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Treatment Planning Systems (TPS) offer algorithms for distortion correction (DC) of Magnetic Resonance (MR) images, whose performances demand proper evaluation. This work develops a procedure using a virtual phantom to quantitatively assess a TPS DC algorithm. Variations of the digital Brainweb MR study were created by introducing known distortions and Control Points (CPs). A synthetic Computed Tomography (sCT) study was created based upon the MR study. Elements TPS (Brainlab, Munich, Germany) was used to apply DC to the MR images, choosing the sCT as the gold standard. Deviations in the CP locations between the original images, the distorted images and the corrected images were calculated. Structural Similarity Metric (SSIM) tests were applied for further assessment of image corrections. The introduced distortion deviated the CP locations by a median (range) value of 1.8 (0.2-4.4) mm. After DC was applied, these values were reduced to 0.6 (0.1-1.9) mm. Correction of the original image deviated the CP locations by 0.2 (0-1.1) mm. The SSIM comparisons between the original and the distorted images yielded values of 0.23 and 0.67 before and after DC, respectively. The SSIM comparison of the original study, before and after DC, yielded a value of 0.97. The proposed methodology using a virtual phantom with CPs can be used to assess a TPS DC algorithm. Elements TPS effectively reduced MR distorsions below radiosurgery tolerances., Competing Interests: Declarations. Conflict of interest: Authors declare no conflicts of interest., (© 2025. Australasian College of Physical Scientists and Engineers in Medicine.)

Monkeypox (mpox), caused by the MPOXV (monkeypox virus), has been endemic in Africa since its first identification in 1958. However, in May 2022, the world witnessed the first global outbreak associated with the West African clade. Even though thousands of cases have been recorded, our understanding of vertical transmission during pregnancy remains restricted due to an absence of reported cases in pregnant women and a lack of adequate clinical descriptions. The cases of two pregnant women, ages 33 and 24, who tested positive for MPOXV at 31 and 13.4 weeks of gestation, respectively, are presented. In all cases, extensive clinical, histological, and molecular examinations of the mothers and neonates revealed no indication of vertical transmission., (© 2024 Scandinavian Societies for Pathology, Medical Microbiology and Immunology.)

Objectives: This study aimed to assess the prevalence and risk factors associated with disease-related malnutrition (DRM) in hospitalized patients using the Subjective Global Assessment (SGA) and Global Leadership Initiative on Malnutrition (GLIM) criteria. Additionally, we sought to identify key determinants of moderate and severe malnutrition., Methods: A retrospective analysis was conducted on 1036 adult patients hospitalized in a tertiary care hospital between August 2019 and November 2020. Nutritional status was evaluated using both the SGA and GLIM criteria. Data on demographic characteristics, comorbidities, dietary intake, and gastrointestinal symptoms were collected. Logistic regression models were employed to identify risk factors for DRM, and multivariate analysis was used to determine independent predictors., Results: The prevalence of DRM was 63.3% according to GLIM and 64.8% according to SGA. Moderate malnutrition was observed in 22.6% of patients, while 40.7% were classified as having severe malnutrition, and severe weight loss was noted in 34.5% of the subjects. The key risk factors for DRM included male sex (OR 1.67, p < 0.0001), non-oncological gastrointestinal conditions (OR 1.48, p = 0.041), infectious diseases (OR 1.66, p = 0.007), inadequate ingestion (OR 5.13, p < 0.0001), and the presence of gastrointestinal symptoms (OR 3.06, p < 0.0001). Individualized diets were found to have a protective effect, while central parenteral nutrition significantly reduced the risk of severe DRM (OR 0.610, p = 0.014). In the final adjusted model, sex ( p < 0.0001), ingestion ( p < 0.0001), and gastrointestinal symptoms ( p < 0.0001) emerged as the most significant independent predictors of DRM., Conclusions: The high prevalence of DRM in hospitalized patients emphasizes the importance of routine nutritional screening and personalized interventions. Proactive management of key risk factors such as inadequate intake and gastrointestinal symptoms is crucial to mitigating malnutrition and improving patient outcomes.

Background/objectives: To evaluate the agreement and discriminant validation of different osteosarcopenic adiposity (OSAd) diagnostic criteria in women post-Roux-en-Y gastric bypass (RYGB) surgery., Methods: Surgery. This is a cross-sectional study with women ≥2 years post-RYGB. OSAd was diagnosed using three criteria: Kelly for OSAd; ESPEN/EASO and SDOC for SO, associated with WHO osteopenia, respectively. Agreement was assessed with Cohen's Kappa, and the predictive discriminatory capability was evaluated by sensitivity, specificity, and accuracy, using impairment of physical function and the increased risk of fracture as reference standards.; Results: A total of 178 women were evaluated, with a mean age of 45.2 ± 9.6 years old and postoperative time of 6.6 ± 3.6 years. The prevalence of OSAd was 2.2% [Kelly]; 2.8% [ESPEN/EASO + WHO]; 6.2% [SDOC + WHO]. Moderate agreement was found between Kelly and ESPEN/EASO (k = 0.658, p < 0.001), but agreement with SDOC was null (k = 0.104, p = 0.114). All criteria demonstrated high specificity (94.0-98.2%) and low sensitivity (0.0-16.7%), with Kelly showing the highest accuracy (92.7%); Conclusions: Among the evaluated criteria, Kelly presented the highest accuracy and 2.2% of OSAd prevalence. Despite consistently high specificity, all criteria exhibited low sensitivity. These findings highlight the need for more sensitive diagnostic approaches for OSAd in postoperative RYGB populations.

Cadmium (Cd) is a toxic heavy metal widely distributed in foodstuffs. In Mexico, few studies have evaluated Cd content in foods. This study aimed to determine Cd concentrations in foodstuffs that are highly consumed and bought in Mexico City to identify foods exceeding the Maximum Level (ML) and to assess the health risks of theoretical Cd intake from a diet following the Mexican Dietary Guidelines. A total of 143 foodstuffs were analyzed by atomic absorption spectrophotometry. Theoretical Cd intake was estimated in portions per week and compared with the Cd Tolerable Weekly Intake (TWI = 2.5 μg/kg per body weight). A total of 68.5% of the foodstuffs had detectable Cd concentrations. Higher concentrations were found in oyster mushrooms (0.575 mg/kg), romaine lettuce (0.335 mg/kg), and cocoa powder (0.289 mg/kg). Food groups with higher mean concentrations were vegetables (0.084 mg/kg) and snacks, sweets, and desserts (0.049 mg/kg). Ancho chili and romaine lettuce exceed the ML. The theoretical Cd intake estimation was 1.80, 2.05, and 3.82 μg/kg per body weight for adults, adolescents, and school-age children, respectively. This theoretical Cd intake represents a health risk only for school children exceeding the TWI by 53.2%. Our study confirms the presence and risk of Cd in Mexican foodstuffs and highlights the importance of monitoring programs.

