Evaluation of the better operative outcome software tool to predict cataract surgical outcome in the early postoperative follow-up.

BACKGROUND: Cataracts are the world's leading cause of avoidable blindness. In low-income countries, there are high rates of poor follow-up, which makes it very difficult to monitor surgical outcomes. To address this issue, the Better Operative Outcome Software Tool (BOOST Cataract app) predicts outcome on the first postoperative day and provides specific advice to improve outcomes. The aim of the study is to evaluate the ability of the BOOST Cataract app to categorise surgical outcomes and to analyse the possible factors that contribute to its performance. This was a prospective observational study performed at the General Hospital of Hospitalet of Llobregat. RESULTS: A total of 126 cataracts were included. Patients had a mean [SD] age of 75.8 [12.19] years, and 52% were females. Manual small-incision cataract surgery was involved in 57% and phacoemulsification in 43%. Thirty-eight percent of eyes presented significant corneal oedema on day 1. The BOOST Cataract app succeeded in categorising the final outcome in 65.6% of the eyes and in 93,4% of the eyes with good outcome.The agreement between the BOOST and UDVA outcomes was 0.353 (p< .000). The level of agreement improved to 0.619 (p< .000) in eyes with clear corneas. Success obtained by BOOST for both types of surgery was not statistically different. Eyes that obtained a good outcome on day one after surgery and eyes with clear cornea had 37 times higher odds (95% CI 6.66, 212.83) and 12 times higher odds (95% CI 3.13, 47.66) of being correctly categorised by the BOOST Cataract app than eyes that obtained a suboptimal (moderate and poor) outcome and eyes with corneal oedema on day 1. CONCLUSIONS: The BOOST Cataract app is an e-Health tool designed to address issues of measuring quality in low- and middle-income settings. Although its reliability is limited to eyes that obtain a good outcome and with clear corneas on day 1, the use of the tool on a regular basis facilitates monitoring and reporting outcomes when clinical data collection is challenging due to low postoperative follow-up rates.

Low aerobic capacity in McArdle disease: A role for mitochondrial network impairment?

BACKGROUND: McArdle disease is caused by myophosphorylase deficiency and results in complete inability for muscle glycogen breakdown. A hallmark of this condition is muscle oxidation impairment (e.g., low peak oxygen uptake (VO2peak)), a phenomenon traditionally attributed to reduced glycolytic flux and Krebs cycle anaplerosis. Here we hypothesized an additional role for muscle mitochondrial network alterations associated with massive intracellular glycogen accumulation. METHODS: We analyzed in depth mitochondrial characteristics-content, biogenesis, ultrastructure-and network integrity in skeletal-muscle from McArdle/control mice and two patients. We also determined VO2peak in patients (both sexes, N = 145) and healthy controls (N = 133). RESULTS: Besides corroborating very poor VO2peak values in patients and impairment in muscle glycolytic flux, we found that, in McArdle muscle: (a) damaged fibers are likely those with a higher mitochondrial and glycogen content, which show major disruption of the three main cytoskeleton components-actin microfilaments, microtubules and intermediate filaments-thereby contributing to mitochondrial network disruption in skeletal muscle fibers; (b) there was an altered subcellular localization of mitochondrial fission/fusion proteins and of the sarcoplasmic reticulum protein calsequestrin-with subsequent alteration in mitochondrial dynamics/function; impairment in mitochondrial content/biogenesis; and (c) several OXPHOS-related complex proteins/activities were also affected. CONCLUSIONS: In McArdle disease, severe muscle oxidative capacity impairment could also be explained by a disruption of the mitochondrial network, at least in those fibers with a higher capacity for glycogen accumulation. Our findings might pave the way for future research addressing the potential involvement of mitochondrial network alterations in the pathophysiology of other glycogenoses.

