Assessment of nitrification process in a sequencing batch reactor: Modelling and genomic approach.

Nitrification of ammoniacal nitrogen (N-NH4+) to nitrate (N-NO3-) was investigated in a lab-scale sequencing batch reactor (SBR) to evaluate its efficiency. During the nitrification process the removal of N-NH4+ reached 96%, resulting in 73% formation of N-NO3-. A lineal correlation (r2 = 0.9978) was obtained between the concentration of volatile suspended solids (VSS) and the maximal N-NO3- concentration at the end of each batch cycle under stationary state. The bacterial taxons in the initial inoculum were identified, revealing a complex diverse community mainly in the two major bacterial phyla Proteobacteria and Actinobacteria. The FAPROTAX algorithm predicted the presence in the inoculum of taxa involved in relevant processes of the nitrogen metabolism, highlighting the bacterial genera Nitrospira and Nitrosomonas that are both involved in the nitrification process. A kinetic model was formulated for predicting and validating the transformation of N-NH4+, N-NO2- and N-NO3- and the removal of organic and inorganic carbon (TOC and IC, respectively). The results showed how the increase in biomass concentration slowed down the transformation to oxidised forms of nitrogen and increased denitrification in the settling and filling stages under free aeration conditions.

Evaluation of succulent plants Echeveria elegans as a biomonitor of heavy metals and radionuclides.

This work evaluates the use of Echeveria elegans as a biomonitor of metals and radionuclides, using semi-urban soils as a study area. The study area is exposed to various trace elements of concern for various social groups in nearby localities. The quantification of metals and radionuclides was performed by X-ray fluorescence spectrometry and gamma spectrometry, respectively. Cumulative frequency distribution curves, descriptive statistics, and multivariate analysis were used to estimate the local geochemical baseline and identify geochemical and anthropogenic patterns of metals and radionuclides from topsoil and E. elegans. The evaluation of contaminants and the contribution of possible exposure routes (topsoil and atmospheric deposition) was performed with the enrichment factor (EF) and the relative concentration factor (CFR). The results suggest that the plant does not present significant physical stress due to the environmental conditions to which it was exposed. Likewise, it can bioaccumulate heavy metals from natural and anthropogenic sources. The quantification of radionuclides in the plant is below the detection limits, indicating a low bioavailability and transfer factor. The CFR and EF results showed that the plant accumulates metals from the topsoil and atmospheric deposition. The bioaccumulation mechanism would be related to the functioning of Crassulaceae Acid Metabolism (CAM). In topsoil, the organic acids of the plant would modify the solubility of the metals present in an insoluble form in the soil, acting as ligands and, subsequently, following the transport route of these metabolites. In atmospheric deposition, the metals deposited in the leaves would be incorporated into the plant through the opening of the stomata because of the capture of CO2 (at night, day, or during environmental stress) by the CAM. Overall, the evidence showed that the succulent can be used as a biomonitor of heavy metals. However, additional studies are required to determine its usefulness as a radionuclide biomonitor.

Surgical maneuvers for long-segment Hirschsprung pull-through in unique patients.

PURPOSE: Patients with Hirschsprung disease affecting the splenic flexure or more proximal segments present a surgical challenge. Mobilizing the transverse colon to the pelvis during a pull-through may obstruct the distal ileum, or the length may be insufficient to reach the lower pelvis. This retrospective study aimed to describe two surgical techniques that facilitate mobilization of the transverse colon and their outcome. METHODS: We included patients operated on between April 2017 and April 2024 and analyzed sex, comorbidities, type of pull- through, age at pull-through, history of previous surgeries, cause of the proximal transverse colon pull-through, technique used (Deloyers or Turnbull), complications , postoperative outcome and follow-up. The first technique used was the maneuver described by Turnbull. This operation creates a mesenteric defect and mobilizes the colon into this mesenteric window at the distal ileum level. The second technique was described by Deloyers and involves a 180-degree rotation of the right colon by dissecting the right colon attachment and the hepatocolic ligament. The cecum and the ileocecal valve are placed in the right upper quadrant, and the distal colon is mobilized into the pelvis. RESULTS: We included 13 patients, 12 boys and 1 girl. Eight patients had previous surgeries in another hospital: five had an initial transverse colostomy, and three had an ileostomy. The remaining five had the initial operation in our hospital: two had an ileostomy, two had a colostomy, and one had a primary pull-through. The median age at pull-through was 16 months (4-59 months). We used the Turnbull technique in four patients whose aganglionosis was limited to the middle transverse colon. The Deloyers technique was used in the remaining patients, with ganglion cells in the proximal transverse colon. We left a protective ileostomy in five patients. The median follow-up was 4.5 years (3 months to 10 years). The stoma takedown is pending in one patient. CONCLUSION: The Turnbull and Deloyers techniques were helpful in patients with aganglionosis affecting the transverse colon.

