Usefulness of somatosensory evoked potentials for monitoring the clinical course of patients with chronic inflammatory demyelinating polyradiculoneuropathy.

INTRODUCTION/AIMS: Somatosensory evoked potentials (SSEPs) are described as a supportive tool to diagnose chronic inflammatory demyelinating polyradiculoneuropathy (CIDP); however, there is a lack of studies determining the effectiveness of SSEPs in monitoring the clinical course of individuals with this condition. The aims of this study are to evaluate the utility of SSEPs in monitoring patients with CIDP and to assess their association with clinical outcomes following immunomodulatory therapy. METHODS: This was a single-center retrospective observational study that included patients who met European Federation of Neurological Societies and Peripheral Nerve Society criteria for CIDP between 2018 and 2023. SSEPs were performed at diagnosis and during follow-up after the start of immunomodulatory treatment. Fisher's exact test was employed to assess the association between clinical improvement and SSEP improvement. RESULTS: Eighteen patients were included in the study. Ten patients had a typical CIDP pattern and 11 were male. In 17, SSEPs were abnormal prior to the start of immunomodulatory treatment. In patients who showed clinical improvement with immunomodulatory therapy, we observed that 15/17 had partial or complete improvement in SSEPs. Patients who showed no clinical improvement with first-line treatment exhibited worsening SSEPs. There was a significant association between clinical and SSEPs improvement (p = 0.009). DISCUSSION: We observed a positive association between improvement in SSEPs and clinical improvement in patients with CIDP. Our data suggest that SSEPs may be useful for monitoring the clinical course of patients with CIDP, but additional, larger studies are needed.

Adherence to the Mediterranean diet in first-year university students and its association with lifestyle-related factors: A cross-sectional study / Adherencia a la dieta mediterránea en estudiantes universitarios de primer año y su asociación con factores relacionados con el estilo de vida: un estudio transversal

Introduction: Students’ dietary habits are moving from Mediterranean diet guidelines towards unhealthy eating patterns. The aim of this study was to determine adherence to the Mediterranean diet in a sample of Spanish university students and its association with lifestyle factors. Material and methods: A descriptive cross-sectional study was conducted with 685 university students who completed a self-report questionnaire. The data collected included demographic characteristics, dietary habits, smoking habits, alcohol consumption and physical activity. Mediterranean diet adherence was assessed by measuring the consumption of the foods that compose this type of diet through a score (range 0–10). Adherence to the Mediterranean diet was considered poor, average, or good. Results: The mean adherence score for the Mediterranean diet was 4.9 (1.2) points out of 10. A higher degree of adherence to the Mediterranean diet was observed in physically active students (OR=2.31, 95% CI: 1.05–5.10; p=0.038). Students who performed ≥150min/week of physical activity (OR=0.45, 95% CI: 0.33–0.62; p<0.001) and those over 25 years old (OR=0.44, 95% CI: 0.26–0.73; p=0.002) were less prone to low adherence to the Mediterranean diet than sedentary and younger students. Conclusion: The university students have poor adherence to the Mediterranean diet. The results of the current study indicate that age and physical activity are associated with Mediterranean diet adherence. It is urgent to raise awareness among university students and implement intervention programmes promoting a healthy lifestyle. (AU)

