Verbal episodic memory in children undergoing temporal lobe epilepsy surgery: a one-year follow-up study. / Memoria episódica verbal en pacientes pediátricos intervenidos de cirugía de la epilepsia del lóbulo temporal: un estudio de seguimiento al año.

INTRODUCTION: Verbal episodic memory (VEM) is often unimpaired in children with focal epilepsy undergoing left temporal lobe resections, unlike what we might expect in the adult brain. The latter findings suggest that epileptiform activity in early life disrupts memory system lateralization, leading to the development of bilateral memory representation. The present study aims to analyze whether the laterality of epilepsy is a major predictor for post-operative VEM prognosis in pediatric temporal lobe epilepsy (TLE) surgery. This research also pretends to provide evidence about the relationship of VEM performance with other relevant demographical and clinical factors such as sex, age at onset of seizures, age at surgery and duration of epilepsy, as well as to study the impact of presurgical VEM performance on postsurgical outcomes. PATIENTS AND METHODS: Pre-operative and one-year follow-up post-operative word-list recall scores from 25 children who underwent TLE surgery (left-sided, n = 11; right-sided, n = 14) were extracted from the Hospital Sant Joan de Deu database and were retrospectively analyzed. RESULTS: No significant presurgical intergroup differences were found when comparing VEM scores by laterality of epilepsy (p > 0.5). Looking at the left TLE group, a high negative correlation was found between the onset age and the pre-operative long-term free recall score (rho = -0.72, p = 0.01). No significant pre- to post-operative intragroup changes were found regarding VEM performance, regardless of epilepsy laterality (left TLE group, p > 0.56; right TLE group, p > 0.12). CONCLUSIONS: The laterality of epilepsy does not show to be a significant factor in and of itself regarding presurgical VEM outcome and its prognosis one year after surgery, thus supporting the bilateral memory representation hypothesis. Furthermore, a younger age at onset of seizures seems to be related with a better pre-operative VEM performance, likely due to a more efficient reorganization of memory system induced by a greater brain plasticity at lower ages; however, this relationship has been only reported for the left-sided epilepsies in our sample.

TITLE: Memoria episódica verbal en pacientes pediátricos intervenidos de cirugía de la epilepsia del lóbulo temporal: un estudio de seguimiento al año.Introducción. La memoria episódica verbal (MEV) no suele resultar alterada en niños con epilepsia focal sometidos a resecciones del lóbulo temporal izquierdo, a diferencia de lo que cabría esperar si se tratara de un cerebro adulto. Los últimos hallazgos sugieren que la actividad epileptógena en los primeros años de vida disrumpe la lateralización del sistema mnésico, lo que conduce al desarrollo de una representación bilateral de la memoria. El presente estudio pretende analizar si la lateralidad de la epilepsia es un predictor significativo de cara al pronóstico posquirúrgico de la MEV en la cirugía de la epilepsia del lóbulo temporal (ELT) en edad pediátrica. Esta investigación también pretende aportar evidencias sobre la relación de la MEV con otros factores demográficos y clínicos relevantes, como el sexo, la edad de inicio de las crisis, la edad quirúrgica y la duración de la epilepsia, así como estudiar el impacto del rendimiento prequirúrgico en la MEV sobre los resultados posquirúrgicos. Pacientes y métodos. Se extrajeron de la base de datos del Hospital Sant Joan de Déu y se analizaron retrospectivamente las puntuaciones prequirúrgicas y al año de seguimiento postoperatorio de una tarea de recuerdo de lista de palabras correspondientes a 25 niños intervenidos de ELT (ELT izquierdo, n = 11; ELT derecho, n = 14). Resultados. No se encontraron diferencias intergrupales prequirúrgicas significativas al comparar las puntuaciones en MEV sobre la base de la lateralidad de la epilepsia (p > 0,5). En cuanto al grupo de ELT izquierdo, se encontró una alta correlación negativa entre la edad de inicio y la puntuación prequirúrgica del recuerdo libre a largo plazo (rho = ­0,72; p = 0,01). No se encontraron cambios intragrupo significativos entre el pre- y el postoperatorio en relación con el rendimiento en la MEV, independientemente de la lateralidad de la epilepsia (grupo de ELT izquierdo, p > 0,56; grupo de ELT derecho, p > 0,12). Conclusiones. La lateralidad de la epilepsia no parece ser un factor significativo por sí solo en relación con el rendimiento prequirúrgico en la MEV y su pronóstico un año después de la cirugía, lo que apoya la hipótesis de una representación bilateral de la memoria. Además, una edad más temprana al inicio de las crisis parece estar relacionada con un mejor resultado preoperatorio en la MEV, probablemente debido a una reorganización más eficiente del sistema de memoria inducida por una mayor plasticidad cerebral en edades más bajas; sin embargo, esta relación sólo se ha observado en nuestra muestra para las epilepsias de lateralidad izquierda.

Soil properties determine the impact of nZVI on Lactuca sativa L and its rhizosphere.

