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Small-bowel atresias are among the most common causes of intestinal obstruction in newborns, and they often require urgent surgical treatment. Imaging techniques play a very important role in their diagnosis, which is often suspected on prenatal obstetric ultrasound and confirmed on postnatal plain-film X-rays. Abdominal ultrasound's lack of ionizing radiation, wide availability, low cost, and high resolution is making this technique increasingly important in confirming atresias and in detecting possible complications in newborns. This review analyzes a series of cases seen at our center. It summarizes the different types of small-bowel atresias, focusing on the clinical presentation, imaging findings on different modalities, presence of associated disease, management, clinical course, and outcomes.

D-dimer levels are elevated in COVID 19 and they correlate to the levels of other inflammatory markers such us ferritin, fibrinogen and C-reactive protein. It may be possible to correct D-dimer value in function of inflammatory markers, thus identifying patients at higher risk of venous thromboembolism (VTE). Our objectives are estimating a corrected value of plasma D-dimer as a linear function of ferritin, C-reactive protein and fibrinogen and stablishing a cut-off point of high probability of VTE.Age and sex matched case-control study of all patients diagnosed with COVID 19 and VTE between March and May 2020 in a tertiary hospital in Madrid (Spain). Using linear regression, the best predictive model will be estimated and residual D-dimer values will be obtained and analyzed using ROC curves to determine its discriminative performance.Thirty-eight cases and seventy-six controls were included. There was 63.2% of men and mean age was 68.2. D-dimer was best predicted by a linear model including fibrinogen, ferritin and C-reactive protein. Using residual values, the optimal cutoff point was 2165 ng/mL, with a sensitivity of 57.9% and specificity of 98.7%.It is possible to estimate a D-dimer corrected value in function of ferritin, C-reactive protein and fibrinogen. Using the observed and estimated value we can obtain a residual value that performs well as a screening method to detect patients who would benefit for further VTE diagnostic testing.El dímero-D está elevado en la COVID-19 y se correlacionan con los niveles de otros marcadores inflamatorios como ferritina, fibrinógeno y proteína C reactiva. Cabe la posibilidad de corregir el dímero-D en función de dichos marcadores inflamatorios, identificando así los pacientes con mayor riesgo de enfermedad tromboembólica venosa (ETV). Nuestros objetivos son estimar un valor corregido de dímero-D como función lineal de ferritina, proteína C reactiva y fibrinógeno, y establecer un punto de corte de alta probabilidad de ETV.Estudio de casos y controles emparejados por sexo y edad de todos los pacientes diagnosticados con COVID-19 y ETV entre marzo y mayo de 2020 en un hospital terciario de Madrid, España. Mediante regresión lineal, se estima el mejor modelo predictivo y se obtiene el valor residual de dímero-D. Este se analizará con curvas ROC para determinar su capacidad discriminativa.Se incluyeron 38 casos y 76 controles. Había un 63,2% de varones y la edad media fue de 68,2 años. El valor de dímero-D fue predicho por un modelo que incluyó fibrinógeno, ferritina y proteína C reactiva. Usando los valores residuales, el punto de corte óptimo estimado de 2.165 ng/ml, con una sensibilidad del 57,9% y una especificidad del 98,7%.Es posible estimar un valor corregido de dímero-D en función de ferritina, fibrinógeno y proteína C reactiva. Usando el valor observado y estimado podemos obtener un valor residual que funciona bien como método de cribado para detectar pacientes que podrían beneficiarse de más estudios diagnósticos de la ETV.

Background Reporting complications and/or adverse events after spinal surgical procedures enables the estimation of their prevalence and of their impact on patient outcomes. However, the documentation of complications is relatively infrequent and highly heterogeneous. The purpose of this study was to evaluate the quality of complication and adverse event reporting in spinal surgery literature. Methods A systematic review of the literature from 5 international, peer-reviewed, indexed spinal journals was performed. Included studies were published between January and December 2020 and reported the surgical results of spinal procedures. Data on the level of evidence and study design were collected and analyzed as well as whether the studies were single-center or multicenter studies. The quality of complication reports was evaluated through a 5-item checklist, with 5 questions divided into 3 parts: definition, evaluation, and report. Results Complications associated with spinal surgical procedures were reported in 292 studies. According to the level of evidence, significantly higher reporting quality was seen in level I and II studies compared with level III and IV studies (P = 0.003). Regarding the 5-item checklist, 49% (143/292) of studies fulfilled the definition section, 16.4% (48/292) fulfilled the evaluation section, and 92% (270/292) fulfilled the report section. Conclusions Overall quality assessment when reporting complications in surgical spinal studies showed that only 13% (38/292) of publications that reported complications as part of the outcomes exhibited all items of the 5-item checklist. Additionally, significantly better reports were observed in level I studies compared with level II–IV studies.

Primary membranous nephropathy (PMN) is an autoimmune disease limited to the kidney that is characterized by the presence of circulating PLAR2 antibodies in 70% of the cases and usually positivity for PLA2R and IgG4 by immunohistochemistry (IHC) staining. We report the first documented case of PMN (PLA2R positive) in a deceased kidney donor, transplanted to two different recipients and their clinical and immunological evolution through serial biopsies. Recipient A's first allograft biopsy (Day 26) was compatible with a MN with both positive PLA2R and IgG4 subepithelial deposits in IHC. The donor's preimplantation kidney biopsies were retrieved and reexamined, revealing MN, with high intensity for PLA2R and IgG4 in IHC. Recipient B's protocol allograft biopsy, performed later at 3 months, also revealed histology compatible with MN but without the presence of PLA2R nor IgG4 in IHC. At 1-year follow-up, both recipients maintain graft function. Serial protocol biopsies were performed in both patients showing disappearance of IgG4 in recipient A but the persistence of PLA2R in IHC. We can conclude that, given the reversal of PMN changes in the grafts, it could be considered to transplant a patient from an asymptomatic deceased donor with PMN as long as he maintains unaltered renal function.

Extracellular vesicles (EVs) have been recently postulated as key players in metabolic disorders emerging as an alternative way of paracrine/endocrine communication. However, the nature of EVs shed by adipose tissue (AT) and their role in obesity is still very limited. Here, we isolated human morbid obese visceral (VAT) and subcutaneous (SAT) whole AT shed EVs from donors submitted to bariatric surgery to characterize their protein cargo by qualitative and quantitative/SWATH mass spectrometry analysis. We identified 574 different proteins shed by morbid obese VAT and 401 proteins in those from SAT, establishing the first obese AT EV proteome reference map. Only 50% of identified proteins in VAT vesicles were common to those in SAT; additionally, EVs shed by obese VAT showed more AT and obesity-related adipokines than SAT. Functional classification shows that obese VAT vesicles exhibit an enrichment of proteins implicated in AT inflammation and insulin resistance such as TGFBI, CAVN1, CD14, mimecan, thrombospondin-1, FABP-4 or AHNAK. Selected candidate biomarkers from the quantitative-SWATH analysis were validated in EVs from independent morbid obese and from moderate obese to lean individuals showing that morbid obese VAT vesicles are characterized by a diminution of syntenin 1 and the elevation of TGFBI and mimecan. Interestingly, TGFBI and mimecan containing vesicles could be detected and quantified at circulating level in plasma. Thus, a significant elevation of -TGFBI-EVs was detected on those obese patients with a history of T2D compared to nondiabetic, and an augmentation of mimecan-EVs in obese plasma compared to those in healthy lean individuals. Thus, we conclude that obese AT release functional EVs carrying AT and obesity candidate biomarkers which vary regarding the AT of origin. Our findings suggest that circulating EV-TGFBI may facilitate monitoring T2D status in obese patients, and EV-mimecan may be useful to track adiposity, and more precisely, visceral obesity.

Purpose The management of scoliosis and kyphoscoliosis in patients with Type 1 Neurofibromatosis (NF-1) among spinal surgeons is still challenging due to the severity of the deformity especially in dystrophic deformity types. This rapid and progressive condition is likely to be associated with dislocated rib heads into the spinal canal, hence representing a real dilemma on the decision making between its resection versus not resection during the corrective surgery, especially in patients with normal neurological status. The objective of this publication is to discuss the management options in this patient population through a literature review. Methods A comprehensive systematic literature search was performed for relevant studies using PubMed, Web of Science, and Scopus databases. Previous publications depicting neurologically intact patients with NF-1 and rib dislocation into the canal were reviewed. Articles reporting individual cases or case series/cohorts with patient-discriminated findings were included. Results The data collection retrieved a total of 55 neurologically intact patients with NF-1 dystrophic scoliosis and rib penetration into the canal who underwent spinal surgery. Among them, 37 patients underwent surgery without head rib resection and 18 patients with rib excision. No patient presented postoperative neurological deficit except for one case of late postoperative neurological deterioration reported in a patient within situ fusion in which the surgeons ignored the presence of previous spinal cord compression. Conclusion Corrective surgery for patients with NF-1 and rib penetration into the canal in neurologically intact patients can be safely performed without the resection of the dislocated rib heads without a higher risk of neurological compromise.

