Iberia consensus on strategies to prevent and manage irritation by topical retinoids in facial and trunk acne. / Consenso Iberia sobre estrategias de prevención y manejo de la irritación por retinoides tópicos en acné localizado en cara y tronco.

OBJECTIVE: To assess the level of agreement on various prevention and management strategies for irritation caused by topical retinoids in facial and trunk acne in an attempt to alleviate it and minimize treatment discontinuations as much as possible. METHOD: After reviewing the scientific medical literatura currently available, 4 different areas of uncertainty in the management of irritation caused by topical retinoids in acne were identified. A questionnaire with 34 recommendations was created and evaluated by a group of 133 dermatologists (Delphi methodology). RESULTS: In 82.3% of the recommendations (28 out of 34), some level of agreement was reached (≥ 85% agreement in 22 recommendations and ≥ 70% agreement in 6). The results with the highest level of agreement focused on specific patient education strategies (explaining that irritation is an expected reaction at the beginning of treatment and tends to decrease over time), gradual and/or spaced application of topical retinoids (at night time to prevent and/or reduce skin irritation), and the importance of using adjuvant products, specific for acne-prone skin, hydration, photoprotection, and skin cleansing. These recommendations reflect a comprehensive approach to managing irritation associated with topical retinoids and promoting long-term adherence. CONCLUSIONS: Skin irritation caused by topical retinoids in facial and trunk acne is an expected, mild, and controllable reaction if proper prevention and management guidelines are followed, meaning that it should not be a reason for treatment discontinuation.

Influence of environmental factors on the occurrence of gastrointestinal and cardiopulmonary nematodes in the red fox in the semi-arid Mediterranean areas of the Iberian Peninsula.

Human-induced ecosystem fragmentation is one of the drivers causing wildlife migration from their natural habitats to urban areas, among other reasons. The red fox (Vulpes vulpes) is the most abundant wild canid in the semi-arid Mediterranean areas of the Iberian Peninsula. Water scarcity may result in areas shared by synanthropic fox populations and domestic animals becoming hotspots for parasite transmission. This study describes the gastrointestinal and cardiopulmonary nematode species affecting fox populations in these semi-arid areas and the influence of environmental variables on parasite abundance. A total of 167 foxes collected from 2015 to 2021 in the Region of Murcia (SE Spain) were analysed. Parasite abundance and spatial distribution were evaluated using environmental variables and host characteristics with a Generalised Linear Model and the Moran index. Eleven species (seven from the gastrointestinal tract and four from the cardiopulmonary tract) were described. The influence of biotic and abiotic variables was studied for Angiostrongylus vasorum, Crenosoma vulpis, Uncinaria stenocephala, Toxocara canis and Toxascaris leonina. Temperature, humidity and areas of forest or agricultural land influenced the abundance of these parasites, providing optimal conditions for free-living stages of the direct life cycle nematodes and intermediate hosts. Absolute abundance distribution maps showed defined locations for C. vulpis, T. canis and T. leonina. The results for U. stenocephala, T. canis and T. leonina were particularly important as their higher abundance levels were found close to anthropized areas, which need to be carefully evaluated to prevent transmission of these nematodes between domestic and wild canids and human health.

Molecular identification of Borrelia and SFG Rickettsia spp. in hard ticks parasitizing domestic and wild animals in southeastern Spain.

Lyme disease and the spotted fever group rickettsiosis, involve bacteria belonging to the genus Borrelia and Rickettsia, respectively. These infections are the most important tick-borne zoonotic diseases involving ticks as vectors. Descriptive and epidemiological studies are essential to determine the animal hosts involved in the maintenance of these diseases. In the present study, 94 tick pool samples from 15 different host species located in the Region of Murcia (southeastern, Spain) were analysed. Ticks were morphologically identified as: Dermacentor marginatus, Hyalomma lusitanicum, Ixodes Ricinus, and Rhipicephalus sanguineus. Our results showed that 5.3% of the tick pool samples carried Borrelia spp. DNA, and 20.2% carried SFG Rickettsia DNA. In every hard tick pool Spot Fever Group (SFG) Rickettsia spp. DNA were detected, except for H. lusitanicum. Likewise, D. marginatum was the only species in which Borrelia spp. DNA was not detected. Barbary sheep and wild boar were the host species in which tick pools showed DNA presence of both pathogens. This study increases the knowledge about the presence of Borrelia spp. DNA and SFG Rickettsia spp. DNA in different hard tick species from this geographical area.