Seasonal epidemics of influenza viruses are responsible for a significant global public health burden. Vaccination remains the most effective way to prevent infection; however, due to the persistence of antigenic drift, vaccines must be updated annually. The selection of vaccine strains occurs months in advance of the influenza season to allow adequate time for production in eggs. RNA vaccines offer the potential to accelerate production and improve efficacy of influenza vaccines. We leveraged the nucleoside-modified RNA (modRNA) platform technology and lipid nanoparticle formulation process of the COVID-19 mRNA vaccine (BNT162b2; Comirnaty®) to create modRNA vaccines encoding hemagglutinin (HA) (modRNA-HA) for seasonal human influenza strains and evaluated their preclinical immunogenicity and toxicity. In mice, a monovalent modRNA vaccine encoding an H1 HA demonstrated robust antibody responses, HA-specific Th1-type CD4 + T cell responses, and HA-specific CD8 + T cell responses. In rhesus and cynomolgus macaques, the vaccine exhibited durable functional antibody responses and HA-specific IFN-γ + CD4 + T cell responses. Immunization of mice with monovalent, trivalent, and quadrivalent modRNA-HA vaccines generated functional antibody responses targeting the seasonal influenza virus(es) encoded in the vaccines that were greater than, or similar to, those of a licensed quadrivalent influenza vaccine. Monovalent and quadrivalent modRNA-HA vaccines were well-tolerated by Wistar Han rats, with no evidence of systemic toxicity. These nonclinical immunogenicity and safety data support further evaluation of the modRNA-HA vaccines in clinical studies., (© 2024. The Author(s).)

Aims: To evaluate the impact of elexacaftor/tezacaftor/ivacaftor (ETI) therapy on Cystic Fibrosis Related Diabetes (CFRD) glycemic control and insulin treatment in patients with CFRD during clinical practice., Methods: We carried out a retrospective observational study of 23 adult patients with CFRD who started treatment with ETI. They had, at least, one F508del mutation. Data were collected before ETI initiation and 3, 6, and 12 months after., Results: Glycemic control measured by HbA1c significantly improved by 0.3 % (0.1-0.5) after 3 months of ETI therapy (p = 0.004) and kept this improvement during follow-up (p < 0.001). The proportion of patients needing multiple daily injections of insulin was reduced by 16 % (p = 0.023). Total daily insulin dose dropped by 0.12 (0.05-0.18) UI/kg/day (p < 0.001). Data derived from Flash Continuous Glucose Monitoring (CGM) for patients treated with insulin stayed unchanged after insulin reduction, except for a significant 8 % (0.3-15.6) increase in the Time In Tight Range (TITR) between 70 and 140 mg/dL (p = 0.043)., Conclusion: ETI therapy impacted CFRD in clinical practice reducing insulin needs and improving glycemic control measured by HbA1c and CGM. The improvements can be observed from the first 3 months of treatment., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Introduction: Persistent post-COVID olfactory dysfunction continues to be studied due to the controversy in its pathophysiology and neuroimaging., Materials and Methods: The patients had confirmed mild COVID-19 infection with olfactory dysfunction of more than one month of evolution and they were compared to controls with normal olfaction, assessed using the Sniffin' Sticks Olfactory Test and underwent brain, magnetic resonance imaging (MRI) of the olfactory bulb and olfactory function., Results: A total of 8 patients and 2 controls participated. The average age of the patients was 34.5 years (SD 8.5), and that of the controls was 28.5 (SD 2.1). The average score in the patients' olfactory test was 7.9 points (SD 2.2). In brain and olfactory bulb MRI tests, no morphological differences were found. When evaluated by functional MRI, none of the patients activated the entorhinal area in comparison to the controls, who did show activation at this level. Activation of secondary olfactory areas in cases and controls were as follows: orbitofrontal (25% vs 100%), basal ganglia (25% vs 50%) and insula (38% vs 0%) respectively., Conclusions: There were no observed morphological changes in the brain MRI. Unlike the controls, none of the patients activated the entorhinal cortex in the olfactory functional MRI., (Copyright © 2024 Elsevier España, S.L.U. All rights reserved.)

