Síndrome de Alicia en el País de las Maravillas secundario a infección por SARS-CoV-2 / Alice in Wonderland syndrome in SARS-CoV-2 infection

El síndrome de Alicia en el País de las Maravillas es un conjunto de trastornos complejos de la percepción visual con múltiples etiologías, siendo las infecciones las más frecuentes en Pediatría. Es un cuadro poco frecuente, pero es importante conocerlo por su carácter generalmente autolimitado. Presentamos el caso de un niño de 11 años que, a las 48 horas de infección por SARS-CoV-2, inició distorsión visual de la forma corporal, micropsias y macropsias. Se descartaron otras causas orgánicas, manteniéndose actitud expectante dada su evolución benigna. Se destaca la aparición de este síndrome en contexto clínico de infección por SARS-CoV-2, no habiendo sido descrita hasta ahora su asociación en la literatura. (AU)

The Alice in Wonderland syndrome is defined by the presence of visual perception disorders with several etiologies, being infectious the most frequent in pediatrics. It is a rare clinical condition, but it is important to recognize it because of the generally self-limited nature. We present an 11 years old child who presented visual body distortions, micropsia and macropsia 48 after SARS-CoV-2 infection. Other organic causes were discarded, maintaining an expectant treatment because of its benign evolution. It is noteworthy that this syndrome associated with SARS-CoV-2 infection has not yet been published. (AU)

A Proposal for a Consolidated Structural Model of the CagY Protein of Helicobacter pylori.

CagY is the largest and most complex protein from Helicobacter pylori's (Hp) type IV secretion system (T4SS), playing a critical role in the modulation of gastric inflammation and risk for gastric cancer. CagY spans from the inner to the outer membrane, forming a channel through which Hp molecules are injected into human gastric cells. Yet, a tridimensional structure has been reported for only short segments of the protein. This intricate protein was modeled using different approaches, including homology modeling, ab initio, and deep learning techniques. The challengingly long middle repeat region (MRR) was modeled using deep learning and optimized using equilibrium molecular dynamics. The previously modeled segments were assembled into a 1595 aa chain and a 14-chain CagY multimer structure was assembled by structural alignment. The final structure correlated with published structures and allowed to show how the multimer may form the T4SS channel through which CagA and other molecules are translocated to gastric cells. The model confirmed that MRR, the most polymorphic and complex region of CagY, presents numerous cysteine residues forming disulfide bonds that stabilize the protein and suggest this domain may function as a contractile region playing an essential role in the modulating activity of CagY on tissue inflammation.

Síndrome de Bertolotti. Dolor lumbar en una adolescente / Bertolotti syndrome. Back pain in a teenager

El síndrome de Bertolotti, también llamado megaapófisis transversa, es una anomalía congénita que consiste en vértebras transicionales a nivel lumbosacro, por lo que la última vértebra lumbar L5 se “sacraliza”. Es una de las causas de dolor lumbar crónico, alcanzando el 20% en menores de 30 años, siendo escasos los casos reportados en niños. Se presenta una niña de 14 años con dolor lumbar de 2 meses de evolución con escasa respuesta al tratamiento sintomático. En la radiografía de columna anteroposterior se observa una megaapófisis transversa en L5. La paciente se mantiene en seguimiento por Traumatología con tratamiento analgésico y fisioterápico. (AU)

Bertolotti syndrome, also called transverse megapophysis, is a congenital anomaly consisting of transitional vertebrae at the lumbosacral level, whereby the last L5 lumbar vertebra becomes “sacralized”. It is one of the causes of chronic low back pain, reaching 20% in those under 30 years of age, with few cases reported in children. A 14-year-old girl is presented with low back pain for 2 months with little response to symptomatic treatment. Complementary tests were requested, finding a transverse megapophysis in L5 in the column X-ray. The patient remains under follow-up by traumatology with analgesic and physiotherapy treatment. (AU)

Importance of Desensitization for Autistic Children in Dental Practice.