Sample preparation for suspect and non-target screening of xenobiotics in human biofluids by liquid chromatography-High resolution tandem mass spectrometry.

The concept of exposome covers all the exposures an individual suffers from conception to death, which can be partially assessed through the monitoring of human biofluids. In there, target analytical approaches tend to focus on a limited set of xenobiotics, whereas exposomic studies need broad scopes in search of a full understanding. Given the issue, suspect and non-target screening are feasible alternatives. However, adequate sample preparation procedures should minimize interferences without significantly reducing the number of xenobiotics. Within this context, the present article aims to describe comprehensive sample preparation procedures for suspect or non-target screening of organic xenobiotics in several human biofluids, all coupled to unified separation and detection conditions based on ultra-high performance liquid chromatography-high resolution tandem mass spectrometry (UHPLC-HRMS/MS). The referred biofluids consist of human urine, breast milk, saliva and ovarian follicular fluid.•Analytical methods for untargeted analysis of a wide range of xenobiotics in human biofluids are fully described in order to ensure reproducibility.•The sample preparation procedures balance selectivity and sensitivity.•Unified analysis conditions allow simultaneous analysis of diverse biofluids.

Concordancia inter e intraobservador en la medida de los agujeros maculares por tomografía de coherencia óptica / Inter- and intra-observer agreement in the measurement of macular holes by optical coherence tomography

Antecedentes y objetivo El agujero macular de espesor completo (AMEC) es una lesión foveal causada por un defecto del espesor completo de la retina neurosensorial. En su diagnóstico y en la indicación de tratamiento quirúrgico se tiene en cuenta la medida del agujero según la herramienta proporcionada por la OCT. Dicha medida puede ser realizada por varios oftalmólogos a lo largo del seguimiento de un paciente. El objetivo de este estudio es averiguar si existe variabilidad intraindividual e interindividual en dichas mediciones. Material y métodos Revisión retrospectiva de imágenes de b-scans de OCT con diagnóstico de AMEC. Se realizaron mediciones del diámetro mínimo del AMEC mediante la herramienta manual disponible en el DRI-Triton (Topcon, Japón) en las escalas 1:1 y 1:2, en días diferentes, por 2 especialistas en retina y 2 residentes. Se compararon dichas mediciones para valorar la correspondencia interobservador e intraobservador Resultados Se analizan 34 imágenes. Para la variabilidad intraobservador se obtuvo un índice de correlación superior a 0,98 en todos los casos. Para la variabilidad interobservador, el coeficiente de correlación intraclase fue de 0,94 (IC del 95%, 0,91-0,97) para la escala 1:1, y de 0,94 (IC del 95%, 0.91-0,97) para la escala 1:2. Conclusiones Los valores del tamaño de los AMEC medidos por OCT son reproducibles entre oftalmólogos especialistas y residentes y son independientes de la escala de la imagen en la que se realice dicha medición (AU)

Background and objective A full-thickness macular hole (FTMH) is a foveal lesion caused by a defect in the full thickness of the neurosensory retina. Its diagnosis and the indication for surgical treatment take into account the measurement of the hole according to the tool provided by the OCT. This measurement can be performed by several ophthalmologists during the follow-up of a patient. The aim of this study is to find out whether there is intra-individual and inter-individual variability in these measurements. Material and methods Retrospective review of OCT b-scan images with a diagnosis of FTMH. Measurements of the minimum diameter of the FTMH were performed using the hand-held tool available on the DRI-Triton (Topcon, Japan) at 1:1 and 1:2 scales, on different days, by 2retina specialists and 2residents. These measurements were compared to assess inter-observer and intra-observer correspondence. Results Thirty-four images were analysed. For intra-observer variability, a correlation index higher than 0.98 was obtained in all cases. For inter-observer variability, the intra-class correlation coefficient was 0.94 (95% CI: 0.91-0.97) for the 1:1 scale, and 0.94 (95% CI: 0.91-0.97) for the 1:2 scale. Conclusions OCT-measured AMEC size values are reproducible between ophthalmic specialists and residents and are independent of the imaging scale at which the measurement is made (AU)

Sustainable use of wastes as reactive material in permeable reactive barrier for remediation of acid mine drainage: Batch and continuous studies.

