Concordancia clínica y patológica en tumores conjuntivales: Análisis de 195 casos / Clinic-pathological agreement in the diagnosis of conjunctival tumours: Analysis of 195 cases

Propósito Evaluar la concordancia entre el diagnóstico clínico y patológico en tumores conjuntivales en una unidad especializada en oncología ocular. Métodos Estudio retrospectivo de pacientes consecutivos con tumores conjuntivales diagnosticados en la Unidad de Oncología Ocular del Hospital Universitario de Valladolid desde 1992 hasta 2017. Los tumores se clasificaron según su origen (epitelial, melanocítico, linfoide y otros) y grado de malignidad (benigno, premaligno, maligno). Se realizó biopsia en los casos de lesiones sintomáticas o en crecimiento. Como indicador de concordancia entre el diagnóstico clínico y el patológico se utilizo el estadístico kappa (κ) de Cohen. Resultados Cuatrocientos sesenta y dos pacientes fueron atendidos de manera consecutiva, requiriendo biopsia en 195 (42,2%). La concordancia con el diagnóstico anatomopatológico fue satisfactoria en 154 (79%) casos. El análisis según el grado de malignidad mostró la menor tasa de concordancia en las lesiones benignas (n = 83; 91,6%) y premalignas (n = 62; 90,3%), con una concordancia total en las lesiones malignas (n = 50; 100%); el valor κ fue de 0,90. Los mayores índices de concordancia se encontraron en las lesiones epiteliales, melanocíticas y de partes blandas, con valores κ de 1, 0,8 y 1 respectivamente. El peor índice de concordancia se observó en lesiones linfoides, con un valor κ de 0,3. Conclusiones La mayoría de los tumores conjuntivales fueron correctamente identificados clínicamente. Las lesiones benignas y malignas mostraron la mayor tasa de precisión; sin embargo, las lesiones premalignas pueden ocultar enfermedad microinvasiva que puede pasar desapercibida en el examen clínico. La biopsia es esencial para un diagnóstico y un tratamiento precisos (AU)

Purpose The present study aims to assess the agreement between clinical and pathological diagnosis in conjunctival tumours in a specialist ocular oncology unit. Methods A retrospective study of consecutive patients with conjunctival tumours diagnosed at the Ocular Oncology Unit of the University Hospital of Valladolid was performed from 1992 to 2017. Tumours were classified according to their origin (epithelial, melanocytic, lymphoid, and others) and degree of malignancy (benign, premalignant, and malignant). A biopsy was performed in cases of symptomatic or growing lesions. Cohen's kappa (κ) statistics was used as an indicator of agreement between clinical and pathological diagnosis. Results Of 462 consecutive patients, a biopsy was required in 195 (42.2%). The agreement with the pathological diagnosis was successful in 154 (79%) cases. Analysis according to the grade of malignancy showed the lowest rate of agreement among benign (n = 83; 91.6%) and premalignant (n = 62; 90.3%) lesions, with a total agreement in malignant lesions (n = 50; 100%); the Cohen's kappa coefficient (κ) was 0.90. The highest rates of concordance were found in epithelial, melanocytic and soft tissue lesions with κ values of 1, 0.8 and 1, respectively. The worst rate of concordance was found in lymphoid lesions with a κ value of 0.3. Conclusions Most of the conjunctival tumours were correctly identified clinically; benign and malignant lesions showed the highest rate of accuracy; however, premalignant tumours can hide micro-invasive diseases that can go unnoticed on clinical examination. The biopsy is essential for accurate diagnosis and treatment (AU)

Clinic-pathological agreement in the diagnosis of conjunctival tumours: Analysis of 195 cases.

