High prevalence of microplastics in the digestive tract of Scyliorhinus canicula (Linneaus, 1758) shows the species biomonitoring potential.

Plastic pollution is widespread in oceans and the ingestion of plastic by marine organisms is causing concern about potential adverse effects. The purpose of this study was to analyze the different types of plastics in the digestive tract of female small-spotted catshark (Scyliorhinus canicula). An alkaline digestion method using 10 % potassium hydroxide (KOH), was used. The samples were filtered and visually observed to classify the plastics according to size, shape, and color. Raman spectroscopy was further employed to identify the polymer types. The study found the presence of plastics in 89.5 % of the 200 females analyzed, including 10 polymers, with polystyrene (PS), polyamide-6 (PA6), polyvinyl chloride (PVC), and silicone rubber (SR) being the most common. The polymers identified largely reflect the results of similar studies in the marine environment and were similar to global polymer diversity of microplastics, which highlights the potential of S. canicula females for biomonitoring microplastic pollution.

Scope for growth and dietary needs of Mediteranean Pinnids maintained in captivity.

BACKGROUND: The measurement of the energy available for growth (scope of growth, SFG) can be used in bivalves to make a long-term prediction in a short-term experiment of the condition of the individual. In order to tackle the best conditions for captive maintenance of Mediterranean Pinnids, a SFG study was conducted using Pinna rudis as a model species. Three diets were examined to test the viability of live microalgae and commercial products: i) a control diet using 100% of live microalgae based on the species Isochrysis galbana (t-ISO), ii) a 100% of commercial microalgae diet based on the product Shellfish Diet 1800®, and iii) a 50/50% mix diet of I. galbana (t-ISO) and Shellfish Diet 1800®. RESULTS: SFG results showed significant differences among diets in the physiological functions measured and suggested lower acceptability and digestibility of the commercial product. Negative SFG values were obtained for the commercial diet which indicates that it should be rejected for both Pinnid maintenance. The mixed diet showed improved physiological performance compared to the commercial diet, resulting in a higher SFG that had no significant differences with the control diet. However, in the long-term, the lower digestibility of the mixed diet compared to the control diet could lead to a deterioration of individuals' conditions and should be considered cautiously. CONCLUSIONS: This work represents the first case study of SFG in Pinna spp. and provides fundamental data on dietary needs for the critically endangered species, P. nobilis.

Effects of COVID-19 on EMS Refresher Course Completion and Delivery.

Introduction: The COVID pandemic has significantly impacted educational development and delivery, yet there is little quantitative research on this topic. The primary objective of this study was to compare the total number of Emergency Medical Service (EMS) Refresher (ER) course completions during 2020 versus prior years. Secondary outcomes examined in person versus on-line/distributive learning during the study period. Methods: The Commission on Accreditation for Prehospital Continuing Education (CAPCE) is the only national organization that accredits continuing education (CE) for paramedics and EMTs and currently has a database with over 14 million CE records. The total number of ER course completions each month in 2020 were compared to 2019 and 2018. We also compared the different educational format types: live in-person (LIP), asynchronous on-line distributive learning (DL), and virtual instructor lead training (VILT) synchronous DL courses. Data was analyzed using descriptive and two-way ANOVA statistics. Results: There were 1,922,783 ER course completions in 2020 versus 1,166,335 in 2019 and 1,074,636 in 2018, representing a 179% increase during the study period. Asynchronous DL course completions in 2020 were 1,830,513 EMS versus 1,078,580 in 2019 and 987,749 in 2018 a 185% increase over the three-year study period. Asynchronous DL monthly means by year was statistically significant, F(2, 99) = 95.632, p < .001. Mean monthly LIP and VLIT educational deliveries by year were not significantly different, p = .802, p = .754, respectively. Total LIP course completions in 2020 were 20,045 versus 51,552 in 2019 and 63,058 in 2018. In 2020 LIP courses made up only 1.0% (20,045/1,922,783) of all ER completions. This study was limited to only EMS professionals taking ER course completions in the CAPCE database. However EMS is not unique, since previous research has suggested that DL has flourished in other health care disciplines while LIP courses have continued to decrease. Conclusion: This large nationwide study of EMS profession has shown the trend toward DL education and a trend away from LIP courses. Future studies should examine the advantages and disadvantages of DL education.

Age and growth of the endangered fan mussel Pinna nobilis in the western Mediterranean Sea.

