Unified Identification Protocol for Cross-Border Healthcare.

The Unified Identification Protocol (UIP) is an innovation which empowers patients and legal guardians to generate their unique digital identity for cross-border healthcare. This digital identity seamlessly links to local identifiers across different territories and organizations, bridging the gap between disparate systems. Combined with the International Patient Summary (IPS) - endorsed by the G7 and the EU - UIP is pioneering a new paradigm in telehealth services. Championing a user-centric approach in line with Web 3.0 principles, UIP places data control directly in the hands of patients and their legal guardians. This ensures accurate identification, streamlined access to health data, and robust privacy protection. When harmonized with tools like the SMART-On-FHIR API, FHIR Contract, DID Documents, and blockchain certification, UIP lays down transparent, user-approved guidelines for sharing healthcare data across borders. This framework guarantees that data is securely exchanged, encrypted specifically for the intended recipients upon user consent, adhering to international standards, and in full compliance with prevailing regulations. Furthermore, UIP facilitates certification of health courses and competences for patients, caregivers, and practitioners, enhancing healthcare understanding and management.

Patient-Centric Interoperability and Cybersecurity for Cross-Border Healthcare.

In Web 3.0 the user owns the information. Decentralized Identity Documents (DID documents) allow users to create their own digital identity and decentralized cryptographic material resistant to quantum computing. A patient's DID document also contains a unique identifier for cross-border healthcare, endpoints for receiving DIDComm messages and for SOS services, and additional identifiers (passport, etc.). We propose a blockchain for cross-border healthcare to store the evidence of different electronic, physical identities, and identifiers, but also the rules approved by the patient or legal guardians to access patient data. The International Patient Summary (IPS) is the de facto standard for cross-border healthcare and includes an index of information classified into sections (HL7 FHIR Composition) that healthcare professionals and services can update and read on the patient's SOS service, then retrieving all the necessary patient information from the different FHIR API endpoints of different healthcare providers according to the approved rules.

Interoperable Universal Resource Identifier for Selective Disclosure of Data.

All the information stored in the different information systems is issued in a format that allows the holder (the information owner) to disclose only certain information to a third party, which will act as a requester, receiver and verifier of the information disclosed by the holder. We define the Interoperable Universal Resource Identifier (iURI) as a harmonized method of representing a claim (minimum piece of verifiable information) using disparate encoding systems, agnostic to the original encoding system and data format. Encoding systems are represented in Reverse Domain Name Resolution (Reverse-DNS) format for HL7 FHIR, OpenEHR, and other data formats. The iURI can then be used in JSON Web Token for Selective Disclosure (SD-JWT) and Verifiable Credential (VC), among others. The method enables a person to demonstrate data that already exists in different information systems in disparate data formats, and even an information system, to verify certain claims, in a harmonized way.

Quality and Traceability of Starting Materials from Supplier to Recipient.

Quality of processes and products is based on traceability and review of both components, material processing and product flow throughout the manufacturing and supply chain. Blockchain technology enables cross-border audit trail and traceability while reducing costs. Donors are the providers of biological raw material (starting material). They can share their health records when donating by using an IPS document or a FHIR Questionnaire-response resource. It allows health personnel to retrieve and verify relevant clinical information when donating. Additionally, health personnel can generate an anonymized and de-identified digital twin of the donor for research purposes, and it can be updated over time. The starting material can include a reference to a digital twin of an unknown supplier, which improves the data quality and enhances research possibilities. Adverse reactions and events can be also recorded on blockchain to improve safety, transparency, traceability, medical research and product quality.

Case Report of Worth Syndrome and Chiari I Malformation: Unusual Association and Surgical Treatment.

BACKGROUND: Worth syndrome or autosomal dominant endosteal hyperostosis (ADEH) is an extremely rare genetic disease involving increased bone density. To the author's knowledge, this is the second case report of a family with neurologic involvement associated with this condition along with its surgical treatment. The most effective treatment for clinically significant neurologic symptoms in this scenario is currently unknown, and there is sparse experience on surgical treatment for this condition reported in the literature. Therefore we aim to make a contribution to the identification of a standard and consistently successful surgical management. CASE DESCRIPTION: Two patients, mother (Patient 1) and daughter (Patient 2), were diagnosed with Worth syndrome. Both presented with the typical facial characteristics described for ADEH. Interestingly, Patient 1 presented the novel mutation in the LRP5 gene that is associated with different conditions involving increased bone density. Although neurologic symptoms are infrequent in ADEH, both referred chronic headache, nausea, and vomiting. Neuroimaging showed an increased cranial bone density and Chiari I malformation. The patients underwent a midline suboccipital craniectomy with excision of the posterior arch of C1 and duroplasty. However, due to a symptomatic recurrence 5 years after surgery, Patient 1 was reoperated on. We extended the craniectomy and also carried out a C2 laminectomy. CONCLUSION: After surgical interventions, patients' neurologic symptoms were successfully resolved. This report shows that posterior fossa decompression including duroplasty may be a valid treatment option in case of neurologic involvement.

[Functional decline and presence of symptoms in palliative care: Cause or consequence?] / Declive funcional y presencia de síntomas en cuidados paliativos: ¿causa o consecuencia?

