Prospective evaluation of the emetogenic profile and analgesic efficacy of intravenous ibuprofen and metamizole in the immediate postoperative period of pediatric acute appendicitis. / Evaluación prospectiva del perfil emético y la eficacia analgésica del ibuprofeno y el metamizol intravenosos en el postoperatorio inmediato de la apendicitis aguda pediátrica.

BACKGROUND: Literature comparing different alternatives for pain control in the immediate postoperative period of pediatric acute appendicitis (PAA) is scarce. MATERIALS AND METHODS: We prospectively compared the analgesic and emetogenic profile of intravenous ibuprofen and metamizole in the immediate postoperative period of PAA. For this purpose, we used a sample of patients operated on in 2021 in our center. Participants were recruited on arrival at the Emergency Department and histopathological confirmation of the diagnosis was obtained in all of them. Pain was evaluated every 8 hours after the surgery with validated visual analog scales ranging from 0 to 10 points. Repeated measures ANOVA was used to compare the evolution of pain in the 48 hours after surgery between the two groups. RESULTS: The sample included 95 patients (65% males) with a mean age of 9.7 years (sd: 3.14). 41 patients were treated with Ibuprofen (group 1) and 54 with metamizole (group 2). No significant differences were found in the level of pain either in the comparisons of point measurements or in its evolution in the 48 hours after surgery (p= 0.58). After adjusting for the received fluid therapy, children in the metamizole group had significantly more emetic episodes and needed significantly more doses of ondansetron. CONCLUSIONS: In our cohort, ibuprofen had a similar analgesic efficacy and a better emetogenic profile than metamizole in the immediate postoperative period of PAA. Future prospective, adequately controlled studies with larger sample sizes are needed to validate these findings.

INTRODUCCION: En la literatura existen pocas referencias que comparen las distintas alternativas disponibles para controlar el dolor en el postoperatorio inmediato de la apendicitis aguda pediátrica (AAP). MATERIAL Y METODOS: Comparación prospectiva del perfil analgésico y emético del ibuprofeno y el metamizol intravenosos en el postoperatorio inmediato de la AAP, para lo cual se recurre a una muestra de pacientes operados en 2021 en nuestro centro. Los participantes fueron reclutados a su llegada a Urgencias, obteniéndose confirmación histopatológica del diagnóstico en todos ellos. La evaluación del dolor se llevó a cabo cada 8 horas tras la cirugía mediante escalas analógicas visuales validadas, con valoraciones entre los 0 y los 10 puntos. Se realizó un ANOVA de las medidas repetidas entre los dos grupos para comparar la evolución del dolor en las 48 horas posteriores a la cirugía. RESULTADOS: La muestra estaba compuesta por un total de 95 pacientes (65% de ellos varones) con una edad media de 9,7 años (DT: 3,14). 41 pacientes fueron tratados con ibuprofeno (grupo 1) y 54 con metamizol (grupo 2). No se hallaron diferencias significativas en lo que respecta al dolor, ni en las comparaciones de las mediciones puntuales, ni en su evolución en las 48 horas posteriores a la cirugía (p= 0,58). Una vez realizado el ajuste correspondiente a la terapia de fluidos recibida, los niños del grupo metamizol tuvieron significativamente más episodios eméticos y necesitaron significativamente más dosis de ondansetrón. CONCLUSIONES: En nuestra cohorte, el ibuprofeno tuvo una eficacia analgésica similar y un mejor perfil emético que el metamizol en el postoperatorio inmediato de la AAP. Se hacen necesarios nuevos estudios prospectivos, adecuadamente controlados y con mayor tamaño muestral que validen estos hallazgos.

Evaluación prospectiva del perfil emético y la eficacia analgésica del ibuprofeno y el metamizol intravenososen el postoperatorio inmediato de la apendicitis agudapediátrica / Prospective evaluation of the emetogenic profile and analgesic efficacy of intravenous ibuprofen and metamizole in the immediate postoperative period of pediatric acute appendicitis

Introducción: En la literatura existen pocas referencias que comparen las distintas alternativas disponibles para controlar el dolor enel postoperatorio inmediato de la apendicitis aguda pediátrica (AAP).Material y métodos: Comparación prospectiva del perfil anal-gésico y emético del ibuprofeno y el metamizol intravenosos en elpostoperatorio inmediato de la AAP, para lo cual se recurre a unamuestra de pacientes operados en 2021 en nuestro centro. Los participantes fueron reclutados a su llegada a Urgencias, obteniéndoseconfirmación histopatológica del diagnóstico en todos ellos. La evaluación del dolor se llevó a cabo cada 8 horas tras la cirugía medianteescalas analógicas visuales validadas, con valoraciones entre los 0 ylos 10 puntos. Se realizó un ANOVA de las medidas repetidas entrelos dos grupos para comparar la evolución del dolor en las 48 horasposteriores a la cirugía.Resultados: La muestra estaba compuesta por un total de 95 pacientes (65% de ellos varones) con una edad media de 9,7 años (DT:3,14). 41 pacientes fueron tratados con ibuprofeno (grupo 1) y 54 conmetamizol (grupo 2). No se hallaron diferencias significativas en lo querespecta al dolor, ni en las comparaciones de las mediciones puntuales,ni en su evolución en las 48 horas posteriores a la cirugía (p= 0,58). Unavez realizado el ajuste correspondiente a la terapia de fluidos recibida,los niños del grupo metamizol tuvieron significativamente más episodioseméticos y necesitaron significativamente más dosis de ondansetrón.Conclusiones: En nuestra cohorte, el ibuprofeno tuvo una eficaciaanalgésica similar y un mejor perfil emético que el metamizol en elpostoperatorio inmediato de la AAP. Se hacen necesarios nuevos estudiosprospectivos, adecuadamente controlados y con mayor tamaño muestralque validen estos hallazgos.(AU)

