Sexual dimorphism in the enamel-dentine junction (EDJ) of permanent canines of European modern humans.

OBJECTIVES: Dental anthropological investigations into sexual dimorphism have conventionally concentrated on evaluating the dimensions and configuration of the enamel cap of canines. However, the morphology of the crown dentine surface can be closely linked to that of the enamel surface. This link can facilitate examination of crown morphology even when the enamel surface is slightly worn. Here, we determine if the morphology of the enamel-dentine junction (EDJ) differs within (maxillary vs. mandibular) and between a sample of male (n = 26) and female (n = 21) contemporary human permanent canines from Europe. METHODS: The morphological data of the EDJ were gathered employing a template comprising 96 landmarks and sliding semilandmarks. Subsequently, the data underwent analysis through form space principal component analysis following Procrustes registration, utilizing standard 3D geometric morphometric techniques. RESULTS: Significant differences in the morphology of the EDJ were observed between the sexes, particularly concerning the overall shape of the crown, the symmetry of the mesial and distal edges, and the development of the distal accessory ridge. CONCLUSIONS: Sex differences in the morphology of the EDJ could relate in part to retention of the canine-premolar honing complex in males. Our results indicate that analyses of the permanent canine EDJ may potentially provide a novel method for estimating the sex of adult and nonadult skeletons.

The Identified Skeletal Collection of the School of Legal Medicine: a contemporary osteological collection housed in Universidad Complutense de Madrid, Spain.

ABSTRA: Osteological collections are an important resource for the development of methods to assist in the study of skeletal remains in archeological and/or forensic contexts. The aim is to describe the current characteristics of the Identified Skeletal Collection of the School of Legal Medicine and its historical context. The Identified Skeletal Collection of the School of Legal Medicine of the Complutense University of Madrid consists of 138 male and 95 female individuals, born between 1880 and 1980 and deceased between 1970 and 2009. The minimum age of the sample is perinatal and the maximum age is 97 years. The collection is an essential tool for forensic research, given that its population characteristics can be extrapolated to those of present-day Spain. Access to this collection offers unique teaching opportunities as well as provides the information necessary to develop various lines of research.

Provenance and Clinical Benefit of Medicines Introduced to the French Market, 2008 to 2018.

Importance: Both the commercial sector and academia play a vital role in medicine development. Ongoing debates exist on their contribution and the value of medicinal products entering the market. Objective: To identify the provenance and clinical benefit of medicines that entered the French market between 2008 and 2018. Design and Setting: In this cross-sectional study, the provenance of each medicine in the French market was established via a review of multiple sources documenting at least 2 matching findings per product. The clinical benefit was assigned using the matched scale developed from the Prescrire and Haute Autorité de Santé (HAS) gradings. The χ2 test was used to analyze the proportions and frequencies of medicines graded by Prescrire and HAS by origin, therapeutic category, and clinical benefit. Main outcomes and measures: The origins and therapeutic categories of medicines. Clinical benefit based on Prescrire and HAS grading. Concordance of Prescrire and HAS grading. Results: Of the 632 medicines that entered the French market between 2008 and 2018, 464 originated (73%) in the commercial sector, and 168 originated (27%) in the academic setting or in collaboration with commercial enterprises. Prescrire graded psychotropic agents (13/14 [93%]), whereas HAS graded respiratory agents (24/25 [96%]) as the highest percentage of medicines that provided no added benefit. Prescrire graded 360 medicines (77.6%) that originated in the industry and 108 medicines (64.3%) that originated in the academic setting (P = .001) to have no added clinical benefit. HAS assigned such grading to 331 ([71.3%] industry) vs 104 ([61.9%] academia) (P = .02). Based on the Prescrire grading, academia invented more medicines delivering some added benefit 57 (33.9%) vs 98 (21.1%) invented by industry (P = .001). HAS grading on some added benefit 51 ([30.4%] academia) vs 121 ([26.1%] industry) did not reach statistical significance (P = .29). However, HAS grading on substantial added clinical benefit reached statistical significance in favor of academia (13 [7.7%] vs 12 [2.6%] in the industry; P = .003), whereas Prescrire grading did not (1.8% academia vs 1.3% industry; P = .64). Conclusions and Relevance: More than 70% of medicines that entered the French market during the 10-year period originated in the commercial sector. Although most medicines were not graded as providing clinical benefit, medicines originating in the academic setting were more likely to be graded as conferring clinical benefit than those originating in the commercial setting.

The Origin of First-in-Class Drugs: Innovation Versus Clinical Benefit.