OBJECTIVES: Dental treatment in special needs patients, including children with autism, can be accomplished by reducing the behaviors that can reduce fear, as it has been demonstrated in other studies. The present study aims to examine the influence of the latency time elapsing between desensitization and the real dental situation on facilitating the access of children with autism to dental treatment. STUDY DESIGN: Nineteen patients with autism, who were aged 3-14 years and attended the Special Education Center in Madrid but were living with their parents at home, were selected for the study. All children in the sample were subjected to a desensitization process before attending the real dental office. Two study groups were established: the latency period between the last desensitization and the real situation was one day for the first group and seven days for the second group. An experimental study was conducted to assess the child's cooperation in the dental chair; the dental examination was divided into several steps and the highest step reached by each child was recorded. RESULTS: There is a statistical difference in the number of steps reached between the children who received the information just before the examination date and the children who experienced a longer latency period between receiving the information and experiencing the examination. CONCLUSIONS: We would like to emphasize the importance of providing information in advance when dealing with autistic children; this information should be as close as possible to the real situation. Additionally, we would like to stress the importance of inter-cooperation between parents, educators, and pediatric dentists in order to guarantee adequate oro-dental care for autistic children. Further studies with larger sample sizes and a control group are recommended.

Synergistic effect of manganese (II) phosphate & diamond nanoparticles in electrochemical sensors for reactive oxygen species determination in seminal plasma.

In this work, we explore the ability of manganese (II) phosphate (MnP) as a catalytic element for the determination of reactive oxygen species (ROS) in seminal plasma, when MnP is employed as modifier of a glassy carbon electrode. The electrochemical response of the manganese (II) phosphate-modified electrode shows a wave at around +0.65 V due to the oxidation of Mn2+ to MnO2+, which is clearly enhanced after addition of superoxide, the molecule considered as the mother of ROS. Once proved the suitability of manganese (II) phosphate as catalyst, we evaluate the effect of including a 0D (diamond nanoparticles) or a 2D (ReS2) nanomaterial in the sensor design. The system consisting of manganese (II) phosphate and diamond nanoparticles yielded the largest improvement of the response. The morphological characterization of the sensor surface was performed by scanning electron microscopy and atomic force microscopy, while cyclic and differential pulse voltammetry were employed for the electrochemical characterization of the sensor. After optimizing the sensor construction, calibration procedures by chronoamperometry were performed, leading to a linear relation between peak intensity and the superoxide concentration in the range of 1.1 10-4 M - 1.0 10-3 M with a limit of detection of 3.2 10-5 M. Seminal plasma samples were analysed by the standard addition method. Moreover, the analysis of samples fortified with superoxide at the µM level leads to recoveries of 95%.

Do GWAS-Identified Risk Variants for Chronic Lymphocytic Leukemia Influence Overall Patient Survival and Disease Progression?

Chronic lymphocytic leukemia (CLL) is the most common leukemia among adults worldwide. Although genome-wide association studies (GWAS) have uncovered the germline genetic component underlying CLL susceptibility, the potential use of GWAS-identified risk variants to predict disease progression and patient survival remains unexplored. Here, we evaluated whether 41 GWAS-identified risk variants for CLL could influence overall survival (OS) and disease progression, defined as time to first treatment (TTFT) in a cohort of 1039 CLL cases ascertained through the CRuCIAL consortium. Although this is the largest study assessing the effect of GWAS-identified susceptibility variants for CLL on OS, we only found a weak association of ten single nucleotide polymorphisms (SNPs) with OS (p < 0.05) that did not remain significant after correction for multiple testing. In line with these results, polygenic risk scores (PRSs) built with these SNPs in the CRuCIAL cohort showed a modest association with OS and a low capacity to predict patient survival, with an area under the receiver operating characteristic curve (AUROC) of 0.57. Similarly, seven SNPs were associated with TTFT (p < 0.05); however, these did not reach the multiple testing significance threshold, and the meta-analysis with previous published data did not confirm any of the associations. As expected, PRSs built with these SNPs showed reduced accuracy in prediction of disease progression (AUROC = 0.62). These results suggest that susceptibility variants for CLL do not impact overall survival and disease progression in CLL patients.