Encuesta sobre las preferencias quirúrgicas entre los glaucomatólogos en España / Survey of glaucoma surgical preferences among glaucoma specialists in Spain

Propósito Conocer las cirugías de glaucoma más frecuentes entre los miembros de la Sociedad Española de Glaucoma (SEG).MétodosUna encuesta anónima de 10 preguntas fue enviada a los socios de la SEG en enero, febrero y julio de 2019 para conocer sus preferencias en las cirugías de glaucoma.Variables a estudiar Edad, tipo de glaucoma, tipo de cirugía realizada, estrategia antifibrótica usada o bien implante de las últimas 10 cirugías realizadas desde la recepción de la encuesta. La experiencia del cirujano se muestra según los años de práctica.Resultados Un total de 97 oftalmólogos repartidos por toda la geografía del país respondieron la encuesta, teniendo el 63,4% más de 10 años de experiencia. El glaucoma más frecuente intervenido fue el glaucoma primario de ángulo abierto, representando un 60,6% del total. La cirugía más realizada fue la esclerectomía profunda no perforante (EPNP) con el 37,3% de las cirugías, seguida por el 17,6% de trabeculectomía, 14,1% del microshunt de colágeno (XEN® Allergan Inc., Irvine, CA) y 10,5% de dispositivos de drenaje. Un 21,7% del total fueron reintervenciones y de estas, en el 27,3% se utilizó un dispositivo de drenaje y en el 20,3% trabeculectomía. Un 47,3% de las cirugías fueron combinadas con facoemulsificación. En un 54,8% se usó únicamente mitomicina C (MMC), en un 8,2% de los casos se usó únicamente matriz de colágeno (Ologen®, Aeon Astron Corporation, Taipei, Taiwán) y en un 13,7% la combinación de MMC y matriz de colágeno. La administración de MMC aplicada en esponja se realizó en el 79% de los casos (de estos, a concentraciones de 0,02% en el 99% y al 0,04% en el 1%) y en el 21% de los casos restante mediante inyección subconjuntival (al 0,01% en el 81% y al 0,02% en el 19% restante).Conclusiones A pesar de que el cirujano de glaucoma domina una gran variedad de técnicas quirúrgicas, la EPNP sigue siendo la técnica quirúrgica más realizada en nuestro país (AU)

Purpose To evaluate the spectrum of glaucoma surgery undertaken among members of the Spanish Glaucoma Society (SEG). Methods A 10 question web-based anonymous survey was mailed through the Annals of the Spanish Glaucoma Society to all its members on January, February and July 2019 to determine their preferred surgical approach. Main outcome measures Age, type of Glaucoma, surgery undertaken, type of anti-scarring strategy and prothesis introduced for the last 10 surgeries since the survey was received. The surgeon experience was registered in years of practice. Results A total of 97 SEG members across the country answered the survey. Sixty-two (63.4%) responders had more than 10 years of experience. Primary open angle glaucoma was the most frequent type of glaucoma (60.6%). The most popular surgery was deep-sclerectomy (37.3%) followed by trabeculectomy (17.6%) and the collagen microshunt (XEN® Allergan Inc., Irvine, CA) (14.1%). Glaucoma drainage device (GDD) was used in 10.5% of the cases. Up to 21.7% of surgeries were reinterventions, where GDD was used in 27.3% and trabeculectomy in 20.3% of the cases. Glaucoma surgery was combined with phacoemulsification in 47.3% of the eyes. Mitomycin C (MMC) was used in 54.8% of the cases, collagen matrix (Ologen®, Aeon Astron Corporation, Taipei, Taiwan) was used alone in 8.2% of the cases and in 13.7% combined with MMC. MMC was used in a soaked sponge in 79% of cases (concentrations of 0.02% in 99% and 0.04% in 1%) and in 21% of cases MMC was injected subconjunctivally (concentrations of 0.01% in 81% and 0.02% in 19%) (AU)

Survey of glaucoma surgical preferences among glaucoma specialists in Spain.

PURPOSE: To evaluate the spectrum of glaucoma surgery undertaken among members of the Spanish Glaucoma Society (SEG). METHODS: A 10 question web-based anonimous survey was mailed through the Annals of the Spanish Glaucoma Society to all its members on January, February and July 2019 to determine their preferred surgical approach. MAIN OUTCOME MEASURES: Age, type of Glaucoma, surgery undertaken, type of anti-scarring strategy and prothesis introduced for the last 10 surgeries since the survey was received. The surgeon experience was registered in years of practice. RESULTS: A total of 97 SEG members across the country answered the survey. Sixty-two (63.4%) responders had more than 10 years of experience. Primary open angle glaucoma was the most frequent type of glaucoma (60.6%). The most popular surgery was deep-sclerectomy (37.3%) followed by trabeculectomy (17,6%) and the collagen microshunt (XEN® Allergan Inc., Irvine, CA) (14.1%). Glaucoma drainage device (GDD) was used in 10.5% of the cases. Up to 21.7% of surgeries were reinterventions, where GDD was used in 27.3% and trabeculectomy in 20.3% of the cases. Glaucoma surgery was combined with phacoemulsification in 47.3% of the eyes. Mitomycin C (MMC) was used in 54,8% of the cases, collagen matrix (Ologen®, Aeon Astron Corporation, Taipei, Taiwan) was used alone in 8.2% of the cases and in 13,7% combined with MMC. MMC was used in a soaked sponge in 79% of cases (concentrations of 0.02% in 99% and 0.04% in 1%) and in 21% of cases MMC was injected subconjunctivally (concentrations of 0,01% in 81% and 0.02% in 19%). CONCLUSIONS: Although the glaucoma surgeon performs a wide range of surgical techniques, deep sclerectomy remains the most widely used surgical technique in Spain. Combined cataract and glaucoma surgery is performed almost in half of the patients and MMC is the most frequently selected antifibrotic agent, alone or combined with collagen matrix. The new minimal invasive surgical techniques represent the 20% of the total.

