Effectiveness and Safety of Postoperative Hospital at Home for Surgical Patients: A Cohort Study

OBJECTIVE

To determine the feasibility and effectiveness of a Hospital at Home (HaH) enabled early transfer pathways for surgical patients.

BACKGROUND

HaH serves as a safe alternative to traditional hospitalization by providing acute care to patients in their homes through a comprehensive range of hospital-level interventions. To our knowledge, no studies have been published to date reporting a large cohort of early home-transferred patients after surgery through a HaH unit.

METHODS

Cohort study enrolling every patient admitted to the HaH unit of a tertiary hospital who underwent any of 6 surgeries with a predefined early transfer pathway and fitting both general and surgery inclusion criteria (clinical and hemodynamic stability, uncomplicated surgery, presence of a caregiver, among others) from November 2021 to May 2023. Protocols were developed for each pathway between surgical services and HaH to deliver the usual postoperative care in the home setting. Discharge was decided according to protocol. An urgent escalation pathway was also established.

RESULTS

During the study period, 325 patients were included: 141 were bariatric surgeries, 85 kidney transplants, 45 thoracic surgeries, 37 cystectomies, 10 appendicectomies, and 7 ventral hernia repairs. The overall escalation of care during HaH occurred in 7.3% of patients and 30-day readmissions in 7%. Most adverse events were managed at home and the overall mortality was zero. The total mean length of stay was 8 days (interquartile range 2-14), and patients with HaH were transferred home 3 days (interquartile range 1-6) earlier than the usual pathway; a total of 1551 bed-days were saved.

CONCLUSIONS

The implementation of early home transfer pathways for surgical patients through HaH is feasible and effective, with favorable safety outcomes.

Individualised, perioperative open-lung ventilation strategy during one-lung ventilation (iPROVE-OLV): a multicentre, randomised, controlled clinical trial

BACKGROUND

It is uncertain whether individualisation of the perioperative open-lung approach (OLA) to ventilation reduces postoperative pulmonary complications in patients undergoing lung resection. We compared a perioperative individualised OLA (iOLA) ventilation strategy with standard lung-protective ventilation in patients undergoing thoracic surgery with one-lung ventilation.

METHODS

This multicentre, randomised controlled trial enrolled patients scheduled for open or video-assisted thoracic surgery using one-lung ventilation in 25 participating hospitals in Spain, Italy, Turkey, Egypt, and Ecuador. Eligible adult patients (age ≥18 years) were randomly assigned to receive iOLA or standard lung-protective ventilation. Eligible patients (stratified by centre) were randomly assigned online by local principal investigators, with an allocation ratio of 1:1. Treatment with iOLA included an alveolar recruitment manoeuvre to 40 cm H2O of end-inspiratory pressure followed by individualised positive end-expiratory pressure (PEEP) titrated to best respiratory system compliance, and individualised postoperative respiratory support with high-flow oxygen therapy. Participants allocated to standard lung-protective ventilation received combined intraoperative 4 cm H2O of PEEP and postoperative conventional oxygen therapy. The primary outcome was a composite of severe postoperative pulmonary complications within the first 7 postoperative days, including atelectasis requiring bronchoscopy, severe respiratory failure, contralateral pneumothorax, early extubation failure (rescue with continuous positive airway pressure, non-invasive ventilation, invasive mechanical ventilation, or reintubation), acute respiratory distress syndrome, pulmonary infection, bronchopleural fistula, and pleural empyema. Due to trial setting, data obtained in the operating and postoperative rooms for routine monitoring were not blinded. At 24 h, data were acquired by an investigator blinded to group allocation. All analyses were performed on an intention-to-treat basis. This trial is registered with ClinicalTrials.gov, NCT03182062, and is complete.

FINDINGS

Between Sept 11, 2018, and June 14, 2022, we enrolled 1380 patients, of whom 1308 eligible patients (670 [434 male, 233 female, and three with missing data] assigned to iOLA and 638 [395 male, 237 female, and six with missing data] to standard lung-protective ventilation) were included in the final analysis. The proportion of patients with the composite outcome of severe postoperative pulmonary complications within the first 7 postoperative days was lower in the iOLA group compared with the standard lung-protective ventilation group (40 [6%] vs 97 [15%], relative risk 0·39 [95% CI 0·28 to 0·56]), with an absolute risk difference of -9·23 (95% CI -12·55 to -5·92). Recruitment manoeuvre-related adverse events were reported in five patients.

INTERPRETATION

Among patients subjected to lung resection under one-lung ventilation, iOLA was associated with a reduced risk of severe postoperative pulmonary complications when compared with conventional lung-protective ventilation.

FUNDING

Instituto de Salud Carlos III and the European Regional Development Funds.

Antirotaviral activity of dairy byproducts enriched in fractions from hyperimmune bovine colostrum: the effect of thermal and high hydrostatic pressure treatments

Nowadays, rotaviruses remain a major health burden, especially in developing countries, and strategies complementary to vaccination are needed. In this view, dairy fractions have attracted great scientific interest, due to their high content of bioactive compounds. The objective of this study was to evaluate the antiviral activity of whey and buttermilk enriched in proteins from hyperimmune bovine colostrum (HBC) against rotavirus. The enriched fractions were spray-dried and subsequently tested for their neutralizing activity against the bovine rotavirus WC3 strain in vitro, using differentiated Caco-2/TC7 cells. The highest antirotaviral activity was observed when whey and buttermilk were enriched in purified immunoglobulin G (IgG), showing complete rotavirus neutralization at concentrations of 3 and 6 mg mL-1 for whey and buttermilk, respectively. Additionally, the use of a crude immunoglobulin fraction also gave satisfactory results. The inhibitory activities of all samples significantly decreased after the application of heat, except for the IgG-enriched buttermilk which showed a slight increase of activity following the application of short-time treatments (75 or 85 °C for 20 s). This sample also showed a significant increase of activity (13%) after the application of low-intensity high hydrostatic pressure treatment (400 MPa for 5 min). The maximum loss of bioactivity was observed at 600 MPa for 10 min (31 and 20% for whey- and buttermilk-based formulas, respectively). This study provides relevant information on the potential of whey, buttermilk, and HBC to be part of functional products as complementary strategies to combat rotavirus infections.

In-Silico Selection of Wound-Healing Plant Secondary Molecules and Their Pro-Healing Activities on Experimental Models

This study explored the potential of plant-derived molecules (PDMs) as a medicinal treatment for skin wounds. To assess their healing properties, 34 potential drug molecules (PDMs) and ten therapeutic targets were subjected to molecular docking and dynamics analysis, with allantoin used as a standard compound. Although aristolochic acid had the most potent inhibitory effect, its toxicity made it unsuitable for testing on cells and mice. Therefore, β-caryophyllene (BC) and caryophyllene oxide (BCoxide) were chosen for further testing. The results showed that BC-treated HaCat cells had significantly improved scratch area closure, and both BC and BCoxide treatment produced positive effects such as reduced dermal cellularity and mast cells, decreased levels of inflammation markers IL-6 and TNF-α, and an increase in collagen deposition in mice tissues. However, these treatments did not accelerate wound healing. This study suggests that the PDMs selected based on in-silico results have significant potential for pro-healing abilities. It is essential to conduct further research to confirm our findings.

