Purpose: To study topographic epithelial and total corneal thickness changes in myopic subjects undergoing successful orthokeratology treatment in connection with the objective assessment of contact lens decentration. Methods: A prospective-observational and non-randomized study in 32 Caucasian myopic eyes undergoing Ortho-k for 3 months. Total, epithelial, and stromal thicknesses were studied before and after Ortho-k treatment, using optical coherence tomography with anterior segment application software. Central, paracentral, and mid-peripheral values are taken along 8 semi-meridians. Results: The central average total corneal thickness was 4.72 ± 1.04 μm thinner after Ortho-K. The paracentral corneal thickness showed no significant changes (p = 0.137), while the mid-peripheral corneal thickness was increased by 3.25 ± 1.6 μm associating this increase exclusively to the epithelial plot (p<0.001). When lens centration was assessed, a lens fitting decentration less than 1.0 mm was found for the whole sample, predominantly horizontal-temporal (87.5%) and vertical-inferior (50%) decentring. Corneal topographical analysis revealed a horizontal and vertical epithelial thickness asymmetric change profile with paracentral temporal thinnest values, and mid-peripheral nasal thickest values. Conclusions: The present study found a central corneal thinning induced by Ortho-k lenses in subjects with moderate myopia, only associated with a change in epithelial thickness, as well as mid-peripheral thickening, that seems to be mainly epithelial in origin. The authors also found a tendency of contact lens decentration toward temporal and inferior areas conditioning an asymmetric epithelial redistribution pattern.(AU)
Humans , Male , Female , Vision, Ocular , Myopia , Lens, Crystalline , Orthokeratologic Procedures , Corneal Stroma , Tomography, Optical Coherence , Retrospective Studies , Optometry , Ophthalmology , Prospective Studies
Campylobacter infections are a leading cause of bacterial-derived gastroenteritis worldwide with particularly profound impacts on pediatric patients in low-and-middle income countries. It remains unclear how Campylobacter impacts these hosts, though it is becoming increasingly evident that it is a multifactorial process that depends on the host immune response, the gastrointestinal microbiota, various bacterial factors, and host nutritional status. Since these factors likely vary between adult and pediatric patients in different regions of the world, it is important that studies define these attributes in well characterized clinical cohorts in diverse settings. In this study, we analyzed the fecal microbiota and the metabolomic and micronutrient profiles of asymptomatic and symptomatic pediatric patients in Colombia that were either infected or uninfected with Campylobacter during a case-controlled study on acute diarrheal disease. Here, we report that the microbiome of Campylobacter- infected children only changed in their abundance of Campylobacter spp. despite the inclusion of children with or without diarrhea. In addition to increased Campylobacter, computational models were used to identify fecal metabolites that were associated with Campylobacter infection and found that glucose-6-phosphate and homovanillic acid were the strongest predictors of infection in these pediatric patients, which suggest that colonocyte metabolism are impacted during infection. Despite changes to the fecal metabolome, the concentrations of intestinal minerals and trace elements were not significantly impacted by Campylobacter infection, but were elevated in uninfected children with diarrhea. Importance: Gastrointestinal infection with pathogenic Campylobacter species has long been recognized as a significant cause of human morbidity. Recently, it has been observed that pediatric populations in low-and-middle income countries are uniquely impacted by these organisms in that infected children can be persistently colonized, develop enteric dysfunction, and exhibit reduced development and growth. While the association of Campylobacter species with these long-term effects continues to emerge, the impact of infection on the gastrointestinal environment of these children remains uncharacterized. To address this knowledge gap, our group leveraged clinical samples collected during a previous study on gastrointestinal infections in pediatric patients to examine the fecal microbiota, metabolome, and micronutrient profiles of those infected with Campylobacter species, and found that the metabolome was impacted in a way that suggests gastrointestinal cell metabolism is affected during infection, which is some of the first data indicating how gastrointestinal health in these patients may be affected.
