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Introducción: La atención al parto es una de las causas de ingreso hospitalario más frecuente, y la cesárea, por lo tanto, una de las intervenciones quirúrgicas más realizadas en nuestro medio. El aumento en la tasa de cesáreas observado en las últimas décadas se ha convertido en una preocupación a nivel mundial. En 2014 la OMS propuso el sistema de clasificación Robson como un estándar global para evaluar, monitorizar y comparar las tasas de cesáreas. Objetivos: El objetivo final de este trabajo es adecuar la tasa de cesáreas en el hospital universitario Virgen del Rocío, mediante el análisis e identificación de factores y grupos de riesgo, implementando la clasificación de Robson; así como la elaboración de un modelo predictivo para el parto por cesárea en nuestro medio. Material y métodos: Se trata de un estudio observacional descriptivo de carácter retrospectivo que incluye los nacimientos acontecidos entre el 1 de enero de 2019 y el 31 de diciembre de 2019 en el Hospital Universitario Virgen del Rocío. Resultados: La tasa de cesáreas en el Hospital Universitario Virgen del Rocío ha aumentado un 3,51% desde el año 2010. La edad media de nuestras pacientes se situó en 31,6 años, siendo la obesidad la comorbilidad más frecuente [15,6% IC 95% (14,7;16,6)]. El 58% [IC 95% (56,7;59,4)] de nuestras pacientes eran nulíparas, y un 11,2% [IC 95% (10,4;12,1)] contaban con el antecedente de una cesárea anterior. El 34,2% [IC 95% (33,0;35,6)] de los partos se iniciaron mediante inducción. Las indicaciones de inducción más frecuentes fueron la RPM 32,8% [IC 95% (30,6;35,0)] y EPRO [IC 95% (22,8;26,9)]. El 74,6% [IC 95% (72,2;76,9)] de las cesáreas que se realizaron fueron urgentes. Las indicaciones más frecuentes fueron el riesgo de pérdida de bienestar fetal 25,6% [IC 95% (23,2;28,0)], seguido de la cicatriz uterina 20,0% [IC 95% (17,9;22,2)] y de la falta de progresión (19,5%) [IC 95% (17,4;21,7)]. Los grupos de Robson más prevalentes fueron el 3 con un 24,2% [IC 95% (23,0

Introducción o motivación de la tesis: Los avances en el conocimiento de las bases moleculares de la respuesta inflamatoria en la rinosinusitis crónica con pólipos nasales (RSCcPN) han conducido el manejo de estos pacientes hacia una medicina personalizada y de precisión. La cirugía de la cavidad nasal se ha posicionado como una alternativa adecuada en aquellos pacientes que no alcanzan el control con el tratamiento médico adecuado, pero las recidivas de la enfermedad siguen siendo una limitación. La aparición de nuevos abordajes quirúrgicos basados en las características específicas de cada paciente y el escaso control de la enfermedad asociado a las formas más severas de la enfermedad hace necesario revisar el papel de la cirugía personalizada y de precisión en el manejo de la RSCcPN. Se espera que esta investigación refuerce las pruebas clínicas disponibles, aporte evidencia sobre los resultados de las técnicas quirúrgicas extendidas y contribuya a proporcionar nuevas recomendaciones quirúrgicas en los pacientes con RSCcPN. Contenido de la investigación: Esta tesis doctoral evalúa el papel los abordajes endoscópicos nasosinusales extendidos en pacientes con RSCcPN, analizando los resultados clínicos, endoscópicos y radiológicos a medio y largo plazo, en comparación con las cirugías más limitadas o localizadas. Por otra parte, examina las mejoras añadidas al uso de la cirugía regenerativa (mucoplastia endonasal), como técnica complementaria, en pacientes con características de la enfermedad más severas y de peor pronóstico. En última instancia recoge una revisión que resume toda la evidencia publicada hasta el momento y posiciona los resultados de esta tesis doctoral en el panorama científico actual. Conclusión: La aplicación de las variantes extendidas de la cirugía endoscópica nasosinusal mejora los resultados clínicos a largo plazo en los pacientes con RSCcPN. La asociación de la mucoplastia endonasal supone una mejora añadida a estos abordajes, con resultados

Introducción: La presencia de una disfunción en la memoria semántica de las personas con esquizofrenia está ampliamente aceptada, pero el perfil de la misma ha sido definido de una forma muy desigual y sin un claro consenso sobre qué pruebas serían más eficientes utilizar en la práctica clínica diaria. De la misma manera, su asociación con la sintomatología negativa y sus diferentes aproximaciones dimensionales han sido descritas escasa y heterogéneamente. La participación de estos dos constructos sobre el funcionamiento social, aunque reconocida y mejor definida para la clínica negativa, no acaba de ser perfilada para la disfunción semántica. Identificar la prueba semántica más eficiente para discriminar entre sujetos sanos y pacientes, con y sin predominio de síntomas negativos, explorar la relación de la disfunción semántica con otras manifestaciones psicopatológicas, sobre todo con las dimensiones sintomáticas negativas, así como perfilar su impacto en el funcionamiento social. Materiales y Método: Se desarrolló un estudio observacional transversal, donde se reclutó una muestra de 30 personas con diagnóstico de esquizofrenia (según criterios DSM-IV-TR) y otra de controles sanos (n = 30). Todos los pacientes se encontraban en tratamiento y estabilizados clínicamente. Se diferenciaron en dos grupos: con predominio de síntomas negativos (n = 15) y sin predominio (n = 15), según su puntuación en la SANS. Se les administró una batería de pruebas semánticas, junto determinaciones de inteligencia premórbida, función ejecutiva y funcionamiento social. Se desarrollaron modelos de regresión y se calcularon curvas ROC y AUC, para determinar qué prueba semántica tenía mayor capacidad discriminativa. Tras determinar la mejor prueba, se amplió la muestra de pacientes (n =40) de acuerdo al calculo del tamaño muestral y se desarrollaron nuevos modelos de regresión para explorar las relaciones entre memoria semántica, síntomas negativos y funcionamiento social. Resultados: Se en

Las distrofias hereditarias de retina (DHR) constituyen un grupo de enfermedades raras de base genética que cursan con pérdida visual progresiva e irreversible debido a la afectación primaria de los fotorreceptores. La elevada heterogeneidad clínica y genética que presentan estas patologías dificulta enormemente su diagnóstico. A pesar de los avances logrados en los últimos años en el diagnóstico genético de las DHR, casi un 40% de los individuos afectos permanece aún sin diagnóstico molecular tras el análisis rutinario. Esto sugiere que la causa de las DHRs en estos pacientes podría deberse a: i) variantes no detectadas por los métodos actuales de rutina diagnóstica como algunas variantes estructurales complejas o variantes en regiones repetitivas; ii) variantes localizadas en regiones no analizadas o no priorizadas de forma rutinaria como las variantes en regiones intrónicas profundas, no codificantes o con significancia clínica desconocida o iii) variantes en genes cuya asociación a las DHRs aún se desconoce. En este escenario, la aplicación de técnicas de secuenciación masiva de gran alcance como la secuenciación de genoma completo, o la aplicación de la secuenciación de lecturas largas muestran un gran potencial diagnóstico especialmente para enfermedades raras. Sin embargo, se hace necesario el desarrollo de protocolos estandarizados para el análisis de los datos obtenidos que permitan la traslación de estas aproximaciones genómicas a la práctica clínica. El principal objetivo de esta tesis doctoral se centra en la generación de flujos de trabajos que faciliten la priorización e interpretación de los datos genómicos permitiendo aumentar las tasas de rendimiento diagnóstico de los pacientes con DHR.

Background The increasing incidence of coeliac disease is leading to a growing interest in active search for associated factors, even the intrauterine and early life. The exposome approach to disease encompasses a life course perspective from conception onwards has recently been highlighted. Knowledge of early exposure to gluten immunogenic peptides (GIP) in utero could challenge the chronology of early prenatal tolerance or inflammation, rather than after the infant’s solid diet after birth. Methods We developed an accurate and specific immunoassay to detect GIP in amniotic fluid (AF) and studied their accumulates, excretion dynamics and foetal exposure resulting from AF swallowing. One hundred twenty-five pregnant women with different gluten diets and gestational ages were recruited. Results GIP were detectable in AF from at least the 16th gestational week in gluten-consuming women. Although no significant differences in GIP levels were observed during gestation, amniotic GIP late pregnancy was not altered by maternal fasting, suggesting closed-loop entailing foetal swallowing of GIP-containing AF and subsequent excretion via the foetal kidneys. Conclusions The study shows evidence, for the first time, of the foetal exposure to gluten immunogenic peptides and establishes a positive correlation with maternal gluten intake. The results obtained point to a novel physiological concept as they describe a plausible closed-loop circuit entailing foetal swallowing of GIP contained in AF and its subsequent excretion through the foetal kidneys. The study adds important new information to understanding the coeliac exposome.