Moderate to Severe Psoriasis in Older Adults: Recommendations on Management from the Psoriasis Working Group of the Spanish Academy of Dermatology and Venereology (AEDV)

Managing moderate to severe psoriasis in older adults is complex due to factors characteristic of the later years of life, such as associated comorbidity, polypharmacy, and immunosenescence. This consensus statement discusses 17 recommendations for managing treatment for moderate to severe psoriasis in patients older than 65 years. The recommendations were proposed by a committee of 6 dermatologists who reviewed the literature. Fifty-one members of the Psoriasis Working Group of the Spanish Academy of Dermatology and Venereology (AEDV) then applied the Delphi process in 2 rounds to reach consensus on which principles to adopt. The recommendations can help to improve management, outcomes, and prognosis for older adults with moderate to severe psoriasis.

[Translated article] Moderate to Severe Psoriasis in Older Adults: Recommendations on Management From the Psoriasis Working Group of the Spanish Academy of Dermatology and Venereology (AEDV)

Managing moderate to severe psoriasis in older adults is complex due to factors characteristic of the later years of life, such as associated comorbidity, polypharmacy, and immunosenescence. This consensus statement discusses 17 recommendations for managing treatment for moderate to severe psoriasis in patients older than 65 years. The recommendations were proposed by a committee of 6 dermatologists who reviewed the literature. Fifty-one members of the Psoriasis Working Group of the Spanish Academy of Dermatology and Venereology (AEDV) then applied the Delphi process in 2 rounds to reach consensus on which principles to adopt. The recommendations can help to improve management, outcomes, and prognosis for older adults with moderate to severe psoriasis.

Accuracy of congenital anomaly coding in live birth children recorded in European health care databases, a EUROlinkCAT study

Electronic health care databases are increasingly being used to investigate the epidemiology of congenital anomalies (CAs) although there are concerns about their accuracy. The EUROlinkCAT project linked data from eleven EUROCAT registries to electronic hospital databases. The coding of CAs in electronic hospital databases was compared to the (gold standard) codes in the EUROCAT registries. For birth years 2010-2014 all linked live birth CA cases and all children identified in the hospital databases with a CA code were analysed. Registries calculated sensitivity and Positive Predictive Value (PPV) for 17 selected CAs. Pooled estimates for sensitivity and PPV were then calculated for each anomaly using random effects meta-analyses. Most registries linked more than 85% of their cases to hospital data. Gastroschisis, cleft lip with or without cleft palate and Down syndrome were recorded in hospital databases with high accuracy (sensitivity and PPV ≥ 85%). Hypoplastic left heart syndrome, spina bifida, Hirschsprung's disease, omphalocele and cleft palate showed high sensitivity (≥ 85%), but low or heterogeneous PPV, indicating that hospital data was complete but may contain false positives. The remaining anomaly subgroups in our study, showed low or heterogeneous sensitivity and PPV, indicating that the information in the hospital database was incomplete and of variable validity. Electronic health care databases cannot replace CA registries, although they can be used as an additional ascertainment source for CA registries. CA registries are still the most appropriate data source to study the epidemiology of CAs.

Hospital at home treatment with remdesivir for patients with COVID-19: real-life experience

OBJECTIVES

Access and appropriateness of therapeutics for COVID-19 vary because of access or regulatory barriers, the severity of the disease, and for some therapies, the stage of the pandemic and circulating variants. Remdesivir has shown benefits in clinical recovery and is the treatment of choice for selected patients, both hospitalized and nonhospitalized, in main international guidelines. The use of remdesivir in alternatives to conventional hospitalization such as hospital at home (HaH) units remains incompletely explored. In this study, we aim to describe the real-life experience of outpatient remdesivir infusion for COVID-19 in a HaH unit.

METHODS

We selected all the consecutive patients receiving remdesivir from a prospective cohort of 507 COVID-19 patients admitted at a HaH unit. Admission criteria included COVID-19 with a fraction of inspired oxygen requirement under 0.35 and respiratory rate under 22 rpm. Patients were daily assessed in person by a nurse and a physician.

RESULTS

A total of 236 patients admitted at the HaH unit received remdesivir, 172 of whom were treated at home. Only 2% presented any adverse event related to the infusion, all of them mild. HaH saved 1416 day-beds, with only 5% of the patients requiring transfer back to the hospital.

CONCLUSION

Remdesivir infusion in HaH units seems to be a safe and efficient alternative to conventional hospitalization for treating patients with nonsevere COVID-19.

Smart Air Quality Monitoring IoT-Based Infrastructure for Industrial Environments

Deficient air quality in industrial environments creates a number of problems that affect both the staff and the ecosystems of a particular area. To address this, periodic measurements must be taken to monitor the pollutant substances discharged into the atmosphere. However, the deployed system should also be adapted to the specific requirements of the industry. This paper presents a complete air quality monitoring infrastructure based on the IoT paradigm that is fully integrable into current industrial systems. It includes the development of two highly precise compact devices to facilitate real-time monitoring of particulate matter concentrations and polluting gases in the air. These devices are able to collect other information of interest, such as the temperature and humidity of the environment or the Global Positioning System (GPS) location of the device. Furthermore, machine learning techniques have been applied to the Big Data collected by this system. The results identify that the Gaussian Process Regression is the technique with the highest accuracy among the air quality data sets gathered by the devices. This provides our solution with, for instance, the intelligence to predict when safety levels might be surpassed.

Implementing HPV testing in 9 Latin American countries: The laboratory perspective as observed in the ESTAMPA study

Background

Replacement of cytology screening with HPV testing is recommended and essential for cervical cancer elimination. HPV testing for primary screening was implemented in 12 laboratories within 9 Latin American countries, as part of the ESTAMPA cervical cancer screening study. Our observations provide information on critical operational aspects for HPV testing implementation in diverse resource settings.

Methods

We describe the implementation process of HPV testing in ESTAMPA, focusing on laboratory aspects. We assess the readiness of 12 laboratories to start HPV testing and their continuity capacity to maintain good quality HPV testing until end of recruitment or up to December 2021. Readiness was based on a checklist. Information from the study database; regular meetings and monitoring visits; and a questionnaire on laboratory operational aspects sent in May 2020 were used to assess continuity capacity. Compliance with seven basic requirements (readiness) and eight continuity requirements (continuity capacity) was scored (1 = compliant, 0 = not compliant) and totaled to classify readiness and continuity capacity as very limited, limited, moderate or high. Experiences, challenges, and enablers of the implementation process are also described.

Results

Seven of 12 laboratories had high readiness, three moderate readiness, and of two laboratories new to HPV testing, one had limited readiness and the other very limited readiness. Two of seven laboratories with high readiness also showed high continuity capacity, one moderate continuity capacity, and the other four showed limited continuity capacity since they could not maintain good quality HPV testing over time. Among three laboratories with moderate readiness, one kept moderate continuity capacity and two reached high continuity capacity. The two laboratories new to HPV testing achieved high continuity capacity. Based on gained expertise, five laboratories have become part of national screening programs.

