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Isolated injury to the axillary nerve associated with the patients surgical position is a very rare complication, and in most cases it is associated with the prone during spinal surgery. The presentation of this pathology in relation to surgeries of another nature is exceptional, with only a few cases in the scientific literature. We present the case of a patient who developed symptoms of isolated left axillary nerve palsy after undergoing lipoabdominoplasty and breast reduction, in which the prone and supine positions were alternated. The use of an infiltration solution with lidocaine and epinephrine could have contributed to the appearance of the lesion in this unique case. Finally, the clinical picture was fully resolved thanks to conservative treatment.

Refeeding syndrome is a serious and life-threatening complication associated with oral, enteral and parenteral nutri-tional therapy. It appears in severely malnourished patients or in those at risk of malnutrition, such as persons with cerebral palsy. We present the case of an 8-year-old girl with cerebral palsy who was admitted with severe hypoglycemia. After starting enteral nutrition by nasogastric tube, she developed refeeding syndrome. In children with cerebral palsy, it is essential to assess the presence of risk factors for refeeding syndrome before starting any nutritional support, and then start feeding progressively and monitor serum electrolytes.

The SARS-CoV-2 pandemic is giving rise to a wide range of clinical manifestations, which can affect all organs and systems. Due to the enormous and constantly growing number of infected people, even the rarest complications will be observed in a very high number of patients. Late periprosthetic seroma of the breast has gained importance since the description of Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL), but this entity is not the only cause. Among the causes of non-BIA-ALCL late seroma, we can include those of mechanical origin and those of non-mechanical origin. Within the latter, the common denominator is the triggering of an aberrant immune reaction that generates an inflammatory exudate from the periprosthetic capsule that gives rise to the seroma. We present two cases of late breast seroma as a manifestation of SARS-CoV-2 infection. Level of evidence: Level V, diagnostic study.

Altres ajuts: Huntington's Disease Society of America Female Huntington's disease (HD) patients have consistently shown a faster clinical worsening than male, but the underlying mechanisms responsible for this observation remain unknown. Here, we describe how sex modifies the impact of neurodegeneration on brain atrophy and clinical severity in HD. Cerebrospinal fluid neurofilament light chain (NfL) levels were used as a biological measure of neurodegeneration, and brain atrophy was assessed by structural magnetic resonance imaging. We found that larger NfL values in women reflect higher brain atrophy and clinical severity than in men (p < 0.05 for an interaction model). This differential vulnerability could have important implications in clinical trials.

Background The primary aim of this study was to analyze the survival of patients undergoing lung transplant (LT) with cytomegalovirus (CMV)-positive serologies at the time of transplantation, according to the presence of CMV events and according to the severity of these events. The secondary objective was to assess whether there are differences in the incidence of chronic lung allograft dysfunction (CLAD) according to the presence of these events. Methods This was an observational, single-center, retrospective study. The inclusion criterion for the study was having undergone LT at the Hospital Universitario 12 de Octubre from October 2008 to February 2019. Survival was calculated using the Kaplan-Meier method and compared using the log-rank test. The incidence of CLAD was compared using the χ2 test. Results Inclusion criteria were met by 239 LTs. In terms of survival, no difference was found between patients with and without CMV events (log-rank P = .52), with mean survival of 3223 ± 164 days and 3024 ± 146 days, respectively. Nor did we find a difference when stratifying patients according to no CMV events, infection, syndrome, and disease (log-rank P = .6). There was also no difference in the incidence of CLAD between patients with and without CMV events (P > .178). Conclusion In patients with positive CMV serology, the development of CMV events, including severe disease, does not seem to influence survival. The incidence of CLAD also is not increased by the presence of CMV events.

The treatment and outcomes of diabetic macular oedema (DMO) have improved with the introduction of intravitreal injections. However, real-world data reveal that the burden of DMO treatment causes large gaps in outcomes between randomized clinical trials and daily clinical practice. Long-lasting intravitreal drugs and devices for DMO might reduce this disparity by achieving optimal treatment due to more feasible injection regimens. In this manuscript, we cover pharmacodynamics, preliminary results from clinical trials, and safety behavior about brolucizumab, faricimab, conbercept, KSI-301, and port-delivery system WR42221. These treatments might present the first step to control the global epidemic of diabetic eye disease in real life.

The consumption of medicinal plants has increased in recent decades due to the fact that they biosynthesize compounds with many biological activities; thus, some plant species with biological potential are being utilized as raw material by the industries for preparation of drugs, phytodrugs, or food supplements. This has the consequence of overexploitation and deforestation, which endangers plant species-of-interest. In recent years, alternatives have been sought to eradicate this problem. A solution that was given and is maintained is plant biotechnology, which favors the production of secondary metabolites (SMt) with important biological activity. Plant biotechnology allows us to increase the yield of a compound-of-interest, reduces its production times and costs, and allows constant and controlled production of the raw material, while aiding in the protection of medicinal plants that are found in danger of extinction. In the scientific literature, procuring the SMt by means of biotechnological processes is described, highlighting the study of five species from Mexican traditional medicine (Lopezia racemosa, Galphimia glauca, Cnidoscolus chayamansa, and Buddleja cordata), and the main biological activities are as follows: anti-inflammatory, hepatoprotector, neuroprotector, anxiolytic, antitumoral, antibacterial, and antioxidant, among others. KEY POINTS: • Secondary metabolites produce by biotechnology processes • Active secondary metabolites isolated from Mexican medicinal plants • Recent advances on the production of some bioactive secondary metabolites.

The popularization of 3D-printing has allowed enhancing affordable prostheses for persons with amputations in developing countries, yet manufacturers are not subjected to any control from any medical regulatory authority. Adopted evaluation protocols seem to cherish optimistic expectations. A reduced performance test, derived from the Southampton Hand Assessment Procedure and two bench tests, to evaluate the mechanical advantage in the fingers and the slip resistance, are proposed to assess affordable tendon-driven devices. Ultimately, five models amongst those most commonly found in the scientific literature and the Internet have been evaluated. Three subjects participated with the aid of an able-bodied adaptor. The reduced test of performance provides consistent results but with a more direct interpretation of the failed patterns of prehension. All these models create far more expectations than the results deliver. With the supplementary material provided, an affordable benchmarking can be established with this reduced performance test and the two bench tests. They can lead to improved designs, prescriptions and regulations.

