Blunted Pain Modulation Response to Induced Stress in Women with Fibromyalgia with and without Posttraumatic Stress Disorder Comorbidity: New Evidence of Hypo-Reactivity to Stress in Fibromyalgia?

There is evidence regarding the presence of alterations in both the stress response and the endogenous pain modulation systems of people with fibromyalgia (FM). However, research on pain modulation under induced stress on FM patients is scarce and contradictory. The present study analyzes stress-induced changes in pain and intolerance thresholds among FM patients, examining the possible existence of differences linked to PTSD comorbidity and gaining insights into the role of cardiovascular reactivity. Eighteen women diagnosed with FM and comorbid PTSD (FM + PTSD), 18 women diagnosed with FM and no PTSD (FM-PTSD), and 38 healthy women (HC) were exposed to the Social Stress Test task. Pressure pain thresholds and intolerance thresholds were measured before and during stress induction, and after a recovery period, while systolic blood pressure and heart rate were simultaneously recorded. Overall, while pain thresholds decreased during stress and recovery for HC, no significant changes were observed for women with FM. The intolerance threshold decreased for HC during stress, but was maintained at basal level during recovery. FM-PTSD women exhibited a delayed response, with a drop at recovery. For FM + PTSD, tolerance levels remained unchanged. In addition, cardiovascular reactivity did not seem to explain these results. This performance of the pain modulation system seems to follow the same pattern of hypoactive responsiveness under stressors that has previously been observed in FM patients on the autonomic and neuroendocrine axes. Such a hypoactive pattern may involve a non-adaptive response that may contribute to the development and maintenance of chronic pain.

Shifts in Composition and Activity of Oral Biofilms After Fluoride Exposure.

Oral diseases are biofilm-mediated diseases caused by imbalances in the ecology of resident microflora. Among them, dental caries (tooth decay) is considered the most common disease worldwide, and toothbrushing, which physically eliminates the oral biofilm, is the most widespread prevention strategy. Although it is well established that fluoride increases enamel resistance to acidic pH and promotes tooth remineralization, its effect on the biofilm bacterial communities' composition and metabolism is not fully understood. We have grown in vitro oral biofilms and used 16S rRNA Illumina sequencing to study the effect of fluoride on DNA- and RNA-based bacterial populations. In addition, a metatranscriptomic approach has also been performed, in which total RNA has been sequenced to study gene expression profiles in the presence/absence of 500 ppm sodium fluoride. Our data show a lower pH drop and a clear shift in total and metabolically active bacterial composition after fluoride exposure. Streptococcus oralis was the species most affected, with a 10-fold reduction in both DNA and RNA samples, whereas Rothia mucilaginosa underwent an 8-fold increase in the DNA and S. salivarius a 4- and 5-fold increase in the RNA and DNA samples, respectively. The metatranscriptomes indicated that fluoride exposure induced a dramatic shutdown of sugar metabolism, including significant under-expression of different sugar transporters, fucosidases, and a pyruvate oxidase, among others. The reduction in saccharolytic organisms and the inhibition of sugar fermentation pathways by fluoride may therefore be considered instrumental for the beneficial effect of fluoride-containing oral hygiene products.

Unveiling introgression in bumblebee (Bombus terrestris) populations through mitogenome-based markers.

The bumblebee, Bombus terrestris, is an important pollinator commercially used on a global scale. The exported subspecies B. t. terrestris has colonised diverse environments, in some cases displacing wild pollinators to the verge of local extinction. In this sense, the native Iberian subspecies B. t. lusitanicus may be threatened by the subspecies B. t. terrestris, naturally distributed from the Pyrenees to Central Europe but also observed in southern Spain due to escapes from commercial nests. Mitochondrial genomes have a low recombination rate and a small effective population size owing to their maternal inheritance, thus providing an accurate approach to study hybridisation events between populations. Therefore, we present the sequences of the mitogenomes of both subspecies as a molecular framework to select suitable markers to detect possible introgression events between them. We used metagenomics to obtain approximately 17 kbp of the mitogenome from both subspecies. Their mitogenomes differed in 358 bp (excluding the AT-rich region). Four mitogenomic fragments were selected to be tested as subspecific diagnostic markers. A RFLP detected in the gene nad2 (NADH dehydrogenase subunit 2) has proven to be an efficient, quick and cost-effective tool to assess the dispersion of the non-endemic subspecies into Iberian native populations. Subspecific haplotypes were observed in both morphological subspecies, suggesting introgression events in the northern natural contact area and in the new human-mediated contact area in the south of the Iberian Peninsula.

