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Extinction catastrophe can be experimentally induced bypromutagenic nucleosides in cell culture models. The loss of HIV infectivity has been observed after passage in 5-hydroxydeoxycytidine or 5,6-dihydro-5-aza-20-deoxycytidine while producing atwo-fold increase in the viral mutation frequency. Among approved nucleoside analogs, experimentswith polioviruses and other RNA viruses suggested that ribavirin can be mutagenic, although itsmechanism of action is not clear. Favipiravir and molnupiravir exert an antiviral effect through lethal mutagenesis. Both drugs are broad-spectrum antiviral agents active against RNA viruses. Favipiravirincorporates into viral RNA, affecting the G→A and C→U transition rates. Molnupiravir (a prodrugof β-D-N4-hydroxycytidine) has been recently approved for the treatment of SARS-CoV-2 infection. Its triphosphate derivative can be incorporated into viral RNA and extended by the coronavirus RNApolymerase. Incorrect base pairing and inefficient extension by the polymerase promote mutagenesisby increasing the G→A and C→U transition frequencies. Molnupiravir is the isopropylester prodrug of the ribonucleoside analogue β-D-N4-hydroxycytidine (NHC).

This work aims to assess the effect of weekly subcutaneous semaglutide on biomarkers of metabolic-associated fatty liver disease (MAFLD), namely the hepatic steatosis index (HSI) and the fibrosis-4 (FIB-4) index, at 24 weeks in outpatients attended to in internal medicine departments.This study analyzed patients in an ongoing, multicenter, prospective, pre-post, uncontrolled cohort registry that enrolls unique, consecutive patients with type 2 diabetes treated with weekly subcutaneous semaglutide. Steatosis/fibrosis were determined by HSI (30 ruled out,36 steatosis) and FIB-4 (1.3 ruled out,2.67 fibrosis), respectively.The sample included 213 patients (46.9% women) with a median age of 64 (19) years. The median baseline body mass index and weight were 36.1 (8.4) kg/mThese results show that weekly subcutaneous semaglutide had a beneficial effect on liver steatosis that went beyond glucose control. Its effects were mainly related to weight loss, a decline in biomarkers, and improvements in insulin sensitivity. For many patients, early detection is essential for improving MAFLD outcomes and may allow for selecting the most efficient treatment options.

BackgroundThe COVID-19 pandemic has put tremendous pressure on hospital resources around the world. Forecasting demand for healthcare services is important generally, but crucial in epidemic contexts, both to facilitate resource planning and to inform situational awareness. There is abundant research on methods for predicting the spread of COVID-19 and even the arrival of COVID-19 patients to hospitals emergency departments. This study builds on that work to propose a hybrid tool, combining a stochastic Markov model and a discrete event simulation model to dynamically predict hospital admissions and total daily occupancy of hospital and ICU beds.MethodsThe model was developed and validated at San Juan de Alicante University Hospital from 10 July 2020 to 10 January 2022 and externally validated at Hospital Vega Baja. An admissions generator was developed using a stochastic Markov model that feeds a discrete event simulation model in R. Positive microbiological SARS-COV-2 results from the health department’s catchment population were stratified by patient age to calculate the probabilities of hospital admission. Admitted patients follow distinct pathways through the hospital, which are simulated by the discrete event simulation model, allowing administrators to estimate the bed occupancy for the next week. The median absolute difference (MAD) between predicted and actual demand was used as a model performance measure.ResultsWith respect to the San Juan hospital data, the admissions generator yielded a MAD of 6 admissions/week (interquartile range [IQR] 2-11). The MAD between the tool’s predictions and actual bed occupancy was 20 beds/day (IQR 5-43), or 5% of the hospital beds. The MAD between the intensive care unit (ICU)’s predicted and actual occupancy was 4 beds/day (IQR 2-7), or 25% of the beds. When the model was further evaluated with data from Hospital Vega Baja, the admissions generator showed a MAD of 2.42 admissions/week (IQR 1.02-7.41). The MAD between the tools’ predictions and the actual bed occupancy was 18 beds/day (IQR 19.57-38.89), or 5.1% of the hospital beds. For ICU beds, the MAD was 3 beds/day (IQR 1-5), or 21.4% of the ICU beds.ConclusionPredictions of hospital admissions, ward beds, and ICU occupancy for COVID-19 patients were very useful to hospital managers, allowing early planning of hospital resource allocation.