Conclusion

High readiness of laboratories is an essential part of effective implementation of HPV testing. However, high readiness is insufficient to guarantee HPV testing high continuity capacity, for which a "culture of quality" should be established with regular training, robust monitoring and quality assurance systems tailored to local context. All efforts to strengthen HPV laboratories are valuable and crucial to guarantee effective implementation of HPV-based cervical screening.

Lewis-Sumner syndrome: contribution of diffusion tensor imaging in its differential diagnosis

Lewis-Sumner syndrome (LSS) is an atypical variant of chronic inflammatory demyelinating polyneuropathy characterized by an asymmetric sensory-motor neuropathy with multifocal distribution. The diagnosis is typically clinical and electrophysiological but in some cases might be challenging causing a significant therapeutic delay. Diffusion tensor imaging (DTI) has been progressively used for the in vivo assessment of peripheral nerves integrity. In this study, we aimed to elucidate if DTI was able to detect the specific nerve damage in a patient with suspected LSS, and determine if DTI presented a specific pattern that could be useful in its differential diagnosis. A 38-year-old male with a right foot drop was studied. Physical examination, electrodiagnostic, and MRI studies were performed. MRI of the lower limb was acquired in a 3-T scanner and included T1-wi, T2-TSE-SPIR, and PD-TSE-SPAIR images in axial and coronal planes. Axial DTI was acquired using a single-shot EPI sequence with diffusion encoding in 32 directions. The electrodiagnostic tests suggested a demyelinating sensorimotor neuropathy with conduction blocks. Conventional MRI was normal. DTI showed pathological results in Tibial and Peroneal nerves consisting of thinning and discontinuities along both nerves but more significant in the Peroneal. Compared with MRI, DTI offered a significant improvement to detect the specific nerve damage and its characteristics. The observed nerve damage in DTI suggested polyneuropathy and was compatible with the electrophysiological findings, endorsing the LSS diagnosis. This is the first report in the literature presenting the DTI findings in LSS.

Variation in the Alcohol Components of Coffea arabica L. Wastewater Distillate Fermented Under Different Conditions

Coffee is the second-most consumed beverage in the world, and its high demand is covered by countries such as Peru, where the waste generated in production causes environmental pollution. We sought to determine the concentration of alcohol components and other volatiles compounds present in the distillate, after fermenting wastewater from the first wash in the wet processing of Coffea arabica var. catimor under five conditions: C1 (pasteurized + 0.325 g sucrose + 8.000 g S. cerevisiae), C2 = (pasteurized + 8.000 g S. cerevisiae), C3 (0.325 g sucrose + 8.000 g S. cerevisiae), C4 = (8.000 g S. cerevisiae), and C5 = (natural state). The solid-phase microextraction technique was used to determine the composition of the distillates by gas chromatography (GC). 35 components were detected, 11 of them under all conditions. Ethanol was the most abundant element in all five fermentation conditions. Condition 1 shows the highest value at 97.29 μg.mL-1, though all five concentrations can be considered high. This study shows that wastewater from the wet processing of coffee can have agro-industrial use as a value-added product. Postharvest Peruvian coffee is amenable to strategies aligned with the sustainable development goal of reducing food losses along production and supply chains.

Abstract 3101: Evaluation of novel therapeutic strategies for KRAS mutated NSCLC patients using our own collections of PDX and PDX-derived organoids

Lung cancer is the leading cause of cancer-related deaths worldwide. KRAS is the most frequent mutated driver gene in NSCLC but today has no effective treatments. Therefore, there is an urgent unmet need to find a tailored treatment alternative in the clinic. We need experimental models which really predict the efficacy of these alternative treatments. PDX and organoids are models that recapitulate more accurately the complexity of human cancer, therefore they are the best models we can use to address such clinically relevant questions. We aim to generate and characterize both NSCLC PDX, and PDX-derived organoids (PDXDOs) collections to perform preclinical assays, address to find alternative therapies for KRAS-mutant lung cancer. Among these therapeutic strategies we evaluated the efficacy of CDK4 inhibitors (CDK4i) in combination with ERK1/2 inhibitors (ERK1/2i). We studied the mechanism of action of the drugs in combination and identified possible predictive response biomarkers by RNAseq. We have established and characterized a collection of 45 NSCLC PDX models derived from early-stage patients, eight of them with KRAS mutations. All retained the principal histologic and molecular characteristics of their donors during the passages. We have also generated a collection of 15 PDXDOs, which maintained the same characteristics of their PDX donors. We evaluate the efficacy of CDK4i in monotherapy and in combination with ERK1/2i in KRAS-mutated models. In vitro, using PDXDOs, the therapeutic combination tested reduced viability and downregulated signaling pathways involved in cell progression, this effect was observed in all PDXDO models tested, including those that were primary resistant to CDK4i in monotherapy. Similarly, in vivo, using the PDX models, the therapeutic combination tested produced a significant reduction in tumor growth compared to the drugs in monotherapy. The transcriptomic analysis showed CDK4i inhibited cell-cycle processes, whereas the combination therapy resulted in an increased inhibition and also reversed the CDK4i-mediated activation of PI3K or WNT pathways, which would explain the synergistic effect of the combination. In conclusion, we have established a collection of 45 NSCLC PDX models and 15 PDXDOs, which allow to evaluate (in vitro and in vivo) the therapeutic efficacy of different drug combinations targeting different driver genes mutated such KRAS, which today has no effective treatments. These preclinical models will be really useful to integrate drug screening with biomarker discovery. Using our collections, we have demonstrated the combination of CDK4i with ERK1/2i was more effective than the drugs in monotherapy, even for those cases which primary showed CDK4i-resistance. Therefore, we propose this therapeutic combination as a good therapeutic strategy to test in the clinic.

Citation Format: Patricia Yagüe, David Gomez, Álvaro C Ucero, Laura García, Patricia Plaza, Nuria Carrizo, José Luis Solorzano, Luis Paz-Ares, Irene Ferrer. Evaluation of novel therapeutic strategies for KRAS mutated NSCLC patients using our own collections of PDX and PDX-derived organoids [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3101.

Chromatographic characterization of the fusion protein SARS-CoV-2 S protein (RBD)-hFc

At the Center of Molecular Immunology (Havana, Cuba), the fusion protein SARS-CoV-2 S protein (RBD)-hFc was synthesized linking the receptor-binding domain (RBD) of the SARS-CoV-2 virus and the crystallizable fragment of a human immunoglobulin. This fusion protein was used in the construction of a diagnostic device for COVID-19 called UMELISA SARS-CoV-2-IgG. Given the relevance of this protein, the characterization of three batches (A1, A2 and A3) was carried out. The molecular weight of the protein was determined to be 120 kDa, using sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE). Its isoelectric point was estimated between 8.3 and 9 by isoelectric focusing. The molecular integrity was evaluated by size exclusion liquid chromatography and SDS-PAGE after one year of the production of the protein; the presence of aggregates and fragments was detected. Batches A1 and A2 have a purity percentage higher than 95% and they can be used for the construction of new diagnostic devices.

