Clinical practice guidelines for the diagnosis and management of Charcot-Marie-Tooth disease.

INTRODUCTION: Charcot-Marie-Tooth (CMT) disease is classified considering the neurophysiological and histological findings, the inheritance pattern and the underlying genetic defect. In recent years, with the advent of next generation sequencing, genetic complexity has increased exponentially, expanding the knowledge about disease pathways, and having an impact in clinical management. The aim of this guide is to offer recommendations for the diagnosis, prognosis, monitoring and treatment of this disease in Spain. MATERIAL AND METHODS: This consensus guideline has been developed by a multidisciplinary panel encompassing a broad group of professionals including neurologists, neuropediatricians, geneticists, rehabilitators, and orthopaedic surgeons. RECOMMENDATIONS: The diagnosis is based in the clinical characterization, usually presenting with a common phenotype. It should be followed by an appropriate neurophysiological study that allows for a correct classification, specific recommendations are established for the parameters that should be included. Genetic diagnosis must be approached in sequentially, once the PMP22 duplication has been ruled out if appropriate, a next generation sequencing should be considered taking into account the limitations of the available techniques. To date, there is no pharmacological treatment that modifies the course of the disease, but symptomatic management is important, as are the rehabilitation and orthopaedic considerations. The latter should be initiated early to identify and improve the patient's functional impairments, including individualised exercise guidelines, orthotic adaptation, and assessment of conservative surgeries such as tendon transpositions. The follow-up of patients with CMT is exclusively clinical, ancillary testing are not necessary in routine clinical practice.

Factores etiopatogénicos y tratamiento de la enfermedad de Müller-Weiss / Etiopathogenic factors and treatment of Müller-Weiss disease

Antecedentes y objetivo: La enfermedad de Müller-Weiss (EMW) es una anomalía poco frecuente del escafoides tarsiano. Maceira y Rochera propusieron la teoría etiopatogénica más comúnmente aceptada, en la que estarían implicados factores displásicos, mecánicos y ambientales socioeconómicos. Se pretende describir las características clínicas y sociodemográficas de los pacientes de nuestro entorno con EMW, corroborar su asociación con los factores socioeconómicos descritos previamente, estimar la influencia de otros factores descritos en el desarrollo de la EMW, así como describir el tratamiento realizado. Materiales y métodos: Estudio retrospectivo de 60 pacientes diagnosticados de EMW en 2 hospitales terciarios de Valencia (España) entre los años 2010 y 2021. Resultados: Se incluyeron 60 pacientes, 21 (35,0%) hombres y 39 (65,0%) mujeres. En 29 (47,5%) casos la afectación fue bilateral. La media de edad de inicio de la sintomatología fue de 41,9±20,3 años. Durante la infancia, 36 (60,0%) pacientes sufrieron movimientos migratorios, y 26 (43,3%) problemas dentarios. La edad media de inicio laboral fue de 14,6±4,5 años. Se trataron de forma ortopédica 35 (58,3%) casos frente a 25 (41,7%) tratados quirúrgicamente, 11 (18,3%) mediante osteotomía de calcáneo y 14 (23,3%) con artrodesis. Conclusiones: Al igual que en la serie de Maceira y Rochera, encontramos una mayor prevalencia de EMW entre los nacidos alrededor de la Guerra Civil española y el periodo de movimientos migratorios masivos acontecidos en la quinta década del siglo xx. El tratamiento sigue sin estar bien establecido.(AU)

Background and aim: Müller-Weiss disease (MWD) is a rare anomaly of the tarsal scaphoid. Maceira and Rochera proposed the most commonly accepted etiopathogenic theory, in which dysplastic, mechanical, and socioeconomic environmental factors would be involved. The aim is to describe the clinical and sociodemographic characteristics of patients with MWD in our setting, corroborate their association with the socioeconomic factors previously described, estimate the influence of other factors involved in the development of MWD, and describe the treatment carried out. Materials and methods: Retrospective study of 60 patients diagnosed with MWD in 2 tertiary hospitals of Valencia (Spain) between 2010 and 2021. Results: Sixty patients were included, 21 (35.0%) men and 39 (65.0%) women. In 29 (47.5%) cases, the disease was bilateral. The mean age of onset of symptomatology was 41.9±20.3 years. During childhood, 36 (60.0%) patients suffered migratory movements, and 26 (43.3%) had dental problems. The mean age of onset was 14.6±4.5 years. Thirty-five (58.3%) cases were treated orthopedically versus 25 (41.7%) treated surgically, 11 (18.3%) by calcaneal osteotomy, and 14 (23.3%) with arthrodesis. Conclusions: As in the series of Maceira and Rochera, we found a higher prevalence of MWD among those born around the Spanish Civil War and the period of massive migratory movements that occurred in the fifth decade of the 20th century. Treatment is still not well established.(AU)

