Validation of a Semiautomatic Optical Coherence Tomography Digital Image Processing Algorithm for Estimating the Tear Meniscus Height.

Purpose: To design and validate a high-sensitivity semiautomated algorithm, based on adaptive contrast image, able to identify and quantify tear meniscus height (TMH) from optical coherence tomography (OCT) images by using digital image processing (DIP) techniques. Methods: OCT images of the lacrimal meniscus of healthy patients and with dry eye are analyzed by our algorithm, which is composed of two stages: (1) the region of interest and (2) TMH detection and measurement. The algorithm performs an adaptive contrast sequence based on morphologic operations and derivative image intensities. Trueness, repeatability, and reproducibility for TMH measurements are computed and the algorithm performance is statistically compared against the corresponding negative obtained manually by using a commercial software. Results: The algorithm showed excellent repeatability supported by an intraclass correlation coefficient equal to 0.993, a within-subject standard deviation equal to 9.88, and a coefficient of variation equal to 2.96%, and for the reproducibility test, the results did not show a significant difference as the mean value was 244.4 ± 114.9 µm for an expert observer versus 242.4 ± 111.2 µm for the inexperienced observer (P = 0.999). The method strongly suggests the algorithm can predict measurements that are manually performed with commercial software. Conclusions: The presented algorithm possess high potential to identify and measure TMH from OCT images in a reproducible and repeatable way with minimal dependency on user. Translational Relevance: The presented work shows a methodology on how, by using DIP, it is possible to process OCT images to calculate TMH and aid ophthalmologists in the diagnosis of dry eye disease.

Are Low Weight or Cardiopathy Contraindications for Thoracoscopic Repair of Esophageal Atresia with Tracheoesophageal Fistula?

BACKGROUND: Thoracoscopic repair of esophageal atresia (EA) with tracheoesophageal fistula (TEF) is becoming an increasingly widespread technique; there is still controversy about its indication in certain patients. Our objective is to analyze if potential risk factors such as major congenital heart disease (CHD) or low birth weight (LBW) are a limitation to this approach. METHODS: Retrospective study (2017-2021) of patients with EA and distal TEF who underwent thoracoscopic repair were included. Patients with LBW less than 2,000 g or major CHD were compared with the rest. RESULTS: Twenty-five patients underwent thoracoscopic surgery. Nine patients (36%) had major CHD. Five of them (20%) were LBW less than 2,000 g, and only 8% (2/25) presented both risk factors. There were no differences in terms of operative time, conversion rate, tolerance evaluated with gasometric parameters (pO2, pCO2, pH) or complications (anastomotic leak and stricture, both early or during follow-up) in patients with major CHD and LBW (1,473 ± 319 vs. 2,664 ± 402 g). One conversion to thoracotomy was performed in a neonate weighing 1,050 g due to anesthetic intolerance. There was no recurrence of TEF. One patient died at the age of 9 months, due to major uncorrectable heart disease. CONCLUSION: Thoracoscopic repair of EA/TEF is feasible technique in patients with CHD or LBW, with similar results to other patients. The complexity of this technique warrants individualizing the indication in each case. LEVEL OF EVIDENCE: IV.

Creatine Kinase Elevation in Autosomal Dominant Polycystic Kidney Disease Patients on Tolvaptan Treatment.

BACKGROUND: Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary cause of end-stage kidney disease. Currently, tolvaptan is the only treatment that has proven to delay disease progression. The most notable side effect of this therapy is drug-induced liver injury; however, recently, there have been two reports of creatine kinase (CK) elevation in ADPKD patients on tolvaptan treatment. We set out to monitor and determine the actual incidence of CK elevation and evaluate its potential association with other clinical factors. METHODS: This is an observational retrospective multicenter study performed in rapidly progressive ADPKD patients on tolvaptan treatment from Barcelona, Spain. Laboratory tests, demographics, treatment dose, and reported symptoms were collected from October 2018 to March 2021. RESULTS: Ninety-five patients initiated tolvaptan treatment during follow-up. The medication had to be discontinued in 31 (32.6%) patients, primarily due to aquaretic effects (12.6%), elevated liver enzymes (8.4%), and symptomatic or persistently elevated CK levels (3.2%). Moreover, a total of 27 (28.4%) patients had elevated CK levels, with most of them being either transient (12.6%), mild and asymptomatic (4.2%), or resolved after dose reduction (3.2%) or temporary discontinuation (2.1%). CONCLUSION: We pre-sent the largest cohort that has monitored CK levels in a real-life setting, finding them elevated in 28.4% of patients. More research and monitoring will help us understand the clinical implications and the pathophysiological mechanism of CK elevation in this population.

