Efficacy and safety of withholding antimicrobial therapy in children with cancer, fever and neutropenia, with a demonstrated viral respiratory infection: a randomized clinical trial.

OBJECTIVES: To validate the efficacy and safety of withholding antimicrobial therapy in a new cohort of children with cancer and febrile neutropenia (FN) having a demonstrated viral respiratory tract infection (RTI). METHODS: Prospective, multicenter, non-inferiority, randomized study, approved by the ethical committee, in children presenting with FN at seven hospitals in Chile, evaluated at admission for diagnosis of bacterial and viral pathogens. Children who were positive for a respiratory virus (RV), negative for a bacterial pathogen and had a favorable evolution after 48-72 hours of antimicrobial therapy were randomized to either maintain or withhold antimicrobial therapy. The primary endpoint was the percentage of episodes with uneventful resolution, whereas the secondary endpoints were days of fever/hospitalization, requirement of antimicrobial treatment readministration, sepsis, pediatric intensive care unit (PICU) admission and death. RESULTS: A total of 301 of 939 children with FN episodes recruited between March 2021 and December 2023 had a RV as a unique identified microorganism, of which 139 had a favorable evolution at 48-72 hours and were randomized, 70 to maintain and 69 to withdraw antimicrobial therapy. The median days of antimicrobial therapy was 5 (IQR 3-6) versus 3 (IQR 3-6) days (p<0.001), with similar frequency of uneventful resolution (66/70 (94%) and 66/69 (96%), RR 1.01, (95% CI 0.93-1.09), absolute risk difference 0.01, (95% CI -0.05-0.08) and similar number of days of fever and days of hospitalization. No cases of sepsis, PICU admission or death were reported. CONCLUSIONS: We validated the strategy of withdrawal antimicrobial therapy in children with FN and viral RTI, based on clinical and microbiological/molecular diagnostic criteria. This will enable advances in antimicrobial stewardship strategies with a possible future impact on antimicrobial resistance.

Predictive value of the Global Activity Limitation Indicator (GALI) on all-cause mortality.

OBJECTIVES: The Global Activity Limitation Indicator (GALI) is an instrument that measures long-term overall disability. The objective of this study was to evaluate GALI's predictive value on mortality while examining variations according to sex, age, and educational level. STUDY DESIGN: Longitudinal study. METHODS: This longitudinal study was based on 42,991 individuals aged ≥15 years who participated in the 2011-2012 National Health Survey and the 2014 European Health Survey in Spain. These records were linked to mortality data up to December 2021. GALI assessed self-reported functional limitation in the past 6 months and classified individuals into three categories: severely limited, limited but not severely, and not limited. Incidence rate ratios (IRR) were calculated using Poisson regression models, adjusting for sociodemographic, lifestyle, and health status variables. RESULTS: Compared to individuals with no limitations, those with non-severe limitations had an IRR for mortality of 1.27 (95% CI: 1.16-1.38), and 2.04 (95% CI: 1.81-2.31) in those with severe limitations. Women with severe limitations exhibited a higher IRR (2.32; 95% CI: 1.98-2.71) compared to men (1.73; 95% CI: 1.45-2.08) (P for interaction = 0.005). Individuals <65 years with severe limitations showed a greater association (2.22; 95% CI: 1.58-3.10) than those ≥65 (1.49; 95% CI: 1.32-1.69) (P for interaction <0.001). Among individuals with lower educational attainment, the IRR was 2.08 (95% CI: 1.83-2.37), and 1.87 (95% CI: 1.37-2.56) for the higher education group (P for interaction = 0.017). CONCLUSIONS: GALI is a robust predictor of all-cause mortality in the general population and subgroups. The association is stronger in women, individuals <65 years, and those with lower educational levels.

[Results of all-inside arthroscopic meniscal sutures, mid-term review]. / Resultado de suturas meniscales por técnica artroscópica ''todo adentro'', revisión a mediano plazo.