Introducción: Los hábitos alimentarios de los estudiantes universitarios se están alejando de las pautas de la dieta mediterránea hacia patrones de alimentación poco saludables. El objetivo de este estudio fue determinar la adherencia a la dieta mediterránea en una muestra de estudiantes universitarios españoles y su asociación con factores del estilo de vida. Material y métodos: Se realizó un estudio descriptivo transversal con 685 universitarios que cumplimentaron un cuestionario autoinformado. Los datos recogidos incluyeron características demográficas, hábitos alimentarios, hábito tabáquico, consumo de alcohol y actividad física. La adherencia a la dieta mediterránea fue evaluada midiendo el consumo de alimentos que componen este tipo de dieta a través de una escala (rango 0-10). La adherencia a la dieta mediterránea se consideró pobre, media y buena. Resultados: La puntuación media de adherencia a la dieta mediterránea fue de 4,9 (1,2) puntos de 10. Se observó un mayor grado de adherencia a esta dieta en los estudiantes físicamente activos (OR=2,31; IC95%: 1,05-5,10; p=0,038). Los estudiantes que realizaban ≥150min/semana de actividad física (OR=0,45; IC95%: 0,33-0,62; p<0,001) y los mayores de 25 años (OR=0,44; IC95%: 0,26-0,73; p=0,002) fueron menos propensos a una baja adherencia a la dieta mediterránea que los estudiantes sedentarios y los más jóvenes. Conclusión: Los estudiantes universitarios tienen una pobre adherencia a la dieta mediterránea. Los resultados del presente estudio indican que la edad y la actividad física están asociadas con la adherencia a la dieta mediterránea. Es urgente concienciar a los universitarios e implementar programas de intervención que promuevan un estilo de vida saludable. (AU)

The archaeological potential of the northern Luangwa Valley, Zambia: The Luwumbu basin.

The Luangwa Basin, Zambia, which forms part of the Zambezi drainage, is strategically located between the Central African plateau and the East African Rift system. The Luangwa River and major tributaries, such as the Luwumbu River, are perennial water sources supporting essential resources that sustain human communities and a rich and diverse fauna and flora. The archaeological record of Luangwa is relatively unknown, despite early archaeological exploration hinting at its potential. Recent research in the southern Luangwa valley, however, suggests that it preserves a long record of hominin occupation spanning the Early to Late Stone Age. The research described here details fieldwork carried out in northeastern Luangwa, in the Luwumbu Basin, that confirms that a relatively deep package of Quaternary deposits, containing evidence of the Stone Age occupation of the region persists in the upper piedmont zone.

Adherence to the Mediterranean diet in first-year university students and its association with lifestyle-related factors: A cross-sectional study.

INTRODUCTION: Students' dietary habits are moving from Mediterranean diet guidelines towards unhealthy eating patterns. The aim of this study was to determine adherence to the Mediterranean diet in a sample of Spanish university students and its association with lifestyle factors. MATERIAL AND METHODS: A descriptive cross-sectional study was conducted with 685 university students who completed a self-report questionnaire. The data collected included demographic characteristics, dietary habits, smoking habits, alcohol consumption and physical activity. Mediterranean diet adherence was assessed by measuring the consumption of the foods that compose this type of diet through a score (range 0-10). Adherence to the Mediterranean diet was considered poor, average, or good. RESULTS: The mean adherence score for the Mediterranean diet was 4.9 (1.2) points out of 10. A higher degree of adherence to the Mediterranean diet was observed in physically active students (OR=2.31, 95% CI: 1.05-5.10; p=0.038). Students who performed ≥150min/week of physical activity (OR=0.45, 95% CI: 0.33-0.62; p<0.001) and those over 25 years old (OR=0.44, 95% CI: 0.26-0.73; p=0.002) were less prone to low adherence to the Mediterranean diet than sedentary and younger students. CONCLUSION: The university students have poor adherence to the Mediterranean diet. The results of the current study indicate that age and physical activity are associated with Mediterranean diet adherence. It is urgent to raise awareness among university students and implement intervention programmes promoting a healthy lifestyle.

Use of a recombinant positive control in the diagnostic of canine Ehrlichiosis from 16sRNA gen of Ehrlichia canis in Mexico City.