BACKGROUND: Line-field confocal optical coherence tomography (LC-OCT) is an emerging diagnostic tool with imaging depth reaching ~400 µm and a novel three-dimensional (3D) cube providing cellular resolution. As far as we are aware, there are only a limited number of papers that have reported diagnostic criteria for melanocytic lesions using this technique, and none of them have been multicentric. OBJECTIVES: Our aim was to establish the diagnostic criteria for melanocytic lesions using LC-OCT and identify the most significant architectural and cytologic features associated with malignancy. METHODS: A retrospective evaluation of 80 consecutive melanocytic lesions from a prospective multicentric data set spanning three European centres was conducted. We excluded facial, acral and mucosal lesions from the study. Dermoscopic and LC-OCT images were evaluated by a consensus of four observers. Multivariate logistic regression with backward elimination was employed. RESULTS: The main melanoma diagnostic criteria include detecting >10 pagetoid cells in 3D acquisition, irregular 3D epidermal architecture, disrupted dermoepidermal junction (DEJ) and clefting. Significant risk factors were irregular 3D epidermal architecture, >10 pagetoid cells, dendritic cells at DEJ without underlying inflammation. Novel malignancy criteria in vertical view were DEJ disruption and clefting around atypical melanocyte nests. Exclusive melanoma features were epidermal nests, epidermal consumption, dense dermal nests with atypia. Protective features in the absence of any malignancy indicators were DEJ ring pattern, cobblestone, elongated rete ridges (vertical), well-defined DEJ and wave pattern (vertical). CONCLUSIONS: A series of diagnostic criteria for the identification of melanocytic lesions with LC-OCT have been established. Validation of these criteria in clinical practice through future studies is essential to further establish their utility.
BACKGROUND: Sarcopenia has been identified as a risk factor for perioperative adverse events. Several studies have shown that tomographic assessment of muscle mass can be an appropriate indicator of sarcopenia associated with morbidity and mortality. The aim of the study was to determine the association between height-adjusted area of ââthe pectoral and erector spinae muscles (haPMA and haESA) and perioperative morbidity and mortality in thoracic surgery. METHODS: Retrospective cohort study. Measurement of muscle areas was performed by tomography. The outcomes were 30-day mortality and postoperative morbidity. The discriminative capacity of the muscle areas was evaluated with an analysis of ROC curves and the Youden index was used to establish a cut-off point. The raw morbidity and mortality risk was determined and adjusted for potential confounders. RESULTS: A total of 509 patients taken to thoracic surgery were included. The incidence of 30-day mortality was 7.3%. An association was found between muscle areas and 30-day mortality and pneumonia, with adequate discriminative power for mortality (AUC 0.68 for haPMA and 0.67 for haESA). An haPMA less than 10 and haESA less than 8.5â¯cm2/m2 were identified as a risk factor for 30-day mortality with an adjusted OR of 2.34 (95%CI 1.03-5.15) and 2.22 (95%CI 1.10-6.04) respectively. CONCLUSIONS: Sarcopenia, defined as low muscle area in the pectoral and erector spinae muscles, is associated with increased morbidity and mortality in patients undergoing thoracic surgery.
BACKGROUND AND OBJECTIVES: cardiovascular changes during pregnancy carry greater risk in heart disease. We analyze cardiovascular, obstetric and perinatal adverse effects associated with congenital and acquired heart disease during pregnancy and postpartum. MATERIALS AND METHODS: Cross-sectional and retrospective study, which included the 2017-2023 registry of pregnant or postpartum patients hospitalised with diagnosis of congenital or acquired heart disease. Adverse events (heart failure, stroke, acute pulmonary edema, maternal death, obstetric haemorrhage, prematurity and perinatal death) were compared with the clinical variables and the implemented treatment. RESULTS: 112 patients with a median age of 28 years (range 15-44) were included. Short circuits predominated 28 (25%). Thirty-six patients (32%) were classified in class IV of the modified WHO scale for maternal cardiovascular risk. Heart failure occurred in 39 (34.8%), acute lung edema 12 (10.7%), stroke 2 (1.8%), maternal death 5 (4.5%), obstetric haemorrhage 4 (3.6%), prematurity 50 (44.5%) and perinatal death 6 (5.4%). Shunts were associated with prematurity (adjusted odds ratio 4; 95% CI: 1.5-10, pâ¯=â¯0.006). Peripartum cardiomyopathy represented higher risk of pulmonary edema (adjusted OR 34; 95% CI: 6-194, pâ¯=â¯0.001) and heart failure (adjusted OR 16; 95% CI: 3-84, pâ¯=â¯0.001). An increased risk of obstetric haemorrhage was observed in patients with prosthetic valves (adjusted OR 30; 95% CI: 1.5-616, pâ¯=â¯0.025) and with the use of acetylsalicylic acid (adjusted OR 14; 95% CI: 1.2-16, pâ¯=â¯0.030). Furthermore, the latter was associated with perinatal death (adjusted OR 9; 95% CI: 1.4-68, pâ¯=â¯0.021). CONCLUSIONS: severe complications were found during pregnancy and postpartum in patients with heart disease, which is why preconception evaluation and close surveillance are vital.
TITLE: Reducción de los niveles plasmáticos de CGRP en pacientes con migraña tratados con erenumab o galcanezumab.
