Glucose metabolism outcomes after pituitary surgery in patients with acromegaly.

AIM: To investigate the impact of pituitary surgery on glucose metabolism and to identify predictors of remission of diabetes after pituitary surgery in patients with acromegaly. METHODS: A national multicenter retrospective study of patients with acromegaly undergoing transsphenoidal surgery for the first time at 33 tertiary Spanish hospitals (ACRO-SPAIN study) was performed. Surgical remission of acromegaly was evaluated according to the 2000 and 2010 criteria. RESULTS: A total of 604 acromegaly patients were included in the study with a total median follow up of 91 months (interquartile range [IQR] 45-163). At the acromegaly diagnosis, 23.8% of the patients had diabetes mellitus (DM) with a median glycated hemoglobin (HbA1c) of 6.9% (IQR 6.4-7.9) [51.9 mmol/mol (IQR 46.4-62.8)]. In the multivariate analysis, older age (odds ratio [OR] 1.02, 95% CI 1.00-1.05), dyslipidemia (OR 5.25, 95% CI 2.81 to 9.79), arthropathy (OR 1.39, 95% CI 2.82 to 9.79), and higher IGF-I levels (OR 1.30, 95% CI 1.05 to 1.60) were associated with a greater prevalence of DM. At the last follow-up visit after surgery, 21.1% of the DM patients (56.7% of them with surgical remission of acromegaly) experienced diabetes remission. The cure rate of DM was more common in older patients (hazard ratio [HR] 1.77, 95% CI 1.31 to 2.43), when surgical cure was achieved (HR 2.10, 95% CI 1.01 to 4.37) and when anterior pituitary function was not affected after surgery (HR 3.38, 95% CI 1.17 to 9.75). CONCLUSION: Glucose metabolism improved in patients with acromegaly after surgery and 21% of the diabetic patients experienced diabetes remission; being more frequent in patients of older age, and those who experienced surgical cure and those with preserved anterior pituitary function after surgery.

Renal screening sonography-A comparative study in a Portuguese basic emergency service.

INTRODUCTION: Renal Point-of-Care Ultrasound (POCUS) is a screening modality that aids in clinical decision-making for patients with suspected renal colic. This study intends to compare the accuracy and pertinence of sonographic findings obtained by a sonographer in a Basic Emergency Service (BES) with the imaging findings at the Referral Hospital (RH). METHODS: Thirty-one patients suspected of having renal pathology underwent initial sonography screening with POCUS at the BES and were subsequently referred to the RH for additional imaging examinations. The results of both examinations were compared to verify whether the findings from the BES were confirmed by the radiologist in the RH and to ensure that the patient referrals from BES to RH were appropriate. RESULTS: In our sample, the majority of patients (80%) exhibited varying degrees of pyelocaliceal distension, with nearly half (48%) patients presenting obstructions. A strong association between the sonographic findings in the BES and the RH was found in the variables 'Dilatation of pyelocaliceal system' (V = 0.895; P = 0.00), 'Simple cystic formation' (V = 0.878; P = 0.000), respectively. There was a statistically significant correlation between BES and RH findings, indicating a strong association between these two variables, respectively (k = 0.890; P = 0.000) and (k = 0.870; P = 0.000). There was also a strong statistically significant correlation in the ultrasonographic findings between BES and RH performers (k = 0.890; P = 0.000 and k = 0.870; P = 0.000). In this research, an achieved sensitivity of 96% and a specificity of 85% were demonstrated in the identification of pyelocaliceal dilatation. CONCLUSION: Renal POCUS screening successfully detected abnormalities in the urinary system of patients suspected of having renal colic. The sonographic findings at the BES had a good correlation with the complementary imaging results obtained at the RH in Portugal. These results suggest that Radiographers/Sonographers can have an important role in the preliminary assessment of urgent renal pathology in remote areas, contributing to a correct referral and early treatment.

Pegvisomant and pasireotide in PRL and GH co-secreting vs GH-secreting Pit-NETs.

The objective of the study was to evaluate the efficacy of second-line therapies in patients with acromegaly caused by a growth hormone (GH) and prolactin (PRL) co-secreting pituitary neuroendocrine tumor (GH&PRL-Pit-NET) compared to their efficacy in patients with acromegaly caused by a GH-secreting pituitary neuroendocrine tumor (GH-Pit-NET). This is a multicenter retrospective study of patients with acromegaly on treatment with pasireotide and/or pegvisomant. Patients were classified in two groups: GH&PRL-Pit-NETs when evidence of hyperprolactinemia and immunohistochemistry (IHC) for GH and PRL was positive or if PRL were >200 ng/dL regardless of the PRL-IHC and GH-Pit-NETs when the previously mentioned criteria were not met. A total of 28 cases with GH&PRL-Pit-NETs and 122 with GH-Pit-NETs met the inclusion criteria. GH&PRL-Pit-NETs presented at a younger age, caused hypopituitarism, and were invasive more frequently than GH-Pit-NETs. There were 124 patients treated with pegvisomant and 49 with pasireotide at any time. The efficacy of pegvisomant for IGF-1 normalization was of 81.5% and of pasireotide of 71.4%. No differences in IGF-1 control with pasireotide and with pegvisomant were observed between GH&PRL-Pit-NETs and GH-Pit-NETs. All GH&PRL-Pit-NET cases treated with pasireotide (n = 6) and 82.6% (n = 19/23) of the cases treated with pegvisomant normalized PRL levels. No differences in the rate of IGF-1 control between pegvisomant and pasireotide were detected in patients with GH&PRL-Pit-NETs (84.9% vs 66.7%, P = 0.178). We conclude that despite the more aggressive behavior of GH&PRL-Pit-NETs than GH-Pit-NETs, no differences in the rate of IGF-1 control with pegvisomant and pasireotide were observed between both groups, and both drugs have shown to be effective treatments to control IGF-1 and PRL hypersecretion in these tumors.

