In vitro activity of cefiderocol and other newly approved antimicrobials against multi-drug resistant Gram-negative pathogens recovered in intensive care units in Spain and Portugal.

OBJECTIVE: The antimicrobial resistance is a significant public health threat, particularly for healthcare-associated infections caused by carbapenem-resistant Gram-negative pathogens which are increasingly reported worldwide. The aim of this study was to provide data on the in vitro antimicrobial activity of cefiderocol and that of commercially available comparator antibiotics against a defined collection of recent clinical multi-drug resistant (MDR) microorganisms, including carbapenem resistant Gram-negative bacteria collected from different regions in Spain and Portugal. METHODS: A total of 477 clinical isolates of Enterobacterales, Pseudomonas aeruginosa, Acinetobacter baumannii and Stenotrophomonas maltophilia were prospectively (n=265) and retrospectively (n=212) included (2016-2019). Susceptibility testing was performed using standard broad microdilution and results were interpreted using CLSI-2021 and EUCAST-2021 criteria. RESULTS: Overall, cefiderocol showed a good activity against Enterobacterales isolates, being 99.5% susceptible by CLSI and 94.5% by EUCAST criteria. It also demonstrated excellent activity against P. aeruginosa and S. maltophilia isolates, all being susceptible to this compound considering CLSI breakpoints. Regarding A. baumannii (n=64), only one isolate was resistant to cefiderocol. CONCLUSIONS: Our results are in agreement with other studies performed outside Spain and Portugal highlighting its excellent activity against MDR gram-negative bacteria. Cefiderocol is a therapeutic alternative to those available for the treatment of infections caused by these MDR bacteria.

A hybrid approach: a safe option for surgical treatment of early-stage cervical cancer.

OBJECTIVE: The aim of the study was to describe the surgical treatment of early-stage cervical cancer (CC) via minimally invasive surgery (MIS) and a sequential hybrid approach combining MIS and mini-Pfannenstiel. Evaluate sentinel lymph node (SLN) detection using a hybrid tracer (ICG-99m Tc nanocolloid). PATIENTS AND METHODS: Prospective, observational, descriptive, single-center study conducted at Son Espases University Hospital between January 2019 and September 2021. Patients with early-stage CC (FIGO 2018 IA1 with ILV-IIA1) who underwent surgical treatment with a follow-up of at least one year were included. RESULTS: Thirty early-stage CC patients were included, of whom four (13.3%) were upstaged due to positive SLNs. In these cases, laparotomy was avoided, and paraaortic lymphadenectomy was performed via MIS approach. Twenty-six patients had a radical hysterectomy: 15 underwent a hybrid approach, 10 laparoscopy, and one laparotomy. Patients undergoing laparoscopic surgery had a smaller estimated tumor size than those undergoing the hybrid approach. The overall SLN detection rate was 96.1%, with 88.5% of cases occurring bilaterally. Five out of 26 patients (19.2%) presented SLN macrometastases, and five (19.2%) had atypical drainage. Surgery refined staging in 33.3% (10/30) of cases. No recurrences were reported after an average follow-up of 32 months. CONCLUSIONS: MIS for SLN avoids laparotomy leading to rapid recovery and early adjuvant treatment initiation in nodal metastasis. In our study, tumor size is an important clinical implication in the surgical approach to be used. The hybrid tracer provided a high detection rate and combined the advantages of the two tracers. The hybrid approach has a quick recovery and optimal results.

Anti-endotoxin antibodies consumption in cardiovascular collapse: Pathophysiological concerns / Consumo de anticuerpos antiendotoxina en el shock: relación etiológica

Objective Abnormal endotoxin activity in critically ill patients has been described in the absence of Gram-negative bacterial (GNB) infection. As disease severity seems to be crucial in the detection of this phenomenon, we decided to assess and compare endotoxin exposure in those patients representing the critical situation: septic shock and cardiogenic shock. Design Prospective, observational non intervention study. Setting Critical Care Department of a University tertiary hospital. Patients Cardiogenic shock (CS) and septic shock (SS) patients. Interventions None. Measurements and main results Follow-up was performed for the first three days. Inflammatory biomarkers (C-reactive protein, procalcitonin and interleuquin-6) and IgM antiendotoxin-core antibodies titter (IgM EndoCAb) were daily analyzed. Sixty-two patients were included; twenty-five patients with SS and thirty-seven with CS. Microbial etiology was established in 23 SS patients (92%) and GNB were present in 13 cases (52%). Although infection was suspected and even treated in 30 CS patients (81%), any episode could be finally confirmed. EndoCAb consumption was more intense in SS patients, although twenty-two CS patients (59.5%) had IgM anti-endotoxin value below 10th percentile range for healthy people. No statistically significant difference in endotoxin exposure was detected between Gram-positive and Gram-negative infections in the SS group. Endotoxin exposure ability to distinguish between SS and CS was moderate (AUC 0.7892, 95% IC: 0.6564–0.9218).Conclusions In the severely ill patient some mechanisms take place allowing endotoxin incursion and therefore blurring the limits of diseases pathophysiology. Our work representatively shows how exposure to endotoxin was not fully capable of distinguishing between CS and SS. (AU)

