Search

Extended criteria donor livers are increasingly being accepted for transplant in an attempt to bridge the gap between the number of patients on the waiting list and the number of available donor livers. Our objective was to describe our first case of hepatic resuscitation by means of an ex situ perfusion machine in hypothermia with oxygen insufflation of a liver graft extracted from a donor in type 3 asystole after regional perfusion in normothermia.A 53-year-old woman with disabling polycystic liver disease was included on the liver transplant waiting list. Donation was offered in type 3 asystole with regional perfusion in normothermia. Given that it was an elderly donor with a low-weight graft, hepatic resuscitation was decided by means of an ex situ perfusion machine in hypothermia with oxygen insufflation.After performing the bench work, the injector is selectively cannulated via the portal to connect it to the hypothermic perfusion machine. The average temperature of the perfusate (3 L modified Belzer) was 10°C for 120 minutes at 250 mL/min. The implant was completed without the need for transfusion of blood products, postreperfusion Sd, or vasoactive support. Peak of GOT/GPT was 803/276 at 24 hours posttransplant.

An organ shortage is the reason why it is necessary to expand the pool of donors, which can be achieved by using elderly donors. The main goal of this study is to analyze the outcomes of liver transplant (LT) when it is performed with donors older than 75 years.We carried out a retrospective case-control study (N = 212) that included LTs with donors older than 75 years (group A, n = 106 cases) that were performed in our center between the years 2010 and 2020. This cohort has been paired off with a similar control group (group B, n = 106) whose donors were significantly younger. A survival analysis using the Kaplan-Meier model was performed.Average (SD) age of donors in group A was statistically greater than group B (A, 79.1 [3.0] years vs B, 54.4 [15.3], P.001). There were no differences either in the average age of the recipients or in the Model for End-Stage Liver Disease score of both groups. Indications for LT were distributed equally in both groups: the most common was cellular hepatocarcinoma followed by alcohol-related cirrhosis. Survival rates for group A were 81%, 78%, and 67%, in 1, 3, and 5 years, respectively, while in group B they were 85%, 76%, and 71%, respectively, without differences found between the groups (P = .57).Using elderly liver donors is safe, achieving good outcomes in terms of short- and midterm rates of survival.

Objetivo: Evaluar el nivel de cumplimiento de las prácticas seguras para la gestión del cuidado enfermero del paciente COVID-19 en el Hospital Anexo Villa Essalud Ferreñafe – Perú, durante el mes de marzo 2021. Metodología: Estudio cuantitativo de diseño no experimental descriptivo de corte transversal, la muestra fueron 21 enfermeras del servicio de hospitalización medicina, empleándose la observación participante pasiva y el análisis documental de los registros de enfermería aplicando la lista de verificación: “cumplimiento de prácticas seguras para prevenir eventos adversos” de Essalud con una validez de KR-20 de 0,8. Resultados: El nivel de cumplimiento general de las prácticas en el Hospital Anexo Villa Essalud Ferreñafe se encuentra en un nivel aceptable en un 79%. En las dimensiones prevención de riesgo de caída, y prevención y reducción de las úlceras por presión el nivel de cumplimiento fue aceptable en el 52.4% y 61.0% respectivamente, evidenciándose un nivel óptimo en las dimensiones identificación segura de paciente (91.4%) y administración segura de medicamentos (85.7%). Conclusiones: Los profesionales de enfermería demostraron un nivel aceptable en el cumplimiento de las prácticas seguras, no obstante, deben mejorarse a fin de prevenir eventos adversos, debiendo fortalecer la cultura de seguridad del paciente.

The initial objective of this study is to analyze the impact on survival of the preservation solution used. Secondarily, the influence of donor age, underlying pathology, and graft ischemia time is investigated.A multicenter retrospective analytical observational study has been carried out. A population of 1822 liver transplant recipients is studied in 4 Andalusian hospitals between 1995 and 2014. Survival of the patient and graft is analyzed by groups based on the conservation solution used, the age of the donor, the pathology indicated for transplant and the ischemia time, and the relationship between the variables through a bivariate study. A descriptive and predictive multivariate analysis of the variables was performed.Comparison of the graft and patient survival functions for each preservation solution did not differ significantly. The bivariate analysis shows a significantly higher utilization of Celsior and histidine-tryptophan-ketoglutarate solution in graft loss. The comparison between donor age groups showed significant differences in favor of donor grafts younger than 50 years. In the multivariate analysis of patient and graft survival, the donor age obtained a hazard ratio of 1.008 (P.005) with donors older than 47.6 and 47.5 years, respectively.Survival analysis between pathology groups found significant differences, not obtaining predictive power for patient or graft survival in the multivariate study. No significant differences were found in survival according to ischemia time, but there was a relationship between early graft loss and longer mean cold ischemia times up to 18 hours.