Management of cyclodialysis cleft with transscleral cryotherapy.

A cyclodialysis cleft is a rare disease that is produced as a result of a separation of the longitudinal fibers of the ciliary body muscle from the scleral spur. A stepwise approach is the best course of action to treat cyclodialysis, starting with medical therapy and continuing with more invasive surgical options. We report a case of ocular hypotony due a traumatic cyclodialysis successfully resolved with transscleral cryotherapy.

Manejo de la hendidura de ciclodiálisis con crioterapia transescleral / Management of cyclodialysis cleft with transscleral cryotherapy

La hendidura de ciclodiálisis es una enfermedad rara que se produce como resultado de una separación de las fibras longitudinales del músculo del cuerpo ciliar del espolón escleral. La mejor forma de tratar la ciclodiálisis es por etapas, comenzando con una terapia médica y continuando con opciones quirúrgicas más invasivas. Presentamos un caso de hipotonía ocular debida a una ciclodiálisis traumática que se resolvió con éxito mediante crioterapia transescleral (AU)

A cyclodialysis cleft is a rare disease that is produced as a result of a separation of the longitudinal fibers of the ciliary body muscle from the scleral spur. A stepwise approach is the best course of action to treat cyclodialysis, starting with medical therapy and continuing with more invasive surgical options. We report a case of ocular hypotony due a traumatic cyclodialysis successfully resolved with transscleral cryotherapy (AU)

Coste-efectividad de la terapia avanzada con productos de cura en ambiente húmedo comparada con terapia tradicional en el tratamiento de úlceras por presión de categorías I y II / Cost-effectiveness of advanced therapy with moist environment dressings compared to traditional therapy in the treatment of Stage I and II pressure ulcers

Objetivo: Demostrar el coste-efectividad de la cura en ambiente húmedo (CAH) sobre la cura tradicional (CT) en pacientes hospitalizados con úlceras por presión (UPP) de categorías I y II. Metodología: Estudio longitudinal comparativo, aleatorizado, abierto, dividido en dos grupos, tratados y seguidos durante 4 semanas. El tamaño de la muestra se calculó con base en el metaanálisis de Heyer. Creamos un árbol de decisión para comparar el coste-efectividad de cada cura. Los datos se recopilaron directamente de los formularios de informes de casos de pacientes y los costes se extrajeron de los registros hospitalarios. Realizamos análisis de sensibilidad y costeefectividad incrementales. Resultados: El análisis mostró un dominio de la CAH sobre la CT (223,00€/0,84 vs. 298,00€/0,51), ya que fue más rentable al final del estudio. La hospitalización fue más corta en la CAH y la curación se logró en menos días que con la CT, lo que tiene un impacto en los costes relacionados con los tiempos de atención de enfermería, gasto de recursos materiales y días de hospitalización de los pacientes. Conclusiones: La CAH es más coste-efectiva que la CT cuando se aplica a pacientes hospitalizados con UPP de categorías I y II (AU)