First-in-class (FIC) designation became a hallmark of innovation, however, even at the marketing authorization stage, little is known about the clinical benefits these products deliver. We identified the provenance of the FIC drugs that entered the French market from 2008 to 2018 and matched these medicines to the clinical benefit grading by Haute Autorité de Santé (HAS) and Prescrire. Analyses were performed using descriptive statistics to present our findings by drug origin and therapeutic area and to establish the degree of concordance between HAS and Prescrire. Of the 135 FIC drugs identified, 71.1% (n = 96) originated from the industry, 16.3% (n = 22) from academia, and 12.6% (n = 17) from joint partnerships. Three therapeutic areas accounted for most FIC medications: antineoplastic (25.9%, N = 35), anti-infective (14.1%, N = 19), and metabolic (11.1%, N = 15) agents. HAS and Prescrire agreed on 60.74% of clinical benefit gradings. According to HAS, only 5% of all FIC drugs had substantial added benefit, and only 3%, according to Prescrire. HAS and Prescrire graded 45.9% and 68.2%, respectively, of FIC drugs as no clinical benefit and 48.9% and 28.9%, respectively, as some clinical benefit. FIC-designated drugs are primarily of industry (> 70%) rather than academic origin. We found that 55% of FIC medicines that entered the French market over the 10-year period deliver no additional clinical benefit. Whereas FIC medicines may represent important scientific advancements in drug development, in > 50% of cases, the new mode of action does not translate into additional clinical benefits for patients.

Botulinum toxin A (IncobotulinumtoxinA) and pneumoperitoneum image-guided for hernia repair with loss of dominance.

Post-incisional ventral hernia is estimated at 5-30%, when the content of the abdominal cavity migrates to the hernial sac (HSV), with a HSV/abdominal cavity volume ratio > 25%, conditioning systemic changes defined as "loss of domain". A 27-year-old male presented with ventral hernia with loss of domain that required pre-operative preparation techniques, using application of botulinum toxin A (IncobotulinumtoxinA) and pneumoperitoneum, both guided by image. A ventral plasty was performed with adequate return of the viscera to the abdominal cavity. The combination of both techniques seems to be a safe procedure to carry out a tension-free repair.

La hernia ventral postincisional se estima en 5 al 30%, cuando el contenido de la cavidad abdominal migra al saco herniario, con una relación VSH/VCA > 25% condicionando cambios sistémicos se define como "pérdida de dominio". Masculino de 27 años con hernia ventral con pérdida de dominio que ameritó técnicas de preparación preoperatoria, utilizando toxina botulínica A (IncobotulinumtoxinA) y neumoperitoneo, ambos guíados por imagen. Se realizó una plastia ventral con adecuado regreso de las vísceras a la cavidad abdominal. La combinación de ambas técnicas es un procedimiento seguro para realizar una reparación libre de tensión.

Dentists' Perceptions of Their SARS-CoV-2 Risk and Infection Control Needs.

OBJECTIVE: Rapid worldwide dissemination of SARS-CoV-2 has prompted dental professionals to optimise their infection control procedures. To help identify areas of opportunity for protecting dentists and their patients, the aim of this investigation was to analyse Mexican dentists' early perceptions of their risk of exposure to SARS-CoV-2 and their need for comprehensive infection control education. METHODS: This cross-sectional survey was conducted from May 9 to June 3, 2020, during the social distancing phase in Mexico. The survey adhered to relevant guidelines for ethical research design. The questionnaire was designed with Google Surveys and applied online in Spanish. The questionnaire included items on demographics and clinical specialisation. To obtain time-sensitive perceptions, statements were preceded by "While SARS-CoV-2 circulates in the community and new COVID-19 cases are reported"; responses were collected in a 5-point Likert-type scale. RESULTS: The survey's link received 1524 "clicks." Over 25 days, 996 dentists participated (39% men; 89% working in Mexico and 11% in other Spanish-speaking Latin American countries). Most participants (73%) fully agreed that "Looking after patients will pose a risk for the dentist." Total agreement was more common (P = .0001) amongst dentists in Mexico (76%) than amongst those in other countries (53%). Knowing someone with COVID-19 was more common amongst Mexican dentists (P = .0008). The perceived need for enhanced infection control procedures increased with age (P = .0001). Forty-nine percent totally agreed that they sterilise dental handpieces between patients. One-third expressed total agreement that everyone in their clinic was trained in infection control. CONCLUSIONS: Amongst this nonprobabilistic self-selected sample of dentists, age and country of work influenced their perceptions about occupational exposure to SARS-CoV-2 and infection control needs. This survey revealed areas of opportunity to improve infection control education and training for dental professionals.

Geometric Morphometrics of the human cervical vertebrae: sexual and population variations.