Background: Literature comparing different alternatives for paincontrol in the immediate postoperative period of pediatric acute appendicitis (PAA) is scarce.Materials and methods: We prospectively compared the analgesicand emetogenic profile of intravenous ibuprofen and metamizole in theimmediate postoperative period of PAA. For this purpose, we used asample of patients operated on in 2021 in our center. Participants wererecruited on arrival at the Emergency Department and histopathologi-cal confirmation of the diagnosis was obtained in all of them. Pain wasevaluated every 8 hours after the surgery with validated visual analogscales ranging from 0 to 10 points. Repeated measures ANOVA wasused to compare the evolution of pain in the 48 hours after surgerybetween the two groups. Results: The sample included 95 patients (65% males) with a meanage of 9.7 years (sd: 3.14). 41 patients were treated with Ibuprofen(group 1) and 54 with metamizole (group 2). No significant differ-ences were found in the level of pain either in the comparisons of pointmeasurements or in its evolution in the 48 hours after surgery (p= 0.58).After adjusting for the received fluid therapy, children in the metamizolegroup had significantly more emetic episodes and needed significantlymore doses of ondansetron. Conclusions: In our cohort, ibuprofen had a similar analgesic ef-ficacy and a better emetogenic profile than metamizole in the immediatepostoperative period of PAA. Future prospective, adequately controlledstudies with larger sample sizes are needed to validate these findings.(AU)

Ocular impairment as the first and only manifestation of Bardet-Biedl syndrome: A case report.

Bardet-Biedl syndrome is a ciliopathy mainly associated with retinal dystrophy, renal dysfunction, post-axial polydactyly, obesity, cognitive deficit and hypogonadism. The symptoms associated with retinal dystrophy do not usually appear until the first decade of life, so the diagnosis is usually delayed. Ocular involvement may be the initial form of manifestation of this syndrome, it may even be the only one, so it should be taken into account in the differential diagnosis of amblyopia in a child who does not improve despite correct compliance with treatment. A case of low visual acuity in a pediatric patient is presented as an initial manifestation that leads to the diagnosis of Bardet-Biedl Syndrome, and which is also the only symptom that the patient presents to date, despite being a multisystem disease.

Aproximaciones a la epidemiología de la neuropatía óptica hereditaria de Leber en la comunidad autónoma de Madrid a través de una encuesta a los neuroftalmólogos / Approaches to the epidemiology of NOHL in the region of Madrid: Survey of neuro-ophthalmologists

Objective To estimate the epidemiology of Leber's optic neuropathy (NOHL) in the Region of Madrid. Material and methodsThe neuro-ophthalmologists who work at public hospitals of the CAM were interviewed by telephone. They were asked about the number of patients with NOHL that they had diagnosed during the time that they had been responsible for the neuro-ophthalmology department of that public hospital. The time worked and the population attended by the hospital were used to calculate the number of patient-years in follow-up by each center during the corresponding period. The basic information of each case (date of birth, mutation, and date of visual loss) was registered to avoid duplications. Results Our work estimates a global incidence of 2.34 cases for 10,000,000 inhabitants-year and a prevalence estimated from incidence of one case for each 106,682 inhabitants. This prevalence was very similar in all the studied areas and considerably lower than that reported by other studies. Conclusion This work constitutes the first approach to the epidemiology of this disease in Spain. The prevalence of NOHL in the region of Madrid is probably lower than that reported in the literature in other regions. The prevalence and the incidence were homogeneously low in the 26 studied areas. (AU)

