Subclinical myocardial involvement in a cohort of patients with antisynthetase syndrome.

OBJECTIVES: There is an increasing interest in knowing whether patients with antisynthetase syndrome (ASSD) may have silent myocardial interstitial involvement. Mapping techniques in cardiac magnetic resonance (CMR) can detect subclinical myocardial involvement. The purpose of this study was to identify alterations in multiparametric CMR in ASSD patients without overt cardiac involvement. METHODS: Patients diagnosed with ASSD underwent a CMR along with the standard clinical workup, investigation of specific and associated myositis antibodies, and high-resolution chest CT. The CMR protocol includes routine morphologic, functional, and late gadolinium enhancement sequences in standard cardiac planes, as well as native T1 and T2 mapping sequences and extracellular volume (ECV) calculation. RESULTS: Twenty-five patients were included in this study (56% women; median age 56.3 years). Three patients were considered in the acute phase at the time of inclusion. Eight patients (32%) showed pathological findings in CMR (6 stable disease, 2 acute phase). Elevated T1, T2 and ECV mapping values were found in 20% (5/25), 17% (4/25) and 24% (6/25) of the group, respectively. Two patients in the acute phase had increased values of both T2 and ECV. CONCLUSIONS: Subclinical myocardial involvement in ASSD is not rare (32%) although its clinical significance is uncertain. Myocardial oedema (T2) was the most frequent finding, followed by increased T1 and/or ECV values likely signalling interstitial fibrosis. Of note, patients in the acute phase showed elevated T2 values.

Infectious diseases experts as part of the antibiotic stewardship team in primary care: protocol for a cluster-randomised blinded study (IDASP).

INTRODUCTION: Antibiotic overuse is directly related to antibiotic resistance, and primary care is one of the main reasons for this overuse. This study aims to demonstrate that including experts on infectious diseases (ID) within the antimicrobial stewardship (AMS) programme team in primary care settings achieves higher reductions in overall antibiotic consumption and increases the quality of prescription. METHODS AND ANALYSIS: A multicentre, cluster-randomised, blinded clinical trial will be conducted between 2021 and 2023. Six primary care centres will be randomly assigned to an advanced or a standard AMS programme. The advanced AMS programme will consist of a standard AMS programme combined with the possibility that general practitioners (GP) will discuss patients' therapies with ID experts telephonically during working days and biweekly meetings. The main endpoint will be overall antibiotic consumption, defined as daily defined dose per 1000 inhabitants per day (DHD). Secondary end-points will be: (1) unnecessary antibiotic prescriptions in patients diagnosed with upper respiratory tract or urinary tract infection, (2) adequacy of antibiotic prescription, (3) reattendance to GP or emergency room within 30 days after the initial GP visit and (4) hospital admissions for any reason within 30 days after the GP visit. Two secondary endpoints (unnecessary antibiotic therapy and adequacy of therapy) will be evaluated by blinded investigators.We will select three clusters (centres) per arm (coverage of 147 644 inhabitants) which will allow the rejection of the null hypothesis of equal consumption with a power of 80%, assuming a moderate intracluster correlation of 0.2, an intracluster variance of 4 and a mean difference of 1 DHD. The type I error will be set at 5%. ETHICS AND DISSEMINATION: The protocol was reviewed and approved by local ethics committees. The results of this study will be published in peer-reviewed journals and presented at medical conferences. TRIAL REGISTRATION NUMBER: NCT04848883.

Substrate characterization of the right ventricle in repaired tetralogy of Fallot using late enhancement cardiac magnetic resonance.

