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OBJETIVO: Estudar o padrão de prescrição de medicação antimicrobiana e analgésica/ antiinflamatória de uso sistêmico na clínica odontológica. MÉTODOS: Estudo observacional realizado a partir de questionários respondidos por uma amostra representativa randômica de 163 cirurgiões-dentistas, clínicos gerais, da Região Metropolitana de Belo Horizonte. Alguns dos aspectos verificados foram a prevalência de prescrições dessas medicações nas duas semanas anteriores à aplicação do questionário; uso do nome genérico nas receitas odontológicas; realização de cursos de reciclagem em farmacologia; auto-avaliação sobre o grau de conhecimento e importância dada a esta disciplina para a prática profissional e preenchimento de fichas clínicas e registro nestas das prescrições realizadas. RESULTADOS E CONCLUSÕES: Observou-se que os medicamentos são prescritos pelo nome comercial, com tendência a prescrever mais freqüentemente antiinflamatórios em relação aos analgésicos. Uma percentagem de 13% de indivíduos não realiza ficha clínica para todos os seus pacientes e cerca de 43% da amostra não registra suas prescrições. Os cursos de reciclagem em farmacologia parecem não alterar a auto-avaliação sobre o nível de conhecimento em farmacologia e o uso do nome genérico.OBJECTIVE: The study of the prescription pattern of antibacterial and analgesic/antiinflammatory systemic medication by dentists. METHODS: Observational study based in questionnaires answered by a representative, randomly selected sample of 163 general dentists from the Metropolitan Region of Belo Horizonte, Southeastern Brazil. Some of the topics verified were: the most frequently prescribed drugs in the fortnight prior to the study, the use of generic names of drugs in the prescriptions, attendance at refresher courses on pharmacology, self-assessment of degree of knowledge on pharmacology, the importance given to this subject in the dentist's professional career, and the filling out of the clinical chart and the registration of the drugs prescribed on it. RESULTS: It was observed that the drugs were usually prescribed by their commercial name. There were a trend to prescribe more antiinflamatory than analgesics drugs. A small, but worrying, 13% of dentists didnot fill out the clinical chart for all the patients and 43% of the sample didnot register the drugs prescribed on it. The courses on pharmacology seemed to produce no significant alteration in self valuation as to the degree of knowledge in pharmacology and the use of the generic names of drugs.

OBJETIVO: Estudar o padrão de prescrição de medicação antimicrobiana e analgésica/ antiinflamatória de uso sistêmico na clínica odontológica. MÉTODOS: Estudo observacional realizado a partir de questionários respondidos por uma amostra representativa randômica de 163 cirurgiões-dentistas, clínicos gerais, da Região Metropolitana de Belo Horizonte. Alguns dos aspectos verificados foram a prevalência de prescrições dessas medicações nas duas semanas anteriores à aplicação do questionário; uso do nome genérico nas receitas odontológicas; realização de cursos de reciclagem em farmacologia; auto-avaliação sobre o grau de conhecimento e importância dada a esta disciplina para a prática profissional e preenchimento de fichas clínicas e registro nestas das prescrições realizadas. RESULTADOS E CONCLUSÕES: Observou-se que os medicamentos são prescritos pelo nome comercial, com tendência a prescrever mais freqüentemente antiinflamatórios em relação aos analgésicos. Uma percentagem de 13% de indivíduos não realiza ficha clínica para todos os seus pacientes e cerca de 43% da amostra não registra suas prescrições. Os cursos de reciclagem em farmacologia parecem não alterar a auto-avaliação sobre o nível de conhecimento em farmacologia e o uso do nome genérico.

OBJETIVO: Estudar o padrão de prescrição de medicação antimicrobiana e analgésica/ antiinflamatória de uso sistêmico na clínica odontológica. MÉTODOS: Estudo observacional realizado a partir de questionários respondidos por uma amostra representativa randômica de 163 cirurgiões-dentistas, clínicos gerais, da Região Metropolitana de Belo Horizonte. Alguns dos aspectos verificados foram a prevalência de prescrições dessas medicações nas duas semanas anteriores à aplicação do questionário; uso do nome genérico nas receitas odontológicas; realização de cursos de reciclagem em farmacologia; auto-avaliação sobre o grau de conhecimento e importância dada a esta disciplina para a prática profissional e preenchimento de fichas clínicas e registro nestas das prescrições realizadas. RESULTADOS E CONCLUSÕES: Observou-se que os medicamentos são prescritos pelo nome comercial, com tendência a prescrever mais freqüentemente antiinflamatórios em relação aos analgésicos. Uma percentagem de 13% de indivíduos não realiza ficha clínica para todos os seus pacientes e cerca de 43% da amostra não registra suas prescrições. Os cursos de reciclagem em farmacologia parecem não alterar a auto-avaliação sobre o nível de conhecimento em farmacologia e o uso do nome genérico.

Objective: Direct-acting antivirals for the treatment of hepatitis C virus (HCV) represented a paradigm shift. In 2017, sofosbuvir/velpatasvir (SOF/VEL-Epclusa®) was approved, which showed a high cure rate in all patient, contributing to HCV elimination. The analysis aimed to quantify the clinical and economic value of SOF/VEL in HCV chronic patients since its approval in Spain., Methods: An economic evaluation was elaborated adapting a Markov model that simulated the lifetime disease progression in of all HCV chronic patients treated with SOF/VEL (30,488 patients) since its launch (5-years), compared to previous therapies. Patients entered the model and were distributed between the fibrosis states (F0-to-F4) in treated and untreated. All patients (100%) were treated with SOF/VEL regardless of their fibrosis, and 49% with previous therapies in ≥F2. The average sustained viral response (SVR) rates 98.9% SOF/VEL versus 61.0% previous therapies. All parameters for the analysis were obtained from real-life data and literature. Only direct healthcare costs associated with disease management were included. The SOF/VEL value was measured as the number of hepatic complications avoided and their associated cost, and hepatic mortality compared to previous therapies. National Health System perspective and a 3% discount rate was applied., Results: SOF/VEL decreased the number of liver complications, avoiding 92% decompensated cirrhosis, 80% hepatocellular carcinomas, and 87% liver transplants, as well as 85% liver-related mortality. Their cost associated was reduced, amounting to savings of 197M€., Conclusion: SOF/VEL adds relevant value to the HCV treatment, reducing the clinical and economic disease burden and contributing to HCV elimination in Spain., (Copyright © 2024 The Authors. Publicado por Elsevier España, S.L.U. All rights reserved.)