Objetivo Estimar la epidemiología (incidencia y prevalencia) de la neuropatía óptica de Leber (NOHL) en la comunidad autónoma de Madrid (CM). Material y métodosLos neuroftalmólogos que trabajan en los hospitales públicos de la CAM fueron entrevistados telefónicamente. Se les preguntó por el número de pacientes con NOHL que habían diagnosticados durante el tiempo que han sido responsables de la consulta de neuroftalmología de ese hospital público. El tiempo trabajado y la población atendida por el hospital se utilizaron para calcular el número de habitantes-años en seguimiento por cada centro durante el periodo correspondiente y estimar la incidencia en cada área. La prevalencia estimada a partir de la incidencia (PEI) se calculó considerando que un paciente con NOHL vive unos 40 años con la enfermedad. Se registró la información básica de cada caso cuando estaba disponible (sexo, fecha de nacimiento, mutación, fecha de la pérdida visual) para evitar duplicaciones. Resultados Nuestro trabajo estima una incidencia global de 2,34 casos por cada 10.000.000 habitantes-año y una PEI de 1 caso por cada 106.682 habitantes. Esta prevalencia es inferior a la referida por otros estudios. Conclusión Este trabajo constituye la primera aproximación a la epidemiología de esta enfermedad en España. La prevalencia estimada de la NOHL en la CM es probablemente inferior a la reportada en la literatura en otras regiones. La prevalencia y la incidencia fueron homogéneamente bajas en las 26 áreas estudiadas. (AU)

Approaches to the epidemiology of NOHL in the region of Madrid: Survey of neuro-ophthalmologists.

OBJECTIVE: To estimate the epidemiology of Leber's optic neuropathy (NOHL) in the Region of Madrid. MATERIAL AND METHODS: The neuro-ophthalmologists who work at public hospitals of the CAM were interviewed by telephone. They were asked about the number of patients with NOHL that they had diagnosed during the time that they had been responsible for the neuro-ophthalmology department of that public hospital. The time worked and the population attended by the hospital were used to calculate the number of inhabitant-years in follow-up by each center during the corresponding period. The basic information of each case (date of birth, mutation, date of visual loss) was registered to avoid duplications. RESULTS: Our work estimates a global incidence of 2.34 cases for 10,000,000 inhabitants-year and a prevalence estimated from incidence of one case for each 106.682 inhabitants. This prevalence was very similar in all the studied areas and considerably lower than that reported by other studies. CONCLUSION: This work constitutes the first approach to the epidemiology of this disease in Spain. The prevalence of LHON in the region of Madrid, is probably lower than that reported in the literature in other regions. The prevalence and the incidence were homogeneously low in the 26 studied areas.

Desarrollo y validación de un nuevo simulador para endourología / The development and validation of a new simulator for endourology

Introducción La simulación en medicina ha evolucionado sustancialmente en las últimas décadas. Actualmente hay una gran variedad de simuladores disponibles, especialmente diseñados para la práctica de procedimientos quirúrgicos. Debido a las largas curvas de aprendizaje de las técnicas endourológicas mínimamente invasivas, la rama de la endourología se puede ver muy beneficiada por el uso de estos simuladores. Material y métodos Se diseñó un simulador de baja fidelidad para la práctica de técnicas endourológicas que utilizan cistoscopia. En el proceso de validación participaron 5 expertos y 19 no expertos. Los expertos eran profesionales médicos de un Departamento de Urología con experiencia de al menos 100 procedimientos de cistoscopia flexible. Los no expertos eran residentes en medicina interna sin experiencia en ningún tipo de técnica endoscópica. Se recogió información sobre la validez aparente y de contenido mediante escalas de Likert con puntuación de 1 a 5. Para evaluar la validez de constructo, se midió el tiempo para completar dos tareas, para lo cual se evaluó el procedimiento mediante la escala de evaluación global OSATS. Resultados El nuevo simulador se fabricó satisfactoriamente de acuerdo con su diseño. En todos los aspectos evaluados de la validez de constructo hubo una diferencia significativa (p<0,05) entre el grupo de expertos y el de no expertos. La validez de contenido fue puntuada con 4,66 (desviación estándar [DE] ±0,56) por los expertos y con 4,41 (DE±0,71) por los no expertos. En el cuestionario de validez aparente, la puntuación media fue de 4,14 (DE±0,94), y la pregunta que recibió la puntuación más alta (4,6 [DE±0,84]) evaluaba la inmersión en el procedimiento. Conclusión El simulador presentado es válido tanto para el entrenamiento de nuevos endourólogos como para el perfeccionamiento de las técnicas de los médicos expertos (AU)

Introduction Simulation in medicine has developed a lot in the last few decades. There is a broad range of simulators available, above all for training in surgical procedures. Endourology can benefit much from simulation because the minimally-invasive procedures of endourology frequently have long learning curves, which can be reduced by training with simulators. Material and methods A low-fidelity simulator was designed for practicing endourology techniques that use cystoscopy. The process of validation involved 5 experts and 19 non-experts. Experts comprised medical professionals working in a department of urology who had performed at least 100 flexible cystoscopy procedures. Non-experts were residents in internal medicine without experience in any type of endoscopy. Information about face and content validity was collected by means of Likert scales from 1 to 5. To evaluate construct validity, we measured the time to complete two tasks, for which the procedure was evaluated by means of the OSATS global evaluation scale. Results New simulator was successfully built according to its design. For all evaluated aspects of construct validity, there was a significant difference (P<.05) between the group of experts and the group of non-experts. Content validity was scored 4.66 (standard deviation±0.56) by the experts and 4.41 (±0.71) by the non-experts. In the face validity questionnaire, the average score was 4.14 (±0.94), the question receiving the highest score: 4.6 (±0.84) concerned immersion in the procedure. Conclusion The simulator presented is valid both for training up new urologists in endourology technique and for experts seeking to perfect their skills (AU)

The development and validation of a new simulator for endourology.