BACKGROUND: Three-dimensional (3D) substrate characterization by high-resolution late gadolinium enhancement cardiac magnetic resonance (LE-CMR) is useful for guiding ventricular tachycardia ablation of the left ventricle in ischemic heart disease. OBJECTIVE: The purpose of this study was to validate the substrate characterization and 3D reconstruction of LE-CMR images of the right ventricle (RV) in patients with repaired tetralogy of Fallot (rTOF) and to identify the algorithm that best fits with electroanatomic mapping (EAM). METHODS: RV LE-CMR images were compared with RV EAM in 10 patients with rTOF. RV LE-CMR images were postprocessed and analyzed to identify fibrotic tissue on 3D color maps. The 3D RV substrate reconstructions were created using an adjustable percentage of the maximum voxel signal intensity (MSI) of the scar region to define the threshold between core, transitional zone (TZ), and healthy tissue. Extensions of the core and TZ areas were compared with the scar (<0.5 mV) and low-voltage (0.5-1.5 mV) areas obtained by RV EAM. Agreement on anatomic isthmi identification was quantified. RESULTS: The best match between core and scar was obtained at 65% MSI cutoff (mean areas 17.4 ± 9.9 cm2 vs 16.9 ± 10.0 cm2, respectively; r = 0.954; P <.001). Agreement on anatomic isthmi identification was best at 60% MSI cutoff, which identified 95% of isthmi and achieved a total fit in 90% of patients. CONCLUSION: This study demonstrates that characterization of the RV substrate by postprocessing LE-CMR images in rTOF patients is feasible and validates the technique against RV EAM, which could help in planning target ablation.

Efecto del sexo en el rendimiento académico de estudiantes de biología biosanitaria de la Universitat Pompeu Fabra / The effect of gender on the academic performance of students of biosanitary biology at Pompeu Fabra University

Introducción: Actualmente, las universidades españolas fomentan políticas de igualdad de género, entre ellas la Universitat Pompeu Fabra. Las autoridades educativas de la Facultad de Ciencias de la Salud y de la Vida de dicha universidad estaban interesadas en conocer si el resultado académico de sus egresados era similar entre hombres y mujeres. Objetivo: Para conseguir la meta anterior, se planteó un estudio con todas las personas egresadas en la licenciatura de biología, primera titulación que se implantó en la facultad y que tenía una orientación biosanitaria. Sujetos y métodos: Se registraron las calificaciones de todos los egresados de las diez promociones de la licenciatura referentes al expediente final y a cinco asignaturas con características cognitivas diferentes: anatomía, fisiología, genética, bioinformática y bioética. Resultados: Los resultados en todas las variables estudiadas fueron similares entre hombres y mujeres, no existiendo ninguna diferencia significativa. Conclusiones: Los resultados se valoraron positivamente ya que, al haber igualdad entre sexos, no se consideró que fueran necesarias medidas especiales respecto al tema estudiado para fomentar la igualdad

Introduction: Currently, Spanish universities promote policies of gender equality, including the Pompeu Fabra University. The educational authorities of the Faculty of Health and Life Sciences of this university were interested in knowing if the academic result of their graduates was similar between men and women. Aim: To achieve the above goal, a study was planned with all the people graduated from the Biology degree, the first degree that was implemented in the faculty and that had a bio sanitary orientation. Subjects and methods: The qualifications of all the graduates of the 10 undergraduate promotions in the final file and five subjects with different cognitive characteristics were recorded: anatomy, physiology, genetics, bioinformatics and bioethics. Results: The results in all the variables studied were similar between men and women, with no significant differences. Conclusions: The results were positively valued since, as there was equality between genders, it was not considered that special measures were necessary to promote equality regarding academic performance

Developing creative and research skills through an open and interprofessional inquiry-based learning course.

BACKGROUND: Biomedicine needs innovative professionals. Inquiry-based learning (IBL) aims to develop higher order thinking skills, such as creativity and research. Stimulatory techniques and interprofessional education, which requires students from different fields to collaborate, also enhances creativity. In this study, the effectiveness of an interprofessional IBL course that introduces a creativity workshop based on stimulatory techniques to develop creative and research skills is examined. METHODS: 529 undergraduate human biology and medical students performed the interprofessional IBL course, 198 with the creativity workshop and 331 without. Students' perceptions of learning processes and outcomes were assessed in surveys and focus groups by the authors of this study. As well, the final learning results from both groups of students were analyzed by the teachers of the course and the researchers. RESULTS: The results show that the open IBL approach promoted the development of these skills, interprofessionality acted as a creativity enhancer and stimulatory techniques contributed to improve the learning outcomes. CONCLUSIONS: This study provides insight into how open interprofessional IBL fosters acquisition of complex skills and knowledge, pointing out the benefits and limitations of this approach in health sciences studies.

Teaching Responsible Research and Innovation: A Phronetic Perspective.