INTRODUCTION: all-in meniscal suture devices have evolved and simplified meniscal repair. In this study we will formulate the following research questions: what is the rate of survival and failure? What are the risk factors associated with failure? And what are the functional results after meniscal repair surgery? MATERIAL AND METHODS: ambispective study from 2001 to 2021 of patients with repairable meniscal injury with all-in meniscal suture devices. The survival and failure ratio were obtained with the Kaplan-Meier test, the risk factors associated with meniscal suture failure were assessed with the logistic regression test, and the pre- and post-surgical functional results were estimated with the test. t-Student. RESULTS: in 20 years of follow-up of 316 menisci repaired with all-in meniscal sutures, a survival rate of 95.9% was obtained. The absence of injury to the anterior horn of the meniscus was shown to be a protective factor [OR = 0.12], together with not practicing impact sports [OR = 0.2]. Post-surgery IKDC and Tegner-Lysholm results were shown to be very good to excellent (p < 0.0001). CONCLUSION: all-in meniscal suture devices are and will continue to be front-line weapons in the repair of meniscal tears. In 20 years of follow-up, a lower failure rate was evidenced, associated with excellent functional results.

INTRODUCCIÓN: los dispositivos de suturas meniscal todo adentro han evolucionado y simplificado la reparación meniscal. En este estudio formulamos las siguientes preguntas de investigación: ¿cuál es la tasa de supervivencia y falla?, ¿cuáles son los factores de riesgo asociado a falla? y ¿cuáles son los resultados funcionales posterior a la cirugía de reparación meniscal? MATERIAL Y MÉTODOS: estudio ambispectivo desde el 2001 al 2021 de pacientes con lesión meniscal reparable con dispositivos meniscales de sutura todo adentro. La razón de supervivencia y falla se obtuvo con el test de Kaplan-Meier, los factores de riesgo asociado con falla de la sutura meniscal se valoraron con el test de regresión logística y los resultados funcionales pre y postquirúrgicos fueron estimados con la prueba t-Student. RESULTADOS: en 20 años de seguimiento de 316 menisco reparados con suturas meniscal todo adentro se obtuvo que la razón de supervivencia de 95.9%. La ausencia de lesión del cuerno anterior del menisco se mostró como un factor protector [OR = 0.12], junto a la no práctica de deportes de impacto [OR = 0.2]. Se mostraron resultados del IKDC y Tegner-Lysholm posterior a la cirugía de muy buenos a excelentes (p < 0.0001). CONCLUSIÓN: los dispositivos de sutura de meniscal todo adentro son y seguirán siendo armas de primera línea en la reparación de las roturas meniscales. En 20 años de seguimiento se evidenció una menor tasa de falla, asociados con excelentes resultados funcionales.

Shift Current with Gaussian Basis Sets and General Prescription for Maximally Symmetric Summations in the Irreducible Brillouin Zone.

The bulk photovoltaic effect is an experimentally verified phenomenon by which a direct charge current is induced within a non-centrosymmetric material by light illumination. Calculations of its intrinsic contribution, the shift current, are nowadays amenable from first-principles employing plane-wave bases. In this work, we present a general method for evaluating the shift conductivity in the framework of localized Gaussian basis sets that can be employed in both the length and velocity gauges, carrying the idiosyncrasies of the quantum-chemistry approach. The (possibly magnetic) symmetry of the system is exploited in order to fold the reciprocal space summations to the representation domain, allowing us to reduce computation time and unveiling the complete symmetry properties of the conductivity tensor under general light polarization.

Diseño de un modelo de ronda de seguridad para unidades de cuidados intensivos / Design of a safety round model for intensive care units

Introducción: Las rondas de seguridad (RS) son una herramienta operativa que permite conocer la adherencia a las buenas prácticas, ayuda a identificar riesgos e incidentes en seguridad del paciente (SP), permitiendo implementar acciones de mejora. El objetivo de este trabajo fue el diseño de un procedimiento para realizar RS en una unidad de cuidados intensivos (UCI). Métodos: Elaboración de un listado de verificación para el desarrollo de RS en una UCI mediante técnica de grupo nominal, con la participación de directivos, mandos intermedios y profesionales de diferentes disciplinas y categorías. En primer lugar, un grupo de expertos consensuó, atendiendo a las recomendaciones en buenas prácticas en SP, la definición de ítems, su codificación, los criterios de cumplimiento y el impacto de su incumplimiento. Posteriormente, determinó su viabilidad mediante un estudio transversal a través del pilotaje de 2 RS para ajustar los ítems en condiciones de práctica clínica real. Resultados: Se ha obtenido un modelo de RS específico para UCI mediante un listado de verificación. El grupo de expertos elaboró un primer listado compuesto por 39 ítems de 6 dimensiones esenciales y definió el modo de realización. El tiempo medio de realización de las 2 RS fue de 85minutos, incluyendo el briefing y debriefing posterior. Tras el pilotaje de validación se redujo las dimensiones a 5, se suprimió 3 ítems, se trasladó 2 ítems a otra dimensión y se modificó 3 ítems relativos a infecciones nosocomiales y consentimiento informado. Además, se redefinieron las fuentes de datos, los criterios de cumplimiento y su peso relativo. El listado definitivo fue considerado útil y relevante para mejorar la práctica. Conclusiones: Mediante una metodología de consenso se ha construido un listado de verificación para ser usado en las RS de una UCI. Este modelo puede servir de base para su empleo en servicios asistenciales de similares características.(AU)