The present work, which is the first comparative study of the growth of the fan mussel Pinna nobilis in the western Mediterranean, encompasses 12 populations of this species living in different environments in France and Spain. Two hundred nine shells were processed and used to obtain growth records from the posterior adductor muscle scar. Size-at-age data were fitted to the Von Bertalanffy growth model. Considerable variability in growth parameters and age was detected among the populations. The results show that the only two fan mussel populations remaining in Spain, which live in an estuary and a coastal lagoon, occupy habitats that are optimal for fast growth, but individuals show low longevity, complicating the long-term conservation of the species. Multivariate analyses groups the populations into three groups (SO, EO and LG), and a general model is proposed for each group; the model can be used as an approximation to calculate the ages of individuals living in similar environments.

Retention of cricothyrotomy skills by paramedics using a wire guided technique.

INTRODUCTION: Cricothyrotomy may be necessary for airway management when a patient's airway cannot be maintained through standard techniques such as oral airway placement, blind insertion airway device, or endotracheal intubation. Wire-guided cricothyrotomy is one of many techniques used to perform a cricothyrotomy. Although there is some controversy over which cricothyrotomy technique is superior, there is no published data regarding long term retention rates. The purpose of this study is to determine whether ground based paramedics can be taught and are able to retain the skills necessary to successfully perform a wire-guided cricothyrotomy. METHODS: This retrospective study was performed in a suburban county with a population of 160,000 with 23,000 EMS calls per year. Participants were ground-based paramedics who were taught wire-guided cricothyrotomy as part of a standardized paramedic educational update program. After viewing an instructional video, the paramedics were shown each the steps of the procedure on a simulation model, using a low fidelity task trainer previously developed to train emergency medicine residents. Using a 16 step procedural checklist, participants were allowed open-ended practice using the task trainer. Critical steps in the checklist were marked in bold lettering indicating automatic failure. Each paramedic was then individually supervised performing a minimum of 5 successful simulations. Retention was assessed using the same 16 step checklist 6 to 12 weeks following the initial training. RESULTS: A total of 55 paramedics completed both the initial training and reassessment during the time period studied. During the initial training phase 100% (55 of 55) of the paramedics were successful in performing all 16 steps of the wire-guided cricothyrotomy. During the retention phase, 87.3% (48 of 55) of paramedics retained the skills necessary to successfully perform the wire-guided cricothyrotomy. On the 16 step checklist, most steps were performed successfully by all the paramedics or missed by only 1 of the 55 paramedics. The step involving removal of the needle prior to advancing the airway device over the guide wire was missed by 34.5% (19 of 55) of the participants. This was not an automatic failure since most participants immediately self-corrected and completed the procedure successfully. CONCLUSION: Paramedics can be taught and can retain the skills necessary to successfully perform a wire-guided cricothyrotomy on a simulator. Future research is necessary to determine if paramedics can successfully transfer these skills to real patients.

Salmonella enterica Serovar Typhimurium Increases Functional PD-L1 Synergistically with Gamma Interferon in Intestinal Epithelial Cells via Salmonella Pathogenicity Island 2.

Nontyphoidal serovars of Salmonella enterica are pathogenic bacteria that are common causes of food poisoning. Whereas Salmonella mechanisms of host cell invasion, inflammation, and pathogenesis are mostly well established, a new possible mechanism of immune evasion is being uncovered. Programmed death ligand 1 (PD-L1) is an immunosuppressive membrane protein that binds to activated T cells via their PD-1 receptor and thereby halts their activation. PD-L1 expression plays an essential role in the immunological tolerance of self-antigens but is also exploited for immune evasion by pathogen-infected cells and cancer cells. Here, we show for the first time that Salmonella infection of intestinal epithelial cells causes the induction of PD-L1. The increased expression of PD-L1 through Salmonella infection was seen in both human and rat intestinal epithelial cell lines. We determined that cellular invasion by the bacteria is necessary for PD-L1 induction, potentially indicating that Salmonella strains are delivering mediators from inside the host cell that trigger the increased PD-L1 expression. Using knockout mutants, we determined that this effect largely originates from the Salmonella pathogenicity island 2. We also show for the first time in any cell type that Salmonella combined with gamma interferon (IFN-γ) causes a synergistic induction of PD-L1. Finally, we show that Salmonella plus IFN-γ induction of PD-L1 decreased the cytokine production of activated T cells. Understanding Salmonella immune evasion strategies could generate new therapeutic targets and help to manipulate PD-L1 expression in other diseases.