Effectiveness of combined first-line medical treatment in acromegaly with prolactin cosecretion.

OBJECTIVE: The aim of this study is to compare the response to first-line medical treatment in treatment-naive acromegaly patients with pure growth hormone (GH)-secreting pituitary adenoma (GH-PA) and those with GH and prolactin cosecreting PA (GH&PRL-PA). DESIGN: This is a retrospective multicentric study of acromegaly patients followed from 2003 to 2023 in 33 tertiary Spanish hospitals with at least 6 months of first-line medical treatment. METHODS: Baseline characteristics, first-line medical treatment strategies, and outcomes were analyzed. We employed a multiple logistic regression full model to estimate the impact of some baseline characteristics on disease control after each treatment modality. RESULTS: Of the 144 patients included, 72.9% had a GH-PA, and 27.1% had a GH&PRL-PA. Patients with GH&PRL-PA were younger (43.9 ± 15.0 vs 51.9 ± 12.7 years, P < .01) and harboring more frequently macroadenomas (89.7% vs 72.1%, P = .03). First-generation somatostatin receptor ligand (fgSRL) as monotherapy was given to 106 (73.6%) and a combination treatment with fgSRL and cabergoline in the remaining 38 (26.4%). Patients with GH&PRL-PA received more frequently a combination therapy (56.4% vs 15.2%, P < .01). After 6 months of treatment, in the group of patients under fgSRL as monotherapy, those patients with GH&PRL-PA had worse control compared to GH-PAs (29.4% vs 55.1%, P = .04). However, these differences in the rate of disease control between both groups disappeared when both received combination treatment with fgSRL and cabergoline. CONCLUSION: In GH&PRL-PA, the biochemical control achieved with fgSRL as monotherapy is substantially worse than in patients harboring GH-PA, supporting the inclusion of cabergoline as first-line medical treatment in combination with fgSRLs in these subgroups of patients.

Differences between GH and PRL co-secreting and GH-secreting pituitary adenomas. A series of 604 cases.

PURPOSE: To evaluate differences in clinical presentation and in surgical outcomes between growth hormone-secreting pituitary adenomas (GH-PAs) and GH and prolactin co-secreting pituitary adenomas (GH&PRL-PAs). METHODS: Multicenter retrospective study of 604 patients with acromegaly submitted to pituitary surgery. Patients were classified into two groups according to serum PRL levels at diagnosis and immunohistochemistry (IHC) for PRL: a) GH&PRL-PAs when PRL levels were above the upper limit of normal and IHC for GH and PRL was positive or PRL levels were >100ng/and PRL IHC was not available (n=130) and b) GH-PAs who did not meet the previously mentioned criteria (n=474). RESULTS: GH&PRL-PAs represented 21.5% (n=130) of patients with acromegaly. The mean age at diagnosis was lower in GH&PRL-PAs than in GH-PAs (P<0.001). GH&PRL-PAs were more frequently macroadenomas (90.6% vs. 77.4%, P=0.001) and tended to be more invasive (33.6% vs. 24.7%, P=0.057) than GH-PAs. Furthermore, they had presurgical hypopituitarism more frequently (OR 2.8, 95% CI 1.83-4.38). IGF-1 upper limit of normality (ULN) levels at diagnosis were lower in patients with GH&PRL-PAs (median 2.4 [IQR 1.73-3.29] vs. 2.7 [IQR 1.91-3.67], P=0.023). There were no differences in the immediate (41.1% vs 43.3%, P=0.659) or long-term post-surgical acromegaly biochemical cure rate (53.5% vs. 53.1%, P=0.936) between groups. However, there was a higher incidence of permanent arginine-vasopressin deficiency (AVP-D) (7.3% vs. 2.4%, P=0.011) in GH&PRL-PAs patients. CONCLUSIONS: GH&PRL-PAs are responsible for 20% of acromegaly cases. These tumors are more invasive, larger and cause hypopituitarism more frequently than GH-PAs and are diagnosed at an earlier age. The biochemical cure rate is similar between both groups, but patients with GH&PRL-PAs tend to develop permanent postsurgical AVP-D more frequently.

