Why do physicians go to work when they are sick? Presenteeism at different career stages.

INTRODUCTION AND OBJECTIVE: Physicians find it difficult to take on the role of the patient and they show unusual behaviors when ill. One of these behaviors is presenteeism, which is working while sick. The objective of this research is to analyze the factors that contribute to the phenomenon of presenteeism in Spanish physicians. MATERIAL AND METHODS: Mixed methodology study: one national survey through the General Council of Medical Associations website (quantitative part), 22 semistructured interviews with sick residents and practicing physicians, and three focus groups involving professionals from the occupational health services (qualitative). A bivariate analysis using parametric and non-parametric tests. The significance level was p<0.05 (95% confidence interval). Qualitative analysis using the comparative-constant method until saturation of information. RESULTS: Presenteeism is reported by 89.4% of doctors who responded to the survey, and it is more common among women. Contributing factors include fear of overburdening colleagues (the main reason and more common among women 58.14% vs 48.35%), self-perception of doing one's duty (the second reason and more common among men, 44.63% vs 33.14%) and economic impact and difficulty in accepting the role of a sick person. This behavior has an impact on patient safety, and is part of the hidden curriculum that also affects the training of medical professionals. CONCLUSIONS: Presenteeism is a widespread and accepted practice among medical professionals. Although normalized, and even appreciated as a way to avoid overburdening colleagues, presenteeism has important implications for clinical ethics and patient safety.

Immediate release fentanyl. Real world data on abuse and dependence in Spain / Fentanilo de liberación inmediata. Datos de vida real de abuso y dependencia en España

Purpose: A substantial increase in the prescription of immediate release fentanyl (IRF) outside hospitals was observed in previous studies between 2012 and 2017, however it remains unknown the extent of immediate release fentanyl use disorders (IRFUD). This study aimed to estimate the incidence and risk factors of IRFUD, such us abuse and dependence, in Spain during this period. Methods: Retrospective cohort study performed in a Spanish electronic primary care healthcare records database (BIFAP). The incidence rate of IRFUD was calculated by dividing the number of incident cases by the total patient-years (p-y) of exposure. Demographic data, lifestyle, cancer diagnosis, comorbidities and concomitant medication were described and analyzed overall and in patients developing IRFUD using Cox regression models. Effect of the type of treatment (continuous/discontinuous) and duration were also evaluated. Results: The incidence of IRFUD in the 12,267 patients analyzed was 1.8 cases per 100 p-y of exposure. Baseline analysis showed higher frequencies of IRFUD for smokers, patients with a history of substance abuse, non-oncology indication and diagnosis of depression and anxiety, respect to non-IRFUD patients. Patients aged ≥ 80 were less likely to develop IRFUD abuse/dependence. Significant differences were for concomitant use of other treatments with potential for dependence and abuse, such as benzodiazepines. The risk of IRFUD increased with treatment duration, being the highest for treatments lasting 180 days and longer. Conclusion: Incidence of IRFUD is difficult to contrast due to the lack of similar studies. It could be considered not too higher outside hospitals but possible in cancer and non-cancer patients... (AU)

En estudios previos se ha observado un aumento considerable en la prescripción de fentanilo de liberación inmediata en el ámbito extrahospitalario entre 2012 y 2017. Sin embargo, aún se desconoce la magnitud de dependencia y abuso derivada de su uso. Este estudio tiene como objetivo estimar la incidencia y los factores de riesgo de los trastornos derivados del uso de fentanilo de liberación inmediata en España, tales como el abuso y la dependencia durante este período. Métodos: Estudio de cohortes retrospectivo realizado en España en la base de datos de historias clínicas electrónicas de atención primaria (BIFAP). La tasa incidencia de trastornos por el uso de fentanilo, se calculó dividiendo el número de casos incidentes entre el total de personas-año de exposición. Se analizaron datos demográficos, estilo de vida, diagnóstico de cáncer, comorbilidades y medicación concomitante. Para el análisis se utilizaron modelos de regresión de Cox. También se evaluó el efecto del tipo de tratamiento (continuo/discontinuo) y la duración de tratamiento. Resultados:La incidencia de trastornos por el uso de fentanilo en los 12,267 pacientes analizados fue de 1.8 casos por 100 personas-año de exposición. Se observó una frecuencia más elevada en aquellos pacientes que al inicio del tratamiento eran fumadores, pacientes con antecedentes de abuso de sustancias, con indicaciones no oncológicas y en pacientes con diagnóstico de depresión y ansiedad en comparación con los pacientes que no desarrollaron el evento. Los pacientes mayores de 80 años presentaron menos probabilidades de desarrollar estos trastornos. Se observaron diferencias significativas en el uso concomitante con otros tratamientos con potencial de desarrollar dependencia y abuso, como las benzodiacepinas. El riesgo aumentó con la duración del tratamiento, siendo más elevado para aquellos tratamientos que duraban 180 días o más... (AU)