Across the European research area and beyond, efforts are being mobilized to align research and innovation processes and products with societal values and needs, and to create mechanisms for inclusive priority setting and knowledge production. A central concern is how to foster a culture of "Responsible Research and Innovation" (RRI) among scientists and engineers. This paper focuses on RRI teaching at higher education institutions. On the basis of interviews and reviews of academic and policy documents, it highlights the generic aspects of teaching aimed at invoking a sense of care and societal obligation, and provides a set of exemplary cases of RRI-related teaching. It argues that the Aristotelian concept of phronesis can capture core properties of the objectives of RRI-related teaching activities. Teaching should nurture the students' capacity in terms of practical wisdom, practical ethics, or administrative ability in order to enable them to act virtuously and responsibly in contexts which are often characterized by uncertainty, contention, and controversy.

Percepciones de estudiantes y docentes sobre la implementación del aprendizaje basado en problemas como método docente / Perceptions of students and teachers about the implementation of problem-based learning as a teaching method

Introducción: La opinión de los participantes es un elemento clave en los procesos de innovación educativa. El presente artículo describe las percepciones de los estudiantes y de los docentes sobre la introducción del aprendizaje basado en problemas para la adquisición de competencias. Sujetos y métodos: El estudio se realizó para evaluar el proyecto de introducción parcial del aprendizaje basado en problemas como método docente en la licenciatura de Biología. Se recogió información durante seis promociones mediante una encuesta en la que se puntuaba de 1 a 10 sobre la percepción del desarrollo de competencias genéricas y científicas, el valor formativo de la metodología, la satisfacción con la experiencia y una pregunta abierta sobre sugerencias de mejora. Resultados: La percepción de adquisición de la competencia científica aumentó ligeramente a lo largo de los cursos, sin diferencias entre tutores y estudiantes, con valores medios cercanos a 7. En las competencias transversales, las puntuaciones fueron similares, pero las de los tutores resultaron generalmente superiores. Sobre la utilidad del método, los estudiantes puntuaron con valores medios de 5,5 a 6 según el curso y los tutores volvieron a dar puntuaciones superiores (rango: 7,3-8). En el caso de la satisfacción, los estudiantes dieron valores medios de 6 y los de los tutores fueron significativamente superiores. Conclusiones: La introducción del aprendizaje basado en problemas fue valorado positivamente por los estudiantes y especialmente por los tutores como método para adquirir competencia científica y diversas competencias transversales

Introduction: The opinions of participants are a key element in the processes of evaluating the effect of educative innovation. This paper describes the perceptions of students and teachers about the usefulness of problem-based learning for the acquisition of competencies. Subjects and methods: This survey was carried out in the Bachelor of Biology to assess the project of partial implementation of problem-based learning as a teaching method. Information was collected during six cohorts using a questionnaire with several questions about the perceptions on the acquisition of scientific competence and generic competences, the didactic usefulness of the method, and the satisfaction with the experience by means of a numerical scale from 0 to 10. An open question to suggest improvements was also included. Results: The perception on the acquisition of scientific competence slightly increased during the years of the Bachelor. No differences were observed between students and tutors, with mean values close to 7. In generic competences, the mean value was similar but tutors scored higher than students. Regarding the question of the usefulness of the method, mean values of students were in the range of 5.5-6 and tutors again scored higher (range: 7.3-8). When satisfaction was evaluated, students scored a mean value of 6 whereas tutors scores were significantly higher. Conclusions: The introduction of problem-based learning was considered positive by students, and especially by tutors, as a method to acquire scientific and generic competences

Primeros casos de « burries o mulas» de cocaína líquida en fallecidos / First cases of deceased burriers due to liquid cocaine

La detección de paquetes de cocaína intracorporal en forma sólida en fallecidos, es común desde hace años. La rotura de alguno de estos envases produce la muerte por intoxicación aguda como consecuencia de la sustancia que contienen. Presentamos 2 casos de fallecidos en que la forma de presentación es líquida. Esta nueva modalidad de presentación de la droga añade además la peligrosidad de las sustancias utilizadas como diluyente (AU)

The detection of intracorporeal packets of drugs in solid form in deceased people has been common for years. The breaking of some of these containers causes death by poisoning because of the substance they contain. We present two cases of deceased people in which the presentation form is liquid. Furthermore, this new modality of presenting the drug also adds the danger of the substances used as the diluent (AU)