Introduction: Malnutrition has always been a problem in CF (cystic fibrosis) patients; however, new treatments with CFTR (cystic fibrosis transmembrane conductance regulator protein) modulators have led to weight gain, with some patients at risk of overweight and obesity., Objective: Our study aimed to analyze the evolution of BMI (body mass index) after one year of treatment with triple therapy and the factors associated with weight gain in CF patients undergoing treatment with triple therapy with CFTR protein modulators (ETI) (elexacaftor/tezacaftor/ivacaftor)., Methods: We conducted a prospective, observational, longitudinal, multicenter study in patients diagnosed with cystic fibrosis, aged 18 years or older, with at least one F508del allele and who underwent ETI therapy for at least one year, from 2020 to 2023. One hundred and eight patients from two cystic fibrosis units in Spain, Princess University Hospital of Madrid (74 patients) and Central University Hospital of Asturias (HUCA) (34 patients), were included. Demographic data, anthropometric data, lung function, and exacerbations were collected, comparing the data in the previous year to the start of therapy with the results after one year of treatment. Multivariant models were developed to account for repeated weight and BMI measurements, using a mixed effects model approach and accounting for possible modifying factors Results: One hundred and eight patients were included in the study, 58 men (53.7%) and 50 women (46.3%) with a mean age of 29.5 ± 9.4 years (18-59). Patient weight and BMI were recorded at baseline and at 3-month intervals during the study period. The weight increased from 59.6 kg to 62.6 kg and BMI increased from 21.9 kg/m 2 to 23.0 kg/m 2 after one year of treatment ( p < 0.0001 for both). The proportion of underweight individuals decreased after one year of ETI therapy, from 9.3% to 1.9%, while the proportion of overweight or obese individuals increased from 8.3% to 22.9 % at the same time ( p < 0.001). In relation to exacerbations, there is a significant increase in the number of patients who did not have any exacerbations after one year of treatment, which increased from 10.2% to 46.2% ( p < 0.001), while the number of patients who had >4 exacerbations decreased significantly, from 40.7% to 1.9% ( p < 0.001). FEV1% (forced expiratory volume) increased from 63.9 ± 20.9 to 76.8 ± 21.4 ( p < 0.001) and the VR/TLC (residual volume/total lung capacity) value decreased from 45.1 ± 10.9 to 34.9 ± 6.2 ( p < 0.001). The proportion with FEV1% > 80% increased from 23.1% before ETI therapy to 49.1% one year after ETI therapy. We performed multivariate mixed models to evaluate the evolution of BMI changes with time, accounting for repeated measures and for possible modifying factors. After the introduction of the triple therapy, patients included in the study had significant weight gain during the 12 months, and when including different covariates in the multivariate mixed model, we found that lower baseline BMI, lower baseline FEV1 and FVC (forced vital capacity), and higher VR/TLC value and higher number of exacerbations were associated with higher BMI changes over the study period., Conclusions: CF patients treated with triple therapy experience significant weight gain, increasing the proportion of overweight patients. CF patients who experienced greater weight gain were those with worse BMI at the start of treatment, as well as patients with worse lung function and a greater number of exacerbations in the year before starting ETI therapy.

This study aimed to evaluate the role of the C-reactive protein-to-prealbumin (CP) ratio and the C-reactive protein-to-albumin (CA) ratio as nutritional and prognostic markers. A retrospective study was conducted on hospitalized patients who underwent a nutritional assessment and the measurement of C-reactive protein, prealbumin, and albumin ( n = 274). Receiver operating characteristic (ROC) curve analysis was used. The area under the curve (AUC) of the CP ratio for predicting mortality was 0.644, 95%CI (0.571 to 0.717), and the CA ratio had an AUC of 0.593, 95%CI (0.518 to 0.669). The AUC of the CP ratio for the differential diagnosis between severe and moderate disease-related malnutrition (DRM) was 0.643, 95%CI (0.564 to 0.722), and the CA ratio had an AUC of 0.650, 95%CI (0.572 to 0.728). The CP and CA ratios showed greater accuracy in predicting mortality compared to C-reactive protein as an isolated marker ( p = 0.011 and p = 0.006, respectively). Both ratios also improved the ability of prealbumin and albumin to identify severe DRM ( p = 0.002 and p = 0.044, respectively). In conclusion, these results suggest that the CP and CA ratios may have a limited role in predicting mortality and identifying severe DRM by outperforming isolated protein markers.

Long-COVID (LC) is characterised by persistent symptoms for at least 3 months after acute infection. A dysregulation of the immune system and a persistent hyperinflammatory state may cause LC. LC patients present differences in activation and exhaustion states of innate and adaptive compartments. Different T CD4 + cell subsets can be identified by differential expression of chemokine receptors (CCR). However, changes in T cells with expression of CCRs such as CCR6 and CXCR3 and their relationship with CD8 + T cells remains unexplored in LC. Here, we performed unsupervised analysis and found CCR6 + CD4 + subpopulations enriched in COVID-19 convalescent individuals upon activation with SARS-CoV-2 peptides. SARS-CoV-2 specific CCR6 + CD4 + are decreased in LC patients, whereas CXCR3 + CCR6 - and CCR4 + CCR6 - CD4 + T cells are increased. LC patients showed lower IFN-γ-secreting CD8 + T cells after stimulation with SARS-CoV-2 Spike protein. This work underscores the role of CCR6 in the pathophysiology of LC., Competing Interests: Declaration of competing interest All authors declare that they have no conflicts of interest., (Copyright © 2024. Published by Elsevier Inc.)

Medication-related osteonecrosis of the jaw (MRONJ) can be a debilitating complication that can arise in patients who took or are taking antiresorptive (including bisphosphonates) or antiangiogenic agents, leading to visible bone or a fistula that continues for more than eight weeks, without any history of radiotherapy. This clinical case aimed to describe the treatment of MRONJ with topical active oxygen therapy using blue ® m oral gel. A 63-year-old female patient that had been taking weekly sodium alendronate (70 mg) for four years by oral via, presented discomfort and implant movement in the #46 region, by that underwent surgical extraction of the implant. After three months the patient returned and was diagnosed with MRONJ. Initially, conventional therapies were performed, including surgical debridement and antibiotic therapy, but without success. The patient still had clinical signs of osteonecrosis six months after the implant extraction. The entire socket was then filled with blue ® m oral gel by topical application. The patient was instructed to continue applying the gel to the region every 8 hours for 15 days. After this period, the patient returned, and it was observed that the wound was in the healing process, with the presence of epithelialized tissue and without bone exposure. The 2-year clinical follow-up showed the lesion had healed entirely, and a new implant was installed. After the osseointegration period, the final prosthesis was placed. The patient remains under clinical follow-up. Therefore, it can be concluded that the application of blue ® m oral gel in this clinical case assisted in the recovery of the osteonecrosis lesion., Competing Interests: Dra. Tatiana Deliberador is part of the bluem international board. The other authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 Deliberador et al.)

Globally, there is growing concern over the presence of lead (Pb) in foods because it is a heavy metal with several toxic effects on human health. However, monitoring studies have not been conducted in Mexico. In this study, we estimated the concentrations of Pb in the most consumed foods and identified those that exceeded the maximum limits (MLs) for Pb in foods established by the International Standards. Based on the Mexican National Health and Nutrition Survey, 103 foods and beverages were selected and purchased in Mexico City retail stores and markets. Samples were analyzed twice using atomic absorption spectrophotometry. Values above the limit of quantification (0.0025 mg/kg) were considered to be detected. The percentage of detected values was 18%. The highest concentration was found in infant rice cereal (1.005 mg/kg), whole wheat bread (0.447 mg/kg), pre-cooked rice (0.276 mg/kg), black pepper (0.239 mg/kg), and turmeric (0.176 mg/kg). Among the foods with detected Pb, the levels in infant rice cereal, whole wheat bread, pre-cooked rice, and soy infant formula exceeded the MLs. The food groups with the highest percentages of exceeded MLs were baby foods (18%) and cereals (11%). Monitoring the concentration of contaminants in foods is essential for implementing food safety policies and protecting consumer health.

