Efectos secundarios oculares de las terapias oncológicas. Revisión / Ocular side effects of oncological therapies: Review

Con el avance de la terapia contra el cáncer en los últimos años, ha aumentado el conocimiento de los mecanismos involucrados en esta enfermedad, lo que ha supuesto un aumento de la calidad de vida y de la supervivencia de los pacientes con afecciones tumorales anteriormente consideradas incurables o refractarias al tratamiento. El número de fármacos utilizados ha sufrido un aumento exponencial, y a pesar de que la toxicidad implícita es menor que la de la terapia antineoplásica convencional, conllevan la aparición de nuevos efectos adversos asociados, que el oftalmólogo debe reconocer y manejar.(AU)

With the advance of cancer therapy in recent years, the knowledge of the mechanisms involved in this disease has increased, which has meant an increase in the quality of life and survival of patients with tumor pathologies previously considered incurable or refractory to treatment. The number of drugs used has increased exponentially in number, and although the implicit toxicity is lower than that of conventional antineoplastic therapy, they lead to the appearance of new associated adverse effects that the ophthalmologist must recognize and manage.(AU)

Ocular side effects of oncological therapies: Review.

With the advance of cancer therapy in recent years, the knowledge of the mechanisms involved in this disease has increased, which has meant an increase in the quality of life and survival of patients with tumor pathologies previously considered incurable or refractory to treatment. The number of drugs used has increased exponentially in number, and although the implicit toxicity is lower than that of conventional antineoplastic therapy, they lead to the appearance of new associated adverse effects that the ophthalmologist must recognize and manage.

[Factors associated with prolonged hospital-stay after appendectomy during the SARS-CoV-2 pandemic]. / Faktory, svyazannye s dlitel'nym prebyvaniem v statsionare posle appendektomii vo vremya pandemii SARS-CoV-2.

OBJECTIVE: To determine the factors associated with prolonged hospital-stay after appendectomy in SARS-CoV-2 pandemic. MATERIAL AND METHODS: A retrospective observational cohort study included 420 patients after surgery for acute appendicitis between March 2019 and March 2020, April 2020 and April 2021. There were 336 patients before the SARS-COV-2 pandemic, and 84 ones underwent surgery during the pandemic. RESULTS: Incidence of prolonged hospital stay was 15% and 26%, respectively (RR 1.76). RR is more than 1 and assumes SARS-CoV-2 infection as a risk factor. CONCLUSION: There is an association between SARS-CoV-2 infection and prolonged hospital-stay after surgery for acute appendicitis (RR 1.76).

Soil amendments to reduce cadmium in cacao (Theobroma cacao L.): A comprehensive field study in Ecuador.

The new EU regulations on maximum levels of cadmium (Cd) in cacao products sparked research on countermeasures to reduce Cd concentrations in cacao beans. This study was set up to test the effects of soil amendments in two established cacao orchards (soil pH 6.6 and 5.1) in Ecuador. Soil amendments included: 1) agricultural limestone at 2.0 and 4.0 Mg ha-1 y-1, 2) gypsum at 2.0 and 4.0 Mg ha-1 y-1 and 3) compost at 12.5 and 25 Mg ha-1 y-1, all amendments were applied at the surface during two subsequent years. Lime application increased the soil pH by one unit down to 20 cm depth. On the acid soil, leaf Cd concentrations decreased by lime application and the reduction factor gradually rose to 1.5 after 30 months. No effects of liming or gypsum on leaf Cd was found in the pH neutral soil. Compost application in the pH neutral soil reduced leaf Cd concentration with factor 1.2 at 22 months but that effect was absent at 30 months after application. Bean Cd concentrations were unaffected by any of the treatments at 22 months after application (acid soil) or 30 months (pH neutral soil) suggesting that any treatment effects on bean Cd might be even more delayed than in leaves. Soil columns experiments in the laboratory showed that mixing lime with compost largely enhanced the depth of lime penetration compared to lime only. Compost + lime reduced 10-3 M CaCl2 extractable Cd in soil without lowering extractable Zn. Our results suggest that soil liming has the potential to lower Cd uptake in cacao in the long term in acid soils and that the compost + lime treatment should be tested at field scale to accelerate the effects of the mitigation.

The role of single nucleotide variant rs3819817 of the Histidine Ammonia-Lyase gene and 25-Hydroxyvitamin D on bone mineral density, adiposity markers, and skin pigmentation, in Mexican population.