Application of MaxEnt Modeling and HRM Analysis to Support the Conservation and Domestication of Gevuina avellana Mol. in Central Chile.

The Chilean hazelnut (Gevuina avellana Mol., Proteaceae) is a native tree of Chile and Argentina of edible fruit-type nut. We applied two approaches to contribute to the development of strategies for mitigation of the effects of climate change and anthropic activities in G. avellana. It corresponds to the first report where both tools are integrated, the MaxEnt model to predict the current and future potential distribution coupled with High-Resolution Melting Analysis (HRM) to assess its genetic diversity and understand how the species would respond to these changes. Two global climate models: CNRM-CM6-1 and MIROC-ES2L for four Shared Socioeconomic Pathways: 126, 245, 370, and 585 (2021−2040; 2061−2080) were evaluated. The annual mean temperature (43.7%) and water steam (23.4%) were the key factors for the distribution current of G. avellana (AUC = 0.953). The future prediction model shows to the year 2040 those habitat range decreases at 50% (AUC = 0.918). The genetic structure was investigated in seven natural populations using eight EST-SSR markers, showing a percentage of polymorphic loci between 18.69 and 55.14% and low genetic differentiation between populations (Fst = 0.052; p < 0.001). According to the discriminant analysis of principal components (DAPC) we identified 10 genetic populations. We conclude that high-priority areas for protection correspond to Los Avellanos and Punta de Águila populations due to their greater genetic diversity and allelic richness.

Photoelasticity for Stress Concentration Analysis in Dentistry and Medicine.

Complex stresses are created or applied as part of medical and dental treatments, which are linked to the achievement of treatment goals and favorable prognosis. Photoelasticity is an optical technique that can help observe and understand biomechanics, which is essential for planning, evaluation and treatment in health professions. The objective of this project was to review the existing information on the use of photoelasticity in medicine and dentistry and determine their purpose, the areas or treatments for which it was used, models used as well as to identify areas of opportunity for the application of the technique and the generation of new models. A literature review was carried out to identify publications in dentistry and medicine in which photoelasticity was used as an experimental method. The databases used were: Sciencedirect, PubMed, Scopus, Ovid, Springer, EBSCO, Wiley, Lilacs, Medigraphic Artemisa and SciELO. Duplicate and incomplete articles were eliminated, obtaining 84 articles published between 2000 and 2019 for analysis. In dentistry, ten subdisciplines were found in which photoelasticity was used; those related to implants for fixed prostheses were the most abundant. In medicine, orthopedic research predominates; and its application is not limited to hard tissues. No reports were found on the use of photoelastic models as a teaching aid in either medicine or dentistry. Photoelasticity has been widely used in the context of research where it has limitations due to the characteristics of the results provided by the technique, there is no evidence of use in the health area to exploit its application in learning biomechanics; on the other hand there is little development in models that faithfully represent the anatomy and characteristics of the different tissues of the human body, which opens the opportunity to take up the qualitative results offered by the technique to transpolate it to an application and clinical learning.

Analytical Validation of a Novel 6-Gene Signature for Prediction of Distant Recurrence in Estrogen Receptor-Positive, HER2-Negative, Early-Stage Breast Cancer.

BACKGROUND: OncoMasTR is a recently developed multigene prognostic test for early-stage breast cancer. The test has been developed in a kit-based format for decentralized deployment in molecular pathology laboratories. The analytical performance characteristics of the OncoMasTR test are described in this study. METHODS: Expression levels of 6 genes were measured by 1-step reverse transcription-quantitative PCR on RNA samples prepared from formalin-fixed, paraffin-embedded (FFPE) breast tumor specimens. Assay precision, reproducibility, input range, and interference were determined using FFPE-derived RNA samples representative of low and high prognostic risk scores. A pooled RNA sample derived from 6 FFPE breast tumor specimens was used to establish the linear range, limit of detection, and amplification efficiency of the individual gene expression assays. RESULTS: The overall precision of the OncoMasTR test was high with an SD of 0.16, which represents less than 2% of the 10-unit risk score range. Test results were reproducible across 4 testing sites, with correlation coefficients of 0.94 to 0.96 for the continuous risk score and concordance of 86% to 96% in low-/high-risk sample classification. Consistent risk scores were obtained across a > 100-fold RNA input range. Individual gene expression assays were linear up to quantification cycle values of 36.0 to 36.9, with amplification efficiencies of 80% to 102%. Test results were not influenced by agents used during RNA isolation, by low levels of copurified genomic DNA, or by moderate levels of copurified adjacent nontumor tissue. CONCLUSION: The OncoMasTR prognostic test displays robust analytical performance that is suitable for deployment by local pathology laboratories for decentralized use.

