Effects of the active botanical blend "WKUP GT" on attention and cognitive functions after lunch in healthy volunteers.

OBJECTIVES: "WKUP GT", a low caffeine beverage consisting of carob, Guarana, Green Tea and Elderberry extracts was studied on attention and cognitive functions post-lunch in a pilot randomized double blind placebo controlled trial. METHODS: Thirty healthy volunteers were included in a crossover design trial, presenting five beverages randomly assigned to the following groups: placebo, "WKUP GT" (single, double or triple doses), or "caffeine" as an active control. Hemodynamic measurements were assessed as safety outcomes. The Cambridge Neuropsychological Test Automated Battery (CANTAB), was used to evaluate the patients when beverages were consumed 30 and 120 min after lunch (respectively Delta30 and Delta120 considering baseline). RESULTS: Drinking "caffeine" or "WKUP GT" after lunch, showed significant improvement (p < 0.05) in rapid visual information processing compared to placebo (Delta120 of "caffeine", "WKUP" single and double). In addition, improvement in Multitasking Test (Delta30 for "WKUP" double, and Delta120 for "caffeine" and "WKUP" triple compared to placebo) was observed. "WKUP" triple also showed significant improvement for "memory" when compared to placebo (Delta120). Compared to "caffeine", WKUP GT did not increase systolic blood pressure. CONCLUSION: "WKUP GT" showed improvements for attention, memory, psychomotor and executive function tasks after lunch without increase in pulse rate.

Cambios en la dermatoscopia digital en lesiones melanocíticas en 368 pacientes con diagnóstico de síndrome de nevus atípicos y su asociación con el desarrollo de melanoma: estudio de cohorte / Dermoscopic Changes in Melanocytic Lesions in 368 Patients With Atypical Nevus Syndrome and Their Association With Melanoma Incidence: A Cohort Study

Antecedentes y objetivo El síndrome de nevus atípico se ha considerado uno de los factores más importantes para el desarrollo de melanoma. El objetivo de este estudio fue describir los cambios dermatoscópicos de las lesiones melanocíticas en pacientes con diagnóstico de síndrome de nevus atípicos, durante el seguimiento digital en 5 años. Material y métodos Se realizó un estudio retrospectivo de seguimiento a una cohorte de pacientes atendidos en un consultorio particular, especializado en cáncer de piel y mapeo digital corporal, localizado en Medellín (Colombia), entre enero de 2017 y diciembre de 2022. Se analizaron las características dermatoscópicas encontradas y su relación con el diagnóstico de un melanoma. Resultados Se incluyeron 368 pacientes, con una mediana de edad de 43 años RIQ (37-51) de los cuales,187 fueron mujeres. Al finalizar el seguimiento, 222 (60,3%) presentaron red atípica, 163 (44,2%) glóbulos asimétricos, 105 (28,5%) regresión blanco gris, 72 (19,5%) regresión de la lesión, 59 (16%) retículo invertido, 28 (7,6%) pigmento excéntrico asimétrico, 21 (5,7%) proyecciones asimétricas y 8 (2,1%) asimetría en el patrón vascular. A los 60 meses de seguimiento a un 12,2% se les diagnosticó un melanoma. Las áreas blanco-grisáceas, los glóbulos asimétricos, el pigmento excéntrico asimétrico y el retículo invertido fueron las estructuras dermatoscópicas que se relacionaron significativamente con un tiempo menor para la presentación de melanoma (p<0,001, p=0,011, p=0,047 y p=0,001, respectivamente). Conclusiones En conclusión, se encontró que las principales características dermatoscópicas de las lesiones melanocíticas en pacientes con nevus displásicos relacionadas con la progresión a melanoma fueron la aparición de áreas blanco-grisáceas, los glóbulos asimétricos, las manchas asimétricas y el retículo invertido (AU)