Genetics of inborn errors of immunity: Diagnostic strategies and new approaches to CNV detection.

BACKGROUND: Genetic diagnosis of inborn errors of immunity (IEI) is complex due to the large number of genes involved and their molecular features. Missense variants have been reported as the most common cause of IEI. However, the frequency of copy number variants (CNVs) may be underestimated since their detection requires specific quantitative techniques. At this point, the use of Next Generation Sequencing (NGS) is acquiring relevance. METHODS: In this article, we present our experience in the genetic diagnosis of IEI based on three diagnostic algorithms that allowed the detection of single nucleotide variants (SNVs) and CNVs. Following this approximation, 703 index cases were evaluated between 2014 and 2021. Sanger sequencing, MLPA, CGH array, breakpoint spanning PCR or a customized NGS-based multigene-targeted panel were performed. RESULTS: A genetic diagnosis was reached in 142 of the 703 index cases (20%), 19 of them presented deletions as causal variants. Deletions were also detected in 5 affected relatives and 16 healthy carriers during the family studies. Additionally, we compile, characterize and present all the CNVs detected by our diagnostic algorithms, representing the largest cohort of deletions related to IEI to date. Furthermore, three bioinformatic tools (LACONv, XHMM, VarSeq™) based on NGS data were evaluated. VarSeq™ was the most sensitive and specific bioinformatic tool; detecting 21/23 (91%) deletions located in captured regions. CONCLUSION: Based on our results, we propose a strategy to guide the molecular diagnosis that can be followed by expert and non-expert centres in the field of IEI.

Silver Nanowire-Based Transparent Electrodes for V2O5 Thin Films with Electrochromic Properties.

The development of electrochromic systems, known for the modulation of their optical properties under an applied voltage, depends on the replacement of the state-of-the-art ITO (In2O3:Sn) transparent electrode (TE) as well as the improvement of electrochromic films. This study presents an innovative ITO-free electrochromic film architecture utilizing oxide-coated silver nanowire (AgNW) networks as a TE and V2O5 as an electrochromic oxide layer. The TE was prepared by simple spray deposition of AgNWs that allowed for tuning different densities of the network and hence the resistance and transparency of the film. The conformal oxide coating (SnO2 or ZnO) on AgNWs was deposited by atmospheric-pressure spatial atomic layer deposition, an open-air fast and scalable process yielding a highly stable electrode. V2O5 thin films were then deposited by radio frequency magnetron sputtering on the AgNW-based TE. Independent of the oxide's nature, a 20 nm protective layer thickness was insufficient to prevent the deterioration of the AgNW network during V2O5 deposition. On the contrary, crystalline V2O5 films were grown on 30 nm thick ZnO or SnO2-coated AgNWs, exhibiting a typical orange color. Electrochromic characterization demonstrated that only V2O5 films deposited on 30 nm thick SnO2-coated AgNW showed characteristic oxidation-reduction peaks in the Li+-based liquid electrolyte associated with a reversible orange-to-blue color switch for at least 500 cycles. The electrochromic key properties of AgNW/SnO2 (30 nm)/V2O5 films are discussed in terms of structural and morphological changes due to the AgNW network and the nature and thickness of the two protective oxide coatings.

Role of PATJ in stroke prognosis by modulating endothelial to mesenchymal transition through the Hippo/Notch/PI3K axis.

Through GWAS studies we identified PATJ associated with functional outcome after ischemic stroke (IS). The aim of this study was to determine PATJ role in brain endothelial cells (ECs) in the context of stroke outcome. PATJ expression analyses in patient's blood revealed that: (i) the risk allele of rs76221407 induces higher expression of PATJ, (ii) PATJ is downregulated 24 h after IS, and (iii) its expression is significantly lower in those patients with functional independence, measured at 3 months with the modified Rankin scale ((mRS) ≤2), compared to those patients with marked disability (mRS = 4-5). In mice brains, PATJ was also downregulated in the injured hemisphere at 48 h after ischemia. Oxygen-glucose deprivation and hypoxia-dependent of Hypoxia Inducible Factor-1α also caused PATJ depletion in ECs. To study the effects of PATJ downregulation, we generated PATJ-knockdown human microvascular ECs. Their transcriptomic profile evidenced a complex cell reprogramming involving Notch, TGF-ß, PI3K/Akt, and Hippo signaling that translates in morphological and functional changes compatible with endothelial to mesenchymal transition (EndMT). PATJ depletion caused loss of cell-cell adhesion, upregulation of metalloproteases, actin cytoskeleton remodeling, cytoplasmic accumulation of the signal transducer C-terminal transmembrane Mucin 1 (MUC1-C) and downregulation of Notch and Hippo signaling. The EndMT phenotype of PATJ-depleted cells was associated with the nuclear recruitment of MUC1-C, YAP/TAZ, ß-catenin, and ZEB1. Our results suggest that PATJ downregulation 24 h after IS promotes EndMT, an initial step prior to secondary activation of a pro-angiogenic program. This effect is associated with functional independence suggesting that activation of EndMT shortly after stroke onset is beneficial for stroke recovery.