Sleep quality and memory function in healthy ageing

OBJECTIVE

To study the relationship between sleep quality and memory in healthy ageing.

METHODS

The study included 99 people older than 50 years (69 women and 30 men; mean age, 68.74±7.18 years) with no associated diseases. Patients completed digital versions of the Word Learning and Visual Paired Associates tests and the Pittsburgh Sleep Quality Index questionnaire to assess the quality of sleep.

RESULTS

Pittsburgh Sleep Quality Index score was negatively correlated with Visual Paired Associates and Word Learning test performance. Performance in these 2 memory tests decreased in line with sleep quality. In addition, performance in Visual Paired Associates test was negatively correlated with subjective sleep quality, duration, and sleep disturbances. Performance on the Word Learning test was negatively correlated with subjective sleep quality and efficiency. Participants' sex showed a weak effect on Visual Paired Associates performance and sleep latency.

CONCLUSIONS

Medical professionals working with elderly patients should take into consideration the effect of poor sleep quality on memory. Cognitive impairment in these patients may be a manifestation of a neuroendocrine imbalance due to a disrupted circadian rhythm. More research is needed to prove this hypothesis.

Women Aged over 40 with Twin Pregnancies Have a Higher Risk of Adverse Obstetrical Outcomes

Maternal age is related to a higher risk of adverse maternal, fetal, and neonatal outcomes in twin pregnancies. However, whether this increase in adverse outcomes is due solely to age or due to risk factors that are more common in women over 40 remains unknown. The aim of this study is to assess if maternal age over 40 years old is an independent risk factor for obstetric adverse outcomes in dichorionic diamniotic twin gestations. In this single-center retrospective cohort study, we compared the obstetric outcomes of women with dichorionic diamniotic twin pregnancies below and over 40 years of age. A twin pregnancy cohort enrolled between 2013 and 2019 was included in the study. Maternal, fetal, and labor complications were recorded. A total of 510 women were analyzed in two groups: 266 women below 40 years old and 244 women over 40 years old. Maternal age over 40 increased the odds of maternal (aOR = 1.9 (1.3; 2.9); p-value = 0.002), fetal (aOR = 1.8 (1.0; 3.0); p-value = 0.037), and labor complications (aOR = 2.5 (1.3; 4.6); p-value = 0.004). Maternal age over 40 years was the most important factor increasing the odds of having a caesarean section (C-section). Over 40 years old was an independent risk factor for complications in dichorionic diamniotic twin pregnancies.

A review of the adsorption-biological hybrid processes for the abatement of emerging pollutants: Removal efficiencies, physicochemical analysis, and economic evaluation

The limited efficiency of conventional wastewater treatment plants (WWTPs) in emerging pollutants (EPs) removal encourages the development of alternative technologies for the adequate treatment of wastewater, due to its adverse effects on human health and ecosystems. The biological, physical or chemical hybrid technologies to treat EPs results interesting since they can enhance the performance of WWTPs. Among them, hybrid adsorption/biological technology could offer different possibilities that are explored in this work (PAC-MBR, PACT/GAC-CAS, BAC configurations). In this way, different variations in the adsorption process have been considered: the form of the adsorbent, the feed to the system, and the type of biological process, either conventional activated sludge (CAS), membrane bioreactor (MBR) or biofilm systems. For each combination, the removal efficiency of micropollutants, classified according to their use into pharmaceuticals, personal care products (PCPs) and other micropollutants (mainly benzotriazoles) was analysed. From reported data, it was observed a beneficial synergistic effect of dipole moment and octanol-water partition coefficient on the removal efficiency of micropollutants by adsorption/biological hybrid technology. Finally, a preliminary economic evaluation of the powdered activated carbon in a conventional activated sludge reactor (PACT), powdered activated carbon-membrane bioreactor (PAC-MBR) and biological activated carbon (BAC) hybrid systems was carried out by analysing the capital expenditure (CAPEX) of plants for capacities up to 75,000 m³d^-1. Likewise, estimations of adsorbent concentration for a hypothetical plant with a capacity of 10,000 m³d^-1 is presented. Among these hybrid configurations, PAC-MBR achieved the highest micropollutant elimination percentages; however, it presents the highest CAPEX and activated carbon requirements.

The combination of dantrolene and nimodipine effectively reduces 5-HT-induced vasospasms in diabetic rats

Diabetics have a higher risk of developing cerebral vasospasms (CVSP) after subarachnoid hemorrhagic stroke than non-diabetics. Serotonin (5-HT) is one of the key vasoconstrictors released in the hemorrhagic blood and an important contributor to the etiology of CVSP. The combination of the ryanodine receptor blocker dantrolene and the Ca2+ channel blocker nimodipine significantly reduces phenylephrine (PHE)-induced vascular contraction in both diabetic and nondiabetic rats, but the effectiveness of this drug combination in reducing 5-HT-induced contraction is unknown. Dose–response curves for the 5-HT-induced contraction (from 0.1 nM to 100 µM) were performed on aortic rings from diabetic and non-diabetic rats after a 30-min incubation period with dantrolene, nimodipine, and both drugs in combination. In diabetic rats, 10 μM of dantrolene alone failed to reduce 5-HT-induced maximal contraction (E_max), but 50 μM reduced this parameter by 34% (n = 7, p < 0.05). In non-diabetic rats, by contrast, dantrolene did not modify the vascular response to 5-HT. 50 nM of nimodipine alone, however, reduced this parameter by 57% in diabetic rats (n = 10, p < 0.05), and by 34% in non-diabetic rats (n = 10, p < 0.05). In addition, concomitant administration of dantrolene and nimodipine reduced vascular reactivity to a similar extent in both diabetic (~ 60% reduction, n = 10, p < 0.05) and non-diabetic rats (~ 70% reduction, n = 10, p < 0.05). Moreover, the combination of nimodipine with the higher concentration of dantrolene significantly increased the EC₅₀ values for the 5-HT-induced contraction curves in both diabetics (from 10.31 ± 1.17 µM to 19.26 ± 2.82; n = 10, p < 0.05) and non-diabetic rats (5.93 ± 0.54 µM to 15.80 ± 3.24; n = 10, p < 0.05). These results suggest that simultaneous administration of dantrolene and nimodipine has a synergistic effect in reducing 5-HT-induced vascular contraction under both diabetic and non-diabetic conditions. If our findings with rats are applicable to humans, concomitant administration of these drugs may represent a promising alternative for the management of CVSP in both diabetics and non-diabetics.

The development of a clinical algorithm for the diagnosis of tumours in the parapharyngeal space. A systematic review

INTRODUCTION

Parapharyngeal space (PPS) is defined as a deep space, located around the upper pharynx, in the shape of an inverted pyramid. Primary tumours in this region are rare, accounting for 0.5% of head and neck neoplasms, and most are benign. The objective of this study is to propose a new study algorithm based on a systematic review and our experience.

MATERIALS AND METHODS

A cross-sectional and analytical study was carried out through review of the clinical records of our hospital. Patients with tumours of the parapharyngeal space operated from January 2010 to December 2019 and a systematic review of Pubmed studies from the last 5years were included. We considered clinical signs, diagnostic methods, presumptive diagnosis and histopathological findings. Statistical analysis was performed with STATA v.14 software.