PURPOSE: The present study aims to assess the agreement between clinical and pathological diagnosis in conjunctival tumours in a specialist ocular oncology unit. METHODS: retrospective study of consecutive patients with conjunctival tumours diagnosed at the Ocular Oncology Unit of the University Hospital of Valladolid was performed from 1992 to 2017. Tumours were classified according to their origin (epithelial, melanocytic, lymphoid and others) and degree of malignancy (benign, premalignant, malignant). A biopsy was performed in cases of symptomatic or growing lesions. Cohen´s kappa (κ) statistics was used as an indicator of agreement between clinical and pathological diagnosis. RESULTS: Of 462 consecutive patients, a biopsy was required in 195 (42.2%). The agreement with the pathological diagnosis was successful in 154 (79.0%) cases. Analysis according to the grade of malignancy showed the lowest rate of agreement among benign (n = 83; 91.6%) and premalignant (n = 62; 90.3%) lesions, with a total agreement in malignant lesions (n = 50; 100%); the Cohen´s kappa coefficient (κ) was 0.90. The highest rates of concordance were found in epithelial, melanocytic and soft tissue lesions with κ values of 1, 0.8 and 1 respectively. The worst rate of concordance was found in lymphoid lesions with a κ value of 0.3. CONCLUSION: Most of the conjunctival tumours were correctly identified clinically; benign and malignant lesions showed the highest rate of accuracy; however, premalignant tumours can hide micro-invasive diseases that can go unnoticed on clinical examination. The biopsy is essential for accurate diagnosis and treatment.

[Impact of COVID-19 on a rare disease (uveal melanoma) in a national reference unit of intraocular tumors in Spain]. / Impacto del COVID-19 en una enfermedad rara (melanoma uveal) en una unidad de referencia nacional de tumores intraoculares en España.

Objective: To analyze the impact of the COVID-19 pandemic on the diagnosis and management of uveal melanoma (a tumor included in the Orphanet catalog of rare diseases) in a Spanish national reference unit for intraocular tumors during the first year of the pandemic. Material and methods: An observational retrospective study of patients with uveal melanoma in the National Reference Unit for Adult Intraocular Tumors of the Hospital Clínico Universitario de Valladolid (Spain) was performed, analyzing the pre- and post-COVID-19 periods: from March 15, 2019 to March 15, 2020 and from March 16, 2020 to March 16, 2021. Demographic data, diagnostic delay, tumor size, extraocular extension, treatment and evolution were collected. A multivariable logistic regression model was used to identify factors that were associated with the variable: enucleation. Results: Eighty-two patients with uveal melanoma were included, of which 42(51.21%) belonged to the pre-COVID-19 period and 40(40.78%) to the post-COVID-19 period. An increase in tumor size at diagnosis and in the number of enucleations was observed during the post-COVID-19 period (p < 0.05). Multivariable logistic regression demonstrated that both medium-large tumor size and patients diagnosed in the post-COVID-19 period were independently related to an increased risk of enucleation (OR 250, 95%CI, 27.69-2256.37; p < 0.01 and OR 10; 95% CI,1.10-90.25; p = 0.04, respectively). Conclusions: The increase in tumor size observed in uveal melanomas diagnosed during the first year of the COVID-19 pandemic may have favored the increase in the number of enucleations performed during that period.

Impacto del COVID-19 en una enfermedad rara (melanoma uveal) en una unidad de referencia nacional de tumores intraoculares en España / Impact of COVID-19 on a rare disease (uveal melanoma) in a national reference unit of intraocular tumors in Spain

Objetivo Analizar el impacto de la pandemia por COVID-19 en el diagnóstico y manejo del melanoma uveal (tumor incluido en el catálogo de enfermedades raras por Orphanet), en una unidad de referencia nacional española de tumores intraoculares, durante el primer año de pandemia. Materiales y métodos Se realizó un estudio retrospectivo observacional de pacientes con melanoma uveal en la Unidad de Referencia Nacional de Tumores Intraoculares del Adulto del Hospital Clínico Universitario de Valladolid (España), analizando los periodos pre- y pos-COVID-19: del 15 de marzo de 2019 al 15 de marzo de 2020 y del 16 marzo de 2020 al 16 de marzo de 2021. Se recogieron datos demográficos, demora diagnóstica, tamaño del tumor, extensión extraocular, tratamiento y evolución. Se utilizó un modelo de regresión logística multivariable para identificar los factores que se asociaron a la variable: enucleación. Resultados Se incluyeron 82 pacientes con melanoma uveal, de los cuales 42(51,21%) pertenecían al periodo pre-COVID-19 y 40(40,78%) al periodo pos-COVID-19. Se observó un aumento del tamaño tumoral al diagnóstico y del número de enucleaciones durante el periodo pos-COVID-19 (p<0,05). La regresión logística multivariable demostró que tanto el tamaño tumoral mediano-grande como los pacientes diagnosticados en el periodo pos-COVID-19 estaban relacionados de forma independiente con un riesgo mayor de enucleación (OR 250, IC95%, 27,69-2256,37; p<0,01 y OR 10; IC95%,1,10-90,25; p=0,04, respectivamente). Conclusiones El incremento del tamaño tumoral observado en los melanomas uveales diagnosticados durante el primer año de pandemia por COVID-19 pudo favorecer el aumento de las enucleaciones realizadas en dicho periodo (AU)

