Impact of congenital uterine anomalies on obstetric and perinatal outcomes: systematic review and meta-analysis.

Background: Congenital uterine anomalies (CUA) can be associated with impairments of early and late pregnancy events. Objective: To assess the impact of CUA on reproductive outcomes in pregnancies conceived spontaneously or after assisted reproduction. Materials and Methods: Systematic review and meta-analysis of cohort studies comparing patients with CUA versus women with normal uterus. A structured literature search was performed in leading scientific databases to identify prospective and retrospective studies. The Newcastle-Ottawa scale, adapted to AHRQ standards, was used to assess the risk of bias. Pooled odds ratios (OR) were calculated. Publication bias and statistical heterogeneity were assessed, and meta-regression was used to analyse the heterogeneity. Main outcome measures: Miscarriage, ectopic pregnancy, placental abruption, term, and premature rupture of membranes (PROM), malpresentation at delivery, preterm delivery prior to 37, 34 and 32 weeks, caesarean delivery, intrauterine growth restriction/small for gestational age, foetal mortality and perinatal mortality. Results: 32 studies were included. CUAs increased significantly the risk of first/second trimester miscarriage (OR:1.54;95%CI:1.14-2.07), placental abruption (OR:5.04;3.60-7.04), PROM (OR:1.71;1.34-2.18), foetal malpresentation at delivery (OR:21.04;10.95-40.44), preterm birth (adjusted OR:4.34;3.59-5.21), a caesarean delivery (adjusted OR:7.69;4.17-14.29), intrauterine growth restriction/small for gestational age (adjusted OR:50;6.11-424), foetal mortality (OR:2.07;1.56-2.73) and perinatal mortality (OR:3.28;2.01-5.36). Conclusions: CUA increases the risk of complications during pregnancy, delivery, and postpartum. Complications most frequent in CUA patients were preterm delivery, foetal malpresentation, and caesarean delivery. What is new?: Bicornuate uterus was associated with the highest number of adverse outcomes, followed by didelphys, subseptate and septate uterus.

Evaluación de las consecuencias físicas y psicosociales de la diástasis de rectos abdominales y su interferencia en la salud: un estudio mixto / Evaluation of the physical and psychosocial consequences of the diastasis of the rectus abdominis and its interference in health: A mixed study

Introducción: La diástasis de rectos abdominales (DRA) se define como la separación de los rectos abdominales a lo largo de la línea alba. Esta condición puede darse en ambos sexos, siendo frecuente en la mujer durante el embarazo y posparto. Existe poca evidencia sobre las consecuencias de la DRA en la calidad de vida de las mujeres. Objetivo: El análisis de la percepción de los síntomas de DRA y su repercusión a nivel físico, psicológico y social en mujeres afectadas por esta condición. Pacientes y métodos: Estudio observacional por medio de una encuesta online semiestructurada, compuesta por 30 preguntas cerradas y 2 abiertas. Los criterios de inclusión fueron mujeres adultas de habla hispana, que hubiesen dado a luz y que presentasen diástasis abdominal. Los datos se analizaron de forma cuantitativa y la información cualitativa se obtuvo mediante un análisis de contenido de las preguntas abiertas. Resultados: Trescientas diecinueve mujeres con DRA fueron incluidas. Los resultados mostraron una afectación negativa de la DRA en la calidad de vida, las capacidades funcionales y en la salud uroginecológica y digestiva. Así mismo se evidenció un impacto negativo a nivel emocional, en la imagen corporal y una mala salud autopercibida. Conclusión:La DRA tiene un impacto negativo en la salud de la mujer. Las mujeres con DRA presentan una afectación de la calidad de vida y de las capacidades funcionales, una alteración de la imagen corporal, sentimientos de abandono por parte de las instituciones sanitarias, vergüenza, tristeza, impotencia, falta de autoestima, resignación y presión social.(AU)

Introduction: Diastasis rectus abdominis (DRA) is defined as the separation of the rectus abdominis along the linea alba. This condition can occur in both sexes, being frequent in women during pregnancy and pospartum. There is little evidence on the consequences of DRA on the quality of life of women. Objective: The analysis of the perception of the symptoms of and its repercussion on a physical, psychological and social level in women affected by this condition. Patients and methods: Observational study through a semi-structured online survey, composed of 30 closed questions and 2 open ones. The inclusion criteria were adult Spanish-speaking women who had given birth and who presented abdominal diástasis. The data were analyzed quantitatively and the qualitative information was obtained through a content analysis of the open questions. Results: 319 women with DRA were included. The results showed a negative effect of DRA on quality of life, functional capacities, and urogynecological and digestive health. Likewise, a negative impact was evidenced at an emotional level, on body image and poor self-perceived health. Conclusion: DRA has a negative impact on women's health. Women with DRA present an impairment of the quality of life and functional capacities, an alteration in body image, feelings of abandonment by health institutions, shame, sadness, powerlessness, lack of self-esteem, resignation and social pressure.(AU)

[Evaluation of the physical and psychosocial consequences of the diastasis of the rectus abdominis and its interference in health: A mixed study]. / Evaluación de las consecuencias físicas y psicosociales de la diástasis de rectos abdominales y su interferencia en la salud: un estudio mixto.