Resumen Objetivo Analizar los determinantes que influyen en la calidad de vida relacionada con la salud de las personas que viven con el VIH en Alicante (Espana). Metodos Se realizo un estudio descriptivo transversal que recluto a 214 participantes castellanoparlantes mayores de 18 anos con VIH atendidos en consultas externas de la Unidad de Enfermedades Infecciosas de un hospital de Alicante entre 2013 y 2014. Se autoadministro un cuestionario sociodemografico y el cuestionario sobre calidad de vida relacionado con la salud Short-Form-36 (SF-36v2) que mide la salud en 8 dimensiones. Resultados El 70% de los entrevistados eran varones, el 50% presentaba cifras de linfocitos CD4+ entre 200 a 499 cel./mm3. El 20% estaba coinfectado por el virus de la hepatitis C (VHC). Para las 8 dimensiones del SF-36v2, las puntuaciones medias fueron superiores a 45. Los hombres presentaron mejores puntuaciones que las mujeres en todas las dimensiones a excepcion de la salud general, siendo estadisticamente significativos. La coinfeccion con VHC y una peor situacion laboral resultaron con una menor puntuacion en el componente sumario fisico, mientras que estar casado o tener pareja se asocio significativamente con una mayor puntacion en el componente sumario mental. Conclusion El nivel socioeconomico y la presencia de factores clinicos como la coinfeccion por el VHC influyen en las dimensiones de calidad de vida de la salud fisica en los adultos que viven con VIH.

To analyze the determinants that influence the health-related quality of life of people living with HIV in Alicante (Spain).A cross-sectional study was conducted, which recruited 214 Spanish-speaking participants over 18 years of age living with HIV from an outpatient consulting office of the infectious diseases in a hospital in Alicante between 2013 and 2014. A self-administration sociodemographic survey and the Short Form Health Survey (SF-36v2) was used to assess health-related quality of life. This questionnaire measures health on 8domains.70% of the participants were male, 50% had CD4 cell count between 200-499 cells/mmThe socioeconomic level and the presence of clinical factors such as HCV influence the scales of quality of life of physical health among adults living with HIV.

INTRODUCTION Among the strategies designed to optimize the number of existing liver grafts for transplantation, the implementation of the graft assessment process is one of the least explored. The main objective is to identify the risk factors presented by liver donors for «NO validity». Secondly, we analyzed the coincidence between the surgeon's assessment and that of the anatomo-pathologist in the invalid donors. MATERIAL AND METHOD Retrospective study conducted from a prospective database that analyzes 190 liver donors, 95 valid and 95 NOT valid. The variables of each of them corresponding to the donation protocol of the National Transplant Organization are studied. Through a multivariate study we determine the independent risk factors of NO validity. We checked the causes of NO validity argued with the histopathological findings of these grafts. RESULTS The independent risk factors of non-validity in the multivariate study (P < .05) were: dyslipidemia, personal medical history other than cardiovascular and abdominal surgical risk factors, GGT, BrT, and the result of previous liver ultrasound. The 3 most frequent causes of NO validity were: steatosis, fibrosis and macroscopic appearance of the organ. 78% of the biopsies confirmed the NO validity of the graft (in 57.9% of the cases the histological findings coincided with those described by the surgeon). The 22.1% of the biopsies hadnt pathological findings. CONCLUSIONS The determination of the risk factors of NO validity will contribute to the design of future assessment scores that are useful tools in the process of liver graft assessment.).

Resumen Introduccion Entre las estrategias disenadas para optimizar el numero de injertos hepaticos existentes para trasplante, la implementacion del proceso de valoracion de injertos constituye una de las menos exploradas. El objetivo principal es identificar los factores de riesgo que presentan los donantes hepaticos para la «NO validez». Secundariamente analizamos la coincidencia entre la valoracion del cirujano y la del anatomopatologo en los donantes NO validos. Material y metodo Estudio retrospectivo realizado a partir de una base de datos prospectiva que analiza 190 donantes hepaticos, 95 validos y 95 NO validos. Se estudian las variables de cada uno de ellos correspondientes al protocolo de donacion de la Organizacion Nacional de Trasplantes. Mediante el estudio multivariante determinamos los factores de riesgo independientes de NO validez. Cotejamos las causas de NO validez argumentadas con los hallazgos histopatologicos de dichos injertos. Resultados Los factores de riesgo independientes de NO validez en el estudio multivariante (p Conclusiones La determinacion de los factores de riesgo de NO validez contribuira al diseno de futuros scores de valoracion que constituyan herramientas utiles en el proceso de valoracion de injertos hepaticos.

