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Simple Summary: Heartworm disease is a zoonotic illness primarily affecting dogs and cats, which poses a significant risk to public health. Gran Canaria (Canary Island, Spain) serves as a hyperendemic region for this disease, offering a model for its study. This research aimed to track Dirofilariosis prevalence and distribution among dogs, cats, and residents from 1994 to 2020. Data from 5841 dogs, 1203 cats, and 1604 humans were analyzed, considering geographical and climatic factors. Results revealed a decline in Dirofilaria immitis prevalence over the years: from 67.02% in dogs (1994) to 15.81% (2020), and from 33.03% (2010) to 17.20% (2020) in cats. Human incidence dropped from 18.66% (2008) to 8.27% (2020). Prevalence was highest in temperate cold zone (TC) and temperate mild zone (TM) climates. Despite a decrease in prevalence, Gran Canaria remains hyperendemic. The study underscores the significance of a "One Health" approach and highlights ongoing risks of disease transmission. Dirofilariosis is a zoonotic disease that mainly affects dogs and cats, with a high risk to public health. The island of Gran Canaria (Spain) has been shown to be a hyperendemic area of infection and, therefore, a model for studying the evolution of the disease. The objective of this study was to track the prevalence and distribution of heartworm in dogs, cats, and residents of Gran Canaria from 1994 to 2020, using published and unpublished data. Blood samples from 5841 dogs, 1203 cats, and 1604 humans were collected in the years analyzed, considering geographical and isoclimatic factors. In 1994, a prevalence of Dirofilaria immitis of 67.02% in dogs was reported, while in 2020 it was 15.81%. In cats, the seroprevalence in 2010 was 33.03%, compared to 17.20% in 2020. The incidence of D. immitis in humans in 2008 was 18.66%, while in 2020 it was 8.27%. For all study groups, temperate cold zone (TC) and temperate mild zone (TM) climates had the highest prevalence. Throughout these 20 years, the prevalence of heartworm disease has decreased. Despite this, it continues to be a hyperendemic island. This study highlights the importance of using the "One Health" perspective and the risks of contagion of the disease. [ABSTRACT FROM AUTHOR]

Introduction: Health institutions have the fundamental duty to educate and inform about health, and to promote social empowerment through their messages, which must always be adapted to the public, both socially, culturally and linguistically (LGSP 33/2011). Applying visual thinking to the health information through animation makes it possible to simplify and transform complex content into attractive and simple messages, in a way that facilitates understanding and retention of information by any audience (Okan Gil et al., 2016; Vivas, 2021; Anibueze et al., 2022). This study seeks to determine the use of animation as an informative resource by the Spanish National Health System (SNS) on YouTube, in order to determine the function assigned to this content and the objectives pursued by its dissemination. Methodology: A review was carried out of all the audiovisual content stored on the available official channels, from their creation until 2022, by means of an analytical file with 14 descriptive variables divided into three blocks -identifying elements, descriptive dimension of the content and narrative dimension-. Results: After analysing 18 official channels, a total of 7944 videos were identified, of which 1371 (17.3%) were animations. They are characterised by messages that, beyond informing, aim to educate in health, as they disseminate recommendations and advice to improve people's lives. Discussion and Conclusions: All this shows that institutions are working to adapt their messages to more dynamic and understandable formats, using representations derived from visual thinking. [ABSTRACT FROM AUTHOR]