Objective: To demonstrate the cost-effectiveness of the moist environment dressings treatment over the Traditional Cure (TC), in hospitalized patients, with Pressure Ulcers (UPP) categories I and II. Methods: This is a comparative, randomized, open-label, longitudinal study, comprising 60 patients, divided into two groups, treated and followed for four weeks. The sample size was calculated based upon the meta-analysis by Heyer. We built a decision tree to compare the cost-effectiveness of each therapy. Data were collected directly from patients' case report forms and costs extracted from hospital records. Additionally, we performed sensitivity and incremental cost-effectiveness analyses. Results: The analysis showed a dominance of advanced therapy over traditional therapy (€ 223.00/0.84 vs. € 298.00/0.51), as it was more cost-effective at the end of the study. Hospitalization was shorter in the advanced therapy and healing was achieved in fewer days than the traditional therapy. Conclusions: Advanced therapy with healing products in a humid environment is more cost-effective than traditional therapy when applied to hospitalized patients with category I and II pressure ulcers (AU)

Management of cyclodialysis cleft with transscleral cryotherapy. / Manejo de la hendidura de ciclodiálisis con crioterapia transescleral.

A cyclodialysis cleft is a rare disease that is produced as a result of a separation of the longitudinal fibers of the ciliary body muscle from the scleral spur. A stepwise approach is the best course of action to treat cyclodialysis, starting with medical therapy and continuing with more invasive surgical options. We report a case of ocular hypotony due a traumatic cyclodialysis successfully resolved with transscleral cryotherapy.

Paracoccidiodomycosis lung reactivation in a patient with signet-ring cell gastric adenocarcinoma after chemotherapy: Case report.

Although the relationship between paracoccidioidomycosis (PCM) and solid tumors has been described more than 80 years ago, reports of PCM and gastric cancer are rare. PCM can present before or concomitantly with the diagnosis of cancer, and its clinical presentation may rise the suspicion of malignancies or be part of reactivation by immunosuppression. We present the case of a 52-year-old Peruvian man with a signet-ring cell (SRC) gastric adenocarcinoma who after 6 chemotherapy sessions with FLOT (docetaxel, oxaliplatin, leucovorin, 5-fluorouracil) presented rapidly growing lung nodules. The lung biopsy showed yeasts compatible with Paracoccidioides sp., so he received initial treatment with itraconazole and after gastrectomy maintenance therapy with trimethoprim/sulfamethoxazole accompanied by tomographic resolution of lesions.

Manejo de la ampolla isquémica hiperfiltrante: crosslinking mediante el uso de riboflavina y radiación ultravioleta versus deslizamiento conjuntival y autotrasplante de conjuntiva / Management of the hyper-filtrating ischaemic bleb: crosslinking with riboflavin and UV radiation versus a conjunctival sliding flap and conjunctival autologous graft

INTRODUCCIÓN: En este estudio se com:para y evalúa la seguridad y los resultados clínicos de 3 técnicas para el manejo de las ampollas isquémicas hiperfiltrantes en glaucoma: el crosslinking con riboflavina (CXL) respecto al deslizamiento y el autotrasplante conjuntival. MÉTODOS: Se seleccionaron un total de 24 ojos de 18 pacientes con ampollas isquémicas intervenidos de cirugía filtrante de glaucoma entre 2012 y 2017. Fueron intervenidos de CXL mediante el uso de riboflavina (n = 4), autotrasplante conjuntival (n = 5) y deslizamiento conjuntival (n = 15). Se comparan los resultados de la presión intraocular (PIO) previa al procedimiento y a los 12 meses, así como de la agudeza visual y de la medicación antiglaucomatosa previa y a los 12 meses. RESULTADOS: Los 4 de la riboflavina pasaron de una PIO media previa de 12,11 ± 3,14 a una PIO al año de 12,32 ± 5,29 (p = 0,655). Los 5 ojos del autotrasplante de conjuntiva tuvieron una PIO previa media de 11,65 ± 5,76 y al año de 14,68 ± 7,21 (p = 0,273). Los 15 ojos tratados mediante deslizamiento conjuntival presentaron una PIO previa de 9,32 ± 5,34 y al año de 15,16 ± 9,24 (p = 0,021). No hubo efectos adversos ni complicaciones asociadas a ninguna de las 3 técnicas. CONCLUSIONES: El manejo de la ampolla isquémica hiperfiltrante resulta difícil. Los procedimientos quirúrgicos se asocian a incrementos tensionales y a necesidad de medicación, mientras que el CXL mediante el uso de riboflavina y radiación UV no parece tener un efecto sobre la revitalización de la ampolla