A novel procedure for phase separation in dispersive liquid-liquid microextraction based on solidification of the aqueous phase.

In this paper, an alternative for handling the organic phase after a dispersive liquid-liquid microextraction using organic solvents lighter than water is presented. It is based on solidification (at -18°C) of the aqueous phase obtained after centrifugation, and the decantation, collection and analysis of the liquid organic layer. The extraction of nicotine in toluene, and its determination in eggplant samples was conducted as a proof of concept. The study has been carried out using standards prepared in water and the formation of the dispersion was assisted by sonication. The organic extract was analysed using gas chromatography coupled to mass spectrometry. Satisfactory analytical figures of merit as: limit of detection (0.4µgL(-1), 2ngg(-1) wet sample), limit of quantification (1.2µgL(-1), 6.5ngg(-1) wet sample), within-day precision (RSD=7%), and linearity interval (up to 384µgL(-1) nicotine) were achieved. It constituted a contribution to the handling of organic extracts after microextraction processes.

Relative value of the Ankle-Brachial Index of intermittent claudication.

INTRODUCTION: The Ankle-Brachial Index (ABI) makes it possible to identify patients with peripheral artery disease (PAD). Intermittent claudication (IC) is the first major symptom of PAD, although many patients with an ABI ≤ 0.9 do not exhibit IC, and the range of ABI among those who do have IC is very variable. This study evaluates the correlation between ABI and the perception (symptomatology) of claudicant patients. MATERIAL AND METHODS: An observational, cross-sectional and multicentre, study of 920 patients with IC. Clinical history, ABI, Walking Impairment Questionnaire (WIQ) and European Quality of Life Questionnaire (EQ-5D) were recorded. Associations were analysed using Spearman's correlation coefficient. RESULTS: The mean ABI of the series was 0.63 (SD = 0.19). The mean WIQ-distance was 34.07 (SD = 26.77), values being smaller for lower ABI values (r = 0.343, p < 0.001). The mean EQ-5D score of the series was 0.58 (SD = 0.21), also showing lower values as the ABI decreased (r = 0.278, p < 0.001). The correlations of WIQ and EQ-5D with ABI were statistically significant in both cases, but always less than 0.400 (between 0.278 and 0.343). CONCLUSIONS: The correlations of ABI with the questionnaires of walking capacity and quality of life are weak. For this reason, although in clinical practice the ABI of CI patients is commonly measured, decisions should not be taken during the development of IC exclusively on the basis of the ABI.

Gas chromatography-mass spectrometry method for rapid identification and differentiation of Burkholderia pseudomallei and Burkholderia mallei from each other, Burkholderia thailandensis and several members of the Burkholderia cepacia complex.

AIMS: To develop a simple gas chromatography-mass spectrometry (GC-MS) method for the detection and differentiation of Burkholderia pseudomallei and Burkholderia mallei from each other, Burkholderia thailandensis and several members of the Burkholderia cepacia complex. METHODS AND RESULTS: Biomarkers were generated by one-step thermochemolysis (TCM) and analysed using a GC-MS system. Fragments of poly-3-hydroxybutyrate-co-hydroxyvalerate [poly(3HBA-co-3HVA)] produced by TCM were useful biomarkers. Several cellular fatty acid methyl esters were important in differentiating the various Burkholderia species. A statistical discrimination algorithm was constructed using a combination of biomarkers. The identities of four B. pseudomallei strains, four B. mallei strains and one strain of each near neighbour were confirmed in a statistically designed test using the algorithm. The detection limit for this method was found to be approximately 4000 cells. CONCLUSIONS: The method is fast, accurate and easy to use. The algorithm is robust against different growth conditions (medium and temperature). SIGNIFICANCE AND IMPACT OF THE STUDY: This assay may prove beneficial in a clinical diagnostic setting, where the rapid identification of B. pseudomallei is essential to effective treatment. This method could also be easily employed after a biological attack to confirm the presence of either B. pseudomallei or B. mallei.

Smoking in tuberculosis patients increases the risk of infection in their contacts.