INTRODUCTION: Diastasis rectus abdominis (DRA) is defined as the separation of the rectus abdominis along the linea alba. This condition can occur in both sexes, being frequent in women during pregnancy and pospartum. There is little evidence on the consequences of DRA on the quality of life of women. OBJECTIVE: The analysis of the perception of the symptoms of and its repercussion on a physical, psychological and social level in women affected by this condition. PATIENTS AND METHODS: Observational study through a semi-structured online survey, composed of 30 closed questions and 2 open ones. The inclusion criteria were adult Spanish-speaking women who had given birth and who presented abdominal diástasis. The data were analyzed quantitatively and the qualitative information was obtained through a content analysis of the open questions. RESULTS: 319 women with DRA were included. The results showed a negative effect of DRA on quality of life, functional capacities, and urogynecological and digestive health. Likewise, a negative impact was evidenced at an emotional level, on body image and poor self-perceived health. CONCLUSION: DRA has a negative impact on women's health. Women with DRA present an impairment of the quality of life and functional capacities, an alteration in body image, feelings of abandonment by health institutions, shame, sadness, powerlessness, lack of self-esteem, resignation and social pressure.

Plasma proteome profiling identifies changes associated to AD but not to FTD.

BACKGROUND: Frontotemporal dementia (FTD) is caused by frontotemporal lobar degeneration (FTLD), characterized mainly by inclusions of Tau (FTLD-Tau) or TAR DNA binding43 (FTLD-TDP) proteins. Plasma biomarkers are strongly needed for specific diagnosis and potential treatment monitoring of FTD. We aimed to identify specific FTD plasma biomarker profiles discriminating FTD from AD and controls, and between FTD pathological subtypes. In addition, we compared plasma results with results in post-mortem frontal cortex of FTD cases to understand the underlying process. METHODS: Plasma proteins (n = 1303) from pathologically and/or genetically confirmed FTD patients (n = 56; FTLD-Tau n = 16; age = 58.2 ± 6.2; 44% female, FTLD-TDP n = 40; age = 59.8 ± 7.9; 45% female), AD patients (n = 57; age = 65.5 ± 8.0; 39% female), and non-demented controls (n = 148; 61.3 ± 7.9; 41% female) were measured using an aptamer-based proteomic technology (SomaScan). In addition, exploratory analysis in post-mortem frontal brain cortex of FTD (n = 10; FTLD-Tau n = 5; age = 56.2 ± 6.9, 60% female, and FTLD-TDP n = 5; age = 64.0 ± 7.7, 60% female) and non-demented controls (n = 4; age = 61.3 ± 8.1; 75% female) were also performed. Differentially regulated plasma and tissue proteins were identified by global testing adjusting for demographic variables and multiple testing. Logistic lasso regression was used to identify plasma protein panels discriminating FTD from non-demented controls and AD, or FTLD-Tau from FTLD-TDP. Performance of the discriminatory plasma protein panels was based on predictions obtained from bootstrapping with 1000 resampled analysis. RESULTS: Overall plasma protein expression profiles differed between FTD, AD and controls (6 proteins; p = 0.005), but none of the plasma proteins was specifically associated to FTD. The overall tissue protein expression profile differed between FTD and controls (7-proteins; p = 0.003). There was no difference in overall plasma or tissue expression profile between FTD subtypes. Regression analysis revealed a panel of 12-plasma proteins discriminating FTD from AD with high accuracy (AUC: 0.99). No plasma protein panels discriminating FTD from controls or FTD pathological subtypes were identified. CONCLUSIONS: We identified a promising plasma protein panel as a minimally-invasive tool to aid in the differential diagnosis of FTD from AD, which was primarily associated to AD pathophysiology. The lack of plasma profiles specifically associated to FTD or its pathological subtypes might be explained by FTD heterogeneity, calling for FTD studies using large and well-characterize cohorts.

