than in the healthy group (p = 0.056). In patients on biological therapy, a high rate of HBV vaccine response can be achieved when a complete vaccination schedule is administered. Vaccination while not on biological agents reduces the requirement for boosters and revaccination. Key points: • Patients on biological therapy can achieve high rates of immune response to HBV vaccine when complete vaccination schedules are administered. • However, to achieve such a high seroconversion rate, more boosters and second vaccination series are required. • This supports the proposal already made to provide HBV vaccination to all patients with an autoimmune inflammatory disease after the diagnosis is made and not when the use of a biological treatment is under consideration.

Objective: Our aim was to describe our antimicrobial stewardship program and the methodology based on the results in a surgical department. Methods: Our study was a quasi-experimental study conducted from January 1, 2009, through September 30, 2017. The site was the General and Digestive Surgery Department in a public primary referral center, the University Hospital of Getafe (Madrid, Spain). We implemented the antimicrobial stewardship program following a prospective audit and feedback model, with a surgeon incorporated into the manaagement group. We studied the deaths and 30-day re-admission rates, length of stay, prevalence of gram-negative bacilli, meropenem resistance, and days of treatment with meropenem. Results: After three years of the program, we recorded a significant decrease in Pseudomonas aeruginosa prevalence, a significant increase in Klebsiella pneumoniae prevalence, a decrease in meropenem resistance, and a reduction in meropenem days of treatment. Conclusions: Antimicrobial stewardship programs have a desirable effect on patients. In our experience, the program team should be led by a staff from the particular department. When human resources are limited, the sustainability, efficiency, and effectiveness of interventions are feasible only with adequate computer support. Finally, but no less important, the necessary feedback between the prescribers and the team must be based on an ad hoc method such as that provided by statistical control charts, a median chart in our study. MINECO ID project (TIN 2013-45491-R) 2.150 JCR (2020) Q3, 125/211 Surgery 0.773 SJR (2020) Q2, 135/293 Infectious Diseases No data IDR 2020 UEM

Objective: To development a predictive clinical model of OSA in children with an inconclusive nocturnal oximetry (INO) using respiratory poligraphy (RP) for diagnosed. Methods: Observational, analytical and retrospective study in a children9s cohort with OSA suspicion and Score1McGuill in NO. Inclusion criterial: aged between 3-14 years old. Exclusion Criterial: craniofacial syndrome, neurological comorbidities and other with symptoms suggestive of sleep disorders other than OSAS. A clinical and sleep history, a physical examination and the Pediatric Sleep Questionnaire (PSQ) was obtained. For diagnosis of OSA, an index of apnea- hipopnea obstructive (AIHo)= 4,5 was consider. A multivariable predictive model, where performance for an OR (95% CI) using a forward model. Results: 495 out of 1085 were evaluated for RP. The mean age: 5,9 ± 2,3; 59,4% boys;pIMC of 58,4 ± 29,8. Symthoms: 73,5% snoring; 69,5% apneas, 24,2% enuresis, 20.8% daytime tiredness, 18,5% hyperactive behaviors, and 13,5% need for naps. Tonsillar hypertrophy=III in 50,9%. In 116 children (23,4%) was diagnosis of OSA. The predictive model showed a statistically significant association with the pathological diagnosis of OSA (95%CI):a Snoring [1,57 (0,92- 2,69)], apneas [2,33 (1,36- 3,99)] and the need for napping [2,34 (1,42- 3,85)] predict the existence of OSA in 91,17% of cases. Conclusion: almonst 1/4 of patients with an INO has OSA. This predictive model is usefull.

Sin financiación 2.298 JCR (2019) Q3, 47/76 Hematology 0.819 SJR (2019) Q2, 54/134 Hematology No data IDR 2019 UEM

