[BMIM][X] Ionic Liquids Supported on a Pillared-Layered Metal-Organic Framework: Synthesis, Characterization, and Adsorption Properties.

Combining ionic liquids (ILs) and metal-organic frameworks (MOFs) can be an intriguing opportunity to develop advanced materials with different adsorption capabilities for environmental applications. This study reports the preparation and characterization of a 3D pillared-layered compound, namely, [Zn2(tz)2(bdc)] (CIM91), formed by 1,2,4-triazole (Htz) and 1,4-benzenedicarboxylic acid (H2bdc) ligands. Then, various loadings of the water-stable and hydrophobic IL, 1-n-butyl-3-methylimidazolium hexafluorophosphate ([BMIM][PF6]), and the water-soluble 1-n-butyl-3-methylimidazolium chloride ([BMIM][Cl]) were incorporated into CIM91. Detailed characterization by X-ray powder diffraction (XRD), FT-IR spectra, scanning electron microscopy (SEM), Energy dispersive X-ray (EDX) analysis, N2 adsorption measurements, and thermogravimetric analysis confirmed the formation of [BMIM][X]/CIM91 composites and the structural stability of the MOF after the incorporation of the ionic liquids. CO2 adsorption-desorption analysis was experimentally carried out for all the materials at 298 K and 318 K, demonstrating a great enhancement in the CO2 adsorption properties of the sole MOF CIM91, particularly by including [BMIM][PF6] species in its structure with a double isosteric heat of CO2 adsorption. The composites were also tested for the adsorption of methylene blue (MB) dye. The results indicate that the incorporation of [BMIM][X] into CIM91 can substantially modify the adsorption properties of the MOF. The influence of the nature of the [BMIM][X] anions on these properties has also been analyzed.

Minimal invasive fluorescence methods to quantify advanced glycation end products (AGEs) in skin and plasma of humans.

Advanced glycation end products (AGEs) are non-enzymatic modifications of proteins and lipids, which are spontaneously produced in the body in relation with several human diseases. Their relevance on protein functions alteration, either structural or enzymatic is under study, but their value as biomarkers or predictors of disease progression and clinical outcomes is unquestionable. The heterogeneity and amplitude of these modifications make their analysis difficult, although, different methods have been developed for specific AGEs based on colorimetric reactions, immunoassays or chromatography. However, for a massive application on human population, methods based on the autofluorescence of some AGEs stand out. Several qualities of these methods such as label-free measurement, rapidity, cost-effectiveness, and minimal invasiveness make them very useful for periodic measurements in critically ill patients and for the analysis of large populations. Here we explain the rationale of these methods, and we present a step-by-step protocol and the equipment requirements to carry out the estimation of AGE content in skin and plasma. AGE plasma content and skin accumulation are temporally related, so AGE plasmatic levels are a possible predictor of skin AGE content. On the other hand, AGE skin accumulation is a surrogate or an indicator of past AGE levels in plasma and in the rest of the body. AGE levels or their variations have shown to be related with prognosis of several diseases, so they can be used as predictor biomarkers for clinicians.

A Review on Biological Processes for Pharmaceuticals Wastes Abatement-A Growing Threat to Modern Society.

Over the last decades, the production and consumption of pharmaceuticals and health care products grew manifold, allowing an increase in life expectancy and a better life quality for humans and animals, in general. However, the growth in pharmaceuticals production and consumption comes with an increase in waste production, which creates a number of challenges as well as opportunities for the waste management industries. The conventional current technologies used to treat effluents have shown to be inefficient to remove or just to reduce the concentrations of these types of pollutants to the legal limits. The present review provides a thorough state-of-the-art overview on the use of biological processes in the rehabilitation of ecosystems contaminated with the pharmaceutical compounds most commonly detected in the environment and eventually more studied by the scientific community. Among the different biological processes, special attention is given to biosorption and biodegradation.

Recovery of Rare Earth Elements from Wastewater Towards a Circular Economy.

