Worldwide diversity in mammalian life histories: Environmental realms and evolutionary adaptations.

Mammalian life history strategies can be characterised by a few axes of variation, conforming a space where species are positioned based on the life history strategies favoured in the environment they exploit. Yet, we still lack global descriptions of the diversity of realised mammalian life history and how this diversity is shaped by the environment. We used six life history traits to build a life history space covering worldwide mammalian adaptation, and we explored how environmental realms (land, air, water) influence mammalian life history strategies. We demonstrate that realms are tightly linked to distinct life history strategies. Aquatic and aerial species predominantly adhere to slower life history strategies, while terrestrial species exhibit faster life histories. Highly encephalised terrestrial species are a notable exception to these patterns. Furthermore, we show that different mode of life may play a significant role in expanding the set of strategies exploitable in the terrestrial realm. Additionally, species transitioning between terrestrial and aquatic realms, such as seals, exhibit intermediate life history strategies. Our results provide compelling evidence of the link between environmental realms and the life history diversity of mammals, highlighting the importance of differences in mode of life to expand life history diversity.

Chronotropic and cardiac autonomic responses in speed motorcycling. A case study / Respuesta cronotrópica y cardíaca autónoma en motociclismo. Un estudio de caso

The purpose of the present study was to analyze the chronotropic and cardiac autonomic response of a motorcyclist during the 7th race week of the FIM-CEV Repsol Moto2 European Championship through heart rate (HRAVG) and sympathetic-parasympathetic ratio (RS-Ps). The effect and relationships of sessions, laps and track segments were analyzed by MANOVA test with Bonferroni post-hoc and Pearson’s r. A low effect of the segments in RS-Ps (p<.01; wp2=0.03), and high effect of the sessions (p<.01; wp2=0.72), laps (p<.01; wp2=0.95) and the interaction between sessions and laps (p<.01; wp2=0.62) in HRAVG were found. Also, a tendency of increasing HRAVG was found with sessions (r=.315; p<0.01) and laps (r=.280; p<0.01). No significant correlations were found with RS-Ps. While HRAVG can be used as a fatigue index during motorcycling competition, RS-Ps indicates the significant rider’s stress at specific segments of the track, being important both variables for improving the riders’ performance. (AU)

El objetivo del presente estudio fue analizar la respuesta cronotrópica y cardiaca autónoma de un piloto de motociclismo durante la 7a prueba del Campeonato de Europa FIM-CEV Repsol Moto2 mediante frecuencia cardíacamedia (FCMEDIA) y ratio simpático-parasimpático (RS-Ps). El efecto y relaciones de las sesiones, vueltas y segmentos del circuito fue analizado mediante MANOVA conpost-hoc Bonferroni y r de Pearson. Se encontró bajo efecto de los segmentos enRS-Ps (p<.01; ωp2=0.03), y alto efecto de sesiones (p<.01; ωp2=0.72), vueltas (p<.01; ωp2=0.95) e interacción sesiones-vueltas (p<.01; ωp2=0.62) en FCMEDIA. Además, se hallo una tendencia de incremento de FCMEDIA respecto a sesiones (r=.315; p<.01) y vueltas (r=.280; p<.01). No se encontraron correlaciones significativas con RS-Ps. La FCMEDIA puede utilizarse como un indicador de fatiga durante la competición, mientras que el RS-Ps indicaría el estrés significativo del piloto en segmentos específicos del circuito, siendo ambas variables importantes para mejorar el rendimiento del piloto. (AU)

Influence of game period and game action in the physical requirements of basketball referees / Influencia del periodo y acción de juego en las exigencias físicas de árbitros de baloncesto

This study aimed to identify internal and external workload demands in professional referees, and to analyse the influence of the situational variables Game Period and Game Action. Three professional referees of the highest category were monitored during a national elite game. WIMU PRO™ inertial devices were used for workload monitoring via microtechnology, ultra-wide band and heart rate (HR) telemetry. The referees worked at around 82%HRMAX and spent 75% of the time at walking-jogging speed (0-12km/h). Game Action influenced the external workload (total distance and per intensities, impacts, player load, maximum and mean speed) while Game Period influenced the internal load (HRMEAN, HRMAX, %HRMAX and per intensities). Workload quantification in competition and the evaluation of the effect of situational variables are essential for setting up performance profiles and designing individual programmes that improve the training of basketball referees. (AU)

Anthropogenic impacts on threatened species erode functional diversity in chelonians and crocodilians.