Ehrlichia canis has gained importance over the years as a zoonotic bacterium, nevertheless in Mexico is unknown the extent of the problem in animals and public health. The country had a few studies carried out locally using serology and molecular tests as diagnostic methods. Ehrlichiosis is not considered endemic in the central valley of Mexico, because the climatic conditions in the region have not allowed the vector (Rhipicephalus sanguineus) to establish itself adequately, therefore, diagnosis is not used in clinical practice in this area. A nested PCR (nPCR) offers rapid results with high sensitivity and specificity regardless of cost. The use of a recombinant positive control provides the advantage of timely diagnosis, follow-up treatment and allows the clinician to decide. In this work, the nPCR reported by Wen et al. (J Clin Microbiol 35(7):1852-2185, 1997) was used for the diagnosis of E. canis by modifying the reaction conditions to improve the detection of the test. We constructed a recombinant positive control to nPCR as diagnostic technique for E. canis, also we modified the reaction conditions to improve detection of the test which allowed the diagnosis of E. canis in dogs in the Mexican Republic using 53 samples from dogs with positive serological diagnosis of Ehrlichiosis, some of them from the valley of Mexico. Currently, this nPCR is offered to public at the Faculty of Veterinary Medicine and Zootechnics of the National Autonomous University of Mexico at an accessible cost and allows to begin to generate epidemiological information to know distribution of the bacterium.

Fragilidad, polifarmacia y riesgo de caídas en personas adultas mayores / Fragility, polypharmacy and risk of falls in older adults

Objetivo: Analizar la relación de fragilidad, polifarmacia y riesgo de caídas en las personas adultas mayores. Metodología: El diseño de estudio fue descriptivo, correlacional y transversal, conformado por 261 personas adultas mayores de Saltillo, Coahuila (México). Se utilizó una cédula de datos personales y prevalencia de polifarmacia, escala Frail y escala de Tinetti. Los datos se analizaron a través de SPSS versión 25 para Windows, se utilizaron frecuencias y porcentajes, medidas de tendencia central y dispersión. Resultados: El 19,2% de los participantes fueron frágiles, el 44,1% de las personas adultas mayores presentaron polifarmacia y el 37,5% reportó un alto riesgo de caídas. La fragilidad se correlacionó positiva y significativamente con la polifarmacia (rs = 0,274; p < 0,01) y el riesgo de caídas se correlacionó negativa y significativamente con fragilidad (rs = -0,333; p < 0,01). Conclusiones: Existe una relación entre la fragilidad y el riesgo de caídas en las personas adultas mayores, la polifarmacia no tuvo relación con el riesgo de las caídas (AU)

Objective: Analyze the relationship of frailty, polypharmacy and risk of falls in older adults. Methodology: The study design was descriptive, correlational and cross-sectional, made up of 261 older adults from Saltillo, Coahuila. A personal data card and the prevalence of polypharmacy, the Frail scale and the Tinetti scale were used. The data was analyzed through SPSS version 25 for Windows, frequencies and percentages, measures of central tendency and dispersion were used. Results: The 19.2% of participants were frail, 44.1% of older adults had polypharmacy, and 37.5% reported a high risk of falls. Frailty was positively and significantly correlated with polypharmacy (rs = 0.274; p < 0.01) and risk of falls was negatively and significantly correlated with frailty (rs = -0.333; p < 0.01). Conclusions: There is a relationship between frailty and the risk of falls in older adults, polypharmacy was not related to the risk of falls (AU)

Floristic evidence for alternative biome states in tropical Africa.

The idea that tropical forest and savanna are alternative states is crucial to how we manage these biomes and predict their future under global change. Large-scale empirical evidence for alternative stable states is limited, however, and comes mostly from the multimodal distribution of structural aspects of vegetation. These approaches have been criticized, as structure alone cannot separate out wetter savannas from drier forests for example, and there are also technical challenges to mapping vegetation structure in unbiased ways. Here, we develop an alternative approach to delimit the climatic envelope of the two biomes in Africa using tree species lists gathered for a large number of forest and savanna sites distributed across the continent. Our analyses confirm extensive climatic overlap of forest and savanna, supporting the alternative stable states hypothesis for Africa, and this result is corroborated by paleoecological evidence. Further, we find the two biomes to have highly divergent tree species compositions and to represent alternative compositional states. This allowed us to classify tree species as forest vs. savanna specialists, with some generalist species that span both biomes. In conjunction with georeferenced herbarium records, we mapped the forest and savanna distributions across Africa and quantified their environmental limits, which are primarily related to precipitation and seasonality, with a secondary contribution of fire. These results are important for the ongoing efforts to restore African ecosystems, which depend on accurate biome maps to set appropriate targets for the restored states but also provide empirical evidence for broad-scale bistability.