To assess the efficacy of sodium-glucose cotransporter-2 inhibitor (SGLT2i) and glucagon-like peptide-1 receptors agonist (GLP-1RA) therapy on liver steatosis measured by fatty liver index (FLI) and hepatic steatosis index (HSI) at 26 weeks in outpatients with diabetes and obesity.Observational, prospective, multicenter study. Patients with steatosis determined by FLI (values30 rule out and60 indicate steatosis) and HIS (values30 rule out and36 indicate steatosis) who received combination therapy were included. Patients were stratified into three groups according to the sequential order of treatment. We used robust statistical methods.In our final report we included 174 patients (58.6% males), mean age 61.9 (10) years. Baseline body mass index, waist circumference and weight were 36.5 (6.8) kg/mOur results show a beneficial effect of the combination of GLP-1RAs plus SGLT2is on liver steatosis that goes beyond glucose control, and it is related mainly to weight loss, a decline in biomarkers and reductions in abdominal circumference. For many patients, early detection is essential to improving outcomes in NAFLD and could allow us to select the most efficient treatment options.

BACKGROUND: The impact of statins on COVID-19 outcomes is important given the high prevalence of their use among individuals at risk for severe COVID-19. Our aim is to assess whether patients receiving chronic statin treatment who are hospitalized with COVID-19 have reduced in-hospital mortality if statin therapy is maintained during hospitalization. METHODS: This work is a cross-sectional, observational, retrospective multicenter study that analyzed 2921 patients who required hospital admission at 150 Spanish centers included in the nationwide SEMI-COVID-19 Network. We compared the clinical characteristics and COVID-19 disease outcomes between patients receiving chronic statin therapy who maintained this therapy during hospitalization versus those who did not. Propensity score matching was used to match each statin user whose therapy was maintained during hospitalization to a statin user whose therapy was withdrawn during hospitalization. RESULTS: After propensity score matching, continuation of statin therapy was associated with lower all-cause mortality (OR 0.67, 0.54-0.83, p < 0.001); lower incidence of acute kidney injury (AKI) (OR 0.76,0.6-0.97, p = 0.025), acute respiratory distress syndrome (ARDS) (OR 0.78, 0.69- 0.89, p < 0.001), and sepsis (4.82% vs 9.85%, p = 0.008); and less need for invasive mechanical ventilation (IMV) (5.35% vs 8.57, p < 0.001) compared to patients whose statin therapy was withdrawn during hospitalization. CONCLUSIONS: Patients previously treated with statins who are hospitalized for COVID-19 and maintain statin therapy during hospitalization have a lower mortality rate than those in whom therapy is withdrawn. In addition, statin therapy was associated with a decreased probability that patients with COVID-19 will develop AKI, ARDS, or sepsis and decreases the need for IMV.

Introduction: Post-hospital syndrome (PHS) is defined as a period of vulnerability during the first 30 days after a patient is discharged from hospital, in which multiple factors come into play. Hyponatremia is the most frequent hydroelectrolytic disorder in hospitalized patients and may be related to the appearance of PHS. Objective: The objective is to estimate the prevalence of PHS that is assessed as the rate of readmissions in the first 30 days after discharge, in patients with hyponatremia. Material and Methods: It is a descriptive observational study of patients with hyponatremia who were discharged from 1 September 2010 to 2 February 2020 at the Internal Medicine Service of the Hospital University of San Juan (Alicante, Spain). Results: Of the 25 included patients, 5 (20%) were readmitted within a month of discharge, after a mean of 11.4 days (standard deviation [SD] 5.1). The overall mortality of the study was 20% (n = 5), with one case of death in the first 30 days post-hospitalization (4%). In 12 patients (48%) the origin of the hyponatremia was undetermined. The most frequently recorded etiology for the condition was pharmacological (n = 7, 28%), and there was pronounced variability in its clinical and laboratory study. The most widely used corrective measure was drug withdrawal, in 16 patients (64%). Water intake restriction was the most common treatment after discharge (5 patients, 20%), followed by urea (2 patients, 8%), while tolvaptan was not used. Conclusion: Hyponatremia may be the cause of PHS, which could increase the rate of early readmission. Hyponatremia is an underdiagnosed and undertreated entity, so it is necessary to apply an appropriate system to optimize its management and, in future studies, to assess its impact on PHS.