The Anthropocene is tightly associated with a drastic loss of species worldwide and the disappearance of their key ecosystem functions. The orders Testudines (turtles and tortoises) and Crocodilia (crocodiles, alligators, and gharials) contain numerous threatened, long-lived species for which the functional diversity and potential erosion by anthropogenic impacts remains unknown. Here, we examine 259 (69%) of the existing 375 species of Testudines and Crocodilia, quantifying their life history strategies (i.e., trade-offs in survival, development, and reproduction) from open-access data on demography, ancestry, and threats. We find that the loss of functional diversity in simulated extinction scenarios of threatened species is greater than expected by chance. Moreover, the effects of unsustainable local consumption, diseases, and pollution are associated with life history strategies. In contrast, climate change, habitat disturbance, and global trade affect species independent of their life history strategy. Importantly, the loss of functional diversity for threatened species by habitat degradation is twice that for all other threats. Our findings highlight the importance of conservation programmes focused on preserving the functional diversity of life history strategies jointly with the phylogenetic representativity of these highly threatened groups.

Hipertiroidismo por enfermedad de Graves posterior a vacuna contra SARS-CoV-2: reporte de 2 casos / Graves' disease hyperthyroidism following SARS-CoV-2 vaccination: a two cases report

Luego del inicio de las campañas de vacunación masiva contra la infección por COVID-19, se han publicado una serie de reportes que muestran la posible asociación entre la vacuna y alteraciones de la función tiroidea. Desde entonces, múltiples teorías han intentado explicar este hallazgo, en su mayoría de índole autoinmune. Dentro de estas destaca el síndrome autoinmune-autoinflamatorio secundario a adyuvantes (ASIA), que podría generar desórdenes tiroideos de novo o exacerbar los ya existentes. Presentamos dos casos de enfermedad de Graves Basedow posterior al uso de Coronavac. Ambas pacientes presentaron características similares a las descritas en la literatura y cumplen con los criterios de ASIA. No obstante, los beneficios de las vacunas superan los posibles riesgos asociados.

After the beginning of COVID-19 vaccination campaigns, a number of reports have shown the potential association between vaccines and thyroid disfunction. Since then several theories have tried to explain this finding, mostly autoinmmune. One of them is the autoimmune/inflammatory syndrome induced by adjuvants, that could trigger or exacerbate thyroid disease. We present two cases of Graves' disease post Coronavac vaccination. Both pacients share similar features than cases published previously and meet criteria for ASIA syndrome. Nevertheless, the benefts of vaccination largely outweigh any adverse events associated.

Percepción espacial de futbolistas semiprofesionales en juegos reducidos: Un estudio de caso / Spatial Perception of Semi-Professional Soccer Players in Small Games: A Case of Study

Este estudio pretende: i) describir las exigencias tácticas objetivas (área ocupada por el equipo, AOE) y subjetivas (percepción subjetiva del espacio ocupado, PSEO), ii) identificar la variabilidad inter-sujeto y explorar la relación entre AOE y PSEO, y iii) comparar las exigencias entre defensa y ataque durante la realización de juegos reducidos. Doce jugadores semiprofesionales de fútbol fueron monitoreados mediante dispositivos inerciales WIMU PRO®. Los resultados indican un AOE (ataque=257.6±60.6; defensa=120.3±37.8 m2) y PSEO (ataque=3.5±0.7; defensa=2.7±0.6 a.u.). Se encontraron diferencias entre fase de ataque y defensa en ambas variables (p>0.001; AOE, d=2.72; PSEO, d=1.23) y una alta relación entre ambos indicadores (r=0.92). En conclusión, las variables AEO y PSEO discriminaron el efecto de la fase de juego y el día de entrenamiento. Son necesarias futuras investigaciones con un mayor tamaño muestral para confirmar la validez de la PSEO. (AU)

