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[Abstract] Sentinel lymph node biopsy is the most powerful prognostic indicator to date for cutaneous melanoma. Even though elderly patients have a lower incidence of sentinel node involvement, its results are still necessary for access to adjuvant therapies. This is highly relevant considering that the Western population shows an aging trend, and the incidence of melanoma has grown exponentially over the years, making elderly patients more likely to die from melanoma than younger ones. We performed a systematic review to investigate the prognostic significance of sentinel lymph node biopsy in elderly patients with melanoma. The systematic review was conducted following the PRISMA guidelines and registered in PROSPERO. The authors searched the Cochrane Database, EMBASE, PubMed, and WOS. Eligible studies for the systematic review were clinical trials, observational population studies, clinical or hospital-based cohort studies, and case-control studies. The meta-analysis was conducted using the R software program applying the meta package. Six reports were identified to meet the inclusion criteria. All studies were retrospective, non-randomized cohorts. The results obtained in this systematic review show a statistically significant influence of sentinel lymph node biopsy on disease-specific survival (HR = 2.87; 95% CI: 1.73-4.74) but also suggest that a positive result negatively impacts disease-free survival (HR = 3.41; 95% CI: 0.96-12.11). This meta-analysis shows that a positive sentinel lymph node biopsy does not imply differences in overall survival but significantly influences disease-specific survival and suggests an unfavorable impact on disease-free survival.

[Abstract] Background: The potential influence of hyperuricemia on the genesis and progression of chronic kidney disease (CKD) remains controversial. In general, the correlation between blood levels of uric acid (UA) and the rate of progression of CKD is considered to be modest, if any, and the results of relevant trials oriented to disclose the effect of urate-lowering therapies on this outcome have been disappointing. Urinary excretion rates of UA could reflect more accurately the potential consequences of urate-related kidney injury. Method: Using a cross-sectional design, we investigated the correlation between different estimators of the rates of urinary excretion of UA (total 24-hour excretion, mean urinary concentration, renal clearance and fractional excretion)(main study variables), on one side, and urinary levels of selected biomarkers of kidney injury and CKD progression (DKK3, KIM1, NGAL, interleukin 1b and MCP)(main outcome variables), in 120 patients with advanced CKD (mean glomerular filtration rate 21.5 mL/minute). We took into consideration essential demographic, clinical and analytic variables with a potential confounding effect on the explored correlations (control variables). Spearman's rho correlation and nonlinear generalized additive regression models (GAM) with p-splines smoothers were used for statistical analysis. Main results: Multivariate analysis disclosed independent correlations between urinary UA concentrations, clearances and fractional excretion rates (but not plasma UA or total 24-hour excretion rates of UA), on one side, and the scrutinized markers. These correlations were more consistent for DKK3 and NGAL than for the other biomarkers. Glomerular filtration rate, proteinuria and treatment with statins or RAA axis antagonists were other independent correlates of the main outcome variables. Conclusions: Our results support the hypothesis that urinary excretion rates of UA may represent a more accurate marker of UA-related kidney in

[Abstract] Background: Attention to mothers during pregnancy, childbirth, and postpartum has focused on the physical aspects, overlooking mental health, which is critical to maternal well-being and childbirth. The aim of this study was to analyze the levels of anxiety experienced during labor and within the first 24 hours post-delivery, in order to identify the associated social and clinical factors associated with such anxiety. Methods: We performed a prospective observational follow-up study involving 448 women. Validated state and trait anxiety questionnaires, namely State-Trait Anxiety Inventory (STAI), which were employed in the study participants. All tests were performed with a bilateral approach. The p-values < 0.05 were considered significant. Statistical analysis was performed with the Statistical Package for the Social Sciences (SPSS, v.22.0, IBM Corp, Chicago, IL, USA). Results: State anxiety was more frequent among primiparous pregnant women, individuals who did not attend maternal education classes, and those with a history of prior abortion or cesarean section. Additionally, a significant association was observed with a history of mental disorder. Concerning Trait anxiety, significantly higher levels of anxiety were found in women with lower levels of education and in patients with a history of mental health issues. At 24 hours postpartum, elevated anxiety was more frequent in primiparous and significantly more frequent in patients with difficult deliveries, women whose infants were admitted to the Neonatal Intensive Care Unit (NICU), those lacking skin-to-skin contact, and those with previous mental health disorders. Conclusions: Insufficient maternal education, along with a complicated birthing process requiring infant hospitalization, both contribute to elevated levels of postpartum anxiety.