The aim of this work was to evaluate the feasibility of the use of different industrial and agricultural wastes as reactive materials in Permeable Reactive Barriers (PRB) for Acid Mine Drainage (AMD) remediation. Sugar foam (SF), paper mill sludge (PMS), drinking water sludge (DWS) and olive mill waste (OMW) were evaluated in terms of pH neutralization and metal removal from AMD. Laboratory batch tests and continuous pilot scale up-flow columns containing 82% of Volcanic Slag (VS), as porous fill material, and 18% w/w of one of the industrial and agricultural wastes previously indicated, were tested. From the batch tests it was observed that the reactive material presenting the best results were the SF and the PMS. The results obtained in all the PRB were accurately described by a pseudo-first order model, presenting coefficient of determination higher than 0.96 in all the cases. During the continuous operation of the PRB, the porosity and hydraulic retention time (HRT) of most of the up-flow columns strongly decreased due to chemical precipitation and biofilm growth. The SF presented a significant number of fine particles that were washed out by the liquid flow, generating an effluent with very high total suspended solid concentration. Despite SF was the material with the highest alkalinity potential, the reduction of the HRT limited its neutralization and metal removal capacity. PMS and DWS presented the best pollutant removal yields in the continuous operation of the PRB, ranging from 55 to 99% and 55-95% (except in the case of the Mn), respectively. These results allowed the metal removal from the AMD. Additionally, these wastes presented very good biological sulphate reduction. Based on these results, the use of PMS and DWS as reactive material in PRB would allow to simultaneously valorise the industrial waste, which is very interesting within the circular economy framework, and to remove metals from the AMD by means of a low-cost and environmentally sustainable procedure.

Inter- and intra-observer agreement in the measurement of macular holes by optical coherence tomography.

BACKGROUND AND OBJECTIVE: A full-thickness macular hole ("FTMH") is a foveal lesion caused by a defect in the full thickness of the neurosensory retina. Its diagnosis and the indication for surgical treatment take into account the measurement of the hole according to the tool provided by the OCT. This measurement can be performed by several ophthalmologists during the follow-up of a patient. The aim of this study is to find out whether there is intra-individual and inter-individual variability in these measurements. MATERIAL AND METHODS: Retrospective review of OCT b-scan images with a diagnosis of FTMH. Measurements of the minimum diameter of the FTMH were performed using the hand-held tool available on the DRI-Triton (Topcon, Japan) at 1:1 and 1:2 scales, on different days, by 2 retina specialists and 2 residents. These measurements were compared to assess inter-observer and intra-observer correspondence. RESULTS: Thirty-four images were analysed. For intra-observer variability, a correlation index higher than 0.98 was obtained in all cases. For inter-observer variability, the intra-class correlation coefficient was 0.94 (95% CI: 0.91-0.97) for the 1:1 scale, and 0.94 (95% CI: 0.91-0.97) for the 1:2 scale. CONCLUSIONS: OCT-measured AMEC size values are reproducible between ophthalmic specialists and residents and are independent of the imaging scale at which the measurement is made.

Endothelial ILK induces cardioprotection by preventing coronary microvascular dysfunction and endothelial-to-mesenchymal transition.