OBJECTIVE: To determine the risk of latent tuberculous infection (LTBI) among contacts of smokers with tuberculosis (TB). METHODS: A study was conducted to determine the prevalence of LTBI among contacts of TB cases aged >14 years in Catalonia, Spain. A survey was carried out for each TB case and their contacts. LTBI was diagnosed using the tuberculin skin test (≥5 mm). The risk of LTBI associated with smoking was determined by multi-variate logistic regression analysis, with adjusted odds ratio (aOR) and their 95% confidence intervals (CI). RESULTS: The smoking prevalence among TB cases was 40.7% (439/1079). The prevalence of LTBI among their contacts was 29.7% (2281/7673). It was higher among contacts of smoking index cases (35.3%) than among those of non-smokers (25.7%). Smoking was independently associated with an increased risk of LTBI among contacts (aOR 1.5, 95%CI 1.3-1.7), and was estimated to be responsible for 12.8% of infections. CONCLUSIONS: Index case smoking increases the risk of LTBI and should be systematically investigated. A reduction in smoking could lower the risk of infection substantially.

Distribution of trace metals in marine sediments of the Bay of Palma de Mallorca (Mallorca Island, Spain).

Metals were determined in surface bottom marine sediments of the Bay of Palma de Mallorca (Spain) by microwave-assisted acid-oxidant digestion and inductively coupled plasma-optical emission spectrometry in order to assess the level and distribution of potentially metallic pollutants. Average concentrations found were 1.2 ± 0.3 Al and 1.9 ± 0.9 Fe (in milligrams per gram), and 8 ± 2 Cr, 2 ± 1 Cu, 60 ± 10 Mn, 4 ± 1 Ni, 6 ± 4 Pb, 50 ± 7 Sn and 10 ± 3 Zn (in micrograms per gram). Enrichment factors using normalized values to Al were also calculated which indicated that sediments were Sn and Pb enriched. Sediments were fractionated by grain size: <63, 63-250, 250-500 and >500 (in micrometres), and the metals' affinity towards the different fractions was studied. The metals' affinity to the finer fraction was evidenced, excluding Sn and Mn that showed practically no affinity for fine grains. Latent variables were extracted from the data using principal components analysis. It allowed samples to be grouped in two clusters, and most of the metals (Al, Cr, Cu, Fe, Ni, Pb and Zn) showed a similar distribution pattern. Sn and Mn showed a distinct pattern.

Clima emocional y comunicación interna en una unidad de gestión clínica y dos servicios hospitalarios tradicionales / Emotional climate and internal communication in a clinical management unit compared with two traditional hospital services

Fundamento y objetivo. El objetivo de este estudio es comparar el clima emocional, la calidad de la comunicación, la valoración de los responsables y compañeros y los indicadores de resultados en una unidad de gestión clínica frente a dos servicios hospitalarios tradicionales. Material y métodos. Estudio cuantitativo. Instrumento: cuestionario de elaboración propia de 94 preguntas. Participantes: 83 profesionales sanitarios, de los que han respondido 63, de la UGC de patología mamaria y de los servicios de oncología médica y oncología radioterápica de un hospital de primer nivel. Análisis: estadística descriptiva, comparación de medias, estudios de correlación y modelos de regresión lineal. Resultados. La UGC alcanza valores superiores en comparación con los servicios hospitalarios en los indicadores de resultados, clima emocional, comunicación interna, valoración de los responsables directos y del centro. Aparecen diferencias entre fuentes, canales, medios y temas de comunicación empleados y los deseados por los profesionales, tanto en la UGC como en los servicios tradicionales. Conclusiones. La organización en UGC promueve una comunicación interna y relaciones interpersonales más favorables, llevando a mejores indicadores de resultados(AU)

Background and objective. The aim of this study is to compare the emotional climate, quality of communication and performance indicators in a clinical management unit and two traditional hospital services. Material and methods. Quantitative study. Instrument: questionnaire of 94 questions. Participants: 83 health professionals (63 responders) from the clinical management unit of breast pathology and the hospital services of medical oncology and radiation oncology. Analysis: descriptive statistics, comparison of means, correlation and linear regression models. Results. The clinical management unit reaches higher values compared with the hospital services about: performance indicators, emotional climate, internal communication and evaluation of the leadership. An important gap between existing and desired sources, channels, media and subjects of communication appear, in both clinical management unit and traditional services. Conclusions. The clinical management organization promotes better internal communication and interpersonal relations, leading to improved performance indicators(AU)

[Emotional climate and internal communication in a clinical management unit compared with two traditional hospital services]. / Clima emocional y comunicación interna en una unidad de gestión clínica y dos servicios hospitalarios tradicionales.