Objetivo En el paciente crítico se ha descrito una actividad incrementada de la endotoxina no asociada a infección por bacterias gramnegativas (BGN). La gravedad de la enfermedad influye en este fenómeno, por ello realizamos este estudio en el paciente crítico por antonomasia: shock séptico y cardiogénico. Diseño Estudio prospectivo, observacional, sin intervención.Lugar de estudioUnidad de Cuidados Intensivos. Pacientes Pacientes en shock cardiogénico (SC) o séptico (SS).Intervención Ninguna. Determinaciones y principales resultados Seguimiento durante los 3 primeros días. Proteína C reactiva, procalcitonina e interleucina-6, y el título de anticuerpos IgM anti-edotoxina (IgM EndoCAb) se analizaron diariamente. Se incluyó a 62 pacientes; 25 con SS y 37 con SC. La etiología fue identificada en 23 pacientes con SS (92%), los BGN estuvieron presentes en 13 casos (52%). Se sospechó e incluso trató la infección en 30 pacientes con SC, pero en ningún caso se pudo confirmar. El consumo de EndoCAb fue más intenso en los pacientes con SS, pero 22 pacientes con SC (59,5%) tuvieron unos valores por debajo del percentil 10. Los niveles de EndoCAb no fueron significativamente diferentes entre las infecciones por BGN y cocos grampositivos. La capacidad de EndoCab para diferenciar entre SC y SS resultó ser moderada (AUC 0,7892; IC del 95%, 0,6564-0,9218).Conclusiones En el paciente crítico es frecuente que la endotoxina provoque una respuesta inflamatoria y la sumación de distintos mecanismos fisiopatológicos. En este sentido, nuestro trabajo pone de manifiesto que la determinación de exposición a endotoxina no es totalmente capaz de distinguir entre los pacientes con SC y SS. (AU)

[Translated article] Relation between the volume of injected cement and the vertebral volume in the clinical outcome and in the appearance of leakage after a percutaneous vertebroplasty.

OBJECTIVES: To assess the connection between the volume of injected cement and the vertebral volume measured through a volumetric analysis with a computed tomography (CT scan) in relation to the clinical result and the appearance of a leakage in patients who underwent a percutaneous vertebroplasty after an osteoporotic fracture. MATERIALS AND METHODS: A prospective study of 27 patients (18 female-9 male) with an average age of 69 years old (50-81), and with a one-year follow-up. The study group presented 41 vertebrae with osteoporotic fractures that were treated with a percutaneous vertebroplasty with a bilateral transpedicular approach. The volume of injected cement was registered in each procedure and it was assessed together with the spinal volume measured through a volumetric analysis with CT scans. The percentage of the spinal filler was calculated. The appearance of cement leakage was proved by means of a simple radiography and a postoperative CT scan in all the cases. The leaks were classified according to the location in relation to the vertebral body (posterior, lateral, anterior and in the disc), and the significance (minor: smaller than the largest diameter of the pedicle; moderate: larger than the pedicle but smaller than the height of the vertebra; major: larger than the height of the vertebra). RESULTS: The average vertebra volume was 26.1cm3, the average volume of the injected cement was 2.0cm3 and the percentage of the average filler was 9%. A total of 15 leaks in 41 vertebrae appeared (37%). The leaks were posterior in 2 vertebrae, vascular in 8 and into the disc in 5 vertebrae. They were deemed as minor in 12 cases, moderate in 1 and major in 2 cases. The preoperative assessment of the pain was as it follows: VAS (8) and Oswestry (67%). The cessation of pain was immediate after a year with the following postoperative results: VAS (1.7) and Oswestry (19%). The only complication was the temporary neuritis with a spontaneous resolution. CONCLUSIONS: The injection of small amounts of cement, lower than the ones referred to by literary sources, obtains clinical results similar to the ones obtained by injecting higher amounts and it reduces the number of cement leaks and further complications.

Adequate timing of diagnostic tests for gastroesophageal reflux in children with esophageal atresia. / Momento adecuado para las pruebas diagnósticas de reflujo esofágico en pacientes con atresia de esófago.

OBJECTIVE: Recent guidelines made recommendations for the management of gastroesophageal reflux in patients with esophageal atresia (EA). However, the timing for some diagnostic tests remained somehow unclear. This investigation studied the tests for gastroesophageal reflux in children aged one year old and children aged two or three. MATERIALS AND METHODS: Patients with EA who underwent Multichannel Intraluminal Impedance-pH monitoring (MII-pH) and endoscopy-histology were studied retrospectively. Patients aged one when the test was performed were the YO group and patients aged two or three years old formed the OL group. Substantially impaired MII-pH was defined as total number of reflux episodes >105 or >85 (depending on age), or reflux index >10%. Substantially impaired endoscopy was defined as erosive esophagitis or Barrett's esophagus. Substantially impaired histology was defined as moderate-severe esophagitis or Barrett's esophagus. Conventional parameters and substantially impaired values of the tests were compared. RESULTS: Twenty-four patients were studied. Twenty-three MII-pH were performed (12 in YO and 11 in OL): percentages of abnormal conventional parameters of MII-pH were not significantly different in both groups. Twenty endoscopies with biopsies were performed (7 in YO and 13 in OL): percentages of esophagitis were not significantly different. Interestingly, 26.9% of all the tests performed in YO were substantially impaired vs. 10.8% of all the tests in OL (χ2 = 2.7; p = 0.1). CONCLUSION: Considering the percentage of alarming results of diagnostic tests in the YO group it would be advisable that patients with EA undergo MII-pH and endoscopy-histology at one year of age.

