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Background and objective This study aims to describe the characteristics of patients with COVID-19 in a state in northern Mexico and establish the comorbidities associated with mortality. Methods Patients with COVID-19, divided into survivors and non-survivors, were analyzed. The data were analyzed using the chi-square test, Student’s t-test, and Cox’s regression model. Results A total of 17,479 patients were included and mortality rate of 6.3% was reported. Age over 60 years (HR = 8.04; 95%CI 7.03–9.19), diabetes (HR = 1.63; 95%CI 1.40–1.89), high blood pressure (HR = 1.48; 95%CI 1.28–1.72), obesity (HR = 1.37; 95%CI 1.18–1.60) and chronic kidney disease (HR = 2.06; 95%CI 1.64–2.59) were significantly associated with mortality. Conclusions Diabetes, high blood pressure, obesity, and chronic kidney disease increased mortality among patients with COVID-19 in the population of Coahuila, Mexico. The factor that most contributed to risk of death was age over 60 years.

Aortic pathology is always a challenge for the clinician, and must be diagnosed and treated by a multidisciplinary team due to the technical and technological complexity of the resources used. Ongoing efforts to implement a systematic, protocolized approach involving "Aortic teams" made up of cardiologists, cardiac surgeons, vascular surgeons, anaesthesiologists and radiologists, among others are now leading to improved outcomes. The aim of this consensus document drawn up by the Aortic working groups of the Spanish Society of Anaesthesiology, Resuscitation and Pain Therapy (SEDAR) and the Spanish Society of Thoracic and Cardiovascular Surgery (SECTCV) is to disseminate a set of working protocols. The latest consensus document of the European Association for Cardio-Thoracic Surgery (EACTS) and the European Society for Vascular Surgery (ESVS) define the concept of "AORTIC TEAM"(1). The aortic team should be closely involved from diagnosis to treatment and finally follow-up, and should be formed of cardiac and vascular surgeons working together with anaesthesiologists, cardiologists, radiologists and geneticists. Treatment of aortic pathologies should be centralised in large centres, because this is the only way to effectively understand the natural course of the disease, provide the entire range of treatment options under one umbrella and treat potential complications. A streamlined emergent care pathway (24/7 availability), adequate transportation and transfer capabilities, as well as rapid activation of the multidisciplinary team must be available. In light of the complexity and constant evolution of therapeutic options, we present this first version of the Anaesthesiology and surgical guidelines for surgery of the ascending aorta and aortic arch. Some questions will no doubt remain unanswered, and future versions will include new techniques that, though implemented in some centres, are still not widely recommended.

This work shows a detailed study of the synthesis, structural characterization, electrical, thermal, and mechanical luminescent behavior of one-dimensional coordination polymer formed by a Cu(I)-I double chain, using 2-amino-4 chloropyrimidine as ligand. The asymmetric structure of double chain type [Cu(L)I]n, (L= 2-amino-4-chloropyrimidine (aCLpym)) with Cu-Cu distances shorter than the sum of the van der Waals radii of two copper atoms, and the substantial flexibility of this structure are crucial to understanding its optoelectronic behavior. The electrical conductivity values at 295 K are in agreement with a possible semiconductor behavior. Additionally, the luminescence properties of this coordination polymer (CP) are characterized at ambient conditions (ambient pressure (AP) and 295 K) by a non-symmetric High Energy (HE) band centered at 465 nm, tentatively assigned to a mixed 3(I+M)LCT. The intensity of the emission increase lowering the temperature. A structural contraction can explain this behaviour, clearly observed when solving the structures employing single-crystal X-ray diffraction of the compound at 296 K and 110 K. A strong mechanochromic behavior was observed when hydrostatic pressure is applied, with the appearance of an additional Low Energy (LE) band around 650 nm, which for this kind of CuI CPs is typically associated with transitions in the CuI cluster-core, involving 3IMCT and clustered centered 3d10→3d94s1 (3MCC) states. This latter because of the shortening with the pressure of the Cu-Cu distances below the Van der Waals limit. Moreover, the study of the mechanochromic behavior versus pressure exerted by grinding shows a decrease in the intensity of the emission due to the increase in the number of defects and decrease in the particle size

Aging induces changes in bone. Growth hormone (GH) is reduced by aging, and age-related changes observed in old bones might be due to a decrease in the GH/insulin-like growth factor-I (IGF-I) axis. GH administration on aged individuals is controversial. This study aimed to assess the effect of systemic GH treatment on bone properties, bone metabolism, and bone mineral density (BMD) in long bone of old rats. Aged Wistar rats were treated with GH at a dose of 2 mg/kg/day during 10 weeks. Plasma osteocalcin, IGF-I, and carboxy-terminal telopeptide of type I collagen levels were measured. Cross-sectional bone areas and BMD were measured by morphometric and densitometric analysis, respectively. Femora were analyzed by three point-bending testing. t-Test was used for statistical evaluation. p < 0.05 was considered to be significant. Significantly enhanced bone area, at the expense of the cortical area, was found in treated rats. The densitometric analysis showed 11% higher BMD in the experimental group. Significantly higher bone flexural modulus, stiffness, and ultimate load were observed in the treated rats. Plasma osteocalcin and IGF-I levels were significantly increased in the treated group, while the resorption marker concentration remained unchanged. Within the limitations of this experimental study, systemic GH administration has shown to enhance biomechanical properties, BMD, cortical mass, and plasma IGF-I and osteocalcin in old treated rats, compared to the control group; consequently, GH could be considered as an alternative therapy against age-related changes in the bone.

The approval of istradefylline, an adenosine 2A receptor (A2AR) antagonist, as an addon treatment in adult patients with Parkinson’s disease by the Food and Drug Administration (FDA) and European Medicines Agency (EMA), is the latest proof of the importance of the adenosinergic system in the nervous system. Adenosine is an endogenous purine nucleoside with a role as a modulator of both neurotransmission and the inflammatory response. As such, the expression pattern of the 4 adenosine receptors (A1R, A2AR, A2BR and A3R) and the extracellular adenosine levels have attracted great interest in the pathogenesis and possible treatment of rare neurodegenerative diseases with motor symptoms. These include Huntington’s Disease (HD), Amyotrophic Lateral Sclerosis (ALS), Multiple Sclerosis (MS), Restless Legs Syndrome (RLS) and Machado-Joseph Disease (MJD, also known as spinocerebellar ataxia type 3, SCA3). In this review, we shall focus on the role of the different adenosine receptor subtypes in the development and possible treatment of the aforementioned rare neurodegenerative diseases with motor symptoms using the currently available data. The last section discusses the possibility of a role for the adenosine receptors in the treatment of other rare diseases based on the available molecular pathology knowledge.