The prevalence of overweight and obesity, and, consequently, associated comorbidities, is increasing significantly worldwide. The guidelines recommend a percentage of weight loss> 5% to achieve beneficial effects on metabolic comorbidities associated with obesity. Furthermore, greater weight losses (> 10%) produce more significant improvements, and may even produce remission of some of these comorbidities. In this chapter, we review the evidence of the effect of weight loss through different strategies (lifestyle intervention, pharmacological treatment, or bariatric surgery) on the main cardiometabolic pathologies associated with excess adipose tissue (type 2 diabetes, high blood pressure, dyslipidemia, metabolic dysfunction-associated steatotic liver disease, inflammation, cardiovascular diseases, and mortality)., (Copyright © 2024 The Author(s). Publicado por Elsevier España S.L.U. All rights reserved.)

Background/aims: Bulevirtide (Hepcludex®) is the first drug approved for the treatment of chronic hepatitis D (CHD), unlike the current off-label treatment (PEG-IFN-α), limited in clinical practice and associated with post-treatment relapses. In a hypothetical cohort of CHD patients in Spain, the study aim was to compare the efficiency of bulevirtide with PEG-IFN-α in terms of clinical events avoided and associated cost savings., Methods: A validated economic model reflecting the natural history of the disease was used to project lifetime liver complications and costs for two hypothetical cohorts treated with bulevirtide or PEG-IFN-α. The model considered progression to complications such as decompensated cirrhosis (DCC), hepatocellular carcinoma (HCC), liver transplantation (LT), and death. The efficacy rates used at 24 and 48 weeks were defined as the combined response rate for bulevirtide and undetectable HDV RNA to PEG-IFN-α. The numbers of clinic events and associated costs were evaluated from the perspective of the National Healthcare System., Results: In a hypothetical cohort of 3882 patients, bulevirtide reduced the numbers of complications events in comparison to PEG-IFN-α (152 DCC, 113 HCC, 11 LT, and 321 deaths over a lifetime). This was associated with a reduction of event-related costs of €11,837,044 (DCC €1,138,059; HCC €1,503,583; LT €7,834,291; and death €1,361,111)., Conclusion: In patients with CHD, bulevirtide could prevent a significant number of clinical events compared to PEG-IFN-α and contribute to cost savings through these reduction in liver complications. Further testing for hepatitis D virus is needed so that more patients can benefit from bulevirtide., (Copyright © 2024 The Author(s). Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: The aim of this study was to assess the implementation of safe medication practices in hospital emergency services, in order to understand the points of greatest risk as well as the safety challenges faced by these departments, and to plan collaboratively improvement initiatives., Method: Multicentric and descriptive study based on completion of the "Medication safety self-assessment of emergency services" from 5/16/2023 to 11/16/2023, at voluntarily participating emergency services. The survey contained 93 items grouped into 10 key elements. Mean score and mean percentages based on the maximum possible values for the overall survey, for the key elements and for each individual item of evaluation, were assessed., Results: A total of 72 emergency services completed the questionnaire. The mean score obtained for the overall questionnaire was 428.3 points (51.1% of the maximum score). Results showed a large variation among the scores of the participating services (range: 164-620.5). Four key elements had values below 50%, corresponding to competence and training of professionals in safety practices (38.4%); incorporation of pharmacists in emergency departments (42.1%), availability and accessibility of information about patients (43.1%), and patient education (48.1%). The highest values corresponded to labeling, packaging, and naming of medications (69.2%) and communication of prescriptions and other medication information (64%). No differences were found between emergency services in the key elements according to the dependency or size of the hospital, or the type of service, except for the item referring to the incorporation of pharmacists in the emergency service, where differences were observed between hospitals with less than 200 beds (28.9%) and those with more than 500 (52.2%)., Conclusion: The application of the specific self-assessment questionnaire has made it possible to identify safety practices that are insufficiently implemented into emergency services in our country and to identify critical points for improvement for which planning collaborative initiatives to reduce medication errors in these departments should become a priority., (Copyright © 2024. Publicado por Elsevier España, S.L.U.)

Introduction and Objectives: Primary percutaneous coronary intervention (pPCI) is recommended for ST elevation myocardial infarction (STEMI). Countries have designed various STEMI network models to optimize out-of-hospital triage, timely treatment, and patient outcomes. The aim of this study was to evaluate the effectiveness of STEMI network implementation including out-of-hospital triage in improving STEMI case-fatality and long-term mortality, and its effect on the proportion of patients presenting with heart failure, their ischemia time, and time to pPCI., Methods: Systematic review and meta-analysis. Searches of PubMed, Scopus, and Web of Science databases covering January 2000 to December 2023, study selection, and data extraction were completed by 3 independent reviewers., Results: A total of 32 articles were selected. STEMI network implementation with out-of-hospital triage was associated with reductions of 35% in case-fatality (95%CI, -23% to -45%), 27% in long-term mortality (95%CI, -22% to -32%), and in the proportion of patients with Killip III-IV at admission, ischemia, time and time to pPCI (-17%, 95%CI, -35% +6%; -19%, 95%CI, -6% to -31%; -33%, 95%CI, -16% to -47%, respectively). Networks based on emergency transport systems and those involving the entire health system, including primary care centers and hospitals without pPCI capabilities, showed similar effectiveness. Greater effectiveness was observed in urban vs rural areas and high-income vs middle- and low-income countries., Conclusions: The implementation of out-of-hospital triage-based STEMI networks is effective in reducing STEMI case-fatality and long-term mortality, independently of the geographic and socioeconomic conditions of the region. Participation of the emergency transport system is the key element of successful networks., (Copyright © 2024. Published by Elsevier España, S.L.U.)

Background: Gallstone disease (GD) is no longer an exclusive condition of adulthood, and its prevalence is increasing in pediatric age. The management and the extent of the etiological investigation of GD in children and adolescents remains controversial. This study aimed to analyze the difficulties in the work-up and management of pediatric GD patients., Methods: A retrospective study performed in a single tertiary center enrolled sixty-five patients with GD followed from January 2014 to June 2021. Patients were categorized conveniently according to their age at diagnosis: Group A (<10years, n=35) and Group B (≥10years, n=30). We analyzed demographic, clinical and laboratory data, ultrasonographic findings at presentation, therapeutics and complications., Results: Symptoms were more frequent in patients >10years old (p=0.001). Cholecystectomy was performed in 31 patients (47.7%). A multivariate regression logistic model identified the age >10years (OR=6.440, p=0.005) and underlying entities (OR=6.823, p=0.017) as independent variables to perform surgery. Spontaneous resolution of GD was more common in children <2years old. A multivariate regression logistic model showed a trend for those >10years old to develop more complications. Two out of 18 patients were diagnosed with ABCB4 gene mutations in heterozygosity., Conclusions: Decision-making on cholecystectomy remains challenging in asymptomatic patients. Identifying predictive factors for the development of complications has proven difficult. However, we found a trend toward the development of complications in individuals older than 10years., (Copyright © 2024 Elsevier España, S.L.U. All rights reserved.)