NEW SKELETON-LESS HOMOSCLEROMORPHS (PORIFERA, HOMOSCLEROMORPHA) FROM THE CARIBBEAN SEA: EXCEPTIONS TO RULES ARE DEFINITELY COMMON IN SPONGE TAXONOMY.

Currently composed of only one order and two families, the class Homoscleromorpha has undergone significant changes in its systematics over the past 20 years. We combined morphological, cytological and molecular (CO1) data to describe three new aspiculate Homoscleromorpha, two Plakinidae and one Oscarellidae. These three sponges live in the dark submarine caves of the Lesser Antilles (Caribbean Sea). Aspiculortis gen. nov. is part of a clade including spiculate Plakortis species. Aspiculortis garifuna gen. nov. sp. nov. is characterized by an original pseudo criblate smooth surface, with a network of translucent canals ending in prominent oscula, and by one type of vacuolar cell concentrated in the ectosome. Aspiculophora papillata sp. nov. is characterized by a papillate surface, a morphological trait that is recorded for the first time among Homoscleromorpha, and one abundant type of vacuolar cell randomly distributed in the mesohyl. Oscarella minka sp. nov. is characterized by a smooth surface and two types of vacuolar cells, one principally found in the ectosome, and a second type which is randomly distributed and which harbors original inclusions. These three new Homoscleromorpha present an abundant microbial community in their mesohyl. After this work, the skeleton-less representatives of this sponge class include four species of Plakinidae belonging to three different genera, and all Oscarellidae described so far. The putative absence of skeleton underlines the need of more cytological descriptions of Plakinidae representatives.

Immunodominant antibody responses directed to SARS-CoV-2 hotspot mutation sites and risk of immune escape.

Introduction: Considering the likely need for the development of novel effective vaccines adapted to emerging relevant CoV-2 variants, the increasing knowledge of epitope recognition profile among convalescents and afterwards vaccinated with identification of immunodominant regions may provide important information. Methods: We used an RBD peptide microarray to identify IgG and IgA binding regions in serum of 71 COVID-19 convalescents and 18 vaccinated individuals. Results: We found a set of immunodominant RBD antibody epitopes, each recognized by more than 30% of the tested cohort, that differ among the two different groups and are within conserved regions among betacoronavirus. Of those, only one peptide, P44 (S415-429), recognized by 68% of convalescents, presented IgG and IgA antibody reactivity that positively correlated with nAb titers, suggesting that this is a relevant RBD region and a potential target of IgG/IgA neutralizing activity. Discussion: This peptide is localized within the area of contact with ACE-2 and harbors the mutation hotspot site K417 present in gamma (K417T), beta (K417N), and omicron (K417N) variants of concern. The epitope profile of vaccinated individuals differed from convalescents, with a more diverse repertoire of immunodominant peptides, recognized by more than 30% of the cohort. Noteworthy, immunodominant regions of recognition by vaccinated coincide with mutation sites at Omicron BA.1, an important variant emerging after massive vaccination. Together, our data show that immune pressure induced by dominant antibody responses may favor hotspot mutation sites and the selection of variants capable of evading humoral response.

Functional Swallow-Related Outcomes Following Transoral Robotic Surgery for Base of Tongue Carcinoma.

In an era where the incidence of oropharyngeal cancer is growing steadily, there have been few studies exploring functional outcomes for individuals whose definitive cancer management approach includes transoral robotic surgical (TORS) resection. This study was designed to examine swallow-related outcomes in individuals newly diagnosed with base of tongue cancer whose treatment plan included surgical resection via TORS. The aims of this study were to determine whether TORS resection for early stage BOT SCCA affected: (a) lingual strength, (b) swallow safety and efficiency, (c) oral intake, and (d) swallowing-related quality of life. Nine individuals meeting the inclusion criteria were recruited to participate from March 2017 to April 2018. Each participant was evaluated at four distinct time points: (a) preoperatively, (b) 1 week postoperatively, (c) 1 month postoperatively, and (d) 3 months postoperatively. The following data were collected at each time point: (a) maximum isometric lingual pressure, (b) Penetration-Aspiration Scale score, (c) Yale Pharyngeal Residue Severity Rating Scale scores, (d) Functional Oral Intake Scale score, and (e) EAT-10 score. Data analysis revealed that a significant decline in maximum isometric lingual pressure, EAT-10 scores, and Functional Oral Intake Scale scores occurred between preoperative baseline measurements and 1 week post surgery. All participants in the study demonstrated a return to levels at or near their baseline level of function for maximum isometric lingual pressure, EAT-10 score, and Functional Oral Intake Scale score by 1 or 3 months post surgery. There were no significant changes in swallow safety or efficiency observed at any time point during the study.