INTRODUCTION: Simulation in medicine has developed a lot in the last few decades. There is a broad range of simulators available, above all for training in surgical procedures. Endourology can benefit much from simulation because the minimally-invasive procedures of endourology frequently have long learning curves, which can be reduced by training with simulators. MATERIALS AND METHODS: A low-fidelity simulator was designed for practicing endourology techniques that use cystoscopy. The process of validation involved 5 experts and 19 non-experts. Experts comprised medical professionals working in a department of urology who had performed at least 100 flexible cystoscopy procedures. Non-experts were residents in internal medicine without experience in any type of endoscopy. Information about face and content validity was collected by means of Likert scales from 1 to 5. To evaluate construct validity, we measured the time to complete two tasks, for which the procedure was evaluated by means of the OSATS global evaluation scale. RESULTS: New simulator was successfully built according to its design. For all evaluated aspects of construct validity, there was a significant difference (p<0.05) between the group of experts and the group of non-experts. Content validity was scored 4.66 (standard deviation ±0.56) by the experts and 4.41 (±0.71) by the non-experts. In the face validity questionnaire, the average score was 4.14 (±0.94), the question receiving the highest score: 4.6 (±0.84) concerned immersion in the procedure. CONCLUSION: The simulator presented is valid both for training up new urologists in endourology technique and for experts seeking to perfect their skills.

Pragmatic, open-label, single-center, randomized, phase II clinical trial to evaluate the efficacy and safety of methylprednisolone pulses and tacrolimus in patients with severe pneumonia secondary to COVID-19: The TACROVID trial protocol.

INTRODUCTION: Some COVID-19 patients evolve to severe lung injury and systemic hyperinflammatory syndrome triggered by both the coronavirus infection and the subsequent host-immune response. Accordingly, the use of immunomodulatory agents has been suggested but still remains controversial. Our working hypothesis is that methylprednisolone pulses and tacrolimus may be an effective and safety drug combination for treating severe COVID-19 patients. METHODS: and analysis: TACROVID is a randomized, open-label, single-center, phase II trial to evaluate the efficacy and safety of methylprednisolone pulses and tacrolimus plus standard of care (SoC) versus SoC alone, in patients at advanced stage of COVID-19 disease with lung injury and systemic hyperinflammatory response. Patients are randomly assigned (1:1) to one of two arms (42 patients in each group). The primary aim is to assess the time to clinical stability after initiating randomization. Clinical stability is defined as body temperature ≤37.5 °C, and PaO2/FiO2 > 400 and/or SatO2/FiO2 > 300, and respiratory rate ≤24 rpm; for 48 consecutive hours. DISCUSSION: Methylprednisolone and tacrolimus might be beneficial to treat those COVID-19 patients progressing into severe pulmonary failure and systemic hyperinflammatory syndrome. The rationale for its use is the fast effect of methylprednisolone pulses and the ability of tacrolimus to inhibit both the CoV-2 replication and the secondary cytokine storm. Interestingly, both drugs are low-cost and can be manufactured on a large scale; thus, if effective and safe, a large number of patients could be treated in developed and developing countries. TRIAL REGISTRATION NUMBER: NCT04341038 / EudraCT: 2020-001445-39.

Neurologic Involvement in COVID-19: Cause or Coincidence? A Neuroimaging Perspective.

The rapid spread of the coronavirus disease 2019 (COVID-19) pandemic has shaken hospitals worldwide. Some authors suggest that neurologic involvement could further complicate the disease. This descriptive study is a cross-sectional review of 103 patients diagnosed with COVID-19 who underwent neuroimaging (of a total of 2249 patients with COVID-19 in our center). Analyzed variables were neurologic symptoms and acute imaging findings. The most frequent symptoms that motivated neuroimaging examinations were mild nonfocal neurologic symptoms, code stroke (refers to patients presenting with signs and symptoms of stroke whose hyperacute assessment and care is prioritized), focal neurologic symptoms, postsedation encephalopathy, and seizures. No cases of encephalitis or direct central nervous system involvement were detected. Thirteen patients presented with acute ischemic events, and 7, with hemorrhagic events; however, most reported multiple vascular risk factors. Despite the large cohort of patients with COVID-19, we found a large number of symptomatic patients with negative neuroimaging findings, and no conclusions can be drawn concerning concrete associations between neuroimaging and COVID-19.