RESULTS

53 of our cases and 1392 from the review were included. The clinical algorithm showed a sensitivity of 76.4% and a specificity of 96.3%, with an AUC of 0.57 for diagnosis.

DISCUSSION

Complementary radiological examinations are essential in the topographic diagnosis of the tumour. Angio-MRI links the tissue of origin of the tumours and provides the highest diagnostic certainty. FNA has some disadvantages in PPS, but it is useful in some patients.

CONCLUSION

The proposed algorithm contributes to obtaining excellent results in the management of these tumours because it turned out to be effective in diagnosis, and this enables improved surgical planning.

Pulmonary Artery Sarcoma With Low 18F-FDG Uptake

ABSTRACT

A 75-year-old man presented with dyspnea for more than 2 months, with blood test showing low platelet count and cardiac ultrasound showing severe pulmonary hypertension (>54 mm Hg). A CT pulmonary angiogram showed a filling defect in the pulmonary trunk, right and left pulmonary arteries, raising the possibilities of pulmonary embolism or artery sarcoma. FDG PET/CT was performed for further evaluation and showed low uptake in the pulmonary wall, which supported the diagnosis of pulmonary embolism. Patient was treated with anticoagulants with no changes on repeated CT pulmonary angiogram. Patient underwent surgery, and histopatological examination revealed a pulmonary artery sarcoma.

A Prospective Cohort of SARS-CoV-2-Infected Health Care Workers: Clinical Characteristics, Outcomes, and Follow-up Strategy

BACKGROUND

During the coronavirus disease 2019 (COVID-19) outbreaks, health care workers (HCWs) are at a high risk of infection. Strategies to reduce in-hospital transmission between HCWs and to safely manage infected HCWs are lacking. Our aim was to describe an active strategy for the management of COVID-19 in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected HCWs and investigate its outcomes.

METHODS

A prospective cohort study of SARS-CoV-2-infected health care workers in a tertiary teaching hospital in Barcelona, Spain, was performed. An active strategy of weekly polymerase chain reaction screening of HCWs for SARS-CoV-2 was established by the Occupational Health department. Every positive HCW was admitted to the Hospital at Home Unit with daily assessment online and in-person discretionary visits. Clinical and epidemiological data were recorded.

RESULTS

Of the 590 HCWs included in the cohort, 134 (22%) were asymptomatic at diagnosis, and 15% (89 patients) remained asymptomatic during follow-up. A third of positive cases were detected during routine screening. The most frequent symptoms were cough (68%), hyposmia/anosmia (49%), and fever (41%). Ten percent of the patients required specific treatment at home, while only 4% of the patients developed pneumonia. Seventeen patients required a visit to the outpatient clinic for further evaluation, and 6 of these (1%) required hospital admission. None of the HCWs included in this cohort required intensive care unit admission or died.

CONCLUSIONS

Active screening for SARS-CoV-2 among HCWs for early diagnosis and stopping in-hospital transmission chains proved efficacious in our institution, particularly due to the high percentage of asymptomatic HCWs. Follow-up of HCWs in Hospital at Home units is safe and effective, with low rates of severe infection and readmission.

Sodium-Glucose Cotransporter-2 Inhibitors at Discharge from Cardiology Hospitalization Department: Decoding A New Clinical Scenario

Sodium-glucose cotransporter-2 inhibitors (SGLT-2 inhibitors) are new glucose-lowering drugs (GLDs) with demonstrated cardiovascular benefits in patients with heart disease and type-2 diabetes mellitus (T2DM). However, their safety and efficacy when prescribed at hospital discharge are unexplored. This prospective, observational, longitudinal cohort study included 104 consecutive T2DM patients discharged from the cardiology department between April 2018 and February 2019. Patients were classified based on SGLT-2 inhibitor prescription and adjusted by propensity-score matching. The safety outcomes included discontinuation of GLDs; worsening renal function; and renal, hepatic, or metabolic hospitalization. The efficacy outcomes were death from any cause, cardiovascular death, cardiovascular readmission, and combined clinical outcome (cardiovascular death or readmission). The results showed that, the incidence rates of safety outcomes were similar in the SGLT-2 inhibitor or non-SGLT-2 inhibitor groups. Regarding efficacy, the SGLT-2 inhibitors group resulted in a lower rate of combined clinical outcomes (18% vs. 42%; hazard ratio (HR), 0.35; p = 0.02), any cause death (0% vs. 24%; HR, 0.79; p = 0.001) and cardiovascular death (0% vs. 17%; HR, 0.83; p = 0.005). No significant differences were found in cardiovascular readmissions. SGLT-2 inhibitor prescription at hospital discharge in patients with heart disease and T2DM was safe, well tolerated, and associated with a reduction in all-cause and cardiovascular deaths.

[Non-invasive brain and spinal cord stimulation for motor and functional recovery after a spinal cord injury]

INTRODUCTION

Spinal cord injury is a traumatic or non-traumatic event that causes an alteration of sensory, motor or autonomic functioning and ultimately affects the physical, psychological and social well-being of the person who suffers it. A comprehensive approach to spinal cord injury requires many health resources and can place a considerable financial burden on patients, their families and the community.

AIM

To review the literature published to date on the use of non-invasive brain stimulation, including repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS), and transcutaneous non-invasive spinal cord stimulation (tcSCS), as therapeutic strategies to improve the functionality of patients with spinal cord injury. The studies were grouped as addressing either non-invasive brain stimulation or non-invasive spinal cord stimulation.

DEVELOPMENT

Altogether 32 studies were identified: 21 involving brain stimulation (14 in rTMS and 7 in tDCS) and 11 with spinal cord stimulation (tcSCS). All the studies were conducted in adult patients who had undergone a spinal cord injury. Despite significant variability in treatment protocols, patient characteristics and clinical assessment, the changes observed were reported in almost all the studies without producing any side effects and with motor or functional improvement.

CONCLUSION

Non-invasive brain stimulation, as well as spinal cord stimulation, are promising techniques for the rehabilitation of patients with spinal cord injury due to their novelty, effectiveness and minimal side effects.

Thoracoscopic Bullectomy for Persistent Air Leak in a 14-Year-Old Child with COVID-19 Bilateral Pulmonary Disease

Introduction: Thoracic surgery in children with coronavirus disease-19 (COVID-19) pulmonary disease is rare, as very limited virus-related lung lesions require intervention. However, some patients may suffer from other pulmonary abnormalities that can be worsened by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and they may consequently require lung surgery. COVID-19 affects the indications, surgical procedure, and postsurgical care of these patients. Background: We present a case of a 14-year-old girl with COVID-19 pulmonary disease and persistent air leak due to right apical bullae that required resection. Clinical, surgical, and safety implications are discussed. The role of thoracic minimally invasive surgery under COVID-19 conditions is also analyzed. Materials and Methods: The thoracoscopic procedure was scheduled earlier than normally expected. The surgery was performed in a COVID-19 reserved theatre with neutral pressure and only the necessary personnel was allowed inside. The use of the required personal protective equipment was supervised by an expert nurse before and after the intervention. Results: The surgeons used a three-port technique to resect the bullae with an endostapler and no mechanical pleural abrasion was added to the procedure. Electrocautery and CO₂ insufflation were avoided, and a chest drain with a closed-circuit aspiration system was installed before removing the ports. The child was discharged home 3 days later after the removal of the chest drain. Conclusions: COVID-19 has an impact on the standard indications, surgical strategies and postoperative care of some conditions requiring intervention. Extra safety measures are needed in the operating room to limit the chance of transmission. Minimally invasive surgery for thoracic surgery remains safe if the current safety guidelines are followed closely.

