Eficacia del ejercicio de alta intensidad en personas con dolor lumbar crónico: una revisión sistemática / Efficacy of high-intensity exercise in people with chronic low back pain: A systematic review

El dolor lumbar crónico causa discapacidad e impacto socioeconómico. El ejercicio de alta intensidad muestra resultados positivos en otras enfermedades, pero no existe evidencia sobre esta patología. Se pretende determinar su eficacia en la calidad de vida relacionada con la salud, la discapacidad, la intensidad del dolor y la adherencia al tratamiento en personas con dolor lumbar crónico. Se realiza una revisión bibliográfica en Pubmed, PEDro y Scopus, incluyendo ensayos clínicos aleatorizados, guías de práctica clínica y revisiones sistemáticas en español, inglés o portugués (2012-2022). Además, se hace una búsqueda en bola de nieve. Se incorporan ocho ensayos clínicos aleatorizados (n=379). Se analizan diferentes modalidades de ejercicio de alta intensidad, que parecen mejorar la calidad de vida relacionada con la salud y reducir la discapacidad y la intensidad del dolor. Estos datos se deben tomar con cautela dada la poca cantidad de estudios y el riesgo de sesgo que presentan.(AU)

Chronic low back pain causes disability and socioeconomic impact. High-intensity exercise shows positive results in other diseases, but there is no evidence on this pathology. The aim is to determine its efficacy on health-related quality of life, disability, pain intensity and adherence to treatment in people with chronic low back pain. A literature review is conducted in Pubmed, PEDro and Scopus, including randomized clinical trials, clinical practice guidelines and systematic reviews in Spanish, English or Portuguese (2012-2022). In addition, a snowball search is performed. Eight randomized clinical trials (n=379) are incorporated. Different high-intensity exercise modalities are analyzed, which seem to improve health-related quality of life and reduce disability and pain intensity. These data should be taken with caution given the small number of studies and the risk of bias presented.(AU)

Cognitive rehabilitation program in patients with multiple sclerosis: A pilot study / Programa de rehabilitación cognitiva para pacientes con esclerosis múltiple: estudio piloto

Introduction In recent years, there has been an increase of studies dedicated to cognitive rehabilitation in patients with multiple sclerosis (MS); however, few of these analyze the impact on such variables as cognitive reserve. The study aims to explore the effects of a cognitive rehabilitation program comprising a combination of cognitive and physical exercises, as well as group sessions to improve cognitive performance, emotional state, and cognitive reserve index. Method Fifty patients with MS were subdivided into 2 groups: the control group, which performed aerobic exercise (n = 25), and the experimental group (n = 25), which participated in the integrated cognitive rehabilitation program (ICRP). All participants were evaluated 3 times (baseline, post-treatment, and long-term) with the Brief Repeatable Battery of Neuropsychological Tests, Cognitive Reserve Scale, Beck Depression Inventory, and a scale evaluating trait and state anxiety. Results Compared with the control group, patients in the experimental group showed improvements in cognitive function, with significant changes in measures of information processing speed, attention, memory, cognitive reserve index, and long-term mood. Conclusions The ICRP was effective in improving cognitive and emotional function in MS, and increased the cognitive reserve index. (AU)

Introducción En los últimos años se ha observado un interés creciente por la rehabilitación cognitiva en pacientes con esclerosis múltiple. Sin embargo, pocos estudios han analizado su impacto en variables como la reserva cognitiva. Analizamos el efecto de un programa de rehabilitación cognitiva que incluye ejercicios físicos y cognitivos, así como sesiones en grupo enfocadas a mejorar el rendimiento cognitivo, el estado emocional y el índice de reserva cognitiva. Métodos Nuestro estudio incluyó a 50 pacientes con esclerosis múltiple, divididos en 2 grupos: un grupo control (n = 25), en el que los pacientes realizaban ejercicio aeróbico, y un grupo experimental (n = 25), al que se administró un programa integral de rehabilitación cognitiva. Evaluamos a todos los pacientes en 3 momentos diferentes (al inicio, tras el tratamiento, y a largo plazo) con la Batería Neuropsicológica Breve, la Escala de Reserva Cognitiva, el Inventario de Depresión de Beck y una escala para medir la ansiedad rasgo y la ansiedad estado. Resultados Los pacientes del grupo experimental mostraron un mejor rendimiento cognitivo que los controles, con cambios significativos en medidas de velocidad de procesamiento de la información, atención, memoria, índice de reserva cognitiva y estado de ánimo a largo plazo. Conclusión Nuestros resultados demuestran la eficacia del programa de rehabilitación cognitiva para mejorar las funciones cognitiva y emocional de los pacientes con esclerosis múltiple y aumentar el índice de reserva cognitiva. (AU)

Cognitive rehabilitation program in patients with multiple sclerosis: A pilot study.