Osteoporotic vertebral compression fractures of the thoracolumbar spine can progress to Kummell’s disease, an avascular vertebral osteonecrosis. Vertebral augmentation (VA)—vertebroplasty and/or kyphoplasty—is the main treatment modality, but additional short-segment fixation (SSF) has been recommended concomitant to VA. The aim is to compare clinical and radiological outcomes of VA + SSF versus VA alone. Systematic review, including comparative articles in Kummell’s disease, was performed. This study assessed the following outcome measurements: visual analog scale (VAS), Oswestry Disability Index (ODI), anterior vertebral height (AVH), local kyphotic angle (LKA), operative time, blood loss, length of stay, and cement leakage. Six retrospective studies were included, with 126 patients in the VA + SSF group and 152 in VA alone. Pooled analysis showed the following: VAS, non-significant difference favoring VA + SSF: MD –0.61, 95% CI (–1.44, 0.23), I2 91%, p = 0.15; ODI, non-significant difference favoring VA + SSF: MD –9.85, 95% CI (–19.63, –0.07), I2 96%, p = 0.05; AVH, VA + SSF had a non-significant difference over VA alone: MD –3.21 mm, 95% CI (–7.55, 1.14), I2 92%, p = 0.15; LKA, non-significant difference favoring VA + SSF: MD –0.85°, 95% CI (–5.10, 3.40), I2 95%, p = 0.70. There were higher operative time, blood loss, and hospital length of stay for VA + SSF (p

Background: Functional outcome measures used to assess efficacy in clinical trials of investigational treatments for rare neuromuscular diseases like Duchenne muscular dystrophy (DMD) are performance-based tasks completed by the patient during hospital visits. These are prone to bias and may not reflect motor abilities in real-world settings. Digital tools, such as wearable devices and other remote sensors, provide the opportunity for continuous, objective, and sensitive measurements of functional ability during daily life. Maintaining ambulation is of key importance to individuals with DMD. Stride velocity 95th centile (SV95C) is the first wearable acquired digital endpoint to receive qualification from the European Medicines Agency (EMA) to quantify the ambulation ability of ambulant DMD patients aged ≥5 years in drug therapeutic studies; it is also currently under review for the US Food and Drug Administration (FDA) qualification. Summary: Focusing on SV95C as a key example, we describe perspectives of multiple stakeholders on the promise of novel digital endpoints in neuromuscular disease drug development.

A leiomyoma is a benign mesenchymal neoplasm that usually develops where smooth muscle is present. In this report, we present the case of a 75-year-old woman who sought medical attention due to pelvic organ prolapse and urinary incontinence, and without defecatory symptoms. Both pelvic floor ultrasound and magnetic resonance imaging (MRI) examination showed a well-defined mass in the ischioanal fossa, eventually diagnosed as a perianal leiomyoma. It is considered a rare entity because of its location involving the anal sphincter and clinical features. We describe the ultrasonographic and MRI findings of this perianal leiomyoma, together with differential diagnoses and immunohistochemical characterization.

Trichomonas vaginalis infections in men are traditionally considered to be benign and consequently have been overlooked. However, men with this common sexually transmitted infection can experience urethritis, prostatitis, reduced fertility, and amplified human immunodeficiency virus risk. In addition, men are often asymptomatic and can unknowingly spread the infection to their female sexual partners. With advances in T. vaginalis diagnostics, more men are being diagnosed, yet the optimal method of treatment in men remains unknown. The purpose of this review is to discuss the epidemiology, natural history, diagnosis, and treatment of T. vaginalis among men.

Objective We sought to compare the outcomes of single-position (SP) circumferential lumbar interbody fusion in lateral decubitus versus dual-position (DP) fusion. Methods A systematic literature review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines in PubMed, Web of Science, and Scopus databases to identify comparative studies reporting the outcomes of SP lumbar interbody fusion versus DP. For risk of bias assessment, the ROBINS-I (risk of bias in nonrandomized studies of interventions) tool was used. Results Four comparative studies were included from an initial search of 3780 papers. All 4 studies were retrospective cohort studies comparing outcomes of SP versus DP LLIF. A total of 349 patients were operated using SP versus 254 using DP. All studies involved reported operating time, estimated blood loss, length of stay, change in segmental lordosis, and complications. From a general perspective, baseline variables were similar in both groups in all the studies and all reported a significant decrease in operative time and length of stays with SP. Conclusions Literature comparing SP versus lateral-then-prone lumbar fusion shows a tendency toward shorter operating time and hospital stays in SP lumbar fusion while maintaining similar perioperative outcomes.

Many efforts are expended to improve health care quality in the surgical treatment of spinal conditions. However, the prevalence of reporting complications in spinal surgeries is highly heterogeneous, which is partially due to the lack of a universal and comprehensive system.A systematic review of the literature was performed in 5 international and indexed spine journals from January to December 2020. All clinical studies that had surgical procedures in any spinal region were classified according to level of evidence, study design, category of spinal condition, and primary outcome. The prevalence and quality of complication reporting were evaluated through a checklist.Of 455 articles screened, complications were reported in 64.2% (292 articles). A significant higher prevalence of reports was observed in randomized compared with nonrandomized studies (P0.05). In 89 articles, at least 1 classification was used to report complications, with 12 different classification systems employed in the total sample. Timing to record complications was as follows: 47 (16.1%) articles reported complications at 30 days, 31 (10.6%) reported complications at 90 days, and 88 (30.1%) reported complications during all follow-ups. In 126 (43.1%) articles, complications were not mentioned.Almost one-third of spine surgical studies did not report complications in their results despite reporting clinical outcomes. The evidence quality of the study was directly related with the reporting of complications. A high heterogeneity regarding complication reporting was seen in the literature.

The hemogram is a routine analysis for equine veterinary practitioners in the assessment of patient clinical status. Reference intervals (RIs) of hematologic constituents vary according to different horse populations and are often described for a particular breed or horse type. The aims of this study were to determine RIs for hematologic constituents in a mixed-breed horse population residing in livery yards in central Spain and evaluate the associations between estimated RIs and multiple phenotypic and management characteristics. A total of 122 healthy horses from different breeds in central Spain were included in the study. RIs were calculated following the American Society for Veterinary Clinical Pathology guidelines. Significant associations between red blood cell (RBC) counts, packed cell volumes (PCVs), hemoglobin (HGB) concentrations, white blood cell (WBC) counts, and phenotypic and management features were evaluated using a novel multiple linear regression model analysis. Reference intervals were 5.8-10.0 × 1012 /L for RBCs, 97-164 g/L for HGB, 0.27-0.46 L/L for PCVs, 37.1-53.6 fL for MCVs, 3.8-10.8 × 109 /L for WBCs, and 76.1-377.9 × 109 /L for platelet counts. The season, discipline, and housing when and where the horses were sampled were factors significantly associated with WBC counts and/or red cell values (HGB, RBC, and PCV). Hematologic RIs for these horses were comparable to the RIs of warm-blooded horses and influenced by husbandry. These location-specific RIs should allow veterinary practitioners to make better-informed decisions for their patients residing in livery yards.