Objectives Several studies have shown an inverse association between diabetes mellitus and prostate cancer (PCa). Some researchers suggest that this relationship is due to reduced PCa detection in diabetics due to lower prostate-specific antigen (PSA) levels compared to non-diabetics. Our objective is to analyze the impact of diabetes on PSA in asymptomatic men without known prostate pathology and without prior prostate intervention. Methods We searched Medline (via PubMed), Embase and Scopus. We included studies that reported the relationship between serum PSA levels and diabetes or diabetes treatment in asymptomatic adult men without known prostate pathology, and without prior prostate intervention. Pooled mean differences were compared between diabetics and non-diabetics. Results Of 2,392 screened abstracts, thirteen studies met the inclusion criteria and 8 (62%) reported appropriate measures that could be included in a meta-analysis. Eleven (85%) examined the influence of diabetes on PSA levels and 8 (62%) evaluated the influence of diabetes treatments on PSA levels. Overall diabetics had a significantly lower PSA level compared to non-diabetics (mean difference: −0.07 ng/mL; 95% CI −0.10, −0.04). Conclusions Diabetes and related factors (such as disease duration, severity and treatment) were significantly associated with lower PSA levels among asymptomatic men, yet differences were small and are unlikely to influence PCa detection in a screening setting.

Objetivo: Determinar la relación entre el Nivel de Percepción de la cultura de Seguridad del paciente y la notificación de eventos adversos referida por el personal asistencial de un hospital nivel I de la provincia de Ferreñafe, Lambayeque, Perú durante el año 2015. Materiales y Métodos: La población muestral estuvo conformada por 91 profesionales de la salud. El estudio fue de tipo analítico, prospectivo, transversal y el diseño de contrastación de hipótesis utilizado fue el descriptivo relacional. Para el análisis estadístico se utilizó la prueba de la Chi- cuadrado leída al 95% de confiabilidad, en la recolección de datos se empleó el cuestionario denominado “Cuestionario sobre seguridad del paciente en los hospitales” de la Agencia de Salud, Investigación y calidad de Estados Unidos (AHRQ). Resultados: los resultados evidenciaron que el nivel de percepción general de la Cultura de Seguridad manifestado por el personal asistencial fue neutral y negativo (90%), consecuentemente estuvo relacionado con un alto porcentaje de eventos adversos no notificados (74%). (p

espanolObjetivo: describir las caracteristicas demograficas y clinicas de los pacientes evaluados por primera vez en el Servicio de Glaucoma del Hospital Especializado Mexiquense de Salud Visual, en Naucalpan, Estado de Mexico. Metodologia: se realizo un estudio observacional de tipo transversal que incluyo a todos los pacientes de primer contacto en el Departamento de Glaucoma entre agosto de 2015 y julio de 2016. Posteriormente se analizaron los datos recabados con el programa Excel 2011, realizando para las variables cuantitativas todas las medidas de tendencia central y de dispersion y para las variables cualitativas frecuencias y porcentajes. Resultados: de 17.206 consultas de primer contacto, 1613 sujetos fueron referidos al servicio de glaucoma, y en 569 casos logro integrarse el diagnostico de algun tipo de glaucoma, lo que representa el 3,30 % de la poblacion. El 58 % de los sujetos pertenecian al sexo femenino (n = 383). El promedio de edad fue 62,9 anos (DE ± 14,17, IC 95 %: 61,73-64,07). La distribucion de los diagnosticos integrados durante la evaluacion inicial fue la siguiente: glaucoma primario angulo abierto (GPAA), 274 sujetos (48,15 %); sospecha de glaucoma, 180 sujetos (31,63 %); glaucoma de angulo cerrado (GAC), 43 sujetos (7,46 %); glaucoma neovascular (GNV), 32 sujetos (5,62 %), y 40 sujetos con otros tipos de glaucoma (7,02 %). Conclusiones: en este estudio se encontro que el tipo de glaucoma con mayor incidencia fue el GPAA, seguido de los pacientes sospechosos de glaucoma; en ambos casos el sexo femenino fue el de mayor frecuencia EnglishObjective: To describe the demographic and clinical characteristics of the patients evaluated for the first time in the Glaucoma Service of the Mexiquense Specialized Hospital of Visual Health, in Naucalpan State of Mexico. Methodology: An observational cross-sectional study was carried out, in which all the patients of first contact in the glaucoma department were included during the period from August 2015 to July 2016. Subsequently, the data collected with Excel 2011 program were analyzed, performing for the quantitative variables all measures of central tendency and dispersion and for the qualitative variables frequencies and percentages. Results: Of 17,206 first contact consultations, 1,613 subjects were referred to the glaucoma service and in 569 cases the diagnosis of some type of glaucoma was integrated, representing 3.30 % of the population. 58 % of the subjects belonged to the female sex (n = 383). The average age was 62.9 years (SD ± 14.17, CI 95: 61.73-64.07). The following diagnoses were assigned during the initial assessment: primary open-angle glaucoma (POAG) 274 subjects (48.15 %), glaucoma suspects 180 subjects (31.63 %), closed angle glaucoma (CAG) 43 subjects (7.46 % ), neovascular glaucoma (NVG) 32 subjects (5.62 %), and 40 subjects with other types of glaucoma representing 7.02 %. Conclusions: In this study it was found that the type of glaucoma with the highest incidence was POAG, followed by patients suspected of glaucoma, being more frequent in females