Relación entre el consumo de productos lácteos y las enfermedades respiratorias sibilantes en escolares / Relationship between lactic product ingestion and wheezing respiratory diseases in school children

Introducción: Los lácteos son alimentos importantes para el desarrollo, pero muchos padres limitan su consumo para evitar enfermedades respiratorias a pesar de que no existe evidencia científica concluyente al respecto. El objetivo de este estudio es estudiar si el consumo de leche y derivados lácteos se asocia con enfermedades respiratorias sibilantes (asma, síndrome de obstrucción bronquial recurrente, sibi-lancias) en escolares. Material y método: Estudio transversal dentro de la co-horte SENDO. La información sobre el consumo de lácteos se obtuvo mediante cuestionario semicuantitativo de frecuen-cia de consumo de alimentos. Los participantes se dividieron a partir de la mediana de consumo. El diagnóstico de enfer-medades sibilantes referido en los cuestionarios se confirmó mediante revisión de los registros médicos digitalizados. Para estudiar la asociación del consumo de leche, queso, yogur y de los lácteos en conjunto con las enfermedades sibilantes se utilizó un test de regresión logística ajustado por posibles factores de confusión. Resultados: En la muestra de 170 escolares (55,9% niñas, edad media 6,1 años) no se encontró una asociación significativa entre el consumo de lácteos en conjunto y las enfermedades sibilantes estudiadas [OR 0,85; IC 95% (0,44-1,64)]. Al analizar cada alimento por separado (le-che, yogur y queso), se encontró que un mayor consumo de leche se asociaba con un menor riesgo de enfermedades sibilantes. Conclusiones: Los resultados no apoyan la existencia de una asociación directa entre el consumo de leche o derivados lácteos y el riego de enfermedades sibilantes

Background: Milk consumption is important in child development, but some parents are avoiding dairy products as a way to prevent respiratory diseases in their children, even though there is no scientific evidence in this regard. Objective: To examine the association between dairy products consumption and wheezing respiratory diseases (asthma, recurrent wheezing episodes) in school-age chil-dren. Materials and methods: Cross-sectional study within SENDO project. Dairy products consumption was assessed through a semiquantitative food frequency questionnaire (FFQ). Participants were divided based on the median of consumption. Wheezing diseases diagnose referred by pa-rents in the questionnaires was confirmed by medical records review. A logistic regression test, adjusted for possible-con-founding factors was used to study the association between dairy products (milk, cheese, and yoghurt) and wheezing diseases.Results. In the 170 participants included (55.9% girls, mean age 6.1 years), no significant association was found between dairy products consumption and the respiratory di-seases studied [OR 0.85, 95% CI (0.44-1.64)]. When analy-sed separately a higher consumption of milk was associated with a lower risk of wheezing diseases. Conclusions: The results do not support the association between dairy products consumption and an increased risk of wheezing respiratory diseases

Validation of the Spanish version of the Borderline Personality Disorder Checklist (BPD Checklist) in a sample of BPD patients: Study of psychometric properties

Background and objectives: Borderline Personality Disorder (BPD) is one of the most complex personality disorders (PD). The Borderline Personality Disorder Checklist (BPD Checklist) is an instrument specifically designed to assess the burden of BPD symptoms according to DSM-IV/5 criteria in the past month. Methods: Our goal was to adapt and validate the BPD Checklist in Spanish and to study its psychometric properties, i.e. reliability and validity. We administered it in a sample of BPD patients (n = 342) and in a sample of patients with other PD diagnoses (n = 190). Results: The results obtained indicated that the psychometric properties of the Spanish version of the BPD Checklist are similar to those of the original version of the instrument. The internal consistency indices were generally good to excellent. The total score and the subscales of the BPD Checklist discriminated between diagnostic samples. As expected, the subscales were associated with the scores on the SCID-II and self-rating measures. Conclusions: Our results are consistent with the original version of BPD Checklist. In general, it is an adequate instrument for clinical screening and to assess the subjective burden of BPD experienced by the patient in the past month

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Serum and gene expression levels of CT-1, IL-6, and TNF-α after a lifestyle intervention in obese children.

BACKGROUND: Inflammation related molecules such as tumor necrosis factor-α (TNF-α), interleukin 6 (IL-6), and cardiotrophin-1 (CT-1) are highly expressed in obese individuals and could partly explain some comorbidities associated to obesity. In obese children, lifestyle interventions are able to lower inflammation and reduce cardiovascular risk factors associated with obesity. The aim of the present work was to study changes in inflammation-related molecules serum and peripheral blood mononuclear cells (PBMC) transcript levels after a 10-week lifestyle intervention in obese children and asses their potential association with glucose metabolism. METHODS: Twenty-three obese children (mean age 11.5 years; 48% males) underwent a 10-week lifestyle not controlled intervention trial. Anthropometric and biochemical measurements were analyzed. Transcript analysis for CT-1, IL-6, and TNF-α in PBMC were performed by RT-PCR. Serum cytokine levels were also measured at baseline and after 10-weeks. RESULTS: Participants achieved a significant reduction in body adiposity (0.34 decrease in body mass index-standard deviation), total cholesterol, and glucose levels after 10-weeks. A Significant decrease in serum TNF-α and C reactive protein (CRP) were observed. CT-1 transcript levels were significantly reduced (P = .005) after lifestyle intervention, and these changes were significantly correlated with changes in serum CT-1 levels (r = 0.451; P = .031). In multiple regression analysis baseline CT-1 transcript levels were positively associated with final insulin (R2 = 0.506; P = .035) and HOMA-IR values (R2 = 0.473; P = .034). CONCLUSIONS: We reported that serum CRP, TNF-α, as well as PBMC CT-1 transcript levels were reduced after lifestyle intervention in obese children. More studies are needed to clarify the role of inflammation-related molecules in glucose metabolism.

