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RESUMEN Introducción. La enfermedad de Peyronie es una malformación adquirida del pene, originada por la deposición de placas fibróticas en la túnica albugínea. La prevalencia en Estados Unidos oscila entre el 0.39% y 11.8%, en Europa 8.9%, en Latinoamérica no existe un porcentaje puntual de prevalencia actual debido a la escasez de reportes de esta patología. Este análisis bibliométrico busca describir la evolución terapéutica de la Enfermedad de Peyronie en la literatura de los últimos 62 años, así como la distribución geográfica de estas publicaciones. Metodología. Estudio observacional, descriptivo, un análisis bibliométrico desde 1957 hasta 2019, utilizando GoPubMed y FABUMED. Resultados. Se obtuvieron 721 referencias sobre tratamiento quirúrgico en enfermedad de Peyronie, con un aumento de la producción científica a lo largo del periodo de estudio. The Journal of Urology fue la revista con mayor cantidad de publicaciones, el 57.9% dentro de la categoría de artículo científico. El país líder fue Estados Unidos con 191 publicaciones. Discusión. Existe poca literatura sobre los avances terapéuticos para el tratamiento de enfermedad de Peyronie, lo que dificulta la comparación de las investigaciones a lo largo de los años en diferentes zonas del mundo. La investigación en Latinoamérica es escasa. Conclusión. La investigación sobre el tratamiento quirúrgico en enfermedad de Peyronie muestra un patrón ascendente en la productividad científica durante los años estudiados. Los países con mayores ingresos económicos son de mayor desarrollo en el tema y en menor medida regiones con recursos limitados. El análisis evidencia la importancia de aumentar producción científica en Colombia, así como estimular la investigación sobre este tema, ya que existen muy pocas publicaciones sobre la evolución del tratamiento quirúrgico para esta enfermedad. Palabras clave: Induración Peniana; Enfermedades del Pene; Bibliometría; Fibrosis; Erección Peniana ABSTRACT Introduction. Peyronie’s disease is an acquired malformation of the penis, caused by the deposition of fibrotic plaques in the tunica albuginea. The prevalence in the United States ranges between 0.39% and 11.8%, in Europe 8.9%, in Latin America there is no specific percentage of current prevalence due to the scarcity of reports of this pathology. This bibliometric analysis seeks to describe the therapeutic evolution of Peyronie’s Disease in the literature over the last 62 years, as well as the geographic distribution of these publications. Methodology. This is an observational, descriptive study, with a bibliometric analysis from 1957 to 2019, using GoPubMed and FABUMED. Results. 721 references on surgical treatment in Peyronie’s disease were obtained, with an increase in scientific production throughout the study period. The Journal of Urology was the journal with the highest number of publications, 57.9% within the scientific article category. The leading country was the United States with 191 publications. Discussion. There is a limited amount of literature on therapeutic advances for the treatment of Peyronie’s disease, which makes it difficult to compare research over the years in different areas of the world. Research in Latin America is scarce. Conclusion. Research on surgical treatment in Peyronie’s disease shows an increasing pattern in scientific productivity over the years. Countries with higher economic income have greater development in the subject and to a lesser extent regions with limited resources. The analysis shows the importance of increasing scientific production in Colombia, as well as stimulating research on this topic, since there are few publications on the evolution of surgical treatment for this disease. Keywords: Penile Induration; Penile Diseases; Bibliometrics; Fibrosis; Penile Erection RESUMO Introdução. A doença de Peyronie é uma malformação adquirida do pênis, causada pela deposição de placas fibróticas na túnica albugínea. A prevalência nos Estados Unidos varia entre 0.39% e 11.8%, na Europa 8.9%, na América Latina não existe um percentual específico de prevalência atual devido à escassez de relatos desta patologia. Esta análise bibliométrica tem como objetivo descrever a evolução terapêutica da Doença de Peyronie na literatura dos últimos 62 anos, bem como a distribuição geográfica destas publicações. Metodologia. Estudo observacional, descritivo, análise bibliométrica de 1957 a 2019, utilizando GoPubMed e FABUMED. Resultados. Foram obtidas 721 referências sobre tratamento cirúrgico na doença de Peyronie, com aumento da produção científica ao longo do período do estudo. The Journal of Urology foi o periódico com maior número de publicações, 57.9% dentro da categoria artigo científico. O país líder foram os Estados Unidos com 191 publicações. Discussão. Há pouca literatura sobre avanços terapêuticos para o tratamento da doença de Peyronie, o que dificulta a comparação de pesquisas ao longo dos anos em diferentes partes do mundo. As pesquisas na América Latina são escassas. Conclusão. As pesquisas sobre o tratamento cirúrgico da doença de Peyronie mostram um padrão crescente de produtividade científica ao longo dos anos estudados. Os países com maior rendimento económico são mais desenvolvidos no assunto e, em menor medida, regiões com recursos limitados. A análise mostra a importância de aumentar a produção científica na Colômbia, bem como estimular a pesquisa sobre o tema, uma vez que existem poucas publicações sobre a evolução do tratamento cirúrgico desta doença. Palavras-chave: Induração Peniana; Doenças do Pênis; Bibliometria; Fibrose; Ereção Peniana