Color preference of Sergentomyia minuta (Diptera: Phlebotominae) determined using Flebocollect Do It Yourself light traps based on LED technology.

Whether phlebotomine sand flies show a preference for different light colors remains controversial. As light-capture methods are widely used to study sand flies, knowing the visual stimuli they respond to could help the design of novel control tools to prevent their attraction to hosts. We have detected a significant preference of male Sergentomyia minuta for green and red light sources. Accordingly, male S. minuta were 2.16 and 2.01 times more likely to be lured by Flebocollect model traps with green and red diode-lights, respectively, than the commercial CDC traps. Flebocollect traps are homemade light traps developed through citizen science. Dipterans are widely considered unable to distinguish the color red so this finding was unexpected. To our knowledge, this is the first description of a color preference in a species of the genus Sergentomyia. Our research also confirms the great potential of Flebocollect light traps for use in medical entomology studies.

Autophagy in Hematological Malignancies.

Autophagy is a highly conserved metabolic pathway via which unwanted intracellular materials, such as unfolded proteins or damaged organelles, are digested. It is activated in response to conditions of oxidative stress or starvation, and is essential for the maintenance of cellular homeostasis and other vital functions, such as differentiation, cell death, and the cell cycle. Therefore, autophagy plays an important role in the initiation and progression of tumors, including hematological malignancies, where damaged autophagy during hematopoiesis can cause malignant transformation and increase cell proliferation. Over the last decade, the importance of autophagy in response to standard pharmacological treatment of hematological tumors has been observed, revealing completely opposite roles depending on the tumor type and stage. Thus, autophagy can promote tumor survival by attenuating the cellular damage caused by drugs and/or stabilizing oncogenic proteins, but can also have an antitumoral effect due to autophagic cell death. Therefore, autophagy-based strategies must depend on the context to create specific and safe combination therapies that could contribute to improved clinical outcomes. In this review, we describe the process of autophagy and its role on hematopoiesis, and we highlight recent research investigating its role as a potential therapeutic target in hematological malignancies. The findings suggest that genetic variants within autophagy-related genes modulate the risk of developing hemopathies, as well as patient survival.

Spanish Registry of Acute Aortic Syndrome (RESA). Changes in therapeutic management and lower mortality in acute aortic syndrome.

INTRODUCTION AND OBJECTIVES: The Spanish Registry of Acute Aortic Syndrome (RESA) was launched in 2005 to identify the characteristics of acute aortic syndrome (AAS) in Spain. The aim of this study was to analyze the differences in management and mortality in the 3 RESA iterations. METHODS: We analyzed data from patients with AAS prospectively included by 24 to 30 tertiary centers during the 3 iterations of the registry: RESA I (2005-2006), RESA-II (2012-2013), and RESA III (2018-2019). RESULTS: AAS was diagnosed in 1902 patients (74% men; age, 60.7±12.5 years): 1329 (69.9%) type A and 573 (30.1%) type B. Comparison of the 3 periods revealed that the use of computed tomography increased as the first diagnostic technique (77.1%, 77.9%, and 84.2%, respectively; P=.001). In type A, surgical management increased (79.6%, 78.7%, and 84.5%; P=.045) and overall mortality decreased (41.2%, 34.5%, and 31.2%; P=.002), due to a reduction in surgical mortality (33.4%, 25.1%, and 23.9%; P=.003). In type B, endovascular treatment increased (22.8%, 32.8%, and 38.7%; P=.006), while medical and surgical treatment decreased. Overall type B mortality also decreased (21.6%, 16.1%, and 12.0%; P=.005) in line with a reduction in mortality with medical (16.8%, 13.8%, and 8.8%, P=.030) and endovascular (27.0%, 18.0%, and 9.2%; P=.009) treatments. CONCLUSIONS: The iterations of RESA show a decrease in mortality from type A AAS, coinciding with an increase in surgical treatment and a reduction in surgical mortality. In type B, the use of endovascular treatment was associated with improved survival, allowing better management in patients with complications.