Application of the Simplified Psoriasis Index in the Routine Clinical Practice: A Pilot Study. / Aplicación del Simplified Psoriasis Index en la práctica clínica habitual: estudio piloto.

BACKGROUND AND OBJECTIVE: The Simplified Psoriasis Index (SPI) is a recently validated tool in Spanish that measures psoriasis severity by integrating 3 different spheres: clinical severity (SPI-s), psychosocial impact (SPI-p), and natural history (SPI-i). Our objective was to study the validity and equivalence of this new scale compared to routinely used scales such as the Psoriasis Area and Severity Index, PASI, and the Dermatology Life Quality Index (DLQI). MATERIALS AND METHODS: This was a cross-sectional and observational study that included 45 patients aged 18 to 74 years. Demographic data and information associated with psoriasis severity and the patients' quality of life were collected, using PASI, DLQI, and SPI simultaneously. The correlation of reference scales (PASI and DLQI) with SPI was examined. The degree of agreement between the 2 versions of SPI completed by the physician (proSPI-s) and self-administered by the patient (saSPI-s), was also studied. RESULTS: The mean age of the study population was 51 years, with a mean psoriasis history of 14.05 years. A strong correlation was found between PASI and proSPI-s (r=0.89), as well as between DLQI and SPI-p (r=0.89), with a moderate correlation being reported between PASI and saSPI-s (r=0.52). The degree of agreement between proSPI-s and saSPI-s was moderate. CONCLUSIONS: These findings represent the initial results of real clinical practice using the validated Spanish version of SPI, making its use truly promising in the routine clinical practice.

Exploring the effect of the covalent functionalization in graphene-antimonene heterostructures.

The growing field of two-dimensional (2D) materials has recently witnessed the emergence of heterostructures, however those combining monoelemental layered materials remain relatively unexplored. In this study, we present the chemical fabrication and characterization of a heterostructure formed by graphene and hexagonal antimonene. The interaction between these 2D materials is thoroughly examined through Raman spectroscopy and first-principles calculations, revealing that this can be considered as a van der Waals heterostructure. Furthermore, we have explored the influence of the antimonene 2D material on the reactivity of graphene by studying the laser-induced covalent functionalization of the graphene surface. Our findings indicate distinct degrees of functionalization based on the underlying material, SiO2 being more reactive than antimonene, opening the door for the development of controlled patterning in devices based on these heterostructures. This covalent functionalization implies a high control over the chemical information that can be stored but also removed on graphene surfaces, and its use as a patterned heterostructure based on antimonene and graphene. This research provides valuable insights into the antimonene-graphene interactions and their impact on the chemical reactivity during graphene covalent functionalization.

GDF15 as a potential biomarker to distinguish fibrotic from non-fibrotic hypersensitivity pneumonitis.

Hypersensitivity Pneumonitis (HP) is an immune-mediated interstitial lung disease (ILD) characterized by fibrotic HP (fHP) or non-fibrotic HP (non-fHP). Fibrosis is associated with poor prognosis, emphasizing the need for biomarkers to distinguish fHP from non-fHP. This study aimed to determine the plasma levels of GDF15 in HP patients and assess its association with lung function and phenotype classification. GDF15 levels were quantified by ELISA in HP (n = 64), idiopathic pulmonary fibrosis (n = 54), and healthy control (n = 128) groups. Clinical, demographic, and functional data were obtained from medical records. High-resolution chest CT scans were used to classify HP patients into fHP and non-fHP groups. In addition, receiver operating characteristic analysis was performed to determine the cut-off point, sensitivity, and specificity. Our results revealed significantly elevated GDF15 levels in fHP compared to non-fHP (2539 ± 821 pg/ml versus 1783 ± 801 pg/ml; p = 0.009). The estimated cut-off point for plasma GDF15 levels to distinguish fHP from non-fHP was 2193.4 pg/ml (AUC 0.75). These findings suggest that GDF15 may serve as a valuable biomarker for differentiating between fHP and non-fHP, potentially indicating its involvement in lung fibrosis development in HP.

