Uso de recursos y costes sanitarios en pacientes con vejiga hiperactiva que inician tratamiento con mirabegrón o un antimuscarínico en monoterapia en Cataluña: estudio MIRACAT / Resource use and healthcare costs in patients with overactive bladder who initiate treatment with mirabegron or antimuscarinic monotherapy in Catalonia: the MIRACAT study

Introducción y objetivo La vejiga hiperactiva (VH) impacta negativamente en la calidad de vida de los pacientes y puede asociarse a un elevado consumo de recursos. Nuestro objetivo fue describir el uso de recursos, costes y persistencia asociados al tratamiento de la VH con mirabegrón (MB) o antimuscarínicos (AM).Materiales y métodos Estudio observacional retrospectivo en registros médicos en adultos que iniciaron tratamiento para VH con MB o AM en Cataluña. Se analizó el uso de recursos sanitarios (visitas, hospitalizaciones, pruebas, medicación, absorbentes para incontinencia) en el primer año tras el inicio del tratamiento, estimando sus costes asociados (€, 2019) y la persistencia terapéutica. Se definió abandono como la falta de prescripción durante ≥ 45 días o el cambio de tratamiento.Resultados El coste medio por paciente (desviación estándar [DE]) con MB fue 1.640,20 € (1.227,60) vs. 2.159,20 € (2.264,60) con AM; el coste asociado al uso de recursos sanitarios fue inferior en MB vs. AM, exceptuando el coste del tratamiento farmacológico con MB. La persistencia al tratamiento a los 12 meses fue superior en MB (42,1 vs. 33,0%), así como el tiempo (mediana) hasta el abandono del tratamiento: 299 (IC 95%: 270,11-327,89) vs. 240 días (IC 95%: 230,46-249,54).Conclusiones Los pacientes tratados con MB mostraron menor uso de recursos, resultando en un coste medio por paciente/año más bajo, a pesar del mayor coste del fármaco respecto a AM. La mayor persistencia al tratamiento y el uso racional de las terapias disponibles mejoran el manejo de la VH y la calidad de vida de los pacientes (AU)

Introduction and aim Overactive bladder (OAB) negatively impacts patient quality of life and may be associated with high resource use. Our aim was to describe the resource use, costs and persistence associated with mirabegron (MB) or antimuscarinic (AM) treatment in patients with OAB.Materials and methods Observational retrospective study of medical records in adult patients initiating OAB treatment with MB or AM in Catalonia. Healthcare resource use (visits, hospital stays, tests, medication, absorbent pads) in the first year after treatment initiation was collected. Associated costs were estimated (€, reference year 2019), as well as treatment persistence. Treatment discontinuation was defined as the absence of prescription for at least 45 days or treatment change.Results The mean cost per patient (SD) was € 1,640.20 (€ 1,227.60) with MB and € 2,159.20 (€ 2,264.40) with AM; the associated healthcare resource use cost was lower with MB compared to AM, except for OAB drug costs. Persistence after 12 months of treatment initiation was higher in MB (42.1%) compared to AM (33.0%), as was the median time until treatment discontinuation: 299 (95% CI: 270-328) vs 240 days (95% CI: 230-250).Conclusions Lower healthcare resource use was observed with MB compared to AM in the first year of index treatment, resulting in a lower mean direct cost per patient and year, despite its higher acquisition cost. Increased treatment persistence, as well as rational use of available treatments improves OAB management and, in return, patients’ quality of life (AU)

Resource use and healthcare costs in patients with overactive bladder who initiate treatment with mirabegron or antimuscarinic monotherapy in Catalonia: the MIRACAT study.

INTRODUCTION AND AIM: Overactive bladder (OAB) negatively impacts patient quality of life and may be associated with high resource use. Our aim was to describe the resource use, costs and persistence associated with mirabegron (MB) or antimuscarinic (AM) treatment in patients with OAB. MATERIALS AND METHODS: Observational retrospective study of medical records in adult patients initiating OAB treatment with MB or AM in Catalonia. Healthcare resource use (visits, hospital stays, tests, medication, absorbent pads) in the first year after treatment initiation was collected. Associated costs were estimated (є, reference year 2019), as well as treatment persistence. Treatment discontinuation was defined as the absence of prescription for at least 45 days or treatment change. RESULTS: The mean cost per patient (SD) was є 1,640.20 (є 1,227.60) with MB and є 2,159.20 (є 2,264.40) with AM; the associated healthcare resource use cost was lower with MB compared to AM, except for OAB drug costs. Persistence after 12 months of treatment initiation was higher in MB (42.1%) compared to AM (33.0%), as was the median time until treatment discontinuation: 299 (95% CI: 270-328) vs 240 days (95% CI: 230-250). CONCLUSIONS: Lower healthcare resource use was observed with MB compared to AM in the first year of index treatment, resulting in a lower mean direct cost per patient and year, despite its higher acquisition cost. Increased treatment persistence, as well as rational use of available treatments improves OAB management and, in return, patients' quality of life.