Clinical characteristics and risk factors associated with lymphoma in patients with systemic lupus erythematosus: a nationwide cohort study.

OBJECTIVES: To assess the characteristics and risk of lymphoma in a large cohort of patients with SLE. METHODS: A case-cohort analysis was performed within a dynamic cohort of SLE patients from the Spanish Society of Rheumatology Lupus Registry (RELESSER). Clinical and analytical features were compared between the lymphoma SLE group and the control SLE group using an independent-sample Student's t-test or Mann-Whitney test for continuous variables and the χ2 test for categorical variables with Fisher's exact test if necessary. The multivariate analysis was based on a generalized linear model. RESULTS: Twenty-one patients with SLE and lymphoma and 3965 non-lymphoma controls with SLE were studied. Most lymphomas were of B cell origin (n = 15/21), with diffuse large B cell lymphoma being the most frequent histological type (8/21, 38.1%). As in the general population, the risk of lymphoma in SLE was higher in male than in female patients and increased with age. In the lymphoma SLE group, bivariate analysis showed a significantly higher percentage of pericarditis, organic brain syndrome, seizures, vasculitis, haemolytic anaemia, splenomegaly, venous thrombosis and mean modified (excluding lymphoma) SLICC/ACR damage index. In contrast, renal involvement, positive anti-dsDNA, and antimalarials ever were less frequent. CONCLUSIONS: In this large multicentre Spanish cohort, we identified characteristics of SLE that are associated with a higher risk of lymphoma. Antimalarials were significantly negatively associated with risk of lymphoma in SLE patients. Nevertheless, further prospective studies are needed to clarify these findings.

Biologic therapy in refractory neurobehçet's disease: a multicentre study of 41 patients and literature review.

OBJECTIVES: To assess efficacy and safety of biologic therapy (BT) in neurobehçet's disease (NBD) refractory to glucocorticoids and at least one conventional immunosuppressive drug. METHODS: Open-label, national, multicentre study. NBD diagnosis was based on the International Consensus Recommendation criteria. Outcome variables were efficacy and safety. Main efficacy outcome was clinical remission. Other outcome variables analysed were glucocorticoid-sparing effect and improvement in laboratory parameters. RESULTS: We studied 41 patients [21 women; age 40.6 (10.8) years]. Neurological damage was parenchymal (n = 33, 80.5%) and non-parenchymal (n = 17, 41.5%). First BTs used were infliximab (n = 19), adalimumab (n = 14), golimumab (n = 3), tocilizumab (n = 3) and etanercept (n = 2). After 6 months of BT, neurological remission was complete (n = 23, 56.1%), partial (n = 15, 37.6%) and no response (n = 3, 7.3%). In addition, median (IQR) dose of oral prednisone decreased from 60 (30-60) mg/day at the initial visit to 5 (3.8-10) mg/day after 6 months (P < 0.001). It was also the case for mean erythrocyte sedimentation rate [31.5 (25.6)-15.3 (11.9) mm/1st h, P = 0.011] and median (IQR) C-reactive protein [1.4 (0.2-12.8) to 0.3 (0.1-3) mg/dl, P = 0.001]. After a mean follow-up of 57.5 months, partial or complete neurological remission persisted in 37 patients (90.2%). BT was switched in 22 cases (53.6%) due to inefficacy (n = 16) or adverse events (AEs) (n = 6) and discontinued due to complete prolonged remission (n = 3) or severe AE (n = 1). Serious AEs were observed in two patients under infliximab treatment. CONCLUSIONS: BT appears to be effective and relatively safe in refractory NBD.