Introduction: Abdominal aortic aneurysm (AAA) constitutes a pathology with high mortality. There is currently no screening program implemented in primary care in Spain., Objectives: To evaluate the usefulness of ultrasound in the detection of AAA in the at-risk population in primary care. Secondarily, to identify subjects whose vascular risk (VR) should be reclassified and to determine whether AAA is associated with the presence of carotid plaque and other risk factors., Material and Methods: Cross-sectional, descriptive, multicenter, national, descriptive study in primary care., Subjects: A consecutive selection of hypertensive males aged between 65 and 75 who are either smokers or former smokers, or individuals over the age of 50 of both sexes with a family history of AAA., Measurements: Diameter of abdominal aorta and iliac arteries; detection of abdominal aortic and carotid atherosclerotic plaque. VR was calculated at the beginning and after testing (SCORE)., Results: One hundred and fifty patients were analyzed (age: 68.3±5 years; 89.3% male). Baseline RV was high/very high in 55.3%. AAA was detected in 12 patients (8%; 95% CI: 4-12); aortic ectasia in 13 (8.7%); abdominal aortic plaque in 44% and carotid plaque in 62% of the participants. VR was reclassified in 50% of subjects. The detection of AAA or ectasia was associated with the presence of carotid plaque, current smoking and lipoprotein(a), p<0.01., Conclusions: The prevalence of AAA in patients with VR is high. Ultrasound in primary care allows detection of AAA and subclinical atherosclerosis and consequently reclassification of the VR, demonstrating its utility in screening for AAA in the at-risk population., (Copyright © 2024 Sociedad Española de Arteriosclerosis. Publicado por Elsevier España, S.L.U. All rights reserved.)

Microelimination strategies for the hepatitis C virus (HCV) in vulnerable populations, such as users of Addiction Centres (AC), are key for the elimination of hepatitis C. The aim of the HepCelentes project was to design a certification program for AC from the generation of a guide with the criteria to favour the prevention, diagnosis, control, and treatment of HCV in Spain. The project was structured in 4 phases: normalisation, implementation, certification, and communication. In the first phase, developed between July and December 2020, a Steering Committee was created (formed by representatives of scientific societies, healthcare professionals from AC, primary care centres and hospital units, and patient associations) that, from of an exhaustive bibliographic review, generated by consensus an accreditation guide for AC. The guide consists of 22 criteria (15 mandatory and 7 recommended) structured based on the requirements to be met by AC, justification for the selection, level of action (management, prevention, diagnosis and treatment/follow-up), measurement of the indicator, objective level to be achieved, evidence of compliance, clarifications to improve understanding, and mandatory / recommendation (depending on their relevance to achieve HCV elimination and its feasibility for implementation in real practice). The development of a certification system for the AC, based on consensus and coordination of multidisciplinary teams, is intended to favour the management of hepatitis C and its elimination in AC users, supporting the international, national, and regional elimination strategies.

Introduction and Objectives: Myocardial infarction (MI) incidence and case fatality trends are highly informative but relatively untested at the population level. The objective of this work was to estimate MI incidence and case fatality in the Girona population aged 35-74 years, and to determine their 30-year trends (1990-2019)., Methods: The REGICOR (Girona Heart Registry) monitored MI incidence and case fatality rates from 1990 to 2008. For the period 2008 to 2019, we linked discharges from Girona hospitals (n=4 974 977) and mortality registry (n=70 405) during this period. Our linkage algorithm selected key MI diagnostic codes and removed duplicates. Estimates from the linkage algorithm and the REGICOR registry were compared using chi-square tests for overlapping years (2008-2009). We estimated the annual percent change (APC) of standardized MI incidence and 28-day case fatality, and analyzed their trends using joinpoint regression., Results: MI incidence and case fatality estimates were similar in the linkage algorithm and the REGICOR registry. We observed significant decreasing trends in the incidence of MI. The trend was APC, -0.96% (95% confidence interval (95%CI), -1.4 to -0.53) in women from 1990 to 2019 and -4.2% (95%CI, -5.5 to -3.0) in men from 1994 to 2019. The largest decrease in case fatality was -3.8% (95%CI, -5.1 to -2.5) from 1995 to 2003 in women and -2.4% (95%CI, -2.9 to -1.9) from 1995 to 2004 in men, mainly due to prehospital case fatality declines: -1.8% (95%CI, -2.6 to -1.1) in men and -3.2% (95%CI, -4.6 to -1.8) in women., Conclusions: In Girona, MI incidence and case fatality decreased between 1990 and 2019. The incidence showed a slow but continuous decrease while case fatality only stabilized in the last decade, particularly in women., (Copyright © 2023. Published by Elsevier España, S.L.U.)

Summary: COVID-19 continues to pose a significant threat: mortality stands at nearly twice that of influenza, and the incidence rate is growing as the population's vaccination rate decreases, particularly in Spain and other areas of Europe. Given this situation, it is vitally important know whether medical protocols are consistent and appropriately implemented by health care staff in the interest of preventing possible inefficiency or inequity. Physicians from hospital emergency departments met to study their hospitals' usual clinical practices for managing SARS-CoV-2 infection and to determine their expert opinions on the use of antiviral agents. The participating physicians then reached consensus on evidencebased recommendations for strategies that would optimize emergency treatment.

Objectives: Mental, neurological, and substance use (MNS) disorders have a high prevalence in Colombia and there is a treatment gap. The World Health Organization (WHO) Mental Health Gap Action Programme (mhGAP) has various components. The mhGAP 2.0 Intervention Guide, aimed at improving primary health care, is a guide for the assessment and management of MNS disorders based on clinical decision-making protocols. The objective of this study was to determine the barriers that may hinder the program implementation process., Methods: A qualitative study with content analysis was conducted in three phases: i) study preparation, organization, and presentation; ii) open coding, categorization, and abstraction of contents; and iii) information analysis. The study included semi-structured interviews with 21 people involved in the provision of mental health services in Chocó (Colombia): five medical doctors, seven nurses, and three psychologists, as well as six professionals working in the administrative area of the department's health secretariats. The perceptions of these stakeholders were explored. Open-ended questions were asked to explore experiences with the process, as well as the barriers identified in practice., Results: Four different thematic categories were identified: intersectoral action, long-standing challenges, opportunities, and suitability of tools., Conclusions: A theoretical model of barriers to implementation of the mhGAP program was constructed, based on stakeholder perceptions. Controlling barriers is perceived as a possible way to contribute significantly to population health., Competing Interests: Conflicto de intereses. Ninguno declarado por los autores.

