Autoimmune findings in patients with silicosis in Spain.

Background: Occupational exposure to silica is related to autoimmune diseases and features of autoimmunity, mainly autoantibodies. The study objectives were to estimate the prevalence of silicosis with associated autoimmune findings or diagnosed autoimmune diseases in Spain, and to assess the clinical and functional characteristics of affected patients. Methods: This is a multicentre prospective study in patients diagnosed with silicosis. Autoantibodies analysed were antinuclear antibodies, isotypes IgA, IgM and IgG, rheumatoid factor, anticyclic citrullinated peptide, anti-Scl70, anti-Ro, and anti-LA. Pulmonary function tests were performed. Results: Autoimmunity was assessed in 105 patients. Autoimmune findings were recorded in 29 (27%) patients, including antinuclear antibodies (n=21), anti-Ro (n=7), rheumatoid factor (n=5) and anti-Scl70 (n=3). Autoimmune disease was diagnosed in 16 (15%) patients, mainly rheumatoid arthritis (n=7) and systemic lupus erythematosus (n=4). Patients with silicosis and autoimmune findings had a lower mean time of exposure to silica and showed a trend toward lower values in pulmonary function tests. Conclusions: Autoimmune findings and diagnosis of autoimmune diseases were frequent in patients with silicosis in Spain.

Urban mobility trends and climate change: sustainability policies in the parking industry.

The concern to create cleaner and more ecosystem-friendly production processes has extended to the parking sector in Spain. Since the creation of the multi-level institutional framework for sustainable mobility management (mainly composed of the Infrastructure, Transport and Housing Plan 2012-2024, the Sustainable Urban Mobility Plans, Law 9/2006, and Law 9/2017), environmental considerations, including sustainable management certificates, have occupied a privileged place in public procedures for the management of parking structures and regulated surface parking facilities. Although there have been previous academic studies on the design and implementation of SUMPs and the growth of the parking sector, this article is novel in that it analyzes the market concentration of the parking sector in a scenario where climate change policies are crucial and the importance of sustainability certificates takes on a new meaning. Therefore, the objective of this article is to analyze whether the growing importance of environmental aspects has led to an increase in the concentration level of the parking sector in Spain. For this purpose, several concentration and stability indices are calculated. The results show that, although there are additional factors, the certification of a cleaner activity is relevant in the process of public tenders in the sector, which has served to strengthen the dominance of the most prominent companies in the sector that are in possession of environmental certificates. This shows that environmental policies can also have negative effects on the market, so the results of this analysis are of great value to policymakers.

Otomastoiditis por Corynebacterium amycolatum / Otomastoiditis caused by Corynebacterium amycolatum

Se presenta el caso de un varón de 33 años que ingresó por otomastoiditis complicada tras manipulación quirúrgica con aislamiento de Corynebacterium amycolatum, un microorganismo que está cobrando interés por su papel como patógeno en los últimos años. El interés del caso radica en lo infrecuente del mismo, ya que no se han descrito en la literatura revisada casos de otomastoiditis por esta bacteria. En el caso se describe cómo se llegó al diagnóstico y el manejo que se realizó, así como una revisión de la literatura publicada hasta el momento de infecciones por C. amycolatum. Consideramos de interés el caso, así como la revisión realizada, ya que es una entidad poco conocida y revisada previamente, por lo que este documento puede aportar información sobre la misma. (AU)

Socio-economic impact of Covid-19 on the fishing sector: A case study of a region highly dependent on fishing in Spain.

Galicia is the most important fishing region in Spain. Nearly 50% of the volume of catches and of the national fishing fleet are concentrated in this region. During the Covid-19 pandemic, the fishing sector had the status of an essential sector and was not forced to stop its activity by the national Government. However, its economic performance has deteriorated in 2020. This article aims to analyze the impact of the pandemic on the extractive fishing sector in Galicia. For this purpose, the performance of the main economic and financial variables of the 246 companies that constitute this industry has been studied. The companies pertain to different extractive sectors (the national, offshore and large-scale fleets) and are in 9 different areas (Vigo, Pontevedra, Arousa, Muros, Fisterra, Costa da Morte, A Coruña-Ferrol, Cedeira and A Mariña). The results of the analysis show that the 9 fishing zones share a generalized negative trend but that there is heterogeneity in the results. Among the most determining factors are the predominant fleet extract, the target species caught, or the perception of public subsidies.