Spanish Curriculum in Cariology for undergraduate dental students: Proceedings and consensus.

INTRODUCTION: Cariology is today a broad-based discipline and in the Spanish university teaching field, all this knowledge is not unified in a curriculum. Therefore, the aim was to develop a consensus text based on the European Core Curriculum, updated, and adapted to the characteristics of the Spanish university environment. MATERIALS AND METHODS: A Spanish Cariology Curriculum Group (SCCG) was set up with members of the Spanish Society of Epidemiology and Oral Public Health (SESPO), Spanish Society of Conservative and Aesthetic Dentistry (SEOC) and Spanish Society of Paediatric Dentistry (SEOP) and university experts to adapt the European Core Curriculum in Cariology for undergraduate dental students (ECCC) for Spain. The work was carried out online during 2018 and 2019, and also face-to-face meetings took place to obtain a draft curriculum open for discussion that was presented to all the Spanish universities. The final modifications to the document were specified in a Consensus Conference of Spanish universities offering a Degree in Dentistry that took place in Madrid on 19 November 2019. RESULTS: Thirty-eight university experts, under SCCG supervision, participated in the elaboration of the new framework document. A total of 16 universities, from 23 invited, reached a consensus as to the contents of the Spanish Curriculum in Cariology for undergraduate dental students. This new Curriculum emphasises learning outcomes, uses a consensus-based terminology pertaining to caries and other hard-tissue conditions, and introduces a new domain of competence in Domain III of ECCC. CONCLUSION: This new Cariology Curriculum is the result of a very broad-based consensus of university experts in Spain and lays the foundation for the implementation of an integrated teaching of Cariology in Spain in adherence to Alliance for a Caries Free Future (ACFF) objectives.

Protector Role of Intraocular Lenses under Artificial Light Conditions.

INTRODUCTION: The aim of this work was to analyze, in an in vitro model, the possible protective effects of ultraviolet- (UV-) or UV/blue-filtering intraocular lens (IOL) under light-emitting diode (LED) lighting conditions. METHODS: Ten models of IOLs were evaluated. Light transmission spectrum was recorded from 300 to 800 nm, in steps of 1 nm. Photodamage in vitro model was induced in ARPE-19 cells by blue LED light (465-475 nm). Changes in cell viability and oxidative stress variables were studied to assess the protective effect of IOLs. RESULTS: UV/blue-filtering IOLs models block blue light spectrum in different proportion and UV-filtering IOLs blocking wavelength below 400 nm. However, in vitro study under blue LED light exposure does not show protective effects related with mitochondrial dysfunction and oxidative stress of UV/blue-filtering IOLs. CONCLUSIONS: The current in vitro study suggests that UV/blue filtering IOLs are not useful in terms of photoprotection in artificial light conditions. The results obtained indicate that it is needed to give attention to other IOL parameters besides the type of filter, as it seems they could have influence on the protective role.

Mood Disturbances, Anxiety, and Impact on Quality of Life in Patients Admitted to Epilepsy Monitoring Units.