Introduction: Safety Rounds (SR) are an operational tool that allow knowing adherence to good practices, help identify risks and incidents in patient safety (PS), allowing improvement actions to be implemented. The objective of this work was the design of a procedure to perform SR in an Intensive Care Unit (ICU). Methods: Preparation of a checklist for the development of SR in the ICU through the nominal group technique, with the participation of managers, middle managers and professionals from different disciplines and categories. In the first place, a group of experts agreed, based on the recommendations on good practices in PS, the definition of items, their coding, the criteria for compliance and the impact of non-compliance. Subsequently, its viability was determined through a cross-sectional study through the piloting of two SRs to adjust the items in real clinical practice conditions. Results: A specific SR model for ICUs has been obtained through a checklist. The group of experts prepared a first list made up of 39 items of 6 essential dimensions and defined the method of implementation. Mean time to complete the two SRs was 85minutes, including the briefing and subsequent debriefing. After the validation pilot, the dimensions were reduced to 5, 3 items were deleted, 2 items were transferred to another dimension and 3 items related to nosocomial infections and informed consent were modified. In addition, the data sources, the compliance criteria and their relative weight were redefined. The final list was considered useful and relevant to improve practice. Conclusions: Through a consensus methodology, a checklist has been built to be used in the RS of an ICU. This model can serve as a basis for its use in healthcare services with similar characteristics.(AU)

Características y tratamiento de los pacientes nonagenarios con enfermedad vascular ingresados en los servicios de medicina interna. Registro NONAVASC-2 / Characteristics and treatment of nonagenarian patients with vascular disease admitted to internal medicine services. NONAVASC-2 registry

Introducción La enfermedad vascular es la causa más frecuente de morbimortalidad, y su prevalencia incrementa con la edad. Los pacientes muy añosos no se encuentran incluidos en los estudios sobre enfermedad vascular, desconociéndose sus características y tratamientos. Objetivo Conocer las características clínicas de los pacientes nonagenarios hospitalizados en servicios de medicina interna con diagnóstico de EV establecida y la adecuación de su manejo farmacológico. Material y métodos El Registro NONAVASC-2 es un estudio observacional, prospectivo y multicéntrico. Se incluyeron pacientes hospitalizados por cualquier causa. La recogida de datos se realizó a través de una base anonimizada online con parámetros sociodemográficos, clínicos, analíticos, terapéuticos y evolutivos. Resultados Se incluyeron 1.049 pacientes con una edad media de 93,14 años (57,8% mujeres). La prevalencia de los factores de riesgo fue muy elevada: hipertensión (84,9%), dislipemia (50,9%) y diabetes mellitus (29,4%). El 33,4% presentaba dependencia grave/total. El 82,9% recibía tratamiento antitrombótico (53,7% antiagregantes, 25,4% anticoagulación y 3,8% doble terapia). Solo el 38,2% recibía estatinas. El porcentaje de dependencia (39,2 vs. 24,1%; p=0,00) y deterioro cognitivo grave (30,8 vs. 13,8%; p=0,00) era significativamente mayor entre los pacientes que no las recibían. El 19% falleció durante el ingreso. Conclusión Los pacientes nonagenarios con EV presentan una elevada comorbilidad, dependencia y mortalidad. A pesar de estar en prevención secundaria, el 17% de ellos no recibía antitrombóticos y solo el 38% estatinas. Esta infraprescripción está condicionada por la situación funcional, entre otros factores, por lo que es necesario realizar más estudios para conocer el impacto sobre su pronóstico (AU)