INTRODUCTION: In recent years, there has been an increase of studies dedicated to cognitive rehabilitation in patients with multiple sclerosis (MS); however, few of these analyze the impact on such variables as cognitive reserve. The study aims to explore the effects of a cognitive rehabilitation program comprising a combination of cognitive and physical exercises, as well as group sessions to improve cognitive performance, emotional state, and cognitive reserve index. METHOD: Fifty patients with MS were subdivided into 2 groups: the control group, which performed aerobic exercise (n=25), and the experimental group (n=25), which participated in the integrated cognitive rehabilitation program (ICRP). All participants were evaluated 3 times (baseline, post-treatment, and long-term) with the Brief Repeatable Battery of Neuropsychological Tests, Cognitive Reserve Scale, Beck Depression Inventory, and a scale evaluating trait and state anxiety. RESULTS: Compared with the control group, patients in the experimental group showed improvements in cognitive function, with significant changes in measures of information processing speed, attention, memory, cognitive reserve index, and long-term mood. CONCLUSIONS: The ICRP was effective in improving cognitive and emotional function in MS, and increased the cognitive reserve index.

Design and baseline characteristics of SALT-HF trial: hypertonic saline therapy in ambulatory heart failure.

AIMS: Hypertonic saline solution (HSS) plus intravenous (IV) loop diuretic appears to enhance the diuretic response in patients hospitalized for heart failure (HF). The efficacy and safety of this therapy in the ambulatory setting have not been evaluated. We aimed to describe the design and baseline characteristics of the SALT-HF trial participants. METHODS AND RESULTS: 'Efficacy of Saline Hypertonic Therapy in Ambulatory Patients with HF' (SALT-HF) trial was a multicenter, double-blinded, and randomized study involving ambulatory patients who experienced worsening heart failure (WHF) without criteria for hospitalization. Enrolled patients had to present at least two signs of volume overload, use ≥ 80 mg of oral furosemide daily, and have elevated natriuretic peptides. Patients were randomized 1:1 to treatment with a 1-h infusion of IV furosemide plus HSS (2.6-3.4% NaCl depending on plasmatic sodium levels) versus a 1-h infusion of IV furosemide at the same dose (125-250 mg, depending on basal loop diuretic dose). Clinical, laboratory, and imaging parameters were collected at baseline and after 7 days, and a telephone visit was planned after 30 days. The primary endpoint was 3-h diuresis after treatment started. Secondary endpoints included (a) 7-day changes in congestion data, (b) 7-day changes in kidney function and electrolytes, (c) 30-day clinical events (need of IV diuretic, HF hospitalization, cardiovascular mortality, all-cause mortality or HF-hospitalization). RESULTS: A total of 167 participants [median age, 81 years; interquartile range (IQR), 73-87, 30.5% females] were randomized across 13 sites between December 2020 and March 2023. Half of the participants (n = 82) had an ejection fraction >50%. Most patients showed a high burden of comorbidities, with a median Charlson index of 3 (IQR: 2-4). Common co-morbidities included diabetes mellitus (41%, n = 69), atrial fibrillation (80%, n = 134), and chronic kidney disease (64%, n = 107). Patients exhibited a poor functional NYHA class (69% presenting NYHA III) and several signs of congestion. The mean composite congestion score was 4.3 (standard deviation: 1.7). Ninety per cent of the patients (n = 151) presented oedema and jugular engorgement, and 71% (n = 118) showed lung B lines assessed by ultrasound. Median inferior vena cava diameter was 23 mm, (IQR: 21-25), and plasmatic levels of N-terminal-pro-B-type natriuretic peptide (NTproBNP) and antigen carbohydrate 125 (CA125) were increased (median NT-proBNP 4969 pg/mL, IQR: 2508-9328; median CA125 46 U/L, IQR: 20-114). CONCLUSIONS: SALT-HF trial randomized 167 ambulatory patients with WHF and will determine whether an infusion of hypertonic saline therapy plus furosemide increases diuresis and improves decongestion compared to equivalent furosemide administration alone.

[Efficacy of high-intensity exercise in people with chronic low back pain: A systematic review]. / Eficacia del ejercicio de alta intensidad en personas con dolor lumbar crónico: una revisión sistemática.