Nanoscale zero-valent iron (nZVI) is a promising material tool for the remediation of metal(loid)-contaminated soils since it reduces metal(loid) availability and plant uptake, thereby enhancing the development of the plants. However, the effects of nZVI as nanoparticles on soil properties, plants, and the microbial rhizosphere in unpolluted soils are poorly understood. Here we tested the impact of nZVI at different doses (0.5 and 5% of commercial suspension) on soil properties, lettuce plants, and their microbial rhizosphere in two non-contaminated soils with distinct physico-chemical properties (alkaline versus acidic soil). To this end, a pot experiment was performed with lettuce plants in a growth chamber for a month. Both soils showed an increase in of pH and available Fe after nZVI application. However, these effects were more marked in the acidic soil. In this regard, the plants in this soil showed increased biomass and Fe content. TEM analysis revealed that although the roots and leaves of plants grown in the alkaline soil showed better cell integrity than those in acidic soil-an observation that was consistent with the visual appearance of the plants-the former were more affected by the nZVI treatment. Regarding the microbial rhizosphere, in general, nZVI enhanced enzyme activity regardless of the soil type. Microbial functional diversity showed a significant decline in response to nZVI in alkaline soil. In contrast, the 0.5% nZVI treatment had a positive effect on this parameter in acidic soil. Bacterial genetic diversity was less affected by the presence of nZVI than fungal diversity, which was higher in nZVI-treated acidic soils. In addition, alterations of bacterial and fungal communities were associated with available Fe in acidic soil. In conclusion, soil properties play a key role in determining the effects of nZVI on lettuce plants and their rhizosphere.

[A multicentre epilepsy registry in Mexico]. / Registro multicéntrico de epilepsia en México.

INTRODUCTION: The National Epilepsy Registry in Mexico was carried out, from March 2021 to December 2022, in public hospitals of the Priority Epilepsy Program 'PPE', with the aim of describing the current situation in our pediatric and adult population. PATIENTS AND METHODS: Observational, cross-sectional, multicenter study. We used a database, according to classifications of the International League Against Epilepsy (ILAE) 2017. Patients of all ages were included, with a diagnosis of epilepsy according to the practical clinical definition ILAE 2014. RESULTS: We registered 10,852 patients, 5,495 men (50.6%) and 5,357 women (49.4%). Family history of epilepsy in 1,714 patients (15.8%), febrile seizures in 987 (9.1%). Type of seizure: 5,542 (51.1%) presented focal onset, of which 1,889 (34.1%) evolved to bilateral tonic-clonic seizures; generalized onset 4,861 (44.8%), unknown 33 (3.1%) and unclassified 115 (1.1%). Almost half had unknown etiology and 40% were structural, of which hypoxic ischemic encephalopathy was the most frequent (21.6%) and neurocysticercosis was 1%. Comorbidities appeared in 6,326 patients (58.3%). Anti-seizure medications (ASM) were used in 96.4% patients, mainly valproate. Status epilepticus was found in 1,383 patients (12.7%) and drug-resistant epilepsy in 18.9%. Paraclinical studies: 79.3% with at least one electroencephalogram and 76.9% with a neuroimaging study. Epilepsy surgery occurred in 275 patients (2.5%). CONCLUSIONS: Despite the efforts of the Pan American Health Organization in its Strategy and Action Plan on epilepsy, diagnostic technologies and ASM supply are still lagging behind.

TITLE: Registro multicéntrico de epilepsia en México.Introducción. Se realizó el Registro Nacional de Epilepsia en México, de marzo de 2021 a diciembre de 2022, en hospitales del sector público del Programa Prioritario de Epilepsia, para conocer la situación actual en población pediátrica y adulta. Pacientes y métodos. Es un estudio observacional, transversal y multicéntrico. Se utilizó una base de datos, acorde con las clasificaciones de la Liga Internacional Contra la Epilepsia (ILAE) de 2017. Se incluyó a pacientes de todas las edades, con diagnóstico de epilepsia según la definición clínica práctica de la ILAE de 2014. Resultados. Se registró a 10.852 pacientes, 5.495 hombres (50,6%) y 5.357 mujeres (49,4%). Había antecedente familiar de epilepsia en 1.714 pacientes (15,8%) y crisis febriles en 987 (9,1%). Los tipos de crisis eran: 5.542 (51,1%) de inicio focal, de las que 1.889 (34,1%) evolucionaban a bilateral tonicoclónica; 4.861 (44,8%) de inicio generalizado; 33 (3,1%) de inicio desconocido; y 115 (1,1%) no clasificadas. Casi la mitad tuvo etiología desconocida y el 40% fueron estructurales; de ellas, la encefalopatía hipóxico-isquémica fue la más frecuente (21,6%) y la neurocisticercosis fue el 1%. Las comorbilidades aparecieron en 6.326 pacientes (58,3%). El 96,4% fueron tratados con fármacos anticrisis epilépticas (FACE), principalmente ácido valproico. El estado epiléptico se encontró en 1.383 pacientes (12,7%), y la farmacorresistencia, en 18,9%. Respecto a los estudios paraclínicos, al 79,3% se le realizó al menos un electroencefalograma, y al 76,9%, un estudio de neuroimagen. Se realizó cirugía de epilepsia a 275 pacientes (2,5%). Conclusiones. A pesar del esfuerzo de la Organización Panamericana de la Salud en su Estrategia y Plan de Acción sobre la Epilepsia, las tecnologías diagnósticas y el abasto de los FACE aún se encuentran rezagados.

Evaluation of connectivity measures to identify Seizure Onset and Propagation Zones in Refractory Epilepsy: A Case study with two different Post- Surgical Outcomes.