Frailty is a term used to quantify the physiological age of patients. Higher levels of frailty correlate with higher complications and mortality rates after different surgical procedures. The objective of this work is to evaluate the relationship between frailty and the complications and mortality rates after elective spinal surgeries within 90 days.A retrospective observational analytical study of patients older than 18 years with elective spine surgery was performed. The following variables were analyzed differentially according to their Modified Frailty Index (mFI) with a cut-off point of 0,18: age, sex, body mass index, ASA score, details of the procedures, length of stay, complications, unscheduled rehospitalizations, reoperations, and mortality within 90 postoperative days.257 patients were included. Within the 30 complications, 16 occurred in the non-frail group (8%) and 14 in frail patients (24.5%), (p = 0.02). Six complications were infectious in the group of frail patients (10.5%) and 4 in the non-frail patients (2%), (p = 0.009). No significant differences were detected regarding the duration of surgeries, the length of stay or the reoperations, re-hospitalizations or mortality rates.Patients with a modified Frailty Index ≥0,18 who underwent elective spine surgery were 3 times more likely to present complications, particularly, infectious ones.La fragilidad es un término utilizado para cuantificar la edad fisiológica de los pacientes. Niveles más altos de fragilidad se correlacionan con mayores tasas de complicaciones y mortalidad luego diferentes procedimientos quirúrgicos. El objetivo de este trabajo es evaluar la relación entre la fragilidad y la tasa de complicaciones y mortalidad posterior a cirugías columna electivas dentro de los 90 días.Se realizó un estudio analítico observacional retrospectivo de pacientes mayores de 18 años operados de manera electiva en su columna vertebral. Se analizaron las siguientes variables de manera diferencial según su Índice de Fragilidad modificado (IFm) con punto de corte en 0,18: edad, sexo, índice de masa corporal, score de ASA, detalles de los procedimientos, días de internación, complicaciones, reinternaciones, reoperaciones, y mortalidad dentro de los 90 días postoperatorios.Se incluyeron 257 pacientes. De las 30 complicaciones, 16 ocurrieron en el grupo de los no frágiles (8%) y 14 a pacientes frágiles (24,5%), (p= 0,02). Seis complicaciones fueron infecciosas en el grupo de pacientes frágiles (10,5%) y 4 en los no frágiles (2%), (p= 0,009). No se detectaron diferencias significativas en cuanto a la duración de las cirugías, los días de internación, en la tasa de reoperaciones, reinternaciones ni en la mortalidad.Los pacientes operados electivamente de columna con un Índice de Fragilidad Modificado ≥0,18 presentaron una probabilidad 3 veces mayor de presentar complicaciones, particularmente infecciosas.

Background and objective The utility of lung ultrasound as a prognostic tool for patients with acute heart failure is well known, but most studies have been conducted in mixed groups of patients with preserved and reduced ejection fraction. While some subgroup analysis suggests that lung ultrasound is useful regardless of ejection fraction, no specific studies have addressed this question. Our objective is to determine the utility of bedside lung ultrasound as a prognostic tool for patients with preserved ejection fraction, acute heart failure. Material and methods Prospective cohort study with 3-month follow-up after bedside lung ultrasound before discharge in patients hospitalized for acute heart failure with preserved ejection fraction. The number of B lines was determined. Two groups were formed: less than fifteen B lines (unexposed) and fifteen B lines or more (exposed). They were compared in terms of readmission and death attributable to worsening heart failure. Results The exposed group was at higher risk of readmission (HR 2.39, 95% CI 1.12–5.12, P = .024), even after multivariable adjustment (HR 2.46, 95% CI 1.11–5.46, P = .03). Differences between groups in terms of mortality were not statistically significant (HR 1.28, 95% CI .23–6.98). Conclusion Subclinical congestion evaluated with lung ultrasound before discharge is associated with worse prognosis in patients with acute heart failure and preserved ejection fraction. Patients with 15 B lines are 2.5 times more likely to be readmitted for acute heart failure than less congestive patients.

Resumen Antecedentes y objetivo La utilidad de la ecografia como herramienta pronostica en pacientes con insuficiencia cardiaca aguda es conocida, pero la mayoria de estudios han sido realizados en grupos mixtos de pacientes con fraccion de eyeccion preservada y reducida. Si bien algunos analisis de subgrupos sugieren ausencia de diferencias en funcion de la fraccion de eyeccion, no existen estudios especificos que lo confirmen. Nuestro objetivo es determinar la utilidad pronostica de la ecografia a pie de cama en pacientes ingresados por insuficiencia cardiaca y fraccion de eyeccion preservada. Material y metodo Estudio de cohortes prospectivo con seguimiento a 3 meses tras realizacion de ecografia pulmonar previa al alta en pacientes ingresados por insuficiencia cardiaca aguda y fraccion de eyeccion preservada. Se determinan las lineas B presentes al alta. Se constituyen dos grupos: con menos de 15 lineas B (no expuestos) y con 15 o mas (expuestos). Se comparan en terminos de reingreso y muerte debidos a insuficiencia cardiaca. Resultados El grupo expuesto tiene mayor riesgo de reingreso (HR: 2,39; IC 95%: 1,12-5,12; p = 0,024), incluso tras ajuste multivariable (HR: 2,46; IC 95%: 1,11-5,46; p = 0,03). No se ha encontrado asociacion con mortalidad por insuficiencia cardiaca (HR: 1,28; IC 95%: 0,23-6,98). Conclusion La congestion subclinica evaluada con ecografia pulmonar al alta se asocia con peor pronostico en pacientes con insuficiencia cardiaca aguda y fraccion de eyeccion preservada. Los pacientes con 15 o mas lineas B tienen un riesgo 2,5 mayor de reingreso que los pacientes menos congestivos.

Introducción: Las técnicas mínimamente invasivas para tratar las fracturas toracolumbares se han desarrollado con el objetivo de reducir, al mínimo, la morbilidad perioperatoria. El objetivo primario de este estudio fue evaluar los resultados clínicos y radiológicos de una serie de pacientes con diagnóstico de fractura toracolumbar por causa traumática tratados con procedimientos mínimamente invasivos. Materiales y Métodos: Se llevó a cabo un análisis retrospectivo de los datos demográficos, radiológicospre y posoperatorios, y funcionales posoperatorios mediante el índice de Oswestry y la escala analógica visual para dolor, en una serie de pacientes que cumplían los criterios de inclusión. Se registraron las complicaciones y la estancia hospitalaria. Resultados: Se analizaron 15 pacientes (10 hombres) con una edad promedio de 59 años y un seguimiento promedio de 32.9 meses. Los pacientes tenían un dolor promedio posoperatorio de 2/10 y un valor promedio del índice de Oswestry de 14/100. El análisis radiológico mostró un valor promedio preoperatorio de cifosis de 16º, que se corrigió a 10° (p = 0,01). La altura promedio de la vértebra comprometida fue de 18 mm en el preoperatorio y de 21 mm en el último seguimiento (p = 0,02). Hubo tres complicaciones (20%) en tres pacientes. La estancia hospitalaria promedio fue de 9 días. Tres pacientes fueron internados nuevamentedentro de los 90 días de la cirugía. Conclusión: El tratamiento de las fracturas toracolumbares por causa traumática mediante técnicas mínimamente invasivas fue un procedimiento seguro y logró buenos resultados clínicos y radiológicos en el seguimiento a mediano plazo.Nivel de Evidencia: IV

Resumen Objetivos Conocer la prevalencia de enfermedad renal cronica (ERC) y determinar los factores asociados al deterioro de la funcion renal en poblacion asistida en atencion primaria. Pacientes y metodo Estudio transversal y multicentrico realizado en los pacientes basales del estudio IBERICAN (identificacion de la poblacion espanola de riesgo cardiovascular y renal). Se considero ERC a un filtrado glomerular estimado (FGe) Resultados Se incluyeron 7.895 pacientes (edad media 57,9 ± 14,8 anos; 54,5% mujeres). El 14,4% (IC 95%: 13,6-15,1) presentaba ERC; en hombres un 16,1% (IC 95%: 14,9-17,3) y en mujeres un 12,9% (IC 95%: 11,9-14,0). Se observo un aumento continuo de la prevalencia con la edad (24,8% ≥ 65 anos) y con la agregacion de FRCV. Las variables que mas se asociaron a la probabilidad de padecer ERC fueron hipertrofia ventricular izquierda (OR: 1,95; p Conclusiones Catorce de cada 100 pacientes incluidos en el estudio IBERICAN presenta ERC. La prevalencia de ERC afecta a la cuarta parte de pacientes ≥ 65 anos y aumenta exponencialmente con la agregacion de FRCV.

Study Design: Multicentric retrospective study, Level of evidence III. Objective: The objective of this multicentric study was to analyze the prevalence and risk factors of early postoperative complications in adult spinal deformity patients treated with fusion. Additionally, we studied the impact of complications on unplanned readmission and hospital length of stay. Methods: Eight spine centers from 6 countries in Latin America were involved in this study. Patients with adult spinal deformity treated with fusion surgery from 2017 to 2019 were included. Baseline and surgical characteristics such as age, sex, comorbidities, smoking, number of levels fused, number of surgical approaches were analyzed. Postoperative complications at 30 days were recorded according to Clavien-Dindo and Glassman classifications. Results: 172 patients (120 females/52 males, mean age 59.4 ± 17.6) were included in our study. 78 patients suffered complications (45%) at 30 days, 43% of these complications were considered major. Unplanned readmission was observed in 35 patients (20,3%). Risk factors for complications were: Smoking, previous comorbidities, number of levels fused, two or more surgical approaches and excessive bleeding. Hospital length of stay in patients without and with complications was of 7.8 ± 13.7 and 17 ± 31.1 days, respectively ( P 0.0001). Conclusion: The prevalence of early postoperative complications in adult spinal deformity patients treated with fusion was of 45% in our study with 20% of unplanned readmissions at 30 days. Presence of complications significantly increased hospital length of stay.