Introduction: We conducted a study to determine the prevalence of structural heart disease in patients with CF, the characteristics of a cardiomyopathy not previously described in this population, and its possible relationship with nutritional deficiencies in CF., Methods: We studied 3 CMP CF patients referred for heart-lung transplantation and a prospective series of 120 adult CF patients. All patients underwent a clinical examination, blood tests including levels of vitamins and trace elements, and echocardiography with evaluation of myocardial strain. Cardiac magnetic resonance imaging (CMR) was performed in patients with CMP and in a control group. Histopathological study was performed on hearts obtained in transplant or necropsy., Results: We found a prevalence of 10% (CI 4.6%-15.4%) of left ventricular (LV) dysfunction in the prospective cohort. Myocardial strain parameters were already altered in CF patients with otherwise normal hearts. Histopathological examination of 4 hearts from CF CMP patients showed a unique histological pattern of multifocal myocardial fibrosis similar to Keshan disease. Four of the five CF CMP patients undergoing CMR showed late gadolinium uptake, with a characteristic patchy pattern in 3 cases ( p  < 0.001 vs. CF controls). Selenium deficiency (Se < 60 µg/L) was associated with more severe LV dysfunction, higher prevalence of CF CMP, higher NTproBNP levels, and more severe pulmonary and digestive involvement., Conclusion: 10% of adults with CF showed significant cardiac involvement, with histological and imaging features resembling Keshan disease. Selenium deficiency was associated with the presence and severity of LV dysfunction in these patients., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Segovia-Cubero, Ruiz-Bautista, Maiz-Carro, Girón-Moreno, Prados-Sánchez, Martínez-Martínez, González-Estecha, Mingo-Santos, Gómez-Bueno, Salas-Antón, Cavero-Gibanel, Pastrana-Ledesma, García-Pavía, Laporta-Hernández, Sánchez-Ortiz and Alonso-Pulpón.)

Background and Objectives: Securing an adequate blood supply relies on accurate knowledge of blood donors and donation practices. As published evidence on Asian populations is sparse, this study aims to gather up-to-date information on blood donors and donation practices in Asia to assist planning and strategy development., Materials and Methods: Ten blood collection agencies (BCAs) provided 12 months' data on donors who met eligibility criteria or were deferred, as well as details of their donation practices. Body mass index and blood volumes were calculated and analysed., Results: Data on 9,599,613 donations and 154,834 deferrals from six national and four regional BCAs revealed varied donation eligibility and collection practices. Seven used haemoglobin (Hb) criteria below the World Health Organization anaemia threshold. Seven accepted donors weighing <50 kg. Data collection on the weight and height of donors and on deferrals was inconsistent, often not routine. Deferred donors appear to weigh less, with corresponding lower estimated blood volume., Conclusion: The diversity in eligibility criteria and donation practices reflects each BCA's strategy for balancing donor health with securing an adequate blood supply. Use of lower Hb criteria substantiate their appropriateness in Asia and indicate the need to define Hb reference intervals relevant to each population. We encourage routine gathering of donor weight and height data to enable blood volume estimation and local optimization of donation volumes. Blood volume estimation formulae specific for the Asian phenotype is needed. Information from this study would be useful for tailoring donation criteria of Asian donors around the world., (© 2023 The Authors. Vox Sanguinis published by John Wiley & Sons Ltd on behalf of International Society of Blood Transfusion.)

Background & Aim: Malnutrition is a prevalent condition in Cystic Fibrosis (CF) and can result in worsening of pulmonary function and other comorbidities. Cystic fibrosis transmembrane regulator (CFTR) modulator therapies are improving the CF-related care and outcomes. Body Mass Index (BMI) is the most commonly used parameter to assess nutritional status, albeit it is a very unspecific indicator. Hence, current guidelines recommend body composition analysis as a part of nutritional assessment. The aim of our study was to evaluate the impact of elexacaftor-tezacaftor-ivacaftor (ELX/TEZ/IVA) treatment on body composition and respiratory function., Methods: We recruited patients with CF from University Hospital La Princesa, with follow-up in the Adult Cystic Fibrosis Unit. All patients were eligible to initiate ELX/TEZ/IVA therapy. Body composition was assessed with a Bioelectrical Impedance Analysis (BIA) and spirometry data were obtained before and after 6 months of treatment., Results: Our study sample was composed of 36 patients with CF. We observed a significant increase in BMI after 6 months of treatment (p < 0.001), as well as an increase in fat mass (p = 0.008) and visceral fat area (p = 0.026). The other body composition parameters did not yield significant changes. Overall, %FEV1 increased from 72.67 % (±17.39) to 84.74 % (±18.18) after 6 months of treatment. Interestingly, we found an inverse correlation between %FEV1 and fat mass (r = -0,476; p = 0,0058), %FEV1 and age (r = -0,411; p = 0,0196) and between %FEV1 and visceral fat area (r = -0,515; p = 0,0025). On the contrary, we found a direct correlation between %FEV1 and body cell mass (r = 0,367; p = 0,038)., Conclusions: Novel CFTR modulators are emerging for the treatment of CF. Specifically, triple combination with ELX/TEZ/IVA has shown to effectively improve both pulmonary and nutritional status in patients with CF with F508del mutation. Body composition should be a part of the routine assessment for patients with CF., Competing Interests: Conflicts of interest The authors have no conflict of interest to declare., (Copyright © 2023. Published by Elsevier Ltd.)