Resumen: A pesar de los tratamientos actuales, que incluyen los inhibidores del sistema renina angiotensina y los inhibidores SGLT2, el riesgo de progresión de la enfermedad renal en los sujetos con diabetes y enfermedad renal crónica (ERC) continúa inaceptablemente alto. La patogenia de la ERC en el paciente con diabetes es compleja e incluiría factores hemodinámicos, metabólicos y de inflamación y fibrosis. La finerenona es un antagonista no esteroideo altamente selectivo del receptor mineralocorticoide que, a diferencia de los tratamientos actuales, podría disminuir directamente la inflamación y la fibrosis, aportando un valor añadido al abordaje de estos pacientes. De hecho, la finerenona disminuye la albuminuria y enlentece la progresión de la ERC en personas con diabetes. La presente revisión aborda el mecanismo de acción de la finerenona, los resultados de ensayos clínicos recientes y la integración en práctica clínica de la nefroprotección y cardioprotección de la finerenona en el abordaje terapéutico integral del paciente diabético con ERC. Abstract: Despite current treatments, that include renin angiotensin system blockers and SGLT2 inhibitors, the risk of renal disease progression among patients with diabetes and chronic kidney disease (CKD) remains unacceptably high. The pathogenesis of CKD in patients with diabetes is complex and includes hemodynamic and metabolic factors, as well as inflammation and fibrosis. Finerenone is a nonsteroidal highly selective mineralocorticoid antagonist that, in contrast to current therapies, may directly reduce inflammation and fibrosis, supporting an added value in the management of these patients. In fact, finerenone decreased albuminuria and slowed CKD progression in persons with diabetes. We now review the mechanisms of action of finerenone, the results of recent clinical trials and a practical approach to integrate the kidney and cardiovascular protection afforded by finerenone in the routine care of patients with diabetes and CKD.

Systemic sclerosis (SSc) is a multifaceted autoimmune disorder characterized by widespread organ involvement, impacting the skin, lungs, gastrointestinal tract, and blood vessels. Patients often confront a reduced lifespan, primarily attributed to pulmonary complications. Current therapeutic strategies concentrate on organ-specific interventions to mitigate inflammation and alleviate symptoms. Immunosuppressive drugs, vasodilators, and anti-fibrotic agents are commonly employed, but ongoing research explores novel drugs and therapeutic approaches. Autologous stem cell transplantation is considered in rapidly progressing interstitial lung disease, although potential complications must be carefully weighed. Recent studies delve into the intricate pathogenesis of SSc, revealing abnormalities in metabolic pathways and protein regulation. The disease manifests with diverse symptoms affecting various organs, with vascular involvement significantly contributing to morbidity, especially pulmonary arterial hypertension. Complications, including heightened susceptibility to infections, are exacerbated by the disease and its treatments. Ongoing research investigates potential treatments such as GPR68 antagonists, soluble guanylate cyclase activators, and melanocortin 1 receptor agonists, displaying promising results in improving pulmonary function. Multiple clinical trials for various drugs are currently underway. In conclusion, addressing the complexities of systemic sclerosis requires a multidisciplinary approach. Understanding its intricate pathogenesis and developing targeted therapies are pivotal for enhancing patient outcomes and extending survival.