The use of rare earth elements is a growing trend in diverse industrial activities, leading to the need for eco-friendly approaches to their efficient recovery and reuse. The aim of this work is the development of an environmentally friendly and competitive technology for the recovery of those elements from wastewater. Kinetic and equilibria batch assays were performed with zeolite, with and without bacterial biofilm, to entrap rare earth ions from aqueous solution. Continuous assays were also performed in column setups. Over 90% removal of lanthanum and cerium was achieved using zeolite as sorbent, with and without biofilm, decreasing to 70% and 80%, respectively, when suspended Bacillus cereus was used. Desorption from the zeolite reached over 60%, regardless of the tested conditions. When in continuous flow in columns, the removal yield was similar for all of the rare earth elements tested. Lanthanum and cerium were the elements most easily removed by all tested sorbents when tested in single- or multi-solute solutions, in batch and column assays. Rare earth removal from wastewater in open setups is possible, as well as their recovery by desorption processes, allowing a continuous mode of operation.

Application of a Pillared-Layer Zn-Triazolate Metal-Organic Framework in the Dispersive Miniaturized Solid-Phase Extraction of Personal Care Products from Wastewater Samples.

The pillared-layer Zn-triazolate metal-organic framework (CIM-81) was synthesized, characterized, and used for the first time as a sorbent in a dispersive micro-solid phase extraction method. The method involves the determination of a variety of personal care products in wastewaters, including four preservatives, four UV-filters, and one disinfectant, in combination with ultra-high performance liquid chromatography and UV detection. The CIM-81 MOF, constructed with an interesting mixed-ligand synthetic strategy, demonstrated a better extraction performance than other widely used MOFs in D-µSPE such as UiO-66, HKUST-1, and MIL-53(Al). The optimization of the method included a screening design followed by a Doehlert design. Optimum conditions required 10 mg of CIM-81 MOF in 10 mL of the aqueous sample at a pH of 5, 1 min of agitation by vortex and 3 min of centrifugation in the extraction step; and 1.2 mL of methanol and 4 min of vortex in the desorption step, followed by filtration, evaporation and reconstitution with 100 µL of the initial chromatographic mobile phase. The entire D-µSPE-UHPLC-UV method presented limits of detection down to 0.5 ng·mL-1; intra-day and inter-day precision values for the lowest concentration level (15 ng·mL-1)-as a relative standard deviation (in %)-lower than 8.7 and 13%, respectively; average relative recovery values of 115%; and enrichment factors ranging from ~3.6 to ~34. The reuse of the CIM-81 material was assessed not only in terms of maintaining the analytical performance but also in terms of its crystalline stability.

Mixed Functionalization of Organic Ligands in UiO-66: A Tool to Design Metal-Organic Frameworks for Tailored Microextraction.

The mixed-ligand strategy was selected as an approach to tailor a metal-organic framework (MOF) with microextraction purposes. The strategy led to the synthesis of up to twelve UiO-66-based MOFs with different amounts of functionalized terephthalate ligands (H-bdc), including nitro (-NO2) and amino (-NH2) groups (NO2-bdc and NH2-bdc, respectively). Increases of 25% in ligands were used in each case, and different pore environments were thus obtained in the resulting crystals. Characterization of MOFs includes powder X-ray diffraction, infrared spectroscopy, and elemental analysis. The obtained MOFs with different degrees and natures of functionalization were tested as sorbents in a dispersive miniaturized solid-phase extraction (D-µSPE) method in combination with high-performance liquid chromatography (HPLC) and diode array detection (DAD), to evaluate the influence of mixed functionalization of the MOF on the analytical performance of the entire microextraction method. Eight organic pollutants of different natures were studied, using a concentration level of 5 µg· L-1 to mimic contaminated waters. Target pollutants included carbamazepine, 4-cumylphenol, benzophenone-3, 4-tert-octylphenol, 4-octylphenol, chrysene, indeno(1,2,3-cd)pyrene, and triclosan, as representatives of drugs, phenols, polycyclic aromatic hydrocarbons, and disinfectants. Structurally, they differ in size and some of them present polar groups able to form H-bond interactions, either as donors (-NH2) or acceptors (-NO2), permitting us to evaluate possible interactions between MOF pore functionalities and analytes' groups. As a result, extraction efficiencies can reach values of up to 60%, despite employing a microextraction approach, with four main trends of behavior being observed, depending on the analyte and the MOF.