Chronic low back pain causes disability and socioeconomic impact. High-intensity exercise shows positive results in other diseases, but there is no evidence on this pathology. The aim is to determine its efficacy on health-related quality of life, disability, pain intensity and adherence to treatment in people with chronic low back pain. A literature review is conducted in Pubmed, PEDro and Scopus, including randomized clinical trials, clinical practice guidelines and systematic reviews in Spanish, English or Portuguese (2012-2022). In addition, a snowball search is performed. Eight randomized clinical trials (n=379) are incorporated. Different high-intensity exercise modalities are analyzed, which seem to improve health-related quality of life and reduce disability and pain intensity. These data should be taken with caution given the small number of studies and the risk of bias presented.

Arritmias en pacientes con miopatía miotubular ligada al cromosoma X / Arrhythmias in patients with X-linked myotubular myopathy

Introducción: La miopatía miotubular es una enfermedad muscular congénita causada por una mutación en el gen de la miotubularina (MTM1). La miopatía miotubular ligada al cromosoma X (XLMTM) afecta a los hombres con síntomas de aparición temprana como debilidad muscular, hipotonía y dificultad respiratoria. Hasta donde sabemos, la afectación cardíaca en estos pacientes no se ha descrito previamente, a diferencia de otros tipos de miopatías congénitas, como la miopatía nemalínica o la miopatía con cores. Casos clínicos: Presentamos dos casos clínicos de XLMTM que comenzaron con bradicardia sinusal grave o bloqueo auriculoventricular desde los primeros días de vida, con Holter patológico en ambos casos. Se descartó una afectación cardíaca primaria por estudios electrofisiológicos y se recuperó la frecuencia cardíaca normal con soporte respiratorio adecuado. Conclusión: Estos casos con bradicardia grave en una patología bien conocida, como la XLMTM, suponen un matiz en el diagnóstico diferencial habitual de las miopatías congénitas.(AU)

Introduction: Myotubular myopathy is a congenital muscle disease caused by a mutation in the myotubularin (MTM1) gene. The X-linked myotubular myopathy (XLMTM) affects males with early-onset symptoms such as muscle weakness, hypotonia, and respiratory distress. To our knowledge, cardiac involvement has not been previously described in this condition, in contrast to other types of congenital myopathies such as nemaline myopathy or core myopathy. Case reports: We report two clinical cases of XLMTM that started with severe sinus bradycardia or auriculoventricular block from the first days of life, with pathologic 24-hours Holter monitoring in both cases. A primary cardiac affection was excluded by electrophysiological studies and normal heart rate was recovered with proper respiratory support. Discussion: These cases with sever bradyarrhythmia in a well know pathology such the XLMTM represents a nuance on the usual differential diagnostics of congenital myopathies.(AU)

Efectos de un programa de rehabilitación cardíaca fase iii en la capacidad funcional y composición corporal en pacientes con cardiopatía isquémica / Effects of a Phase III cardiac rehabilitation program on functional capacity and body composition for coronary heart disease

Introducción y objetivos: Los programas de rehabilitación cardíaca (PRC) fase III han sido poco investigados tanto por los métodos de entrenamiento como por las modalidades de administración. Estudiamos los efectos en capacidad funcional, composición corporal y adherencia a la actividad física de un PRC interdisciplinar basado en ejercicio terapéutico aeróbico combinado con fuerza muscular tras síndrome coronario agudo. Diseño del estudio: Ensayo clínico aleatorizado. Métodos: Ochenta pacientes con cardiopatía isquémica estable y función sistólica preservada fueron incluidos posteriormente a un PRC fase II. Se distribuyeron en grupo control (GC), con ejercicio autónomo y grupo experimental (GE), con ejercicio aeróbico combinado con fuerza muscular comunitaria, además de estrategia educativa de mensajería telefónica instantánea. Ambos grupos realizaron terapia grupal hospitalaria. Se compararon los resultados de capacidad funcional, composición corporal y nivel de actividad física tras 12 meses. Resultados: La capacidad funcional presentó niveles más altos en el GE en la prueba de marcha de 6min, 26,03m (DE: 27,4; p<0,001), y en la ergometría incremental convencional, 0,6METs (DE: 2,2; p=0,021). El nivel de actividad física domiciliaria medido con el cuestionario IPAQ en el GE incrementó 90,38min/semana (DE: 79,7; (p=0,047), y disminuyó el tiempo sedentario entresemana −50,3min/día (DE: 94,5; p=0,001). Ambos grupos aumentaron el tejido adiposo, sobre todo el GC 1,4% (DE: 3,1; p=0,039). Conclusiones: Los pacientes con síndrome coronario agudo que realizaron un PRC fase III comunitario durante 12 meses, mediante ejercicio terapéutico aeróbico combinado con fuerza muscular y estrategias educativas de mensajería telefónica instantánea, presentaron niveles más altos en capacidad funcional y actividad física reportada.(AU)