Environmental evidence of Valencia lagoon coastal barrier stabilization from 8500 BP to Present. Climate and eustatic variations.

The Albufera de Valencia is one of the largest lagoon in the Spanish Mediterranean. Two continuous borehole cores reaching depths of 8 and 14 m in the northern part of the lagoon underwent sedimentological, micropaleontological and biological study. The organic content was also analysed, and 14C radiometric dating and amino acid racemization were performed. Study of the content of benthic foraminifera and n-alkanes and alkanoic acids in the lagoon sedimentary record identified several periods. The core records showed seven different environments: alluvial; freshwater marsh; brackish marsh; brackish lagoon; brackish lagoon with marine connection, backbarrier flat, and backshore. These environments changed due to eight phases associated with the transgression and regression of the barrier system, which caused the shift from exposed environments as the backshore with washover, to the typical low-energy lagoon and marsh deposition. The paleoenvironmental evolution described above is interpreted as a response to global climate changes. The shift from an alluvial setting to a brackish lagoon is probably related to the late of Early Holocene sea level rise ending at the Holocene Climate Optimum, when the highest sea level was reached. The persistence of the brackish lagoon, with no marine connection, is probably synchronous with dry conditions in the area (Booth et al., 2005) at the time of Bond event 3 (i.e., 4.2 ka) in the North Atlantic region (Bond et al., 2001). Finally, the arrival of large amounts of sediment triggered the accretion of the barrier, also enhancing coastal progradation until the present day. These results allow an evaluation of the impact of anthropic action on the Valencia lagoon, especially since the eighteenth century, and a short- and medium-term projection of the consequences of present-day climate change.

Biallelic variants in genes previously associated with dominant inheritance: CACNA1A, RET and SLC20A2.

A subset of families with co-dominant or recessive inheritance has been described in several genes previously associated with dominant inheritance. Those recessive families displayed similar, more severe, or even completely different phenotypes to their dominant counterparts. We report the first patients harboring homozygous disease-related variants in three genes that were previously associated with dominant inheritance: a loss-of-function variant in the CACNA1A gene and two missense variants in the RET and SLC20A2 genes, respectively. All patients presented with a more severe clinical phenotype than the corresponding typical dominant form. We suggest that co-dominant or recessive inheritance for these three genes could explain the phenotypic differences from those documented in their cognate dominant phenotypes. Our results reinforce that geneticists should be aware of the possible different forms of inheritance in genes when WES variant interpretation is performed. We also evidence the need to refine phenotypes and inheritance patterns associated with genes in order to avoid failures during WES analysis and thus, raising the WES diagnostic capacity in the benefit of patients.

Dehiscencia de la cúpula vaginal como causa de abdomen agudo / Acute abdomen due to vaginal cuff dehiscence

La dehiscencia de la cúpula vagina tras una histerectomía es una complicación poco frecuente con una mayor incidencia en casos de cirugía laparoscópica. Su diagnóstico es clínico y, en caso de acompañarse de evisceración de contenido intraabdominal, supone una auténtica emergencia quirúrgica debido al riesgo de lesión intestinal y peritonitis. Respecto a la vía de abordaje para su tratamiento continua existiendo controversia, recomendándose la laparoscopia si la situación de la paciente lo permite. Presentamos el caso de una paciente con antecedente de histerectomía total y doble anexectomía 3 meses antes con exploración compatible con abdomen agudo y TC indicativa de perforación de víscera hueca. En la cirugía por vía laparoscópica se evidenció una dehiscencia a nivel de la cúpula vaginal. (AU)

Vaginal cuff dehiscence after hysterectomy is a rare complication. It is more frequent in laparoscopic surgery and its diagnosis isclinical. In case of bowel evisceration it is a surgical emergency due to the risk of bowel injury and peritonitis. Controversy existsregarding the surgical approach. If the patient´s situation allows it, laparoscopy is recommended. We present the case of a patientwith total hysterectomy with bilateral salpingo-oophorectomy 3 months before. She presented an acute abdomen and the CT scanwas indicative of hollow viscus perforation. Laparoscopic surgery showed a vaginal cuff dehiscence. (AU)

Programa de optimización del uso de antimicrobianos (PROA): análisis de indicadores basados en el consumo / Antimicrobial stewardship programs: analysis of indicators of antimicrobial agents based on consumption