This study aims to: i) describe the objective tactical demands (surface area occupied by team, AOE) and subjective (spatial perception of occupied area, PSEO), ii) identify the inter-subjects variability and the relationship between AOE and PSEO iii) to compare the demands between offensive and defensive phases during small-sided games. Twelve semi-professional football players were tracked using WIMU PRO®. The results indicated an AOE (attack=257.6±60.6; defense=120.3±37.8 m2) and PSEO (attack=3.5±0.7; 2.7±0.6 a.u.). Differences were found between attack and defense phase in both variables (p>0.001; AOE, d=2.72; PSEO, d=1.23) and high relationship between both indicators (r=0.92). In conclusion, the variables AEO and PSEO discriminated the effect of the game phase and the training day. Future research with a larger sample size is necessary to confirm the validity of the PSEO. (AU)

Effect of continuous positive airway pressure in very elderly with moderate-to-severe obstructive sleep apnea pooled results from two multicenter randomized controlled trials.

STUDY OBJECTIVE: There is very limited information about the effect of continuous positive airway pressure (CPAP) in the very elderly. Here we aimed to analysed the effect of CPAP on a clinical cohort of patients with obstructive sleep apnea (OSA) ≥80 years old. METHODS: Post-hoc pooled analysis of two open-label, multicenter clinical trials aimed to determine the effect of CPAP in a consecutive clinical cohort of elderly (≥70 years old) with moderate-to-severe OSA (apnea-hipopnea index ≥15 events/hour) randomized to receive CPAP or no CPAP for three months. Those consecutive patients ≥80 years old were included in the study. The primary endpoint was the change in Epworth Sleepiness scale (ESS). Secondary outcomes included sleep-related symptoms, quality of life, neurocognitive and mood status as well as office blood pressure measurements. RESULTS: From the initial 369 randomized individuals with ≥70 years, 97 (26.3%) with ≥80 years old were included (47 in the CPAP group and 50 in the no-CPAP group). The mean (SD) age was 81.5 (2.4) years. Average use of CPAP was 4.3 (2.6) hours/night (53% with good adherence) Patients in the CPAP group significantly improved snoring and witnessed apneas as well as AHI (from 41.9 to 4.9 events/hour). However no clinical improvements were seen in ESS (-1.2 points, 95%CI, 0.2 to -2.6), any domain of QSQ, any neurocognitive test, OSA-related symptoms, depression/anxiety or blood pressure levels. CONCLUSIONS: The present study does not support the use of CPAP in very elderly patients with moderate-to-severe OSA.

Effect of Isolated Vs in-Game Curvilinear Displacements in Multi-Location External Workload Profile. A Case Study in Semi-Professional Basketball Players / Efecto de los desplazamientos curvilíneos aislados versus en el juego en el perfil de carga de trabajo externo de múltiples ubicaciones. Un estudio de caso en jugadores de baloncesto semiprofesionales

In team sports, linear and non-linear displacements are combined during the game. In this sense, the importance of curvilinear trajectories and their impact on body joints have not been addressed yet. Therefore, the present research aims to: (a) describe the multi-location external workload profile during curvilinear displacements in isolated and in-game conditions, (b) compare the effect of direction and displacement context, and (c) analyse the correlation between impacts and curvilinear performance. Thirteen semi-professional male basketball players were assessed in two tests: (a) isolated (2 directions x 5 repetitions x 6.75-m line) and (b) in-game (10-min 3vs3 small-sided game). To evaluate curvilinear performance and impacts suffered per joints, six WIMU PROTM inertial devices (scapulae, centre of mass, 2x knee, 2x ankle) were placed through a specific integral whole-body vest. Statistical analysis was composed by ANOVA with Bonferroni post-hoc, t-test for independent samples and Pearson correlation coefficient, analysing the effect of magnitude by Cohen’s d and omega partial squared. The key findings indicate that straight displacements presented lower external workload than curvilinear displacements during in-game conditions (p<.01; = 0.47-to-0.50), but no differences were found between left and right directions (p>0.67; d<0.12). In addition, differences were found at lower limb locations in external workload in maximum sprinting during curvilinear displacements, with higher workload at left lower limb in right direction (knee: p<.01, d= -1.35; ankle: p<.01, d= -0.91), and at right lower limb in left direction (knee: p<.01, d= 1.23; ankle: p<.01, d= 0.91). Very high between-subjects variability has been shown in both tests. Besides, a nearly perfect relationship between external workload at different body locations (p<.01; r>0.918) and a high relationship between external workload and centripetal force were found.(AU)

Prognostic Value of Inflammatory Biomarkers in 5-Year Survival After Endovascular Repair of Abdominal Aortic Aneurysms in a Predominantly Male Cohort: Implications for Practice.