[Translated article] Aetiopathogenic factors and treatment of Müller-Weiss disease / Factores etiopatogénicos y tratamiento de la enfermedad de Müller-Weiss

Antecedentes y objetivo: La enfermedad de Müller-Weiss (EMW) es una anomalía poco frecuente del escafoides tarsiano. Maceira y Rochera propusieron la teoría etiopatogénica más comúnmente aceptada, en la que estarían implicados factores displásicos, mecánicos y ambientales socioeconómicos. Se pretende describir las características clínicas y sociodemográficas de los pacientes de nuestro entorno con EMW, corroborar su asociación con los factores socioeconómicos descritos previamente, estimar la influencia de otros factores descritos en el desarrollo de la EMW, así como describir el tratamiento realizado. Materiales y métodos: Estudio retrospectivo de 60 pacientes diagnosticados de EMW en 2 hospitales terciarios de Valencia (España) entre los años 2010 y 2021. Resultados: Se incluyeron 60 pacientes, 21 (35,0%) hombres y 39 (65,0%) mujeres. En 29 (47,5%) casos la afectación fue bilateral. La media de edad de inicio de la sintomatología fue de 41,9±20,3 años. Durante la infancia, 36 (60,0%) pacientes sufrieron movimientos migratorios, y 26 (43,3%) problemas dentarios. La edad media de inicio laboral fue de 14,6±4,5 años. Se trataron de forma ortopédica 35 (58,3%) casos frente a 25 (41,7%) tratados quirúrgicamente, 11 (18,3%) mediante osteotomía de calcáneo y 14 (23,3%) con artrodesis. Conclusiones: Al igual que en la serie de Maceira y Rochera, encontramos una mayor prevalencia de EMW entre los nacidos alrededor de la Guerra Civil española y el periodo de movimientos migratorios masivos acontecidos en la quinta década del siglo xx. El tratamiento sigue sin estar bien establecido.(AU)

Background and aim: Müller-Weiss disease (MWD) is a rare anomaly of the tarsal scaphoid. Maceira and Rochera proposed the most commonly accepted etiopathogenic theory, in which dysplastic, mechanical, and socioeconomic environmental factors would be involved. The aim is to describe the clinical and sociodemographic characteristics of patients with MWD in our setting, corroborate their association with the socioeconomic factors previously described, estimate the influence of other factors involved in the development of MWD, and describe the treatment carried out. Materials and methods: Retrospective study of 60 patients diagnosed with MWD in 2 tertiary hospitals of Valencia (Spain) between 2010 and 2021. Results: Sixty patients were included, 21 (35.0%) men and 39 (65.0%) women. In 29 (47.5%) cases, the disease was bilateral. The mean age of onset of symptomatology was 41.9±20.3 years. During childhood, 36 (60.0%) patients suffered migratory movements, and 26 (43.3%) had dental problems. The mean age of onset was 14.6±4.5 years. Thirty-five (58.3%) cases were treated orthopedically versus 25 (41.7%) treated surgically, 11 (18.3%) by calcaneal osteotomy, and 14 (23.3%) with arthrodesis. Conclusions: As in the series of Maceira and Rochera, we found a higher prevalence of MWD among those born around the Spanish Civil War and the period of massive migratory movements that occurred in the fifth decade of the 20th century. Treatment is still not well established.(AU)

[Translated article] Aetiopathogenic factors and treatment of Müller-Weiss disease.