This study aims to carry out the first geometric morphometric analysis of the 3D size and shape of the full series of cervical vertebrae delving into variability related to sex and population background. For this reason, we analyzed the cervical vertebrae of both males and females belonging to Europeans, Africans, and Greenland Inuit. We 3D-scanned a total of 219 cervical vertebrae of males and females of three different modern human populations (European, African, and Inuit). A minimum of 72 landmarks and curve semilandmarks were positioned in each of the 3D vertebral models. Landmark configurations were analyzed following the standards of 3D Geometric Morphometrics to test for size and shape differences related to sex or population variation. Results show that male cervical vertebrae are consistently larger than in females while no regular shape differences are observed between males and females in any of the populations. Sex differences in cervical lordosis are thus not supported at the skeletal level of the 3D shape. On the other hand, there is no evidence for population-specific differences in size while shape does vary considerably, possibly also in relation to eco-geographic factors of overall trunk shape. Cervical vertebrae in cold-adapted Inuit were consistently shorter than in Europeans and Africans. The cervical spine may show a different pattern than the thoracic and lumbar spine, which might be related to stronger integration with the cranium, head mobility, and soft-tissue dependence. Our findings suggest that morpho-functional interpretations of the cervical spine based on vertebral skeletal morphology requires caution.

Experiencias de los estudiantes de ciencias médicas en la pesquisa activa en tiempos de COVID-19 / Experiences of medical sciences students in active screening in times of COVID-19

RESUMEN Fundamento: la motivación para realizar una tarea resulta esencial en el logro de sus objetivos. Objetivo: exponer las experiencias de los estudiantes vinculados a la pesquisa activa en el enfrentamiento a la COVID-19 en el Policlínico Universitario "Van Troi" del municipio Centro Habana. Métodos: se realizó una investigación descriptiva, exploratoria, con énfasis en el análisis cualitativo, en la que se emplearon métodos teóricos: histórico-lógico, analítico-sintético e inductivo-deductivo; y empíricos: la utilización de la composición como técnica de expresión abierta, realizada por los estudiantes de ciencias médicas que participaron en la pesquisa activa para el enfrentamiento a la COVID-19, de marzo a octubre de 2020. Resultados: el 100 % de la muestra manifestó un carácter positivo hacia la tarea, tanto en el indicador vínculo afectivo como elaboración personal. Se apreciaron discursos con un vínculo optimista a partir de lo aprendido en la actividad, reconocieron la necesidad del esfuerzo y del sacrificio ante el estudio. No se observó una visión negativa, ni rechazo. Conclusiones: la realización de este trabajo permitió reconocer que existe alta motivación en los estudiantes hacia la pesquisa activa, dado que los juicios emitidos fueron siempre satisfactorios; sus experiencias permitieron establecer la influencia positiva de su incorporación en el currículo de las carreras.

ABSTRACT Background: motivation to carry out a task is essential to achieve its goals Objectives: to present the experiences of the students linked to active screening while facing COVID-19 at "Van Troi" University Polyclinic from Centro Habana municipality. Methods: a descriptive, exploratory research was carried out, with emphasis on qualitative analysis, in which theoretical methods were used: historical-logical, analytical-synthetic and inductive-deductive; and empirical ones: the use of composition as an open expression technique, carried out by medical science students who participated in the active screening while facing COVID-19, from March to October 2020. Results: 100% of the sample showed a positive character towards the task, both in the affective link indicator and personal development. Opinions with an optimistic character were appreciated from what was learned in the activity, they recognized the need for effort and sacrifice while studying. No negative view or rejection was observed. Conclusions: carrying out this work allowed us to recognize that there is high motivation in students towards active screening, since the judgments made were always satisfactory; their experiences made it possible to establish the positive influence of their incorporation into the degree curriculum.

Balance del asesoramiento médico-legal hospitalario mediante análisis factorial exploratorio / Balance of hospital legal medical counselling through exploratory factor analysis

Introducción: El estudio de los enfoques de la medicina legal ha sido ampliamente afrontado en publicaciones en el ámbito de la justicia. Sin embargo, la temática de los servicios de medicina legal hospitalaria ha sido escasamente abordada en investigaciones; no atendiendo a la importancia que tienen estos servicios para el perfeccionamiento de la gestión del riesgo legal de los sistemas sanitarios. Objetivo: Reconocer la estructura factorial de las prestaciones del servicio de medicina legal en un hospital de alto nivel, entre los demandantes de consulta por problemas derivados de la actividad asistencial del hospital. Material y método: Se realizó un estudio descriptivo transversal con una muestra de 1.213 expedientes abiertos durante los años 2007 y 2017. Se efectuó un análisis factorial exploratorio por extracción de componentes principales con Rotación Varimax. Resultados: La media de expedientes fue de 110,27 por año con una desviación típica de 39,51. El análisis factorial mostró la bidimensionalidad de la utilidad del registro (carta de servicios de medicina legal y fundamento médico-legal de las consultas), con la existencia de dos factores subyacentes que, sumados, explicaron el 68,04% de la varianza total. Conclusiones: Se ha obtenido una estructura factorial simplificada a dos factores con una confiabilidad elevada del cuestionario de registro. Por su naturaleza registral y facilidad de empleo, es aconsejable considerar su utilización en la evaluación de la demanda de asesoramiento al servicio de medicina legal hospitalaria por parte de los diferentes usuarios que acuden por problemas relacionados con las actividades habituales del hospital. (AU)