Children with severe motor impairment due to cerebral palsy have difficulties engaging in play, although they want to play games that typically developing children play. The barriers imposed by motor impairments against engaging in play can be addressed through the use of robots. We aim to identify how children, who have extensive experience of play, imagine what a robot is and what features would make a robot good to play with. Using a qualitative description design, 19 children from urban and rural settings participated in focus groups to draw and talk about the robots they would like to exist. The data were coded and analyzed using a summative approach to content analysis. The findings revealed that the children imagined that a good robot to play with is one that has an anthropomorphic appearance, is tough and strong, has controls, and that is able to move, grab, speak, and play popular children’s games. In particular, the girls imagined that robots should be able to express positive emotions towards children. Age, gender, culture, and the physical environment in which the children lived influenced what they expected to find in a robot for playing with and how they imagined child–robot interactions.

Background: Reading comprehension is a complex process influenced by many factors. However, the abilities that are known to influence reading comprehension may not contribute equally for children with different levels of oral language. Aims: Here we examined the relationship of two factors known to influence reading comprehension (morphology and syntax) in a group of children who varied in their levels of oral vocabulary. Method: Two hundred seventy-three typically developing Spanish-speaking fourth graders were assessed on non-verbal intelligence, word and pseudoword reading, oral vocabulary, morphological awareness and syntax, along with reading comprehension ability. Standardised oral language scores within this group ranged from the first to the 99th percentile. Mediated multiple regression with moderation was used to assess (1) whether the influence of oral vocabulary on reading comprehension was mediated by decoding, morphology or syntax and (2) whether the effects of syntax on reading comprehension varied as a function of oral vocabulary levels. Results: There was a direct positive relationship between vocabulary and reading comprehension, and this was mediated by word reading and syntax, but not by pseudoword reading or morphology. Furthermore, the relation between syntax and reading comprehension was moderated by oral vocabulary such that the strength of this relationship diminished as oral vocabulary levels increased. Conclusions: These findings suggest that longitudinal research is necessary to explore the possibility that a syntax intervention might be beneficial for readers with low oral vocabulary. FEDER 2014-2020 Consejería de Economía, Conocimiento, Empresas y Universidad US-1264792

The pathology of the aorta is a challenge for medicine. Diagnostic and therapeutics move a huge volume of variables. This has let this pathology to be addressed by a big number of specialists. The surgical management of these pathologies implies an extraordinary effort on the part of many professionals, given the technical and technological complexity employed. Throughout these years, these efforts are paying off in the form of improved results, thanks to a systematic and protocolized approach within a group of experts (Aortic Committees or "Aortic team") in which they have to involve cardiologists, cardiac surgeons, vascular surgeons, anesthesiologists and radiologists, mainly. In this document, agreed between the Aorta working groups of the Spanish societies of Anesthesiology and Thoracic-Cardiovascular Surgery, it is sought to disseminate the most agreed working modes among the centers of greatest activity in the country by both specialties, as far as surgical treatment is concerned in descending chronical aortic pathology. We are aware of the constant evolution of therapeutics, which can undoubtedly make some of the opinions expressed here questionable and that will undoubtedly be modified in future editions. This document aims to be a working tool for the different professionals involved in the treatment of aorticpathology.

Friedreichs Ataxia is an autosomal recessive genetic disease causing the defective gene product, frataxin. A body of literature has been focused on the attempts to counteract frataxin deficiency and the consequent iron imbalance, in order to mitigate the disease-associated prooxidant state and clinical course. The present mini review is aimed at evaluating the basic and clinical reports on the roles and the use of a set of iron chelators, antioxidants and some cofactors involved in the key mitochondrial functions. Extensive literature has focused on the protective roles of iron chelators, coenzyme Q10 and analogs, and vitamin E, altogether with varying outcomes in clinical studies. Other studies have suggested mitoprotective roles for other mitochondrial cofactors, involved in Krebs cycle, such as alpha-lipoic acid and carnitine, involved in acyl transport across the mitochondrial membrane. A body of evidence points to the strong antioxidant properties of these cofactors, and to their potential contribution in mitoprotective strategies in Friedreich's Ataxia clinical evolution. Thus, we suggest the rationale for planning combination strategies based on the three mitochondrial cofactors and of some antioxidants and iron binders as mitoprotective cocktails in FRDA patients, calling attention to clinical practitioners of the importance to implement clinical trials. Copyright © 2020. Published by Elsevier Inc.

El trabajo que presentamos se deriva de una investigación sobre inclusión escolar, sus implicaciones para la educación, indicadores de calidad y la necesidad de orientar la formación del profesorado hacia la educación inclusiva. El objetivo de la investigación es analizar las creencias y necesidades formativas que tiene el personal docente sobre la educación inclusiva, y así considerar algunos indicadores de calidad para su formación. La investigación se realiza en todos los niveles del sistema educativo español exceptuando el nivel universitario, concretamente en educación infantil, primaria, secundaria, bachillerato y módulos formativos. La metodología se apoya en el uso de un cuestionario de pregunta abierta que ha sido utilizado mediante la técnica de la entrevista, se realizaron 16 entrevistas, una por participante, exceptuando al director y jefe de estudios que realizaron una como miembros de equipo directivo. El estudio se inscribe en un enfoque cualitativo de investigación. El análisis de datos, la discusión de resultados y las conclusiones obtenidas nos permiten realizar una propuesta de indicadores de calidad para orientar la formación del profesorado. Los indicadores más relevantes están vinculados a la necesidad de promover un modelo educativo inclusivo, en el que los centros educativos desarrollen proyectos institucionales inclusivos y la formación del profesorado esté orientada a la inclusión educativa, a través de programas formativos basados en prácticas educativas comprometidas con la inclusión, que recojan el estudio de necesidades educativas y estén centrados en los principios de comprensión, democracia y participación.

