Guidelines for enhanced recovery after cardiac surgery. Consensus document of Spanish Societies of Anesthesia (SEDAR), Cardiovascular Surgery (SECCE) and Perfusionists (AEP). / Vía clínica de recuperación intensificada en cirugía cardiaca. Documento de consenso de la Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor (SEDAR), la Sociedad Española de Cirugía Cardiovascular y Endovascular (SECCE) y la Asociación Española de Perfusionistas (AEP).

The ERAS guidelines are intended to identify, disseminate and promote the implementation of the best, scientific evidence-based actions to decrease variability in clinical practice. The implementation of these practices in the global clinical process will promote better outcomes and the shortening of hospital and critical care unit stays, thereby resulting in a reduction in costs and in greater efficiency. After completing a systematic review at each of the points of the perioperative process in cardiac surgery, recommendations have been developed based on the best scientific evidence currently available with the consensus of the scientific societies involved.

Mutational Screening of BRCA1/2 Genes as a Predictive Factor for Therapeutic Response in Epithelial Ovarian Cancer: A Consensus Guide from the Spanish Society of Pathology (SEAP-IAP) and the Spanish Society of Human Genetics (AEGH).

Germline/somatic BRCA-mutated ovarian carcinomas (OC) are associated to have better response with platinum-based chemotherapy and long-term prognosis than non-BRCA-associated OCs. In addition, these mutations are predictive factors to response to Poly(ADP-ribose) polymerase (PARP) inhibitors. Different positioning papers have addressed the clinical recommendations for BRCA testing in OC. This consensus guide represents a collection of technical recommendations to address the detection of BRCA1/2 mutations in the molecular diagnostic testing strategy for OC. Under the coordination of Spanish Society of Pathology (SEAP-IAP) and the Spanish Society of Human Genetics (AEGH), these recommendations have been developed by pathologists and geneticists taking into account previously published recommendations and their experience in the molecular characterization of these genes. Since the implementation of BRCA testing as a predictive factor can initiate the workflow by testing germline mutations in the blood or by testing both germline and somatic mutations in tumor tissue, distinctive features of both strategies are discussed. Additionally, the recommendations included in this paper provide some references, quality parameters, and genomic tools aimed to standardize and facilitate the clinical genomic diagnosis of OC.

Long-term results of genital prolapse surgery with polypropylene mesh. / Resultados a largo plazo de la cirugía de prolapsos genitales con mallas de polipropileno.

INTRODUCTION AND OBJECTIVE: The risk of intervention due to urogenital prolapse in a woman's life is 11.1%. Recurrences after classic surgery reach up to 38%. With the aim of improving these results, transvaginal mesh kits are used. The purpose of the study is to describe the results of efficacy and long-term safety of vaginal prolapse surgery with polypropylene mesh, assess subjective symptoms before and after surgery and the level of satisfaction. PATIENTS AND METHODS: A descriptive, retrospective study of 58 women with symptomatic genital prolapses operated with polypropylene mesh between September / 2011-November / 2016. Mean age: 66.53 years, 98.27% menopausal women, 77.59% overweight/obesity, 29.31% with previous gynaecological surgery and 55.17% with combined prolapse. 46 Elevate anterior and 12 posterior were inserted. The mean follow-up period was 34.02 months. The PFDI questionnaire was used pre and post-surgery, as well as the satisfaction questionnaire. RESULTS: Healing rate of 91.38%. Recurrences were associated with a higher BMI and with background of recurrence of previous surgery. Mean length of stay: 2.5 days. 70.69% did not need analgesia at discharge. Clavien-Dindo complications: 1 type I (urinary retention), 5 type II (urinary tract infection) and 1 type IIIa (erosion). De novo stress urinary incontinence occurred in 3.44%, while de novo dyspareunia 14.28%. 89.36% patients improved subjective symptoms, and 95.92% were satisfied. CONCLUSION: This surgery achieves high healing rates, with few complications, improvement of subjective symptoms and high level of satisfaction of the patients.