BACKGROUND: Prognostic factors of long-term survival can guide selection of patients for endovascular repair of abdominal aortic aneurysms (EVAR). The aim of this study was to evaluate the relationship between the neutrophil-to-lymphocyte ratio (NLR), the platelet-to-lymphocyte ratio (PLR), the lymphocyte-to-monocyte ratio (LMR) and the systemic immune-inflammation index (SIII) with survival after EVAR and to assess whether the addition of these biomarkers improved the prediction of survival after surgery. METHODS: Retrospective analysis of 284 consecutive patients who underwent an EVAR at a single institution. The association between biomarkers and survival was explored using generalized additive models with penalized smoothing splines and multivariate Cox models. C-statistics and continuous net reclassification indexes (c-NRI) were used to assess the improvement in prediction. RESULTS: Survival rates at 2 and 5 years were 83.9% and 66.2%, respectively. The predictive score of survival included hemoglobin (HR = 0.849, p = 0.004), statin intake (HR = 0.538, p = 0.004), atrial fibrillation (HR = 2.515, p < 0.001), heart failure (HR = 2.542, p = 0.017) and the non-revascularized coronary artery disease (HR = 2.163, p = 0.004). Spline analyses showed a linear relationship between survival and NLR, PLR, LMR and SII. After adjusting for the predictive score, there was an independent relationship between survival and NLR (HR = 1.072, p = 0.006), PLR (HR = 1.002, p = 0.014) and SII (HR = 1.000, p = 0.043). However, only the addition of NLR improved moderately the c-NRI. A NLR ≥ 3 was independently associated with lower survival rates at 2-years (HR 1.98; 95% CI 1.07-3.66) and 5-years (HR 1.84, 95% CI 1.22-2.78) of follow-up. CONCLUSIONS: Most inflammatory biomarkers are linear and independently associated with survival after EVAR, but only the NLR improved moderately the prediction of a survival score. Therefore, a NLR ≥ 3 may be used to identify patients with a low survival rate and help in decision-making.

Acute kidney injury: prevention, detection, and management. Summary of updated NICE guidance for adults receiving iodine-based contrast media.

The National Institute for Health and Care Excellence (NICE) has recently updated the guideline for Acute kidney injury: prevention, detection and management (NG148), providing new recommendations on preventing acute kidney injury (AKI) in adults receiving intravenous iodine-based contrast media. The association between intravenous iodinated contrast media and AKI is controversial, particularly with widespread use of iso-osmolar agents. Associations between contrast media administration and AKI are largely based on observational studies, with inherent heterogeneity in patient populations, definitions applied, and timing of laboratory investigations. In an attempt to mitigate risk, kidney protection has typically been employed using intravenous volume expansion and/or oral acetylcysteine. Such interventions are in widespread use, despite lacking high-quality evidence of benefit. In the non-emergency setting, glomerular filtration rate (GFR) measurements should be obtained within the preceding 3 months before offering intravenous iodine-based contrast media. In the acute setting, adults should also have their risk of AKI assessed before offering intravenous iodine-based contrast media; however, this should not delay emergency imaging. Based on the evidence available from randomised controlled trials, the NICE committee recommends that oral hydration should be encouraged in adults at increased risk of AKI and that volume expansion with intravenous V fluids should only be considered for inpatients at particularly high risk.

ACELT y PLAYERLOADTM: Dos variables para la cuantificación de la carga neuromuscular / ACELT and PLAYERLOADTM: Two Variables to Quantify Neuromuscular Load

Los objetivos de esta investigación son: (I) describir el comportamiento de las variables Player Load y AcelT y (II) cuantificar la carga neuromuscular en diferentes puntos anatómicos (espalda, centro de masas, rodilla y tobillo) durante un test incremental en rampa en tapiz rodante. Veintitrés jugadores semiprofesionales de fútbol varones participaron voluntariamente en este estudio (edad: 22,56 ± 4,8 años; masa corporal: 75,5 ± 5,5 kg; altura: 1,79 ± 0,5 m). Ambas variables se registraron empleando 4 dispositivos inerciales WIMU PRO(TM). Los principales resultados indican que: (1) existe una correlación casi perfecta entre ambas variables (r = 0,931), (2) los mayores valores en ambas variables se han encontrado en la rodilla (PL = 8,01 ± 2,76; AcelT = 2,70 ± 0,50) y el tobillo (PL = 7,85 ± 2,27; AcelT = 2,87 ± 0,49) y (3) existe una amplia variabilidad intersujeto. En conclusión, Player Load y AcelT son dos indicadores válidos para el análisis y cuantificación de las demandas neuromusculares