Factores relacionados con una respuesta inmediata a los síntomas en pacientes con ictus o accidente isquémico transitorio / Factors related to immediate response to symptoms in patients with stroke or transient ischaemic attack

INTRODUCCIÓN: Pese a los recientes avances en el manejo agudo del ictus, se aplican terapias de reperfusión a menos de un 10% de los pacientes. Una de las causas es el retraso en la búsqueda de atención médica por el paciente y sus familiares, que analizaremos a continuación. MÉTODOS: Se realizó un estudio observacional, prospectivo, en pacientes consecutivos con ictus o accidente isquémico transitorio. Se recogieron parámetros sociodemográficos y clínicos, y datos sobre el retraso en la decisión, retraso prehospitalario y el tipo de contacto médico seleccionado. Se realizaron análisis descriptivo, bivariante y multivariante para determinar los factores relacionados con la búsqueda de atención médica en los primeros 15minutos. RESULTADOS: Se recogieron 382 pacientes. Un 24,9% decidió solicitar atención médica en los primeros 15 minutos. Lo favorecieron la severidad del evento (OR: 1,08; IC 95%: 1,04-1,13; p < 0,001), estar acompañado de un hijo (OR: 3,44; IC 95%: 1,88-6,27; p < 0,001) y el tratamiento con insulina (OR: 2,89; IC 95%: 1,35-6,20; p = 0,006). Los infartos lacunares (OR: 0,41; IC 95%: 0,17-0,97; p = 0,042), los infartos parciales de circulación anterior (OR: 0,43; IC 95%: 0,22-0,85; p = 0,015) y los cuadros monosintomáticos sin afasia o paresia de miembros (OR: 0,15; IC 95%: 0,033-0,724; p = 0,018) se relacionaron con retrasos mayores de 15 minutos. CONCLUSIONES: La severidad y estar acompañado de un hijo fueron los principales determinantes de una reacción inmediata. Futuras intervenciones deben promocionar una consulta inmediata independientemente de la severidad, así como incidir en un mayor abanico de síntomas

INTRODUCTION: Despite recent advances in the management of acute stroke, fewer than 10% of patients receive reperfusion therapy. One of the main reasons for such a low rate of administration is the delay on the part of patients and their families in seeking medical attention. This study aimed to analyse this delay. METHODS: A prospective observational study was conducted on consecutive stroke or transient ischaemic attack. Data on sociodemographic and clinical parameters, decision delay, pre-hospital delay, and first medical contact were collected. Descriptive, bivariate, and multivariate logistic regression analyses were performed to determine factors associated with seeking medical attention within the first 15minutes of stroke or TIA occurrence. RESULTS: A total of 382 patients were included, 24.9% of whom had a decision delay of 15 minutes or less. Stroke severity (OR 1.08; 95% CI, 1.04-1.13; P < .001), patient's son/daughter witnessing the event (OR 3.44; 95% CI, 1.88-6.27; P < .001), and insulin treatment (OR 2.89; 95% CI, 1.35-6.20; P = .006) were related to an immediate reaction. Lacunar infarcts (OR 0.41; 95% CI, 0.17-0.97; P=.042), partial anterior circulation infarcts (OR 0.43; 95% CI, 0.22-0.85; P = .015), and monosymptomatic events not involving limb paresis or aphasia (OR 0.15; 95% CI, 0.033-0.724; P = .018) favoured delays longer than 15 minutes. CONCLUSIONS: Severity of the event and presence of a son/daughter are the factors most frequently associated with an immediate response to stroke. Future interventions should emphasise the need for an immediate response irrespective of severity and include a wider spectrum of symptoms

Data preprocessing for heart disease classification: A systematic literature review.