Camera fingerprints based on sensor PhotoResponse Non-Uniformity (PRNU) have gained broad popularity in forensic applications due to their ability to univocally identify the camera that captured a certain image. The fingerprint of a given sensor is extracted through some estimation method that requires a few images known to be taken with such sensor. In this paper, we show that the fingerprints extracted in this way leak a considerable amount of information from those images used in the estimation, thus constituting a potential threat to privacy. We propose to quantify the leakage via two measures: one based on the Mutual Information, and another based on the output of a membership inference test. Experiments with practical fingerprint estimators on a real-world image dataset confirm the validity of our measures and highlight the seriousness of the leakage and the importance of implementing techniques to mitigate it. Some of these techniques are presented and briefly discussed. Agencia Estatal de Investigación | Ref. TEC2016-76409-C2-2-R Xunta de Galicia | Ref. ED431C2017/53

Background Neuropathic pain (NP) after spinal cord injury (SCI) is a disabling condition, without an effective treatment. Hyperexcitability of N-methyl-D-aspartate (NMDA) receptors and oxidative stress have been reported to be associated with pain development. Amantadine, an NMDA receptor antagonist, has been proposed as a potential therapy for NP. However, its use has not been tested for NP after SCI. Methods To produce SCI, 120 female Wistar rats were used, a contusion injury to the T10 and T12 thoracic vertebrae was performed from heights of 6.25 mm and 12.5 mm. Nociceptive behaviour, was evaluated with the use of von Frey filaments for 31 days. The final products of lipid peroxidation (LP) and concentration of reduced glutathione (GSH) in the injured tissue were quantified by fluorescence spectrophotometry. The antinociceptive effect of the acute (15 days after the injury) and chronic (once daily for three days immediately after the injury) with amantadine (6.25-50 mg/Kg. I.p.) was determined. Finally, the LP and GSH were quantified in the injured tissue. Results Acute treatment with amantadine reduced nociceptive behaviour. Concomitantly, LP was decreased by Amantadine treatment while GSH increased in the injured tissue. Similar effects were observed with chronic treatment with amantadine. Conclusions Data from this study suggested that the antinociceptive effects of amantadine treatment are modulated through oxidative stress and excitotoxicity reduction associated with N-methyl-D-aspartate receptors activation. Significance This study suggests that acute treatment with amantadine decreases hypersensitivity threshold and frequency of hypersensitivity response in a dose-dependent manner, in rats with SCI, by decreasing oxidative stress. Since amantadine is an easily accessible drug and has fewer adverse effects than current treatments for hypersensitivity threshold and frequency of hypersensitivity response, amantadine could represent a safe and effective therapy for the treatment of neuropathic pain. However, further research is required to provide evidence of the effectiveness and feasibility.

Previous works that have analysed the efficiency of the management of professional football clubs have not paid much attention to the interaction between the sporting, social and economic dimensions of their activity. To bridge this research gap, a DEA model is developed and applied to determine the relative efficiency of clubs participating in one of the main football leagues while taking into account their multiplicity of objectives. The proposed two-stage relational network DEA model assumes that the financial resources of the clubs are distributed between social and sporting dimensions, contributing to generate results in both areas that, in the second stage, determine the business performance of the clubs. As the actual distributions of the primary inputs are unknown, two complementary approaches are used. First, the model is solved by assuming a parameterization of the distribution. Then, a simulation model is used to study the effect of the different distributions on the efficiency by means of contour charts. A final cluster analysis completes the study. The sample consists of the 20 clubs that played in Spain’s First Division in the 2016–17 season. The evidence shows that the efficiency of the clubs increases when a higher proportion of the primary inputs is allocated to the social dimension. In addition, the clubs are more efficient in converting their sporting and social results into income, than when turning their economic resources into sporting successes and social support. As a result, the model makes it possible to extend efficiency analysis to professional sports organisations which have multiple objectives.

Several accreditation agencies in Latin America introduce their standards and guidance for documentation but they do not explicitly elaborate on the key performance indicators on which higher education institutions can rely for evaluating their activities. The purpose of this research is to analyse the management indicators that higher education institutions in the region have implemented to identify those that have more impact in obtaining an institutional accreditation. A quantitative survey of 114 institutional leaders from 97 universities in 11 countries identified the management indicators. Findings in this research may serve as guidelines for leaders and practitioners to decide which indicators to implement and help institutions in the region to succeed in national and international institutional accreditation processes.

Made available in DSpace on 2022-05-01T09:30:47Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-09-01 Background: DNA damage is accumulated in the cells over time as the result of both exogenous and endogenous factors. The objective of this study was to analyze the immunohistochemical expression of the repair proteins in oral leukoplakia (OL) and oral squamous cell carcinoma (OSCC). Materials and Methods: Paraffin blocks were selected from the archives of the Laboratory of Hospital Clinico Universitario de Santiago de Compostela, Spain. The sample was composed of 16 cases of OL without dysplasia, 14 cases of OL with dysplasia, and 15 cases of OSCC. The patients' clinical data were collected and immunohistochemical analysis was performed for MLH1, MSH2, MRE11, and XRCC1. The data were submitted to the χ2and the Kruskal-Wallis (P≤0.05) tests. Results: MSH2 was overexpressed in OSCC (P=0.020) and was positive in 100% of patients with OL with dysplasia or OSCC (P=0.019). Positivity for MLH1 was significantly associated with comorbidity (P=0.040), especially in patients who presented with 2 or more pathologies (P=0.028). XRCC1 positivity was also associated with comorbidity (P=0.039). No significant associations were found for the MRE11A expression. Although the simultaneous positivity for the 4 markers was observed in presence of comorbidities (P=0.006). Conclusions: This study supports the effect of the overexpression of MSH2 protein in samples of OL with dysplasia and OSCC, most notably in patients who present with comorbidities and negativity for OL without dysplasia. Oral Medicine Unit Technology Research Center (NPT) Mogi das Cruzes University Mogi das Cruzes, 200 Dr. C ndido Xavier de Almeida Souza Avenue Department of Pathology Clinical Hospital Santiago de Compostela Department of Forensic Sciences and Pathology University of Santiago de Compostela Translational Oncology Laboratory Idichus Foundation Santiago de Compostela School of Medicine Anhembi Morumbi University Department of Biosciences and Oral Diagnosis Institute of Science and Technology São Paulo State University (UNESP) Department of Biosciences and Oral Diagnosis Institute of Science and Technology São Paulo State University (UNESP)

