Reflexiones sobre la aplicación de la "Ley Trans” en la atención sanitaria / Reflections on the application of the “trans law” in health care

En este artículo se reflexiona sobre la reciente ley aprobada por el Congreso de los Diputados conocida como Ley 4/2023 para la igualdad real y efectiva de las personas trans y para la garantía de los derechos de las personas LGTBI (BOE-A-2023-5366, 2023). Se analizan inicialmente los artículos que más polémica han causado en el ámbito social, que son los relativos a la rectificación registral (Art. 43-51), y posteriormente los que hacen referencia directa o indirectamente a aspectos sanitarios; 1) el que prohíbe de métodos, programas o las llamadas terapias de conversión (Art. 17), 2) los que definen cómo debe ser en términos generales la atención sanitaria (Art. 56-59), y 3) finalmente el único artículo que menciona a los menores (Art 70). Se comenta que el término utilizado de persona trans, al englobar un amplio abanico de diversidades sexuales, variantes y expresiones de género, incluye tanto a personas que necesitan una atención médica como a otras que no. Se plantea que la rectificación registral acorde con esta ley 2023 al no precisar ningún requisito para su inscripción, ofrece menos garantías que la legislación ya existente de marzo 2007. Se considera que las directrices de la nueva ley se están traduciendo en una toma de decisiones por parte del usuario sin disponer de una valoración o diagnóstico por el equipo de profesionales que atienden el caso. Se destaca que la ley no incluye ninguna referencia a la atención por salud mental. Y en conjunto, se concluye que el texto aprobado, en el ámbito sanitario, puede mermar la calidad de la asistencia integral, sobre todo en menores, o personas con identidades complejas, dudosas, o con comorbilidades, que pueden generar discrepancia entre el criterio del profesional y la opinión del usuario.(AU)

Genetic diversity based on multivariate techniques in elephant grass genotypes for bioenergy.

The use of biomass for energy production constitutes a promising strategy that warrants the search for new sources of biomass. Elephant grass has been gaining notoriety due to its high dry matter yield and rapid growth. The present study was carried out to quantify the genetic divergence of nine elephant grass half-sib families in order to identify genotypes with greater genetic divergence and productive potential for hybridization, using the hierarchical clustering methodology based on principal components. Half-sib families were generated using genotypes from the Active Germplasm Bank of Elephant Grass. The experiment was laid out in a randomized-block design with nine half-sib families, three replicates, and eight plants per plot. A total of 216 genotypes of elephant grass were evaluated. Principal component (PC), biplot, and hierarchical clustering analyses for diversity estimation were conducted using R software. The first two PCs of biplot analysis accounted for 64% of the cumulative variation. Dry matter yield was the most important trait for genotype discrimination (0.89), followed by plant height (0.67) and stem diameter (0.61) in PC1. In this analysis, the distances between accessions were considered and there were no family links, which indicates the existence of wide variability within the evaluated families, since genotypes belonging to the same family were not grouped together, but rather distributed into different groups. Crosses between genotypes of group three and genotypes of groups one and two are recommended for the development of high-yielding genotypes when aiming at energy production.

Acoustically targeted noninvasive gene therapy in large brain volumes.

Focused Ultrasound Blood-Brain Barrier Opening (FUS-BBBO) can deliver adeno-associated viral vectors (AAVs) to treat genetic disorders of the brain. However, such disorders often affect large brain regions. Moreover, the applicability of FUS-BBBO in the treatment of brain-wide genetic disorders has not yet been evaluated. Herein, we evaluated the transduction efficiency and safety of opening up to 105 sites simultaneously. Increasing the number of targeted sites increased gene delivery efficiency at each site. We achieved transduction of up to 60% of brain cells with comparable efficiency in the majority of the brain regions. Furthermore, gene delivery with FUS-BBBO was safe even when all 105 sites were targeted simultaneously without negative effects on animal weight or neuronal loss. To evaluate the application of multi-site FUS-BBBO for gene therapy, we used it for gene editing using the clustered regularly interspaced short palindromic repeats (CRISPR)/CRISPR-associated 9 (Cas9) system and found effective gene editing, but also a loss of neurons at the targeted sites. Overall, this study provides a brain-wide map of transduction efficiency, shows the synergistic effect of multi-site targeting on transduction efficiency, and is the first example of large brain volume gene editing after noninvasive gene delivery with FUS-BBBO.