Objective To analyze the impact of the COVID-19 pandemic on the diagnosis and management of uveal melanoma (a tumor included in the Orphanet catalog of rare diseases) in a Spanish national reference unit for intraocular tumors during the first year of the pandemic. Material and methods An observational retrospective study of patients with uveal melanoma in the National Reference Unit for Adult Intraocular Tumors of the Hospital Clínico Universitario de Valladolid (Spain) was performed, analyzing the pre- and post-COVID-19 periods: from March 15, 2019 to March 15, 2020 and from March 16, 2020 to March 16, 2021. Demographic data, diagnostic delay, tumor size, extraocular extension, treatment and evolution were collected. A multivariable logistic regression model was used to identify factors that were associated with the variable: enucleation. Results Eighty-two patients with uveal melanoma were included, of which 42(51.21%) belonged to the pre-COVID-19 period and 40(40.78%) to the post-COVID-19 period. An increase in tumor size at diagnosis and in the number of enucleations was observed during the post-COVID-19 period (p<0.05). Multivariable logistic regression demonstrated that both medium-large tumor size and patients diagnosed in the post-COVID-19 period were independently related to an increased risk of enucleation (OR 250, 95%CI, 27.69-2256.37; p<0.01 and OR 10; 95% CI,1.10-90.25; p=0.04, respectively). Conclusions The increase in tumor size observed in uveal melanomas diagnosed during the first year of the COVID-19 pandemic may have favored the increase in the number of enucleations performed during that period (AU)

Impact of COVID-19 on a rare disease (uveal melanoma) in a national reference unit of intraocular tumors in Spain.

OBJECTIVE: To analyse the impact of the COVID-19 pandemic on the diagnosis and management of uveal melanoma (a tumour included in the Orphanet catalogue of rare diseases) in a Spanish national reference unit for intraocular tumours during the first year of the pandemic. METHOD: An observational retrospective study of patients with uveal melanoma in the National Reference Unit for Adult Intraocular Tumors of the Hospital Clínico Universitario de Valladolid (Spain) was performed, analysing the pre- and post-COVID-19 periods: from March 15, 2019 to March 15, 2020 and from March 16, 2020 to March 16, 2021. Demographic data, diagnostic delay, tumour size, extraocular extension, treatment and evolution were collected. A multivariable logistic regression model was used to identify factors that were associated with the variable: enucleation. RESULTS: Eighty-two patients with uveal melanoma were included, of which 42 (51.21%) belonged to the pre-COVID-19 period and 40(40.78%) to the post-COVID-19 period. An increase in tumour size at diagnosis and in the number of enucleations was observed during the post-COVID-19 period (p < 0.05). Multivariable logistic regression demonstrated that both medium-large tumour size and patients diagnosed in the post-COVID-19 period were independently related to an increased risk of enucleation (OR 250, 95%CI, 27.69-2256.37; p < 0.01 and OR 10; 95%CI, 1.10-90.25; p = 0.04, respectively). CONCLUSIONS: The increase in tumour size observed in uveal melanomas diagnosed during the first year of the COVID-19 pandemic may have favored the increase in the number of enucleations performed during that period.

Nicotiana hairy roots for recombinant protein expression, where to start? A systematic review.