PURPOSE: Vitamin D (VD) deficiency and osteoporosis have become a global public health problem. A variant in the Histidine Ammonia-Lyase (HAL) gene has been associated with VD levels and bone mineral density (BMD). However, whether this variant has an influence on VD levels and BMD in Mexican adults remain unclear. METHODS: This cross-sectional analysis included 1,905 adults participating in the Health Worker Cohort Study and 164 indigenous postmenopausal women from the Metabolic Analysis in an Indigenous Sample (MAIS) cohort. The rs3819817 variant was genotyped by TaqMan probe assay. Total 25 hydroxyvitamin D levels were measured by DiaSorin Liaison. BMD at the different sites was assessed through dual-energy X-ray absorptiometry. Linear and logistic regression models were performed to evaluate the associations of interest. RESULTS: The prevalence of VD deficiency was 41%, showing differences between sexes. Obesity and skin pigmentation were associated with lower levels of VD in males and females. rs3819817-T allele was associated with low levels of 25-hydroxyvitamin D, VD deficiency, and hip and femoral neck BMD values (g/cm2). We found two interactions with VD levels, one between adiposity and rs3819817-T allele (P = 0.017) and another between skin pigmentation and rs3819817-T allele (P = 0.019). In indigenous postmenopausal women, we observed higher VD levels in the southern region compared to the northern region (P < 0.001); however, we did not observe differences by genotype. CONCLUSION: Our findings confirm that the genetic variant rs3819817 has an essential function in VD levels and BMD and suggests a role in skin pigmentation in the Mexican population.

Pathophysiological Role of Genetic Factors Associated With Gestational Diabetes Mellitus.

Gestational Diabetes Mellitus (GDM) is a highly prevalent maternal pathology characterized by maternal glucose intolerance during pregnancy that is, associated with severe complications for both mother and offspring. Several risk factors have been related to GDM; one of the most important among them is genetic predisposition. Numerous single nucleotide polymorphisms (SNPs) in genes that act at different levels on various tissues, could cause changes in the expression levels and activity of proteins, which result in glucose and insulin metabolism dysfunction. In this review, we describe various SNPs; which according to literature, increase the risk of developing GDM. These SNPs include: (1) those associated with transcription factors that regulate insulin production and excretion, such as rs7903146 (TCF7L2) and rs5015480 (HHEX); (2) others that cause a decrease in protective hormones against insulin resistance such as rs2241766 (ADIPOQ) and rs6257 (SHBG); (3) SNPs that cause modifications in membrane proteins, generating dysfunction in insulin signaling or cell transport in the case of rs5443 (GNB3) and rs2237892 (KCNQ1); (4) those associated with enzymes such as rs225014 (DIO2) and rs9939609 (FTO) which cause an impaired metabolism, resulting in an insulin resistance state; and (5) other polymorphisms, those are associated with growth factors such as rs2146323 (VEGFA) and rs755622 (MIF) which could cause changes in the expression levels of these proteins, producing endothelial dysfunction and an increase of pro-inflammatory cytokines, characteristic on GDM. While the pathophysiological mechanism is unclear, this review describes various potential effects of these polymorphisms on the predisposition to develop GDM.

Manufacture of magnesium-fortified Chihuahua cheese.

The aim of this study was to manufacture magnesium-fortified Chihuahua cheese and to evaluate the effect of magnesium fortification on quality parameters. Addition of magnesium chloride to milk during pasteurization (5.44, 10.80, 16.40, 22.00, and 25.20 g of MgCl2·6H2O/L of milk) resulted in cheese with increased magnesium content, proportional to the amount of magnesium added (up to 2,957.13 mg of Mg/kg of cheese). As magnesium content increased, coagulation time and moisture content also increased, whereas calcium content decreased. Higher levels of magnesium fortification (16.40 g of MgCl2·6H2O/L of milk or more) induced the development of bitter-acid flavors and softer texture. Addition of 10.80 g of MgCl2·6H2O/L to milk resulted in Chihuahua cheese that meets regulatory standards and possesses physicochemical and sensory characteristics similar to those of nonfortified Chihuahua cheese. Under this milk fortification level, the manufactured cheese is able to provide 148.4 mg of magnesium per day (35% of the recommended daily intake of magnesium for adult males and 46% for adult females) assuming 3 portions (28 g each) are consumed.

Effects of mesenchymal stem cell culture on radio sterilized human amnion or radio sterilized pig skin in burn wound healing.