Prevalencia de acidosis metabólica en derivaciones ileales tras más de un año de la cistectomía radical y repercusiones metabólicas secundarias asociadas / Prevalence of metabolic acidosis in ileal diversions more than one year after radical cystectomy and associated secondary metabolic effects

Introducción y objetivo La acidosis metabólica (AM) es una alteración conocida en pacientes con derivaciones ileales. Es más frecuente en etapas tempranas postoperatorias y disminuye con el tiempo. Nuestro objetivo es determinar su prevalencia tras más de un año de seguimiento, analizar sus factores de riesgo y evaluar su impacto en diferentes perfiles metabólicos. Materiales y métodos Realizamos un estudio observacional entre enero de 2018 y septiembre de 2022 siguiendo las normas STROBE. La AM fue definida con valores de bicarbonato venoso <22mEq/l. Analizamos 133 pacientes con una media de seguimiento de 55,24±42,36 meses. Resultados Se identificaron 16 (12%) pacientes con AM. Los pacientes con y sin AM fueron comparables en edad, sexo y tiempo de seguimiento. El grupo con AM presentó una mayor tasa de anemia (68,75 vs. 19,65%; p<0,001) e insuficiencia renal (100 vs. 45,29%; p<0,001) y niveles venosos estadísticamente significativos mayores de creatinina, cloro, potasio, hormona paratiroidea y fósforo, pero menores valores de hemoglobina, filtrado glomerular, colesterol total, vitamina D, calcio y albúmina (todos p<0,05). El filtrado glomerular fue el único factor de riesgo independiente relacionado con la AM (OR: 0,914; IC 95%: 0,878-0,95; p<0,0001), demostrando una estrecha correlación con los valores de bicarbonato venoso (r=0,387; p<0,001). Conclusiones La AM es una alteración poco prevalente en derivaciones urinarias ileales transcurrido más de un año de la cistectomía, pero tiene implicaciones en el metabolismo hematológico, renal, proteico, lipídico y óseo. Aconsejamos su monitorización en pacientes con insuficiencia renal para poder realizar un diagnóstico y tratamientos precoces (AU)

Introduction and objective Metabolic acidosis (MA) is a well-known complication in patients with ileal urinary diversions. It is common in the early postoperative stages and decreases over time. Our objective is to investigate the prevalence of MA after more than one year of follow-up, identify the associated risk factors, and analyze its secondary metabolic consequences. Materials and methods We conducted an observational study between January 2018 and September 2022 following the STROBE guidelines. MA was defined as a serum bicarbonate level <22mEq/L. Finally, we analyzed 133 patients with a mean follow-up of 55.24±42.36 months. Results MA was observed in 16 (12%) patients. Patients with and without MA were comparable in age, sex, and follow-up time. The group with MA presented a higher rate of anemia (68,75% vs 19.65%, P<.001) and renal failure (100% vs 45.29%, P<.001), statistically significant higher levels of serum creatinine, chloride, potassium, parathyroid hormone, and phosphorus but lower serum values of hemoglobin, renal glomerular filtration rate, total cholesterol, vitamin D, calcium, and albumin (all P<.05). Renal glomerular filtration rate was the only independent risk factor related to the development of MA (OR: 0.914; 95% CI: 0.878-0.95; P<.0001), proving a close correlation with venous bicarbonate values (r=.387, P<.001). Conclusions MA is a little prevalent disorder in ileal urinary diversions more than one year after radical cystectomy is performed but it has secondary consequences on hematologic, renal, protein, lipid, and bone metabolism. We recommend to a close follow-up in patients with renal failure for early diagnosis and treatment (AU)

Low Antioxidant Glutathione Levels Lead to Longer Telomeres: A Sex-Specific Link to Longevity?