Prevalence of human papillomavirus in the saliva of sexually active women with cervical intraepithelial neoplasias.

BACKGROUND: The main objective of this study was to estimate the prevalence of human papillomavirus-DNA (HPV-DNA) in the saliva of sexually active women with HPV-related cervical intraepithelial neoplasias (CIN) and compare the findings with a healthy control group. The secondary objectives were: 1) to determine the concordance between genital and oral HPV types in sexually active women with HPV-related CIN; 2) to analyze whether sexual habits influence the presence of HPV-related CIN; 3) to determine whether sexual habits influence the presence of oral HPV. MATERIAL AND METHODS: Saliva samples were collected from 100 sexually active women, 50 with HPV-related CIN and 50 healthy subjects presenting normal cytology. PCR assay was used to detect HPV-DNA. RESULTS: The prevalence of oral HPV infection in saliva samples was 14% in women with HPV-related CIN, while in the healthy group it was 12%, without statistically significant difference (p=0.766). As for the concordance between genital and oral HPV types in women with HPV-related CIN, concordance was only observed for HPV-16, whereby among 22 women with genital HPV-16, only one (4.54%) also presented oral HPV-16. Regarding the possible influence of sexual habits on the presence of cervical pathology and presence of oral HPV, it was found that marital status, age at first intercourse, number of lifetime sexual partners, and condom use are related with the presence of cervical pathology (p<0.001; p=0.017; p=0.002; and p<0.001, respectively); condom use was also found to be related to the presence of oral HPV (p<0.001). CONCLUSIONS: The prevalence of HPV-DNA in the saliva of sexually active women with HPV-related CIN is similar to healthy women. The concordance between genital and oral HPV types is low. Both the presence of cervical pathology and the presence of oral HPV are related to sexual habits. Wider sample size is required to confirm this results.

A Multicentre and stratified study of the attitude of medical students towards organ donation in Spain.

INTRODUCTION: Medical students represent a new generation of medical thought, and if they have a favourable attitude towards organ donation this will greatly encourage its promotion. OBJECTIVE: To analyse the attitude of medical students in Spanish universities towards the donation of their own organs and to determine the factors affecting this attitude. MATERIAL AND METHODS: Type of study: A sociological, interdisciplinary, multicentre, and observational study in Spain. STUDY POPULATION: Students studying a degree in medicine enrolled in Spain (n = 34,000). SAMPLE SIZE: A sample of 9598 students (confidence of 99% and precision of ±1%), stratified by geographical area and academic year. Instrument of measurement: A validated questionnaire of attitude towards organ donation and transplantation (PCID-DTO RIOS) was self-administered and completed anonymously. RESULTS: The questionnaire completion rate was 95.7% (n = 9.275). 80% were in favour of donation, 2% against and 18% were undecided. The following main variables were related to a favourable attitude: being of the female sex (Odds Ratio = 1.739); being in the sixth year of the degree (OR = 2.506); knowing a donor (OR = 1.346); having spoken about the subject with one's family (OR = 2.132) and friends (OR = 1.333); having a family circle that is in favour, more specifically, having a father (OR = 1.841), mother (OR = 2.538) or partner in favour (OR = 2.192); being a blood donor (OR = 2.824); acceptance of the mutilation of the body if it were necessary (OR = 2.958); and being an atheist or an agnostic (OR = 1.766). CONCLUSIONS: Spanish medical students generally have a favourable attitude towards organ donation, although 20% are not in favour.

Do Spanish Medical Students Understand the Concept of Brain Death?