UK-wide risk factor study of broiler carcases highly contaminated with Campylobacter.

Campylobacter is a major cause of food poisoning and is typically the most common cause of gastroenteritis in the UK. Data collected at broiler farm and abattoir level, for slaughter batches that were sampled for UK-wide monitoring, were used to generate two epidemiological risk factor models. A total of 483 batches slaughtered between January 2016 and March 2017 were used in the analysis, coming from 19 abattoirs representing more than 85% of UK broiler production. For each selected slaughter batch, one carcase was sampled after primary chilling and 10 randomly sampled birds had caecal samples collected at the evisceration point. Samples were used for Campylobacter identification and quantification. Two multivariable mixed-effects models were designed, one with the binary outcome for the detection of a highly contaminated (>1000 colony forming units (CFU)/g) Campylobacter-positive carcase, whereas the other used the Campylobacter colony count (CFU/g) carcase outcome. The results suggest that caecal colonization within the batch was a key factor for the occurrence of Campylobacter on carcases, and many factors that were identified in the model were also likely to be related to colonization or related to the risk of introduction of Campylobacter from partial depopulation (referred to as thinning) of ~30% of the flock approximately 1 week before full flock depopulation events. The amount of neck skin in the sample was another key factor identified and was included in both models as a risk factor. The models have also identified other factors which may be related to the general health and husbandry on-farm (use of prebiotics or vaccines, and identification of the product used for drinking line cleaning), whereas the other factors may identify control points related to transmission within a farm. The identification of these variables could help focus control efforts on-farm, especially for relatively easy improvements, such as improving the provision of house-specific bird-weighing buckets/cages in houses.

Sequential Imaging of a Rapidly Progressive Rheumatoid Vasculitis: A Unique Depiction.

Rheumatoid vasculitis is a clinically heterogenous complication of rheumatoid arthritis (RA), primarily affecting small- and medium-sized vessels.1 A 63-year-old man with long-standing seropositive erosive RA presented to our emergency department with abdominal pain and diarrhea.

As and S speciation in a submarine sulfide mine tailings deposit and its environmental significance: The study case of Portmán Bay (SE Spain).

The dumping of an estimated amount of 57 million tons of hazardous sulfide mine waste from 1957 to 1990 into Portmán's Bay (SE Spain) caused one of the most severe cases of persistent anthropogenic impact in Europe's costal and marine environments. The resulting mine tailings deposit completely infilled Portmán's Bay and extended seawards on the continental shelf, bearing high levels of metals and As. The present work, where Synchrotron XAS, XRF core scanner and other data are combined, reveals the simultaneous presence of arsenopyrite (FeAsS), scorodite (FeAsO4·2H2O), orpiment (As2S3) and realgar (AsS) in the submarine extension of the mine tailings deposit. In addition to arsenopyrite weathering and scorodite formation, the, the presence of realgar and orpiment is discussed, considering both potential sourcing from the exploited ores and in situ precipitation from a combination of inorganic and biologically mediated geochemical processes. Whereas the formation of scorodite relates to the oxidation of arsenopyrite, we hypothesize that the presence of orpiment and realgar is associated to scorodite dissolution and subsequent precipitation of these two minerals within the mine tailings deposit under moderately reducing conditions. The occurrence of organic debris and reduced organic sulfur compounds evidences the activity of sulfate-reducing bacteria (SRB) and provides a plausible explanation to the reactions leading to the formation of authigenic realgar and orpiment. The precipitation of these two minerals in the mine tailings, according to our hypothesis, has important consequences for As mobility since this process would reduce the release of As into the surrounding environment. Our work provides for the first time valuable hints on As speciation in a massive submarine sulfide mine tailings deposit, which is highly relevant for similar situations worldwide.

Assessing the Equivalence of Brain-Derived Measures from Two 3D T1-Weighted Acquisitions: One Covering the Brain and One Covering the Brain and Spinal Cord.