Introduction and objectives: The effects of a phase III cardiac rehabilitation program (CRP) have been insufficiently studied in terms of training methods and administration. We studied the impact on functional capacity, body composition and physical activity engagement of interdisciplinary program based on aerobic and community strength therapeutic exercise after an acute coronary syndrome. Trial design: Randomised clinical trial. Methods: Eighty consecutive patients with stable ischemic heart disease and preserved systolic function before phase II CRP were included. They were distributed into a control group (CG), with autonomous exercise, and an experimental group (EG), that follows supervised community program based on aerobic exercise and overload dynamic muscle strength, and an educational strategy through short messaging. Both groups underwent monthly inpatient group therapy. Results were compared after 12 months. Results: Functional capacity presented higher levels in the EG and measured by the 6-min walk test (26.0±27.4m; P<.001), and maximal exercise test (0.6±2.2METs; P=.021). Home physical activity measured in minutes by IPAQ questionnaire increased more in the EG (90±78min/week) (P=.047), and the sitting time during the week decreased (−50.25±94.48min/day) (P=.001). There were no differences in body mass index, although we found a higher percentage of adipose tissue in CG after 12 months (P=.039). Conclusions: A multidisciplinary community phase III CRP based on aerobic and dynamic muscle strength therapeutic exercise combined with a short message service educational strategy was feasible. After 12 months, patients in the EG presented higher levels on functional capacity, reported higher physical activity engagement compared to the CG.(AU)

ß-hydroxybutyrate is a metabolic regulator of proteostasis in the aged and Alzheimer disease brain.

Loss of proteostasis is a hallmark of aging and Alzheimer disease (AD). Here, we identify ß-hydroxybutyrate (ßHB), a ketone body, as a regulator of protein solubility in the aging brain. ßHB is a small molecule metabolite which primarily provides an oxidative substrate for ATP during hypoglycemic conditions, and also regulates other cellular processes through covalent and noncovalent protein interactions. We demonstrate ßHB-induced protein insolubility across in vitro, ex vivo, and in vivo mouse systems. This activity is shared by select structurally similar metabolites, is not dependent on covalent protein modification, pH, or solute load, and is observable in mouse brain in vivo after delivery of a ketone ester. Furthermore, this phenotype is selective for pathological proteins such as amyloid-ß, and exogenous ßHB ameliorates pathology in nematode models of amyloid-ß aggregation toxicity. We have generated a comprehensive atlas of the ßHB-induced protein insolublome ex vivo and in vivo using mass spectrometry proteomics, and have identified common protein domains within ßHB target sequences. Finally, we show enrichment of neurodegeneration-related proteins among ßHB targets and the clearance of these targets from mouse brain, likely via ßHB-induced autophagy. Overall, these data indicate a new metabolically regulated mechanism of proteostasis relevant to aging and AD.

Arrhythmias in patients with X-linked myotubular myopathy. / Arritmias en pacientes con miopatía miotubular ligada al cromosoma X.

INTRODUCTION: Myotubular myopathy is a congenital muscle disease caused by a mutation in the myotubularin (MTM1) gene. The X-linked myotubular myopathy (XLMTM) affects males with early-onset symptoms such as muscle weakness, hypotonia, and respiratory distress. To our knowledge, cardiac involvement has not been previously described in this condition, in contrast to other types of congenital myopathies such as nemaline myopathy or core myopathy. CASE REPORTS: We report two clinical cases of XLMTM that started with severe sinus bradycardia or auriculoventricular block from the first days of life, with pathologic 24-hours Holter monitoring in both cases. A primary cardiac affection was excluded by electrophysiological studies and normal heart rate was recovered with proper respiratory support. DISCUSSION: These cases with sever bradyarrhythmia in a well know pathology such the XLMTM represents a nuance on the usual differential diagnostics of congenital myopathies.

TITLE: Arritmias en pacientes con miopatía miotubular ligada al cromosoma X.Introducción. La miopatía miotubular es una enfermedad muscular congénita causada por una mutación en el gen de la miotubularina (MTM1). La miopatía miotubular ligada al cromosoma X (XLMTM) afecta a los hombres con síntomas de aparición temprana como debilidad muscular, hipotonía y dificultad respiratoria. Hasta donde sabemos, la afectación cardíaca en estos pacientes no se ha descrito previamente, a diferencia de otros tipos de miopatías congénitas, como la miopatía nemalínica o la miopatía con cores. Casos clínicos. Presentamos dos casos clínicos de XLMTM que comenzaron con bradicardia sinusal grave o bloqueo auriculoventricular desde los primeros días de vida, con Holter patológico en ambos casos. Se descartó una afectación cardíaca primaria por estudios electrofisiológicos y se recuperó la frecuencia cardíaca normal con soporte respiratorio adecuado. Conclusión. Estos casos con bradicardia grave en una patología bien conocida, como la XLMTM, suponen un matiz en el diagnóstico diferencial habitual de las miopatías congénitas.