A Rural revitalization has been paid great attention in China as a result of rapid socio-economic development, and officially established as a national strategy in recent years. The study aims to identify the potential of tea tourism, as a specific form of rural gastronomic tourism, could contribute to regional revitalization, on the strength of rich tea resources and authentic tea culture in China. From an actor-oriented perspective, the comparative case study in Zhejiang province shows that, the actual tea tourism practice in case areas is shaped by environmental and personal factors. Meanwhile, the potential of tea resources hasn’t been fully integrated in tourism activities, as practitioners’ operating capability restricted by conceptual issues and other self-limitations. Despite, the evolution of tea tourism becomes a channel to facilitate residents’ livelihood and life quality, turning the situation of rural residents’ outflow to inflow, achieved various aspects of rural revitalization. Finally, practical implications are also discussed to offer enlightenments to regional tea tourism practice.

Les Baléares sont devenues une grande destination touristique balnéaire pendant le fordisme. La croissance de ce tourisme n’a cessé de s’affirmer et mérite des études et réflexions, même si toutes les îles et tous les littoraux n’ont pas connu cette évolution. Ce développement était principalement lié aux plages. Les communes qui ne disposent que de peu de plages n’ont pas connu cette évolution. Tel est le cas du village d’Andratx (Majorque). Néanmoins, avec l’arrivée des formules postfordistes, d’autres éléments que les plages sont devenus attractifs comme les paysages et la nature. Dans le cadre de ces nouvelles aspirations, le développement touristique d’Andratx s’est axé autour de l’activité nautique, du résidentiel et du golf. Ce travail analyse les deux périodes, l’impact sur la société (social, économique et environnemental) et les réactions des autochtones au travers d’entretiens avec des dirigeants politiques et économiques. During Fordism sun and beach tourism transformed the Balearic Islands into a great tourist destination. Its growth was unstoppable and it was object to multiple studies and reflections; nonetheless, all the islands nor all the coastlines experienced such evolution. It was the presence of sand beaches what paved the way for this advancement. The coastal municipalities, scarce in beaches, remained marginalised in the face of this development, as was the case of Andratx (Mallorca). Yet with the arrival of postfordist formulas, other elements aside from beaches became a point of interest, such as the landscape or nature. Andratx experienced a strong development with the application of these new formulas, for which this municipality specialised in three sectors: nautical, residential and golf. This paper analyses the two stages mentioned and their impact on society: social, economic and environmental, as well as the reactions of the natives, by conducting interviews with political and economic leaders. The final outcome has not been as satisfactory as one might expect. El turismo de sol y playa transformó las Baleares en un gran destino turístico durante el fordismo. Su crecimiento fue imparable y mereció muchos estudios y reflexiones, pero ni todas las islas ni todos los litorales conocieron esta evolución. La existencia de playas fue la principal condición para este desarrollo. Los municipios litorales, escasos en playas se quedaron marginados frente a este desarrollo, como fue el caso de Andratx (Mallorca). Por el contrario, con la llegada de fórmulas postfordistas, otros elementos distintos de las playas, merecieron el interés, como el paisaje o la naturaleza. Andratx conoció un fuerte desarrollo con la aplicación de estas nuevas fórmulas, y este municipio se especializó en tres sectores: náutico, residencial y de golf. Este trabajo analiza las dos etapas y el impacto sobre la sociedad: social, económico y ambiental, y las reacciones de los autóctonos, mediante la realización de entrevistas a los responsables políticos y económicos. El balance final no ha sido tan satisfactorio como cabría esperar.