[Simple Summary] Effective biomarkers are needed to enable personalized medicine for pancreatic cancer patients. This study analyzes the prognostic value, in early pancreatic cancer, of circulating tumor cells and clusters from the central venous catheter and portal blood. Circulating tumor cells were isolated using an immunomagnetic selection and were detected by microscopy using immunocytochemistry staining. In conclusion, the circulating tumor cell number in portal blood identifies a death risk in patients with early pancreatic cancer., [Abstract] Background. Effective biomarkers are needed to enable personalized medicine for pancreatic cancer patients. This study analyzes the prognostic value, in early pancreatic cancer, of single circulating tumor cell (CTC) and CTC clusters from the central venous catheter (CVC) and portal blood (PV). Methods. In total, 7 mL of PV and CVC blood from 35 patients with early pancreatic cancer were analyzed. CTC were isolated using a positive immunomagnetic selection. The detection and identification of CTC were performed by immunocytochemistry (ICC) and were analyzed by Epi-fluorescence and confocal microscopy. Results. CTC and the clusters were detected both in PV and CVC. In both samples, the CTC number per cluster was higher in patients with grade three or poorly differentiated tumors (G3) than in patients with well (G1) or moderately (G2) differentiated. Patients with fewer than 185 CTC in PV exhibited a longer OS than patients with more than 185 CTC (24.5 vs. 10.0 months; p = 0.018). Similarly, patients with fewer than 15 clusters in PV showed a longer OS than patients with more than 15 clusters (19 vs. 10 months; p = 0.004). These significant correlations were not observed in CVC analyses. Conclusions. CTC presence in PV could be an important prognostic factor to predict poor prognosis in early pancreatic cancer. In addition, the number of clustered-CTC correlate to a tumor negative differentiation degree and, therefore, could be used as a diagnostic biomarker for pancreatic cancer., This research was funded by Carlos III Health Institute (Health Research Fund) grant number PI16/01465 and PI19/01821 (Co-financed by the European Regional Development Fund “A way to make Europe”).