Background and objective Atypical nevus syndrome has been described as one of the main risk factors for melanoma. The aim of this study was to analyze dermoscopic changes observed in melanocytic lesions over a follow-up period of 5 years in patients with atypical nevus syndrome. Material and methods We conducted a retrospective follow-up study of a cohort of patients seen at a specialized skin cancer and digital body mapping clinic in Medellin, Colombia, between January 2017 and December 2022. We analyzed the dermoscopic changes observed during this period and explored their association with newly diagnosed melanoma. Results A total of 368 patients (187 women) with a median (interquartile range) age of 43 (37-51) years were included. The dermoscopic features observed at 5 years were an atypical network (222 patients, 60.3%), asymmetric globules (163, 44.2%), white-gray regression areas (105, 28.5%), lesion regression (72, 19.5%), a negative pigment network (59, 16%), asymmetric eccentric pigmentation (28, 7.6%), asymmetric projections (21, 5.7%), and asymmetric vascular patterns (8, 2.1%). Melanoma was diagnosed in 12.2% of patients during follow-up. Features significantly associated with a shorter time to melanoma onset were grayish-white areas (P <.001), asymmetric globules (P=.011), asymmetric eccentric pigmentation (P=.047), and a negative pigment network (P=.001). Conclusions The main dermoscopic features of melanocytic lesions in patients with atypical nevus syndrome associated with progression to melanoma were grayish-white areas, asymmetric globules, asymmetric spots, and a negative pigment network (AU)

[Translated article] Dermoscopic Changes in Melanocytic Lesions in 368 Patients With Atypical Nevus Syndrome and Their Association With Melanoma Incidence: A Cohort Study / Cambios en la dermatoscopia digital en lesiones melanocíticas en 368 pacientes con diagnóstico de síndrome de nevus atípicos y su asociación con el desarrollo de melanoma: estudio de cohorte

Background and objective Atypical nevus syndrome has been described as one of the main risk factors for melanoma. The aim of this study was to analyze dermoscopic changes observed in melanocytic lesions over a follow-up period of 5 years in patients with atypical nevus syndrome. Material and methods We conducted a retrospective follow-up study of a cohort of patients seen at a specialized skin cancer and digital body mapping clinic in Medellin, Colombia, between January 2017 and December 2022. We analyzed the dermoscopic changes observed during this period and explored their association with newly diagnosed melanoma. Results A total of 368 patients (187 women) with a median (interquartile range) age of 43 (37-51) years were included. The dermoscopic features observed at 5 years were an atypical network (222 patients, 60.3%), asymmetric globules (163, 44.2%), white-gray regression areas (105, 28.5%), lesion regression (72, 19.5%), a negative pigment network (59, 16%), asymmetric eccentric pigmentation (28, 7.6%), asymmetric projections (21, 5.7%), and asymmetric vascular patterns (8, 2.1%). Melanoma was diagnosed in 12.2% of patients during follow-up. Features significantly associated with a shorter time to melanoma onset were grayish-white areas (P <.001), asymmetric globules (P=.011), asymmetric eccentric pigmentation (P=.047), and a negative pigment network (P=.001). Conclusions The main dermoscopic features of melanocytic lesions in patients with atypical nevus syndrome associated with progression to melanoma were grayish-white areas, asymmetric globules, asymmetric spots, and a negative pigment network (AU)

Antecedentes y objetivo El síndrome de nevus atípico se ha considerado uno de los factores más importantes para el desarrollo de melanoma. El objetivo de este estudio fue describir los cambios dermatoscópicos de las lesiones melanocíticas en pacientes con diagnóstico de síndrome de nevus atípicos, durante el seguimiento digital en 5 años. Material y métodos Se realizó un estudio retrospectivo de seguimiento a una cohorte de pacientes atendidos en un consultorio particular, especializado en cáncer de piel y mapeo digital corporal, localizado en Medellín (Colombia), entre enero de 2017 y diciembre de 2022. Se analizaron las características dermatoscópicas encontradas y su relación con el diagnóstico de un melanoma. Resultados Se incluyeron 368 pacientes, con una mediana de edad de 43 años RIQ (37-51) de los cuales,187 fueron mujeres. Al finalizar el seguimiento, 222 (60,3%) presentaron red atípica, 163 (44,2%) glóbulos asimétricos, 105 (28,5%) regresión blanco gris, 72 (19,5%) regresión de la lesión, 59 (16%) retículo invertido, 28 (7,6%) pigmento excéntrico asimétrico, 21 (5,7%) proyecciones asimétricas y 8 (2,1%) asimetría en el patrón vascular. A los 60 meses de seguimiento a un 12,2% se les diagnosticó un melanoma. Las áreas blanco-grisáceas, los glóbulos asimétricos, el pigmento excéntrico asimétrico y el retículo invertido fueron las estructuras dermatoscópicas que se relacionaron significativamente con un tiempo menor para la presentación de melanoma (p<0,001, p=0,011, p=0,047 y p=0,001, respectivamente). Conclusiones En conclusión, se encontró que las principales características dermatoscópicas de las lesiones melanocíticas en pacientes con nevus displásicos relacionadas con la progresión a melanoma fueron la aparición de áreas blanco-grisáceas, los glóbulos asimétricos, las manchas asimétricas y el retículo invertido (AU)

Dermoscopic Changes in Melanocytic Lesions in 368 Patients With Atypical Nevus Syndrome and Their Association With Melanoma Incidence: A Cohort Study. / Cambios en la dermatoscopia digital en lesiones melanocíticas en 368 pacientes con diagnóstico de síndrome de nevus atípicos y su asociación con el desarrollo de melanoma: estudio de cohorte.