Multicentric study of cervical cancer screening with human papillomavirus testing and assessment of triage methods in Latin America: the ESTAMPA screening study protocol

INTRODUCTION

Human papillomavirus (HPV) testing is replacing cytology in primary screening. Its limited specificity demands using a second (triage) test to better identify women at high-risk of cervical disease. Cytology represents the immediate triage but its low sensitivity might hamper HPV testing sensitivity, particularly in low-income and middle-income countries (LMICs), where cytology performance has been suboptimal. The ESTAMPA (EStudio multicéntrico de TAMizaje y triaje de cáncer de cuello uterino con pruebas del virus del PApiloma humano; Spanish acronym) study will: (1) evaluate the performance of different triage techniques to detect cervical precancer and (2) inform on how to implement HPV-based screening programmes in LMIC.

METHODS AND ANALYSIS

Women aged 30-64 years are screened with HPV testing and Pap across 12 study centres in Latin America. Screened positives have colposcopy with biopsy and treatment of lesions. Women with no evident disease are recalled 18 months later for another HPV test; those HPV-positive undergo colposcopy with biopsy and treatment as needed. Biological specimens are collected in different visits for triage testing, which is not used for clinical management. The study outcome is histological high-grade squamous intraepithelial or worse lesions (HSIL+) under the lower anogenital squamous terminology. About 50 000 women will be screened and 500 HSIL+ cases detected (at initial and 18 months screening). Performance measures (sensitivity, specificity and predictive values) of triage techniques to detect HSIL+ will be estimated and compared with adjustment by age and study centre.

ETHICS AND DISSEMINATION

The study protocol has been approved by the Ethics Committee of the International Agency for Research on Cancer (IARC), of the Pan American Health Organisation (PAHO) and by those in each participating centre. A Data and Safety Monitoring Board (DSMB) has been established to monitor progress of the study, assure participant safety, advice on scientific conduct and analysis and suggest protocol improvements. Study findings will be published in peer-reviewed journals and presented at scientific meetings.

TRIAL REGISTRATION NUMBER

NCT01881659.

Accelerated partial breast irradiation with interstitial multicatheter brachytherapy after breast-conserving surgery for low-risk early breast cancer

Patients with low-risk invasive ductal carcinoma treated with breast-conserving surgery (BCS) were included in a multicatheter brachytherapy APBI protocol. The primary endpoint was ipsilateral breast recurrence. Between December 2008–December 2017, 186 low-risk breast cancer patients were treated with APBI using interstitial multicatheter brachytherapy and followed prospectively. At 5-years of follow-up, cumulative local recurrence (LR) and cause-specific survival was 1.1% (95% CI 0.3–1.9) and 98.3% (95% CI 97.3–99.3%) respectively. No grade 3 adverse effects were observed. Postoperative APBI using multicatheter brachytherapy after BCS in early breast cancer patients have excellent rates of local control and survival, without significant toxicity.

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Low risk early breast cancer patients have low rate of recurrences.

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APBI with interstitial multicatheter brachytherapy in low risk early breast cancer patients have excellent rates of local control and survival.

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Reducing time of treatment.

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Reducing adverse effects.

Characteristic limits of 230Th in alpha spectrometry with 229Th as tracer, calculated by simulating interfering tails and overlapping peaks

This study explores the effect of ²²⁹Th tracer tail interference on the determination of the sensitivity of ²³⁰Th alpha spectrometry of samples with environmental levels of radioactivity. Tracer peak tail interference was calculated with Suma-Alpha, whilst Visual Basic for Applications (VBA in Excel©) software was used to study the variation in sensitivity in terms of the amount of tracer added. Unnecessary increases in the amount of tracer or extended sample measuring times were observed to have adverse effects on method sensitivity (Detection Limit- L_d).

Comparison of ART outcomes in men with altered mRNA protamine 1/protamine 2 ratio undergoing intracytoplasmic sperm injection with ejaculated and testicular spermatozoa

Assisted reproductive technologies involving the use of spermatozoa and eggs for in vitro fertilization (IVF) have come as the solution for many infertile couples to become parents. However, in some cases, the use of ejaculated spermatozoa delivers poor IVF performance. Some studies have suggested the use of testicular spermatozoa in severe male infertility cases, but no guidelines regarding their utilization are currently available. In the present study, we found the mRNA protamine 1/protamine 2 (P1/P2) ratio to be a valuable biomarker of poor sperm function that could be used as a diagnostic key for the identification of cases that would benefit from the use of testicular spermatozoa. A total of 23 couples undergoing egg donation cycles with at least one previous cycle failure were studied. All couples underwent two consecutive intracytoplasmic sperm injection (ICSI) cycles with either ejaculated or testicular spermatozoa (TESA). The sperm mRNA P1/P2 ratio, fertilization rate, blastocyst rate, and pregnancy and live birth rate were compared. Results showed improved ICSI and clinical outcomes in cycles with testicular spermatozoa in men with altered mRNA P1/P2 ratios. TESA cycles presented significantly higher rates of fertilization (mean ± standard deviation: 76.1% ± 15.1% vs 65.5% ± 18.8%), blastocyst formation (55.0% ± 20.3% vs 30.8% ± 23.8%), and good morphological quality blastocyst (28.9% ± 22.9% vs 13.5% ± 17.9%) and also improvements on pregnancy (60.9% vs 0%) and healthy birth rates (56.5% vs 0%) than EJACULATE cycles. The results described here suggest that in patients with previous IVF/ICSI failures and aberrant mRNA protamine ratios, the use of testicular spermatozoa may be a good alternative to improve clinical outcomes.

Effectiveness of randomized controlled trial of a mobile app to promote healthy lifestyle in obese and overweight patients

BACKGROUND

Health advice is useful for establishing behavioural changes, but such changes tend not to last. It would therefore be good to identify mechanisms for reinforcing advice and one option is the use of information and communication technologies. Given the limited evidence on the effectiveness of such technologies, we decided to conduct a clinical trial to assess the efficacy of a mobile application (app) for supporting the provision health advice for weight loss.

METHODS

A randomized clinical trial with 110 obese and overweight patients from the Basque public health care network (Araba). Patients were randomly allocated to the control (health advice) or intervention (health advice + app) groups. Primary (weight) and secondary (blood cholesterol level, blood pressure, haemoglobin A1c (HbA1c) and adherence to dietary and exercise recommendations) outcome variables were assessed at 1, 3 and 6 months after the end of the intervention.