CONTEXT: Early detection of heart disease is an important challenge since 17.3 million people yearly lose their lives due to heart diseases. Besides, any error in diagnosis of cardiac disease can be dangerous and risks an individual's life. Accurate diagnosis is therefore critical in cardiology. Data Mining (DM) classification techniques have been used to diagnosis heart diseases but still limited by some challenges of data quality such as inconsistencies, noise, missing data, outliers, high dimensionality and imbalanced data. Data preprocessing (DP) techniques were therefore used to prepare data with the goal of improving the performance of heart disease DM based prediction systems. OBJECTIVE: The purpose of this study is to review and summarize the current evidence on the use of preprocessing techniques in heart disease classification as regards: (1) the DP tasks and techniques most frequently used, (2) the impact of DP tasks and techniques on the performance of classification in cardiology, (3) the overall performance of classifiers when using DP techniques, and (4) comparisons of different combinations classifier-preprocessing in terms of accuracy rate. METHOD: A systematic literature review is carried out, by identifying and analyzing empirical studies on the application of data preprocessing in heart disease classification published in the period between January 2000 and June 2019. A total of 49 studies were therefore selected and analyzed according to the aforementioned criteria. RESULTS: The review results show that data reduction is the most used preprocessing task in cardiology, followed by data cleaning. In general, preprocessing either maintained or improved the performance of heart disease classifiers. Some combinations such as (ANN + PCA), (ANN + CHI) and (SVM + PCA) are promising terms of accuracy. However the deployment of these models in real-world diagnosis decision support systems is subject to several risks and limitations due to the lack of interpretation.

Factors related to immediate response to symptoms in patients with stroke or transient ischaemic attack. / Factores relacionados con una respuesta inmediata a los síntomas en pacientes con ictus o accidente isquémico transitorio.

INTRODUCTION: Despite recent advances in the management of acute stroke, fewer than 10% of patients receive reperfusion therapy. One of the main reasons for such a low rate of administration is the delay on the part of patients and their families in seeking medical attention. This study aimed to analyse this delay. METHODS: A prospective observational study was conducted on consecutive stroke or transient ischaemic attack. Data on sociodemographic and clinical parameters, decision delay, pre-hospital delay, and first medical contact were collected. Descriptive, bivariate, and multivariate logistic regression analyses were performed to determine factors associated with seeking medical attention within the first 15minutes of stroke or TIA occurrence. RESULTS: A total of 382 patients were included, 24.9% of whom had a decision delay of 15minutes or less. Stroke severity (OR 1.08; 95% CI, 1.04-1.13; P<.001), patient's son/daughter witnessing the event (OR 3.44; 95% CI, 1.88-6.27; P<.001), and insulin treatment (OR 2.89; 95% CI, 1.35-6.20; P=.006) were related to an immediate reaction. Lacunar infarcts (OR 0.41; 95% CI, 0.17-0.97; P=.042), partial anterior circulation infarcts (OR 0.43; 95% CI, 0.22-0.85; P=.015), and monosymptomatic events not involving limb paresis or aphasia (OR 0.15; 95% CI, 0.033-0.724; P=.018) favoured delays longer than 15minutes. CONCLUSIONS: Severity of the event and presence of a son/daughter are the factors most frequently associated with an immediate response to stroke. Future interventions should emphasise the need for an immediate response irrespective of severity and include a wider spectrum of symptoms.