Introducción y objetivos: La evaluación actual de la insuficiencia cardiaca (IC) aguda no permite predecir adecuadamente su evolución. La bioimpedancia eléctrica (BI) permite conocer el estado de volemia, hasta ahora solo con equipos fijos. Hemos desarrollado y validado un dispositivo portátil e inalámbrico para medir la BI en el tobillo (IVOL). El objetivo del estudio es conocer el valor pronóstico a largo plazo de la medición puntual de la BI con IVOL en pacientes con IC aguda. Métodos: Estudio de cohorte prospectivo de pacientes no seleccionados ingresados por IC aguda en un hospital de tercer nivel. Se analizó la asociación entre la BI y diferentes variables (clínicas, analíticas y ecocardiográficos) al ingreso y evolución clínica. Resultados: Se incluyeron 76 pacientes (edad media 66,1 anos, ˜ 71,1% varones, 68,4% hipertensos, 34,2% diabéticos, NT-ProBNP medio: 7.103 pg/ml). De ellos, el 52,6% con fracción de eyección del ventrículo izquierdo (FEVI) no preservada (< 50%) y el 56,6% con disfunción del ventrículo derecho (VD). El 26,3% fallecieron durante un seguimiento medio de 35,8 meses. La supervivencia en pacientes con BI ≤ 21,8 fue menor, globalmente, y en los subgrupos de pacientes sin FEVI preservada y con disfunción del VD; p < 0,008). En el análisis multivariante una BI ≥ 21,8 fue un factor independiente de supervivencia (HR: 0,242; IC 95%: 0,86-0,681; p = 0,007). Conclusiones: Los valores de la BI medidos con IVOL pueden ser un predictor independiente de mortalidad a largo plazo en pacientes hospitalizados por IC aguda. Este valor pronóstico se mantiene en pacientes con FEVI no preservada y con disfunción ventricular derecha.

This study investigates the effectiveness of inclusion measures for women with disabilities at a public university in southern Spain, aiming to understand their needs and experiences. Utilizing a gender perspective, the research engaged 12 women from various university roles in semi-structured interviews, later analyzed using NVivo 20, and organized into categories assessing institutional resources, working/academic conditions, and the interplay of disability and gender. Findings indicate that, despite no direct discrimination based on sex, the patriarchal social framework still fosters gender and inclusion gaps. Peer support emerges as a protective factor, whereas obstacles such as resource scarcity, access challenges, and a lack of awareness about disability measures pose risks. The study highlights the need for enhanced visibility of inclusive measures and the development of agile, individualized policies. It underscores the importance of raising awareness, particularly about non-visible disabilities, through educational initiatives.

Introduction and Hypothesis The objective was to create and validate the usefulness of a convolutional neural network (CNN) for identifying different organs of the pelvic floor in the midsagittal plane via dynamic ultrasound. Methods This observational and prospective study included 110 patients. Transperineal ultrasound scans were performed by an expert sonographer of the pelvic floor. A video of each patient was made that captured the midsagittal plane of the pelvic floor at rest and the change in the pelvic structures during the Valsalva maneuver. After saving the captured videos, we manually labeled the different organs in each video. Three different architectures were tested—UNet, FPN, and LinkNet—to determine which CNN model best recognized anatomical structures. The best model was trained with the 86 cases for the number of epochs determined by the stop criterion via cross-validation. The Dice Similarity Index (DSI) was used for CNN validation. Results Eighty-six patients were included to train the CNN and 24 to test the CNN. After applying the trained CNN to the 24 test videos, we did not observe any failed segmentation. In fact, we obtained a DSI of 0.79 (95% CI: 0.73 – 0.82) as the median of the 24 test videos. When we studied the organs independently, we observed differences in the DSI of each organ. The poorest DSIs were obtained in the bladder (0.71 [95% CI: 0.70 – 0.73]) and uterus (0.70 [95% CI: 0.68 – 0.74]), whereas the highest DSIs were obtained in the anus (0.81 [95% CI: 0.80 – 0.86]) and levator ani muscle (0.83 [95% CI: 0.82 – 0.83]). Conclusions Our results show that it is possible to apply deep learning using a trained CNN to identify different pelvic floor organs in the midsagittal plane via dynamic ultrasound.

Background: Dry eye disease (DED), a prevalent condition with a multifactorial etiology, significantly impacts global health by causing discomfort and visual disturbance. This historical cohort study evaluates the efficacy of Intense Pulsed Light (IPL) therapy on meibomian gland dysfunction (MGD)-related evaporative DED. Methods: The study involved 110 patients (220 eyes) who underwent IPL therapy. Ethical approval was secured, and informed consent was obtained from all participants. A Tearcheck® (ESWvision, Houdan, France) device was used for ocular surface evaluation, measuring tear film stability (NIFBUT, NIABUT), tear film quantity (CTMH, TTMH), and inflammation (OSIE). The study assessed tear film and ocular surface health across multiple IPL sessions. Results: Significant improvements were observed in subjective symptoms (EFT score increased from 29.10 ± 8.87 to 35.91 ± 7.03, p < 0.01), tear film stability (NIFBUT increased from 9.37 ± 6.04 to 10.78 ± 5.83 s, p < 0.01; NIABUT increased from 11.07 ± 4.98 to 12.34 ± 4.66 s, p < 0.01), and tear film surface evaluation (TFSE score decreased from 337.78 ± 414.08 to 206.02 ± 240.44, p < 0.01). Tear film quantity remained unchanged (CTMH and TTMH, p > 0.05). Conclusions: IPL therapy is a promising treatment for DED, improving symptoms and ocular surface health. Further research is warranted to explore long-term efficacy and optimization.

Postpartum depression is a significant health issue affecting both mothers and newborns during the postpartum period. Group support interventions during this period have proven effective in helping women cope with depression and improving breastfeeding rates. This study aimed to assess the effectiveness of a midwife-led breastfeeding support group intervention on breastfeeding rates, postpartum depression and general self-efficacy. This was a multicentric cluster randomised controlled trial with control and intervention groups and was not blinded. It was conducted in Andalusia (southern Spain) from October 2021 to May 2023. A total of 382 women participated in the study. The results showed a significant difference in exclusive breastfeeding rates at 4 months postpartum between the groups (control 50% vs. intervention 69.9%; p < 0.001). Additionally, there was a lower mean score on the Edinburgh Postnatal Depression Scale in the intervention group (12.49 ± 3.6 vs. 13.39 ± 4.0; p = 0.044). Similarly, higher scores of general self-efficacy were observed among breastfeeding women at 2 and 4 months postpartum (77.73 ± 14.81; p = 0.002 and 76.46 ± 15.26; p < 0.001, respectively). In conclusion, midwife-led breastfeeding support groups enhanced self-efficacy, prolonged breastfeeding and reduced postpartum depression 4 months after giving birth.

Nasal obstruction is a frequently reported symptom that prompts patients to seek appointments with Ear, Nose, and Throat (ENT) specialists. Loss of smell, while commonly associated with nasal issues, often occurs with low self-awareness, making it challenging to assess patients' symptoms solely based on their clinical history. Anatomical factors can significantly impact both olfactory function and nasal airflow, making an understanding of their pathologies and surgical solutions crucial for optimizing patient outcomes. The primary objective of this study was to assess methods for enhancing the results of nasal surgery, particularly concerning olfactory function and nasal airflow. We initiated the investigation with a comprehensive overview of reviews of literature pertaining to the loss of smell and nasal obstruction. Subsequently, we developed and validated the 'Algarve Smell Test.' To facilitate clinical application, we established a specialized 'rhinology and olfaction' consultation that adhered to a predefined protocol. For cases where surgery was deemed necessary, we closely monitored surgical outcomes, and in select patients, a local anesthetic protocol was administered. The optimization of respiratory function in endoscopic sinus surgery and rhinoseptoplasty was predominantly accomplished through meticulous preoperative selection, employing subjective nasal permeability scales such as the NOSE and SNOT- 22. This decision-making process was further refined by integrating standardized clinical history, objective examinations, and complementary tests. In parallel, the optimization of olfactory function was achieved through the administration of smell tests. Notably, this improvement was observed in endoscopic sinus surgery but was less pronounced in rhinoplasty and septoplasty procedures. Patients undergoing endoscopic surgery experienced marked improvements in their overall smell scores, primarily due to enhanced odor threshold and discrimination scores. Intrig

Introduction: Lid-parallel conjunctival folds (LIPCOF) and conjunctivochalasis (CCH) are similar conditions that seem to be related to dry eye severity. In addition, there is a lack of studies on the topic of LIPCOF and CCH on dry eye symptoms in non-contact lens and contact lens (CL) wearers. Therefore, the aim of this study is to review the relationship of LIPCOF and CCH with dry eye symptoms in non-CL and CL wearers, as well as to report the treatment of dry eye disease (DED) in non-CL and CL wearers who present LIPCOF or CCH. Methods: A literature review of full-length original studies in two databases, PubMed and Scopus, was performed. The search period included observational studies in humans published between April 21, 2009 and March 20, 2023. Results: A total of 26 studies were included. The studies suggest that LIPCOF and CCH are significantly related to dry eye symptoms in non-CL and CL wearers. However, the impact of CL wear on LIPCOF and CCH may be complex and may vary depending on individual factors such as lens type, lens care regimen, and pre-existing ocular conditions. Regarding LIPCOF management, tear substitutes seem to significantly reduce LIPCOF and dry eye symptoms in non-CL wearers, while vectored thermal pulsation (VTP) and microblepharoexfoliation (MBE) are suggested as promising treatment for LIPCOF and dry eye symptoms in CL wearers. Regarding CCH management, surgical interventions may be effective in reducing CCH when medical treatments have no response. In addition, an ocular examination by slit lamp is necessary to distinguish both conditions. Conclusions: Tear substitutes, VTP, MBE, and fitting CLs with low coefficient of friction (CoF) seem to reduce and prevent LIPCOF. However, surgical treatment options seem to be more effective in the complete elimination of CCH. An adequate evaluation and differentiation between LIPCOF and CCH are important, and they should be considered by practitioners in managing dry eye symptoms in non-CL and C