[Concordance of medication prescription records in the hospitalised surgical patient]. / Concordancia de los registros de prescripción de medicamentos en el paciente quirúrgico hospitalizado.

INTRODUCTION: Electronic prescription is the prescription system that allows healthcare professionals to send medication prescriptions directly to community pharmacies and the outpatient unit of Hospital Pharmacy Services for dispensing. However, there is difficulty in obtaining a reliable pharmacotherapeutic history in chronic patients through electronic prescription upon hospital admission as a critical point for adequate treatment adaptation. Therefore, the pharmacist as a member of the multidisciplinary team must ensure, through medication conciliation, an adequate transition of care through the correct management of the treatment that the chronic patient requires during their hospitalization. OBJECTIVES: To evaluate the quality of electronic prescription records for routine chronic treatment by analyzing the concordance of the electronic prescription. MATERIAL AND METHODS: Observational, cross-sectional and retrospective study at the General University Hospital of Elche. Hospitalized patients in charge of the Orthopedic Surgery and Traumatology, Urology and Neurosurgery Services in which the responsible doctor requested medication reconciliation by the Pharmacy Service between January 2022 - December 2022 were included. RESULTS: 378 patients, 209 (55.3%) women and 169 (44.7%) men, with a mean age±standard deviation of 71.0±11.6 years and 69.0±11.8 years, respectively. The total percentage of patients with discrepancies in the electronic prescription with respect to the usual chronic treatment was 60.6%, reflecting that only 39.4% of the patients had non-discordant electronic prescriptions. CONCLUSIONS: More than half of hospitalized surgical patients present discrepancies in the medications prescribed in the home electronic prescription, which justifies the importance of treatment reconciliation upon admission carried out by hospital pharmacists.

Primary staging of rectal cancer on MRI: an updated pictorial review with focus on common pitfalls and current controversies.

Magnetic resonance imaging (MRI) plays a pivotal role in primary staging of rectal cancer, enabling the determination of appropriate management strategies and prediction of patient outcomes. However, inconsistencies and pitfalls exist in various aspects, including rectal anatomy, MRI protocols and strategies for artifact resolution, as well as in T- and N-staging, all of which limit the diagnostic value of MRI. This narrative and pictorial review offers a comprehensive overview of factors influencing primary staging of rectal cancer and the role of MRI in assessing them. It highlights the significance of the circumferential resection margin and its relationship with the mesorectal fascia, as well as the prognostic role of extramural venous invasion and tumor deposits. Special attention is given to tumors of the lower rectum due to their complex anatomy and the challenges they pose in MRI staging. The review also addresses current controversies in rectal cancer staging and the need for personalized risk stratification. In summary, this review provides valuable insights into the role of MRI in the primary staging of rectal cancer, emphasizing key aspects for accurate assessment to enhance patient outcomes.

Exploring the muscle architecture effect on the mechanical behaviour of mouse rotator cuff muscles.

Incorporating detailed muscle architecture aspects into computational models can enable researchers to gain deeper insights into the complexity of muscle function, movement, and performance. In this study, we employed histological, multiphoton image processing, and finite element method techniques to characterise the mechanical dependency on the architectural behaviour of supraspinatus and infraspinatus mouse muscles. While mechanical tests revealed a stiffer passive behaviour in the supraspinatus muscle, the collagen content was found to be two times higher in the infraspinatus. This effect was unveiled by analysing the alignment of fibres during muscle stretch with the 3D models and the parameters obtained in the fitting. Therefore, a strong dependence of muscle behaviour, both active and passive, was found on fibre orientation rather than collagen content.

Undetectable circulating tumor DNA confirms the inability of pseudomyxoma peritonei to systemic dissemination.

The study of circulating tumor DNA (ctDNA) plays a pivotal role in advancing precision oncology, providing valuable information for individualized patient care and contributing to the ongoing effort to improve cancer diagnosis, treatment, and management. However, its applicability in pseudomyxoma peritonei (PMP) remains unexplored. In this multicenter retrospective study involving 21 PMP patients, we investigated ctDNA presence in peripheral blood using three distinct methodologies. Despite mucinous tumor tissues exhibiting KRAS and GNAS mutations, ctDNA for these mutations was undetectable in blood samples. In this pilot study, circulating tumor DNA was not detected in blood when the tumor harbored mutations of known significance. In the future, a study with a larger sample size is needed to confirm these findings and to determine whether ctDNA could identify patients at risk for early recurrence and/or systemic metastases.