BACKGROUND AND AIM: Müller-Weiss disease (MWD) is a rare anomaly of the tarsal scaphoid. Maceira and Rochera proposed the most commonly accepted etiopathogenic theory, in which dysplastic, mechanical, and socioeconomic environmental factors would be involved. The aim is to describe the clinical and sociodemographic characteristics of patients with MWD in our setting, corroborate their association with the socioeconomic factors previously described, estimate the influence of other factors involved in the development of MWD, and describe the treatment carried out. MATERIALS AND METHODS: Retrospective study of 60 patients diagnosed with MWD in 2 tertiary hospitals of Valencia (Spain) between 2010 and 2021. RESULTS: Sixty patients were included, 21 (35.0%) men and 39 (65.0%) women. In 29 (47.5%) cases, the disease was bilateral. The mean age of onset of symptomatology was 41.9±20.3 years. During childhood, 36 (60.0%) patients suffered migratory movements, and 26 (43.3%) had dental problems. The mean age of onset was 14.6±4.5 years. Thirty-five (58.3%) cases were treated orthopedically versus 25 (41.7%) treated surgically, 11 (18.3%) by calcaneal osteotomy, and 14 (23.3%) with arthrodesis. CONCLUSIONS: As in the series of Maceira and Rochera, we found a higher prevalence of MWD among those born around the Spanish Civil War and the period of massive migratory movements that occurred in the fifth decade of the 20th century. Treatment is still not well established.

Etiopathogenic factors and treatment of Müller-Weiss disease. / Factores etiopatogénicos y tratamiento de la enfermedad de Müller-Weiss.

BACKGROUND AND AIM: Müller-Weiss disease (MWD) is a rare anomaly of the tarsal scaphoid. Maceira and Rochera proposed the most commonly accepted etiopathogenic theory, in which dysplastic, mechanical, and socioeconomic environmental factors would be involved. The aim is to describe the clinical and sociodemographic characteristics of patients with MWD in our setting, corroborate their association with the socioeconomic factors previously described, estimate the influence of other factors involved in the development of MWD, and describe the treatment carried out. MATERIALS AND METHODS: Retrospective study of 60 patients diagnosed with MWD in 2 tertiary hospitals of Valencia (Spain) between 2010 and 2021. RESULTS: Sixty patients were included, 21 (35.0%) men and 39 (65.0%) women. In 29 (47.5%) cases, the disease was bilateral. The mean age of onset of symptomatology was 41.9±20.3 years. During childhood, 36 (60.0%) patients suffered migratory movements, and 26 (43.3%) had dental problems. The mean age of onset was 14.6±4.5 years. Thirty-five (58.3%) cases were treated orthopedically versus 25 (41.7%) treated surgically, 11 (18.3%) by calcaneal osteotomy, and 14 (23.3%) with arthrodesis. CONCLUSIONS: As in the series of Maceira and Rochera, we found a higher prevalence of MWD among those born around the Spanish Civil War and the period of massive migratory movements that occurred in the fifth decade of the 20th century. Treatment is still not well established.

Resultados perinatales tras prueba diagnóstica invasiva en el embarazo / Perinatal outcomes after invasive diagnostic test in pregnancy

Introducción: Las técnicas invasivas de diagnóstico prenatal nos permiten realizar pruebas genéticas. El desarrollo de técnicas no invasivas ha reducido su uso. Clásicamente se ha afirmado que, tras realizar la técnica invasiva, la tasa de pérdida fetal se sitúa en torno al 1%. Los datos publicados son heterogéneos, y aunque todo indica que se ha sobrestimado el riesgo, necesitamos realizar nuevos estudios. Material y métodos: En nuestro estudio retrospectivo unicéntrico analizamos los procedimientos realizados mediante técnicas invasivas de diagnóstico prenatal entre 2011 y 2019, incluyendo 832 técnicas invasivas realizadas. Los resultados perinatales se comparan con el grupo control de mujeres embarazadas (n=1.734). Resultados: La tasa de pérdida fetal temprana para las diferentes técnicas fue de 1,1% para amniocentesis, del 1,6% para biopsia corial transvaginal y del 0,5% para biopsia corial abdominal, con una tasa total del 1,1%, sin diferencias estadísticamente significativas entre ellas (p=0,57). Encontramos diferencias en el desenlace fetal, en cuanto a la variable pérdida fetal temprana, en relación con los intentos realizados (cuando se hacían tres intentos aumentaba el riesgo). Al comparar los resultados perinatales posparto del grupo sometido a técnicas con el grupo control, se encontró una mayor tasa de cesáreas en el grupo estudio (28,9% vs 20,5%), además de una menor edad gestacional media al parto (38,33 vs. 38,95 semanas). Discusión: Cuando la técnica invasiva se realiza en el momento adecuado y con no más de dos intentos, consideramos que el riesgo de pérdida fetal no se ve afectado por su realización, siendo igual al de la población general.(AU)