Influence of Ligand Functionalization of UiO-66-Based Metal-Organic Frameworks When Used as Sorbents in Dispersive Solid-Phase Analytical Microextraction for Different Aqueous Organic Pollutants.

Four metal-organic frameworks (MOFs), specifically UiO-66, UiO-66-NH2, UiO-66-NO2, and MIL-53(Al), were synthesized, characterized, and used as sorbents in a dispersive micro-solid phase extraction (D-µSPE) method for the determination of nine pollutants of different nature, including drugs, phenols, polycyclic aromatic hydrocarbons, and personal care products in environmental waters. The D-µSPE method, using these MOFs as sorbents and in combination with high-performance liquid chromatography (HPLC) and diode-array detection (DAD), was optimized. The optimization study pointed out to UiO-66-NO2 as the best MOF to use in the multi-component determination. Furthermore, the utilization of isoreticular MOFs based on UiO-66 with the same topology but different functional groups, and MIL-53(Al) to compare with, allowed us for the first time to evaluate the influence of such functionalization of the ligand with regards to the efficiency of the D-µSPE-HPLC-DAD method. Optimum conditions included: 20 mg of UiO-66-NO2 MOF in 20 mL of the aqueous sample, 3 min of agitation by vortex and 5 min of centrifugation, followed by the use of only 500 µL of acetonitrile as desorption solvent (once the MOF containing analytes was separated), 5 min of vortex and 5 min of centrifugation. The validation of the D-µSPE-HPLC-DAD method showed limits of detection down to 1.5 ng·L-1, average relative recoveries of 107% for a spiked level of 1.50 µg·L-1, and inter-day precision values with relative standard deviations lower than 14%, for the group of pollutants considered.

A Hexameric Cationic Copper(II) Metallacrown as a Pertechnetate and Perrhenate Scavenger.

Materials based on the cationic copper(II) hexanuclear 18-membered metallacrown [18-MCCuII-N(2ph)-6](6+) (2phH=2-piconyl hydrazide) and tetrafluoroborate, perchlorate, nitrate, sulfate, and perrhenate anions were prepared by an easy method in aqueous medium. Single-crystal X-ray characterization of six members of this new family of complexes showed that the anions are attached to the metallacrown by direct coordination to a copper cation or by hydrogen-bonding interaction with the center of the hexamer. The stable cationic nature of the complexes and their ability to bind different anions allows them to adsorb and immobilize environmentally relevant anions such as MO4(-) (M=Tc, Re). The MO4(-) trapping capacities suggest that these materials would be useful in the treatment of oxoanionic contaminants in water.

[Transcutaneous Electrical Nerve Stimulation (TENS) for Pain Management During Labor]. / La estimulación eléctrica nerviosa transcutánea (TENS) en el manejo del dolor durante el proceso de parto.

Currently, epidural analgesia is considered the most used method for pain management during labor, but this technique could have side effects. There are non-pharmacological methods that can be used alternatively or in synergy with epidural analgesia, without adverse effects on maternal and fetal outcomes. These methods include transcutaneous electrical nerve stimulation (TENS). TENS is a physiotherapy technique particularly suitable for the dilation period, during the first state of labor, and while women do not perceive a very intense pain. The use in childbirth is recent and controversial. Despite being well received by women and midwives, their effectiveness has not been clearly demonstrated. Organizations such as the Spanish Society of Gynaecology and Obstetrics and the Department of Health, consider this therapy an inefficient non-pharmacological mechanism for pain relief in the active stage of labor. Women should have the option to choose any pain relief method in any stage of their process. Health professionals are the responsible to know, investigate and work with these different methods, offering to pregnant women, adequate information, which must be based on scientific evidence.

[INMERSION IN HOT WATER: A NATURAL HELPER IN LABOUR]. / Inmersión en agua caliente. UN AYUDANTE NATURAL EN EL PROCESO DE PARTO.