The current article contains compilation of significant contributions done by theorists over the years about the phenomenon of perinatal loss. The objective of this paper is to provide information about important emotional and psychological consequences on parents who suffer stillbirth. This article addresses identity issues of the mother, father, and their relationship as a couple. It also provides information on the psychological, emotional, and legal aftermath of healthcare professionals who assist during the process of loss.

[EN] In neurosciences, imaging techniques are used to diagnose diseases and assist in surgical interventions to determine the exact location and size of a tumor. International research has used different techniques for the fusion of Positron Emission Tomography and Computed Tomography because it allows us to observe metabolic functions in correlation with anatomical structures. From the study of these techniques and algorithms a software was developed that performs the fusion of neuroimaging, using the fusion scheme based on Wavelet. Bicubic interpolation was used to correct the images. As a discrete Wavelet transform, Haar's was used. An evaluation of the quality of the resulting images was performed, obtaining 512 × 512 × 24 bit resolution images and a signal-to-noise ratio with values greater than 18. It was verified by histograms that the merged image contains more information than the input images independent., [ES] En neurociencias se utilizan técnicas imagenológicas para el diagnóstico de enfermedades y la asistencia en intervenciones quirúrgicas para determinar la ubicación y dimensión exactas de un tumor. Investigaciones a nivel internacional han utilizado diferentes técnicas para la fusión de la Tomografía por Emisión de Positrones y la Tomografía Computarizada debido a que permite observar las funciones metabólicas en correlación con las estructuras anatómicas. A partir del estudio de estas técnicas y algoritmos se desarrolló un software que realiza la fusión de neuroimágenes, utilizando el esquema de fusión basado en Wavelet. Para el corregistro de las imágenes se utilizó la interpolación Bicúbica. Como transformada discreta de Wavelet se utilizó la de Haar. Se realizó una evaluación de la calidad de las imágenes resultantes, obteniendo imágenes de resolución 512 × 512 × 24 bits y una relación señal-ruido con valores superiores a 18. Se comprobó mediante histogramas que la imagen fusionada contiene más información que las imágenes de entrada independientes., Este trabajo ha sido realizado parcialmente gracias al apoyo del Centro de Informática Médica de la Universidad de las Ciencias Informáticas de la Habana y el Centro de Neurociencias de Cuba CNEURO, por el apoyo logístico y asesoría especializada en temas de Neuroinformática.

Pseudoxanthoma elasticum (PXE) is a rare genetic disorder characterised by elastic tissue alterations and caused by mutations in a single gene, ABCC6, on chromosome 16p that includes manifestations that are predominantly cutaneous, ocular and cardiovascular. PXE-like lesions in association with β-thalassemia have previously been reported in the literature in patients with β-thalassaemia intermediate and major, being clinically indistinguishable from classic PXE. The case is presented of a 10-year-old boy with β-thalassaemia minor and characteristic lesions of PXE. It is worth noting the benefit of multimodal imaging in the diagnosis and monitoring of the lesions.

Aim To determine in the adult population the crude and the sex- and age-adjusted prevalence rates of hypertriglyceridaemia (HTG) and to assess its association with cardiovascular risk factors, chronic kidney disease, cardiovascular and cardiometabolic diseases. Methods Cross-sectional observational study conducted in Primary Care, with 6,588 adult study subjects, randomly selected on base-population. Patients had HTG if the triglyceride level was ≥150 mg/dL (≥1.7 mmol/L), or were on lipid-lowering therapy to lower triglyceride. Associations were assessed by univariate and multivariate analysis, and crude and sex- and age-adjusted prevalence rates were determined. Results The arithmetic and geometric means of triglyceride levels were respectively 120.5 and 104.2 mg/dL in global population, 135.7 and 116.0 mg/dL in men, and 108.6 and 95.7 mg/dL in women. The crude HTG prevalence rates were 29.6% in global population, 36.9% in men and 23.8% in women. The sex- and age-adjusted HTG prevalence rates were 27.0% in global population, 34.6% in men and 21.4% in women. The independent variables that were most associated with HTG were hypercholesterolemia (OR: 4.6), low HDL-C (OR: 4.1), hepatic steatosis (OR: 2.8), diabetes (OR: 2.0), and obesity. (OR: 1.9). Conclusions The means of triglyceride levels and HTG prevalence rates are intermediate between those of other national and international studies. A fifth of the female adult population and more than a third of the male population had HTG. The independent factors associated with HTG were hypercholesterolemia and low HDL-C, and the cardiometabolic variables diabetes, hepatic steatosis and obesity.

Objetivo: Ofrecer un alcance de la relevancia del diagnóstico oportuno del cáncer testicular, a partir de un caso infrecuente de rabdomiosarcoma paratesticular en un adulto. Reporte de Caso: Se trata de un paciente varón de 39 años, que ingresa al servicio de cirugía - urología por un aumento de volumen de contenido escrotal, de forma progresiva desde hace 2 años, con crecimiento paulatino de la masa. En la ecografía testicular se evidencia un notorio aumento de volumen de bolsas escrotales por aparente tumoración o masa de consistencia dura, de estructura heterogénea y aspecto sólido de bordes mal definidos. Considerando los hallazgos clínicos, marcadores testiculares e imagenológicos se diagnosticó un tumor paratesticular derecho. Se realizó una orquiectomía derecha más exéresis de tumor paratesticular derecho. Patología concluyó en rabdomiosarcoma embrionario paratesticular con cápsula rota. Paciente fue dado de alta con seguimiento por consulta externa y referido a hospital oncológico de cuarto nivel. Trujillo Escuela Profesional de Medicina Revisión por pares