Aproximación al coste de enfermedades profesionales atendidas en siete hospitales en España / Approximation to the cost of occupational diseases treated in seven hospitals in Spain

Objetivo: Estimar el coste hospitalario de una muestra de casos atendidos en siete hospitales del Sistema Nacional de Salud de diferentes ciudades españolas. Método: Estudio basado en 78 casos de enfermedad profesional reconocida por la Seguridad Social, atendidos en centros hospitalarios de Badalona, Barcelona, Ferrol, Gijón, Girona, Madrid y Vigo entre 2017 y 2019. Resultados: La actividad asistencial generada en estos hospitales para atender estos procesos supuso un coste total para el Sistema Nacional de Salud de 282.927 €. Conclusiones: Urge mejorar la coordinación entre los dos sistemas públicos de salud: la asistencia sanitaria de la Seguridad Social y el Sistema Nacional de Salud. (AU)

Objective: To estimate the hospital cost of a sample of cases treated in seven hospitals of the National Health System in several Spanish cities. Method: Study based on 78 cases of occupational disease recognized by the social security, and previously treated in hospitals in Badalona, Barcelona, Ferrol, Gijón, Girona, Madrid and Vigo between 2017 and 2019. Results: The healthcare activity generated by these hospitals to attend these processes involved a total cost of 282,927€. Conclusions: It is urgent to improve the coordination between the two public health systems, the social security health care system and the National Health System. (AU)

Structural, dynamic, and hydration properties of quercetin and its aggregates in solution.

Quercetin is a flavonoid present in the human diet with multiple health benefits. Quercetin solutions are inhomogeneous even at very low concentrations due to quercetin's tendency to aggregate. We simulate, using molecular dynamics, three systems of quercetin solutions: infinite dilution, 0.22 M, and 0.46 M. The systems at the two highest concentrations represent regions of the quercetin aggregates, in which the concentration of this molecule is unusually high. We study the behavior of this molecule, its aggregates, and the modifications in the surrounding water. In the first three successive layers of quercetin hydration, the density of water and the hydrogen bonds formations between water molecules are smaller than that of bulk. Quercetin has a hydrophilic surface region that preferentially establishes donor hydrogen bonds with water molecules with relative frequencies from 0.12 to 0.46 at infinite dilution. Also, it has two hydrophobic regions above and below the planes of its rings, whose first hydration layers are further out from quercetin (≈0.3 Å) and their water molecules do not establish hydrogen bonds with it. Water density around the hydrophobic regions is smaller than that of the hydrophilic. Quercetin molecules aggregate inπ-stacking configurations, with a distance of ≈0.37 nm between the planes of their rings, and form bonds between their hydroxyl groups. The formation of quercetin aggregates decreases the hydrogen bonds between quercetin and the surrounding water and produces a subdiffusive behavior in water molecules. Quercetin has a subdiffusive behavior even at infinite dilution, which increases with the number of molecules within the aggregates and the time they remain within them.

Estudio ADENI-UCI: Análisis de las decisiones de no ingreso en UCI como medida de limitación de los tratamientos de soporte vital / ADENI-UCI Study: Analysis of non-income decisions in ICU as a measure of limitation of life support treatments

Objetivo: Analizar las variables asociadas a las decisiones de rechazo al ingreso en una Unidad de Cuidados Intensivos (UCI) como medida de limitación de tratamiento de soporte vital. Diseño: Prospectivo, multicéntrico. Ámbito: Sesenta y dos UCI de España entre febrero de 2018 y marzo de 2019. Pacientes: Mayores de 18 años a los que se les negó el ingreso a una UCI como medida de limitación de tratamiento de soporte vital. Intervenciones: Ninguna. Variables de interés principals: Comorbilidades de los pacientes, situación funcional previa medida por la escala KNAUS y Karnosfky; escalas pronósticas de Lee y Charlson; gravedad del enfermo medida por las escalas APACHE II y SOFA, motivo que justifica la toma de la decisión, persona a la cual es trasmitida la información; fecha de alta o fallecimiento intrahospitalario, destino al alta hospitalaria. Resultados: Se registraron un total de 2.312 decisiones de no ingreso como medida de limitación del tratamiento de soporte vital (LTSV), de las cuales se analizaron 2.284. El principal motivo de consulta fue la insuficiencia respiratoria (1.080 [47,29%]). La pobre calidad de vida estimada de los enfermos (1.417 [62,04%]), la presencia de una enfermedad crónica grave (1.367 [59,85%]) y la limitación funcional previa de los pacientes (1.270 [55,60%]) fueron los principales motivos esgrimidos para denegar el ingreso. La tasa de mortalidad intrahospitalaria fue del 60,33%. La futilidad del tratamiento se constató como factor de riesgo asociado a mortalidad (OR: 3,23; IC 95%: 2,62-3,99). Conclusiones: Las decisiones para limitar el ingreso en UCI como medida de LTSV se basan en los mismos motivos que las decisiones tomadas dentro de la UCI. La futilidad valorada por el intensivista se relaciona adecuadamente con el resultado final de muerte (AU)