Bernal-Soriano, Mari Carmen/0000-0002-9174-0068; Berbel, Pere/0000-0001-6124-6037, WOS: 000555874000001, PubMed: 32498666, Background:Thyroxine (T4) to triiodothyronine (T3) deiodination in the hypothalamus/pituitary is mediated by deiodinase type-2 (D2) activity.Dio2((-/-))mice show central resistance to exogenous T4. Patients with resistance to exogenous thyroxine (RETH) have not been described. the aim of this study was to identify hypothyroid patients with thyrotropin (TSH) unresponsiveness to levothyroxine (LT4) and to characterize the clinical, hormonal, and genetic features of human RETH. Methods:We investigated hypothyroid patients with elevated TSH under LT4 treatment at doses leading to clinical and/or biochemical hyperthyroidism. TSH and free T4 (fT4) were determined by chemiluminescence, and total T4, T3, and reverse T3 (rT3) by radioimmunoassay. TSH/fT4 ratio at inclusion and T3/T4, rT3/T4, and T3/rT3 ratios at follow-up were compared with those from patients with resistance to thyroid hormone (RTH) due to thyroid hormone receptor-beta (THRB) mutations.DIO2,including the Ala92-D2 polymorphism, selenocysteine binding protein 2 (SECISBP2), andTHRBwere fully sequenced. Results:Eighteen hypothyroid patients (nine of each sex, 3-59 years) treated with LT4 showed elevated TSH (15.5 +/- 4.7 mU/L; reference range [RR]: 0.4-4.5), fT4 (20.8 +/- 2.4 pM; RR: 9-20.6), and TSH/fT4 ratio (0.74 +/- 0.25; RR: 0.03-0.13). Despite increasing LT4 doses from 1.7 +/- 1.0 to 2.4 +/- 1.7 mu g/kg/day, TSH remained elevated (6.9 +/- 2.7 mU/L). Due to hyperthyroid symptoms, LT4 doses were reduced, and TSH increased again to 7.9 +/- 3.2 mU/L. in the euthyroid/hyperthyrotropinemic state, T3/T4 and T3/rT3 ratios were decreased (9.2 +/- 2.4, RR: 11.3-15.3 and 2.5 +/- 1.4, RR: 7.5-8.5, respectively) whereas rT3/T4 was increased (0.6 +/- 0.2; RR: 0.43-0.49), suggesting reduced T4 to T3 and increased T4 to rT3 conversion. These ratios were serum T4-independent and were not observed in RTH patients. Genetic testing was normal. the Ala92-D2 polymorphism was present in 7 of 18 patients, but the allele dose did not correlate with RETH. Conclusions:Human RETH is characterized by iatrogenic thyrotoxicosis and elevated TSH/fT4 ratio. in the euthyroid/hyperthyrotropinemic state, it is confirmed by decreased T3/T4 and T3/rT3 ratios, and elevated rT3/T4 ratio. This phenotype may guide clinicians to consider combined T4+T3 therapy in a targeted fashion. the absence of germlineDIO2mutations suggests that aberrant post-translational D2 modifications in pituitary/hypothalamus or defects in other genes regulating the T4 to T3 conversion pathway could be involved in RETH., Fondo de Investigaciones Sanitarias, Instituto de Salud Carlos IIIInstituto de Salud Carlos III [PI16/00830]; Rare Diseases Networking Biomedical Research Centre (CIBERER), This work was supported by funding from the Fondo de Investigaciones Sanitarias, Instituto de Salud Carlos III (grant PI16/00830 to J.C.M.) and by the Rare Diseases Networking Biomedical Research Centre (CIBERER).

Introduction The Diabetes Health Profile (DHP‐18), structured in three dimensions (psychological distress (PD), barriers to activity (BA) and disinhibited eating (DE)), assesses the psychological and behavioural burden of living with type 2 diabetes. The objectives were to adapt the DHP‐18 linguistically and culturally for use with patients with type 2 DM in Ecuador, and to evaluate its psychometric properties. Methods Participants were recruited using purposive sampling through patient clubs at primary health centres in Quito, Ecuador. The DHP-18 validation consisted in the linguistic validation made by two Ecuadorian doctors and eight patient interviews. And in the psychometric validation, where participants provided clinical and sociodemographic data and responded to the SF-12v2 health survey and the linguistically and culturally adapted version of the DHP-18. The original measurement model was evaluated with confirmatory factor analysis (CFA). Reliability was assessed through internal consistency using Cronbach’s alpha and test–retest reproducibility by administering DHP-18 in a random subgroup of the participants two weeks after (n = 75) using intraclass correlation coefficient (ICC). Convergent validity was assessed by establishing previous hypotheses of the expected correlations with the SF12v2 using Spearman’s coefficient. Results Firstly, the DHP-18 was linguistically and culturally adapted. Secondly, in the psychometric validation, we included 146 participants, 58.2% female, the mean age was 56.8 and 31% had diabetes complications. The CFA indicated a good fit to the original three factor model (χ2 (132) = 162.738, p −0.40 in two of three hypotheses). Conclusions The original three factor model showed good fit to the data. Although reliability parameters were adequate for PD and DE dimensions, the BA presented lower internal consistency and future analysis should verify the applicability and cultural equivalence of some of the items of this dimension to Ecuador.

Background Liver retransplantation can be classified as urgent (when performed in the first week after the transplantation) or elective, which may be considered as early (first month post-transplantation) or late (after the first month). The time in which retransplantation takes place is determined by the cause that makes it necessary. The goal of this study is to analyze the causes and results of early retransplantation in our center. Methods A retrospective analysis of liver retransplantations performed within the first month after the original transplantation in our center between 2007 and 2017 was carried out. The variables analyzed were demographic, causes of the first transplant and retransplantation, and the complications and mortality resulting from the latter. Results A total of 698 liver transplants were performed, including 67 patients who required retransplantation (8.9%). Among these, 37 were late elective retransplantations and 30 were early retransplantations. Regarding the latter, the causes that led to the first transplant were hepatocellular carcinoma (46.7%) and noncholestatic cirrhosis (30%). On the other hand, the main precipitants of the retransplantation were hepatic artery thrombosis (60%) and primary graft failure (13.3%). The reoperation rate was 16.7%, and the perioperative mortality rate was 16.7%. The 1-, 2-, and 5-year survival rates were 83.3%, 76.7% and 59.9%, respectively. Conclusion Despite the high perioperative morbidity of liver retransplantation, its results in terms of survival are similar to those of the global series of liver transplantation.