BACKGROUND: Hairy roots are a plant-tissue culture raised by Rhizobium rhizogenes infection (formerly known as Agrobacterium rhizogenes). Nowadays, these roots have been gaining more space in biotechnology due to their benefits for the recombinant expression of valuables proteins; it includes simplified downstream processing, protein rhizosecretion, and scalability in bioreactors. However, due to methodological inconsistency among reports, the tissue platform is still a promising technology. METHODS AND RESULTS: In the current paper, we propose the first step to overcome this issue through a systematic review of studies that employ Nicotiana hairy roots for recombinant expression. We conducted a qualitative synthesis of 36 out of 387 publications initially selected. Following the PRISMA procedure, all papers were assessed for exclusion and inclusion criteria. Multiple points of root culture were explored, including transformation methods, root growth curve, external additives, and scale-up with bioreactors to determine which approaches performed best and what is still required to achieve a robust protocol. CONCLUSION: The information presented here may help researchers who want to work with hairy roots in their laboratories trace a successful path to appraisal the literature status.

Correlated Chained Gaussian Processes for Datasets With Multiple Annotators.

The labeling process within a supervised learning task is usually carried out by an expert, which provides the ground truth (gold standard) for each sample. However, in many real-world applications, we typically have access to annotations provided by crowds holding different and unknown expertise levels. Learning from crowds (LFC) intends to configure machine learning paradigms in the presence of multilabelers, residing on two key assumptions: the labeler's performance does not depend on the input space, and independence among the annotators is imposed. Here, we propose the correlated chained Gaussian processes from the multiple annotators (CCGPMA) approach, which models each annotator's performance as a function of the input space and exploits the correlations among experts. Experimental results associated with classification and regression tasks show that our CCGPMA performs better modeling of the labelers' behavior, indicating that it consistently outperforms other state-of-the-art LFC approaches.

[Clinical and epidemiologic description of a severe outbreak of Salmonellosis in an urban nursery school]. / Descripción clínica y epidemiológica de un brote grave de salmonelosis en una escuela infantil urbana.

OBJECTIVE: We describe clinically and epidemiologically an outbreak of gastrointestinal infection by Salmonella enterica ser. (serotype) Enteritidis in an urban infant school, which led to high morbidity and significant social alarm. The immediate communication, as well as the adequate study of the outbreak, in both aspects, allowed identifying the pathogen and establishing control measures in a reasonable period of time. Controversial aspects such as the indication of antibiotherapy or the moment of closing the center are discussed. METHODS: We retrospectively collected clinical, analytical and epidemiological information and we reviewed the methodology of the outbreak study and its results. RESULTS: A total of 57 children (3-45 months), were affected and had microbiological confirmation. Diarrhea and fever were the main symptoms. 74% went to the hospital and 37% were admitted (mean stay 3.3 days). Factors associated with admission were: dehydration, significant elevation of acute phase reactants and coagulopathy. Twelve patients received parenteral cefotaxime. There were 2 complications: 1 bacteremia and 1 readmission. The initial suspicion of the origin of the outbreak was food, but the analysis of the control samples was negative. Five workers were positive (2 symptomatic). Epidemiologic Surveillance concluded that the probable origin of the outbreak was an asymptomatic carrier and improper diapers handling. The center was closed for 8 days. Cleaning and disinfection measures were carried out, as well as instruction on diaper changing, and the carriers were followed. CONCLUSIONS: Clustering in time and space of cases should be reported immediately for early control of the outbreak. Children may present severe forms of Salmonella gastroenteritis.

Development and validation of a new methodological platform to measure behavioral, cognitive, and physiological responses to food interventions in real time.

To fully understand the causes and mechanisms involved in overeating and obesity, measures of both cognitive and physiological determinants of eating behavior need to be integrated. Effectively synchronizing behavioral measures such as meal micro-structure (e.g., eating speed), cognitive processing of sensory stimuli, and metabolic parameters, can be complex. However, this step is central to understanding the impact of food interventions on body weight. In this paper, we provide an overview of the existing gaps in eating behavior research and describe the development and validation of a new methodological platform to address some of these issues. As part of a controlled trial, 76 men and women self-served and consumed food from a buffet, using a portion-control plate with visual stimuli for appropriate amounts of main food groups, or a conventional plate, on two different days, in a random order. In both sessions participants completed behavioral and cognitive tests using a novel methodological platform that measured gaze movement (as a proxy for visual attention), eating rate and bite size, memory for portion sizes, subjective appetite and portion-size perceptions. In a sub-sample of women, hormonal secretion in response to the meal was also measured. The novel platform showed a significant improvement in meal micro-structure measures from published data (13 vs. 33% failure rate) and high comparability between an automated gaze mapping protocol vs. manual coding for eye-tracking studies involving an eating test (ICC between methods 0.85; 90% CI 0.74, 0.92). This trial was registered at Clinical Trials.gov with Identifier NCT03610776.