Objective: To analyze the variables associated with ICU refusal decisions as a life support treatment limitation measure. Design: Prospective, multicentrico. Scope: 62 ICU from Spain between February 2018 and March 2019. Patients: Over 18 years of age who were denied entry into ICU as a life support treatment limitation measure. Interventions: None. Main interest variables: Patient comorities, functional situation as measured by the KNAUS and Karnosfky scale; predicted scales of Lee and Charlson; severity of the sick person measured by the APACHE II and SOFA scales, which justifies the decision-making, a person to whom the information is transmitted; date of discharge or in-hospital death, destination for hospital discharge. Results: A total of 2312 non-income decisions were recorded as an LTSV measure of which 2284 were analyzed. The main reason for consultation was respiratory failure (1080 [47.29%]). The poor estimated quality of life of the sick (1417 [62.04%]), the presence of a severe chronic disease (1367 [59.85%]) and the prior functional limitation of patients (1270 [55.60%]) were the main reasons for denying admission. The in-hospital mortality rate was 60.33%. The futility of treatment was found as a risk factor associated with mortality (OR: 3.23; IC95%: 2.62-3.99). Conclusions: Decisions to limit ICU entry as an LTSV measure are based on the same reasons as decisions made within the ICU. The futility valued by the intensivist is adequately related to the final result of death (AU)

ADENI-UCI study: Analysis of non-income decisions in ICU as a measure of limitation of life support treatments.

OBJECTIVE: To analyze the variables associated with ICU refusal decisions as a life support treatment limitation measure. DESIGN: Prospective, multicentrico. SCOPE: 62 ICU from Spain between February 2018 and March 2019. PATIENTS: Over 18 years of age who were denied entry into ICU as a life support treatment limitation measure. INTERVENTIONS: None. MAIN INTEREST VARIABLES: Patient comorities, functional situation as measured by the KNAUS and Karnosfky scale; predicted scales of Lee and Charlson; severity of the sick person measured by the APACHE II and SOFA scales, which justifies the decision-making, a person to whom the information is transmitted; date of discharge or in-hospital death, destination for hospital discharge. RESULTS: A total of 2312 non-income decisions were recorded as an LTSV measure of which 2284 were analyzed. The main reason for consultation was respiratory failure (1080 [47.29%]). The poor estimated quality of life of the sick (1417 [62.04%]), the presence of a severe chronic disease (1367 [59.85%]) and the prior functional limitation of patients (1270 [55.60%]) were the main reasons for denying admission. The in-hospital mortality rate was 60.33%. The futility of treatment was found as a risk factor associated with mortality (OR: 3.23; IC95%: 2.62-3.99). CONCLUSIONS: Decisions to limit ICU entry as an LTSV measure are based on the same reasons as decisions made within the ICU. The futility valued by the intensivist is adequately related to the final result of death.

Trajectories of prenatal alcohol exposure and behavioral outcomes: Findings from a community-based sample.

OBJECTIVE: To characterize patterns of prenatal alcohol exposure (PAE), and determine whether PAE trajectories were associated with behavior from a community-based sample of first-grade children. METHODS: Using data collected as part of the Collaboration of Fetal Alcohol Spectrum Disorders Prevalence study (n = 1663), we performed longitudinal cluster analysis on prenatal alcohol use reported for four time points around conception and pregnancy. From the sample, 638 respondents reported any alcohol use in pregnancy and were included in trajectories for average daily and maximum drinks per drinking day (max DDD). We then estimated the association with behavioral problems measured by the Child Behavior Checklist (CBCL) and Teacher Report Form (TRF) with multivariable linear regression. The reference group had 1025 children with no reported PAE. RESULTS: Five trajectories were selected to describe max DDD patterns: very low/discontinuing (n = 186), low/discontinuing (n = 111), very low/continuing (n = 47), med/high (n = 245), and high (n = 49). Six trajectories best described average daily alcohol use: very low/discontinuing (n = 378), very low/continuing (n = 98), low/continuing (n = 56), low/discontinuing (n = 37), medium/high (n = 35), and high (n = 31). When assessing max DDD trajectories for both the CBCL and TRF, individuals with PAE in the two highest trajectories and the very low/continuing trajectory had more behavioral problems relative to children with no PAE, although confidence intervals for most estimates included the null. PAE modeled as average drinks per day did not predict behavior in any consistent pattern. CONCLUSIONS: In this community-based sample, select PAE trajectories were associated with behavior, even at relatively low levels of PAE that continued later in gestation.

