Impact of overweight and obesity in postmenopausal women.

OBJECTIVE: This study aimed to investigate the association between overweight and obesity in postmenopausal women and different aspects related to health such as quality of life, physical activity, sleep quality and level of physical activity. METHODS: An observational cross-sectional study was carried out during 2021-2022 in Spain in postmenopausal women. Health-related quality of life was assessed using the 12-item short-form survey (SF-12). The Pittsburgh Sleep Quality Index (PSQI) was used to determine sleep quality, and the International Physical Activity Validated Questionnaire (IPAQ) was used for physical activity. A multivariate analysis was conducted using binary logistic regression to control the confounding bias. RESULTS: A total of 395 postmenopausal women participated: 64.6% (n = 255) were overweight or obese. Obesity was associated with higher odds of having a lower quality of life (adjusted odds ratio [aOR] = 2.88; 95% confidence interval [CI]: 1.51-5.49), including alterations in physical role and function, pain and vitality. Postmenopausal women with overweight/obesity had higher odds of cardiovascular problems (aOR = 2.09; 95% CI: 1.04-4.19/aOR = 4.44; 95% CI: 2.12-9.31), and women with obesity were more likely to develop endocrine problems (aOR = 2.29; 95% CI: 1.10-4.75). Finally, women with obesity had higher odds of suffering urinary incontinence (aOR = 2.10; 95% CI: 1.10-4.01) or fecal incontinence (aOR = 2.70; 95% CI: 1.35-5.39), and pelvic pain (aOR = 2.33; 95% CI: 1.18-4.59). CONCLUSIONS: Obesity in postmenopausal women negatively affects perceived quality of life, sleep quality, physical activity, the development of cardiovascular problems and pelvic floor-related problems.

Risk of caesarean delivery in labour induction: a systematic review and external validation of predictive models.

BACKGROUND: Despite the existence of numerous published models predicting the risk of caesarean delivery in women undergoing induction of labour (IOL), validated models are scarce. OBJECTIVES: To systematically review and externally assess the predictive capacity of caesarean delivery risk models in women undergoing IOL. SEARCH STRATEGY: Studies published up to 15 January 2021 were identified through PubMed, CINAHL, Scopus and ClinicalTrials.gov, without temporal or language restrictions. SELECTION CRITERIA: Studies describing the derivation of new models for predicting the risk of caesarean delivery in labour induction. DATA COLLECTION AND ANALYSIS: Three authors independently screened the articles and assessed the risk of bias (ROB) according to the prediction model risk of bias assessment tool (PROBAST). External validation was performed in a prospective cohort of 468 pregnancies undergoing IOL from February 2019 to August 2020. The predictive capacity of the models was assessed by creating areas under the receiver operating characteristic curve (AUCs), calibration plots and decision curve analysis (DCA). MAIN RESULTS: Fifteen studies met the eligibility criteria; 12 predictive models were validated. The quality of most of the included studies was not adequate. The AUC of the models varied from 0.520 to 0.773. The three models with the best discriminative capacity were those of Levine et al. (AUC 0.773, 95% CI 0.720-0.827), Hernández et al. (AUC 0.762, 95% CI 0.715-0.809) and Rossi et al. (AUC 0.752, 95% CI 0.707-0.797). CONCLUSIONS: Predictive capacity and methodological quality were limited; therefore, we cannot currently recommend the use of any of the models for decision making in clinical practice. TWEETABLE ABSTRACT: Predictive models that predict the risk of cesarean section in labor inductions are currently not applicable.

Papillary thyroid microcarcinoma with minimal extrathyroidal extension. Has it so indolent course to require a less aggressive treatment? / Microcarcinoma papilar de tiroides con extensión extratiroidea mínima. ¿Tiene un curso tan indolente para precisar un tratamiento menos intensivo?