[Abstract] Objective: To develop predictive clinical models of bronchopulmonary dysplasia (BPD) through competing risk analysis. Methods: Retrospective observational cohort study, including preterm newborns ≤32 weeks gestational age, conducted between January 1, 2013 and September 30, 2022 in a third-level Neonatal Intensive Care Unit in Spain. A prediction study was carried out using competing risk models, where the event of interest was BPD and the competing event was death. A multivariate competing risk model was developed separately for each postnatal day (days 1, 3, 7 and 14). Nomograms to predict BPD risk were developed from the coefficients of the final models and internally validated. Results: A total of 306 patients were included in the study, of which 73 (23.9%) developed BPD and 29 (9.5%) died. On day 1, the model with the greatest predictive capacity was that including birth weight, days since rupture of membranes, and surfactant requirement (area under the receiver operating characteristic (ROC) curve (AUC), 0.896; 95% CI, 0.792–0.999). On day 3, the final predictive model was based on the variables birth weight, surfactant requirement, and Fraction of Inspired Oxygen (FiO2) (AUC, 0.891; 95% CI, 0.792–0.989). Conclusions: Competing risk analysis allowed accurate prediction of BPD, avoiding the potential bias resulting from the exclusion of deceased newborns or the use of combined outcomes. The resulting models are based on clinical variables measured at bedside during the first 3 days of life, can be easily implemented in clinical practice, and can enable earlier identification of patients at high risk of BPD.

[Resumo] Introdución y obxectivos: O proceso de parto e posparto é un período de especial vulnerabilidade para as mulleres, polo que analizar a súa satisfacción e ansiedade resulta de interese para a práctica científica e clínica. O obxectivo deste estudo foi determinar o nivel de ansiedade ao final do embarazo e posparto, satisfacción coa atención recibida e factores asociados, en mulleres embarazadas atendidas no Hospital Universitario Lucus Augusti (HULA) en 2016. Material e métodos: Realizouse un estudo observacional de seguimento prospectivo en mulleres embarazadas >=18 anos que acudiron á consulta de seguimento fetal do HULA durante o ano 2016. Recolléronse datos demográficos e clínicos, cubrindo cuestionarios validados para avaliar o nivel de ansiedade (STAI A/ E) e satisfacción coa atención recibida (COMFORTS). Resultados: Iincluíronse 448 mulleres, cunha idade de 33,6±4,7 anos. O 46,4% eran primíparas e o 39,5% embarazos de alto risco. O 52,8% realizou o parto eutócicamente, cun 27,0% cesáreas. No tocante á ansiedade como estado, na consulta de seguimento fetal, o 12,6% das mulleres presentaron un grao de ansiedade severa, o 63,1% ansiedade moderada/leve e o 24,3% ansiedade mínima. Estes datos posparto foron do 10,9%, 51,3% e 37,8%, respectivamente. A ansiedade por trazos foi mínima no 43,7%, moderada/leve no 48,0% e grave no 8,3%. A única variable que estivo significativamente asociada co estado de ansiedade-anteparto na análise multivariante foi a historia de trastornos mentais (OR=2,571; IC 95%: (1,341-4,928)). Un resultado similar obtívose en termos de trazo-ansiedade (OR=2.190; IC 95%:(1,269-3,777)) e estado posparto-ansiedade (OR=2,652; IC 95%:(1,126-6,244)). O 94,5% das embarazadas mostrouse satisfeita coa atención recibida. Os aspectos con maior grao de insatisfacción ou indiferenza asociada foron o coidado do neonato (12,3%) e o posparto (7,9%). Obsérvase que presentar ansiedade moderada-grave durante o preparto e o posparto aumenta significativame, [Resumen] Introducción y objetivos: El proceso de parto y puerperio es un periodo de especial vulnerabilidad para la mujer, por lo que analizar su satisfacción y ansiedad es de interés para la práctica científica y clínica. El objetivo de este estudio fue determinar el nivel de ansiedad al final del embarazo y postparto, la satisfacción con los cuidados recibidos y los factores asociados, en gestantes atendidas en el Hospital Universitario Lucus Augusti (HULA) en 2016. Material y métodos: Se realizó un estudio observacional de seguimiento prospectivo en gestantes >=18 años que acudieron a consulta de monitorización fetal en el HULA durante 2016. Se recogieron datos demográficos y clínicos, cumplimentando cuestionarios validados para evaluar el nivel de ansiedad (STAI A/E) y la satisfacción con los cuidados recibidos (COMFORTS). Resultados: Se incluyeron 448 mujeres, con una edad de 33,6±4,7 años. El 46,4% eran primíparas y un 39,5% embarazos de alto riesgo. Finalizaron el parto de manera eutócica el 52,8%, con un 27,0% de cesáreas. Respecto a la ansiedad como estado, en la consulta de monitorización fetal, un 12,6% de las mujeres presentó un grado de ansiedad severo, un 63,1% ansiedad moderada/leve y un 24,3% ansiedad mínima. Estos