The objective was to estimate the prevalence of polydrug use of tobacco and cannabis and to see its relationship with self-perceived health and mood state in adolescents from Central Catalonia in the 2019-2020 academic year. A cross-sectional study was carried out with a sample of 7,319 students, who answered a self-administered questionnaire. The dependent variables were the polydrug use of tobacco and cannabis and polydrug use of tobacco and high-risk cannabis. The main independent variables were self-perceived health status and mood state. Frequencies and percentages were analyzed for the prevalence analysis, and the Chi-square test was used. Poisson regression models were adjusted with robust variance, obtaining Prevalence Ratios. The prevalence of polydrug use of tobacco and cannabis was 3.5% and polydrug use of tobacco and high-risk cannabis was 2.5%. In boys, attending higher academic courses (4th of ESO (aPR: 3.88; 95% CI: 2.14-7.05) vs. CFGM (aPR: 8.67; CI95%: 4.51-16.67), having worse self-perceived health (aPR: 4.79; CI95%: 3.24-7.08) and worse mood state (aPR: 1.47; CI95%: 1.05-2.08) act as factors associated with polydrug use of tobacco and cannabis. The results for girls, and risky use of cannabis follow a similar pattern. Among the main conclusions we observe is that there are no differences in self-perceived health and mood state when comparing polydrug use of tobacco and cannabis and polydrug use of tobacco and high-risk cannabis, so risk reduction strategies must be applied whether the use of cannabis is occasional or problematic.

Introduction: Acute pancreatitis is one of the main reasons for digestive admissions. Adequate pain treatment is crucial in its management. However, there are hardly any descriptions of the analgesic guidelines used in our setting., Methods: On-line survey on analgesic management in acute pancreatitis, aimed at attending physicians and residents practising in Spain., Results: Two hundred and nine physicians from 88 centres responded to the survey. Ninety percent were specialists in gastrointestinal medicine and 69% worked in a tertiary centre. The majority (64.4%) do not routinely use scales to measure pain. When choosing a drug, experience in its use was the most important factor. The most commonly prescribed initial treatments are: combination of paracetamol and metamizole (53.5%), paracetamol alone (19.1%) and metamizole alone (17.4%). As rescue: meperidine (54.8%), tramadol (17.8%), morphine chloride (17.8%) and metamizole (11.5%). Continuous perfusion is used in 8.2% of initial treatments. Physicians with >10 years of service use more metamizole as monotherapy (50%), while residents and attending physicians with <10 years of service prescribe it in combination with paracetamol (85%). If progression is needed, morphine chloride and meperidine are mainly used. The speciality of the respondent, the size of the work centre and the unit/service where the patients were admitted did not influence the analgesia prescribed. Satisfaction with pain management reached 7.8/10 (SD 0.98)., Conclusion: In our setting, metamizole and paracetamol are the most commonly used analgesics as initial pain treatment in acute pancreatitis, and meperidine is the most commonly used rescue analgesic., (Copyright © 2023 Elsevier España, S.L.U. All rights reserved.)

Introduction and Objectives: The optimal antithrombotic strategy following left atrial appendage closure (LAAC) is poorly defined in patients with nonvalvular atrial fibrillation. We assessed the safety and effectiveness of a single antiplatelet treatment (SAPT) strategy after LAAC in a population at high risk of ischemic and bleeding events., Methods: This single-center, observational, prospective study included a consecutive cohort of patients who underwent LAAC using the LAmbre device (Lifetech Scientific, China) and who were discharged with SAPT. The primary outcome was a composite of stroke, systemic embolism, and device-related thrombosis during follow-up. Secondary endpoints were cardiovascular mortality and major bleeding events (BARC ≥3a). Clinical follow-up was performed at 1, 6, and 12 months and subsequently on an annual basis. Transesophageal echocardiography was performed at 1 and 12 months of follow-up., Results: The study comprised 74 patients. The median age was 77 [72-83] years and 43% were women. The cohort exhibited a high prevalence of comorbidities and cardiovascular risk factors. The median CHA 2 DS 2 -VASc and HAS-BLED scores were 4 [3-6] and 4 [4-5], respectively. The median length of follow-up was 2.5 years (188 patients-year). During follow-up, device-related thrombosis occurred in 3 patients (4%). Ischemic stroke occurred in 1 patient (1.3%, rate 0.5%/y), representing a 90.9% relative risk reduction compared with the risk predicted by CHA 2 DS 2 -VASc. Major bleeding events occurred in 12 patients (16%, 6.4%/y), with a relative risk reduction of 26.4% of that predicted by HAS-BLED. Cardiovascular-related mortality was observed in 2 patients (2.7%)., Conclusions: SAPT appears to be a safe and effective treatment following LAAC in patients at high ischemic and hemorrhagic risk. Further studies are needed to confirm our findings., (Copyright © 2023 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction and Objectives: Data on the clinical profile and outcomes of younger patients with ST-elevation myocardial infarction (STEMI) is scarce. This study compared clinical characteristics and outcomes between patients aged<45 years and those aged ≥ 45 years with STEMI managed by the acute myocardial infarction code (AMI Code) network. Sex-based differences in the younger cohort were also analyzed., Methods: This multicenter study collected individual data from the Catalonian AMI Code network. Between 2015 and 2020, we enrolled patients with an admission diagnosis of STEMI. Primary endpoints were all-cause mortality within 30 days, 1 year, and 2 years., Results: Overall, 18 933 patients (23% female) were enrolled. Of them, 1403 participants (7.4%) were aged<45 years. Younger patients with STEMI were more frequently smokers (P<.001) and presented with cardiac arrest and TIMI flow 0 before pPCI (P<.05), but the time from first medical contact to wire crossing was shorter than in the older group (P<.05). All-cause mortality rates were lower in patients aged<45 years (P<.001). Among younger patients, cardiogenic shock was most prevalent in women than in their male counterparts (P=.002), with the time from symptom onset to reperfusion being longer (P<.05). Compared with men aged<45 years, younger women were less likely to undergo pPCI (P=.004)., Conclusions: Despite showing high-risk features on admission, young patients exhibit better outcomes than older patients. Differences in ischemia times and treatment were observed between men and women., (Copyright © 2023 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