The objectives of this study were: (I) describe the dynamics of Player Load and AcelT and (II) analyze the neuromuscular load in different anatomical locations (scapulae, center of mass, knee and ankle) in an incremental test in treadmill. Twenty-three semiprofessional male football players participated voluntarily in this research (age: 22.56 ± 4.8 years; body mass: 75.5 ± 5.5 kg; height: 1.79 ± 0.5 m). Four WIMUPROTM inertial devices were utilized for recording both variables. The main results indicated that: (1) exists a nearly perfect relation between both variables (r > 0.931), (2) the highest values were in knee (PLRT = 8.01 ± 2.76; AcelT = 2.70 ±.50) and in ankle (PL = 7.85 ± 2.27; AcelT = 2.87±.49) and (3) a great variability was found between athletes. In conclusion, Player Load and AcelT are two valid variables to analyze and quantify neuromuscular demands

Prevalencia de infecciones osteoarticulares por enterobacterias productoras de ß-lactamasas de espectro extendido / Prevalence of osteoarticular infections by Enterobacteria producing extended-spectrum ß-lactamases

Resumen: Introducción: Las infecciones por enterobacterias productoras de β-lactamasas de espectro extendido (BLEEs) ocasionan una gran carga a los sistemas de salud. Poco se conoce de las infecciones osteoarticulares, por lo que este trabajo estudió la prevalencia de estas infecciones en un hospital de tercer nivel. Material y métodos: Estudio de prevalencia en pacientes de un servicio de traumatología durante 2016, con criterios de infección proporcionados por el CDC de Atlanta, Georgia. Se utilizó el sistema VITEK® 2 AST-N272 (bioMérieux) para la identificación bacteriana a nivel de especie y para las pruebas de susceptibilidad antimicrobiana. Resultados: Se reportaron 7.85% (n = 86) con infecciones osteoarticulares; 22.09% (n = 19) fueron por enterobacterias BLEEs. Con un promedio de 77.1 días de hospitalización (DE 37.7) (46-200 días); el aislamiento del microorganismo se produjo 15 días posteriores al ingreso; 16 (84.2%) pacientes presentaron osteomielitis, tres (15.8%) tuvieron infección protésica de rodilla o cadera. El promedio de días de tratamiento fue de 60 días (21-129 días); 18 pacientes (94.7%) fueron dados de alta con resolución de su cuadro infeccioso; un paciente falleció con infección sobreagregada por neumonía debida a K. pneumoniae resistente a carbapenémicos. Discusión: La prevalencia de infecciones osteoarticulares por enterobacterias BLEEs no se pudo calcular con precisión, pero consideramos que se encuentra dentro de lo esperado, las medidas de control de infecciones requieren tener estándares más elevados y falta desarrollar programas de uso racional de antimicrobianos para controlar la aparición de estas patologías.

Abstract: Introduction: Infections of enterobacteria producing extended-spectrum ß-lactamases place a heavy burden on health systems. Little is known in osteoarticular infections, so this work studied the prevalence of these infections in a third-level hospital. Material and methods: Prevalence study in patients of a Traumatology Service during 2016, with infection criteria provided by the CDC in Atlanta, Georgia. The VITEK® 2 AST-N272 (bioMérieux) system was used for bacterial identification at the species level and for antimicrobial susceptibility tests. Results: 7.85% (n = 86) were reported with osteoarticular infections; 22.09% (n = 19) were by enterobacteria BLEEs. An average of 77.1 days of hospitalization (SD 37.7) (46-200 days); isolation of the microorganism occurred 15 days after entry. Sixteen (84.2%) patients had osteomyelitis, three (15.8%) had a prosthetic knee or hip infection. The average number of treatment days was 60 days (21-129 days). Eighteen patients (94.7%) were discharged with resolution of their infectious picture; one patient died with infection over aggregated pneumonia due to carbapenem-resistant K. pneumoniae. Discussion: The prevalence of osteoarticular infections by enterobacteria BLEEs could not be accurately calculated, but we consider it to be within what is expected, infection control measures require higher standards and there is a lack of development programs to use antimicrobials rationally to control the emergence of these pathologies.