There are numerous recognized benefits of breastfeeding; however, sociocultural, individual, and environmental factors influence its initiation and continuation, sometimes leading to breastfeeding rates that are lower than recommended by international guidelines. The aim of this study was to evaluate the effectiveness of a group intervention led by midwives supporting breastfeeding during the postpartum period in promoting exclusive breastfeeding, as well as to assess the impact of this intervention on perceived self-efficacy. This was a non-blind, multicentric, clusterrandomized controlled trial. Recruitment started October 2021, concluding May 2023. A total of 382 women from Andalusia (Spain) participated in the study. The results showed that at 4 months postpartum there was a higher prevalence of breastfeeding in the intervention group compared to formula feeding (p = 0.01), as well as a higher prevalence of exclusive breastfeeding (p = 0.03), and also at 6 months (p = 0.01). Perceived self-efficacy was similar in both groups for the first two months after delivery, which then remained stable until 4 months and decreased slightly at 6 months in both groups (p = 0.99). The intervention improved the average scores of perceived self-efficacy and indirectly caused higher rates of exclusive breastfeeding (p = 0.005). In conclusion, the midwife-led group intervention supporting breastfeeding proved to be effective at maintaining exclusive breastfeeding at 6 months postpartum and also at increasing perceived self-efficacy

Las guías clínicas recomiendan las técnicas mínimamente invasivas en la hernia inguinofemoral de la mujer, ya que las mujeres obtienen peores resultados en cuanto a recidiva herniaria e inguinodinia crónica (CPIP). Hasta la fecha, no existen estudios randomizados que comparen las técnicas laparoendoscópicas en la mujer. Se lleva a cabo un ensayo clínico randomizado entre abril de 2019 y marzo de 2023. Se incluyen mujeres mayores de 18 años con hernia inguinofemoral primaria, sin cirugías previas salvo apendicectomía y aptas para el régimen de CMA. Se asignan de forma aleatorizada a los grupos de intervención TAPP y TEP. El objetivo principal es comparar la estancia hospitalaria postoperatoria. El objetivo secundario es, por una parte, evaluar el dolor al alta y el desarrollo de inguinodinia crónica postoperatoria a lo largo del primer año tras la intervención. Por otra parte, se evalúa la tasa de recidiva y los eventos adversos. Se reclutan 78 pacientes, 39 por grupo, excluyéndose dos por no cumplir los criterios de inclusión y exclusión. La mediana de estancia postoperatoria es de 360 minutos (IQR 120) para el grupo TAPP y 300 minutos (IQR 90) para el grupo TEP (p<0.001). De forma global, la mediana de dolor al alta es de 3,5 (IQR 4) sobre la escala numérica, sin diferencias entre técnicas. La estancia postoperatoria se relaciona con el dolor al alta (?=0.268, p=0.021), cuya intensidad se relaciona a su vez con la reparación herniaria bilateral (?=1.223, p=0.002) y la utilización de tacks (?=1.833, p=0.034). La incidencia de CPIP es del 14,9% a los tres meses tras la intervención (n=74; TAPP 7,9%, TEP 22,2%, p=0,108) y del 14,8% al año (n= 61; TAPP 12,5%, TEP 17,2%, p=0,724). El CPIP limita la recuperación de la vida diaria al tercer mes (p=0,040), pero no un año tras la cirugía. El dolor al alta se relaciona con el dolor durante el seguimiento en el análisis de muestras pareadas (p<0,001). El CPIP al año se relaciona con el seroma/hematoma postoperatorio (p=0,020

Background: Polycystic ovary syndrome (PCOS) is a highly prevalent endocrine–metabolic disorder in women of reproductive age. Diagnosis is based on the evidence-based international guideline 2018 and the Rotterdam Consensus to classify PCOS phenotypes. This study aims to characterize the biodemographic, clinical, metabolic, and reproductive variables and their relationship with PCOS phenotypes in a population from the Ecuadorian Andes. Methodology: A cross-sectional study was conducted with a non-random consecutive sample of 92 women who attended the outpatient gynecology and endocrinology clinic at the Hospital of the Technical University of Loja (UTPL)—Santa Inés, Loja, Ecuador, between January 2022 and July 2023. Descriptive statistics, mean calculations, standard deviation, parametric and nonparametric tests, odds ratios (OR), confidence intervals (CI), and p-values were employed. Results: The average age was 22 ± 3.4 years, with a predominantly mestizo, urban, single, highly educated, and medium–high socioeconomic level population. It was identified that phenotypes A + B are at a higher risk of developing oligomenorrhea and hypertriglyceridemia compared to phenotypes C + D, with statistically significant differences (p < 0.05). Furthermore, in terms of reproductive variables, phenotypes A + B exhibit a significantly higher frequency of elevated anti-Müllerian hormone (AMH) compared to phenotypes C + D, also with statistical significance (p < 0.05). Conclusions: The classical phenotypes A and B of PCOS are the most common in Ecuadorian Andean women and carry a higher risk of insulin resistance, anovulation, metabolic disorders, and elevated triglyceride levels compared to phenotypes C and D. Ethnic diversity and sociocultural habits influence the prevalence and clinical manifestations of these phenotypes.

Background: Accidental dural puncture (ADP) is the most frequent major complication when performing an epidural procedure in obstetrics. Consequently, loss of pressure in the cerebrospinal fluid (CSF) leads to the development of postdural puncture headache (PDPH), which occurs in 16%–86% of cases. To date, the efficacy of epidural fibrin patches (EFP) has not been evaluated in a controlled clinical trial, nor in comparative studies with epidural blood patches (EBP). Methods: The objective of the present study was to compare the efficacy of EFP with respect to EBP for the treatment of refractory accidental PDPH. This prospective, randomized, open-label, parallel, comparative study included 70 puerperal women who received an EBP or EFP (35 in each group) after failure of the conventional analgesic treatment for accidental PDPH in a hospital. Results: A higher percentage of women with EFP than EBP achieved complete PDPH relief after 2 (97.1% vs. 54.3%) and 12h (100.0% vs. 65.7%) of the patch injection. The percentage of patients who needed rescue analgesia was significantly lower with EFP after 2 (2.9% vs. 48.6%) and 12h (0.0% vs. 37.1%). After 24h, PDPH was resolved in all women who received EFP. The recurrence of PDPH was reported in one woman from the EBP group (2.9%), who subsequently required a second patch. The mean length of hospital stay was significantly lower with EFP (3.9days) than EBP (5.9days). Regarding satisfaction, the mean value (Likert scale) was significantly higher with EFP (4.7 vs. 3.0). Conclusions: EFP provided better outcomes than EBP for the treatment of obstetric PDPH in terms of efficacy, safety, and patient satisfaction.

Objectives—The changes of the extracellular matrix of the connective tissue have significantly contributed to the incidence of pelvic organ prolapse (POP). It seems reasonable that sonoelastography could be a useful tool to evaluate the elasticity of pelvic floor tissue in patients with POP and compare it to those without POP. The main aim of this pilot study was to determine if there are differences in the elasticity of the levator ani muscle (LAM) and vaginal tissue between patients with and without POP. Methods—Prospective observation study, including 60 patients (30 with POP and 30 without POP). Sonoelastography was performed to evaluate the elasticity (in kilopascals, kPa) of the following regions of interest: vagina at the level of middle third of the urethra; vagina at the level of the bladder trigone; vagina in the anterior and posterior fornix; vagina at the level of middle third of the anorectal canal; posterior third of the LAM. Results—A total of 60 patients completed the study (30 with POP, 30 without POP). In the POP group, 18/30 (60%) had an anterior vaginal wall prolapse, 3/30 (10%) a uterine prolapse, 15/30 (50%) a rectocele, and 6/30 (20%) a enterocele. Patients with POP had higher elasticity in all anatomical study areas, with statistically significant differences in the anterior fornix (13.6 vs 11.2 kPa; P: .012). A multiple regression (controlling age, menopausal stage, and parity) allowed to detect statistically significant differences in the elasticity of the middle third of the urethra (P: .03) and the middle third of the anorectal canal (P: .019). Conclusion—It is possible to evaluate the elasticity of the LAM and vaginal tissue using sonoelastography, detecting a higher elasticity in patients with POP than in those without POP.

Purpose: To compare the effectiveness of meibomian gland expression (MGX) combined with home-based therapy versus home-based therapy alone for the treatment of dry eye disease (DED) caused by meibomian gland dysfunction (MGD). Methods: A systematic review of randomized controlled studies (RCTs), reporting the effects of MGX combined with home-based therapy in 2 databases, PubMed and Web of Science, was performed according to the PRISMA statement. The search period was until August 20, 2023. According to the heterogeneity, a random or fixed effects model was performed in the meta-analysis. The standardized mean difference (SMD) was calculated to analyze dry eye symptoms (DES) score, tear film break-up time (TBUT), total corneal fluorescein staining (tCFS) and meibomian glands expressibility (MGE). All analyses were performed by RevMan Web, version 5.7. The Cochrane risk of bias tool was used to analyze the quality of the studies selected. Results: Two RCTs with a total of 99 patients were included. The studies reported that MGX combined with home-based therapy improves DES score, TBUT, tCFS and MGE compared to the home-based therapy. However, the meta-analysis indicated that MGX combined with home-based therapy only seems to be beneficial in reducing DES score (SMD -0.49; 95 % CI: -0.89 to -0.08; P = 0.02; I2 = 0 %). In addition, although TBUT, tCFS and MGE reported a slight trend in favor of MGX combined with home-based therapy, it was non-significant. Conclusions: While MGX combined with home-based therapy seem to show some evidence of alleviating dry eye symptoms, there is insufficient evidence to conclude the effects of this treatment definitively particularly in improving dry eye signs caused by MGD, such as TBUT, tCFS and MGE. Therefore, further RCTs are needed to elucidate these results.