BACKGROUND AND OBJECTIVE: Atypical nevus syndrome has been described as one of the main risk factors for melanoma. The aim of this study was to analyze dermoscopic changes observed in melanocytic lesions over a follow-up period of 5 years in patients with atypical nevus syndrome. MATERIAL AND METHODS: We conducted a retrospective follow-up study of a cohort of patients seen at a specialized skin cancer and digital body mapping clinic in Medellin, Colombia, between January 2017 and December 2022. We analyzed the dermoscopic changes observed during this period and explored their association with newly diagnosed melanoma. RESULTS: A total of 368 patients (187 women) with a median (interquartile range) age of 43 (37-51) years were included. The dermoscopic features observed at 5 years were an atypical network (222 patients, 60.3%), asymmetric globules (163, 44.2%), white-gray regression areas (105, 28.5%), lesion regression (72, 19.5%), a negative pigment network (59, 16%), asymmetric eccentric pigmentation (28, 7.6%), asymmetric projections (21, 5.7%), and asymmetric vascular patterns (8, 2.1%). Melanoma was diagnosed in 12.2% of patients during follow-up. Features significantly associated with a shorter time to melanoma onset were grayish-white areas (P <.001), asymmetric globules (P=.011), asymmetric eccentric pigmentation (P=.047), and a negative pigment network (P=.001). CONCLUSIONS: The main dermoscopic features of melanocytic lesions in patients with atypical nevus syndrome associated with progression to melanoma were grayish-white areas, asymmetric globules, asymmetric spots, and a negative pigment network.

[Translated article] Dermoscopic Changes in Melanocytic Lesions in 368 Patients With Atypical Nevus Syndrome and Their Association With Melanoma Incidence: A Cohort Study.

BACKGROUND AND OBJECTIVE: Atypical nevus syndrome has been described as one of the main risk factors for melanoma. The aim of this study was to analyze dermoscopic changes observed in melanocytic lesions over a follow-up period of 5 years in patients with atypical nevus syndrome. MATERIAL AND METHODS: We conducted a retrospective follow-up study of a cohort of patients seen at a specialized skin cancer and digital body mapping clinic in Medellin, Colombia, between January 2017 and December 2022. We analyzed the dermoscopic changes observed during this period and explored their association with newly diagnosed melanoma. RESULTS: A total of 368 patients (187 women) with a median (interquartile range) age of 43 (37-51) years were included. The dermoscopic features observed at 5 years were an atypical network (222 patients, 60.3%), asymmetric globules (163, 44.2%), white-gray regression areas (105, 28.5%), lesion regression (72, 19.5%), a negative pigment network (59, 16%), asymmetric eccentric pigmentation (28, 7.6%), asymmetric projections (21, 5.7%), and asymmetric vascular patterns (8, 2.1%). Melanoma was diagnosed in 12.2% of patients during follow-up. Features significantly associated with a shorter time to melanoma onset were grayish-white areas (P<.001), asymmetric globules (P=.011), asymmetric eccentric pigmentation (P=.047), and a negative pigment network (P=.001). CONCLUSIONS: The main dermoscopic features of melanocytic lesions in patients with atypical nevus syndrome associated with progression to melanoma were grayish-white areas, asymmetric globules, asymmetric spots, and a negative pigment network.

[Multidrug resistant narcolepsy]. / Narcolepsia multirresistente.

INTRODUCTION: Narcolepsy type 1 is a focal degenerative disease of the hypothalamus that selectively affects orexin (hypocretin)-producing neurons. It presents multiple clinical manifestations, both in wakefulness and in sleep. The symptoms are often so disruptive that they cause enormous suffering and impair patients' quality of life. Although a non-pharmacological approach is sometimes sufficient, the vast majority of patients need medication for adequate clinical management. CASE REPORT: A male who, at 43 years of age, began to present acutely with excessive daytime sleepiness and episodes of cataplexy. After a thorough examination, he was diagnosed with narcolepsy type 1. Throughout the course of the disease, he was prescribed antidepressants, neurostimulants and sodium oxybate, in monotherapy or in combination. The response to pharmacological treatment was insufficient and accompanied by numerous side effects. Following the introduction of pitolisant, there was a marked improvement in his symptoms and a reduction in the dose of the other drugs and their adverse effects was achieved. CONCLUSION: A number of measures are now available to address the cardinal symptoms of the disease, although there are still cases that are resistant to anti-narcoleptic treatment. Drugs with mechanisms of action that act upon receptors in the histaminergic system can be very useful in these cases.