Study design Prospective longitudinal experimental study. Objective We evaluate the effect of dapsone on tactile allodynia and mechanical hyperalgesia and to determine its anti-oxidant effect in a spinal cord injury (SC) model in rats. Summary of background data Neuropathic pain (NP) as result of traumatic spinal cord injury is a deleterious medical condition with temporal or permanent time-course. Painful stimuli trigger a cascade of events that activate the N-methyl-D-aspartate (NMDA) receptor, inducing an increase in oxidative stress. Since there is no effective treatment for this condition, dapsone (4,4'diaminodiphenylsulfone) is proposed as potential treatment for NP. Its anti-oxidant, neuroprotective, and anti-inflammatory properties have been documented, however, there is no evidence regarding its use for treatment of NP induced by SCI. Methods In this study, we evaluated the anti-allodynic and anti-hyperalgesic effect of dapsone as preventive or acute treatment after NP was already established. Furthermore, participation of oxidative stress was evaluated by measuring lipid peroxidation (LP) and glutathione concentration (GSH) in rats with SCI. Results Acute treatment with dapsone (3.1-25 mg/kg, i.p.) decreased nociceptive behaviors in a dose-dependent manner, decreased LP, and increased GSH in the injured tissue 15 days after the injury was produced. On the other hand, preventive treatment (3 h post-injury, once daily for 3 days) with dapsone (3.1-25 mg/kg, i.p.) yielded similar results. Conclusion The findings suggest that the anti-nociceptive effect of dapsone is regulated through the decrease of oxidative stress and the excitotoxicity is associated with the activation of NMDA receptors.Level of Evidence: N/A.

The treatment of neovascular AMD (nAMD) has been revolutionized by the introduction of anti-vascular endothelial growth factor (VEGF) agents. Though, there is a tremendous gap between the outcomes in randomized clinical trials and real-world settings, where long-term outcomes are not as good as expected. This is due to undertreatment, i.e., fewer injection and low monitoring frequency. Treatment burden due to frequent injections remains a major limitation. Long-lasting treatments provide promising solutions for this unmet need by achieving better results with less mandatory injections. This review aims to cover the current state in this field and also discuss the mechanism of action, data from pivotal trials, and safety profile of long-acting treatments in present and future, going into details about the following agents: Brolucizumab, Faricimab, Abipicar, and Conbercept.摘要: 抗血管内皮生长因子 (VEGF) 药物的应用使新生血管性AMD (nAMD) 的治疗发生了革命性变化。但随机临床试验的结果与现实世界存在巨大差距, 临床实际的长期疗效远低于预期。这是由于治疗不足所致, 即注射次数较少以及随访频率低。其中频繁注射造成的治疗负担为主要的制约因素。而长效制剂通过减少注射次数以及获得的更好疗效, 为满足临床上述的需求提供了解决方案。本综述旨在阐述该领域的现状, 讨论长期治疗在目前和未来阶段的作用机制、重要临床试验数据和安全性, 并详细介绍以下药物: Brolucizumab、Faricimab、Abipicar和Conbercept。.

Objective The Acute Flaccid Paralysis (AFP) and Enterovirus (EV) Surveillance systems are key to achieving the eradication of poliomyelitis worldwide. Among others, they allow detecting the reintroduction of poliovirus (PV) from endemic areas. Material and methods Analysis of the results of the protocol for the surveillance of AFPs and EVs in 2019 and the standard quality index established by the World Health Organization. Results 38 cases of AFP were reported, -notification rate of 0.55 / 100,000 Conlusions As long as there is circulation of poliovirus in the world, it is necessary to keep the surveillance systems of EV -polio and nonpolio- active, reinforcing the collection and processing of samples to detect the unexpected circulation of these viruses in time.

Resumen La enfermedad de Dieterich o necrosis avascular de la cabeza de los metacarpianos es una enfermedad muy poco frecuente, con poco mas de 50 casos reportados en la literatura. De etiologia desconocida, clinicamente se puede manifestar de forma variable, desde asintomatica hasta con evidente inflamacion y limitacion funcional dolorosa de la articulacion metacarpofalangica afectada. Presentamos el caso de un paciente de 82 anos que presentaba dolor a nivel de la articulacion metacarpofalangica del tercer dedo de la mano derecha, de un ano de evolucion, sin causa aparente. La exploracion fisica no evidenciaba limitacion funcional, ni dolor; tampoco se objetivo eritema, tumefaccion o efecto masa. Se realizo un estudio radiologico con diagnostico de enfermedad de Dieterich avanzada, estableciendo tratamiento conservador con antiinflamatorios no esteroideos con mejoria clinica significativa.

Dieterich´s disease, or avascular necrosis of the metacarpal head, is a very rare disease, with just over 50 cases reported in the literature. Of unknown aetiology, it can manifest clinically in a variable way, from asymptomatic to obvious inflammation and painful functional limitation of the affected metacarpophalangeal joint. The case is presented of an 82-year-old patient who presented with pain at the level of the metacarpophalangeal joint of the third finger of the right hand of 1 year of duration without apparent cause. The physical examination showed no functional limitation or pain. Furthermore, no erythema, swelling, or mass effect was observed. A radiological study was carried out, leading to a diagnosis of advanced Dieterich´s disease. Conservative treatment was started with nonsteroidal anti-inflammatory drugs, with a significant clinical improvement