[Prevalence of osteoarticular infections by Enterobacteria producing extended-spectrum -lactamases]. / Prevalencia de infecciones osteoarticulares por enterobacterias productoras de -lactamasas de espectro extendido.

INTRODUCTION: Infections of enterobacteria producing extended-spectrum -lactamases place a heavy burden on health systems. Little is known in osteoarticular infections, so this work studied the prevalence of these infections in a third-level hospital. MATERIAL AND METHODS: Prevalence study in patients of a Traumatology Service during 2016, with infection criteria provided by the CDC in Atlanta, Georgia. The VITEK® 2 AST-N272 (bioMérieux) system was used for bacterial identification at the species level and for antimicrobial susceptibility tests. RESULTS: 7.85% (n = 86) were reported with osteoarticular infections; 22.09% (n = 19) were by enterobacteria BLEEs. An average of 77.1 days of hospitalization (SD 37.7) (46-200 days); isolation of the microorganism occurred 15 days after entry. Sixteen (84.2%) patients had osteomyelitis, three (15.8%) had a prosthetic knee or hip infection. The average number of treatment days was 60 days (21-129 days). Eighteen patients (94.7%) were discharged with resolution of their infectious picture; one patient died with infection over aggregated pneumonia due to carbapenem-resistant K. pneumoniae. DISCUSSION: The prevalence of osteoarticular infections by enterobacteria BLEEs could not be accurately calculated, but we consider it to be within what is expected, infection control measures require higher standards and there is a lack of development programs to use antimicrobials rationally to control the emergence of these pathologies.

INTRODUCCIÓN: Las infecciones por enterobacterias productoras de -lactamasas de espectro extendido (BLEEs) ocasionan una gran carga a los sistemas de salud. Poco se conoce de las infecciones osteoarticulares, por lo que este trabajo estudió la prevalencia de estas infecciones en un hospital de tercer nivel. MATERIAL Y MÉTODOS: Estudio de prevalencia en pacientes de un servicio de traumatología durante 2016, con criterios de infección proporcionados por el CDC de Atlanta, Georgia. Se utilizó el sistema VITEK® 2 AST-N272 (bioMérieux) para la identificación bacteriana a nivel de especie y para las pruebas de susceptibilidad antimicrobiana. RESULTADOS: Se reportaron 7.85% (n = 86) con infecciones osteoarticulares; 22.09% (n = 19) fueron por enterobacterias BLEEs. Con un promedio de 77.1 días de hospitalización (DE 37.7) (46-200 días); el aislamiento del microorganismo se produjo 15 días posteriores al ingreso; 16 (84.2%) pacientes presentaron osteomielitis, tres (15.8%) tuvieron infección protésica de rodilla o cadera. El promedio de días de tratamiento fue de 60 días (21-129 días); 18 pacientes (94.7%) fueron dados de alta con resolución de su cuadro infeccioso; un paciente falleció con infección sobreagregada por neumonía debida a K. pneumoniae resistente a carbapenémicos. DISCUSIÓN: La prevalencia de infecciones osteoarticulares por enterobacterias BLEEs no se pudo calcular con precisión, pero consideramos que se encuentra dentro de lo esperado, las medidas de control de infecciones requieren tener estándares más elevados y falta desarrollar programas de uso racional de antimicrobianos para controlar la aparición de estas patologías.