INTRODUCTION: The pain during the birth process is the result of a pile of physiological, psychological and socio-cultural stimulus. In our society, epidural analgesia is the most common technique used in obstetrics to relieve this pain, despite not being harmless. However, there are other complementary techniques based on methods that have demonstrated analgesic effects and they benefit of lacking adverse effects either on the mother or on the fetus. Among these methods is the immersion in warm water (WI). The aim of this review is to show the usefulness, advantages and disadvantages of WI, to make it an accessible resource for pregnant women and those who are responsible for their care. METHODS: Literature review about Water Immersion during the first and second stage of labor. RESULTS: The WI as a method to relieve discomfort and pain during labor was popularized by the obstetrician Michel Odent in 7980s. The Spanish Society of Gynecology and Obstetrics, among other associations, highly recommend its use during the cervical dilation period. It is benificial for the mother blood circulation, psychologically and for body mechanics; however, this use in the second stage of labor seems to be more controversial. CONCLUSIONS: WI is an analgesic non-invasive, accessible and affordable. Its use is associated with lower rates of intervention by professionals and provide a more focused attention on the needs of pregnant women.

[Prevention and detection of obstetric violence: A need in the Spanish delivery rooms?].

Introduction: The obstetric violence (OV) is the type of violence perpetrated against the pregnant woman through acts such as lack of respect to her autonomy and her freedom to decide. The increasing medicalization of the labour process, seems to be associated to this type of violence. Objective: Our objective is to provide health professionals with the necessary knowledge to be able to inform their patients about their rights and recognize those situations that can imply violence during the care process. Material and methods: The literature search was conducted in the following databases: PubMed, Cochrane Database of Systematic Reviews, EMBASE, Joanna Briggs Institute, UpToDate and CUIDEN. The search was limited to articles published during the last five years. The next medical subject heading were used both in English and Spanish: "humanizing delivery", "obstetrics", "medicalization" and "violence". Results: The performance of harmful practices and the unjustified medicalization of the labour process represent a potential damage to pregnant women by action, violating their rights as a result. To prevent and eradicate this, new lines of less interventionist work are being proposed. Conclusion: As health professionals we should promote the humanization of labour and informs women about the existent legislation, protocols and guidelines that offer adequate information based on the latest evidence and promote their advance role as patients. The health institutions are responsible for initiating this change, by implementing protocols to guide the practice of the health professionals involved in the care of women during labour. These protocols should be based on the WHO recommendations.

Homo- and heteronuclear compounds with a symmetrical bis-hydrazone ligand: synthesis, structural studies, and luminescent properties.

Nine new coordination compounds have been synthesized by the reaction of salts of bivalent metal ions (a=Zn(II) , b=Cu(II) , c=Ni(II) , d=Co(II) ) with the bis(benzoylhydrazone) derivative of 4,6-diacetylresorcinol (H4 L). Three kinds of complexes have been obtained: homodinuclear compounds [M2 (H2 L)2 ]⋅nH2 O (1 a, 1 b, 1 c, and 1 d), homotetranuclear compounds [M4 (L)2 ]⋅n(solv) (2 a and 2 c), and heterotetranuclear compounds [Zn2 M2 (L)2 ]⋅n(solv) (2 ab, 2 ac, and 2 ad). The structures of the free ligand H4 L⋅2 DMSO and its complexes [Zn2 (H2 L)2 (DMSO)2 ] (1 a*), [Zn4 (L)2 (DMSO)6 ] (2 a*), and [Zn0.45 Cu3.55 (L)2 (DMSO)6 ]⋅2 DMSO (2 ab*) were elucidated by single-crystal X-ray diffraction. The ligand shows luminescence properties and its fluorimetric behavior towards M(II) metals (M=Zn, Cu, Ni and Co) has been studied. Furthermore, the solid-state luminescence properties of the ligand and compounds have been determined at room temperature. (1) H NMR spectroscopic monitoring of the reaction of H4 L with Zn(II) showed the deprotonation sequence of the OH/NH groups upon metal coordination. Heteronuclear reactions have also been monitored by using ESI-MS and spectrofluorimetric techniques.