BACKGROUND AND OBJECTIVE: The aim of this study is to compare the emotional climate, quality of communication and performance indicators in a clinical management unit and two traditional hospital services. MATERIAL AND METHODS: Quantitative study. INSTRUMENT: questionnaire of 94 questions. PARTICIPANTS: 83 health professionals (63 responders) from the clinical management unit of breast pathology and the hospital services of medical oncology and radiation oncology. ANALYSIS: descriptive statistics, comparison of means, correlation and linear regression models. RESULTS: The clinical management unit reaches higher values compared with the hospital services about: performance indicators, emotional climate, internal communication and evaluation of the leadership. An important gap between existing and desired sources, channels, media and subjects of communication appear, in both clinical management unit and traditional services. CONCLUSIONS: The clinical management organization promotes better internal communication and interpersonal relations, leading to improved performance indicators.

Análisis de los costes y la efectividad del uso de cilostazol frente a naftidrofurilo y pentoxifilina en el tratamiento de la claudicación intermitente en España / Cost-effectiveness analysis of cilostazol vs naftidrofuryl and pentoxifylline for the treatment of intermittent claudication in Spain

Introducción: El cilostazol es un inhibidor reversible de la fosfodiesterasa III que presenta actividad antiagregante plaquetaria y vasodilatadora. El objetivo de este estudio fue estimar las consecuencias clínicas y económicas del uso de cilostazol en comparación con naftidrofurilo y pentoxifilina en el tratamiento de la claudicación intermitente (CI) en España. Métodos: Se ha construido un modelo fármaco económico basado en la literatura para describir el manejo de la CI y sus consecuencias clínicas y económicas para cada opción terapéutica evaluada en pacientes con 40 o más años y una historia de CI sintomática, secundaria a enfermedad vascular periférica de las extremidades inferiores. Los resultados clínicos provienen de una revisión de los ensayos clínicos respectivos. Se utilizaron costes unitarios españoles para medir las consecuencias económicas asociadas al uso de recursos sanitarios a partir de un estudio similar realizado en el Reino Unido. Resultados: Iniciar el tratamiento con cilostazol en lugar de pentoxifilina aumentaría la distancia máxima recorrida en un 72%, reduciendo los costes en un 11,5%. En comparación con naftidrofurilo, cilostazol se asoció a un aumento de la efectividad del 34% y un aumento de los costes sanitarios del 11,2%. Estos resultados suponen que cilostazol, naftidrofurilo y pentoxifilina presentarían ratios de coste por punto porcentual de aumento de la distancia máxima recorrida de 7,8, 9,1 y 14,7 € respectivamente. Conclusiones: Los resultados de este estudio muestran que iniciar tratamiento con cilostazol presenta una relación de costes y efectividad más favorable respecto a otros tratamientos para la CI en España(AU)

Introduction: Cilostazol is a reversible selective inhibitor of phosphodiesterase III which has platelet antiaggregating and vasodilatory activity. The aim of this study was to estimate the clinical and economic consequences of the use of cilostazol compared with naftidrofuryl and pentoxifylline in the treatment of intermittent claudication (IC) in Spain. Methods: A pharmaco economic model was built based on the literature to describe the management of IC and its clinical and economic consequences for each treatment option evaluated in patients 40 years or older with a medical history of symptomatic IC secondary to peripheral vascular disease of the lower extremities. Clinical results were obtained from a review of clinical trials of the comparators. Spanish unit costs were used to measure the economic consequences associated with the use of healthcare resources based on a similar study performed in the UK. Results: Starting treatment with cilostazol instead of pentoxifylline would increase the maximum distance covered by 72%, reducing costs by 11.5%. Compared with naftidrofuryl, cilostazol was associated with an increase in effectiveness of 34% and an increase in healthcare costs of 11.2%. These results mean that cilostazol, naftidrofuryl and pentoxifylline would have a cost, per one percentage point increase of the maximum distance covered, of € 7.8, € 9.1 and € 14.7, respectively. Conclusions: The study results demonstrate that starting treatment with cilostazol has a more favourable cost-effectiveness ratio compared to other treatments for IC in Spain(AU)

[Opinions and expectations of patients with health problems associated to asbestos exposure]. / Opiniones y expectativas de pacientes con enfermedades relacionadas con la exposición al amianto.