Antibodies, Monoclonal, Humanized , Calcitonin Gene-Related Peptide , Migraine Disorders , Humans , Antibodies, Monoclonal, Humanized/therapeutic use , Migraine Disorders/drug therapy , Migraine Disorders/blood , Female , Male , Calcitonin Gene-Related Peptide Receptor Antagonists/therapeutic use , Adult , Middle Aged , Antibodies, Monoclonal/therapeutic use
PURPOSE: It is unclear whether preoperative serum uric acid (SUA) elevation may play a role in the development of acute kidney injury (AKI) associated with cardiac surgery (CSA-AKI). We conducted a cohort study to evaluate the influence of preoperative hyperuricemia on AKI in patients at high risk for developing SC-AKI. DESIGN: Multicenter prospective international cohort study. SETTING: Fourteen university hospitals in Spain and the United Kingdom. PARTICIPANTS: We studied 261 consecutive patients at high risk of developing CSA-AKI, according to a Cleveland scoreâ¯≥â¯4 points, from July to December 2017. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: AKIN criteria were used for the definition of AKI. Multivariable logistic regression models and propensity score-matched pairwise analysis were used to determine the adjusted association between preoperative hyperuricemia (≥7â¯mg/dL) and AKI. Elevated preoperative AUS (≥7â¯mg/dL) was present in 190 patients (72.8%), whereas CSA-AKI occurred in 145 patients (55.5%). In multivariable logistic regression models, hyperuricemia was not associated with a significantly increased risk of AKI (adjusted Odds Ratio [OR]: 1.58; 95% confidence interval [CI]: 0.81-3; Pâ¯=â¯.17). In propensity score-matched analysis of 140 patients, the hyperuricemia group experienced similar adjusted odds of AKI (OR 1.05, 95%CI 0.93-1.19, Pâ¯=â¯.37). CONCLUSIONS: Hyperuricemia was not associated with an increased risk of AKI in this cohort of patients undergoing cardiac surgery at high risk of developing CSA-AKI.
La degeneración macular asociada a la edad (DMAE) constituye una de las principales causas de la pérdida de agudeza visual (AV) en los mayores de 50 años en el mundo, siendo la DMAE neovascular (DMAEn) la causante del 80% de los casos de pérdida de visión severa debido a esta enfermedad. Hace ya más de una década que se emplean los fármacos antifactor de crecimiento del endotelio vascular (anti-VEGF) para el tratamiento de esta enfermedad, cambiando drásticamente el pronóstico visual de estos pacientes. Sin embargo, los primeros estudios de los que se disponían datos de los resultados eran a corto plazo. En la actualidad existen ya diferentes series publicadas de los resultados de la DMAE a largo plazo tras el tratamiento con anti-VEGF, siendo el objetivo de la presente revisión sintetizar dichos resultados. El seguimiento medio de los estudios incluidos fue de 8,2 años (rango: 5-12 años). La AV inicial media fue 55,3 letras del Early Treatment Diabetic Retinopathy Study (ETDRS) (rango: 45,6-65) siendo la AV final media 50,1 letras (rango: 33,0-64,3), existiendo una pérdida media de 5,2 letras. Al final del seguimiento un 29,4% de los pacientes mantuvieron una AV>70 letras. El 67,9% de los pacientes se mantuvo estable al final del seguimiento (<15 letras de pérdida), existiendo una pérdida severa (≥15 letras) del 30,1%. La fibrosis y la atrofia fueron las principales causas de pérdida de AV a largo plazo, presentándose al final del seguimiento en un 52,5% y un 60,5%, respectivamente.(AU)
Age-related macular degeneration (AMD) is one of the main causes of visual acuity (VA) loss in people over 50 years of age worldwide, with neovascular AMD (nAMD) accounting for 80% of cases of severe vision loss due to this disease. Anti-vascular endothelial growth factor (anti-VEGF) drugs have been used for the treatment of this disease for more than a decade, changing drastically the visual prognosis of these patients. However, initial studies reporting data on outcomes were short term. Currently, there are different series published on the long-term results of AMD after treatment with anti-VEGF, and the aim of this review is to synthesize these results. The mean follow-up of the included studies was 8.2 years (range 5-12 years). The mean initial VA was 55.3 letters in the Early Treatment Diabetic Retinopathy Study (ETDRS) (range 45.6-65) and the mean final VA was 50.1 letters (range 33.0-64.3), with a mean loss of 5.2 letters. At the end of follow-up, 29.4% of the patients maintained a VA>70 letters. The 67.9% of patients remained stable at the end of follow-up (<15 letter loss), with a severe loss (≥15 letters) of 30.1%. Fibrosis and atrophy were the main causes of long-term VA loss, occurring at the end of follow-up in 52.5% and 60.5%, respectively.(AU)
Humans , Male , Female , Child , Macular Degeneration , Angiogenesis Inhibitors , Prognosis , Epiretinal Membrane , Ophthalmology , Eye Diseases
Chronic pain and functional limitations caused by coxarthrosis are important factors in the onset of depression, as there are higher rates of depression in this group of patients than in the general population. Total hip arthroplasty (THA) has been shown to decrease pain and improve function in these patients, which may positively influence the patient's depressive symptoms. The objectives of the study are to evaluate the differences between patients with depression and patients without depression in the immediate postoperative period (pain and hospitalization time) and to evaluate functional outcomes one year after surgery. Therefore, we conducted a prospective cohort study in which all patients with indications for primary total hip arthroplasty during 2018 were included. Preoperatively, patients completed the PHQ-9 questionnaire, and were classified into patients with depression (if preoperative PHQ-9 > or = to 10) and patients without depression (pre PHQ-9 < to 10). During the hospital stay, postoperative pain was assessed by VAS, and the need for analgesic rescue with major opioids. One year after surgery, the PHQ-9 test was retaken, and functional outcomes were assessed. The results showed that both groups were comparable in terms of sex, age, BMI, and ASA. No differences were found in postoperative pain or hospitalization time. There were also no differences between the two groups of patients in functional outcomes one year after surgery. Therefore, we can conclude that patients with a diagnosis of depression do not present worse postoperative pain after THA. In addition, they show a significant improvement in their depressive symptoms one year after surgery.