Biomarkers to predict the onset of biphosphonate-related osteonecrosis of the jaw: A systematic review.

BACKGROUND: The goal of this paper was to identify available biomarkers to predict the onset of biphosphonate-related osteonecrosis of the jaw (BRONJ). MATERIAL AND METHODS: Case-control studies comparing the different concentrations of a series of molecules detected in serum and urine as matrices of BRONJ affected patients vs. non-affected were included. PRISMA guidelines for systematic reviews were used for the present paper. Two reviewers independently screened electronic databases (Medline, Web of science, and The Cochrane Library) and performed hand searches. Risk of bias assessment of selected studies was performed by the Newcastle-Ottawa Scale. This study is registered as PROSPERO CRD42017078149. RESULTS: From a total of 601 identified studies, 7 (4 articles with high methodological quality and 3 with medium) articles were included. They investigate 2623 patients, of whom 91 (3.47%) developed BRONJ. A total of 7 biomarkers were identified and classified into 3 groups: bone turnover, angiogenesis and endocrine markers. Conflicting results were found in relation to most biomarkers. CONCLUSIONS: The present review suggests that no useful markers are currently available to evaluate BRONJ risk. Nevertheless, the present paper indicates that a paradigm shift from bone turnover biomarkers to angiogenesis and endocrine markers could shed light on this search.

Efectividad del parche de capsaicina 8% en el dolor neuropático / Effectiveness of capsaicin 8% patch in neuropathic pain

No disponible

Evaluación propia en mujeres gestantes al respecto de opiniones, hábitos y estado de su salud oral en una población del sur de Galicia / Self-assessment of opinions, habits and oral health status by pregnant women in the south of Galicia, Spain

Se ha constatado en el embarazo la asociación entre problemas de salud oral y complicaciones obstétricas. Por ello, el objetivo principal de este trabajo es evaluar en embarazadas la percepción de salud oral, hábitos y creencias relativas. Se diseñó un cuestionario para obtener información de las embarazadas que acudían a la consulta de Obstetricia del Hospital Comarcal Valdeorras y Odontología de atención primaria del Centro de Salud Valle Inclán (n=96). Se encontró que la percepción propia de muchas gestantes era padecer algún problema en la cavidad oral. Además, se reflejó que las gestantes tenían hábitos relativos a salud oral adecuados; en adición, creían que su embarazo iba a traer implícitamente problemas a su boca. Las gestantes son capaces de comprender la relación entre su salud oral, su salud sistémica y la de su futuro hijo. Se detectaron una serie de hábitos y creencias en las que sería conveniente incidir para reducir problemas sanitarios

An association has been found between oral health problems and obstetric complications during pregnancy. The main aim of this study was to assess the perception by pregnant women on their oral health and related habits and beliefs. A questionnaire was designed in order to obtain information from 96 pregnant women attending the Valdeorras Local Hospital and the primary health dental practice in the Valle Inclan Health Center. It was found that many pregnant women perceived they were suffering from some kind of problem affecting their mouth. It was shown that pregnant women had adequate habits regarding oral health, but they believed that their pregnancy would implicitly cause them to have mouth problems. Pregnant women are able to understand the impact of their oral health on their general well-being and the health of their unborn child. It has been detected that a series of habits and beliefs would ideally need to be acted upon in order to reduce health problems

[Self-assessment of opinions, habits and oral health status by pregnant women in the south of Galicia, Spain]. / Evaluación propia en mujeres gestantes al respecto de opiniones, hábitos y estado de su salud oral en una población del sur de Galicia.