Scientific societies have provided guidelines to reduce PSA-specific harms. We studied the potential non-compliance of PSA testing with current guidelines in general practice. A cross-sectional study of a random sample of 1291 patients with a PSA test was performed between January and April 2018 in primary health care. Patients with a previous prostate cancer diagnosis or those who were being followed-up for previous high PSA values were excluded. Two independent researchers classified whether each test was potentially non-compliant with recommendations. We estimated frequencies of potentially non-compliant PSA determinations and calculated prevalence ratios (PR) to assess their relationship with possible explanatory variables. A total of 66% (95% CI: 62–69%) of PSA requests in asymptomatic patients were potentially non-compliant with the current guideline. This was associated with having a previous diagnosis of neoplasm (PR adjusted by age and life expectancy: 1.18, 95% CI: 1.02–1.37) as well as being a current consumer of tobacco, alcohol, or other drugs (PR: 0.80, 95% CI: 0.67–0.97). Real world data shows that patients are still frequently exposed to overdiagnosis risk with a PSA potentially non-compliant with recommendations. Patients diagnosed with another neoplasm or non-consumers of toxic substances were more exposed, probably due to increased contact with doctors or health-seeking behaviour.

Diabetes is a major public health problem, increasingly affecting low- and middle-income countries. The project CEAD (Contextualizing Evidence for Action in Diabetes in low-resource settings) aims to evaluate the implementation of comprehensive diabetes care in two low-resource settings in Ecuador and to stimulate context-led health systems innovations to improve diabetes care and reduce inequity. The mixed-methods approach includes a 24-month retrospective study to assess the current level of implementation of comprehensive diabetes care and participants will be followed up prospectively for two years to assess changes in healthcare and clinical outcomes from the outset of the research. We will include individuals diagnosed with type-2 diabetes aged over 18 years, who are accessing diabetes care in health facilities in the study districts. Varied stakeholders (patients and family members, community members, healthcare workers and decision-makers) will interpret the underlying causes of the observed weaknesses and propose solutions to strengthen diabetes-related healthcare in focus group discussions (FG). A second set of FG will analyze perceived improvements in healthcare based on prospective cohort findings and consider the success/failure of any context-led innovations occurring throughout the research. Our study will demonstrate how evidence can be contextualized to stimulate local innovations and overcome weaknesses of diabetes-related healthcare in low resource settings.

Background: Patient adherence to treatment in chronic obstructive pulmonary disease (COPD) is essential to optimize disease management. We aimed to assess the impact of patients' perception of their treatment and disease on adherence and Health-Related Quality of Life (HRQL) in patients attending a community pharmacy, where usually subjects have a better condition than those in clinical settings. Methods: We performed a cross-sectional study of 318 patients with COPD in treatment with inhalers in the last 3 months from 53 community pharmacies. We assessed HRQL with St George's Respiratory Questionnaire (SGRQ). Persistence was assessed from the three previous refills and adherence through the Test of Adherence to Inhalers test. Results: Persistence was achieved by 78.6% of the patients and 58.5% had good adherence. Patients having a multidose DPI and those with MDI showed a 2.8-fold and 4.1-fold increased association, respectively, with intermediate/poor adherence in comparison with those having a single dose DPI. Those patients who did not have knowledge about COPD (aOR 2.106, p = 0.006) and those who thought that the inhaler effectiveness was fair/poor (aOR 2.361, p = 0.006) were more likely to have intermediate/poor adherence. Overall SGRQ score was significantly worse in patients with intermediate/poor adherence (p = 0.036) and in those who thought the inhaler's effectiveness was fair/poor (p < 0.001). Conclusions: The type of inhaler and patients' knowledge and perceptions of their disease and treatment were associated with good adherence and higher HRQL. Clinicians should promote shared-decision making in the choice of inhaler depending on patients' individual abilities and beliefs.

