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Resumen La hidatidosis es una zoonosis causada por la larva del cestodo Echinococcus granulosus. La afectacion cerebral en el ser humano es inusual, solo en el 1-2% de los casos se observa compromiso encefalico. Este cuadro se presenta fundamentalmente en poblacion pediatrica y se caracteriza por la presencia de quistes unicos y uniloculares. A continuacion, se presenta el caso de una paciente de 29 anos que acude a urgencias por una cefalea invalidante de varias semanas de evolucion. El estudio cerebral mediante imagen, revela la presencia de una masa de origen desconocido, siendo el diagnostico final de quiste hidatidico bilobulado. A proposito de este caso, se revisaran los aspectos clinico-epidemiologicos, los diagnosticos y los tratamientos de la hidatidosis cerebral.

Resumen Introduccion Los datos disponibles de las causas de muerte en pacientes ingresados por insuficiencia cardiaca en servicios de medicina interna y en poblacion espanola segun fraccion de eyeccion reducida (FER), preservada (FEP) e intermedia (FEI) son escasos. Su estudio puede mejorar el conocimiento de estos pacientes y su pronostico. Metodos Estudio de cohortes multicentrico y prospectivo de 4.144 pacientes que ingresaron por insuficiencia cardiaca en unidades de medicina interna. Se registraron sus caracteristicas clinicas, tasa de fallecimientos y sus causas agrupadas segun FEP (≥ 50%), FEI (40-49%) y FER ( Resultados Se registraron 1.198 fallecimientos (29%), de los que 833 fallecieron por causas cardiovasculares (69,5%), fundamentalmente por insuficiencia cardiaca (50%) y por muerte subita (7,5%) y 365 por causas no cardiovasculares (NoCV) (30,5%), sobre todo por infecciones (13%). La causa mas frecuente y temprana en todos los grupos fue la insuficiencia cardiaca. Los pacientes con FEP tenian menor tasa de muerte subita y mayor de infecciones (p Conclusiones Las causas de muerte en pacientes con insuficiencia cardiaca fueron diferentes dependiendo del tipo de fraccion de eyeccion. Los pacientes con FEI y FEP, por su elevada comorbilidad y mayor frecuencia de muerte NoCV, son los que mas se beneficiarian de un manejo integral por parte de medicina interna.

Introduction and objective Arachnoid cysts (ACs) are relatively frequent lesions related to different neurological symptoms, being mostly incidentally diagnosed. This study aims to clarify whether AC surgery in epileptic patients is useful in their treatment. Material and methods The patients registered in the database of the Neuropediatrics Section from May 1990 to August 2019 are analyzed retrospectively. Patients in whom the diagnosis of ACs and epilepsy coincide are studied. The location, size and number of ACs, neurological development, age at diagnosis, follow-up time, the performance of surgery on the cyst, evolution, anatomical relationship between brain electrical activity and location of AC, and type of epilepsy are analyzed. Results After analyzing the database, we found 1881 patients diagnosed with epilepsy, of which 25 had at least one intracranial AC. In 9 of the patients, cerebral or genetic pathologies were the cause of epilepsy. Of the other 16, only 2 patients showed that the type of epilepsy and the epileptogenic focus coincided with the location of the AC; one of them was surgically treated without success, and the other one remained asymptomatic without receiving medical or surgical treatment. Conclusions Although it is necessary to design a prospective study to establish causality, the results of our research and the available literature suggest that there is no causal relationship between the presence of ACs and epilepsy. The study and treatment of these patients should be carried out in a multidisciplinary epilepsy surgery unit, without initially assuming that the AC is the cause of epilepsy.

Background Ultra-processed foods (UPF) are associated with poor diet quality and chronic diseases. UPF falls into one of the four groups classified according to the extent and purpose of processing: Group 1 includes unprocessed and minimally processed foods (MPF); group 2 refers to processed culinary ingredients (PCI); group 3, processed foods (PF); and group 4, UPF. Objective The aim of this study was to evaluate the relative validity of a semi-quantitative food frequency questionnaire (SFFQ) compared to two 24-hour dietary recalls to estimate dietary intake per NOVA food group in Mexican children and adolescents. Design This study is a secondary analysis of dietary data from a subsample of children and adolescents who participated in the 2012 Mexican National Health and Nutrition Survey Participants/setting The study participants were 217 children (5 to 11 years) and 165 adolescents (12 to 19 years) with complete information for the SFFQ and two 24 hour-dietary recalls (24DRs). Main outcome measures Daily averages of energy intake and % of energy intake for each NOVA category were calculated using the SFFQ and two 24DRs. Statistical analysis To assess relative validity, the SFFQ was compared with two 24DRs to estimate dietary intake per NOVA food group. Mean differences, Spearman correlations and intra-class correlations coefficients (ICC) and Bland–Altman plots for continuous variables and weighted kappa for ordinal variables were calculated. Results For percentage of energy intake, ICC in children and adolescents were moderate for MPF (ICC=0.47, ICC=0.56, respectively) and UPF (ICC=0.53, ICC=0.57, respectively). Bland–Altman plots indicated reasonably consistent agreement for UPF and MPF groups in children and adolescents. Classification by quintiles was acceptable in all groups. Conclusions Data from this study indicated reasonable relative validity of the SFFQ to rank the percentage of energy intake from MPF and UPF in Mexican children and adolescents.