Familial ApoB-specific familial hypobetalipoproteinemia in a patient with non-classical congenital adrenal hyperplasia. / Hipobetalipoproteinemia familiar ApoB específica en una paciente con hiperplasia suprarrenal congénita no clásica.

Familial hypobetalipoproteinaemia is a disorder of lipid metabolism characterized by low levels of total cholesterol, low-density lipoprotein cholesterol and apolipoprotein B. ApoB-related familial hypolipoproteinemia is an autosomal condition with a codominance inheritance pattern. Non-classical congenital adrenal hyperplasia is an autosomal recessive disorder due to mutations in the CYP21A2, a gene encoding for the enzyme 21-hydroxylase, which results in an androgen excess production from adrenal source. We here present the case of a 25-year-old woman with NCAH showing decreased levels of total-cholesterol, low-density lipoprotein cholesterol and triglycerides. Her parent had digestive symptoms and severe hepatic steatosis with elevated liver enzymes, as well as decreased levels of total and low-density lipoprotein cholesterol. A genetic-molecular study of the proband identified a mutation in the APOB gene, which allowed a diagnosis of heterozygous ApoB-related hypolipoproteinaemia to be made.

Exploring the degradation of silver nanowire networks under thermal stress by coupling in situ X-ray diffraction and electrical resistance measurements.

The thermal instability of silver nanowires (AgNWs) leads to a significant increase of the electrical resistance of AgNW networks. A better understanding of the relationship between the structural and electrical properties of AgNW networks is primordial for their efficient integration as transparent electrodes (TEs) for next-generation flexible optoelectronics. Herein, we investigate the in situ evolution of the main crystallographic parameters (i.e. integrated intensity, interplanar spacing and peak broadening) of two Ag-specific Bragg peaks, (111) and (200), during a thermal ramp up to 400 °C through in situ X-ray diffraction (XRD) measurements, coupled with in situ electrical resistance measurements on the same AgNW network. First, we assign the (111) and (200) peaks of χ-scans to each five crystallites within AgNWs using a rotation matrix model. Then, we show that the thermal transition of bare AgNW networks occurs within a temperature range of about 25 °C for the electrical properties, while the structural transition spans over 200 °C. The effect of a protective tin oxide coating (SnO2) on AgNW networks is also investigated through this original in situ coupling approach. For SnO2-coated AgNW networks, the key XRD signatures from AgNWs remain constant, since the SnO2 coating prevents Ag atomic surface diffusion, and thus morphological instability (i.e. spheroidization). Moreover, the SnO2 coating does not affect the strain of both (111) and (200) planes. The thermal expansion for bare and SnO2-coated AgNW networks appears very similar to the thermal expansion of bulk Ag. Our findings provide insights into the underlying failure mechanisms of AgNW networks subjected to thermal stress, helping researchers to develop more robust and durable TEs based on metallic nanowire networks.

Molecular diagnosis of cystic fibrosis by RNA obtained from nasal epithelial cells.

BACKGROUND: The diagnosis of cystic fibrosis (CF) is established when characteristic clinical signs are coupled with biallelic CFTR pathogenic variants. No previously reported non-canonical splice site variants have to be considered as variants of uncertain significance unless their effect on splicing has been validated. METHODS: Two variants identified by next-generation sequencing were evaluated. We assayed their effects on splicing employing RNA analysis and real-time expression quantification from RNA obtained from the nasal epithelial cells of a patient with clinically suspected CF and of two patients with milder phenotypes (CFTR-related disorders). RESULTS: The variant c.164+2dup causes skipping of exon 2 (p.(Ser18_Glu54del)) and exon 2 plus 3 (p.(Ser18Argfs*16)) in CFTR mRNA. Exon 2 expression in the patient heterozygous for c.164+2dup was decreased to 7 % of the exon 2 expression in the controls. The synonymous variant c.1584G>A causes a partial skipping of exon 11. The exon 11 expression in the two patients heterozygous for this variant was 22 % and 42 % of that of the controls, respectively. CONCLUSION: We conclude that variant c.164+2dup affects mRNA processing and can be considered a CF-causing variant. The results of the functional assay also showed that the p.(Glu528=) variant, usually categorized as a neutral variant based on epidemiological data, partially affects mRNA processing in our patients. This finding would allow us to reclassify the variant as a CFTR-related variant with incomplete penetrance. RNA obtained from nasal epithelial cells is an easy and accurate tool for CFTR functional studies in patients with unclassified splice variants.