Radiaciones ionizantes en trabajadores sanitarios: función tiroidea y niveles de riesgo de exposición laboral / Ionizing radiation in healthcare workers: thyroid function and risk levels of occupational exposure

Introducción: Uno de los sectores donde más se emplean las radiaciones ionizantes es el sanitario. Existen evidencias que sugieren que la exposición a radiaciones ionizantes podría relacionarse con alteraciones en las hormonas tiroideas. Objetivos: Analizar la posible asociación de alteraciones de hormonas tiroideas con la exposición a radiaciones ionizantes en trabajadores sanitarios según la clasificación actual con mayor probabilidad de riesgo (PER A) y menor probabilidad de riesgo (PER B), y la influencia de otros factores asociados, así como, valorar las dosimetrías personales en función de la exposición laboral en distintas zonas de trabajo según el nivel de riesgo. Material y Métodos: Estudio retrospectivo comparativo de valores de TSH, T3 y T4 en trabajadores expuestos (PER A y/o PER B) y un grupo control. Finalmente, se realizó una comparación de valores de dosimetrías personales respecto a zonas de trabajo con distintos niveles de exposición. Resultados: se halla un ligero aumento de los valores de TSH en los trabajadores PER B (2,6 ± 1,4) y PER A (2,7 ± 1,3), frente a no PER (2,4 ± 1,5) sin alcanzar significación estadística. Se ha encontrado diferencia estadísticamente significativa en las dosis quinquenales individuales de los trabajadores en relación a los niveles de exposición laboral con valores de 0,1 ± 0,3 en la zona de exposición baja y de 0,9 ± 1,4 en la zona de exposición media/alta. Conclusiones: Se evidencia la relación entre exposición laboral a radiaciones ionizantes y los valores individuales dosimétricos en trabajadores sanitarios expuestos, por lo que parece conveniente considerar también las zonas de trabajo de cara a las medidas preventivas realizadas en los trabajos con riesgo de exposición a radiaciones ionizantes. (AU)

Introduction: One of the sectors with the highest rates of use of ionizing radiations is the healthcare system. There is some evidence to suggest that exposure to ionizing radiations could be associated with alterations in thyroid hormone levels. Objectives: To analyze a possible association between the levels of thyroid hormones and the occupational exposure to ionizing radiation in healthcare workers according to the current classification of PER A (with more probability of risk of exposure) and PER B (with less probability of risk of exposure), plus the influence of other factors. To analyze the values of personal dosimeters according to the occupational exposure in the different areas of work and level of risk. Material and Methods: Retrospective comparative study of TSH, T3 and T4 in exposed healthcare workers (PER A and PER B) and control group, working from 2014 to 2019. Levels of personal dosimeters were compared in the areas classified according to the level of risk of exposure. Results: No statistically significant relationship was found between the levels of thyroid hormones and the occupational exposure to radiation in PER A, PER B, though higher levels of TSH were found in the exposed groups PER B (2,6 ± 1,4) and PER A (2,7 ± 1,3) compared to TSH levels in the control group (2,4 ± 1,5). There is a statistically significant difference between the individual five-year dose of healthcare workers and the levels of occupational exposure, with values in the areas classified according to the level of exposure with values of 0,1 ± 0,3 in the low exposure area and 0,9 ± 1,4 in the medium/high exposure area. Conclusions: There is a relationship between occupational exposure to ionizing radiations and the individual dosimetric values, thus areas of work should be considered when designing preventive measures in healthcare workers exposed to ionizing radiations. (AU)

[Approximation to the cost of occupational diseases treated in seven hospitals in Spain]. / Aproximación al coste de enfermedades profesionales atendidas en siete hospitales en España.

OBJECTIVE: To estimate the hospital cost of a sample of cases treated in seven hospitals of the National Health System in several Spanish cities. METHOD: Study based on 78 cases of occupational disease recognized by the social security, and previously treated in hospitals in Badalona, Barcelona, Ferrol, Gijón, Girona, Madrid and Vigo between 2017 and 2019. RESULTS: The healthcare activity generated by these hospitals to attend these processes involved a total cost of 282,927€. CONCLUSIONS: It is urgent to improve the coordination between the two public health systems, the social security health care system and the National Health System.

Time to a Negative SARS-CoV-2 PCR Predicts Delayed Return to Work After Medical Leave in COVID-19 Infected Health Care Workers.

OBJECTIVE: To investigate whether HCWs return to work (RTW) after COVID-19 was associated with time to a negative viral detection test. METHODS: To evaluate the association of RTW with an undetectable RT-PCR adjusting for different factors. RESULTS: Three hundred seventy-five HCWs who required medical leave for COVID-19 at a hospital in Madrid. Multivariable analyses confirmed the association of delayed RTW with interval to negative PCR (ORadj 1.12, 95% CI 1.08, 1.17) as well as age, sex, and nursing staff and clinical support services compared to physicians. A predictive model based on those variables is proposed, which had an area under the receiver operating curve of 0.82. CONCLUSIONS: Delayed RTW was associated with longer interval to a negative RT-PCR after symptom onset, adjusting for occupational category, age, and sex.

Serological study of healthcare workers in four different hospitals in Madrid (Spain) with no previous history of COVID-19.