There is uncertainty regarding Wilson's disease (WD) management., Objectives: To assess, in a multicenter Spanish retrospective cohort study, whether the approach to WD is homogeneous among centers., Methods: Data on WD patients followed at 32 Spanish hospitals were collected., Results: 153 cases, 58% men, 20.6 years at diagnosis, 69.1% hepatic presentation, were followed for 15.5 years. Discordant results in non-invasive laboratory parameters were present in 39.8%. Intrahepatic copper concentration was pathologic in 82.4%. Genetic testing was only done in 56.6% with positive results in 83.9%. A definite WD diagnosis (Leipzig score ≥4) was retrospectively confirmed in 92.5% of cases. Chelating agents were standard initial therapy (75.2%) with frequent modifications (57%), particularly to maintenance zinc. Enzyme normalization was not achieved by one third, most commonly in the setting of poor compliance, lack of genetic mutations and/or presence of cardiometabolic risk factors. Although not statistically significant, there were trends for sex differences in number of diagnosed cases, age at diagnosis and biochemical response., Conclusions: Significant heterogeneity in diagnosis and management of WD patients emerges from this multicenter study that includes both small and large reference centers. The incorporation of genetic testing will likely improve diagnosis. Sex differences need to be further explored., (Copyright © 2022 Elsevier España, S.L.U. All rights reserved.)

Introduction and Objectives: Prognosis in ST-elevation myocardial infarction (STEMI) is determined by delay in primary percutaneous coronary intervention (PPCI). The impact of first medical contact (FMC) facility type on reperfusion delays and mortality remains controversial., Methods: We performed a prospective registry of primary coronary intervention (PCI)-treated STEMI patients (2010-2020) in the Codi Infart STEMI network. We analyzed 1-year all-cause mortality depending on the FMC facility type: emergency medical service (EMS), community hospital (CH), PCI hospital (PCI-H), or primary care center (PCC)., Results: We included 18 332 patients (EMS 34.3%; CH 33.5%; PCI-H 12.3%; PCC 20.0%). Patients with Killip-Kimball classes III-IV were: EMS 8.43%, CH 5.54%, PCI-H 7.51%, PCC 3.76% (P <.001). All comorbidities and first medical assistance complications were more frequent in the EMS and PCI-H groups (P <.05) and were less frequent in the PCC group (P <.05 for most variables). The PCI-H group had the shortest FMC-to-PCI delay (median 82 minutes); the EMS group achieved the shortest total ischemic time (median 151 minutes); CH had the longest reperfusion delays (P <.001). In an adjusted logistic regression model, the PCI-H and CH groups were associated with higher 1-year mortality, OR, 1.22 (95%CI, 1.00-1.48; P=.048), and OR, 1.17 (95%CI 1.02-1.36; P=.030), respectively, while the PCC group was associated with lower 1-year mortality than the EMS group, OR, 0.71 (95%CI 0.58-0.86; P <.001)., Conclusions: FMC with PCI-H and CH was associated with higher adjusted 1-year mortality than FMC with EMS. The PCC group had a much lower intrinsic risk and was associated with better outcomes despite longer revascularization delays., (Copyright © 2023 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction and Objectives: Dual antiplatelet therapy (DAPT) duration after ST-segment elevation myocardial infarction (STEMI) remains a matter of debate., Methods: We analyzed the effect of DAPT on 5-year all-cause mortality, cardiovascular mortality, and cardiovascular readmission or mortality in a cohort of 1-year survivor STEMI patients., Results: A total of 3107 patients with the diagnosis of STEMI were included: 93% of them were discharged on DAPT, a therapy that persisted in 275 high-risk patients at 5 years. Cardiovascular mortality in patients on single antiplatelet therapy vs DAPT at 5 years was 1.4% vs 3.6% (P <.01), respectively, whereas noncardiovascular mortality was 3.3% vs 5.8% (P=.049) at 5 years. Cardiovascular readmission or mortality in patients with single antiplatelet therapy vs DAPT was 11.4% vs 46.5% (P <.001). Extended DAPT was independently associated with worse 5-year all-cause mortality (HR, 2.16; 95%CI, 1.40-3.33), cardiovascular mortality (HR, 2.83; 95%CI, 1.37-5.84), and cardiovascular readmission or mortality (HR, 5.20; 95%CI, 3.96-6.82). These findings were confirmed in propensity score matching and inverse probability weighting analyses., Conclusions: Our results suggest the hypothesis that, in 1-year STEMI survivors, extending DAPT up to 5 years in high-risk patients does not improve their long-term prognosis., (Copyright © 2022 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Background: Retrospective studies suggest that coronavirus disease (COVID-19) commonly involves gastrointestinal (GI) symptoms and complications. Our aim was to prospectively evaluate GI manifestations in patients hospitalized for COVID-19., Methods: This international multicentre prospective cohort study recruited COVID-19 patients hospitalized at 31 centres in Spain, Mexico, Chile, and Poland, between May and September 2020. Patients were followed-up until 15 days post-discharge and completed comprehensive questionnaires assessing GI symptoms and complications. A descriptive analysis as well as a bivariate and multivariate analysis were performer using binary logistic regression. p<0.05 was considered significant., Results: Eight hundred twenty-nine patients were enrolled; 129 (15.6%) had severe COVID-19, 113 (13.7%) required ICU admission, and 43 (5.2%) died. Upon admission, the most prevalent GI symptoms were anorexia (n=413; 49.8%), diarrhoea (n=327; 39.4%), nausea/vomiting (n=227; 27.4%), and abdominal pain (n=172; 20.7%), which were mild/moderate throughout the disease and resolved during follow-up. One-third of patients exhibited liver injury. Non-severe COVID-19 was associated with ≥2 GI symptoms upon admission (OR 0.679; 95% CI 0.464-0.995; p=0.046) or diarrhoea during hospitalization (OR 0.531; 95% CI 0.328-0.860; p=0.009). Multivariate analysis revealed that worse hospital outcomes were not independently associated with liver injury or GI symptoms., Conclusion: GI symptoms were more common than previously documented, and were mild, rapidly resolved, and not independently associated with COVID-19 severity. Liver injury was a frequent complication in hospitalized patients not independently associated with COVID-19 severity., (Copyright © 2022 The Authors. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: Bacterial infections remain one of the main complications in cirrhosis and worsen patients' prognosis and quality of life. An increase in multidrug resistant microorganism (MDRM) infections among patients with cirrhosis, together with infection-related mortality rates, have been reported in recent years. Therefore, adaptation of the initial empiric antibiotic approach to different factors, particularly the local epidemiology of MDRM infections, has been recommended. We aim to describe the main features, outcomes and risk factors of MDRM infections in patients with cirrhosis., Methods: Prospective registry of all episodes of in-hospital infections occurring among cirrhotic patients admitted within a 2-year period at a single center. Clinical and microbiological data were collected at the time of infection diagnosis, and the in-hospital mortality rate of the infectious episode was registered., Results: A total of 139 infectious episodes were included. The disease-causing microorganism was identified in 90 episodes (65%), of which 31 (22%) were caused by MDRM. The only two factors independently associated with MDRM infections were rectal colonization by MDRM and a nosocomial or healthcare-associated source. The infection-related mortality rate was 18.7%. MDRM infection and a past history of hepatic encephalopathy were independently associated with in-hospital mortality., Conclusions: Almost one fourth of bacterial infections occurring in admitted cirrhotic patients were due to MDRM. Rectal colonization was the most important risk factor for MDRM infections in decompensated cirrhosis. Screening for MDRM rectal colonization in patients admitted for decompensated cirrhosis should be assessed as a tool to improve local empiric antibiotic strategies., (Copyright © 2022 Elsevier España, S.L.U. All rights reserved.)