High Frequency Oscillations (HFO) have been found very useful in refractory epilepsy. They have been used to identify the epileptogenic zone and as a promising clinical biomarker for presurgical evaluation in childhood epilepsy. There is controversy about whether there is a spread of HFOs and their propagation. Some researchers reinforce the idea of dealing with epilepsy as a network disorder, so the fact of propagation can promote this research. The hypothesis of this study is that connectivity methods can be useful to detect the seizure onset and propagation zones. Methodology has been applied to two cases where the clinical outcomes after surgery were free of seizures and not free. Promising results were obtained to understand both situations. A future study with more cases is necessary to obtain strong conclusions.Clinical Relevance- This exploratory study shows the relationship between connectivity measures and the propagation of HFOs and this can be useful to know the epileptogenic function of these waves that, nowadays, are unknown. Connectivity features in conjunction with other multivariate estimators can be a tool to help in identifying the regions of interest in refractory epilepsy.

Epidemiología y calidad asistencial de las intoxicaciones agudas en el adulto mayor de 65 años en Alicante, España / Epidemiology and quality of care of acute intoxication in people over 65 years of age in Alicante, Spain

Introducción El objetivo fue estudiar la epidemiología de las intoxicaciones agudas en el servicio de urgencias (SU) de un centro de tercer nivel y analizar el grado de cumplimiento de los indicadores de calidad (IC) en pacientes ≥65 años comparado con el resto de los adultos. Material y métodos Estudio observacional y retrospectivo, se incluyeron los casos diagnosticados de intoxicación aguda de pacientes >14 años atendidos en el SU de un hospital terciario. Se recogieron las variables demográficas, tipo de tóxicos y causa de la intoxicación, 19 IC y destino, siendo la variable de resultado el grado de cumplimiento de los IC. Resultados Se registraron 1.144 casos, 10,4% (n=119) personas ≥65 años. Hubo mayor proporción de mujeres en este grupo (72,8 vs. 60,9%; p=0,015), más intoxicación accidental (37,6 vs. 25,7% p=0,006), y menos voluntaria (35,0 vs. 49,6%; p=0,003), menos intoxicación por alcohol (5 vs. 17,8%; <0,001) y ningún caso intoxicado por drogas ilegales (p<0,001). En la mayoría de los IC tenían un alto grado de cumplimento (> 85%) en personas ≥65 años como en el resto de los adultos. De todos los IC hubo diferencias en la indicación de oxigenoterapia en el caso de intoxicación por monóxido de carbono (CO) en aquellos ≥65 años (64,2 vs. 40,9%; p=0,005). Conclusiones El perfil epidemiológico de la intoxicación en personas ≥65 años es diferente al de los más jóvenes y con un cumplimiento de los IC. Dado los resultados obtenidos no consideramos que existan diferencias en la asistencia del paciente intoxicado con respecto a su edad (AU)

Introduction The objective of this study was to examine the epidemiology of acute poisonings in the emergency department (ED) of a tertiary center and to analyze the compliance level with quality indicators (QIs) in patients 65 years and older compared rest of adults. Materials and methods This was an observational and retrospective study that included diagnosed cases of acute poisoning in patients over 14 years old treated in the ED of a tertiary hospital. Demographic variables, type of toxic substances, and cause of poisoning were collected, along with 19 QIs and patient outcomes, with the main outcome variable being the degree of compliance with the QIs. Results A total of 1144 cases were recorded, with 10.4% (n=119) being patients 65 years and older. Patients 65 years and older were more likely to be female (72.8% vs. 60.9%; p=0.015), experience more accidental poisonings (37.6% vs. 25.7%; p=0.006), and fewer intentional poisonings (35.0% vs. 49.6%; p=0.003). There were fewer cases of alcohol poisoning (5% vs. 17.8%; p<0.001), and no cases of illegal drug poisoning (p<0.001) in this age group. Most QIs showed a high degree of compliance (>85%) in both patients 65 years and older and rest of adults. However, there were differences in the indication of oxygen therapy in cases of carbon monoxide poisoning (64.2% vs. 40.9%; p=0.005). Conclusions The epidemiological profile of poisoning in patients 65 years and older differs from that of adult patients, with a similar degree of compliance with QIs. Based on the results obtained, there does not appear to be significant differences in the management of poisoned patients based on their age (AU)

Resultados de la cirugía de agujero macular grande empleando distintas técnicas de interposición macular. Serie de 9 casos / Results of large macular hole surgery using different interposition techniques. A report on 9 cases

Objetivo Describir la restauración anatómica y funcional observada a largo plazo en pacientes intervenidos por agujero macular (AM) grande empleando distintas técnicas de interposición macular. Método Análisis retrospectivo de los resultados obtenidos en una serie de 9 pacientes sometidos a cirugía de AM grande (≥450μm) realizando 4 técnicas de interposición macular distintas: flap invertido de membrana limitante interna en 4 casos, plegado de membrana limitante interna en 2, injerto de membrana amniótica en 2 e injerto autógeno de cápsula anterior en uno. El tiempo de seguimiento medio fue de 11 meses. Anatómicamente las medidas de resultados exploradas fueron la restauración de las capas externas de la retina y el patrón de cierre macular. Funcionalmente se valoró la agudeza visual final y la calidad visual. Resultados La restauración de las capas externas fue parcial en 6 casos. La tasa de cierre macular fue del 100%, apreciándose un patrón incompleto en 4 casos. La agudeza visual mejoró en 7 pacientes, manteniéndose estable en 2. Tres casos mostraron un patrón de fijación excéntrico y/o metamorfopsias. Conclusiones El desarrollo de nuevas técnicas quirúrgicas ha incrementado la tasa de cierre macular en AM grandes. Sin embargo, la restauración anatómica y funcional sigue siendo impredecible. En este trabajo se logró el cierre macular en todos los pacientes y una mayor tasa de cierre completo empleando flap invertido de membrana limitante interna. La restauración de las capas externas fue más favorable en los grupos en los que se había empleado membrana limitante interna. La recuperación funcional fue independiente de la técnica empleada (AU)