Atypical uremic haemolytic syndrome is a variant of thrombotic micro-andiopathy characterized by non-autoimmune hemolytic anemia, thrombocytopenia and acute renal failure as a result of excessive activation of the complement. Up to 60% of patients have mutations in the genes that encode the complement system. A disensing factor is required for its manifestation, including gestation. It is an entity with a high morbidity, which can decrease drastically if an early diagnosis is made and appropriate treatment is initiated. Administration of ecuilizumab has demonstrated rapid process disruption, reducing the need for extrarenal purification therapies and improving renal function and patient prognosis.

After the increase in inequalities following the Great Recession, studies on wage bargaining systems have increasingly focused on wage inequality. This research examines wage inequality associated with collective bargaining levels in Spain, based on matched employer–employee microdata and quantile regression methods. These methods are applied across the wage distribution, following the method proposed by Firpo et al. (2011), to estimate wage premiums associated with agreement levels and to decompose the wage differentials observed at different points of the wage distribution. From the evidence obtained it can be concluded that, although the higher wages found in firm-level agreements are explained by the better observed characteristics of firms and workers covered by these collective agreements, there remains a positive wage premium. Although this premium is seen throughout the wage distribution, it favours mostly workers in the middle and upper-middle end. This slightly increases wage inequality in comparison with sectoral agreements. In contrast, workers without collective bargaining coverage generally suffer a wage penalty. This penalty is only observed on the left of the wage distribution. It becomes a significant wage premium in the upper end of the distribution, which implies a significant increase in wage inequality. In short, the evidence of this research suggests that reducing the coverage of collective bargaining could be associated with a significant increase in wage inequality. A better policy option for countries with a predominant sectoral model, such as Spain, would be to move towards an organized decentralization model. This would cause significant gains in employment as suggested by OECD (2019) and only a slight increase in wage inequality. Support received from the Agencia Estatal de Investigación (AEI - 10.13039/501100011033) through projects PID2020-118800GB-I00, PID2020-114896RB-I00 and PID2019-108265RB-100 and from the Generalitat Valenciana (Consellería de Innovación, Universidades, Ciencia y Sociedad Digital) through action AICO/2021/062.

There is currently a degree of divergence among the main clinical practice guidelines on the management of risk factors for peripheral arterial disease (PAD). This project aims to gain understanding of the management of PAD risk factors in clinical practice and to reach a multidisciplinary consensus on the strategies to be followed in order to optimize its identification, treatment, and follow-up.A multidisciplinary consensus following the Delphi methodology.Professionals (n = 130) with extensive experience in PAD participated in this consultation. The results suggest that in order to optimize the control of risk factors, efforts should be aimed at: (1) promoting the involvement and awareness of all specialists in the identification of and screening for the disease; (2) guaranteeing the possibility of evaluating the ankle-brachial index (ABI) in all the medical specialties involved; (3) promoting strategies for patients to quit smoking through the use of drugs, programs, or referrals to specialized units; (4) promoting an appropriate Mediterranean-based diet and the prescription of daily exercise; (5) raising awareness of the importance of ensuring LDL cholesterol values below 70 mg/dL, especially in symptomatic but also in asymptomatic patients (55 mg/dL following the publication of the ESC/EAS guide); (6) recommending the use of antiplatelet therapy in asymptomatic patients with diabetes mellitus (DM) and/or a pathological ABI; and (7) protocolizing the annual evaluation of ABI in high-risk patients.This document presents the 22 agreed-upon strategies which are intended to help professionals optimize multidisciplinary management of PAD risk factors.

Objective To assess whether a sustained optimal haemoglobin value in the 3 months after admission for heart failure (HF) decompensation reduces morbidity and mortality during the 12 months after admission for acute HF. Patients and method Retrospective study of the 1408 patients older than 65 years included in the RICA registry divided into 3 groups: no anaemia (group A), recovered anaemia (group B), and persistent anaemia (group C), according to haemoglobin levels on admission, and 3 months after discharge. Kaplan-Meier curves were constructed, comparing the groups using the log-rank test and a Cox regression model was performed to analyse survival. Results 578 (41.1%), 299 (21.2%) and 531 (37.7%) were included in groups A, B and C, respectively. We recorded a total of 768 deaths and readmissions. There were 23 (4%), 12 (4%) and 49 (9.2%), (p=.001) individuals who died due to HF and 154 (27%), 73 (24%) and 193 (36%) (P Conclusions Persistent anaemia in the months after admission for HF increases morbidity and mortality in the subsequent year.

Resumen Introduccion La inmunoterapia con inhibidores de puntos de control (ICC) ha demostrado ser una de las nuevas estrategias mas efectivas para tratar varios tipos de cancer. Sin embargo, al detener la supresion ejercida por los puntos de chequeo, principalmente CTLA-4 y PD-1/PD-L1, algunos pacientes presentan diferentes reacciones inmunologicas (irAE) que pueden ir desde compromiso organico leve hasta grave, con riesgo de muerte. Esto hace importante que durante el tratamiento, los pacientes sean evaluados cuidadosamente para lograr detectar y entender este tipo de manifestaciones y encontrar herramientas para su manejo. Objetivos Determinar la presencia de autoanticuerpos en un grupo de pacientes en tratamiento con ICC, con o sin clinica sugestiva de enfermedad reumatologica asociada a la terapia. Ademas, evaluar las caracteristicas clinicas y demograficas de dichos pacientes. Metodos En este estudio transversal se reclutaron pacientes diagnosticados con cancer y bajo tratamiento con ICC. En el suero se determinaron autoanticuerpos mediante kits comerciales. La presencia de irAE fue evaluada de acuerdo con las definiciones propuestas en las guias de la Sociedad Americana de Oncologia Clinica. Resultados De los 24 pacientes evaluados, 15 presentaron al menos un evento adverso inmunologico, siendo los dermatologicos y los musculoesqueleticos los mas prevalentes. Respecto a la presencia de autoanticuerpos, de los 22 sueros analizados 19 presentaban al menos un autoanticuerpo, siendo los anticuerpos antinucleares y antimusculo liso los mas comunes. Conclusion La seroprevalencia encontrada en nuestros pacientes nos sugiere que los autoanticuerpos podrian hacer parte de las irAE en pacientes tratados con ICC. Sin embargo, se requieren mas estudios para lograr definir la utilidad de la determinacion de autoanticuerpos en estos pacientes como predictores de manifestaciones clinicas.