Anastomosis near to the ileocecal valve in neonates with focal intestinal perforation, is it safe.

BACKGROUND: Anastomosis near the ileocecal valve (ICV) are controversial due to the increased pressure on the suture; in this situation, the valve could be removed at a first stage or at the moment of stoma closure. However, preservation of the ICV has proved important benefits in the long term. The aim of this study is to evaluate its feasibility in neonates with focal intestinal perforation (FIP). METHODS: Retrospective study (2010-2019) of neonates with FIP who underwent intestinal resection and primary anastomosis. Patients were divided into group A (anastomosis less than 5 cm from ICV) and group B (more than 5 cm). RESULTS: Forty patients were treated. Patients ostomized or with resection of ICV were excluded. Finally, 24 patients (birth weight 1043 ± 594 g (520-3000), age 8.8 ± 7.8 days (2-39)) were included for analysis. Patent ductus arteriosus was present in 75%. There were 6 patients in group A (25%) and 18 in group B (75%). Groups were comparable in terms of gestational age, birth weight, and age at the time of surgery (p > .05). There were no cases of dehiscence nor stenosis of the anastomosis. There were no differences in reoperation rate, infectious complications, time to enteral feeding, days of parenteral nutrition, hospital stay nor survival (p > .05). CONCLUSION: Ileo-ileal anastomosis closer to the ileocecal junction, in neonates with focal intestinal perforation, is an effective and safe option which also allows the preservation of the ICV avoiding the complications derived from its absence in a group of patients with high morbidity.

Landscape Anthropization Affects Mosquito Diversity in a Deciduous Forest in Southeastern Mexico.

Mosquitoes (Diptera: Culicidae) are considered the group of insects that most impacts human health. Land use change, conversion of conserved sites into agricultural environments, urbanization, defaunation, and introduction of domestic animals can affect mosquito diversity positively or negatively, increasing the risk of transmission of zoonotic diseases. Here, we describe the diversity of adult mosquitoes in two environments (deciduous forest and anthropized zone) over 2 yr (2014-2016), using eight CDC traps at each site in three climatic seasons (rainy, cold, and dry). We captured 795 individuals belonging to 22 species. We constructed rank-abundance curves to determine spatial and temporal changes in the mosquito communities. We measured alpha diversity using the Shannon index (H'), Shannon exponential (eH) and Simpson dominance (Ds), and beta diversity using Jaccard's coefficient of similarity (Ij). The most abundant species were Culex quinquefasciatus (40.5%), Culex coronator (18.3%), and Anopheles pseudopunctipennis (12.4%). The highest mosquito diversity was in the deciduous forest during the rainy season. Beta diversity analysis showed that species overlap varied among climatic seasons, with the sites sharing 65% species during the rainy season, but only 33% of species during the dry season. We found differences in the diversity of mosquitoes at the two sites, and the mosquito assemblage of the anthropized zone was significantly different from that of the deciduous forest.

Predictive Model of Preventive Behaviors against COVID-19 in the Older Adult: The PREASOC-COVID-19 Study.

BACKGROUND: The purpose of this study was to analyze the relationship between COVID-19 preventive behaviors, as the dependent variable, with risk perception, coping style and sense of coherence, as independent variables, in older people living in the community. METHODS: An observational design for predictive model development. This study was reported following the STROBE statement. The subjects were people over 65 years of age living in the community. Data collection included sociodemographic variables related to COVID-19, risk perception and types, coping styles in the face of contagion, sense of coherence, and preventive behaviors in the face of COVID-19. The data collection period was from November 2020 to January 2021. RESULTS: A total of 305 people participated in this study (71.5% women, mean age 71.34 years; 6.9% suffered from COVID-19 and 44.3% knew someone close to them who suffered from the virus). The coping style variables problem-focused, emotion-focused, and sense of coherence subscales Significance and manageability explained 17% of the variable preventive behaviors against COVID-19. There were statistically significant differences by gender in all subscales, with women scoring higher in all of them; Conclusions: Men with low risk perception, extrinsic risk perception, and low sense of coherence presented worse COVID-19 preventive behaviors. It would be interesting to develop specific prevention and health education campaigns for this population.