Objective To describe the long-term anatomical and functional restoration observed in patients operated on for a large macular hole (MH) using different macular interposition techniques. Method Retrospective analysis of the results obtained in a series of 9 patients undergoing large MH surgery (≥450μm) performing 4 different macular interposition techniques: inverted internal limiting membrane flap in 4 cases, autotransplantation of internal limiting membrane in 2, amniotic membrane graft in 2, and autologous anterior capsule graft in one. The mean follow-up time was 11 months. Anatomically, the outcome measures explored were the restoration of the outer layers of the retina and the pattern of MH closure. The final visual acuity and visual quality were functionally assessed. Results The restoration of the outer layers was partial in 6 cases. The macular closure rate was 100%, showing an incomplete pattern in 4 cases. Visual acuity improved in 7 patients, remaining stable in 2. Three cases showed an eccentric fixation pattern and/or metamorphopsia. Conclusion The development of new surgical techniques has increased the rate of macular closure in large MHs. However, the anatomical and functional restoration remains unpredictable. In this work, macular closure was achieved in all patients and a higher rate of complete closure using inverted internal limiting membrane flap. The restoration of the outer layers was more favorable in the groups in which internal limiting membrane had been used. Functional recovery was independent of the technique used (AU)

Results of large macular hole surgery using different interposition techniques. A report on 9 cases.

OBJECTIVE: To describe the long-term anatomical and functional restoration observed in patients operated on for a large macular hole (MH) using different macular interposition techniques. METHOD: Retrospective analysis of the results obtained in a series of 9 patients undergoing large MH surgery (≥450µm) performing 4 different macular interposition techniques: inverted internal limiting membrane flap in 4 cases, autotransplantation of internal limiting membrane in 2, amniotic membrane graft in 2, and autologous anterior capsule graft in one. The mean follow-up time was 11 months. Anatomically, the outcome measures explored were the restoration of the outer layers of the retina and the pattern of MH closure. The final visual acuity and visual quality were functionally assessed. RESULTS: The restoration of the outer layers was partial in 6 cases. The macular closure rate was 100%, showing an incomplete pattern in 4 cases. Visual acuity improved in 7 patients, remaining stable in 2. Three cases showed an eccentric fixation pattern and/or metamorphopsia. CONCLUSIONS: The development of new surgical techniques has increased the rate of macular closure in large MHs. However, the anatomical and functional restoration remains unpredictable. In this work, macular closure was achieved in all patients and a higher rate of complete closure using inverted internal limiting membrane flap. The restoration of the outer layers was more favorable in the groups in which internal limiting membrane had been used. Functional recovery was independent of the technique used.

Treatment patterns and intensification within 5 year of follow-up of the first-line anti-TNFα used for the treatment of IBD: Results from the VERNE study.

BACKGROUND: Anti-TNFα represent one of the main treatment approaches for the management of inflammatory bowel diseases (IBD). Therefore,the evaluation of their treatment patterns over time provides valuable insights about the clinical value of therapies and associated costs. AIMS: To assess the treatment patterns with the first anti-TNFα in IBD. METHODS: Retrospective, observational study. RESULTS: 310 IBD patients were analyzed along a 5-year follow-up period. 56.2% of Crohn's disease (CD) patients started with adalimumab (ADA), while 43.8% started with infliximab (IFX). 12.9% of ulcerative colitis (UC) patients initiated with ADA, while 87.1% initiated with IFX. Treatment intensification was required in 28.9% of CD and 37.1% of UC patients. Median time to treatment intensification was shorter in UC than in CD (5.3 vs. 14.3 months; p = 0.028). Treatment discontinuation due to reasons other than remission were observed in 40.7% of CD and 40.5% of UC patients, although, in UC patients there was a trend to lower discontinuation rates with IFX (36.6%) than with ADA (66.7%). Loss of response accounted for approximately one-third of discontinuations, in both CD and UC. CONCLUSIONS: Around one-third of IBD biologic-naive patients treated with an anti-TNFα required treatment intensification (earlier in UC) and around 40% discontinued the anti-TNFα due to inappropriate disease control.

How the COVID-19 contingency affects children.