In the last 10 years enzyme replacement therapy (ERT) has become an alternative for the treatment of patients with Hunter disease (HD). Nevertheless, the information regarding efficacy and safety is scarce and mainly based on the pivotal trials. This scarcity is especially evident for adults and severe forms of HD.A systematic review of publications in the electronic databases PUBMED, EMBASE and Cochrane Central was undertaken. Clinical trials and observational studies were included. The data about efficacy and security were retrieved and analysed with Review Manager version 5.3.677 records were found, 559 remaining after the removal of duplicates. By title and abstract review, 427 were excluded. Full reading of the rest was made (122 publications) and 42 were finally included. It was not possible to perform meta-analysis of all the endpoints due to high heterogeneity in the reporting and measuring of variables in each publication. Eight clinical trials were included, 6 with high risk of bias. The quality of the other studies was low in 12%, average in 68% and good in 21%. Main findings were: a reduction in the elimination of glycosaminoglycans (GAG) in urine in all the studies (26/26), decrease in liver and spleen size (18/18), increase of 52.59 m (95% CI, 36, 42-68.76, p .001) in the 6-min walk test (TM6M), increase in forced vital capacity (FVC) of 9.59% (95% CI 4.77-14.51, p .001), reduction of the left ventricular mass index of 3.57% (95% CI 1.2-5.93) and reduction in mortality (OR) of 0.44 (0.27-0.71).The data suggests a clear and consistent effect of ERT in HD reducing the accumulation of GAGs in the body, demonstrated by the reduction of its urinary excretion, as well as by the reduction of its deposits (spleen, liver and heart). Likewise, there is an improvement in physical and respiratory function. In addition, a reduction in mortality has been observed. Lack of studies, small size of the samples, and methodological deficiencies are the main limitations to establish definite conclusions.The data suggests that ERT is effective and safe in the treatment of HD. There is a need to evaluate patient-centred outcomes and the impact on quality of life.

[EN] Reverse engineering and medical image-based modeling technologies allow manufacturing of 3D biomodels of anatomical structures of human body. These techniques are based on anatomical information from scanning data such as CT and MRI, whose scanners are used for scanning data acquisition of the external and internal geometry of anatomical structures. These 3D biomodels have many medical applications such surgical training, preoperative planning, surgical simulation, diagnosis and treatments. 3D virtual models of human body structures based on CT are increasingly being used in clinical practice. A data processing methodology is required to obtain an accurate 3D model suitable for manufacturing using AM, and specially the FDM technologies. This study shows a step-by-step methodology to process the CT information in bounded uncertainty conditions in order to obtain the STL models of the degenerated bone components, and to manufacture the 3D biomodels for surgery analysis with optimal design and details, and with an adequate accuracy to ensure proper results by surgeons analysis., The authors wish to acknowledge the support of Ms. Jerica Risent and Mr. Joan Ortiz of Ford Motor Company for his assistance in the scanning of printed models. This work was supported by the Polisabio Funding (UPV-Fisabio 2017)

Background: Both competitive and recreational sports are considered a positive practice that is good for human health and quality of life, so it is difficult to understand how young, energetic and apparently healthy people can die while playing their usual sports. When these events occur in elite athletes during monitored events, they normally receive considerable media attention. Objective: To describe the case of sudden death in a young professional athlete who was successfully aided and resuscitated outside our hospital, and to review the literature about sudden death in sports. Materials and Method: We searched for Sudden Death (according to the International Classification of Diseases (ICD-9 and ICD-10)) in our hospital but found no other relevant cases. We performed a literature search on the state of the art in sudden death (Google Scholar, PubMed, LILACS, Scielo and the Revista Espanola de Cardiologia). Results: Although we observed that the prevalence of sudden death is not very high, it still represents a potentially avoidable event. An adequate medical examination prior to regular sporting practice can decrease the incidence of sudden death in athletes under the age of 35. Data available in the literature support medical check-ups that include history-taking, physical examination and electrocardiogram. The findings of this evaluation may also prompt further assessment (electrocardiograph, ergometry). Conclusions: We could not identify standard, obligatory guidelines for screening possible heart diseases causing cardiorespiratory failure and sudden death. As a measure for primary prevention, we propose a protocol for reducing the risk of sudden death in athletes.