Knowledge, attitudes, and practices regarding vector-borne diseases in central Mexico.

BACKGROUND: While vector-borne diseases (VBDs) pose an important public health problem worldwide, there is a limited and conflicting knowledge about such illnesses in rural or urban settings. The present study aimed to explore the social representations (SRs) held by people in the state of Puebla, Mexico on insects and the diseases they transmit. Understood as the group of ideas held and shared by a group of human beings which enable them to understand and interpret the world, SRs constitute what could be called a collective science or knowledge of everyday life. METHODS: The present study was conducted in six municipalities in the state of Puebla, wherein an open-ended questionnaire was applied with three age ranges. A total of 360 questionnaires were applied with people dedicated to a variety of activities. The survey data was analyzed to identify the SR's structure (the central nucleus of the SR and its peripheral system) and the level of organization in order to explore the degree to which the ideas that constitute it are shared and based on consensus. To describe the structure of the SR, a network analysis was conducted and complemented by a correspondence analysis, which also enables the differences between social groups to be identified. RESULTS: Popular knowledge on insects and VBDs is often limited, even in communities in which more than one-vector insect is found. The elements that were most frequently mentioned in the data, as pertaining to the insect-disease relationship, were mosquitoes and dengue fever, with scorpions (which are arachnids and not insects) receiving the second-highest number of mentions, while other insects such as kissing bugs, flies, and cockroaches were also mentioned as transmitting VBDs. While television was the main information source on VBDs for the residents of these communities, biology books were also mentioned. Chemical control measures (insect repellents) were the most used prevention method, and traditional medicine was the remedy most commonly used to treat insect bites and transmitted diseases. Entomophobia was the main cause for the respondents' fear and rejection of insects. Beyond the deleterious effects of many insects, those surveyed also recognized a positive relationship with insects due to economic and nutritional benefits they provide. CONCLUSIONS: The present study provides relevant information on how insects and the diseases they transmit are perceived by rural and urban communities. Although the population is aware of dengue fever and the role of mosquitoes in transmitting it, information campaigns are required for other historically neglected VBDs, such as leishmaniasis, Chagas disease, and, even, rickettsiosis. As it is important to understand the impact that these illnesses have on communities further research is required to ensure that better information and guidance is provided on VBDs in order to develop a culture of illness prevention in not only the rural but also the metropolitan communities of the state of Puebla.

Prognostic value of the 6-gene OncoMasTR test in hormone receptor-positive HER2-negative early-stage breast cancer: Comparative analysis with standard clinicopathological factors.

AIM: The aim of the study was to assess the prognostic performance of a 6-gene molecular score (OncoMasTR Molecular Score [OMm]) and a composite risk score (OncoMasTR Risk Score [OM]) and to conduct a within-patient comparison against four routinely used molecular and clinicopathological risk assessment tools: Oncotype DX Recurrence Score, Ki67, Nottingham Prognostic Index and Clinical Risk Category, based on the modified Adjuvant! Online definition and three risk factors: patient age, tumour size and grade. METHODS: Biospecimens and clinicopathological information for 404 Irish women also previously enrolled in the Trial Assigning Individualized Options for Treatment [Rx] were provided by 11 participating hospitals, as the primary objective of an independent translational study. Gene expression measured via RT-qPCR was used to calculate OMm and OM. The prognostic value for distant recurrence-free survival (DRFS) and invasive disease-free survival (IDFS) was assessed using Cox proportional hazards models and Kaplan-Meier analysis. All statistical tests were two-sided ones. RESULTS: OMm and OM (both with likelihood ratio statistic [LRS] P < 0.001; C indexes = 0.84 and 0.85, respectively) were more prognostic for DRFS and provided significant additional prognostic information to all other assessment tools/factors assessed (all LRS P ≤ 0.002). In addition, the OM correctly classified more patients with distant recurrences (DRs) into the high-risk category than other risk classification tools. Similar results were observed for IDFS. DISCUSSION: Both OncoMasTR scores were significantly prognostic for DRFS and IDFS and provided additional prognostic information to the molecular and clinicopathological risk factors/tools assessed. OM was also the most accurate risk classification tool for identifying DR. A concise 6-gene signature with superior risk stratification was shown to increase prognosis reliability, which may help clinicians optimise treatment decisions.