Background Bilateral retinoblastoma (Rb) treatment remains a challenge for ophthalmologists and pediatric oncologists despite new therapeutic strategies for eye preservation. The purpose of this work is to evaluate treatment outcomes in patients who underwent eye salvage treatment at a single-center prior to the chemotherapy in situ era. Procedure We followed a cohort of 88 consecutive Rb patients diagnosed at Hospital Infantil de Mexico between November 2000 and June 2014. Eye salvage treatment consisted of systemic chemotherapy plus focal therapy planned by a multidisciplinary team. Unresponsive tumors were treated with episcleral brachytherapy and external beam radiotherapy (EBRT). Results A total of 96 eyes underwent eye salvaging therapy. Seventy-eight eyes (81%) were salvaged. Seven patients (8%) required brachytherapy and 34 patients (39%) underwent EBRT. Thirty-three of 78 preserved eyes (42%) achieved normal visual acuity: 5/27 (20%) in radiated patients and 28/51 (61%) in nonradiated patients. Eight patients developed secondary primary malignancies; however, those treated with EBRT did not have a significantly increased risk when compared with nonirradiated patients (OR: 1.66; P = 0.492). The overall survival rate was 86% (95% CI, 76%-92%) after a mean follow-up of 10 years. Conclusions Eye preservation, long-term tumor control, and functional visual acuity could be maintained in many child and adolescent Rb survivors. Our data suggest that ocular radiotherapy can be used as consolidation treatment when other recently developed therapies with potentially fewer side effects are not available. Multidisciplinary management of Rb is mandatory to obtain cancer control during eye salvage treatment.

11th Congress of the Andalusian Society of Organ and Tissue Transplantation. Liver transplantation., [Background] The presence of collateral circulation in liver cirrhosis patients with portal hypertension is quite frequent due to re-permeabilization of closed embryonic channels. In some cases, these shunts could measure over 1 cm wide, therefore, containing a significative blood flow. Its management during liver transplantation could be challenging due to possible complications resulting from either ligation of the shunts or from ignoring them. We present the case of a patient with recurrent hepatic encephalopathy (HE) and a large spontaneous portosystemic shunt (SPSS) who submitted to liver transplant and review the literature identifying options, complications, and outcomes with the aim of facilitating decision making., [Material and Methods] A 68-year-old, Spanish man diagnosed with liver cirrhosis with portal hypertension and recurrent episodes of HE is proposed for LT. The patient’s Child-Pugh score was A6-B7, and the Model for End-stage Liver Disease score was 12. Preoperatively, a computed tomography scan showed a large SPSS running to the inferior cava vein. During the surgery, a small-sized portal vein and a large shunt measuring almost 3 cm wide were identified. After reperfusion, portal vein flow was 1000 to 1100 mL/min. Owing to the previous HE and the risk of low portal flow, the shunt was closed increasing the portal flow to 1800 mL/min. The patient was discharged without any complications., [Conclusions] The presence of large SPSSs are frequent during LT. Decision making intraoperatively can be challenging due to possible complications derived from ligation of the SPSS or from ignoring it. Either preoperative assessment of a further HE risk or portal vein flow measurement after reperfusion are essential to achieve a correct resolution.

Objective To assess the importance of intraoperative portal vein flow measurement during liver transplantation in relation to postoperative complications and graft and patient survival. Materials and methods Retrospective review including 291 patients who had all the information and covering a period of 10 years (2007–2017). Using a receiver operating characteristic curve, a cut-off point that would have the greatest impact on the probability of being alive at 5 years was established. In relation to this value, 2 groups were formed (low and high flow) and demographic variables, intraoperative variables, postoperative complications, and graft and patient survival were compared. Results A portal flow of 123 mL/min per100 g of liver tissue was established (area under the curve = 0.58), obtaining a low-flow (n = 129) and a high-flow group (n = 162). The 2 groups were similar in their preoperative characteristics, except for a higher proportion of preoperative ascites, a higher Model for End-Stage Liver Disease score and a lower weight of donors in the high-flow group. The arterial and portal flows were significantly higher in the high-flow group. In the postoperative period, the high-flow group presented a higher rate of ascites. The 5-year survival rate of patients was significantly higher in the high-flow group (76% vs 84%, P = .03). Conclusions Patients undergoing liver transplantation with an intraoperative portal vein flow measurement >123 mL/min per 100 g present a greater 5-year survival rate.

Many centers implement everolimus-based immunosuppression in liver transplant patients with hepatocellular carcinoma. We aimed to explore the potential impact of early initiated everolimus on tumor recurrence after liver transplantation.This study included 192 patients with hepatocellular carcinoma undergoing liver transplantation among who 64 individuals were prospectively enrolled (2012-2015) and received early initiated everolimus (ie, started between postoperative day 15 to 21), whereas the remaining 128 patients acted as historical controls without everolimus. Propensity score matching was performed to ensure comparability. Multivariate Cox regression and competing risks analysis were used to control for potential confounders.Patients with and without everolimus were comparable in terms of number of nodules (P = 0.37), total tumor diameter (P = 0.44), Milan criteria fulfillment (P = 0.56), and histological differentiation (P = 0.61), but there were increased microvascular invasion rates in the everolimus group (26.5% vs 13.3%; P = 0.026). Tumor recurrence rates were similar with and without everolimus (10.9% vs 9.9% at 36 months respectively; P = 0.18). After controlling for microvascular invasion among other potential confounders, everolimus had no significant impact on tumor recurrence, neither in the multivariate Cox regression (relative risk = 3.23; P = 0.09), nor in the competing risks analysis for tumor recurrence-death (relative risk = 1.02; P = 0.94). Patients receiving everolimus had reduced tacrolimus trough concentrations and lower serum creatinine within the first 18 months postliver transplantation.Everolimus may not be universally prescribed to prevent tumor recurrence in liver transplant patients with hepatocellular carcinoma. Future randomized trials should be focused on patients with histological features of increased tumor aggressiveness, in whom the potential benefit would be higher.