Deep second and third degree burns treatment requires fibroblasts, keratinocytes and other skin cells in order to grow new dermis and epidermis. Cells can proliferate, secrete growth factors and extracellular matrix required to repair the damaged tissue. Radiosterilized human amnion and radiosterilized pig skin have been used as natural origin skin dressings for burned patients. Adipose-derived mesenchymal stem cells can differentiate into fibroblasts and keratinocytes and improve wound-healing progress. These cells can stimulate vascular tissue formation, release growth factors, synthetize new extracellular matrix and immunoregulate other cells. In this study, we developed mesenchymal stem cells-cellularized skin substitutes based from radiosterilized human amnion or pig skin. Third-degree burns were induced in mice animal models to evaluate the effect of cellularized skin substitutes on burn wound healing. Mesenchymal phenotype was immunophenotypically confirmed by flow cytometry and cell viability was close to 100%. Skin recovery was evaluated in burned mice after seven and fourteen days post-coverage with cellularized and non-cellularized sustitutes. Histological techniques and immunofluorescence were used to evaluate re-epithelization and type I collagen deposition. We determined that cellularized-human amnion or cellularized-pig skin in combination with mesenchymal stem cells improve extracellular matrix deposition. Both cellularized constructs increase detection of type I collagen in newly formed mouse skin and can be potentially used as skin coverage for further clinical treatment of burned patients.

The unknown third - Hydrogen isotopes in tree-ring cellulose across Europe.

This is the first Europe-wide comprehensive assessment of the climatological and physiological information recorded by hydrogen isotope ratios in tree-ring cellulose (δ2Hc) based on a unique collection of annually resolved 100-year tree-ring records of two genera (Pinus and Quercus) from 17 sites (36°N to 68°N). We observed that the high-frequency climate signals in the δ2Hc chronologies were weaker than those recorded in carbon (δ13Cc) and oxygen isotope signals (δ18Oc) but similar to the tree-ring width ones (TRW). The δ2Hc climate signal strength varied across the continent and was stronger and more consistent for Pinus than for Quercus. For both genera, years with extremely dry summer conditions caused a significant 2H-enrichment in tree-ring cellulose. The δ2Hc inter-annual variability was strongly site-specific, as a result of the imprinting of climate and hydrology, but also physiological mechanisms and tree growth. To differentiate between environmental and physiological signals in δ2Hc, we investigated its relationships with δ18Oc and TRW. We found significant negative relationships between δ2Hc and TRW (7 sites), and positive ones between δ2Hc and δ18Oc (10 sites). The strength of these relationships was nonlinearly related to temperature and precipitation. Mechanistic δ2Hc models performed well for both genera at continental scale simulating average values, but they failed on capturing year-to-year δ2Hc variations. Our results suggest that the information recorded by δ2Hc is significantly different from that of δ18Oc, and has a stronger physiological component independent from climate, possibly related to the use of carbohydrate reserves for growth. Advancements in the understanding of 2H-fractionations and their relationships with climate, physiology, and species-specific traits are needed to improve the modelling and interpretation accuracy of δ2Hc. Such advancements could lead to new insights into trees' carbon allocation mechanisms, and responses to abiotic and biotic stress conditions.

Reliability and validity of the Mexican teachers' physical activity questionnaire (MTPAQ) in a subsample of female Mexican teachers.

BACKGROUND: Reliable and valid instruments are needed to estimate physical activity levels. The purposes of this study were to estimate the reliability and validity of the Physical Activity Questionnaire (MTPAQ) in a subsample of the Mexican Teachers Cohort study. METHODS: We completed telephone interviews and clinical examinations of 82 teachers. Two MTPAQ, five International Physical Activity Questionnaire (IPAQ)-long form, and two accelerometer (AC) measures were used to determine physical activity levels throughout 24 months. Moderate and walking physical activity (MWPA min/week), vigorous physical activity (VPA min/week), and moderate-to-vigorous physical activity minutes per week (MVPA min/week) were estimated for each instrument. Pearson, Intra-class correlations and deattenuated adjustments were used to determine the reliability and validity of MTPAQ. RESULTS: MWPA and MVPA min/week of MTPAQs were moderately correlated (r ≥ 0.54) to min/week of IPAQ-long form. MWPA and MVPA min/week average MTPAQ and MTPAQ1 and average AC, AC1 and AC2 were fairly correlated (r ≥ 0.20). A higher correlation was observed when correlation coefficients were attenuated (r ≥ 0.32). CONCLUSIONS: MTPAQ1 is a reliable and valid tool to measure physical activity levels.

Survival of the nematophagous fungus Duddingtonia flagrans to in vitro segments of sheep gastrointestinal tract.