OBJECTIVES: Healthcare workers (HCWs) have been one of the most severely affected groups during the COVID-19 pandemic, though few studies have sought to determine the rate of undiagnosed cases among this population. In this study, we aim to determine the rate of undetected infection in HCWs, a potential source of nosocomial infection. METHODS: Serological screening for IgG and IgM antibodies against SARS-CoV-2 was carried out among HCWs from four different hospitals in Madrid, Spain, from 6 April to 25 April 2020; HCWs with a previous diagnosis of infection based on real-time reverse transcriptase-PCR assay performed after presenting compatible symptoms were excluded. Prevalence of IgG and IgM antibodies was calculated among HCWs to obtain the rate of COVID-19 presence of antibodies in each hospital. RESULTS: Of the 7121 HCWs studied, 6344 (89.09%) had not been previously diagnosed with COVID-19. A total of 5995 HCWs finally participated in the study, resulting in a participation rate of 94.49%. A positive IgM or IgG test against COVID-19 was revealed in 16.21% of the HCWs studied (n=972). CONCLUSION: This study reveals the importance of early detection of SARS-CoV-2 infection among HCWs to prevent nosocomial infection and exposure of patients, visitors and workers and the spread of COVID-19 in the overall community.

Vaccination adjuvated against hepatitis B in Spanish National Healthcare System (SNS) workers typed as non-responders to conventional vaccines.

TRIAL DESIGN: An interventional, phase 4, single group assignment, without masking (open label), preventive clinical trial was carried out in health workers with biological risk in their tasks, who have been filed as non-responders to conventional vaccination against Hepatitis B. METHODS: 67 health workers with biological risk in their tasks, who have been filed as non-responders to conventional vaccination against Hepatitis B, were enrolled in the Clinical Trial. All participants were from 18 years up to 64 years old. INCLUSION CRITERIA: NHS workers -including university students doing their internships in health centres dependent on the National Health System (inclusion of students is regulated and limited by specific instructions on labour prevention in each autonomous community)- classified as non-responders. The criteria defining them as non-responders to the conventional hepatitis B vaccine is anti HBsAb titers < 10 mUI/ml following the application of six doses of conventional vaccine at 20 µg doses (two complete guidelines). The objective of this study was to provide Health workers-staff with an additional protection tool against hepatitis B infection, and to evaluate the efficacy of the adjuvanted vaccine in healthy non-responders to conventional hepatitis B vaccine. The primary outcome was the measurement of antibody antiHBs before the first Fendrix® dose and a month after the administration of each dose. Other outcome was collection of adverse effects during administration and all those that could be related to the vaccine and that occur within 30 days after each dose. In this study, only one group was assigned. There was no randomization or masking. RESULTS: The participants were recruited between April 13, 2018 and October 31, 2019. 67 participants were enrolled in the Clinical Trial and included the analyses. The primary immunisation consists of 4 separate 0.5 ml doses of Fendrix®, administered at the following schedule: 1 month, 2 months and 6 months from the date of the first dose. Once the positivity was reached in any of the doses, the participant finished the study and was not given the following doses. 68.66% (46 out 67) had a positive response to first dose of Fendrix®. 57.14% (12 out 21) had a positive response to second dose of Fendrix®. 22.22% (2 out 9) had a positive response to third dose of Fendrix and 42.96% (3 out 7) had a positive response to last dose of Fendrix®. Overall, 94.02% (64 out 67) of participants had a positive response to Fendrix®. No serious adverse event occurred. CONCLUSIONS: The use of Fendrix®, is a viable vaccine alternative for NHS workers classified as "non-responders". Revaccination of healthy non-responders with Fendrix®, resulted in very high proportions of responders without adverse events. TRIAL REGISTRATION: The trial was registered in the Spanish National Trial Register (REEC), ClinicalTrials.gov and inclusion has been stopped (identifier NCT03410953; EudraCT-number 2016-004991-23). FUNDING: GRS 1360/A/16: Call for aid for the financing of research projects in biomedicine, health management and socio-health care to be developed in the centres of the Regional Health Management of Autonomous Community of Castile-Leon. In addition, this work has been supported by the Spanish Platform for Clinical Research and Clinical Trials, SCReN (Spanish Clinical Research Network), funded by the Subdirectorate General for Research Evaluation and Promotion of the Carlos III Health Institute (ISCIII), through the project PT13/0002/0039 and project PT17/0017/0023 integrated in the State Plan for R&D&I 2013-2016 and co-financed by and the European Regional Development Fund (ERDF).

Covid-19 y su impacto en la salud y el trabajo / Covid-19: health and occupational impact

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Stereotactic body radiation therapy for liver metastasis from colorectal cancer: size matters.