OBJETIVOS: Recientemente se han publicado recomendaciones para el manejo del reflujo gastroesofágico en pacientes con atresia de esófago (AE). Sin embargo, el momento de realización de algunas pruebas no está completamente aclarado. Esta investigación evalúa las pruebas para reflujo gastroesofágico en niños de 1 año y niños de 2-3 años. MATERIAL Y METODOS: Estudio retrospectivo de pacientes con AE sometidos a impedanciometría-phmetría (IMpH) y a endoscopia-histología. Los pacientes con 1 año en el momento de la prueba formaron el grupo MEN, y los pacientes con 2-3 años, el grupo MAY. Se consideró IMpH sustancialmente alterada aquella con un número total de reflujos >105 o >85 (según la edad), o un índice de reflujo >10%. La endoscopia se consideró sustancialmente alterada si presentaba esofagitis erosiva o esófago de Barrett. La histología se consideró sustancialmente alterada si presentaba esofagitis severa-moderada o esófago de Barrett. Se compararon los parámetros convencionales y los sustancialmente alterados. RESULTADOS: Se estudiaron 24 pacientes. Se realizaron 23 IMpH (12 en el grupo MEN y 11 en el MAY); los porcentajes de los parámetros convencionales patológicos no fueron estadísticamente diferentes en ambos grupos. Se realizaron 20 endoscopias (7 en el grupo MEN y 13 en el MAY); los porcentajes de esofagitis no fueron estadísticamente diferentes. El 26,9% de todas las pruebas en el grupo MEN resultaron sustancialmente alteradas, frente al 10,8% en el MAY (χ2 = 2,7; p = 0,1). CONCLUSION: Teniendo en cuenta el porcentaje de resultados alarmantes en el grupo MEN, sería recomendable realizar una IMpH y una endoscopia con biopsias a los pacientes con AE a la edad de un año.

Pain and Late-Onset of Hidradenitis Suppurativa Can Have a Negative Influence on Occupational Status and Educational Level. A Cross-Sectional Study / El dolor y la aparición tardía de la hidrosadenitis supurativa pueden tener una influencia negativa en el estatus ocupacional y el nivel educativo. Estudio transversal

Background and objectives Hidradenitis suppurativa is a chronic and painful condition with negative impact on daily activity. Little information on the impact of disease-specific factors on educational level and occupational status in hidradenitis suppurativa patients has been reported. We sought to identify how disease-specific factors could influence occupational status and educational level in patients with hidradenitis suppurativa. Methods Cross-sectional study of patients with hidradenitis suppurativa seen between September 2017 and September 2018. Disease-specific variables were analyzed to find associations in patients with different educational levels and occupational status. Results Ninety-eight patients were included. Patients with non-university studies had more frequently ≥ 3 affected areas (22.5% [16/73] vs 4.8% [1/22], p = 0.049), a higher number of painful days (8.5 [SD 8.8] vs 4.6 [SD 4.8], p = 0.048) and a higher score on the VAS scale (6.7 [SD 2.8] vs 5.0 [3.3], p = 0.031). Patients from the inactive group had a significantly increased number of painful days (11.2 [SD 10.4] vs 5.7 [SD 6.2], p = 0.004). This group had a greater number of patients with a history of depression (61.3% [19/31] vs 27.4% [17/62], p = 0.002) and a higher mean BMI (32.3 [9.1] vs 28.4 [6.4], p = 0.016). Late disease onset was significantly associated with being “inactive” (26.7% [8/31] vs 6.5% [4/62], p = 0.026). No significant differences between severity scales of hidradenitis suppurativa and educational level or occupational status were found. Limitations: cross-sectional and single center study. Conclusions Pain, ≥3 affected areas, history of depression, higher mean BMI, and late onset of hidradenitis suppurativa, are associated with low education level and inactive occupational status (AU)

Antecedentes y objetivos La hidrosadenitis supurativa es una condición crónica y dolorosa, con impacto negativo en la actividad diaria. Se ha reportado poca información sobre el impacto que tienen los factores específicos de la enfermedad en el nivel educativo y el estatus ocupacional de los pacientes con esta situación. Nuestro objetivo fue identificar el modo en que dichos factores específicos de la enfermedad podrían influir en el nivel educativo y el estatus ocupacional de los pacientes con hidrosadenitis supurativa. Métodos Estudio transversal de pacientes con hidrosadenitis supurativa examinados entre septiembre de 2017 y septiembre de 2018. Se analizaron las variables específicas de la enfermedad para encontrar una asociación en los pacientes con diferentes niveles educativos y estatus ocupacionales. Resultados Se incluyó a 98 pacientes. Aquellos con estudios no universitarios tenían afectadas más frecuentemente ≥ 3 zonas (22,5% [16/73] vs. 4,8% [1/22], p = 0,049), pasaban un elevado número de días con dolor (8,5 [DE 8,8] vs. 4,6 [DE 4,8], p = 0,048) y su puntuación en la escala EVA era alta (6,7 [DE 2,8] vs. 5 [3,3], p = 0,031). Los pacientes pertenecientes al grupo inactivo tenían un número considerablemente incrementado de días con dolor (11,2 [DE 10,4] vs. 5,7 [DE 6,2], p = 0,004). En este grupo había un mayor número de pacientes con historia de depresión (61,3% [19/31] vs. 27,4% [17/62], p = 0,002) y un mayor IMC medio (32,3 [9,1] vs. 28,4 [6,4], p = 0,016). El inicio tardío de la enfermedad se asoció significativamente a la situación de «inactivo» (26,7% [8/31] vs. 6,5% [4/62], p = 0,026). No se encontraron diferencias significativas entre las escalas de gravedad de la hidrosadenitis supurativa y el nivel educativo y el estatus ocupacional. Limitaciones: estudio transversal y unicéntrico (AU)