Telomeres are repetitive DNA sequences at the end of chromosomes that protect them from degradation. They have been the focus of intense research because short telomeres would predict accelerated ageing and reduced longevity in vertebrates. Oxidative stress is considered a physiological driver of the telomere shortening and, consequently, short lifespan. Among molecules fighting against oxidative stress, glutathione is involved in many antioxidant pathways. Literature supports that oxidative stress may trigger a compensatory "hormetic" response increasing glutathione levels and telomere length. Here, we tested the link between total glutathione concentration and telomere length in captive birds (zebra finches; Taeniopygia guttata). Total glutathione levels were experimentally decreased during birds' growth using a specific inhibitor of glutathione synthesis (buthionine sulfoximine; BSO). We monitored the birds' reproductive performance in an outdoor aviary during the first month of life, and their longevity for almost 9 years. Among control individuals, erythrocyte glutathione levels during development positively predicted erythrocyte telomere length in adulthood. However, BSO-treated females, but not males, showed longer telomeres than control females in adulthood. This counterintuitive finding suggests that females mounted a compensatory response. Such compensation agrees with precedent findings in the same population where the BSO treatment increased growth and adult body mass in females but not males. BSO did not influence longevity or reproductive output in any sex. However, early glutathione levels and adult telomere length interactively predicted longevity only among control females. Those females with "naturally" low (non-manipulated) glutathione levels at the nestling age but capable of producing longer telomeres in adulthood seem to live longer. The results suggest that the capability to mount a hormetic response triggered by low early glutathione levels can improve fitness via telomere length. Overall, the results may indicate a sex-specific link between glutathione and telomere values. Telomerase activity and sexual steroids (estrogens) are good candidates to explain the sex-biased mechanism underlying the early-life impact of oxidative stress on adult telomere length.

Spanish abstract Los telómeros son secuencias repetitivas de ADN que se encuentran al final de los cromosomas protegiéndolos de la degradación. Los telómeros han sido foco de intensa investigación ya que tener telómeros cortos predice un envejecimiento acelerado y una longevidad reducida en vertebrados. El estrés oxidativo se considera causante del acortamiento de los telómeros y, consecuentemente, una corta esperanza de vida. Entre las moléculas que luchan contra el estrés oxidativo, el glutatión está relacionado con numerosas vías metabólicas de otros antioxidantes. La literatura defiende que el estrés oxidativo podría desencadenar una respuesta hormética compensatoria, aumentando los niveles de glutatión y la longitud de los telómeros. En este trabajo testamos la relación entre los niveles de glutatión y la longitud de los telómeros en aves en condiciones de cautividad (diamantes mandarines; Taeniopygia guttata). Los niveles de glutatión fueron reducidos experimentalmente durante el desarrollo de las aves usando un inhibidor específico de la síntesis de glutatión (Buthionina sufolximina; BSO). El desempeño reproductivo de estas aves fue monitoreado en un aviario exterior durante los primeros meses de vida y la longevidad durante casi nueve años. Entre los individuos controles, los niveles de glutatión durante el desarrollo predijeron positivamente la longitud de los telómeros a edad adulta. Sin embargo, las hembras tratadas con BSO, pero no los machos, mostraron telómeros más largos a edad adulta que las hembras controles. Este hallazgo aparentemente contradictorio sugiere que las hembras desarrollaron una respuesta compensatoria. Tal compensación concuerda con los hallazgos anteriores obtenidos en la misma población: las hembras tratadas con BSO vieron aumentado su peso corporal a edad adulta, resultado no encontrado entre los machos. El tratamiento con BSO no afectó la longevidad o el desempeño reproductivo de ningún sexo. Sin embargo, los niveles de glutatión durante el desarrollo y la longitud de los telómeros a edad adulta predijeron interactivamente la longevidad de las hembras controles. Aquellas hembras con niveles bajos "naturales" (no manipulados) de glutatión cuando eran pollos pero que pudieron producir telómeros más largos a edad adulta vivieron más. Este resultado sugiere que la capacidad de desarrollar una respuesta hormética desencadenada por niveles bajos de glutatión durante el desarrollo puede mejorar la eficacia biológica a través de la longitud de los telómeros. De manera general, los resultados indicarían una relación específica del sexo entre los valores de glutatión y de telómeros. La actividad de la enzima telomerasa y los esteroides sexuales (estrógenos) son buenos candidatos para explicar este mecanismo dependiente del sexo que impulsa el impacto del estrés oxidativo sufrido durante el desarrollo en la longitud de los telómeros de adultos.