BACKGROUND: Although the incidence of papillary thyroid microcarcinoma (PTMC) has increased in recent decades, the role played by minimal extrathyroidal extension (mETE) in the prognosis of PTMC is still unclear. The aim of this study is to analyse the factors associated with PTMC and mETE and the long-term prognosis of PTMC. MATERIAL AND METHODS: We conducted a retrospective study with a population consisting of patients with a histological diagnosis of PTMC. We excluded patients who had previously undergone thyroid surgery, those who had other synchronous malignancies, those with an ectopic location of the PTMC and those lost to follow-up within 2years. We compared group 1 (PTMC without extrathyroidal extension) versus group 2 (PTMC with mETE) and performed a multivariate analysis. RESULTS: We observed PTMC with mETE in 11.2% (n=18) of the patients. In the multivariate analysis, mETE was associated with an age ≥45 years (OR, 4.383; 95% CI 1.051-18.283, p=.043), a tumour size ≥8mm (OR, 5.913; 95% CI 1.795-19.481; p=.003), bilaterality (OR, 4.430; 95% CI 1.294-15.173; p=.018) and metastatic lymph nodes (OR, 12.588; 95% CI 2.919-54.280; p=.001). During a mean follow-up of 119.8±65 months, one recurrence was detected in group 2 (0% vs. 5.6%; p=.112), but none of the patients died due to the disease. Disease-free survival was lower in group 2 (124.9±5.6 vs. 97.4±10.3 months; p=.034). CONCLUSIONS: The mETE of MCPT is a factor of worse prognosis, associated with the presence of metastatic lymph nodes and lower disease-free survival.

Evolution After Anti-TNF Discontinuation in Patients With Inflammatory Bowel Disease: A Multicenter Long-Term Follow-Up Study.

OBJECTIVES: The aims of this study were to assess the risk of relapse after discontinuation of anti-tumor necrosis factor (anti-TNF) drugs in patients with inflammatory bowel disease (IBD), to identify the factors associated with relapse, and to evaluate the overcome after retreatment with the same anti-TNF in those who relapsed. METHODS: This was a retrospective, observational, multicenter study. IBD patients who had been treated with anti-TNFs and in whom these drugs were discontinued after clinical remission was achieved were included. RESULTS: A total of 1,055 patients were included. The incidence rate of relapse was 19% and 17% per patient-year in Crohn's disease and ulcerative colitis patients, respectively. In both Crohn's disease and ulcerative colitis patients in deep remission, the incidence rate of relapse was 19% per patient-year. The treatment with adalimumab vs. infliximab (hazard ratio (HR)=1.29; 95% confidence interval (CI)=1.01-1.66), elective discontinuation of anti-TNFs (HR=1.90; 95% CI=1.07-3.37) or discontinuation because of adverse events (HR=2.33; 95% CI=1.27-2.02) vs. a top-down strategy, colonic localization (HR=1.51; 95% CI=1.13-2.02) vs. ileal, and stricturing behavior (HR=1.5; 95% CI=1.09-2.05) vs. inflammatory were associated with a higher risk of relapse in Crohn's disease patients, whereas treatment with immunomodulators after discontinuation (HR=0.67; 95% CI=0.51-0.87) and age (HR=0.98; 95% CI=0.97-0.99) were protective factors. None of the factors were predictive in ulcerative colitis patients. Retreatment of relapse with the same anti-TNF was effective (80% responded) and safe. CONCLUSIONS: The incidence rate of inflammatory bowel disease relapse after anti-TNF discontinuation is relevant. Some predictive factors of relapse after anti-TNF withdrawal have been identified. Retreatment with the same anti-TNF drug was effective and safe.

Killer immunoglobulin-like receptor repertoire analysis in a Caucasian Spanish cohort with inflammatory bowel disease.