Introduction: The study of legal medicine approaches has been widely addressed in publications in the field of justice. However, the subject of hospital legal medicine services has been scarcely addressed in research; not attending to the importance of these services for the improvement of the legal risk management of health systems. Objective: To recognize the factorial structure of the benefits of the legal medicine service in a high-level hospital, among those seeking consultation for problems arising from the hospital's healthcare activity. Material and method: A descriptive cross-sectional study was carried out with a sample of 1213 files opened during the years 2007 and 2017. An exploratory factor analysis was performed by extraction of main components with varimax rotation. Results: The average of records was 110.27 per year with a standard deviation of 39.51. The factorial analysis showed the two-dimensionality of the usefulness of the registry (letter of legal medicine services and medical-legal basis of the consultations), with the existence of two underlying factors that, added together, explained 68.04% of the total variance. Conclusions: A simplified factor structure to two factors has been obtained with a high reliability of the registration questionnaire. Due to its registry nature and ease of use, it is advisable to consider its use in evaluating the demand for advice to the hospital legal medicine service by the different users who come for problems related to the usual activities of the hospital. (AU)

[Defensive medicine in hospital emergency services.] / Medicina defensiva en los Servicios de Urgencias Hospitalarias.

OBJECTIVE: Hospital emergency services have specific care characteristics that make them more vulnerable to the risk of legal claims. The fact of suffering a legal claim for professional practice is a very traumatic event. The objective of this study was to find out the opinion of the professionals of the hospital emergency services in Spain on the importance of practices associated with defensive medicine. METHODS: Survey of 1,449 professionals from public and private hospital emergency services throughout the national territory was made, in the period between March 13th and April 3rd, 2017. A univariate analysis was performed to identify variables in relation to the practice of defensive medicine, and the determination of the groups of greater association (chi2 test) to evaluate these variables. RESULTS: 96.1% expressed the need to strengthen their medical-legal training. 91.3% of the cases felt more legal pressure and 88.7% declared that they act conditioned by the threat of judicial claim. Regarding patient treatments, 89.8% stated that they perform diagnostic tests that may not be necessary and 63% of professionals stated that they extend the stay of patients in the emergency department. As for the healthcare organization, 88% declared that they do not feel protected by the structure and 79.1% do not felt support from the center's management. CONCLUSIONS: Practices associated with defensive medicine are frequent in our country, with a high proportion of criminal proceedings, and the two main causes are dispensable diagnostic tests and unnecessary prolongation of length of stay.

OBJETIVO: Los Servicios de Urgencias Hospitalarias presentan características asistenciales específicas que los hacen más vulnerables al riesgo de reclamaciones legales. El hecho de sufrir una reclamación judicial por la praxis profesional es un evento muy traumático. El objetivo de este estudio fue conocer la opinión de los profesionales de los Servicios de Urgencias Hospitalarias en España sobre la importancia de las prácticas asociadas a la medicina defensiva. METODOS: Se realizó un estudio mediante encuesta a 1.449 profesionales de Servicios de Urgencias Hospitalarias públicas y privadas de todo el territorio nacional, en el periodo comprendido entre el 13 de marzo y el 3 de abril de 2017. Se realizó un análisis univariante para la identificación de variables en relación con la práctica de la medicina defensiva, así como la determinación de los grupos de mayor asociación (test χ2) para evaluar estas variables. RESULTADOS: Un 96,1% expresaron la necesidad de fortalecer su formación médico-legal. Un 91,3% de los casos sintió mayor presión legal y un 88,7% declaró actuar condicionado por la amenaza de reclamación judicial. En lo referente a los tratamientos a los pacientes, un 89,8% afirmó realizar pruebas diagnósticas que podrían no ser necesarias y un 63% de los profesionales declaró alargar la estancia de los pacientes en las Urgencias. En cuanto a la organización sanitaria, un 88% manifestó no sentirse protegido por la estructuray un 79,1% no sintió el respaldo de la dirección del centro. CONCLUSIONES: Las prácticas asociadas a la medicina defensiva son frecuentes en nuestro país, con una alta proporción de procedimientos penales, y las dos causas principales son las pruebas diagnósticas prescindibles y la prolongación innecesaria de los tiempos de estancia.