Aim: To determine the patterns of antibiotic susceptibility of Escherichia coli strains isolated from adult patients with urinary tract infection (UTI), and to stratify the results by age and type of UTI to verify if there are statistically significant differences that can help physicians to prescribe better empirical antibiotherapy. Design: Cross-sectional prospective study. Location: Community of Getafe (Madrid). Primary care level. Participants: 100 E. coli strains, randomly chosen, isolated from the urine (104–105 cfu/ml) of different patients from primary care centers in the Getafe area. Main measurements: The antibiotic susceptibility of the strains was evaluated and the results were stratified by age and type of UTI. The clinical and demographic data of the patients were analyzed, classifying each episode as complicated UTI or uncomplicated UTI. Results: Strains isolated from patients with uncomplicated UTI showed significantly greater susceptibility than those of complicated UTI to amoxicillin (65.9% vs. 30.6%, p = 0.001), amoxicillin/clavulanic acid (95.5% vs. 77.6%, p = 0.013) and ciprofloxacin (81.8% vs. 63.3%, p = 0.047). In complicated UTI, susceptibility to ciprofloxacin was significantly greater in the ≤65 years age group compared to the older age group (78.3% vs. 50%, respectively, p = 0.041). In the rest of antibiotics, no statistically significant differences were obtained when comparing by age (≤65 years versus >65 years), both in uncomplicated and complicated UTI. Conclusions: Clinical and demographic data of patients with UTI are of great importance in the results of the antibiotic susceptibility in E. coli. Antibiograms stratified by patient characteristics may better facilitate empirical antibiotic selection for UTI in primary care. Resumen: Objetivo: Determinar los patrones de sensibilidad antibiótica de cepas de Escherichia coli aisladas de pacientes adultos con infección del tracto urinario (ITU), y estratificar los resultados por edad y tipo de ITU para verificar si existen diferencias estadísticamente significativas que puedan ayudar a los médicos a la prescripción de una mejor antibioterapia empírica. Diseño: Estudio transversal prospectivo. Emplazamiento: Comunidad de Getafe (Madrid). Nivel de atención primaria. Participantes: 100 cepas de E. coli, escogidas al azar, aisladas de orina (104 ->105 ufc/ml) de diferentes pacientes de centros de atención primaria del área de Getafe. Mediciones principales: Se evaluó la sensibilidad antibiótica de las cepas y los resultados se estratificaron por edad y tipo de ITU. Se analizaron los datos clínicos y demográficos de los pacientes de los que provenían, clasificándose cada episodio como ITU complicada o ITU no complicada. Resultados: Las cepas aisladas de pacientes con ITU no complicada mostraron una sensibilidad antibiótica significativamente mayor que las de ITU complicada a amoxicilina (65,9% vs. 30,6%, p = 0.001), amoxicilina/clavulánico (95,5% vs. 77,6%, p = 0.013) y ciprofloxacino (81,8% vs. 63,3%, p = 0.047). En la ITU complicada, la sensibilidad al ciprofloxacino fue significativamente mayor en el grupo de edad ≤65 años en comparación con el grupo de mayor edad (78,3% vs. 50%, p = 0.041). Para el resto de antibióticos no se observaron diferencias significativas cuando se compararon por edad (≤65 versus >65), tanto en ITU no complicada como complicada. Conclusiones: Los datos clínicos y demográficos de los pacientes con ITU son de gran importancia en los resultados de la sensibilidad antibiótica en E. coli. Los antibiogramas estratificados por características de los pacientes podrían facilitar una mejor selección de antibioterapia empírica para las ITU en atención primaria. Keywords: Urinary tract infections, Antimicrobial resistance, Escherichia coli, Palabras clave: Infecciones del tracto urinario, Resistencia a antibióticos, Escherichia coli

Aim: To analyse the efficacy and toxicity of postprostatectomy SRT in patients with a BCR evaluated with mpMRI. Background: Multiparametric magnetic resonance imaging (mpMRI) has the ability to detect the site of pelvic recurrence in patients with biochemical recurrence (BCR) after radical prostatectomy (RP). However, we do not know the oncological outcomes of mpMRI-guided savage radiotherapy (SRT). Results: Local, lymph node, and pelvic bone recurrence was observed in 13, 4 and 2 patients, respectively. PSA levels were significantly lower in patients with negative mpMRI (0.4 ng/mL [0.4]) vs. positive mpMRI (2.2 ng/mL [4.1], p = 0.003). Median planning target volume doses in patients with visible vs. non-visible recurrences were 76 Gy vs. 70 Gy. Overall, mean follow-up was 41 months (6-81). Biochemical relapse-free survival (bRFS) at 3 years was 82.3% and 82.5%, respectively, for the negative and positive mpMRI groups (p = 0.800). Three-year rates of late grade ≥2 urinary and rectal toxicity were 14.8% and 1.9%, respectively; all but one patient recovered without sequelae. Conclusion: SRT to the macroscopic recurrence identified by mpMRI is a feasible and well-tolerated option. In this study, there were no differences in bRFS between MRI-positive and MRI-negative patients, indicating effective targeting of MRI-positive lesions. Sin financiación No data JCR 2019 0.412 SJR (2019) Q3, 247/372 Oncology No data IDR 2019 UEM