Introduction: Prognostic markers for fetal transmission of Cytomegalovirus (CMV) infection during pregnancy are poorly understood. Maternal CMV-specific T-cell responses may help prevent fetal transmission and thus, we set out to assess whether this may be the case in pregnant women who develop a primary CMV infection. Methods: A multicenter prospective study was carried out at 8 hospitals in Spain, from January 2017 to April 2020. Blood samples were collected from pregnant women at the time the primary CMV infection was diagnosed to assess the T-cell response. Quantitative analysis of interferon producing specific CMV-CD8+/CD4+ cells was performed by intracellular cytokine flow cytometry. Results: In this study, 135 pregnant women with a suspected CMV infection were evaluated, 60 of whom had a primary CMV infection and samples available. Of these, 24 mothers transmitted the infection to the fetus and 36 did not. No association was found between the presence of specific CD4 or CD8 responses against CMV at the time maternal infection was diagnosed and the risk of fetal transmission. There was no transmission among women with an undetectable CMV viral load in blood at diagnosis. Conclusions: In this cohort of pregnant women with a primary CMV infection, no association was found between the presence of a CMV T-cell response at the time of maternal infection and the risk of intrauterine transmission. A detectable CMV viral load in the maternal blood at diagnosis of the primary maternal infection may represent a relevant biomarker associated with fetal transmission. [ABSTRACT FROM AUTHOR]

Objective: Late presenters (LP) for HIV care are associated with higher morbidity and mortality rates. Our aim was to describe the characteristics associated with LP among adolescents in Spain. Identification of particular features may help in the design of strategies for improvement. Methods: Late‐presenting adolescents diagnosed at 12–19 years of age and enrolled in the Spanish paediatric and adult HIV/AIDS cohorts (CoRIS‐CoRISpe) from 2004 to 2019 were selected. LP were defined as those presenting with CD4 count <350 cells/mm3 or an AIDS‐defining event in the 6 months following HIV diagnosis. Confirmed low CD4 count in the next 3 months and before antiretroviral treatment initiation defined confirmed LP (cLP). Results: Of 410 adolescents newly diagnosed with HIV, 303 (73.9%) had available data for assessing late presentation. Of these, 34.7% were LP and 23.7% were cLP. The median CD4 count for cLP was 235 cells/mm3 (interquartile range 122–285). In a multivariable analysis, adolescents at the highest risk of late presentation were early adolescents (age 12–14 years; odds ratio [OR] 6.50; 95% confidence interval [CI] 2.61–18.2), middle adolescents (age 15–17 years; OR 1.85; 95% CI 0.92–3.59), and adolescents born abroad (OR 1.71; 95% CI 0.97–3.00), particularly those of African origin (OR 3.08; 95% CI 1.38–6.79). Conclusions: One‐quarter of adolescents presented late for HIV care in Spain. Early adolescents, middle adolescents, and those born abroad presented a sevenfold, twofold, and twofold higher risk of being cLP, respectively. Enhancing the awareness of HIV risk and the access to care, especially for younger and foreign adolescents, could help reduce late presentation and tackle the adolescent HIV epidemic. [ABSTRACT FROM AUTHOR]

Simple Summary: Angiostrongylus vasorum (A. vasorum) is the causal agent of canine angiostrongylosis, an emerging disease in Europe. In Spain, A. vasorum mainly affects wild animals (red foxes and wolves), although studies in domestic dogs are scarce but show evidence of an expansion of the disease. The aim of this study was to analyze the presence of A. vasorum in domestic dogs throughout Spain, taking into account that there were still provinces where this canine infection has not been studied. Blood samples from 5544 domestic dogs were collected from January 2020 to March 2022. These samples were tested for the presence of circulating A. vasorum antigens. The overall prevalence of canine angiostrongylosis in Spain was 1.39%. No significant differences were found for sex and age, but significant differences were found for habitat. Infected domestic dogs were reported in most Spanish provinces, with lower prevalence observed for inland provinces and higher prevalence observed for provinces along the coast, where climatic factors seem to be determinant in the establishment of the parasite. Canine angiostrongylosis is an emerging disease caused by Angiostrongylus vasorum, mainly affecting wild carnivores and dogs. In Spain, there are studies reporting infections in foxes, wolves, and badgers in different regions of the country. However, there are hardly any publications on its prevalence in dogs. The aim of this study was to complete and update the epidemiologic map of A. vasorum in dogs in Spain. A total of 5619 canine blood samples from all autonomous cities and provinces of Spain were collected and tested for the presence of circulating A. vasorum antigens. The overall apparent prevalence of canine A. vasorum infection in Spain was 1.39%. No significant differences were found for sex or age, but significant differences between outdoor and indoor/outdoor dogs were found. A high prevalence was also observed in the northern third of the country, where an oceanic climate prevails, being humid and rainy and where abundant vegetation can be found, thus favoring the proliferation of intermediate hosts. The results suggest that A. vasorum canine infections are heterogeneously present in a large part of the territory, demonstrating its expansion throughout the country, and therefore, awareness and prevention campaigns for this disease should be promoted. [ABSTRACT FROM AUTHOR]