Objective We sought to identify the factors associated with a worse prognosis in Emergency Department (ED) patients with atrial fibrillation (AF), crucial information to guide management decisions. Methods This is a secondary analysis of a prospective, multicenter, observational cohort of consecutive AF patients attended in 62 EDs in Spain. Clinical variables were collected on enrollment. Follow-up was performed at 30 days and one year. The primary composite outcome was all-cause mortality, major bleeding and/or stroke at one year. Secondary outcomes were each of these components considered separately, plus one-year cardiovascular mortality and the composite outcome at 30 days. Results We analyzed 1107 patients. The primary outcome occurred in 209 patients (18.9%), one-year all-cause mortality in 151 (13.6%), major bleeding in 47 (4.2%), and stroke in 31 (2.8%). Disability (HR 2.064, 95% CI 1.478–2.882), previous known AF (HR 1.829, 95% CI 1.096–3.051), long duration of the AF episode (HR 1.849, 95% CI 1.052–3.252) and renal failure (HR 2.073, 95% CI 1.433–2.999) were independently associated with the primary outcome, whereas anticoagulation at discharge was inversely associated (HR 0.576, 95% CI 0.415–0.801). Disability was associated with mortality, cardiovascular mortality, and the composite at 30 days, and renal failure with mortality and major bleeding. Conclusions Comorbidities like renal failure, long AF duration and disability were related to adverse outcomes and should be decisive to guide management decisions in ED patients with AF. Anticoagulation had a positive impact on prognosis and should be the mainstay of therapy in AF patients attended in ED.

espanolObjetivo. Analizar la asociacion entre seropositividad a SARS-CoV-2 y enfermedades cronicas en adultos y adultos mayores mexicanos. Material y metodos. Se utilizo la Encuesta Nacional de Salud y Nutricion 2020 sobre Covid-19 (Ensanut 2020 Covid-19) para evaluar la asociacion de sero-positividad a SARS-CoV-2 con hipertension arterial sistemica, diabetes tipo 2, indice de masa corporal, LDL-c elevado, HDL-c bajo, colesterol total elevado e hipertrigliceridemia. Resultados. Se observo una mayor seropositividad en per-sonas con mayor indice de masa corporal. La seroprevalencia fue 25% mayor entre los adultos que presentaban obesidad en comparacion con aquellos de peso normal en modelos ajustados (RP: 1.25 IC95%: 1.08,1.46). No se observo aso-ciacion entre seropositividad y otras enfermedades cronicas en adultos o adultos mayores. Conclusiones. Las personas con obesidad podrian tener una mayor susceptibilidad ala infeccion por SARS-CoV-2. Este hallazgo debe ser confirmado con estudios longitudinales. No se encontro evidencia de asociacion para otras enfermedades. EnglishObjective. To analyze the association between seropositiv-ity to SARS-CoV-2 and chronic diseases in Mexican adults and older adults. Materials and methods. We used the 2020 National Health and Nutrition Survey on Covid-19 to evaluate the association of seropositivity to SARS-CoV-2 with high blood pressure, type 2 diabetes, body mass in-dex, elevated LDL-c, low HDL-c, high total cholesterol, and hypertriglyceridemia. Results. We observeda higher seropositivity at higher body mass index levels. In adjusted models, seroprevalence was 25% higher among adults with obesity compared to those of normal weight (PR: 1.25 95%CI: 1.08,1.46). We did not observe any association between sero-positivity and other chronic diseases in adults or older adults. Conclusions. Adults with obesity could be at increased susceptibilityof SARS-CoV2 infection. This observation needs to be confirmed through longitudinal studies. We did not find evidence of an association with other chronic diseases.

espanolObjetivo. Describir la prevalencia de hipertension arterial (HTA) en adultos mexicanos, la proporcion que tiene tension arterial (TA) controlada y la tendencia en el periodo 2018-2020. Material y metodos. Se midio la TA a 9 844 adul-tos en la Encuesta Nacional de Salud y Nutricion (Ensanut) 2020. Se considero que tenian HTA o TA controlada cuando cumplian los criterios del Eighth Joint National Committee(JNC-8) o American Heart Association (AHA). Resultados. La prevalencia de HTA fue 49.4% (segun JNC-8), de los cuales 70% desconocia su diagnostico. Segun la clasificacion AHA, 30.2% de los adultos tenia HTA y 51.0% ignoraba su diagnostico. Entre adultos con diagnostico previo de HTA, 54.9% tuvo TA controlada. Entre el periodo 2018-2020 no se observaron cambios en las prevalencias. Conclusiones. Al menos un tercio de los adultos mexicanos tiene HTA y de ellos al menos la mitad no habian sido diagnosticados. Debe evaluarse la pertinencia de los actuales programas de diagnostico de HTA porque el subdiagnostico y mal control pueden ocasionar complicaciones y la muerte. EnglishObjective. To describe the prevalence of hypertension in Mexican adults, the proportion with controlled blood pres-sure (BP), and the trend in the 2018-2020 period. Materials and methods. BP was measured in 9 844 adults who parti-cipated in the National Health and Nutrition Survey (Ensanut, in Spanish) 2020. They were considered to have hypertension or BP controlled when adults met the Eighth Joint National Committee (JNC-8) or American Heart Association (AHA) criteria. Results. The prevalence of hypertension was 49.4% (according to JNC-8), of which 70.0% were unaware of their diagnosis. When using AHA criteria, 30.2% of the adults had hypertension and 51.0% were unaware of your diagnosis. Among adults with a previous diagnosis of hypertension, 54.9% had controlled BP. Between the 2018-2020 period, no changes in prevalences were observed. Conclusions. At least a third of Mexican adults have hypertension and of them, at least half have not been diagnosed. The relevance of current hypertension diagnostic programs should be eva-luated because underdiagnosis and poor control can lead to complications and death.