Mujer y urología: ¿cuál es la situación en España? / Women in urology: What is their current situation in Spain?

Objetivo Analizar la situación actual de las mujeres en la especialidad de Urología en España. Material y métodos Estudio descriptivo a partir de los resultados de una encuesta electrónica remitida entre febrero y abril de 2020 a través de la base de datos del grupo de Residentes y Jóvenes Urólogos (RAEU) de la Asociación Española de Urología (AEU). Se analizaron las características demográficas de la encuesta y los resultados de la misma. Resultados Se obtuvieron 257 respuestas, correspondientes a 210 mujeres (81,71%) y 47 hombres (18,29%) procedentes de 111 hospitales en total. Se obtuvieron diferencias estadísticamente significativas (p<0,001), con una mayor proporción de hombres en todas las categorías, excepto en el grupo de adjuntas y adjuntos jóvenes (29-39años; p=0,789) y en el de residentes mujeres frente a residentes hombres (p=0,814). En los hospitales con unidades subespecializadas se encontró un mayor número de hombres en todas, excepto en la unidad de suelo pélvico, en la que no se observó una diferencia estadísticamente significativa (p=0,06). Respecto a cargos de responsabilidad, en solo 7 de 111 hospitales había jefas de servicio. Conclusiones La presencia de las mujeres en la especialidad de Urología es cada vez mayor, debido mayoritariamente a las generaciones más jóvenes. Sin embargo, el acceso de estas mujeres a puestos de relevancia es anecdótica (AU)

Objective To analyze the current state of women in urology in Spain. Material and methods Descriptive study based on the results of an online survey sent between February and April 2020 through the database of the Residents and Young Urologists group (RAEU) of the Spanish Association of Urology (AEU). Demographic characteristics of the survey and its results were analyzed. Results In total, 257 responses were obtained from 210 women (81.71%) and 47 men (18.29%) belonging to 111 hospitals. Statistically significant differences were observed (P<.001) with a higher proportion of men in all categories except for the group of young female and male attendings (29-39 years, P=.789), and the group of female residents against male residents (P=.814). The number of men was higher in hospitals with subspecialty units except for the Pelvic Floor Unit, where no statistically significant difference was observed (P=.06). Regarding positions of responsibility, only 7 out of 111 hospitals had female department chiefs. Conclusions Women's representation in urology is increasing, mainly due to the younger generations. However, the access of these women to relevant positions is anecdotal (AU)

Discovery of Gamma Rays from the Quiescent Sun with HAWC.

We report the first detection of a TeV γ-ray flux from the solar disk (6.3σ), based on 6.1 years of data from the High Altitude Water Cherenkov (HAWC) observatory. The 0.5-2.6 TeV spectrum is well fit by a power law, dN/dE=A(E/1 TeV)^{-γ}, with A=(1.6±0.3)×10^{-12} TeV^{-1} cm^{-2} s^{-1} and γ=3.62±0.14. The flux shows a strong indication of anticorrelation with solar activity. These results extend the bright, hard GeV emission from the disk observed with Fermi-LAT, seemingly due to hadronic Galactic cosmic rays showering on nuclei in the solar atmosphere. However, current theoretical models are unable to explain the details of how solar magnetic fields shape these interactions. HAWC's TeV detection thus deepens the mysteries of the solar-disk emission.

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)

Women in urology: what is their current situation in Spain?