Acompanyament parental als nounats de les unitats neonatals i plantes de maternitat durant la pandèmia per SARS-CoV-2 / Acompañamiento parental a recién nacidos en las unidades neonatales y plantas de maternidad en relación A lA pandemia por sars-coV-2 / Policies on parental Access restriction in neonatal units And maternity wards during the sars-cov-2 pandemic

Fonament: Des de l’inici de la pandèmia per SARS-CoV-2,la majoria d’unitats neonatals d’arreu del món han aplicatprotocols de restricció de la presència de mares i pares,amb l’objectiu de protegir el personal sanitari i els nounats.Objectiu. Avaluar els efectes col·laterals derivats de la pocapresència de mares i pares al costat dels seus nadons a lesunitats neonatals, i els relacionats amb les restriccions ales plantes de maternitat. Mètode: Revisió de la literatura. S’ha consultat Pubmed iGoogle Scholar utilitzant com a paraules clau ‘SARS-CoV-2’i ‘covid-19’ combinades amb ‘neonatal’, ‘NICU’ i ‘parents’,‘family centered care’ i ‘neurodevelopmental care’. S’hanconsultat dominis en què es recullen resums actualitzatsde l’evidència científica disponible sobre la pandèmia perSARS-CoV-2: www.dontforgetthebubles.com i el web de laSocietat Espanyola de Neonatologia (www.seneo.es). Laveu de les famílies s’ha cercat mitjançant les pàgines deles associacions que els representen i a les xarxes socials.Resultats. El model de cures centrades en el desenvolupa-ment i la família, que ha demostrat efectes positius sobre lasalut dels nadons ingressats i el neurodesenvolupament delsprematurs, es veu amenaçat si es limita la presència paren-tal. La restricció també ha demostrat tenir efectes adversossobre la lactància materna i la salut psicològica dels pares imares. Les dades disponibles fins ara posen de manifest uncomportament benigne de la infecció covid-19 en nadons.Conclusions: En un moment crucial per a la implantació delmodel de cures centrades en el desenvolupament a les uni-tats neonatals catalanes, i amb les dades disponibles, ésimprescindible redissenyar les polítiques d’acompanyamentparental als nadons ingressats.(AU)

Fundamento: Desde el inicio de la pandemia por SARS-CoV-2, lamayoría de unidades neonatales de todo el mundo han aplicadoprotocolos de restricción de la presencia parental, con el objetivode proteger al personal sanitario y a los propios recién nacidos. Objetivo: Evaluar los efectos colaterales derivados de la menor pre-sencia de los padres junto a sus bebés en las unidades neonatales,y los relacionados con las restricciones en las plantas de maternidad.Método: Revisión de la literatura. Se ha realizado búsqueda enPubmed i Google Scholar utilizando como palabras clave ‘SARS-CoV-2’ y ‘covid-19’ en combinación con ‘neonatal’, ‘NICU’ y ‘pa-rents’, ‘family centered care’ y ‘neurodevelopmental care’. Se hanconsultado dominios donde se recogen resúmenes actualizados dela evidencia científica disponible sobre la pandemia por SARS-CoV-2: www.dontforgetthebubles.com y la web de la Sociedad Es-pañola de Neonatología (www.seneo.es). La opinión de las familiasse ha buscado en las páginas web de las asociaciones que las re-presentan y en las redes sociales. Resultados: El modelo de cuidados centrados en el desarrollo y lafamilia, que ha demostrado efectos positivos sobre la salud de losrecién nacidos ingresados y el neurodesarrollo de los prematuros,se ve amenazado si se limita la presencia parental. La restriccióntambién ha demostrado tener efectos adversos sobre la lactanciamaterna y la salud psicológica de los progenitores. Los datos dis-ponibles hasta ahora ponen de manifiesto un comportamiento be-nigno de la infección por covid-19 en recién nacidos. Conclusiones: En un momento crucial para la implantación del mo-delo de cuidados centrados en el desarrollo en las unidades neo-natales catalanas, y con los datos disponibles, es imprescindiblerediseñar las políticas de acompañamiento de los padres a sushijos recién nacidos ingresados.(AU)

Objective: To evaluate the side effects of the limitation of parentspresence with their babies in neonatal units and those related torestrictions on maternity wards access. Method: Literature review. A search using ‘SARS-CoV-2’ and ‘CO-VID-19’ as keywords combined to ‘neonatal’, ‘NICU’, ‘parents’,‘family centered care’ and ‘neurodevelopmental care’. Consulta-tion of websites containing updated and summarized scientific li-terature about the pandemic and its consequences in newbornshas also been performed: www.dontforgetthebubles.com andwww.seneo.es. The voice of the families has been mainly obtainedthrough the websites of their associations and the social networks. Results. The family-centered care model has shown positive effectson the health of sick newborns and on premature infants’ neuro-development. This model of care is under threat if parental accessis limited. It has been shown that these restrictions have also ad-verse effects on breastfeeding and on caregivers’ psychologicalwellbeing. Data from different neonatal series report a benigncourse of COVID-19 infection in neonates and preterm babies. Conclusions: At a crucial moment for the implementation of thedevelopmental centered care model in Catalan neonatal units, andwith the available data, it is essential to redesign the policies regar-ding parents who accompany their babies admitted to the units.(AU)

Effectivity of a Program for the Control and Prevention of COVID-19 Healthcare-Associated Infections in a Spanish Academic Hospital.