[Artículo traducido] El dolor y la aparición tardía de la hidrosadenitis supurativa pueden tener una influencia negativa en el estatus ocupacional y el nivel educativo. Estudio transversal / Pain and late-onset of hidradenitis suppurativa can have a negative influence on occupational status and educational level. A cross-sectional study

Antecedentes y objetivos La hidrosadenitis supurativa es una condición crónica y dolorosa, con impacto negativo en la actividad diaria. Se ha reportado poca información sobre el impacto que tienen los factores específicos de la enfermedad en el nivel educativo y el estatus ocupacional de los pacientes con esta situación. Nuestro objetivo fue identificar el modo en que dichos factores específicos de la enfermedad podrían influir en el nivel educativo y el estatus ocupacional de los pacientes con hidrosadenitis supurativa. Métodos Estudio transversal de pacientes con hidrosadenitis supurativa examinados entre septiembre de 2017 y septiembre de 2018. Se analizaron las variables específicas de la enfermedad para encontrar una asociación en los pacientes con diferentes niveles educativos y estatus ocupacionales. Resultados Se incluyó a 98 pacientes. Aquellos con estudios no universitarios tenían afectadas más frecuentemente ≥ 3 zonas (22,5% [16/73] vs. 4,8% [1/22], p = 0,049), pasaban un elevado número de días con dolor (8,5 [DE 8,8] vs. 4,6 [DE 4,8], p = 0,048) y su puntuación en la escala EVA era alta (6,7 [DE 2,8] vs. 5 [3,3], p = 0,031). Los pacientes pertenecientes al grupo inactivo tenían un número considerablemente incrementado de días con dolor (11,2 [DE 10,4] vs. 5,7 [DE 6,2], p = 0,004). En este grupo había un mayor número de pacientes con historia de depresión (61,3% [19/31] vs. 27,4% [17/62], p = 0,002) y un mayor IMC medio (32,3 [9,1] vs. 28,4 [6,4], p = 0,016). El inicio tardío de la enfermedad se asoció significativamente a la situación de «inactivo» (26,7% [8/31] vs. 6,5% [4/62], p = 0,026). No se encontraron diferencias significativas entre las escalas de gravedad de la hidrosadenitis supurativa y el nivel educativo y el estatus ocupacional. Limitaciones: estudio transversal y unicéntrico (AU)

Background and objectives Hidradenitis suppurativa is a chronic and painful condition with negative impact on daily activity. Little information on the impact of disease-specific factors on educational level and occupational status in hidradenitis suppurativa patients has been reported. We sought to identify how disease-specific factors could influence occupational status and educational level in patients with hidradenitis suppurativa. Methods Cross-sectional study of patients with hidradenitis suppurativa seen between September 2017 and September 2018. Disease-specific variables were analyzed to find associations in patients with different educational levels and occupational status. Results Ninety-eight patients were included. Patients with non-university studies had more frequently ≥ 3 affected areas (22.5% [16/73] vs 4.8% [1/22], p = 0.049), a higher number of painful days (8.5 [SD 8.8] vs 4.6 [SD 4.8], p = 0.048) and a higher score on the VAS scale (6.7 [SD 2.8] vs 5.0 [3.3], p = 0.031). Patients from the inactive group had a significantly increased number of painful days (11.2 [SD 10.4] vs 5.7 [SD 6.2], p = 0.004). This group had a greater number of patients with a history of depression (61.3% [19/31] vs 27.4% [17/62], p = 0.002) and a higher mean BMI (32.3 [9.1] vs 28.4 [6.4], p = 0.016). Late disease onset was significantly associated with being “inactive” (26.7% [8/31] vs 6.5% [4/62], p = 0.026). No significant differences between severity scales of hidradenitis suppurativa and educational level or occupational status were found. Limitations: cross-sectional and single center study. Conclusions Pain, ≥3 affected areas, history of depression, higher mean BMI, and late onset of hidradenitis suppurativa, are associated with low education level and inactive occupational status (AU)

Momento adecuado para las pruebas diagnósticas de reflujo esofágico en pacientes con atresia de esófago / Adequate timing of diagnostic tests for gastroesophageal reflux in children with esophageal atresia