INTRODUCTION: This article compares and evaluates the safety and clinical results of 3 techniques for the management of hyper-filtrating ischaemic bleb in glaucoma, such as collagen crosslinking (CXL) with riboflavin versus conjunctival sliding and conjunctival autologous graft. METHODS: A total of 24 eyes were selected from 18 patients with ischemic blebs that underwent filtering glaucoma surgery between 2012 and 2017 and subjected them to crosslinking using riboflavin (n = 4), conjunctival autologous graft (n = 5), and conjunctival sliding (n = 15). The results of the intraocular pressure (IOP) prior to the procedure and at 12 months were compared, as well as visual acuity and previous anti-glaucoma medication at 12 months. RESULTS: The 4 eyes that underwent CXL, went from a previous mean IOP of 12.11 ± 3.14 to an IOP of 12.32 ±5.29 at one year (P = .655). Five eyes were treated by conjunctival autologous graft, had a previous mean IOP of 11.65 ± 5.76 and an IOP at one year of 14.68 ± 7.21 (P = .273). Fifteen eyes subjected to conjunctival sliding had a previous IOP of 9.32 ±5.34 and at one year it was 15.16 ± 9.24 (P =. 021). There were no adverse effects or complications associated with any of the 3 techniques. CONCLUSIONS: The management of the hyper-filtrating ischaemic bleb is difficult. Surgical procedures are associated with increased IOP and need for medication, while CXL using riboflavin and UV radiation does not seem to have an effect on the revitalisation of the bleb

Management of the hyper-filtrating ischaemic bleb: crosslinking with riboflavin and UV radiation versus a conjunctival sliding flap and conjunctival autologous graft. / Manejo de la ampolla isquémica hiperfiltrante: crosslinking mediante el uso de riboflavina y radiación ultravioleta versus deslizamiento conjuntival y autotrasplante de conjuntiva.

INTRODUCTION: This article compares and evaluates the safety and clinical results of 3techniques for the management of hyper-filtrating ischaemic bleb in glaucoma, such as collagen crosslinking (CXL) with riboflavin versus conjunctival sliding and conjunctival autologous graft. METHODS: A total of 24 eyes were selected from 18 patients with ischemic blebs that underwent filtering glaucoma surgery between 2012 and 2017 and subjected them to crosslinking using riboflavin (n=4), conjunctival autologous graft (n=5), and conjunctival sliding (n=15). The results of the intraocular pressure (IOP) prior to the procedure and at 12 months were compared, as well as visual acuity and previous anti-glaucoma medication at 12 months. RESULTS: The 4eyes that underwent CXL, went from a previous mean IOP of 12.11 ± 3.14 to an IOP of 12.32 ±5.29 at one year (P=.655). Five eyes were treated by conjunctival autologous graft, had a previous mean IOP of 11.65 ± 5.76 and an IOP at one year of 14.68 ± 7.21 (P=.273). Fifteen eyes subjected to conjunctival sliding had a previous IOP of 9.32 ±5.34 and at one year it was 15.16 ± 9.24 (P=.021). There were no adverse effects or complications associated with any of the 3techniques. CONCLUSIONS: The management of the hyper-filtrating ischaemic bleb is difficult. Surgical procedures are associated with increased IOP and need for medication, while CXL using riboflavin and UV radiation does not seem to have an effect on the revitalisation of the bleb.

Enhancing violations of Leggett-Garg inequalities in nonequilibrium correlated many-body systems by interactions and decoherence.

We identify different schemes to enhance the violation of Leggett-Garg inequalities in open many-body systems. Considering a nonequilibrium archetypical setup of quantum transport, we show that particle interactions control the direction and amplitude of maximal violation, and that in the strongly-interacting and strongly-driven regime bulk dephasing enhances the violation. Through an analytical study of a minimal model we unravel the basic ingredients to explain this decoherence-enhanced quantumness, illustrating that such an effect emerges in a wide variety of systems.

[Study of the relationship between adherence to back school and coping with pain in patients with chronic low back pain]. / Estudio de la relación entre adherencia a la Escuela de la Espalda y afrontamiento del dolor en pacientes con lumbalgia crónica.