Introduction: There has been a global increase in patients with special needs. Undergraduate dental curricula need to adjust to meet the needs of these patients. This study aimed to identify how confident final year dental students felt about treating patients with special needs upon graduation and evaluate the influence that the curriculum had on their preparedness based on competencies outlined by the International Association for Disability and Oral Health (iADH)., Methods: A questionnaire was administered to final year dental students at two different Universities in Scotland and in Spain to: (1) evaluate how prepared students felt when treating patients with special needs and (2) assess the competencies outlined by iADH., Results: The response rate was 18.4% (30/163 students). Overall, 83.3% of the students (n = 25) perceived they would benefit from more practical sessions with patients with learning and physical disabilities to improve their clinical management of these patients. 53.3% (n = 16) didn't feel that had the knowledge to properly treat all special care dentistry (SCD) patients upon graduation (scored 5 or 6 on the IADH competency framework). 83.3% of the students (n = 25) felt that the mode of teaching should be problem-based complemented with small group seminars., Conclusion: Students from both Universities agreed that more clinical practice might be required for them to further their skills to treat special needs patients upon graduation, which correlates with the need to have more practical sessions to consolidate competency 4 (communication skills with SCD) and competency 6 (clinical management of patients requiring SCD)., (© 2023 The Authors. Special Care in Dentistry published by Special Care Dentistry Association and Wiley Periodicals LLC.)

Tamales are a traditional dish rich in fat and carbohydrates with increasing popularity. The present study aimed to investigate the use of agave inulin powder (AIP) as a potential fat replacer in tamales. The effect of replacing 0%, 33%, 66%, and 100% (w/w) of fat with AIP was evaluated in the physicochemical, sensory, and nutritional features of tamales. The fat content of tamales decreased up to 88% in AIP tamales, whereas total dietary fiber (TDF) increased up to 14%. TDF in AIP tamales had a higher proportion of soluble dietary fiber (SDF). Moreover, results indicated that both insoluble and SDF were formed during the processing of tamales. Fat replacement led to a reduction of up to 26% in the calorie load of tamales. Fourier transform infrared spectroscopy analysis confirmed changes in the absorption bands related to carbohydrates, with increments in peaks associated with inulin (936 and 862 cm -1 ), and inhibition of retrogradation when inulin was included. AIP addition resulted in tamales with lighter color. Fat replacement with AIP affected the texture of tamales increasing their softness, adhesiveness, and cohesiveness. In general, inulin positively affected the hedonic attributes and acceptance of tamales. Interestingly, full-fat tamales had a lower glycemic index and presented higher contents of resistant starch compared to tamales with AIP. Nevertheless, agave inulin may serve as a fat replacer yielding reduced-fat tamales with higher TDF and SDF and yielding a lower calorie load without significantly affecting the sensory acceptability of this traditional meal., (© 2023 Institute of Food Technologists.)

Paracetamol (PAR) is an over-the-counter analgesic/antipyretic used during pregnancy worldwide. Epidemiological studies have been associating gestational PAR exposure with neurobehavioral alterations in the progeny resembling autism spectrum disorders and attention-deficit hyperactivity disorder symptoms. The endocannabinoid (eCB) dysfunction was previously hypothesized as one of the modes of action by which PAR may harm the developing nervous system. We aimed to evaluate possible effects of gestational exposure to PAR on male and female rat's offspring behavior and if an acute injection of WIN 55,212-2 (WIN, 0.3 mg/kg), a non-specific cannabinoid agonist, prior to behavioral tests, would induce different effects in PAR exposed and non-exposed animals. Pregnant Wistar rats were gavaged with PAR (350 mg/kg/day) or water from gestational day 6 until delivery. Nest-seeking, open field, apomorphine-induced stereotypy, marble burying and three-chamber tests were conducted in 10-, 24-, 25- or 30-days-old rats, respectively. PAR exposure resulted in increased apomorphine-induced stereotyped behavior and time spent in the central area of the open field in exposed female pups. Additionally, it induced hyperactivity in the open field and increased marble burying behavior in both male and female pups. WIN injection modified the behavioral response only in the nest seeking test, and opposite effects were observed in control and PAR-exposed neonate females. Reported alterations are relevant for the neurodevelopmental disorders that have been associated with maternal PAR exposure and suggest that eCB dysfunction may play a role in the action by which PAR may harm the developing brain., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Introduction: Elexacaftor/tezacaftor/ivacaftor (ETI) was used through the early access programme in Spain from December 2019 in cystic fibrosis (CF) patients with homozygous or heterozygous F508del mutation with advanced lung disease., Methodology: Multicentre, ambispective, observational, study in which 114 patients in follow-up in 16 national CF units were recruited. Clinical data, functional tests, nutritional parameters, quality of life questionnaires, microbiological isolates, number of exacerbations, antibiotic treatments and side effects were collected. The study also compared patients with homozygous and heterozygous F508del mutations., Results: Of the 114 patients, 85 (74.6%) were heterozygous for F508del mutation, and the mean age was 32.2±9.96 years. After 30 months of treatment, lung function measured by FEV 1 % showed improvement from 37.5 to 48.6 (p<0.001), BMI increased from 20.5 to 22.3 (p<0.001), and all isolated microorganisms decreased significantly. The total number of exacerbations was also significantly reduced from 3.9 (±2.9) to 0.9 (±1.1) (p<0.001). All items in the CFQ-R questionnaire showed improvement, except for the digestive domain. Oxygen therapy use decreased by 40%, and only 20% of patients referred for lung transplantation remained on the active transplant list. ETI was well-tolerated, with only 4 patients discontinuing treatment due to hypertransaminemia., Conclusions: ETI decreases the number of exacerbations, increases lung function and nutritional parameters, decrease in all isolated microorganisms, for 30 months of treatment. There is an improvement in the CFQ-R questionnaire score except for the digestive item. It is a safe and well-tolerated drug., (Copyright © 2023 SEPAR. Published by Elsevier España, S.L.U. All rights reserved.)