Background Prospective registries are necessary to evaluate the safety of inflammatory bowel disease (IBD) treatment during pregnancy and in children in the long term. Aims The overall aim of DUMBO registry is to know the risk of serious adverse events (SAEs) during pregnancy and in children up to 4 years of age exposed during pregnancy to drugs for IBD (mainly focused on biologics), compared to unexposed children. In this analysis we aim to evaluate the risk of SAEs during pregnancy and the predictive factors of it (mainly focused on IBD drugs). Methods Prospective, observational and multicentre registry, which enrols pregnant women with IBD (Crohn’s disease, ulcerative colitis, IBD-unclassified) over 5 years in 70 centres in Spain. The registry was kicked off in September 2019. SAE was defined based on “Clinical Safety Data Management: Definitions and Standards for Expedited Reporting by European Medicines Agency”. Study protocol is summarized in figure 1. Results 433 women have been included so far; 241 got pregnant at least 9 months before this interim analysis (table 1). Mean age was 34 years, and 17% of women had active disease at any time during pregnancy. 23% of pregnancies were exposed to immumodulators (thiopurines), 25% to biologics and 10% to combo therapy (biologics and immunomodulators). 85 pregnancies (35%) were exposed to biologics (60 anti-TNF, 17 ustekinumab, and 8 vedolizumab) either in combo or in monotherapy. There were 237 newborns (227 singleton and 5 pair of twins), 9 miscarriages and 1 abortion. 72% of patients had vaginal delivery and 28% C-sections (18% due to perianal CD or active disease). A total of 59 pregnancies (24.5%) reported at least one SAE: 32% in exposed to biologics and 20.5% in non-exposed group (p>0.05) (figure 2). Four out of 17 pregnancies exposed to ustekinumab and 3 out of 8 exposed to vedolizumab had SAEs (non-related with the drug). In the multivariate analysis, adjusted by disease activity, in comparison with no immunosuppressive treatment, neither immunosuppressants [Odds ratio (OR)=1.1, 95% confidence interval (CI)=0.3–4.3] nor biologics in monotherapy or in combo (OR=0.8; 95%CI=0.2–3) were associated with higher risk of SAEs. 40 patients (17%) were hospitalised due to complications during pregnancy or delivery (figure 3). Two patients underwent surgery during pregnancy due to IBD complications Conclusion IBD treatment (either immunomodulators or biologics) does not increase the risk of SAEs during pregnancy. Nevertheless, one-quarter of IBD women suffer SAEs during pregnancy and about 20% need hospitalisation, which should be taken into account when managing IBD during pregnancy.

Objective To analyze which factors predict mediastinal N2/N3 lymph node staging and diagnostic accuracy of PET and CT to determine it. Patients and methods We analyzed data collected prospectively in a database that included patients with non-small cell lung cancer (NSCLC) who underwent EBUS-TBNA. Prior to EBUS-TBNA, CT and PET were used to define the radiographic N stage and lymph nodes with short axis ≥ 1 cm by CT or with ratio between maximum standardized uptake value (maxSUV), by PET, of lymph node and primary tumor greater than 0.56, were considered pathological. Definitive lymph node staging was established through EBUS-TBNA, mediastinoscopy or surgical lymph node dissection. Results One hundred and thirty four patients were included, in 88 of whom (65.6%), definitive lymph node staging was N2 or N3. Primary tumor of central location, lymph node size, maxSUV of lymph node and radiographic N stage by CT or PET were associated with N2/N3 in univariate analysis, but in logistic regression model it was only independently related with N stage by CT or PET. Negative predictive value and positive predictive value of CT were 0.81 and 0.74, respectively, and for PET 0.78 and 0.68. Conclusion In NSCLC, in locoregional disease radiographic staging by CT or PET predict the existence of N2/N3 mediastinal disease, but negative and positive predictive values of both imaging techniques are not adequate, so EBUS-TBNA samples should be taken in all lymph nodes with a diameter greater than 5 mm, regardless of PET findings.

Resumen Antecedentes El efecto del tratamiento primario de privacion androgenica (TPA) en pacientes con cancer de prostata (CP) localizado no esta bien documentado. El objetivo del presente estudio fue analizar el resultado de los tumores tratados con TPA como terapia primaria en el Registro Espanol de Cancer de Prostata (19,4% de la serie). Pacientes y metodos Los pacientes se clasificaron en tres grupos: 1) con tumores clinicamente localizados de riesgo bajo/intermedio; 2) con tumores de alto riesgo y localmente avanzados (T3-4); 3) con tumores metastasicos. Se analizo el tiempo hasta la resistencia a la castracion y la supervivencia general especifica del cancer. En tumores no metastasicos, las supervivencias en pacientes tratados con TPA se compararon con los datos de pacientes que recibieron tratamientos locales del Registro Espanol de Cancer de Prostata. Resultados Se analizaron 703 casos. Hubo diferencias significativas en el tiempo de resistencia a la castracion, que fue menor en el grupo de tumores metastasicos. Durante el seguimiento hubo 179 muertes (25,5%), de las cuales 89 (12,6%) se debieron a CP. Despues de 3 anos de TPA, solo el 14,6% de los pacientes en el grupo 1 fallecieron (1% debido a CP), el 20,5% en el grupo 2 y el 46,8% en el grupo 3 (9,2% y 31,3% debido a CP, respectivamente). La supervivencia especifica del cancer fue significativamente peor en el grupo 1 tratado con TPA que en el que recibio prostatectomia radical o radioterapia. En los tumores de alto riesgo y localmente avanzados, la TPA tambien tuvo una menor supervivencia especifica al cancer que los tratamientos locales. Conclusion Se observo un tiempo mas largo hasta la resistencia a la castracion en pacientes con tumores localizados de riesgo intermedio y bien tratados con TPA. Los pacientes con tumores metastasicos mostraron el menor tiempo hasta la resistencia a la castracion.

The propagation of uncertainty in fatigue crack growth life aims to find the effects of the process variables randomness in the fatigue lifespan. This treatment of the crack growth process commonly provides the probability distribution of the fatigue lifespan which is essential to predict the performance of a component concerning risk assessment and management. This paper presents a procedure that uses the first four moments of the fatigue crack growth life predicted by the full second-order approach to fit the parameters of a probability distribution based on the Pearson distribution family. A numerical example to illustrate the fatigue crack growth in a railway axle under random bending loading is given. The probabilistic results are compared with Monte Carlo simulations to check the goodness of the first four moments predicted and the quality of the probability density function constructed. The probabilistic description of fatigue lifespan provided can be used in ensuring the continued safe operation of a damage tolerant component.