OBJECTIVE: To analyze the level of understanding of the brain death concept among medical students in universities in Spain. METHODS: This cross-sectional sociological, interdisciplinary, and multicenter study was performed on 9598 medical students in Spain. The sample was stratified by geographical area and academic year. A previously validated self-reported measure of brain death knowledge (questionnaire Proyecto Colaborativo Internacional Donante sobre la Donación y Transplante de Organos) was completed anonymously by students. RESULTS: Respondents completed 9275 surveys for a completion rate of 95.7%. Of those, 67% (n = 6190) of the respondents understood the brain death concept. Of the rest, 28% (n = 2652) did not know what it meant, and the remaining 5% (n = 433) believed that it did not mean that the patient was dead. The variables related to a correct understanding of the concept were: (1) being older ( P < .001), (2) studying at a public university ( P < .001), (3) year of medical school ( P < .001), (4) studying at one of the universities in the south of Spain ( P = .003), (5) having discussed donation and transplantation with the family ( P < .001), (6) having spoken to friends about the matter ( P < .001), (7) a partner's favorable attitude toward donation and transplantation ( P < .001), and (8) religious beliefs ( P < .001). CONCLUSIONS: Sixty-seven percent of medical students know the concept of brain death, and knowledge improved as they advanced in their degree.

CHRONIC UNPREDICTABLE MILD STRESS PROGRESSIVELY DISTURBS GLUCOSE METABOLISM AND APPETITE HORMONES IN RATS.

CONTEXT: Chronic stress is characterized by increased release of catecholamines, glucocorticoids and other neurohumoral factors, predisposing individuals to obesity, insulin resistance and vascular disease, pathologies considered priority health problems. Study of alterations induced by stress on metabolism in association with food intake modulatory hormones (insulin, leptin and ghrelin) is mandatory. OBJECTIVE: This research studied temporal course during 60 days of chronic unpredictable mild stress (CUMS) on glucose and lipids metabolism, and on the neuroendocrine system that regulates appetite-satiety balance. MATERIALS AND METHODS: Wistar rats were exposed to CUMS for 20, 40 and 60 days. Corticosterone stayed high during 60 days of CUMS; after 40 days, body weight, cholesterol and triglycerides decreased and glucose intolerance was evident at day 60; insulin and ghrelin increased at 20 and 40 days, respectively; leptin decreased after day 20. Data suggest that 60 days of CUMS progressively disturb metabolism of carbohydrates and lipids as well as food intake regulatory hormones, affecting the metabolism, and can lead to the development of chronic degenerative diseases, such as cardiovascular disease, metabolic syndrome and type 2 diabetes.

Medical students faced with related and unrelated living kidney donation: a stratified and multicentre study in Spain.

INTRODUCTION: The attitude of medical students towards living kidney donation (LKD) is of great interest given that they will become promoters of this technique in the near future. OBJECTIVE: To analyse the attitude of Spanish medical students towards related and unrelated LKD and to determine the factors affecting this attitude. MATERIALS AND METHODS: Type of study: A sociological, interdisciplinary, multicentre, and observational study. STUDY POPULATION: Medical students enrolled in Spain (n = 34.000). SAMPLE SIZE: A sample of 9598 students (99 % confidence and precision of ±1 %), stratified by geographical area and academic year. Measurement instrument: A validated questionnaire (PCID-DVR RIOS) was administered and completed anonymously. RESULTS: There was a completion rate of 95.7 % (n = 9275); 93 % (n = 8630) were in favour of related LKD, and 30 % (n = 2784) were in favour of unrelated LKD. The following factors were associated with this attitude: (1) age (p = 0.008); (2) sex (p < 0.001); (3) year of university degree (p < 0.001); (4) a belief that a transplant might be necessary in the future (p < 0.001); (5) attitude towards deceased organ donation (p < 0.001); (6) a willingness to accept a kidney from a living donor (p < 0.001); (7) attitude towards living liver donation (p < 0.001); (8) a partner's attitude towards donation (p < 0.001); (9) having spoken about the subject with one's family (p < 0.001), or friends (p < 0.001); (10) pro-social behaviour (p < 0.001); (11) the respondent's religious attitude (p < 0.001); and (12) fear of possible mutilation of the body after donation (p < 0.001). CONCLUSIONS: The attitude of medical students towards LKD is very favourable when it is the related kind of donation, and it is associated with factors of general knowledge about organ donation and transplantation and social interaction and religion.