The nematophagous fungus Duddingtonia flagrans is used in integrated management of gastrointestinal nematodes in ruminants. The chlamydospores of the fungus, orally administered, pass through the segments of the ruminant digestive tract and, in the feces, capture the nematodes preventing their migration to grasslands. The drastic conditions of the gastrointestinal segments can negatively affect the fungus' biocontrol activity. The aim of this study was to assess the effect of in vitro conditions of the sheep's main gastrointestinal segments on the concentration, viability and nematode predatory ability of D. flagrans chlamydospores. The segments evaluated separately in vitro were the oral cavity, rumen, abomasum, and small intestine. The results showed that chlamydospores concentration was not affected by exposure to the different segments. The viability of the chlamydospores after exposure to the oral cavity (2.53 × 106 CFU/mL) and small intestine (1.24 × 105 CFU/mL) was significantly lower than its control treatment, with values of 6.67 × 106 CFU/mL and 2.31 × 105 CFU/mL respectively. Nematode predatory ability after rumen exposure was reduced by 7% compared to the control treatment, by 25% after abomasum exposure and by 17% after small intestine. This study revealed the individual in vitro effect of each segment of ovine gastrointestinal tract on the integrity of this strain of the fungus D. flagrans affecting its viability and nematode predatory ability under the evaluated conditions. Delivery systems could be designed to protect chlamydospores considering the impact of each gastrointestinal segment.

Effect of tannins from tropical plants on methane production from ruminants: A systematic review.

Methane (CH4) is a greenhouse gas generated during the feed fermentation processes in the rumen. However, numerous studies have been conducted to determine the capacity of plant secondary metabolites to enhance ruminal fermentation and decrease CH4 production, especially those plants rich in tannins. This review conducted a descriptive analysis and meta-analysis of the use of tannin-rich plants in tropical regions to mitigate CH4 production from livestock. The aim of this study was to analyse the effect of tannins supplementation in tropical plants on CH4 production in ruminants using a meta-analytic approach and the effect on microbial population. Sources of heterogeneity were explored using a meta-regression analysis. Final database was integrated by a total of 14 trials. The 'meta' package in R statistical software was used to conduct the meta-analyses. The covariates defined a priori in the current meta-regression were inclusion level, species (sheep, beef cattle, dairy cattle, and cross-bred heifers) and plant. Results showed that supplementation with tropical plants with tannin contents have the greatest effects on CH4 mitigation . A negative relationship was observed between the level of inclusion and CH4 emission (-0.09), which means that the effect of CH4 mitigation is increasing as the level of tannin inclusion is higher. Therefore, less CH4 production will be obtained when supplementing tropical plants in the diet with a high dose of tannins.

Factores relacionados con los conocimientos del profesorado sobre el trastorno por déficit de atención/hiperactividad / Factors related to teacher knowledge about attention-deficit/hyperactivity disorder

Introducción: En la bibliografía no abundan los estudios sobre los conocimientos del profesorado sobre el trastorno por déficit de atención/hiperactividad (TDAH). La escasa investigación realizada indica puntuaciones bajas o moderadas. Objetivo: Examinar los conocimientos acerca del TDAH del profesorado de educación infantil, primaria y secundaria, y estudiar posibles diferencias atribuibles a formación y experiencia previa en el trastorno y otras variables sociodemográficas. Sujetos y métodos: A una muestra de 130 profesores de la Región de Murcia (España) se le administró un cuestionario de conocimientos sobre el TDAH y se registraron las variables sociodemográficas. Resultados: Los docentes contestaron de manera correcta a más de la mitad de los ítems del cuestionario (63,9%). La escala de síntomas/diagnóstico alcanzó el porcentaje más alto de aciertos (69,1%) y la de etiología, el más bajo (32%). Las profesoras mostraron conocimientos superiores a los profesores en todas las dimensiones del cuestionario. Los docentes que habían recibido formación sobre el trastorno presentaron un nivel de conocimientos superior. Además, los profesores que habían tenido experiencia profesional previa manifestaron conocimientos superiores a los que carecían de dicha experiencia. Según la especialidad docente, no se obtuvieron diferencias estadísticamente significativas casi en ninguna de las dimensiones del cuestionario. El grupo de edad que mostró un nivel superior de conocimientos sobre el TDAH fue el de 27 a 32 años. Conclusión: Los resultados apuntan hacia la necesidad de una mejor formación en conocimientos y actitudes hacia el TDAH que facilite la detección temprana de estos casos y su atención especializada en los diferentes niveles educativos.(AU)