AIM Gender dysphoria is the disagreement between the gender of birth and the one with which the patient identifies. For its management it is mandatory to have a multidisciplinary team. Gender confirmation surgery with penoscrotal skin flap is the procedure of choice, and a sigmoid vaginoplasty is a feasible alternative. The new technologies and the help of indocyanine green (ICG) fluorescence can help to guarantee a correct neovagina vascularization. The objective of this paper is to present the surgical technique of laparoscopic sigmoid vaginoplasty assisted by ICG. METHODS We present two patients with gender dysphoria and a history of stricture of the penoscrotal skin flap vaginoplasty. We performed sigmoid vaginoplasty by the laparoscopic approach. We began the procedure with the mobilization and section of 30 cm of sigmoid colon, selective ligation of the vessels assisted by ICG, 180° sigmoid rotation, externalized on antiperistaltic position, construction of colovestibular anastomosis and promontory fixation. We finished the procedure with virtual ileostomy construction and drain placement. RESULTS Patients recovered satisfactorily and were discharged on the seventh day after surgery without complications. CONCLUSION Sigmoid vaginoplasty is a safe and feasible procedure. ICG has great value, contributing to the selective ligation of the vessels, allowing 180° sigmoid rotation and guaranteeing the irrigation of the neovagina.

Objective To estimate the incidence of falls and to know their characteristics in terms of location, temporality and injuries produced, and to analyse the sociodemographic and clinical characteristics of the patients who suffer falls. Methodology A retrospective observational cohort study was carried out in a level 2 hospital of the Madrid Health Service. Falls in hospitalized patients between July 1, 2018 and June 30, 2019 were studied. The incidence rate of falls per 1000 days of stay was estimated considering a Poisson distribution. The characteristics of the falls are described: temporality, injuries produced, location of the injuries and prescribed drugs. Sociodemographic and clinical characteristics of patients who suffered a fall were registered. A univariate analysis was performed to compare the results by gender. All data were obtained from the electronic medical record. Results One hundred and thirty-two falls were studied, which represent a rate of 1.61 falls per 1,000 days of stay. Men, older age, and admission to a medical specialty showed a significantly higher fall rate. The patients who suffered a fall had a mean age of 77.5 years (SD: 11.7), and had a median of 12.5 drugs prescribed (IQR: 9.25-15). Of the falls, 63.6% did not present any injury. Difference in gender was only found in the situation in which the fall occurred. Conclusions Our data report an incidence of falls similar to other institutions in our environment. The profile of the patient who suffers a fall is an older man, admitted under the charge of a medical specialty, with longer hospital stay, with associated comorbidity and polymedicated, without an obvious temporal feature.

Resumen Antecedentes y objetivo La paquimeningitis hipertrofica es un proceso inflamatorio fibrosante infrecuente de la duramadre intracraneal. En la mayor parte de los casos la causa es desconocida y se denomina paquimeningitis hipertrofica idiopatica (PHI). La sintomatologia audiovestibular asociada es poco frecuente y su patogenia no esta aclarada. Materiales y metodos Se realizo una revision sistematica de literatura medica de los casos publicados de PHI asociados a sintomatologia audiovestibular desde el ano 2000 hasta febrero de 2020. Se siguieron los criterios PRISMA para revisiones sistematicas evaluando las bases de datos electronicas PubMED, Web of Science y Cochrane. Se complementa con el caso clinico de una adolescente que empezo con neuritis vestibular en el contexto de PHI atendida en nuestro servicio. Resultados Se han revisado 5 articulos con casos publicados de PHI que asociaban sintomatologia audiovestibular. Se encontraron un total de 7 casos (5 mujeres y 2 varones), con edades comprendidas entre los 27 y 68 anos, con diagnostico de PHI. El 100% presentaron sintomatologia audiovestibular. A diferencia de nuestra paciente, todos presentaron hipoacusia neurosensorial uni- o bilateral. No se ha encontrado ningun otro caso descrito de asociacion entre PHI y neuritis vestibular. El tratamiento empleado fueron los corticoides, con los que se consiguio mejoria en el 87,5% de los pacientes. Conclusiones Las manifestaciones vestibulares en el contexto de una PHI son muy poco frecuentes. La patogenesis no esta clara. La principal causa de la hipoacusia y la sintomatologia vestibular podria ser el atrapamiento de los nervios en el conducto auditivo interno con dano neuronal secundario.