La especialidad de Medicina Legal y Forense en España: La consolidación por el sistema de residencia / Legal and Forensic Medicine Specialty in Spain: the consolidation by the medical residency system

No disponible

[Utility of the classification analysis in the typology of the the suicide attempt in a hospital population.] / Utilidad del análisis de clasificación en la tipología del intento de suicidio en una población hospitalaria.

OBJECTIVE: Subjects who attempt suicide are not a homogeneous group. Numerous studies accredit different subtypes of individuals with suicide attempts. One of the main applications of classification analysis is the segmentation and selection of the subject's characteristics. The objective of this study is to identify groups of subjects with a suicide attempt and to discover the relationships between them in the hospital population of an area of the Community of Madrid. METHODS: In a case-control study, the classification tree technique based on the CHAID (Chi-square automatic interaction detector) algorithm, included in the SPSS 23.0 program, was applied to a sample of 201 subjects admitted to a highly complex hospital of Madrid. Impulsiveness, couple conflict, psychiatric history and depression were evaluated. RESULTS: Three subtypes or differentiable profiles of the subject related to the suicide attempt have been obtained, (high profile 144 cases 71.64%, medium 35 cases 17.41% and low 22 cases 10.94% of basic risk patterns) with high application value to the clinical setting. CONCLUSIONS: The typologies found allow us to adapt preventive measures on the suicide attempt and carry out focused clinical interventions of a preventive and predictive nature.

OBJETIVO: Las personas que intentan suicidarse no constituyen un grupo homogéneo. Numerosos estudios acreditan distintos subtipos de individuos con intentos de suicidio. Una de las principales aplicaciones del análisis de clasificación es la segmentación y selección de las características del sujeto. El objetivo de este estudio fue identificar grupos de sujetos con intentos de suicidio y descubrir las relaciones entre ellos en la población hospitalaria de un área de la Comunidad de Madrid. METODOS: En un estudio de caso-control se aplicó la técnica de árbol de clasificación basado en el algoritmo CHAID (Chi-square automatic interaction detector), incluido en el programa SPSS 23.0, sobre una muestra de 201 sujetos ingresados en un hospital de alta complejidad de Madrid. Se evaluaron la impulsividad, la conflictividad de pareja, los antecedentes psiquiátricos y la depresión. RESULTADOS: Se obtuvieron tres subtipos o perfiles diferenciables del sujeto vinculados al intento de suicidio (perfil alto 144 casos 71,64%, medio 35 casos 17,41% y bajo 22 casos 10,94% de patrones básicos de riesgo), con alto valor de aplicación al ámbito clínico. CONCLUSIONES: Las tipologías encontradas permiten adecuar medidas preventivas sobre el intento de suicidio y realizar intervenciones clínicas focalizadas de carácter preventivo y predictor.

[Evaluation of risk factors for suicide attempt in a hospital clinical population in the Community of Madrid.] / Evaluación de factores de riesgo del intento suicida en población clínica hospitalaria en la Comunidad de Madrid.

OBJECTIVE: Suicide attempts have increased considerably in recent decades. They are multifactorial in nature with preventable biopsychosocial components. Suicide attempt constitutes a vital event that affects the family and socioeconomic systems with important repercussions on public health. It is important to identify and analyze the associated risk factors, so that health professionals can consider them in their clinical practice in order to prevent them. The objective of this study was to identify the risk and protection factors that were associated with suicide attempt in the hospital population of an area of the Community of Madrid. METHODS: An analytical study of paired case-controls of patients who attended the reference hospital in Area 6 of the Community of Madrid during 2016 was carried out. Percentages were calculated and chi-square tests were used to establish an association and calculation of odds ratio with its confidence intervals and for a statistical significance of p≤0.05. RESULTS: An association was identified between the suicide attempts of the following variables: depression, couple conflict, psychiatric history and high anxiety, among others. Influence of insufficient economic income and low educational level was found. Of the 67 cases, 59.7% were female, with a predominance of the age groups 21-30 and 31-40 years with 28.36% in both. 82.2% had low income. 35.8% used drugs. 62.7% had some chronic disease. 59.7% presented high anxiety, 53.7% major depression and 67.1% high impulsivity. CONCLUSIONS: There are psychopathological and personal behavioral factors related to suicide attempts, as well as a high percentage of people who attempt to commit suicide by factors of socio-economic and cultural deprivation.