Objetivos: Recientemente se han publicado recomendaciones para el manejo del reflujo gastroesofágico en pacientes con atresia de esófago (AE). Sin embargo, el momento de realización de algunas pruebas no está completamente aclarado. Esta investigación evalúa las pruebas para reflujo gastroesofágico en niños de 1 año y niños de 2-3 años. Material y métodos: Estudio retrospectivo de pacientes con AE sometidos a impedanciometría-phmetría (IMpH) y a endoscopia-histología. Los pacientes con 1 año en el momento de la prueba formaron el grupo MEN, y los pacientes con 2-3 años, el grupo MAY. Se consideró IMpH sustancialmente alterada aquella con un número total de reflujos >105 o >85 (según la edad), o un índice de reflujo >10%. La endoscopia se consideró sustancialmente alterada si presentaba esofagitis erosiva o esófago de Barrett. La histología se consideró sustancialmente alterada si presentaba esofagitis severa-moderada o esófago de Barrett. Se compararon los parámetros convencionales y los sustancialmente alterados. Resultados: Se estudiaron 24 pacientes. Se realizaron 23 IMpH (12 en el grupo MEN y 11 en el MAY); los porcentajes de los parámetros convencionales patológicos no fueron estadísticamente diferentes en ambos grupos. Se realizaron 20 endoscopias (7 en el grupo MEN y 13 en el MAY); los porcentajes de esofagitis no fueron estadísticamente diferentes. El 26,9% de todas las pruebas en el grupo MEN resultaron sustancialmente alteradas, frente al 10,8% en el MAY (χ2 = 2,7;p = 0,1). Conclusión: Teniendo en cuenta el porcentaje de resultados alarmantes en el grupo MEN, sería recomendable realizar una IMpH y una endoscopia con biopsias a los pacientes con AE a la edad de un año.(AU)

Objective: Recent guidelines made recommendations for the management of gastroesophageal reflux in patients with esophageal atresia (EA). However, the timing for some diagnostic tests remained somehow unclear. This investigation studied the tests for gastroesophageal reflux in children aged one year old and children aged two or three. Material and methods: Patients with EA who underwent Multichannel Intraluminal Impedance-pH monitoring (MII-pH) and endoscopy-histology were studied retrospectively. Patients aged one when the test was performed were the YO group and patients aged two or three years old formed the OL group. Substantially impaired MII-pH was defined as total number of reflux episodes >105 or >85 (depending on age), or reflux index >10%. Substantially impaired endoscopy was defined as erosive esophagitis or Barrett’s esophagus. Substantially impaired histology was defined as moderate-severe esophagitis or Barrett’s esophagus. Conventional parameters and substantially impaired values of the tests were compared. Results: Twenty-four patients were studied. Twenty-three MII-pH were performed (12 in YO and 11 in OL): percentages of abnormal conventional parameters of MII-pH were not significantly different in both groups. Twenty endoscopies with biopsies were performed (7 in YO and 13 in OL): percentages of esophagitis were not significantly different. Interestingly, 26.9% of all the tests performed in YO were substantially impaired vs. 10.8% of all the tests in OL (χ2 = 2.7; p = 0.1). Conclusion: Considering the percentage of alarming results of diagnostic tests in the YO group it would be advisable that patients with EA undergo MII-pH and endoscopy-histology at one year of age.(AU)

Pain and late-onset of hidradenitis suppurativa can have a negative influence on occupational status and educational level. A cross-sectional study. / [Artículo traducido] El dolor y la aparición tardía de la hidrosadenitis supurativa pueden tener una influencia negativa en el estatus ocupacional y el nivel educativo. Estudio transversal.

BACKGROUND AND OBJECTIVES: Hidradenitis suppurativa (HS) is a chronic and painful condition with negative impact on daily activity. Little information on the impact of disease-specific factors on educational level and occupational status in hidradenitis suppurativa patients has been reported. We sought to identify how disease-specific factors could influence occupational status and educational level in patients with HS. METHODS: Cross-sectional study of patients with HS seen between September 2017 and September 2018. Disease-specific variables were analyzed to find associations in patients with different educational levels and occupational status. RESULTS: Ninety-eight patients were included. Patients with non-university studies had more frequently ≥ 3 affected areas (22.5% [16/73] vs. 4.8% [1/22], p = 0.049), a higher number of painful days (8.5 [SD 8.8] vs. 4.6 [SD 4.8], p = 0.048) and a higher score on the VAS scale (6.7 [SD 2.8] vs. 5.0 [3.3], p = 0.031). Patients from the inactive group had a significantly increased number of painful days (11.2 [SD 10.4] vs. 5.7 [SD 6.2], p = 0.004). This group had a greater number of patients with a history of depression (61.3% [19/31] vs. 27.4% [17/62], p = 0.002) and a higher mean BMI (32.3 [9.1] vs. 28.4 [6.4], p = 0.016). Late disease onset was significantly associated with being «inactive¼ (26.7% [8/31] vs. 6.5% [4/62], p = 0.026). No significant differences between severity scales of HS and educational level or occupational status were found. LIMITATIONS: cross-sectional and single center study. CONCLUSIONS: Pain, ≥ 3 affected areas, history of depression, higher mean BMI, and late onset of HS, are associated with low education level and inactive occupational status.

Primary Cutaneous Lymphoma Registry of the Spanish Academy of Dermatology and Venereology (AEDV): Data for the First 5 Years. / Registro de linfomas cutáneos primarios (RELCP) de la AEDV: datos tras 5 años de funcionamiento.