Cardiovascular diseases (CVD) are known to be the world's leading cause of death and different factors are known to increase the risk of death, including aging, mainly due to increased oxidative stress and inflammation observed in older people. Acute myocardial infarctions and cerebrovascular accidents belong to CVD, and are the ones that cause the most deaths and disabilities, where greater platelet activation plays an important role in pathophysiology. These diseases are more prevalent in older people, which have a clear relationship with increased platelet function and are strongly related to aging. Platelet function is affected by diet, which varies in its requirements and characteristics according to age. Coffee belongs to the family of diet elements that can alter platelet function and an increase in coffee consumption with advancing age, and a U-shaped correlation with the risk of CVD have been reported. However, the effect of coffee consumption and its bioactive compounds on platelet function and aging presents controversial evidence, and therefore, a complex effect is not fully elucidated in the cardiovascular system. This review focuses on the relationship between coffee consumption (and its constituent bioactive compounds), and platelet function, and aging.

In Colombia, the prevalence of intestinal parasitosis varies throughout its regions, social classes, and living conditions. We performed a cohort study (2017–2018) on children from 1–10 years old in El Cedro, Ayapel, Colombia. We tested a convenience sampling of those who accepted and signed the consent form. The National Intestinal Parasite Survey was applied; feces and water source sampling were tested for coprological and microbiology analysis, respectively. Education and pharmacologic treatment to the minor and co-inhabitants were performed. After the recruiting, we followed up at 7 and 12 months. Statistical analysis was performed using IBM® SPSS22. Participants 47, 61,7% male, average age 5,7 years. The caretakers had a low educational background. The monthly income of 72,3% of households was < USD 87. The coprological test showed 61,7% with at least one type of parasite; 32,2% with two or more. Trichuris trichiura was the most frequent. Water sources were positive for Escherichia coli. The population tested showed a high frequency of parasitic infection. We did not find a reduction of intestinal parasitosis with education and pharmacologic treatment at the end of the follow-up. It must be necessary to impact social determinants of public health to achieve intestinal parasitosis control.

This essay draws from Fabiola Cabeza de Baca’s previously unexamined publication files housed at the University of New Mexico Press to elucidate how US settler regimes of print and crop, upheld by the seizure of Mexican and Indigenous lands, unleashed ecological violence. A noted New Mexican folklorist and teacher, Cabeza de Baca also served as a home economics agent for the US extension service. In the essay’s first section, I trace Cabeza de Baca’s extension writings to demonstrate how US print modernity intersected with devastating ecological transformations sparked by agricultural industrialization. In the following section, I analyze her folkloric work in the context of La Folklórica, a New Mexican Hispanic folkloric society formed in the early twentieth century that amplified the racisms of US modernity while also challenging its claims to agricultural expertise. After tracing Cabeza de Baca’s writings at the juncture of multiple publishing institutions that vied over the value of land and the means of subsistence, I conclude by showing how her folkloric work paradoxically unfolds an ecological praxis that disputes capitalist extraction and centers the vitality of Indigenous knowledge.

Current data on CAR-T cell-based therapy is really promising in multiple myeloma, especially in terms of response. In heavily pretreated patients, who have already received proteasome inhibitors, immunomodulatory drugs and monoclonal antibodies, current trials report an overall response rate ranging from 81 to 97% and 45 to 67% of complete remission rates. Data are less encouraging in terms of duration of response, although most recent trials have shown significant improvements in terms of event-free survival, with medians ranging from 8 to 14 months and up to 77% progression-free survival at 12 months with an acceptable toxicity profile. These data will be consolidated in future years and will provide new evidence on the best timing for CAR-T cell therapy. Moreover, new CAR-T designs are underway and will challenge the current results.

Haematological malignancies were previously thought to be driven solely by genetic or epigenetic lesions within haematopoietic cells. However, the niches which maintain and regulate daily production of blood and immune cells are now increasingly being recognised as having an important role in the pathogenesis and chemoresistance of haematological malignancies. Within haematopoietic cells, the accumulation of a small number of recurrent mutations initiates malignancy. Concomitantly, specific alterations of the niches, which support haematopoietic stem cells and their progeny, can act as predisposition events, facilitating mutant haematopoietic cell survival and expansion as well as contributing to malignancy progression and providing protection of malignant cells from chemotherapy, ultimately leading to relapse. In this Perspective article, we summarise our current understanding of the composition and function of the specialised haematopoietic niches of the bone marrow (BM) during health and disease. We discuss disease mechanisms (rather than malignancy subtypes) to provide a comprehensive description of key niche-associated pathways that are shared across multiple haematological malignancies. These mechanisms include primary driver mutations in bone marrow niche cells, changes associated with increased hypoxia, angiogenesis and inflammation as well as metabolic reprogramming by stromal niche cells. Consequently, remodelling of bone marrow niches can facilitate immune evasion and activation of survival pathways favouring malignant haematopoietic cell maintenance, defence against excessive reactive oxygen species (ROS) and protection from chemotherapy. Lastly, we suggest guidelines for the handling and biobanking of patient samples and analysis of the niche to ensure that basic research identifying therapeutic targets can be more efficiently translated to the clinic. The hope is that integrating knowledge of how bone marrow niches contribute to haematological disease predisposition, initiation, progression and response to therapy into future clinical practice will likely improve the treatment of these disorders.

In this study, we aimed to modify the immune response in the long term after allogeneic bone marrow transplantation (allo-BMT) by using the proteasome inhibitor ixazomib (IXZ) at the late stages of the post-transplant period. This approach facilitated the immune reconstitution after transplantation. IXZ significantly prolonged survival and decreased the risk of chronic graft-versus-host disease (cGvHD) in two different murine models without hampering the graft-versus-leukemia (GvL) effect, as confirmed by bioluminescence assays. Remarkably, the use of IXZ was related to an increase of regulatory T cells both in peripheral blood and in the GvHD target organs and a decrease of effector donor T cells. Regarding B cells, IXZ treated mice had faster recovery of B cells in PB and of pre-pro-B cells in the bone marrow. Mice receiving ixazomib had a lower number of neutrophils in the GvHD target organs as compared to the vehicle group. In summary, delayed administration of IXZ ameliorated cGvHD while preserving GvL and promoted a pro-tolerogenic immune response after allo-BMT., Takeda company (PCRS-2016-101751) partially supported the study; This work has been partially supported by the CIBERONC (CB16/12/00480), and TerCel 16/0011/0035. Spanish Association Against Cancer (AECC-POSTD18023LOPE) fellowship (TLR).