Etapa de diagnóstico del Cáncer de Próstata ¿Estamos llegando a tiempo? / Prostate cancer stage at diagnosis. Are we running late?

INTRODUCCIÓN: El cáncer de próstata es el segundo cáncer más diagnosticado en hombres en Chile y el mundo. El tamizaje modificó la etapa de diagnóstico, siendo actualmente en EE.UU. un 80 por cinto localizada, 12 por cinto compromiso regional y 4 por ciento metastásico. Tamizaje con APE no está considerado dentro de un programa nacional en Chile. El objetivo de este estudio es caracterizar a la población diagnosticada de cáncer de próstata en un Hospital público en Chile. MATERIALES Y MÉTODO: Estudio descriptivo, retrospectivo. Se revisaron todas las fichas de los pacientes ingresados al GES por Cáncer de Próstata en el Hospital Carlos Van Buren de Valparaíso desde el año 2014 a 2016. RESULTADOS: Se revisaron 259 fichas y se analizaron 226. Edad promedio fue 70,5 años. 46 por ciento presentó APE sobre 20 ng/dL. 31 por ciento presentó metástasis. 42 por ciento recibió tratamiento paliativo. 57 por ciento se realizó tratamiento curativo, con edad promedio 67,4 años. De estos, 31,8 por ciento a cirugía, 68 por ciento índice Gleason <6 y 90 por ciento APE <20. 68 por ciento a RDT con o sin HT, 44 por ciento índice Gleason <6, 75 por ciento APE <20. DISCUSIÓN: El tamizaje del cáncer de próstata es un tema en discusión. En Chile no hay un programa nacional para realizar APE. Centros de atención primaria con acceso a APE tienen mayor tasa de tamizaje. La etapa al diagnóstico en nuestro centro difiere a las series de países desarrollados, siendo considerablemente superior la etapa metastásica. Esto podría deberse a la poca cobertura para detección temprana. Parece ser necesario implementar un programa nacional con cobertura de tamizaje para cáncer de próstata.(AU)

INTRODUCTION: Prostate cancer is the second most diagnosed cáncer in Chile and the world. Screening modified the stage at diagnosis, beeing now in the US 80 pertcent localized, 12 pertcent with regional compromised and 4 pertcent metastatic. Screening with PSA isn't considerd within a national program in Chile. The objetive of this study is to caracterize men diagnosed with prostate cancer at a public hospital in Chile. MATERIALS AND METHODS: Retrospective and descriptive study. Every patient who entered GES because of prostate cancer at the Carlos Van Buren Hospital from Valparaiso between 2014 and 2016 was review. RESULTS: 259 clinical records were review and 226 analized. Mean age was 70,5 years. 46 pertcent had PSA above 20 ng/dL. 31 % had metástasis. 42 % received paliative treatment. 57 % had curative treatment with a mean age of 67,4 years.From this group 31,8 pertcent surgery with a Gleason index <6 and 90 pertcent PSA <20. 68 pertcent had EBRT with or without HT, 44 pertcent of this group had Gleason index <6 and 75 pertcent PSA <20. DISCUSSION: Prostate cancer screening it's a debated topic. In Chile there's no national program to do a PSA. Primary care centers with acces to PSA have more rate of screening. Stage at diagnosis in our center difers from developed countries series, beeing metastatic stage considerably superior. This could be because of the low screening rate for early diagnosis. It seems necesary to implement a national program for prostate cancer screening.(AU)

Nasal airflow simulations suggest convergent adaptation in Neanderthals and modern humans.

Both modern humans (MHs) and Neanderthals successfully settled across western Eurasian cold-climate landscapes. Among the many adaptations considered as essential to survival in such landscapes, changes in the nasal morphology and/or function aimed to humidify and warm the air before it reaches the lungs are of key importance. Unfortunately, the lack of soft-tissue evidence in the fossil record turns difficult any comparative study of respiratory performance. Here, we reconstruct the internal nasal cavity of a Neanderthal plus two representatives of climatically divergent MH populations (southwestern Europeans and northeastern Asians). The reconstruction includes mucosa distribution enabling a realistic simulation of the breathing cycle in different climatic conditions via computational fluid dynamics. Striking across-specimens differences in fluid residence times affecting humidification and warming performance at the anterior tract were found under cold/dry climate simulations. Specifically, the Asian model achieves a rapid air conditioning, followed by the Neanderthals, whereas the European model attains a proper conditioning only around the medium-posterior tract. In addition, quantitative-genetic evolutionary analyses of nasal morphology provided signals of stabilizing selection for MH populations, with the removal of Arctic populations turning covariation patterns compatible with evolution by genetic drift. Both results indicate that, departing from important craniofacial differences existing among Neanderthals and MHs, an advantageous species-specific respiratory performance in cold climates may have occurred in both species. Fluid dynamics and evolutionary biology independently provided evidence of nasal evolution, suggesting that adaptive explanations regarding complex functional phenotypes require interdisciplinary approaches aimed to quantify both performance and evolutionary signals on covariation patterns.