Background Hemolytic Uremic Syndrome (HUS) is a rare disorder characterized by the triad of microangiopathic hemolytic anemia, thrombocytopenia, and acute renal failure, considered within the group of thrombocytic microangiopathies. Ocular complications in HUS are very rare. Here, we report an adult patient who suffered from acute onset of paracentral scotoma, caused by branch retinal artery occlusion (BRAO), as a leading symptom of atypical HUS. Case presentation A 39-year-old healthy male was lately diagnosed with essential hypertension and mild renal impairment. He complained about acute onset of central scotoma in his left eye. Fundus examination revealed marked narrowing of retinal vessels, cotton wool spots and few retinal hemorrhages in both eyes. The patient was diagnosed with bilateral ischemic retinal vasculopathy and acute macular BRAO in his left eye. Workup revealed thrombocytopenia, worsening renal failure. Renal biopsy showed signs of chronic thrombotic microangiopathy. The patient was diagnosed with atypical HUS (aHUS) and started on plasmapheresis, together with eculizumab. As his condition continued to worsen, he was put on renal replacement therapy. Due to a persistent monoclone of IgG1, the patient underwent bone marrow biopsy which revealed Monoclonal Gammopathy of renal significance, triggering a HUS and treatment was initiated accordingly. Two months after initial presentation, the patient developed neovascularization of the optic disc (NVD) in his left eye, and was treated with 3 monthly intravitreal bevacizumab injections with complete regression of the NVD. The patient suffered from myocardial infarction in the later course and was lost for follow-up. He returned 11 months after the last bevacizumab injection because of sudden loss of vision in his left eye caused by a dense vitreous hemorrhage. Biomicroscopy revealed a new NVD in his right eye. The patient underwent panretinal photocoagulation in both eyes with regression of neovascularization. Vision improved and remained 20/20 in both eyes. Conclusion We present a case report showing retinal ischemia can be linked with aHUS. As clinal diagnosis might be challenging, physicians should be aware of the rare ocular manifestations of this devastating multi-organ disease. In case of retinal ischemia, panretinal photocoagulation should be initiated soon to avoid blinding complications.

An acceptable level of quality in data is nowadays a paramount for any kind of organization or enterprise that wishes its business processes to prosper. Thus, introducing activities focused in the data quality management is a crucial requirement for the analysts if the level of quality of data for the functionality or service at hand is to be ensured. Such specialized data quality management activities should be presented as early as possible during the software development process. So far and having done a search for proposals in this field, there is still a lack of either methodological or technological proposals with which a developer could be able to design data quality aware applications in the specific field of Web application development. Considering the benefits offered in the field of Model Driven Web Engineering, this work presents a partial outcome of our research in this novel field: a metamodel and a UML profile, both able to be used as data quality artefacts during the design stage of Web applications. The main objective is to provide the designer with the tools needed to design Web applications, in order to prevent data quality issues.

BackgroundSurvivors to COVID-19 have described long-term symptoms after acute disease. These signs constitute a heterogeneous group named long COVID or persistent COVID.ObjectiveThe aim of this study is to describe persisting symptoms six months after COVID-19 diagnosis in a prospective cohort in the Northwest SpainDesignThis is a prospective cohort study performed in the COVID-19 Cohort of Galicia Sur Health Institute (COHVID-GS).ParticipantsThis cohort includes patients in clinical follow-up in a health area of 569,534 inhabitants after SARS-CoV-2/COVID-19 diagnosis. Clinical and epidemiological characteristics were collected during the follow up.Main measures and key resultsA total of 284 patients completed 6 months follow-up, 176 (69.4%) required hospitalization and 29 (10.2%) of them needed critical care. At six months, 119 (48.0%) patients described one or more persisting symptoms. The most prevalent were: extra-thoracic symptoms (39.1%), chest symptoms (27%), dyspnoea (20.6%), and fatigue (16.1%). These symptoms were more common in hospitalized patients (52.3% vs 38.2%) and in women (59.0% vs 40.5%). The multivariate analysis identified Chronic Obstructive Pulmonary Disease (COPD), female gender and tobacco consumption as risk factors for long COVID.ConclusionsPersisting symptoms are common after COVID-19 especially in hospitalized patients compared to outpatients (52.3% vs. 38.2%). Based on these findings, special attention and clinical follow-up after acute SARS-CoV-2 infection should be provided for hospitalized patients with previous lung diseases, tobacco consumption, and females.

Azathioprine is a drug widely used to treat patients with inflammatory bowel disease, with not an inconsiderable frequency of adverse events. Among these, myelotoxicity is one of the most serious. For some time, the existence of specific genetic variations of the gene encoding thiopurine-methyltransferase that affect enzymatic activity and produce alterations in thiopurine metabolism that translate into a higher frequency of adverse events in these patients has been known. It has recently been observed that patients carrying certain genetic variations in the nudix hydrolase gene also present a higher rate of adverse events induced by azathioprine, mainly related to leukopenia and alopecia, the latter behaving as an early clinical marker of myelotoxicity. These genetic variants are more common in the Asian population. We present the case of a European patient with azathioprine-induced alopecia and leukopenia whose genetic analysis confirmed that she had one of the genetic alterations associated with the appearance of these adverse events.

Introduction Surgical inferior alveolar nerve (IAN) reposition techniques offer an alternative approach to implant-based rehabilitation in patients with severe mandibular atrophy The aim of this systematic review, was to determine the complications associated with the technique and to determine which of two variants (lateralization or transposition) is less invasive. Materials and methods An electronic search was conducted in databases complimented by a manual search to identify clinical studies investigating complications derived from these surgical techniques. Only studies of adult humans, published in English during the last seven years were included. The initial search located 78 articles, of which seven were included in analysis on the basis of the following characteristics: four investigated inferior alveolar nerve lateralization (IANL), one inferior alveolar nerve transposition (IANT), and two investigated both reposition techniques. Results This review included data from 289 patients who were recruited for lateralization (N = 319) or transposition surgery (N = 33) making a total of 352 reposition procedures. Five patients (1.73%) suffered persistent damage to the IAN at the end of the follow-up periods. The overall implant survival rate was 99.26% of a total of 817 implants. The most common complications were neurosensory problems, mandibular fracture, infection, implant loss, and insufficient anatomical reconstruction of the atrophic mandible; neurosensory complications (hypoesthesia, paraesthesia, and hyperesthesia caused by traumatic damage to the nerve) were the most prevalent. Conclusions Lateralization of the inferior alveolar nerve would appear to be less invasive as it produces lower percentages of persistent neurosensory disorders (1.56%) than transposition (12.12%). Nevertheless, both techniques offer a viable approach to implant placement in edentulous atrophic mandibles, obtaining predictable clinical and radiological results after 5 years implant loading.