Análisis de la atención sanitaria realizada en el buque escuela «Juan Sebastián de Elcano» durante diez años (2010-2020) / Analysis of health care performed on the Juan Sebastian de Elcano School Ship during ten years (2010-2020)

Introducción: El buque escuela Juan Sebastián de Elcano es un bergantín-goleta de la Armada. Debido a sus características y tipo de navegaciones, la asistencia sanitaria (prestada por un Role 1 embarcado y, puntualmente, por un equipo quirúrgico compuesto por un oficial médico cirujano general y un oficial médico anestesiólogo), está considerada un recurso esencial. Material y métodos: Estudio descriptivo retrospectivo sobre las atenciones médicas realizadas a bordo agrupadas por especialidad, pruebas médicas complementarias, consumo de hemoderivados, motivo de asistencia médica en puerto, número de evacuaciones hasta territorio nacional y tipo de consultas realizadas por telemedicina al Role 4 durante doce cruceros de navegación entre 2010 y 2020. Resultados: Las asistencias sanitarias más prevalentes han sido: traumatológicas (n=1.982, 22.04 %), seguidas de otorrinolaringológicas (n=1.234, 13,72 %) y finalmente la tercera especialidad con consultas más prevalentes fue medicina interna (n=1.125, 12,50 %). Se llevaron a cabo 112 interconsultas en puerto (primera causa odontología y segunda traumatología) y 24 evacuaciones a territorio nacional. Las pruebas complementarias más frecuentemente solicitadas fueron: control de estupefacientes y radiografías. Se realizaron 37 consultas de telemedicina y no se transfundió ninguna unidad de hemocomponentes durante el periodo analizado. Conclusiones: El estudio de la asistencia sanitaria en el buque escuela de la Armada ha revelado que la traumatología es la causa más prevalente de las consultas a bordo, seguida de las interconsultas en puerto, las consultas por telemedicina y evacuaciones en territorio nacional. Gracias a la labor de la Sanidad Militar a bordo es posible la función marinera, docente y embajadora en los mares. (AU)

Overview: Juan Sebastián de Elcano training ship is a brigantine-school of the Spanish Navy. Due to its characteristics and navigation type, health care (provided by a Role 1 on-board and occasionally enhanced by a surgical team that includes a general surgeon medical officer and an anesthesiologist medical officer), is considered an essential resource. Material and methods: Retrospective descriptive study of medical care provided on board, grouped by medical specialty, complementary tests, blood products consumption, reason of medical assistance in port, number of evacuations to national territory and type of consultations performed by telemedicine to Role 4 during twelve sailing cruises between 2010 and 2020. Results: The most prevalent healthcare services were traumatology (n=1.982, 22.04%), followed by otorhinolaryngology (n=1.234, 13.72%) and the third was internal medicine (n=1.125, 12.50%). 112 internal medicine consultations were conducted in port (dental first and traumatology second) and 24 evacuations to national territory. The most often requested complementary tests were drug control and X-rays. There were 37 telemedicine consultations and no unit of blood components were transfused during the analyzed period. Conclusions: The study of health care on the navy training ship has shown that traumatology is the most frequent cause of medical consultations on board, followed by internal medicine consultations in port, telemedicine consultations and evacuations to national territory. Thanks to the work of the Military Health on board, it is possible to sail, teach and be ambassador on the seas. (AU)

Análisis de la atención sanitaria realizada en el buque escuela «Juan Sebastián de Elcano» durante diez años (2010-2020) / Analysis of health care performed on the Juan Sebastian de Elcano School Ship during ten years (2010-2020)