OBJECTIVE: To analyze the current state of women in urology in Spain. MATERIAL AND METHODS: Descriptive study based on the results of an online survey sent between February and April 2020 through the database of the Residents and Young Urologists group (RAEU) of the Spanish Association of Urology (AEU). Characteristics of the survey and its results were analyzed. RESULTS: In total, 257 responses were obtained from 210 women (81.71%) and 47 men (18.29%) belonging to 111 hospitals. Statistically significant differences were observed (p < 0.001) with a higher proportion of men in all categories except for the group of young female and male attendings (29-39 years, p = 0.789), and the group of female residents against male residents (p = 0.814). The number of men was higher in hospitals with subspecialty units except for the Pelvic Floor Unit, where no statistically significant difference was observed (p = 0.06). Regarding positions of responsibility, only 7 out of 111 hospitals had female Department Chiefs. CONCLUSIONS: Women's representation in urology is increasing, mainly due to the younger generations. However, the access of these women to relevant positions is anecdotal.

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.

Response of cows with osteomalacia grazing sub-tropical native pastures to phosphorus supplementation with loose mineral mix or feed blocks.

Osteomalacia outbreaks often occur in cattle grazing native pastures in regions with endemic phosphorous (P) deficiency. This study evaluated the responses of two groups of cows, initially with clinical signs of chronic P deficiency, to P supplements (100 g P/kg) offered ad libitum for 13 weeks as a loose mineral mix (LMM group) or the same mineral mix offered as blocks (BMM group). Half of the cows in each group were categorized as 'with' or 'without' severe osteopenia according to a test that depended on the resistance to penetration of a needle through the left lateral process of the L4-L5 lumbar vertebra. The groups grazed two paddocks that were switched each 3 weeks. The liveweight, supplement intakes, and the P-concentrations in soil, forage, blood, and external cortical bone (ECB) of the ribs were measured. The bicarbonate-extractable P in soil was 3.5 mg/kg. The mean of total P in forage (0.95 g/kg/DM), inorganic P in serum (iP, 0.96 mmol/L), and total P in the ECB of the ribs (85 mg/mL) at the beginning of the experiment were all low and consistent with severe chronic P deficiency. The P supplementation allowed clinical recovery in 18/20 cows with their serum and ECB P and calcium approaching normal values and in the two remaining cows the only sign was abnormal gait. Cows consumed more of the LMM than BMM supplement (means 8.3 and 6.6 g P/day, respectively). After 13 weeks cows initially classified as 'with severe osteopenia' and supplemented with LMM had higher (P < 0.05) final liveweight (difference = 21.6 kg), iP (difference = 0.74 mmol/L), bone Ca (difference = 65.7 mg/mL) and bone P (difference = 26.5 mg/mL) concentrations and lower (P < 0.01) final serum Ca/iP ratio (difference = -0.65) than cows with severe osteopenia but supplemented with BMM. The treatment of severe P deficiency cows grazing P deficient sub-tropical grasslands by P supplementation for 13 weeks was more effective with LMM than BMM.

[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)

Acidosis metabólica tras cistectomía radical con derivación urinaria ileal. ¿Sabemos tanto como creemos? Revisión sistemática / Metabolic acidosis after ileal urinary diversion and radical cystectomy. Do we know as much as we believe? A systematic review

El contacto de la orina con la mucosa de la derivación urinaria (DU) tras la cistectomía radical (CR) produce diversos intercambios iónicos que promueven el desarrollo de la acidosis metabólica (AM). Esta alteración es una causa frecuente de reingresos y complicaciones a corto/largo plazo. Realizamos una revisión sistemática sobre la AM en CR con DU ileales, analizando su prevalencia, diagnóstico, factores de riesgo y tratamiento. Llevamos a cabo una revisión de la literatura de artículos publicados en Pubmed® y Cochrane Library antes de mayo de 2022 siguiendo las recomendaciones PRISMA. Se identificaron 421 artículos, de los cuales 25 cumplieron los criterios de inclusión sumando un total de 5.811 pacientes. Los estudios analizados demuestran mucha heterogeneidad en los criterios analíticos de diagnóstico y tratamiento utilizados, pudiendo sesgar los resultados de prevalencia. El desarrollo de la AM es multifactorial, siendo más frecuente su aparición durante el periodo postoperatorio temprano, especialmente en DU con segmentos ileales más largos, con mayor continencia urinaria y en pacientes con insuficiencia renal. La edad avanzada y la diabetes son factores de riesgo relacionados en periodos más tardíos. La AM es la causa más frecuente de segundos o más reingresos hospitalarios. La realización de profilaxis alcalinizante durante 3 meses en pacientes de riesgo podría mejorar estos resultados. Aunque la AM en DU ileales es una alteración conocida, esta revisión revela la necesidad de implementar criterios homogéneos de diagnóstico, monitorización y tratamiento, además de protocolizar estrategias de prevención/profilaxis en pacientes de riesgo (AU)