datos postparto fueron 10,9%, 51,3% y 37,8%, respectivamente. La ansiedad como rasgo fue mínima en un 43,7%, moderada/leve en el 48,0%, y severa en el 8,3%. La única variable que se asoció de forma significativa con la ansiedad-estado preparto en el análisis multivariante fueron los antecedentes de trastornos mentales (OR=2,571; IC95%:(1,341-4,928)). Se obtuvo un resultado similar en cuanto a la ansiedad-rasgo (OR=2,190; IC95%:(1,269-3,777)) y la ansiedad-estado en el postparto (OR=2.652; IC95%:(1,126-6,244)). El 94,5% de las gestantes se mostraron satisfechas con los cuidados recibidos. Los aspectos con mayor grado de insatisfacción o indiferencia asociada fueron los cuidados del recién nacido (12,3%) y los cuidados en el puerperio (7,9%, [Abstract] Introduction and objectives: The process of childbirth and puerperium is a period of special vulnerability for women, so analyzing their satisfaction and anxiety is of interest for scientific and clinical practice. The objective of this study was to determine the level of anxiety at the end of pregnancy and postpartum, satisfaction with the care received and associated factors, in pregnant women treated at the Lucus Augusti University Hospital (HULA) in 2016. Material and methods: An observational prospective follow-up study was carried out in pregnant women >=18 years of age who attended the fetal monitoring consultation at HULA during 2016. Demographic and clinical data were collected, completing validated questionnaires to assess the level of anxiety (STAI A/E) and satisfaction with the care received (COMFORTS). Results: 448 women were included, with an age of 33.6±4,7 years. 46,4% were primiparous and 39,5% high-risk pregnancies. 52,8% completed a eutocic delivery, with 27,0% cesarean sections. Regarding anxiety as a state, in the fetal monitoring consultation, 12,6% of the women presented a degree of severe anxiety, 63,1% moderate/mild anxiety and 24,3% minimal anxiety. These postpartum data were 10,9%, 51,3% and 37,8%, respectively. Trait anxiety was minimal in 43,7%, moderate/mild in 48,0%, and severe in 8,3%. The only variable that was significantly associated with anxiety-antepartum state in the multivariate analysis was a history of mental disorders (OR=2,571; 95%CI:(1,341-4,928)). A similar result was obtained in terms of trait-anxiety (OR=2,190; 95%CI:(1,269-3,777)) and postpartum state-anxiety (OR=2,652; 95%CI:(1,126-6,244)). 94,5% of the pregnant women were satisfied with the care received. The aspects with the highest degree of dissatisfaction or associated indifference were newborn care (12,3%) and postpartum care (7,9%). It is observed that presenting moderate-severe prepartum and postpartum anxiety significantly increases dissatisfaction

[Resumo] Introdución e obxectivos: son escasos os estudos en España que actualicen a evidencia sobre a idade materna avanzada como un factor de risco obstétrico. O obxectivo foi determinala prevaleza da idade materna avanzada (≥35 años) en xestantes que dan a luz nun hospital do noroeste de España, e a súas asociacións coa incidencia de morbimortalidade materno-perinatal, en canto as complicación durante a xestación, o parto e os resultados perinatais. Material e métodos: Estudo observacional de seguimento retrospectivo que incluíu a mulleres ≥20 anos que deron a luz durante 2014 (n=1378). Analizouse ademais a evolución temporal das idades maternas no día do parto das xestantes que deron a luz en dito hospital no período 2011-2021. Os datos recolléronse das historias clínicas, incluíndo as características sociodemográficas, comorbilidade, patoloxía xestacional e variables relacionadas co parto e os resultados perinatais. A evolución na prevaleza da idade materna avanzada estudouse mediante unha análise de regresión joinpoint. Realizouse unha análise de regresión loxística multivariante para determinala asociación da idade avanzada cos resultados obstétricos e perinatais. Resultados: nos últimos anos, rexistrouse un aumento progresivo e significativo da prevaleza de xestantes con 35 anos ou máis, pasando dun 35,4% des partos atendidos no 2011 o 45,5% do ano 2021 (incremento medio anual 2,1%; 95% IC=1,0%-2,7%). Tras axustar por potenciais factores de confusión na análise multivariable, a idade materna avanzada asociouse con unha maior probabilidades de diabetes xestacional (OR=1,84; 95% IC=1,10-3,07), hipotiroidismo (OR=2,11; 95% IC=1,17-3,80), menor probabilidade de un parto eutócico (OR=0,74; 95% IC=0,56-0,98) e un maior risco de precisar ingreso hospitalario >4 días (OR=2,91; 95% IC=1,95-4,35). Non se atopou unha asociación coa taxa de cesáreas (OR=1,24; 95% IC=0.89-1,72) ni co resto de complicacións analizadas. Conclusións: Confírmase a alta prevaleza de xestantes, [Resumen] Introducción y objetivos: Son escasos los estudios en España que actualicen la evidencia sobre la edad materna avanzada como un factor