Objetivos: Implantar un programa de optimización del uso de antimicrobianos (PROA) para intervenir en el uso de antimicrobianos. Analizar el impacto de las intervenciones mediante indicadores basados en el consumo.Métodos: Fase 1. Creación equipo PROA: nombramiento; asesoramiento externo; formación; desarrollo programa informático. Fase 2. Análisis indicadores de consumo: estudio retrospectivo de intervención cuasi-experimental con evaluación pre-post: se evaluaron los indicadores del uso de antimicrobianos basados en el consumo en fase no-intervención y en fase intervención. El programa PROA consistió en un modelo de intervención no restrictivo.Resultados: Se formó e implantó el equipo PROA como órgano estructural y organizativo para la consulta, intervención y vigilancia del uso de antimicrobianos. Durante la fase intervención se realizaron 134 recomendaciones: terapia secuencial (12,69%), cambio de antimicrobiano/desescalada terapéutica (31,34%), suspensión de tratamiento antimicrobiano (55,97%); el grado de aceptación fue del 67,16%. Se analizaron 13 indicadores. En 11 de ellos se observó mejoría: consumo global antibacterianos (-2,26%), consumo global antifúngicos sistémicos (-40,60%), consumo carbapenémicos (-22,63%), consumo fluoroquinolonas (-16,52%), ratio macrólidos i.v./fluoroquinolonas respiratorias i.v. (17,49%), ratio metronidazol/carbapenémicos + piperacilina-tazobactam (15,82%), consumo fosfomicina (69,21%), ratio agentes anti-SASM/agentes anti-SARM (45,14%), ratio amoxicilina-clavulánico/piperacilina-tazobactam (24,38%), diversificación betalactámicos antipseudomónicos (7,61%), ratio fluconazol/equinocandinas (8,74%). Los indicadores en los que se obtuvo resultado negativo fueron: terapia secuencial (-8,89%), ratio amoxicilina/amoxicilina-clavulánico (-4,03%). ... (AU)

Objectives: Implementation of a program for optimizing the use of antibiotics (PROA) to manage the use of antimicrobials. Analyse the impact through indicators based on consumption.Methods: Phase 1. Creation of PROA: appointment; external advice; training; software development. Phase 2. Consumption indicators analysis: interventional, quasi-experimental, retrospective study with pre-post evaluation: indicators based on consumption were evaluated in non-intervention phase and in intervention phase. PROA consisted of a non-restrictive intervention model.Results: PROA was formed and implemented as a structural and managing body for the advice, intervention and monitoring of the use of antimicrobials. During the intervention phase, 134 recommendations related to sequential therapy IV/PO (12.69%), change of antimicrobial/de-escalation (31.34%), discontinuation of antimicrobial treatment (55.97%) were made; the degree of acceptance was 67.16%. 13 indicators based on consumption were analysed. 11 of them led to an improvement: antibacterials global consumption (-2.26%), systemic antifungals global consumption (-40.60%), carbapenems consumption (-22.63%), fluoroquinolones consumption (-16.52%), macrolide IV/ respiratory fluoroquinolones IV ratio (17.49%), metronidazole/carbapenem + piperacillin-tazobactam ratio (15.82%), fosfomycin consumption (69.21%), anti-MSSA agents/anti-MRSA agents ratio (45.14%), amoxicillin-clavulanic/piperacillin-tazobactam ratio (24.38%), diversification antipseudomonic beta-lactam (7.61%), fluconazole/echinocandins ratio (8.74%). Indicators with negative result were: sequential therapy IV/PO (-8.89%), amoxicillin/amoxicillin-clavulanic ratio (-4.03%). ... (AU)

Divertículo de meckel: diagnóstico y tratamiento / Meckel's diverticulum: diagnosis and treatment

INTRODUCCIÓN: el divertículo de Meckel supone la anomalía congénita más frecuente del tracto gastrointestinal, siendo lo más habitual su diagnóstico como hallazgo incidental. OBJETIVO: realizar una revisión de todos los pacientes diagnosticados de divertículo de Meckel en nuestro hospital. Material y MÉTODO: a través de las historias clínicas se revisaron las principales características de los pacientes con diagnóstico de divertículo de Meckel entre 1993 y 2019 en el hospital General Universitario Reina Sofía de Murcia. RESULTADOS: se revisaron 32 pacientes, de los cuales 30 fueron intervenidos quirúrgicamente. La forma más habitual de diagnóstico fue como hallazgo casual intraoperatorio (17 casos) y la técnica quirúrgica más empleada fue la diverticulectomía abierta (16 casos). En 8 casos se halló tejido ectópico en la mucosa diverticular. DISCUSIÓN: el diagnóstico por imagen del divertículo de Meckel resulta complicado. Respecto al tratamiento, en los casos sintomáticos se proceder a su resección, mientras que persiste la controversia sobre la actitud en casos asintomáticos. CONCLUSIÓN: en nuestro centro, la forma más habitual de diagnóstico de un divertículo de Meckel fue como hallazgo casual en una intervención quirúrgica indicada por otro motivo. Tras su hallazgo de forma intraoperatoria se procedió a su resección en todos los casos