An association has been found between oral health problems and obstetric complications during pregnancy. The main aim of this study was to assess the perception by pregnant women on their oral health and related habits and beliefs. A questionnaire was designed in order to obtain information from 96 pregnant women attending the Valdeorras Local Hospital and the primary health dental practice in the Valle Inclan Health Center. It was found that many pregnant women perceived they were suffering from some kind of problem affecting their mouth. It was shown that pregnant women had adequate habits regarding oral health, but they believed that their pregnancy would implicitly cause them to have mouth problems. Pregnant women are able to understand the impact of their oral health on their general well-being and the health of their unborn child. It has been detected that a series of habits and beliefs would ideally need to be acted upon in order to reduce health problems.

Implicación patogénica de dos nuevas mutaciones en cáncer de mama familiar / Pathogenic implication of two novel mutations in familial breast cancer

Se estima que entre el 5-10% de todos los casos de cáncerde mama (CM) son causados por mutaciones en los genessupresores de tumores BRCA1y BRCA2. El análisis mutacionalcompleto de estos genes ha permitido la identificación demutaciones patogénicas así como variantes de efecto desconocido(VED). Las VED se caracterizan porque su implicaciónpatogénica es confusa, y por lo tanto su importancia clínica esincierta, disminuyendo el valor de los resultados genéticos. Elobjetivo de este estudio ha sido caracterizar la significación clínicade dos nuevas variantes detectadas en un estudio previode 48 familias de la Comunidad Valenciana analizadas en elHospital Universitario La Fe de Valencia (España).Se han realizado análisis genéticos y bioinformáticos y se hanutilizado criterios bioquímicos para establecer si las VED sonpatogénicas. Estos análisis han determinado que la variantec.5025delT es una mutación deletérea y la variante c.8038C>Tafecta a secuencias consenso, requiriéndose estudios complementariospara determinar con precisión su significado

It is estimated that 5% to 10% of all breast cancer (BC)cases are caused by inherited mutations in the tumour suppressorgenes, BRCA1 and BRCA2. Whole gene mutationanalyses of these genes have led to the identification of pathogenicmutations and others variants known as genetic variantsof uncertain significance (USV). The pathogenicity of thesegenetic variants is unclear, and therefore their clinical relevanceis uncertain, diminishing the value of genetic test results. Theaim of the study has been to characterize the clinical significanceof two novel variants detected in a previous study of 48families from the Valencian Community analyzed in the UniversityHospital La Fe of Valencia (Spain). A range of genetic andbioinformatics analyses were performed and several biochemicalcriteria were used to establish whether the genetics variantsof study were pathogenic. These assays showed that thec.5025delT variant was a deleterious mutation and thec.8038C>T variant required of complementary studies to characterizeits meaning. This work highlights the importance ofstudying the USV in order to clarify their pathogenic effect thenthis information is essential for providing efficient counsellingfor BC families

Erythrocyte aggregability and disaggregability in thalassemia trait carriers analyzed by a laser backscattering technique.

Erythrocyte aggregability was determined by a laser backscattering light technique in 23 beta minor thalassemia carriers and in 36 age and sex matched controls. The aggregation time (Ta) was statistically higher in cases than in controls (2.8 +/- 1.0 vs 2.3 +/- 0.4, p < 0.05) and the aggregation index at 10 sec (AI10) was statistically lower (25.1 +/- 5.7 vs 28.2 +/- 3.8, p < 0.05), suggesting both parameters a statistically lower erythrocyte aggregability tendency. However, the total disaggregation threshold (gammaD) was statistically higher in cases than in controls (134.4 +/- 34.1 vs 105.1 +/- 33.1, p < 0.05), indicating that once aggregates are formed a higher shear rate is needed to break them up. No differences were observed in plasmatic factors, i.e., fibrinogen, total cholesterol and triglycerides, that could have influenced erythrocyte aggregation. A negative statistically significant correlation was found between erythrocyte indexes and the total disaggregation threshold. The lower erythrocyte aggregation found in minor thalassemia carriers could be attributed in part to the morphological alterations, although others mechanisms such as modifications in the membrane structure of the RBC can not be ruled out.