Introduction: Invasive prenatal diagnostic techniques allow us to conduct genetic tests. The development of non-invasive techniques has reduced their use. The foetal loss rate following an invasive procedure is considered to be around 1%. The published data is heterogeneous however, although everything indicates that the risk has been overestimated, we need to conduct further studies. Material and methods: In our single-centre retrospective study we analysed the procedures carried out using invasive prenatal diagnostic techniques between 2011 and 2019. A total of 832 invasive techniques were performed. Perinatal results are compared with a control group of pregnant women (n=1734). Results: The early foetal loss rate for the different techniques were 1.1% for amniocentesis, 1.6% for transvaginal chorionic biopsy and 5% for abdominal chorionic biopsy, with a total rate of 1.1%, without statistically significant differences between them (P=.57). We found differences in foetal outcome, in terms of variable early foetal loss, related to the attempts made (when three attempts were made, the risk increased). When comparing the perinatal outcomes after delivery of the group that underwent techniques with the control group, a higher rate of caesarean sections was found in the study group (28.9% vs 20.5%), in addition to lower mean gestational age at delivery (38.33 vs. 38.95 weeks). Discussion: When the invasive technique is performed at the right time and with no more than two attempts, we consider that the risk of foetal loss is not affected, and is equal to that of the general population.(AU)

Debut y manejo de leucemia mieloblástica aguda durante la gestación: a propósito de un caso / Debut and management of acute myeloblastic leukaemia during pregnancy: a case report

La leucemia mieloide aguda (LMA) es una de las neoplasias hematológicas más mortales. Durante el embarazo es una complicación rara, que puede dar resultados adversos, como la muerte, sin tratamiento adecuado. El manejo de la LMA durante el embarazo sigue siendo un desafío. Presentamos el caso de una mujer primigesta de 34 años con 18 semanas de gestación que acudió a Urgencias por cuadro de dolor e hipertrofia de mucosa oral, acompañado de astenia intensa. Se diagnóstico leucemia mieloblástica aguda (LAM-M4). Se ofertó posibilidad de interrumpir la gestación, dada la poca evidencia referente a la evolución materno-fetal, que la paciente rechazó, por lo que se inició tratamiento quimioterápico. En los controles ecográficos no se evidenciaron alteraciones teratogénicas; el crecimiento fetal tuvo parámetros normales, sin alteraciones en los valores del flujo Doppler. Se decidió finalizar gestación a las 32 semanas y tres días. Nació un varón pretérmino mediante parto eutócico con test de Apgar y pH de cordón umbilical normales, sin precisar reanimación. El puerperio fue favorable y a los 15 días del alta ingresó para un trasplante de médula ósea de su hermana, HLA idéntica. La paciente finalmente falleció por rechazo del trasplante y las complicaciones derivadas de este suceso.

Acute myeloid leukaemia (AML) is one of the deadliest haematological malignancies. During pregnancy it is a rare comorbidity and can lead to adverse outcomes, such as death, without adequate treatment. The management of AML during pregnancy remains a challenge. We report the case of a primigravida 34-year-old, with 18 weeks of amenorrhoea, who attended the emergency department presenting with pain and hypertrophy of the oral mucosa, accompanied by intense asthenia. Acute myeloblastic leukaemia was diagnosed. The possibility of terminating the pregnancy was offered given the lack of evidence regarding the maternal-foetal outcome, but the patient rejected it, so chemotherapy treatment was started. In the ultrasound controls there was no evidence of teratogenic alterations nor foetal growth restriction, and there were no alterations in Doppler flow values. It was decided to end the pregnancy at 32+3 GW. A preterm male was born through eutocic delivery with a normal Apgar test and umbilical cord pH, and did not require resuscitation. The puerperium was favourable and 15 days following discharge she was admitted for a bone marrow transplant from her HLA identical sister. The patient died due to rejection of the transplant and the complications derived from this event.