Arthroplasty, Replacement, Hip , Depression , Pain, Postoperative , Humans , Arthroplasty, Replacement, Hip/adverse effects , Female , Male , Prospective Studies , Depression/etiology , Pain, Postoperative/psychology , Pain, Postoperative/etiology , Aged , Middle Aged , Pain Measurement , Osteoarthritis, Hip/surgery , Length of Stay , Surveys and Questionnaires
Chile, the world's leading copper producer, generates significant volumes of mining waters, some of which cannot be recirculated into the production process. These mining waters are characterized by elevated sulfate (SO42-) concentrations, requiring sustainable management strategies for potential reuse. This study aims to evaluate the rhizofiltration technique using Carpobrotus chilensis for treating mining waters with a high SO42- concentration. Initially, the mining waters exhibited a pH of 7.97 ± 0.16 and a SO42- concentration of 2,743 ± 137 mg L-1, while the control water had a pH of 7.88 ± 0.08 and a SO42- concentration of 775 ± 19.0 mg L-1. The plants were hydroponically cultivated in 40 L containers with mining waters and drinking water as a control. Over an 8-week period, the pH of the mining water decreased to 3.12 ± 0.01, and the SO42- concentration declined to 2,200 ± 110 mg L-1. Notably, the fresh weight of roots was significantly higher in plants grown in mining water (22.2 ± 6.66 g) compared to those in the control treatment (14.3 ± 4.28 g). However, an undesirable increase in the acidity was observed in the mining waters after rhizofiltration, which was attributed to hydrogen sulfate (HSO4-) and/or root exudates. Despite the unexpected increase in acidity, C. chilensis effectively reduced the concentration of SO42- in mining waters by 20%. Additionally, the C. chilensis roots accumulated 4.84 ± 1.40% of sulfur (S), a level comparable to thiophore plants. This study provides evidence that this non-aquatic plant can be used in sulfate rhizofiltration.
Caprobrotus chilensis is a good candidate for sulfate rhizolfiltration in mining waters.The accumulation of sulfur by the roots of Carpobrotus chilensis reached 4.84%Mining waters with a high concentration of sulfates require control of the redox potential.
PURPOSE: To analyze if, after implementation of an evidence-based local multidisciplinary protocol for acute cholecystitis (AC), an intermediate surgical audit could improve early cholecystectomy (EC) rate and other therapeutic indicators. METHODS: Longitudinal cohort study at a tertiary center. The local protocol, promoted, created, and periodically revised by the Acute Care Surgery Unit (ACSu) was updated and approved on March 2019. A specific registry was prospectively fulfilled with demographics, comorbidity, type of presentation, diagnostic items, therapeutic decision, and clinical course, considering both non-operative management (NOM) or cholecystectomy, early and delayed (EC and DC). Phase 1: April 2019-April 2021. A critical analysis and a surgical audit with the participation of all the involved Departments were then performed, especially focusing on improving global EC rate, considered primary outcome. Phase 2: May 2021-May 2023. Software SPSS 23.0 was used to compare data between phases. RESULTS: Initial EC rate was significantly higher on Phase 2 (39.3%vs52.5%, p < 0.004), as a significantly inferior rate of patients were initially bailed out from EC to NOM because of comorbidity (14.4%vs8%, p < 0.02) and grade II with severe inflammatory signs (7%vs3%, p < 0.04). A higher percentage of patients was recovered for EC after an initial decision of NOM on Phase 2, but without reaching statistical significance (21.8%vs29.2%, n.s.). Global EC rate significantly increased between phases (52.5%vs66.3%, p < 0.002) without increasing morbidity and mortality. A significant minor percentage of elective cholecystectomies after AC episodes had to be performed on Phase 2 (14%vs6.7%, p < 0.009). Complex EC and those indicated after readmission or NOM failure were usually performed by the ACSu staff. CONCLUSION: To adequately follow up the implementation of a local protocol for AC healthcare, registering and periodically analyzing data allow to perform intermediate surgical audits, useful to improve therapeutic indicators, especially EC rate. AC constitutes an ideal model to work with an ACSu.