TITLE: Narcolepsia multirresistente.Introducción. La narcolepsia de tipo 1 es una enfermedad degenerativa focal del hipotálamo que afecta selectivamente a las neuronas productoras de orexina (hipocretina). Presenta múltiples manifestaciones clínicas, tanto en vigilia como en sueño. Con frecuencia, los síntomas son tan disruptivos que ocasionan enorme sufrimiento y deterioro de la calidad de vida de los pacientes. Aunque en ocasiones es suficiente con un abordaje no farmacológico, la gran mayoría de los enfermos necesita medicación para un adecuado control clínico. Caso clínico. Varón que a los 43 años comenzó a presentar de forma aguda excesiva somnolencia diurna y episodios de cataplejía. Tras un exhaustivo estudio se le diagnosticó narcolepsia de tipo 1. A lo largo de la evolución de la enfermedad se le prescribieron antidepresivos, neuroestimulantes y oxibato sódico, en monoterapia o en combinación. La respuesta al tratamiento farmacológico fue insuficiente y se acompañó de numerosos efectos secundarios. Tras la introducción de pitolisant se objetivó una franca mejoría de los síntomas, y se consiguió reducir la dosis de los otros fármacos y de sus efectos adversos. Conclusión. Son numerosas las medidas disponibles en la actualidad para abordar los síntomas cardinales de la enfermedad, aunque siguen existiendo casos resistentes al tratamiento antinarcoléptico. Los fármacos con mecanismos de acción sobre receptores del sistema histaminérgico pueden resultar de gran utilidad en estos casos.

[Recommendations for thromboembolic disease in oncological processes. A view from primary care]. / Recomendaciones sobre enfermedad tromboembólica venosa en procesos oncológicos. Una visión desde la medicina de familia.

Venous thromboembolic disease (VTE) is a frequent complication in patients diagnosed with cancer and a cause of morbidity and mortality. Approximately 20% of thromboembolic episodes develop in association with active cancer. On the other hand, it is estimated that about 2-12% of cases, the thromboembolic episode is the first manifestation of an occult cancer, diagnosed at that time or subsequently, which offers an opportunity for early diagnosis and treatment. There are multiple factors that contribute to increase the risk of VTE in oncological patients in relation to specific characteristics of the patient, the tumor and the treatments. Knowledge of these risk factors will contribute to early diagnosis when signs of VTE appear, as well as the assessment of thromboprophylaxis if indicated. The diagnosis of VTE in patients with cancer does not differ of those who do not suffer from it. Regarding the treatment of VTE in these patients, low molecular weight heparin (LMWH), direct acting anticoagulants (DACs) and antivitamin K (VKA) are the most commonly used, although the dosing regimen and length are not clear yet. The management of these patients should be interdisciplinary and early, so the primary care physician plays a key role in this process as he/she is liaise with his/her patients. It is also necessary to update knowledge in order to improve the care of these patients. For these reasons, this document has been prepared by the Working Group on Vasculopathies of the Spanish Society of Primary Care Physicians (SEMERGEN) whose objective is to present the available information regarding the management of VTE that may appear in oncological patients, as well as the assessment of thromboprophylaxis and treatment, if appropriate, from an approach focused on a primary care field.

Valoración multidisciplinar de las secuelas al mes del alta hospitalaria por neumonía grave COVID-19, ¿existen diferencias en función de la terapia respiratoria empleada durante su ingreso en Cuidados Intensivos? / Multidisciplinary approach of the sequelae one month after hospital discharge in patients with severe bilateral COVID-19 pneumonia, are there differences depending on the respiratory therapy used during admission to intensive care?