Calidad del sueño y déficit de memoria en el envejecimiento sano / Sleep quality and memory function in healthy ageing

Objetivo: Se estudió la relación entre la calidad del sueño y la memoria en el envejecimiento sano. Método: Participaron 99 personas mayores de 50 años, 69 mujeres y 30 hombres, con una media de edad de 68,74 años (DT = 7,18) y sin patologías asociadas. Se aplicaron las pruebas aprendizaje de palabras y pares visuales asociados mediante versiones computarizadas así como el cuestionario índice de calidad de sueño de Pittsburgh para evaluar la calidad del sueño. Resultados: Los resultados mostraron que el índice de calidad de sueño de Pittsburgh estaba relacionado negativamente con el rendimiento en las pruebas de pares visuales asociados y de aprendizaje de palabras. A peor calidad del sueño peor rendimiento en estas 2 pruebas de memoria. Además, el rendimiento en la prueba de pares visuales asociados estuvo negativamente relacionado con la calidad subjetiva de sueño, la duración y las perturbaciones del sueño. El rendimiento en la prueba de aprendizaje de palabras estuvo relacionado negativamente con la calidad subjetiva del sueño y la eficiencia. Se encontró un efecto débil del género de los participantes sobre el rendimiento en pares asociados y la latencia de sueño. Conclusiones: Los profesionales a cargo de personas de la tercera edad deberían tomar en consideración el efecto negativo de la baja calidad del sueño sobre la memoria. El deterioro de la cognición en estos pacientes puede ser manifestación del desequilibrio neuroendocrino asociado a la rotura de los ritmos circadianos. Sería necesaria más investigación para probar esta hipótesis. (AU)

Objective: To study the relationship between sleep quality and memory in healthy ageing. Methods: The study included 99 people older than 50 years (69 women and 30 men; mean age, 68.74 ± 7.18 years) with no associated diseases. Patients completed digital versions of the Word Learning and Visual Paired Associates tests and the Pittsburgh Sleep Quality Index questionnaire to assess the quality of sleep. Results: Pittsburgh Sleep Quality Index score was negatively correlated with Visual Paired Associates and Word Learning test performance. Performance in these 2 memory tests decreased in line with sleep quality. In addition, performance in Visual Paired Associates test was negatively correlated with subjective sleep quality, duration, and sleep disturbances. Performance on the Word Learning test was negatively correlated with subjective sleep quality and efficiency. Participants’ sex showed a weak effect on Visual Paired Associates performance and sleep latency. Conclusions: Medical professionals working with elderly patients should take into consideration the effect of poor sleep quality on memory. Cognitive impairment in these patients may be a manifestation of a neuroendocrine imbalance due to a disrupted circadian rhythm. More research is needed to prove this hypothesis. (AU)

Sleep quality and memory function in healthy ageing.

OBJECTIVE: To study the relationship between sleep quality and memory in healthy ageing. METHODS: The study included 99 people older than 50 years (69 women and 30 men; mean age, 68.74 ± 7.18 years) with no associated diseases. Patients completed digital versions of the Word Learning (WL) and Visual Paired Associates (VPA) tests and the Pittsburgh Sleep Quality Index (PSQI) questionnaire to assess the quality of sleep. RESULTS: PSQI score was negatively correlated with VPA and WL test performance. Performance in these 2 memory tests decreased in line with sleep quality. In addition, performance in VPA test was negatively correlated with subjective sleep quality, duration, and sleep disturbances. Performance on the WL test was negatively correlated with subjective sleep quality and efficiency. Participants' sex showed a weak effect on VPA performance and sleep latency. CONCLUSIONS: Medical professionals working with elderly patients should take into consideration the effect of poor sleep quality on memory. Cognitive impairment in these patients may be a manifestation of a neuroendocrine imbalance due to a disrupted circadian rhythm. More research is needed to prove this hypothesis.

Electrocatalytic activity of calcined manganese ferrite solid nanospheres in the oxygen reduction reaction.