Evaluación de las características de la clínica típica del síndrome coronario agudo en mujeres del Área Básica de Salud de Florida Sud, Florida Nord y Pubilla Cases de 2015 a 2019 / Evaluation of the typical clinical characteristics of acute coronary syndrome in women from the basic health area of Florida Sud, Florida Nord and Pubilla Cases from 2015 to 2019

Objetivo: se pretende analizar la adecuación de la clínica previa al diagnóstico de síndrome coronario agudo (SCA) en mujeres de tres Áreas de Salud de Barcelona. El objetivo secundario fue determinar si existe retraso terapéutico en las mujeres analizadas. Métodos: estudio observacional descriptivo transversal sobre mujeres con nuevo diagnóstico de SCA durante 2015-2019 a través de recogida de datos de la historia clínica. Se estimó la adecuación clínica mediante el porcentaje de mujeres que presentaban o no la clínica típica de SCA. Se consideró la presencia de otros síntomas sugestivos y de factores de riesgo cardiovascular. Se tuvieron en cuenta el número acumulado de visitas previas al diagnóstico, el decalaje entre diagnóstico y tratamiento y la actuación en Atención Primaria el mes anterior al diagnóstico. Resultados: se incluyeron 102 mujeres, con una media de edad de 75 años. El 49% presentaron clínica típica (intervalo de confianza [IC] 95%: 39,32-58,72). Los antecedentes más frecuentes fueron hipertensión y dislipemia. De las pacientes analizadas, 11 (10,8%) presentaron debilidad, y, de ellas, 9 (81,8%) presentaron clínica típica, siendo estadísticamente significativo (IC 95%: 4,76-16,80). En el 66,3% de los casos se administró tratamiento inmediato y en el 22,5% se llevó a cabo cateterismo inmediato. Conclusiones: la mitad de las pacientes presentaron clínica típica y ninguno de los síntomas atípicos fue más prevalente. Solo la mitad de las mujeres recibieron tratamiento temprano, con una minoría de tratamientos invasivos. Podría ser beneficioso una mejora del registro de los síntomas en las historias clínicas para mejorar los tiempos en la instauración de tratamiento.(AU)

Aim: to analyze the clinic’s suitability prior to the diagnosis of Acute Coronary Syndrome in women from three health areas of Barcelona. The secondary objective was to determine whether there is a therapeutic delay in the women analyzed. Methods: cross-sectional, descriptive, observational study on women with a new diagnosis of ACS during 2015-2019 by means of data collection from the medical history. Clinical suitability was estimated using the percentage of women who presented or did not present typical symptoms of ACS (dependent variable). The existence of other suggestive symptoms and cardiovascular risk factors (independent variables) was considered. The cumulative number of visits prior to diagnosis, the gap between diagnosis and treatment, and treatment and performance in primary care the month prior to diagnosis (covariables) were taken into account. Results: a total of 102 women with a mean age of 75 years were included; 49% presented typical symptoms. The most common histories were hypertension and dyslipidaemia. Of the patients analyzed, 11 (10.8%) presented weakness, of whom 9 (81.8%) presented typical clinical symptoms. This was statistically significant. Immediate treatment was performed in 66.3% and immediate catheterization was performed in 22.5%. Conclusions: half of the patients presented typical symptoms and none of the atypical symptoms was more prevalent. Only half the women received early treatment with a minority of invasive treatments. Improved recording of symptoms in the clinical histories could be beneficial to improve the times to establish treatment.(AU)

Serie de casos sobre la mortalidad a 30 días tras trombectomía o fibrinólisis. El reto de la dispersión demográfica / Case series on 30-day mortality after thrombectomy or fibrinolysis. The challenge of demographic dispersion

Objetivo: el presente estudio tiene como propósito conocer la supervivencia de la trombectomía o fibrinólisis de pacientes con criterios de código ictus al cabo de 30 días. Además, se propone observar si la dispersión demográfica por ubicación del hospital tiene alguna influencia en dicha relación para el paciente. Método: estudio longitudinal, retrospectivo y observacional. Pacientes dentro del código ictus en la provincia de Ourense (Galicia). Los participantes son 153 pacientes con una media de edad de 76 ± 12 años, de los cuales 83 son mujeres, reclutados durante 17 meses. Las variables a considerar incluyeron la arteria afectada, intervención fibrinólisis/trombectomía, mortalidad al cabo de 30 días, aplicación de angiotomografía computarizada (angio-TC), cambios en la National Institutes Health Stroke Scale (NIHSS) y tiempos en el servicio de urgencias en tres hospitales de la provincia (Ourense, O Barco y Verín). Resultados: el 12,9% de los pacientes fallecieron en los 30 días siguientes a partir del evento. El 54,2% (84 pacientes) fueron sometidos a fibrinólisis; el 19,4%, a trombectomía, y el 26,0% (40 pacientes) fueron tratados mediante intervención combinada (fibrinólisis + trombectomía). El 13,1% de los pacientes bajo fibrinólisis alcanzaron el exitus letalis al cabo de 30 días. El análisis de regresión logística determinó que hacer una trombectomía disminuye la probabilidad de fallecimiento, pero no de forma significativa. Conclusiones: no se encontró una relación significativa entre la aplicación de un tratamiento concreto (trombectomía/fibrinólisis) o su combinación y la tasa de mortalidad de los pacientes al cabo de 30 días.(AU)