Simple Summary: Dirofilaria immitis is a nematode parasite causing heartworm disease worldwide. Spain is one of the southern European countries where the risk of infection in domestic dogs is moderate/high. The aim of this study was to update the epidemiology of canine heartworm and analyse the results based on climate and other geo-environmental factors. For this, 9543 blood samples from dogs from all provinces, autonomous cities and islands that comprise Spain were tested using D. immitis antigen tests. The mean prevalence obtained was 6.47%. Prevalences exceeding 11% were located in the northwestern and southern provinces, in the Balearic and Canary Islands. The presence of positive dogs was described for the first time in provinces and islands where previously no cases of infected dogs had been reported. Considering its zoonotic character, further studies are needed to identify infected animals and to carry out national control programmes for the prevention of heartworm disease. The climate of Spain has favourable characteristics for the development of D. immitis in dogs, being an endemic country. Given that vector-borne diseases are spreading rapidly through Europe, due to factors such as climate change, the expansion of vectors and the increased mobility of reservoir animals, the aim was to update the epidemiology of heartworm in dogs and analyse the results based on climate and other epidemiological and geo-environmental factors. To this aim, 9543 blood samples from dogs from all provinces and autonomous cities of Spain were analysed for the detection of antigens of D. immitis, obtaining a prevalence of 6.47%. The northwestern and southern provinces showed the highest prevalences, as well as in the Balearic and Canary Islands. Prevalences were higher in dogs outdoors. Furthermore, most of the positive dogs were found in regions with high humidity and water availability. This study shows, for the first time, positive cases in provinces and islands where no cases had previously been described and demonstrates the continuous expansion and consolidation of heartworm in Spain. Considering its zoonotic character, the implementation of control and awareness programmes for the prevention of D. immitis in pets is necessary. [ABSTRACT FROM AUTHOR]

The SARS-CoV-2 pandemic has caused an increase in antibiotic use in different settings. We describe the antibiotic prescribing prevalence, associated factors and trends, as well as concomitant bacterial infections in children hospitalized with COVID-19 or multisystemic inflammatory syndrome related to SARS-CoV-2 in Spain. [ABSTRACT FROM AUTHOR]

A retrospective study that compared children younger than 6 months versus older children of a Spanish cohort of patients diagnosed with Kawasaki disease between 2011 and 2016 (Kawa-Race study). From the 598 patients recruited, 42 patients were younger than 6 months (7%) and presented more frequently with an incomplete diagnosis of Kawasaki disease (52.4 vs 27.9%, p = 0.001). Cardiac abnormalities detected by echocardiography were more common in younger patients (52.4 vs 30%, p = 0.002). These younger patients presented with a higher proportion of coronary aneurysms as well (19 vs 8.6%, p < 0.001). Shock at diagnosis (9.5 vs 1.9%, p = 0.016) and admission to intensive care units (17.7 vs 4.1%, p = 0.003) were more frequent in patients younger than 6 months. There were no statistically significant differences in relation to infections, non-response to IVIG, or mid- or long-term outcomes. Conclusion: Data of the Spanish cohort are consistent with other American and Asian studies, although Spanish children younger than 6 months had a lower rate of non-response to IVIG and better clinical outcomes. A high index of suspicion should be considered for this population due to a higher risk of coronary abnormalities, presentation of shock, and admission to the intensive care unit. What is Known: •Children below 6 months of age with Kawasaki disease (KD) have different features compared to older. •Younger patients usually have an incomplete form of KD and coronary artery abnormalities. What is New: •Younger than 6 months with KD presented with shock and required admission to PICU more frequently compared to older. •Infections play a similar role in KD despite the age of the patients. [ABSTRACT FROM AUTHOR]