The aim of the study was to evaluate the clinical features and long-term therapeutic outcome of giant prolactinoma (gPRLoma) in men and to compare them with those of a group of male patients with non-gPRL macroprolactinomas (non-gPRLomas). A retrospective and multicenter study of gPRLomas in men diagnosed in a 20-year period was performed. Clinical data and treatment outcome were registered. The diagnosis of gPRLoma was established when the maximal tumor diameter was ≥40 mm or the tumor had ≥20 mm of suprasellar extension associated to hyperprolactinemia (PRL>1000 ng/ml). Non-gPRLoma was considered when tumor diameter was ≥ 10 mm and1 year and no radiological evidence of pituitary tumor) was achieved in 2 (8.7%) gPRLoma patients and in 2 (4.8%) non-gPRLoma patients (NS). gPRLomas in men are usually diagnosed at a mean age of 40 years, an age similar to that of non-gPRLomas. The only clinical difference with non-gPRLomas is their greater prevalence of visual disturbances. The therapeutic approaches and tumor outcomes were similar to those obtained in patients with non-gPRLomas. Complete cure in gPRLoma is rare, but similar to that achieved in non-gPRLomas, reached in less than 10% of patients.

Resumen Introduccion La mayor supervivencia del paciente trasplantado viene acompanada del aumento en la tasa de tumores de novo (TN) que representan la complicacion tardia mas frecuente. Podemos distinguir entre tumores de piel no melanoma (TPNM), sindrome linfoproliferativo postrasplante (SLPT) y tumores de organo solido (TOS). Nuestro objetivo es determinar la incidencia de los distintos TN, el tiempo trascurrido hasta su diagnostico y su supervivencia en nuestro medio. Material y metodo Realizamos un estudio retrospectivo de 1.071 trasplantados hepaticos desde 1990 hasta 2015 en nuestro centro. Analizamos las variables demograficas, la incidencia de TN y la supervivencia. Resultados Se desarrollaron 184 TN en 1.071 pacientes trasplantados (17%), en el 19% de los varones y en el 13% de las mujeres (p = 0,004). Los TN mas frecuentes fueron los TPNM (29%), pulmon (18%), cabeza y cuello (16%), SLPT (10%) y gastrointestinales (8%). La mediana del tiempo de diagnostico fue de 7,9 anos en los TPNM, 3,9 anos en SLPT y de 9,8 anos en TOS. Los pacientes con TPNM tuvieron significativamente mejor supervivencia que aquellos con SLPT o TOS. La incidencia de los tumores de novo (excluidos TPNM) fue 1.889/100.000 trasplantados/ano. Por genero, el cancer de pulmon fue el TOS mas comun en varones y el cancer de mama en mujeres. Conclusion En nuestro medio, excluidos los TPNM, la incidencia es 8,8 veces la estimada para la poblacion general, con una alta tasa de cancer de pulmon por lo que deberiamos implementar estrategias preventivas y diagnosticas.

Between 1991 and 2013, 1,000 liver transplantations were performed at Virgen del Rocio Hospital (Seville, Spain). A retrospective study was conducted, analyzing the characteristics of recipients and donors, indications, surgical technique, complications and survival in 2 different stages (1991-2002 vs. 2003-2013) coinciding with the implementation of the MELD scale as a prioritization model. The most frequent indication were of hepatopathy of hepatocellular origin in 48.8%. There was a significant increase in the indications for hepatocarcinoma (8.6% and 24.1% P=0.03), and the rate of retransplantation (5.9% vs 9.6%, P=0.04). There was a change in the age of donation, going from 27.7 years in 1990 to 62.9 years in 2012 (P=0.001). The percentage of patients who did not require blood transfusion doubled (6.16 vs. 14.31%, P=.001). Survival of all patients after one, 5 and 10 years was 77, 63.5 and 51.3%, respectively.