[Infantile hypertrofic pyloric stenosis or gastric adenomyoma? Differential diagnosis of gastric outlet obstruction in children]. / ¿Estenosis hipertrófica de píloro o adenomioma pilórico? Diagnóstico diferencial de obstrucción gástrica en niños.

PURPOSE: Gastrointestinal adenomyoma is a rare benign tumor most frequently located in the stomach. The differential diagnosis is wide because of its large clinical spectrum and unspecific radiological findings. Surgical excision is both diagnostic and therapeutic. CASE REPORT: A 49-days old girl presented with nonbilious vomiting of 48 hours of evolution. Infantile hypertrofic pyloric stenosis was suspected. Ultrasound showed a nonobstructive nodular lesion in the anterior pyloric wall. MRI suggested a myofibroblastic tumor. We proceeded to laparotomy and complete resection of the pyloric tumor. Histologic diagnosis was gastric adenomyoma. CONCLUSIONS: Pyloric adenomyoma causes obstructive symptoms similar to other common entities such as hypertrophic pyloric stenosis or cystic duplication. We have to consider this condition in children with digestive symptoms and radiological images of intussusceptions or duplication. Surgical excision is recommended to reach a definitive diagnosis and to avoid a possible malignant degeneration.

INTRODUCCION: El adenomioma gastrointestinal es una tumoración benigna rara cuya localización más frecuente es gástrica. Su diagnóstico diferencial es amplio debido a su gran espectro clínico y baja especificidad radiológica. La escisión quirúrgica es diagnóstico-terapeútica. CASO CLINICO: Niña de 49 días que presenta vómitos no biliosos de 48 horas de evolución. Ante sospecha de estenosis hipertrófica de píloro se solicita ecografía que muestra lesión nodular no obstructiva en pared anterior del píloro. Se realiza RM sugestiva de tumor miofibroblástico. Se procede a laparotomía y resección completa de tumoración pilórica, informada histológicamente como adenomioma gástrico. COMENTARIOS: El adenomioma pilórico produce clínica obstructiva y se confunde con entidades comunes como la estenosis hipertrófica de píloro o la duplicación quística. En un niño con síntomas digestivos e imagen radiológica de invaginación o duplicación, debemos tener en cuenta esta patología. La resección quirúrgica es de elección para un diagnóstico certero y para evitar una posible degeneración maligna.

Glucose pathways adaptation supports acquisition of activated microglia phenotype.

With its capacity to survey the environment and phagocyte debris, microglia assume a diversity of phenotypes to respond specifically through neurotrophic and toxic effects. Although these roles are well accepted, the underlying energetic mechanisms associated with microglial activation remain largely unclear. This study investigates microglia metabolic adaptation to ATP, NADPH, H(+) , and reactive oxygen species production. To this end, in vitro studies were performed with BV-2 cells before and after activation with lipopolysaccharide + interferon-γ. Nitric oxide (NO) was measured as a marker of cell activation. Our results show that microglial activation triggers a metabolic reprogramming based on an increased glucose uptake and a strengthening of anaerobic glycolysis, as well as of the pentose pathway oxidative branch, while retaining the mitochondrial activity. Based on this energy commitment, microglial defense capacity increases rapidly as well as ribose-5-phosphate and nucleic acid formation for gene transcription, essential to ensure the newly acquired functions demanded by central nervous system signaling. We also review the role of NO in this microglial energy commitment that positions cytotoxic microglia within the energetics of the astrocyte-neuron lactate shuttle.

[Enterocolitis episodes in patients who have previously undergone Hirschsprung disease surgery]. / Episodios de enterocolitis postoperatorios en pacientes intervenidos de enfermedad de Hirschsprung.