Acute Care Surgery , Cholecystitis, Acute , Humans , Longitudinal Studies , Cholecystectomy , Registries
Introducción El tratamiento de los pacientes con cáncer de próstata (CaP) está establecido en las guías de práctica clínica, las cuales se basan en estudios aleatorizados según el nivel de evidencia. En España se desconoce el grado de cumplimiento de estas guías en la práctica clínica. Objetivos Describir los perfiles de los pacientes con CaP en el momento del diagnóstico y el manejo de los pacientes con CaP localizado y con recurrencia bioquímica (RBQ) en España. Materiales y métodos Se realizó una encuesta médica en 3 especialidades médicas (85 urólogos [URO], 64 oncólogos radioterápicos [OR] y 21 oncólogos médicos [OM]). Para este estudio se elaboraron 3 cuestionarios, 2 con 22 preguntas (URO y OR) y uno con 21 preguntas (OM). Resultados La incidencia anual de CaP en los hospitales participantes (N=131) fue de 24.057 casos. La incidencia anual extrapolada a España fue de 40.531 casos. La prevalencia estimada de CaP en España es de 221.689. Cabe destacar que el 79 y el 80% de los pacientes atendidos por URO y OR, respectivamente, presentaban CaP localizado en el momento del diagnóstico. La biopsia fue la prueba diagnóstica más utilizada en las 3 especialidades, seguida de la tomografía computarizada abdominopélvica. Más del 90% de los pacientes con RBQ se sometieron a pruebas estándar. Las técnicas de imagen de nueva generación y la PET con colina/PSMA se siguen utilizando en menor medida. Actualmente, la mayoría de los pacientes con CaP localizado reciben tratamiento con cirugía o radioterapia, pero en el caso de los pacientes con RBQ, los URO y OR prefieren la radioterapia y los OM la terapia de privación androgénica exclusiva o combinada. Conclusión Este estudio describe los perfiles de los pacientes en el momento del diagnóstico y proporciona una visión general del manejo terapéutico actual del CaP localizado y con RBQ en la práctica clínica en España. (AU)
Introduction The management of patients with prostate cancer (PCa) is established in clinical practice guidelines, which are based on randomized studies according to the level of evidence. In Spain, the degree of compliance with these guidelines in clinical practice is unknown. Objectives To describe the profiles of PCa patients at the time of diagnosis and the management of patients with localized PCa and those with biochemical recurrence (BCR) in Spain. Materials and methods A medical survey was conducted in specialized care (85 urologists [UROs], 64 radiation oncologists [ROs], and 21 medical oncologists [MOs]). Three questionnaires were developed for this study with 22 (UROs and ROs) or 21 questions (MOs). Results The annual incidence of PCa was 24,057 in participating hospitals (N=131). The extrapolated annual incidence in Spain is 40,531 cases. The estimated prevalence of PCa in Spain is 221,689. Of note, 79 and 80% of patients seen by UROs and ROs, respectively had localized PCa at diagnosis. Biopsy was the most used diagnostic test among the 3 specialties, followed by abdominopelvic computer tomography. More than 90% of patients with BCR underwent standard tests. Next generation imaging tests and PET-choline/PSMA are still used residually. Most patients with localized PCa are currently treated with either surgery or radiotherapy, while for BCR patients, UROs and ROs prefer radiotherapy and MOs androgen deprivation therapy alone or in combination. Conclusion This study describes patient profiles at the time of diagnosis and provides an overview of the current therapeutic management of localized PCa and BCR in clinical practice in Spain. (AU)
Prostatic Neoplasms , Biochemical Reactions , Surveys and Questionnaires , Spain
El síndrome de linfedema-distiquiasis es uno de los fenotipos más frecuentes de aparición de linfedema primario; aun así, su prevalencia es baja.Este síndrome cursa con la aparición en la infancia o en la pubertad de pestañas aberrantes y otras formas de distiquiasis que pueden disminuir la calidad de vida, especialmente en pacientes en edades tan tempranas. La valoración clínica de este tipo de signos debe hacernos tener en mente este grupo de síndromes, ya que contamos, en este caso, con el diagnóstico de certeza gracias al análisis genético en suero del gen FOXC2, como ocurre en el caso que presentamos.De esta manera podemos prevenir, diagnosticar y tratar tanto los síntomas oftalmológicos como el resto de los síntomas sistémicos de forma precoz y más efectiva, aumentando así la calidad de vida de nuestros pacientes. (AU)