PURPOSE: We analysed our initial experience with SBRT in liver metastasis from colorectal cancer at our institution. MATERIALS AND METHODS: Between January/2014 and December/2017, 22 patients with 31 LMCCR were treated. Local control (LC) was assessed using the Kaplan-Meier and log-rank tests. We analysed potential prognostic factors for LC: sex, PTV size, number of LM and the radiation scheme. RESULTS: Median age: 69 years. Prior chemotherapy or local liver treatments: 81.8% and 63.6% of patients, respectively. SBRT consisted of 3 × 20 Gy (42.9%) and 3 × 15 Gy (31.4%). There were 88.5% responses (57.1% CR and 31.4% PR). Median follow-up was 30 months. LC per lesion at 12 and 24 months was 85.3% and 61.8%, respectively. Tumour volumes > 30 cc correlated with worsened 2-year-control rates (90% vs 34.5%) (p = 0.005). There was only a patient with CTC-grade 3 toxicity. CONCLUSIONS: Liver SBRT is a safe and effective treatment that achieves high local control rates. We found a significant correlation between larger LMCRC and worse local control.

Modelos colaborativos hospitalarios de asistencia compartida e interconsultas a demanda. ¿Cuál ofrece mejores resultados en Cirugía Ortopédica y Traumatología? / Collaborative hospital models for shared care and on-demand interconsultations. Which offer the best results for Orthopaedic Surgery and Trauma?

ANTECEDENTES Y OBJETIVO: Los enfermos quirúrgicos hospitalizados están aumentando su complejidad médica, incrementando la necesidad de apoyo por Medicina Interna. Este apoyo se realiza mediante la interconsulta, la cual presenta problemas que han inducido el desarrollo de la asistencia compartida (AC). Nuestro objetivo es comparar los resultados asistenciales alcanzados por los modelos de interconsulta y AC en Cirugía Ortopédica y Traumatología. MATERIAL Y MÉTODO: Estudio observacional, prospectivo, multicéntrico, de los enfermos hospitalizados de urgencia en Cirugía Ortopédica y Traumatología recogidos en el registro REINA-SEMI, atendidos por Medicina Interna mediante interconsulta o AC. Se registraron las características demográficas, comorbilidad, complicaciones médicas, estancia hospitalaria y mortalidad. RESULTADOS: Se incluyeron 697 pacientes, 415 con AC y 282 con interconsulta. Los de AC tenían más edad (78,9 vs. 74,3; p <0,001), se operaron más (89,9 vs. 78,7%; p <0,001), tuvieron menos complicaciones médicas (50,4 vs. 62,8%; p <0,001) y su estancia hospitalaria fue menor (10 vs. 18 días; p <0,001), sin diferencias en la comorbilidad ni mortalidad. Los factores independientes asociados a estancia superior a 15 días fueron: insuficiencia cardiaca (OR: 3,4; IC 95%: 1,8-6,1; p <0,001), sexo (hombre) (OR: 1,9; IC 95%: 1,2-3,1; p = 0,004), trastorno electrolítico (OR: 2,4; IC 95%: 1,3-4,4; p = 0,003), infección respiratoria (OR: 1,9; IC 95%: 1,04-3,7; p = 0,035), demora quirúrgica (OR: 1,1; IC 95%: 1,08-1,2; p <0,001) y ser atendido mediante el modelo de interconsulta a demanda (OR: 3,5; IC 95%: 2,3-5,4; p <0,001). CONCLUSIONES: La AC ofrece mejores resultados asistenciales que las interconsultas en pacientes ingresados de urgencia en Cirugía Ortopédica y Traumatología

BACKGROUND AND OBJECTIVES: Hospitalized surgical patients are increasing in medical complexity, thereby increasing the need for support by internal medicine departments. This support is provided through interconsultations, which present problems that have resulted in the development of shared care (SC). Our objective was to compare the healthcare results achieved by the SC and interconsultation models in Orthopaedic Surgery and Trauma. MATERIALS AND METHODS: We conducted an observational, prospective, multicentre study of patients hospitalized for emergency Orthopaedic Surgery and Trauma recorded in the REINA-SEMI registry, treated by internal medicine departments through interconsultation or SC. We recorded the demographic characteristics, comorbidity, medical complications, hospital stay and mortality. RESULTS: The study included 697 patients, 415 with SC and 282 with interconsultations. The SC patients were older (78.9 vs. 74.3; P<.001) underwent more operations (89.9 vs. 78.7%; P<.001), had fewer medical complications (50.4 vs. 62.8%; P<.001) and had shorter hospital stays (10 vs. 18 days; P<.001), with no differences in comorbidity or mortality. The following independent factors were associated with stays longer than 15 days: heart failure (OR 3.4; 95% CI 1.8-6.1; P<.001), the male sex (OR 1.9; 95% CI 1.2-3.1; P=.004), electrolyte disorder (OR 2.4; 95% CI 1.3-4.4; P=.003), respiratory infection (OR 1.9; 95% CI 1.04-3.7; P=.035), surgical delay (OR 1.1; 95% CI 1.08-1.2; P<.001) and treatment using the interconsultation on demand model (OR 3.5; 95% CI 2.3-5.4; P<.001). CONCLUSIONS: SC offers better healthcare results than interconsultations for patients hospitalized for emergency Orthopaedic Surgery and Trauma