RESULTS

There were no significant differences in weight (0.357 kg; P = 0.7), blood cholesterol (2.6 mg/dl; P = 0.617), blood pressure (2.3 mmHg; P = 0.369) or adherence to recommendations on diet (84.6% in control and 92.9% the intervention group, P = 0.413) or physical activity (56% in controls and 75% the intervention group, P = 0.145). On the other hand, there were significant differences in HbA1c in favour of the control group (-0.095%; %; P = 0.046).

DISCUSSION

The use of AKTIDIET® to support health advice for weight loss cannot be recommended. More high quality studies are needed, and patients should be involved in the design of apps to increase their efficacy and usability.

CLINICAL TRIAL REGISTRATION

NCT02308176.

Normative Data for Executive Function and Emotion Interaction Assessment in Adolescents from Rural Areas

Objective

The present work is part of the ongoing project of examining the validation and standardization of the Executive Functions and Emotion Assessment for Adolescents with Risk Behaviors (EFEAA) test in the rural areas of Northwest Mexico. The objectives of the present study were (1) to examine the effects of age and risk behavior on emotionally interfered working memory ability, measured as performance on the Emotionally Interfered Working Memory Task (EIWMT) section of the EFEAA in a group of healthy adolescents from rural areas; and (2) to use these results to construct normative data that can be used in clinical practice.

Participants and Method

A total of 275 adolescents, 14.1 years old, geographically distributed among northwest Mexico were included in the sample. They were individually assessed using the Montreal Cognitive Assessment, Risk Behavior Questionnaire, including: sexual risk behavior, impulsiveness, drug, alcohol, and tobacco consumption, unhealthy food intake, and physical inactivity; for measuring emotion-cognition interaction we used the EIWMT.

Results

Results of this study present a database supported by factors of risk behavior and working memory, which includes: predictors for conduct disorders, drug use, and delinquency, in addition to correlations between the performance of emotionally interfered working memory and risk behaviors associated to health. Percentile and normal distribution tables were generated, demonstrating that there is a high prevalence of risk behavior in rural areas.

Conclusions

This study demonstrates data related to rural areas in northwest Mexico, a region where adolescents are frequently involved in risk behaviors. Additionally, protective factors are understudied in Mexico-US border cities. Further analyses are needed to find reward delay skills on the studied sample as well as urban area comparisons.

[Measurement, monitoring and knowledge of blood pressure: May Measurement Month, Colombia 2017]

AIM

To describe the findings of implementing May Measurement Month 2017 in the adult Colombian population to raise awareness of the importance of blood pressure measuring, monitoring, and awareness.

MATERIALS AND METHODS

May Measurement Month is a cross-sectional survey that follows the directives of the International Society of Hypertension and the World Hypertension League, which gathers information on cardiovascular risk factors and blood pressure readings. Its implementation in Colombia was lead by the Santander Ophthalmological Foundation (FOSCAL) and the Latin American Society of Hypertension (LASH) with the support of the Colombian Network for the Prevention of Cardiovascular Diseases and Diabetes (RECARDI).

RESULTS

Data was collected from 11 departments on 21,797 people, 58.7% of whom were female, with an average age of 40.5±17.7 years. The overall prevalence of high blood pressure (HBP) was 20.8% (self-reported antihypertensive treatment or systolic blood pressure reading [systolic blood pressure≥140mmHg]). Of the total number of hypertensives, 46.5% had systolic blood pressure readings classified as uncontrolled (systolic blood pressure<140mmHg), and 26.4% were unaware that they were hypertensive who, in this report, we consider to be new cases of HBP.

CONCLUSION

The prevalence of (elevated) blood pressure is high in this young adult population, whose lack of awareness of HBP is also high, and HBP in those aware of their condition is poorly controlled. These results highlight the need to implement effective detection programmes for hypertensive patients and to establish standardised treatments to improve HBP control as a strategy to reduce cardiovascular events.

Increased renal damage in hypocomplementemic patients with ANCA-associated vasculitis: retrospective cohort study

INTRODUCTION

The complement system has an important role in the pathogenesis of vasculitis associated with antineutrophilic cytoplasmic antibody (AAV) mainly at the level of the kidneys because patients with complement deposits on the glomerular basal membrane present more aggressive disease compared with those with pauci-immune vasculitis.

AIM

To analyze the association of hypocomplementemia with the clinical manifestations, laboratory data, renal histology, progress to renal insufficiency, and mortality of patients with AAV.

METHODS

Retrospective cohort study (2000-2007) included 93 patients with AAV. Hypocomplementemia is defined as having C3 values lower than 80 mg/dL or C4 values below 15 mg/dL. Demographic, statistical, clinical, hematological, serological, and histopathological characteristics of all the patients with and without diagnosis of hypocomplementemia were compared. In order to evaluate variable independence, a logistic regression analysis was used.

RESULTS

Ninety-three patients were studied of whom 63 (67.7%) had complement dosage at the moment of AAV diagnosis. Seven patients (11.1%) presented hypocomplementemia and a greater kidney involvement compared with normocomplementemic patients. Thirty renal biopsies were analyzed and 4 (13.3%) showed immunocomplex (IC) or complement deposits by an immunofluorescence test (IFT). Patients with "non-pauci-immune" AAV also presented terminal chronic renal disease (TCRD).

CONCLUSION

There is an association between low complement and the degree of renal damage in patients with AAV. Patients with renal biopsies confirming IC and/or complement deposits showed more aggressive renal disease. Key Points • The complement system has an important role in the pathogenesis of vasculitis associated to antineutrophilic cytoplasmic antibody. • The studies in murine models confirming the complement activation by alternative pathway and particularly the receptor C5a (C5aR) is necessary for the development of glomerulonefritis. • Complement deposit observed in the renal biopsies of patients diagnosed with AAV was correlated to greater kidney damage, greater proteinuria and major disease activity compared to patients diagnosed with typical pauci-immune vasculitis. • The presence of hypocomplementemia at the onset of the disease was also associated with a greater organ involvement, poor prognosis and greater mortality.

Improving healthcare access for older adults with intellectual disability: What are the needs?

This qualitative study was carried out in Spain with the aim of identifying the changes that the health system should make to improve healthcare access for older adults with intellectual disability. Three hundred and sixty-nine family members and professionals expressed their opinion on how healthcare access could be improved. Participants responded to two open-ended questions included in a general survey about the health status of older individuals with intellectual disability. Most informants were women and professionals who had known the person with intellectual disability for more than 12 months. A system of categories, which showed good inter-rater agreement, was developed to analyse participants' written responses. Both family members and professionals emphasized the need to improve disability training for healthcare practitioners and highlighted the urgent need for flexibility in the structure of a healthcare system that currently overlooks the specific needs of this vulnerable population.