Impacto de una intervención informativa sobre el programa de cribado de cáncer colorrectal en profesionales de atención primaria / Impact of an informative intervention on the colorectal cancer screening program in primary care professionals

OBJETIVO: Evaluar el impacto de una intervención informativa a profesionales de atención primaria sobre sus conocimientos de cribado de cáncer colorrectal, recomendaciones de vigilancia posterior y estrategias de derivación. Método DISEÑO: Ensayo clínico controlado y aleatorizado por conglomerados. Emplazamiento: centros de atención primaria de L'Hospitalet de Llobregat (Barcelona). PARTICIPANTES: médicos y enfermeras de atención primaria. Intervención: sesión informativa y envío de píldoras informativas en 6 de 12 centros (seleccionados aleatoriamente) sobre el programa de cribado cáncer colorrectal. MEDICIONES PRINCIPALES: cuestionario ad hoc que recoge las características de los profesionales, los centros y 2 variables contextuales; implicación de los profesionales en el programa de cribado; conocimientos sobre el cáncer colorrectal, los factores de riesgo, los procedimientos de cribado, las recomendaciones de seguimiento posterior a la exploración diagnóstica y las estrategias de derivación. RESULTADOS: La media de la puntuación total en el primer cuestionario fue 8,07(1,38) sobre 11 y la del segundo 8,31(1,39). No se encontraron diferencias estadísticamente significativas entre el grupo intervención y control, sin embargo, en 9 preguntas se aumentó el porcentaje de respuestas correctas en el grupo intervención, mayoritariamente relacionadas con el seguimiento posterior a la exploración diagnóstica. CONCLUSIONES: La intervención mejora el porcentaje de respuestas correctas, sobre todo en aquellas en las que se obtuvo peor puntuación en el primer cuestionario. Este estudio muestra que los profesionales están familiarizados con el cribado de cáncer colorrectal, pero es importante tener una comunicación frecuente con ellos para mantener actualizada la información relacionada con el cribado y fomentar su implicación con el mismo

OBJECTIVE: To evaluate the impact of an intervention in primary care professionals on their current knowledge about colorectal cancer screening, subsequent surveillance recommendations and referral strategies. Methods DESIGN: Cluster randomized controlled trial. LOCATION: Primary Care Centers in L'Hospitalet de Llobregat (Barcelona). PARTICIPANTS: Primary Care Professionals (doctors and nurses). Intervention: Training session in six of the 12 centers (randomly selected) about the colorrectal cancer screening program, and three emails with key messages. MAIN MEASUREMENTS: Professionals and centers characteristics and two contextual variables; involvement of professionals in the screening program; information about colorectal cancer knowledge, risk factors, screening procedures, surveillance recommendations and referral strategies. RESULTS: The total score mean on the first questionnaire was 8.07 (1.38) and the second 8.31 (1.39). No statistically significant differences between the intervention and control groups were found, however, in 9 out of 11 questions the percentage of correct responses was increased in the intervention group, mostly related to the surveillance after the diagnostic examination. CONCLUSIONS: The intervention improves the percentage of correct answers, especially in those in which worst score obtained in the first questionnaire. This study shows that professionals are familiar with colorectal cancer screening, but there's a need to maintain frequent communication in order to keep up to date the information related to the colorectal cancer screening

[Impact of an informative intervention on the colorectal cancer screening program in primary care professionals]. / Impacto de una intervención informativa sobre el programa de cribado de cáncer colorrectal en profesionales de atención primaria.

OBJECTIVE: To evaluate the impact of an intervention in primary care professionals on their current knowledge about colorectal cancer screening, subsequent surveillance recommendations and referral strategies. METHODS DESIGN: Cluster randomized controlled trial. LOCATION: Primary Care Centers in L'Hospitalet de Llobregat (Barcelona). PARTICIPANTS: Primary Care Professionals (doctors and nurses). INTERVENTION: Training session in six of the 12 centers (randomly selected) about the colorrectal cancer screening program, and three emails with key messages. MAIN MEASUREMENTS: Professionals and centers characteristics and two contextual variables; involvement of professionals in the screening program; information about colorectal cancer knowledge, risk factors, screening procedures, surveillance recommendations and referral strategies. RESULTS: The total score mean on the first questionnaire was 8.07 (1.38) and the second 8.31 (1.39). No statistically significant differences between the intervention and control groups were found, however, in 9 out of 11 questions the percentage of correct responses was increased in the intervention group, mostly related to the surveillance after the diagnostic examination. CONCLUSIONS: The intervention improves the percentage of correct answers, especially in those in which worst score obtained in the first questionnaire. This study shows that professionals are familiar with colorectal cancer screening, but there's a need to maintain frequent communication in order to keep up to date the information related to the colorectal cancer screening.