The acute, systemic effects of aerobic exercise in recently concussed adolescent student-athletes: preliminary findings.

OBJECTIVES: Examine the acute effects (pre-, during, post-intervention) of two different intensities of aerobic exercise or rest on autonomic, oculomotor, and vestibular function and symptom burden in patients with a recent sport-related concussion (SRC) and compare their responses to sex-matched, age-stratified, non-concussed (HEALTHY) student-athletes. METHODS: Student-athletes between the ages of 13 and 18 that presented to the sports medicine clinic within Day 3-7 post-SRC and from local schools were recruited for a randomized controlled trial (RCT). The participants were administered the Vestibular/Ocular Motor Screening (VOMS), King-Devick (K-D), and Post-Concussion Symptom Scale (PCSS) before and after the intervention. Heart rate variability (HRV) and mean arterial pressure (MAP) were collected before, during, and after the intervention. The intervention was either a single, 20-min session of treadmill walking at 40% (40HR) or 60% of age-predicted max heart rate (60HR), or seated, rest (NOEX). RESULTS: 30 participants completed the intervention with the SRC group treated 4.5 ± 1.3 days post-injury. Pre-exercise HRV and MAP were significantly different (p's < 0.001) during treatment but returned to pre-exercise values within 5 min of recovery in both the SRC and HEALTHY groups. Both the SRC and HEALTHY groups exhibited similar reductions pre- to post-intervention for symptom severity and count (p's < 0.05), three VOMS items (p's < 0.05) but not K-D time. CONCLUSIONS: To date, this is the first adolescent RCT to report the acute, systemic effects of aerobic exercise on recently concussed adolescent athletes. The interventions appeared safe in SRC participants, were well-tolerated, and provided brief therapeutic benefit. TRIAL REGISTRATION: Clinicaltrials.gov Identifier NCT03575455.

Idiopathic pulmonary fibrosis.

Idiopathic pulmonary fibrosis (IPF) is the most common fibrosing lung disease. It is associated with a very poor prognosis. Treatments can delay the progression of IPF, so early diagnosis is fundamental. Radiologists play a fundamental role in the evaluation and accurate diagnosis of IPF. Identifying the characteristic patterns of IPF on high-resolution computed tomography (HRCT) is key in the process of multidisciplinary diagnosis, often obviating the need for surgical lung biopsies. This review describes and illustrates the clinical and imaging findings in IPF in the context of the most recent international guidelines, as well as the differential diagnosis and the role of HRCT in follow-up and assessment of complications.

Resección endoscópica la coalición calcaneonavicular / Endoscopic resection of the calcaneonavicular coalition

Las coaliciones tarsianas tienen una incidencia global en la población entre el 2 y el 5%. La coalición calcaneonavicular representa el 53% de ellas. El tratamiento inicial debe ser conservador, quedando relegada la cirugía al fracaso de éste. Como alternativa al tratamiento quirúrgico convencional se ha descrito la resección endoscópica, que supone una técnica con menor agresividad y más rápida recuperación funcional. MATERIAL Y MÉTODOS: Realizamos un estudio retrospectivo de todos los pacientes con coalición calcáneo-navicular intervenidos quirúrgicamente en nuestro hospital mediante resección endoscópica durante los años 2015 al 2018. Para la valoración de resultados se usó la escala AOFAS de pie y tobillo. RESULTADOS: Se revisaron siete pies durante un periodo mínimo de 12 meses. La escala AOFAS preoperatoria era de 42 y de 92 en la última revisión clínica. No hubo complicaciones mayores derivadas de la cirugía. Tuvimos un caso de disestesias en el dorso de pie que se resolvió al tercer mes de evolución y un paciente con tumefacción local que se solucionó con hielo y pie elevado. CONCLUSIONES: La resección endoscópica ofrece ciertas ventajas sobre la cirugía abierta convencional. Ofrece una visión óptima de las estructuras anatómicas y un buen control de la resección de la barra. Permite una rehabilitación precoz, la estancia hospitalaria disminuye, los efectos cosméticos se minimizan y la probabilidad de neuromas es prácticamente nula con un buen control de la técnica