Major determinants of prolonged remission in systemic lupus erythematosus: retrospective study over a 41+ year period.

OBJECTIVES: To investigate predictors of sustained complete remission (CR) for 3 and 5 years, minimum. METHODS: Retrospective observational study from January 1978 to December 2019, including systemic lupus erythmatosus (SLE) patients who attended the Lupus Clinic in a tertiary hospital, for at least 3 years. We used the BILAG score and serological profile to classify patients into CR, serologically active clinically quiescent (SACQ) and serological remission (SR). Multivariable Cox regression analysis was performed to investigate predictors of CR and Kaplan-Meier curves were obtained. RESULTS: We included 564 patients; 15% achieved CR, 7% SACQ and 15% SR. Some 63% attained no remission. In the CR group, 73% sustained the remission for 5 years or more. Patients who did not reach any kind of sustained remission died significantly earlier (P < 0.001). Cumulative survival figures at 5, 10, 20 and 30 years were 100, 100, 94 and 90%, respectively, for CR patients and 96, 93, 77 and 58%, respectively, for patients in the no-remission group. Significant predictors of CR were White ethnicity [adjusted hazard ratio (HR) 2.16 (95% CI 1.30-3.59); P = 0.003]; older age at diagnosis (>32 years) [HR 1.92 (1.24-2.97); P = 0.003]; absence of renal involvement [HR 2.55 (1.39-4.67); P = 0.002]; and of antiphospholipid syndrome (APS) [HR 4.92 (1.55-15.59); P = 0.007]. CONCLUSION: Patients not achieving any kind of sustained remission have a higher risk of early mortality. White ethnicity, older age at diagnosis, absence of renal involvement and of APS were significantly associated with CR. Predictors for sustained CR do not change whether a 3-year or 5-year period is applied.

Faecal Immunochemical Test Impact on Prognosis of Colorectal Cancer Detected in Symptomatic Patients.

The use of the faecal immunochemical test (FIT) to stratify the risk of colorectal cancer (CRC) in symptomatic patients in primary healthcare enables improved referrals to colonoscopy. However, its effect on diagnostic delays or the prognosis of patients has been poorly evaluated in this setting. We performed a retrospective cohort study that included symptomatic patients with outpatient CRC diagnosis between 2009 and 2017. We identified whether FIT had been analysed between initial healthcare contact and diagnostic confirmation. We included 589 patients (male = 65%, 71.7 ± 11.6 years, TNM IV = 17.1%) in the analysis. FIT was performed in 411 (69.8%) patients with a positive result (≥10 µg/g of faeces) in 96.4% of the evaluated patients. The use of FIT was associated with increased diagnostic delay (yes = 159 ± 277 days, no = 111 ± 172 days; p = 0.01). At five years follow up, 193 (32.8%) patients died (151 due to CRC). Mean survival was not modified by the use of FIT or its result (not performed = 46.8 ± 1.5 months, FIT+ = 48.9 ± 1 months, FIT- = 45.6 ± 5.5 months; p = 0.5) in Kaplan-Meier analysis, and was confirmed later in multivariate Cox regression analysis. In conclusion, FIT determination in symptomatic patients in primary healthcare did not modify CRC prognosis.

The Use of Corticosteroids or Tocilizumab in COVID-19 Based on Inflammatory Markers.