[MANAGEMENT OF VAGINAL CONES IN THE TREATMENT OF PELVIC FLOOR REHABILITATION]. / Manejo de los conos vaginales en el tratamiento rehabilitador del suelo pélvico.

The pelvic floor (PF) is a sheet of muscles and other tissues that support the pelvic organs in their physiological positions. Throughout women's lives, these structures can become weak or be injured by events such as pregnancy, childbirth, surgery, overweight or constipation. PF dysfunction includes a group of disorders causing urinary incontinence, as well as genital prolapse or pelvic pain, and can significantly deteriorate women's quality of life. Vaginal cones (VC) represent a non-pharmacological, economical, safe and non-invasive method for the treatment of PF dysfunction; they allow the patient to increase the physiological consciousness of the musculature of the PF while promoting an increase in the muscle tone. The midwife, as a professional intimately connected with women's health care, works with the multidisciplinary team which treats pelvic dysfunctions; therefore, they need to provide updated information about the different methods for improving perineal function, including VC, and providing advice on their use and management, and establishing individualized exercise programs and tracking information for each case. The available scientific evidence on the effectiveness of the VC is limited and there may be other methods to treat PF dysfunctions.

[OPTIMIZATION OF GLUCOSE METABOLISM IN PATIENTS UNDERGOING THERAPEUTIC HYPOTHERMIA AFTER SUDDEN CARDIAC ARREST]. / Optimización del metabolismo glucémico: DE LOS PACIENTES SOMETIDOS A HIPOTERMIA TERAPÉUTICA TRAS UNA PARADA CARDIORRESPIRATORIA.

OBJECTIVE: Therapeutic hypothermia (TH) is recommended to improve survival and neurologic prognosis in sudden cardiac arrest (SCA) survivors. There are few data aboutglycemic levels in these patients. The aim of this study is to evaluate the glycemic control using a specific protocol in this group ofpeople. METHOD: A retrospective analysis of the patients receiving TH in our institution, between January 2010 and March 2013,. was performed. Baseline characteristics, in-hospital prognosis and glycemic levels during different stages of the TH were analyzed. RESULTS: From a total of 55 patients suffering a SCA, 49 patients underwent TH and received a specific insulin protocol. The mean age was 57.5 ± 12.8 years, the main cause of SCA was ischemic (76%) and ventricular fibrillation was the most frequent first rhythm detected (55%). Regarding glycemic alterations as each stage of TH, a high rate of glycemic alteration was observed in the induction stage, decreasing after starting the insulin protocol (induction stage: 95.9%; maintenance stage: 89.8%; rewarming stage: 69.4%; p = 0.001). With respectto clinicresults, there were low rates of severe hypoglycemia (12%), in-hospital mortality (20%) and anoxic encephalopathy (27%), with a high rate of infections (75%). CONCLUSIONS: The implementation of a specific insulin protocol in patients receiving TH contributes to improve the blood glucose levels. Further studies are needed to evaluate the clinical impact of these protocols in this group ofpatients.

[The birthing ball: rediscovering a non pharmacological resource of great importance in the birth process]. / A pelota de parto. Redescubriendo un recurso no farmacológico de gran importancia en el proceso del parto.

Advances occurred in recent years in obstetrics show that the free movement of the pelvis during labour decreases pain and facilitates the birth of the newborn. Nowadays, many techniques have effective non pharmacological relief in pain during labour. The birthing ball (BB) is one of them, closely linked to freedom of movement, the pelvic tilt and vertical feeding; it has shown a decrease in anxiety and pain during the birthing process and increased rate of normal deliveries. The BB does not replace other non-pharmacological techniques during the period of expansion, but can complement it, thereby improving their effectiveness. Not shown any harmful effects associated with the use of the BB both the mother and the newborn. As health professionals, we must know how to use and the benefits that are associated with the BB, to offer it as an effective method of pain relief in labour available to us.