Introduction: Studies on teachers’ knowledge about attention deficit/hyperactivity disorder (ADHD) are not abundant in the literature. The little research done indicates low or moderate scores. Aim: To examine the knowledge of Childhood, Primary, and Secondary Education teachers on ADHD, as well as to study possible differences attributable to the previous training, the experience in the disorder and other sociodemographic variables. Subjects and methods: A sample of 130 teachers from the Region of Murcia (Spain) was administered a knowledge questionnaire about ADHD and sociodemographic variables were recorded. Results: The teachers answered correctly to more than half of the items in the questionnaire (63,9%). The Symptoms/Diagnostic scale reached the highest percentage of correct answers (69,1%) and the Etiology scale the lowest (32%). The female teachers showed superior knowledge to the male teachers in all dimensions of the questionnaire. Those teachers who had received training on the disorder presented a higher level of knowledge. In addition, teachers who had previous professional experience showed superior knowledge than those without such experience. According to the teaching specialty, no statistically significant differences were obtained almost in any of the dimensions of the questionnaire. The age group that showed a higher level of knowledge about ADHD was 27-32 years old. Conclusion: The results point to the need for better training on knowledge and attitudes of teachers towards ADHD that facilitate the early detection of these cases and their specialized care at different educational levels.(AU)

[Factors related to teacher knowledge about attention-deficit/hyperactivity disorder]. / Factores relacionados con los conocimientos del profesorado sobre el trastorno por déficit de atención/hiperactividad.

INTRODUCTION: Studies on teachers' knowledge about attention deficit/hyperactivity disorder (ADHD) are not abundant in the literature. The little research done indicates low or moderate scores. AIM: To examine the knowledge of Childhood, Primary, and Secondary Education teachers on ADHD, as well as to study possible differences attributable to the previous training, the experience in the disorder and other sociodemographic variables. SUBJECTS AND METHODS: A sample of 130 teachers from the Region of Murcia (Spain) was administered a knowledge questionnaire about ADHD and sociodemographic variables were recorded. RESULTS: The teachers answered correctly to more than half of the items in the questionnaire (63,9%). The Symptoms/Diagnostic scale reached the highest percentage of correct answers (69,1%) and the Etiology scale the lowest (32%). The female teachers showed superior knowledge to the male teachers in all dimensions of the questionnaire. Those teachers who had received training on the disorder presented a higher level of knowledge. In addition, teachers who had previous professional experience showed superior knowledge than those without such experience. According to the teaching specialty, no statistically significant differences were obtained almost in any of the dimensions of the questionnaire. The age group that showed a higher level of knowledge about ADHD was 27-32 years old. CONCLUSION: The results point to the need for better training on knowledge and attitudes of teachers towards ADHD that facilitate the early detection of these cases and their specialized care at different educational levels.

TITLE: Factores relacionados con los conocimientos del profesorado sobre el trastorno por déficit de atención/hiperactividad.Introducción. En la bibliografía no abundan los estudios sobre los conocimientos del profesorado sobre el trastorno por déficit de atención/hiperactividad (TDAH). La escasa investigación realizada indica puntuaciones bajas o moderadas. Objetivo. Examinar los conocimientos acerca del TDAH del profesorado de educación infantil, primaria y secundaria, y estudiar posibles diferencias atribuibles a formación y experiencia previa en el trastorno y otras variables sociodemográficas. Sujetos y métodos. A una muestra de 130 profesores de la Región de Murcia (España) se le administró un cuestionario de conocimientos sobre el TDAH y se registraron las variables sociodemográficas. Resultados. Los docentes contestaron de manera correcta a más de la mitad de los ítems del cuestionario (63,9%). La escala de síntomas/diagnóstico alcanzó el porcentaje más alto de aciertos (69,1%) y la de etiología, el más bajo (32%). Las profesoras mostraron conocimientos superiores a los profesores en todas las dimensiones del cuestionario. Los docentes que habían recibido formación sobre el trastorno presentaron un nivel de conocimientos superior. Además, los profesores que habían tenido experiencia profesional previa manifestaron conocimientos superiores a los que carecían de dicha experiencia. Según la especialidad docente, no se obtuvieron diferencias estadísticamente significativas casi en ninguna de las dimensiones del cuestionario. El grupo de edad que mostró un nivel superior de conocimientos sobre el TDAH fue el de 27 a 32 años. Conclusión. Los resultados apuntan hacia la necesidad de una mejor formación en conocimientos y actitudes hacia el TDAH que facilite la detección temprana de estos casos y su atención especializada en los diferentes niveles educativos.

Update on the perioperative management of antiplatelets and anticoagulants in ophthalmic surgery.