Introducción: El buque escuela Juan Sebastián de Elcano es un bergantín-goleta de la Armada. Debido a sus características y tipo de navegaciones, la asistencia sanitaria (prestada por un Role 1 embarcado y, puntualmente, por un equipo quirúrgico compuesto por un oficial médico cirujano general y un oficial médico anestesiólogo), está considerada un recurso esencial. Material y métodos: Estudio descriptivo retrospectivo sobre las atenciones médicas realizadas a bordo agrupadas por especialidad, pruebas médicas complementarias, consumo de hemoderivados, motivo de asistencia médica en puerto, número de evacuaciones hasta territorio nacional y tipo de consultas realizadas por telemedicina al Role 4 durante doce cruceros de navegación entre 2010 y 2020. Resultados: Las asistencias sanitarias más prevalentes han sido: traumatológicas (n=1.982, 22.04 %), seguidas de otorrinolaringológicas (n=1.234, 13,72 %) y finalmente la tercera especialidad con consultas más prevalentes fue medicina interna (n=1.125, 12,50 %). Se llevaron a cabo 112 interconsultas en puerto (primera causa odontología y segunda traumatología) y 24 evacuaciones a territorio nacional. Las pruebas complementarias más frecuentemente solicitadas fueron: control de estupefacientes y radiografías. Se realizaron 37 consultas de telemedicina y no se transfundió ninguna unidad de hemocomponentes durante el periodo analizado. Conclusiones: El estudio de la asistencia sanitaria en el buque escuela de la Armada ha revelado que la traumatología es la causa más prevalente de las consultas a bordo, seguida de las interconsultas en puerto, las consultas por telemedicina y evacuaciones en territorio nacional. Gracias a la labor de la Sanidad Militar a bordo es posible la función marinera, docente y embajadora en los mares. (AU)

Overview: Juan Sebastián de Elcano training ship is a brigantine-school of the Spanish Navy. Due to its characteristics and navigation type, health care (provided by a Role 1 on-board and occasionally enhanced by a surgical team that includes a general surgeon medical officer and an anesthesiologist medical officer), is considered an essential resource. Material and methods: Retrospective descriptive study of medical care provided on board, grouped by medical specialty, complementary tests, blood products consumption, reason of medical assistance in port, number of evacuations to national territory and type of consultations performed by telemedicine to Role 4 during twelve sailing cruises between 2010 and 2020. Results: The most prevalent healthcare services were traumatology (n=1.982, 22.04%), followed by otorhinolaryngology (n=1.234, 13.72%) and the third was internal medicine (n=1.125, 12.50%). 112 internal medicine consultations were conducted in port (dental first and traumatology second) and 24 evacuations to national territory. The most often requested complementary tests were drug control and X-rays. There were 37 telemedicine consultations and no unit of blood components were transfused during the analyzed period. Conclusions: The study of health care on the navy training ship has shown that traumatology is the most frequent cause of medical consultations on board, followed by internal medicine consultations in port, telemedicine consultations and evacuations to national territory. Thanks to the work of the Military Health on board, it is possible to sail, teach and be ambassador on the seas. (AU)

[Impact of COVID-19 on a rare disease (uveal melanoma) in a national reference unit of intraocular tumors in Spain]. / Impacto del COVID-19 en una enfermedad rara (melanoma uveal) en una unidad de referencia nacional de tumores intraoculares en España.

Objective: To analyze the impact of the COVID-19 pandemic on the diagnosis and management of uveal melanoma (a tumor included in the Orphanet catalog of rare diseases) in a Spanish national reference unit for intraocular tumors during the first year of the pandemic. Material and methods: An observational retrospective study of patients with uveal melanoma in the National Reference Unit for Adult Intraocular Tumors of the Hospital Clínico Universitario de Valladolid (Spain) was performed, analyzing the pre- and post-COVID-19 periods: from March 15, 2019 to March 15, 2020 and from March 16, 2020 to March 16, 2021. Demographic data, diagnostic delay, tumor size, extraocular extension, treatment and evolution were collected. A multivariable logistic regression model was used to identify factors that were associated with the variable: enucleation. Results: Eighty-two patients with uveal melanoma were included, of which 42(51.21%) belonged to the pre-COVID-19 period and 40(40.78%) to the post-COVID-19 period. An increase in tumor size at diagnosis and in the number of enucleations was observed during the post-COVID-19 period (p < 0.05). Multivariable logistic regression demonstrated that both medium-large tumor size and patients diagnosed in the post-COVID-19 period were independently related to an increased risk of enucleation (OR 250, 95%CI, 27.69-2256.37; p < 0.01 and OR 10; 95% CI,1.10-90.25; p = 0.04, respectively). Conclusions: The increase in tumor size observed in uveal melanomas diagnosed during the first year of the COVID-19 pandemic may have favored the increase in the number of enucleations performed during that period.

Issue 2 - "Update on adverse respiratory effects of indoor air pollution". Part 2): Indoor air pollution and respiratory diseases: Perspectives from Italy and some other GARD countries.