BACKGROUND AND OBJECTIVE: Primary cutaneous lymphomas (PCL) are uncommon. Observations based on the first year of data from the Spanish Registry of Primary Cutaneous Lymphomas (RELCP, in its Spanish abbreviation) of the Spanish Academy of Dermatology and Venereology (AEDV) were published in February 2018. This report covers RELCP data for the first 5 years. PATIENTS AND METHODS: RELCP data were collected prospectively and included diagnosis, treatments, tests, and the current status of patients. We compiled descriptive statistics of the data registered during the first 5 years. RESULTS: Information on 2020 patients treated at 33 Spanish hospitals had been included in the RELCP by December 2021. Fifty-nine percent of the patients were men; the mean age was 62.2 years. The lymphomas were grouped into 4 large diagnostic categories: mycosis fungoides/Sézary syndrome, 1112 patients (55%); primary B-cell cutaneous lymphoma, 547 patients (27.1%); primary CD30+lymphoproliferative disorders, 222 patients (11%), and other T-cell lymphomas, 116 patients (5.8%). Nearly 75% of the tumors were registered in stage I. After treatment, 43.5% achieved complete remission and 27% were stable at the time of writing. Treatments prescribed were topical corticosteroids (1369 [67.8%]), phototherapy (890 patients [44.1%]), surgery (412 patients [20.4%]), and radiotherapy (384 patients [19%]). CONCLUSION: The characteristics of cutaneous lymphomas in Spain are similar to those reported for other series. The large size of the RELCP registry at 5 years has allowed us to give more precise descriptive statistics than in the first year. This registry facilitates the clinical research of the AEDV's lymphoma interest group, which has already published articles based on the RELCP data.

Anti-endotoxin antibodies consumption in cardiovascular collapse: Pathophysiological concerns.

OBJECTIVE: Abnormal endotoxin activity in critically ill patients has been described in the absence of Gram-negative bacterial (GNB) infection. As disease severity seems to be crucial in the detection of this phenomenon, we decided to assess and compare endotoxin exposure in those patients representing the critical situation: septic shock and cardiogenic shock. DESIGN: Prospective, observational non intervention study. SETTING: Critical Care Department of a University tertiary hospital. PATIENTS: Cardiogenic shock (CS) and septic shock (SS) patients. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Follow-up was performed for the first three days. Inflammatory biomarkers (C-reactive protein, procalcitonin and interleuquin-6) and IgM antiendotoxin-core antibodies titter (IgM EndoCAb) were daily analyzed. Sixty-two patients were included; twenty-five patients with SS and thirty-seven with CS. Microbial etiology was established in 23 SS patients (92%) and GNB were present in 13 cases (52%). Although infection was suspected and even treated in 30 CS patients (81%), any episode could be finally confirmed. EndoCAb consumption was more intense in SS patients, although twenty-two CS patients (59.5%) had IgM anti-endotoxin value below 10th percentile range for healthy people. No statistically significant difference in endotoxin exposure was detected between Gram-positive and Gram-negative infections in the SS group. Endotoxin exposure ability to distinguish between SS and CS was moderate (AUC 0.7892, 95% IC: 0.6564-0.9218). CONCLUSIONS: In the severely ill patient some mechanisms take place allowing endotoxin incursion and therefore blurring the limits of diseases pathophysiology. Our work representatively shows how exposure to endotoxin was not fully capable of distinguishing between CS and SS.

Relation between the volume of injected cement and the vertebral volume in the clinical outcome and in the appearance of leakage after a percutaneous vertebroplasty. / Relación entre el volumen de cemento inyectado y el volumen vertebral en el resultado clínico y en la aparición de fugas tras vertebroplastia percutánea.

OBJECTIVES: To assess the connection between the volume of injected cement and the vertebral volume measured through a volumetric analysis with a computed tomography (CT scan) in relation to the clinical result and the appearance of a leakage in patients who underwent a percutaneous vertebroplasty after an osteoporotic fracture. MATERIALS AND METHODS: A prospective study of 27 patients (18 female-9 male) with an average age of 69 years old (50-81), and with a one-year follow-up. The study group presented 41 vertebrae with osteoporotic fractures that were treated with a percutaneous vertebroplasty with a bilateral transpedicular approach. The volume of injected cement was registered in each procedure and it was assessed together with the spinal volume measured through a volumetric analysis with CT scans. The percentage of the spinal filler was calculated. The appearance of cement leakage was proved by means of a simple radiography and a postoperative CT scan in all the cases. The leaks were classified according to the location in relation to the vertebral body (posterior, lateral, anterior and in the disc), and the significance (minor: smaller than the largest diameter of the pedicle; moderate: larger than the pedicle but smaller than the height of the vertebra; major: larger than the height of the vertebra). RESULTS: The average vertebra volume was 26.1 cc, the average volume of the injected cement was 2.0 cc and the percentage of the average filler was 9%. A total of 15 leaks in 41 vertebrae appeared (37%). The leaks were posterior in 2 vertebrae, vascular in 8 and into the disc in 5 vertebrae. They were deemed as minor in 12 cases, moderate in 1 and major in 2 cases. The preoperative assessment of the pain was as it follows: VAS (8) and Oswestry (67%). The cessation of pain was immediate after a year with the following postoperative results: VAS (1.7) and Oswestry (19%). The only complication was the temporary neuritis with a spontaneous resolution. CONCLUSIONS: The injection of small amounts of cement, lower than the ones referred to by literary sources, obtains clinical results similar to the ones obtained by injecting higher amounts and it reduces the number of cement leaks and further complications.