Background: Kawasaki disease (KD) is an acute self-limited systemic vasculitis of unknown etiology affecting mainly children less than 5 years of age. Risk factors for cardiac involvement and resistance to treatment are insufficiently studied in non-Japanese children. Objective: This study aimed to investigate the epidemiology, clinical features and risk factors for resistance to treatment and coronary artery lesions (CAL) in KD in Spain. Methods: Retrospective study (May 2011-June 2016) of all patients less than 16 years of age diagnosed with KD included in KAWA-RACE network (84 Spanish hospitals). Results: A total of 625 cases were analyzed, 63% were males, 79% under 5 year-olds and 16.8% younger than 12 months. On echocardiographic examination CAL were the most frequent findings (23%) being ectasia the most common (12%). Coronary aneurysms were diagnosed in 9.6%, reaching 20% in infants under 12 months (p<0.001). A total of 97% of the patients received intravenous immunoglobulin (IVIG) with a median number of days from fever onset to IVIG administration of 7.2. A second dose was given to 15.7% and steroids to 14.5% patients. Only 1.4% patients received infliximab. No deaths were reported. A multivariate analysis identified anemia, hypoalbuminemia, hyponatremia, higher creatinine and procalcitonin as independent risk factors for treatment failure and length under 103 cm, hemoglobin < 10.2 mg/dL, platelets > 900,000 cells/mm3, maximum temperature < 39.5°C, total duration of fever > 10 days and fever before treatment ≥ 8 days as independent risk factors for developing coronary aneurysms. Conclusions: In our population, children under 12 months develop coronary aneurysms more frequently and children with KD with anemia and leukocytosis have high risk of cardiac involvement. Adding steroids early should be considered in those patients, especially if the treatment is not started before 8 days of fever. A score applicable to non-Japanese children able to predict the risk of aneurysm development and IVIG resistance is necessary. [ABSTRACT FROM AUTHOR]

Abstract Coastal litter abundance and its effects have increased for years. Waste reduction is the most effective countermeasure to fight against this problem. Littering attitudes may have an effect on people's involvement in coastal cleanups. In this study, coastal litter perception, awareness about its impact and likely sources were investigated in local population from south Bay of Biscay, Spain. People of different age groups and commitment levels regarding litter were interviewed and their answers compared with data from the area. Results showed differences in perception between volunteers and non-volunteers, but not between children and adults. Interaction effect of age was found for awareness. Volunteers and children tended to erroneously attribute the main litter origin to beachgoers, more than non-volunteers or adults. Our results suggest that encouraging local population to clean beaches would contribute to improve their perception of the problem and their attitudes toward taking action. Highlights • Coastal and marine litter presence depends on human activity and attitudes. • People's actions on the field can determine litter fate and measures effectiveness. • Coastal litter perception determines citizens opinion and their actions. • Volunteering increases perception and measures taken against marine litter. • Encouraging population would contribute to improve coastal and marine conservation. [ABSTRACT FROM AUTHOR]

This paper studies the sensitivity of share prices of Spanish companies included in the IBEX-35 to changes in different explanatory variables, such as market returns, interest rates and factors proposed by Fama and French (1993, 2015) between 2000 and 2016. In addition, for robustness, this paper analyses whether the sensitivity of stock returns is different between two periods: precrisis and recent financial crisis. The results confirm that, in general, all the considered factors are relevant. Furthermore, "market return" and "size" factors show greater explanatory power, together with the "value" factor in the crisis period. Regarding the analysis at sector level, "Oil and Energy", "Basic Materials, Industry and Construction" and "Financial and Real Estate Services" sectors appear to be highly sensitive to changes in the risk factors included in the asset pricing factor model. [ABSTRACT FROM AUTHOR]