Purpose: this study aims to analyze the survival and mortality rate after 30 days in patients with stroke code and fibrinolysis/thrombectomy. In addition, it is proposed to observe whether the demographic dispersion by the hospital’s location has any impact on this relationship for the patient. Method: longitudinal, retrospective and observational study. Patients with stroke code in the province of Ourense, Galicia. Subjects are 153 patients with a mean age of 76±12 years (83 women), recruited over 17 months. The variables to consider included the affected artery, fibrinolysis/thrombectomy intervention, mortality after 30 days, application of computerized tomography angiography, changes in the NIHSS (National Institutes Stroke Scale) and times in the casualty department in three hospitals in the province (Ourense, O Barco and Verín). Results: 12.9% of patients died within 30 days of the event. At least 54.2% of patients (84) received fibrinolysis, 19.4% underwent thrombectomy and at least 40 patients (26.0%) underwent a combined intervention (fibrinolysis + thrombectomy). A total of 13.1% of patients with fibrinolysis reached exitus letalis after 30 days. Logistic analysis determined that performing a thrombectomy reduces the probability of death, but not significantly. Conclusions: no statistically significant relationship was detected between the application of a specific treatment (thrombectomy/fibrinolysis) or its combination with the mortality rate of patients after 30 days. Ourense hospital that is closest to the thrombectomy referral centres shows P<0.005 in regard to mortality.(AU)

Análisis de los factores de riesgo cardiovascular en el código ictus. Una aproximación en edades avanzadas / Analysis of cardiovascular risk factors in the stroke code. An approach in advanced ages

FUNDAMENTOS: El presente estudio tuvo como propósito analizar el efecto de los factores de riesgo cardiovascular (FRCV) en 153 pacientes de la provincia de Ourense que habían sufrido ictus, donde se había activado el código ictus. Su realización parte del propósito de los autores de incidir en la patología crónica para prevenir este evento en concreto. MÉTODOS: Se realizó un estudio longitudinal, retrospectivo y observacional aplicado a 153 pacientes con una media de edad de 76±12 años que habían presentado algún de tipo de ictus. Las variables independientes fueron clasificadas en cuantitativas (índice internacional normalizado [INR], presión arterial y glucemia) y en cualitativas (fibrilación auricular [FA], consumo de anticoagulantes [ACO], hábito de fumar y nivel de lípidos en sangre). Las variables dependientes fueron el tipo de ictus, la arteria afectada y la mortalidad de paciente al cabo de treinta días, seis meses y un año. Para las variables cualitativas se utilizó el método de comprobación no paramétrico de Kruskal-Wallis (K-W) y Mann-Whitney (M-W) para comparación de medias y para asociación Chi-cuadrado. RESULTADOS: El INR resultó asociado con el tipo de evento así como con la mortalidad a seis y doce meses (p<0,001). La glucemia se relacionó de forma estadísticamente significativa tanto con el tipo de evento como con la arteria afectada, así como con la mortalidad en los tres periodos. Tanto la FA como los ACO se asociaron con el tipo de evento y con la arteria afecta, los últimos además con la mortalidad a un año. La edad se relacionó con la mortalidad en los tres periodos sin llegar a ser significativa a los treinta días. Ser hombre podría ser un factor de riesgo (OR>1) para la mortalidad a treinta días y ser mujer para la mortalidad a un año . En cuanto al tipo de intervención realizada someterse a fibrinolisis o a trombectomía aumentó el riesgo de mortalidad frente al tratamiento combinado, siendo estadísticamente...(AU)

BACKGROUND: The purpose of this study was to analyze the effect of cardiovascular risk factors (CVRF) in 153 patients who had suffered a stroke in the province of Ourense and where the stroke code had been activated.Its realization is part of the purpose of the authors to influence chronic pathology to prevent this specific event. METHODS: A longitudinal, retrospective and observational study was applied to 153 patients with a mean age of 76±12 years who had presented some type of stroke. The independent variables were classified as quantitative (international normalized ratio [INR], blood pressure and glycemia) and in qualitative (atrial fibrillation [AF], consumption of anticoagulants [ACO], smoking and blood lipid levels). The dependent variables were the type of stroke, the affected artery, and patient mortality after thirty days, six months, and one year. For the qualitative variables, the non-parametric verification method of Kruskal-Wallis (K-W) and Mann-Whitney (M-W) was used for comparison of means and for Chi-square association. RESULTS: INR was associated with the type of event and mortality at six and twelve months (p<0,001). Glycemia was related in a statistically significant way both with the type of event, the affected artery and with mortality in the three periods. Both AF and OACs were associated with the type of event and the artery affected, the latter also with one-year mortality. Age was related to mortality in the three periods without becoming significant at thirty days. Being a man could be a risk factor for thirty -day mortality (OR>1) and being a woman for one-year mortality. Regarding the type of intervention performed, undergoing fibrinolysis or thrombectomy increased the risk of mortality compared to combined treatment, the relationship between thrombectomy and increased mortality being statistically significant exclusively in the six-month period...(AU)