Meta-analysis of genome-wide association studies for cancer therapy-related cardiovascular dysfunction and functional mapping highlight an intergenic region close to TP63.

Cancer therapy-related cardiac dysfunction (CTRCD), which commonly includes left ventricular dysfunction and heart failure, is the main adverse effect of anticancer therapy. In recent years several candidate genes studies and genome-wide association studies have identified common genetic variants associated with CTRCD, but evidence remains limited and few genetic variants are robust. A genome-wide meta-analysis of CTRCD was performed with 852 oncology patients receiving cancer therapy. DNA samples were genotyped and imputed to perform a GWAS meta-analysis for case-control (N = 852 (380 cases and 472 controls) and extreme phenotypes (N = 618 (78 cases and 472 controls) looking for genetic variants that predispose to CTRCD. The results were validated in a replicate cohort of 1,191 oncology patients (245 cases and 946 controls). Functional mapping of the replicated loci was then performed. The meta-analysis showed 9 and 17 loci suggestively associated (P-value < 1 × 10-5) with CTRCD in case-control and extreme phenotypes analyses, respectively. The 3q28 locus (rs rs7652759, P = 5.64 × 10-6) in the case-control analysis was the strongest signal, with up to 64 SNPs above the suggestive significance threshold. The rs7652759, an intergenic variant between TPRG1 and TP63 genes, was the only variant validated in the replication cohort (P-value = 0.01). Functional mapping of this significant locus revealed up to 5 new genes potentially involved in the CTRCD. We identified the intergenic region near TP63 as a novel CTRCD susceptibility locus. In the future, the genotyping of these markers could be considered in new CTRCD risk scores to improve preventive strategies in cardio-oncology.

Comparación de la efectividad entre distintas intervenciones en los síntomas posconmoción en adolescentes y jóvenes: una revisión bibliográfica / Comparison of effectiveness between different interventions in postconcussive symptoms in adolescents and young people: A literature review

Introducción: Actualmente la conmoción cerebral se considera un problema de gran magnitud, siendo los adolescentes y jóvenes la población de riesgo, ya que se encuentran en proceso de maduración. Nuestro objetivo ha sido comparar la eficacia de diferentes intervenciones (ejercicio físico terapéutico, terapia vestibular y descanso) en adolescentes y jóvenes con conmoción cerebral.Desarrollo: Se realizó una búsqueda bibliográfica en las principales bases de datos. Una vez aplicados los criterios de inclusión/exclusión y la escala metodológica Physiotherapy Evidence Database PEDro, fueron revisados seis artículos. Los resultados apoyan la utilización del ejercicio y la terapia vestibular en las etapas iniciales para disminuir los síntomas posconmoción. Según la mayoría de los autores, el ejercicio físico terapéutico y la terapia vestibular reportan mayores beneficios, aunque se necesitaría un protocolo que unificara escalas de valoración, variables de estudio y parámetros de análisis para poder realizar la inferencia en la población diana.Conclusión: Desde el momento del alta hospitalaria del paciente, la aplicación combinada de ejercicio físico y terapia vestibular, podría considerarse como la mejor opción para disminuir los síntomas posconmoción.(AU)

Introduction: Currently, concussion considers a problem of great magnitude, adolescents and young people being the population at risk, since it is in the process of maturation. Our goal has been to compare the effectiveness of different interventions (exercise therapy, vestibular rehabilitation and rest) in adolescents and young people with concussion. Development: A bibliographic search was carried out in the main databases. Once the inclusion / exclusion criteria and the PEDro methodological scale were applied, 6 articles were reviewed. The results support the use of exercise and vestibular rehabilitation in the initial stages to reduce post-concussion symptoms. According to most authors, therapeutic physical exercise and vestibular rehabilitation report greater benefits, although a protocol that unifies assessment scales, study variables and analysis parameters would be needed to be able to make the inference in the target population. Conclusión: From the moment of hospital discharge, the combined application of exercise and vestibular rehabilitation could be the best option to reduce post-concussion symptoms.(AU)

Uso del dermatoscopio en la lectura de pruebas epicutáneas: ¿qué puede aportar? / Dermoscopy in Patch Testing: How Can It Help?