Introduction Vascular disease is the most frequent cause of morbidity and mortality and its prevalence increases with age. Old patients are not included in studies on vascular disease, their characteristics and treatments being unknown. Objective Know the clinical characteristics of nonagenarian patients hospitalized in Internal Medicine services with a diagnosis of established VD and the adequacy of their pharmacological management. Material and methods The NONAVASC-2 registry is an observational, prospective, multicentre study. Hospitalized patients for any cause were included. Data collection was carried out through an anonymous online database with sociodemographic, clinical, analytical, therapeutic and evolutionary parameters. Results One thousand forty-nine patients with a mean age of 93.14 years (57.8% women) were included. The prevalence of risk factors and VD was high: hypertension (84.9%), dyslipidemia (50.9%) and diabetes mellitus (29.4%). 33.4% presented severe-total dependency. 82.9% received antithrombotic treatment (53.7% antiplatelets, 25.4% anticoagulation and 3.8% double therapy). Only 38.2% received statins. The percentage of severe dependence (39.2% vs 24.1%; p=0.00) and severe cognitive impairment (30.8% vs 13.8%; p=0.00) was significantly higher among patients who did not receive them. 19% died during admission. Conclusions Nonagenarian patients with VD present high comorbidity, dependence and mortality. Despite being in secondary prevention, 17% did not receive antithrombotics and only 38% received statins. The underprescription is conditioned, among other factors, by the functional status. More studies are necessary to determine the impact of this issue on their prognosis (AU)

Characteristics and treatment of nonagenarian patients with vascular disease admitted to internal medicine services. NONAVASC-2 registry.

INTRODUCTION: Vascular disease (VD) is the most frequent cause of morbidity and mortality and its prevalence increases with age. Old patients are not included in studies on VD, their characteristics and treatments being unknown. OBJECTIVE: Know the clinical characteristics of nonagenarian patients hospitalized in Internal Medicine services with a diagnosis of established VD and the adequacy of their pharmacological management. MATERIAL AND METHODS: The NONAVASC-2 registry is an observational, prospective, multicentre study. Hospitalized patients for any cause were included. Data collection was carried out through an anonymous online database with sociodemographic, clinical, analytical, therapeutic and evolutionary parameters. RESULTS: One thousand forty-nine patients with a mean age of 93.14 years (57.8% women) were included. The prevalence of risk factors and VD was high: hypertension (84.9%), dyslipidemia (50.9%) and diabetes mellitus (29.4%). 33.4% presented severe-total dependency. 82.9% received antithrombotic treatment (53.7% antiplatelets, 25.4% anticoagulation and 3.8% double therapy). Only 38.2% received statins. The percentage of severe dependence (39.2% vs 24.1%; p = 0.00) and severe cognitive impairment (30.8% vs 13.8%; p = 0.00) was significantly higher among patients who did not receive them. 19% died during admission. CONCLUSIONS: Nonagenarian patients with VD present high comorbidity, dependence and mortality. Despite being in secondary prevention, 17% did not receive antithrombotics and only 38% received statins. The underprescription is conditioned, among other factors, by the functional status. More studies are necessary to determine the impact of this issue on their prognosis.

Sequence analysis of exons 30 and 31 of LAMA3 gene variants and its association with human papillomavirus infection predisposition: no evidence was found.

OBJECTIVE: Human papillomavirus (HPV) is associated with cervical cancer. For the infection to occur, most HPV types depend on interactions with heparan sulfate proteoglycans (HSPGs); however, non-HSPGs receptors are also involved. Laminin 332 is a crucial component of the epidermis's base membrane. It has shown interactions with HPV that suggest its function as a transient viral receptor in the extracellular matrix (ECM). We provide new information about Laminin 332 and HPV by identifying LAMA3 gene allelic variants from exons 30 and 31 and their distribution among women with and without HPV infection. PATIENTS AND METHODS: We included 192 cervical cancer scrape samples from two groups of patients, 96 samples from patients with a low-grade squamous intraepithelial lesion (LSIL) and 96 samples from HPV-negative samples without LSIL. Identification of the HPV type was performed using an LCD-Array kit. Exons 30 and 31 of LAMA3 were amplified by PCR and analyzed by Sanger's sequencing. RESULTS: We identified a wide range of HPV types. The most frequent low-risk (lrHPV) HPV types were 6, 42, 44, and 90. For high-risk (hrHPV) HPV were 16, 31, 56, and 66. Only the genetic variant rs1131521 was identified in both groups. However, no significant association was observed between rs1131521 and the study groups. CONCLUSIONS: A single silent polymorphism was identified in both groups with similar frequency, whereas no mutations related to increased epithelial friability were identified.