Urine contact with the mucosa of the urinary diversion (UD) after radical cystectomy (RC) produces different ion exchanges that favor the development of metabolic acidosis (MA). This phenomenon is a frequent cause of hospital readmission and short/long-term complications. We performed a systematic review of MA in RCs with ileal UD, analyzing its prevalence, diagnosis, risk factors and treatment. We systematically searched Pubmed® and Cochrane Library for original articles published before May 2022 according to PRISMA guidelines. A total of 421 articles were identified. We selected 25 studies that met the inclusion criteria involving 5811 patients. Obtaining precise data on the prevalence of MA is difficult, largely due to the heterogeneity of the diagnostic criteria used given the diversity of studies analyzed. Development of MA is multifactorial. In the early period, MA is more prevalent in patients with UD with longer ileal segments, better urinary continence, and impaired renal function. Age and diabetes are risk factors associated with MA in later periods. MA is the most common cause of second or more hospital readmissions. Prophylaxis with oral bicarbonate for three months in patients at risk could improve these results. Although MA after ileal UD is a well-known condition, this review highlights the need to implement homogeneous criteria for the diagnosis, follow-up, and treatment, in addition to protocolizing prevention/prophylaxis strategies in patients at risk (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.

Prevalence of metabolic acidosis in ileal diversions more than one year after radical cystectomy and associated secondary metabolic effects.

INTRODUCTION AND OBJECTIVE: Metabolic acidosis (MA) is a well-known complication in patients with ileal urinary diversions. It is common in the early postoperative stages and decreases over time. Our objective is to investigate the prevalence of MA after more than one year of follow-up, identify the associated risk factors, and analyze its secondary metabolic consequences. MATERIALS AND METHODS: We conducted an observational study between January 2018 and September 2022 following the STROBE guidelines. MA was defined as a serum bicarbonate level ​​<22mEq/L. Finally, we analyzed 133 patients with a mean follow-up of 55.24 ± 42.36 months. RESULTS: MA was observed in 16 (12%) patients. Patients with and without MA were comparable in age, sex, and follow-up time. The group with MA presented a higher rate of anemia (68,75% vs 19,65%, p < 0.001) and renal failure (100% vs 45,29%, p < 0.001), statistically significant higher levels of serum creatinine, chloride, potassium, parathyroid hormone, and phosphorus but lower serum values ​​of hemoglobin, renal glomerular filtration rate, total cholesterol, vitamin D, calcium, and albumin (all p < 0.05). Renal glomerular filtration rate was the only independent risk factor related to the development of MA (OR 0.914; 95% CI 0.878-0.95; p < 0.0001), proving a close correlation with venous bicarbonate values ​​(r = 0.387, p < 0.001). CONCLUSIONS: MA is a little prevalent disorder in ileal urinary diversions more than one year after radical cystectomy is performed but it has secondary consequences on hematologic, renal, protein, lipid, and bone metabolism. We recommend to a close follow-up in patients with renal failure for early diagnosis and treatment.

Doble recubrimiento con membrana amniótica en estrabismo restrictivo / Double covering with amniotic membrane in restrictive strabismus

El manejo del estrabismo restrictivo sigue siendo un problema no resuelto hoy en día.Se presenta un caso de estrabismo restrictivo posquirúrgico severo tras una cirugía de exotropía consecutiva. Describimos a continuación el manejo exitoso mediante una técnica que consiste en envolver el músculo afectado con membrana amniótica o «wrap» en la que añadimos un segundo injerto de membrana amniótica en la reconstrucción de la superficie ocular. (AU)

The management of restrictive strabismus remains an unresolved problem today.A case of severe restrictive strabismus after a consecutive exotropia surgery is presented. We describe the exitosus managment through a technique consist of wrapping with amniotic membrane the affected muscle where we add a second amniotic membraneA graft in the reconstruction of the ocular surface. (AU)