Endothelial dysfunction is an early event in coronary microvascular disease. Integrin-linked kinase (ILK) prevents endothelial nitric oxide synthase (eNOS) uncoupling and, thus, endothelial dysfunction. However, the specific role of endothelial ILK in cardiac function remains to be fully elucidated. We hypothesised that endothelial ILK plays a crucial role in maintaining coronary microvascular function and contractile performance in the heart. We generated an endothelial cell-specific ILK conditional knock-out mouse (ecILK cKO) and investigated cardiovascular function. Coronary endothelial ILK deletion significantly impaired cardiac function: ejection fraction, fractional shortening and cardiac output decreased, whilst left ventricle diastolic internal diameter decreased and E/A and E/E' ratios increased, indicating not only systolic but also diastolic dysfunction. The functional data correlated with extensive extracellular matrix remodelling and perivascular fibrosis, indicative of adverse cardiac remodelling. Mice with endothelial ILK deletion suffered early ischaemic-like events with ST elevation and transient increases in cardiac troponins, which correlated with fibrotic remodelling. In addition, ecILK cKO mice exhibited many features of coronary microvascular disease: reduced cardiac perfusion, impaired coronary flow reserve and arterial remodelling with patent epicardial coronary arteries. Moreover, endothelial ILK deletion induced a moderate increase in blood pressure, but the antihypertensive drug Losartan did not affect microvascular remodelling whilst only partially ameliorated fibrotic remodelling. The plasma miRNA profile reveals endothelial-to-mesenchymal transition (endMT) as an upregulated pathway in endothelial ILK conditional KO mice. Our results show that endothelial cells in the microvasculature in endothelial ILK conditional KO mice underwent endMT. Moreover, endothelial cells isolated from these mice and ILK-silenced human microvascular endothelial cells underwent endMT, indicating that decreased endothelial ILK contributes directly to this endothelial phenotype shift. Our results identify ILK as a crucial regulator of microvascular endothelial homeostasis. Endothelial ILK prevents microvascular dysfunction and cardiac remodelling, contributing to the maintenance of the endothelial cell phenotype.

A critical review of textile industry wastewater: green technologies for the removal of indigo dyes.

The denim textile industry represents an important productive sector. It generates wastewater with low biodegradability due to the presence of persistent pollutants, which can produce toxic and carcinogenic compounds; therefore, wastewater treatment reduces risks to aquatic life and public health. This paper presents a review of 172 papers regarding textile industry wastewater treatment for the removal of contaminants, especially indigo dyes used in the denim industry, in the context of green technologies. The physicochemical characteristics of textile wastewater, its environmental and health impacts, and the permissible limit regulations in different countries were reviewed. Biological, physicochemical and advanced oxidation processes for the removal of indigo dyes were reviewed. The goal of this study was to analyze the characteristics of green technologies; however, the research does not clearly demonstrate an effect on energy consumption savings, carbon footprint decreases, and/or waste generation. Advanced oxidation processes showed the highest color removal efficiency (95 and 97% in synthetic or real wastewater, respectively). Photocatalysis and Fenton reactions were the most efficient processes. None of the revised works presented results regarding upscaling for industrial application, and the results should be discussed in terms of the guidelines and maximum permissible limits established by international legislation. New technologies need to be developed and evaluated in a sustainable context with real wastewater.

Treating Nerve Injury after Endodontic Microsurgery Using Laser Photobiomodulation: A Report of 2 Cases.

The purpose of this case report was to inform dentists and dental specialists about a noninvasive, viable treatment option that could aid in the recovery of patients who have experienced iatrogenic nerve injuries. Nerve injury is an inherent risk of many dental procedures and a complication that can negatively impact a patient's quality of life and activities of daily living. Managing neural injuries presents a challenge for clinicians because there are no standard protocols reported in the literature. Although spontaneous healing of these injuries can occur, the duration and degree of healing can vary greatly between individuals. Photobiomodulation (PBM) therapy is used as an adjunct in medicine for functional nerve recovery. Once target tissues are illuminated with a low-level laser during PBM, the light energy is absorbed by the mitochondria causing adenosine triphosphate production, modulation of reactive oxygen species, and the release of nitric oxide. These cellular changes explain why PBM has been shown to aid in cell repair, vasodilation, a reduction in inflammation, accelerated healing, and an improvement in postoperative pain. This case report presents 2 patients with neurosensory alterations after endodontic microsurgery with a significant improvement in their condition after PBM treatment using a 940-nm diode laser.

A real life cohort of Mepolizumab treatment in severe eosinophilic asthma.