BACKGROUND AND PURPOSE: In MS, it is common to acquire brain and spinal cord MR imaging sequences separately to assess the extent of the disease. The goal of this study was to see how replacing the traditional brain T1-weighted images (brain-T1) with an acquisition that included both the brain and the cervical spinal cord (cns-T1) affected brain- and spinal cord-derived measures. MATERIALS AND METHODS: Thirty-six healthy controls (HC) and 42 patients with MS were included. Of those, 18 HC and 35 patients with MS had baseline and follow-up at 1 year acquired on a 3T magnet. Two 3D T1-weighted images (brain-T1 and cns-T1) were acquired at each time point. Regional cortical thickness and volumes were determined with FastSurfer, and the percentage brain volume change per year was obtained with SIENA. The spinal cord area was estimated with the Spinal Cord Toolbox. Intraclass correlation coefficients (ICC) were calculated to check for consistency of measures obtained from brain-T1 and cns-T1. RESULTS: Cortical thickness measures showed an ICC >0.75 in 94% of regions in healthy controls and 80% in patients with MS. Estimated regional volumes had an ICC >0.88, and the percentage brain volume change had an ICC >0.79 for both groups. The spinal cord area measures had an ICC of 0.68 in healthy controls and 0.92 in patients with MS. CONCLUSIONS: Brain measurements obtained from 3D cns-T1 are highly equivalent to those obtained from a brain-T1, suggesting that it could be feasible to replace the brain-T1 with cns-T1.

Conocimiento previo sobre fisioterapia de estudiantes de nuevo ingreso y comparación entre españoles y franceses: estudio observacional de base poblacional en Cataluña / Previous knowledge about Physiotherapy and comparison between Spanish and French new-entry students: a population-based observational study in Catalonia

Antecedentes y objetivo Evaluar el conocimiento previo sobre fisioterapia de los estudiantes de nuevo ingreso, analizando diferencias entre españoles y franceses. Material y métodos Estudio observacional, multicéntrico, transversal. Criterios de inclusión: mayores de edad inscritos en primer curso de grado único de fisioterapia. Los datos se recogieron mediante cuestionario y se analizaron mediante tests de Mann-Whitney y X2/Fisher. Resultados La muestra fue de 861 estudiantes (460 españoles y 401 franceses). Las ramas más citadas fueron la deportiva (47,2%), pediátrica (37,4%) y general (36,5%). Hubo diferencia estadísticamente significativa en el número de ramas citadas, con superioridad en los franceses (0,71 puntos). Los estudiantes franceses citaron significativamente más fisioterapia cardíaca, respiratoria, deportiva, geriátrica, neurológica, pediátrica, y urgencias/Unidad de Cuidados Intensivos (UCI), mientras que los españoles la educación o formación, osteopatía, preventiva, uroginecológica y veterinaria. Los centros sanitarios representaron el lugar de trabajo más enunciado (93,4%), seguido de las consultas privadas (61,7%), centros deportivos (54,7%) e instituciones geriátricas (33,6%). Los españoles citaron más lugares de trabajo (0,14 puntos). Los centros deportivos, sanitarios, sociales/cívicos, los entornos laborales y con animales y las instituciones educativas fueron significativamente más nombradas por los españoles, mientras que los franceses citaron más las consultas privadas y los domicilios. Conclusiones Los estudiantes franceses enumeraron significativamente más ramas de la fisioterapia, mientras que los españoles citaron más lugares de trabajo (próximo a la significancia estadística). Los franceses destacan significativamente más las consultas privadas y domicilios y ramas como la neurológica, pediátrica, deportiva, respiratoria o geriátrica (AU)