Introduction: The overall combined prevalence of anxiety and depression in patients with epilepsy has been estimated at 20.2 and 22.9%, respectively, and is considered more severe in drug-refractory epilepsy. Patients admitted to epilepsy monitoring units constitute a particular group. Also, patients with psychogenic non-epileptic seizures can reach more than 20% of all admissions. This study aims to characterize these symptoms in a large cohort of patients admitted for evaluation in a tertiary epilepsy center. Materials and Methods: The study was conducted among 493 consecutive patients (age: 38.78 ± 12.7, 57% females) admitted for long-term video EEG from January 2013 to February 2021. Demographic, clinical, and mood disorder patients' data were collected. Anxiety and depression symptoms were assessed through the Hospital Anxiety Depression Scale (HADS-A and HADS-D), the State Trait Anxiety Inventory (STAI), and Beck Depression Inventory (BDI-II). Quality of life was determined using the QOLIE-10. Patients were divided into three groups: patients with epilepsy (n = 395), psychogenic non-epileptic seizures (PNES) (n = 56), and combined (n = 33). A univariate and multivariate regression analysis was performed for variables associated with quality of life. Results: Of 493 patients, 45.0% had structural etiology, and considering epilepsy classification, 43.6% were of temporal lobe origin. In addition, 32.45% of patients had a previous psychiatric history, 49.9% of patients had depressive symptoms in BDI, and 30.9% according to HADS-D; 56.42 and 52.63% of patients presented pathological anxiety scores in STAI-T and STAI-S, respectively; and 44.78% according to HADS-A. PNES and combined groups revealed a higher incidence of pathologic BDI scores (64.29 and 78.79%, p < 0.001) as well as pathologic HADS-A scores (p = 0.001). Anxiety and depression pathologic results are more prevalent in females, HADS-A (females = 50.7%, males = 36.8%; p = 0.0027) and BDI > 13 (females = 56.6%, males = 41.0%; p = 0.0006). QOLIE-10 showed that 71% of the patients had their quality of life affected with significantly higher scores in the combined group than in the epilepsy and PNES groups (p = 0.0015). Conclusions: Subjective anxiety, depression, and reduced quality of life are highly prevalent in patients with refractory epilepsy. These symptoms are more evident when PNES are associated with epilepsy and more severe among female patients. Most of the cases were not previously diagnosed. These factors should be considered in everyday clinical practice, and specific approaches might be adapted depending on the patient's profile.

[Characteristics and factors associated with the severity of COVID-19 in Primary Care professionals followed in a Basic Prevention Unit.] / Características y factores asociados a la gravedad de COVID-19 en profesionales de Atención Primaria seguidos en una Unidad Básica de Prevención.

OBJECTIVE: 24.1% of COVID-19 cases reported in Spain from the start of the COVID-19 alert until 29 May 2020 were in healthcare workers. The aim was to describe the demographic, clinical and epidemiological characteristics of Primary Care professionals notified for suspected or contact COVID-19 and to know the factors associated with the severity of the disease. This will allow the development of risk prevention strategies in Primary Care professionals. METHODS: We included all Primary Care professionals of the Territorial Management of Barcelona (GTBCN) notified as suspicion or contact with COVID-19 between March 15 and June 15, 2020. Demographic, clinical and epidemiological variables of the professionals and episodes reported were collected, as well as possible risk factors associated with severity. Descriptive and logistic regression analysis were performed. RESULTS: 1,511 episodes corresponding to 1,427 professionals (31.3% of the GTBCN staff) were reported. 76.4% were women, with a mean age of 45.32 years. Of the professionals reported, 28.5% presented COVID-19 in some episode, and of these 18.2% presented severe symptomatology. Risk factors associated with severity were: respiratory pathology (OR: 2.54, 95%CI: 1.16-5.56) and neoplasia (OR: 4.48, 95%CI: 1.38-14.55). CONCLUSIONS: The proportion of professionals notified due to suspicion or contact with COVID-19 is similar to that observed in other studies, being mostly concentrated in the care categories of primary care teams. The factors associated with symptom severity were previous respiratory disease and neoplasia.