Sra. Editora: Con sumo interés, he leído el artículo “Enfermedad por esteatohepatitis no alcohólica en pacientes diabéticos tipo 2: artículo de revisión” (1), publicado por Gonzalo Miranda en el número 2 del volumen 23 de la revista Horizonte Médico, donde se concluye que la alta prevalencia de la diabetes mellitus tipo 2 (DM2) y la enfermedad por esteatohepatitis no alcohólica (EHGNA) podría generar una situación de salud pública preocupante en el futuro, debido a las consecuencias en términos de mortalidad y morbilidad asociadas a estas enfermedades. Por tal razón, se considera oportuno reflexionar al respecto tomando en cuenta su gran importancia.

La enfermedad por esteatohepatitis no alcohólica (EHGNA) se genera por el depósito de macrovesículas de triglicéridos en el hígado, y se excluye de otras etiologías como alcohólica, medicamentosa o secundaria a trastornos genéticos. El espectro de este trastorno considera la esteatohepatitis no alcohólica y esteatosis hepática simple. En 2020, un panel internacional de expertos propuso una nueva denominación para esta entidad, y se consideró que el término “enfermedad del hígado graso asociado a disfunción metabólica” (MAFLD, por sus siglas en inglés) sería el más apropiado para referirse a un conjunto completo, pero sencillo, de criterios para el diagnóstico de MAFLD, los cuales son independientes de la cantidad de alcohol consumido y pueden aplicarse a los pacientes en cualquier entorno clínico. La EHGNA es una manifestación del síndrome metabólico, y uno de los grupos de riesgo de prevalencia y progresión rápida son los pacientes con diabetes tipo 2 (DM2). El modelo vigente considera que este proceso ocurre como consecuencia de “múltiples hits” que podrían anteceder a la esteatosis hepática como una explicación más apropiada para considerar la evolución de la EHGNA en un contexto de estado de inflamación. La DM2 agudiza el EHGNA, lo que conduce a la hiperglicemia, por ende, a la creación de un círculo vicioso. Es importante valorar, para el caso de los pacientes diabéticos, el riesgo de fibrosis debido a su impacto en un mayor riesgo cardiovascular y progresión de la enfermedad hepática, para lo cual podrían emplearse pruebas no invasivas, tales como los biomarcadores de fibrosis, elastografía o una biopsia hepática. A medida que se disponga de alternativas de tratamiento más efectivas, será aún más relevante determinar el grado de fibrosis. Actualmente, el manejo de esta entidad incluye cambios en el estilo de vida como una de las medidas terapéuticas más efectivas. Dentro del tratamiento farmacológico, se considera que la intervención más eficaz para esta enfermedad en pacientes diabéticos es el uso de tiazolidinedionas. El tratamiento con agonistas de péptido similar al glucagón tipo 1 (GLP-1), como liraglutida, o con inhibidores del cotransportador 2 de sodio-glucosa también han mostrado resultados prometedores en estudios preliminares.