With the current COVID-19 pandemic that humanity is experiencing and the mobilization of all health systems to exercise sanitary measures such as quarantines and other measures to reduce infections, it should be remembered that these practices have been possible thanks to the experiences that in hygiene matters we have accumulated in our history. This essay aims to highlight about hygiene, the historicity of the concept, and its object of study as a medical discipline, in medical texts published in Spain during the 19th century, to help us understand the contributions of this science to current clinical practice and for these purposes, the bibliographic material was obtained from the National Library of Spain.

Introduction Long ambulatory ECG monitoring can be a useful component in the evaluation of the patient with unexplained syncope or syncope with suspected arrhythmic origin, as well as a sensitive tool for detecting asymptomatic spontaneous cardiac arrhythmias or conduction abnormalities in predisposed patients. Purpose To determine the diagnostic cost-effectiveness of the implantable loop recorder (ILR) in the origin of unexplained syncope in our center. Methods A retrospective observational study was carried out in a tertiary center, those patients with an ILR between August 2014 and March 2021 were included. Baseline characteristics of the population and their previous ECG, arrythmias detected during follow-up and pacemaker implant rate were evaluated. Results One hundred twenty-seven patients with a ILR were included (age 67 years, 49.6% males). Most often cause of ILR was unexplained syncope (90.6%) followed by monitoring after TAVI implant (3.9%). Normal LVEF (>50%) was present in 85.6%,and 75.6% had NYHA I functional class. 118 patients (92.9%) presented sinus rhythm at implant time, and 8 (6.3%) presented AF. 12.6% presented first degree atrioventricular (AV) block, 2 patients (1.6%) had presented previously Mobitz Type I AV block and one patient 2:1 block. Left bundle branch block (LBBB) was present in 13.4%,RBBB in 3.1%,LAFB in 9.4%, RBBB+LAFB in 11% and RBBB+LPFB in 2.4%. Median time of follow-up was 21 months. 3rd degree AV block was the most frequent arrhythmia detected (12.1%), followed by >3s pause (8%) and previously unknown AF (2.4%).The patients with syncope who suffered head trauma (33%) presented a higher rate of pacemaker (PCM) implant compared to those without head trauma: 31.6% vs 14.7%. In total,19.8% PCM rate implant during follow-up. No complications ILR related. Conclusion In conclusion, long home ECG monitoring with ILR is a powerful and helpful tool to find out or rule out potentially dangerous arrhythmias as cause of syncope, with no complications in our experience. Funding Acknowledgement Type of funding sources: None. Baseline characteristicsArrhythmias detected during follow-up

Chronic osteoarthritis pain is accompanied by several comorbidities whose treatment has not been completely resolved. The anti-inflammatory, analgesic, and antidepressant effects of slow-releasing hydrogen sulfide (H2S) donors during osteoarthritic pain have been shown, but their actions in the accompanying memory impairment and anxious-like behaviors have not yet been demonstrated. Using female mice with chronic osteoarthritic pain, the effects of natural, diallyl disulfide (DADS) or synthetic, morpholin-4-ium 4-methoxyphenyl(morpholino) phosphinodithioate dichloromethane complex (GYY4137) slow-releasing H2S donors, on associated cognitive and grip strength deficits and anxiodepressive-like behaviors, were assessed. Their effects on specific brain areas implicated in the modulation of pain and emotional responses were also determined. Results demonstrated an improvement in memory and grip strength deficits, as well as in the anxious-like behaviors associated with chronic pain in GYY4137 and/or DADS treated mice. The painkiller and antidepressant properties of both treatments were also established. Treatment with DADS and/or GYY4137 inhibited: oxidative stress in the amygdala; phosphoinositide 3-kinase overexpression in the amygdala, periaqueductal gray matter, and anterior cingulate cortex; protein kinase B activation in the amygdala and infralimbic cortex; up-regulation of inducible nitric oxide synthase in the amygdala, periaqueductal gray matter and infralimbic cortex and apoptotic responses in the amygdala. These results might explain the recovery of memory and grip strength and the inhibition of allodynia and associated anxiodepressive-like behaviors by these treatments. In conclusion, this study revealed new properties of slow-releasing H2S donors in cognitive impairment and affective disorders linked with chronic osteoarthritis pain and their effects on the central nervous system.

Antecedentes: La psicoterapia familiar ha demostrado tener un impacto positivo en la evolución de enfermos con trastornos psicosomáticos, y en aquellos con hipertensión arterial arterial pudiera mejorar el nivel de control de la enfermedad. Objetivo: Evaluar el impacto de una intervención en psicoterapia familiar en pacientes con hipertensión arterial sistémica no controlada. Método: Estudio con grupos comparados. 15 pacientes hipertensos no controlados, asignados a dos grupos: un de intervención, con 10 pacientes que recibieron psicoterapia familiar, y otro de control con 5 pacientes. En ambos grupos se continuó con el tratamiento farmacológico indicado por expertos. Se compararon ambos grupos antes y después de la intervención respecto a calidad de vida (InCaViSa), funcionamiento familiar (Escala de Funcionamiento Familiar), presión arterial sistólica y diastólica, índice de masa corporal, glucosa, colesterol, triglicéridos, ácido úrico y creatinina. Resultados: Hubo una mejoría cualitativa en los dominios de la escala InCaViSa para estimar la calidad de vida en el grupo de intervención y no hubo cambios estadísticamente significativos entre los grupos en cuanto a funcionamiento familiar y peso corporal. Entre las variables bioquímicas, solo el colesterol mostró una reducción significativa (p = 0.47). Se encontró una mayor movilidad de la familia hacia comportamientos más funcionales en el grupo que recibió la intervención, y también en este grupo disminuyeron las cifras de presión sistólica y diastólica (p < 0.001), así como el uso de antihipertensivos, ansiolíticos y antidepresivos. Conclusiones: La intervención psicoterapéutica familiar puede favorecer el control de la presión arterial, reducir las dosis de antihipertensivos, ansiolíticos y antidepresivos, y ayudar en la transición a estados de mejor funcionalidad familiar.