An infrastructure to enable lightweight context-awareness for mobile users.

Mobile phones enable us to carry out a wider range of tasks every day, and as a result they have become more ubiquitous than ever. However, they are still more limited in terms of processing power and interaction capabilities than traditional computers, and the often distracting and time-constricted scenarios in which we use them do not help in alleviating these limitations. Context-awareness is a valuable technique to address these issues, as it enables to adapt application behaviour to each situation. In this paper we present a context management infrastructure for mobile environments, aimed at controlling context information life-cycle in this kind of scenarios, with the main goal of enabling application and services to adapt their behaviour to better meet end-user needs. This infrastructure relies on semantic technologies and open standards to improve interoperability, and is based on a central element, the context manager. This element acts as a central context repository and takes most of the computational burden derived from dealing with this kind of information, thus relieving from these tasks to more resource-scarce devices in the system.

From Cu(I) and Cu(I)-Cu(II) mixed-valence clusters to 2D Cu(II) and Cu(I) coordination polymers supported by a flexible bis-tetrazole organosulfur ligand.

Three coordination compounds from the reaction of copper(II) bromide with the flexible bis-tetrazole organosulfur ligand, 1,2-bis(1-methyl-1H-tetrazole-5-ylthio)ethane (bmtte) have been isolated and characterised. The identification of polymeric 2∞Cu2Br4(bmtte) (1), trinuclear [Cu3Br4(bmtte)2] (2) and tetranuclear [Cu2Br2(bmtte)]2 (3) compounds shows that the reaction conditions have a significant influence on the structure of the complexes formed. Moreover, two polymorphs of the 2D Cu(II)-coordination polymer 1 have been isolated and these crystallise in the monoclinic C2/m (1m) and the triclinic P1̄ (1t) space groups. The thermal stabilities and behaviour in aqueous media of compounds 1-3 were investigated along with the reactivity of compound 2 with CuBr2 and KI. The solid-state reaction between mixed-valence compound 2 with KI or the direct reaction of CuI and bmtte under microwave irradiation allowed the preparation of the polymeric 2∞Cu4I4(bmtte)2 (4). The redox behaviour of complexes 2 and 3 was analysed by cyclic voltammetry.

Procalcitonin and C-reactive protein to rule out early bacterial coinfection in COVID-19 critically ill patients.

PURPOSE: Although the prevalence of community-acquired respiratory bacterial coinfection upon hospital admission in patients with coronavirus disease 2019 (COVID-19) has been reported to be < 5%, almost three-quarters of patients received antibiotics. We aim to investigate whether procalcitonin (PCT) or C-reactive protein (CRP) upon admission could be helpful biomarkers to identify bacterial coinfection among patients with COVID-19 pneumonia. METHODS: We carried out a multicentre, observational cohort study including consecutive COVID-19 patients admitted to 55 Spanish intensive care units (ICUs). The primary outcome was to explore whether PCT or CRP serum levels upon hospital admission could predict bacterial coinfection among patients with COVID-19 pneumonia. The secondary outcome was the evaluation of their association with mortality. We also conducted subgroups analyses in higher risk profile populations. RESULTS: Between 5 February 2020 and 21 December 2021, 4076 patients were included, 133 (3%) of whom presented bacterial coinfection. PCT and CRP had low area under curve (AUC) scores at the receiver operating characteristic (ROC) curve analysis [0.57 (95% confidence interval (CI) 0.51-0.61) and 0.6 (95% CI, 0.55-0.64), respectively], but high negative predictive values (NPV) [97.5% (95% CI 96.5-98.5) and 98.2% (95% CI 97.5-98.9) for PCT and CRP, respectively]. CRP alone was associated with bacterial coinfection (OR 2, 95% CI 1.25-3.19; p = 0.004). The overall 15, 30 and 90 days mortality had a higher trend in the bacterial coinfection group, but without significant difference. PCT ≥ 0.12 ng/mL was associated with higher 90 days mortality. CONCLUSION: Our study suggests that measurements of PCT and CRP, alone and at a single time point, are not useful for ruling in or out bacterial coinfection in viral pneumonia by COVID-19.