Immunological molecules are implicated in inflammatory disorders, including inflammatory bowel disease (IBD; Crohn disease [CD] and ulcerative colitis [UC]). Killer cell immunoglobulin-like receptors (KIRs) are also genetically variable proteins involved in immune function. They are expressed by NK cells and certain T lymphocytes, regulate specificity and function by interaction with HLA Class I molecules, may be either inhibitory or activating and are polymorphic both in terms of alleles and haplotype gene content. Genetic associations between activating KIRs and certain autoimmune and inflammatory diseases have been reported; however, a possible association between KIR and IBD remains unclear. The aim of this study was to determine the relationship between KIR repertoire and IBD pathologies in a Spanish cohort. KIR variability was analyzed using PCR-sequence specific oligonucleotide probes (SSOP). Inhibitory KIR2DL5 was found more frequently in UC and IBD patient groups than in healthy controls (P = 0.028 and P = 0.01, respectively), as was activating KIR2DS1 (P = 0.02, Pc > 0.05, UC vs. Controls; P = 0.001, Pc = 0.01, IBD vs Controls; P = 0.01, Pc > 0.05, Controls vs CR), KIR2DS5 (P = 0.0028, Pc = 0.04, Controls vs UC; P = 0.0001, Pc = 0.0017, Controls vs IBD; P = 0.01, Pc > 0.05, Controls vs CD) and KIR3DS1 (P = 0.012, Pc > 0.05, Controls vs IBD). Our data suggest that imbalance between activating and inhibitory KIR may partially explain the different pathogeneses of these IBDs and that there is a hypothetical role for the telomeric B region (which contains both KIR2DS5 and KIR2DS1) in these diseases.

High prevalence of microplastics in the digestive tract of Scyliorhinus canicula (Linneaus, 1758) shows the species biomonitoring potential.

Plastic pollution is widespread in oceans and the ingestion of plastic by marine organisms is causing concern about potential adverse effects. The purpose of this study was to analyze the different types of plastics in the digestive tract of female small-spotted catshark (Scyliorhinus canicula). An alkaline digestion method using 10 % potassium hydroxide (KOH), was used. The samples were filtered and visually observed to classify the plastics according to size, shape, and color. Raman spectroscopy was further employed to identify the polymer types. The study found the presence of plastics in 89.5 % of the 200 females analyzed, including 10 polymers, with polystyrene (PS), polyamide-6 (PA6), polyvinyl chloride (PVC), and silicone rubber (SR) being the most common. The polymers identified largely reflect the results of similar studies in the marine environment and were similar to global polymer diversity of microplastics, which highlights the potential of S. canicula females for biomonitoring microplastic pollution.

[Has 2020 been a lost year in orthopedic surgery and trauma training? Residents' perceptions]. / ¿Ha sido el 2020 un año perdido en la formación de cirugía ortopédica y traumatología? Percepción de los residentes.

Objective: The COVID-19 pandemic has affected specialized healthcare training at all levels. Surgical learning has been severely affected, and the impact on orthopedic surgery residency training has so far not been assessed. Material and methods: An online survey of 17 questions was sent via web link to orthopedic surgery residents throughout Spain between February 10, 2021 and February 28, 2021. The effects of the COVID-19 pandemic on the care and training activities of residents were analyzed. Results: A total of 307 orthopedic surgery residents from all over Spain responded to the online survey. A total of 77.2% of the respondents had to suspend their rotations. Of these, 67.5% would like to resume the rotations they missed during the pandemic. A total of 69.7% of scheduled surgeries were suspended. Surgical activity was completely stopped for an average of 8 weeks. 66.8% of the residents consider that their surgical training has been affected and this will have repercussions on their future work. 49.5% considered the online training offered to be insufficient. Of the total number of respondents, 52.1% considered that the impact of the pandemic situation on their training situation was bad or very bad. Conclusions: The data collection shows a negative impact on both theoretical and clinical training. This study highlights the need to continue offering quality training by maximizing learning opportunities.

[Translated article] Has 2020 been a lost year in orthopaedic surgery and trauma training? Residents' perceptions.

OBJECTIVE: The COVID-19 pandemic has affected specialised healthcare training at all levels. Surgical learning has been severely affected, and the impact on orthopaedic surgery residency training has so far not been assessed. MATERIAL AND METHODS: An online survey of 17 questions was sent via web link to orthopaedic surgery residents throughout Spain between February 10, 2021 and February 28, 2021. The effects of the COVID-19 pandemic on the care and training activities of residents were analysed. RESULTS: A total of 307 orthopaedic surgery residents from all over Spain responded to the online survey. A total of 77.2% of the respondents had to suspend their rotations. Of these, 67.5% would like to resume the rotations they missed during the pandemic. A total of 69.7% of scheduled surgeries were suspended. Surgical activity was completely stopped for an average of 8 weeks. 66.8% of the residents consider that their surgical training has been affected and this will have repercussions on their future work. 49.5% considered the online training offered to be insufficient. Of the total number of respondents, 52.1% considered that the impact of the pandemic situation on their training situation was bad or very bad. CONCLUSIONS: The data collection shows a negative impact on both theoretical and clinical training. This study highlights the need to continue offering quality training by maximising learning opportunities.