Background Intravenous drug administration is associated with potential complications, such as phlebitis. The physiochemical characteristics of the infusate play a very important role in some of these problems. Aim The aim of this study was to standardize the dilutions of intravenous drugs most commonly used in hospitalized adult patients and to characterize their pH, osmolarity and cytotoxic nature to better guide the selection of the most appropriate vascular access. Methods The project was conducted in three phases: (i) standardization of intravenous therapy, which was conducted using a modified double-round Delphi method; (ii) characterization of the dilutions agreed on in the previous phase by means of determining the osmolarity and pH of each of the agreed concentrations, and recording the vesicant nature based on the information in literature; and (iii) algorithm proposal for selecting the most appropriate vascular access, taking into account the information gathered in the previous phases. Results In total, 112 drugs were standardized and 307 different admixtures were assessed for pH, osmolarity and vesicant nature. Of these, 123 admixtures (40%), had osmolarity values >600 mOsm/L, pH < 4 or > 9, or were classified as vesicants. In these cases, selection of the most suitable route of infusion and vascular access device is crucial to minimize the risk of phlebitis-type complications. Conclusions Increasing safety of intravenous therapy should be a priority in the healthcare settings. Knowing the characteristics of drugs to assess the risk involved in their administration related to their physicochemical nature may be useful to guide decision making regarding the most appropriate vascular access and devices.

RESUMEN El propósito de este artículo es dar a conocer características del Síndrome Cornelia de Lange con respecto a un caso clínico, en una paciente atendida en el Hospital de Especialidades Carlos Andrade Marín. Introducción: El Síndrome Cornelia de Lange, es un trastorno del desarrollo poco frecuente, heterogéneo genéticamente, que se define en su forma clásica por hipo crecimiento antenatal y postnatal, microcefalia, rasgos faciales distintivos, sinofridia e hirsutismo, retraso mental y micromelia. A continuación, se resumirá datos de una paciente con diagnóstico de este síndrome y algunas de sus complicaciones. Caso clínico: Paciente lactante mayor con antecedente de retraso en el crecimiento prenatal, fenotípicamente presenta características clásicas de Síndrome de Cornelia Lange. Su diagnóstico temprano permitió identificar complicaciones y que la niña reciba tratamiento multidisciplinario, desafortunadamente la niña falleció por una obstrucción intestinal con posterior parada cardíaca. Discusión: Debido a que es un Síndrome con características interesantes y por la poca información disponible en el país consideramos se debe continuar con la investigación y reporte de casos de esta patología. Conclusiones: Se hace necesario realizar medicina preventiva desde el momento de la gestación, con diagnóstico oportuno y preciso para conseguir un tratamiento multidisciplinario eficaz que evite complicaciones y el posible deceso de los pacientes con SCdL.

Introduction:Heart transplant after Fontan completion poses a unique surgical challenge. Twenty patients are presented, stressing the technical hints performed in the five anastomoses to match the graft in the recipient.Methods:Data are collected from 20 Fontan patients between 2013 and 2019. Age (13 years), weight (37 kg.), and time interval between Fontan and transplant (7 years) are presented as median. Extracardiac conduit (size 18/20) was implanted in 15 patients, whereas atrio-pulmonary connection was performed in 4 and lateral tunnel in 1. Six patients developed protein-losing enteropathy. Seventeen stents had been previously deployed.Results:The five anastomoses underwent some changes. Left atrium once, aorta 9 times, superior vena cava 7 times, pulmonary branches 15 times, and inferior vena cava 12 times. Follow-up was complete for a median of 42 months (range 6–84). Two patients died. ECMO was needed in six cases for pulmonary hypertension. Four patients had collateral vessels occluded in the cath lab, and stents were placed in superior vena cava (1) and aorta (1) post-transplant. Protein-losing enteropathy was resolved in five patients. Interestingly, one patient was on a systemic assist device before transplant (Levitronix) and right assistance (ECMO) afterwards.Conclusions:Transplant in Fontan patients is actually challenging. Hints in every of the five proposed anastomoses must be anticipated, including stents removal. Extra tissue from the donor (innominate vein, aortic arch, and pericardium) is strongly advisable. ECMO for right ventricular dysfunction was needed in nearly one-third of the cases. Overall results can match other transplant cohorts.

Resumen: El 11 de marzo de 2020, la Organización Mundial de la Salud (OMS) declaró como pandemia a la Covid-19. Esta nueva situación ha provocado que los ciudadanos de todo el mundo estén confinados en sus hogares. En España, uno de los países más fuertemente golpeados por el virus, sus ciudadanos se mantienen recluidos en sus casas desde el día 14 de marzo, fecha en la cual se decretó el estado de alarma. Este confinamiento ha conllevado, entre otras cosas (aislamiento social, baja exposición a la luz solar, etc.), una disminución drástica de la actividad física diaria. Debido a que la falta de ejercicio físico o la mala ejecución de este empeora la salud general de las personas, los profesionales de las ciencias de la actividad física y el deporte (CCAFD) cobran importancia estos días. El objetivo del presente estudio fue recabar y conocer las opiniones de diferentes profesionales de la salud (médicos, podólogos, fisioterapeutas, investigadores, etc.) sobre la importancia presente y futura del profesional en CCAFD en la sociedad. Para conseguir el objetivo propuesto, se llevaron a cabo entrevistas semiestructuradas en profesionales de la salud (n=33). Los resultados mostraron que el 72,7% de la muestra consideró que el profesional en CCAFD está poco reconocido por las autoridades, asimismo el 60,6% opinó que no están reconocidos por la sociedad. Las conclusiones principales son que se debería de considerar la inclusión de los profesionales en CCAFD en la sanidad pública, así como la regulación de su profesión para evitar el intrusismo laboral.

Background: Treatment of amblyopia in esotropic subjects with accommodative component currently consists of optical correction and subsequent occlusion, or penalisation, of the dominant eye. This treatment obtains a good outcome in visual acuity but poor outcomes in binocular vision. An intervention protocol that could improve the outcome of conventional treatment is presented. Methods: A retrospective study in subjects with amblyopia associated with both fully accommodative and partially accommodative esotropia is presented. Subjects were refracted under cycloplegia and treated with occlusion (passive therapy). Subjects who did not achieve orthotropia through optical correction (partially accommodative esotropia) performed an active therapy (full‐time prismatic correction and subsequent fusional vergence therapy or surgery in larger angles > 12 prism dioptres). After treatment, the subjects were examined by a masked optometrist in an external ophthalmology clinic. Results: Twenty‐six subjects (12 males and 14 females) aged from six to 13 years (median 8.50; interquartile range [IQR] 3) were included. Median age of detection was three years (IQR 1). All the subjects were hyperopic. In the baseline, median best‐corrected visual acuity of the amblyopic eye was 0.40 logMAR (IQR 0.30) and 0.00 logMAR (IQR 0.01) in the dominant eye. After the treatment, the median best‐corrected visual acuity in the amblyopic eye was 0.06 logMAR (IQR 0.08). These differences were statistically significant (p

BACKGROUND Theileria equi and Babesia caballi cause equine piroplasmosis (EP), one of the most important tick-borne diseases of horses due to its high negative impact to the equine industry. Although infections with these parasites have been reported for decades in Spain, epidemiological studies have only been carried out in certain regions. OBJECTIVES To determine the (sero)prevalence of these parasites in asymptomatic horses nationwide in Spain and to identify potential individual and environmental factors associated with seropositivity to EP. STUDY DESIGN Sample size was calculated according to the horses registered in Spain in 2013 and by autonomous community using a random stratified sampling. A questionnaire was used to collect data on factors associated with EP seropositivity. METHODS Serological (cELISA and complement fixation test) and molecular (real-time PCR) analyses were carried out in 740 horses. Risk factors were identified computing two independent logistic regression models with the collated data. RESULTS Antibodies against EP were detected in 42.9% (95% CI 39.4-46.5) of horses, whereas 30.3% (95% CI 27.0-33.6) were EP positive by PCR. A substantial strength of agreement (k = 0.721) was estimated between serological tests. Exposure to T. equi was significantly higher than to B. caballi and the highest (sero)prevalence was detected in the northern communities. Increasing horse age, presence of ticks and contact with cows were factors related to EP seropositivity in the horses, whereas tetanus vaccination and fairs attendance were associated with lower seropositivity. CONCLUSIONS Almost half of the horses residing in Spain had antibodies against EP or circulating parasitaemia. Appropriate prevention measures and implementation of a EP surveillance programme should be considered in order to reduce and control the infection.