Lymphedema-distichiasis syndrome is one of the most frequent phenotypes of primary lymphedema, even so, its prevalence is still low.This syndrome courses with the appearance of abnormal eyelashes and distichiasis during childhood or puberty. This can cause a notable discomfort on our patients, especially at such an early age. The clinic evaluation of this signs must make us have in mind this group of syndromes, because in the case of lymphedema distichiasis syndrome, we can certainly diagnose it with the genetic analysis of the FOXC2 gen on patient's serum.With this we could prevent, diagnose and treat the ophthalmologic syndrome alongside the rest of systemic symptoms of this syndrome in a more effective way, giving our patients a higher quality of life. (AU)
Humans , Female , Child , Lymphedema , Phenotype , Quality of Life , Ophthalmology
OBJECTIVES: Optimizing rehabilitation strategies for osteoarthritis necessitates a comprehensive understanding of chondrocytes' mechanoresponse in both health and disease, especially in the context of the interplay between loading and key pathways involved in osteoarthritis (OA) development, like canonical Wnt signaling. This study aims to elucidate the role of Wnt signaling in the mechanoresponsiveness of healthy and osteoarthritic human cartilage. METHODS: We used an ex-vivo model involving short-term physiological mechanical loading of human cartilage explants. First, the loading protocol for subsequent experiments was determined. Next, loading was applied to non-OA-explants with or without Wnt activation with CHIR99021. Molecular read-outs of anabolic, pericellular matrix and matrix remodeling markers were used to assess the effect of Wnt on cartilage mechanoresponse. Finally, the same set-up was used to study the effect of loading in cartilage from patients with established OA. RESULTS: Our results confirm that physiological loading maintains expression of anabolic genes in non-OA cartilage, and indicate a deleterious effect of Wnt activation in the chondrocyte mechanoresponsiveness. This suggests that loading-induced regulation of chondrocyte markers occurs downstream of canonical Wnt signaling. Interestingly, our study highlighted contrasting mechanoresponsiveness in the model of Wnt activation and the established OA samples, with established OA cartilage maintaining its mechanoresponsiveness, and mechanical loading rescuing the chondrogenic phenotype. CONCLUSION: This study provides insights into the mechanoresponsiveness of human cartilage in both non-OA and OA conditions. These findings hold the potential to contribute to the development of strategies that optimize the effect of dynamic compression by correcting OA pathological cell signaling.
OBJECTIVE: To determine the prevalence, impact and management of hypertension-mediated organ damage (HMOD) according to the presence of type 2 diabetes (T2DM). METHODS: IBERICAN is an ongoing multicenter, observational and prospective study, including outpatients aged 18-85 years who attended the Primary Care setting in Spain. In this study, the prevalence, impact and management of HMOD according to the presence of T2DM at baseline were analyzed. RESULTS: At baseline, 8066 patients (20.2% T2DM, 28.6% HMOD) were analyzed. Among patients with T2DM, 31.7% had hypertension, 29.8% dyslipidemia and 29.4% obesity and 49.3% had ≥1 HMOD, mainly high pulse pressure (29.6%), albuminuria (16.2%) and moderate renal impairment (13.6%). The presence of T2DM significantly increased the risk of having CV risk factors and HMOD. Among T2DM population, patients with HMOD had more dyslipidemia (78.2% vs 70.5%; P=0.001), hypertension (75.4% vs 66.4%; P=0.001), any CV disease (39.6% vs 16.1%; P=0.001) and received more drugs. Despite the majority of types of glucose-lowering agents were more frequently taken by those patients with HMOD, compared to the total T2DM population, the use of SGLT2 inhibitors and GLP-1 receptor agonists was marginal. CONCLUSIONS: In patients daily attended in primary care setting in Spain, one in five patients had T2DM and nearly half of these patients had HMOD. In patients with T2DM, the presence of HMOD was associated with a higher risk of CV risk factors and CV disease. Despite the very high CV risk, the use of glucose-lowering agents with proven CV benefit was markedly low.