Background. Several aspects of the occurrence and management of mycotic aneurysm (MA) in patients with infective endocarditis (IE) have not been studied. Objectives. To determine the incidence and factors associated with MA presence and rupture and to assess the evolution of those initially unruptured MA. Methods. Prospective multicenter cohort including all patients with definite IE between January 2008 and December 2020. Results. Of 4548 IE cases, 85 (1.9%) developed MA. Forty-six (54.1%) had intracranial MA and 39 (45.9%) extracranial MA. Rupture of MA occurred in 39 patients (45.9%). Patients with ruptured MA had higher 1-year mortality (hazard ratio, 2.33; 95% confidence interval, 1.49–3.67). Of the 55 patients with initially unruptured MA, 9 (16.4%) presented rupture after a median of 3 days (interquartile range, 1–7) after diagnosis, being more frequent in intracranial MA (32% vs 3.3%, P = .004). Of patients with initially unruptured MA, there was a trend toward better outcomes among those who received early specific intervention, including lower follow-up rupture (7.1% vs 25.0%, P = .170), higher rate of aneurysm resolution in control imaging (66.7% vs 31.3%, P = .087), lower MA-related mortality (7.1% vs 16.7%, P = .232), and lower MA-related sequalae (0% vs 27.8%, P = .045). Conclusions. MA occurred in 2% of the patients with IE. Half of the Mas occurred in an intracranial location. Their rupture is frequent and associated with poor prognosis. A significant proportion of initially unruptured aneurysms result from rupture during the first several days, being more common in intracranial aneurysms. Early specific treatment could potentially lead to better outcomes

Introduction: To evaluate the efficacy and safety of Quantum Molecular Resonance (QMR) treatment in patients with severe dry eye disease (DED), as well as its effects on aqueous-deficient (ADDE), evaporative (EDE), and mixed (MDE) dry eye. Methods: In this prospective, interventional study, 81 patients were randomly allocated to received four treatment sessions of QMR at 1-week intervals (Rexon-Eye®, Resono Ophthalmic, Trieste, Italy) (QRM group) or tear substitute four times daily, containing 0.15% sodium hyaluronate and 3% trehalose (Thealoz Duo®, Thea Pharma, France) (SH-TH group). Outcome measures included ocular surface disease index (OSDI) questionnaire, tear meniscus height (TMH), tear breakup time (TBUT), non-invasive breakup time (NIBUT), corneal fluorescein staining (CFS), lipid layer thickness (LLT), tear film osmolarity (OSM), and meibomian gland dysfunction (MGD) grade, which were assessed at baseline and 1-month and 3-month follow-up. Results: The QMR group achieved better improvements than the SH-TH group in OSDI and SANDE questionnaires, NIBUT, LLT, and CFS. The mean differences between the groups were as follows: OSDI (− 12.4 ± 0.25 points, P = 0.01), SANDE (10.6 ± 1.7 points, P = 0.01), NIBUT (2 ± 0.25 s, P = 0.01), LLT (18.7 ± 0.7 nm, P = 0.01), and CFS (1.2 ± 0.1 points, P = 0.02). In subgroups analysis, QMR treatment demonstrated a beneficial role to improve DED symptoms and signs in ADDE, EDE, and MDE. Conclusion: QMR is an effective and well-tolerated treatment that seems to improve DED symptoms and signs in patients with severe DED. However, further studies are needed to confirm this. Trial Registration: ClinicalTrials.gov identifier NCT06119386.

Purpose: To characterize microbial keratitis diversity utilizing species richness and Shannon Diversity Index. Methods: Corneal impression membrane was used to collect samples. All swabs were processed and analyzed by Biolab Laboratory (level V—SSN Excellence: ISO 9001:2015), Biolab Srl (Ascoli Piceno, Italy). DNA extraction, library preparation, and sequencing were performed in all samples. After sequencing, low-quality and polyclonal sequences were filtered out by the Ion software. At this point, we employed Kraken2 for microbial community analysis in keratitis samples. Nuclease-free water and all the reagents included in the experiment were used as a negative control. The primary outcome was the reduction in bacterial DNA (microbial load) at T1, expressed as a percentage of the baseline value (T0). Richness and Shannon alpha diversity metrics, along with Bray–Curtis beta diversity values, were calculated using the phyloseq package in R. Principal coordinate analysis was also conducted to interpret these metrics. Results: 19 samples were included in the study. The results exhibited a motley species richness, with the highest recorded value surpassing 800 species. Most of the samples displayed richness values ranging broadly from under 200 to around 600, indicating considerable variability in species count among the keratitis samples. Conclusions: A significant presence of both typical and atypical bacterial phyla in keratitis infections, underlining the complexity of the disease’s microbial etiology.

INTRODUCCIÓN: Tras el confinamiento domiciliario acontecido con la nueva enfermedad SARS-CoV2, ha sobrevenido un cambio respecto al uso de nuevas tecnologías de la información y comunicación (TICs) aumentando la exigencia visual en etapas susceptibles al desarrollo de defectos refractivos. Estudiamos cómo el confinamiento domiciliario y el uso de TICs hubieran podido influir en la distribución de defectos refractivos infantiles. MATERIAL Y MÉTODOS: Se realizó un estudio epidemiológico analítico trasversal incluyendo una muestra de conveniencia de 244 niños en 2 grupos independientes: los que sufrieron confinamiento domiciliario (n=113) y los que no (n=131). Se recogieron antecedentes personales y familiares, tipo de colegio, horario escolar, actividades extraescolares, uso de TICs y tareas escolares. Se exploró la refracción bajo cicloplejia. Posteriormente se examinó la distribución de defectos refractivos en ambos grupos. RESULTADO: La distribución de defectos refractivos en el grupo que sufrió el confinamiento mostró menor número de niños emétropes y mayor número con astigmatismo. CONCLUSIONES: El confinamiento domiciliario tras el Covid-19 y los cambios en la educación escolar y familiar respecto al uso de TICs pudieran haber supuesto una mayor exigencia visual en pleno proceso de emetropización infantil. En nuestro estudio observamos menos niños emétropes y más con astigmatismo después del confinamiento, lo que en un futuro pudiera derivar en un incremento de casos de miopía.

This study evaluated the effectiveness of hyaluronic acid and trehalose (HA/trehalose) eyedrops in managing dry eye disease (DED) symptoms by measuring tear stability and administering a DED questionnaire. Sixty patients were treated with either HA/trehalose eyedrops (Tear A) or carmellose sodium eyedrops (Tear B) as controls. The tear breakup time (TBUT) and non-invasive breakup time (NIBUT) were monitored, and patients completed the standard patient evaluation of eye dryness (SPEED) questionnaire. After two months of twice-daily applications, patients treated with the HA/trehalose eyedrops demonstrated significant improvements in the NIBUT (12.98 ± 3.22 s) and TBUT (12.95 ± 2.98 s), indicating increased tear stability. Moreover, they reported lower dry eye sensation (6.70 ± 4.94 SPEED score points), suggesting a reduction in DED symptoms. These findings underscore the efficacy of HA/trehalose eyedrops in improving both the objective and subjective signs of DED, with twice-daily application enhancing ocular surface conditions and reducing patient-reported symptoms. © 2023 by the authors.

Introducción: La cirugía citorreductora (CCR) seguida de quimioterapia intraperitoneal hipertérmica (HIPEC) se asocia frecuentemente a alteraciones de la coagulación y a elevados requerimientos transfusionales perioperatorios debidos a la agresión quirúrgica, fluidoterapia agresiva, quimioterapia intraperitoneal e hipertermia. Objetivos: Determinar los trastornos hemostáticos asociados a cada una de las fases de este procedimiento mediante los estudios habituales de laboratorio, ROTEM, niveles de fibrinógeno, factor de von Willebrand y recuento plaquetario, así como su posible relación con las necesidades transfusionales. Materiales y método: Estudio prospectivo observacional, no aleatorizado en una muestra consecutiva de pacientes afectos de carcinomatosis peritoneal primaria o secundaria, que completaron la CCR y posterior HIPEC en un único centro hospitalario. Se comparan basalmente con los donantes de sangre voluntarios sanos (DSVS). La toma de muestra se realiza en tres tiempos (T0, estudio basal; T2, dos horas después de la intervención; T72, a las 72 horas de la cirugía). Se realizaron comparaciones entre sujetos e intrasujetos utilizando la prueba ANOVA de medidas repetidas. Resultados: Se incluyeron 44 pacientes intervenidos y 40 DSVS. La media de edad fue de 59 años. La media de índice de carcinomatosis peritoneal fue de 23,4 puntos. De mediacla intervención duró 7,6 horas. Los citostáticos utilizados fueron paclitaxel (48%), mitomicina (38,6%) y cisplatino (13%). En las primeras 24 horas de intervención y UCI se administraron una media de 8.810 ml de cristaloides. Durante la intervención quirúrgica 20,5% presentaron sangrado mayor de 500 ml. Durante las primeras 72 horas 12 pacientes (27,3%) presentaron sangrado mayor de 500 ml. Durante la intervención se transfundieron CH en 20,5%, en la estancia en UCI 20,5% y durante su estancia en planta 55,8%. Los pacientes intervenidos parten de niveles más bajos de hemoglobina (p 0,0001) y presentan PCR, fibrinógen