PURPOSE: To evaluate the prognostic factors associated with survival in patients treated with neoadjuvant treatment [chemoradiotherapy (CRT) or chemotherapy] followed by surgery (CRTS) in patients with stage IIIA-N2 non-small cell lung cancer (NSCLC). METHODS: A retrospective study was conducted of 118 patients diagnosed with stage T1-T3N2M0 NSCLC and treated with CRTS at 14 hospitals in Spain between January 2005 and December 2014. Overall survival (OS) and progression-free survival (PFS) were estimated using the Kaplan-Meier method and compared using the log-rank test. Cox regression analysis was performed. RESULTS: Surgery consisted of lobectomy (74.5% of cases), pneumectomy (17.8%), or bilobectomy (7.6%). Neoadjuvant treatment was CRT in 62 patients (52.5%) and chemotherapy alone in 56 patients (47.5%). Median follow-up was 42.5 months (5-128 months). 5-year OS and PFS were 51.1% and 49.4%, respectively. The following variables were independently associated with worse OS and PFS: pneumonectomy (vs. lobectomy); advanced pathologic T stage (pT3 vs. pT0-pT2); and presence of persistent N2 disease (vs. ypN0-1) in the surgical specimen. CONCLUSIONS: In this sample of patients with stage IIIA-N2 NSCLC treated with CRTS, 5-year survival (both OS and PFS) was approximately 50%. After CRTS, the patients with the best prognosis were those whose primary tumour and/or mediastinal nodal metastases were downstaged after induction therapy and those who underwent lobectomy. These findings provide further support for neoadjuvant therapy followed by surgery in selected patients Sin financiación 2.737 JCR (2019) Q3, 157/244 Oncology 0.833 SJR (2019) Q2, 178/367 Oncology, 720/2754 Medicine (miscellaneous); Q3, 143/214 Cancer Research No data IDR 2019 UEM

Objectives: To describe the clinical characteristics, 30-day mortality, and associated factors of patients living in nursing homes (NH) with COVID-19, from March 20 to June 1, 2020. Design: This is a retrospective study. A geriatric hospital-based team acted as a consultant and coordinated the care of older people living in NHs from the hospital. Setting and participants: A total of 630 patients aged 70 and older with Coronavirus Disease 2019 COVID-19 living in 55 NHs. Methods: A logistic regression was performed to analyze the factors associated with mortality. In addition, Kaplan-Meier curves were applied according to mortality and its associated factors using the log-rank Mantel-Cox test. Results: The diagnosis of COVID-19 was mainly made by clinical compatibility (N = 430). Median age was 87 years, 64.6% were women and 45.9% were transferred to be cared for at the hospital. A total of 282 patients died (44.7%) within the 30 days of first attention by the team. A severe form of COVID-19 occurred in 473 patients, and the most frequent symptoms were dyspnea (n = 332) and altered level of consciousness (n = 301). According to multiple logistic regression, male sex (P = .019), the Clinical Frailty Score (CFS) ≥6 (P = .004), dementia (P = .012), dyspnea (P < .001), and having a severe form of COVID-19 (P = .001), were associated with mortality, whereas age and care setting were not. Conclusions and implications: Mortality of the residents living in NHs with COVID-19 was almost 45%. The altered level of consciousness as an atypical presentation of COVID-19 should be considered in this population. A severe form of the disease, present in more than three-quarters of patients, was associated with mortality, apart from the male sex, CFS ≥6, dementia, and dyspnea, whereas age and care setting were not. These findings may also help to recognize patients in which the Advance Care Planning process is especially urgent to assist in the decisions about their care. Sin financiación 4.367 JCR (2019) Q1, 8/51 Geriatrics & Gerontology 2.054 SJR (2019) Q1, 5/109 Geriatrics and Gerontology No data IDR 2019 UEM