INTRODUCTION: Meckel 's diverticulum is the most prevalent congenital anomaly of the gastrointestinal tract. The diagnosis is usually made incidentally. OBJECTIVE: to perform a review about all patients with Meckel ́s diverticulum in our hospital. Material and method: we reviewed the records and analysed main characteristics of all patients with Meckel ́s diverticulum between 1993 and 2019 at Reina Sofía General University hospital in Murcia. RESULTS: we reviewed 32 patients, of which 30 underwent surgery. The most common way of diagnosis was as a casual intraoperative finding (17 cases) and the most frequent surgery was open diverticulectomy (16 cases). In 8 cases ectopic mucosa was found. DISCUSSION: the role of imaging in the diagnosis of Meckel ́s diverticulum is limited. Regarding the treatment, in symptomatic patients it must be removed. Nevertheless, in patients without symptom there is no consensus on the best treatment. CONCLUSION: in our study, the most common way of Meckel ́s diverticulum diagnosis was as a casual finding in a surgery carried out for another reason. After it intraoperative discovery, it was removed in all cases

Global ocean freshening, ocean mass increase and global mean sea level rise over 2005-2015.

Global mean sea level has experienced an unabated rise over the 20th century. This observed rise is due to both ocean warming and increasing continental freshwater discharge. We estimate the net ocean mass contribution to sea level by assessing the global ocean salt budget based on the unprecedented amount of in situ data over 2005-2015. We obtain the ocean mass trends of 1.30 ± 1.13 mm · yr-1 (0-2000 m) and 1.55 ± 1.20 mm · yr-1 (full depth). These new ocean mass trends are smaller by 0.63-0.88 mm · yr-1 compared to the ocean mass trend estimated through the sea level budget approach. Our result provides an independent validation of Gravity Recovery And Climate Experiment (GRACE)-based ocean mass trend and, in addition, places an independent constraint on the combined Glacial Isostatic Adjustment - the Earth's delayed viscoelastic response to the redistribution of mass that accompanied the last deglaciation- and geocenter variations needed to directly infer the ocean mass trend based on GRACE data.

[Translation and transcultural adaptation of the Toe Walking Tool: screening tool of toe walking patients]. / Traduccion y adaptacion transcultural de la Toe Walking Tool: herramienta para el cribado de la marcha de puntillas.

INTRODUCTION: The Toe Walking Tool (TWT) is a clinical screening instrument which helps in the differentiation of children with normal development, idiopathic toe-walking or toe-walking due to a medical cause. AIM: To carry out the translation and cross-cultural adaptation of the TWT for the Spanish pediatric population and to evaluate its content validity. SUBJECTS AND METHODS: This paper was carried out following an inverted method of translation and back-translation. Once the pre-final Spanish version was obtained, its analysis was conducted through the Delphi method by a panel of experts. The content validity of the tool explores its clarity, viability, applicability and usefulness. RESULTS: An expert panel composed by 15 professionals determine the content validity of the Spanish version of the TWT. The questionnaire translated and adapted transculturally into Spanish presented an excellent global content validity index (0.94) and the expert committee considered that the scale was easily understandable, viable, simple to apply and useful in the pediatric setting. CONCLUSIONS: The Spanish version of the TWT presents an excellent content validity and is an understandable, viable, simple and useful assessment tool. It is necessary to carry out future studies to analyze its psychometric properties with a Spanish pediatric population.

TITLE: Traduccion y adaptacion transcultural de la Toe Walking Tool: herramienta para el cribado de la marcha de puntillas.Introduccion. La Toe Walking Tool (TWT) es una herramienta clinica de cribado que permite discriminar a los niños con desarrollo normal de los que presentan marcha de puntillas idiopatica o marcha de puntillas de origen medico. Objetivo. Realizar la traduccion y adaptacion transcultural de la TWT para la poblacion infantil española y evaluar su validez de contenido. Sujetos y metodos. El proceso se realizo segun el metodo invertido de traduccion-retrotraduccion. Una vez obtenida la version prefinal en castellano, se llevo a cabo su analisis mediante el metodo Delphi por parte de un panel de expertos para analizar su validez de contenido, asi como la comprension, viabilidad, aplicabilidad y utilidad de la herramienta. Resultados. Se constituyo un panel de expertos compuesto por 15 profesionales que determinaron la validez de contenido de la version española de la TWT. El cuestionario traducido y adaptado transculturalmente al castellano presento un indice de validez de contenido global excelente (0,94). A traves del metodo Delphi se determino que la escala era comprensible, viable, de aplicacion sencilla y util en el ambito pediatrico. Conclusiones. La version en castellano de la TWT presenta una excelente validez de contenido y se considera un instrumento comprensible, viable, sencillo y util con aplicacion en la poblacion pediatrica española. En futuros estudios resulta necesario analizar sus caracteristicas psicometricas en niños con marcha de puntillas.