Control de la presión arterial en pacientes con fibrilación auricular tratados con acenocumarol e índice de Rosendaal alterado / Control of blood pressure in patients with atrial fibrillation treated with acenocoumarol and with an altered Rosendaal index

No disponible

Radix entomolaris: reporte de caso / Radix entomolaris: report of a case

Una de las variaciones anatómicas que pueden presentar los molares inferiores es una tercera raíz que ha sido denominada radix entomolaris o paramolaris dependiendo de su localización, ya sea lingual o vestibular respectivamente. Conocer las variaciones morfológicas de las piezas dentarias es un requisito fundamental para el éxito del tratamiento endodóntico. El objetivo de este artículo es la presentación de un caso clínico de una paciente con ambos primeros molares inferiores con presencia de radix entomolaris; en la pieza dentaria 4.6 se realizó tratamiento endodóntico y en 3.6 con una lesión endoperiodontal combinada verdadera se decidió su exodoncia (AU)

A Systematic Mapping Study of Data Preparation in Heart Disease Knowledge Discovery.

The increasing amount of data produced by various biomedical and healthcare systems has led to a need for methodologies related to knowledge data discovery. Data mining (DM) offers a set of powerful techniques that allow the identification and extraction of relevant information from medical datasets, thus enabling doctors and patients to greatly benefit from DM, particularly in the case of diseases with high mortality and morbidity rates, such as heart disease (HD). Nonetheless, the use of raw medical data implies several challenges, such as missing data, noise, redundancy and high dimensionality, which make the extraction of useful and relevant information difficult and challenging. Intensive research has, therefore, recently begun in order to prepare raw healthcare data before knowledge extraction. In any knowledge data discovery (KDD) process, data preparation is the step prior to DM that deals with data imperfectness in order to improve its quality so as to satisfy the requirements and improve the performances of DM techniques. The objective of this paper is to perform a systematic mapping study (SMS) on data preparation for KDD in cardiology so as to provide an overview of the quantity and type of research carried out in this respect. The SMS consisted of a set of 58 selected papers published in the period January 2000 and December 2017. The selected studies were analyzed according to six criteria: year and channel of publication, preparation task, medical task, DM objective, research type and empirical type. The results show that a high amount of data preparation research was carried out in order to improve the performance of DM-based decision support systems in cardiology. Researchers were mainly interested in the data reduction preparation task and particularly in feature selection. Moreover, the majority of the selected studies focused on classification for the diagnosis of HD. Two main research types were identified in the selected studies: solution proposal and evaluation research, and the most frequently used empirical type was that of historical-based evaluation.

Extrusión: una alternativa de tratamiento de la fractura corono-radicular / Extrusion: an alternative for the treatment of crown-root fracture

La extrusión dentaria o erupción forzada es una opción de tratamiento con enormes ventajas cuando nos vemos obligados a tratar fracturas corono-radiculares. Se define como el movimiento en dirección coronal a través de la aplicación de fuerzas ligeras y continuas para provocar cambios en los tejidos blandos y hueso. La extrusión dental forzada amplía las alternativas en cuanto a la rehabilitación futura del paciente, ya que se puede optar por la restauración periférica total con anclaje del resto radicular, o bien por la exodoncia posterior a la extrusión, con la consecuente mejoría de las condiciones del tejido óseo para una posterior rehabilitación implanto-asistida. Presentación de caso clínico, pieza dentaria 2.2 con fractura corono-radicular en la cual se realizó tratamiento de erupción forzada y rehabilitación protésica (AU)

Extrusion or forced eruption es a treatment option with enormous advantages when we are forced to treat crown-root fractures. It is defined as the movement in the coronal direction through the application of light and continuous forces to cause changes in the soft tissues and bone. Forced dental extrusion expands the alternatives regarding the future rehabilitation of the patient, since it is possible to choose either total peripheral restoration with anchoring of the radicular rest of the post-extrusion extraction, with the consequent improvement of bone tissue conditions for subsequent implant-assissted rehabilitation. Presentation of a case report: tooth 2.2 with a crown-root fracture in which forced eruption and prosthetic rehabilitation were performed (AU)

A systematic map of medical data preprocessing in knowledge discovery.