Hypertension impairs the function of the kidney and its vasculature. Adrenergic activation is involved in these processes by promoting oxidative stress and mitochondrial dysfunction. Thus, the targeting of mitochondrial function and mitochondrial oxidative stress may be an approach to alleviate hypertensive kidney damage. Avocado oil, a source of oleic acid and antioxidants, improves mitochondrial dysfunction, decreases mitochondrial oxidative stress, and enhances vascular function in hypertensive rats. However, whether avocado oil improves the function of renal vasculature during the adrenergic stimulation, and if this is related to improvement in renal damage and enhancement of mitochondrial activity is unknown. Thus, the effects of avocado oil on renal vascular responses to adrenergic stimulation, mitochondrial dysfunction, oxidative stress, and renal damage were compared with prazosin, an antagonist of α1-adrenoceptors, in hypertensive rats induced by L-NAME. Avocado oil or prazosin decreased blood pressure, improved endothelium—dependent renal vasodilation, prevented mitochondrial dysfunction and kidney damage in hypertensive rats. However, avocado oil, but not prazosin, decreased mitochondrial ROS generation and improved the redox state of mitochondrial glutathione. These results suggest that avocado oil and prazosin prevented hypertensive renal damage due to the improvement in mitochondrial function.

El objetivo del estudio fue mostrar rasgos identitarios del proceso de institucionalizacion de la Medicina en el siglo XIX en Michoacan. Se senalan aspectos relevantes de la creacion y la evolucion de las instituciones relacionadas con el cuidado de la salud de los michoacanos durante el siglo XIX a partir de la revision de material hemerografico y textos referentes a la practica de la Medicina en esa centuria, en el Estado de Michoacan. The objective of the study was to show identity traits of the process of institutionalization of Medicine in the 19th century in Michoacan. Relevant aspects of the creation and evolution of the institutions related to the health care of Michoacans during the 19th century are pointed out from the review of hemerographic material and texts referring to the practice of medicine in that century, in the State from Michoacan.

INTRODUCTION Multiple studies attempt to demonstrate the superiority of Toupet fundoplication over the classic Nissen technique in the treatment of gastro- oesophageal reflux disease (GERD). In our study we compared the results of both techniques. MATERIAL AND METHODS A retrospective descriptive study of patients operated because of GERD using laparoscopic Nissen and Toupet fundoplication in our centre between January 1, 2015 and December 31, 2019. RESULTS 80 patients were operated, 56 Nissen (70%) versus 24 Toupet (30%). Both groups are comparable in terms of mean age, distribution by sex, obesity, toxic habits, the prevalence of typical symptoms, DeMeester, and presurgical lower oesophagal sphincter pressure; although there are differences regarding the presence of associated hiatal hernia and within them the type. A similar surgical time (136.59 vs 132.71 minutes) and mean stay (4.02 vs 5 days) were observed. In the Nissen group, 12 patients (21.42%) presented initial postoperative dysphagia, requiring 2 endoscopic dilations and 5 reoperations, compared to 5 patients (20.83%) in the Toupet group, that did not require dilation and with 1 reoperation. The conversion and mortality rate was 0% in both groups, with a variable follow-up of 22.08 versus 14.45 months. CONCLUSIONS Both techniques present similar results, including the rate of postoperative dysphagia, which is one of the most feared complications. However, it would be necessary to increase the size and longer follow-up to establish long-term results.

INTRODUCTION Several publications have highlighted the importance of the peritumoral matrix in various epithelial tumors. Our team has pointed out the value of ColXIα1 in the stroma of breast, colon and pancreatic cancer. The possible prognostic factor of the stroma in colon cancer is debated. Our aim is to analyze the prognostic role of the stroma and ColXIα1 in colon adenocarcinoma. MATERIAL AND METHODS Samples of 189 patients with colon cancer were studied by image analysis. The matrix was stained with Gomori green trichrome and the CAFs with the mouse monoclonal anti-proColXIα1 antibody. The samples were evaluated with an optical microscope, obtaining data from the area stained with proColXIα1, the area stained with Gomori and the number of pro ColXIα1 positive cells. 35 Gb of images were analyzed with Image J-FIJI, which measures the number of cells and the total area of marked regions, and also quantifies the number and area of unlabeled cells. Statistical analysis by MedCalc v1o and SpSS v15. RESULTS Colon cancer stages (%): I, 13; II, 40; III, 29; IV, 18. Recurrences (%), 32; by stages: I, 0; II, 21; III, 44; IV, 86. Global survival: median, 28 months; S5, 33%. Total stromal cells, number of CAFs and its area: higher in early stages. Gomori area, smaller in early stages and in cases without recurrences. CONCLUSIONS The number of CAFs and the extension of the stromal area could have influence in the development of the cancer colon, and may be related to the prognosis of disease.

INTRODUCTION The incidence of peritoneal metastases in gastric cancer are frequent and are associated with very poor median survival rates. The multimodal treatment of cytoreduction surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) could offer a better prognosis in selected cases although it is not currently contemplated in clinical practice guidelines. MATERIAL AND METHODS Of the 100 patients operated on for peritoneal carcinomatosis in our centre between May 2014 and December 2020, we selected those of gastric origin. Multidisciplinary CRS treatment with HIPEC was indicated in those patients with positive cytology and/or preoperative PCI RESULTS Four men and one woman with a mean age of 63 years underwent surgery. The mean preoperative PCI was 2 and complete cytoreduction was achieved in all cases (CC-0). Complications included a biliary leak, a postoperative collection and a bronchoaspirative pneumonia. One patient died at 34 months. The other four are still alive: one with recurrence at 18 months and the rest without disease with a mean follow-up of 25 months. In one of the cases CRS surgery with HIPEC was performed as surgical salvage after initial surgery and in the rest as the only treatment. CONCLUSIONS Palliative systemic chemotherapy is considered the treatment of gastric cancer with peritoneal involvement, however, treatment based on CRS and HIPEC in selected cases could improve survival rates, disease-free interval and even be considered as salvage treatment in resectable oligometastatic recurrences.