Hidatidosis cervical primaria. A propósito de un caso / Primary hydatid cyst of the neck: Case report

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Evaluación de dos estrategias de cribado de cáncer colorrectal: test inmunológico versus test bioquímico. Cataluña, 2008-2010 / Evaluating colorectal cancer screening strategies (Immunological Test vs Biochemical Test) in Catalonia, Spain 2008-2010

Fundamento: El objetivo del estudio fue evaluar el cambio de estrategia de cribado (test inmunológico cuantitativo) en un programa poblacional de detección precoz de cáncer colorrectal (CCR) en Cataluña. Métodos: La cuarta ronda del programa de cribado de CCR en Hospitalet de Llobregat se implementó en 2008-2010. Se ofreció un test bioquímico a 50.227 individuos y uno inmunológico cuantitativo a 12.707 individuos. Se analizaron diferencias en las dos estrategias de cribado respecto a variables de aceptabilidad (entre participación, abandonos y adherencia a la colonoscopia), de precisión diagnóstica (valor predictivo positivo y tasas de detección), de resultados (tamaño y localización de lesiones, estadio de los cánceres detectados) y de recursos (número necesario de colonoscopias e intervalo de tiempo entre el resultado positivo del test y la colonoscopia). Resultados: La participación en el cribado fue superior entre los individuos que utilizaron el test inmunológico (OR: 1,35; IC95%:1,27- 1,42). Las tasas de detección fueron superiores para el test inmunológico destacando la de adenomas de alto riesgo (26,7‰vs 3,0‰). El valor predictivo positivo para adenomas de alto riesgo fue del 45,0% y del 46,9% en el inmunológico y el guayaco, respectivamente. El número de colonoscopias necesarias para detectar un cáncer fue de casi el doble que en el guayaco (13,6 vs 7,4). Conclusiones: El test inmunológico es una buena estrategia de cribado especialmente sensible para la detección de adenomas de alto riesgo. Sin embargo, requiere realizar un gran número de colonoscopias y por ello se debe disponer de los recursos y medios necesarios (AU)

Background: The aim of this study was to evaluate the screening strategy (quantitative immunological test vs biochemical test) in a population- based screening program for colorectal cancer (CRC) in Catalonia. Methods: The fourth round of a screening program for CRC with a fecal occult blood test was implemented in Hospitalet de Llobregat during 2008-2010.Abiochemical test was offered to 50,227 individuals and a quantitative immunological test was offered to 12,707 individuals. We analysed differences according to the screening strategy in the following variables: acceptability of the target population (participation, dropouts, and adherence to colonoscopy), diagnostic accuracy (positive predictive value and detection rates), results (size and location of lesions, staging of CRC) and resources (number of colonoscopies needed and time interval between the positive test and colonoscopy). Results: Participation was higher among individuals who used the immunological test (OR: 1.35; CI95%:1.27-1.42). Detection rates for adenomas and cancer were also higher for the immunological test, hightlighting the detection rate for high-risk adenomas (26.7‰ vs. 3.0‰). The positive predictive value for high-risk adenomas was 45.0% and 46.9% in the immunological test and guaiac test, respectively. The number of colonoscopies needed to detect cancer with the immunological test was almost two-fold than those needed with the guaiac test (13.6 vs 7.4). Conclusions: The immunological test is a good screening strategy particularly sensitive for detecting high-risk adenomas. However, it is paramount to have enough resources to assure the quality of the CRC screening due to the large number of colonoscopies that would be required (AU)

Identification of potential biomarkers for giant cell tumor of bone using comparative proteomics analysis.