independiente de riesgo obstétrico. El objetivo fue determinar la prevalencia de edad materna avanzada (≥35 años) en embarazadas que dan a luz en un hospital del noroeste de España, y su asociación con la morbimortalidad materno-perinatal, en cuanto a las complicaciones durante el embarazo, el parto y los resultados perinatales. Material y métodos: Estudio observacional de seguimiento retrospectivo, incluyó a mujeres ≥20 años que dieron a luz durante 2014 (n=1378). Se analizó la evolución temporal de las edades en el periodo 2011-2021. Los datos fueron recolectados de las historias clínicas: características sociodemográficas, comorbilidades, variables relacionadas con el parto y resultados perinatales. La evolución en la prevalencia de edad materna avanzada se estudió mediante un análisis de regresión joinpoint. Se realizó un análisis de regresión logística multivariante para determinar la asociación de la edad materna avanzada con los resultados obstétricos y perinatales. Resultados: En los últimos años, se registró un aumento progresivo y significativo de la prevalencia de gestantes con 35 años o más, pasando de un 35,4% de los partos atendidos en 2011 al 45,5% del año 2021 (incremento medio anual 2,1%; 95% IC=1,0%- 2,7%). Tras ajustar por potenciales factores de confusión en el análisis multivariante, la edad materna avanzada se asoció con una mayor probabilidad de diabetes gestacional (OR = 1,84; IC del 95% = 1,10 - 3,07), hipotiroidismo (OR = 2,11; IC del 95% = 1,17 - 3,80), menor probabilidad de un parto eutócico (OR = 0,74; IC del 95% = 0,56 - 0,98) y un mayor riesgo de precisar un ingreso hospitalario >4 días (OR = 2,91; IC del 95% = 1,95 - 4,35). No se encontró una asociación con la tasa de cesáreas (OR = 1,24; IC del 95% = 0,89 - 1,72) ni con el resto de complicaciones analizadas. Conclusión: Se confirmó una alta, [Abstract] Introduction and objectives: there are a few studies in Spain that update the evidence on advanced maternal age as an independent obstetric risk factor. The objective of this study was to determine the prevalence of advanced maternal age (≥35 age) in pregnant women who give birth in a Hospital from Northwestern Spain, and its association with the incidence of maternal-perinatal morbidity, in terms of complications during pregnancy, childbirth and perinatal outcomes. Material and Methods: Retrospective follow-up observational study that included women ≥ 20 years-old who gave birth during 2014 (n=1378). The temporal evolution of maternal age on the day of delivery of pregnant women who gave birth in that hospital in the period 2011-2021 was also analysed. Data were collected from medical records, including socio-demographic characteristics, comorbidities, gestational conditions, and variables related with the delivery and perinatal outcomes. The evolution of the prevalence of advanced maternal age was studied using a joinpoint regression analysis. Multivariable logistic regression analysis was performed to determine the association of advanced maternal age with obstetric and perinatal outcomes. Results: In the lasts years, there has been a progressive and significative increase of pregnant women age 35 or over, going from 35,4% of deliveries attended in 2011 to 45,5% in 20221 (average annual increase 2,1%; 95% IC=1,0%-2,7%). After adjusting for potential confounding factors in the multivariate analysis, advanced maternal age was associated with the likelihood of gestational diabetes (OR=1.84; 95% CI=1,10-3,07), hypothyroidism (OR=2,11; 95% CI=1,17-3,80), lower probability of an eutocic delivery (OR= 0,74; 95% CI=0,56-0,98) and an increased risk of requiring hospital admission ≥4 days (OR=2,91; 95% CI=1,95-4,35). No association was found with C-section’s rate (OR=1,24; 95% CI=0,89-1,72) or with the rest of complications. Conclusions: A high prevalence of pre

[Abstract] Aim: To investigate the usefulness of multistate models (MSM) for determining colorectal cancer (CRC) recurrence rate, to analyse the effect of different factors on tumour recurrence and death, and to assess the impact of recurrence for CRC prognosis. Methods: Observational follow-up study of incident CRC cases disease-free after curative resection in 2006-2013 (n = 994). Recurrence and mortality were analyzed with MSM, as well as covariate effects on transition probabilities. Results: Cumulative incidence of recurrence at 60 months was 13.7%. Five years after surgery, 70.3% of patients were alive and recurrence-free, and 8.4% were alive after recurrence. Recurrence has a negative impact on prognosis, with 5-year CRC-related mortality increasing from 3.8% for those who are recurrence-free 1-year after surgery to 33.6% for those with a recurrence. Advanced stage increases recurrence risk (HR = 1.53) and CRC-related mortality after recurrence (HR = 2.35). CRC-related death was associated with age in recurrence-free patients, and with comorbidity after recurrence. As expected, age≥75 years was a risk factor for non-CRC-related death with (HR = 7.76) or without recurrence (HR = 4.26), while its effect on recurrence risk was not demonstrated. Conclusions: MSM allows detailed analysis of recurrence and mortality in CRC. Recurrence has a negative impact on prognosis. Advanced stage was a determining factor for recurrence and CRC-death after recurrence.