Varied detection methods have resulted in conflicting reports on the prevalence of cardiac disease in Duchenne and Becker muscular dystrophy carriers (MDC).We performed a prospective cohort study of 77 genetically-confirmed MDC mothers, 22 non-carrier mothers, and 25 controls. All participants underwent Cardiopulmonary Exercise Testing (CPET) and Cardiac Magnetic Resonance imaging (CMR).25% of carriers had ventricular ectopy in recovery of exercise (RecVE) as compared to 1 non-carrier and no controls (p = .003). No difference in age or maximal oxygen consumption was noted. 11 carriers had abnormal (55%) left ventricular ejection fraction by CMR. Evidence of late gadolinium enhancement (LGE) was noted in 48% of MDC, 1 non-carrier patient and no control subjects (p .0001). Subset analysis of LGE+ and LGE- subjects revealed differences in age (44.1 v 38.6 yrs.; p = .005), presence of RecVE, (38.9% v 10.5%, p = .004), and high serum creatine kinase (CK) (289 U/l; 52.8% v 31.6%, p = .065).We describe the prevalence of disease using CPET and CMR in genetically-proven MDC. 49% of carriers had fibrosis, opposed to 5% of non-carriers, highlighting the importance of genetic testing in this population. Despite cardiomyopathy, functional assessment by treadmill was normal, illustrating the discrepancy in cardiac and skeletal muscle impacts. Age, RecVE and serum CK appear to have an important role in predicting cardiomyopathy. Serum CK levels suggest that a systemic higher global disease severity and not tissue heterogeneity may be the etiology for greater cardiac disease and relatively spared skeletal muscle disease in this population. Clinical Trial Registration https://clinicaltrials.gov/ct2/show/NCT02972580?term=mendellcond=Duchenne+Muscular+Dystrophyrank=5; ClinicalTrials.gov Identifier: NCT02972580.

Background The optimal duration of antibiotic treatment for community-acquired pneumonia (CAP) is not well established. The aim of this study was to assess the impact of reducing the duration of antibiotic treatment on long-term prognosis in patients hospitalized with CAP. Methods This was a multicenter study assessing complications developed during 1 year of patients previously hospitalized with CAP who had been included in a randomized clinical trial concerning the duration of antibiotic treatment. Mortality at 90 days, at 180 days and at 1 year was analyzed, as well as new admissions and cardiovascular complications. A subanalysis was carried out in one of the hospitals by measuring C-reactive protein (CRP), procalcitonin (PCT) and proadrenomedullin (proADM) at admission, at day 5 and at day 30. Results A total of 312 patients were included, 150 in the control group and 162 in the intervention group. Ninety day, 180 day and 1-year mortality in the per-protocol analysis were 8 (2.57%), 10 (3.22%) and 14 (4.50%), respectively. There were no significant differences between both groups in terms of 1-year mortality (p = 0.94), new admissions (p = 0.84) or cardiovascular events (p = 0.33). No differences were observed between biomarker level differences from day 5 to day 30 (CRP p = 0.29; PCT p = 0.44; proADM p = 0.52). Conclusions Reducing antibiotic treatment in hospitalized patients with CAP based on clinical stability criteria is safe, without leading to a greater number of long-term complications.

espanolIntroduccion. La neumonia por SARS-CoV-2 genera un grave impacto en el ambito sociosanitario en todo el mundo. Es imperativo aunar esfuerzos para diagnostico, terapeutica e intentar predecir sus secuelas. La ecografia pulmonar es una tecnica estrategica para valorar lesiones, evolucion y posiblemente tiene valor pronostico. Objetivos. Determinar los hallazgos ecograficos en pacientes con neumonia por SARS-CoV-2 en la red de atencion primaria, segun patron de lineas B o consolidativo, desde el inicio de los sintomas hasta su resolucion clinica. Metodologia del estudio. Estudio observacional, prospectivo, multicentrico; se incluiran pacientes con diagnostico clinico o confirmado por PCR que acuden a los servicios de atencion primaria. Se realizara ecografia pulmonar. El periodo de estudio: mayo-diciembre del 2020, hasta alcanzar un tamano muestral de 1.000. Se hara seguimiento clinico, analitico y ecografico y se correlacionaran los hallazgos con la evolucion. Los resultados de este estudio contribuiran a caracterizar las lesiones pulmonares segun fase evolutiva y a estratificar a la poblacion por grupos de riesgo en funcion del pronostico. EnglishIntroduction. SARS-CoV-2 pneumonia generates a severe impact in the socio-health field worldwide, it is imperative to join efforts for diagnosis, therapy and try to predict its sequelae; Pulmonary ultrasound is a strategic technique to assess lesions, evolution, and possibly has prognostic value. Objectives. To determine the ultrasound findings in patients with Pneumonia due to SARS-COV-2 in the Primary Care Network, according to the B-line or consolidative pattern, from the onset of symptoms to their clinical resolution. Study methodology. Observational, prospective, multicenter study; Patients with a clinical diagnosis or confirmed by PCR who go to the Primary Care services will be included. A lung ultrasound will be performed. The study period: May-December 2020, patients will be included until reaching a sample size of 1000. Clinical, analytical and ultrasound follow-up, correlating findings with evolution. The results of this study will help to characterize lung lesions according to evolutionary phase and to stratify the population by risk group looking at prognosis.

The number of potential pediatric heart transplant recipients continues to exceed the number of donors, and consequently the waitlist mortality remains significant. Despite this, around 40% of all donated organs are not used and are discarded. This document (62 authors from 53 institutions in 17 countries) evaluates factors responsible for discarding donor hearts and makes recommendations regarding donor heart acceptance. The aim of this statement is to ensure that no usable donor heart is discarded, waitlist mortality is reduced, and post-transplant survival is not adversely impacted.

[EN] Myotonic Dystrophy Type 1 (DM1) is a multisystemic disease that affects gray and white matter (WM) tissues. WM changes in DM1 include increased hyperintensities and altered tract integrity distributed in a widespread manner. However, the precise temporal and spatial progression of the changes are yet undetermined. MRI data were acquired from 8 adult- and late-onset DM1 patients and 10 healthy controls (HC) at two different timepoints over 9.06 years. Fractional anisotropy (FA) and mean diffusivity (MD) variations were assessed with Tract-Based Spatial Statistics. Transversal and longitudinal intra- and intergroup analyses were conducted, along with correlation analyses with clinical and neuropsychological data. At baseline, reduced FA and increased MD values were found in patients in the uncinate, anterior-thalamic, fronto-occipital, and longitudinal tracts. At follow-up, the WM disconnection was shown to have spread from the frontal part to the rest of the tracts in the brain. Furthermore, WM lesion burden was negatively correlated with FA values, while visuo-construction and intellectual functioning were positively correlated with global and regional FA values at follow-up. DM1 patients showed a pronounced WM integrity loss over time compared to HC, with a neurodegeneration pattern that suggests a progressive anterior–posterior disconnection. The visuo-construction domain stands out as the most sensitive neuropsychological measure for WM microstructural impairment. The present study has been supported by funding from the Institute of Health Carlos III co-founded by Fondo Europeo de Desarrollo Regional-FEDER [Grant Numbers PI17/01231 and PI17/01841], CIBERNED (Grant Number: 609), the Basque Government [SAIO08-PE08BF01] and the University of the Basque Country (Neurosciences group: GIU20-057). BC was supported by a predoctoral grant from the Basque Government [PRE-2020-1-0187]. AJM was supported by a predoctoral grant from the Basque Government [PRE-2019-1-0070]. JG was supported by a predoctoral grant from the University of the Basque Country [PIF20/238].