Background and objective To assess pre-existing knowledge about Physiotherapy and to analyze potential differences between new-entry students from Spain and France. Material and methods Observational, multicenter, cross-sectional study. Inclusion criteria: age 18 + years and enrolled in first year of a single degree in Physiotherapy. Data was collected via questionnaire and analized by Mann-Whitney and Chi-squared or Fisher tests. Results The sample consisted of 861 students (460 Spain and 401 France). The most mentioned branches were sports (47.2%), pediatric (37.4%) and general (36.5%). A statistically significant difference was found in the number of branches mentioned, with French students being ahead (0.71 points). Physiotherapy branches such as cardiac, respiratory, sports, geriatric, neurologic, pediatric, emergencies/ICU were mentioned significantly more by the French. Spanish students more frequently mentioned education, osteopathy, preventive, urogynecologic and veterinarian. Healthcare centers were the most cited (93.4%) workplaces, followed by outpatient clinics (61.7%), sports facilities (54.7%) and geriatric settings (33.6%). The Spanish mentioned more places than the French (0.14 points). Sports centers, healthcare settings, social/civic, workplace, places with animals and educational institutions were significantly more cited by Spanish students. French students cited outpatient private clinics and home visits more frequently. Conclusions French students cited a statistically significant higher number of branches of physiotherapy, while Spanish students cited a greater number of workplaces (close to statistical significance). Workplaces such as private consultations and in-home physiotherapy were mentioned significantly more by the French, and so were branches such as neurology, pediatrics, sports, respiratory or geriatrics (AU)

Política de medicamentos de alto costo en un hospital público pediátrico: Análisis de utilización y costos / High-cost medication policy at a public pediatric hospital: utilization and cost analysis

Objetivos. Analizar el circuito de utilización de los medicamentos de alto costo (MAC) y los resultados clínicos obtenidos en un hospital de pediatría público de alta complejidad de Argentina y presentar una estrategia de selección replicable para otras instituciones de similares características de la región. Métodos: Estudio prospectivo, descriptivo, aleatorizado, conducido en el Hospital de Pediatría Juan P. Garrahan de la Ciudad Autónoma de Buenos Aires en el período entre el 1 de setiembre de 2018 y el 31 de marzo de 2019. Se evaluaron dos unidades de estudio, la unidad paciente y la unidad MAC. Resultados: Los MAC consumen 7.921.200 dólares estadounidenses (USD) anuales y representan el 41% del costo de los medicamentos del hospital de alta complejidad. El 50% del costo de los MAC estuvo representado por la gammaglobulina (medicamento utilizado en diferentes enfermedades). Los pacientes proceden de toda la Argentina y otros países y un 44% tiene cobertura de salud. Los diagnósticos para los que se prescribieron MAC con mayor frecuencia fueron los relacionados con patología oncológica (leucemia linfoide aguda, leucemia mieloblástica aguda). El 54% de los pacientes presentó mejoría atribuible directamente a la administración de los MAC, 39% no presentó cambios y el 7% empeoró. Conclusiones: La efectividad en los resultados clínicos y el análisis de los circuitos de aprobación indican que, además de la aprobación por las entidades nacional e internacionales, la evaluación responsable por parte de las instituciones efectoras, mediante la discusión interdisciplinaria basada en la mejor evidencia, contribuye a optimizar la utilización de los MAC y la seguridad de los pacientes (AU)

Objectives. To analyze the utilization circuit of high-cost medications (HCM) and the clinical results obtained in a tertiarycare public pediatric hospital in Argentina and to present a selection strategy that may be disseminated to other institutions of similar characteristics in the region. Methods: A prospective, descriptive, randomized study was conducted at Hospital de Pediatría Juan P. Garrahan in Buenos Aires between September 1, 2018 and March 31, 2019. Two study units were evaluated, the patient and the HCM. Results: HCMs account for 7,921,200 US dollars (USD) per year and represent 41% of the cost of drugs in this tertiary-care hospital. Gamma globulin (a drug used for different diseases) accounted for 50% of the cost of HCMs. Patients came from Argentina and other countries and 44% had a health insurance. Cancer (acute lymphoid leukemia, acute myeloblastic leukemia) was the diagnosis for which HCMs were most frequently prescribed. Fifty-four percent of patients showed improvement directly attributable to the administration of HCMs, 39% showed no change, and 7% worsened. Conclusions: The effectiveness in clinical outcomes and the analysis of approval circuits show that, in addition to approval by national and international entities, responsible evaluation by the effector institutions through interdisciplinary discussion based on the best evidence contributes to optimizing the use of HCMs and patient safety (AU)

Management of Borderline ovarian tumors (BOT): results of a retrospective, single center study in Switzerland.