BACKGROUND: The prevalence of diseases related to asbestos exposure requires the development of monitoring programs and specific health care protocols. The aim of this study is to determine the opinions and expectations of former workers of an asbestos factory, in order to adapt the care process to the needs of the affected population, and to learn about the activity of the association that represents them. METHODS: Qualitative study. Focus groups with former employees of a corrugated asbestos factory, members of the association AVIDA (Seville). Recording and transcription of interviews. Discourse analysis with Nudist Vivo 1.0. RESULTS: All respondents have health problems, including asbestosis, lung cancer and mesothelioma. Through the association, they are involved in an ongoing process of negotiation with the public administration, to improve healthcare, achieve recognition as having an occupational disease and the payment of compensation. The lack of monitoring and continuity in care is designated as the major problem in the current care process. They welcome the creation of special care units, the good treatment received and the quality of technical instruments in the public health system. On the contrary, they criticize the difficulties in finding an accurate diagnosis, the lack of continuity of care, and the bureaucratic difficulties and lack of specific care directed to affected relatives. The participants' expectations highlight their intention to participate in the development of future programs and protocols. CONCLUSIONS: This study confirms the multifactor nature of diseases related to asbestos exposure and the importance of determining the needs and demands of the affected population in order to improve health care.

[Patients' opinions and expectations about the dialysis care process]. / Análisis de calidad percibida y expectativas de pacientes en el proceso asistencial de diálisis.

BACKGROUND: To determine the experiences and needs of patients on dialysis, in order to identify critical points of the care process and develop proposals for improvement. METHODS: Qualitative study using semistructured interviews with 22 patients on hemodialysis and peritoneal dialysis, from the Andalusian Health Service. Discourse analysis, using the SERVQUAL model. Triangulation of results. RESULTS: The diagnostic stage is described as the hardest moment as it requires acceptance of the disease. During hemodialysis, we see both positive adaptation and the perception of a diminished quality of life. The technique of peritoneal dialysis is evaluated positively, enabling greater independence, despite requiring more responsibility for self care. The contact with patients' organizations or the provision of a counseling service are valued as an aid in the process. With respect to different dimensions of the SERVQUAL model, human treatment and professional competence are valued. The critical points are lack of coordination, malfunctioning of transportation and lack of transparency in the management of waiting lists. Shortcomings in dealing with informal caregivers and the level of knowledge of professionals from areas other than Nephrology, also appear as deficiencies. CONCLUSIONS: The main proposals for improving the dialysis process are: attention to psychosocial aspects, the improvement of organizational aspects such as transport, and greater attention to informal caregivers.

Influence of surgical or endovascular distal revascularization of the lower limbs on ischemic ulcer healing.

AIM: Our aim is to analyze the ability of distal endovascular procedures, performed as first treatment option, to promote ischemic ulcer healing. METHODS: Retrospective analysis of 91 primary distal procedures, 49 (53.8%) surgical and 42 (46.2%) endovascular, performed consecutively between January 2005 and December 2007 in patients with critical limb ischemia (CLI) and ischemic ulcers. Patient comorbidities, intervention duration time, postoperative hospital stay and complications were recorded. Ischemic ulcer healing time, patency, limb salvage and survival rates were compared between both groups. Data were included in a Cox regression model to determine predictive factors for healing RESULTS: Endovascular therapy was associated with shorter intervention time (128±53 versus 301±91 min; P=0.001) and postoperative hospital stay (13±13 versus 19±14 days; P=0.05). Surgical procedures were associated with more local complications (28.6% versus 7.1% P=0.01), more readmissions for surgical wound complications (12.2% versus 0% P=0.03) and more early major amputations (16.3% versus 0% P=0.007). Ischemic ulcer healing in endovascular and surgical procedures was 80% versus 83% at 12 months (P=NS). Overall patency, limb salvage, survival and amputation-free survival with healed ulcers at 24 months in endovascular and surgical groups were 82% versus 82% (P=NS), 83% versus 72% (P=NS), 81% versus 79% (P=NS) and 63% versus 56% (P=NS). Diabetes mellitus (HR: 2.86 95% CI [1.44-5.68]), free ambulatory status (HR: 0.57 95% CI [0.33-0.98]) and the presence of severe wounds (HR: 2.73 95% CI [1.40-5.30]) were predictors for ulcer healing. CONCLUSION: Endovascular and surgical distal procedures had a similar ulcer healing rate and limb salvage. Our experience supports endovascular-first strategy for CLI with tissue loss.