We investigated whether the difference of antigen tube 2 (TB2) minus antigen tube 1 (TB1) (TB22TB1) of the QuantiFERON-TB gold plus test, which has been postulated as a surrogate for the CD81 T-cell response, could be useful in identifying recent tuberculosis (TB) exposure. We looked at the interferon gamma (IFN-g) responses and differences in TB2 and TB1 tubes for 686 adults with QFT-plus positive test results. These results were compared among groups with high (368 TB contacts), low (229 patients with immune-mediated inflammatory diseases [IMID]), and indeterminate (89 asylum seekers or people from abroad [ASPFA]) risks of recent TB exposure. A TB2-TB1 value.0.6 IU.ml(-1) was deemed to indicate a true difference between tubes. In the whole cohort, 13.6%, 10.9%, and 11.2% of cases had a TB2>TB1 result in the contact, IMID, and ASPFA groups, respectively (P = 0.591). The adjusted odds ratios (aORs) for an association between a TB2-TB1 result of >0.6 IU.ml(-1) and risk of recent exposure versus contacts were 0.71 (95% confidence interval [CI], 0.31 to 1.61) for the IMID group and 0.86 (95% CI, 0.49 to 1.52) for the ASPFA group. In TB contact subgroups, 11.4%, 15.4%, and 17.7% with close, frequent, and sporadic contact had a TB2>TB1 result (P = 0.362). The aORs versus the close subgroup were 1.29 (95% CI, 0.63 to 2.62) for the frequent subgroup and 1.55 (95% CI, 0.67 to 3.60) for the sporadic subgroup. A TB2-TB1 difference of.0.6 IU.ml(-1) was not associated with increased risk of recent TB exposure, which puts into question the clinical potential as a proxy marker for recently acquired TB infection. IMPORTANCE Contact tuberculosis tracing is essential to identify recently infected people, who therefore merit preventive treatment. However, there are no diagnostic tests that can determine whether the infection is a result of a recent exposure or not. It has been suggested that by using the QuantiFERON-TB gold plus, an interferon gamma (IFN-gamma) release assay, a difference in IFN-gamma production between the two antigen tubes (TB2 minus TB1) of.0.6 IU.ml(-1) could serve as a proxy marker for recent infection. In this large multinational study, infected individuals could not be classified according to the risk of recent exposure based on differences in IFN- g in TB1 and TB2 tubes that were higher than 0.6 IU.ml(-1). QuantiFERON-TB gold plus is not able to distinguish between recent and remotely acquired tuberculosis infection, and it should not be used for that purpose in contact tuberculosis tracing. Funding Agencies|Department of Clinical Sciences of the University of Barcelona

Study Design: Diagnostic study, level of evidence III. Objectives: Low back pain is a common cause of disability among elderly patients. Percutaneous discoplasty has been developed as a tool to treat degenerative disease when conservative management is not successful. Indications for this procedure include low back pain and the presence of vacuum phenomenon. The objective of this study was to describe a new classification of vacuum phenomenon based on computed tomography scan in order to improve the indications for percutaneous discoplasty. Methods: We developed a classification of vacuum phenomenon based on computed tomography scan images. We describe 3 types of vacuum based on the relationship between vacuum and the superior/inferior endplates and 2 subtypes based on the presence of significant subchondral sclerosis. A validation study was conducted selecting 10 orthopedic residents with spine surgery training to analyze 25 vacuum scenarios. Inter- and intraobserver reliabilities were assessed through the Fleiss’s and Cohen’s kappa statistics, respectively. Results: The overall Fleiss’s κ value for interobserver reliability was 0.85 (95% CI 0.82-0.86) in the first reading and 0.93 (95% CI 0.92-0.95) in the second reading. Cohen’s κ for intraobserver reliability was 0.88 (95% CI 0.77-0.99). Conclusion: The new classification has shown almost perfect inter- and intraobserver reliabilities for grading the vacuum phenomenon and could be an important tool to improve the indications for percutaneous cement discoplasty.

Introduction Levator ani avulsion rates after assisted vaginal delivery have been reported in the literature. However, there are no definitive data regarding the association between overdistention and assisted vaginal delivery. Therefore, our aim is to report overdistention rates after assisted vaginal delivery with a postpartum ultrasound examination. Materials and methods This multicenter study involved a retrospective analysis of data from primiparous women (n = 602) who had previously been recruited at three tertiary hospitals between January 2015 and January 2017. Overdistention was assessed at 6 months postpartum using three-/four-dimensional transperineal ultrasound. Patients with levator ani muscle avulsion were excluded. Overdistention was defined as a levator hiatal area ≥ 25 cm2 on Valsalva. Results Of the 602 primiparous patients, 250 patients who satisfied the inclusion criteria (139 patients who underwent forceps delivery and 111 patients who underwent vacuum delivery) were evaluated. Overdistention occurred in 20% (50 of 250) of these patients. Overdistention was observed for 1% (1/111) of vacuum deliveries and 35.3% (49 of 139) of forceps deliveries. We found an increased risk of overdistention following forceps delivery compared to vacuum delivery, with a crude odds ratio (OR) of 59.9 (95% confidence interval [CI]: 8.1, 442.2) and an adjusted OR (adjusted for maternal age, second-stage duration, and head circumference) of 17.6 (95% CI: 2.3, 136.7). Conclusions Postpartum overdistention occurred for 20% of assisted vaginal deliveries, with an increased risk of overdistention following forceps delivery compared to vacuum delivery.

Despite remarkable improvements in survival of childhood acute lymphoblastic leukemia (ALL), nonresponding or relapsing patients still represent one of the most frequent causes of death by disease in children. Accurate patient risk stratification based on genetic markers could increases survival rates. miRNAs can represent novel candidates with diagnostic, predictive and prognostic potential; however, many groups investigated their involvement with contradictory results. Aim: To clarify the role of miRNAs as biomarkers through a systematic review. Results: From a revision of 45 manuscripts, we found that miR-128 and miR-181 overexpression could represent markers for ALL diagnosis and underexpression of miR-708 and miR-99a could be markers for bad prognosis. Conclusion: These signatures could refine classification and risk stratification of patients and improve ALL outcome.

OBJECTIVES The objective of this study is to investigate a multicenter study to establish if differences exist in the levator ani muscle avulsion (LAM) rates between deliveries performed with Malmstrom's vacuum and the Kiwi vacuum. STUDY DESIGN A prospective, multicenter observational study with 199 primiparous subjects was performed. All patients had undergone vaginal delivery by vacuum (Malmstrom's or Kiwi). Avulsion was defined as an abnormal insertion of LAM in the lower pubic branch in the multiplanar mode, as identified in the three central sections by transperineal 3/4D echography 6 months after delivery. The area of ​​the levator hiatus was measured in the plane of minimum dimensions at rest, during the Valsalva maneuver and during contraction. RESULTS LAM avulsion occurred in 33.1% of cases in which Malmstrom's vacuum was used and in 29.4% of cases in which the Kiwi vacuum was used (the difference was not statistically significant), which resulted in a crude odds ratio (OR) of 0.977 (0.426, 2.241; P = .957) and an adjusted OR of 2.90 (0.691; 12.20; P = .146). Women in the Malmstrom's vacuum group had a larger LHA at rest 14.77 vs 12.64 cm2 ; P = .001) and at maximum contraction (13.41 vs 10.83 cm2 ; P

Glucose-6-phosphate dehydrogenase deficiency (D-G6PD) is a common erythroenzymopathy that needs to be addressed as an important public health issue. Proper population monitoring is needed to anticipate clinical complications. A joint venture between Genomi-k (a Mexican company focused on newborn screening) and several university researchers conducted a retrospetive study for D-G6PD based on 156,152 newborn screening reports belonging to the Mexican population comprising a period of 10 years. We identified 540 male newborns affected with this deficiency, representing an incidence of 6.78 cases per 1,000 newborn males. A single double mutation of G202A:A376G was detected in 97.22% of cases. In regions where there is an absence of a national centralized health data for D-G6PD, information from a non-probabilistic large population sample can be used as a national incidence subrogate.

El osteosarcoma “tipo osteoblastoma”, una variante menos agresiva del osteosarcoma, es una enfermedad poco frecuente y representa un desafío diagnóstico tanto clínico como histopatológico. Se han publicado escasos reportes de casos de este tumor.Presentamos a un paciente de 16 años con un osteosarcoma “tipo osteoblastoma” localizado en la columna cervical. La biopsia ósea bajo tomografía reveló una lesión con un patrón de crecimiento permeativo, con sospecha de osteosarcoma “tipo osteoblastoma”. Se realizó una espondilectomía total en bloque mediante un doble abordaje. Se describen el caso clínico, la secuencia diagnóstica, la técnica quirúrgica y el seguimiento a 10 años. ABSTRACT Osteoblastoma-like osteosarcoma; a less aggressive variant of osteosarcoma;is a rare entity and represents a clinical and histopathological diagnostic challenge. We have found few reports of cases of this tumor in the literature. In this case we describe an osteoblastoma-like osteosarcoma located in the cervical spine in a 16-year-old patient. Tomography guided bone biopsy showed a lesion with a permeative growth pattern with suspicion of an osteoblastoma-like osteosarcoma. A total block spondylikectomy wasperformed through a double approach. We present the clinical case, the diagnostic sequence, the surgical technique and 10-year follow-up.

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.