Papillary thyroid microcarcinoma with minimal extrathyroidal extension. Is its course so indolent that it requires a less aggressive treatment?

BACKGROUND: Although the incidence of papillary thyroid microcarcinoma (PTMC) has increased in recent decades, the role played by minimal extrathyroidal extension (mETE) in the prognosis of PTMC is still unclear. The aim of this study is to analyze the factors associated with PTMC with mETE and its long-term prognosis. MATERIAL AND METHODS: We conducted a retrospective study on patients with a histological diagnosis of PTMC. We excluded patients who had previously undergone thyroid surgery, those who had other synchronous malignancies, those with an ectopic location of the PTMC, and those lost to follow-up within two years. We compared group 1 (PTMC without extrathyroidal extension) to group 2 (PTMC with mETE) and performed a multivariate analysis. RESULTS: We observed PTMC with mETE in 11.2% (n = 18) of patients. On the multivariate analysis, mETE was associated with an age ≥45 years (OR: 4.383; 95% CI: 1.051-18.283, p = .043), tumor size ≥8 mm (OR: 5.913; 95% CI: 1.795-19.481; p = .003), bilaterality (OR: 4.430; 95% CI: 1.294-15.173; p = .018) and metastatic lymph nodes (OR: 12.588; 95% CI: 2.919-54.280; p = .001). Over the mean follow-up period of 119.8 ±â€¯65 months, one case of recurrence was detected in group 2 (0% vs. 5.6%; p = .112). No patients died of the disease. Disease-free survival was lower in group 2 (124.9 ±â€¯5.6 vs. 97.4 ±â€¯10.3 months; p = .034). CONCLUSIONS: The mETE of PTMC is a factor of worse prognosis associated with the presence of metastatic lymph nodes and a lower rate of disease-free survival.

[99mTc-MAA peritoneal scintigraphy in pleuroperitoneal comunication in peritoneal dialysis patients]. / Gammagrafía peritoneal con 99mTc-MAA en las comunicaciones pleuroperitoneales en pacientes en diálisis peritoneal.

Peritoneal dialysis is a fully-contrasted alternative for the treatment of end-stage renal disease although it is not exempt of complications. Peritonitis and exit-site infections are among the most frequent complications found. Pleural effusion secondary to pleuroperitoneal communication (PPC) is a serious and uncommon complication in these patients. We present the case of a 50-year old man diagnosed of end-stage renal disease undergoing treatment with peritoneal dialysis who presented progressive dyspnea and right pleural effusion. The peritoneal scintigraphy with (99m)Tc-MAA makes it possible to confirm communication of intraperitoneal dialysis fluid to the pleural cavity.

Risk factors for methicillin-resistant Staphylococcus aureus and extended-spectrum ß-lactamase producing Enterobacterales in patients with diabetic foot infections requiring hospital admission.