Le tourisme de croisière a bien évolué au cours des dernières décennies du xxe siècle, entre démocratisation et massification. Cela s’est traduit par une augmentation considérable des navires et des croisiéristes dans les ports visités. Ces visites massives ont généré de nombreux effets positifs, notamment d’un point de vue économique, ce qui a renforcé l’engagement de nombreuses villes méditerranéennes dans leur politique d’attractivité de leurs ports. Mais ces croisières génèrent également des impacts négatifs sur les plans environnemental et social avec la concentration des flux dans certains quartiers des villes visitées. Cette massification est à l’origine de la naissance de mouvements anti-tourisme de croisière dans les grandes villes de la Méditerranée occidentale qui demandent la prise en compte de ces nuisances et ils exigent des réponses. Trouver un juste compromis entre les effets positifs et les impacts négatifs est toujours la meilleure voie pour établir un équilibre entre tous les intérêts et entretenir le désir de découvrir la ville. El turismo de cruceros ha evolucionado mucho durante este último siglo y se democratizado. La consecuencia ha sido una invasión de cruceristas en los puertos visitados. Estas llegadas masivas han originado muchos efectos positivos, especialmente desde el punto de vista económico, lo que ha provocado que muchas ciudades mediterráneas intenten atraerlos hacia sus puertos. Pero, los cruceros generan también impactos negativos desde el punto de vista medioambiental y la masificación de algunos barrios de las ciudades visitadas con la llegada de los cruceros. Esta masificación es la causa del nacimiento de movimientos anti-cruceros en las grandes ciudades del Mediterráneo occidental, que exigen parar estas molestias y exigen soluciones a la administración. El equilibrio entre los efectos positivos y los impactos negativos es la mejor solución para encontrar el equilibrio entre todos los intereses y el sueño a alcanzar para toda ciudad que acoge a los cruceristas. Cruise tourism has evolved a lot during this last century and has become democratized. The consequence has been an invasion of cruise ships in the ports visited. These massive arrivals have produced many positive effects, especially from an economic point of view, which has caused many Mediterranean cities to try to attract them to their ports. But cruise ships also generate negative impacts from the environmental point of view and the massification of some neighborhoods of the cities visited with the arrival of cruises. This massification is the cause of the birth of anti-cruise movements in the large cities of the Western Mediterranean, which demand to stop these nuisances and demand solutions from the administration. The balance between positive and negative impacts is the best solution to find the balance between all the interests and the dream to be achieved for every city that welcomes cruise passengers.

La búsqueda de información es un elemento clave a la hora de escoger un destino turístico, lo cual, provoca que la divulgación de información turística a través de internet sea uno de los principales objetivos que persiguen los destinos para intentar atraer a la demanda hacia su territorio. Este trabajo ha analizado la forma con la que los municipios de Mallorca ofrecen información turística a través de internet. Los resultados que se han obtenido muestran como a pesar de que el turismo es el principal motor económico de la isla, la mayoría de los municipios están ofreciendo de forma deficiente su información turística online. The search for information is a key element when choosing a tourist destination, which means that the dissemination of tourist information through the Internet is one of the main objectives pursued by destinations to try to attract demand to their territory. This study has analyzed the way in which the municipalities of Mallorca offer tourist information through the Internet. The results obtained show that even though tourism is the main economic engine of the island, most of the municipalities perform poorly in terms of providing online tourist information.

AIMS We aimed to determine the efficacy and safety of sodium-glucose cotransporter type 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists to prevent worsening urinary albumin-to-creatinine ratio as an early biomarker of diabetes kidney disease. METHODS A total of 178 patients with type 2 diabetes and obesity received combination treatment with SGLT2i added to GLP1ra (n = 76), GLP1ra added to SGLT2i (n = 50) or GLP1ra plus SGLT2i from start (n = 52), according to investigators´ best clinical judgement. Major outcomes assessed at 26 weeks were changes in urine albumintocreatinine-ratio (UACR), estimated glomerular filtration rate (eGFR), glycated haemoglobin, body weight and systolic blood pressure. RESULTS All patients (58.6% men, mean age 61.9 ± 10.0 years) completed the study. Baseline HbA1c, weight and eGFR levels were 8.2 ± 0.9%, 109.9 ± 19 kg and 83.3 ± 19.6 mL/min/m2 , respectively. At 26 weeks, we found significant reductions in HbA1c (1.16%), weight (5.17 kg) and systolic blood pressure (8.13 mmHg). The reduction in UACR was 15.14 mg/g (95% CI 8.50-22.4) (-24.6 ± 64.7%), which was greatest in the group of patients with SGLT2i added on to GLP1ra therapy (116.7 mg/g; 95% CI: 54-296.5 mg/g; P