Objetivo Describir las secuelas al mes del alta hospitalaria en pacientes que precisaron ingreso en Cuidados Intensivos por neumonía grave COVID-19 y analizar las diferencias entre los que recibieron terapia exclusivamente con oxigenoterapia con alto flujo con respecto a los que precisaron ventilación mecánica invasiva (VMI). Diseño Estudio de cohorte, prospectivo y observacional. Ámbito Consulta multidisciplinar pos Cuidados Intensivos. Pacientes o participantes Pacientes que superaron el ingreso en la Unidad de Cuidados Intensivos (UCI) por neumonía grave COVID-19 desde abril 2020 hasta octubre 2021. Intervenciones Inclusión en el programa multidisciplinar pos UCI. Variables de interés principales Secuelas motoras, sensitivas, psicológicas/psiquiátricas, respiratorias y nutricionales tras el ingreso hospitalario. Resultados Se incluyeron 104 pacientes. 48 pacientes recibieron oxigenoterapia nasal de alto flujo (ONAF) y 56 VMI. Las principales secuelas encontradas fueron la neuropatía distal (33,9% VMI vs. 10,4% ONAF); plexopatía braquial (10,7% VMI vs. 0% ONAF); disminución de fuerza de agarre: mano derecha 20,67 kg (± 8,27) en VMI vs. 31,8 kg (± 11,59) en ONAF y mano izquierda 19,39 kg (± 8,45) en VMI vs. 30,26 kg (± 12,74) en ONAF; y balance muscular limitado en miembros inferiores (28,6% VMI vs. 8,6% ONAF). Las diferencias observadas entre ambos grupos no alcanzaron significación estadística en el estudio multivariable. Conclusiones Los resultados obtenidos tras el estudio multivariable sugieren no existir diferencias en cuanto a las secuelas físicas percibidas al mes del alta hospitalaria en función de la terapia respiratoria empleada, ya fuera ONAF o ventilación mecánica prolongada, si bien son precisos más estudios para poder obtener conclusiones al respecto (AU)

Objective To describe the sequelae one month after hospital discharge in patients who required admission to intensive care for severe COVID-19 pneumonia and to analyze the differences between those who received therapy exclusively with high-flow oxygen therapy compared to those who required invasive mechanical ventilation. Design Cohort, prospective and observational study. Setting Post-intensive care multidisciplinary program. Patients or participants Patients who survived admission to the intensive care unit (ICU) for severe COVID-19 pneumonia from April 2020 to October 2021. Interventions Inclusion in the post-ICU multidisciplinary program. Main variables of interest Motor, sensory, psychological/psychiatric, respiratory and nutritional sequelae after hospital admission. Results One hundred and four patients were included. 48 patients received high-flow nasal oxygen therapy (ONAF) and 56 invasive mechanical ventilation (IMV). The main sequelae found were distal neuropathy (33.9% IMV vs. 10.4% ONAF); brachial plexopathy (10.7% IMV vs. 0% ONAF); decrease in grip strength: right hand 20.67 kg (± 8.27) in VMI vs. 31.8 kg (± 11.59) in ONAF and left hand 19.39 kg (± 8.45) in VMI vs. 30.26 kg (± 12.74) in ONAF; and limited muscle balance in the lower limbs (28.6% VMI vs. 8.6% ONAF). The differences observed between both groups did not reach statistical significance in the multivariable study. Conclusions The results obtained after the multivariate study suggest that there are no differences in the perceived physical sequelae one month after hospital discharge depending on the respiratory therapy used, whether it was high-flow nasal oxygen therapy or prolonged mechanical ventilation, although more studies are needed to be able to draw conclusions (AU)

Multidisciplinary approach of the sequelae one month after hospital discharge in patients with severe bilateral COVID-19 pneumonia, are there differences depending on the respiratory therapy used during admission to intensive care?

OBJECTIVE: To describe the sequelae one month after hospital discharge in patients who required admission to Intensive Care for severe COVID 19 pneumonia and to analyze the differences between those who received therapy exclusively with high-flow oxygen therapy compared to those who required invasive mechanical ventilation. DESIGN: Cohort, prospective and observational study. SETTING: Post-intensive care multidisciplinary program. PATIENTS OR PARTICIPANTS: Patients who survived admission to the intensive care unit (ICU) for severe COVID 19 pneumonia from April 2020 to October 2021. INTERVENTIONS: Inclusion in the post-ICU multidisciplinary program. MAIN VARIABLES OF INTEREST: Motor, sensory, psychological/psychiatric, respiratory and nutritional sequelae after hospital admission. RESULTS: 104 patients were included. 48 patients received high-flow nasal oxygen therapy (ONAF) and 56 invasive mechanical ventilation (IMV). The main sequelae found were distal neuropathy (33.9% IMV vs 10.4% ONAF); brachial plexopathy (10.7% IMV vs 0% ONAF); decrease in grip strength: right hand 20.67kg (±8.27) in VMI vs 31.8kg (±11.59) in ONAF and left hand 19.39kg (±8.45) in VMI vs 30.26kg (±12.74) in ONAF; and limited muscle balance in the lower limbs (28.6% VMI vs 8.6% ONAF). The differences observed between both groups did not reach statistical significance in the multivariable study. CONCLUSIONS: The results obtained after the multivariate study suggest that there are no differences in the perceived physical sequelae one month after hospital discharge depending on the respiratory therapy used, whether it was high-flow nasal oxygen therapy or prolonged mechanical ventilation, although more studies are needed to be able to draw conclusions.