Carfentanilo: una doble amenaza para la salud pública / Carfentanil: a double threat to public health

El carfentanilo es un opioide sintético con una potencia 10.000 veces superior a la de la morfina. Esta y otras características posicionan al carfentanilo como una sustancia de interés dual, pues ha sido empleada como agente incapacitante y como droga de abuso. Entre las características toxicocinéticas del carfentanilo destacan su elevada liposolubilidad y la posibilidad de que siga una cinética de eliminación no lineal. En 2002 este compuesto fue empleado por las Fuerzas de Seguridad Rusas para intentar resolver la crisis de rehenes del teatro Dubrovka de Moscú, causando la muerte de al menos 123 rehenes. Por otro lado, el carfentanilo, se ha empleado como droga de abuso y como adulterante en otras drogas. En caso de intoxicación por carfentanilo puede ser necesaria la administración de dosis repetidas de antídoto. Los antecedentes expuestos en este trabajo justifican la necesidad de desarrollar y validar un método analítico para la detección del carfentanilo y su metabolito norcarfentanilo en muestras biológicas. (AU)

Carfentanil is a synthetic opioid with a potency 10,000 times greater than that of morphine. For this and other reasons carfentanil is a substance with dual interest, since it has been used as an incapacitating agent and as an abuse drug. Among the toxicokinetic characteristics of carfentanil, its high lipid solubility stands out. In addition, there is the possibility that carfentanil follows a non-linear elimination kinetics. In 2002 this compound was used by the Russian Security Forces to try to resolve the hostage crisis at the Dubrovka theater in Moscow, causing the death of at least 123 hostages. On the other hand, carfentanil has been used as a drug of abuse and as an adulterant in other drugs. In case of carfentanil overdose, the administration of repeated doses of antidote may be necessary. The content of this review justifies the need to develop and validate an analytical method for the detection of carfentanil and its metabolite norcarfentanil in biological samples. (AU)

Carfentanilo: una doble amenaza para la salud pública / Carfentanil: a double threat to public health

El carfentanilo es un opioide sintético con una potencia 10.000 veces superior a la de la morfina. Esta y otras características posicionan al carfentanilo como una sustancia de interés dual, pues ha sido empleada como agente incapacitante y como droga de abuso. Entre las características toxicocinéticas del carfentanilo destacan su elevada liposolubilidad y la posibilidad de que siga una cinética de eliminación no lineal. En 2002 este compuesto fue empleado por las Fuerzas de Seguridad Rusas para intentar resolver la crisis de rehenes del teatro Dubrovka de Moscú, causando la muerte de al menos 123 rehenes. Por otro lado, el carfentanilo, se ha empleado como droga de abuso y como adulterante en otras drogas. En caso de intoxicación por carfentanilo puede ser necesaria la administración de dosis repetidas de antídoto. Los antecedentes expuestos en este trabajo justifican la necesidad de desarrollar y validar un método analítico para la detección del carfentanilo y su metabolito norcarfentanilo en muestras biológicas. (AU)

Carfentanil is a synthetic opioid with a potency 10,000 times greater than that of morphine. For this and other reasons carfentanil is a substance with dual interest, since it has been used as an incapacitating agent and as an abuse drug. Among the toxicokinetic characteristics of carfentanil, its high lipid solubility stands out. In addition, there is the possibility that carfentanil follows a non-linear elimination kinetics. In 2002 this compound was used by the Russian Security Forces to try to resolve the hostage crisis at the Dubrovka theater in Moscow, causing the death of at least 123 hostages. On the other hand, carfentanil has been used as a drug of abuse and as an adulterant in other drugs. In case of carfentanil overdose, the administration of repeated doses of antidote may be necessary. The content of this review justifies the need to develop and validate an analytical method for the detection of carfentanil and its metabolite norcarfentanil in biological samples. (AU)

Design of a safety round model for intensive care units.