BACKGROUND: Borderline tumors are malignant epithelial ovarian tumors with a very low incidence. Thus experience in diagnostics and treatment is still rare. The aim of this study was to present and analyze data of women with borderline ovarian tumor (BOT) regarding clinical features, histological characteristics, diagnostics and treatment management. METHODS: In this single center retrospective study women with BOT treated at the Departement of Gynecology and Obstetrics at the Kantonsspital Luzern between 2011 and 2018 were analyzed according to their clinical and histological reports. RESULTS: A total of 42 women were enrolled. The median age was 58.5 with a range from 26 to 85, of which 31 (73.8%) were postmenopausal. Regarding the histological subtypes, 23 women (54.8%) had serous and 15 (35.7%) had mucinous BOT. Seromucinous histology was found in 3 patients (7.1%) and endometrioid in 1 woman (2.4%), respectively. All women underwent surgery. In a total of 39 women (92.9%) a complete surgical staging for BOT was performed. In 29 women (69.0%) staging was performed by laparoscopy, 13 (31.0%) underwent laparotomy. The mean follow up was 52 months (range = 16.3-101.4 months). During this period two patients, initially diagnosed in FIGO stage 1, recurred after 21.7 and 44 months, respectively, the second woman died after 53 months because of the BOT. CONCLUSION: In the present study women were treated according to the international therapy recommendations and the rate of recurrence was very low. The most common risk factors for relapse are known to be FIGO stage, incomplete staging and peritoneal implants but were not present in our group. Thus further studies are necessary to investigate additional recurrence risks.

Effects of manual therapy on body posture: Systematic review and meta-analysis.

BACKGROUND: Several clinical trials investigated the effectiveness of MT on body posture, but a systematic review grouping the results of these studies was not found in the literature. RESEARCH QUESTION: Does manual therapy (MT) cause postural changes? METHODS: Inclusion criteria were: randomized controlled trials in any population; studies in which the primary intervention was the use of any MT technique; studies that evaluated the immediate, short, medium, or long-term effects of interventions on body posture; and studies published in peer-reviewed scientific journals in any year and language. In March 2022, we conducted a search in the PUBMED, Cinahl, Embase, PEDro, and Cochrane Central databases that yielded 6627 articles, of which 38 including 1597 participants were eligible; of these, 35 could be grouped into 12 meta-analyses. The risk of bias was assessed using the PEDro scale and the certainty in the scientific evidence rated through the GRADE system. RESULTS: The results allowed us to conclude with moderate certainty in the evidence that, when compared to no intervention or sham, in the short and medium term, MT reduced the forward head posture (14 studies, 584 individuals, 95%CI 0.38, 1.06), reduced thoracic kyphosis (5 studies, 217 individuals, 95%CI 0.37, 0.94), improved lateral pelvic tilt (5 studies, 211 individuals, 95%CI 0.11, 0.67) and pelvic torsion (2 studies, 120 individuals, 95%CI 0.44, 1.19) and increased plantar area (3 studies, 134 individuals, 95%CI 0.04, 0.74). With moderate certainty, there was no significant effect on shoulder protrusion (5 studies, 176 individuals, 95%CI -0.11, 0.61), shoulder alignment in the frontal plane (3 studies, 160 individuals, 95%CI -0.15, 0.52), scoliosis (2 studies, 26 individuals, 95%CI -1.57, 2.19), and pelvic anteversion (5 studies, 233 individuals, 95%CI -0.02, 0.51). With low certainty, MT had no effect on scapular upward rotation (2 studies, 74 individuals, 95%CI -0.76, 2.17). With low to very low certainty, it is possible to conclude that MT was not superior to other interventions in the short or medium term regarding the improvement of forward head posture (5 studies, 170 individuals, 95%CI -1.39, 0.67) and shoulder protrusion (3 studies, 94 individuals, 95%CI -4.04, 0.97). SIGNIFICANCE: MT can be recommended to improve forward head posture, thoracic kyphosis and pelvic alignment in the short and medium term, but not shoulder posture and scoliosis. MT reduces the height of the plantar arch and this must be taken into account in physical therapy planning. PROSPERO registration number: CRD42021244423.