BACKGROUND: Although recommendations to prevent COVID-19 healthcare-associated infections (HAIs) have been proposed, data on their effectivity are currently limited. OBJECTIVE: The aim was to evaluate the effectivity of a program of control and prevention of COVID-19 in an academic general hospital in Spain. METHODS: We captured the number of COVID-19 cases and the type of contact that occurred in hospitalized patients and healthcare personnel (HCP). To evaluate the impact of the continuous use of a surgical mask among HCP, the number of patients with COVID-19 HAIs and accumulated incidence of HCP with COVID-19 was compared between the preintervention and intervention periods. RESULTS: Two hundred fifty-two patients with COVID-19 have been admitted to the hospital. Seven of them had an HAI origin (6 in the preintervention period and 1 in the intervention period). One hundred forty-two HCP were infected with SARS-CoV-2. Of them, 22 (15.5%) were attributed to healthcare (2 in the emergency department and none in the critical care departments), and 120 (84.5%) were attributed to social relations in the workplace or during their non-work-related personal interactions. The accumulated incidence during the preintervention period was 22.3 for every 1000 HCP and 8.2 for every 1000 HCP during the intervention period. The relative risk was 0.37 (95% confidence interval, 0.25 to 0.55) and the attributable risk was -0.014 (95% confidence interval, -0.020 to -0.009). CONCLUSIONS: A program of control and prevention of HAIs complemented with the recommendation for the continuous use of a surgical mask in the workplace and social environments of HCP effectively decreased the risk of COVID-19 HAIs in admitted patients and HCP.

Frequency, Associated Risk Factors, and Characteristics of COVID-19 Among Healthcare Personnel in a Spanish Health Department.

INTRODUCTION: This study examines the frequency, associated factors, and characteristics of healthcare personnel coronavirus disease 2019 cases in a healthcare department that comprises a tertiary hospital and its associated 12 primary healthcare centers. METHODS: This study included healthcare personnel that showed symptoms or were in contact with a coronavirus disease 2019 case patient from March 2, 2020 to April 19, 2020. Their evolution and characteristics (age, sex, professional category, type of contact) were recorded. Correlations between the different characteristics and risk of developing coronavirus disease 2019 and severe coronavirus disease 2019 were analyzed using chi-square tests. Their magnitudes were quantified with ORs, AORs, and their 95% CIs using a logistic regression model. RESULTS: Of the 3,900 healthcare professionals in the department, 1,791 (45.9%) showed symptoms or were part of a contact tracing study. The prevalence of those with symptoms was 20.1% (784/3,900; 95% CI=18.8, 21.4), with coronavirus disease 2019 was 4.0% (156/3,900; 95% CI=3.4, 4.6), and with severe coronavirus disease 2019 was 0.5% (18/3,900; 95% CI=0.2, 0.7). The frequency of coronavirus disease 2019 in symptomatic healthcare personnel with a nonprotected exposure was 22.8% (112/491) and 13.7% (40/293) in those with a protected exposure (AOR=2.2, 95% CI=1.2, 3.9). The service in which the healthcare personnel performed their activity was not significantly associated with being diagnosed with coronavirus disease 2019. A total of 26.3% (10/38) of male healthcare personnel with coronavirus disease 2019 required hospitalization, compared with 6.8% (8/118) among female healthcare personnel (OR=4.9, 95% CI=1.8, 13.6). CONCLUSIONS: A surveillance and monitoring program centred on healthcare personnel enables an understanding of the risk factors that lead to coronavirus disease 2019 among this population. This knowledge allows the refinement of the strategies for disease control and prevention in healthcare personnel during the coronavirus disease 2019 pandemic.