INTRODUCTION: Back School (BS) is a treatment modality for patients with chronic low back pain with educational contents associated with other therapeutic measures such as exercise. If followed, it is effective but it is well known that it is difficult to make changes to daily habits. This study evaluated whether patients completing BS had a predominance of active strategies in coping with pain, as they adhered better to the recommendations of BS. MATERIAL AND METHOD: Prospective observational study to evaluate BS adherence in patients with chronic low back pain. Adult patients attending BS were included in the study. Patients whose educational level, concomitant pathology or personal situation prevented them from completing the study were excluded. The patients were evaluated at the beginning and after the third session of BS. The variables studied were adherence to exercises and recommendations, coping with pain, pain intensity, functional disability and other sociodemographic characteristics. RESULTS: A total of 67.2% of the 116 included patients acknowledged that they did not perform the exercises and recommendations of BS every day. No relationship was established between patients with active strategies for coping with pain and adherence to BS. Functional capacity and pain intensity did not differ between adherent and non-adherent patients. CONCLUSIONS: This study did not demonstrate that adherence to the exercises and habits taught in BS is related to coping with pain strategies, pain intensity and functional capacity in patients with chronic low back pain.

Theoretical equations of state for a charged fluid.

In this article, we present a molecular thermodynamic study of a system of N particles contained within a volume V and interacting via a hard-core pair potential with an attractive interaction according to the Wolf model for charged systems. This variable-range potential is characterized by three parameters: the repulsive hard-core diameter σ, the energy-well depth ϵ, and the inverse range α; a fourth parameter of the model is a cut-off distance xc that depends on α according to the relation xc = 2/α. Two equations of state (EOSs) are presented and derived from thermodynamic perturbation theory and Monte Carlo (MC) simulation data. The first EOS is given by the standard Zwanzig's high-temperature expansion of the Helmholtz free energy, where the first three perturbation terms a1, a2, and a3 were obtained from MC simulations in the canonical ensemble (NVT) and parameterized as functions of α and the reduced density of particles ρ* = Nσ3/V. The second EOS was obtained from the discrete perturbation theory applied to a discrete representation of the Wolf potential. Results for pressures, internal energies, and isochoric heat capacities are compared to the MC computer simulation data of the Wolf system, including vapor-liquid coexistence curves, for different values of α. Overall, both EOSs give a very good representation of the thermodynamic properties of the Wolf fluid when 0.3 ≤ α ≤ 1.0 and 0.05 ≤ ρ* ≤ 0.8. Since the Yukawa fluid can reproduce information of screened ionic interactions, we discuss the equivalence between the Wolf and Yukawa fluids in the context of equivalent systems in liquid theory.

Síndrome de mascarada: un problema ocular como manifestación de un mal mayor / Multimodal imaging and treatment of Purtscher-like retinopathy

Varón de mediana edad con factores de riesgo cardiovascular, que presenta leve pérdida de visión unilateral de 6 meses de evolución. Tras obtener diagnóstico de coroiditis difusa + papilitis en el seno de un probable síndrome de mascarada, es derivado a consultas externas de Medicina Interna, donde es corroborado dicho diagnóstico en el seno de una enfermedad neoplásica extendida

A middle-aged man with cardiovascular risk factors, who suffered from a slight loss of unilateral vision for 6 months. After obtaining a diagnosis of diffuse choroiditis + papillitis within a probable masquerade syndrome, the patient was referred to outpatient Internal Medicine where this diagnosis was confirmed as an extended neoplastic disease

Masquerade syndrome: An eye problem as a manifestation of a more sinister disease. / Síndrome de mascarada: un problema ocular como manifestación de un mal mayor.

A middle-aged man with cardiovascular risk factors, who suffered from a slight loss of unilateral vision for 6 months. After obtaining a diagnosis of diffuse choroiditis+papillitis within a probable masquerade syndrome, the patient was referred to outpatient Internal Medicine where this diagnosis was confirmed as an extended neoplastic disease.

Water phase transitions from the perspective of hydrogen-bond network analysis.

We analyze the water vapour-liquid and solid-liquid phase transitions from the perspective of hydrogen bond networks. Using molecular dynamics simulation data for the TIP4P/2005 and TIP4P/ice water models, we built hydrogen bond networks in the neighbourhood of the transitions. We studied the behaviour of some topological network properties: the average degree, clustering coefficient, and average path length. We found that these properties exhibit a discontinuity while approaching a phase transition region, similar to those that appear for some thermodynamic properties in the same region. This approach can be extended to characterize other water phase transitions. Besides, it can also be applied to study the phase transitions of other hydrogen-bonded substances or to other scenarios whose relevant "interaction" could be identified together with a "proper criterion" defined in an analogous way as in the case of hydrogen bonded systems.

Non-osteogenic muscle hypertrophy in children with McArdle disease.