OBJECTIVES: To highlight the risk factors for the occurrence of this complication in order to achieve an early diagnosis. METHODS: Retrospective descriptive study in which the medical records of patients diagnosed with enterocolitis and who have previously undergone surgery for Hirschsprung's disease in a tertiary hospital from 1994 to 2013, inclusive (N=29), were reviewed. Epidemiological, surgical and clinical data from two groups of patients: Group A (6 patients with ECPD) and Group B (23 patients without ECPD) were compared. Enterocolitis episode data in the Group A were studied too. RESULTS: The incidence of an episode of ECPD was 20.6% and the incidence of two episodes of ECPD was 33.3%. The onset occurred at 12.17 months (SD 13.04) after pull-through procedure. The incidence was higher in patients operated at a younger age [10 months in Group A [6-16] versus 14 months in the group B (1-153)] and in those patients with the longest segment resected [23.20 cm in group A (DS 10,52) versus 19.20 cm in group B (DS 6.92)]. No patient with a discharge colostomy before pull-through surgery showed this complication. It must be highlighted the highest incidence in patients undergone by Swenson's technique (25%) compared to other surgical techniques (Georgeson (15.80%), Soave (0%)). CONCLUSION: Just the length of the resected segment and the patient's age at the time of the pull-through procedure appear to influence the outcome. It is considered advisable to be extremely vigilant in children operated at an early age and subjected to extensive intestinal resection for an early diagnosis and establishment of a treatment to avoid high morbidity.

OBJETIVOS: Identificar los factores de riesgo de la aparición de esta complicación para conseguir un diagnóstico precoz. MATERIAL Y METODOS: Estudio descriptivo retrospectivo en el que se revisan las historias clínicas de pacientes diagnosticados de enterocolitis e intervenidos previamente de la enfermedad de Hirschsprung en un hospital de tercer nivel desde 1994 hasta el 2013, ambos inclusive (N=29). Se comparan datos epidemiológicos, quirúrgicos y clínicos entre dos grupos de pacientes: grupo A (6 pacientes con enterocolitis postdescenso abdómino-perineal (ECPD) y grupo B (23 pacientes sin ECPD). Se estudian, además, los datos sobre el episodio de ECPD en el grupo A. RESULTADOS: La incidencia de un episodio de ECPD fue de 20,6% y la incidencia de dos episodios de ECPD fue de 33,3%. El inicio del cuadro se produjo a los 12,17 meses (DS 13,04) tras la cirugía. Su incidencia fue más alta en aquellos pacientes intervenidos con menor edad [10 meses en el Grupo A (6-16) frente a 14 meses en el grupo B (1-153)] y con mayor longitud del segmento resecado [23,20 cm del grupo A (DS 10,52) frente a 19,20 cm del grupo B (DS 6,92)]. Ningún paciente portador de una colostomía de descarga previa a la cirugía de descenso presentó esta complicación. Destaca, además, la mayor incidencia en pacientes intervenidos mediante la técnica de Swenson (25%) frente a otras técnicas quirúrgicas [Georgeson (15,80%), Soave (0%)]. CONCLUSION: Solo la longitud del segmento resecado y la edad del paciente en el momento de la cirugía de descenso parecen influir en la evolución de los pacientes. Se considera aconsejable extremar la vigilancia en los niños intervenidos a edades tempranas y sometidos a una resección intestinal amplia para realizar un diagnostico precoz e instaurar un tratamiento precoz que evite su alta morbilidad.

[Compressive anterior thoracoplasty (modified Abramson's repair) for pectus carinatum repair]. / Toracoplastia anterior compresiva (técnica de Abramson modificada) para el tratamiento del pectus carinatum.

OBJECTIVES: For anterior protruding chest wall deformities treatment, mainly pectus carinatum, pediatric surgeons have been managing either orthotic methods or open surgical repairs. Anterior compressive thoracoplasty (Abramson's technique) has widened the therapeutic options. We describe herein a modification of this technique in the first reported Europen series. PATIENTS AND METHODS: From 2010 to 2012, a total of five patients (four male and one female) underwent a modified Abramson's technique to correct pectus carinatum or combined protrusion of the chest at our center. We report the operative technique used for these reconstructions. RESULTS: In all five cases, the operation was completed uneventfully and with excellent results either for the surgical team or the patients. Mean operative time was 190 minutes and hospitalization lasted for three to six days, at the time of analgesic drugs withdrawal. CONCLUSIONS: We consider the anterior compresive thorocoplasty (modified Abramson's technique) a safe and feasible method to correct protruding chest deformities, particularly in those patients with stiff chest or lack of compliance, in order to avoid the agressive open procedures.