Cancer patients in Palliative Care: occurrences related to venipuncture and hypodermoclysis. / Pacientes oncológicos sob cuidados paliativos: ocorrências relacionadas à punção venosa e hipodermóclise.

OBJECTIVE: to identify the occurrences related to peripheral venipuncture and hypodermoclysis among patients hospitalized in a general hospital and in an exclusive hospital institution for the care of patients in palliative cancer care. METHOD: an observational, descriptive and multicenter study. The consecutive and non-probabilistic sample consisted of 160 cancer patients hospitalized in Palliative Care. The outcome variable corresponded to the occurrences and complications related to each type of puncture. A questionnaire containing the sociodemographic and clinical variables and a structured script for monitoring and daily evaluation of the puncture were used. Descriptive statistics were employed for data analysis. RESULTS: the occurrences related to venipuncture at a general hospital were blood soiling at catheter insertion (17.4%) and expired use period (15.8%), while at a specific service for the care of patients under palliative care they were expired use period (32%) followed by infiltration (18.9%). As for hypodermoclysis, there were two subcutaneous punctures with phlogistic signs (1.0%) at the general hospital and a hematoma at the catheter insertion site (0.5%). At the specific service for the care of patients under palliative care there were three subcutaneous punctures with phlogistic signs (5.7%). CONCLUSION: the number of occurrences related to peripheral venipuncture was higher than those related to hypodermoclysis.

[New approach in the Screening Program for the early detection of cervical cancer in Galicia.] / Nuevo enfoque en el Programa de cribado para la detección precoz del cáncer de cérvix en Galicia.

Cervical cancer (CUC) is the fourth most common gynaecological malignancy worldwide, the second most common in low- and middle-income countries. The human papilloma virus (HPV) is the main cause of CUU and considered a necessary but not sufficient cause for its development. In Spain, Pap smear and HPV testing are the main screening strategies for UCC. Since the 1980s, opportunistic (on-demand) screening has been carried out in most autonomous communities by performing conventional cytology on women between 25 and 65 years of age. The assessment of the presence of HPV infection in the early diagnosis of cervical cancer has a higher sensitivity and better predictive value than cervical cytology, especially in women over 30 years of age, with a minimal loss of specificity. Galicia, in accordance with the new recommendations available, has established the "New Galician Program for the early detection of cervical cancer" population screening based on the detection of High Risk HPV in women between 35 and 65 years of age and is preparing to launch a pilot study, to be carried out in 2021 in the region of Lugo. The midwife, in the Primary Health System, is emerging as the professional of reference in the prevention and early diagnosis of UCC, leading UCC screening in Spain.

El cáncer de cuello uterino (CCU) es la cuarta neoplasia ginecológica más frecuente a nivel mundial, la segunda en países con bajo y medio nivel de ingresos. El virus del papiloma humano (VPH) es la causa principal del CCU, considerándose causa necesaria pero no suficiente para su desarrollo. En España, la citología vaginal y la prueba de VPH representan las principales estrategias de tamizaje para el CCU. Desde los años 80, en la mayoría de las comunidades autónomas se realiza un cribado oportunista (a demanda), mediante la realización de la citología convencional a mujeres entre los 25 y los 65 años. La valoración de la presencia de infección por VPH en el diagnóstico precoz del CCU, presenta una mayor sensibilidad y un mejor valor predictivo que la citología cervical, especialmente en las mujeres mayores de 30 años, con una pérdida mínima de especificidad. Galicia, atendiendo a las nuevas recomen-daciones disponibles, establece el "Nuevo Programa Gallego para la detección precoz del cáncer de cérvix", cribado poblacional basado en la detección del VPH de Alto Riesgo en mujeres comprendidas entre los 35 y los 65 años; y se prepara para la puesta en marcha de un estudio piloto, que se llevará a cabo en el año 2021 en la comarca de Lugo. La matrona, desde la consulta de Atención Primaria, se perfila como el profesional de referencia en la prevención y diagnóstico precoz del CCU, liderando su cribado en España.