Background: Due to the pandemic, children are undergoing many changes in their daily lives. Methods: We analyzed how parents perceive the effects of the contingency on their children through an online survey shared by digital media for 7 days. Results: We obtained 4000 responses. The most frequent difficulty of the children was online homeschooling (30.4%), followed by sleeping disorders (20.3%). The use of screens increased 30-80% in over 65% of children. Tantrum was detected in 34% and mood swings in 30% of children. The majority of parents (77.8%) considered that distance education does not guarantee children's education and that the level of learning acquired through online classes is not the same as that of face-to-face education (83.5%). In contrast, 70.6% of parents considered that it is not yet time to reopen schools, 78.8% believed that there is sufficient evidence to keep them closed, and 45% indicated that it is better not to return to campus this year. Regarding activities to improve mental health during the contingency, 51.3% have created home games, and 23.6% perform physical activity. However, 74.4% do not have the peace of mind to restart daily life. Among the positive aspects of the contingency, adaptability (35%) and family union (33.5%) were reported. Conclusions: Health professionals in contact with children must be prepared for the problems that this contingency is generating and sensitize parents to observe their children and seek professional help on any alarm data on the emotional or behavioral state of the child.

Introducción: Debido a la pandemia, la población infantil ha experimentado cambios en varios aspectos de su vida cotidiana. Métodos: Se analizó la percepción de los padres con respecto a los efectos de la contingencia en sus hijos a través de una encuesta en línea compartida por medios digitales durante 7 días. Resultados: Se obtuvieron 4000 respuestas. La dificultad más frecuente a la que se enfrentan los niños en la pandemia son las clases en línea en casa (30.4%), seguida de problemas para dormir (20.3%). Se identificó un incremento en el uso de pantallas del 30-80% en más del 65% de los niños. Se detectaron berrinches en el 34% y cambios de humor en el 30% de los niños. La mayoría de los padres (77.8%) consideraron que la educación a distancia no garantiza la educación de los niños, y que el nivel de aprendizaje de las clases en línea no es igual que el de las clases presenciales (83.5%). Por otro lado, el 70.6% de los padres opinaron que no es momento para abrir los colegios, el 78.8% indicaron que existe evidencia para mantenerlos cerrados y el 45% consideraron que es mejor no regresar este año al plantel. En cuanto a actividades para mejorar la salud mental en la contingencia, el 51.3% han creado juegos en casa y el 23.6% realizan actividad física. Sin embargo, el 74.4% no tienen tranquilidad para reiniciar su vida cotidiana. Dentro de las cosas positivas de la contingencia, se reportó adaptabilidad (35%) y unión familiar (33.5%). Conclusiones: Los profesionales de la salud en contacto con niños deben estar preparados para los problemas generados por esta contingencia y sensibilizar a los padres para observar a sus hijos y solicitar ayuda si detectan datos de alarma del estado emocional o conductual del niño.

How the COVID-19 contingency affects children / Cómo afecta a los niños la contingencia por COVID-19

Abstract Background: Due to the pandemic, children are undergoing many changes in their daily lives. Methods: We analyzed how parents perceive the effects of the contingency on their children through an online survey shared by digital media for 7 days. Results: We obtained 4000 responses. The most frequent difficulty of the children was online homeschooling (30.4%), followed by sleeping disorders (20.3%). The use of screens increased 30-80% in over 65% of children. Tantrum was detected in 34% and mood swings in 30% of children. The majority of parents (77.8%) considered that distance education does not guarantee children’s education and that the level of learning acquired through online classes is not the same as that of face-to-face education (83.5%). In contrast, 70.6% of parents considered that it is not yet time to reopen schools, 78.8% believed that there is sufficient evidence to keep them closed, and 45% indicated that it is better not to return to campus this year. Regarding activities to improve mental health during the contingency, 51.3% have created home games, and 23.6% perform physical activity. However, 74.4% do not have the peace of mind to restart daily life. Among the positive aspects of the contingency, adaptability (35%) and family union (33.5%) were reported. Conclusions: Health professionals in contact with children must be prepared for the problems that this contingency is generating and sensitize parents to observe their children and seek professional help on any alarm data on the emotional or behavioral state of the child.

Resumen Introducción: Debido a la pandemia, la población infantil ha experimentado cambios en varios aspectos de su vida cotidiana. Métodos: Se analizó la percepción de los padres con respecto a los efectos de la contingencia en sus hijos a través de una encuesta en línea compartida por medios digitales durante 7 días. Resultados: Se obtuvieron 4000 respuestas. La dificultad más frecuente a la que se enfrentan los niños en la pandemia son las clases en línea en casa (30.4%), seguida de problemas para dormir (20.3%). Se identificó un incremento en el uso de pantallas del 30-80% en más del 65% de los niños. Se detectaron berrinches en el 34% y cambios de humor en el 30% de los niños. La mayoría de los padres (77.8%) consideraron que la educación a distancia no garantiza la educación de los niños, y que el nivel de aprendizaje de las clases en línea no es igual que el de las clases presenciales (83.5%). Por otro lado, el 70.6% de los padres opinaron que no es momento para abrir los colegios, el 78.8% indicaron que existe evidencia para mantenerlos cerrados y el 45% consideraron que es mejor no regresar este año al plantel. En cuanto a actividades para mejorar la salud mental en la contingencia, el 51.3% han creado juegos en casa y el 23.6% realizan actividad física. Sin embargo, el 74.4% no tienen tranquilidad para reiniciar su vida cotidiana. Dentro de las cosas positivas de la contingencia, se reportó adaptabilidad (35%) y unión familiar (33.5%). Conclusiones: Los profesionales de la salud en contacto con niños deben estar preparados para los problemas generados por esta contingencia y sensibilizar a los padres para observar a sus hijos y solicitar ayuda si detectan datos de alarma del estado emocional o conductual del niño.