Objetivo Este estudio tiene como objetivo describir la implementación de la metodología estandarizada en la transferencia de información en sala de partos y unidad de cuidados obstétricos intermedios en un hospital de tercer nivel de Barcelona e identificar el impacto de esta implementación en los factores que actúan como facilitadores y barreras en el procedimiento. Método Estudio cuasiexperimental tipo pretest-postest sin grupo control en la unidad de cuidados obstétricos intermedios y sala de partos del servicio de Medicina Maternofetal de un hospital de tercer nivel de Barcelona. El personal sanitario autocumplimentó un cuestionario ad hoc antes y después de implementar la metodología estandarizada IDEAS en el servicio durante 2019 y 2020. Se evaluó la autopercepción personal en el procedimiento de transferencia de información. El test de Wilcoxon por pares se utilizó para la comparación antes y después. Resultados El uso de una metodología estandarizada ha mostrado un impacto en la mejora de la transmisión de la información. Se detectaron diferencias significativas antes y después de la intervención en las siguientes dimensiones: ubicación, personas implicadas, periodo de tiempo del procedimiento, estructurada ordenada y clara y tiempo suficiente para preguntas (p<0,001); mientras que no se observaron diferencias en transmisión al profesional referente, actuaciones bien definidas y realización de un resumen. Conclusiones Existen factores, como aspectos estructurales, organizativos y falta de tiempo, que dificultan la comunicación efectiva, por tanto, actúan como barreras en la transferencia de información. La implementación de una metodología con las personas implicadas, el tiempo y el espacio adecuado permite mejorar aspectos en la comunicación en el equipo multiprofesional y, por tanto, la seguridad del paciente. (AU)
Aim This study aims to describe the implementation of the standard methodology for information transfer in the labour ward and Intermediate Obstetric Care Unit and to identify the impact of this implementation on the factors that act as facilitators and barriers in the procedure. Method Quasi-experimental pretest-posttest study without a control group in an Intermediate Obstetric Care Unit and delivery room of the Maternal-Fetal Medicine Service of a tertiary hospital in Barcelona. Healthcare staff self-completed an ad hoc questionnaire before and after implementing the standardised IDEAS methodology in the service during 2019 and 2020. Personal self-perception in the information transfer procedure was assessed. The Wilcoxon pairwise test was used for comparison before and after. Results The use of a standardised methodology has shown an impact on improving the transmission of information. Significant differences were detected before and after the intervention in the following dimensions: location, people involved, time period of the procedure, structured, orderly and clear, and sufficient time for questions (p<0.001); while no differences were observed in: transmission to the referring professional, well-defined actions, and completion of a summary. Conclusions There are factors such as structural and organisational aspects and lack of time that hinder effective communication and therefore act as barriers to the transfer of information. The implementation of a methodology with the health professionals involved, the time and the appropriate space allows for the improvement of communication aspects in the multiprofessional team and, therefore, patient safety. (AU)
Humans , Interdisciplinary Communication , Teaching Rounds , Patient Safety , Delivery Rooms , Obstetrics and Gynecology Department, Hospital , Non-Randomized Controlled Trials as Topic , Statistics, Nonparametric
La pandemia COVID-19 ha puesto a prueba los sistemas sanitarios a nivel mundial. Las sucesivas ondas epidémicas han mostrado características diferentes. La variante Ómicron del SARS-CoV-2 modificó el comportamiento epidémico que habían seguido las variantes previas. El objetivo de este análisis fue determinar las características epidemiológicas de la COVID-19 durante la 6.ª onda epidémica y sus diferencias según predominara las variantes Delta u Ómicron. Se analizaron los datos epidemiológicos correspondientes a la 6.ª onda epidémica publicados por los organismos oficiales, y se analizaron la incidencia acumulada de infección (IA-I) y las tasas de letalidad (TL), tanto del conjunto de España como de las diferentes Comunidades Autónomas, en el conjunto de la población y por grupos etarios. Los resultados mostraron que la IA-I era mayor con la variante Ómicron (10,89 vs. 0,75% con Delta) mientras que la TL lo era con la variante Delta (4,2 vs. 1,3 con Ómicron), así como una mayor tasa de hospitalización e ingreso en UCI con la variante Delta.(AU)
The COVID-19 pandemic has strained healthcare systems globally. The successive epidemic waves have shown different characteristics. The Omicron variant of SARS-CoV-2 modified the epidemic behavior that previous variants had followed. The aim of this analysis was to determine the epidemiological characteristics of COVID-19 during the sixth epidemic wave and its differences according to the predominance of the Delta or Omicron variants. The epidemiological data corresponding to the sixth wave of the epidemic published by official organizations were analyzed, and the cumulative incidence of infection (CI-I) and case fatality rates (CFR) were calculated, both for Spain as a whole and for the different Autonomous Communities, in the population as a whole and by age groups. The results showed that the CI-I was higher with the Ómicron variant (10.89% vs 0.75% with Delta) while the CFR was higher with the Delta variant (4.2 vs 1.3 with Ómicron), as well as a higher rate of hospitalization and ICU admission with the Delta variant.(AU)