INTRODUCTION: Safety Rounds (SR) are an operational tool that allow knowing adherence to good practices, help identify risks and incidents in patient safety (PS), allowing improvement actions to be implemented. The objective of this work was the design of a procedure to perform SR in an Intensive Care Unit (ICU). METHODS: Preparation of a checklist for the development of SR in the ICU through the nominal group technique, with the participation of managers, middle managers and professionals from different disciplines and categories. In the first place, a group of experts agreed, based on the recommendations on good practices in PS, the definition of items, their coding, the criteria for compliance and the impact of non-compliance. Subsequently, its viability was determined through a cross-sectional study through the piloting of two SRs to adjust the items in real clinical practice conditions. RESULTS: A specific SR model for ICUs has been obtained through a checklist. The group of experts prepared a first list made up of 39 items of 6 essential dimensions and defined the method of implementation. Mean time to complete the two SRs was 85 min, including the briefing and subsequent debriefing. After the validation pilot, the dimensions were reduced to 5, 3 items were deleted, 2 items were transferred to another dimension and 3 items related to nosocomial infections and informed consent were modified. In addition, the data sources, the compliance criteria and their relative weight were redefined. The final list was considered useful and relevant to improve practice. CONCLUSIONS: Through a consensus methodology, a checklist has been built to be used in the RS of an ICU. This model can serve as a basis for its use in healthcare services with similar characteristics.

Durvalumab plus tremelimumab for the treatment of advanced neuroendocrine neoplasms of gastroenteropancreatic and lung origin.

Single immune checkpoint blockade in advanced neuroendocrine neoplasms (NENs) shows limited efficacy; dual checkpoint blockade may improve treatment activity. Dune (NCT03095274) is a non-randomized controlled multicohort phase II clinical trial evaluating durvalumab plus tremelimumab activity and safety in advanced NENs. This study included 123 patients presenting between 2017 and 2019 with typical/atypical lung carcinoids (Cohort 1), G1/2 gastrointestinal (Cohort 2), G1/2 pancreatic (Cohort 3) and G3 gastroenteropancreatic (GEP) (Cohort 4) NENs; who progressed to standard therapies. Patients received 1500 mg durvalumab and 75 mg tremelimumab for up to 13 and 4 cycles (every 4 weeks), respectively. The primary objective was the 9-month clinical benefit rate (CBR) for cohorts 1-3 and 9-month overall survival (OS) rate for Cohort 4. Secondary endpoints included objective response rate, duration of response, progression-free survival according to irRECIST, overall survival, and safety. Correlation of PD-L1 expression with efficacy was exploratory. The 9-month CBR was 25.9%/35.5%/25% for Cohorts 1, 2, and 3 respectively. The 9-month OS rate for Cohort 4 was 36.1%, surpassing the futility threshold. Benefit in Cohort 4 was observed regardless of differentiation and Ki67 levels. PD-L1 combined scores did not correlate with treatment activity. Safety profile was consistent with that of prior studies. In conclusion, durvalumab plus tremelimumab is safe in NENs and shows modest survival benefit in G3 GEP-NENs; with one-third of these patients experiencing a prolonged OS.

Monocyte distribution width (MDW) as an infection indicator in severe patients attending in the Emergency Department: a pilot study.

OBJECTIVE: The aim of the present study was to evaluate the diagnostic performance of monocyte distribution width (MDW) as a biomarker for sepsis diagnosis in severe patients attended in the Emergency Department for different conditions and not only infections. METHODS: We performed an observational study in a consecutive prospective cohort including severe patients attending the Emergency Department with different conditions. MDW and other biomarkers were determined from samples obtained during the first care of patients. The diagnostic performance of the different biomarkers was determined based on the final diagnosis at patient discharge. RESULTS: One hundred two patients, with a mean age of 76.7 (SD 16.5) years were included, 53 being (51.9%) male. Among the patients included, 65 (63.7%) had an infectious disease while the remaining had other different conditions. A MDW cut-off of 20.115 provided the best accuracy to identify infected patients, with a sensitivity of 89.2 (95% CI 79.4-94.7), a specificity of 89.2 (95% CI 75.3-95.7), a positive predictive value of 93.5 (95% CI 84.6-97.5), a negative predictive value of 82.5% (95% CI 68.0-91.3), a positive likelihood ratio of 8.25 (3.26-20.91), and a negative likelihood ratio of 0.12 (0.06-0.24). The area under the receiver operating characteristic curve for infection according to MDW was 0.943 (95% CI 0.897-0.989; p<0.001). CONCLUSIONS: A MDW > 20.115 may be associated with infection and could help to distinguish between infected and non-infected patients in severe patients. These results must be confirmed in new studies due to the limited patient sample included.