BACKGROUND AND OBJECTIVE: Datamining (DM) has, over the last decade, received increased attention in the medical domain and has been widely used to analyze medical datasets in order to extract useful knowledge and previously unknown patterns. However, historical medical data can often comprise inconsistent, noisy, imbalanced, missing and high dimensional data. These challenges lead to a serious bias in predictive modeling and reduce the performance of DM techniques. Data preprocessing is, therefore, an essential step in knowledge discovery as regards improving the quality of data and making it appropriate and suitable for DM techniques. The objective of this paper is to review the use of preprocessing techniques in clinical datasets. METHODS: We performed a systematic map of studies regarding the application of data preprocessing to healthcare and published between January 2000 and December 2017. A search string was determined on the basis of the mapping questions and the PICO categories. The search string was then applied in digital databases covering the fields of computer science and medical informatics in order to identify relevant studies. The studies were initially selected by reading their titles, abstracts and keywords. Those that were selected at that stage were then reviewed using a set of inclusion and exclusion criteria in order to eliminate any that were not relevant. This process resulted in 126 primary studies. RESULTS: Selected studies were analyzed and classified according to their publication years and channels, research type, empirical type and contribution type. The findings of this mapping study revealed that researchers have paid a considerable amount of attention to preprocessing in medical DM in last decade. A significant number of the selected studies used data reduction and cleaning preprocessing tasks. Moreover, the disciplines in which preprocessing have received most attention are: cardiology, endocrinology and oncology. CONCLUSIONS: Researchers should develop and implement standards for an effective integration of multiple medical data types. Moreover, we identified the need to perform literature reviews.

Tyrosine kinase inhibitors in iodine-refractory differentiated thyroid cancer: experience in clinical practice.

PURPOSE: The aim of this study is to describe our clinical experience with tyrosine kinase inhibitors (TKIs) and to evaluate their efficacy and tolerability in patients with iodine-refractory differentiated thyroid cancer (DTC). METHODS: There were 17 patients (47.1% women, mean age: 65.7) with DTC iodine-refractory (9 papillary, 2 follicular and 3 Hürthle cell), treated with TKIs: 16 with sorafenib and 1 with lenvatinib as first-line treatment; 7 required second-line treatment (4 lenvatinib and 3 axitinib). Primary endpoints were progression-free survival (PFS) and radiographic response (determinate at 3, 6, 12, 18, and 24 months after the initiation of treatment) and second endpoints were determining differences in baseline characteristics depending on clinical course and describing toxicities and tolerability. RESULTS: Median PFS was 18 months. During the first 24 months of treatment with TKIs PR rate was 35.3% (only 5.8% ≥ 6 months) and SD ≥ 6 months was observed in 58.8%. There were no significant differences in baseline characteristics between patients with good and poor evolution. Adverse events (AEs) were present in 100% of patients, but most of them were grade 1 and 2. CONCLUSIONS: In our population of patients with iodine-refractory DTC, treatment with sorafenib, lenvatinib, and axitinib allows the stabilization of the disease in a high percentage of cases, with acceptable tolerability.

Most advisable strategy in search of asymptomatic target organ damage in hypertensive patients / Estrategia óptima de búsqueda de daño de órgano diana asintomático en el hipertenso

Objective: To evaluate the diagnostic potential of seven examinations in order to define the most suitable strategy for target organ damage (TOD) search in hypertensive patients. Methods: This is a descriptive, cross-sectional study. 153 consecutive treated and essential hypertensive patients were enrolled. Patients with established cardiovascular or chronic renal disease (stage ≥ 4) were excluded. TOD search was assessed by: glomerular filtration rate (GFR), albumin/creatinine ratio (ACR), electrocardiogram (ECG), echocardiogram (ECO), ankle-brachial index (ABI), pulse wave velocity (PWV), and carotid ultrasound (intima media thickness and presence of plaques). The rationale of our strategy ought to determine the performance of applying a set of the most widely available tests (GFR, ACR, ABI, ECG) and advise about the optimal sequence of the remaining tests. Results: The sample was 64.4 ± 7.9 years old, 45.8% males. 82.6% of the sample had any TOD at all. The resulting algorithm found a 37% TOD in relation to GFR, ACR, ABI and ECG values. Adding carotid ultrasound added up to 70% of the studied population and properly classified (TOD+/TOD−) 89% of the cohort. When performing PWV, 78% of the patients had been identified as TOD+ and 96% of the population was correctly identified. Contribution of ECO was minor. Conclusion: After running the more widely available explorations (GFR, ACR, ABI, ECG), a step-by-step strategy that included carotid ultrasound, PWV and ECO could be the best sequence for TOD search in asymptomatic hypertensive patientsien