OBJECTIVE: to synthesize the Italian epidemiological contribution to knowledge on indoor pollution respiratory impact, and to analyze the perspective of some GARD countries on the health effects of indoor air pollution. RESULTS: Italian epidemiological analytical studies confirmed a strong relationship between indoor air pollution and health in general population. Environmental tobacco smoke, biomass (wood/coal) fuel for cooking/heating and indoor allergens (house dust mites, cat and dog dander, mold/damp) are the most relevant indoor pollution sources and are related to respiratory and allergic symptoms/diseases in Italy and in other GARD countries such as Mexico, Brazil, Vietnam, India, Nepal and Kyrgyzstan. Community-based global health collaborations are working to improve prevention, diagnosis and care of respiratory diseases around the world, specially in low- and middle-income countries, through research and education. CONCLUSIONS: in the last thirty years, the scientific evidence produced on respiratory health effects of indoor air pollution has been extensive, but the necessity to empower the synergies between scientific community and local administrations remains a challenge to address in order to implement effective interventions. Based on abundant evidence of indoor pollution health effect, WHO, scientific societies, patient organizations and other members of the health community should work together to pursue the GARD vision of "a world where all people breathe freely" and encourage policy makers to increase their engagement in advocacy for clean air.

Impacto del COVID-19 en una enfermedad rara (melanoma uveal) en una unidad de referencia nacional de tumores intraoculares en España / Impact of COVID-19 on a rare disease (uveal melanoma) in a national reference unit of intraocular tumors in Spain

Objetivo Analizar el impacto de la pandemia por COVID-19 en el diagnóstico y manejo del melanoma uveal (tumor incluido en el catálogo de enfermedades raras por Orphanet), en una unidad de referencia nacional española de tumores intraoculares, durante el primer año de pandemia. Materiales y métodos Se realizó un estudio retrospectivo observacional de pacientes con melanoma uveal en la Unidad de Referencia Nacional de Tumores Intraoculares del Adulto del Hospital Clínico Universitario de Valladolid (España), analizando los periodos pre- y pos-COVID-19: del 15 de marzo de 2019 al 15 de marzo de 2020 y del 16 marzo de 2020 al 16 de marzo de 2021. Se recogieron datos demográficos, demora diagnóstica, tamaño del tumor, extensión extraocular, tratamiento y evolución. Se utilizó un modelo de regresión logística multivariable para identificar los factores que se asociaron a la variable: enucleación. Resultados Se incluyeron 82 pacientes con melanoma uveal, de los cuales 42(51,21%) pertenecían al periodo pre-COVID-19 y 40(40,78%) al periodo pos-COVID-19. Se observó un aumento del tamaño tumoral al diagnóstico y del número de enucleaciones durante el periodo pos-COVID-19 (p<0,05). La regresión logística multivariable demostró que tanto el tamaño tumoral mediano-grande como los pacientes diagnosticados en el periodo pos-COVID-19 estaban relacionados de forma independiente con un riesgo mayor de enucleación (OR 250, IC95%, 27,69-2256,37; p<0,01 y OR 10; IC95%,1,10-90,25; p=0,04, respectivamente). Conclusiones El incremento del tamaño tumoral observado en los melanomas uveales diagnosticados durante el primer año de pandemia por COVID-19 pudo favorecer el aumento de las enucleaciones realizadas en dicho periodo (AU)

Objective To analyze the impact of the COVID-19 pandemic on the diagnosis and management of uveal melanoma (a tumor included in the Orphanet catalog of rare diseases) in a Spanish national reference unit for intraocular tumors during the first year of the pandemic. Material and methods An observational retrospective study of patients with uveal melanoma in the National Reference Unit for Adult Intraocular Tumors of the Hospital Clínico Universitario de Valladolid (Spain) was performed, analyzing the pre- and post-COVID-19 periods: from March 15, 2019 to March 15, 2020 and from March 16, 2020 to March 16, 2021. Demographic data, diagnostic delay, tumor size, extraocular extension, treatment and evolution were collected. A multivariable logistic regression model was used to identify factors that were associated with the variable: enucleation. Results Eighty-two patients with uveal melanoma were included, of which 42(51.21%) belonged to the pre-COVID-19 period and 40(40.78%) to the post-COVID-19 period. An increase in tumor size at diagnosis and in the number of enucleations was observed during the post-COVID-19 period (p<0.05). Multivariable logistic regression demonstrated that both medium-large tumor size and patients diagnosed in the post-COVID-19 period were independently related to an increased risk of enucleation (OR 250, 95%CI, 27.69-2256.37; p<0.01 and OR 10; 95% CI,1.10-90.25; p=0.04, respectively). Conclusions The increase in tumor size observed in uveal melanomas diagnosed during the first year of the COVID-19 pandemic may have favored the increase in the number of enucleations performed during that period (AU)

Impact of COVID-19 on a rare disease (uveal melanoma) in a national reference unit of intraocular tumors in Spain.