Purpose: In geriatric patients, hip fracture is considered the greatest complication of osteoporosis in terms of morbidity, mortality, and cost. The aim of this study is to assess the effects of a multidisciplinary shared care protocol (trauma services, internal medicine, emergencies, anesthesia, nursing, hematology, pharmacy, rehabilitation, home hospitalization unit, and social services) on hospital stay and in-hospital mortality in inpatients aged 65 years or older and operated for hip fracture.Methods: Retrospective cohort study between January 2011 and December 2017. The unexposed group was made up of patients who did not receive care according to the multidisciplinary protocol, while the exposed group did. We excluded patients with polytrauma, conservative treatment, bilateral hip fracture, pathological fracture, or previous fracture already included in the series. Variables analyzed were demographic data, medical comorbidities, Charlson index, hemoglobin levels, hematocrit and blood transfusion, antiplatelet drugs, length of surgical delay, length of hospital stay, in-hospital mortality, and a composite risk outcome considering in-hospital mortality and/or hospital stay of more than 10 days. We fit a multivariable logistic regression model to calculate the odds ratio (OR) of experiencing outcomes.Results: The cohort included 681 patients: 310 were unexposed and 371, exposed. Compared to the unexposed group, patients receiving protocolized multidisciplinary care showed significantly lower in-hospital mortality (3.5% versus 7.7%; p = 0.015) and were less likely to have a hospital stay of more than 10 (16.4% versus 24.2%; p = 0.012). Mean length of hospital stay was 0.7 fewer days in the exposed group. Multivariable analysis showed the composite risk outcome was 51% lower in the exposed group, after adjusting for age, sex, heart failure, days to surgery, blood transfusion after surgery, and postoperative hemoglobin levels.Conclusion: Implementing the multidisciplinary shared care protocol halved the risk of in-hospital mortality and/or a hospital admission of more than 10 days in patients over 65 years with proximal femur fracture. It also reduced mean length of hospital stay.

Objectives : This study aimed to determine the risk factors that increase the risk of in-hospital mortality and/or prolonged hospital stay in hip fracture patients aged over 65 years. Methods : We conducted a retrospective study of patients aged over 65 years who underwent hip fracture surgery in the period from January 2015 to December 2017. Our analysis included 54 variables related to medical, psychological, functional and laboratory comorbidities present at admission; treatment, complications and laboratory follow-up during the hospital stay; and functional status and destination on discharge. We performed a bivariate analysis and a multivariate analysis with a composite endpoint combining in-hospital mortality and hospital stay lasting more than 10 days. Results : We included 360 patients with an average age of 84 years. Women accounted for 75% of the sample, and 53.5% of all patients had a pertrochanteric fracture. The mean number of comorbidities per patient was 2.72, and the most common comorbidities were high blood pressure, dementia and diabetes. The rate of in-hospital mortality was 3.6% (n 13) and the mean length of hospital stay was 8.48 days, with 16.4% of patients staying in hospital for more than 10 days. Medical complications, lower hemoglobin on admission, high blood pressure, obesity and Parkinson’s disease were significantly associated with our endpoint in the multivariate analysis Conclusions : Patients who suffer medical complications during hospitalization, and those with lower hemoglobin on admission, high blood pressure, obesity or Parkinson’s disease, have an increased risk of in-hospital mortality or prolonged hospital stay

Aim: Advanced age and fragility often lead to dependence, making caregiver assistance necessary for performing the activities of daily living. Patients with diabetes are characterized by an elevated presence of comorbidities and subsequent frailty—a relevant consideration when making decisions regarding treatment goals. Health professionals may overlook the caregiver experience when assessing the circumstances surrounding frail elderly patients with diabetes, but this factor can have a large impact on relevant caregiver and patient outcomes. Methods: An observational, retrospective study was carried out to assess the impact of improved management in diabetes on caregiver burden. We assessed patients’ performance of activities of daily living using the Barthel scale. Our primary outcome was caregiver burden, as assessed using the Zarit scale. Results: At baseline, 81.4% of the caregivers reported severe overburden (>55 points on the Zarit scale). At three months, the proportion of caregivers reporting this level of burden had dropped to 76.7% and remained stable at six months (77.1%). In contrast, 8.5% of the caregivers reported moderate overburden (47 to 55 points) at baseline, compared to 13.3% at three months and 12.5% at six. The proportion of caregivers reporting no overburden (