Resumen: Introducción y objetivos: La estadificación de la fibrosis en pacientes con enfermedad por hígado graso no alcohólico (EHGNA) se realiza aplicando distintos algoritmos. Sin embargo, hay pocos reportes de cómo se utilizan en la vida real. Nuestro objetivo fue estimar la proporción de pacientes con EHGNA que teniendo riesgo indeterminado o alto de fibrosis según scores no-invasivos se someten a estudios adicionales de estadificación. Materiales y métodos: Estudio de corte transversal multicéntrico de pacientes con EHGNA evaluados por hepatólogos del 1 de junio del 2018 al 31 de julio del 2018. Se calcularon FIB-4 y NAFLD fibrosis score en todos los pacientes y se consideró que, si al menos uno de los scores sugería riesgo indeterminado o alto de fibrosis, el paciente debería haberse sometido a estudios adicionales de estadificación. Resultados: Se incluyeron 238 pacientes. La mediana de tiempo entre el diagnóstico de EHGNA y la inclusión en el estudio fue de 12.2 (IQR 3.0-36.5) meses. En total, 128 (54%) pacientes tuvieron al menos una evaluación con score no-invasivo que sugería riesgo indeterminado o alto de fibrosis. Sin embargo, solamente 72 (56%) se realizaron estudios para confirmar el grado de fibrosis (elastografía, biopsia, etc.). Las principales barreras encontradas por los médicos para aplicar los algoritmos de estadificación fueron relacionadas a cobertura de salud y a costos. Conclusiones: Un alto porcentaje de pacientes con EHGNA tiene riesgo indeterminado o alto de fibrosis, de acuerdo con los resultados obtenidos con scores no invasivos. Sin embargo, solamente la mitad se realizó estudios adicionales, evidenciando una baja adherencia a las recomendaciones actuales. Abstract: Introduction and aims: Fibrosis staging in patients with nonalcoholic fatty liver disease (NAFLD) is carried out through the application of stepwise algorithms but there is little real-world data on their use. Our aim was to calculate the number of patients with NAFLD and indeterminate or high risk for fibrosis, assessed through noninvasive scores, that consequently underwent further staging evaluation. Materials and methods: A cross-sectional multicenter cohort study was conducted on patients with NAFLD evaluated by hepatologists within the time frame of June 1 and July 31, 2018. The FIB-4 and NAFLD fibrosis scores were calculated in all the patients, and if at least one of the scores suggested indeterminate or high risk for fibrosis, we believed the patient should have undergone additional fibrosis staging assessment. Results: The study included 238 patients. The median time interval from NAFLD diagnosis and inclusion in the analysis was 12.2 months (IQR 3.0-36.5). A total of 128 (54%) patients had at least one noninvasive score that suggested indeterminate or high risk for fibrosis but studies to confirm the fibrosis grade (elastography, biopsy, etc.) were performed on only 72 (56%). The main barriers encountered by the physicians for applying the staging algorithms were related to health insurance coverage and imaging study costs. Conclusions: A high percentage of patients with NAFLD were at indeterminate or high risk for fibrosis, according to noninvasive scores, but additional studies were carried out on only half of them, showing low adherence to current recommendations.

Objetivo: Determinar la efectividad de la vitamina E en la esteatosis hepática no alcohólica (EHGNA) en pacientes diabéticos tipo 2 sin fibrosis avanzada. Materiales y métodos: Estudio analítico de tipo cuasi experimental. Se formaron dos grupos, un grupo experimental que recibió vitamina E de 400 UI además del manejo convencional, y otro grupo de control con manejo convencional. El estudio incluyó a 71 pacientes en cada grupo. Ambos grupos fueron sometidos al cálculo de un puntaje de fibrosis hepática, ecografía hepática y a la medición de la transaminasa glutámico-pirúvica al inicio del estudio y tras 6 meses. Asimismo, para comparar concentraciones de los valores de puntaje de fibrosis y de la transaminasa glutámico-pirúvica dentro de un mismo grupo se empleó la prueba Wilcoxon, y para evaluar diferencias entre el grupo experimental y control se realizó la prueba de U de Mann-Whitney. Para comparar la severidad ecográfica se empleó la prueba de Wilcoxon. Luego se realizó la regresión logística. Se procedió a registrar la información en una ficha de recolección de datos haciendo uso del programa Microsoft Excel, posteriormente, se procedió a codificar y generar una base de datos con el paquete estadístico SPSS v. 23. Resultados: Dentro de los resultados se halló que la vitamina E fue efectiva en reducir el puntaje fibrosis hepática, transaminasas y severidad ecográfica en forma significativa (Z = -4,727 y p < 0,05). De acuerdo al análisis de regresión lineal el nivel de TGP y de score de fibrosis no son explicados significativamente por las variables confusoras incluidas en el modelo al 95 % de confianza. Conclusiones: La vitamina E a una dosis de 400 UI vía oral durante 6 meses es una intervención efectiva para controlar la progresión de la hepatopatía que puede cuantificarse mediante puntaje de fibrosis, disminución de transaminasas y valoración ecográfica tras 6 meses de seguimiento.