La apendicitis aguda es la causa más frecuente de intervención quirúrgica por dolor abdominal en el mundo. Se sabe que aproximadamente el 7% de la población sufrirá apendicitis en algún momento de su vida. El tratamiento de elección es la apendicectomía, que se realiza principalmente por abordaje laparoscópico, lo que permite una pronta recuperación del paciente. Esta cirugía a menudo se asocia con una estancia promedio en el hospital de entre 24 y 48 horas. En los últimos años tras el primer trabajo en 194, se ha sugerido un tratamiento ambulatorio de pacientes con apendicitis aguda no complicada después de una apendicectomía. Sin embargo, aunque los primeros estudios sobre apendicectomía ambulatoria se publicaron hace una década, actualmente no existe un consenso claro para generalizar la apendicectomía ambulatoria. Faltan estudios de alta calidad estadística que apoyen una estandarización de este procedimiento. La mayoría de los estudios son retrospectivos y existe una gran variabilidad en cuanto a los criterios de selección de pacientes, el tiempo de seguimiento y la definición de cirugía ambulatoria. Sin embargo, actualmente no existen estudios que hayan analizado las razones por las cuales la cirugía ambulatoria falla en pacientes con apendicitis aguda en los que se propone este manejo. Los dos metaanálisis publicados en 2019 y 2021 concluyen que hay una falta de estudios comparativos de alta calidad que hacen que las recomendaciones concluyentes no sean posibles en este momento. La gran heterogeneidad de los estudios y la dificultad de implementar protocolos en cirugía de urgencia parecen ser las razones por las que la apendicectomía ambulatoria no se ha generalizado en la actualidad. Hasta donde sabemos, no existe ningún ensayo aleatorio registrado que compare la cirugía sin ingreso en este contexto. Por lo tanto, el objetivo del presente estudio es evaluar la seguridad, eficacia, satisfacción y eficiencia de la apendicectomía abierta o laparoscópica en régi

Introducción El cuestionario Burn Specific Health Scale-Brief (BSHS-B) es un instrumento validado para evaluar la calidad de vida de los pacientes quemados. Fue desarrollado por Kildal et al en 2001 y ha sido validado en muchos idiomas, pero no en español. El BSHS-B contiene 40 ítems agrupados en 9 subdominios. Los pacientes deben puntuar cada ítem en una escala de 0 (totalmente de acuerdo) a 4 (nada en absoluto), donde a mayores puntuaciones, mejor es la calidad de vida. Objetivos El objetivo principal de este estudio es realizar la adaptación transcultural y validación al español del cuestionario BSHS-B. Esta validación se realizará midiendo su fiabilidad (consistencia interna) y su validez a través de las correlaciones con el cuestionario de salud Short Form 36 Health Survey (SF-36) para su uso generalizado en regiones hispanohablantes. Dentro de los objetivos secundarios se encuentra realizar un estudio retrospectivo de la población de pacientes quemados que cumplimentaron el cuestionario. Material y método Siguiendo las recomendaciones del Comité Asesor Científico del “Medical Outcome Trust”, la adaptación del BSHS-B se llevó a cabo mediante una serie de fases: (I) consentimiento de los creadores, (II) traducciones independientes al español, (III) síntesis de las traducciones, (IV) traducción inversa al inglés y (V) elaboración de la versión definitiva. El estudio fue realizado en el servicio de Cirugía Plástica y Grandes Quemados del Hospital Universitario Virgen del Rocío de Sevilla (España). Para el estudio se revisaron historias clínicas y se recogieron datos clínicos y demográficos de pacientes ingresados en nuestro hospital desde enero de 2015 a diciembre de 2020. Los criterios de inclusión en el estudio fueron: (1) mayores de 18 años, (2) pacientes con quemaduras de espesor total con una extensión igual o superior al 5% de la SCTQ a partir de los 6 meses de la quemadura y (3) pacientes con dicha SCTQ sometidos a intervención quirúrgica y/o desbridamiento

Objetivo: Evaluar la eficacia de la terapia visual (TV) en pacientes con estrabismo divergente (exotropía intermitente). Materiales y métodos: Se realizó una revisión detallada de artículos científicos, ensayos clínicos y revisiones bibliográficas usando distintas bases de datos que pudieran estar relacionadas con la salud visual como Pubmed y Science Direct. Otro recurso de búsqueda utilizado fue Google Académico. Resultados: Se incluyeron en el estudio 6 artículos. Se examinaron un total de 357 pacientes. Los pacientes estudiados fueron niños de edad mínima 5 años y adultos. El tratamiento más efectivo fue la terapia visual. Conclusiones: La prevalencia del estrabismo divergente no es relativamente alta, pero supone un importante problema de salud pública tanto en niños como en adultos. En los estudios donde se llevó a cabo el tratamiento de la exotropia intermitente mediante terapia visual, se experimentó una mejora. No disponemos de suficientes estudios que evidencien la eficacia de los diferentes tratamientos para este tipo de afección ocular pero podemos obtener una idea de cuál puede ser el más efectivo y esto puede incentivar la aparición de estudios futuros., Objective: To assess the efficacy of vision therapy (TV) in patients with divergent strabismus (intermittent exotropia). Materials and methods: A detailed review of scientific articles, clinical trials and bibliographic reviews was carried out using different databases that might be related to visual health such as Pubmed and Science Direct. Another search resource used was Google Scholar. 5 Results: Six articles were included in the study. A total of 357 patients were examined. The patients studied were children of at least 5 years of age and adults. The most effective treatment was visual therapy. Conclusions: The prevalence of divergent strabismus is not relatively high, but It is a major public health problem for both children and adults. In studies where intermittent exotropia was treated with vision therapy, an improvement was experienced. We do not have enough studies that show the efficacy of the different treatments for this type of eye condition, but we can obtain an idea of which may be the most effective and this may encourage the appearance of future studies.

Objective To determine if the addition of the assessment of levator ani muscle (LAM) avulsion to the measurement of the difference in the pubis-uterine fundus distance between rest and with the Valsalva maneuver could increase the diagnostic capacity of ultrasound for uterine prolapse (UP). Methods This multicenter, observational and prospective study included 145 patients. Ultrasound assessment was performed, establishing the diagnosis of UP as a difference between the pubic-uterine fundus distance at rest and during the Valsalva maneuver ≥15 mm (standard technique), while LAM avulsion was defined as an abnormal LAM insertion in three central slices using multislice ultrasound. A binary multivariate logistic regression model was made using nonautomated methods to predict surgical UP (general population, premenopausal, and postmenopausal patients), including the difference between the pubis-uterine fundus distance at rest and with the Valsalva maneuver as well as LAM avulsion. Results A total of 143 patients completed the study. The addition of LAM avulsion criteria to the standard dynamic distance-based protocol for the diagnosis of UP resulted in a higher sensitivity for the general population (79.7 vs 68.1%) as well as for premenopausal (89.3 vs 79.9%) and postmenopausal patients (76 vs 66.1%). In contrast, the standard technique showed a higher specificity than the model based on the standard technique associated with LAM avulsion for the general population (89.2 vs 74.3%) and premenopausal women (91.7 vs 63.2%). For postmenopausal patients, the model based on the standard technique associated with LAM avulsion had a higher sensitivity (76 vs 66.1%) and specificity (91.7 vs 86.8%) than the ultrasound diagnosis of UP. Conclusion The implementation of the assessment of LAM avulsion in the ultrasound diagnosis of UP is useful in postmenopausal patients, increasing sensitivity and specificity relative to the ultrasound assessment based only on the difference between

El diagnóstico definitivo del cáncer de ovario precisa de confirmación histológica. En determinadas situaciones, para evitar la morbilidad de la resección quirúrgica, es posible hacer una biopsia guiada por ecografía para obtener el diagnóstico anatomopatológico. El objetivo de esta revisión sistemática fue evaluar la adecuación, fiabilidad, precisión y perfil de seguridad de la biopsia guiada por ecografía de masas ováricas. Siguiendo el modelo PRISMA 2020, se hizo una búsqueda bibliográfica en PubMed, Embase y Scopus y se recopilaron un total de 10.245 artículos, de los cuales 24 fueron finalmente incluidos. Los trabajos incluían de forma mayoritaria pacientes con tumores inoperables avanzados, pobre performance status y otros factores de mal pronóstico, con masas de contenido sólido y márgenes irregulares, generalmente accesibles por vía transvaginal. En la mayoría de los artículos las pacientes presentaban historia previa de malignidad o tumores inoperables en estadios avanzados. Las masas ováricas biopsiables se definían en la ecografía como malignas o potencialmente malignas, con la presencia destacada de un componente sólido o mixto con márgenes irregulares o heterogéneos. La técnica más utilizada en los estudios incluidos fue la biopsia con aguja gruesa o tru-cut, con altos valores de adecuación, fiabilidad, precisión y rendimiento, así como un buen perfil de seguridad y bajas tasas de complicaciones. En conclusión, la biopsia con aguja gruesa de las masas anexiales guiada por ecografía, en pacientes subsidiarios de tratamiento neoadyuvante, es una técnica con altas tasas de adecuación, fiabilidad, precisión y buen perfil de seguridad., The definitive diagnosis of ovarian cancer requires histological confirmation. In certain situations, to avoid the morbidity of surgical resection, it is possible to perform an ultrasound-guided biopsy to obtain the pathological diagnosis. The aim of this systematic review was to assess the adequacy, reliability, accuracy, and safety profile of ultrasound-guided biopsy of ovarian masses. Following the PRISMA 2020 model, a bibliographic search was carried out in PubMed, Embase and Scopus, collecting a total of 10,245 articles, of which 24 were finally included. The studies mainly included patients with advanced inoperable tumors, poor performance status and other poor prognostic factors, with masses of solid content and irregular margins, generally accessible through the transvaginal route. In most of the articles, the patients had a previous history of malignancy or had inoperable tumors in advanced stages. Biopsiable ovarian masses were defined ultrasonographically as malignant or potentially malignant, mainly highlighting the presence of a solid or mixed component and irregular or heterogeneous margins. The most widely used technique in the included studies was core needle or tru-cut biopsy, presenting high values of adequacy, reliability, precision and performance, as well as a good safety profile with low complication rates. In conclusion, ultrasound-guided core needle biopsy of adnexal masses in patients eligible for neoadjuvant treatment is a technique with high adequacy, reliability, and precision rates, as well as a good safety profile.