I-MOVE-COVID-19 primary care study team (in addition to authors above): Nick Andrews, Jamie Lopez Bernal, Heather Whitaker, Caroline Guerrisi, Titouan Launay, Shirley Masse, Sylvie van der Werf, Vincent Enouf, John Cuddihy, Adele McKenna, Michael Joyce, Cillian de Gascun, Joanne Moran, Ana Miqueleiz, Ana Navascués, Camino Trobajo-Sanmartín, Carmen Ezpeleta, Paula López Moreno, Javier Gorricho, Eva Ardanaz, Fernando Baigorria, Aurelio Barricarte, Enrique de la Cruz, Nerea Egüés, Manuel García Cenoz, Marcela Guevara, Conchi Moreno-Iribas, Carmen Sayón, Verónica Gomez, Baltazar Nunes, Rita Roquete, Adriana Silva, Aryse Melo, Inês Costa, Nuno Verdasca, Patrícia Conde, Diogo FP Marques, Anna Molesworth, Leanne Quinn, Miranda Leyton, Selin Campbell, Janine Thoulass, Jim McMenamin, Ana Martínez Mateo, Luca Basile, Daniel Castrillejo, Carmen Quiñones Rubio, Concepción Delgado-Sanz, Jesús Oliva. The I-MOVE-COVID-19 network collates epidemiological and clinical information on patients with coronavirus disease (COVID-19), including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virological characterisation in 11 European countries [1]. One component of I-MOVE-COVID-19 is the multicentre vaccine effectiveness (VE) study at primary care/outpatient level in nine European study sites in eight countries. We measured overall and product-specific COVID-19 VE against symptomatic SARS-CoV-2 infection among those aged 65 years and older. We also measured VE by time since vaccination. This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 101003673. info:eu-repo/semantics/publishedVersion

Background and Objective:The most common adverse events following Alemtuzumab include adverse infusion reactions, infections and autoimmune disorders. Skin adverse events are common during infusion but there are few reported cases of long-term skin autoimmune disease.Methods:A retrospective case series of patients developing long-term autoimmune skin disorders following alemtuzumab administration in a tertiary care hospital.Results:Of 133 patients treated with alemtuzumab, eight patients (6.02%) developed nine autoimmune cutaneous adverse events, including four events of alopecia areata, two of vitiligo, two of chronic urticaria and one of inflammatory atrichia. Three of them occurred between the first and the second infusion.Discussion:The lesions described are secondary to autoimmune disorders, probably related to immune dysregulation due to a differential lymphocyte repopulation following alemtuzumab. Autoimmune cutaneous adverse events may be frequent, and it would be recommended to monitor its appearance in order to treat them.

Background The American National College Health Association reports that college students have frequent, condomless sex. Student health and wellness clinics (SHWC) offer sexual health services, but few have dedicated sexual health clinics (SHC). We evaluated screening service use at a university SHWC after implementation of a SHC two half-days per week. Methods This was a retrospective analysis of data from patients receiving sexual health screening at the University of Alabama at Birmingham (UAB) SHWC from 2015 to 2019. Demographic variables and rates of STIs were extracted from the electronic medical record and were compared by clinic (SHC vs. SHWC). Univariate models were fit, and multi-variable models will be fit, selecting variables with p values of 0.1 or less. Odds ratios with corresponding 95% confidence intervals for univariate analysis are presented. Results A total of 5025 STI screenings were performed. Males (OR 4.13; 3.61–4.72), undergraduates (OR 1.33; 1.15–1.54), and persons reporting sex with the same sex (OR 1.88; 1.56–2.28), were significantly more likely to seek care at the SHC. Students with symptoms were more likely to seek care at the SHWC (OR 0.53; 0.47–0.61), while persons who reported contact with STIs were more likely to seek care at the SHC (OR 2.88; 2.22–3.74). The overall percentage of positive screenings was 9.3% for chlamydia (CT), 3.0% for gonorrhea (GC), 0.8% for trichomoniasis (TV), 0.7% for syphilis, and 0.3% for HIV with higher percentages of positive for CT (OR 1.60; 1.30–1.96) and GC (OR 2.02; 1.44–2.85) in the SHC. Conclusion Embedding a dedicated SHC within a university SHWC may expand populations reached for STI screening. With higher percentages of patients testing positive for CT and GC, a SHC may allow for greater diagnosis and treatment of STIs in general screening and persons presenting as contacts.

Background Transgender women (TGW) are significantly impacted by HIV in the Southeastern U.S., where HIV prevalence is the highest in the nation. Uptake of HIV Pre-Exposure Prophylaxis (PrEP) is low among TGW nationwide. We aimed to explore barriers to PrEP awareness and uptake among TGW in the Southeastern U.S. Methods HIV-negative TGW ≥18 years old in Alabama participated in virtual focus groups (FGs) exploring barriers and beliefs related to HIV risk and PrEP among TGW in the Southeastern U.S. Participants were recruitment via social media, community outreach, and financial incentives to participants for referrals. A trained qualitative researcher coded transcripts after each FG and iteratively amended the FG protocol as new themes emerged. Results Between July 2020 and December 2020, 17 TGW participated in 4 FGs. Mean participant age was 28.1±8.5 years. Black, non-Hispanic and white, non-Hispanic TGW represented 41% (n=7) and 47% (n=8) of participants, respectively. Fifteen participants had heard of PrEP but only one had ever taken PrEP. Participants identified several barriers to PrEP use, including frustration regarding the conflation of transgender identity and HIV risk, lack of appropriate transgender representation in PrEP advertising, concerns for drug-drug interactions between PrEP and hormone replacement therapy, the perception that PrEP is primarily meant for cisgender men who have sex with men, and limited trans-affirming healthcare resources. Participants expressed that sexual risk behaviors, rather than transgender identity, should be central to healthcare providers’ discussion of PrEP with TGW. Conclusion Nuanced messaging from healthcare providers and media is necessary to properly educate and engage TGW in HIV prevention strategies such as PrEP. A one-size-fits-all approach is inappropriate given the diversity among TGW regarding sexual behaviors and HIV risk factors. Discussions between TGW and healthcare providers should focus on individual HIV risk and patient concerns when determining whether or not PrEP is appropriate.

To report clinical results after percutaneous cement discoplasty (PCD) in a multicentric case series with a minimum of 2 years of follow-up.Between December 2014 and January 2019, 180 patients with low back pain and advanced degeneration were treated with percutaneous discoplasty in 2 centers. The inclusion criteria were as follows: patients 65 years or older, with mechanical low back pain with or without spinal stenosis, who did not respond to conservative management. Patients were divided into 3 groups: group 1: patients without previous spine surgeries who underwent PCD, group 2: patients with previous spine surgeries who underwent PCD, and group 3: patients with/without previous surgery who underwent PCD plus decompression surgery. Clinical and radiological analyses were performed as well as complication and readmission rates.A total of 156 patients (74% female; mean age, 75.8 ± 5.7 years; mean body mass index, 29.9 ± 5.2) were included in our study. Overall preoperative visual analog score (VAS) and Oswestry Disability Index (ODI) were 7.8 ± 0.9 and 68.1 ± 9.6, respectively. At 2 years of follow-up, mean VAS improvement was 3.56 (95% confidence interval: 3.92-3.20; P0.0001) and mean ODI improvement was 17.18 (95% confidence interval: 19.52-14.85; P0.0001), showing a significant and sustained improvement in both scores. In addition, 84% of patients reached both VAS and ODI minimum important clinical difference at the final follow-up. Finally, 5.7% of patients suffered major complications 30 days postoperatively.PCD showed significant improvement of VAS and ODI scores at 2 years of follow-up with relatively low rate of complications.

Fetal growth restriction (FGR) is one of the most important obstetric pathologies. It is frequently caused by placental insufficiency. Previous studies have shown a relationship between FGR and impaired new-born neurodevelopment, although the molecular mechanisms involved in this association have not yet been completely clarified. Reelin is an extracellular matrix glycoprotein involved in development of neocortex, hippocampus, cerebellum and spinal cord. Reelin has been demonstrated to play a key role in regulating perinatal neurodevelopment and to contribute to the emergence and development of various psychiatric pathologies, and its levels are highly influenced by pathological conditions of hypoxia. The purpose of this article is to study whether reelin levels in new-borns vary as a function of severity of fetal growth restriction by gestational age and sex. We sub-grouped fetuses in: normal weight group (Group 1, n = 17), FGR group with normal umbilical artery Doppler and cerebral redistribution at middle cerebral artery Doppler (Group 2, n = 9), and FGR with abnormal umbilical artery Doppler (Group 3, n = 8). Our results show a significant association of elevated Reelin levels in FGR fetuses with cerebral blood redistribution compared to the normal weight group and the FGR with abnormal umbilical artery group. Future research should focus on further expanding the knowledge of the relationship of reelin and its regulated products with neurodevelopment impairment in new-borns with FGR and should include larger and more homogeneous samples and the combined use of different in vivo techniques in neonates with impaired growth during their different adaptive phases. © 2021 by the authors. Licensee MDPI, Basel, Switzerland.