La esteatosis no alcohólica es asociada con pronóstico benigno. Sin embargo, puede progresar a fibrosis, aunque no se comprende completamente el comportamiento de los genes que contribuyen a esta progresión. El objetivo de esta investigación fue analizar los indicios tempranos de fibrogénesis en la esteatosis no alcohólica en pacientes obesos frente a no obesos. Se realizó un estudio descriptivo prospectivo que incluyó a pacientes con esteatosis no alcohólica. Estos fueron divididos en dos grupos: obesos y no obesos. Se obtuvo información sociodemográfica, antropométrica y de padecimientos de componentes del síndrome metabólico. Se determinaron parámetros bioquímicos y niveles de expresión de los genes TNF-α, NF-kβ, CYP2E1, TGF-β, OPN, COL4α5 y HGF por RT-PCR. Los resultados muestran diferencias significativas en los niveles de expresión del gen CYP2E1, siendo mayor en pacientes obesos que padecían síndrome metabólico completo. Además, en pacientes no obesos sin componentes del síndrome metabólico se activa TGF-β como participante de vías fibrogénicas, y en pacientes obesos con síndrome metabólico completo el nivel de expresión significativo de CYP2E1 podría indicar una señal de alarma por un posible progreso de la enfermedad. Debe prestarse especial atención y seguimiento de la esteatosis en pacientes obesos.

Resumen: Describimos el caso de una paciente de 12 años de edad, quien presentó contractura aislada del músculo recto femoral izquierdo con posterior ruptura traumática de la unión miotendinosa distal; razón por la cual no presentaba contractura en extensión de la rodilla, pero cursaba con contractura dinámica en flexión de la cadera (prueba de Ely positiva), que generaba gran impacto en la marcha. Se realizó manejo quirúrgico con tenotomía del recto anterior, obteniendo buenos resultados. Esta patología tiene baja incidencia y se ha reportado poco en la literatura, por lo que es importante sospecharla. Brindamos un abordaje diagnóstico y terapéutico actualizado. Abstract: We described the case of a 12-year-old patient who presented isolated contracture of the left rectus femoris muscle with subsequent traumatic rupture of the distal myotendinous junction; for this reason she did not present contracture in extension of the knee but she presented dynamic contracture in flexion of the hip (Ely positive test), which generated great impact on walking. Surgical management with tenotomy of the anterior rectum was performed, obtaining good results. This pathology has low incidence and it has been reported little in the literature, so it is important to suspect it. We provide an updated diagnostic and therapeutic approach.

The goal of our case-control research was to study the associations between speed progression of NAFLD and the level of fatty acids among patients with the type 2 diabetes. All patients were divided into two groups: with speed (n=38) and slow (n=44) progression of fibrosis. We studied the level of saturated, monounsaturated and polyunsaturated fatty acids and their rate. Our study showed higher median value of sum of saturated fatty acids level in the group of patients with speed progression of fibrosis (51,6% and 45,75%, p=0,001) and lower median value of arachidonic acids than in the group of patients with slow progression of fibrosis (10,5 and11,5 inthe group of slow fibrosis progression, р=0,049). In the group of patients with speed fibrosis progression saturated fatty acids prevailed unsaturated fatty acids (Ме=1,02). According to our data, the risk factor of speed progression of fibrosis among patients with type 2 diabetes and NAFLD, is the rate of saturated and unsaturated fatty acids. We found the significant associations between the rate of saturated and unsaturated fatty acids and the speed progression of fibrosis (OR 77,3; р=0,004).Abbreviations: BMI, body mass index, IR, insulin resistance, NAFLD, nonalcoholic fatty liver disease, OR, odds ratio, FFA, free fatty acids, FA, fatty acids, LDL, low density lipoproteins, RPF, median rate of fibrosis progression, TG, triglycerides