The Spanish second-person singular tú may acquire two different kinds of references when used in concrete discursive and communicative interactions. Besides its prototypical deictic one, commonly referring to the interlocutor, there is another one that it is used to convey general and unspecific meanings that detach the reference from the speaker notional sphere, presenting utterances in a depersonalized and objective way. Some recent researches have delved into the cognitive and discursive properties of this usage and renamed it as objectivizing second-person singular, as it constitutes a communicative resource that tends to provide discourse with an objective meaning by means of the cognitive salience. This work is aimed at analyzing this phenomenon in a corpus of both oral and written texts from media advertising taking into account the expressed and omitted variants of the second-person singular as well as the grammatical elements most frequently co-appearing with them. It will be concluded that this phenomenon acts as a powerful persuasive advertising strategy. [ABSTRACT FROM AUTHOR]

The energy sector is the main contributor to greenhouse gas emissions and one of the thirstiest sectors worldwide. Within the energy sector, thermoelectricity directly impacts on both emissions and water. This study assesses the evolution of the direct CO 2 emissions and operational water consumption of the Spanish thermoelectricity generation from 1969 to 2019. Both carbon emissions and water consumption correlate over time, led by the trends in total thermal generation, although over the past half century, water requirements swelled far more than carbon emissions. This results in a long-term trade-off between carbon emissions and consumptive water use in relative terms: while the CO 2 per thermal MWh generated halved since 1969 in Spain, the operational water consumption per MWh of thermoelectricity generated more than doubled due to switching from coal burning to nuclear and combined cycle technologies. We find no real trade-off in absolute levels. Although moving towards smaller environmental impacts since the mid-2000s, thermoelectricity remains one of the largest carbon emitters while becoming one of thirstiest energy technologies in Spain. • Thermoelectricity's direct carbon emissions and water consumption estimates from 1969. • Uses real data per plant for CO2 and consumptive water use, extrapolating backwards. • Some small technological improvement to reduce emissions within generation technologies. • Carbon emissions and water consumption correlate over time in absolute levels. • CO2 per MWh halved while the water per MWh more than doubled since 1969. [ABSTRACT FROM AUTHOR]

Introduction: Fighting against antimicrobial resistance is a current priority, and further efforts need to be made to improve antimicrobial prescribing and reduce the spread of infections in paediatric care settings., Methods: We conducted a prospective longitudinal study on the use of antimicrobials from the time the antimicrobial stewardship programme (ASP) was introduced in January 2016 to December 2017 (period 2 [P2]) in our children's hospital. We compared the obtained results on antimicrobial prescribing with retrospective data from the period preceding the introduction of the ASP (2014-2015, period 1 [P1]). The sample consisted of paediatric inpatients who received broad-spectrum antimicrobials, antifungals or intravenous antibiotherapy lasting more than 5 days. We compared the use of antimicrobials in P1 versus P2., Results: A total of 160 patients were included during P2. The antibiotics for which a recommendation was made most frequently were meropenem (41.6%) and cefotaxime (23.4%). In 45% of care episodes, the consultant recommended "no change" to the prescribed antimicrobial. The final rate of acceptance of received recommendations by the prescribing physicians was 89%. We found average decreases of 27.8% in the days of treatment per 1000 inpatient days and 22.9% in the number of antimicrobial starts per 1000 admissions in P2. The use of carbapenems, cephalosporins and glycopeptides decreased in P2 compared to P1. The average annual cost of antimicrobial treatment decreased from є150 356/year during P1 to є98 478/year in P2., Conclusion: Our ASP achieved a significant decrease in the use of broad-spectrum antibiotics and antifungals. The costs associated with antimicrobial prescribing decreased following the introduction of the ASP, which was a cost-effective action in this study period., (Copyright © 2023 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.)