[International adoption of children from Ethiopia and language: a pilot study]. / Adopcion internacional de niños de Etiopia y lenguaje: un estudio piloto.

INTRODUCTION: Children who have gone through international adoption offer a great and unique learning opportunity around language development. Time elapsed since the first international adoptions took place in Spain has given a unique opportunity to research and conclude whether learning the second language follows the same developmental patterns and outcomes as compared to acquiring tongue language. AIM: To verify whether the evaluated subjects have reached the expected use and language proficiency for their chronological age. SUBJECTS AND METHODS: This pilot study focuses on the evaluation of language acquired in the first years of adolescence of 7 Ethiopian children who have lived over 8 years in Spain. CELF-4 test and the verbal tests of the WISC-IV have been administered. Scores have been analyzed and compared to the control group (same age group). In order to generate qualitative information about parents' concerns an on-line questionnaire has been administered in a form of a semi-structured interview. RESULTS: Both the CELF-4 test and the WISC-IV verbal tests reflect average or low average results in language abilities. Qualitative interviews reflect deep concern about academic outcome. CONCLUSIONS: Subjects in this study are showing an average to low average proficiency in the Spanish language. The results, nevertheless, do not explain the academic difficulties shown.

TITLE: Adopcion internacional de niños de Etiopia y lenguaje: un estudio piloto.Introduccion. Los niños que han vivido una adopcion internacional ofrecen una oportunidad unica de conocer como ocurre el desarrollo del lenguaje. El tiempo que ha transcurrido desde que en nuestro pais se iniciaran las primeras adopciones internacionales esta permitiendo investigar si el desarrollo inicial del lenguaje culmina en una equiparacion real. Objetivo. Comprobar si se ha producido en los sujetos evaluados una equiparacion real en el lenguaje de acuerdo con lo esperado con su edad cronologica. Sujetos y metodos. En este estudio piloto se realiza una valoracion del lenguaje adquirido en los primeros años de la adolescencia de siete niños etiopes que han vivido ya mas de ocho años en España. Para ello se analizan las puntuaciones obtenidas por los siete sujetos en la prueba CELF-4 y en las puntuaciones de las pruebas verbales del WISC-IV, teniendo como referencia a su grupo normativo de edad (grupo control). Para obtener informacion cualitativa sobre las preocupaciones de los padres se ha administrado un cuestionario online a traves de una entrevista semiestructurada. Resultados. Tanto el CELF-4 como las pruebas verbales del WISC-IV estan reflejando un funcionamiento promedio o promedio-bajo en las competencias verbales analizadas. Las entrevistas cualitativas reflejan elevados niveles de preocupacion acerca del rendimiento academico. Conclusiones. Los sujetos del estudio parecen mostrar un funcionamiento promedio o promedio bajo en el uso del castellano. Las puntuaciones obtenidas, sin embargo, no parecen poder explicar las dificultades que estan manifestando en el ambito escolar.

Antibody-Mediated Acute Vascular Rejection of Kidney Allografts: Fifteen-Year Follow-up.

BACKGROUND: Although acute vascular rejection (AVR) is associated with a high risk of graft loss, it remains unclear whether AVR with accompanied cellular or humoral rejection (AHR) has dissimilar outcomes. The aim of this study was to examine the association between subtypes of AVR and graft loss. METHODS: We assessed patients who provided biopsy samples for acute allograft rejection from 1998 to 2014. To investigate distinct rejection patterns, we retrospectively assessed rejection episodes with review of graft histology as well as donor-specific anti-HLA antibodies when available. RESULTS: A total of 1,004 patients were biopsied and included in the main analyses, of which 259 (32.87%) had acute biopsy-proven rejection. We identified three patterns of graft rejection defined according to the presence of peritubular capillaritis (ptc): a) T-cell-mediated acute vascular rejection if ptc free; b) humoral-mediated acute vascular rejection if ptc >0; and c) T-cell-mediated rejection if vasculitis = 0 and ptc = 0 (148 [57%], 70 [27%], and 41 [16%], respectively). At 5 years, graft survival was lower among patients with ptc-vascular rejection than those with T-cell vascular rejection (72.3% vs 83.2%; P = .010). T-cell-mediated rejection without vasculitis had similar survival compared with rejection absence (89.3% vs 8 9.2%; P = .698). Multivariate analysis adjusted by age and sex showed that risk of graft loss was higher in biopsies with high scores of glomerulitis (g2-g3); vasculitis (v2-v3), capillaritis (ptc2-ptc3), or interstitial inflammation (i2-i3). However, tubulitis and C4d were not statically significant. CONCLUSIONS: We conclude that antibody-mediated AVR involves a poorer prognosis than T-cell-mediated AVR. The presence of tubulitis does not seem to determine a poor long-term renal graft prognosis.