OBJETIVO: El 24,1% de los casos de COVID-19 notificados en España desde el inicio de la alerta por COVID-19 hasta el 29 de mayo 2020 fue en trabajadores de la salud. El objetivo de este trabajo fue describir las características demográficas, clínicas y epidemiológicas de los profesionales de Atención Primaria notificados por sospecha o contacto COVID-19 y conocer los factores asociados a la gravedad de la enfermedad. Esto permitirá desarrollar estrategias de prevención de riesgos en los profesionales de Atención Primaria. METODOS: Se incluyeron todos los profesionales de Atención Primaria de la Gerencia Territorial de Barcelona (GTBCN) del Institut Català de la Salut notificados como sospecha o contacto con COVID-19 entre el 15 de marzo y el 15 de junio de 2020. Se recogieron variables demográficas, clínicas, epidemiológicas de los profesionales y episodios notificados, así como posibles factores de riesgo asociados a gravedad. Se realizó análisis descriptivo y de regresión logística. RESULTADOS: Se notificaron 1.511 episodios correspondientes a 1.427 profesionales (31,3% de la plantilla de la GTBCN). El 76,4% fueron mujeres, con una edad media de 45,32 años. El 28,5% de los profesionales notificados presentaron COVID-19 en algún episodio, y de estos 18,2% presentó sintomatología grave. Los factores de riesgo asociados a gravedad fueron: patología respiratoria (OR: 2,54, IC95%: 1,16-5,56) y neoplasia (OR: 4,48, IC95%: 1,38-14,55). CONCLUSIONES: El porcentaje de profesionales afectados por sintomatología compatible o contacto con COVID-19 es similar al observado en otros estudios concentrándose mayoritariamente en las categorías asistenciales de los equipos de atención primaria. Los factores asociados con la gravedad de los síntomas son enfermedad respiratoria previa y neoplasia.

Plasma Rich in Growth Factors Promotes Autophagy in ARPE19 Cells in Response to Oxidative Stress Induced by Blue Light.

Age-related macular degeneration (AMD) causes the degeneration of photoreceptors and retinal cells leading to vision loss in older subjects. Among possible exogenous risk factors, it has been recently proposed that long-term exposure to blue light could aggravate the course of AMD. In the search for therapeutic options, plasma rich in growth factors (PRGF) has been shown to enhance cell antioxidant pathways and protect photoreceptors against the harm produced by blue light, although its mechanism of action remains unknown. One possible mechanism, autophagy, is one of the most conservative cell renewal systems used in eukaryotes to destroy cellular components that have been damaged by some kind of insult. The oxidative stress of exposure to blue light is known to induce cell autophagy. In this study, we examined the combined effects on autophagy of blue light and PRGF in a retinal cell line, ARPE19. In response to treatment with both PRGF and blue light, we detected the modulated expression of autophagy markers such as NF-kB, p62/sqstm1, Atg5, LC3 and Beclin1, and inflammatory markers such as IL1B and IL18. Our findings suggest that PRGF promotes cell autophagy in response to exposure to blue light.

Necesidades y dificultades de los/las profesionales sanitarios/as de los servicios de prevención de riesgos laborales de Cataluña / Needs and barriers of medical personnel in Catalonian occupational health services

Objetivo: conocer las dificultades y necesidades del personal de medicina de los servicios de prevención de riesgos laborales de Cataluña para desarrollar sus funciones sanitarias descritas por la ley. Métodos: estudio Delphi en tres rondas. La selección de participantes se realizó diferenciadamente para servicios de prevención propios y ajenos. La primera ronda incluyó dos preguntas abiertas: ¿Qué dificultades tiene para realizar las funciones sanitarias de su SPRL? y ¿Qué necesidades tiene para realizar las funciones sanitarias de su SPRL? En la segunda y tercera ronda las personas participantes puntuaron las categorías identificadas en la primera ronda según su importancia y relevancia. Se calcularon un índice de acuerdo interjueces (ICC) y un “índice de preocupación (IP)”. Resultados: la gestión de las personas trabajadoras con limitaciones y la vigilancia colectiva de la salud de baja calidad son las dificultades más importantes para los Servicios de Prevención Propios. Para los Ajenos, la falta de comunicación con otros organismos, la preeminencia de los criterios económicos y de rentabilidad asociado al alto volumen de trabajo son las más relevantes. La necesidad de establecer canales de comunicación con otras instituciones u organismos como la Atención Primaria, las Mutuas, el Instituto de Evaluaciones Médicas y las Unidades de Salud Laboral es común a ambos grupos. Conclusiones: la diferente naturaleza de las actividades preventivas que realizan los servicios de prevención determina diferencias importantes en las dificultades expresadas, no así en las necesidades identificadas donde se encuentran puntos en común (AU)