Pain and Late-Onset of Hidradenitis Suppurativa Can Have a Negative Influence on Occupational Status and Educational Level. A Cross-Sectional Study.

BACKGROUND AND OBJECTIVES: Hidradenitis suppurativa is a chronic and painful condition with negative impact on daily activity. Little information on the impact of disease-specific factors on educational level and occupational status in hidradenitis suppurativa patients has been reported. We sought to identify how disease-specific factors could influence occupational status and educational level in patients with hidradenitis suppurativa. METHODS: Cross-sectional study of patients with hidradenitis suppurativa seen between September 2017 and September 2018. Disease-specific variables were analyzed to find associations in patients with different educational levels and occupational status. RESULTS: Ninety-eight patients were included. Patients with non-university studies had more frequently≥3 affected areas (22.5% [16/73] vs 4.8% [1/22], p=0.049), a higher number of painful days (8.5 [SD 8.8] vs 4.6 [SD 4.8], p=0.048) and a higher score on the VAS scale (6.7 [SD 2.8] vs 5.0 [3.3], p=0.031). Patients from the inactive group had a significantly increased number of painful days (11.2 [SD 10.4] vs 5.7 [SD 6.2], p=0.004). This group had a greater number of patients with a history of depression (61.3% [19/31] vs 27.4% [17/62], p=0.002) and a higher mean BMI (32.3 [9.1] vs 28.4 [6.4], p=0.016). Late disease onset was significantly associated with being "inactive" (26.7% [8/31] vs 6.5% [4/62], p=0.026). No significant differences between severity scales of hidradenitis suppurativa and educational level or occupational status were found. LIMITATIONS: cross-sectional and single center study. CONCLUSIONS: Pain, ≥3 affected areas, history of depression, higher mean BMI, and late onset of hidradenitis suppurativa, are associated with low education level and inactive occupational status.

Contributions to the revision of the genus Entoloma (Basidiomycota, Agaricales) in Europe: six new species from subgenus Cyanula and typification of E. incarnatofuscescens.

In anticipation of a phylogenetically revised monograph of Entoloma in Europe, six new species of subgenus Cyanula are described here. Entoloma cistocruentatum is associated with Cistus in Spain, E. dislocatum occurs in montane regions in Catalonia (Spain) and Tuscany (Italy), E. indikon is known from Denmark and three species are mainly distributed in the Nordic countries in Europe: E. calceus, E. perchalybeum and E. praecipuum. Entoloma incarnatofuscescens, from the /Rusticoides clade is neotypified. A fully amended description is given based on molecular evidence, which includes the recently described E. violaceoparkensis and E. klofacianum which became later synonyms. Citation: Noordeloos ME, Vila J, Jordal JB, Kehlet T, Brandrud TE, Bendiksen E, Moreau P-A, Dondl M, Lorås J, Larsson E, Dima B (2022). Contributions to the revision of the genus Entoloma (Basidiomycota, Agaricales) in Europe: six new species from subgenus Cyanula and typification of E. incarnatofuscescens. Fungal Systematics and Evolution 9: 87-97. doi: 10.3114/fuse.2022.09.06.

Esfinteroplastia anatómica mediante reconstrucción combinada del esfínter anal interno y externo en el tratamiento quirúrgico de la incontinencia anal / Anatomic sphincteroplasty with combined reconstruction of internal and external anal muscles in the anal incontinence surgical treatment

Los estudios que evalúan la efectividad de la esfinteroplastia clásica muestran una mejoría de alrededor del 75% a corto plazo, constatándose un deterioro en el tiempo con resultados satisfactorios a largo plazo de alrededor del 50%. Tras introducir la realización de la reparación por separado del esfínter anal interno y el externo, se publicaron tasas de éxito del 80%, observando que estos resultados se mantenían a largo plazo. Pensamos que la introducción de modificaciones en la técnica quirúrgica desde una mentalidad anatómica y reconstructiva, que hemos denominado «esfinteroplastia anatómica mediante reconstrucción combinada de esfínter anal interno y externo», puede obtener muy buenos resultados clínicos y manométricos en el seguimiento a corto y medio plazo. Asimismo, el aumento de longitud de la barrera presiva generada por la técnica puede colaborar a que estos resultados se mantengan más estables a lo largo del tiempo que con la técnica clásica (AU)

Several groups studying the results of the classic sphincteroplasty show improvement of 75% of patients treated in a short-term follow-up, with a worsening of this data in the long-term follow-up down to an improvement of 50% of the patients. Some other groups published more optimistic results, showing an 80% success rate without any deterioration of the technique over time after introducing a separate repair of the internal and external muscles. We think that the introduction of some modifications in the classic technique, named “anatomic sphincteroplasty with combined reconstruction of external and internal anal sphincter muscles” may obtain very good clinical and anorectal manometric results both in a short and mid-term follow-up. In addition, increasing the pressive length in the anal canal may contribute to maintain more stable results over time (AU)

Impact of the first lockdown related to the COVID-19 pandemic on ophthalmic emergencies in a French University Hospital.