Genomic analysis and proteomic response of the chromium-resistant and phenanthrene-degrading strain Streptomyces sp. MC1.

AIM: Chemically disparate toxic organic and/or inorganic molecules produced by anthropogenic activities often hinder the bioremediation process. This research was conducted to understand the capacity of Streptomyces sp. MC1 to remove chemically disparate toxics such as Cr(VI) or phenanthrene. METHODS AND RESULTS: Genomic, metabolic modeling and proteomic approaches were used in this study. Our results demonstrated that Streptomyces sp. MC1 has the genetic determinants to remove Cr(VI) or degrade phenanthrene. Proteomics showed that these genetic determinants were expressed. Metabolic versatility of the strain was confirmed by two metabolic models in complex and minimal media. Interestingly, our results also suggested a connection between the degradation of phenanthrene and synthesis of specialized metabolites. CONCLUSIONS: Streptomyces sp. MC1 has the genetic and physiological potential to remove Cr(VI) or degrade phenanthrene SIGNIFICANCE AND IMPACT OF STUDY: The probability of a microorganism to survive in the presence of different contaminants depends on its genetic potential and the ability to express it. The genetic and proteomic profiles obtained for Streptomyces sp. MC1 can be recommended as model and predict if other Streptomyces strains can be used in bioremediation processes. Our work also hypothesized that intermediates of the phenanthrene degradation serve as precursors for the specialized metabolism.

Patterns of relapse and treatment outcome after active surveillance or adjuvant carboplatin for stage I seminoma: a retrospective study of the Spanish Germ Cell Cancer Group

Purpose Active surveillance (AS) and adjuvant chemotherapy (AC) with carboplatin are valid alternatives for managing stage I seminoma, and most relapses can be cured with cisplatin-based chemotherapy. However, some reports suggest that AC may modify the classical pattern of recurrences. Methods We analyzed all relapses observed in a series of 879 patients with stage I seminoma included in 4 consecutive studies of the Spanish Germ Cell Cancer Group. After a median follow-up of 67 months, recurrences were detected in 56/467 (12%) low-risk cases on AS and 13/412 (3%) high-risk cases after AC (p < 0.001). The objective was to describe clinical features, treatment and outcome. Univariate comparisons were performed between both groups. Results No significant differences were found between relapses on AS and those after AC in terms of time to relapse (13 vs 17 months), size (26 vs 27 mm), location (retroperitoneum in 88% vs 85%), and method of detection (computed tomography in 77% vs 69%). Treatment consisted of chemotherapy (etoposide + cisplatin ± bleomycin) in 89% and 92%, respectively. Late relapses (after > 3 years) were seen in 11% vs 7.7% (p = NS) and second or successive recurrences in 1.8 vs 23% (p < 0.05). With a median follow-up of 130 moths, two patients died of seminoma-unrelated causes (AS group) and the rest are alive and disease-free. Conclusion In the setting of a risk-adapted treatment of stage I seminoma, the administration of two courses of AC in patients with tumor size > 4 cm and/or rete testis invasion is associated with a higher incidence of second recurrences but does not significantly modify the pattern of relapses or their outcome (AU)

Incidence and clinical pattern of contralateral synchronous and metachronous germ cell testicular cancer.

BACKGROUND: Incidence of a second testicular tumor is higher in patients diagnosed with testicular cancer than in the general population. As incidence of unilateral germ cell cancer is increasing worldwide and most of these patients are cured, a growing number of patients at risk of developing a contralateral testis cancer is expected. OBJECTIVE: To analyze clinical and histological characteristics, as well as the absolute and cumulative incidence of a second testicular cancer in a cohort of 3,834 patients diagnosed with germ cell testicular cancer between I/1994 and I/2018 in 18 referral hospitals of the Spanish Germ Cell Cancer Group. METHODS: Patients were treated according to stage and year of diagnoses. Contralateral testis biopsy was not routinely performed, according to European Association of Urology rules. Follow-up of the contra lateral testis consists of a physical exam only and an annual optional testicular ultrasound for 10 years. RESULTS: Median age of the patients included was 32 years (18-82). With a median follow-up of 61 months (0-240), 67/3,834 patients (1.74%) were diagnosed with a second testicular tumor. The second testicular tumor was synchronic (diagnosed within 6 months of the first orchiectomy) in 19 patients, and metachronous in 48. Pathology of the second tumor was reported as a seminomatous testis tumor in 47 patients and a nonseminomatous cancer in 20. Cumulative incidence of contralateral testicular cancer was 2% at 5 years, and 4% (IC 95% 3%-5%) at 14 years. Younger age was a risk factor for developing a second testicular tumor (P = 0.006), whereas chemotherapy reduced the risk for a metachronous testicular cancer (P = 0.046). Within our cohort, 6 families with testicular cancer aggregation (more than 2 tumors in the same family) were identified. CONCLUSIONS: Incidence of second testicular neoplasm in this cohort of 3,834 patients was similar to that which has been reported in other countries. Metachronous tumors and seminomas are more common. Follow-up of the contralateral testis is mandatory, as well as adequate information for patients to prevent a second neoplasm if feasible, and to detect and treat it as soon as possible.