OBJECTIVE: To analyse the impact of the COVID-19 pandemic on the diagnosis and management of uveal melanoma (a tumour included in the Orphanet catalogue of rare diseases) in a Spanish national reference unit for intraocular tumours during the first year of the pandemic. METHOD: An observational retrospective study of patients with uveal melanoma in the National Reference Unit for Adult Intraocular Tumors of the Hospital Clínico Universitario de Valladolid (Spain) was performed, analysing the pre- and post-COVID-19 periods: from March 15, 2019 to March 15, 2020 and from March 16, 2020 to March 16, 2021. Demographic data, diagnostic delay, tumour size, extraocular extension, treatment and evolution were collected. A multivariable logistic regression model was used to identify factors that were associated with the variable: enucleation. RESULTS: Eighty-two patients with uveal melanoma were included, of which 42 (51.21%) belonged to the pre-COVID-19 period and 40(40.78%) to the post-COVID-19 period. An increase in tumour size at diagnosis and in the number of enucleations was observed during the post-COVID-19 period (p < 0.05). Multivariable logistic regression demonstrated that both medium-large tumour size and patients diagnosed in the post-COVID-19 period were independently related to an increased risk of enucleation (OR 250, 95%CI, 27.69-2256.37; p < 0.01 and OR 10; 95%CI, 1.10-90.25; p = 0.04, respectively). CONCLUSIONS: The increase in tumour size observed in uveal melanomas diagnosed during the first year of the COVID-19 pandemic may have favored the increase in the number of enucleations performed during that period.

Valor pronóstico de la resonancia magnética precoz en la morbilidad y mortalidad de la lesión medular traumática / Prognostic value of early magnetic resonance imaging in the morbidity and mortality of traumatic spinal cord injury

Objetivo Valorar en individuos con lesión medular traumática (LMT) la relación en re la mortalidad y la necesidad de UCI y las alteraciones objetivadas mediante resonancia magnética (RM) precoz, analizando alteraciones parenquimatosas, disrupción de ligamentos vertebrales (DLV) y compresión del cordón medular (CCM). Diseño Estudio retrospectivo. Ámbito Hospital de tercer nivel, unidad de lesionados medulares y UCI. Pacientes Individuos con LMT aguda entre los años 2010 y 2019. Intervenciones Análisis de RM realizada en las primeras 72horas. Variables de interés Ingreso en UCI y mortalidad. Resultados Recogidos 269 casos. El patrón que se asoció a una mayor mortalidad fue la hemorragia (16,7%) por 12,5% de los edemas a un nivel y 6,5% de los edemas a múltiples niveles (p=0,125). Lo mismo aconteció con los ingresos en UCI: 69,0% en hemorragia por 60,2% en edema múltiple y 46,3% en edemas cortos (p=0,018). Con respecto a la CCM, la mortalidad fue del 13,4% con 59,2% de ingresos en UCI por 2,2% y 42,2% de quienes no presentaban compresión (p=0,020 y p=0,003). Las cifras de éxitus e ingreso en UCI en los individuos con DLV fueron del 15,0% y el 67,3%, respectivamente, por un 6,2% y 44,4% de los individuos sin DLV (p<0,001 y p=0,013). Conclusiones La presencia de hemorragia medular, CCM y DLV se asoció a una mayor necesidad de UCI. Existe un significativo aumento de la mortalidad en los casos con CCM y DLV (AU)

Objective To assess in individuals with traumatic spinal cord injury (TSCI) the relationship between mortality and need for ICU and early magnetic resonance imaging (MRI), analyzing spinal parenchymal alterations, disruption of vertebral ligaments (DVL) and spinal cord compression (SCC). Design Retrospective study. Setting Third-level hospital, Spinal Cord Injury Unit and ICU. Patients Individuals with acute TSCI between 2010 and 2019. Interventio Analysis of MRI performed in the first 72h. Variables of interest Admission to ICU and mortality. Results 269 cases collected. The pattern that demonstrated higher mortality was cord hemorrhage (16.7%) for 12.5% of single-level edema and 6.5% of multilevel edema (p=0.125). The same happened with ICU admissions: 69.0% in hemorrhage, 60.2% in multilevel edema and 46.3% in short edema (p=0.018). Analyzing CCM, mortality was 13.4% with 59.2% of ICU admissions, for 2.2% and 42.2% of individuals without cord compression (p=0.020 and p=0.003). The figures of death and ICU admission among cord injuries with DVL were 15.0% and 67.3%, for 6.2% and 44.4% of the individuals without DLV (p<0.001 and p=0.013). Conclusions The presence of spinal cord hemorrhage, SCC and DVL was associated with a higher admission in ICU. A significant increase in mortality was observed in cases with SCC and DVL (AU)