Factores relacionados con el abandono de la suplementación de los micronutrientes en niños / Factors related to the abandonment of micronutrient supplementation in children / Fatores relacionados ao abandono da suplementação de micronutrientes em crianças

La anemia es uno de los problemas más importantes de la salud pública, viéndose un crecimiento sostenido en los últimos años. Existen diversos factores relacionados al abandono de la suplementación de los micronutrientes. Objetivo. Establecer los factores relacionados con el abandono de la suplementación de los micronutrientes en niños de 6 a 36 meses atendidos en un Centro Materno Infantil. Materiales y métodos. El enfoque fue cuantitativo, de tipo básica, diseño no experimental transversal. La población estuvo constituida por 120 pacientes neonatos y la muestra fue de 80 pacientes neonatos del Centro Materno infantil, elegidos mediante muestreo no probabilístico, con la técnica de la encuesta y el instrumento fue el cuestionario. Resultados. El 25% presentó niveles inadecuados, el 62.5% presentó niveles moderados y el 12.5% presentó niveles adecuados de uso de suplementación de los micronutrientes. Conclusiones. El abandono de la suplementación de los micronutrientes se encuentra asociado con los factores generales del infante, como la edad, sexo, y número de hijo, tipo de seguro y número de micronutriente y además dependen de los factores relacionados al cuidador a edad del cuidador, grado de instrucción, estado civil, número de hijos, procedencia y ocupación, tal como muestra al prueba de la independencia de Chi-cuadrado y el p< 0.05, y se establecen que los factores generales del niño y los Factores relacionados al cuidador se encuentran asociados en la suplementación de los micronutrientes.

Anemia is one of the most important public health problems, with a sustained growth in recent years. There are several factors related to the abandonment of micronutrient supplementation. Objective. To establish the factors related to the abandonment of micronutrient supplementation in children aged 6 to 36 months attended in a Maternal and Child Center. Materials and methods. The approach was quantitative, basic, non-experimental cross-sectional design. The population consisted of 120 neonatal patients and the sample consisted of 80 neonatal patients of the Maternal and Child Center, chosen by non-probabilistic sampling, with the survey technique and the instrument was the questionnaire. Results. The 25% presented inadequate levels, 62.5% presented moderate levels and 12.5% presented adequate levels of micronutrient supplementation. Conclusions. The abandonment of micronutrient supplementation is associated with the general factors of the infant, such as age, sex, and number of children, type of insurance and number of micronutrients and also depend on the factors related to the caregiver such as age of the caregiver, education level, marital status, number of children, origin and occupation, as shown by the Chi-square test of independence and p< 0.05, and it is established that the general factors of the child and the factors related to the caregiver are associated in the supplementation of micronutrients.

A anemia é um dos mais importantes problemas de saúde pública, com um aumento constante nos últimos anos. Há vários fatores relacionados ao descaso com a suplementação de micronutrientes. Objetivo. Estabelecer os fatores relacionados ao abandono da suplementação de micronutrientes em crianças de 6 a 36 meses de idade que freqüentam um Centro Mãe e Criança. Materiais e métodos. A abordagem foi quantitativa, básica e não-experimental, de corte transversal. A população consistia de 120 pacientes neonatais e a amostra consistia de 80 pacientes neonatais do Centro Materno e Infantil, escolhidos por amostragem não-probabilística, utilizando a técnica de pesquisa e o questionário como instrumento. Resultados. 25% apresentaram níveis inadequados, 62,5% apresentaram níveis moderados e 12,5% apresentaram níveis adequados de suplementação de micronutrientes. Conclusões. O abandono da suplementação de micronutrientes está associado aos fatores gerais da criança, tais como idade, sexo e número de crianças, tipo de seguro e número de micronutrientes e também depende dos fatores do cuidador relacionados à idade do cuidador, nível de educação, estado civil, número de crianças, origem e ocupação, como demonstrado pelo teste de independência Qui-quadrado e p< 0,05, e é estabelecido que os fatores gerais da criança e os fatores do cuidador estão associados na suplementação de micronutrientes.

Social status and friendship in peer victimization trajectories / Estatus social y amistad en trayectorias de victimización entre iguales

Background/Objective: Most studies have evaluated victimization at a single time point, making it difficult to determine the impact of the time during which an individual is victimized. This longitudinal study aims to examine the differences in the levels of social status (social preference and perceived popularity) and friendship in peer victimization trajectories, and to analyse if there were changes over time in the levels of social status and friendship in each trajectory. Method: The final sample was composed of 1,239 students (49% girls) with ages between 9 and 18 (M = 12.23, SD = 1.73), from 22 schools in southern Spain. Peer nominations were collected. Results: The General Linear Model results associated the highest levels of social preference, perceived popularity and friendship with the sporadic victimization profile and the lowest levels of these dimensions with the stable profile. Conclusions:The results are discussed based on important personal aspects of stable victimization that confirms social rejection, unpopularity, and the low social support that victimization causes. This contribution is discussed in terms of health and social welfare in adolescence. (AU)