Patterns of relapse and treatment outcome after active surveillance or adjuvant carboplatin for stage I seminoma: a retrospective study of the Spanish Germ Cell Cancer Group.

PURPOSE: Active surveillance (AS) and adjuvant chemotherapy (AC) with carboplatin are valid alternatives for managing stage I seminoma, and most relapses can be cured with cisplatin-based chemotherapy. However, some reports suggest that AC may modify the classical pattern of recurrences. METHODS: We analyzed all relapses observed in a series of 879 patients with stage I seminoma included in 4 consecutive studies of the Spanish Germ Cell Cancer Group. After a median follow-up of 67 months, recurrences were detected in 56/467 (12%) low-risk cases on AS and 13/412 (3%) high-risk cases after AC (p < 0.001). The objective was to describe clinical features, treatment and outcome. Univariate comparisons were performed between both groups. RESULTS: No significant differences were found between relapses on AS and those after AC in terms of time to relapse (13 vs 17 months), size (26 vs 27 mm), location (retroperitoneum in 88% vs 85%), and method of detection (computed tomography in 77% vs 69%). Treatment consisted of chemotherapy (etoposide + cisplatin ± bleomycin) in 89% and 92%, respectively. Late relapses (after > 3 years) were seen in 11% vs 7.7% (p = NS) and second or successive recurrences in 1.8 vs 23% (p < 0.05). With a median follow-up of 130 moths, two patients died of seminoma-unrelated causes (AS group) and the rest are alive and disease-free. CONCLUSION: In the setting of a risk-adapted treatment of stage I seminoma, the administration of two courses of AC in patients with tumor size > 4 cm and/or rete testis invasion is associated with a higher incidence of second recurrences but does not significantly modify the pattern of relapses or their outcome.

[The role of eslicarbazepine acetate in the treatment of focal-onset epilepsy in pediatric age: practical issues]. / Papel del acetato de eslicarbazepina en el tratamiento de la epilepsia de origen focal en la edad pediátrica: consideraciones prácticas.

Eslicarbazepine acetate (ESL) is a third-generation antiepileptic drug (AED) of the carboxamide family and structurally related to carbamazepine and oxcarbazepine, although it has pharmacological differences that may have relevant implications of clinical utility. Since 2009 in Europe, ESL has been indicated for use in adults as adjuvant therapy in patients with partial-onset seizures (currently called focal-onset), with or without secondary generalization (with or without evolution to bilateral tonic-clonic, in current terminology). In 2017, the indication for adjunctive therapy of patients with partial-onset seizures with or without secondary generalization was extended to its use as monotherapy in adults and as adjuvant therapy in adolescents and children older than 6 years. A group of experts carried out this review aimed at the aspects of most interest in the clinical practice of the use of ESL in the pediatric population, including differential aspects from other AEDs. Aspects such as efficacy, dosage, clinical response depending on age, tolerability and its management, neurocognitive and behavioral profile, need for monitoring of any analytical parameter, role of plasma level monitoring, possible added value of the once-daily administration, clinical situations in which the addition of ESL would be recommended, use with other sodium channel blockers, how to switch from carbamazepine/oxcarbazepine, potential interactions with other AEDs, potential interactions with drugs other than AEDs, and some practical issues that require additional research.

TITLE: Papel del acetato de eslicarbazepina en el tratamiento de la epilepsia de origen focal en la edad pediátrica: consideraciones prácticas.El acetato de eslicarbazepina (ESL) es un fármaco antiepiléptico (FAE) de tercera generación de la familia de las carboxamidas y estructuralmente relacionado con la carbamazepina y la oxcarbazepina, aunque presenta diferencias farmacológicas que pueden tener implicaciones de utilidad clínica relevantes. Desde 2009, en Europa, el ESL está indicado para su utilización en adultos como terapia adyuvante en pacientes con crisis de inicio parcial (actualmente denominada de inicio focal), con o sin generalización secundaria (con o sin evolución a tonicoclónica bilateral, en terminología actual). En 2017, la indicación como tratamiento adyuvante de los pacientes con crisis de inicio parcial con o sin generalización secundaria se amplió a su utilización en monoterapia en adultos y en combinación en adolescentes y niños mayores de 6 años. Un grupo de expertos realizó esta revisión orientada a la práctica clínica del uso de ESL en población pediátrica, incluyendo aquellos puntos diferenciales respecto a otros FAE. Se han incluido aspectos como la eficacia, dosificación, respuesta clínica en función de la edad, tolerabilidad y su manejo, perfil neurocognitivo y conductual, necesidad de control de algún parámetro analítico, papel de la monitorización de los niveles plasmáticos, posible valor añadido de la administración única, situaciones clínicas en las que sería recomendable la adición de ESL, utilización con otros bloqueantes de los canales del sodio, realización del cambio desde carbamazepina/oxcarbazepina, potenciales interacciones con otros FAE, potenciales interacciones con otros fármacos distintos de los FAE, y algunas consideraciones prácticas que requieren una investigación adicional.