INTRODUCCION: Entre las opciones terapéuticas para las deformidades anteriores del tórax, la cirugía pediátrica ha dispuesto de tratamientos ortóticos y de técnicas quirúrgicas "abiertas". La toracoplastia compresiva anterior se une a las anteriores y amplía las opciones terapéuticas. Se describe aquí esta técnica en lo que supone la primera serie europea comunicada. MATERIAL Y METODOS: Revisión retrospectiva de las toracoplastias por técnica de Abramson modificada para el tratamiento del pectus carinatum y protrusiones costales en nuestro servicio entre 2010 y 2012. Descripción de la técnica a partir de los primeros cinco casos completados de nuestra serie, cuatro varones y una mujer, con edades entre los 13 y los 19 años. RESULTADOS: En todos los casos la técnica se ha podido completar sin complicaciones intra o perioperatorias y con resultados excelentes, tanto para el equipo quirúrgico como para los pacientes. El tiempo operatorio medio ha sido de 190 minutos y el alta hospitalaria se ha conseguido entre los tres y seis días después de la intervención, una vez completado el control analgésico. CONCLUSIONES: Consideramos que la toracoplastia compresiva anterior es una técnica mínimamente invasiva para la corrección del pectus carinatum y deformidades afines que resulta particularmente útil en los casos en los que la rigidez del tórax impide la adopción de tratamientos ortopédicos, en casos de no aceptación del tratamiento ortótico o cuando la cirugía convencional se considera demasiado agresiva.

[Management of pediatric urolithiasis in our center]. / Tratamiento de la urolitiasis pediátrica en nuestro medio.

OBJECTIVES: To determine clinical, epidemiological and therapeutic characteristics of pediatric urolithiasis in our institution. MATERIAL AND METHODS: We reviewed retrospectively patients diagnosed with urolithiasis between 1998 and 2010 in our hospital. RESULTS: A total of 32 patients (19 males and 13 females) with a mean age of 4.5 years (SD 1.9) were studied. 72% had a history of metabolic or nephro-urological malformations. The most common presentation was urinary tract infection (53%) and abdominal pain (21%). The diagnosis was made by ultrasound, with compatible X-ray in 18 cases. The most common location was pyelocalyceal level, affecting the left kidney mostly. A 38% had multiple stones with a size of 11 mm medium (3-30 mm). Ureteroscopy was used 16 times for stones in the bladder and distal ureter, with an effectiveness of 75%, and 2 patients required laparoscopic trocar cystotomy for removal. 8 extracorporeal lithotripsy procedures were performed (25% success) and 8 percutaneous nephrolithotomy procedures (37.5% success). In 3 patients we decided to perform a lumbotomy due to the size of the calculi, and, in 1 patient nephrectomy was necessary due to malfunction. The most common complication was lithiasis recurrence in 10 patients, most with multiple stones or metabolic alterations, and favourable outcome for the rest. CONCLUSIONS: Pediatric urolithiasis is uncommon, showing an increased incidence in patients with a history of metabolic and urologic pathology; it is important to do additional studies. In the last few years, it has been demonstrated that surgical treatment using minimally invasive procedures is effective and safe.

[Abdominal lymphatic malformation (ALM). Our experience]. / Malformación linfática abdominal (MLA). Nuestra experiencia.

INTRODUCTION: Lymphatic malformations are congenital lesions usually placed in the head and neck, the abdominal location is infrequent. OBJECTIVES: Analyze our experience in ALM management. METHOD: Retrospective study of pediatric patients with ALM from 1996 to 2011. It is a descriptive analysis of clinical, diagnostic and therapeutic features. RESULTS: 10 patients with ALM were treated (6 girls: 4 boys), with a median age of 4.03 years (3 days-13 years). Acute abdomen was the most common presenting feature (40%). Ultrasound was carried out in all these cases, completing the study with CT (9 cases), MRI (1) or both (1). Treatment was surgical, excepting one case that presented infection of the ALM. The approach by laparotomy allowed total resection in all cases, involving bowel resection in 6. The mass was located in small bowel mesentery (6), mesocolon (1), liver (1), and in retroperitoneum (1). The final pathologic diagnosis showed an error in diagnostic imaging of 60%.The mean follow-up was 18 months (SD: 12.8), with not recurrences. CONCLUSIONS: ALM often manifests in a non-specific form and it may remain silent. Imaging studies guide the diagnosis, but only the histology provides a definitive result. Total resection is the best option to prevent recurrences and minimize complications.