INTRODUCTION: McArdle disease is an inborn disorder of muscle glycogen metabolism that produces exercise intolerance, and has been recently associated with low values ​​of lean mass (LM) and bone mineral content (BMC) and density (BMD) in affected adults. Here we aimed to study whether this bone health problem begins in childhood. METHODS: Forty children and adolescents were evaluated: 10 McArdle disease and 30 control children (mean age of both groups, 13 ± 2y). Body composition was evaluated by dual-energy X-ray absorptiometry and creatine kinase (CK) levels were determined in the patients as an estimate of muscle damage. RESULTS: Legs bone mass was significantly lower in patients than in controls (-36% for BMC and -22% for BMD). Moreover, patients had significantly higher LM values in the legs than controls, whereas no difference was found for fat mass. CK levels were positively associated with LM in McArdle patients. A correlation was found between LM and BMD variables in the control group but not in McArdle patients. CONCLUSION: We have identified a 'non-osteogenic muscle hypertrophy' in children with McArdle disease. This phenomenon warrants special attention since low osteogenesis at an early age predicts a high risk for osteoporosis later in life.

Antibiotic-associated diarrhea: Clinical characteristics and the presence of Clostridium difficile. / Diarrea asociada a antibióticos: características clínicas y presencia de Clostridium difficile.

INTRODUCTION AND AIMS: Evidence in Colombia and Latin America has been insufficient for establishing the clinical characteristics of patients with antibiotic-associated diarrhea (AAD). The present study attempts to describe the clinical characteristics of patients with AAD and to determine the presence of Clostridium difficile, utilizing the polymerase chain reaction (PCR) technique. MATERIALS AND METHODS: Forty-three patients with AAD, managed at the Hospital Universitario San Ignacio in Bogotá, Colombia, were evaluated. Prospective patient information was collected, with respect to demographic characteristics, profile of the antibiotic management received, clinical manifestations, risk factors, and paraclinical reports. In addition, the real time PCR test for Clostridium difficile (Cepheid Xpert®, Sunnyvale, CA, United States) was performed. RESULTS: Patient mean age was 58 years (19.31 SD). The majority of the patients received 2 or more antibiotics (62.9%) and the beta-lactams were the most frequently used. Hospital stay ranged from 2 to 104 days with a median of 10 days. The most frequent clinical manifestations were abdominal pain and bloating, followed by fever and tachycardia. At the time of diagnosis, 23 patients had noninflammatory results in the stool sample analyses and 18 had kidney failure. The mean level of albumin was 2.4mg/dl (0.7 SD). The presence of Clostridium difficile was documented through PCR in 6 patients (13.95% of the cases). CONCLUSIONS: AAD patients were characterized by a high frequency of severe comorbidities and prolonged hospital stay. The presence of Clostridium difficile in only 13.9% of the cases suggests that other causes of diarrhea in the hospitalized patient should be considered.

Effectiveness and safety of ombitasvir, paritaprevir, ritonavir ± dasabuvir ± ribavirin: An early access programme for Spanish patients with genotype 1/4 chronic hepatitis C virus infection.

Over the last 5 years, therapies for hepatitis C virus (HCV) infection have improved significantly, achieving sustained virologic response (SVR) rates of up to 100% in clinical trials in patients with HCV genotype 1. We investigated the effectiveness and safety of ombitasvir/paritaprevir/ritonavir±dasabuvir in an early access programme. This was a retrospective, multicentre, national study that included 291 treatment-naïve and treatment-experienced patients with genotype 1 or 4 HCV infection. Most patients (65.3%) were male, and the mean age was 57.5 years. The mean baseline viral load was 6.1 log, 69.8% had HCV 1b genotype, 72.9% had cirrhosis and 34.7% were treatment-naïve. SVR at 12 weeks posttreatment was 96.2%. Four patients had virological failure (1.4%), one leading to discontinuation. There were no statistical differences in virological response according to genotype or liver fibrosis. Thirty patients experienced serious adverse events (SAEs) (10.3%), leading to discontinuation in six cases. Hepatic decompensation was observed in five patients. Four patients died during treatment or follow-up, three of them directly related to liver failure. Multivariate analyses showed a decreased probability of achieving SVR associated with baseline albumin, bilirubin and Child-Pugh score B, and a greater probability of developing SAEs related to age and albumin. This combined therapy was highly effective in clinical practice with an acceptable safety profile and low rates of treatment discontinuation.