INTRODUCTION: Several publications have related functional decline to the appearance of symptoms, especially psychiatric or psychological ones, such as anxiety and depression. Moreover, an initial depressive disorder or prior to functional decline usually worsens it. It was decided to investigate the relationship between the presence of functional decline, measured by a decrease in the Barthel index (BI), and the presence of symptoms. MATERIAL AND METHODS: A prospective analytical study conducted on patients referred to a Home Care Support Team (HCST). RESULTS: The study included 638 cases, of which 53.9% (N=344) were male, 56% (N=357) with cancer and 44% (N=281) geriatric. The mean age was 79.64 years+- 10.8. Significant differences (P<.001) were found in functional decline measured by mean decline in the BI between cancer (34.4) and non-cancer patients (12.12). Significant differences (P<.001) were also found in all recorded symptoms (pain, dyspnoea, anorexia, nausea, anxiety, depression, and insomnia), more frequently in cancer patients, except psychomotor agitation. A higher presence of symptoms was detected in patients with greater functional decline, with decreases in BI above 20 points. There were no differences in previous treatments, except in certain analgesics. Differences were found in the different treatments prescribed by HCST. CONCLUSIONS: The presence of functional decline and its level may be related to the appearance of symptoms, especially in cancer patients.

Correlación entre el defecto del campo visual y tractografía postoperatoria en casos de cirugía de epilepsia por esclerosis temporomesial. Estudio anátomo-imagenológico del fascículo de Meyer / Correlation between visual field defect and postoperative tractography in cases of epilepsy surgery due to temporomandibular sclerosis. Anatomic-imaging study of Meyer's fascicle

Objetivo: describir la anatomía del fascículo de Meyer (FM) y los resultados del campo visual computarizado (CVC) y tractografía, por tensor de difusión (TTD) en la identificación del compromiso de este fascículo en pacientes tratados quirúrgicamente por epilepsia refractaria. Introducción: Hasta un 80% de los pacientes con epilepsia temporo-mesial asociada a esclerosis hipocampal son refractarios a la medicación. Para estos pacientes la cirugía es un tratamiento bien establecido y efectivo. No obstante son frecuentes los defectos del campo visual por lesión del FM luego de este tipo de procedimientos. Materiales y métodos: Se realizó disección de fibras blancas de tres cerebros humanos, fijados en formaldehído, mediante la técnica de Klingler, con el fin de reconocer los fascículos que conforman la vía visual en la profundidad del lóbulo temporal. A su vez, se estudiaron 8 pacientes sometidos a lobectomía temporal anterior y amigdalohipocampectomía por esclerosis temporomesial, realizándose TTD y CVC, al menos 3 meses después de la cirugía. Los individuos se clasificaron en cuatro grupos según el defecto campimétrico y se realizaron distintas mediciones en tractografía y resonancia magnética. Finalmente se correlacionaron los resultados de las distintas variables y se realizó una extensa revisión bibliográfica...

Objective: to describe the anatomy of the Meyer´s loop (ML) and the results of computerized visual field (CVF) and diffusion tensor tractography (DTT) to identify the damage of this fascicle in patients surgically treated for refractory epilepsy secondary to mesial-temporal sclerosis. Introduction: Up to 80% of patients with temporo-mesial epilepsy associated with hippocampal sclerosis are refractory to medication. For these patients, surgery is a well established and effective treatment. However visual field defects are frequent by optic radiation´s injury after these procedures. Materials and methods: We performed the dissection of white fibers on three human brains, previously fixed in formaldehyde, by Klingler´s technique, to recognize the fascicles that make up the visual pathway in the depth of the temporal lobe. Then, eight patients submitted to anterior temporal lobectomy and amygdalohippocampectomy were studied performing CVF and TTD at least 3 months after surgery. Individuals were classified into four groups according to visual field defects and other measurements in magnetic resonance imaging and tractography. Finally the results of the different variables were correlated and an extensive review of literature was performed...

Endoscopic endonasal middle clinoidectomy: anatomic, radiological, and technical note.

BACKGROUND: The middle clinoid is an osseous prominence that arises from the body of the sphenoid bone at the anterolateral margin of the sella. OBJECTIVE: To illustrate the radiological and surgical anatomy of the middle clinoid and describe the technical nuances for endonasal endoscopic middle clinoid removal. METHODS: The fine-cut head CT-angiogram scans of 100 patients and 50 anatomic specimens were examined. The middle clinoid was categorized as: absent, small, prominent, or caroticoclinoidal ring. Ten colored silicon-injected anatomic specimens were used to study the surgical anatomy for the endonasal middle clinoidectomy. Extensive surgical experience allowed for intraoperative observations regarding the surgical anatomy of the middle clinoid and the technical nuances for its removal. RESULTS: The middle clinoid was identifiable in 60% of scans (bilateral in 35%), and 20% had at least one caroticoclinoidal ring (bilateral in 6%). When present, the middle clinoid is located at the transition between the intracavernous internal carotid artery (ICA) and paraclinoidal ICA, and covers the anteromedial roof of the cavernous sinus. Endonasal removal of the middle clinoid improves access to the parasellar region. The middle clinoidectomy is completed exposing the following structures sequentially: sellar dura, anterior wall of the cavernous sinus, dura of the lateral tuberculum sella, and paraclinoidal ICA. When a caroticoclinoidal ring is identified, progressive reduction of the middle clinoid can be achieved without fracturing the ring. CONCLUSION: Recognition of the middle clinoid and caroticoclinoidal ring on preoperative imaging is critical for surgical planning and middle clinoid removal in endonasal skull base surgery.