La lectura de los parches de pruebas epicutáneas no es sencilla, presenta una gran variabilidad inter- e intraobservador y requiere experiencia. En ocasiones es realmente difícil determinar si se trata de una reacción alérgica de intensidad leve o si estamos ante una reacción irritativa. Recientemente se han publicado algunos trabajos que han estudiado las características dermatoscópicas de las distintas reacciones que se producen tras realizar pruebas epicutáneas. La característica dermatoscópica más frecuentemente observada en los parches alérgicos es el eritema homogéneo, si bien vasos puntiformes, vesículas o costras y áreas amarillo-anaranjadas también parecen indicar una reacción alérgica, guardando cierta similitud con lo observado en patología inflamatoria como en el eccema. Por otro lado, en cuanto a las reacciones irritativas, el patrón más indicativo sería el «patrón del poro», acompañado de eritema perifolicular. Estos hallazgos dermatoscópicos pueden ser de utilidad al clínico en su toma de decisiones ante una reacción dudosa (AU)

Interpreting patch test reactions is not easy. It requires experience and is characterized by high intraobserver and interobserver variability. It can sometimes be truly difficult to discern between a weak allergic reaction and an irritant reaction. A number of recent studies have investigated the dermoscopic features of patch test reactions. Homogeneous erythema is the main feature observed in patients with a positive allergic reaction, although dotted vessels, vesicles, crusts and yellow-orange areas may also provide clues. These features are somewhat similar to those observed in inflammatory conditions, such as eczema. In patients with an irritant reaction, the most common dermoscopic findings are the pore reaction pattern and perifollicular erythema. Dermoscopy could be useful for establishing a diagnosis in the case of doubtful patch test reactions (AU)

[Translated article] Dermoscopy in Patch Testing: How Can It Help? / Uso del dermatoscopio en la lectura de pruebas epicutáneas: ¿qué puede aportar?

Interpreting patch test reactions is not easy. It requires experience and is characterized by high intraobserver and interobserver variability. It can sometimes be truly difficult to discern between a weak allergic reaction and an irritant reaction. A number of recent studies have investigated the dermoscopic features of patch test reactions. Homogeneous erythema is the main feature observed in patients with a positive allergic reaction, although dotted vessels, vesicles, crusts and yellow-orange areas may also provide clues. These features are somewhat similar to those observed in inflammatory conditions, such as eczema. In patients with an irritant reaction, the most common dermoscopic findings are the pore reaction pattern and perifollicular erythema. Dermoscopy could be useful for establishing a diagnosis in the case of doubtful patch test reactions (AU)

La lectura de los parches de pruebas epicutáneas no es sencilla, presenta una gran variabilidad inter- e intraobservador y requiere experiencia. En ocasiones es realmente difícil determinar si se trata de una reacción alérgica de intensidad leve o si estamos ante una reacción irritativa. Recientemente se han publicado algunos trabajos que han estudiado las características dermatoscópicas de las distintas reacciones que se producen tras realizar pruebas epicutáneas. La característica dermatoscópica más frecuentemente observada en los parches alérgicos es el eritema homogéneo, si bien vasos puntiformes, vesículas o costras y áreas amarillo-anaranjadas también parecen indicar una reacción alérgica, guardando cierta similitud con lo observado en patología inflamatoria como en el eccema. Por otro lado, en cuanto a las reacciones irritativas, el patrón más indicativo sería el «patrón del poro», acompañado de eritema perifolicular. Estos hallazgos dermatoscópicos pueden ser de utilidad al clínico en su toma de decisiones ante una reacción dudosa (AU)

Síndrome de lisis tumoral en paciente hematológico / Tumor lysis syndrome in hematologic patient

El síndrome de lisis tumoral (SLT) es una complicación potencialmente mortal caracterizada por una lisis masiva de células tumorales. A continuación, se presenta el caso de un varón de 28 años, diagnosticado de linfoma no Hodking de células B de alto grado. Este presentó un SLT tras la administración de la quimioterapia, de especial interés debido a las recomendaciones farmacológicas propuestas desde el Servicio de Farmacia en cuanto a la dosis de rasburicasa y las interacciones a nivel electrolítico con la medicación concomitante prescrita durante el ingreso. (AU)

Tumor lysis syndrome (TLS) is a life-threatening complication characterized by a massive lysis of tumor cells. The following is the case of a 28-year-old man diagnosed with high-grade B-cell non-Hodking lymphoma. The patient presented a TLS after the administration of chemotherapy. This case is of special interest due to the pharmaco logical recommendations proposed by the Pharmacy Service regarding the rasburicasa dose and the interactions at the electrolyte level with the concomitant medication prescribed during admission. (AU)