The effect of posterior tibial nerve stimulation (PTNS) on the mechanisms of anal continence has not been fully demonstrated. The aim of this study was to assess the anal manometric response after percutaneous PTNS in patients with fecal incontinence (FI). This was a prospective study in patients with FI undergoing 1 weekly session of percutaneous PTNS for 8 weeks. A clinical assessment (Wexner scale) and a complete study of up to 22 manometric parameters were carried out prior to treatment and 2–4 weeks after the end of treatment. A total of 32 patients were evaluated. After therapy, there was a decrease in the average Wexner score [12.6 (± 5.2) to 9.5 (± 5.2) (P

BackgroundThe indications for expanded endoscopic transnasal approaches continue to increase, with more complex skull base defects needing to be repaired. This study reviews the management of large anterior skull base defects with opening of the sellar diaphragm.MethodA prospective analysis of endonasal endoscopic surgery carried out at Son Espases University Hospital between January 2013 and December 2018 was performed. The analysis included only the cases with a significative intra-operative cerebrospinal fluid leak. In all cases, reconstruction was performed by combining the gasket seal technique with a pedicled mucosal endonasal flap.ResultsTwenty-eight patients were included. The mucoperiosteal nasoseptal flap, the lateral wall flap and the middle turbinate flap were used in 13, 8 and 7 patients, respectively, combined with the gasket seal technique. One case of post-operative cerebrospinal fluid leak was observed (3.57 per cent).ConclusionThe combination of a gasket seal with an endonasal mucosal flap is an excellent technique for repairing large anterior skull base defects.

Con el objetivo de describir las características clínicas y complicaciones del síndrome de Takotsubo, se realizó un estudio de serie de casos de pacientes que ingresaron con esta patología al Instituto Nacional Cardiovascular-INCOR en Lima-Perú, entre enero de 2013 a diciembre de 2018. Se incluyeron 26 pacientes, con una edad promedio de 69 años y predominio del sexo femenino (96,2%), además un desencadenante se identificó en 23 casos (88,5%). En el electrocardiograma, el 61,5% tuvo supradesnivel del segmento ST; y en la evolución el 92,3% mostró ondas T negativas y el 38,5% un intervalo QTc >500 ms. Las complicaciones intrahospitalarias fueron choque cardiogénico (11,5%), fibrilación auricular (7,7%) y taquicardia ventricular (7,7%). En esta serie, el síndrome de Takotsubo predominó en mujeres posmenopáusicas, generalmente desencadenado por un factor estresante, con una baja tasa de complicaciones y ausencia de mortalidad intrahospitalaria. In order to describe the clinical features and complications of Takotsubo syndrome, a case series study was conducted with patients admitted with this pathology to the National Cardiovascular Institute-INCOR in Lima-Peru between January 2013 and December 2018. Twenty-six patients (26) were included, with an average age of 69 years and female predominance (96.2%); additionally, a trigger was identified in 23 cases (88.5%). In the electrocardiogram, 61.5% had ST segment elevation; and, in the evolution, 92.3% showed negative T waves and 38.5% a QTc interval >500 ms. In-hospital complications were cardiogenic shock (11.5%), atrial fibrillation (7.7%) and ventricular tachycardia (7.7%). In this series, Takotsubo syndrome predominated in postmenopausal women, usually triggered by a stressor, with a low complication rate and no in-hospital mortality.

Figure 1 as published in the original version of this article was unfortunately incomplete.

Introduction Few studies conducted in primary care setting report about age-adjusted prevalence rates of erectile dysfunction (ED). Aims of SIMETAP-ED study were to determine crude and age-adjusted prevalence rates of ED diagnosis, to compare these rates with other similar studies, and to compare prevalence rates of cardiovascular risk factors (CVRF), cardiovascular diseases (CVD), metabolic diseases and chronic kidney disease (CKD) between populations with and without ED. Methods Cross-sectional observational study conducted in primary care setting. Population-based random sample: 2934 adult men. Response rate: 66%. A clinical interview was conducted to diagnose ED using a question derived from ED definition. The medical records of patients were reviewed to identify their CVRF and diseases associated with ED. The age-adjustments were standardized to Spanish population. Results The prevalence rates of metabolic diseases, CVD, CVRF, and CKD in population with ED were higher than population without ED, highlighting the CVD. The crude prevalence of ED was 17.2% (95% confidence interval: 15.8•18.6). The age-adjusted prevalence rates of ED were 0.71% in men under 40 years, 12.4% in men over 18 years, 10.8% in men aged 40•69 years, 18.9% in men over 40 years, and 48.6% in men over 70 years. Conclusions SIMETAP-ED study showed association of ED with metabolic diseases, CKD, CVRF, and highlighting CVD. The age-adjusted prevalence of ED was 12.4% in adult men, 19% in men over 40 years, and almost 50% in men over 70 years.

Introduction: There are only a limited number of studies on the impact of influenza in the Spanish child population. The present work intends to increase this knowledge by studying some key aspects, such as the incidence of hospital admissions, clinic variables, comorbidities, and the vaccination status in the hospitalised children. Methods: A retrospective, observational study was conducted by reviewing the medical records of children under 15 years and hospitalised due to community acquired influenza confirmed microbiologically, during 2 ́flu seasons (2014–2015 and 2015–2016). The study was carried out in 10 hospitals of 6 cities, which represent approximately 12% of the Spanish child population. Results: A total of 907 children were admitted to hospital with main diagnosis of influenza infection (447 10 years. Admission to the PICU was required in 10% (92) of the cases, mainly due to acute respiratory failure. Conclusion: Influenza continues to be an important cause of hospitalization in the Spanish child population. Children 50%) of the cases. Many of the severe forms of childhood influenza that occur today could be avoided if current vaccination guidelines were met. Resumen: Introducción: La información existente sobre el impacto de la gripe en la población infantil española es escasa. El presente trabajo pretende aumentar este conocimiento estudiando aspectos clave como la incidencia de hospitalización, clínica, comorbilidades y el estado vacunal en los niños hospitalizados. Métodos: Estudio retrospectivo, observacional, por revisión de historias clínicas, en menores de 15 años hospitalizados por gripe adquirida en la comunidad, confirmada microbiológicamente, durante 2 temporadas gripales (2014-2015 y 2015-2016). El estudio se realizó en 10 hospitales de 6 ciudades, que atienden aproximadamente al 12% de la población infantil española. Resultados: Fueron hospitalizados 907 niños con diagnóstico principal de gripe (447 50%) de los casos. Una gran parte de las formas graves de gripe en población infantil podrían ser evitada si se cumplieran las indicaciones actuales de vacunación.