Humans , Male , Female , /drug therapy , /epidemiology , Mortality , Incidence , Epidemiology, Descriptive , Spain
Objetivo Este estudio tiene como objetivo describir la implementación de la metodología estandarizada en la transferencia de información en sala de partos y unidad de cuidados obstétricos intermedios en un hospital de tercer nivel de Barcelona e identificar el impacto de esta implementación en los factores que actúan como facilitadores y barreras en el procedimiento. Método Estudio cuasiexperimental tipo pretest-postest sin grupo control en la unidad de cuidados obstétricos intermedios y sala de partos del servicio de Medicina Maternofetal de un hospital de tercer nivel de Barcelona. El personal sanitario autocumplimentó un cuestionario ad hoc antes y después de implementar la metodología estandarizada IDEAS en el servicio durante 2019 y 2020. Se evaluó la autopercepción personal en el procedimiento de transferencia de información. El test de Wilcoxon por pares se utilizó para la comparación antes y después. Resultados El uso de una metodología estandarizada ha mostrado un impacto en la mejora de la transmisión de la información. Se detectaron diferencias significativas antes y después de la intervención en las siguientes dimensiones: ubicación, personas implicadas, periodo de tiempo del procedimiento, estructurada ordenada y clara y tiempo suficiente para preguntas (p<0,001); mientras que no se observaron diferencias en transmisión al profesional referente, actuaciones bien definidas y realización de un resumen. Conclusiones Existen factores, como aspectos estructurales, organizativos y falta de tiempo, que dificultan la comunicación efectiva, por tanto, actúan como barreras en la transferencia de información. La implementación de una metodología con las personas implicadas, el tiempo y el espacio adecuado permite mejorar aspectos en la comunicación en el equipo multiprofesional y, por tanto, la seguridad del paciente. (AU)
Aim This study aims to describe the implementation of the standard methodology for information transfer in the labour ward and Intermediate Obstetric Care Unit and to identify the impact of this implementation on the factors that act as facilitators and barriers in the procedure. Method Quasi-experimental pretest-posttest study without a control group in an Intermediate Obstetric Care Unit and delivery room of the Maternal-Fetal Medicine Service of a tertiary hospital in Barcelona. Healthcare staff self-completed an ad hoc questionnaire before and after implementing the standardised IDEAS methodology in the service during 2019 and 2020. Personal self-perception in the information transfer procedure was assessed. The Wilcoxon pairwise test was used for comparison before and after. Results The use of a standardised methodology has shown an impact on improving the transmission of information. Significant differences were detected before and after the intervention in the following dimensions: location, people involved, time period of the procedure, structured, orderly and clear, and sufficient time for questions (p<0.001); while no differences were observed in: transmission to the referring professional, well-defined actions, and completion of a summary. Conclusions There are factors such as structural and organisational aspects and lack of time that hinder effective communication and therefore act as barriers to the transfer of information. The implementation of a methodology with the health professionals involved, the time and the appropriate space allows for the improvement of communication aspects in the multiprofessional team and, therefore, patient safety. (AU)
Humans , Interdisciplinary Communication , Teaching Rounds , Patient Safety , Delivery Rooms , Obstetrics and Gynecology Department, Hospital , Non-Randomized Controlled Trials as Topic , Statistics, Nonparametric
This study delves into the intricate interplay between ocean acidification (OA), metal bioaccumulation, and cellular responses using mussels (Mytilus galloprovincialis) as bioindicators. For this purpose, environmentally realistic concentrations of isotopically labelled metals (Cd, Cu, Ag, Ce) were added to investigate whether the OA increase would modify metal bioaccumulation and induce adverse effects at the cellular level. The study reveals that while certain elements like Cd and Ag might remain unaffected by OA, the bioavailability of Cu and Ce could potentially escalate, leading to amplified accumulation in marine organisms. The present findings highlight a significant rise in Ce concentrations within different mussel organs under elevated pCO2 conditions, accompanied by an increased isotopic fractionation of Ce (140/142Ce), suggesting a heightened potential for metal accumulation under OA. The results suggested that OA influenced metal accumulation in the gills of mussels. Conversely, metal accumulation in the digestive gland was unaffected by OA. The exposure to both trace metals and OA affects the biochemical responses of M. galloprovincialis, leading to increased metabolic capacity, changes in energy reserves, and alterations in oxidative stress markers, but the specific effects on other biomarkers (e.g., lipid peroxidation, some enzymatic responses or acetylcholinesterase activity) were not uniform, suggesting complex interactions between the stressors and the biochemical pathways in the mussels.
Mytilus , Trace Elements , Water Pollutants, Chemical , Animals , Trace Elements/toxicity , Trace Elements/metabolism , Cadmium/metabolism , Acetylcholinesterase/metabolism , Hydrogen-Ion Concentration , Ocean Acidification , Seawater , Water Pollutants, Chemical/toxicity , Metals/metabolism , Biomarkers/metabolism