Giant cell tumor of bone can be locally aggressive and occasionally can metastasize in the lungs. To identify new markers predictive of aggressive behavior, we analyzed five patients who developed lung metastasis and five who remained disease free for a minimum of 5 years. Using two-dimensional electrophoresis, we detected 28 differentially expressed spots. Fourteen spots were identified using mass spectrometry, including seven up-regulated and seven down-regulated in metastatic samples and classified according to functional categories. We then selected five proteins involved in cell cycle or apoptosis. Thioredoxin peroxidase, allograft inflammatory factor 1, and ubiquitin E2N had more than threefold up-regulation; glutathione peroxidase 1 had 1.9-fold up-regulation; and heat shock protein 27 showed down-regulation in metastatic samples with a very low P value. After validation and analysis of protein levels, evaluation of clinical impact was assessed in a much wider cohort of primary archival specimens. Immunodetection showed a higher frequency of thioredoxin peroxidase, allograft inflammatory factor 1, ubiquitin E2N, and glutathione peroxidase 1 overexpression in primary tumors that developed into lung metastases or that locally relapsed than in the disease-free group, with variable stain intensity and distribution. Kaplan-Meier analysis showed that high expression of glutathione peroxidase 1 was strongly related to local recurrence and metastasis, suggesting that its up-regulation may identify a subset of high-risk patients with giant cell tumor prone to receive diverse clinical management.

[Evaluating colorectal cancer screening strategies (immunological test vs biochemical test) in Catalonia, Spain 2008-2010]. / Evaluación de dos estrategias de cribado de cáncer colorrectal: test inmunológico versus test bioquímico. Cataluña, 2008-2010.

BACKGROUND: The aim of this study was to evaluate the screening strategy (quantitative immunological test vs biochemical test) in a population-based screening program for colorectal cancer (CRC) in Catalonia. METHODS: The fourth round of a screening program for CRC with a fecal occult blood test was implemented in Hospitalet de Llobregat during 2008-2010. A biochemical test was offered to 50,227 individuals and a quantitative immunological test was offered to 12,707 individuals. We analysed differences according to the screening strategy in the following variables: acceptability of the target population (participation, dropouts, and adherence to colonoscopy), diagnostic accuracy (positive predictive value and detection rates), results (size and location of lesions, staging of CRC) and resources (number of colonoscopies needed and time interval between the positive test and colonoscopy). RESULTS: Participation was higher among individuals who used the immunological test (OR: 1.35; CI95%:1.27-1.42). Detection rates for adenomas and cancer were also higher for the immunological test, hightlighting the detection rate for high-risk adenomas (26.7‰ vs. 3.0‰). The positive predictive value for high-risk adenomas was 45.0% and 46.9% in the immunological test and guaiac test, respectively. The number of colonoscopies needed to detect cancer with the immunological test was almost two-fold than those needed with the guaiac test (13.6 vs 7.4). CONCLUSIONS: The immunological test is a good screening strategy particularly sensitive for detecting high-risk adenomas. However, it is paramount to have enough resources to assure the quality of the CRC screening due to the large number of colonoscopies that would be required.

Cerebellar involvement in Hodgkin's lymphoma: an atypical site of relapse.

The presentation of intracranial metastases from Hodgkin's lymphoma is an infrequent event that worsens clinical outcome. A case of Hodgkin's lymphoma relapse in the cerebellum is described in a 70-year-old woman with a previously treated stage IVA Hodgkin's lymphoma. Diagnostic workup and treatment strategies for central nervous system relapses are reviewed and discussed. A combination of surgery, radiotherapy and occasionally chemotherapy remains the most appropriate approach to intracranial Hodgkin's lymphoma.

Chylothorax due to metastatic prostate carcinoma: an unusual complication.

Chylothorax, the abnormal accumulation of lymphatic fluid within the pleural space, is an infrequent complication of tumours affecting the mediastinum. The development of chylothorax is extraordinary in association with prostate cancer, although it has been described before. Adequate treatment of malignant chylothorax comprises both a conservative approach, including dietary and hormonal manipulations, and mechanic intercostal drainage that have been demonstrated to be effective in the management of chylothorax of malignant origin. Radiation therapy has been used for the treatment of neoplasic chylothorax but with inconsistent results. We present a new case of chylothorax associated to prostate adenocarcinoma and review the existing evidence for its treatment.