Multiple dental impactions not associated with craniofacial syndromes are a rare condition and present the dentist with a therapeutic challenge when it comes to performing surgical/restorative treatments in adult patients. This case report describes a geriatric patient with multiple impacted teeth restored by means of two different protocols. In the second quadrant, an impacted tooth was extracted followed by regeneration and placement of an implant. In the third quadrant, implants were placed though impacted teeth for restoration with a fixed partial prosthesis. Placing dental implants through impacted teeth may offer a possible therapeutic option for implant-supported restorations in middle-aged or elderly patients, for whom surgery and orthodontic traction are not possible, and/or patients who refuse to undergo more invasive extraction surgery.

INTRODUCTION: We present the first registry of patients with congenital bleeding disorders and COVID-19. The study has been carried out in the Community of Madrid, which has the highest number of cases in Spain. The objective is to understand the incidence of COVID-19, the course of the disease if it occurs and the psychosocial and occupational impact on this population. METHODS: We included 345 patients (246 of haemophilia, 69 of von Willebrand Disease, two rare bleeding disorders and 28 carriers of haemophilia). A telephone survey was used to collect the data. RESULTS: Forty-two patients presented symptoms suggestive of infection by COVID-19, and in six cases, the disease was confirmed by RT-PCR. The cumulative incidence of our series was 1.73%. It is worth noting the complexity of the management of COVID-19 in two patients on prophylaxis with non-factor replacement therapy. Adherence to the prescribed treatment was maintained by 95.5% of patients. Although 94% were independent for daily living activities, 42.4% had a recognized disability and 58% required assistance, provided by the Madrid Haemophilia Association (Ashemadrid) in 75% of cases. Only 4.4% of consultations were held in person. CONCLUSIONS: Patients with congenital bleeding disorders infected with SARS-CoV-2 presented a mild course of the disease that did not require admission. Their identification and treatment by a specialist team from a Haemophilia Treatment Center are essential to make a correct assessment of the risk of haemorrhage/thrombosis. COVID-19 had a major impact on the psychosocial aspects of these patients which must be remedied with recovery plans.

The purpose of this study is to identify whether cooperativism in Andalusia is related to the territory in which it takes place. The discovery of a “cooperativism–territory” relationship is of particular interest, given Andalusia's significant territorial diversity and the ability of cooperative societies to adapt to different surroundings. Noteworthy among the results is the greater connection shown by cooperative societies to the area in which they carry out their activities, compared with that seen in the conventional business sector. As such, cooperative societies are strategic entities in terms of responding and adapting to the evolution of certain localized social needs emerging in the region of Andalusia.

Introduction & objectives Liver cirrhosis is a major cause of mortality worldwide. Adequate diagnosis and treatment of decompensating events requires of both medical skills and updated technical resources. The objectives of this study were to search the demographic profile of hospitalized cirrhotic patients in a group of Latin American hospitals and the availability of expertise/facilities for the diagnosis and therapy of decompensation episodes. Methods A cross sectional, multicenter survey of hospitalized cirrhotic patients. Results 377 patients, (62% males; 58 ± 11 years) (BMI > 25, 57%; diabetes 32%) were hospitalized at 65 centers (63 urbans; 57 academically affiliated) in 13 countries on the survey date. Main admission causes were ascites, gastrointestinal bleeding, hepatic encephalopathy and spontaneous bacterial peritonitis/other infections. Most prevalent etiologies were alcohol-related (AR) (40%); non-alcoholic-steatohepatitis (NASH) (23%), hepatitis C virus infection (HCV) (7%) and autoimmune hepatitis (AIH) (6%). The most frequent concurrent etiologies were AR + NASH. Expertise and resources in every analyzed issue were highly available among participating centers, mostly accomplishing valid guidelines. However, availability of these facilities was significantly higher at institutions located in areas with population > 500,000 (n = 45) and in those having a higher complexity level (Gastrointestinal, Liver and Internal Medicine Departments at the same hospital (n = 22). Conclusions The epidemiological etiologic profile in hospitalized, decompensated cirrhotic patients in Latin America is similar to main contemporary emergent agents worldwide. Medical and technical resources are highly available, mostly at great population urban areas and high complexity medical centers. Main diagnostic and therapeutic approaches accomplish current guidelines recommendations.

The coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. COVID-19 affected close to 2 million persons worldwide in fewer than 4 months, after the report of the first cases in China in December 2019. The relation of the disease caused by SARS-Cov-2 to immunosuppressive treatment used in different gastrointestinal disorders is uncertain, resulting in debate with regard to suspending immunosuppressive therapy to improve infection outcome. Said suspension implies the inherent risk for graft rejection or autoimmune disease exacerbation that can potentially worsen the course of the infection. Based on the presently available evidence, a treatment stance has been established for patients with gastrointestinal diseases that require immunosuppressive therapy. Resumen: La enfermedad por coronavirus 2019 (COVID-19) es causada por el virus de Síndrome Respiratorio Agudo Grave - Coronavirus 2 (SARS-CoV-2). COVID 19 afectó cerca de 2 millones de personas en todo el mundo en menos de 4 meses posterior al reporte de los primeros casos en China en diciembre 2019. La relación que guarda la enfermedad por SARS-Cov-2 con el tratamiento inmunosupresor utilizado en diversos trastornos gastrointestinales es incierta, esto genera el debate sobre suspender el tratamiento inmunosupresor para mejorar el pronóstico de la infección, lo cual incluye el riesgo inherente de rechazo de injerto o agudización de enfermedades autoinmunes que potencialmente pudieran agravar el curso de la infección. En base a la evidencia disponible se logra establecer una postura de tratamiento en pacientes con enfermedades gastrointestinales que requieren terapia inmunosupresora.