Antecedentes/Objetivo:La mayoría de los estudios han evaluado la victimización en un único momento temporal, lo que impide determinar el impacto del tiempo durante el que un individuo es victimizado. Este estudio longitudinal pretende examinar las diferencias en los niveles de estatus social (preferencia social y popularidad percibida) y amistad entre las diferentes trayectorias de las víctimas de iguales en función de su trayectoria de victimización, y explorar si existen cambios con el paso del tiempo en los niveles de estatus social y amistad de cada trayectoria. Método:La muestra se compuso por 1.239 estudiantes (49% chicas) entre 9 y 18 años (M = 12,23, DT = 1,73), pertenecientes a 22 centros educativos del sur de España. Se utilizaron las hetero-nominaciones de sus iguales dentro del grupo de clase. Resultados:Los resultados del Modelo Lineal General asociaron los niveles más altos de preferencia social, popularidad percibida y amistad a la victimización esporádica, y los niveles más bajos de estas dimensiones a la trayectoria estable. Conclusiones:Los resultados se discuten en base al rechazo social, la impopularidad y los escasos apoyos sociales que provoca la victimización. Se valora esta aportación a nivel de salud y bienestar social adolescente. (AU)

E-Learning in Dental Schools in the Times of COVID-19: A Review and Analysis of an Educational Resource in Times of the COVID-19 Pandemic / E-learning en las escuelas de odontología en los tiempos de COVID-19: Una revisión y análisis de un recurso educativo en tiempos de la pandemia de COVID-19

Abstract While countries are facing different stages in their COVID-19 infection rates, worldwide there are millions of students affected by universities' facilities closures due to the pandemic. Some institutions have enforced strategies to transfer some courses to a virtual modality, but many Dental Schools have been challenged to deal with a situation which requires emergency measures to continue the academic course in the middle of lock-downs and social distancing measures. Despite the fact that the number of online academic programs available, especially graduate programs, has increased in diverse modalities, this pandemic forced e-learning processes to develop abruptly. The likelihood of using e-learning strategies in dentistry was substantiated in the scientific literature and an overview of these opportunities is presented. Additionally, the experience of the University of Costa Rica Faculty of Dentistry is presented, as it was evident that some of the key elements in a e-learning environment needed a quick enhancement and initiation of some processes was required. First, it was necessary to categorize the academic courses depending on their virtualization's possibility (curricula analysis and classification), to better understand the extent of the impact and the work needed to contain, as far as the possibilities allowed, negative consequences on students learning process. Second, teachers needed further training in the application of virtual strategies which they hadn't used before. do Third, an evaluation of the students' conditions and needs was conducted in a form of a survey. Finally, teachers and students activated the available virtual platforms. For many Dental Schools, this virtualization process is an ongoing progress although it was abruptly imposed, but this moment indeed represents an enormous opportunity to move forward and get immerse in the virtualization environment as a teaching/learning experience.

Resumen Mientras muchos países están enfrentando distintas etapas en sus tasas de contagio de COVID-19, millones de estudiantes alrededor del mundo han sido afectados por el cierre de instalaciones universitarias debido a la pandemia. Algunas instituciones han aplicado estrategias para transferir algunos cursos a una modalidad virtual, pero muchas facultades de odontología se han visto enfrentadas a una situación que requiere medidas de emergencia para continuar el curso académico en medio de bloqueos y medidas de distanciamiento social. A pesar de que el número de programas académicos en línea disponibles, especialmente los programas de postgrado, ha aumentado en diversas modalidades, esta pandemia obligó a desarrollar abruptamente los procesos de aprendizaje electrónico. La probabilidad de utilizar estrategias de aprendizaje electrónico en odontología se vió corroborada en la literatura científica y se presenta una visión general de estas oportunidades. Además, se presenta la experiencia de la Facultad de Odontología de la Universidad de Costa Rica, ya que fue evidente que algunos de los elementos clave en un entorno de aprendizaje electrónico necesitaban una rápida mejora y se requería la iniciación de algunos procesos. En primer lugar, era necesario clasificar los cursos académicos en función de las posibilidades de su virtualización (análisis y clasificación de los planes de estudio), para comprender mejor el alcance de las repercusiones y la labor necesaria para contener, en la medida de las posibilidades, las consecuencias negativas en el proceso de aprendizaje de los estudiantes. En segundo lugar, los profesores necesitaban más capacitación en la aplicación de estrategias virtuales que no habían utilizado antes. En tercer lugar, se realizó una evaluación de las condiciones y necesidades de los estudiantes en forma de encuesta. Finalmente, los profesores y estudiantes activaron las plataformas virtuales disponibles. Para muchas escuelas de odontología, este proceso de virtualización es un continuo progreso y a pesar de haber tenido un inicio abrupto, pero este momento representa, de hecho, una enorme oportunidad para avanzar y sumergirse en el entorno de la virtualización como una experiencia de enseñanza/aprendizaje.

Pulmonary Embolism in Patients With Covid-19 Pneumonia: The Utility of D-dimer / Embolia pulmonar en pacientes con neumonia por covid-19: utilidad del dímero-d

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