Tarsal coalition has an incidence between 2-5% of the general population, and calcaneonavicular is the most frequent (53%). When conservative treatment fails, surgical resection must be indicated. Endoscopic resection is a less invasive technique and can be considered an alternative with better functional recovery. MATERIAL AND METHODS: We performed a retrospective study of the patients with calcaneonavicular coalition operated in our hospital between 2015 and 2018. We performed an endoscopic resection. We used AOFAS scale score for the results. RESULTS: We reviewed seven cases for a minimum of 12 months. AOFAS score improved from 42 before surgery to 92. There were no major complications from surgery. We had a patient with dysesthesias in the forefoot that improved at 3 months and a case of local swelling that solved with ice and rest. CONCLUSIONS: Endoscopic resection has advantages over open surgery. Offers a great vision and good control of the coalition resection, provides an early rehabilitation, decrease hospital stay, improves cosmetic results and the probability of neuroma is minimum with an adequate control of the technique

Endoscopic resection of the calcaneonavicular coalition. / Resección endoscópica la coalición calcaneonavicular.

Tarsal coalition has an incidence between 2-5% of the general population, and calcaneonavicular is the most frequent (53%). When conservative treatment fails, surgical resection must be indicated. Endoscopic resection is a less invasive technique and can be considered an alternative with better functional recovery. MATERIAL AND METHODS: We performed a retrospective study of the patients with calcaneonavicular coalition operated in our hospital between 2015 and 2018. We performed an endoscopic resection. We used AOFAS scale score for the results. RESULTS: We reviewed seven cases for a minimum of 12 months. AOFAS score improved from 42 before surgery to 92. There were no major complications from surgery. We had a patient with dysesthesias in the forefoot that improved at 3 months and a case of local swelling that solved with ice and rest. CONCLUSIONS: Endoscopic resection has advantages over open surgery. Offers a great vision and good control of the coalition resection, provides an early rehabilitation, decrease hospital stay, improves cosmetic results and the probability of neuroma is minimum with an adequate control of the technique.

Spanish Guidelines for Diagnosis, Management, Treatment, and Prevention of DRESS Syndrome.

BACKGROUND AND OBJECTIVE: Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a complex multisystemic severe drug hypersensitivity reaction whose diagnosis and management are troublesome. DRESS syndrome requires management by various specialists. The correct identification of the culprit drug is essential to ensure safe future therapeutic options for the patient. There are no previous Spanish guidelines or consensus statements on DRESS syndrome. Objective: To draft a review and guidelines on the clinical diagnosis, allergy work-up, management, treatment, and prevention of DRESS syndrome in light of currently available scientific evidence and the experience of experts from multiple disciplines. METHODS: These guidelines were drafted by a panel of allergy specialists from the Drug Allergy Committee of the Spanish Society of Allergy and Clinical Immunology (SEAIC), together with other medical specialists involved in the management of DRESS syndrome and researchers from the PIELenRed consortium. A review was conducted of scientific papers on DRESS syndrome, and the expert panel evaluated the quality of the evidence of the literature and provided grades of recommendation. Whenever evidence was lacking, a consensus was reached among the experts. RESULTS: The first Spanish guidelines on DRESS syndrome are now being published. Important aspects have been addressed, including practical recommendations about clinical diagnosis, identification of the culprit drug through the Spanish pharmacovigilance system algorithm, and the allergy work-up. Recommendations are provided on management, treatment, and prevention. Algorithms for the management of DRESS in the acute and recovery phases have been drawn up. Expert consensus-based stepwise guidelines for the management and treatment of DRESS syndrome are provided.

Simultaneous robotic assisted laparoscopic prostatectomy (RALP) and inguinal herniorrhaphy (IHR): proof-of-concept analysis from a high-volume center.