[Role of low molecular weight heparins in prophylaxis of thromboembolic events on oncological patients with indwelling central venous catheter]. / Heparinas de bajo peso molecular en la profilaxis de episodios tromboembólicos en pacientes con cáncer portadores de catéter venoso central.

BACKGROUND AND OBJECTIVE: Our study was designed to assess the incidence of thrombosis in the upper limbs and of pulmonary embolism in oncological patients with indwelling central venous catheters, and to evaluate, also, the potential role of LMWH to prevent these events. PATIENTS AND METHODS: Oncological patients undergoing placement of a central venous acccess (port-a-cath type) were treated with or without bemiparin in a non-randomized fashion. Assessment included clinical and radiological follow-up. A phlebography on the first day and ecodoppler on days 1th, 45th and 90th were performed. Patients received or not prophylactic bemiparin (3500UI/day) in a non-randomized way. The incidence of thrombosis in both groups was assessed as well as its relation with some risk factors. RESULTS: One hundred and forty eight patients were eligible; 19 thrombotic events were found. The incidence of symptomatic upper extremity thrombosis was 5.41%, asymptomatic thrombosis in 2.03% ; there was one case of pulmonary embolism ( 0,68%); catheter failure occurred in 2.70%; incidence of lower extremities deep venous thrombosis was 2.03%. There was a higher percentage of events in the group of patients treated with bemiparin than in the not treated individuals (9.4%), although the difference did not reach statistical significance (p=0.27). The only risk factors reaching statistical significance were the prothrombin time, high blood pressure and overweight. CONCLUSIONS: Central venous catheters are very useful in oncology. The procedure was related with a low percentage of thrombotic complications. Sodic bemiparin does not reduce the thrombotic risk in these patients.

[Treatment of urinary calculi in transplanted kidney with extracorporeal shock wave lithotripsy]. / Tratamiento de la litiasis urinaria en el riñón trasplantado mediante litotricia extracorpórea por ondas de choque.

OBJECTIVES: To know the factors associated to a successful result in the treatment of kidney transplant lithiasis by extracorporeal shockwave lithotripsy (ESWL). METHODS: From 850 kidney transplants performed at our center, we analyze 15 patients who developed urinary stones. Successful result by ESWL was the dependent variable, and size, location, and multiplicity of the stones were independent variables. Associations between variables were studied by the chi-square test (categorical variables) and the U-Mann Whitney test (continuous variables). RESULTS: Incidence was 1.76%. ESWL effectiveness was 87%; it was greater in solitary stones than in multiple stones (p = 0.001). No significant differences were found for stone size, although largest stones had a high risk for insertion of a nephrostomy tube (p = 0.013). Finally, ESWL was more effective for stones located at the ureteral anastomosis, although this difference was found not significant. CONCLUSIONS: The treatment of kidney transplant lithiasis by ESWL has an effectiveness of 87%. The best result was found for solitary stones located at the ureteral anastomosis.

Impacto de las unidades móviles de emergencia en la sobrevida del infarto agudo de miocardio / Impact of mobile emergency units on survival of patients having an acute myocardial infarction

OBJETIVO: Demostrar que los pacientes con Infarto Agudo de Miocardio (IAM) atendidos por una Unidad Móvil de Emergencia (UME) tienen menos complicaciones y menor gravedad que los pacientes que acuden al hospital en ambulancia convencional. METODOLOGÍA: Estudio descriptivo con contraste, entre 45 pacientes con IAM que habían sido atendidos por una UME y 50 pacientes con IAM que habían acudido al hospital en ambulancia convencional sin asistencia médica prehospitalaria. Se estudiaron los factores de riesgo cardiovascular en ambos grupos. Al objeto de determinar la influencia que la demora en el tratamiento tiene en la mayor o menor supervivencia y calidad de vida residual, los pacientes fueron clasificados según la distancia de su domicilio al centro hospitalario como urbanos <25 Km y rurales >25Km. RESULTADOS: En pacientes atendidos por una UME se producen menos complicaciones como fibrilación y taquicardia ventricular, bloqueos, paro cardiorrespiratorio y muerte, shock, insuficiencia cardíaca, edema agudo de pulmón, pericarditis, derrame pericárdico y ruptura cardíaca. CONCLUSIONES: El número de complicaciones y la gravedad de las mismas durante la fase evolutiva de un IAM es menor en pacientes que han sido atendidos inicialmente por una UME. La fracción de eyección residual es mejor en pacientes atendidos por una UME. Por todo ello, la calidad de vida residual es mejor en los pacientes que son atendidos en una UME