Trifluridine/Tipiracil (TAS-102) for refractory metastatic colorectal cancer in clinical practice: a feasible alternative for patients with good performance status.

INTRODUCTION: Our aim was to assess efficacy and safety and prognostic factors associated with TAS-102 in clinical practice. METHOD: Retrospective, multicenter, and observational study including patients with advanced refractory colorectal cancer who started TAS-102 between March 2016 and August 2018. The primary end point was overall survival (OS). Secondary end points included progression-free survival, toxicity and analyze prognostic factors present at the beginning of TAS-102. RESULT: 84 patients were evaluable. The median OS was 8.30 (95% CI 6.23-9.87) months and PFS was 2.62 (95% CI 2.36-3.05) months. In multivariate analysis, ECOG 0 and reduced dose combined with more cycles were associated with better prognosis. Patients with an ECOG > 0 had worse prognosis (HR 3.34, 95% CI 1.09-10.27, p = 0.035). 95.2% experienced some type of adverse effect and 45.2% had grade ≥ 3 toxicities. CONCLUSION: Results suggest reconsidering TAS-102 in patients with ECOG > 0, something that should be investigated in prospective randomized clinical trials.

Absceso masivo de pared abdominal por diverticulitis aguda evolucionada / Massive abscess in abdominal wall due to complicated diverticulitis

La mayoría de los pacientes con divertículos de colon no presentan complicaciones y, en caso de presentarlas, suelen ser intraabdominales. Exponemos el caso de un varón de 52 años que consultó en el Servicio de Urgencias por dolor abdominal de 3 semanas de evolución asociado a tumoración infraumbilical con signos de flogosis. La analítica sanguínea mostró leucocitosis importante con desviación izquierda y elevación de la proteína C reactiva. La tomografía computarizada evidenció un gran absceso de pared abdominal que comunicaba con cambios inflamatorios en sigma ("en reloj de arena"). Se decidió intervenir de forma quirúrgica urgente hallando diverticulitis aguda de sigma muy evolucionada. Se realizó drenaje y colostomía en cañón de escopeta sobre varilla. El absceso de pared abdominal como debut de diverticulitis aguda complicada es una forma de presentación muy infrecuente de esta patología, existiendo pocos antecedentes descritos en la literatura al respecto

The majority of patients with diverticula have not any complications. If they appear, they use to present as an intra-abdominal complication. We present the case of a 52-year-old man who came to the Emergency Service with lower abdominal pain for 3 weeks and a visible mass with inflammatory signs in this site. The blood test showed a marked leucocytosis with neutrophilia and the compute tomography revealed an abscess of the abdominal wall related with inflammatory changes in sigmoid colon ("hourglass"). We decided emergency surgery and we found evolved acute sigmoid diverticulitis. Local drainage of the abscess and loop colostomy opened over a rod were performed. The abdominal wall abscess as a form of debut of acute complicated diverticulitis is a very uncommon presentation of this pathology. There are few antecedents in the literature about this matter

ASPRE trial: incidence of preterm pre-eclampsia in patients fulfilling ACOG and NICE criteria according to risk by FMF algorithm.

OBJECTIVE: To report the incidence of preterm pre-eclampsia (PE) in women who are screen positive according to the criteria of the National Institute for Health and Care Excellence (NICE) and the American College of Obstetricians and Gynecologists (ACOG), and compare the incidence with that in those who are screen positive or screen negative by The Fetal Medicine Foundation (FMF) algorithm. METHODS: This was a secondary analysis of data from the ASPRE study. The study population consisted of women with singleton pregnancy who underwent prospective screening for preterm PE by means of the FMF algorithm, which combines maternal factors and biomarkers at 11-13 weeks' gestation. The incidence of preterm PE in women fulfilling the NICE and ACOG criteria was estimated; in these patients the incidence of preterm PE was then calculated in those who were screen negative relative to those who were screen positive by the FMF algorithm. RESULTS: A total of 34 573 women with singleton pregnancy delivering at ≥ 24 weeks' gestation underwent prospective screening for preterm PE, of which 239 (0.7%) cases developed preterm PE. At least one of the ACOG criteria was fulfilled in 22 287 (64.5%) pregnancies and the incidence of preterm PE was 0.97% (95% CI, 0.85-1.11%); in the subgroup that was screen positive by the FMF algorithm the incidence of preterm PE was 4.80% (95% CI, 4.14-5.55%), and in those that were screen negative it was 0.25% (95% CI, 0.18-0.33%), with a relative incidence in FMF screen negative to FMF screen positive of 0.051 (95% CI, 0.037-0.071). In 1392 (4.0%) pregnancies, at least one of the NICE high-risk criteria was fulfilled, and in this group the incidence of preterm PE was 5.17% (95% CI, 4.13-6.46%); in the subgroups of screen positive and screen negative by the FMF algorithm, the incidence of preterm PE was 8.71% (95% CI, 6.93-10.89%) and 0.65% (95% CI, 0.25-1.67%), respectively, and the relative incidence was 0.075 (95% CI, 0.028-0.205). In 2360 (6.8%) pregnancies fulfilling at least two of the NICE moderate-risk criteria, the incidence of preterm PE was 1.74% (95% CI, 1.28-2.35%); in the subgroups of screen positive and screen negative by the FMF algorithm the incidence was 4.91% (95% CI, 3.54-6.79%) and 0.42% (95% CI, 0.20-0.86%), respectively, and the relative incidence was 0.085 (95% CI, 0.038-0.192). CONCLUSION: In women who are screen positive for preterm PE by the ACOG or NICE criteria but screen negative by the FMF algorithm, the risk of preterm PE is reduced to within or below background levels. The results provide further evidence to support the personalized risk-based screening method that combines maternal factors and biomarkers. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