INTRODUCTION: Anti-thrombotic drugs (antiplatelets and anticoagulants) are widely used for different clinical reasons. This means that there are an increasing number of patients undergoing elective ophthalmic surgery that are being treated with these drugs. A better knowledge of their implications and their peri-operative use may help to prevent surgical and secondary adverse events. There is often no firm recommendation on how to manage certain drugs in certain surgeries. OBJECTIVE: To review the recommendations in the scientific literature as regards managing anti-thrombotic agents during the peri-operative period of ophthalmic surgery. MATERIAL AND METHODS: A review was made of the relevant guidelines and studies using an antiplatelet and anticoagulant drugs approach for cataract, vitreo-retinal, glaucoma, oculoplastic, and strabismus surgeries. RESULTS: Recommendations about whether to continue or discontinue anti-thrombotic drugs in the peri-operative period of different ophthalmic surgical fields are presented. CONCLUSIONS: There are only firm recommendations of maintaining anti-thrombotic drugs as regards cataract surgery using phacoemulsification with topical anaesthesia. In other surgical fields, ophthalmologists should balance the risk of thromboembolic events and risks of haemorrhagic complications in order to carry out a proper management. A multi-disciplinary approach is recommended for complex cases. Additional studies should be performed to better characterise the peri-operative use of anti-thrombotic agents in order to prepare clinical guidelines for ophthalmic surgery.

Actualización en el manejo perioperatorio de antiagregantes y anticoagulantes en cirugía oftalmológica / Update on the perioperative management of antiplatelets and anticoagulants in ophthalmic surgery

Introducción Los fármacos anticoagulantes y antiagregantes son ampliamente utilizados con indicaciones médicas diversas. Por tanto, hay cada vez más pacientes que precisan una cirugía oftalmológica programada y se encuentran en tratamiento con esta medicación. El conocimiento de sus implicaciones y su correcto abordaje perioperatorio permite reducir complicaciones quirúrgicas y efectos adversos en los pacientes. En muchas ocasiones no hay una recomendación clara sobre cómo actuar con estas familias de fármacos en determinadas cirugías. Objetivo Realizar una revisión bibliográfica sobre el manejo perioperatorio de los antiagregantes y anticoagulantes en cirugía oftalmológica. Material y métodos Se revisan los protocolos y la literatura existente acerca del empleo de dichos fármacos en diversas cirugías oftálmicas: catarata, vítreo-retina, glaucoma, cirugía oculoplástica y orbitaria y estrabismo. Resultados Se referencian guías clínicas y estudios que recogen las recomendaciones acerca del mantenimiento o suspensión de antiagregantes y anticoagulantes en diferentes campos quirúrgicos de la oftalmología. Conclusiones En la cirugía de catarata mediante facoemulsificación con anestesia tópica existe evidencia de que el mantenimiento de la medicación antitrombótica es seguro. En el resto de las cirugías oftalmológicas se debería actuar en función del riesgo hemorrágico y trombótico que presente la cirugía y el paciente para su correcta utilización. En casos complejos, se recomienda un abordaje multidisciplinar. Serían necesarios más estudios para la confección de guías clínicas que facilitasen el manejo perioperatorio de estos fármacos en cirugía oftalmológica (AU)

Introduction Anti-thrombotic drugs (antiplatelets and anticoagulants) are widely used for different clinical reasons. This means that there are an increasing number of patients undergoing elective ophthalmic surgery that are being treated with these drugs. A better knowledge of their implications and their peri-operative use may help to prevent surgical and secondary adverse events. There is often no firm recommendation on how to manage certain drugs in certain surgeries. Objective To review the recommendations in the scientific literature as regards managing anti-thrombotic agents during the peri-operative period of ophthalmic surgery. Material and methods A review was made of the relevant guidelines and studies using an antiplatelet and anticoagulant drugs approach for cataract, vitreo-retinal, glaucoma, oculoplastic, and strabismus surgeries. Results Recommendations about whether to continue or discontinue anti-thrombotic drugs in the peri-operative period of different ophthalmic surgical fields are presented. Conclusions There are only firm recommendations of maintaining anti-thrombotic drugs as regards cataract surgery using phacoemulsification with topical anaesthesia. In other surgical fields, ophthalmologists should balance the risk of thromboembolic events and risks of haemorrhagic complications in order to carry out a proper management. A multi-disciplinary approach is recommended for complex cases. Additional studies should be performed to better characterise the peri-operative use of anti-thrombotic agents in order to prepare clinical guidelines for ophthalmic surgery (AU)

Guidelines for enhanced recovery after cardiac surgery. Consensus document of Spanish Societies of Anesthesia (SEDAR), Cardiovascular Surgery (SECCE) and Perfusionists (AEP). / Vía clínica de recuperación intensificada en cirugía cardiaca. Documento de consenso de la Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor (SEDAR), la Sociedad Española de Cirugía Cardiovascular y Endovascular (SECCE) y la Asociación Española de Perfusionistas (AEP).