Objective To estimate the seroprevalence of anti-JCV antibodies, seroconverting rates and evolution of antibody levels in a multiple sclerosis (MS) Spanish cohort. Methods Multicenter, retrospective cross-sectional and longitudinal study. The JCV seroprevalence was analyzed in 711 MS patients by using 1st (STRATIFY-1) and 2nd generation (STRATIFY-2) two-step ELISA over 2.65 (±0.97) years. Seroconversion rate was obtained over 2 samples from 314 patients, and index stability from 301 patients with 3 or more samples available. The effect of each ELISA generation, demographics, clinical characteristics and therapy on seroprevalence was assessed by logistic regression. Results The overall anti-JCV seroprevalence was 55.3% (51.6–58.9), similar across regions ( p =0.073). It increased with age ( p p =0.001). Neither sex nor immunosuppressive therapy had any influence. Yearly seroconversion rate was 7% (considering only STRATIFY-2). Serological changes were observed in 24/301 patients, 5.7% initially seropositive reverted to seronegative and 7% initially seronegative changed to seropositive and again to seronegative, all these cases had initial index values around the assay's cut-off. Conclusions JCV seroprevalence in Spanish MS patients was similar to that reported in other European populations. Changes in serostatus are not infrequent and should be considered in clinical decisions.

Background:Choroidal thickness (CT) has been proposed and evaluated as a potential marker of systemic inflammation associated with inflammatory diseases as Ankylosing spondylitis (AS). Patients with active AS have a thicker choroid than healthy subjects, regardless of eye inflammation. The evolution of choroid after treatment is poorly known.Objectives:This study evaluates the CT of patients with severe AS disease activity before and after six months of biological therapy.Methods:This prospective multicenter study evaluates the CT in 44 patients with high AS disease activity, naïve for biological treatment, and no history of eye inflammation before and after six months of biological therapy, aged from 18 to 65 years. The correlations between the CT and C-reactive protein (CRP) with the disease activity indices and scales as Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), night pain and Patient Global Assessment (PGA) were calculated at baseline and after six months of biological therapy. The concordance between the CT and CRP was determined. Finally, we assessed potential predictors of response to treatment. Clinically important improvement was defined as a decrease in ASDAS score ≥ 1.1 points.Results:Globally, 44 eyes of 44 patients aged between 18-65 years were included in the study, 12 (27%) women. The biological treatments prescribed were: Adalimumab 13 (29.5%), Certolizumab 9 (20.5%), Secukinumab 10 (20%), Etanercept 8 (18%), Infliximab 3 (6.8%), and Golimumab 1 (2.2%).Mean CT values were significantly higher at baseline than after six months of treatment (baseline 355.28±80.46 µm; 6 months, 341.26±81.06 µm) (pCT decreased both in patients on biological treatment without effect in eye (Secukinumab and Etanecept; p=0.024) and in patients on treatment with effect in eye (other; p=0.005). Also, CRP, BASDAI, night pain and PGA decreased after six months of treatment ((pMultivariable analysis showed that clinically important improvement was associated with higher CT and age as independent factors (OR 0.97, CI95% 0.91-0.93; p=0.009, and OR 0.81, CI95% 0.7-0.95; p=0.005). Clinically important improvement was associated with basal CT >374 µm (sensitivity 78 %, [CI 95% 60-90], specificity 78% [CI 95% 52-92], area under the curve of ROC, 0.70, likelihood ratio 3.6).Conclusion:CT decreased significantly after six months of biological treatment. CT and CPR had a 95% concordance. A high CT is associated with risk of failure to biological treatment. CT can be considered as a useful biomarker of inflammation and predictor of response to treatment in AS.References:[1]Karkucak M, Kalkisim A, Kola M, et al. SAT0408 anti Tnf-α therapy provides beneficial effects on choroidal thickness increase in patients with active ankylosing spondylitis: a possible mechanism of infliximab effectiveness in suppressing uveitis attacks.Ann Rheum Dis. 2016;75:817.Disclosure of Interests:None declared