Introduction: After the World Health Organization declared the COVID-19 outbreak a pandemic, the number of patients with confirmed SARS-CoV-2 infection (COVID-19) has increased exponentially, and gastroenterologists and other specialists most likely will be involved in the care of those patients. Aim: To evaluate the knowledge Latin American gastroenterologists and endoscopists (staff physicians and residents) have about the characteristics of COVID-19, as well as the prevention measures to be taken during endoscopic procedures. Materials and methods: We conducted a cross-sectional study that included gastroenterologists and endoscopists from 9 Latin American countries. An electronic questionnaire was applied that was designed to evaluate the knowledge of symptoms, risk groups for severe disease, prevention measures, and the reprocessing of endoscopes utilized in patients with COVID-19. Results: Information was obtained from 133 physicians. Ninety-five percent of them correctly identified the most frequent symptoms of the virus, and 60% identified the 3 risk groups for severe disease. Sixty-six percent of those surveyed did not consider it necessary to use standard precautions during endoscopic procedures, and 30% did not consider contact precautions necessary. Forty-eight percent of the participants surveyed were not familiar with the protocol for reprocessing the endoscopes utilized in patients with COVID-19. Conclusion: The majority of the gastroenterologists and endoscopists surveyed were familiar with the signs and symptoms of COVID-19 and the populations at risk for complications. There was a lack of knowledge about prevention measures (during clinical care and endoscopic procedures) and the reprocessing of endoscopic equipment by 70% and 48%, respectively, of those surveyed. Dissemination and teaching strategies that increase the knowledge of specific biosafety measures must be carried out. Resumen: Introducción: Después de que la Organización Mundial de la Salud (OMS) declaró a la enfermedad por SARS-CoV-2 (COVID-19) pandemia, el número de pacientes con infección confirmada ha incrementado exponencialmente. Es muy probable que gastroenterólogos y otros especialistas se involucren en la atención de estos pacientes. Objetivo: Evaluar el conocimiento de gastroenterólogos y endoscopistas (adscritos y residentes) en Latinoamérica sobre las características de COVID-19 y las medidas de prevención durante procedimientos endoscópicos. Material y métodos: Realizamos un estudio transversal que incluyó a gastroenterólogos y endoscopistas de nueve países de Latinoamérica. Se aplicó un cuestionario electrónico diseñado para valorar conocimientos sobre síntomas, grupos de riesgo para enfermedad grave, medidas de prevención y reprocesamiento de endoscopios utilizados en pacientes con COVID-19. Resultados: Se obtuvo información de 133 médicos, 95% de los encuestados identificó correctamente los síntomas más frecuentes y 60% identificó los tres grupos de riesgo para enfermedad grave. El 66% no consideró necesario usar precauciones estándar durante procedimientos endoscópicos y 30% no consideró necesarias las precauciones de contacto. El 48% desconoció el protocolo para reprocesamiento de los endoscopios en pacientes con COVID-19. Conclusión: Los signos y síntomas de COVID-19 y las poblaciones de riesgo de complicaciones son conocidos por la mayoría de los gastroenterólogos y endoscopistas. El conocimiento sobre medidas de prevención (durante atención clínica y procedimientos endoscópicos), así como el reprocesamiento del equipo endoscópico son desconocidos por 70 y 48% de los encuestados respectivamente. Se deben realizar estrategias de difusión y enseñanza que incrementen el conocimiento sobre estos aspectos de bioseguridad.

Irreversible electroporation (IRE) is a non-thermic ablation therapy which has been proposed for locally advanced pancreatic adenocarcinoma (LAPC) as well as for the local control of other types of tumors (kidney or liver). Its use has been extended in the last few years worldwide. Its advantage over other ablation techniques is that it only affects the lipids bilayer of the cell membrane avoiding vascular damage. Safety and viability have been demonstrated in recent studies. Overall survival seems (OS) to improve when it is combined with chemotherapy compared to chemotherapy with or without radiotherapy. Clinical trials should confirm these encouraging data.

INTRODUCTION: The incidence of thyroid papillary cancer (PTC) has increased from 1975 to 2015. Ultrasound is effective for predicting thyroid malignancy based on published criteria. All of these criteria focus on thyroid nodules but also 2% of the cases may appear as diffuse punctuate echogenic foci without an identifiable nodule. CASE: A 17-year-old female with a 3-month history of a palpable mass on the right anterior side of the neck without any further symptoms. Neck ultrasound revealed multiple punctuate echogenic foci scattered along the thyroid parenchyma with a 6 mm nodule TI-RADS 5 on the left lobe, lymph nodes with cystic and solid components, loss of echogenic hilum and punctuate echogenic foci. The patient underwent a total thyroidectomy with bilateral lymphadenectomy. The pathology report revealed diffuse distribution of papillary cancer with a nodule on the left lobe and metastatic disease on the lymph nodes. DISCUSSION: Microcalcifications are highly suggestive of PTC. Punctuate echogenic foci correlate in pathology with a form of dystrophic calcifications, called Psammoma bodies, which are deposited in nonviable tissue. Chronic thyroiditis may also present dystrophic calcifications. Thus, a normal thyroid parenchyma with microcalcifications should encourage the radiologist perform a fine-needle aspiration biopsy (FNAB). Recent studies suggest that lobectomy is a viable option and should be pursued in the setting of localized PTC (

Non-static scenes represent one of the main barriers for retrieving the electrical network frequency (ENF) from digital videos recorded in realistic scenarios, since movement influences the luminance of pixels, hindering the recovery of the desired information. Aiming to mitigate the effects of changes in the scene, in this letter a video processing stage, that detects and combines those pixels that are not affected by movement, is proposed. The sequence obtained thereby is delivered to a PLL-based FM demodulator, that estimates the ENF taking into account its autoregressive nature. Additionally, a frame rate estimation algorithm is employed to avoid time-consuming trial and error loops in the extraction process. The performance of the system is tested by computing the probability of estimating correctly the time of recording of a given video, using ground-truth sequences obtained directly from the mains or a reliable database.