[Abstract] BACKGROUND: The time to perform a surgical intervention in necrotizing enterocolitis remains a challenge for the pediatric surgeon. We design a novel score system to predict infants in high risk for the development of surgical necrotizing enterocolitis. METHODS: A total of 124 consecutively patients diagnosed of NEC at the University Hospital of A Coruña, Spain were included in the study. Associations were analyzed by bivariate and multivariate analysis. We applied multivariate logistic regression modeling to identify factors that could provide accurate risk of surgical NEC. We include not only analytical and radiological parameters or physical examination, but we also analyzed prenatal, sociodemographic, perinatal and peripartum variables that conditioned the presence of predispose factors, which could determine the debut of this entity and in its progression. RESULTS: Patients requiring surgical treatment have presented an antecedent of respiratory distress (worsening of the ventilatory requirements) in the perinatal period, they present higher values of glycemia at diagnosis of the illness, debut with coagulopathy and have in laboratory findings marked neutrophilia. CONCLUSIONS: Our score system obtained by combining several parameters could detect infants at risk of developing severe necrotizing enterocolitis improving the morbidity and mortality associated with delay in the surgical treatment.

[Resumen] El SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) ha provocado mas de 767 millones de infecciones y cerca de 7 millones de muertes y ha desestabilizado incluso a los sistemas sanitarios mas avanzados. Las Unidades de Cuidados Intensivos (UCI) tuvieron que afrontar una nueva enfermedad, sin tratamiento conocido, y un numero de pacientesmuy superior a su capacidad habitual. Los objetivos de esta tesis fueron: i) Analizar el efecto de un ciclo corto de corticoides a dosis bajas en los parametros inflamatorios y de intercambio gaseoso de pacientes con COVID-19 en ventilacion mecanica; ii) Describir la incidencia, microbiologia e impacto en el pronostico de la coinfeccion bacteriana al ingreso en UCI; iii) Describir como las UCI de Espana se adaptaron para dar respuesta durante el primer ano de la pandemia. Se realizo un estudio observacional restrospectivo de los pacientes adultos ingresados en la UCI del Complexo Hospitalario Universitario de Ourense entre marzo de 2020 y diciembre de 2021. A su vez, se llevo a cabo una encuesta entre los miembros de la Sociedad Espanola de Medicina Intensiva, Critica y Unidades Coronarias que prestaron asistencia durante el primer ano de la pandemia. Los hallazgos muestran que un ciclo corto de corticoides mejoro, al menos transitoriamente, los parametros inflamatorios y el intercambio gaseoso de los pacientes COVID ingresados en UCI. Posteriormente, un ensayo clinico demostro el beneficio de este tratamiento. Por otro lado, la incidencia de coinfeccion bacteriana al ingreso en UCI fue elevada y, ademas, afecta negativamente al pronostico de los pacientes, por lo que se propone el tratamiento antibiotico de todos los pacientes al ingreso en UCI y la retirada precoz del mismo si la evolucion clinica, analitica y microbiologica del paciente en las siguientes 24-48 horas permite descartar la coinfeccion bacteriana. La encuesta realizada permitio corroborar que las primeras olas de la pandemia sobrepasaron la capac, [Resumo] O SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) causou mais de 767 millons de infeccions e case 7 millons de mortes e desestabilizou ata os sistemas de saude mais avanzados. As Unidades de Coidados Intensivos (UCI) tiveron que afrontar unha nova enfermidade, sen tratamento conecido, e un numero de pacientes moi superior a sua capacidade habitual. Os obxectivos desta tese foron: i) Analizar o efecto dun curso curto de corticoides en doses baixas sobre os parametros inflamatorios e de intercambio gaseoso dos pacientes con COVID-19 en ventilacion mecanica; ii) Describir a incidencia, microbioloxia e impacto no prognostico da coinfeccion bacteriana ao ingreso na UCI; iii) Describir como se adaptaron as UCI en Espana durante o primeiro ano da pandemia. Realizouse un estudo observacional retrospectivo de pacientes adultos ingresados na UCI do Complexo Hospitalario Universitario de Ourense entre marzo de 2020 e decembro de 2021. A sua vez, realizouse unha enquisa entre os membros da Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias que prestaron asistencia durante o primeiro ano da pandemia. Os resultados mostran que un curso curto de corticoides mellorou, polo menos temporalmente, os parametros inflamatorios e o intercambio de gases dos pacientes con COVID ingresados na UCI. Posteriormente, un ensaio clinico demostrou o beneficio deste tratamento. Por outra banda, a incidencia de coinfeccion bacteriana ao ingreso na UCI foi elevada e, ademais, afecta negativamente ao prognostico dos pacientes, polo que se propon un tratamento antibiotico para todos os pacientes ao ingreso na UCI e a sua retirada precoz se a evolucion clinica, analitica e microbioloxica do paciente nas seguintes 24-48 horas permite descartar a coinfeccion bacteriana. A enquisa realizada confirmou que as primeiras vagas da pandemia superaron a capacidade das UCI do pais. Foi posible subsanar as deficiencias materiais, pero non as de recursos humanos. O persoal da, [Abstract] SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) has caused more tan 767 million infections and nearly 7 million deaths and has destabilized even the most advanced healthcare systems. Intensive Care Units (ICU) had to face a new disease, with no known treatment, and a number of patients much higher than their usual capacity. The objectives of this thesis were: i) Analyze the effect of a short course of low-dose corticosteroids on the inflammatory and gas exchange parameters of patients with COVID- 19 on mechanical ventilation; ii) Describe the incidence, microbiology and impact on the prognosis of bacterial coinfection upon admission to the ICU; iii) Describe how the ICUs in Spain adapted to respond during the first year of the pandemic. A retrospective observational study was carried out on adult patients admitted to the ICU of the Complexo Hospitalario Universitario de Ourense between March 2020 and December 2021. In turn, a survey was carried out among the members of the Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias who provided assistance during the first year of the pandemic. The findings show that a short course of corticosteroids improved, at least temporarily, the inflammatory parameters and gas exchange of COVID patients admitted to the ICU. Subsequently, a clinical trial demonstrated the benefit of this treatment. On the other hand, the incidence of bacterial coinfection upon admission to the ICU was high and, in addition, it negatively affects the prognosis of the patients, which is why antibiotic treatment is proposed for all patients upon admission to the ICU followed by early withdrawal if the clinical, analytical and microbiological evolution of the patient in the following 24-48 hours allows us to rule out bacterial coinfection. The survey carried out confirmed that the first waves of the pandemic exceeded the capacity of the country's ICUs. It was possible to remedy the material deficiencies, but not t

[Abstract] Background: Chemotherapy is one of the most widely used therapies for breast cancer, triggering important repercussions on people's quality of life. However, little research has been undertaken about podiatric adverse effects. This study aimed was to determine the prevalence of podiatric pathology developed in people with breast cancer who receive chemotherapy. Methods: Observational, descriptive, and cross-sectional study was conducted in the Oncology service of the A Coruña University Hospital (northwest Spain). People with breast cancer and undergoing chemotherapy treatment of legal age (≥ 18), who signed the informed consent (n = 117) were included. Sociodemographic, comorbidity, disease and foot health variables, as well as two self-administered questionnaires (Foot Health Status Questionnaire and Foot Function Index) were studied. The current ethical-legal aspects were followed. Results: Foot health problems were highly prevalent, highlighting nail color changes (59.8%), onychocryptosis (39.7%), xerosis (62.4%), plantar fasciitis (12.8%), and neuropathic symptoms (75.2%). Some foot pain was presented in 77.8% of the sample, predominantly at nail level (15.4%) or sole of the foot and nail (14.5%). Most participants described their foot health as fair or poor (56.4%) and felt limited in walking (65.8%). The lowest score for the Foot Health Status Questionnaire was footwear (30.6(33.5)). Conclusions: Foot health adverse effects represent worrisome problems in women with breast cancer undergoing chemotherapy, due to their high prevalence and negative implications on quality of life. These problems are critical as they may have implications for stopping or reducing chemotherapy. All these results call for the development of more research to contribute to the care and wellbeing of people with cancer who receive treatments such as chemotherapy. Thus, this line of research is a new path to be developed by the podiatry community.