Nanofibers have shown promising clinical results in the process of tissue regeneration since they provide a similar structure to the extracellular matrix of different tissues, high surface-to-volume ratio and porosity, flexibility, and gas permeation, offering topographical features that stimulate cell adhesion and proliferation. Electrospinning is one of the most used techniques for manufacturing nanomaterials due to its simplicity and low cost. In this review, we highlight the use of nanofibers produced with polyvinyl alcohol and polymeric associations (PVA/blends) as a matrix for release capable of modifying the pharmacokinetic profile of different active ingredients in the regeneration of connective, epithelial, muscular, and nervous tissues. Articles were selected by three independent reviewers by analyzing the databases, such as Web of Science, PubMed, Science Direct, and Google Scholar (last 10 years). Descriptors used were "nanofibers", "poly (vinyl alcohol)", "muscle tissue", "connective tissue", "epithelial tissue", and "neural tissue engineering". The guiding question was: How do different compositions of polyvinyl alcohol polymeric nanofibers modify the pharmacokinetics of active ingredients in different tissue regeneration processes? The results demonstrated the versatility of the production of PVA nanofibers by solution blow technique with different actives (lipo/hydrophilic) and with pore sizes varying between 60 and 450 nm depending on the polymers used in the mixture, which influences the drug release that can be controlled for hours or days. The tissue regeneration showed better cellular organization and greater cell proliferation compared to the treatment with the control group, regardless of the tissue analyzed. We highlight that, among all blends, the combinations PVA/PCL and PVA/CS showed good compatibility and slow degradation, indicating their use in prolonged times of biodegradation, thus benefiting tissue regeneration in bone and cartilage connective tissues, acting as a physical barrier that results in guided regeneration, and preventing the invasion of cells from other tissues with increased proliferation rate., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Background: Cystic Fibrosis Liver Disease is a poorly understood entity, especially in adults, in terms of its real prevalence, natural history and diagnostic criteria, despite being the most important extrapulmonary cause of mortality. The aim was to evaluate the prevalence, characteristics and potential risk factors of liver disease in adults with cystic fibrosis, according to two diagnostic criteria accepted in the scientific literature., Methods: Patients were recruited in a tertiary referral hospital, and laboratory, ultrasound, non-invasive liver fibrosis tests (AST to Platelet Ratio Index; Fibrosis-4 Index) and transient elastography (Fibroscan) were performed. The proportion of patients with liver disease according to the Debray and Koh criteria were evaluated., Results: 95 patients were included, 48 (50.5%) females, with a mean age of 30.4 (28.6-32.2) years. According to the Debray criteria, 6 (6.3%) patients presented liver disease. According to the Koh criteria, prevalence increased up to 8.4%, being statistically different from the 25% value described in other published series (p = 0.005). Seven (7.5%) presented ultrasonographic chronic liver disease. Eleven (13%) presented liver fibrosis according to the APRI score; 95 (100%) had a normal FIB-4 value. Mean liver stiffness value was 4.4 (4.1-4.7) kPa. FEV1 (OR=0.16, p 0.05), meconium ileus (OR=14.16, p 0.002), platelets (Pearson coefficient -0.25, p 0.05) and younger age (Pearson coefficient -0.19, p 0.05) were risk factors., Conclusions: Prevalence and severity of liver disease in adult cystic fibrosis patients were lower than expected. Meconium ileus, platelets, age and respiratory function were confirmed as risk factors associated to cystic fibrosis liver disease.

Information and communication technologies have significantly transformed the way advanced societies interact, produce, deliver services and consume resources. All walks of life are now touched by these technologies. However, compared to other areas of society, digital penetration is much lower in the development of and access to social services. The main objective of this paper was to find out what technological devices are used, how they are used and the way citizens interact with public bodies using technology to deliver social services. This has been part of a wider project on innovation in social services using participative methodologies centred on the development of local Hubs. The findings reveal a digital divide in technology-enabled access to social services that excludes the very people most in need of benefits and support., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Moreno et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Unlike acidic sulfide mine wastes, where metal/loid mobility and bioaccessibility has been widely studied, less attention has been paid to alkaline cyanide heap leaching wastes. Thus, the main goal of this study is to evaluate the mobility and bioaccessibility of metal/loids in Fe-rich (up to 55%) mine wastes resulting from historical cyanide leaching activities. Wastes are mainly composed of oxides/oxyhydroxides (i.e. goethite and hematite), oxyhydroxisulfates (i.e. jarosite), sulfates (i.e., gypsum, evaporitic sulfate salts), carbonates (i.e., calcite, siderite) and quartz, with noticeable concentrations of metal/loids (e.g., 1453-6943 mg/kg of As, 5216-15,672 mg/kg; of Pb, 308-1094 mg/kg of Sb, 181-1174 mg/kg of Cu, or 97-1517 mg/kg of Zn). The wastes displayed a high reactivity upon rainfall contact associated to the dissolution of secondary minerals such as carbonates, gypsum, and other sulfates, exceeding the threshold values for hazardous wastes in some heap levels for Se, Cu, Zn, As, and sulfate leading to potential significant risks for aquatic life. High concentrations of Fe, Pb, and Al were released during the simulation of digestive ingestion of waste particles, with average values of 4825 mg/kg of Fe, 1672 mg/kg of Pb, and 807 mg/kg of Al. Mineralogy may control the mobility and bioaccessibility of metal/loids under rainfall events. However, in the case of the bioaccessible fractions different associations may be observed: i) the dissolution of gypsum, jarosite and hematite would mainly release Fe, As, Pb, Cu, Se, Sb and Tl; ii) the dissolution of an un-identified mineral (e.g., aluminosilicate or Mn oxide) would lead to the release of Ni, Co, Al and Mn and iii) the acid attack of silicate materials and goethite would enhance the bioaccessibility of V and Cr. This study highlights the hazardousness of wastes from cyanide heap leaching, and the need to adopt restoration measures in historical mine sites., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