Los pacientes intervenidos de artroplastia de cadera a los que se implanta una prótesis con par de fricción metal-metal pueden desarrollar patologías locales o sistémicas relacionadas con la liberación de partículas de cobalto y cromo como consecuencia del roce continuo de sus superficies metálicas, fenómeno denominado metalosis. Conocer las patologías producidas por esta metalosis es fundamental para, tras su sospecha, solicitar una determinación sérica de cobalto y cromo que confirme el diagnóstico. El tratamiento de la metalosis sintomática consiste en la retirada y sustitución protésica, consiguiendo un descenso en las concentraciones sanguíneas de cobalto, y mejorando el cuadro clínico sistémico. Se presenta el caso de una mujer portadora de prótesis de cadera evaluada en Medicina Interna por presentar de forma crónica astenia, cefaleas, alteraciones sensitivas (vista, oído) e hipotiroidismo.

Aim: To analyze changes in Fatty Liver Index (FLI) in obese and T2DM patients under treatment with GLP-1RA - SGLT2i combination. Methods: Observational, prospective, multicenter study. Patients were stratified according to predetermined treatment schedule groups (successively vs. simultaneously). Results: We included 142 patients (59.1% men, mean age 60.8±8.9 years). 76.7% had hypertension and 81.7% dyslipidemia. The BMI was 36.9 ±.7.1 kg/m2, FLI was 97±11, A1C was 8.0% ±1.5%, Triglyceride (Tg) was 158±102 mg/dl, Waist circumference (WC) 120.3 cm and gamma-glutamyl-transferase (GGT) was 43±45 UI/L. At 26 weeks follow-up we found a significant reduction in FLI (-5 points; p Discussion: Nonalcoholic fatty liver disease (NAFLD) is characterized by the accumulation of fat in the absence of other causes of steatosis. FLI is an accurate algorithm which can be used as a surrogate marker of steatosis; it combines measures of Tg, GGT, WC and BMI. GLP-1RA have direct effects on hepatocytes improving liver histology and reducing GGT levels. However, data on SGLT2i over the liver fat are scarce. Our study demonstrated that the combination of GLP-1RAs-SGLT2i reduces liver fat in patients with T2DM being positively correlated with improvement in A1C, BMI, WC and GGT. Disclosure J. Carretero Gómez: None. J. Arevalo Lorido: None. R. Gómez-Huelgas: None. J. Seguí-Ripoll: None. M. Suarez Tembra: None. J. Casas: None. J. Carrasco: None.

An amendment to this paper has been published and can be accessed via the original article.

Objectives Scientific literature about the combination of glucagon-like peptide-1 receptor agonists (GLP-1ra) and sodium-glucose cotransporter 2 (SGLT2) inhibitors in older patients is scarce. We sought to assess the real-world efficacy and safety of SGLT2 inhibitors and GLP-1ra combination therapy in older patients (>65 years of age). Methods This was an observational, prospective, multicenter study based on clinical practice. Patients were stratified according to tertiles of baseline glycated hemoglobin (A1C) levels and to treatment schedule. Results We included 113 patients (65.5% men, mean age 70.4±8.8 years). The body mass index was 36.5 (±6.6) kg/m2. The baseline A1C level was 8.0% (±1.2%). At the 6-month follow up, we found a significant reduction in A1C levels (–1.1%; p Conclusions This study's findings provide evidence of clinically meaningful reductions in A1C level, body weight and systolic blood pressure in older patients with type 2 diabetes who are taking combined regimens. The dropout and hypoglycemia rates were minimal, and treatment was tolerated well.

In response to the case of a patient with mesenteric panniculitis (MP) and proliferative disease, we reviewed the literature on their possible association and associations with other neoplasms. MP is a non-specific chronic inflammation of the mesenteric fat, with low prevalence and unknown etiology; patients may be asymptomatic or present predominantly gastrointestinal complaints. The disease can be either primary or secondary to other pathologies, including neoplastic ones. Diagnosis is made via computed tomography (CT) and confirmed by biopsy. Currently, there is no established treatment for MP. The literature contains series of variable sample sizes, case reports, reviews of other published studies, and some series after a 5-year follow-up. Papers tend to be relatively consistent when it comes to prevalence data and clinical manifestations. However, there is still controversy regarding the role that secondary MP could play in a paraneoplastic picture. From the diagnostic point of view, the incorporation and use of positron emission tomography (PET), together with CT, has been helpful for the approach and the diagnostic focus in this field. Nevertheless, its usage and the discrimination cut point between inflammatory pathology and tumor pathology (maximum standard uptake value: SUVmax) are not clearly defined in neoplastic cases.