[Multidisciplinary approach of the sequelae one month after hospital discharge in patients with severe bilateral COVID-19 pneumonia, are there differences depending on the respiratory therapy used during admission to intensive care?] / Valoración multidisciplinar de las secuelas al mes del alta hospitalaria por neumonía grave COVID-19, ¿existen diferencias en función de la terapia respiratoria empleada durante su ingreso en Cuidados Intensivos?

Objective: To describe the sequelae one month after hospital discharge in patients who required admission to intensive care for severe COVID-19 pneumonia and to analyze the differences between those who received therapy exclusively with high-flow oxygen therapy compared to those who required invasive mechanical ventilation. Design: Cohort, prospective and observational study. Setting: Post-intensive care multidisciplinary program. Patients or participants: Patients who survived admission to the intensive care unit (ICU) for severe COVID-19 pneumonia from April 2020 to October 2021. Interventions: Inclusion in the post-ICU multidisciplinary program. Main variables of interest: Motor, sensory, psychological/psychiatric, respiratory and nutritional sequelae after hospital admission. Results: One hundred and four patients were included. 48 patients received high-flow nasal oxygen therapy (ONAF) and 56 invasive mechanical ventilation (IMV). The main sequelae found were distal neuropathy (33.9% IMV vs. 10.4% ONAF); brachial plexopathy (10.7% IMV vs. 0% ONAF); decrease in grip strength: right hand 20.67 kg (± 8.27) in VMI vs. 31.8 kg (± 11.59) in ONAF and left hand 19.39 kg (± 8.45) in VMI vs. 30.26 kg (± 12.74) in ONAF; and limited muscle balance in the lower limbs (28.6% VMI vs. 8.6% ONAF). The differences observed between both groups did not reach statistical significance in the multivariable study. Conclusions: The results obtained after the multivariate study suggest that there are no differences in the perceived physical sequelae one month after hospital discharge depending on the respiratory therapy used, whether it was high-flow nasal oxygen therapy or prolonged mechanical ventilation, although more studies are needed to be able to draw conclusions.

Calcifying aponeurotic fibroma: Radiologic-pathologic analysis of ten cases and review of the literature.

Calcifying aponeurotic fibroma (CAF) is a very rare benign entity that principally affects the volar fascia, tendons, and aponeuroses of the hands and feet with a peak incidence of between 5 and 15 years, although there have been cases found for a wide age range and at various anatomical sites. We present ten CAF cases; consisting of eight children and two adults. CAF occurred in the extremities in nine of the cases and in the chest wall in one case. CAF ultrasound and radiological findings are nonspecific but may help orientate diagnosis. Magnetic resonance imaging should be performed when there are doubtful cases, when occurring in nontypical sites, and when there are cases of nontypical clinical presentation. Histologically, all cases showed two components, a fibromatosis-like component and a nodular component. Chondroid areas were present in five cases. Calcifications were observed in nine cases. ERG immunostaining showed the same patterns in all the cases; diffuse positivity in pericalcified areas, and patchy positivity in areas away from calcifications. CAF has distinctive histopathological features which should aid in the differential diagnoses with other entities.

Efficacy of Antiresorptive Treatment in Osteoporotic Older Adults: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.