OBJETIVO: Los intentos de suicidio han aumentado considerablemente en las últimas décadas. Son de causa multifactorial con componentes biopsicosociales prevenibles. El intento suicida constituye un evento vital que repercute en el sistema familiar y en el socioeconómico, presentando importantes repercusiones en la salud pública. El objetivo de este estudio fue identificar los factores de riesgo y protección que se asociaban con el intento suicida en la población hospitalaria de un área de la Comunidad de Madrid. METODOS: Se realizó un estudio analítico de casos-controles pareados de los pacientes que acudieron por intento de suicidio al hospital de referencia del Área 6 de la Comunidad de Madrid durante el año 2016. Se calcularon porcentajes y para establecer la asociación se utilizaron pruebas de chi-cuadrado y cálculo de odds ratio con sus intervalos de confianza y para una significación estadística de p≤0,05. RESULTADOS: Se reconoció asociación con el intento suicida de las siguientes variables: depresión, conflictividad de pareja, antecedentes psiquiátricos y elevada ansiedad, entre otros. Se halló influencia de insuficientes ingresos económicos y el escaso nivel educativo. De los 67 casos, 59,7% fueron del sexo femenino, con un predominio de los grupos etarios de 21-30 y 31-40 años con 28,36% en ambos. El 82,2% presentaron bajos ingresos económicos. Un 35,8% consumía drogas. El 62,7% presentaba alguna enfermedad crónica. Presentaron ansiedad elevada un 59,7%, depresión mayor el 53,7% e impulsividad alta el 67,1%. CONCLUSIONES: Existen factores psicopatológicos y personales de conducta relacionados con los intentos de suicidio, así como un alto porcentaje de personas que intentan suicidarse por factores de privación socioeconómica y cultural.

A meta-analytic review for the patella sexual dimorphism assessment / Una revisión meta-analítica para la evaluación del dimorfismo sexual de la patela

Sexual dimorphism is one of the most important ways to identify bone remains in mass disasters. Many of them have been used for this purpose; mainly skull, pelvis and long bones. However, only a few studies using the patella have been done and, to our knowledge, there are no assessments of previous results in the literature. Meta-analysis provides a useful strong tool to test, in a systematic way, the most relevant information about a given research field. The aim of this study is to apply the meta-analytic technique to assess the major studies concerning sexual dimorphism in the patella by measuring classical metric traits: maximum height and maximum width, with different techniques, such as caliper, radiography, tomography and magnetic resonance. The 17 papers found, involving a total sample size higher than 2600 patellae, showed a very high heterogeneity- around 93 % of I2 value, for height and width measurements when all the studies were analyzed together. Homogeneity increased when each study was classified according to the techniques used. In this case, a statistical difference appeared, among the several subgroups of techniques for the two measurements, suggesting the importance of the methodology used. Maximum height and maximum width were all showed to be statistically relevant in distinguishing both sexes.

El dimorfismo sexual es una de las formas más importantes para identificar restos óseos en desastres masivos. Se han utilizado huesos como cráneo, pelvis y huesos largos para la diferenciación sexual. Sin embargo, solo se han realizado unos pocos estudios con la patela y, hasta donde sabemos, no hay evaluaciones de resultados anteriores en la literatura. El meta-análisis proporciona una herramienta sólida y útil para probar, de manera sistemática, la información más relevante sobre un cierto campo de investigación. El objetivo de este estudio consiste en aplicar la técnica metaanalítica para evaluar los principales estudios sobre dimorfismo sexual en la patela midiendo los rasgos métricos clásicos: altura máxima y anchura máxima, con diferentes técnicas: calibre, radiografía, tomografía y resonancia magnética. Los 17 de documentos encontrados, con un tamaño de muestra total superior a 2600 patelas, mostraron una heterogeneidad muy alta, alrededor del 93 % del valor de I2, para mediciones de altura y anchura cuando todos los estudios se analizaron juntos. La homogeneidad aumentó cuando cada estudio se clasificó de acuerdo con las técnicas utilizadas. En este caso, se observó diferencias estadísticas, entre los subgrupos de técnicas para las dos mediciones, lo que sugiere la importancia de la metodología utilizada. La altura máxima y la anchura máxima mostraron ser estadísticamente relevantes para distinguir ambos sexos.

Hipotalamotomía en pacientes con agresividad refractaria: resultados funcionales / Hypothalamotomy in patients with treatment-resistant aggressiveness: functional outcomes