Monitorización farmacocinética de antagonistas del factor de necrosis tumoral: utilidad clínica en enfermedad inflamatoria intestinal / Pharmacokinetics monitoring of tumour necrosis factor inhibitors: utility in inflammatory bowel disease management

Introducción: El fracaso de la terapia con biológicos en la enfermedad inflamatoria intestinal (EII) es un problema común. La monitorización farmacocinética es una herramienta que podría permitir optimizar estos tratamientos mediante la individualización de la posología en los diferentes escenarios clínicos. Objetivo: Describir las determinaciones de concentraciones séricas de infliximab y adalimumab en pacientes con EII y evaluar el impacto de las recomendaciones farmacocinéticas en la toma de decisiones clínicas y la evolución de los pacientes.Métodos: Estudio trasversal observacional retrospectivo de dos años de duración (2017-2018) de las determinaciones de inhibidores del factor de necrosis tumoral (anti-TNF) realizadas en pacientes del Servicio de Medicina Digestiva de un hospital general. Resultados: Se realizaron 133 determinaciones correspondientes a 66 sujetos (38% tratados con adalimumab; 62% infliximab). El principal motivo de monitorización (>55%) fue la presencia de enfermedad activa. Más de la mitad de los pacientes tenían concentraciones fuera del intervalo terapéutico (el 51% de adalimumab y 37% de infliximab presentaban una exposición subóptima). La recomendación de mantener la pauta posológica previa se propuso en <40% de los informes farmacocinéticos, siendo el grado de aceptación de la recomendación superior al 80% en todos los casos. Los datos analíticos de inflamación se redujeron tras la monitorización sin mostrar significación estadística en todos los casos.Conclusión: La mayoría de pacientes con EII tratados con anti-TNF presentan concentraciones de fármaco inadecuadas. La monitorización ha demostrado ser una herramienta útil para guiar la toma de decisiones terapéuticas y podría contribuir en la mejora de los parámetros clínicos de estos pacientes. (AU)

Introduction: The failure of biologic therapy in inflammatory bowel disease (IBD) is a common problem. The pharmacokinetic monitoring is a useful tool that allows to optimize these treatments.Objective: To describe the pharmacokinetic determinations of plasma concentrations of infliximab and adalimumab in patients with IBD and evaluate its impact on clinical decision.Method: Retrospective, observational study of two years duration (2017-2018) of the tumor necrosis factor (anti-TNF) inhibitor determinations performed in patients of the Digestive Service of a general hospital.Results: A total of 133 determinations were obtained about 66 subjects (38% adalimumab, 62% infliximab). The main reason (>55%) of the request for monitoring was the presence of active disease. More than half of the patients had concentrations outside the therapeutic range (51% of patients with adalimumab and 37% of those with infliximab had plasma levels below the lower range considered suboptimal). The maintenance of the previous dosage was recommended only in <40% of the monitoring and the degree of acceptance of the interventions were more than 80% in all cases. The analytical data of inflammation were reduced after monitoring without showing statistical significance in all cases.Conclusion: Standard anti-TNF regimen was not adequate to obtain range concentrations in more than half of analyzed cases. Monitoring has proven to be very useful in supporting clinical decision and it may promote an improvement in the clinical parameters of patients with IBD. (AU)

Riesgo de contagio por COVID-19 en función del tipo de contacto y de la renta familiar / Risk of contagion by COVID-19 depending on the type of contact and family income

Introducción: tras una segunda oleada de la pandemia COVID-19 en Zaragoza, se estudian los contactos estrechos con pacientes con COVID-19, con la finalidad de valorar el riesgo de infección tras exposición en función del paciente índice, adulto o niño, y la renta familiar. Material y métodos: se realiza un estudio descriptivo de todos los pacientes pediátricos que han tenido contacto con pacientes con COVID-19 en el centro de salud de Delicias Sur de Zaragoza entre los meses de julio y agosto de 2020 y se valora la aparición de síntomas, consultas en servicio de urgencias, realización de pruebas complementarias, contacto estrecho con adulto o con niño y la renta familiar. Resultados: un total de 292 pacientes fueron contacto estrecho con pacientes con COVID-19, de los cuales 128 fueron positivos para la PCR de SARS-CoV-2. Al analizar el tipo de contacto, se encontró que un 10,94% había mantenido contacto estrecho con un niño y un 89,06% con un adulto. El riesgo de contagio tras sufrir contacto con un niño positivo fue del 34,15%, mientras que, tras contacto con un adulto positivo, el riesgo fue del 45,78%. Asimismo, el riesgo de contagio entre las rentas inferiores a 18 000 € fue de 47,9 frente al 27,6% de aquellos pacientes con rentas superiores a 18 000 €. Conclusiones: el riesgo de contagio de COVID-19 es mayor cuando el contacto estrecho es con un adulto y cuando el nivel de renta familiar es inferior (AU)