We conducted a prospective population-based cohort study to assess risk factors for infection, hospitalization, and death from SARS-CoV-2. The study comprised the people covered by the Health Service of Navarre, Spain. Sociodemographic variables and chronic conditions were obtained from electronic healthcare databases. Confirmed infections, hospitalizations, and deaths from SARS-CoV-2 were obtained from the enhanced epidemiological surveillance during the second SARS-CoV-2 epidemic surge (July–December 2020), in which diagnostic tests were widely available. Among 643,757 people, 5497 confirmed infections, 323 hospitalizations, 38 intensive care unit admissions, and 72 deaths from SARS-CoV-2 per 100,000 inhabitants were observed. A higher incidence of confirmed infection was associated with people aged 15–29 years, nursing home residents, healthcare workers, people born in Latin America or Africa, as well as in those diagnosed with diabetes, cardiovascular disease, chronic obstructive pulmonary disease (COPD), chronic kidney disease, dementia, severe obesity, hypertension and functional dependence. The risk of hospitalization in the population was associated with males, higher age, nursing home residents, Latin American or African origin, and those diagnosed with immunodeficiency, diabetes, cardiovascular disease, COPD, asthma, kidney disease, cerebrovascular disease, cirrhosis, dementia, severe obesity, hypertension and functional dependence. The risk of death was associated with males, higher age, nursing home residents, Latin American origin, low income level, immunodeficiency, diabetes, cardiovascular disease, COPD, kidney disease, dementia, and functional dependence. This study supports the prioritization of the older population, nursing home residents, and people with chronic conditions and functional dependence for SARS-CoV-2 prevention and vaccination, and highlights the need for additional preventive support for immigrants.

Resumen Introduccion El sindrome de pseudotumor cerebri (SPTC) en pacientes prepuberales presenta caracteristicas que lo diferencian respecto a su presentacion en la etapa pospuberal. Nuestro objetivo es describir las caracteristicas de los pacientes diagnosticados de SPTC pediatrico en nuestro centro y compararlas en funcion de su estado puberal. Pacientes y metodos Se incluyeron a los pacientes diagnosticados de SPTC en un hospital de tercer nivel entre los anos 2006 y 2019 con edades comprendidas entre uno y 18 anos que cumplieran los criterios diagnosticos actualizados del SPTC. Se clasificaron en funcion de su estado puberal y peso corporal. Posteriormente, se analizaron los datos de las punciones lumbares, estudios de neuroimagen, valoraciones oftalmologicas, asi como el regimen terapeutico recibido a lo largo de su seguimiento. Resultados Se recogieron 28 pacientes, 22 prepuberales y seis pospuberales, con edad media de 9,04 ± 2,86 anos. El 83,3% de los pacientes pospuberales eran varones presentando sobrepeso/obesidad en el 66,7%. Eran varones el 27% de los pacientes prepuberales, de ellos asociaban sobrepeso el 31,8%. La sintomatologia mas frecuente fue cefalea (89,9%) y vision borrosa (42,9%). Todos los pacientes presentaron papiledema; un 21,4% de los casos presentaron paralisis del VI par. Se identifico un posible desencadenante en un 28,6%. El 19% presentaron recurrencia clinica, siendo todos ellos prepuberales. La resolucion clinica completa se produjo en el 55,6% de los pacientes. Conclusion Pacientes con SPTC presentan menor prevalencia de obesidad en la etapa prepuberal, junto con un mayor porcentaje de etiologias secundarias y tasa de recurrencia que los pacientes pospuberales.

COVID-19 vaccine effectiveness was evaluated in close contacts of cases diagnosed during January–April 2021. Among 20,961 contacts, 7,240 SARS-CoV-2 infections were confirmed, with 5,467 being symptomatic and 559 leading to hospitalisations. Non-brand-specific one and two dose vaccine effectiveness were respectively, 35% (95% confidence interval (CI): 25 to 44) and 66% (95% CI: 57 to 74) against infections, 42% (95% CI: 31 to 52) and 82% (95% CI: 74 to 88) against symptomatic infection, and 72% (95% CI: 47 to 85) and 95% (95% CI: 62 to 99) against COVID-19 hospitalisation. The second dose significantly increased effectiveness. Findings support continuing complete vaccination.

Background To date, no immunological data on COVID-19 heterologous vaccination schedules in humans have been reported. We assessed the immunogenicity and reactogenicity of BNT162b2 (Comirnaty, BioNTech, Mainz, Germany) administered as second dose in participants primed with ChAdOx1-S (Vaxzevria, AstraZeneca, Oxford, UK). Methods We did a phase 2, open-label, randomised, controlled trial on adults aged 18–60 years, vaccinated with a single dose of ChAdOx1-S 8–12 weeks before screening, and no history of SARS-CoV-2 infection. Participants were randomly assigned (2:1) to receive either BNT162b2 (0·3 mL) via a single intramuscular injection (intervention group) or continue observation (control group). The primary outcome was 14-day immunogenicity, measured by immunoassays for SARS-CoV-2 trimeric spike protein and receptor binding domain (RBD). Antibody functionality was assessed using a pseudovirus neutralisation assay, and cellular immune response using an interferon-γ immunoassay. The safety outcome was 7-day reactogenicity, measured as solicited local and systemic adverse events. The primary analysis included all participants who received at least one dose of BNT162b2 and who had at least one efficacy evaluation after baseline. The safety analysis included all participants who received BNT162b2. This study is registered with EudraCT (2021-001978-37) and ClinicalTrials.gov (NCT04860739), and is ongoing. Findings Between April 24 and 30, 2021, 676 individuals were enrolled and randomly assigned to either the intervention group (n=450) or control group (n=226) at five university hospitals in Spain (mean age 44 years [SD 9]; 382 [57%] women and 294 [43%] men). 663 (98%) participants (n=441 intervention, n=222 control) completed the study up to day 14. In the intervention group, geometric mean titres of RBD antibodies increased from 71·46 BAU/mL (95% CI 59·84–85·33) at baseline to 7756·68 BAU/mL (7371·53–8161·96) at day 14 (p

Aims The pharmacokinetic (PK) similarity between MB02, a proposed bevacizumab biosimilar, and reference bevacizumab approved from the USA (US-bevacizumab) and European Union (EU-bevacizumab) was evaluated. Safety and immunogenicity were also assessed. Methods In this phase 1, randomized, double blind, single dose, parallel group study, 114 healthy male volunteers were randomized 1:1:1 to receive a 3 mg/kg intravenous dose of MB02, US-bevacizumab or EU-bevacizumab, and evaluated for 100 days. PK similarity between MB02 and reference bevacizumab was determined using the standard bioequivalence criteria (0.80-1.25) for the area under the serum concentration-time curve from time 0 extrapolated to infinity (AUC(0-∞) ) and the maximum observed serum concentration (Cmax ). Results Baseline demographics were similar across treatment groups. All study drugs exhibited similar PK profile. The 90% confidence interval for the geometric lead square means ratios for the primary parameters AUC(0-∞) and Cmax for MB02, US-bevacizumab and EU-bevacizumab were fully contained within the pre-defined bioequivalence limits for the 3 pairwise comparisons: AUC(0-∞) (MB02:US-bevacizumab 0.998 [0.944 to 1.05]; MB02:EU-bevacizumab 1.07 [1.00 to 1.14]; and US-bevacizumab:EU-bevacizumab 0.934 [0.884 to 0.988]) and Cmax (MB02:US-bevacizumab 0.983 [0.897 to 1.08]; MB02:EU-bevacizumab 1.06 [0.976 to 1.16]; and; US-bevacizumab: EU-bevacizumab 0.926 [0.851 to 1.01]). Treatment emergent adverse events were reported in 87 subjects (76.3%), most being mild and with comparable incidence among treatment groups. Thirty-three subjects (28.9%) reported 56 possibly related treatment emergent adverse events with comparable incidence across treatments, the most frequent being headache (10.5%) and fatigue (3.5%). Anti-drug antibody incidence was low and similar between treatment groups. Conclusions This study demonstrates the PK similarity and bioequivalence of MB02 to the reference bevacizumab, whether approved from USA or EU. The safety and immunogenicity profile of MB02 was shown also to be similar to the bevacizumab reference product (NCT04238663).