Análisis exploratorio de las variables de personalidad y aptitudes de los pilotos de drones de la Unidad Militar de Emergencias / Exploratory analysis of personality and aptitude variables of drone pilots of the Military Emergency Unit

Antecedentes y objetivos: el uso de aeronaves no tripuladas o drones, como comúnmente se conoce, ha crecido exponencialmente en los últimos años, tanto en el ámbito militar como en el civil. No existen en la actualidad procedimientos específicos que delimiten de manera clara las variables de evaluación de este tipo de pilotos, por lo que la tendencia es repetir evaluaciones similares a las que realizan los pilotos de aeronaves tripuladas. El objetivo de este estudio ha sido establecer de forma exploratoria un patrón de variables y aptitudes específicas que afecten a los pilotos de sistemas de aeronaves no tripuladas de la Unidad Militar de Emergencias (UME). Material y métodos: para ello se han realizado pruebas de personalidad y aptitudes a 19 miembros de la UME. Resultados: el hallazgo principal encontrado fue que tres de las aptitudes cognitivas medidas en el estudio (aptitud espacial, atención y aptitud mecánica) prevalecían en los pilotos expertos en comparación con el resto del personal encuestado. Conclusiones: estos resultados pueden contribuir en el futuro a concretar aún más los procesos de evaluación de pilotos RPAS, siempre que la investigación con muestras más grandes de pilotos confirme los datos aportados en esta investigación. (AU)

Background and objectives: The use of remotely piloted aircraft systems (RPAS), or more commonly known as drones, has grown exponentially in the last years not only in military but also in civilian environments. No specific procedures to clearly delimitate assessment variables for these pilots have been described. Therefore, there is a general tendency in the assessment of RPAS pilots, to apply similar assessments to those carried out for piloted aircraft pilots. The main aim of this exploratory study was to analyze specific variables and aptitudes which affect RPAS pilots belonging to the Emergency Military Unit (UME). Material and method: Several personality and aptitude tests were administered to 19 UME pilots. Results: The most important finding of the present study was the dominance of three cognitive aptitudes (spatial aptitude, attention and mechanical aptitude) in expert pilots over the rest of the participants. Conclusions: This result contributes to the creation in the future of more specific procedures of assessment for RPAS pilots, if further research with bigger samples confirms the data found in the present study. (AU)

Posible influencia de factores no controlados en las concentraciones séricas de uracilo / Possible influence of uncontrolled factors on serum uracil concentrations

Antecedentes y objetivos: el déficit de dihidropirimidina deshidrogenasa (DPD) se ha asociado con un mayor riesgo de toxicidad tras exposición a fluoropirimidinas (FP). La determinación de las concentraciones plasmáticas de uracilo endógeno (U) es la prueba recomendada para identificar el déficit de DPD. Sin embargo, el valor de U puede verse afectado por diversos factores. El objetivo fue determinar la concentración sérica de U en una población candidata a recibir tratamiento con FP y comprobar si su distribución era compatible con la prevalencia del déficit parcial de DPD estimada en población caucásica. Material y métodos: estudio observacional prospectivo en el que se incluyeron pacientes oncológicos candidatos a tratamiento con FP. Para la determinación analítica se empleó un sistema Dionex Ultimate 3000 UHPLC, acoplado a un espectrómetro de masas cuadrupolo-orbitrap híbrido Q-exactive. Resultados: se incluyeron 77 pacientes con una edad media de 71 años. La media y la mediana de las concentraciones séricas de U fue 30,4 y 24,0 ng/ml, respectivamente. El rango fue de 7,1 a 139,7 ng/ml. Un 79,2% de los pacientes presentó un nivel de U comprendido entre 16 y 150 ng/ml, mostrando una diferencia estadísticamente significativa al compararlo con la prevalencia estimada en población caucásica (8%) (p-valor <0,0001). El método analítico empleado tiene un coeficiente de correlación R2 > 0,99 y un límite de detección <0,2 ng/ml. Conclusiones: es necesario llevar a cabo más estudios con un diseño dirigido a establecer las condiciones óptimas relativas al pretratamiento de las muestras a fin de evitar o minimizar la influencia de estos factores sobre los valores del analito. (AU)