The ERAS guidelines are intended to identify, disseminate and promote the implementation of the best, scientific evidence-based actions to decrease variability in clinical practice. The implementation of these practices in the global clinical process will promote better outcomes and the shortening of hospital and critical care unit stays, thereby resulting in a reduction in costs and in greater efficiency. After completing a systematic review at each of the points of the perioperative process in cardiac surgery, recommendations have been developed based on the best scientific evidence currently available with the consensus of the scientific societies involved.

The most highly cited articles of the Revista de Gastroenterología de México over a 22-year period (1996-2018). / Los artículos más citados en la Revista de Gastroenterología de México en un período de 22 años (1996-2018).

INTRODUCTION AND AIM: The Revista de Gastroenterología de México (RGM), founded in 1935, is one of the most influential journals of scientific dissemination in Mexico and Latin America. The aim of the present review was to characterize the RGM's most frequently cited original articles, review articles, and consensuses. METHODS: The most cited original articles, review articles, and consensuses of the RGM were identified using the Scopus, PubMed, and Google Scholar databases. Their designs and topics, as well as their authors and participating institutions, were analyzed. RESULTS: The most highly cited articles of the RGM corresponded to the period from 1996 to 2018, with a mean of 16.5 citations per article. Fifty-eight percent (n = 29) of the articles belonged to the area of gastroenterology and 20% (n = 10) to surgery. The most frequent topics were functional gastrointestinal disorders, hepatitis virus, and gastric cancer. Thirty-six percent of the articles had a nonrandomized prospective design, followed by cross-sectional studies (26%) and randomized prospective studies (18%). CONCLUSION: The 50 most-cited articles included a total of 826 citations and the 10 most-cited consensuses and review articles had a total of 208 citations. Those studies encompass a diversity of disciplines related to gastroenterology that have impacted the scientific community and correspond to the work of different active research groups in Mexico and other countries.

A systematic review of worldwide data on tinea capitis: analysis of the last 20 years.

Dermatophyte infections are the most common fungal infections in humans; among them, tinea capitis (TC) - the most contagious fungal infection - is caused by anthropophilic, zoophilic and geophilic dermatophytes. The purpose of this systematic review was to determine the different aetiological variants involved in TC and the overall epidemiology of the causes of this infection in the last two decades. We searched the MEDLINE (PubMed) and Embase databases for articles published from July 2000 to August 2019 using the following search terms: 'Tinea capitis', 'Africa', 'America', 'Asia', 'Europe', 'Oceania', and the names of the countries on each continent. The flow of information through the different phases in this systematic review was depicted using a PRISMA flow diagram, which mapped the number of records identified, included and excluded, and the reasons for exclusion. Our findings indicate that the frequency of different aetiologic agents of TC in the reported studies varied globally, from 0.4-87.7% in Africa, 0.2-74.0% in North America, 0.0-91.2% in Eastern Asia, 0.0-69.0% in Eastern Europe and 2.9-86.4% in Oceania. Microsporum canis is the most frequent reported zoophilic agent worldwide, while Trichophyton violaceum and Trichophyton tonsurans are the predominant anthropophilic agents. Over time, the frequency of these latter fungal infections has increased globally, and these fungi have become the major species globally. Anthropophilic transmission - the most prevalent type of transmission - could be explained by two factors: (i) the socioeconomic status of affected countries and population groups with associated risk factors and (ii) movement of populations importing new causes of infection to areas where they had not been encountered previously. We observed that intercontinental migration and travel; globalization; environmental, climatic and ecological changes; and accelerated evolution of health technologies may influence the observed epidemiological changes and, consequently, contributed to the variations in the global status of TC.

Innovating at the human-technology interface in disasters and disease outbreaks.

Disasters and disease outbreaks have long been a catalyst for innovative applications of emerging technologies. The urgent need to respond to an emergency leads to resourceful uses of the technologies at hand. However, the best and most cost-effective use of new technologies is to prevent disease and improve resilience. In this paper, the authors present a range of approaches through which both opportunities can be grasped. Global connectedness enables more data to be collected and processed in emergencies, especially with the rise of open-source data, including social media. In general, the poorest and most remote populations are most vulnerable to disaster. However, with smaller, faster, smarter, cheaper and more connected technology, reliable, efficient, and targeted response and recovery can be provided. Initially, crowdsourcing was used to find people, map affected areas, and determine resource allocation. This led to the generation of an overwhelming amount of data, and the need to extract valuable information from that data in a timely manner. As technology evolved, organisations started outsourcing many tasks, first to other people, then to machines. Since the volume of data generated outpaces human capacity, data analysis is being automated using artificial intelligence and machine learning, which furthers our abilities in predictive analytics. As we move towards prevention rather than remediation, information collection and processing must become faster and more efficient while maintaining accuracy. Moreover, these new strategies and technologies can help us to move forwards, by integrating layers of human, veterinary, public, and environmental health data for a One Health approach.