The molecular epidemiology of SARS-CoV-2 in the Pityusic Islands shows multiple introductions and fast replacements of variants in a touristic worldwide hot spot.

The public health emergency caused by the Covid-19 outbreak in March 2020 encouraged worldwide initiatives to monitor the genetic diversity and features of the SARS-CoV-2 circulating variants, mainly based on the genomic surveillance. However, due to the impossibility to carry out extensive sequencing in resource-limited hospitals, other PCR-based strategies could be applied to efficiently monitor the circulating variants without the need to greatly expand the sequencing capacity. In our case, overpassing the technical limitations inherent to a second level hospital, we were able to characterize the weekly distribution of SARS-CoV-2 by the RT-qPCR amplification patterns visualization, single nucleotide polymorphism genotyping, and sequencing of randomly selected samples. All these molecular approaches allowed us to trace the epidemiology of SARS-CoV-2 viruses circulating in Ibiza and Formentera (Balearic Islands, Spain) during the third to the sixth pandemic waves (January 2021-July 2022), in which three major lineages that were considered as VOCs (Alpha, Delta, and Omicron), and many other non-VOC variants were detected and tracked.

Impact of mobilization in patients with short-term mechanical circulatory support such as Levitronix® CentriMag as a bridge to heart transplantation.

INTRODUCTION: Despite the benefits of mobilisation in the critical patient, the evidence in patients with Levitronix® CentriMag as a bridge to heart transplantation (HT) is scarce. The objective of this study is to analyze the impact of mobility on these patients. METHODS: Retrospective observational study of patients who received a HT with Levitronix® CentriMag admitted between 2010 and 2019 to a tertiary hospital. Degree of mobility and nutritional status were assessed at the time of HT. Outcomes including infections, length of hospital admission and mortality were evaluated. RESULTS: 27 patients were included and divided in two groups according to degree of mobility (22 with low mobility and 5 with high mobility). 90-day survival after HT was 63.6% in patients with low mobility and 80% in high mobility group; no statistically significant differences were observed. No differences were observed regarding ICU discharge after HT at 30 days. Nevertheless, lower albumin levels were observed in low mobility group (24,5 g/L (IQR: 23-30) vs 33 g/L (IQR: 26-36); p = .029). Invasive mechanical ventilation (IMV) post HT was longer in patients with low mobility (p = .014). There were no significant differences in appearance of pressure ulcers, or post HT infections among mobility groups. CONCLUSIONS: Patients with high mobility had a shorter time of IMV and a better nutritional status. No complications were observed associated to mobility. No differences were observed between the degree of mobility and 90-day mortality, ICU stay or post HT adverse events.

[Laparoscopic appendectomy with endoloop: results of our experience]. / Apendicectomía laparoscópica con endolazo: resultados de nuestra experiencia.

There are several different techniques for laparoscopic appendectomy (LA), with different material requirements and approach. We present the results from our series, where we employ monopolar hook for mesoappendix dissection and double polyglactin endoloop for ligation of appendicular stump. The appendix is taken out through the Hasson trocar without any contact with abdominal wall, in a completely laparoscopic procedure. We sought to analyze the security of this technique. We reviewed retrospectively every LA for acute appendicitis performed during the last 10 years in our Hospital. We collected data regarding surgical procedure and postoperative outcome, focusing on intraoperative or postoperative complications. A total of hundred and ten (110) LA for acute appendicitis (from simple appendicitis to perforated appendicitis) were performed. Mean operative time was 74.7 minutes (median 70 min, SD 24.43 min, min. 25, max. 130 min). Ten patients (9.09%) had postoperative complications, consisting in intraabdominal abscess in 6 patients (5.4%) and wound infection in 3 patients (2.7%). No major complication was found, as uncontrolled hemorrhage, bowel perforation or stump dehiscence. No patient needed a second surgical procedure in the postoperative time. Laparoscopic appendectomy with polyglactin endoloops is a completely laparoscopic and safe procedure, without any intraoperative complication in our series. Laparoscopic approach with 12 mm Hasson trocar and two 5 mm working trocars allows a nice aesthetic result.