Recent years have seen important advances in our understanding of calciphylaxis, especially regarding newly identified risk factors and histologic findings that may aid diagnosis. This retrospective study of cases of calciphylaxis treated in our hospital in the last 13 years focuses on newly revealed aspects of this disease. We describe 16 patients (62.5% women; mean age, 67.9 years). In addition to advanced kidney disease (in 75% of our patients), other factors associated with the presence of calciphylaxis were a history of treatments related to phosphorus and calcium metabolism (75%) and anticoagulation (62.5%), usually with vitamin-K antagonists. Histology showed alterations in elastic fibers in only 25% of the biopsy specimens. Eleven of the patients died: sepsis was most often the cause.

Objectives To identify general characteristics, the use of persuasive techniques, and the nutritional quality of Mexican digital marketing of food and beverages/brand with the greatest number of followers and views (Facebook, Twitter, and YouTube) with specific appeal to children/adolescents. Study design Cross sectional, quantitative, exploratory, and descriptive study. Methods Multistep process to select a sample of 46 products with a Mexican website and major audiences on social networks. The energy and nutrient content of the foods and beverages were analyzed with the Pan American Health Organization Nutrient Profile Model. Results Cola and soft drinks, sweetened juices were the products with the greatest number of followers on Facebook and Twitter (13,321,274 and 1,020,504). Companies used diverse persuasive techniques combining promotional characters (79.1%), incentives (65.1%), and digital techniques (78.3%). Products with excess critical nutrients were most frequently advertised regardless of the type of social network and the marketing techniques used. Conclusion Digital Marketing represents a major threat for children and adolescents in Mexico, and probably all over the world, because of its persuasive techniques, and it shall be regulated.

In the current context of mandatory growth of renewable energy sources for electrical supply, in order to reduce CO2 emissions in the process of electricity generation, it is worth interest to evaluate the feasibility of the deployment of new large solar photovoltaic production facilities. This study seeks to analyze the costs and benefits of this type of infrastructures, considering the region of Leon (Spain) as case study due to its high potential. The Levelized Cost of Energy is used in this study as main decision tool, so a sensibility study on this indicator has been carried out, including the financial interest rates, the capital and operation expenditures, the facilities performance and the expected life span of the installations. Three main locations have been selected in the region, close to the main power demand sites, in order to minimize power distribution losses between the power plants and end-users. Results show that an LCOE in the range between 0.21 and 0.26 €/kWh can be achieved. The simplified calculation presented allows a preliminary and quick assessment of the grid parity of a photovoltaic plant in locations where they are not known in detail.

Unexplained infertility (UI) and recurrent implantation failure (RIF) are diagnoses based on failed pregnancy attempts within current infertility treatment models. Both diagnoses are made when fertility is unexplained based on current diagnostic methods and has no clear cause; UI is diagnosed when testing is inconclusive, and RIF is diagnosed after three failed in vitro fertilization cycles. In both cases, interventions are often introduced without an understanding of the cause of the infertility, frequently leading to frustration for patients and caregivers. Here, we review evidence to support an influence of endometrial factor in patients given these poorly defined diagnoses and possible treatments targeting the endometrium to improve outcomes in these patients.

Background Age is a risk factor for COVID severity. Most studies performed in hospitalized patients with SARS-CoV2 infection have shown an over-representation of older patients and consequently few have properly defined COVID-19 in younger patients who require hospital admission. The aim of the present study was to analyze the clinical characteristics and risk factors for the development of respiratory failure among young (18 to 50 years) hospitalized patients with COVID-19. Methods This retrospective nationwide cohort study included hospitalized patients from 18 to 50 years old with confirmed COVID-19 between March 1, 2020, and July 2, 2020. All patient data were obtained from the SEMI-COVID Registry. Respiratory failure was defined as the ratio of partial pressure of arterial oxygen to fraction of inspired oxygen (PaO2/FiO2 ratio) ≤200 mmHg or the need for mechanical ventilation and/or high-flow nasal cannula or the presence of acute respiratory distress syndrome. Results During the recruitment period, 15,034 patients were included in the SEMI-COVID-19 Registry, of whom 2327 (15.4%) were younger than 50 years. Respiratory failure developed in 343 (14.7%), while mortality occurred in 2.3%. Patients with respiratory failure showed a higher incidence of major adverse cardiac events (44 (13%) vs 14 (0.8%), p320 U/I (OR, 1.69; 95% CI, 1.18 to 2.42; p=0.0039), AST >35 mg/dL (OR, 1.74; 95% CI, 1.2 to 2.52; p=0.003), sodium 8 mg/dL (OR, 2.42; 95% CI, 1.72 to 3.41; p