OBJECTIVE: Methicillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum ß-lactamase-producing Enterobacterales (ESBL-E) may complicate the treatment of diabetic foot infections (DFIs). The aim of this study was to determine the risk factors for these pathogens in DFIs. METHODS: This was a prospective observational study of 167 consecutive adult patients with DFIs. The diagnosis and severity of DFIs were based on the Infectious Disease Society of America (IDSA) classification system. Multivariate analyses were performed in order to identify risk factors for MRSA and ESBL-E infections. RESULTS: S. aureus was the most isolated pathogen (n=82, 37.9 %) followed by Escherichia coli (n= 40, 18.5%). MRSA accounted for 57.3% of all S. aureus and 70% of Klebsiella pneumoniae and 25% of E. coli were ESBL producers, respectively. Deep ulcer [OR 8,563; 95% CI (1,068-4,727)], previous use of fluoroquinolones [OR 2,78; 95% CI (1,156-6,685)] and peripheral vasculopathy [OR 2,47; 95% CI (1.068-4.727)] were the independent predictors for MRSA infections; and osteomyelitis [OR 6,351; 95% CI (1,609-25,068)] and previous use of cephalosporins [OR 5,824; 95% CI (1,517-22,361)] for ESBL-E infections. CONCLUSIONS: MRSA and ESBL-E have adquired a great clinical relevance in DFIs. The availability of their risk factors is very convenient to choose the empirical treatment in severe forms.

18F-FDG PET/CT in staging and delineation of radiotherapy volume for head and neck cancer. / 18F-FDG PET/TC para la estadificación y la delineación del volumen de radioterapia en el cáncer de cabeza y cuello.

PURPOSE: The aim is to investigate the use of 18F-FDG (fluorine-18 fluorodeoxyglucose) PET/CT in head and neck cancer (HNC) staging and its effect on the therapeutic strategy and radiotherapy (RT) planning. METHODS AND MATERIALS: One hundred patients with HNC were included. Primary tumor sites: 18% oral cavity, 20% oropharynx, 12% hypopharynx, 11% nasopharynx, 37% larynx, 2% paranasal sinuses. Patients were staged according to the American Joint Committee of Cancer 7th edition. Stage: 5% stage I, 7% stage II, 14% stage III, 61% stage IVA, 7% stage IVB and 6% stage IVC. A contrast-enhanced CT and a 18F-FDG PET/CT acquired under RT position were performed. Both exams were compared to analyze patients' staging reclassification. Changes in therapeutic strategy were analyzed. RESULTS: 18F-FDG PET/CT detected 6 distant metastases and treatment intention changed to palliative. Eight synchronous tumors were detected; one received palliative treatment. 18F-FDG PET/CT reclassified cTNM staging in 27patients. Tumor extension changed in 28 (14% up-staged; 14% down-staged), implying a change in GTV (Gross Tumor Volume) delineation. Nodal detection was reclassified in 47 patients: 8 patients down-staged (N2C to N2A/N2B/N1) and 2 were false positive. Nineteen patients were false negatives and 5 staged as N+(N1/N2A/N2B) turned out into N2C. These staging modifications imply adapting the nodal volume to be irradiated. CONCLUSIONS: 18F-FDG PET/CT reclassification was higher than 10% in almost all categories studied (cTNM, tumor extension and nodal disease) and detects more metastases and synchronous tumors than conventional studies, which has an impact on the therapeutic patient management and RT planning.

Efecto de un programa de refuerzo motriz en alumnado con dificultades motrices y/o sociales / Efeito de um programa de reforço motor sobre os estudantes com dificuldades motoras e/ou sociais / Effect of a motor reinforcement programme in students with motor and/or social difficulties

El objetivo del presente estudio fue mejorar la competencia motriz y las relaciones sociales en alumnado con dificultades de coordinación y/o sociales a través de un programa integral de refuerzo motriz. Para ello, el estudio se dividió en cuatro fases. En la primera fase se seleccionaron, de entre los 60 niños participantes de tercer curso de Educación infantil, aquellos susceptibles de sufrir dificultades de movimiento y/o déficit en sus relaciones sociales, tras la aplicación de una serie de pruebas filtro. En la segunda y tercera fase se evaluó la competencia motriz, mediante la Batería de evaluación del movimiento para niños (MABC-2) y se implementó un programa de alfabetización física orientado al desarrollo de las habilidades motrices básicas para, finalmente, en la cuarta fase, comprobar si se había producido alguna mejora en la competencia motriz y en las relaciones sociales del alumnado participante. Tras la aplicación de la intervención se comprobaron mejoras significativas entre las medias pre y post en la dimensión equilibrio, puntería y atrape y puntuación global, además de una mejora significativa en amigo positivo. Estos resultados invitan a seguir trabajando en esta línea para favorecer un adecuado desarrollo de los alumnos de la etapa de infantil, tanto a nivel motriz como a nivel social. (AU)