Presence of T-275A and C-2152T Polymorphisms of the Promoter Region of Uridine Diphosphate-Glucuronosyltransferase 1A9 Increases Mortality From Digestive Tumors: Results After 10 Years of Follow-up in a Renal Transplant Population.

BACKGROUND: The aim of this study was to determine the distribution of uridine diphosphate-glucuronosyltransferase 1A9 (UGT1A9) promoter region T-275A and C-2152T single-nucleotide polymorphisms (SNPs) in stable transplant patients and to investigate the impact of these SNPs on the evolution of this population after 10 years of follow-up. METHODS: White renal transplant recipients (n = 873) were studied. The median time of follow-up was 91.8 months (P25-75 46-146). Amplification with specific "primers" to delimit the study area was performed for each polymorphism. Amplification was performed with the use of real-time polymerase chain reaction. RESULTS: T-275A promoter mutation was detected in 13% of patients and C-2152T in 12% of patients. Survival analysis was performed on 873 renal transplants, carried out between 2004 and 2013. We found a higher frequency of death from cancer among polymorphism carriers (P = .001). CONCLUSIONS: It appears that carriers of T-275A and C-2152T SNPs of the UGT1A9 gene promoter region show a greater incidence of death from cancer, with a significantly higher cumulative incidence of death from gastrointestinal tumors.

Risk Factors of Recurrence of Diabetic Nephropathy in Renal Transplants.

BACKGROUND: Renal transplantation has been established as the treatment of choice for end-stage renal disease (ESRD) due to diabetic nephropathy. This study aimed to investigate the risk factors for recurrence of diabetic nephropathy (RDN) in renal allografts. METHODS: We studied 1,011 renal transplant patients from 1986 to 2003, of which 95 had ESRD due to diabetic nephropathy. We retrospectively analyzed the clinical characteristics and outcomes of RDN after renal transplantation. RESULTS: Of the 95 recipients with ESRD due to diabetic nephropathy, 41 developed RDN and 11 of those 41 underwent graft biopsy. The mean durations from transplantation to RDN and to renal replacement therapy was 81.58 months (range, 54-120 mo), and 109.66 months (range, 27-188.4 mo), respectively. At 5 years, treatment on statins and renin-angiotensin-aldosterone system (RAAS) blockers were associated with a higher survival free from RND (82.2% vs 63.2% [P = .070] and 100% vs 80% vs 0.6% [P = .013], respectively). Compared with cyclosporine, tacrolimus was associated with a higher risk for RND (odds ratio [OR], 4.27; 95% confidence interval [CI], 1.75-5.13; P = .047). High doses of prednisone (>0.06 mg/kg) were also associated with a higher risk of RDN (OR, 3.03; 95% CI, 1.19-8.30; P = .029). The combination of calcineurin inhibitor and mammalian target of rapamycin inhibitor (mTORi) demonstrated the highest risk of RDN (OR, 14.08; 95% CI, 3.72-53.29; P < .01). CONCLUSIONS: Treatment with tacrolimus and mTORi is the most diabetogenic immunosuppressive regimen. Treatment with tacrolimus entails a greater risk of RDN than with cyclosporine. The administration of statins or RAAS blockers could delay the progression of RDN.

Adherence to the Mediterranean dietary pattern and BMI change among US adolescents.

BACKGROUND: Among adults, the Mediterranean dietary pattern (MDP) is inversely related to body mass index (BMI). Data are lacking on adherence to the MDP among youth in the United States and whether the MDP is related to weight change in that group. OBJECTIVE: To assess whether adherence to the MDP was associated with BMI change among adolescents. To examine temporality, we studied the association between baseline and 2-3-year changes in adherence to the MDP with concurrent changes in BMI, as well as subsequent changes in BMI over a 7-year period. METHODS: We prospectively followed 6002 females and 4916 males in the Growing Up Today Study II, aged 8-15 years in 2004, living across United States. Data were collected by questionnaire in 2004, 2006, 2008 and 2011. Dietary intake was assessed by the Youth/Adolescent Questionnaire. The KidMed Index was derived to measure the adherence to the MDP. We used generalized estimating equations with repeated measures within subjects to assess the association between MDP and BMI change. RESULTS: A two-point increment in the KidMed Index was independently associated with a lower gain in BMI (-0.04 kg m(-2); P=0.001). A greater increase in adherence to the KidMed Index was independently related to a lower gain in BMI in both the concurrent (P-for-trend<0.001) and the subsequent period (P-for-trend=0.002). CONCLUSIONS: Adherence to MDP was inversely associated with change in BMI among adolescents. Two-year improvement in adherence to MDP was independently associated with less steep gain in the BMI in both the concurrent and the subsequent period.