Correct food labelling is primordial for consumers to receive truthful information and help them with their purchasing decisions. This renders the need to adapt each label to fulfil the demands of the new regulations in force. Artisanal cheese with no Designation of Origin has traditionally presented defects that affect its commercialization from incomplete or misleading information on labels. As the Strengths, Weaknesses, Opportunities and Threats analysis in this sector has revealed the need to update labelling to adapt to legal changes, this study evidences non-compliances to be corrected and proposes correct generic design labels for several commercialized cheese types with no Protected Designation of Origin on the European market. The information on 76 artisanal cheese labels from several types with neither Designation of Origin nor containers, produced by different cheese makers in Gran Canaria Island (Spain), was analyzed. Most deficiencies that didn’t meet current legislation involved: origin (100%); quantity of ingredients (89.5%); conservation (86.84%); denomination (79%); ingredients (67.10%); marked identification (61.8%); marked dates (58%); milk processing (27%); batch (20%); net quantity (16%). A label model is proposed that covers and meets everything legally set out, favours competitiveness in making artisanal products, and allows their controlled commercialization throughout the European Union.

Travel time reliability is one of the most important assets when it comes to designing and assessing freight fluidity of transportation systems. Guaranteeing reliable delivery times is, according to different international studies, a strategic competitive advantage. Nonetheless, emerging countries such as Mexico, do not currently count with specific indicators to measure travel time reliability from a freight fluidity approach. As such, there is no clear measurement of the impact and propagation of the variability of transit times throughout the supply chains. Since road transportation is the main mean of transportation in emerging countries, the aim of this paper is to present the analysis carried out to measure the travel time reliability thanks to different methodologies based on freight data collection using GPS (Global Positioning System), as a key element to assess freight fluidity in freight transportation corridors. The analysis measured items such as: (i) percentiles of travel time; (ii) planning time index; (iii) buffer time index; (iv) skew and range of travel. Different probability distributions were analysed and the distribution of travel time data was determined through statistical hypothesis test. The conclusion was that distributions with upper tails longer than usual fit better to the collected data. Evidences of mixture distributions in the travel time data were also found. Finally, the paper also presents useful conclusions to develop future research as well as to improve practices for decision makers.

The aim of this work is to describe our Image-Guided Radiation Therapy (IGRT) protocol for lung Stereotactic Body Radiation Therapy (SBRT) together with the evaluation of the results from applying this protocol over a sample of 47 patients analyzed retrospectively. Simulation time-resolved four-dimensional CT (4DCT) images are acquired taking into account the respiratory cycle of the patient. During the treatment, using VMAT technique, pre- and post- treatment Cone Beam Computer Tomography (CBCT), as well as intrafraction fluoroscopy whenever possible due to lesion position visualization, are performed to verify tumor amplitude motion and position. Fluoroscopy image was acquired in 72% of patients analyzed, from which 71% verified the right position against 29% who needed to be reposition by using intrafraction CBCT at least in one fraction. Post-treatment CBCT systematic and random errors are below 1 mm, thereby protocol validation is accepted. Fluoroscopy manages to verify tumor position accuracy depending on high contrast visualization. However, in comparison to intrafraction CBCT, it involves reducing treatment duration and minimizing dose to patient. Fluoroscopy, in conjunction with CBCT, allows monitoring motion during the treatment.

Purpose To determine the differences in short- and long-term mortality in elderly septic patients with multiorgan dysfunction syndrome and establish the factors related to non-survival. Materials and methods A retrospective cohort study was made of 206 patients over 65 years of age with septic and septic shock criteria admitted to the ICU of Rio Hortega Hospital between January 2011 and February 2017. Study variables were obtained from electronic database records. Results A total of 206 patients were included, divided into three groups of age (65–74, 75–85, >85 years). There were no significant differences in mortality according to age group after 28 days, 90 days or one year (28.6%, 32.1% and 45.2% in the 65–74 years age group; 32.5%, 38.6% and 45.8% in the 75–85 years age group, 41%, 48.7% and 56.4% in the >85 years age group). The factors related to mortality were: chronic heart failure, non-haematological cancer, liver dysfunction and central nervous system dysfunction. Conclusions The results indicate that there is no significant difference in mortality among the different age groups. About 50% of the elderly patients survive a septic process. There is a close relationship between the number of affected organs and days of dysfunction, the use of interventional techniques and long-term mortality.

Purpose The purpose of this paper is to expand current knowledge about the security organizational practices and analyze its effects on the information security management performance. Design/methodology/approach Based on the literature review, the authors propose a research model together with hypotheses. The survey questionnaires were developed to collect data, which then validated the measurement model. The authors collected 111 responses from CEOs at manufacturing small- and medium-sized enterprises (SMEs) that had already implemented security policies. The hypothesized relationships were tested using the structural equation model approach with EQS 6.1 software. Findings Results validate that information security knowledge sharing, information security education and information security visibility, as well as security organizational practices, have a positive effect on the information security management performance. Research limitations/implications The consideration of organizational aspects of information security should be taken into account by academics, practitioners and policymakers in SMEs. Besides, the work helps validate novel constructs used in recent research (information security knowledge sharing and information security visibility). Practical implications The authors extend previous works by analyzing how security organizational practices affect the performance of information security. The results suggest that an improved performance of information security in the industrial SMEs requires innovative practices to foster knowledge sharing among employees. Originality/value The literature recognizes the need to develop empirical research on information security focused on SMEs. Besides the need to identify organizational practices that improve information security, this paper empirically investigates SMEs’ organizational practices in the security of information and analyzes its effects on the performance of information security.

Background Gastrointestinal complications after lung transplatation are associated with an increased risk of morbidity and mortality. This study aims to describe severe gastrointestinal complications (SGC) after lung transplantation. Methods We performed a prospective, observational study that included 136 lung transplant patients during a seven year period in a tertiary care universitary hospital. SGC were defined as any diagnosis related to the gastrointestinal or biliary tract leading to lower survival rates or an invasive therapeutic procedure. Early and late complications were defined as those occurring p Results There were 17 (12.5%) SGC in 17 patients. Five were defined as early. Twelve patients (70.6%) required surgical treatment. Mortality was 52.9% (n = 9). Patients with SGC had a lower overall survival rate compared to those who did not (14 vs 28 months, p = 0.0099). The development of arrhythmias in the first 48 h of transplantation was a risk factor for gastrointestinal complications (p = 0.0326). Conclusions SGC are common after lung transplantation and are associated with a considerable increase in morbidity-mortality. Early recognition is necessary to avoid delays in treatment, since a clear predictor has not been found in order to forecast this relevant comorbidity.