The goal of this study was to improve motor competence and social relationships among students with coordination and / or social difficulties, through an integrative reinforcement program, from motor skills. For that purpose, the study was divided into four phases. In the first one, from among 60 children participating in the third year of Early Childhood Education, those who were susceptible to suffer difficulties with movement and / or deficits in their social relationships were selected, after having applied different filter tests. In the second and third phase, motor competence was evaluated through the Children's Movement Assessment Battery (MABC-2) and a physical literacy program was implemented aimed at the development of basic motor skills. Finally, in the fourth phase, it was checked whether there had been any improvement in the motor competence and social relations of the participating students. After intervention, significant improvements were found between the pre and post averages in the dimension balance, aim and catch and overall score, plus a significant improvement in positive friend. These results invite us to continue working to promote the adequate development among students in the infant stage, both at the motor and social levels. (AU)

Esta pesquisa tem como objetivo melhorar a competência motora e as relações sociais em estudantes com dificuldades de coordenação e/ou sociais, por meio de um programa abrangente de reforço das habilidades motoras. Para isso, o estudo está dividido em quatro fases. Na primeira, foram selecionados entre os 60 alunos participantes do terceiro curso de educação infantil, aqueles suscetíveis de apresentar dificuldades de movimento e/ou de relações sociais, após a aplicação de uma série de testes de filtragem. Na segunda e terceira fases, avaliou-se a competência motora por meio da Bateria de Avaliação de Movimentos para Crianças (Mabc-2) e se implementou um programa de alfabetização física orientada ao desenvolvimento das habilidades motoras básicas; para, finalmente, na quarta fase, comprovar se houve melhora na competência motora e nas relações sociais dos participantes. Após a aplicação da intervenção, melhorias significativas entre as médias pré e post na dimensão equilíbrio, pontaria e captura e pontuação global , bem como uma melhoria significativa em amigo positivo. O que nos sugere a continuar trabalhando nesta linha para promover o desenvolvimento adequado dos alunos na fase infantil, tanto no nível motor quanto no social. (AU)

Ha sido el 2020 un año perdido en la formación de cirugía ortopédica y traumatología? Percepción de los residentes / Has 2020 been a lost year in orthopedic surgery and trauma training? Residents’ perceptions

Objetivo: La pandemia de la COVID-19 ha afectado a la formación sanitaria especializada a todos los niveles. El aprendizaje en el ámbito quirúrgico se ha visto gravemente afectado y hasta ahora no se ha valorado el impacto en la formación de residentes de traumatología. Material y métodos: Se hizo llegar mediante enlace web y redes sociales una encuesta en línea de 17 preguntas a los residentes de cirugía ortopédica y traumatología de todo el territorio español entre el 10 de febrero y el 28 de febrero de 2021. Se analizaron los efectos de la pandemia de la COVID-19 en la actividad asistencial y formativa de los residentes. Resultados: Un total de 307 residentes de cirugía ortopédica y traumatología de toda España respondieron la encuesta. El 77,2% de los encuestados tuvo que suspender sus rotaciones. De estos, al 67,5% le gustaría retomar las rotaciones perdidas durante la pandemia. Un 69,7% de las cirugías programadas fueron suspendidas. La actividad quirúrgica estuvo completamente parada una media de 8 semanas. El 66,8% de los residentes considera que se ha visto afectada su formación quirúrgica y que esto repercutirá en su futuro laboral. El 49,5% considera insuficiente la oferta formativa en línea. Del total de encuestados, el 52,1% considera que el impacto de la situación de pandemia respecto a su situación formativa ha sido malo o muy malo. Conclusiones: La recogida de datos muestra un impacto negativo sobre la formación asistencial y teórica. Este estudio pone de manifiesto la necesidad de continuar ofreciendo una formación de calidad y maximizar las oportunidades de aprendizaje.(AU)