Purpose: during the second wave of the COVID-19 pandemic in Zaragoza, we studied the paediatric contacts of COVID-19-positive patients to estimate the risk of infection after exposure to a positive child or adult and the risk of infection based on household income.Methods: we conducted a descriptive study of all paediatric patients that were close contacts of individuals with COVID-19 in the Delicias Sur Primary Care Centre (Zaragoza, Spain) between July and August 2020. We also analysed the most frequent symptoms, visits to the emergency department, diagnostic tests, contact with a child versus an adult with COVID-19 and household income.Results: a total of 292 patients had had close contact with individuals with COVID-19; 218 of them had positive SARS-CoV-2 PCR test results. When we analysed the close contacts, we found that 10.94% of patients that tested positive had been in close contact with a child with COVID-19 and 89.06% with an adult with COVID-19. The estimated risk of infection after exposure was 29.8% in the case of close contact with a child with COVID-19 compared to 46.53% when it came to close contact with an adult case. The risk of infection was higher in patients with an annual household income of less than €18000 (47.9%) compared to patients with a higher annual household income (27.6%).Conclusion: the risk of SARS-CoV-2 infection was higher in patients that had close contact with adult cases and with lower household incomes. (AU)

Descripción y aplicación clínica de las escalas de valoración geriátrica integral: una revisión sistemática rápida de revisiones / Description and clinical application of comprehensive geriatric assessment scales: a rapid systematic review of reviews

Objetivo Realizar una descripción de las principales escalas utilizadas en la valoración geriátrica integral mediante un análisis narrativo detallando su aplicación clínica en relación con sus ventajas y desventajas en función de sus propiedades psicométricas (valoración mental) y los sesgos en su aplicación. Las escalas seleccionadas fueron: índice de Barthel, índice de Katz, escala de Lawton y Brody, mini-examen del estado mental, test del reloj, escala de depresión geriátrica y la escala de recursos sociales. Métodos Se realizó una revisión sistemática rápida de revisiones en MEDLINE (PubMed) hasta enero de 2021, informando de los hallazgos mediante PRISMA, 2020. Para construir la estrategia de búsqueda reproducible se empleó el lenguaje MeSH, palabras clave y los operadores booleanos AND y OR. Resultados Se seleccionaron 31 que cumplieron los criterios de elegibilidad; 18 revisiones sistemáticas, 12 revisiones de la literatura y una revisión de alcance. Se encontraron múltiples versiones para algunas de las escalas y se constataron sesgos en su interpretación. Se recomienda la administración de cuestionarios cortos y fáciles de aplicar y se aconseja que los puntos de corte se definan según la educación formal. Conclusión Las escalas de valoración geriátrica integral son instrumentos baratos, eficaces y útiles para detectar problemas y potencialidad en las personas mayores. Deben ser de fácil aplicación, no extensas, válidas para múltiples culturas y distintos niveles de educación formal y aplicables a diferentes grados de discapacidad. Es recomendable que los profesionales sanitarios se entrenen en su uso para evitar sesgos en la interpretación de los resultados (AU)

Objective This work aims to describe the main scales used in comprehensive geriatric assessment through a narrative analysis detailing their clinical application in relation to their advantages and disadvantages in terms of their psychometric properties (mental assessment) and biases in their application. The scales selected were: Barthel Index, Katz Index, Lawton and Brody Scale, Mini-Mental State Examination, Clock Test, Geriatric Depression Scale, and the Social Resources Scale. Methods We conducted a rapid systematic review of reviews in MEDLINE (PubMed) up to January 2021, reporting findings using PRISMA, 2020. MeSH language, keywords, and the Boolean operators AND and OR were used to construct the reproducible search strategy. Results Thirty-one works were selected that met the eligibility criteria: 18 systematic reviews, 12 literature reviews, and one scoping review. Multiple versions were found for some of the scales and biases in their interpretation were observed. Short, easy-to-administer questionnaires are recommended and cut-off points should be defined by formal education. Conclusion Comprehensive geriatric assessment scales are inexpensive, effective, and useful instruments for identifying problems and potential problems in the elderly. They should be easy to apply, not extensive, valid for multiple cultures and different levels of formal education, and applicable to individuals with different degrees of disability. It is recommended that health professionals be instructed in their use to avoid biases in the interpretation of the results (AU)