The goal of our case-control research was to study the associations between speed progression of NAFLD and risk factors among patients with the type 2 diabetes. 82 patients with type 2 diabetes and NAFLD took part in the study. We divided the patients into two groups: with speed (n=38) and slow (n=44) progression of fibrosis. The results of our study revealed the definitive associations between speedy progression of fibrosis and the level of insulin, ACT and alkaline phosphatase. We found the direct relations of speed fibrosis progression with the level of TC and TG. We also showed the significant influence the inflammatory mechanisms have on fibrosis progression (direct definitive relations between fibrosis and the consistence of cytokines - IL-1β (OR 1,017; р=0,035), TNF-α (OR 0,004; р=0,049) and the inverse relations between the speed progression of fibrosis and the consistence of IL-6 (OR 0,94; р=0,058). Using the results of a step-by-step multivariate regression analysis we created the final clinical model of fibrosis speed progression among the type two diabetes patients and people affected with NAFLD, which includes six prognostic variables: TG, alkaline phosphatase, insulin, IL-6, TNF-α and adiponectin.

Introduction: Peyronie's disease is an inflammatory disorder characterized by the presence of a fibrous plaque in the tunica albuginea of the penis that causes pain, curvature and shortening of the penis and, in some cases, erectile dysfunction. Objective: to describe the use, findings and potential of elastosonography in the diagnosis of Peyronie's disease. Method: a search of the literature is carried out in databases such as Medline, Hinari and Imbiomed. Results: elastosonography is a method for the evaluation of fibrosis in different organs, so it can be used in the diagnosis of fibrous lesions of Peyronie's disease. Conclusions: elastosonography has the potential to better identify and characterize these fibrous lesions underestimated by B-mode ultrasound.