INTRODUCTION: At the beginning of the COVID-19 pandemic, the French government implemented its first national lockdown between March and May 2020 in order to limit the dissemination of the virus. This historic measure affected patients' daily lives and transportation, resulting in changes in the delivery of medical care, particularly emergency care. This study aimed to assess the impact of this restriction policy on the number and severity of ophthalmic emergencies seen in an ophthalmology emergency department. METHODS: This retrospective study conducted at the regional university Hospital of Tours included all patients presenting to the ophthalmology emergency department over four periods: lockdown (03/16/2020 to 05/10/2020), post-lockdown (05/11/2020 to 06/12/2020) and the two corresponding periods in 2019. The following data were recorded: sex, age, time of visit, reason for visit, diagnosis, severity of emergency graded on the BaSe SCOrE, time from first symptoms until visit, existence of a work-related injury, and referral source (ophthalmologist or other). RESULTS: A total of 1186 and 1905 patients were respectively included during the 2020 lockdown period and the corresponding period in 2019. The study populations for the 2019 and 2020 post-lockdown periods consisted of 1242 and 1086 patients respectively. During the lockdown, the number of consultations decreased significantly (-37.7%), affecting mild and severe emergencies similarly. During the post-lockdown period, the number of emergencies gradually increased but did not reach the level of the corresponding period in 2019 (-12.6%). CONCLUSION: The first French lockdown resulted in a significant decrease in ophthalmic emergency visits, similar for all levels of severity. All age groups were impacted similarly, without the expected exaggerated decrease for patients over 50 years of age, who are considered to be at greater risk for developing a severe form of COVID-19. The post-lockdown period showed a gradual increase in ophthalmic emergency visits, although these remained fewer than the previous year.

EpCAM y obstrucción microvascular en pacientes con un IAMCEST: estudio con resonancia magnética cardiaca / EpCAM and microvascular obstruction in patients with STEMI: a cardiac magnetic resonance study

Introducción y objetivos: La obstrucción microvascular (OMV) se asocia negativamente con la estructura cardiaca y el pronóstico de los pacientes tras un infarto agudo de miocardio con elevación del segmento ST (IAMCEST). El factor epithelial cell adhesion molecule (EpCAM), implicado en la cohesión de las células epiteliales, está poco estudiado en el contexto de la OMV. Por ello, el objetivo de este estudio es evaluar en una cohorte de pacientes con IAMCEST la asociación entre la concentración de EpCAM circulante con la extensión de la OMV, determinada por resonancia magnética cardiaca (RMC), y la función sistólica en fases crónicas. Métodos: Se incluyó prospectivamente a 106 pacientes con un primer IAMCEST tratados con angioplastia primaria percutánea. La concentración sérica de EpCAM se determinó 24h tras la reperfusión coronaria. Se estudió a todos los pacientes mediante RMC a la semana y a los 6 meses del IAMCEST. Se evaluó la correlación entre los valores de EpCAM circulante con la OMV, los índices de función sistólica y la fracción de eyección del ventrículo izquierdo. Resultados: La media de edad de la cohorte era 59±13 años y el 76% eran varones. Se dicotomizó a los pacientes según la mediana de EpCAM (4,48 pg/ml). Se observó que los pacientes que tenían valores más bajos de EpCAM presentaban una mayor extensión de la OMV (p=0,021) y un mayor tamaño de infarto (p=0,019) en los estudios de RMC realizados 1 semana después del evento cardiovascular. Respecto a las variables de presentación, la concentración de EpCAM se asoció significativamente con la presencia de OMV en análisis de regresión logística binaria univariable (OR=0,58; IC95%, 0,38-0,88; p=0,011) y multivariable (OR=0,55; IC95%, 0,35-0,87; p=0,010). A pesar de que la OMV tiende a resolverse espontáneamente en fases crónicas, unos valores más bajos de EpCAM se correlacionaron con una peor función sistólica (AU)

Introduction and objectives: Microvascular obstruction (MVO) is negatively associated with cardiac structure and worse prognosis after ST-segment elevation myocardial infarction (STEMI). Epithelial cell adhesion molecule (EpCAM), involved in epithelium adhesion, is an understudied area in the MVO setting. We aimed to determine whether EpCAM is associated with the appearance of cardiac magnetic resonance (CMR)-derived MVO and long-term systolic function in reperfused STEMI. Methods: We prospectively included 106 patients with a first STEMI treated with percutaneous coronary intervention, quantifying serum levels of EpCAM 24hours postreperfusion. All patients underwent CMR imaging 1 week and 6 months post-STEMI. The independent correlation of EpCAM with MVO, systolic volume indices, and left ventricular ejection fraction was evaluated. Results: The mean age of the sample was 59±13 years and 76% were male. Patients were dichotomized according to median EpCAM (4.48 pg/mL). At 1-week CMR, lower EpCAM was related to extensive MVO (P=.021) and larger infarct size (P=.019). At presentation, EpCAM values were significantly associated with the presence of MVO in univariate (OR, 0.58; 95%CI, 0.38-0.88; P=.011) and multivariate logistic regression models (OR, 0.55; 95%CI, 0.35-0.87; P=.010). Although MVO tends to resolve at chronic phases, decreased EpCAM was associated with worse systolic function: reduced left ventricular ejection fraction (P=.009) and higher left ventricular end-systolic volume (P=.043). Conclusions: EpCAM is associated with the occurrence of CMR-derived MVO at acute phases and long-term adverse ventricular remodeling post-STEMI