In this study, we synthesized MnFe2O4 solid nanospheres (MSN) calcined at different temperatures (200-500 °C) and MSN-based materials mixed with carbon black, for their use as electrocatalysts in the oxygen reduction reaction (ORR) in alkaline medium (0.1 M KOH). It was demonstrated that the calcination temperature of MSN material determined its chemical surface composition and microstructure and it had an important effect on the electrocatalytic properties for ORR, which in turn was reflected in the performance of MSN/CB-based electrocatalysts. The study revealed that the presence of Mn species plays a key role in the ORR activity. Among tested, MSN200/CB and MSN350/CB exhibited the best electrochemical performances together with outstanding stability.

Prevalence of primary eosinophilic colitis in patients with chronic diarrhea and diarrhea-predominant irritable bowel syndrome.

INTRODUCTION: Primary eosinophilic colitis (PEC) is an inflammatory disease caused by the infiltration of eosinophils into the mucosa of the colon, determined after having ruled out other possible causes. It is characterized by abdominal pain and diarrhea and its prevalence is unknown. AIMS: To know the prevalence of PEC in patients with chronic diarrhea and in those with clinical criteria for diarrhea-predominant irritable bowel syndrome (IBS-D). PATIENTS AND METHODS: All patients with chronic noninflammatory diarrhea that were consecutively seen over a decade were studied through colonoscopy, with systematic biopsy. Patients with a known or decompensated organic disease, alarm features, abnormal minimal laboratory test results, and factors associated with eosinophilia were excluded. Patients with the clinical criteria for IBS-D (Rome III) were selected from the general group. Eosinophilic colitis was defined as the presence of > 35 eosinophils/100 epithelial cells per field in any of the segments. RESULTS: From the 683 patients seen, a total of 545 patients (361 women) were included in the study. Twenty-two cases of PEC were detected, resulting in a prevalence of 4.0%. A total of 343 patients had IBS-D criteria (223 women), with 16 cases of PEC detected, for a prevalence of 4.7%. Colonoscopy was normal, or almost normal, in all the PEC cases detected. CONCLUSIONS: The prevalence of PEC was 4.0% in the patients with chronic diarrhea and 4.7% in the patients with IBS-D. Peripheral eosinophilia appeared to be the main distinctive clinical characteristic, but systematic biopsy was essential for making the diagnosis.

Estudio descriptivo sobre el perfil de los pacientes derivados a la Unidad de Tratamiento del Dolor Crónico del Hospital Universitario de Gran Canaria Dr. Negrín (utdc-hugcdn) como base para la reorganización de esta / Descriptive study on the profile of patients sent to the Chronic Pain Treatment Unit of the University Hospital of Gran Canaria Dr. Negrín (utdc-hugcdn) as a basis for the reorganization of this

Objetivo: Conocer las necesidades y fortalezas de nuestra Unidad derivadas del conocimiento del perfil de paciente que es remitido para la atención en la misma. Pacientes y métodos: Estudio descriptivo transversal sobre 5000 pacientes derivados a nuestra Unidad entre 2017 y 2020. Se recogieron de forma anónima los siguientes datos: número de pacientes remitidos por mes, edad, sexo, servicio remisor, localización del dolor, pacientes/interconsultas preferentes, rechazados y atendidos previamente. De los 1000 primeros pacientes también se registraron los antecedentes quirúrgicos, existencia o no de obesidad y consumo de fármacos psicoactivos. Resultados: Son derivados para valoración unos 1560 pacientes de media anuales (130 al mes), con una edad media de 59,8 años (± 14,3) de los cuales el 62,6 % son mujeres. Un 62,08 % se encontraba en edad laboral. Los servicios asistenciales que remitieron más pacientes fueron: Traumatología, Neurocirugía, Unidad de Raquis y Rehabilitación. El 6,6 % de las derivaciones fueron calificadas como preferentes. Fueron rechazadas el 9,98 % de las interconsultas. Los tipos de dolores según su localización más frecuentes fueron: lumbalgia, cervicalgia y dolores generalizados. Se constató la toma habitual de ansiolíticos y/o antidepresivos en un 34,9 %, el 10,8 % eran obesos y el 10,3 % sufrían dolor crónico postquirúrgico. Conclusiones: El perfil del paciente predominante derivado a nuestra unidad suele ser el de un adulto mayor, en edad laboral, de género femenino, derivado desde el servicio de Traumatología y con dolor en la región lumbar, perfil muy similar al descrito en otras unidades del dolor del mundo occidental desarrollado. Más de 1 de cada 3 pacientes puede sufrir ansiedad y/o depresión, siendo también muy frecuente el dolor postquirúrgico y la obesidad.(AU)