Results of an early intervention programme for patients with bacteraemia: analysis of prognostic factors and mortality.

BACKGROUND: Bacteraemia is a common cause of morbidity and mortality in patients admitted to hospital. The aim of this study is to analyse the results of a two-year programme for the early optimisation of antibiotic treatment in patients admitted to the Costa del Sol Hospital (Marbella. Spain). METHODS: A prospective two-year cohort study was conducted, evaluating all episodes of bacteraemia at the Costa del Sol Hospital. Epidemiological and microbiological characteristics, any modification of the initial antibiotic treatment, prognostic risk stratification, early mortality related to the episode of bacteraemia, and mortality after the seventh day, were included in the analysis. RESULTS: Seven hundred seventy-three episodes of bacteraemia were treated, 61.6% males and 38.4% females. The mean age was 65.2 years. The condition was most commonly acquired in the community (41.4%). The bacteraemia was most frequently urological in nature (30.5%), and E coli was the microorganism most frequently isolated (31.6%). In 51.1% of the episodes, a modification was made to optimise the treatment. In the first week, 8.2% died from bacteraemia, and 4.5% had died when they were located. The highest rates of death were associated with older patients, nosocomial acquisition, no source, McCabe score rapidly fatal, Charlson index ≥3, Pitt index ≥3 and treatment remained unmodified. CONCLUSION: The existence of bacteraemia control programmes and teams composed of clinicians who are experienced in the treatment of infectious diseases, can improve the disease outcome by enabling more severe episodes of bacteraemia to be recognised and their empirical treatment optimised.

Sleep disturbance, obesity, physical fitness and quality of life in older women: EXERNET study group.

OBJECTIVES: To investigate the association between physical fitness, obesity, health related quality of life (HRQoL) and sleep disturbance in 463 community-dwelling older Spanish women (66-91 years of age). STUDY DESIGN: Cross-sectional study. METHOD: Sleep disturbance was assessed with the Jenkins Sleep Scale. Active and sedentary behaviors were recorded by standardized questionnaires. HRQoL was assessed with the EuroQoL-5D. Anthropometric measurements were obtained using standardized techniques. Body fat was measured using bioelectrical impedance. Physical fitness was evaluated by a set of eight tests. RESULTS: Sleep disturbance was reported by 45.1% of women, being associated with higher body mass index (p < 0.05) and waist circumference (p < 0.01). Presence of insomnia was inversely associated with physical fitness. Women in the upper tertile of fitness index had 92.0% lower risk of sleep disturbance as compared to the lower tertile (p = 0.08), while women in the highest tertile of upper body strength had 76.4% lower risk of sleep disturbance as compared to the lower tertile (p < 0.05). Women without sleep disturbance showed better HRQoL. CONCLUSION: Sleep disturbance was associated with central obesity, lower physical fitness and reduced HRQoL. Interventions involving weight management and improvement of physical fitness may contribute to better sleep quality in older women.

The homozygous R504C mutation in MTO1 gene is responsible for ONCE syndrome.

We report clinical and biochemical finding from three unrelated patients presenting ONCE (Optic Neuropathy, Cardiomyopathy and Encephalopathy with lactic acidosis and combined oxidative phosphorylation deficiency) syndrome. Whole-exome sequencing (WES) of the three patients and the healthy sister of one of them was used to identify the carry gene. Clinical and biochemical findings were used to filter variants, and molecular, in silico and genetic studies were performed to characterize the candidate variants. Mitochondrial DNA (mtDNA) defects involving mutations, deletions or depletion were discarded, whereas WES uncovered a double homozygous mutation in the MTO1 gene (NM_001123226:c.1510C>T, p.R504C, and c.1669G>A, p.V557M) in two of the patients and the homozygous mutation p.R504C in the other. Therefore, our data confirm p.R504C as pathogenic mutation responsible of ONCE syndrome, and p.V557M as a rare polymorphic variant.