INTRODUCCIÓN: La agresividad forma parte de las manifestaciones comportamentales asociadas a algunos trastornos mentales, es un síntoma de difícil manejo y, con frecuencia, es refractaria a las medidas farmacológicas. La cirugía de los trastornos del comportamiento surge como una alternativa terapéutica. Este procedimiento consiste en realizar intervenciones sobre distintas estructuras del sistema límbico, con el fin de corregir la alteración del circuito que estaría implicado en la producción de los síntomas. OBJETIVO: Describir los resultados clínicos de la hipotalamotomía posterior con gamma knife en el control de la agresividad en 20 pacientes refractarios al tratamiento, intervenidos en el Centro Médico Imbanaco entre 2013 y 2018. PACIENTES Y MÉTODOS: La gravedad de la agresividad se cuantificó mediante la escala de agresividad manifiesta (OAS) y la escala de impresión clínica global (CGI-SI), y su impacto funcional, a través de la escala de evaluación de la actividad global (EEAG). RESULTADOS: El control de la agresividad se observó en todos los pacientes tratados con hipotalamotomía posterior con gamma knife, evidenciado por la disminución en las puntuaciones de la OAS y la CGI-SI y la mejoría en la EEAG. CONCLUSIONES: La hipotalamotomía posterior muestra bajas complicaciones, seguridad en el procedimiento y buenos resultados, lo cual sugiere que podría ser una buena alternativa de tratamiento en los casos de agresividad refractaria donde las medidas farmacológicas y terapéuticas parecen agotarse

INTRODUCTION: Aggressiveness is part of the behavioural manifestations associated with some mental disorders; it is a symptom that is difficult to manage and is often resistant to pharmacological measures. Surgery for behavioural disorders emerges as a therapeutic alternative. This procedure consists in performing interventions on different structures of the limbic system in order to correct the alteration of the circuit involved in producing the symptoms. AIM: To describe the clinical outcomes of a posterior hypothalamotomy with gamma knife to control aggressiveness in 20 patients resistant to treatment, who underwent surgery at the Imbanaco Medical Centre between 2013 and 2018. PATIENTS AND METHODS: The severity of the aggressiveness was quantified using the Overt Aggression Scale (OAS) and the Clinical Global Impression Scale (CGI-SI), and its functional impact is evaluated using the Global Assessment of Functioning scale (GAF). RESULTS: Control over aggressiveness was observed in all patients treated by posterior hypothalamotomy with gamma knife, evidenced by a decrease in the scores on the OAS and CGI-SI and an improvement in the GAF. CONCLUSIONS: Posterior hypothalamotomy gives rise to few complications, is a safe procedure and offers good results, suggesting that it could be a good alternative treatment in cases of treatment-resistant aggressiveness where it seems that all the possible pharmacological and therapeutic measures have failed

Actividad de un servicio de medicina legal hospitalaria del siglo XXI / Activity of a 21st century hospital medico-legal department

INTRODUCCIÓN: La implantación de un Servicio de medicina legal hospitalaria, como asesor y consultor en aspectos médico-legales, éticos y deontológicos de la práctica asistencial, se ha consolidado en el Hospital Clínico de San Carlos de Madrid. Una cartera de servicios sencilla basada en la prevención de riesgos legales, ha permitido que los profesionales, la administración sanitaria y los propios pacientes confíen en él. RESULTADOS: En el período 2007-2017 se gestionaron 1.213 expedientes, aumentando de forma progresiva y destacando los años 2009 y 2017 con un 13,8 y 12,3% de la actividad total, respectivamente. Las unidades que más consultaron fueron el equipo directivo 158 (13%), el Instituto de la Mujer 144 (11,9%) y el Servicio de Atención al Paciente 116 (9,6%). DISCUSIÓN Y CONCLUSIONES: El servicio participa en múltiples comisiones y grupos de trabajo elaborando guías, documentos y protocolos, abordando conflictos, dudas normativas, deficiencias formativas, recomendando cursos de acción, e intermediando con pacientes y familiares para disminuir la incertidumbre del profesional

INTRODUCTION: A hospital legal medicine department, to advice and consult on the legal, ethical and deontological aspects of healthcare practice, has been implemented in our centre, Hospital Clínico San Carlos (Madrid Spain). A simple service portfolio based on the prevention of legal risks, has allowed professionals, health service and patients to place their trust in it. RESULTS: The number of cases over the period 2007-2017 reflects major activity, and 2009 and 2017 are highlighted with 13.8% and 12.3% of the total activity respectively. The units that consulted the most were the management team 158 (13%), the Institute for Women's Affairs 144 (11.9%) and the Patient Care Service 116 (9.6%). DISCUSSION AND CONCLUSIONS: The department participates in multiple committees and working groups preparing guidelines, documents and protocols, addressing conflicts, regulatory doubts, training deficiencies, recommending courses of action, and mediating with patients and family members to reduce professional uncertainty

Spanish allele and haplotype database for 32 X-chromosome Insertion-Deletion polymorphisms.