El presente trabajo tiene como objetivo: analizar la representación mental de alumnos de educación primaria de la ciudad de Bahía Blanca, a partir de la metodología de mapas mentales; siguiendo como hipótesis que el espacio vivido de los niños de dicha aglomeración, se estructura a partir de espacios de socialización vinculados a la recreación y el esparcimiento, en detrimento de aquellos asociados a la historia y cultura del lugar. En este contexto, se obtiene como resultado, que los espacios de carácter contemporáneo prevalecen ante aquellos patrimoniales, que configuran la identidad de la sociedad local. This paper aims to analyze the mental representation of primary school students in the Bahía Blanca city, starting from mental mapping methodology; following the hypothesis that the children lived space is structured for spaces of socialization associated to recreation and leisure, to the detriment of those heritage spaces. In this context, it is obtained as a result, the spaces of contemporary character prevail over those heritage, which structure the local social identity. Fil: Pinassi, Andrés. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Bahía Blanca; Argentina. Universidad Nacional del Sur. Departamento de Geografía y Turismo; Argentina Fil: Seguí Llinás, Miguel. Universidad de las Islas Baleares; España

L’avanç de les polítiques neoliberals a escala mundial ha provocat que hagi augmentat la privatització dels recursos públics, especialment en un moment de crisi econòmica i de necessitat de cercar fonts noves de finançament per part de l’Administració. Dins d’aquest context, els espais litorals destinats a l’oci i al turisme tampoc s’han salvat de la pressió exercida per part dels governs i de les empreses privades, i han vist com el seu caràcter públic s’ha privatitzat de manera directa o indirecta. L’illa de Mallorca no s’ha mantingut aliena a aquest procés global i, durant els darrers anys, s’hi està observant un augment de privatitzacions d’espais públics. Per això, una de les fórmules utilitzades és la regulació de l’aparcament dels vehicles dins el domini municipal, la qual cosa s’ha convertit en una important font de finançament per a les poblacions turístiques de l’illa., El avance de las políticas neoliberales a escala mundial ha provocado que haya aumentado la privatización de los recursos públicos, especialmente en un momento de crisis económica y necesidad de buscar nuevas fuentes de financiación por parte de la Administración. En este contexto, los espacios litorales destinados al ocio y al turismo tampoco se han salvado de la presión ejercida por parte de los gobiernos y de las empresas privadas, y han visto cómo su carácter colectivo se ha privatizado directa o indirectamente. La isla de Mallorca no se ha mantenido ajena a este proceso global y, durante los últimos años, se está observando un aumento de privatizaciones de espacios públicos. Para ello, una de las fórmulas utilizadases la regulación del estacionamiento de los vehículos en el dominio municipal. Dicha iniciativa se ha convertido en una importante fuente de financiación para las poblaciones turísticas de la isla., Les progrès des politiques néolibérales mondiales, a causé l’augmentation de la privatisation des ressources publiques, en particulier en temps de crise économique, ainsi que la nécessité de trouver de nouvelles sources de financement du gouvernement. Dans ce contexte, les zones côtières pour les loisirs et le tourisme n’ont pas été épargnées par la pression des gouvernements et des entreprises privées, et ont vu leur caractère public directement ou indirectement privatisé. L’île de Majorque n’est pas restée à l’abri de ce processus global, et ces dernières années, on assiste à une privatisation croissante des espaces publics. Pour ce faire, l’une des formules utilisées est la réglementation du stationnement des véhicules dans le domaine public, qui est devenu une source importante de financement pour les villes touristiques de l’île., The advance of neoliberal policies worldwide has led to the increasing privatization of public resources, especially in the midst of the economic crisis, which has required seeking new sources of government funding. In this context, coastal leisure and tourism areas have not escaped from the pressure exerted by governments and private companies to privatize such public areas either directly or indirectly. The island of Majorca has not remained unaffected by this global process, and has seen an increase in the privatization of public spaces in recent years. One of the formulas used to privatize these spaces is the regulation of the parking of vehicles in the public domain, which has become a major source of funding for the tourist towns on the island.