Chilean currants (Ribes magellanicum and Ribes punctatum) are wild polyphenol-rich berries with interesting bioactivities in several in vitro models. The aim of this study was to investigate the effects of the pre-digested PEE (polyphenol-enriched extract) in a simulated colon model. Fruits were extracted, submitted to simulated gastrointestinal digestion and further colonic fermentation with feces from healthy human donors. Samples were taken at 1, 4, 8 and 24 h of incubation, monitoring pH, ammonia, branched-chain fatty acids (BCFA), short-chain fatty acids (SCFA) and bacterial growth. FOS (fructooligosaccharides) and fecal slurry without treatments were positive and negative control, respectively. Both Ribes species reduced (p < 0.05) both BCFA and SCFA at 24 h. R. punctatum promoted the growth (p < 0.05) of beneficial bacteria such as Clostridium cluster XIVa, and Faecalibacterium prausnitzii; while a trend to increase Akkermansia muciniphila was observed. R. magellanicum increased (p < 0.05) Clostridium cluster XIVa population. Escherichia coli, Lactobacillus spp. and Bifidobacterium spp. remained unaffected. Our results suggest that polyphenols from R. punctatum and R. magellanicum may modulate both bacterial metabolism and some selected gut beneficial bacteria under simulated conditions. Therefore, Chilean currants might be useful as supplements to maintain a healthy colon; however, further in vivo studies are needed to confirm their effect and their mechanisms. Ministry of Economy and Competitiveness Ramón y Cajal Fellowship 2012_11910 MINECO (Project AGL2016-75878-R) National Commission for Scientific and Technological Research of Chile CONICYT-PCHA/Doctorado Nacional/2015-21151561 6.475 JCR (2020) Q1, 9/143 Food Science and Technology 1.479 SJR (2020) Q1, 16/332 Food Science No data IDR 2020 UEM

OBJECTIVES: The role of surgery in stage IIIA-N2 non-small cell lung cancer (NSCLC) is an actively debated in oncology. To evaluate the value of surgery in this patient population, we conducted a multi-institutional retrospective study comparing neoadjuvant chemoradiotherapy or chemotherapy plus surgery (CRTS) to definitive chemoradiotherapy (dCRT). MATERIAL AND METHODS: A total of 247 patients with potentially resectable stage T1-T3N2M0 NSCLC treated with either CRTS or dCRT between January 2005 and December 2014 at 15 hospitals in Spain were identified. A centralized review was performed to ensure resectability. A propensity score matched analysis was carried out to balance patient and tumor characteristics (n = 78 per group). RESULTS: Of the 247 patients, 118 were treated with CRTS and 129 with dCRT. In the CRTS group, 62 patients (52.5%) received neoadjuvant CRT and 56 (47.4%) neoadjuvant chemotherapy. Surgery consisted of either lobectomy (97 patients; 82.2%) or pneumonectomy (21 patients; 17.8%). In the matched samples, median overall survival (OS; 56 vs 29 months, log-rank p = .002) and progression-free survival (PFS; 46 vs 15 months, log-rank p

The incidence of clinical complications in hip fracture (HF) patients is high and variable due to their heterogeneous nature. The aim of the study was to assess the clinical complications and their associated factors in HF patients admitted to the Orthopaedic Geriatric Unit of a 283 bed University Hospital. An average of 200 HF patients is attended yearly. MATERIAL AND METHODS: A prospective, observational and analytical study was conducted on 383 consecutive patients admitted to the unit during the years 2013 and 2014. Clinical complications were defined according to recommendations supported by the AOTrauma Network (International Network of Traumatologists for the Study of Osteosynthesis). RESULTS: A total of 273 patients (71.28%) showed some clinical complication. The main ones were, delirium (55.4%), renal failure (15.4%), and cardiac complications (12.3%). An ASA III-IV score of OR = 1.962 (95% CI; 1.040-3.704, P=.038), lower Barthel index at discharge (b = -3.572, 95% CI -0.866 to -0.104, P=.01), the increase in pre-operative stay (OR = 1.165, 95% CI 1.050-1.294, P=.004) and an increased length of stay (b = 2.663, 95% CI 3.522-0.325; P