[Abstract] To date, recommendations for the implementation of awake prone positioning in patients with hypoxia secondary to SARSCoV2 infection have been extrapolated from prior studies on respiratory distress. Thus, we carried out a systematic review and metaanalysis to evaluate the benefits of pronation on the oxygenation, need for endotracheal intubation (ETI), and mortality of this group of patients. We carried out a systematic search in the PubMed and Embase databases between June 2020 and November 2021. A randomeffects metaanalysis was performed to evaluate the impact of pronation on the ETI and mortality rates. A total of 213 articles were identified, 15 of which were finally included in this review. A significant decrease in the mortality rate was observed in the group of pronated patients (relative risk [RR] = 0.69; 95% confidence interval [CI]: 0.480.99; p = 0.044), but no significant effect was observed on the need for ETI (RR = 0.79; 95% CI: 0.631.00; p = 0.051). However, a subgroup analysis of randomized clinical trials (RCTs) did reveal a significant decrease in the need for this intervention (RR = 0.83; 95% CI: 0.710.97). Prone positioning was found to significantly reduce mortality, also diminishing the need for ETI, although this effect was statistically significant only in the subgroup analysis of RCTs. Patients’ response to awake prone positioning could be greater when this procedure is implemented early and in combination with noninvasive mechanical ventilation (NIMV) or highflow nasal cannula (HFNC) therapy.

[Resumen] El dolor lumbar crónico causa discapacidad e impacto socioeconómico. El ejercicio de alta intensidad muestra resultados positivos en otras enfermedades, pero no existe evidencia sobre esta patología. Se pretende determinar su eficacia en la calidad de vida relacionada con la salud, la discapacidad, la intensidad del dolor y la adherencia al tratamiento en personas con dolor lumbar crónico. Se realiza una revisión bibliográfica en Pubmed, PEDro y Scopus, incluyendo ensayos clínicos aleatorizados, guías de práctica clínica y revisiones sistemáticas en español, inglés o portugués (2012-2022). Además, se hace una búsqueda en bola de nieve. Se incorporan ocho ensayos clínicos aleatorizados (n = 379). Se analizan diferentes modalidades de ejercicio de alta intensidad, que parecen mejorar la calidad de vida relacionada con la salud y reducir la discapacidad y la intensidad del dolor. Estos datos se deben tomar con cautela dada la poca cantidad de estudios y el riesgo de sesgo que presentan., [Abstract] Chronic low back pain causes disability and socioeconomic impact. High-intensity exercise shows positive results in other diseases, but there is no evidence on this pathology. The aim is to determine its efficacy on health-related quality of life, disability, pain intensity and adherence to treatment in people with chronic low back pain. A literature review is conducted in Pubmed, PEDro and Scopus, including randomized clinical trials, clinical practice guidelines and systematic reviews in Spanish, English or Portuguese (2012-2022). In addition, a snowball search is performed. Eight randomized clinical trials (n = 379) are incorporated. Different high-intensity exercise modalities are analyzed, which seem to improve health-related quality of life and reduce disability and pain intensity. These data should be taken with caution given the small number of studies and the risk of bias presented.