Objective: Determine the shortcomings and strengths of our pain clinic derived from the knowledge of the profile of the patients who are referred for care in the clinic. Patients and methods: Cross-sectional descriptive study on 5000 patients referred to our pain clinic between 2017 y 2020. The following data were collected: number of patients referred per month, age, sex, referring service, location of pain, patients referred preferentially, rejected patients, and previously attended consultations. Data on surgical history, obesity, and use of psychoactive drugs were also recorded for the first 1000 patients. Results: An average of 1560 patients were referred for evaluation per year (130 per month), with a mean age of 59.8 years (± 14.3) of which 62.6 % are women and 62.08 % were of working age. The healthcare services that referred the most patients were Orthopedic Surgery, Neurosurgery, Spine Unit and Rehabilitation. 6.6 % of the requests were derived preferentially. Of the referrals, 9.98 % were rejected. The most frequent pain locations were low back pain, neck pain and generalized pain. In the The usual taking of anxiolytics and / or antidepressants was found in 34.9 %, 10.8 % were diagnosed as obese and 10.3 % were referred for chronic postoperative pain. Conclusions: The profile of the predominant patient referred to our pain clinic is an older adult, of working age, female, referred from the orthopedics department and with pain in the lumbar region. This described profile is very similar to other pain units in the developed western world. Almost one in 3 patients may suffer from anxiety and / or depression, and post-surgical pain and obesity are also very common.(AU)

Metastatic involvement of optic nerve in patient with breast and lung neoplasia.

Metastases are the most common adult intraocular tumors. However, those located in the optic nerve are very uncommon and are usually associated with spread to other locations such as the central nervous system, which darkens the prognosis. There is a case of a 67-year-old woman who reports progressive vision loss in the right eye of 15 days of evolution. The ophthalmological examination shows a relative afferent pupil defect in this eye and a pseudoedema of the papilla with retinal hemorrhages in the fundus. Personal history and characteristics of the optic nerve suggest the diagnosis of metastatic infiltration.

Afectación metastásica del nervio óptico en paciente con neoplasia de mama y pulmón / Metastatic involvement of optic nerve in patient with breast and lung neoplasia

Las metástasis son los tumores intraoculares más frecuentes del adulto. Sin embargo, aquellas localizadas en el nervio óptico son muy infrecuentes y suelen asociarse a diseminación en otras localizaciones como el sistema nervioso central, lo que ensombrece el pronóstico.Se presenta un caso de una mujer de 67 años que refiere pérdida de visión progresiva en el ojo derecho de 15 días de evolución. En la exploración oftalmológica se observa un defecto pupilar aferente relativo en dicho ojo y un pseudoedema de papila con hemorragias retinianas en el fondo de ojo. Los antecedentes personales y las características del nervio óptico apuntan al diagnóstico de infiltración metastásica. (AU)

Metastases are the most common adult intraocular tumors. However, those located in the optic nerve are very uncommon and are usually associated with spread to other locations such as the central nervous system, which darkens the prognosis.There is a case of a 67-year-old woman who reports progressive vision loss in the right eye of 15 days of evolution. The ophthalmological examination shows a relative afferent pupil defect in this eye and a pseudoedema of the papilla with retinal hemorrhages in the fundus. Personal history and characteristics of the optic nerve suggest the diagnosis of metastatic infiltration (AU)

Intraocular metastasis as a systemic presentation of neuroendocrine differentiation of prostate carcinoma.