We have designed a systemic model to understand the effect of Photodynamic Therapy (PDT) on long time scales. The model takes into account cell necrosis due to oxygen reactive species, cell apoptosis through the caspase pathway and the competition between healthy and tumor cells. We attempted to describe the system using state of the art computational techniques (necrosis and apoptosis) and simple models that allow a deeper understanding of the long time scale processes involved (healing and tumor growth). We analyzed the influence of the surface and tumor depth on the effectiveness of different treatment plans and we proposed, for the set of parameters used in this work, an optimum timing between sessions of PDT.

Background It has been documented that anxiety and depression are prevalent in patients with asthma and are associated with greater frequency of exacerbations, increased use of health care resources, and poor asthma control. Objective To examine the association of asthma diagnosis with symptoms of depression/anxiety and asthma control not only at baseline but also over a 6-month period of specialist supervision. Methods We enrolled 3182 patients with moderate to severe asthma. All were evaluated with spirometry, the Asthma Control Test, and the Hospital Anxiety and Depression Scale at baseline and at 6 months. Treatments were decided by specialists according to published guidelines. Results At baseline, 24.2% and 12% of the patients were diagnosed with anxiety and depression, respectively, according to the Hospital Anxiety and Depression Scale. After 6 months, anxiety and depression improved, affecting 15.3% and 8.1% of patients, respectively (P Conclusion Under standardized asthma care and after a specific visit with the specialist, patients present significant improvement in these psychological disorders and exhibit better asthma control and functional parameters.

Adherence to Enhanced Recovery Protocols (ERPs) is associated with faster functional recovery, better patient satisfaction, lower complication rates and reduced length of hospital stay. Understanding institutional barriers and facilitators is essential for improving adherence to ERPs. The purpose of this study was to identify institutional factors associated with adherence to an ERP for colorectal surgery.A secondary analysis of a nationwide study was conducted including 686 patients who underwent colorectal surgery across twenty-one institutions in Spain. Adherence to ERPs was calculated based upon the components recommended by the Enhanced Recovery After Surgery (ERAS®) Society. Institutional characteristics (i.e., case volume, ERP duration, anesthesia staff size, multidisciplinary meetings, leadership discipline) were captured from each participating program. Multivariable regression was performed to determine characteristics associated with adherence.The median adherence to ERAS was 68.2% (IQR 59.1%-81.8%). Multivariable linear regression revealed that anesthesiologist leadership (+5.49%, 95%CI +2.81% to +8.18%, P 0.01), duration of ERAS implementation (+0.46% per year, 95%CI +0.06% to +0.86%, P 0.01) and the use of regular multidisciplinary meetings (+4.66%, 95%CI +0.06 to +7.74%, P 0.01) were independently associated with greater adherence. Case volume (-2.38% per 4 cases weekly, 95%CI -3.03 to -1.74, P 0.01) and number of anesthesia providers (-1.19% per 10 providers, 95%CI +2.23 to -8.18%, P 0.01) were negatively associated with adherence.Adherence to ERPs is strongly associated with anesthesiology leadership, regular multidisciplinary meetings, and program duration, whereas case volume and the size of the anesthesia staff were potential barriers. These findings highlight the importance of strong leadership, experience and establishing a multidisciplinary team when developing an ERP for colorectal surgery.

Identification of the causative pathogen is required to optimize the effective therapy in infective endocarditis (IE). The aim of this study was to assess a 16S rDNA PCR to identify bacteria from heart valve tissues and to evaluate its usefulness as a complement to blood and removed valves cultures. A total of 266 patients diagnosed with IE from January 2015 to December 2019 were evaluated. Results between 16S rDNA PCR from heart valve tissues were compared with microbiological cultures. Blood cultures were positive in 83.5% of patients diagnosed with IE, while 39.6% and 71.8% of the evaluated heart valve samples were positive by culture and 16S rDNA PCR, respectively. For 32 (12%) patients, 16S rDNA tissue PCR provided valuable information supporting the results of blood cultures in the case of bacteria characteristic from the skin microbiota. Additionally, a microorganism was identified by using 16S rDNA PCR in 36% of blood culture-negative cases. The present study reveals that molecular diagnosis using 16S rDNA tissue PCR provides complementary information for the diagnosis of IE, and it should be recommended in surgical endocarditis, especially when blood cultures are negative.

Resumen En situación de pandemia, los tres principios básicos en la atención sanitaria son priorizar los recursos, mantener el confinamiento del paciente para evitar la transmisión comunitaria y el colapso sanitario y reducir la asistencia no prioritaria con el fin de evitar la exposición del paciente y de salvaguardar la salud del profesional sanitario. El control antenatal debe mantenerse durante el periodo de crisis sanitaria, independientemente del estado de alerta COVID-19. La ecografía obstétrica en una prueba fundamental para la toma de decisiones clínicas durante el embarazo, con un impacto en el manejo del binomio madre-feto y en el resultado perinatal, por lo que se ha de garantizar su realización. Con el fin de reducir las visitas presenciales al mínimo número posible, estas se intentarán organizar teniendo en cuenta los controles ecográficos establecidos. Basados en la evidencia científica y en las principales guías nacionales e internacionales, hemos elaborado este documento que incluye las principales recomendaciones para el cuidado antenatal de la gestante en el contexto de la pandemia por SARS-CoV-2. En él se recoge cómo debe reestructurarse una Sección de Medicina Fetal ante esta nueva situación, qué medidas de seguridad deben seguirse para la realización de las exploraciones ecográficas y técnicas invasivas y de qué modo debe procederse para la limpieza y desinfección de los equipos ecográficos. Estas recomendaciones deberán adaptarse a los diferentes medios teniendo en cuenta la infraestructura del centro y sus recursos.