Objective: One in one hundred minors has some mental health problem. Symptomatology varies according to gender. Most research has been conducted with the general population. The objective of this paper was to analyze the moderating role of sex in the presence of internalizing (emotional disorders, anxiety and depression) and externalizing symptomatology (behavioral disorders and hyperactivity) in childhood, as well as to compare the general population with the clinical population., Methods: A descriptive cross-sectional study was conducted with 552 boys and girls between ten and twelve years of age, 94 mental health patients and 458 schoolchildren. Participants completed self-report measures: Strengths and Difficulties Questionnaire (SDQ-Cas), Modified Depression Scale (MDS) and a sociodemographic information questionnaire. For data analysis, descriptive statistics and multivariate and univariate mean comparisons were performed by parametric and re-sampling procedures., Results: Statistically significant differences were observed between clinical and school population groups in externalizing, internalizing and depressive symptomatology (p<0.001). No sex differences were found in externalizing and depressive symptomatology. Sex differences were found in internalizing symptoms (p<0.001, p boot <0.001) as well as group interaction effects (p=0.016), girls had higher scores than boys, with greater differences in the clinical group (p<0.001, p boot =0.003)., Conclusions: Research with mental health patients is essential to verify the existence or not of differences with the general population as well as differences by sex, which will allow adapting preventive and intervention strategies to each case., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Introduction: Clinical guidelines recommend the combined use of "self-completed questionnaires such as the Test of Adherence to Inhalers (TAI)" and the pharmacy refill rate (PRR) to determine adherence, but evidence based on comparative studies to support these recommendations is limited. Our objective was to determine adherence to inhalers in asthmatic patients, using the TAI and the PRR, as well as the correlation and concordance between both methods., Methods: Multicentre cross-sectional study including the first 196 consecutive adult asthmatic patients, of whom 183 were on maintenance treatment with Inhaled Corticosteroids (ICS). Nonadherence was defined as TAI < 50 or PRR < 80% in the previous 12 months., Results: A statistically significant positive correlation was observed between TAI and PRR scores (Spearman's rho coefficient = 0.185; p = 0.012). Prevalence of nonadherence based on TAI was 73.22%; 95%CI (66.54-79.91) and 57.92%; 95%CI (50.50-65.35) based on PRR was. In terms of agreement, a Cohen's kappa index = 0.174 and an overall % agreement of 61.7% were obtained. Twenty-two of the 49 patients who scored 50 on TAI (44.9%) refilled < 80% of inhalers. In contrast, 48 of the 134 patients who scored ≤ 49 on TAI (35.8%) refilled ≥ 80% at the pharmacy., Conclusions: Adherence remains suboptimal with prevalences of nonadherent patients > 50%. The concordance results supports, in line with guideline recommendations, that the use of both approaches (TAI and PRR) increases the ability to identify poor adherence compared to TAI or PRR alone., (© 2023 Sociedad Española de Neumología y Cirugía Torácica (SEPAR). Published by Elsevier España, S.L.U.)

With the advancement of knowledge in relation to the physiopathogenesis of atopic dermatitis (AD), several new therapeutic forms have been developed. There are also new guidelines for self-care. On the other hand, there is still an underdiagnosis of AD in Mexico. Thus, the need was seen to develop a national guide, with a broad base among the different medical groups that care for patients with AD. The Atopic Dermatitis Guidelines for Mexico (GUIDAMEX) was developed with the ADAPTE methodology, with the endorsement and participation of ten national medical societies, from physicians in Primary Healthcare to allergists and dermatologists. Throughout the manuscript, key clinical questions are answered that lead to recommendations and suggestions for the diagnosis of AD (including differential diagnosis with immunodeficiency syndromes), the recognition of comorbidities and complications, non-pharmacological treatment including therapeutic education, treatment of flares and maintenance therapy. The latter encompasses general measures to avoid triggering factors, first-line treatment focussed on repair of the skin barrier, second-line treatment (topical proactive therapy), and third-line phototherapy or systemic treatment, including dupilumab and JAK inhibitors.

There are different etiologies of neonatal ophthalmia such as viral ones. Among them, the Herpes simplex virus, both type I and II, is particularly relevant due to its potential severity. It is a rare, in frequent entity, but with a high rate of morbidity and mortality without appropriate diagnosis and management., Objective: To describe a case of neonatal ophthalmia caused by Herpes Virus type I, its clinical characteristics, and correct diagnosis., Clinical Case: 8-days old newborn, with no notable history, presenting edema and erythema of eyelids, accompanied by bilateral ocular discharge. Her pes Virus type I infection was diagnosed by PCR, without evidence of disseminated disease or central nervous system involvement. He received full treatment with intravenous Acyclovir with complete clinical improvement., Conclusions: Herpes Simplex Virus should always be considered as a diffe rential diagnosis in all neonatal ophthalmia. Early and timely diagnosis and treatment are of vital importance.