A 68 year-old male was referred for assessment of an amelanotic lesion in the right eye (RE) that was associated with a gradual loss of visual acuity (VA), of 2 months onset, as the main symptom. It was noted in his medical history, that 6 years ago, he had prostate cancer treated with prostatectomy, lymphadenectomy, and coadjuvant local radiotherapy (RT). He was asymptomatic until 6 months ago, when a metastasis was discovered in the left femur, which was treated with radiotherapy. There were no findings of interest in the left eye (LE). His AV was very low in his RE, and in the eye fundus examination a mass without pigment was observed in the posterior pole with an adjacent exudative retinal detachment. Due to his personal history and results of the complementary tests such as ultrasound and magnetic resonance, the most likely diagnostic option was metastasis of prostate carcinoma, subsequently being confirmed with the histopathology results. Despite 4 cycles of chemotherapy, the patient did not show any clinical or radiological response, worsening until his death 3 months later.

Estudio observacional y prospectivo sobre la eficacia y seguridad de la estimulación del ganglio de la raíz dorsal en pacientes con dolor neuropático refractario / Observational and prospective study on the effectiveness and safety of the dorsal root ganglion stimulation in patients with refractory neuropathic pain

Introducción: La estimulación del ganglio de la raíz dorsal forma parte del manejo terapéutico del dolor neuropático refractario en aquellos casos donde el tratamiento médico, intervencionista o la estimulación central no han podido dar solución al mismo. Metodología: Se presentan los resultados de un estudio observacional, prospectivo, en 10 pacientes a los que les ha sido implantado el sistema de estimulación del ganglio de la raíz dorsal (EGRD), según la práctica clínica habitual, para el alivio de dolores neuropáticos refractarios al tratamiento médico e intervencionista. Los objetivos principales del estudio fueron la valoración en los cambios de la intensidad del dolor, en la funcionalidad y en los niveles de ansiedad y depresión. El tiempo de seguimiento fue de 6 meses tras el implante del generador. Resultados: 8 pacientes superaron la fase de prueba al constatarse una disminución de la intensidad del dolor superior al 50 %: 5 de estos sufrían dolores secundarios a lesión nerviosa periférica traumática o postquirúrgica, los otros 3 padecían dolores neuropáticos de otros orígenes. Se constató una disminución de la intensidad del dolor del 63 % en la EVA, mejoría general subjetiva del 70 %, disminución de la toma de analgésicos, mejoría funcional en la escala Oswestry, así como en los niveles de ansiedad y depresión (Escala HAD). Los mejores resultados se obtuvieron en los pacientes en los que se les implantó un electrodo en el ganglio de la raíz dorsal L5 para el tratamiento de dolores en miembros inferiores y con sensación de alodinia. No se objetivaron cambios en la estimulación en relación con la postura y sí gran concordancia entre el área de parestesia y del dolor. Las complicaciones fueron escasas y en ningún caso graves. Conclusión: Se trata de una técnica eficaz, segura y que probablemente tendrá un gran futuro dentro del campo de la neuroestimulación para los dolores neuropáticos refractarios.(AU)

Background: The Dorsal Root Ganglion Stimulation is a part from the treatment of the refractory neuropathic pain to a medical treatment, interventionism or central neurostimulation which have not work. Methods: This observational, prospective study show the results of 10 patients who has been implanted a Dorsal Root Ganglion Stimulation (DRGS) system following the clinical practice. All the patients suffer from refractory neuropathic pain to a medical and interventionism treatment. Eight of these patients passed the test phase due to an improvement of 50 %, 5 cases were patients who suffer from a traumatic or postsurgical peripheral nerve injury. The main objectives of the study were the assessment of changes in pain intensity, functionality and levels of anxiety and depression. The follow-up time was 6 months after the implantation of the generator. Results: Eight patients passed the test phase when a decrease in pain intensity was found to be greater than 50 %, 5 of these suffered pains secondary to traumatic or postsurgical peripheral nerve injury, the other three suffered neuropathic pains of other origins. We found a 63 % decrease in pain intensity in the VAS, a 70 % subjective general improvement, a clear decrease in analgesia, a functional improvement on the Oswestry scale, and an improvement in anxiety and depression levels (HAD scale). The best results were obtained in patients with electrode implanted at L5 root for the treatment of pain in the foot or ankle and allodynia. We found an absence of changes in stimulation in relation to posture and an area of stimulation similar with the area of pain. The complications were few and not severe. Conclusion: To conclude, this technique is an effective, safe and it will probably have a great future in the field of neurostimulation for refractory neuropathic pain.(AU)