Summary: Background. Mepolizumab, a monoclonal antibody that interacts with IL-5, was the first anti-IL-5 approved for uncontrolled severe eosinophilic asthma. In several randomised, placebo-controlled trials, treatment with mepolizumab has shown a significant improvement in asthma symptoms and the need to use of oral corticosteroids (OCS). Several studies have correlated blood levels of eosinophil cationic protein (ECP) with the degree of eosinophilic inflammation, which could make it an indirect marker of eosinophilic activity. Methods. This was a single-centre retrospective study that included all patients diagnosed with severe eosinophilic asthma under treatment with mepolizumab. We recorded the number of exacerbations, daily prednisone intake, asthma control test scores and forced expiratory volume in the first second. Results. We followed 22 patients, 14 of whom were OCS-dependent with a mean daily dose of 15.85 ± 15.62 mg prednisone. After 12 months, only five continued taking OCS and the mean daily dose was reduced by up to 2.50 ± 3.84 mg (p less than 0.007). The exacerbation rate at baseline was 2.91 ± 2.27 and decreased to 0.82 ± 1.14 in the following year (p less than 0.001). ACT scores increased significantly from 16.00 ± 5.85 to 20.71 ± 4.45 after six months (p = 0.003). We also observed a decrease in ECP from 81.46 ± 43.99 µg/L to 19.12 ± 18.80 µg/L (p > 0.001). Conclusions. These real-life results are consistent with previous clinical trials demonstrating the efficacy and safety of mepolizumab in routine clinical practice for severe uncontrolled eosinophilic asthma. We observed a significant decrease in blood eosinophil counts and in ECP levels, suggesting a reduction in eosinophil activity following mepolizumab treatment.

Dolor abdominal inespecífico, un cuadro a vigilar / Non-specific abdominal pain, a case to keep under observation

El dolor abdominal es un síntoma inespecífico, común a múltiples procesos, con una alta prevalencia en la población general. Representa el 15-20% de los motivos de consulta en los servicios de urgencias.1 La mayoría de estos dolores tienen una etiología benigna, por lo que el objetivo inicial de la asistencia médica es identificar a aquellos pacientes cuyo dolor abdominal sea debido a una patología grave2. En ocasiones, puede tener una evolución tanto rápida como tórpida pudiendo provocar un abdomen agudo. El abdomen agudo se define como un dolor abdominal de instauración reciente, que requiere de un diagnóstico rápido y preciso debido a la posibilidad de que derive en un tratamiento quirúrgico urgente. Para ello es importante una buena anamnesis y exploración, enfocado a detectar signos y síntomas de alarma. Si no es diagnosticado y tratado de forma adecuada y precoz, puede originar consecuencia como sepsis, shock, insuficiencia renal, con elevada mortalidad3. A continuación presentamos el caso de una paciente con dolor abdominal inespecífico y pruebas complementarias anodinas en el inicio del cuadro, que evoluciona en las siguientes horas, obligando a la paciente a consultar de nuevo, llegando a precisar una intervención quirúrgica de urgencia. Se trata de un caso que nos obliga a determinar múltiples diagnósticos diferenciales y cómo abordar esta clínica tan frecuente como cambiante. (AU)

Abdominal pain is a nonspecific symptom, common to multiple processes, with a high prevalence in the general population. It represents 15-20% of the reasons for consultation in the Emergency Department1. Most of these pains have a benign etiology, so the initial objective of medical care is to identify those patients whose abdominal pain is due to a serious pathology2. Sometimes, it can have both a fast and torpid evolution and can cause an acute abdomen. Acute abdomen is defined as abdominal pain of recent onset, which requires a rapid and accurate diagnosis due to the possibility that it may lead to urgent surgical treatment. For this, a good history and examination is important, focused on detecting alarm signs and symptoms. If it is not diagnosed and treated properly and early, it can cause consequences such as sepsis, shock, kidney failure, with high mortality3. Below we present the case of a patient with nonspecific abdominal pain and anodyne complementary tests at the beginning of the condition, which evolves in the following hours, forcing the patient to consult again, eventually requiring an emergency surgical intervention. This is a case that forces us to determine multiple differential diagnoses and how to approach this clinic that is as frequent as it is changing. (AU)

First report of Metathelazia capsulata in red foxes (Vulpes vulpes) in Europe and new contributions to its identification.

Metathelazia capsulata is a lungworm that inhabit in the bronchi and bronchioles from mammal carnivore species, which life cycle is unknown. M. capsulata-like spirurid nematodes were isolated at necropsy from the respiratory tract of red foxes (Vulpes vulpes) from the Region of Murcia (SE Spain). The main objective of this study was to describe in detail the morphometric features of these nematodes, as well as to report some molecular markers. The principal morphometric difference compared to previous M. capsulata descriptions was the shorter total length for both males and females (6.6 mm and 7.4 mm, respectively). In addition, the mean values of buccal cavity depth and distance between the excretory pore and the anterior end of the nematode were also lower than those previously reported. On the other hand, sequence data of the mitochondrial (COI) and nuclear (rDNA) genes of M. capsulata were described, being the first time that molecular markers are reported for the genus Metathelazia and also for the entire family Pneumospiruridae. Based on data available from GenBank, these results indicate that M. capsulata sequences are closely related to the family Rhabdochonidae, which is assumed to belong to superfamily Thelazioidea, a superfamily including the family Pneumospiruridae, but also suggest the distant relations with the family Thelaziidae. This is the first time that M. capsulata is reported in red fox from Europe. This study provides valuable information for future phylogenetic studies on Metathelazia spp. nematodes and, in general, on species of the family Pneumospiruridae.