Objective: to identify the difficulties and needs of medical professionals in occupational health services in Catalonia with respect to carrying out their functions, as prescribed by law. Methods: Delphi study in three rounds. The selection of participants was carried out separately for in-house versus outsourced occupational health services. The first round included two open-ended questions: What difficulties do you encounter when performing your duties in your occupational health service? And, what are your needs in terms of being able to perform your duties in your occupational health service? In the second and third rounds, participants ranked the categories identified in the first round according to their importance and relevance. We calculated an inter-rater agreement index (ICC) and an "index of concern (IP)". Results: Among in-house occupational health services, the most highly ranked difficulties were case management of workers with limitations and the low quality of medical surveillance systems. Among outsourced occupational health services, the most notable difficulties were the lack of communication with other organizations and the prioritization of economic and profitability criteria associated with the high work volume. For both types of services, there was a clear need to establish communication channels with other institutions or organizations such as primary care, mutual insurance companies, public medical evaluation units and public occupational health units. Conclusions: The different type of occupational health services reflects important differences in the types of difficulties encountered, but not in needs, where there are more points in common (AU)

Complicaciones neurológicas asociadas a la COVID-19 en pediatría

En la población pediátrica se han reportado casos de la COVID-19 con complicaciones neurológicas. El objetivo fue describir las complicaciones neurológicas en los pacientes pediátricos con la COVID-19 que acudieron a la emergencia del HUC. Estudio observacional, descriptivo, retrospectivo, de corte transversal, se revisaron 104 historias médicas del Servicio de Emergencia Pediátrica, durante marzo a noviembre 2020. Se incluyeron 15 pacientes que presentaron complicaciones neurológicas en edades comprendidas entre 1 meses a 11 años (media 2,41 (±) años con desviación estándar de 3,3 años), siendo más frecuente, en los lactantes menores con 40,0 % (n=6). Entre las complicaciones neurológicas la más predominante fue la encefalitis/meningoencefalitis, siendo la sintomatología más descrita la crisis epiléptica sintomática aguda en 93 % (n=14), con estatus epiléptico en el 57 % (n=8). La mayoría de la muestra presentó desnutrición en 87 % (n=13) y comorbilidades neurológicas con 47 % (n=7), pulmonares en un 13 % (n=2), cardiopatías en 6,5 % (n=1) y genéticas con 6,5 % (n=1). Las complicaciones neurológicas asociadas a la COVID-19 tuvieron una incidencia de 14,4 % (n=15). Las crisis epilépticas y el status epiléptico fueron la sintomatología neurológica más frecuente. La severidad de la enfermedad pudiera estar condicionada a un estado de desnutrición.

In the pediatric population, cases of COVID-19 with neurological complications have been reported. The objective was to describe the neurological complications in pediatric patients with COVID-19 who attended the HUC emergency. Observational, descriptive, retrospective, cross-sectional study, 104 medical records of the Pediatric Emergency Service were reviewed, during March to November 2020. 15 patients who presented neurological complications between 1 months and 11 years of age were included (mean 2.41 (±) years with standard deviation of 3.3 years), being more frequent, in infants under 40.0 % (n = 6). Among the neurological complications, the most predominant was Encephalitis / Meningoencephalitis, with the most described symptoms being acute symptomatic seizures in 93 % (n = 14), with status epilepticus in 57 % (n = 8). Most of the sample presented malnutrition in 87 % (n = 13) and neurological comorbidities with 47 % (n = 7), pulmonary in 13 % (n = 2), heart disease in 6.5 % (n = 1) and genetic with 6.5 % (n = 1). Neurological complications associated with COVID-19 had an incidence of 14.4 % (n = 15). Epileptic seizures and status epilepticus were the most frequent neurological symptoms. The severity of the disease could be conditioned to a state of malnutrition.