BACKGROUND: The inflammatory cascade is the main cause of death in COVID-19 patients. Corticosteroids (CS) and tocilizumab (TCZ) are available to treat this escalation but which patients to administer it remains undefined. OBJECTIVE: We aimed to evaluate the efficacy of immunosuppressive/anti-inflammatory therapy in COVID-19, based on the degree of inflammation. DESIGN: A retrospective cohort study with data on patients collected and followed up from March 1st, 2020, to May 1st, 2021, from the nationwide Spanish SEMI-COVID-19 Registry. Patients under treatment with CS vs. those under CS plus TCZ were compared. Effectiveness was explored in 3 risk categories (low, intermediate, high) based on lymphocyte count, C-reactive protein (CRP), lactate dehydrogenase (LDH), ferritin, and D-dimer values. PATIENTS: A total of 21,962 patients were included in the Registry by May 2021. Of these, 5940 met the inclusion criteria for the present study (5332 were treated with CS and 608 with CS plus TCZ). MAIN MEASURES: The primary outcome of the study was in-hospital mortality. Secondary outcomes were the composite variable of in-hospital mortality, requirement for high-flow nasal cannula (HFNC), non-invasive mechanical ventilation (NIMV), invasive mechanical ventilation (IMV), or intensive care unit (ICU) admission. KEY RESULTS: A total of 5940 met the inclusion criteria for the present study (5332 were treated with CS and 608 with CS plus TCZ). No significant differences were observed in either the low/intermediate-risk category (1.5% vs. 7.4%, p=0.175) or the high-risk category (23.1% vs. 20%, p=0.223) after propensity score matching. A statistically significant lower mortality was observed in the very high-risk category (31.9% vs. 23.9%, p=0.049). CONCLUSIONS: The prescription of CS alone or in combination with TCZ should be based on the degrees of inflammation and reserve the CS plus TCZ combination for patients at high and especially very high risk.

Can we predict if patients with SLE will require more than one cycle of rituximab?

OBJECTIVE: To identify clinical and serological features that distinguish patients with SLE who require single as opposed to repeated rituximab (RTX) cycles. METHODS: All 175 SLE patients followed up at University College Hospital from 2000 onwards were retrospectively reviewed. They were divided into a one-RTX-cycle group and a multiple-cycle group (2 or more cycles). Patients included had a follow-up of at least 3 years after their first RTX cycle, unless they needed a second infusion sooner. RESULTS: A total of 131 patients were included; 44 (33.6%) received one cycle of RTX and 87 (66.4%) received two or more. The former were older at diagnosis (31.4 vs 21 years, P < 0.001) and at first RTX infusion (39.9 vs 29 years, P < 0.001). This group of patients had more organs/systems involved (P = 0.044), more leukopenia, lymphopenia and thrombocytopenia (P = 0.001, P < 0.0001 and P = 0.003, respectively) and lower C3 levels (P = 0.035). They also had fewer immunosuppressive drugs before RTX therapy compared with those who required multiple RTX cycles (P = 0.003). There was no statistical difference in either the clinical or serological response after the first RTX cycle between both groups. Furthermore, patients who had received more immunosuppressive treatments were more likely to require more than one cycle of RTX infusions (P = 0.007). CONCLUSIONS: RTX is an effective option for SLE patients with severe flares. Patients who received more immunosuppressive drugs were more likely to receive more than one set of RTX infusions. This suggests that RTX is best used for SLE patients with no history of refractory disease.

Síndrome de Guillain-Barré ¿seguimos en el siglo XX? / Guillain-Barré syndrome, still in XX century?

La primera descripción del síndrome de Guillain-Barré fue en 1916, surgiendo en ese mismo siglo avances en el manejo de esta entidad, de la mano de la plasmaféresis y las inmunoglobulinas intravenosas. Pasadas varias décadas desde entonces, el objetivo del presente artículo es repasar esta patología así como los avances más recientes en su manejo. (AU)

Since the first report of Guillain-Barré syndrome in 1916, appeared -in this century- new treatments, plasma exchange and intravenous immunoglobulin. Several decades ago, this report try to review this syndrome and the advances in treatment. (AU)

Impact of the COVID-19 crisis: Analysis of the fishing and shellfishing sectors performance in Galicia (Spain).

The COVID-19 crisis has had consequences in every area of the Spanish economy. The fisheries and shellfishing sectors in Galicia have been significantly affected due to the measures taken to curb the pandemic. In particular, the closure of the HORECA channel and the confinement of the population have adversely affected the production of fresh fish and shellfish. In this study, a three-stage analysis of the management of the pandemic in Spain has been carried out (confinement, "new normality" and closure of the HORECA channel). The direct and indirect effects of the pandemic have been considered, as well as other factors independent of it, which usually influence production. The results show a decrease in catches, revenue and average price (euros/kg) at first sale of Galician fish and shellfish products over the three study periods, with an incidence level that varies between phases, species, fleet segments and sectors.