Presentado en sesión de 25 de octubre de 1961

Atrial fibrillation (AF) causes progressive structural and electrical changes in the atria that can be summarized within the general concept of atrial remodeling. In parallel, other clinical characteristics and comorbidities may also affect atrial tissue properties and make the atria susceptible to AF initiation and its long-term persistence. Overall, pathological atrial changes lead to atrial cardiomyopathy with important implications for rhythm control. Although there is general agreement on the role of the atrial substrate for successful rhythm control in AF, the current classification oversimplifies clinical management. The classification uses temporal criteria and does not establish a well-defined strategy to characterize the individual-specific degree of atrial cardiomyopathy. Better characterization of atrial cardiomyopathy may improve the decision-making process on the most appropriate therapeutic option. We review current scientific evidence and propose a practical characterization of the atrial substrate based on 3 evaluation steps starting with a clinical evaluation (step 1), then assess outpatient complementary data (step 2), and finally include information from advanced diagnostic tools (step 3). The information from each of the steps or a combination thereof can be used to classify AF patients in 4 stages of atrial cardiomyopathy, which we also use to estimate the success on effective rhythm control., (Copyright © 2024 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction: Traumatic spinal cord injury (SCI) leads to increased intraspinal pressure that can be prevented by durotomy and duroplasty. The aim of the study was to evaluate fibrosis and neural damage in a porcine model of SCI after duroplasty and application of hyaluronic acid (HA) in the tissue cavity., Materials and Methods: Experimental study. We created a porcine SCI model by durotomy and spinal cord hemisection of a cervical segment (1cm). Six pigs (Sus scrofa domestica) were used to evaluate three surgical scenarios: (1)control injury with dural reparative microsurgery, (2)duroplasty using bovine pericardium (BPD), and (3)previous method plus HA applied at the lesion. Animals were sacrificed one-month post-injury to assess fibrotic responses and neural tissue damage using conventional histological and immunohistochemical methods., Results: In the control case, dural suture prevented invasion of the lesion by extradural connective tissue, and the dura mater showed a 1-mm thickening in the perilesional area. The bovine pericardium patch blocked the entrance of extradural connective tissue, decreased dura-mater tension, and satisfactorily integrated within the receptor tissue. However, it also enhanced subdural and perilesional fibrosis, which was not inhibited by filling the lesion cavity with low- or high-molecular-weight HA., Conclusions: Duroplasty prevents collapse of the dura-mater over the spinal cord tissue, as well as invasion of the lesion by extramedullary fibrotic tissue, without creating additional neural damage. Nevertheless, it enhances the fibrotic response in the spinal cord lesion and the perilesional area. Additional antifibrotic strategies are needed to facilitate spinal cord repair., (Copyright © 2023 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: Traumatic spinal cord injury (SCI) leads to increased intraspinal pressure that can be prevented by durotomy and duroplasty. The aim of the study was to evaluate fibrosis and neural damage in a porcine model of SCI after duroplasty and application of hyaluronic acid (HA) in the tissue cavity., Materials and Methods: Experimental study. We created a porcine SCI model by durotomy and spinal cord hemisection of a cervical segment (1cm). Six pigs (Sus scrofa domestica) were used to evaluate three surgical scenarios: (1) control injury with dural reparative microsurgery, (2) duroplasty using bovine pericardium (BPD), and (3) previous method plus HA applied at the lesion. Animals were sacrificed one-month post-injury to assess fibrotic responses and neural tissue damage using conventional histological and immunohistochemical methods., Results: In the control case, dural suture prevented invasion of the lesion by extradural connective tissue, and the dura mater showed a 1-mm thickening in the perilesional area. The bovine pericardium patch blocked the entrance of extradural connective tissue, decreased dura-mater tension, and satisfactorily integrated within the receptor tissue. However, it also enhanced subdural and perilesional fibrosis, which was not inhibited by filling the lesion cavity with low- or high-molecular-weight HA., Conclusions: Duroplasty prevents collapse of the dura-mater over the spinal cord tissue, as well as invasion of the lesion by extramedullary fibrotic tissue, without creating additional neural damage. Nevertheless, it enhances the fibrotic response in the spinal cord lesion and the perilesional area. Additional antifibrotic strategies are needed to facilitate spinal cord repair., (Copyright © 2023 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background and Aims: Chronic hepatitis D (CHD) is a severe form of chronic viral hepatitis. The estimated hepatitis delta prevalence in Spain is around 5% of patients with hepatitis B. Reimbursement of new antiviral therapies (Bulevirtide, BLV) was delayed in our country until February 2024. We aimed to characterize the clinical profile of patients with HDV/HBV infection in Spain and current barriers in their management at the time of BLV approval., Method: Multicenter registry including patients with positive anti-HDV serology actively monitored in 30 Spanish centers. Epidemiological, clinical and virological variables were recorded at the start of follow-up and at the last visit., Results: We identified 329 anti-HDV patients, 41% were female with median age 51 years. The most common geographical origin was Spain (53%) and East Europe (24%). Patients from Spain were older and had HCV and HIV coinfection probably associated to past drug injection (p<0.01). HDV-RNA was positive in 138 of 221 assessed (62%). Liver cirrhosis was present at diagnosis in 33% and it was more frequent among viremic patients (58% vs 25%, p<0.01). After a median follow-up of 6 (3-12) years, 44 (16%) resolved infection (18 spontaneously and 26 after Peg-INF). An additional 10% of patients developed cirrhosis (n=137) during follow-up (45% had portal hypertension and 14% liver decompensation). Liver disease progression was associated to persisting viremia., Conclusion: One-third of the patients with CHD already have cirrhosis at diagnosis. Persistence of positive viremia is associated to rapid liver disease progression. Importantly, barriers to locally determine/quantify HDV-RNA were present., (Copyright © 2024. Publicado por Elsevier España, S.L.U.)