X-chromosome markers have been proved to be decisive both complementing and solving kinship analysis, particularly when autosomal markers are not able to produce adequate likelihood ratios between different hypothesis. On the other hand, Pereira et al., (2012) have demonstrated that 32 Insertion/Deletion (InDel) markers located on the X-Chromosome have a very important power of discrimination in human populations, being a novel tool in the forensic and population fields. So, the aim of the present work was testing the forensic and population genetic efficiency of the 32 X-InDel polymorphisms in the Spanish population, and subsequently build an allele/haplotype frequencies database. To accomplish this objective, a total of 555 samples comprising male individuals from 13 Spanish regions were analysed for the above mentioned 32 X-InDels in two independent laboratories. A pairwise FST analysis was performed in order to understand if the studied Spanish sub-populations present significant differences among them, detecting possible population substructure. Also, linkage disequilibrium analyses were computed to investigate the presence of association between markers in the Spanish population. After Bonferroni correction, the absence of significant differences among the studied regions supports a global Spanish population database. Concerning LD, besides previously reported linked markers MID356-MID357 and MID3690-MID3719-MID2089, we also detected significant association between MID3703-MID3774, even after Bonferroni correction. Finally, after computing allele and haplotype frequencies, forensic efficiency parameters were calculated (PDmales = 99.999976 %; PDfemales = 99.99999999998 %). Mean exclusion chance values for duos were 0.999 and trios 0.99999. These results reinforce the suitability of the 32 X-InDels marker set both in identification and kinship studies.

Remote monitoring of implantable cardiac devices in heart failure patients: a systematic review and meta-analysis of randomized controlled trials.

This study aims to determine whether the use of remote monitoring (RM) in implantable cardiac devices decreases all-cause mortality and heart failure (HF)-related hospitalization. We sought to conduct a systematic review and a meta-analysis of published randomized controlled studies. The population is adult patients with a diagnosis of HF with implantable devices. The intervention is RM using implantable cardiac devices whether added or used alone compared to standard of care. The outcomes are HF-related hospitalization and all-cause mortality. Risk of bias was assessed using the criteria defined in the Revised Cochrane Collaboration's tool for assessment of risk of bias. Data were extracted and validity was assessed independently by two reviewers. Electronic databases EMBASE and MEDLINE (Ovid) were searched up to 14th of October 2019, supplemented by a second search in CENTRAL (Cochrane Central Register of Controlled Trials) and clinicaltrials.gov. Only randomized controlled studies published in peer-reviewed journals with full format text in English of adult HF patients with a minimum follow-up of 6 months reporting mortality and/or hospitalization. Observational studies and studies that did not meet inclusion criteria were excluded. Thirteen randomized controlled studies that enrolled a total of 7015 patients were identified, 7 of which reported on all-cause mortality only and included 4460 patients. Compared with standard of care, the pooled relative risk (RR) of all-cause mortality and HF-related hospitalization in patients with RM compared to those receiving standard of care was 0.88 (95% confidence interval (CI) 0.69 to 1.11) and 0.95 (95% CI 0.78-1.16), respectively. In the subgroup analysis, using pulmonary pressure for RM was associated with a decrease in HF-related hospitalization (RR 0.73; 95% CI 0.60-0.88). RM showed benefit in reducing HF-related hospitalization when compared to standard of care only when using pulmonary pressure monitoring.

Management of Heart Failure with Reduced Ejection Fraction after ESC 2016 Heart Failure Guidelines: The Linx Registry.

AIMS: In May 2016, a new version of the European Society of Cardiology (ESC) Guidelines for the management of heart failure (HF) was released. The aim of this study was to describe the management of HF with reduced ejection fraction after the publication of ESC Guidelines. METHODS AND RESULTS: The Linx registry is a multicentre, observational, cross-sectional study from 14 Catalan hospitals that enrolled 1056 patients with HF and reduced left ventricular ejection fraction (≤40%) from 1 February to 30 April 2017 in outpatient cardiology clinics. Results were compared between hospitals according to their level of complexity in our own registry and compared with previously published registries similar to ours. Sacubitril/valsartan was prescribed to 23.9% of patients in our population, as a consequence, use of angiotensin-converting enzyme inhibitor and angiotensin receptor blockers in monotherapy decreased to 48.1% and 16.9%, respectively, and prescription of beta-blockers (91.8%), mineralocorticoid receptor antagonists (72.7%), and ivabradine (21.4%) remained similar to previous registries. Target doses of beta-blockers (25.4%), angiotensin-converting enzyme inhibitors (24.9%), angiotensin receptor blockers (7.7%), sacubitril/valsartan (8.1%), and mineralocorticoid receptor antagonists (19.7%) were accomplished in a low proportion of patients. Our results also suggest that prescription and up-titration of class I HF drugs were greater in hospitals with higher level of complexity. CONCLUSIONS: The Linx registry shows an appropriate adherence to pharmacological recommendations from ESC HF Guidelines despite a low proportion of patients reached target doses. Almost one-quarter of patients were under treatment with sacubitril/valsartan a few months after ESC HF Guidelines recommendations.