Cirugía combinada de tumor mediastínico en reloj de arena. Caso / Combined surgery of thoracic dumbell tumor. Clinical case

Introducción: los tumores neurogénicos son las masas del mediastino posterior más frecuentes. Aproximadamente el 10% de los localizados en el mediastino posterior tienen un componente intraespinal, a través de algún foramen vertebral. Siendo conocidos como tumores de Dumbbell o en reloj de arena. Reporte de caso: paciente con diagnóstico casual de tumor neurogénico en mediastino posterior con componente intraespinal (tumor en reloj de arena o Dumbell). El tratamiento quirúrgico se realizó conjuntamente en un mismo acto por parte del servicio de Neurocirugía y Cirugía Torácica. En un primer tiempo se llevó a cabo la laminectomía posterior, identificación de raíz dorsal izquierda afecta, ligadura y sección. Posteriormente, mediante videotoracoscopia por puerto único se realizó resección del tumor neurogénico por plano libre de afectación tumoral. Conclusión: el tratamiento quirúrgico en un solo acto de los tumores mediastínicos con componente intraespinal, ha demostrado ser seguro, eficaz y no aumentar las complicaciones intraoperatorias o postoperatoria

Introduction: neurogenic tumors are the most frequent masses of the posterior mediastinum. Approximately 10% of those located in the posterior mediastinum have an intraspinal component, through some vertebral foramen. They are known as dumbbell tumors. Clinical case: Patient with a diagnosis of neurogenic tumor in the posterior mediastinum with intraspinal component (dumbbell tumor). Surgical treatment was performed jointly in the same act by the Neurosurgery and Thoracic Surgery service. In a first time the posterior laminectomy, identification of left dorsal root affected, ligation and section was carried out. Subsequently, by single port video-assisted thoracoscopy, the neurogenic tumor was resected through a free plane of tumor involvement. Conclusion: surgical treatment in a single act of mediastinal tumors with intraspinal component has been shown to be safe, effective and does not increase intraoperative or postoperative complications

Use of donor sperm in addition to oocyte donation after repeated implantation failure in normozoospermic patients does not improve live birth rates.

STUDY QUESTION: Does switching to donor semen after at least three failed oocyte donation (OD) cycles with the partner normozoospermic semen increase the live birth rate in a subsequent OD cycle? SUMMARY ANSWER: Switching to donor semen after at least three failed OD cycles with the partner normozoospermic semen does not increase the live birth rate. WHAT IS ALREADY KNOWN: In some patients, a viable pregnancy cannot be achieved after several OD cycles, despite normal diagnostic findings for the couple. The ESHRE Capri Workshop Group indicates that, in order to improve reproductive outcomes, a semen donation can be offered after three failed ICSI cycles. STUDY DESIGN, SIZE, DURATION: A retrospective cohort analysis of fourth and fifth OD cycles with either the partner's normozoospermic semen (OD) or double-donation cycles (DD), performed between January 2011 and December 2014 in a private fertility center. These couples did not have a known male factor. PARTICIPANTS/MATERIALS, SETTING, METHOD: The study included 228 cycles (159 OD and 69 DD). The fertilization method was ICSI in all cycles and embryos were transferred fresh. Fertilization rates were compared between groups using ANOVA while pregnancy outcomes were compared using Chi-square tests. Effect of DD on pregnancy outcomes was further analyzed using a logistic regression model adjusted for recipient's age and BMI, number of embryos transferred, day of embryo transfer and morphological embryo quality score. MAIN RESULTS AND THE ROLE OF CHANCE: There was no difference in live birth rate between the DD and OD groups (38.2 versus 35.8%, P = 0.73), even after adjustment for confounding factors (odds ratio 1.41, 95% confidence interval 0.72, 2.76; P = 0.31). Rates of biochemical pregnancy (52.2 versus 54.1%, P = 0.79), clinical pregnancy (41.2 versus 45.9%, P = 0.51) and ongoing pregnancy (38.2 versus 37.1%, P = 0.87) were not different between the DD and the OD groups, as well as fertilization rate (75.3 versus 75.2%, P = 0.97). The DD and OD groups were comparable at baseline in all demographic and cycle variables analyzed (recipient's BMI, number of transferred embryos and embryo quality) with the exception of recipient's age (42.3 in DD versus 44.1 in OD, P = 0.005), and day of embryo transfer (56.5% of DD and 83.6% of OD embryo transfers were performed on blastocyst stage, P < 0.001); both variables were adjusted for in the multivariate analysis. LIMITATIONS, REASONS FOR CAUTION: The main limitations of this study are its retrospective nature, the relatively small sample size, the transfer of embryos of different developmental stages and the lack of extensive molecular testing, such as sperm DNA fragmentation test, in normozoospermic patients. WIDER IMPLICATIONS OF THE FINDINGS: After excluding several causes for the failed OD cycles, the partner's normozoospermic semen was a common factor in all of them. Nevertheless, the change to a donor's semen does not seem to improve the reproductive outcomes in the subsequent cycle. STUDY FUNDING/COMPETING INTERESTS: No extra-mural funding was obtained for this study. There are no conflicts of interest to declare. TRIAL REGISTRATION NUMBER: NA.