Human schistosomiasis is the parasitic disease with the highest morbidity and mortality worldwide after malaria. It is endemic in more than 78 tropical and subtropical countries, especially in sub-Saharan Africa, and it is estimated that 236 million people are infected. It can cause serious health complications at the genitourinary and hepatosplenic level, leading to the death of 300,000 people each year. The number of imported cases in Western countries has increased in recent years due to the arrival of a significant number of migrants from endemic regions and a growing number of travelers who have visited them. On the other hand, outbreaks of autochthonous transmission have recently been reported in Corsica (France) and Almería (Spain). For all these reasons, the European health authorities have recommended serological screening for the disease in all migrants from endemic areas who have been living in Europe for less than 5 years. Since Primary Care is usually the first point of contact for these people with the Health System, doctors must know the main aspects of the disease, and be provided with the necessary means for its diagnosis and treatment. This document has been prepared by professionals belonging to five scientific societies of Primary Care (SEMFyC, SEMG, SEMERGEN), Pediatrics (SEIP) and Tropical Medicine and International Health (SEMTSI), in order to establish clear recommendations for the diagnosis and management of schistosomiasis in Primary Care., (Copyright © 2022 The Authors. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction and Objectives: To assess, in patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous intervention, the pace of introduction in clinical practice (2010-2017) of drug-eluting stents (DES), ticagrelor, prasugrel, and prolonged dual antiplatelet therapy (DAPT) duration, and their potential impact on the risk of 2-year outcomes., Methods: Prospective and exhaustive community-wide cohort of 14 841 STEMI patients undergoing primary percutaneous intervention between 2010 and 2017. Index episodes were obtained from the Catalan Codi IAM Registry, events during follow-up from the Minimum Data Set and DAPT were defined by pharmacy dispensation. Follow-up was 24 months. The temporal trend for exposures and outcomes was assessed using regression models., Results: Age> 65 years, diabetes, renal failure, previous heart failure, and need for anticoagulation at discharge were more frequent in later periods (P <.001). From 2010 to 2017, the use of DES increased from 31.1% to 69.8%, ticagrelor from 0.1% to 28.6%, prasugrel from 1.5% to 23.8%, and the median consecutive months on DAPT from 2 to 10 (P <.001 for all). Adjusted analysis showed a temporal trend to a lower risk of the main outcome over time: the composite of death, acute myocardial infarction, stroke and repeat revascularization (absolute odds reduction 0.005% each quarter; OR, 0.995; 95%CI, 0.99-0.999; P=.028). The odds of all individual components except stroke were reduced, although significance was only reached for revascularization., Conclusions: Despite a strong increase between 2010 and 2017 in the use and duration of DAPT and the use of ticagrelor, prasugrel and DES, there was no substantial reduction in major cardiovascular outcomes., (Copyright © 2021 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Non-alcoholic fatty liver disease (NAFLD) is a chronic disease that may lead to cirrhosis and hepatocellular carcinoma; its close relationship with obesity and the metabolic syndrome involves an increasing prevalence. Invasive liver biopsy is the gold standard diagnosis technique for NAFLD but entails risks. Therefore, transient elastography, a non-invasive technique with high reliability, is frequently used in clinical practice. Bariatric surgery is the only effective treatment for long-term weight loss and obesity-related metabolic conditions improvement. Although studies report encouraging results of bariatric surgery as a valuable therapy for NAFLD, guidelines for its use in NAFLD are ambiguous. Indeed, the mechanisms driving this improvement are largely unknown, but likely involve weight loss-dependent and independent factors including anatomic and hormonal changes. This review aims to update the relationship between NAFLD and bariatric surgery, focusing on the indications for surgery and the mechanisms implied in NAFLD improvement., (Copyright © 2022 Elsevier España, S.L.U. All rights reserved.)

Background: Acute-on-chronic liver failure (ACLF) is a common syndrome that occurs in patients with advanced chronic liver disease. It consists of the rapid failure of various organs and is associated with high short-term mortality. We aim to describe the main features and outcomes of inpatients who developed ACLF and to identify the factors associated with in-hospital and 28-day mortality., Patients and Methods: All patients meeting ACLF criteria with advanced chronic liver disease admitted for decompensation from January 2014 to December 2016 were identified. Clinical and biological data were collected at the time of ACLF diagnosis and at 3-7 days thereafter, as well as in-hospital and 28-day mortality., Results: Eighty nine out of 354 admission episodes (28%) developed ACLF, which was present at the time of admission in 72% of cases. A precipitating factor was identified in 83% of cases, the most frequent being infection (53%) and gastrointestinal bleeding (19%). In the multivariate regression analysis, the ACLF grade at 3-7 days after diagnosis was predictive of in-hospital mortality and 28-day mortality, and lower creatinine and bilirubin levels at the time of ACLF diagnosis and a precipitating factor other than bacterial infection were associated with ACLF reversion at 3-7 days., Conclusions: ACLF is a frequent complication among patients with chronic liver disease admitted for acute decompensations and is associated with a high mortality rate and is related to the number of organs involved. Bacterial infection is the most frequent precipitating factor of ACLF and probably entails a worse prognosis., (Copyright © 2021 Elsevier España, S.L.U. All rights reserved.)

Introduction: COVID-19 pneumonia is the most frequent clinical manifestation of this disease, and its long-term sequelae and possible progression to pulmonary fibrosis are still unknown. The aim of this study is a mid-term review of the sequelae on plain chest radiography (CXR) in patients with a previous diagnosis of COVID-19 pneumonia., Patients and Methods: Retrospective review of patients with a diagnosis of COVID-19 pneumonia, assessing the persistence of residual lesions in the control CXR and analysing their possible relationship with epidemiological factors, risk factors, treatments received and initial radiological patterns., Results: A total of 143 patients (52 women and 91 men) were analysed. Mean age was 64 years. Radiological complete resolution (CR) was observed in 104 (73%) and partial resolution (PR) in 39 (27%). Of the risk factors only age was significantly related to persistence of residual lesions (OR 1.06 CI 95% (1.02,1.10). In relation to treatments, significant differences were found with tocilizumab and glucocorticoids, where treated patients had a higher risk of residual lesions (OR 2.44 (1.03,5.80) and 3.05(1.43,6.51) respectively. In the analysis of radiological patterns, significant differences were observed in patients with peripheral condensations in the acute course and a pattern of early radiological worsening. A clinical-radiological dissociation was evident: 83% of patients with residual lesions had no respiratory symptoms., Discussion: COVID19 pneumonias may have a slower radiological resolution in older patients with certain initial radiological patterns, but the development of pulmonary fibrosis in these patients is still questionable., (Copyright © 2021 Elsevier España, S.L.U. All rights reserved.)