Background: The identification of late-onset fetal growth restriction (FGR) fetuses remains a challenge, given the difficulty to distinguish them from healthy small for gestational age (SGA) fetuses. Given the limitations of conventional Doppler for the identification of placental insufficiency, the appearance of superb microvascular imaging (SMI) Doppler seems promising. Our main objective was to evaluate the diagnostic capability of SMI Doppler for the detection of placental insufficiency findings. Methods: A prospective observational study was conducted at a tertiary care center, including 51 patients who had been diagnosed with late on-set SGA or FGR. A placental ultrasonographic evaluation was carried out using SMI Doppler. Patients were sorted into two groups attending to the histologic evaluation of the placentas after delivery: Group 1 (21 cases), Normal group; and Group 2 (30 cases), FGR group. Results: Placentas in the FGR group had lower peak systolic velocity (PV) values of the chorionic plate. The PV of the other vessels were consistently lower in the FGR group that in the normal group, although without reaching statistical significance. Conclusions: The PV of the chorionic plate measured with SMI Doppler, have the capacity to identify placental insufficiency findings. Ultrasonographic placental assessment using SMI Doppler appears to be a useful technique for the evaluation of suspected late on-set placental insufficiency.

Background The aim of this study was to analyze the strength status of the rectus abdominis muscle in patients with incisional hernia and the relationship between the width of the hernia defect and the strength of the rectus abdominis muscle. Methods This is a observational cohort study of patients with medial line incisional hernia (July–October 2022), classified as W2 according to the European Hernia Society (EHS). The data collected were demographic and clinical characteristics related to hernia, and measure of the rectus abdominis muscle strength using an isokinetic dynamometer and a strain gauge. We analyzed the relationship between hernia width and rectus abdominis muscle strength with correlation tests to adjustment by age, sex, BMI, and body composition. Results A total of 40 patients (64% female) with a mean age of 57.62 years (SD 11) were enrolled in the study. The mean BMI was 29.18 (SD 5.06), with a mean percentage of fat mass of 37.8% (SD 8.47) and a mean percentage of muscle mass of 60.33% (SD 6.43). The maximum width of the hernia defect was 6.59 cm (SD 1.54). In the male group, the mean bending force moment (ISOK_PT) was 94.01 Nw m (SD 34.58), bending force moment relative to body weight (ISOK_PT_Weight) was 103.32 Nw m (SD 37.48), and peak force (PK_90) was 184.71 N (SD 47.01). In the female group, these values were 58.11 Nw m (SD 29.41), 66.48 Nw m (SD 32.44), and 152.50 N (SD 48.49), respectively. Statistically significant differences were observed in the relationship between the data obtained with the isokinetic dynamometer and sex (p = 0.002), as well as between the data obtained with the isokinetic dynamometer and age (p = 0.006). Patients in the 90th percentile (P90) of rectus abdominis muscle strength also had smaller hernia defect widths (p = 0.048). Conclusions In this study, age and sex were identified as the most statistically significant predictor variables for rectus abdominis muscle strength. The width of the hernia defect exhibited a

Introducción: El melanoma es considerado una amenaza de salud pública, ya que representa más del 90% de los fallecimientos por cáncer cutáneo. El principal objetivo de la dermatoscopia es la detección precoz de melanomas, aunque la discriminación entre melanoma in situ (Mis) e invasivo (Miv) puede ser desafiante incluso para dermatólogos expertos. Los avances recientes en inteligencia artificial la convierten en una herramienta prometedora como herramienta de ayuda a la toma de decisiones diagnósticas. Objetivo: Desarrollar y validar distintos modelos de Machine Learning para la clasificación de imágenes dermatoscópicas centrados en la predicción del índice de Breslow del melanoma cutáneo. Material y métodos: En este trabajo, se llevaron a cabo dos experimentos. En el primer experimento, se emplearon 1.045 imágenes dermatoscópicas de melanoma de tres conjuntos de datos independientes recogidas de forma retrospectiva, para entrenar y evaluar tres modelos de Deep Transfer Learning (ResNetV2, EfficientNetB6 and InceptionV3) en imágenes dermatoscópicas para la clasificación de Mis o Miv, así como melanomas < ó ? 0,8 mm de índice de Breslow. En el segundo experimento, 1.449 imágenes etiquetadas de cuatro conjuntos de datos independientes y 2.508 imágenes no etiquetadas se utilizaron para entrenar y evaluar modelos de Machine Learning para las mismas tareas de clasificación. Se consideraron y evaluaron modelos de aprendizaje supervisado y semisupervisado usando un ensemble Multi-Teacher mediante Knowledge Distillation empleando un esquema de validación cruzada estratificada en cinco particiones. Se llevó a cabo un análisis descriptivo y cuantitativo del rendimiento de los modelos de ambos experimentos. Resultados: En el primer experimento, el mejor modelo para la clasificación entre Mis y Miv fue Inceptionv3 (AUC = 0,63), y ResNetV2 (AUC = 0,76) para la clasificación entre melanomas < ó ? 0,8 mm de índice de Breslow. Para esta segunda tarea, los modelos ResNetV2 (AUC = 0

Background Treating complex perianal fstulas in Crohn’s disease patients remains a challenge. Classical surgical treatments for Crohn’s disease fstulas have been extrapolated from cryptoglandular fstulas treatment, which have diferent etiology, and this might interfere with its efectiveness, in addition, they increase fecal incontinence risk. Recently, new surgical techniques with support from biological approaches, like stem cells, have been developed to preserve the function of the sphincter. We have performed a systematic literature review to compare the results of these diferent techniques in the treatment of Crohn’s or Cryptoglandular fstula. Methods PubMed, EMBASE, Database of Abstracts of Reviews of Efectiveness, Cochrane Central Register of Con‑ trolled Trials were searched systematically for relevant articles. We included randomized controlled trials and obser‑ vational studies that referred to humans, were written in English, included adults 18+ years old, and were published during the 10-year period from 2/01/2010 to 2/29/2020. Evidence level was assigned as designated by the Scottish Intercollegiate Guidelines Network. Results Of the 577 citations screened, a total of 79 were ultimately included in our review. In Crohn’s disease patients, classical techniques such as primarily seton, Ligation of Intersphincteric Fistula Tracks, or lay open, healing rates were approximately 50–60%, while in cryptoglandular fstula were around, 70–80% for setons or faps. In Crohn’s disease patients, new surgical techniques using derivatives of adipose tissue reported healing rates exceeding 70%, stem cells-treated patients achieved higher combined remission versus controls (56.3% vs 38.6%, p=0.010), mesenchymal cells reported a healing rate of 80% at week 12. In patients with cryptoglandular fstulas, a healing rate of 70% using derivatives of adipose tissue or platelets was achieved, and a healing rate of 80% was achieved using laser technology. Fecal incontinence was impro

Introducción: Desde la irrupción del SARS-CoV-2, la pandemia COVID ha tenido un gran impacto sobre el sistema sanitario, incluyendo la necesidad durante varios momentos de la pandemia de suspender otras actividades asistenciales, incluida la actividad quirúrgica, y de reorganizar el uso de los recursos. Esta situación podría haberse traducido en un empeoramiento del funcionamiento de otros circuitos asistenciales, como el del cáncer colorrectal (CCR). Objetivo: Determinar si la pandemia COVID-19 ha tenido impacto en los pacientes con diagnóstico CCR en el Hospital Universitario Virgen del Rocío. Metodología: Estudio retrospectivo observacional unicéntrico realizado en el área sanitaria de los Hospitales Universitarios Virgen del Rocío en el que se incluyeron a todos los pacientes mayores de 18 años con diagnóstico anatomopatológico de CCR en alguno de los tres periodos del estudio. Se definieron tres periodos del estudio: a) Periodo no COVID19: Febrero-Mayo 2019; b) Primera ola COVID19: Febrero-Mayo 2020 y c) Cuarta ola COVID19: Febrero-Mayo 2021. Se realizó una comparación de las características de los casos de CCR en función del periodo del estudio en el que fueron diagnosticados. La supervivencia tras el diagnóstico del CCR fue analizado mediante un análisis de supervivencia con estrategia de análisis tiempo al evento. Resultados: Se incluyeron 220 pacientes diagnosticados de un CCR en los tres periodos de estudio. De ellos, 67 (30.5%) fueron diagnosticados en el periodo no COVID, 76 (34.5%) durante la primera ola COVID y 77 (35%) durante la cuarta ola COVID19. De los 220 casos, 81 (36.8%) se localizaron en colon izquierdo, 84 (38.2%) en colon derecho y 55 (25%) fueron neoplasias de recto. La proporción de pacientes metastásicos al diagnóstico fue del 11.9% en el periodo no COVID, del 18.4% en la primera ola COVID y del 29.9% en la cuarta ola (p=0.008). No existieron diferencias en la proporción de pacientes sometidos a cirugía ni en el tipo de cirugía en los dis