High-flow Priapism in Pediatric Population: Case Series and Review of the Literature. / Priapismo de alto flujo en población pediátrica: serie de casos y revisión de la literatura.

INTRODUCTION: Priapism is a prolonged erection that lasts longer than four hours. It is a rare pathology in the pediatric population, with an estimation of 0.3-1.5 per 100,000 children per year. The diagnostic sequence includes clinical history, physical examination and penile Doppler ultrasound (PDUS). Puncture of corpora cavernosa is not always necessary to establish the differential diagnosis between high-flow and low-flow priapism. The treatment of choice in pediatric age is not well defined. PATIENTS AND METHODS: Multicentric, retrospective and descriptive study including patients under 14 years with high-flow priapism between 2010 and 2020. RESULTS: A total of seven patients were diagnosed with high-flow priapism. None of them required puncture of the corpora cavernosa. Patients were treated with a conservative management, two patients required superselective arterial embolization due to persistent symptoms. CONCLUSIONS: High-flow priapism is a very rare entity in pediatric age; therefore, knowing the proper diagnosis and management is crucial. Currently, penile doppler ultrasound is enough for diagnosis in most cases and allows obviating the use of blood gas analysis. Children should be initially treated with a conservative management, reserving embolization for refractory cases.

High-flow priapism in pediatric population: Case series and review of the literature.

INTRODUCTION: Priapism is a prolonged erection that lasts longer than four hours. It is a rare pathology in the pediatric population, with an estimation of 0.3-1.5 per 100,000 children per year. The diagnostic sequence includes clinical history, physical examination and penile Doppler ultrasound (PDUS). Puncture of corpora cavernosa is not always necessary to establish the differential diagnosis between high-flow and low-flow priapism. The treatment of choice in pediatric age is not well defined. PATIENTS AND METHODS: Multicentric, retrospective and descriptive study including patients under 14 years with high-flow priapism between 2010 and 2020. RESULTS: A total of seven patients were diagnosed with high-flow priapism. None of them required puncture of the corpora cavernosa. Patients were treated with a conservative management, two patients required superselective arterial embolization due to persistent symptoms. CONCLUSIONS: High-flow priapism is a very rare entity in pediatric age; therefore, knowing the proper diagnosis and management is crucial. Currently, penile doppler ultrasound is enough for diagnosis in most cases and allows obviating the use of blood gas analysis. Children should be initially treated with a conservative management, reserving embolization for refractory cases.

Lipolytic activity of the yeast species associated with the fermentation/storage phase of ripe olive processing.

Ripe olives account for ca. 30% of the world's table olive production. Fruits intended for this type of product are preserved in an aqueous solution (acidic water or brine) for several months, where they may undergo a spontaneous fermentation. Enterobacteriaceae and lactic acid bacteria were not detected in the present survey during storage. Thus, the work focused on studying the yeast microflora associated with the ripe olive storage of Manzanilla and Hojiblanca cultivars in acidified brines. A total of 90 yeast isolates were identified by means of molecular methods using RFLP analysis of the 5.8S-ITS rDNA region and sequencing of the D1/D2 domains of the 26S rDNA gene. The two most important species identified in both cultivars were Saccharomyces cerevisiae and Pichia galeiformis, which were present throughout the storage period, while Candida boidinii was detected during the later stages of the process. The species Pichia membranifaciens was detected only in the early stages of the Hojiblanca cultivar. The lipase assays performed with both extracellular and whole cell fractions of the yeast isolates showed that neither of the S. cerevisiae and P. galeiformis species had lipase activity, while the P. membranifaciens isolates showed a weak activity. On the contrary, all C. boidinii isolates gave a strong lipase activity. Change in olive fat acidity was markedly higher in the presence of the yeast population than in sterile storage, indicating that lipases produced by these microorganisms modify the characteristics of the fat in the fruit.