Valencia's Cathedral Church Bell Acoustics Impact on the Hearing Abilities of Bell Ringers

Studies on the effect of occupational noise have been widely performed for occupations such as construction workers, workers of factories or even musicians and workers of nightclubs. However, studies on the acoustics of church bells are very scarce and usually reported in languages other than English. In Spain, although the tradition of bell ringers is progressively getting lost, some bell ringers that continue transmitting the tradition remain. Church bells create sound with a large sound pressure level that can be heard from a great distance. However, despite the characteristics of the sound of church bells, bell ringers do not present symptoms of occupational hearing loss unlike musicians and construction workers. To determine the effects of the sound of the church bells on bell ringers, in this paper, an acoustic study of the church bells and a physiological study of the hearing abilities of bell ringers. Results show sound pressure levels reaching 120 dB inside the bell tower. The resulting hearing loss in bell ringers is small considering the great intensity of the sound produced by the bells. This is likely due to the short amount of time that bell ringers are exposed to the sound even if it reaches high sound pressure levels.

Endoscopic progression of ulcerative proctitis to proximal disease. Can we identify predictors of progression?

INTRODUCTION

Ulcerative proctitis is a type of ulcerative colitis circumscribed to the rectum. Proximal progression rates of the disease have been reported as between 27% and 54%. Several predictive factors have been identified for its progression; however, none has been established as definitive.

MATERIAL AND METHODS

Retrospective study of patients diagnosed with ulcerative proctitis with at least 12 months of follow-up. Patients diagnosed between January 1992 and March 2017. Variables were collected at the time of diagnosis and during the first year of follow-up. The extent of the progression was evaluated endoscopically during follow-up. The endoscopic progression rate was determined and possible risk factors related to this progression were evaluated.

RESULTS

The analysis involved 137 patients. In 77 of the patients, we performed a second colonoscopy during follow-up to evaluate endoscopic progression. The average time before the second colonoscopy performed was 5 years (SD 3.9). Of the 77 patients, 32 (41.6%) presented proximal progression to the rectosigmoid junction. Logistic regression analysis showed a statistically significant association for progression in patients who had suffered one or more flares in the first year following diagnosis. Significant progression was also observed in those with the longest time of progression at the final colonoscopy.

CONCLUSIONS

Ulcerative proctitis is not a stable disease over time. In addition, during the first year of the disease progression, it is possible to predict in which patients the disease will progress to more extensive forms.

Expresión génica de ligandos mica, micb y ulbp (1-6) del receptor NKG2D de células natural killer y metaloproteinasas adam10, adam17 y mmp14 en lineas celulares de cancer de cervical

El CCU es la segunda causa de muerte en mujeres de nuestro país. Dentro de los primeros mecanismos de defensa del hospedero se encuentra la respuesta inmune de las células NK y su función lítica a expensas de su receptor activador NKG2D, el cual posee como ligandos mica, micb y ulbp (1-6), los cuales se expresan en células transformadas y/o infectadas por virus.  Uno de los mecanismos de evasión por parte de la célula tumoral es el clivaje de estas proteínas a través de metaloproteinasas como adam10, adam17 y mmp14. Se analizó la expresión de estos ligandos y metaloproteinasas mediante PCR tiempo real, en lineas celulares de referencia para cáncer cervical como HeLa (positiva para VPH-18) y C33A (negativa para VPH). Se obtuvieron valores representativos de expresion relativa genica con diferencias significativas asi: mmp14 en linea HeLa (p= 0.006); y mica y ulbp-3 en la linea C33A (p= 0.020 y p=0.003 respectivamente).  Por lo tanto, se podría sugerir que la expresión de mmp14 se encuentran posiblemente involucrados con la presencia de VPH causante del cancer cervical y la respuesta inmunne innata desarrollada.

Implantes auditivos de conducción ósea percutáneo, transcutáneo: comparación

Introducción: Los implantes de conducción ósea son alternativas en rehabilitación para pacientes con sordera conductiva/mixta o unilateral. Objetivo: Analizar desenlaces audiológicos, calidad de vida y percepción subjetiva de beneficios en pacientes con sordera conductiva y/o mixta o unilateral, usuarios del sistema transcutáneo Bonebridge®, o del sistema percutáneo BAHA®. Método: Estudio prospectivo en diez pacientes usuarios del sistema transcutáneo, y comparación con diez usuarios del sistema percutáneo. Evaluación audiológica, percepción de calidad de vida y satisfacción. Resultados: Con el sistema transcutáneo en sordera conductiva/mixta se registró ganancia promedio de 39 dB SPL (desviación estándar [DE] ±4; intervalo de confianza [IC] 95% 35-43), y con el sistema percutáneo, 33 dB SPL (DE ±7; IC 95% 26-40); diferencia de 6 dB SPL (EE ±3; IC 95% −1-13, p = 0,09). Discriminación de lenguaje con sistema transcutáneo 100% a 63 dB (DE ±2 dB; IC 95% 61-65) y con sistema percutáneo 100% a 58 dB (DE ±7 dB; IC 95% 51-65), diferencia de 5 dB (EE ±3 dB; IC 95% −2-12, p = 0,12). En sordera unilateral, la comparación de umbrales promedio con los dispositivos: 37 dB SPL (DE ±4; IC 95% 31-43) para el sistema transcutáneo y 32 dB SPL (DE ±3, IC 95% 27-37) para el sistema percutáneo, diferencia de 5 dB SPL (EE ±3; IC 95% −1-11, p = 0,09). Discriminación de lenguaje para sistema transcutáneo 100% a 66 dB SPL (DE ±7; IC 95% 55-77) y con sistema percutáneo 100% a 64 dB SPL (DE ±5; IC 95% 56-72), diferencia de 2 dB SPL (EE ±4; IC 95% –9-13, p = 0,7). Promedio total para percepción de beneficios con el uso de los dispositivos: 33 (DE ±18; IC 95% 20-46) para el sistema transcutáneo y 22 (DE ±12; IC 95% 13-31) en sistema percutáneo, diferencia de 11 puntos (EE ±7; IC 95% –3-25, p = 0,12). El nivel de satisfacción fue cuantificado de manera semejante, excepto en: Aspectos generales, sub-ítem Comodidad a favor del sistema transcutáneo. Conclusiones: Los beneficios audiológicos, satisfacción y calidad de vida identificados en los pacientes con el sistema Bonebridge son evidentes y comparables a los que han logrado los pacientes con el sistema BAHA.

Physical Wellbeing Monitoring Employing Non-Invasive Low-Cost and Low-Energy Sensor Socks

Determining and improving the wellbeing of people is one of the priorities of the OECD countries. Nowadays many sensors allow monitoring different parameters in regard to the wellbeing of people. These sensors can be deployed in smartphones, clothes or accessories like watches. Many studies have been performed on wearable devices that monitor certain aspects of the health of people, especially for specific diseases. In this paper, we propose a non-invasive low-cost and low-energy physical wellbeing monitoring system that provides a wellness score based on the obtained data. We present the architecture of the system and the disposition of the sensors on the sock. The algorithm of the system is presented as well. The wellness threshold evaluation module allows determining if the monitored parameter is within healthy ranges. The message forwarding module allows decreasing the energy consumption of the system by detecting the presence of alerts or changes in the data. Finally, a simulation was performed in order to determine the energy consumption of the system. Results show that our algorithm allows saving 44.9% of the initial energy in 10,000 min for healthy people.