Colocación de pulseras identificativas y de grupo sanguíneo en quirófano de ortopedia / Use of identification and blood type wristbands at the orthopedic surgery operating room

OBJETIVO: determinar si es correcta la identificación a través de las pulseras identificativas y de grupo sanguíneo en los pacientes intervenidos de cirugía ortopédica. MÉTODO: estudio descriptivo transversal. La población de estudio fueron los pacientes intervenidos de cirugía ortopédica de prótesis de rodilla y cadera en el Hospital Universitario de Burgos. Técnica de recogida de los datos: observación directa. Variables de estudio: sexo; edad; tipo de cirugía; lado de la cirugía; colocación de pulseras; portador de vía venosa; canalización de vía en quirófano; calibre; retirada de las pulseras; sustitución de las pulseras; tiempo sin pulseras; vía y pulsera en el mismo brazo y planta de origen. RESULTADOS: se analizaron 153 casos. El 100% de los pacientes contaba con una pulsera identificativa y el 98% tenía pulsera de grupo sanguíneo. Fue necesario retirar por colocación incorrecta el 27% de las pulseras identificativas y el 29% de las de grupo sanguíneo; todas fueron sustituidas. La media del tiempo que el paciente pasó en el quirófano sin pulsera con datos personales fue de 51,62 minutos y sin la pulsera de grupo sanguíneo de 50,36 minutos. CONCLUSIONES: la gran mayoría de los pacientes se encontraban correctamente identificados a través de las dos pulseras, aunque por necesidades de la cirugía en algunos casos debían retirarse quedando los pacientes sin identificar durante aproximadamente una hora. La comunicación e información con las enfermeras resulta fundamental para mejorar la calidad de los cuidados y la seguridad del enfermo

OBJECTIVE: to determine if there is an adequate use of identification and blood type wristbands in patients undergoing ortophedic surgery. METHOD: a cross-sectional descriptive study. The study population consisted of patients who had undergone orthopedic surgery for knee and hip prosthesis at the Hospital Universitario de Burgos. Data collection technique: direct observation. Study variables: gender, age, type of surgery, side of surgery, wristband placement, central venous line, IV line catheterization at the operating room, gauge, wristband removal, wristband replacement, time without wristbands, IV line and wristband in the same arm, and ward of origin. RESULTS: the study analyzed 153 cases; 100% of patients had an identification wristband, and 98% had blood type wristbands. It was necessary to remove 27% of the identification wristbands and 29% of the blood type wristbands due to incorrect placement; all of them were replaced. The mean time that the patient stayed at the operating room without a personal data wristband was 51.62 minutes, and 50.36 minutes without blood type wristband. CONCLUSIONS: the vast majority of patients were adequately identified through the two wristbands; though, for surgical requirements, in some cases these had to be removed, and patients were unidentified during approximately one hour. Communication and information with nurses becomes essential in order to improve the quality of care and patient safety

ADENI-UCI Study: Analysis of non-income decisions in ICU as a measure of limitation of life support treatments. / Estudio ADENI-UCI: Análisis de las decisiones de no ingreso en UCI como medida de limitación de los tratamientos de soporte vital.

OBJECTIVE: To analyze the variables associated with ICU refusal decisions as a life support treatment limitation measure. DESIGN: Prospective, multicentrico SCOPE: 62 ICU from Spain between February 2018 and March 2019. PATIENTS: Over 18 years of age who were denied entry into ICU as a life support treatment limitation measure. INTERVENTIONS: None. MAIN INTEREST VARIABLES: Patient comorities, functional situation as measured by the KNAUS and Karnosfky scale; predicted scales of Lee and Charlson; severity of the sick person measured by the APACHE II and SOFA scales, which justifies the decision-making, a person to whom the information is transmitted; date of discharge or in-hospital death, destination for hospital discharge. RESULTS: A total of 2312 non-income decisions were recorded as an LTSV measure of which 2284 were analyzed. The main reason for consultation was respiratory failure (1080 [47.29%]). The poor estimated quality of life of the sick (1417 [62.04%]), the presence of a severe chronic disease (1367 [59.85%]) and the prior functional limitation of patients (1270 [55.60%]) were the main reasons for denying admission. The in-hospital mortality rate was 60.33%. The futility of treatment was found as a risk factor associated with mortality (OR: 3.23; IC95%: 2.62-3.99). CONCLUSIONS: Decisions to limit ICU entry as an LTSV measure are based on the same reasons as decisions made within the ICU. The futility valued by the intensivist is adequately related to the final result of death.