Background and objective: dihydropyridine dehydrogenase (DPD) deficiency has been associated with an increased risk of toxicity after exposure to fluoropyrimidines (FP). Determination of endogenous uracil (U) plasma concentrations is the recommended test to identify DPD deficiency. However, the value of U can be affected by various factors. The objective was to determine the serum concentration of U in a population candidate to receive treatment with FP and to verify if its distribution was compatible with the prevalence of partial DPD deficiency estimated in the Caucasian population. Material and methods: prospective observational study in which cancer patients candidates for FP treatment were included. For the analytical determination, a Dionex Ultimate 3000 UHPLC system coupled to a Q-exactive hybrid quadrupole-orbitrap mass spectrometer was used. Results: 77 patients, with a mean age of 71 years, were included. The mean and median serum U concentrations were 30.4 and 24.0 ng/ml, respectively. The range was from 7.1 to 139.7 ng/ml. 79.2% of the patients presented a U level between 16 and 150ng/ml, showing a statistically significant difference when compared to the estimated prevalence in the Caucasian population (8%) (p-value <0.0001). The analytical method used has a correlation coefficient R2 > 0.99 and a detection limit <0.2 ng/ml. Conclusions: it is necessary to carry out more studies with a design aimed at establishing the optimal conditions related to the pretreatment of the samples in order to avoid or minimize the influence of these factors on the analyte values. (AU)

Triple Dufourmentel hexagonal flap for scalp reconstruction.

Transposition flaps are some of the most commonly used flaps for reconstructing scalp defects. Limberg first described his rhomboid transposition flap in 1946. Dufourmentel flap was an improved version of the Limberg flap published in 1962 in which the base of the flap is widened to improve vascularisation. Transposition flaps are one of the best known and most widely used transposition flaps in reconstructive surgery. They have proven successful in different types of reconstructive and aesthetic situations as a full-thickness random transposition flap. Combination of three Dufourmentel flaps to reconstruct hexagonal defects has not been reported in the literature. It is a modification of the triple Limberg flap, in which, after removing a hexagonal defect, we reconstruct the primary defect with a triple Dufourmentel flap. This flap is very useful for reconstructing large scalp defects as it provides a large amount of skin tissue with high viability; however, given its versatility, it could be used in other anatomical areas. Ann Med Surg (Lond) 2021 7:102544; Plast Reconstr Surg 2015 136:163-164; Atlas Oral Maxillofac Surg Clin North Am 2020 28:17-22.

Underreporting and Underrepresentation of Racial and Ethnic Minority Patients in Lymphedema Clinical Trials: A Systematic Review.

The generalizability of findings from Clinical Trials (CTs) investigating lymphedema treatment modalities requires an accurate representation of the target population. This study aims to evaluate racial and ethnic reporting and representation in lymphedema CTs. A comprehensive systematic literature search was conducted during May 2023 using multiple databases, following the PRISMA guidelines. All CTs published from 2018 to 2023 were included. A total of 84 articles were included in this review, from which 6,546 participants were included in the analysis. Seventy-four (88.1%) articles addressed secondary lymphedema, of which 60 (81.1%) were related to breast cancer. Only 12 (13%) of CTs reported at some extend race or ethnicity. Of these, five (41.6%) reported race and two (16.6%) reported ethnicity according to FDA guidelines. White race had the highest pooled prevalence (80%; 95% CI 72-86%; I2=90%), followed by Black (7%; 95% CI 2- 15%; I2= 94.3%) and Asian (4%; 95% CI 1-8%; I2= 89.9%). In studies reporting ethnicity, participants were predominantly non-Hispanic (92.1%; 95% CI 90 - 94%). There is an underreporting and underrepresentation of racial and ethnic minorities among lymphedema CTs, limiting their generalizability. It is imperative to future development of strategies to enhance diversity in the study sample.