Objective: The COVID-19 pandemic has affected specialized healthcare training at all levels. Surgical learning has been severely affected, and the impact on orthopedic surgery residency training has so far not been assessed. Material and methods: An online survey of 17 questions was sent via web link to orthopedic surgery residents throughout Spain between February 10, 2021 and February 28, 2021. The effects of the COVID-19 pandemic on the care and training activities of residents were analyzed. Results: A total of 307 orthopedic surgery residents from all over Spain responded to the online survey. A total of 77.2% of the respondents had to suspend their rotations. Of these, 67.5% would like to resume the rotations they missed during the pandemic. A total of 69.7% of scheduled surgeries were suspended. Surgical activity was completely stopped for an average of 8 weeks. 66.8% of the residents consider that their surgical training has been affected and this will have repercussions on their future work. 49.5% considered the online training offered to be insufficient. Of the total number of respondents, 52.1% considered that the impact of the pandemic situation on their training situation was bad or very bad. Conclusions: The data collection shows a negative impact on both theoretical and clinical training. This study highlights the need to continue offering quality training by maximizing learning opportunities.(AU)

[Translated article] Has 2020 been a lost year in orthopaedic surgery and trauma training? Residents’ perceptions / Ha sido el 2020 un año perdido en la formación de cirugía ortopédica y traumatología? Percepción de los residentes

Objetivo: La pandemia de la COVID-19 ha afectado a la formación sanitaria especializada a todos los niveles. El aprendizaje en el ámbito quirúrgico se ha visto gravemente afectado y hasta ahora no se ha valorado el impacto en la formación de residentes de traumatología. Material y métodos: Se hizo llegar mediante enlace web y redes sociales una encuesta en línea de 17 preguntas a los residentes de cirugía ortopédica y traumatología de todo el territorio español entre el 10 de febrero y el 28 de febrero de 2021. Se analizaron los efectos de la pandemia de la COVID-19 en la actividad asistencial y formativa de los residentes. Resultados: Un total de 307 residentes de cirugía ortopédica y traumatología de toda España respondieron la encuesta. El 77,2% de los encuestados tuvo que suspender sus rotaciones. De estos, al 67,5% le gustaría retomar las rotaciones perdidas durante la pandemia. Un 69,7% de las cirugías programadas fueron suspendidas. La actividad quirúrgica estuvo completamente parada una media de 8 semanas. El 66,8% de los residentes considera que se ha visto afectada su formación quirúrgica y que esto repercutirá en su futuro laboral. El 49,5% considera insuficiente la oferta formativa en línea. Del total de encuestados, el 52,1% considera que el impacto de la situación de pandemia respecto a su situación formativa ha sido malo o muy malo. Conclusiones: La recogida de datos muestra un impacto negativo sobre la formación asistencial y teórica. Este estudio pone de manifiesto la necesidad de continuar ofreciendo una formación de calidad y maximizar las oportunidades de aprendizaje.(AU)

Objective: The COVID-19 pandemic has affected specialized healthcare training at all levels. Surgical learning has been severely affected, and the impact on orthopedic surgery residency training has so far not been assessed. Material and methods: An online survey of 17 questions was sent via web link to orthopedic surgery residents throughout Spain between February 10, 2021 and February 28, 2021. The effects of the COVID-19 pandemic on the care and training activities of residents were analyzed. Results: A total of 307 orthopedic surgery residents from all over Spain responded to the online survey. A total of 77.2% of the respondents had to suspend their rotations. Of these, 67.5% would like to resume the rotations they missed during the pandemic. A total of 69.7% of scheduled surgeries were suspended. Surgical activity was completely stopped for an average of 8 weeks. 66.8% of the residents consider that their surgical training has been affected and this will have repercussions on their future work. 49.5% considered the online training offered to be insufficient. Of the total number of respondents, 52.1% considered that the impact of the pandemic situation on their training situation was bad or very bad. Conclusions: The data collection shows a negative impact on both theoretical and clinical training. This study highlights the need to continue offering quality training by maximizing learning opportunities.(AU)

[Factors associated with blood loss during precipitate labor]. / Factores asociados a la pérdida sanguínea en partos precipitados.