Evaluation of waiting times for breast cancer diagnosis and surgical treatment

Purpose: To analyse any delays in breast cancer diagnosis and surgical treatment, influence of clinical and biological factors and influence of delays on survival. Methods/patients: A descriptive, observational, and retrospective study was conducted between 2006 and 2016 on stages I-III breast cancer patients. This is a retrospective review of health records to collect data on delays, patients’ clinical data, biological features of the tumour and information on treatment. Mortality data from the National Death Index. Results: In 493 evaluable patients, the median of days from the first symptom to mammography, biopsy, and surgery was 41, 57, and 92, respectively. The median of days from screening mammography to biopsy and surgery was 10 and 51, respectively. From biopsy to surgery, the median was 34 days in every case. Over the last 5 years, an increase in biopsy-surgery delay has been observed (p = 0.0001). Tumour stages I and II vs. stage III (RR 1.74. 95% CI 1.08-2.80, p = 0.027), diagnosis in screening (RR 0.66. 95% CI 0.45-0.96, p = 0.030), and use of magnetic resonance imaging (RR 2.08. 95 CI 1.21-3.56, p = 0.008) condition a greater biopsy-surgery delay. No influence of delays on survival has been identified. Conclusions: Delays in diagnosis and surgery in the case of women diagnosed on the basis of symptoms may be improved. There is a temporary tendency to a greater delay in surgery. Some clinical and biological factors must be taken into account to optimise delays. Survival results are not adversely affected by delays

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Evaluation of waiting times for breast cancer diagnosis and surgical treatment.

PURPOSE: To analyse any delays in breast cancer diagnosis and surgical treatment, influence of clinical and biological factors and influence of delays on survival. METHODS/PATIENTS: A descriptive, observational, and retrospective study was conducted between 2006 and 2016 on stages I-III breast cancer patients. This is a retrospective review of health records to collect data on delays, patients' clinical data, biological features of the tumour and information on treatment. Mortality data from the National Death Index. RESULTS: In 493 evaluable patients, the median of days from the first symptom to mammography, biopsy, and surgery was 41, 57, and 92, respectively. The median of days from screening mammography to biopsy and surgery was 10 and 51, respectively. From biopsy to surgery, the median was 34 days in every case. Over the last 5 years, an increase in biopsy-surgery delay has been observed (p = 0.0001). Tumour stages I and II vs. stage III (RR 1.74. 95% CI 1.08-2.80, p = 0.027), diagnosis in screening (RR 0.66. 95% CI 0.45-0.96, p = 0.030), and use of magnetic resonance imaging (RR 2.08. 95 CI 1.21-3.56, p = 0.008) condition a greater biopsy-surgery delay. No influence of delays on survival has been identified. CONCLUSIONS: Delays in diagnosis and surgery in the case of women diagnosed on the basis of symptoms may be improved. There is a temporary tendency to a greater delay in surgery. Some clinical and biological factors must be taken into account to optimise delays. Survival results are not adversely affected by delays.

Etapa de diagnóstico del Cáncer de Próstata ¿Estamos llegando a tiempo? / Prostate cancer stage at diagnosis. Are we running late?

INTRODUCCIÓN: El cáncer de próstata es el segundo cáncer más diagnosticado en hombres en Chile y el mundo. El tamizaje modificó la etapa de diagnóstico, siendo actualmente en EE.UU. un 80 por cinto localizada, 12 por cinto compromiso regional y 4 por ciento metastásico. Tamizaje con APE no está considerado dentro de un programa nacional en Chile. El objetivo de este estudio es caracterizar a la población diagnosticada de cáncer de próstata en un Hospital público en Chile. MATERIALES Y MÉTODO: Estudio descriptivo, retrospectivo. Se revisaron todas las fichas de los pacientes ingresados al GES por Cáncer de Próstata en el Hospital Carlos Van Buren de Valparaíso desde el año 2014 a 2016. RESULTADOS: Se revisaron 259 fichas y se analizaron 226. Edad promedio fue 70,5 años. 46 por ciento presentó APE sobre 20 ng/dL. 31 por ciento presentó metástasis. 42 por ciento recibió tratamiento paliativo. 57 por ciento se realizó tratamiento curativo, con edad promedio 67,4 años. De estos, 31,8 por ciento a cirugía, 68 por ciento índice Gleason <6 y 90 por ciento APE <20. 68 por ciento a RDT con o sin HT, 44 por ciento índice Gleason <6, 75 por ciento APE <20. DISCUSIÓN: El tamizaje del cáncer de próstata es un tema en discusión. En Chile no hay un programa nacional para realizar APE. Centros de atención primaria con acceso a APE tienen mayor tasa de tamizaje. La etapa al diagnóstico en nuestro centro difiere a las series de países desarrollados, siendo considerablemente superior la etapa metastásica. Esto podría deberse a la poca cobertura para detección temprana. Parece ser necesario implementar un programa nacional con cobertura de tamizaje para cáncer de próstata.(AU)