Objectives: To describe the etiology of community-acquired pneumonia (CAP) in hospitalized children in Spain and analyze the predictors of the etiology., Hypothesis: The different etiological groups of pediatric CAP are associated with different clinical, radiographic, and analytical data., Design: Observational, multicenter, and prospective study., Patient Selection: This study included children aged 1 month to 17 years with CAP, who were hospitalized between April 2012 and May 2019., Methods: An extensive microbiological workup was performed. The clinical, radiographic, and analytical parameters were analyzed for three etiological groups., Results: Among the 495 children included, at least one causative pathogen was identified in 262 (52.9%): pathogenic viruses in 155/262 (59.2%); atypical bacteria (AB), mainly Mycoplasma pneumonia, in 84/262 (32.1%); and typical bacteria (TyB) in 40/262 (15.3%). Consolidation was observed in 89/138 (64.5%) patients with viral CAP, 74/84 (88.1%) with CAP caused by AB, and 40/40 (100%) with CAP caused by TyB. Para-pneumonic pleural effusion (PPE) was observed in 112/495 (22.6%) patients, of which 61/112 (54.5%) presented a likely causative pathogen: viruses in 12/61 (19.7%); AB in 23/61 (37.7%); and TyB in 26/61 (42.6%). Viral etiology was significantly frequent in young patients and in those with low oxygen saturation, wheezing, no consolidation, and high lymphocyte counts. CAP patients with AB as the etiological agent had a significantly longer and less serious course as compared to those with other causative pathogens., Conclusions: Viruses and M. pneumoniae are the main causes of pediatric CAP in Spain. Wheezing, young age, and no consolidation on radiographs are indicative of viral etiology. Viruses and AB can also cause PPE. Since only a few cases can be directly attributed to TyB, the indications for antibiotics must be carefully considered in each patient., (© 2021 The Authors. Pediatric Pulmonology published by Wiley Periodicals LLC.)

Background: Knowledge about SARS-CoV-2 infection in pregnancy and newborns is scarce. The objective of this study is to analyse clinical and epidemiological characteristics of a cohort of women infected with SARS-CoV-2 during pregnancy and their newborns exposed to SARS-CoV-2 during gestation., Methods: Multicentric observational study of Spanish hospitals from the GESNEO-COVD cohort, participants in RECLIP (Spanish Network of Paediatric Clinical Assays). Women with confirmed SARS-CoV-2 infection by PCR and/or serology during pregnancy, diagnosed and delivering during the period 15/03/2020-31/07/2020 were included. Epidemiological, clinical, and analytical data was collected., Results: A total of 105 pregnant women with a median of 34.1 years old (IQR: 28.8-37.1) and 107 newborns were included. Globally, almost 65% of pregnant women had some COVID-19 symptoms and more than 43% were treated for SARS-COV-2. Overall, 30.8% of pregnant women had pneumonia and 5 (4.8%) women were admitted to the intensive care unit needing invasive mechanical ventilation. There was a rate of 36.2% of caesarean sections, which was associated with pneumonia during pregnancy (OR: 4.203, CI 95%: 1.473-11.995) and lower gestational age at delivery (OR: 0.724, CI 95%: 0.578-0.906). The prevalence of preterm birth was 20.6% and prematurity was associated with pneumonia during gestation (OR: 6.970, CI95%: 2.340-22.750) and having a positive SARS-CoV-2 PCR at delivery (OR: 6.520, CI95%: 1.840-31.790). All nasopharyngeal PCR in newborns were negative at birth and one positivized at 15 days of life. Two newborns died, one due to causes related to prematurity and another of unexpected sudden death during early skin-to-skin contact after delivery., Conclusions: Although vertical transmission has not been reported in this cohort, the prognosis of newborns could be worsened by SARS-CoV-2 infection during pregnancy as COVID-19 pneumonia increased the risk of caesarean section deliveries and preterm births.