BACKGROUND AND PURPOSE Comorbidities are common in multiple sclerosis (MS), and have been associated with worse outcomes and increased health care resource usage. We studied the frequency of comorbidities and adverse health behaviors (AHBs) in MS patients in the Mediterranean region of Catalonia. METHODS This population-based, case-control study used primary health care information covering 80% of Catalonia's population. Cases were matched by age/sex with randomly chosen controls (ratio = 1:5). Demographic information, comorbidities, AHBs, annual visits, sick leave days, and medication dispensing were studied. The association of comorbidities with MS and the profile of comorbidities according to sex within MS cases were assessed with multivariate logistic regression models, after adjusting for confounding variables. Health care resource usage was analyzed in MS cases compared to controls, and within MS cases in those with compared to those without comorbidities. RESULTS Five thousand five hundred forty-eight MS cases and 27,710 controls (70% female, mean age = 48.3 years) were included. Stroke (odds ratio [OR] = 1.54, 95% confidence interval [CI] = 1.17-1.99), epilepsy (OR = 2.46, 95% CI = 1.94-3.10), bipolar disorder (OR = 1.67, 95% CI = 1.17-2.36), and depression (OR = 1.83, 95% CI = 1.70-1.98) were more frequent in MS. Cases were more prone to smoking but less to alcohol intake. Among cases, psychiatric comorbidities were more frequent in women, whereas cardiovascular diseases and AHBs were more frequent in men. MS patients, particularly with comorbidities, had higher health care resource usage than controls. CONCLUSIONS Psychiatric comorbidities, stroke, epilepsy, and AHBs are more common in MS patients than in the general population in the western Mediterranean region of Catalonia. The presence of comorbidities increases the health care resource usage in MS patients.

espanolEl desperdicio de frutas, verduras y otros alimentos es un problema mundial, que puede disminuir con la utilizacion de las Tecnologias de la Informacion y la Comunicacion (TIC), en todos los escenarios de los sistemas alimentarios. El proposito de este trabajo fue identificar las TIC que se han propuesto e implementado en el comercio electronico, en diferentes cadenas alimentarias, como estrategia para reducir el desperdicio de frutas y verduras. Entre las tecnologias revisadas se encuentran: internet de las cosas (IoT), sensores RFID, crowdsourcing, aplicaciones moviles (APP), plataformas web y tecnologia de computacion en la nube. Las herramientas tecnologicas arrojan informacion de valor para su analisis y aplicacion, por las partes interesadas, para tomar las mejores decisiones y contribuir de mejor manera a la reduccion del desperdicio de alimentos y dar respuesta a acciones oportunas, que favorezcan la seguridad alimentaria y nutricional y el cuidado al medio ambiente. Las TIC pueden orientar a los diferentes actores involucrados en los sistemas alimentarios sostenibles. Tambien es factible implementarlas en el comercio electronico en Mexico, obteniendo beneficios economicos, sociales y medioambientales. EnglishThe waste of fruits, vegetables and other foods is a global problem, which can be reduced with the use of Information and Communication Technologies (ICTs) in all scenarios of food systems. The purpose of this work was to identify how some ICTs that have been proposed and implemented in electronic commerce intervene in different food chains where they have been applied as strategies to reduce the waste of fruits and vegetables. Features of some technologies are shown: Internet of Things (IoT), RFID sensors, crowdsourcing, mobile applications (APPs), web platforms and cloud computing technology. Technological tools provide valuable information for analysis and applications by stakeholders to make the best decisions and better contribute to reducing food waste and responding to timely actions that promote food and nutritional security and caring for the environment. ICTs can serve as guidelines for the different actors involved in sustainable food systems. They can also be implemented in electronic commerce in Mexico, in a way of obtaining economic, social and environmental benefits.

Human dirofilariosis is a clinical entity caused by infection with nematode species of the genus Dirofilaria. The traditional picture depicts the disease as a sporadic event associated with the presence of a single immature worm causing a nodular lesion. With the aim to reassess this paradigm, establishing a more accurate picture of the disease and homogenize criteria, a scoping review was conducted by searching, screening and analysing published clinical cases of human dirofilariosis worldwide during the 21st century. After extracting data from 305 publications containing 576 case reports, results showed that human dirofilariosis is currently caused by 5 Dirofilaria species (mainly D. repens). Maturation was not uncommon, since 42.95% of the parasites recovered were described as mature worms, most of them females, 26.42% of which contained micofilariae in the uterus. Moreover, 6 microfilaremic cases have been described. The predominant clinical manifestation was the presence of a worm encapsulated within a nodule, but there is a considerable variety of accompanying symptoms depending on anatomical location and type of dirofilariosis. Parasites/nodules were found in 71 different anatomical locations, being the traditional nomenclature of human dirofilariosis unable to properly cover this complex situation. Delay in seeking medical assistance (patient perception) and the frequency of wrong clinical suspicions (doctor knowledge), strongly influenced clinical management. The initial suspicion in cases of subcutaneous and pulmonary dirofilariosis is predominantly a tumour, while in the ocular dirofilariosis a parasite (but not directly Dirofilaria) is mostly suspected. Surgery is usually applied, regardless of the use of non-invasive techniques during preoperative management and although its use is still limited, molecular approach is the most accurate technique to establish a species-level diagnosis. Accurate epidemiological, parasitological and clinical information while handling and reporting human clinical cases is a need for physicians and researchers to improve and standardize the clinical management of human dirofilariosis. This article is protected by copyright. All rights reserved.