One-Year Follow-up of Children and Adolescents with Major Depressive Disorder: Relationship between Clinical Variables and Abcb1 Gene Polymorphisms.

Introduction: Differences in response to fluoxetine (FLX) may be influenced by certain genes that are involved in FLX transportation (ABCB1). We examined remission and recovery from the index episode in a cohort of patients treated with FLX, and also investigated associations between genetic variants in ABCB1 and remission, recovery, and suicide risk. Methods: This was a naturalistic 1-year follow-up study of 46 adolescents diagnosed with major depressive disorder (MDD). At 12 months they underwent a diagnostic interview with the K-SADS-PL. Results: It was found that remission was around 69.5% and recovery 56.5%. Remission and recovery were associated with lower scores on the CDI at baseline, with fewer readmissions and suicide attempts, and with lower scores on the CGI and higher scores on the GAF scale. No relationship was found between ABCB1 and remission or recovery. However, a significant association was observed between the G2677T ABCB1 polymorphism and suicide attempts. Conclusion: Other factors such as stressful events, family support, and other genetic factors are likely to be involved in MDD outcome.

Globos de látex de caucho natural: objetos peligros a desterrar de las instituciones de salud / Natural rubber latex balloons: dangerous objects to be banned from health institutions

Los globos de látex de caucho natural y los guantes de examinación del mismo material inflados como globos, que se entregan a los pacientes para aliviar el estrés de la atención sanitaria en las instituciones de salud tanto públicas como privadas, pueden provocar reacciones de hipersensibilidad de tipo I y son una de las causas más comunes de aspiración fatal. La suelta de globos contaminan el ambiente y agravan la extinción de la fauna y de la vida marina. Los pacientes sensibilizados o alérgicos al látex que participan en los festejos donde se utilizan globos de látex corren el riesgo de una reacción anafiláctica, potencialmente fatal. Aconsejarles no concurrir a dichos eventos, implica impedirles el disfrute de las actividades recreativas que es un derecho de la infancia manifestado en la Declaración de los Derechos del Niño. Muchos hospitales de países desarrollados ya cuentan con una política de prohibición de los globos de látex en sus instituciones, que podría replicarse en nuestro medio por las ventajas que conlleva y su muy bajo costo de implementación (AU)

Natural rubber latex balloons and examining gloves of the same material blown up as balloons to entertain patients to alleviate the stress of care at public and private health institutions, may cause reactions of type-1 hypersensitivity and are the most common cause of fatal asphyxia. Balloons that are released up into the air contaminate the environment and aggravate the extinction of fauna and marine life. Patients who are sensitized or allergic to latex and participate in celebrations in which latex balloons are used are at risk of a potentially fatal anaphylactic reaction. To advise them not to participate in these events means to stop them from enjoying recreational activities which is a right manifested in the Declaration of the Rights of the Child. In many hospitals in developed countries a policy of prohibition of latex gloves is already in place. This prohibition may be replicated in our environment considering its advantages and very low cost of implementation (AU)

Impacto del cambio climático en la salud / The impact of climate change on health

El Cambio Climático (CC) está afectando la salud humana y los sistemas naturales. En los últimos 50 años, las actividades del hombre, particularmente la quema de combustibles fósiles, han liberado importante cantidad de gases de efecto invernadero (GEI) los que atrapan el calor adicional en la atmósfera calentando el planeta. La temperatura y el nivel del mar aumentan, los glaciares se derriten y los patrones de las precipitaciones están cambiando. Los eventos climáticos extremos son más intensos y frecuentes. Es importante conocer el impacto del CC en la salud y en los ecosistemas porque es posible manejar sus efectos a través de medidas de adaptación y mitigación (AU)

Climate change (CC) is affecting human health and natural systems. Over the past 50 years, activities of mankind, mainly the burning of fossil fuels, has released important amounts of greenhouse gases (GHG) that trap additional heat in the atmosphere heating the planet. The sea temperature and level rise, glaciers melt, and patterns of precipitations have changed. Extreme climatic events have become more intense and frequent. It is important to recognize the impact of CC on health and ecosystems as it is possible late its effects through measures of adaptation and mitigation (AU)