Introducción. Tras debutar con insuficiencia cardíaca con fracción de eyección reducida (ICFEr) se instaura tratamiento de bloqueo neurohormonal con el que un subgrupo de pacientes responde mejorando significativamente la fracción de eyección del ventrículo izquierdo (FEVI), lo cual modifica el pronóstico. El sistema inmune, y más concretamente los monocitos, juegan un papel relevante en el remodelado del ventrículo izquierdo. Por tanto, el estudio de las subpoblaciones de monocitos puede ayudar a predecir si se producirá o no mejoría de la FEVI. Objetivos: 1. Calcular el valor predictivo de las subpoblaciones de monocitos en relación a la mejoría de la FEVI. 2. Comparar a los 6 meses aquellos pacientes que han mejorado la FEVI respecto a los que no. 3. Valorar los cambios de las subpoblaciones de monocitos con el tratamiento médico. 4. Comparar las subpoblaciones de monocitos entre individuos sanos y pacientes que han mejorado la FEVI. 5. Valor de las subpoblaciones de monocitos para predecir recidivas en pacientes que han mejorado la FEVI. Material y método: Estudio prospectivo de pacientes que debutan con ICFEr. Se realizó estudio de ecocardiografía transtorácica y una muestra para analizar las subpoblaciones de monocitos circulantes mediante citometría de flujo al debut y a los 6 meses. A los 6 meses la muestra se dividió entre pacientes que habían mejorado la FEVI o no según criterios vigentes de las sociedades científicas. Paralelamente se han analizado las subpoblaciones de monocitos en una cohorte de individuos sanos. Resultados: Se obtuvieron diferencias estadísticamente significativas (p=0,012) entre la ratio basal de monocitos intermedios con monocitos no clásicos (MI/MNC) entre los que mejoraron la FEVI (0,81; 0,6–1,17) y los que no (1,45; 0,93-2,1). La ratio MI/MNC como predictor de no mejoría de la FEVI mostró en una curva ROC un área bajo la curva de 0,77 (IC95%: 0,6-0,94). A los 6 meses la ratio MI/MNC fue inferior (p=0,012) en los pacientes que mejo

Achilles tendon ruptures that are not immediately recognized and treated are sometimes diagnosed as delayed injuries and may require different surgical repair options based on gap size. The potential complications associated with using an allograft for reconstruction may lead some surgeons to prefer the use of autologous techniques. However, allografts are often considered a salvagement option when large defects are present. In this study, we examined the long-term clinical outcomes and complications of 17 patients who underwent surgical repair for chronic ruptures with large gaps using both autologous and allograft techniques. During an 11-year period, nine patients were treated with autologous techniques (mean gap of 4.33 ± 1.32 cm) and Achilles allograft reconstruction was performed in eight patients (47.1%) (mean gap of 7.75 ± 0.89 cm). At a mean of 82 ± 36.61 months of follow-up, all 17 patients (100%) were able to perform a single heel rise and improved AOFAS (American Orthopaedic Foot and Ankle Society) and ATRS (Achilles Tendon Total Rupture Score) scores. No infections, complications, or re-ruptures were recorded at the end of the follow-up. No significant differences were found in the AOFAS and ATRS scales between both techniques. When an extensive defect is present, the reconstruction with an Achilles tendon allograft can be considered a proper treatment option, as it does not show a higher rate of complications than autologous techniques achieving similar functional outcomes.

Introducción. Entre el 11 y el 18% de los esguinces de tobillo presentan lesión de los ligamentos de la sindesmosis tibioperonea. La RMN permite detectar alteraciones morfológicas en los ligamentos y por lo tanto nos permite diagnosticar la lesión ligamentosa. Sin embargo, debido a que la cascada degenerativa de la articulación del tobillo se inicia con la alteración del movimiento fisiológico del peroné en la articulación tibioperonea distal, la decisión terapéutica se basa en la capacidad de dichos ligamentos para mantener la estabilidad de la articulación. Aquellas lesiones ligamentosas categorizadas como estables se tratan de manera conservadora y aquellas que se comportan como inestables se les indica tratamiento quirúrgico. Por lo tanto, es fundamental diferenciar aquellas lesiones ligamentosas que mantienen estabilidad de la articulación de aquellas que originan un movimiento anormal o excesivo del peroné. En la actualidad carecemos de un método diagnóstico fiable y no invasivo de la inestabilidad sutil de la sindesmosis tibioperonea. Objetivo. El objetivo general de esta investigación es hallar un método diagnóstico no invasivo, objetivo, fiable, accesible y reproducible que permita detectar la inestabilidad sutil de la sindesmosis tibioperonea. Metodología. Se empleó la tomografía axial computarizada en combinación con el dispositivo de carga simulada ajustable. Se realizaron dos TACs en carga de ambos tobillos (uno en posición de estrés de la sindesmosis y otro en posición de relajación) a 15 voluntarios sanos y 15 pacientes con sospecha clínica de inestabilidad de la sindesmosis tibioperonea sin fractura acompañante. Se realizaron mediciones sobre las imágenes axiales de TAC y se analizaron las diferencias entre ambos tobillos y entre ambos grupos a estudio. Conclusiones. La medición del área sindesmótica realizada sobre imágenes axiales de tomografía computarizada en conjunción con el dispositivo de carga simulada ajustable podría constituir un método di

El cáncer de células renales (CCR) con trombo tumoral vascular (TTV) es un reto terapéutico, que hace imprescindible una adecuada planificación quirúrgica. Los modelos 3D son copias impresas de la anatomía del paciente a partir de las imágenes radiológicas que podrían mejorar la planificación quirúrgica. Objetivos: Determinar si en CCR y TTV la planificación quirúrgica con modelos 3D es factible y, si en comparación con las pruebas de imagen, permite una cirugía más predecible, eficaz y costo-beneficiosa. Metodología: Ensayo clínico aleatorizado y multicéntrico, sobre una cohorte de pacientes con CCR y TTV (n=66). Brazo experimental: planificación con imagen y modelo 3D; brazo control: planificación con imagen. Se evaluó: 1) predictibilidad (concordancia entre planificación y cirugía); 2) Resultados quirúrgicos (tiempo quirúrgico, complicaciones, tiempo hospitalario). Se valoró la satisfacción de urólogos y pacientes y el coste-beneficio. Resultados Se obtuvo un modelo 3D factible para planificar y simular la cirugía. La concordancia entre planificación y cirugía fue mayor en el grupo 3D (Kappa 0,9 – 1 vs. 0 – 1). No hubo diferencias en tiempo quirúrgico (p = 0,9). Hubo menos complicaciones (p < 0,0001) y tiempo de estancia en UCI (p = 0,006) en el grupo 3D. Se demostró el coste beneficio de la impresión 3D y, tanto urólogos como pacientes, quedaron muy satisfechos con los modelos. Conclusiones • Se obtuvo un modelo 3D factible para planificación quirúrgica. • El modelo 3D demostró mayor capacidad de predicción y mejores resultados quirúrgicos. • La planificación con modelos 3D fue costo-beneficiosa y el nivel de satisfacción tanto de pacientes como urólogos fue muy elevado.

Introducción y objetivos Las sales de platino y taxanos son fármacos quimioterápicos ampliamente utilizados y constituyen la primera línea de tratamiento de diferentes tipos de cáncer. Las reacciones de hipersensibilidad a estos fármacos se estiman entre el 1% y el 17%. En consecuencia, evitar la primera opción de tratamiento en pacientes oncológicos podría suponer un descenso de la esperanza y calidad de vida, y por tanto, derivar en una progresión de la enfermedad de base. El objetivo principal de esta tesis doctoral es analizar las características clínicas y el valor de biomarcadores que ayuden a fenoendotipar a los pacientes y a mejorar el diagnóstico y manejo de las reacciones a sales de platino y taxanos. Metodología Se han incluido 100 pacientes que han presentado reacciones a sales de platino y taxanos. Se les han realizado pruebas cutáneas y test de activación de basófilos y en función del resultado de estas pruebas, de las características del paciente y de la reacción inicial, se ha caracterizado el fenoendotipo y realizado una estratificación del riesgo dividiéndolos en riesgo bajo, moderado y alto. A los pacientes con un riesgo bajo, se les ha realizado una prueba de exposición controlada con el fármaco responsable y los pacientes con un riesgo moderado y alto, han sido candidatos a desensibilización. Se han analizado estadísticamente distintas variables con el fin de identificar factores predictores y biomarcadores que ayuden al diagnóstico y manejo de las reacciones. Resultados Treinta y tres pacientes han presentado reacciones a carboplatino, 28 a oxaliplatino, 5 a cisplatino, 19 a paclitaxel y 15 a docetaxel. La media de edad se sitúa en 53,4 años, siendo el 73% de los pacientes mujeres. El fenotipo más frecuente ha sido el IgEmediado, presente en el 52% de las reacciones, seguido del No-IgE, liberación de citoquinas y mixto respectivamente. Hay una clara predominancia del fenotipo IgE en las sales de platino y del no-IgE en los taxanos (p<0,001). La

Numerous studies suggest that immersive reality (IR) is an educational technology with great potential in the field of health sciences. Its integration allows for an increase in the motivation and academic performance of students. In this sense, this research aims to study the self-perception of motivation and performance levels obtained by students who are completing their degree in medicine at the University of Seville after experiencing a session with IR. To achieve this, 136 student participants answered two questionnaires, the IMMS and the academic performance test. The results show high levels of motivation during the IR session, where the interaction with “hot spots” predominates. In the same way, the measured performance results are quite great. For this reason, it is concluded that the potential of using IR as an educational technology is evident, and new lines of related research are opened.