Papel de la impresión 3D para la protección de los profesionales del área quirúrgica y críticos en la pandemia de COVID-19 / Role of 3D printing for the protection of surgical and critical care professionals in the COVID-19 pandemic

ANTECEDENTES Y OBJETIVO: Durante la pandemia de COVID-19 se produce una reducción del material para la protección de los profesionales. La impresión 3D ofrece la posibilidad de compensar la escasez de algunos de los suministros. El objetivo es describir el papel de la impresión 3D en un servicio de salud durante la pandemia de COVID-19, con énfasis en proceso para desarrollar un producto final listo para ser implementado en el entorno clínico. MATERIALES Y MÉTODOS: Se formó un grupo de trabajo entre la administración sanitaria, clínicos y otras instituciones público-privadas de Cantabria coordinado en el Hospital virtual Valdecilla. El proceso incluyó la recepción de las propuestas de impresión, el conocimiento de los recursos de impresión en la región, la selección de los dispositivos, la creación de un equipo para cada proyecto, diseño de prototipos, evaluación y rediseño, fabricación montaje y distribución. RESULTADOS: Se producen 1) dispositivos que ayudan a prevenir el contagio de los profesionales: pantallas de protección facial (2.400 unidades), accesorios personalizados para fotóforos (20 unidades) y horquillas salvaorejas para mascarillas (1.200 unidades); 2) productos relacionados con la ventilación de pacientes infectados: conectores de sistemas de ventilación no invasiva entre tubuladura y mascarilla; y 3) hisopos oro y nasofaríngeos (7.500 unidades) para la identificación de portadoras del coronavirus con el objetivo de diseñar protocolos de actuación en las área clínicas. CONCLUSIONES: La impresión 3D es un recurso válido para la producción de material de protección de los profesionales cuyo suministro está reducido durante una pandemia

BACKGROUND AND OBJECTIVE: There is a shortage of supplies for the protection of professionals during the COVID-19 pandemic. 3D printing offers the possibility to compensate for the production of some of the equipment needed. The objective is to describe the role of 3D printing in a health service during the COVID-19 pandemic, with an emphasis on the process to develop a final product ready to be implemented in the clinical environment. METHODS: A working group was formed between the healthcare administration, clinicians and other public and private institutions in Cantabria, Spain coordinated by the Valdecilla Virtual Hospital. The process included receiving the printing proposals, learning about the printing resources in the region, selecting the devices, creating a team for each project, prototyping, evaluation and redesign, manufacturing, assembly and distribution. RESULTS: The following supplies are produced: 1) devices that help protect providers: face protection screens (2,400 units), personalized accessories for photophores (20 units) and ear-protection forks for face-masks (1,200 units); 2) products related to the ventilation of infected patients: connectors for non-invasive ventilation systems; and 3) oral and nasopharyngeal swabs (7,500 units) for the identification of coronavirus carriers with the aim of designing action protocols in clinical areas. CONCLUSIONS: 3D printing is a valid resource for the production of protective material for professionals whose supply is reduced during a pandemic

Experiences of caregiving and quality of healthcare among caregivers of patients with complex chronic processes: A qualitative study.

Aim To explore the perceptions of main caregivers regarding caring for chronic complex patients in two different regions of Spain. BACKGROUND: Spain is a country with an ageing population and a high number of people with chronic diseases. It is well known that the role of the caregiver is important to ensure quality of life and appropriate care. METHODS: Qualitative design using focus groups. Five focus groups, from two different regions, were conducted with 22 caregivers of people with chronic complex diseases to explore their personal experience, examine the quality of care received by the patient and their family and to develop strategies for the improvement of the quality of health care. The focus groups were audio and video recorded. The transcriptions of the focus group sessions were exported to qualitative software analysis MAXQDA 2018.2. The qualitative content analysis was based on different analytical cycles. RESULTS: In general terms, caregivers would refer to accepting the care of their family members, but they highlight many negative aspects such as tiredness, lack of help and overload of care. They indicated general satisfaction with the health system but indicated that help was insufficient and that strategies to better address the situations of the complex chronic patient should be improved. The main categories observed were: Conclusions. Complex chronic illnesses are increasingly common at present, generating important consequences on the lives of patients and that of their caregivers. The design of any health strategy for facing the dilemma of chronic illnesses, must necessarily include the vision of the caregivers.

Role of 3D printing for the protection of surgical and critical care professionals in the COVID-19 pandemic. / Papel de la impresión 3D para la protección de los profesionales del área quirúrgica y críticos en la pandemia de COVID-19.

BACKGROUND AND OBJECTIVE: There is a shortage of supplies for the protection of professionals during the COVID-19 pandemic. 3D printing offers the possibility to compensate for the production of some of the equipment needed. The objective is to describe the role of 3D printing in a health service during the COVID-19 pandemic, with an emphasis on the process to develop a final product ready to be implemented in the clinical environment. METHODS: A working group was formed between the healthcare administration, clinicians and other public and private institutions in Cantabria, Spain coordinated by the Valdecilla Virtual Hospital. The process included receiving the printing proposals, learning about the printing resources in the region, selecting the devices, creating a team for each project, prototyping, evaluation and redesign, manufacturing, assembly and distribution. RESULTS: The following supplies are produced: 1) devices that help protect providers: face protection screens (2,400 units), personalized accessories for photophores (20 units) and ear-protection forks for face-masks (1,200 units); 2) products related to the ventilation of infected patients: connectors for non-invasive ventilation systems; and 3) oral and nasopharyngeal swabs (7,500 units) for the identification of coronavirus carriers with the aim of designing action protocols in clinical areas. CONCLUSIONS: 3D printing is a valid resource for the production of protective material for professionals whose supply is reduced during a pandemic.