Incidencia, prevalencia y patrones de tratamiento del cáncer de próstata metastásico hormonosensible en España: Estudio ECHOS / Incidence, prevalence, and treatment patterns in metastatic hormone-sensitive prostate cancer in Spain: ECHOS study

Introducción y objetivo: El manejo de los pacientes con cáncer de próstata hormonosensible metastásico (CPHSm) ha cambiado en los últimos años debido a la autorización de nuevos medicamentos. El objetivo fue caracterizar la prevalencia, incidencia y patrones de tratamiento para el CPHSm en España.Pacientes y métodos: Estudio multicéntrico, observacional, longitudinal, retrospectivo en condiciones de práctica clínica habitual con pacientes con CPHSm atendidos en hospitales españoles entre 2015 y 2019 (estudio ECHOS). Las historias clínicas se extrajeron de la base de datos BIG-PAC (geográficamente representativa).Resultados: Se incluyeron los datos de 379 hombres con CPHSm. La prevalencia varió entre 12,2-14,6%. Hubo de 671 a 824 nuevos casos anualmente, con una tendencia creciente. La incidencia media en el periodo del estudio fue de 2,5%, con valores anuales en el rango 2,2-3%. Los nuevos casos anuales de pacientes de novo y recurrentes osciló en el rango 7-11 y 77-104, respectivamente, sin tendencia observada. Mayoritariamente eran pacientes recurrentes (91%) y de alto volumen tumoral (68,6%). La primera línea de tratamiento fue la combinación de docetaxel y terapia de deprivación de andrógenos (TDA) (53%), seguida por TDA sola (23,8%), combinación de TDA y abiraterona (11,1%) y radioterapia (8,6%). En los 12 meses anteriores al diagnóstico de metástasis, la mayoría se sometieron a una prostatectomía (84,9%). El resto había recibido radioterapia (12%) o no recibieron tratamiento (3,8%).Conclusiones: El estudio ECHOS proporciona datos epidemiológicos y patrones de tratamiento actuales en la práctica clínica en pacientes con CPHSm en España. Los resultados obtenidos destacan la necesidad médica de terapias dirigidas. (AU)

Introduction and objective: The management of patients with metastatic hormone-sensitive prostate cancer (mHSPC) has changed in recent years due to the approval of new drugs. The aim of this study was to evaluate the prevalence, incidence, and treatment patterns in mHSPC in Spain.Patients and methods: Multicenter, observational, longitudinal, retrospective study in routine clinical practice of patients diagnosed with mHSPC treated in Spanish hospitals between 2015 and 2019 (ECHOS study). Electronic medical records were extracted from BIG-PAC database, which contains geographically representative Spanish centers.Results: Data from 379 men with mHSPC were included. The prevalence of mHSPC ranged between 12.2-14.6% per year, representing from 671 to 824 annual cases with an increasing trend. The mean incidence along the 4-year period was 2.5%, with annual incidence ranging 2.2-3.0%. New annual cases of de novo and recurrent disease ranged between 7-11 and 77-104, respectively, with no trend being observed. These patients were mostly recurrent (91%) with high-volume disease (68.6%). The most common first-line therapy was ADT combined with docetaxel (53%), followed by ADT alone (23.8%), combination of ADT and abiraterone (11.2%), and radiotherapy (8.6%). In the last 12 months before diagnosis of metastasis, most men had been submitted to radical prostatectomy (84.9%). The remaining patients had received radiotherapy (12%) or no treatment at all (3.8%).Conclusions: The ECHOS study provides epidemiologic data and current patterns of treatment in clinical practice of patients with mHSPC in Spain. These results emphasize the medical need of targeted treatments in these clinical settings. (AU)