[Resumen] Introducción: A pesar de los beneficios establecidos, la lactancia materna se enfrenta a múltiples barreras y determinantes. Esto es así para todas las mujeres y familias que optan por la lactancia como forma de alimentación para sus hijos. Es sabido que el retorno al trabajo es uno de los tantos factores que afectan la continuidad de la lactancia. En este estudio nos centramos en un colectivo de mujeres trabajadoras, pertenecientes al ámbito sanitario, ya que con ellas se presenta una situación particular, como trabajadoras de la salud, muchas veces se encuentran dando apoyo y promoción a la lactancia, sin embargo, no siempre pueden cumplir a nivel personal, lo que predican con sus pacientes. En España no hay un sistema oficial de monitorización y seguimiento de la lactancia y en el campo de las trabajadoras sanitarias estos datos tampoco se encuentran. Por lo que nos parece importante como punto de partida saber cuáles son las prácticas de lactancia en las trabajadoras sanitarias, para poder diseñar estrategias que colaboren en el cambio necesario para que la lactancia no sea un privilegio, sino un derecho para todas las mujeres que así lo deseen. Objetivos: en este estudio se busca determinar la prevalencia de lactancia materna en las trabajadoras sanitarias del Área sanitaria de A Coruña y Cee, las prácticas diferenciales según datos demográficos y laborales y los factores que se asocian al abandono prematuro de la misma. Metodología: se realizará un estudio observacional, descriptivo, transversal, de prevalencia o asociación cruzada, en el Área sanitaria de A Coruña y Cee, durante los meses de enero 2024 y agosto 2025. Se accederá a la muestra, a través del correo electrónico institucional del Sergas (Servicio Gallego de Salud), sesiones y díptico informativo y se obtendrán las variables de estudio con un cuestionario online, anónimo realizado con Formularios de Google. El estudio estadístico se realizará a través del programa estadístico R Commander, [Resumo] Introdución: A pesar dos beneficios establecidos, a lactación materna enfróntase a múltiples barreiras e determinantes. Isto é así para todas as mulleres e familias que optan por amamantar como forma de alimentar aos seus fillos. Sábese que a volta ao traballo é un dos moitos factores que inciden na continuidade da lactación. Neste estudo centrámonos nun grupo de mulleres traballadoras, pertencentes ao ámbito sanitario, xa que con elas se presenta unha situación particular, como traballadoras sanitarias, moitas veces están a apoiar e promover a lactación materna, non obstante, non sempre poden cumprir a nivel persoal, o que predican cos seus pacientes. En España non existe un sistema oficial de seguimento e seguimento da lactación e no ámbito das traballadoras sanitarias tampouco se atopan estes datos. Polo tanto, parécenos importante como punto de partida coñecer cales son as prácticas de lactación materna nas traballadoras sanitarias, para poder deseñar estratexias que colaboren no necesario cambio para que a lactación materna non sexa un privilexio, senón un dereito de todas as mulleres. quen o fagan.desexan. Obxectivos: este estudo busca determinar a prevalencia da lactación materna nos traballadores sanitarios da área sanitaria da Coruña e Cee, as prácticas diferenciais segundo datos demográficos e laborais, e os factores asociados ao abandono prematuro. Metodoloxía: realizarase un estudo observacional, descritivo, transversal, de prevalencia ou de asociación transversal na área sanitaria da Coruña e Cee, durante os meses de xaneiro de 2024 e agosto de 2025. Accederase á mostra a través do correo institucional do Sergas (Servizo Galego de Saúde), sesións e díptico informativo e as variables de estudo obteranse cun cuestionario en liña anónimo realizado con Google Forms. O estudo estatístico realizarase mediante o programa estatístico R Commander, versión 4.2.2., [Abstract] Introduction: Despite the established benefits, breastfeeding faces multiple barriers and determinants. This is so for all women and families who choose to breastfeed as a way of feeding their children. It is known that the return to work is one of the many factors that affect the continuity of lactation. In this study we focus on a group of working women, belonging to the health field, since a particular situation arises with them, as health workers, many times they are supporting and promoting breastfeeding, however, they cannot always comply on a personal level, what they preach with their patients. In Spain there is no official system for monitoring and follow-up of lactation and in the field of health workers these data are not found either. Therefore, it seems important to us as a starting point to know what are the breastfeeding practices in health workers, in order to be able to design strategies that collaborate in the necessary change so that breastfeeding is not a privilege, but a right for all women who do so. they wish. Objectives: this study seeks to determine the prevalence of breastfeeding in health workers in the health area of A Coruña and Cee, the differential practices according to demographic and employment data, and the factors associated with premature abandonment. Methodology: an observational, descriptive, cross-sectional, prevalence or cross-association study will be carried out in the health area of A Coruña and Cee, during the months of January 2024 and August 2025. The sample will be accessed through the institutional email of the Sergas (Galician Health Service), sessions and informative diptych and the study variables will be obtained with an anonymous online questionnaire carried out with Google Forms. The statistical study will be carried out using the statistical program R Commander, version 4.2.2.