OBJECTIVES: To investigate concerns surrounding the benefits of antiresorptive drugs in older adults, a systematic review was carried out to evaluate the efficacy of these treatments in the prevention of osteoporotic hip fractures in older adults. DESIGN: a systematic review and meta-analysis of randomized clinical trials. SETTING AND PARTICIPANTS: older adults ≥65 years with osteoporosis, with or without a previous fragility fracture. Studies with cancer-related and corticosteroid-induced osteoporosis, participants <65 years and no reported hip fracture were not included. METHODS: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, ISI Web of Science and Scopus databases were searched. The primary outcome was hip fracture, and subgroup analysis (≥75 years, with different drug types and secondary prevention) and sensitivity analysis was carried out using a GRADE evaluation. Secondary outcomes were any type of fractures, vertebral fracture, bone markers and adverse events. The risk of bias was assessment with the Cochrane risk of bias tool. RESULTS: A total of 12 randomised controlled trials (RCTs) qualified for this meta-analysis, with 36,196 participants. Antiresorptive drugs have a statistically significant effect on the prevention of hip fracture (RR=0.70; 95%CI 0.60 to 0.81), but with a moderate GRADE quality of evidence and a high number needed to treat (NNT) of 186. For other outcomes, there is a statistically significant effect, but with a low to moderate quality of evidence. Antiresorptives showed no reduction in the risk of hip fracture in people ≥75 years. The results for different drug types, secondary prevention and sensitivity analysis are similar to the main analyses and have the same concerns. CONCLUSIONS: Antiresorptive drugs have a statistically significant effect on preventing hip fracture but with a moderate quality (unclear/high risk of bias) and high NNT (186). This small benefit disappears in those ≥75 years, but increases in secondary prevention. More RCTs in very old osteoporotic adults are needed.

Realidad virtual de bajo coste. Una nueva aplicación para rehabilitación motora de los miembros superiores en patología neurológica: Estudio piloto / Low-cost virtual reality. A new application for upper extremity motor rehabilitation in neurological pathology: Pilot study

Antecedentes y objetivo: El objetivo de este estudio es presentar una nueva aplicación de realidad virtual (RV) de bajo coste basada en el dispositivo Leap Motion Controller (LMC) desarrollada para la rehabilitación motora de miembros superiores tras patología neurológica y mostrar su viabilidad clínica realizando una experiencia piloto. Material y métodos: El LMC permite la interacción con las aplicaciones virtuales mediante la captación de los movimientos de la mano. Se realizó una prueba piloto con cuatro pacientes con afectación de miembros superiores con Upper Extremity Motor Score (UEMS) mayor de 10. Se les valoró con los test Box and Block (BBT) y tarea de escritura del Jebsen-Taylor Hand Function (JTHF) antes y después de la intervención. Resultados: Los pacientes completaron el protocolo de nueve sesiones de 30 minutos de duración dividido en tres sesiones por semana. En el BBT pasaron de 38 (DE 20) cubos antes de la intervención a 44 (DE 21,72) cubos tras finalizarla. En el JTHF pasaron de 28,25 s (DE 8,61) a 26, 75 s (DE 21,72). No hubo diferencias estadísticamente significativas. La usabilidad del dispositivo se valoró con la escala Quebec User Evaluation of Satisfaction with assistive Technology, versión 2.0 (QUEST) siendo la seguridad, efectividad y facilidad de uso los aspectos prioritarios. Conclusión: Se presenta un nuevo desarrollo de RV basado en el dispositivo LMC y se ha comprobado su viabilidad clínica en pacientes neurológicos con afectación de los miembros superiores. Es preciso realizar un estudio clínico con una muestra amplia para valorar su posible efectividad clínica como elemento de tratamiento.(AU)

Background and objectives: The aim of this study is to present a new virtual reality (VR) low cost application based on Leap Motion Controller (LMC) device for upper extremity motor rehabilitation after neurological pathology and to demonstrate its clinical feasibility by carrying out a pilot experience. Material and methods: The LMC allows the interaction with virtual applications by capturing the patient's hand movements. A pilot study was carried out with 4 patients with upper limb impairment reflected with Upper Extremity Motor Score (UEMS) greater than 10. They were assessed using the Box and Block (BBT) and the writing task within the Jebsen-Taylor Hand Function (JTHF) before and after the intervention. Results: All patients completed the 9-session, 30-min protocol divided into 3 sessions per week. They went from an average result of 38 (SD 20) blocks in BBT before the intervention to 44 (SD 21.72) after it. They went from 28.25 s (SD 8.61) to 26.75 s (SD 21.72) in the JTHF. Statistically significant differences were no found. The device usability was assessed by the QUEST scale, being the security, effectiveness and ease to use the aspects that patients considered to be a priority. Conclusión: A new VR development based on the LMC device is presented and the clinical feasibility of its application in neurological patients with upper limb involvement has been proven. A clinical study with a large sample size is needed to assess its potential clinical effectiveness as a treatment element.(AU)

Evaluation of Expanded Criteria Donors Using the Kidney Donor Profile Index and the Preimplantation Renal Biopsy.