BACKGROUND: Precipitate labour is related to the appearance of postpartum haemorrhage due to posterior uterine atony. However, preventive measures that may be effective in reducing blood loss in this type of delivery are still unknown. Therefore, the objective of this study was to determine the risk factors associated with blood loss produced in precipitate labour. METHODS: This was an observational, analytical retrospective cohort study based on a total sample of 742 women with vaginal delivery whose duration was less than 180 minutes, during the period 2010-2014. Dead foetus antepartum gestations, twin gestations and labour induction were excluded from the analysis. The main outcome variable was intrapartum blood loss. RESULTS: By making use of multivariate analysis, the risk factors independently associated with higher blood loss (g/dL) during precipitate labour were nulliparity (0.38; p<0.001), higher antepartum haemoglobin levels (0.23; p<0.001), higher gestational age (0.06; p<0.001), manual removal of the placenta (0.92; p=0.004) and the use of episiotomy (0.34; p<0.001). Performing active management emerges as a protective factor against increased blood loss (-0.23; p<0.001). The average loss of haemoglobin was 1.0 g/dL (standard deviation =0.92). CONCLUSION: The restriction in the practice of episiotomy and the use of active management can therefore be established as key measures that professionals can modify in order to reduce blood loss during precipitate labour and to improve these mothers' postpartum period. Key words. Haemoglobin. Precipitate labour.

Effects of extraction solvents on photoluminescent properties of eysenhardtia polystachia and their potential usage as biomarker.

Currently, nanomaterials had been used for several applications; one of them is as bio-markers. These nanomaterials contain fluorescent compounds as effective indicators for imaging and other applications in Biotechnology. In previous studies, we proposed a functionalized nanomaterial-based biomarker from silica and Eysenhardtia Polystachia, a medicinal tree known in Mexico as "palo azul" (Kidneywood). Our previous results showed the feasibility of the nanomaterial obtained as bio-marker. In this article, our purpose is to evaluate the effects of extraction solvents on fluorescence of that biomarker. The photoluminescence (PL) effect was evaluated at different pH (4, 7.4 and 8); four extraction solvents, ethanol, methanol, methanol-ethanol and methanol-ethanol-water were evaluated. A molecular dynamics simulation was performed to recognize molecular interaction between the compounds of the extracts with solvent molecules and to investigate the solvent molecules effect on photoluminescence spectra. The results were also compared with rhodamine 6G and we found that, at physiological pH (7.4), the fluorescent-coated silica nanoparticles obtained were also stable. We found that extraction solvents could be used for obtaining different nanomaterials for specific applications, and also found the best extraction solvent for obtaining EP nanomaterials for health care applications, specifically for imaging techniques.

[Predictive validity of Bishop and Burnett Scores for vaginal delivery modified by parity]. / Validación de la capacidad predictiva de resultado de parto del índice de Bishop y Burnett modificado por paridad.

BACKGROUND: Validating the predictive capacity on the outcome of labour of the Bishop Score (BS) and the simplified Burnett Score (BRS) compared to their modified versions, in which parity is incorporated. METHODS: Historical cohorts out of a total of 728 inductions during the years 2012-2013 in the "La Mancha-Centro" Hospital of Alcázar de San Juan. We evaluated the predictive characteristics by areas under the (AUC) ROC curve for each parameter of BS and BRS and for parity, as well as for each of the 4 indices. RESULTS: Parity and all the parameters of BS and BRS, except for foetal station and cervical position, were associated with the outcome of labour. Two modified scales were defined on the basis of BS and BRS, following removal of the "foetal station" parameter due to its low discriminative capacity: BSM and BRSM. Nulliparity was given a value of 0 points, and multiparity a value of 3 points for BSM, and 2 for BRSM. Modified indices showed a higher predictive ability (AUC) for vaginal delivery than the original indices, for both BS (0.70 vs. 0.62) and for BRS (0.69 vs. 0.62). CONCLUSION: Replacing the "foetal station" parameter with parity in BS and BRS, improves predictive capacity with regard to the original indices in order to determine the outcome of labour. Key Words. Bishop Score. Induction of labour. Outcome of labour. Parity. Predictive model.