Accidente de trabajo por infección por Covid-19 en trabajadores sanitarios y socio-sanitarios en Asturias / Occupational accident due to COVID-19 infection in health and social-health workers in the fifth sanitary area of asturias

Introducción: El contagio COVID-19 en trabajadores sanitarios y socio-sanitarios en España se considera accidente de trabajo (AT) si lo certifican los Servicios de Prevención de Riesgos Laborales (SPRL). El objetivo del estudio fue verificar su cumplimiento en nuestra Área y subsanar posibles deficiencias. Material y Métodos: Estudio descriptivo del 28 de mayo de 2020 al 27 de enero de 2021. Inspección solicitó certificado AT a SPRL, y que el Instituto Nacional de Seguridad Social (INSS) reconociera el AT si la Mutua lo negaba. Resultados: 204 casos: 55,4% sanitarios, 52,5% públicos. Certificado AT de SPRL: 61,8%. INSS reconoció AT: 41,2%. Mayor reconocimiento AT en trabajadores socio-sanitarios y privados, menor en sanitarios y públicos del Área V. La intervención de la Inspección mejoró parcialmente los resultados. Conclusiones: Pese a cumplir los requisitos legales la infección COVID-19 en estos colectivos no siempre fue reconocida AT. El papel garante de la Inspección fue insufiente. (AU)

Introduction: In Spain, COVID-19 infection in the health and social-health workers is considered as an occupational accident (OA) if the Occupational Risk Prevention Services (ORPS) certificate it. The aim of our study was to verify it in our area and to correct deficiencies. Material and Method: Descriptive study from May 28, 2020 to January 27, 2021. The health Inspection Unit of our area required OA certificate to the ORPS, and the assessment by the National Institute of Social Security (NISS) when the private insurance fund denied OA. Results: Total of 204 cases (55.4% healthcare workers, 52.5% from public centres (33.3% in our area). ORPS OA certificate: 61.8%. NISS recognised OA: 41.2%. OA recognition was greater in socio-health and private workers than in sanitary and public workers. The medical inspection Unit intervention partially improve the results. Conclusions: Despite complying with legal requirements there were no OA recognition in all cases of COVID-19 infection in these workers. The medical inspection Unit was not guarantor enough. (AU)

Multisensor hyperspectral imaging approach for the microchemical analysis of ultramarine blue pigments.

This work presents a multisensor hyperspectral approach for the characterization of ultramarine blue, a valuable historical pigment, at the microscopic scale combining the information of four analytical techniques at the elemental and molecular levels. The hyperspectral images collected were combined in a single hypercube, where the pixels of the various spectral components are aligned on top of each other. Selected spectral descriptors have been defined to reduce data dimensionality before applying unsupervised chemometric data analysis approaches. Lazurite, responsible for the blue color of the pigment, was detected as the major mineral phase present in synthetic and good quality pigments. Impurities like pyrite were detected in lower quality samples, although the clear identification of other mineral phases with silicate basis was more difficult. There is no correlation between the spatial distribution of the bands arising in the Raman spectra of natural samples in the region 1200-1850 cm-1 and any of the transition metals or rare earth elements (REE). With this information, the previous hypothesis (based on bulk analysis) attributing these bands to luminescence emissions due to impurities of these elements must be revised. We propose the consideration of CO2 molecules trapped in the cages of the aluminosilicate structure of sodalite-type. Additionally, correlation between certain Raman features and the combined presence of Ca, P, and REE, in particular Nd, was detected for the lowest quality pigment. Our results highlight the usefulness of fusing chemical images obtained via different imaging techniques to obtain relevant information on chemical structure and properties.

Unleashing the full power of LHCb to probe stealth new physics.

In this paper, we describe the potential of the LHCb experiment to detect stealth physics. This refers to dynamics beyond the standard model that would elude searches that focus on energetic objects or precision measurements of known processes. Stealth signatures include long-lived particles and light resonances that are produced very rarely or together with overwhelming backgrounds. We will discuss why LHCb is equipped to discover this kind of physics at the Large Hadron Collider and provide examples of well-motivated theoretical models that can be probed with great detail at the experiment.