Resultados funcionales y radiográficos de la prótesis reversa y la reinserción del troquíter en pacientes con fracturas de húmero proximal / Functional and radiologic outcomes of reverse shoulder arthroplasty and greater tuberosity reattachment in proximal humerus fractures

Objetivo: Comunicar los resultados funcionales y radiográficos de pacientes tratados con prótesis reversa por fracturas complejas. El objetivo secundario fue determinar la relación entre rangos de movilidad y puntaje ASES con la evolución radiográfica del troquíter. Materiales y Métodos: Se incluyeron 16 pacientes >65 años, tratados con prótesis reversa y reinserción del troquíter, entre 2013 y 2017, operados antes de las 4 semanas del trauma y con un seguimiento mínimo de 2 años. Se consignaron el puntaje ASES y el rango de movilidad activa. En las radiografías, se evaluaron la posición y la consolidación del troquíter, y se registraron las complicaciones y su tratamiento. Resultados: La media de la edad fue 74.5 años (RIC 66-78.5), 11 (69%) eran mujeres. Once fracturas (69%) eran a 4 fragmentos y 5, luxofracturas a 4 fragmentos. La media entre el trauma y la cirugía fue 9.4 días y el seguimiento, 29.5 meses. En 9 casos (56%), el troquíter presentó consolidación. Rotación interna: 5 pacientes alcanzaron la región glútea con el pulgar; 4, la vértebra T12; 4, la vértebra L3; 3, la T7. Las medianas de rotación externa y flexión anterior fueron 30° (RIC 17,5-40) y 100° (RIC 87,5-160). El puntaje ASES promedio fue 78,3 (RIC 63,3-87,4). No hubo una asociación estadísticamente significativa entre la evolución del troquíter y la flexión anterior y el puntaje (p = 0,24 y 0,52, respectivamente). Conclusión: La prótesis reversa en fracturas agudas con reinserción de las tuberosidades puede llevar a buenos resultados funcionales. No se encontró relación entre la consolidación del troquíter y el puntaje ASES. Nivel de Evidencia: IV

Objective: To report functional and radiologic outcomes of reverse shoulder arthroplasty (RSA) in patients with complex proximal humeral fractures. A second objective was to assess the relation between the greater tuberosity healing and the range of motion (ROM) and the American Shoulder and Elbow Surgeons (ASES) score. Materials and Methods: Sixteen patients treated between 2013 and 2017, older than 65 years old, operated before 4 weeks after the trauma, and with a minimum of 2-year follow-up were included. ASES scores and active ROMs were recorded. Greater tuberosity and the prosthesis position and healing were radiologically evaluated, and the complications and treatment were recorded. Results: The median age was of 74.5 years (IQR 66-78.5), 11 patients were females (69%). According to Neer classification, 11 cases were four-part fractures and 5 were four-part fracture-dislocations. The average time between trauma and surgery was 9.4 days, and the average follow-up was of 29.5 months. The greater tuberosity was healed in 9 cases (56%). Internal rotation: 5 patients (31.25%) were able to reach up with their thumbs to gluteal level, 4 (25%) to T12, 3 (18.75%) to T7, and 4 (25%) to L3. The medians for external rotation and forward flexion were 30° (IQR 17.5°-40°) and 100° (IQR 87.5°-160°). The average ASES score was of 78.3 (IQR 63.3-87.4). There was no significant statistical relation between greater tuberosity healing and forward flexion or ASES score (P=0.24 and P=0.52, respectively). Conclusion: The use of reverse prostheses for complex fractures with greater tuberosity reattachment could lead to good functional outcomes, low complication rates and reoperations. There was no significant statistical relation between ASES score and greater tuberosity healing or failure to heal. Level of Evidence: IV

New cave-dwelling Plakina (Plakinidae, Homoscleromorpha, Porifera) from Martinique Island (French Antilles).

Knowledge of homoscleromorph sponge biodiversity has greatly improved during the last decade thanks to the increasing use of integrative taxonomy and extensive exploration of remote ecosystems. Indeed, recently described species have mostly been small sponges living in dark and near-impenetrable habitats. This work integrates morphological, cytological, ecological and molecular data to describe a new species belonging to the Plakina genus. Plakina doudou sp. nov. was found first during close inspection of photographs taken previously in a submarine cave on Martinique Island, where several new species had already been revealed. The new species lives in syntopy with P. arletensis. It is thinly encrusting, whitish in vivo, and its skeleton harbors a unique composition of diods, triods, monolophose triods and monolophose, dilophose and trilophose calthrops. Sequencing of a portion of the mitochondrial gene cox-1 indicates that the new species belongs to a well-supported clade containing the Mediterranean P. crypta and P. trilopha. However, at the time of publication of this work, we have not yet managed to identify synapomorphies that would support the different clades of Plakina. This genus includes a total of 39 species to date, of which 10 have been recorded in the Western Tropical Atlantic, and 4 in Caribbean submarine caves.