Purpose: To evaluate the microbiota of culture negative Corneal Impression Membrane (CIM) microbial keratitis samples with the use of shotgun metagenomics analysis. Methods: DNA of microbial keratitis samples were collected with CIM and extracted using the MasterPure™ Complete DNA and RNA Purification Kit (Epicentre). DNA was fragmented by sonication into fragments of 300 to 400 base pairs (bp) using Bioruptor® (Diagenode, Belgium) and then used as a template for library preparation. DNA libraries were sequenced on Illumina® HiSeq2500. The resulting reads were quality controlled, trimmed and mapped against the human reference genome. The unmapped reads were taxonomically classified using the Kraken software. Results: 18 microbial keratitis samples were included in the study. Brevundimonas diminuta was found in 5 samples while 6 samples showed the presence of viral infections. Cutibacterium acnes, Staphylococcus aureus, Moraxella lacunata and Pseudomonas alcaligenes were also identified as the presumed putative cause of the infection in 7 samples. Conclusions: Shotgun sequencing can be used as a diagnostic tool in microbial keratitis samples. This diagnostic method expands the available tests to diagnose eye infections and could be clinically significant in culture negative samples.

Introduction: The purpose of this article was to ascertain the existing literature and find the gaps in economic evaluations of cataracts. Methods: Systematic methods were used to search and collect the published literature on economic evaluations of cataracts. A mapping review of studies published in the following bibliographical databases was performed: the National Library of Medicine (PubMed), EMBASE, Web of Science (WOS), and the Central of Reviews and Dissemination (CRD) database. A descriptive analysis was conducted and relevant studies were classified into different groups. Results: Among 984 studies screened, 56 studies were included in the mapping review. Four research questions were answered. There has been a progressive increase of publications during the last decade. The majority of the included studies werepublished byauthors frominstitutionsinthe USA and UK. The most commonly investigated area was cataract surgery followed by intraocular lenses (IOLs). The studies were classified into dif ferent categories according to the main outcome evaluated, such as comparisons between different surgical techniques, costs of the cataract surgery, second eye cataract surgery costs, quality of life gainaftercataractsurgery, waitingtimeofcataract surgery and costs, and cataract evaluation, follow-up, and costs. In the IOL classification, the most frequently studied area was the comparison between monofocal and multifocal IOLs, fol lowed by the comparison between toric and monofocal IOLs. Conclusions: Cataract surgery is a cost-effective procedure compared with other non-oph thalmic and ophthalmic interventions and sur gery waiting time is an important factor to consider because vision loss has a huge and broad-ranging impact on society. Numerous gaps and inconsistencies are found among the studies included. For this reason, there is a need for further studies according to the classification described in the mapping review.

Suprachoroidal hemorrhage (SCH) is a rare and sight-threatening complication of various intraocular surgeries, including cataract surgery. Although the rate of SCH complicating cataract surgery has decreased in the era of phacoemulsification, most likely due to smaller self-sealing incisions and modern equipment, it remains a challenging complication to manage. The aim of this review is to summarize the current evidence of the pathophysiology and management of SCH complicating phaco surgery. A literature review was performed using the PubMed database searching for diagnosis, therapy, and management of SCH during phacoemulsification. The evidence available on the optimal management of this condition is low, and there is no consensus so far. An early diagnosis is thought to be essential to avoid progression to the devastating stage of expulsion of intraocular contents (expulsive hemorrhage). Sudden intraoperative anterior chamber shallowing, red reflex loss, and a significant increase in intraocular pressure are highly suspicious for this severe complication. A fundus examination and ocular ultrasound are crucial to confirm the diagnosis and, if it is confirmed, stabilize the globe immediately. The initial therapeutic approach includes aggressive topical and systemic medication focused on controlling ocular inflammation and intraocular pressure, whereas the timing and the indications of surgical intervention remain controversial.

Background New intraocular lenses (IOLs) have emerged since the originally coined monofocal and multifocal IOLs. The extended depth of focus (EDoF) and enhanced monofocal IOLs (mono‑EDoF) that have appeared in the last decade have caused some confusion in their classification. The aim of this review was to summarize the outcomes provided by mono‑EDOF IOLs and to determine which of the endpoints, described by the American National Stand‑ ard (ANSI) for EDoF IOLs, are fulfilled. Methods The MEDLINE, EMBASE, and WEB OF SCIENCE databases were searched. Two independent reviewers screened the studies for inclusion and data extraction. The search strategy was limited to studies published between 2020 and 2022, but not by language. The results are presented as a narrative summary accompanied by tables, in alignment with the objectives of this scoping review. Compliance with the endpoints for clinical outcomes described in the American National Standard Z80.35–2018 (ANSI) for EDoF lenses was checked and additional endpoints were defined. Results Two systematic reviews, 13 laboratory, 21 clinical, and two mixed studies were included. Tecnis Eyhance was the mono‑EDOF with the highest volume of evidence to date. Although laboratory studies included other IOLs, clini‑ cal evidence for them is still scarce, with only one study of IsoPure compared to a standard monofocal IOL. Evidence in comparison to EDoF lenses is also scarce, even for Tecnis Eyhance, with only three studies including this lens in comparison to an EDoF lens. After evaluation of the ANSI criteria, agreement was found in the failure for the increase in depth of field equal to or greater than 0.5 D for a visual acuity (VA) level of 0.2 logMAR and none of the studies sup‑ ported that the median monocular VA at intermediate distance was at least 0.2 logMAR. Conclusions Additional clinical evidence is required for other mono‑EDOF IOLs beyond Tecnis Eyhance. Until the arrival of a standard classification, mono‑EDOF sho

Background: Some individuals present positional end-point nystagmus when the Dix–Hallpike tests are performed on them if they unintentionally look towards the examined ear. Objective: To describe the prevalence and the characteristics of end-point nystagmus during positional testing in healthy subjects. Methods: Sixty healthy subjects were included. Eight positional tests were performed on them, two Pagnini–McClure tests and six Dix–Hallpike tests, while keeping the eyes in different positions; one on each side. Two independent observers filled in a questionnaire about the presence of positional nystagmus, its latency, duration, direction, and sense. Results and conclusions: Of the subjects, 65% showed positional end-point nystagmus. This nystagmus had a short latency and last for as long as the head is maintained in the test position. They can show any direction or sense, but the most common are torsional clockwise in left tests and anticlockwise in right tests. Unlike BPPV, this nystagmus did not appear with the eyes in the straight-ahead position, it is asymptomatic, and its intensity does not decline.

Background: The anorectal angle (ARA) has been assessed with different imaging methods and its measurement has traditionally been based on defecography or magnetic resonance studies. Different ultrasound methodologies have also been used for ARA assessment and have been validated as alternatives for the ARA measurement, such as three-dimensional (3D) endovaginal ultrasound and 3D transperineal ultrasound. 3D transperineal ultrasound does not require the introduction of ultrasound transducers inside the anal canal. Therefore, it is reasonable to think that the use of transperineal ultrasound can provide more reproducible ARA measurements, something that has not been established by 3D endovaginal probe or defecography. Our objective is to determine the intraobserver and interobserver variability of transperineal ultrasound for the assessment of ARA. Methods: A retrospective observational study was performed with 40 patients. The study of the ARA was performed from the mid-sagittal plane (at rest, Valsalva and maximum contraction), visualizing the anorectal canal, the anorectal junction and the rectal ampulla. ARA measurements were performed initially by explorer 1 (E1), subsequently by explorer 2 (E2) and finally again by E1. Intraobserver and interobserver variability was calculated by calculating the intraclass correlation coefficient (ICC) with 95% confidence interval (CI). Results: Intraobserver variability was excellent for all measurements of the ARA at rest, Valsalva and maximal contraction, with ICC ranging from 0.968 to 0.975. Interobserver variability was also superb for all measurements of the ARA at rest, Valsalva and maximal contraction, with ICC ranging from 0.971 to 0.979. Conclusions: Intraobserver and interobserver variability were excellent for the ARA measurements by transperineal ultrasound.

Additive manufacturing techniques allow the customized design of medical devices according to the patient's requirements. Enteroatmospheric fistula is a pathology that benefits from this personalization due to its extensive clinical variability since the size and morphology of the wound differ extensively among patients. Standard prosthetics do not achieve proper isolation of the wound, leading to a higher risk of infections. Currently, no effective personalized technique to isolate it has been described. In this work, we present the workflow for the design and manufacture of customized devices adapted to the fistula characteristics as it evolves and changes during the treatment with Negative Pressure Wound Therapy (NPWT). For each case, a device was designed with dimensions and morphology depending on each patient's requirements using white light scanning, CAD design, and additive manufacturing. The design and manufacture of the devices were performed in 230.50 min (184.00– 304.75). After the placement of the device, the wound was successfully isolated from the intestinal content for 48–72 h. The therapy was applied for 27.71 ± 13.74 days, and the device was redesigned to adapt to the wound when geometrical evolutionary changes occur during the therapy. It was observed a decrease in weekly cures from 23.63 ± 10.54 to 2.69 ± 0.65 (p = 0.001). The fistulose size was reduced longitudinal and transversally by 3.25 ± 2.56 cm and 6.06 ± 3.14 cm, respectively. The wound depth also decreased by 1.94 ± 1.08 cm. In conclusion, customization through additive manufacturing is feasible and offers promising results in the generation of personalized devices for the treatment of enteroatmospheric fistula.