Background: Maternal HIV coinfection is a key factor for mother-to-child transmission (MTCT) of HCV. However, data about HCV MTCT in HIV/HCV-coinfected pregnant women on combined antiretroviral treatment (ART) are scarce. This study assessed the HCV MTCT rate in the Madrid Cohort of HIV-infected women., Methods: Retrospective study within the Madrid Cohort of HIV-infected pregnant women (2000-2012). Epidemiological, clinical and treatment related variables were analysed for the mother and infant pairs. HCV MTCT rate was determined., Results: Three hundred thirty-nine HIV/HCV-coinfected women and their exposed infants were recorded. A total of 227 (67%) paired mother-children had available data of HCV follow-up and were included for the analysis. Sixteen children (rate 7.0%, 95%CI 3.7-10.4%) were HCV infected by 18 months of age, none of them coinfected with HIV. HIV/HCV-coinfected pregnant women were mostly of Spanish origin with a background of previous injection drug use. HCV-genotype 1 was predominant. The characteristics of mothers that transmitted HCV were similar to those that did not transmit HCV with respect to sociodemographic and clinical features. A high rate (50%) of preterm deliveries was observed. Infants infected with HCV were similar at birth in weight, length and head circumference than those uninfected., Conclusion: MTCT rates of HCV among HIV/HCV-coinfected women on ART within the Madrid cohort were lower than previously described. However, rates are still significant and strategies to eliminate any HCV transmission from mother to child are needed., Competing Interests: The authors have declared that no competing interests exist.

Background: Congenital cytomegalovirus infection (CMVc) affects 0.7%-6% of recent births. Among its clinical manifestations are low weight and length at birth., Objective: Describe the growth patterns of children with CMVc in their early years., Methods: Observational, multicenter study of patients with CMVc. Anthropometric data were collected during the first 2 years of life and compared with World Health Organization standards., Results: Anthropometric characteristics of 383 children with CMVc were studied, of which 198 (51%) were symptomatic at birth. At birth, 9% were small for gestational age (SGA) in terms of their weight and length and 17% had microcephaly. At 24 ± 3 months, 10% had a weight and length ≤2 SD, and 13% a head circumference ≤2 SD. Of those who were SGA at birth, at 24 ± 3 months >20% remained at ≤2 SD of their weight and length. Conversely, 75% of children with low weight or length at 24 ± 3 had not been SGA at birth. 20% of infants with microcephaly at birth remained with microcephaly, and 10% of those without microcephaly developed it at 24 ± 3 months. The average growth rate in length and weight was normal. Patients who were symptomatic at birth, premature and with motor and neurocognitive impairment had a significantly higher risk of low weight and length at 24 ± 3 months., Conclusion: Around 10% of children with CMVc are at ≤2 SD in weight, length and head circumference at 24 ± 3 months. The lack of adequate growth is associated with symptoms at birth, prematurity and motor and neurocognitive impairment. Growth impairment could be incorporated into the symptomatic spectrum of CMVc.

Introduction and Objectives: There is current controversy regarding the benefits of percutaneous recanalization (PCI) of chronic total coronary occlusions (CTO). Our aim was to determine acute and follow-up outcomes in our setting., Methods: Two-year prospective registry of consecutive patients undergoing PCI of CTO in 24 centers., Results: A total of 1000 PCIs of CTO were performed in 952 patients. Most were symptomatic (81.5%), with chronic ischemic heart disease (59.2%). Previous recanalization attempts had been made in 15%. The mean SYNTAX score was 19.5 ± 10.6 and J-score was > 2 in 17.3%. A retrograde procedure was performed in 92 patients (9.2%). The success rate was 74.9% and was higher in patients without previous attempts (82.2% vs 75.2%; P = .001), those with a J-score ≤ 2 (80.5% vs 69.5%; P = .002), and in intravascular ultrasound-guided PCI (89.9% vs 76.2%, P = .001), which was an independent predictor of success. In contrast, severe calcification, length > 20mm, and blunt proximal cap were independent predictors of failed recanalization. The rate of procedural complications was 7.1%, including perforation (3%), myocardial infarction (1.3%), and death (0.5%). At 1-year of follow-up, 88.2% of successfully revascularized patients showed clinical improvement (vs 34.8%, P < .001), which was associated with lower mortality. At 1-year of follow-up, the mortality rate was 1.5%., Conclusions: Compared with other national registries, patients in the Iberian registry undergoing PCI of a CTO showed similar complexity, success rate, and complications. Successful recanalization was strongly associated with functional improvement, which was related to lower mortality., (Copyright © 2018. Published by Elsevier España, S.L.U.)