Introduction: Background: dysphagia is a disabling, uncomfortable symptom with repercussions on daily basic aspects of well-being. The SWAL-QoL test is validated for checking dysphagia's impact on quality of life (QoL). Methods: a descriptive cross-sectional study. Randomized patients from our in-house Nutrition & Dietetics database. Telephone interviews directly with patients or caregivers. SWAL-QoL test, 11 sections: swallowing, eating, symptoms, food selection, communication, fears, mental health, fatigue, and social function. A 1-5 Likert scale was adjusted and final results were linearly transferred to 0-100 (100 being best positive score). Results as follows: 0-49 severe impact (SI), 50-70 moderate impact (MI), and 71-100 mild impact or no impact (DI/NI). Variables: gender, age, days with treatment, residence: Home (H)/nursing home (NH), indication of commercial thickener (CT) by V/V test: nectar (N), honey (H), pudding (P), days with CT, type of diets; pureed (PD), soft diet (SD), mixed(P&S/D), regular (RD), SWAL-QoL sections. Results: a total of 202 patients with a mean age of 85 years (23-103); IQR: 12. Mostly women, 57.9 %. Dwelling: 43.1 % H/56.9 % NH. SWAL-QoL: SI affects 19.3 %, 59.9 % MI and 20.8 % DI/NI. Using less thickener proved a better QoL; SI in pudding 21.1 % vs nectar 15.3 %, p = 0.04. Diets included 66.3 % PD; 3 % SD; MD, 21.3 %, and RD, 9.4 %. At NH 86.1 % of PD vs 40.2 % at H, p < 0.001. Direct impact of diet on QoL: 30.8 % on DI or no impact of grouped diets vs 15.7 % with PD, p = 0.016. Analysing each section by H/NH, significant difference between fears, higher at H, 57.01 ± 36.41 vs NH, 48.70 ± 27.03, p < 0.001; worse mental health for NH, 66.44 ± 34.30 vs H, 47.48 ± 24.06, p < 0.001; better food selection for H, 75.86 ± 34.12 vs NH, 68.17 ± 33.60, p < 0.01. Conclusions: defining QoL contributes to a better understanding of patient needs. More information to confront their fears is helpful to adjust the texture of liquids properly. Increasing adaptations of diets and diversity in food selection are needed especially in those living in NH.

The COVID-19 pandemic has hit Spain particularly hard, despite being a country with a developed economy and being praised for the robustness of its national health system. In order to understand what happened and to identify how to improve the response, we believe that an independent multi-disciplinary evaluation of the health, political and socio-economic spheres is essential. In this piece we propose objectives, principles, methodology and dimensions to be evaluated, as well as outlining the type of results and conclusions expected. Inspired by the requirements formulated by the WHO Independent Panel for Pandemic Preparedness and Response and by experiences in other countries, we detail the multidimensional aspects to be evaluated. The goal is to understand key aspects in the studied areas and their scope for improvement in terms of preparedness, governance, regulatory framework, national health system structures (primary care, hospital, and public health), education sector, social protection schemes, minimization of economic impact, and labour framework and reforms for a more resilient society. We seek to ensure that this exercise serves not only at present, but also that in the future we are better prepared and more agile in terms of our ability to recover from any pandemic threats that may arise., (Copyright © 2020 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

COVID-19 has tested the resilience and adaptability of governments, workers and companies. We have lived through very harsh circumstances, with social and economic consequences that we could never have imagined, but it has also been shown that civil society works and that it has been up to the task, with companies at the forefront. They have made a great effort to adapt to the new and exceptional situation, playing a very important role in preventing and slowing down the spread of COVID-19 in the workplace, and in establishing economic and social agreements to mitigate the effects of the crisis. This article describes how companies have had to face this situation in economic and preventive matters, the difficulties experienced due to the changing behavior of the pandemic, the agreements reached with the Government and other social partners in matters of employment and social reform and the important role of Spanish Confederation of Business Organizations Foundation (CEOE), Insurance associations and Prevention Services in the fight against COVID-19.

Introduction: Background: peri- and post-menopausal women exhibit a high tendency towards obesity and visceral fat deposition, which increases cardiometabolic risk. Objective: to evaluate through a prospective nutritional study the effect of carotenoid consumption on cardiometabolic risk biomarkers in peri- and post-menopausal women. Material and methods: twelve peri- and post-menopausal women without previous symptoms of cardiovascular disease, but with some cardiometabolic risk factor, were recruited. Their diet was supplemented during 4 weeks with orange-carrot juice, tomato juice, and boiled spinach, providing 415 mg of total carotenoids/week (carotenes, cryptoxanthin, lycopene, and lutein + zeaxanthin). At the beginning (TI) and at the end (TF) of the intervention period blood samples were drawn to measure biochemical parameters, oxidative stress, inflammation and endothelial function biomarkers, and plasma carotenoid levels. Results: at TF a significant decrease (p < 0.05) in LDL-cholesterol and atherogenic index, and an increase in HDL-cholesterol were observed. Plasma carotenoids increased significantly (p < 0.05) from 0.56 µg/mL at TI to 1.22 µg/mL at TF. Concurrently, a shift in oxidative stress and inflammation biomarkers was detected, with a decrease in plasma C-reactive protein and malonaldehyde levels, and an increase in adiponectin. However, endothelial dysfunction biomarkers (sVCAM and sICAM) and total antioxidant capacity remained unchanged. Conclusions: dietary supplementation with carotenoids leads to an increase in plasma carotenoids, a decrease in atherogenic dyslipidemia, and an improvement in oxidative stress and inflammation biomarkers, which indicates a reduction in cardiometabolic risk.

Hydrocephalus is a clinical condition that consists of an accumulation of cerebrospinal fluid around the brain; Dandy- Walker syndrome is a rare cause of it. We present the case of a newborn with prenatal diagnose of hydrocephalus due to a Dandy-Walker malformation, as well as ambiguous genitalia. After birth, diagnosis of Dandy-Walker malformation associated with uncommon extracranial manifestations is confirmed. Specifically, the baby presents interscrotal hypospadias and coronary sinus dilatation due to the persistence of the left superior vena cava. With the exposition of this case, we bring Malformación de Dandy-Walker asociada a malformaciones extracraneales en un neonato Dandy-Walker malformation associated with extracranial abnormalities in a newborn out the complexity of the Dandy-Walker syndrome due to the malformations associated with it; the ones that will determine the prognosis and the need of a multidisciplinary treatment., Competing Interests: None, (Sociedad Argentina de Pediatría.)