Objectives: The aim of this study was to evaluate bone health and the potential influencing factors of bone metabolism disorders in adults ≥5 y after Roux-en-Y gastric bypass (RYGB) surgery., Methods: In this cross-sectional study, patients who were ≥5 y post-RYGB were invited. Bone health considered as bone mineral content (BMC) and bone mineral density (BMD) in this study was assessed by dual x-ray absorptiometry. We also assessed 25-hydroxy-vitamin D concentrations, individual ultraviolet B radiation levels, serum ionized calcium, alkaline phosphatase, parathyroid, anthropometric, and body composition., Results: The study evaluated 104 adults (90% women; 49.6 ± 9.1 y old; postoperative period 8.7 ± 2.2 y). Lumbar and femoral BMC and BMD were positively correlated to body mass index (BMI), appendicular lean mass (ALM), and negatively to %excess of weight loss (EWL). Femoral BMD was negatively correlated to age, and both femoral BMD and BMC were positively correlated to weekly exposed body part score. Sex, age, BMI, ALM, and weekly exposed body part score explained 35% and 54% of the total variance of femoral BMD and BMC, respectively., Conclusions: The present findings suggested that older age, lower BMI, higher %EWL, lower ALM, and lower weekly body part exposure score are important determinants in lowering BMD and BMC parameters in long-term post-bariatric surgery individuals, rather than serum 25-hydroxy-vitamin D and parathyroid., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Objectives: In cystic fibrosis (CF), there is a predisposition to bronchial colonization by potentially pathogenic microorganisms, such as fungi. Our aims were to describe the dynamics of respiratory mycobiota in patients with CF and to evaluate the geographic, age and gender variability in its distribution., Methods: Cohort study in which 45 patients with CF from four hospitals in three Spanish cities were followed up during a 1-year period, obtaining spontaneous sputum samples every 3 to 6 months. Fungal microbiota were characterized by Internal Transcribed Spacer sequencing and Pneumocystis jirovecii was identified by nested PCR in a total of 180 samples., Results: The presence of fungi were detected in 119 (66.11%) of the 180 samples and in 44 (97.8%) of the 45 patients: 19 were positive and 1 negative throughout all follow-ups and the remaining 25 presented alternation between positive and negative results. A total of 16 different genera were identified, with Candida spp. (50/180, 27.78%) and Pneumocystis spp. (44/180, 24.44%) being the most prevalent ones. The distribution of fungal genera was different among the evaluated centres (p < 0.05), by age (non-adults aged 6-17 years vs. adults aged ≥18 years) (p < 0.05) and by gender (p < 0.05)., Discussion: A high prevalence of fungal respiratory microbiota in patients with CF was observed, whose dynamics are characterized by the existence of multiple cycles of clearance and colonization, reporting the existence of geographic, age and gender variability in the distribution of fungal genera in this disease., (Copyright © 2022 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.)

Dengue fever is a disease with a high mortality rate around the world, which is an important issue for the health authorities of many countries. As a result of this, the search for new drugs that are effective to combat this disease has become necessary. Medicinal plants have been used since ancient times to treat a wide list of diseases, including dengue fever. In this mini-review, 12 medicinal plants with known pharmacological properties are presented, which have been used in studies to evaluate their antiviral activity in vitro tests. Among the chemical agents involved in the antiviral response, found in the alcoholic extracts of these plants, are flavonoids, terpenes and alkaloids, which within the mechanism of action in blocking viral replication are considered entry inhibitors, fusion inhibitors, translation inhibitors and protease inhibitors. The present work shows whether these plants possess antiviral activity and the chemical compounds involved in this response., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Background and Aims: Postpartum glucose metabolism disorders are a common problem in women with gestational diabetes mellitus (GDM). They are often underdiagnosed since many patients do not attend the postpartum screening. This study aims to assess predictors of postpartum glucose metabolism disorders and type 2 diabetes mellitus (T2DM) after GDM., Material and Methods: Retrospective study in women with GMD who underwent postpartum screening for glucose metabolism disorders (n = 2688). Logistic regression was used in the statistical analysis., Results: 24.6% of women had postpartum glucose metabolism disorder. In multivariate analysis, pre-pregnancy body mass index (BMI) 25-30 kg/m 2 (OR 1.46, 95%CI 1.05 to 2.02) or BMI ≥30 kg/m 2 (OR 2.62, 95%CI 1.72 to 3.96), diagnosis of GDM before 20 weeks of pregnancy (OR 2.33, 95%CI 1.57 to 3.46), fasting plasma glucose after diagnosis of GDM ≥90 mg/dl (OR 2.12, 95%CI 1.50 to 2.98), postprandial glucose ≥100 mg/dl (OR 1.47, 95%CI 1.09 to 2.99), and HbA1c in the third trimester of pregnancy ≥5.3% (2.04, 95%CI, 1.52 to 2.75) were independent predictors for any postpartum glucose metabolism disorder., Conclusion: postpartum screening for T2DM should be performed in all women with GDM, and it is especially important not to lose follow-up in those with one or more predictive factors., Competing Interests: Declaration of competing interest The authors declare that there is no conflict of interest regarding the publication of this paper., (Copyright © 2022 Diabetes India. Published by Elsevier Ltd. All rights reserved.)

This study aimed to evaluate the potential of 10%, 20%, and 30% of raw (ARF) and germinated (AGF) ayocote bean flour as a partial substitute for wheat flour in breadmaking. Substitution with both ayocote bean flours modified the water absorption and development time while maintaining the dough stability. Supplemented breads had 13%, 51%, and 132% higher protein, mineral, and crude fiber content, respectively, than control bread (100% wheat). The breadmaking features, color and crumb firmness, were affected by the substitution level. Sensory analysis revealed that germination could improve the taste and smell of breads produced with ayocote bean flour. The sensory attribute scores of 10% AGF bread were comparable to those of the control bread. Supplementation reduced the in vitro protein digestibility, although the effect was less pronounced in 10% ARF and 20% AGF breads. The limiting amino acid score of supplemented breads increased up to 70%, which improved their protein digestibility-corrected amino acid scores. Supplementation with 20% or 30% of both ARF and AGF increased resistant starch values and decreased the total digestible starch of breads. Thus, the results showed that substituting wheat with ARF or AGF improves the nutritional properties of bread. However, low substitution levels should be selected to avoid a considerable decrease in physical and sensory properties. PRACTICAL APPLICATION: Substituting wheat flour with ayocote bean flour improved the nutritional value of bread. Germination of ayocote beans decreased the cooking stability of composite dough. Bread fortified with ayocote flour had high levels of essential amino acids. Bread with raw or germinated ayocote flours had high limiting amino acid scores. Composite bread had high resistant starch and low total digestible starch., (© 2022 Institute of Food Technologists®.)