The increasing comorbidity of kidney transplant (KT) donors make it necessary to develop scores to correctly assess the quality of kidney grafts. This study analyzes the usefulness of the preimplantation biopsy and the Kidney Donor Profile Index (KDPI) as indicators of KT survival from expanded criteria donors (ECD). Retrospective study of KT in our center between January 2010 to June 2019 who received a kidney from an ECD and underwent a preimplantation biopsy. 266 KT were included. Graft survival was categorized by KDPI quartiles: Q1 = 86%, Q2 = 95%, Q3 = 99% and Q4 = 100%. KT from KDPI Q1 presented better survival (p = 0.003) and Q4 donors had worse renal function (p = 0.018) and poorer glomerular filtration rate (3rd month; p = 0.017, 1st year; p = 0.010). KT survival was analyzed according to KDPI quartile and preimplantation biopsy score simultaneously: Q1 donors with biopsy score ≤3 had the best survival, especially comparing against Q3 with a biopsy score >3 and Q4 donors (p = 0.014). In multivariable analysis, hyaline arteriopathy, glomerulosclerosis, and KDPI Q4 were predictors for graft survival. High KDPI and a greater histological injury in the preimplantation biopsy, especially glomerular and vascular lesions, were related to a higher rate of KT loss from ECD.

Impacto de la formación en pacientes con diabetes y/o hipertensión para la prevención de la enfermedad renal y cardiovascular en el ámbito de Atención Primaria / Impact of training in patients with diabetes and/or hypertension for the prevention of renal and cardiovascular disease in primary care

Introducción: La prevalencia de la enfermedad renal crónica (ERC) ha aumentado a nivel global (8-16%), debido principalmente a la incidencia de diabetes mellitus tipo 2 (DM2) y de hipertensión arterial (HTA). La educación o formación de los pacientes con enfermedades crónicas se considera una herramienta fundamental para prevenir el empeoramiento de estas. Objetivos: 1) Determinar si la asistencia a la formación de pacientes con hipertensión y/o diabetes, influye en la progresión o el desarrollo del deterioro de la función renal. 2) Valorar la asociación de la función renal con HTA, DM2 y la aparición de eventos cardiovasculares, analizando la influencia del grado de control de la presión arterial (PA) y la hemoglobina glicada (HbA1c). 3) Estudiar la aparición de eventos cardiovasculares. Material y métodos: Estudio observacional analítico de cohortes retrospectivo llevado a cabo en un Centro de Salud de Leganés, Madrid, utilizando bases de datos de pacientes con hipertensión, diabetes y ambas patologías a la vez (n = 200), asistentes o no a la formación del equipo médico durante los años 2017 a 2019. Resultados: Recibieron formación 120 de 200 pacientes (67,5% mujeres). Sólo en estos se observó una mejoría de la función renal acompañada de una reducción de las cifras de presión arterial (PA) y HbA1c, donde se apreció un mejor control y seguimiento de la enfermedad, siendo más destacada en pacientes con una sola patología, especialmente aquellos con hipertensión. Conclusiones: La formación de los pacientes resultó beneficiosa para prevenir el deterioro de la función renal, mediante la reducción de las cifras de PA y HbA1c, y fue más evidente en aquellos que partieron de un peor control de ambas. Se demostró la asociación de la evolución de la función renal con HTA y DM2 (AU)

Introduction: The prevalence of chronic kidney disease has increased globally (8–16%), mainly due to the incidence of type 2 diabetes mellitus (DM2) and hypertension (HT). Education or training programs for patients with chronic diseases is considered a fundamental tool to prevent their worsening. Objectives: (1) To determine whether attendance at training for patients with HT and/or diabetes affects the progression of the deterioration of renal function. (2) To assess the association of renal function with HT, DM2 and the occurrence of cardiovascular events, analyzing the influence of the control degree of blood pressure (BP) and glycated hemoglobin (HbA1c). (3) To study the occurrence of cardiovascular events. Material and methods: Retrospective analytical observational cohort study carried out in a Primary Care Center in Leganés, Madrid, using databases of patients with HT, diabetes and both pathologies simultaneously (n = 200), attending or not to the training of the medical team during the years 2017–2019. Results: 120 of 200 patients received training (60% women). Only in these patients, an improvement of renal function was observed. This was accompanied by a reduction in BP and HbA1c levels, being more prominent in patients with a single pathology, especially hypertensive patients. Conclusions: Training of patients was beneficial to prevent the deterioration of renal function, by means of the reduction of the BP and HbA1c. It was more evident in those who started from a worse control of both parameters. Association of renal function evolution with HT and DM2 was demonstrated (AU)