PURPOSE: Inguinal hernia (IH) is detected in approximately 33% of RALP's either pre or intraoperatively wherein all are repaired during RALP to circumvent future herniorrhaphy (Fukuta et al., Urology 68(2):267-271, 2006; Nielsen, Urology 66(5):1034-1037, 2005). Some debate this policy by quoting the potential risk of mesh lying close to the vesicourethral anastomosis leading to infections and adhesions. The current study was initiated to elucidate the feasibility and outcomes of simultaneous inguinal herniorrhaphy (IHR) during RALP. METHODS: Historic analysis of prospectively maintained data of 1224 RALP patients, as per inclusion criteria, between 2012 and 2017 was done, among whom 143 patients had a concurrent IHR using 3DmaxTM polypropylene monofilament mesh. Patients were then compared for demographics, peri-operative features, and outcomes. RESULTS: The mean age and AUA score were significantly different (p < 0.002, p < 0.01 respectively) between patients undergoing only RALP and RALP with IHR. BMI was not significantly different. One hundred forty-three patients (11.6%) underwent IHR at 155 hernial sites, 12 sites being bilateral. One hundred and one sites (65.2%) were diagnosed intraoperatively. The mean console time was 67.4 ± 11.5 min for RALP which increased by 6.9 ± 10.7 min in unilateral and by 10.7 ± 8.6 min in bilateral IHR. There were no mesh-associated or Clavien Dindo class II-V complications. Mean follow-up was 36 ± 1.4 months with no recurrences. CONCLUSION: This study reiterates the feasibility and advisability of repairing most inguinal hernias encountered during RALP as it is without any significant alteration of peri-operative morbidity, is associated with excellent post-operative outcomes, and obviates the need for a future surgical procedure.

Heterogeneous Predisposing Factors and Etiology of Edema of the Uvula in a Spanish Population.

BACKGROUND AND OBJECTIVE: Edema of the uvula (EU) may appear in isolation or in association with clinical manifestations such as urticaria, angioedema, and anaphylaxis. EU may lead to upper airway obstruction, provoking obstructive respiratory distress and asphyxia. Objective: We sought to investigate the etiology of and predisposing factors for EU in a large population of patients referred to an outpatient clinic. METHODS: In this 3-year follow-up cohort study, 171 patients presenting with EU were identified and classified as having isolated EU or nonisolated EU. The etiology of each patient's condition was studied, and possible predisposing factors were recorded. An allergology work-up and a statistical study (bivariate/multivariate analyses) were performed. RESULTS: The predisposing factors for both groups of EU patients were found to be different. The etiology of the problem was identified for most patients; allergy to Anisakis simplex was the most common cause in both groups. Nonsteroidal anti-inflammatory drugs and antibiotics were also found to be triggers in both groups. CONCLUSIONS: Isolated EU was associated with snoring, an elongated uvula, and having experienced previous episodes of EU. We found no associations between groups of EU patients and gender, obesity, smoking, alcohol consumption, personal and family history of atopy, and obstructive sleep apnea. Allergy to A simplex was the most commonly recorded cause.

Analysis of a phenol-adapted microbial community: degradation capacity, taxonomy and metabolic description.

AIMS: In this study, the ability of the consortium MR-01 to degrade phenol was determined. The effects of this chemical on the taxonomy and the metabolic behaviour were analysed through metagenomics. METHODS AND RESULTS: Consortium MR-01 was acclimated in a sublethal concentration of phenol. After this process, the capacity to degrade this molecule was analysed. Results showed that degradation increased with the increment of the initial phenol concentration. Metagenomic analysis indicates that the consortium metabolized phenol under aerobic conditions using phenol 2-monooxygenase and the meta-cleavage pathway. Sequence of the enzymes involved in the phenol degradation was ascribed to the Actinomycetales and Chloroflexales orders, with relative abundances <1%. The most abundant genera were part of the Sphingomonadales order; however, the role of these species in the consortium is not clear. CONCLUSIONS: Consortium MR-01 degrades efficiently high concentrations of phenol. The participation of extremophiles in the degradation process and the emergence of beneficial metabolic dependencies between the community members are some of the strategies used by the consortium to survive and develop under harsh environmental conditions. SIGNIFICANCE AND IMPACT OF THE STUDY: This is one of the few studies describing the taxonomy and metabolic profile of a phenol degrading consortium.