Comparison of professional pharmacy degrees and health systems in United States, Canada, Spain and Mexico / Comparación del grado profesional de farmacia y los sistemas de salud en Estados Unidos, Canadá, España y México

Introduction: It is known that in countries like United States, Canada or Spain, pharmacists are well recognized as important members of the healthcare team, in both community and hospital settings, due to their vital role in caring for patients’ medication safety. In Mexico, just a short time ago, pharmacists were recognized in this manner. The objective to this study is to compare professional pharmacy training programs and healthcare systems in the United States, Canada, Spain and Mexico.Methods: A convenience sample of four universities were selected due to the authors’ extensive knowledge of the content and development of the profession.Results: Pharmacy curricula in the United States and Canada are very similar. They have many clinical pharmacy subjects, such as pharmacotherapy, therapeutics, pharmaceutical care, drug calculations and skills-based lab courses. In Spain and Mexico, however, while some of the coursework is similar, Spain has an experiential rotation program and Mexico does not. Mexican universities allow students practice in workshops to simulate pharmacy practice.Conclusion: It will be important to develop pharmacist training programs in Mexico (químico, farmacéutico biólogo), with more clinical pharmacy subjects as well as patient-centered communication skills to strengthen the profession and be able to contribute within the health team and provide better patient care. (AU)

Introducción: Es sabido que en países como Estados Unidos, Canadá o España, el farmacéutico es reconocido como un elemento importante en el equipo de salud, ya sea en la farmacia comunitaria u hospitalaria, teniendo un papel importante en la seguridad de la medicación del paciente. El objetivo de este estudio fue comparar los planes de estudio de farmacia y los sistemas de salud de Estados Unidos, Canadá, España y México.Métodos: Se tomó una muestra a conveniencia de cuatro universidades, las cuales fueron seleccionadas por el amplio conocimiento de los autores del contenido de los programas y el desarrollo de la profesión.Resultados: La currícula de farmacia de Estados Unidos y Canadá son muy similares, sus programas contienen gran cantidad de materias relacionadas a farmacia clínica como farmacoterapia, terapéutica, cuidado farmacéutico, cálculos de medicamentos y habilidades con el paciente. España y México, varias de sus materias son similares, con la diferencia de que en España, como en los otros dos países ellos tienen programas de rotaciones en farmacias comunitarias u hospitalarias. En México, la mayoría de las universidades aborda por talleres en estos temas.Conclusión: Sería importante enriquecer los programas de químico, farmacéutico biólogo en México con un mayor número de materias en el área de farmacia clínica, así como habilidades de comunicación con el paciente para fortalecer la profesión y tener la capacidad de participar dentro del equipo de salud, así como informar de una mejor manera al paciente sobre su medicación. (AU)

Absceso subretinal por Candida tropicalis en un paciente con leucemia mieloide: reporte de caso / Subretinal abscess due to Candida tropicalis in a patient with acute myeloid leukaemia: case report

Paciente mujer de 54 años con historia de leucemia mieloide aguda, bajo quimioterapia de mantenimiento, cursa con recaída sistémica y candidemia por Candida tropicalis (C. tropicalis), tratada con antifúngico, con respuesta favorable es referida a oftalmológica como parte de protocolo. El examen fundoscópico en ojo izquierdo halló una lesión blanquecina, coriorretiniana en el cuadrante súpero temporal. Los exámenes de angiografía retinal y tomografía de coherencia óptica correlacionaron con absceso subretinal. La paciente fue tratada con antifúngicos sistémicos con resolución favorable de la lesión. Los abscesos subretinianos son una rara manifestación intraocular por C. tropicalis, este organismo es potencial agente causal de afección ocular en presencia de antecedente sistémico de inmunosupresión y factores de riesgo asociados.

A 54-year-old female patient with a history of acute myeloid leukaemia and receiving maintenance chemotherapy had a systemic relapse. She also had candidaemia caused by Candida tropicalis. Her blood cultures were negative after receiving antifungal treatment. Later, she had an ophthalmological assessment as part of the protocol, without ocular discomfort. In the fundoscopic examination, a whitish chorioretinal lesion was found in the left eye in relation to subretinal abscess, which correlated with retinal angiography and optical coherence tomography. The patient was treated with systemic antifungals with a favourable resolution of the lesion.