Background/aims: The aim of this study was to apply the European Society for Clinical Nutrition and Metabolism/European Association for the Study of Obesity (ESPEN/EASO) consensus to identify sarcopenic obesity (SO) in adults mid to long-term post-Roux-en-Y gastric bypass (RYGB) using both dual-energy x-ray absorptiometry (DXA) and bioelectrical impedance analysis (BIA). Further, this approach was compared to accepted sarcopenia diagnostic criteria (Revised European Working Group on Sarcopenia in Older People [EWGSOP2] and Sarcopenia Definition and Outcomes Consortium [SDOC])., Methods: This cross-sectional study included adults ≥2 years post-RYGB surgery. Obesity was diagnosed by excess fat mass (FM) for all diagnostic criteria. Agreement was evaluated using Cohen's Kappa., Results: We evaluated 186 participants (90.9% female, median age 43.9 years, 6.8 years post-surgery), of which 60.2% (BIA), and 83.3% (DXA) had excess FM. Low muscle strength was not identified using absolute handgrip strength. The prevalence of SO by BIA or DXA, respectively, was 7.9% (95%CI 3.9-12.5), and 23.0% (95%CI 17.1-30.3) [ESPEN/EASO SO consensus]; 0.7% (95%CI 0-2.0), and 3.3% (95%CI 0.7-5.9) [EWGSOP2]; and 27.0% (95%CI 19.7-34.2), and 30.3% (95%CI 23.0-37.5) [SDOC]. Agreement between the ESPEN/EASO SO consensus and other diagnostic criteria was none to slight using DXA: EWGSOP2 k = 0.19; 95% CI 0.04-0.34, or SDOC k = 0.16; 95% CI -0.01-0.32. Moderate agreement was observed within the ESPEN/EASO SO consensus for BIA and DXA (k = 0.43; 95% CI 0.26-0.60)., Conclusions: This is the first study to explore the prevalence of SO using the ESPEN/EASO criteria. We identified a high but variable prevalence of SO in post-bariatric surgery patients (7.9-23.0%), depending on the body composition technique used; prevalence was higher using DXA. Little agreement was observed for the diagnosis of SO using the three diagnostic criteria. Future studies are needed to explore the relationship between SO identified by the ESPEN/EASO consensus and health status/outcomes., Competing Interests: Conflict of interest CMP reports receiving honoraria and/or paid consultancy from Abbott Nutrition, Nutricia, Nestle Health Science, Fresenius Kabi, and Pfizer, and grant funding from Almased., (Copyright © 2022 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Background: Infection by SARS-CoV-2 has unquestionably had an impact on the health of patients with chronic respiratory airway diseases, such as COPD and asthma, but little information is available about its impact on patients with bronchiectasis. The objective of the present study was to analyze the effect of the SARS-CoV-2 pandemic on the state of health, characteristics, and clinical severity (including the number and severity of exacerbations) of patients with non-cystic fibrosis bronchiectasis., Methods: This study was multicenter, observational, and ambispective (with data collected before and during the SARS-CoV-2 pandemic), and included 150 patients diagnosed with non-cystic fibrosis bronchiectasis., Results: A significant drop was observed in the number and severity of the exacerbations (57% in all exacerbations and 50% in severe exacerbations) in the E-FACED and BSI multidimensional scores, in the pandemic, compared with the pre-pandemic period. There was also a drop in the percentage of sputum samples positive for pathogenic microorganisms in general (from 58% to 44.7%) and, more specifically, Pseudomonas aeruginosa (from 23.3% to 13.3%) and Haemophilus influenzae (from 21.3% to 14%)., Conclusions: During the SARS-CoV-2 period, a significant reduction was observed in the exacerbations, severity, and isolations of pathogenic microorganisms in patients with bronchiectasis.

Physical barrier membranes have been used to release active substances to treat critical bone defects; however, hydrophilic membranes do not present a prolonged release capacity. In this sense, hydrophobic membranes have been tested. Thus, this study aimed to develop hydrophobic membranes based on mixtures of ureasil-polyether-type materials containing incorporated dexamethasone (DMA) for the application in guided bone regeneration. The physicochemical characterization and biological assays were carried out using small-angle X-ray scattering (SAXS), an in vitro DMA release study, atomic force microscopy (AFM), a hemolysis test, and in vivo bone formation. The swelling degree, SAXS, and release results revealed that the u-PPO400/2000 membrane in the proportion of 70:30 showed swelling (4.69% ± 0.22) similar to the proportions 90:10 and 80:20, and lower than the proportion 60:40 (6.38% ± 0.49); however, an equal release percentage after 134 h was observed between the proportions 70:30 and 60:40. All u-PPO materials presented hemocompatibility (hemolysis ≤2.8%). AFM results showed that the treatments with or without DMA did not present significant differences, revealing a flat/smooth surface, with no pores and/or crystalline precipitates. Finally, in vivo results revealed that for both the commercial hydrophilic membrane and u-PPO400/2000 (70:30) after 60 days, the bone formation volume was 21%. In conclusion, hybrid membranes present unique characteristics for treating critical bone defects, considering the delayed and prolonged release results associated with the physical barrier capacity.

Objectives. This study aims to evaluate the need to modify the total and weight-adjusted doses of levothyroxine after bariatric surgery, identify predictors, and assess the influence of the weight loss on the levothyroxine requirements. Methods. A retrospective study in patients with treated hypothyroidism that underwent bariatric surgery. The modification of the levothyroxine dose and its association with the weight loss and other potential predictors were evaluated at 6, 12, and 24 months post-surgery. Results. Among the 63 patients included, 82.54% needed an adjustment of levothyroxine dose during the follow-up. The total weekly dose of levothyroxine (µg) decreased post-surgery at 6 months (β= -49.1; 95%CI-93.7 to -4.5; p=0.031) and 12 months (β=-54.9; 95%CI-102 to -7.8; p=0.022), but did not significantly change at 24 months (p=0.114). The weekly weight-adjusted dose (µg/k) increased at 6 months (β=1.37; 95%CI 0.91 to 1.83; p<0.001), 12 months (β=2.05; 95%CI 1.43 to 2.67; p<0.001), and 24 months (β=2.52; 95%CI 1.74 to 3.30; p<0.001). The weight loss showed association with the weight-adjusted dose (OR=1.07; 95%CI 1.02 to 1.12; p=0.004), but not the total dose (p=0.320). Conclusions. This study shows a significant decrease in the total dose of levothyroxine requirements change after bariatric surgery during the first year of the follow-up and an increase in the weight-adjusted dose over the first two years. No predictors of modification of the total dose of levothyroxine were identified., (© 2022 Rosa Maria Garcia-Moreno et al., published by Sciendo.)