Objetivo: Evaluar el rendimiento diagnóstico de un panel de siete pruebas de determinación de daño de órgano diana (DOD) aplicadas de forma sistemática, a fin de sugerir la estrategia óptima para la búsqueda de DOD en el hipertenso. Método: Estudio descriptivo y transversal. Se incluyeron 153 pacientes diagnosticados de hipertensión esencial bajo tratamiento farmacológico. Se excluyeron pacientes con enfermedad cardiovascular establecida o enfermedad renal crónica estadio ≥4. Se realizó una búsqueda de DOD mediante filtrado glomerular estimado (FGe), índice albúmina creatinina (IAC), hipertrofia ventricular por electrocardiograma (ECG) y ecocardiograma (ECO), índice tobillo brazo (ITB), velocidad de la onda de pulso (VOP) y ecografía carotídea (placas y grosor íntima media). Se propuso una estrategia de búsqueda de DOD en la que tras la realización de las exploraciones más accesibles (FGe, IAC, ITB y ECG) se sugiere la secuencia de exploraciones a realizar con mayor eficacia diagnóstica. Resultados: La edad media fue 64.4 ± 7.9 años, siendo el 45.8% varones. El 82.6% presentó algún tipo de DOD. Según el algoritmo propuesto, las pruebas de mayor accesibilidad diagnosticaron un 37% de DOD en la muestra. Tras añadir la ecografía carotídea, se detectó DOD en el 70%, y el 89% de la población fue apropiadamente clasificada en DOD+/DOD−. La realización de VOP incrementó la prevalencia de DOD hasta el 78%, y el 96% de la muestra fue correctamente clasificada. La contribución de la ECO fue menor. Conclusión: Tras la realización de las exploraciones más accesibles (FGe, IAC, ITB y ECG), la realización sistemática de ecografía carotídea, VOP y ECO podría ser la estrategia óptima para la búsqueda de DOD en el hipertenso

Most advisable strategy in search of asymptomatic target organ damage in hypertensive patients.

OBJECTIVE: To evaluate the diagnostic potential of seven examinations in order to define the most suitable strategy for target organ damage (TOD) search in hypertensive patients. METHODS: This is a descriptive, cross-sectional study. 153 consecutive treated and essential hypertensive patients were enrolled. Patients with established cardiovascular or chronic renal disease (stage ≥4) were excluded. TOD search was assessed by: glomerular filtration rate (GFR), albumin/creatinine ratio (ACR), electrocardiogram (ECG), echocardiogram (ECO), ankle-brachial index (ABI), pulse wave velocity (PWV), and carotid ultrasound (intima media thickness and presence of plaques). The rationale of our strategy ought to determine the performance of applying a set of the most widely available tests (GFR, ACR, ABI, ECG) and advise about the optimal sequence of the remaining tests. RESULTS: The sample was 64.4±7.9 years old, 45.8% males. 82.6% of the sample had any TOD at all. The resulting algorithm found a 37% TOD in relation to GFR, ACR, ABI and ECG values. Adding carotid ultrasound added up to 70% of the studied population and properly classified (TOD+/TOD-) 89% of the cohort. When performing PWV, 78% of the patients had been identified as TOD+ and 96% of the population was correctly identified. Contribution of ECO was minor. CONCLUSION: After running the more widely available explorations (GFR, ACR, ABI, ECG), a step-by-step strategy that included carotid ultrasound, PWV and ECO could be the best sequence for TOD search in asymptomatic hypertensive patients.