INTRODUCTION: Prostate cancer is the second most diagnosed cáncer in Chile and the world. Screening modified the stage at diagnosis, beeing now in the US 80 pertcent localized, 12 pertcent with regional compromised and 4 pertcent metastatic. Screening with PSA isn't considerd within a national program in Chile. The objetive of this study is to caracterize men diagnosed with prostate cancer at a public hospital in Chile. MATERIALS AND METHODS: Retrospective and descriptive study. Every patient who entered GES because of prostate cancer at the Carlos Van Buren Hospital from Valparaiso between 2014 and 2016 was review. RESULTS: 259 clinical records were review and 226 analized. Mean age was 70,5 years. 46 pertcent had PSA above 20 ng/dL. 31 % had metástasis. 42 % received paliative treatment. 57 % had curative treatment with a mean age of 67,4 years.From this group 31,8 pertcent surgery with a Gleason index <6 and 90 pertcent PSA <20. 68 pertcent had EBRT with or without HT, 44 pertcent of this group had Gleason index <6 and 75 pertcent PSA <20. DISCUSSION: Prostate cancer screening it's a debated topic. In Chile there's no national program to do a PSA. Primary care centers with acces to PSA have more rate of screening. Stage at diagnosis in our center difers from developed countries series, beeing metastatic stage considerably superior. This could be because of the low screening rate for early diagnosis. It seems necesary to implement a national program for prostate cancer screening.(AU)

Dietary management of maternal phenylketonuria with glycomacropeptide and amino acids supplements: A case report.

BACKGROUND: In maternal PKU, protein substitute (PS) is provided by phenylalanine (PHE)-free l-amino acids (AA), but glycomacropeptide-based protein substitute (GMP) is an alternative consideration. OBJECTIVE: To describe the first Portuguese Maternal Phenylketonuria (MPKU) partially managed with GMP. CASE REPORT: A 31 year old MPKU female with classical PKU (mutations P281L/P281L), diagnosed by newborn screening, had a lifelong history of poor metabolic control. She has a history of partial bicornuate uterus and had a previous miscarriage in the first trimester. Pre-conception, her median blood PHE was 462 µmol/L but throughout pregnancy the median reduced to 258 µmol/L. GMP provided 30 g/day protein equivalent (46 mg/day PHE). Total protein equivalent from PS increased from 58 to 86 g/day during pregnancy but AA provided all additional protein equivalent intake. Both GMP and AA were well tolerated with no morning sickness. Normal morphologic evaluation and adequate fetal growth with cephalic biometry near the 5th percentile was determined. The infant was born at 39.3 weeks: weight 2570 g (3rd percentile), length 47.5 cm (10th percentile) and head circumference (HC) of 31.5 cm (1st percentile). In the neonatal period, the infant had craniofacial dimorphism with metopic suture prominence. Father also had bitemporal narrowing. By 12 months of age, the infant's weight (15th percentile), length (50th percentile) and HC (10th-50th percentile) were normal although bitemporal narrowing persisted. CONCLUSIONS: This is the first case reporting the use of GMP in MPKU. Its PHE content did not adversely affect metabolic control although it only provided part of the PS intake. Some intrauterine development delay occurred in the last trimester, although we consider that this is unlikely to be associated with MPKU syndrome or the use of GMP. More published data is essential to examine the impact of using GMP in MPKU on morning sickness severity and aversion, maternal weight gain, blood amino acid concentrations and variability of blood PHE concentrations.

Metástasis deltoidea de un carcinoma papilar seroso ovárico / Deltoid metastasis of an ovarian papillary serous carcinoma

Las metástasis intramusculares son un hallazgo muy infrecuente, suponen aproximadamente el 1% de las metástasis, siendo más frecuente a nivel de musculatura abdominal y miembros inferiores. Esta baja incidencia es debido a que existen diferentes mecanismos de resistencia al desarrollo de las mismas, además existe un infradiagnóstico de las mismas por su baja sintomatología

Intramuscular metastases are rarely diagnosed, it about 1% all kind of metastases, and frequently are localized in the abdominal muscles and lower extremity. Low incidence is due to different resistance mechanisms to its develop, thus an underdiagnosis because its low symptomatology