Objectives: The efficacy of new direct-acting antivirals (DAAs) in treating hepatitis C infection can depend on treatment adherence, which may be influenced by the patient's current lack of awareness of the disease. This study set out to understand the treatment naïve chronic hepatitis C patients' preferences for new DAAs (attributes) and to compile information about the diagnosis process. Material and method: Spanish quantitative market research study conducted between November 2018 and January 2019 to assess the posology preferences of treatment-naïve patients with chronic hepatitis C before starting treatment (seen by hepatologists and infectious diseases specialists). A telephone interview was carried out to collect demographic, diagnostic and treatment preference data, consisting of two dosing OPTIONS: 1) three tablets/day (single dose), at the same time, with food (8 weeks). 2) single tablet/day, at any time with/without food (12 weeks). A descriptive analysis of pooled results was performed. Results: 104 patients (mean age: 49 years) with hepatitis C diagnosed 7.3±9.7 years ago (average), mainly in primary care (PC) (42%). The most common reasons for not having started treatment were health problems/comorbidities (31%). Fifty-eight percent of patients were not informed about the available treatments. Seventy-two percent of patients preferred a simple tablet/day, at any time, with/without food (12 weeks), and considered compatibility with other treatments, side effects, ease of administration, treatment duration and the number of tablets to be very important. Discussion: Patient preferences are mainly driven by dosing flexibility and simplicity, including freedom to take the medication with/without food. The role of PC in the diagnosis should be taken into account. There are still patients who are untreated after diagnosis.

Introduction The aim of this study was to determine the feasibility of applying the MIPO technique with a helical-shaped plate in the treatment of humeral shaft fractures with proximal extension. Patients and methods We present an observational prospective study of patients with a humeral shaft fracture involving the proximal humerus fixed with a long proximal humerus polyaxial locking plate with an anterior curvature and helical shape (ALPS® Zimmerbiomet, Warsaw, Indianapolis, USA), using a MIPO technique. Between January 2017 and July 2020, 15 patients were treated at our institution. Proximally a 4–5 cm anterolateral transdeltoid approach was made. And distally, a 5–7 cm incision was made 4 cm proximal to the elbow crease. At each follow-up, radiographs were taken to evaluate fracture healing. Funtional scales were applied to evaluate clinical results. Results Ten women and five men were included, with a mean age of 62 yo (range 26–86). All but one fracture healed uneventfully. The mean time to union was 28 weeks (range 12–48 weeks). Two out of 15 patients presented complications (an atrophic nonunion and a peri‑implant distal fracture). None of the patients had a nerve palsy prior neither after the surgery. No other complications, including infection, were registered during follow-up. Shoulder range of motion showed the following means: abduction of 147° (range 50°-180°), anterior flexion of 144° (range 80°-180°), external rotation of 77,5 ° (range 70°-80°) and internal rotation of 54.5° (range 45°-60°). All patients recovered their pre-fracture elbow range of motion. All patients presented less than 10° of angular deviation in varus/valgus or ante/recurvatum after the surgical procedure. At the end of the follow-up, all final functional scores were “good” or “excellent”: mean Constant-Murley score was 72 ± 13 (range 38–91), ASES score was 73 ± 12 (range 41–88), UCLA shoulder scale was 30 ± 3,5 (range 10–35), and Q-DASH score was 16.5 ± 0,11 (range 4–57). Conclusion When applied correctly, the treatment of diaphyseal humeral fractures involving the proximal humerus using a polyaxial locking helical plate with a MIPO technique is a reliable treatment method. It has high union rates with low complications.

As part of its repressive programme, Franco’s regime significantly limited the publication of literature in Catalan, a language that was pejoratively reduced to the category of dialect. In that context, the decision of writing and editing books in Catalan during the military dictatorship (1939‐75) was itself an act of resistance. This article studies a series of testimonial narratives that were published in the late 1960s and early 1970s in Spain about French concentration camps, including Crist de 200.000 braços. Refugiats catalans als camps de concentració francesos (1968), by Agustí Bartra; El desgavell (1969), by Ferran Planes; and Cartes des dels camps de concentració (1972), by Pere Vives i Clavé. Testimonial narratives about French concentration camps already circulated in the countries where Spanish intellectuals were exiled. However, writers such as Bartra, Planes, Vives i Clavé (survivors of Argelès-sur-Mer, Saint-Cyprien and other French concentration camps) and some Catalan editors committed to the Republican cause were interested in telling their traumatic experiences to Spanish and Catalan readers living in Spain. Therefore, they undertook the task of editing these works although in many cases they were strongly censored. Taking this into account, the purpose of this article is to analyse some aspects of these editions in order to consider how their testimonial narratives remain in constant tension between two forces: Republican writers’ intention to show their own version of recent history and the Spanish government’s imposition of its own institutional and conservative official discourse.

Novel anticancer compounds and their precision delivery systems are actively developed to create potent and well‐tolerated anticancer therapeutics. Here, we report the synthesis of a novel anthracycline, Utorubicin (UTO), and its preclinical development as an anticancer payload for nanocarriers. Free UTO was significantly more toxic to cultured tumor cell lines than the clinically used anthracycline, doxorubicin. Nanoformulated UTO, encapsulated in polymeric nanovesicles (polymersomes, PS), reduced the viability of cultured malignant cells and this effect was potentiated by functionalization with a tumor‐penetrating peptide (TPP). Systemic peptide‐guided PS showed preferential accumulation in triple‐negative breast tumor xenografts implanted in mice. At the same systemic UTO dose, the highest UTO accumulation in tumor tissue was seen for the TPP‐targeted PS, followed by nontargeted PS, and free doxorubicin. Our study suggests potential applications for UTO in the treatment of malignant diseases and encourages further preclinical and clinical studies on UTO as a nanocarrier payload for precision cancer therapy., Utorubicin (UTO) is a novel anthracycline with higher anticancer activity than doxorubicin in cultured cancer cells. Nanoencapsulation of UTO in polymeric vesicles functionalized with tumor‐penetrating peptides increases the cytotoxicity of the drug in receptor‐positive cells in vitro and, after systemic administration into mice bearing triple‐negative tumors, potentiates UTO accumulation in malignant tissue.