The aim of this chapter is to look more closely at the impact that the crisis generated by the SARS-CoV-2 is having on health, the economy and education in the field of dentistry. The considerations that must be taken into account in dental practice will be presented, as well as the usefulness that the use of teledentistry (TD) could have in times of pandemic, reflecting on the different specialties of dentistry that can benefit from this modality, as well as the advantages and disadvantages that its use can present. Likewise, teaching has been condemned to a lack of presence, having to resort to distance learning, both synchronous and non-synchronous, which can cause needs and deficiencies in undergraduate and postgraduate students. We will analyse the health risks in the dental field and the changes and needs for safe dentistry in times of pandemic. We will also break down the effect of the crisis on the medical-dental sector and the economy, from the point of view of patients and professionals, especially in times of increased restriction and confinement worldwide.

This study was carried out in the Navachiste coastal lagoon, Mexico, surrounded by intensive agricultural and aquaculture activities that cause environmental pollution by the deposition of trace metal residues in the sediments of this coastal lagoon. The trace metals are bioaccumulated by benthic organisms such as the blue swimming warrior crab, Callinectes bellicosus, which inhabits this lagoon and is consumed by humans. Ninety-five C. bellicosus edible tissue samples were collected (April 2014–January 2015). The extraction procedure of the trace metals in edible tissue samples was carried out by acid digestion with nitric acid. Based on the Environmental Protection Agency (EPA) of the United States, two indices were used to measure health risk: the estimated daily intake (EDI) and the target hazard quotient (THQ). The hazard index (HI) was used to calculate the probability of adverse carcinogenic risk and the target hazard quotient per sample (MHI) to calculate the probability of developing a carcinogenic or non-carcinogenic risk. The analysis of variance (ANOVA) showed significant differences among trace metal concentrations (p < 0.01), but all trace metal concentrations in the edible tissues of C. bellicosus were higher than the maximum residual limits (MRLs). The highest EDI was for Zn, Fe, and Cu, showing that the consumption of these crabs might represent health risks. The THQ >1 was for Ni, Zn, Cd, and Cu, and the HI = 16 revealed the risk of C. bellicosus for high-level consumers. The MHI showed that 98% of samples presented a THQ >1, implying a high rate of bioaccumulation of trace metals by the crabs independent of the sampling site in the NAV. The presence of trace metals in the edible tissue of crabs reflects contamination by trace metals, and the indices results mean that the NAV lagoon is constantly polluted with trace metal residues by neighboring agriculture and aquaculture activities. These trace metal residues are being bioaccumulated in the edible tissues of C. bellicosus due to its feeding habits, resulting in a health risk if its consumption is high, including carcinogenic and non-carcinogenic risks.

The aim of the study is to research the effects of individual evaluation of fake and truthful news about COVID-19, compared to the exposure to fact-checking on the intention to share them via WhatsApp. An online experiment was conducted with a convenience sample of 819 Costa Ricans. Results show that people in the individual evaluation condition assess completely fake news with greater veracity and completely truthful information with less veracity, compared to the fact-checking condition. This response is more pronounced in the most religious people and among those most affected by structural inequalities in Costa Rican society (e.g., lower educational level, living on the coasts and lower subjective income). Finally, both the individual evaluation of disinformation content and exposure to fact-checking reduce the intention to share fake news about COVID-19 via WhatsApp. Universidad de Costa Rica/[835-C0-451]/UCR/Costa Rica UCR::Vicerrectoría de Investigación::Unidades de Investigación::Ciencias Sociales::Centro de Investigación en Comunicación (CICOM) UCR::Vicerrectoría de Investigación::Unidades de Investigación::Ciencias Sociales::Instituto de Investigaciones Psicológicas (IIP)

Medicinal plants are being utilized as raw material and the use has increased in recent decades due that these biosynthesize compounds with several pharmacological activities. Some plant species with biological potential are of interest to the industry for preparation of drugs, phytodrugs, or food supplements. This causes overexploitation and deforestation, which endangers plant species-of-interest. In recent years, alternatives have been sought to eradicate this problem. A solution that was give and is maintained is plant biotechnology, which favors the production of active Secondary Metabolites (SMt). Plant biotechnology allows us to increase the yield of a compound-of-interest, reduces its production times and costs, and allows constant and controlled production of the raw material, and while aiding in the protection of medicinal plants that are found in danger of extinction. In the scientific literature, procuring the SMt by means of biotechnological processes is described, highlighting the study of four species from Mexican traditional medicine (Lopezia racemosa, Galphimia glauca, Cnidoscolus chayamansa, Sphaeralceae angustifolia and Buddleja cordata), and the main biological activities are as follows: anti-inflammatory, hepatoprotector, neuroprotector, anxiolytic, antitumoral, antibacterial, and antioxidant, among others.

Helicobacter pylori (H. pylori) infection is associated with various gastrointestinal diseases and is the dominant microorganism in gastric microbiota. There are multiple therapeutic combinations used with uneven results for eradication. Studies have been carried out with some strains of Lactobacillus (L) that support its preponderant role in the treatment of infection and reduction of inflammation.

Pancreatic necrosis infection (PNI) accounts for about 20–40 % of severe acute pancreatitis. PNI caused by anaerobic bacteria is unusual but when they present,Clostridium perfringensis the microorganism most commonly involved. We present a 60-year-old patient with a previous history of SARS-CoV-2, diagnosed with acute pancreatitis. During the hospitalisation he developedClostridium perfringensbacteraemia. A CT-scan showed pancreatic gas gangrene and a surgical necrosectomy was performed.Clostridium perfringenswas isolated in cultures of the pancreatic tissue and collections. The patient’s clinical status improved after surgery and the appropriate medical therapy. He was discharged 76 days after admission. Nowadays, the ‘step-up approach’ is an accepted therapeutic tool in treatment of pancreatic necrosis and peripancreatic fluid collections. However, most authors suggest thatClostridum perfringensinfection requires a more aggressive approach due to the high mortality associated to clostridial infection.