Les catastrophes et les foyers de maladies font depuis longtemps office de catalyseurs pour l'émergence d'applications technologiques innovantes. Le besoin impérieux de répondre à une urgence encourage les utilisations ingénieuses des technologies disponibles. Cependant, la meilleure utilisation des nouvelles technologies, et la plus rentable, consiste à prévenir les maladies et à améliorer la résilience. Les auteurs présentent une gamme d'approches permettant de tirer le meilleur parti de ces deux possibilités. La connectivité mondiale permet de recueillir et de traiter davantage de données lors des situations d'urgence, en particulier grâce à l'essor des données de sources ouvertes, y compris dans les réseaux sociaux. De manière générale, les populations les plus pauvres et les plus isolées sont aussi les plus vulnérables aux catastrophes. Cependant, en recourant à des technologies plus compactes, plus rapides, plus intelligentes, plus abordables et plus connectées, il est possible de proposer des interventions d'urgence et de redressement fiables, efficaces et ciblées. À l'origine, on a fait appel à la production ouverte et participative (crowdsourcing) pour la recherche de personnes, la cartographie des zones affectées et les décisions d'allocation des ressources. Cela a engendré un volume exorbitant de données, d'où la nécessité de parvenir à extraire l'information utile de cet ensemble de données et ce, en temps opportun. À mesure de l'évolution de la technologie, les organisations ont commencé à externaliser davantage de tâches, en les confiant d'abord à des tiers, puis à des machines. Étant donné que le volume des données générées dépasse les capacités humaines, l'analyse des données a été progressivement automatisée en recourant à l'intelligence artificielle et à l'apprentissage automatique, ce qui a amélioré nos capacités en matière d'analyse prédictive. Lorsqu'il s'agit de passer de la réhabilitation à la prévention, les informations doivent être recueillies et traitées de manière plus rapide et plus efficace, tout en maintenant leur exactitude. En outre, ces nouvelles stratégies et technologies peuvent nous aider à progresser en intégrant différentes strates de données provenant des secteurs de la santé humaine, vétérinaire, publique et environnementale, conformément à l'approche Une seule santé.

Los desastres y los brotes infecciosos vienen catalizando desde hace tiempo aplicaciones innovadoras de las nuevas tecnologías. La acuciante necesidad de responder a una emergencia obliga a aguzar el ingenio con las tecnologías que se tienen a mano. Con todo, el uso idóneo de las nuevas tecnologías, y el más efectivo en relación con el costo, pasa por prevenir las enfermedades y mejorar la resiliencia. Los autores presentan aquí diversos métodos que posibilitan ambas cosas. La interconexión planetaria hace posible que en el curso de las emergencias se reúnan y traten cada vez más datos, sobre todo con el auge de los datos de código abierto (incluidas las redes sociales). Por regla general, las poblaciones más pobres y aisladas son las más vulnerables a los desastres. Sin embargo, la existencia de tecnología cada vez más pequeña, rápida, inteligente, barata e interconectada hace posible una labor fiable, eficiente y selectiva de respuesta y recuperación. En un primer momento, los dispositivos de colaboración abierta (crowdsourcing) fueron utilizados para encontrar a personas, cartografiar áreas afectadas y determinar la asignación de recursos, todo lo cual generaba una ingente cantidad de datos y, a la vez, la necesidad de extraer de ellos información útil sin tardanza. A medida que la tecnología evolucionaba las organizaciones empezaron a externalizar muchas tareas, delegándolas primero en terceras personas y después en máquinas. Dado que el volumen de datos generados supera la capacidad humana, se tiende a automatizar el análisis de datos recurriendo a la inteligencia artificial y el aprendizaje automático, lo que potencia aún más nuestra capacidad de análisis predictivo. Cuanto más avanzamos hacia una lógica de prevención, dejando atrás la de mera reparación, más necesitamos procesos de recogida y tratamiento de datos cada vez más rápidos y eficientes, sin perder por ello en precisión. Por añadidura, estas nuevas estrategias y tecnologías pueden ayudarnos a avanzar gracias a la combinación de acervos de datos de salud humana, veterinaria, pública y ambiental, integrados todos ellos en clave de Una sola salud.