Dihydrosphingolipids are associated with steatosis and increased fibrosis damage in non-alcoholic fatty liver disease.

Dihydrosphingolipids are lipids biosynthetically related to ceramides. An increase in ceramides is associated with enhanced fat storage in the liver, and inhibition of their synthesis is reported to prevent the appearance of steatosis in animal models. However, the precise association of dihydrosphingolipids with non-alcoholic fatty liver disease (NAFLD) is yet to be established. We employed a diet induced NAFLD mouse model to study the association between this class of compounds and disease progression. Mice fed a high-fat diet were sacrificed at 22, 30 and 40 weeks to reproduce the full spectrum of histological damage found in human disease, steatosis (NAFL) and steatohepatitis (NASH) with and without significant fibrosis. Blood and liver tissue samples were obtained from patients whose NAFLD severity was assessed histologically. To demonstrate the effect of dihydroceramides over NAFLD progression we treated mice with fenretinide an inhibitor of dihydroceramide desaturase-1 (DEGS1). Lipidomic analyses were performed using liquid chromatography-tandem mass spectrometry. Triglycerides, cholesteryl esters and dihydrosphingolipids were increased in the liver of model mice in association with the degree of steatosis and fibrosis. Dihydroceramides increased with the histological severity observed in liver samples of mice (0.024 ± 0.003 nmol/mg vs 0.049 ± 0.005 nmol/mg, non-NAFLD vs NASH-fibrosis, p < 0.0001) and patients (0.105 ± 0.011 nmol/mg vs 0.165 ± 0.021 nmol/mg, p = 0.0221). Inhibition of DEGS1 induce a four-fold increase in dihydroceramides improving steatosis but increasing the inflammatory activity and fibrosis. In conclusion, the degree of histological damage in NAFLD correlate with dihydroceramide and dihydrosphingolipid accumulation. LAY SUMMARY: Accumulation of triglyceride and cholesteryl ester lipids is the hallmark of non-alcoholic fatty liver disease. Using lipidomics, we examined the role of dihydrosphingolipids in NAFLD progression. Our results demonstrate that de novo dihydrosphingolipid synthesis is an early event in NAFLD and the concentrations of these lipids are correlated with histological severity in both mouse and human disease.

Photo-acclimatory thresholds anticipate sudden shifts in seagrass ecosystem state under reduced light conditions.

Seagrass ecosystems usually respond in a nonlinear fashion to increasing pressures and environmental changes. Feedback mechanisms operating at the ecosystem level and involving multiple interactions among the seagrass meadow, its associated community and the physical environment are known to play a major role in such nonlinear responses. Phenotypic plasticity may also be important for buffering these ecological thresholds (i.e., regime shifts) as many physiological processes show nonlinear responses to gradual environmental changes, conferring the appearance of resistance before the effects at the organism and population levels are visible. However, the potential involvement of plant plasticity in driving catastrophic shifts in seagrass ecosystems has not yet been assessed. In this study, we conducted a manipulative 6-month light-gradient experiment in the field to capture nonlinearities of the physiological and population responses of the seagrass Cymodocea nodosa to gradual light reduction. The aim was to explore if and how the photo-acclimatory responses of shaded plants are translated to the population level and, hence, to the ecosystem level. Results showed that the seagrass population was rather stable under increasing shading levels through the activation of multilevel photo-acclimative responses, which are initiated with light reduction and modulated in proportion to shading intensity. The activation of photo-physiological and metabolic compensatory responses allowed shaded plants to sustain nearly constant plant productivity (metabolic carbon balance) along a range of shading levels before losing linearity and starting to decline. The species then activated plant- and meadow-scale photo-acclimative responses and drew on its energy reserves (rhizome carbohydrates) to confer additional population resilience. However, when the integration of all these buffering mechanisms failed to counterbalance the effects of extreme light limitation, the population collapsed, giving place to a phase shift from vegetated to bare sediments with catastrophic ecosystem outcomes. Our findings evidence that ecological thresholds in seagrass ecosystems under light limitation can be explained by the role of species' compensatory responses in modulating population-level responses. The thresholds of these plastic responses anticipate the sudden loss of seagrass meadows with the potential to be used as early warning indicators signalling the imminent collapse of the ecosystem, which is of great value for the real-world management of seagrass ecosystems.

Onset of Nut Allergy in a Pediatric Cohort: Clinical and Molecular Patterns in the AFRUSEN Study.

BACKGROUND AND OBJECTIVE: Nut allergy is a growing problem, yet little is known about its onset in children. Objective: To characterize the onset of nut allergy in children in southern Europe. METHODS: The study population comprised consecutive patients up to 14 years of age who visited allergy departments with an initial allergic reaction to peanut, tree nut, or seed. The allergy work-up included a clinical history, food challenge, skin prick testing, determination of whole-extract sIgE, and ImmunoCAP ISAC-112 assay. RESULTS: Of the 271 children included, 260 were first diagnosed with nut allergy at a mean age of 6.5 years and at a mean (SD) of 11.8 (21.2) months after the index reaction. The most common culprit nuts at onset were walnut (36.5%), peanut (28.5%), cashew (10.4%), hazelnut (8.5%), pistachio (5.4%), and almond (5%). Onset of peanut allergy was more frequent in children ≤6 years and walnut in those aged >6 years (P=.032). In 65% of cases, the allergic reaction occurred the first time the patient consumed the nut, and 35% of reactions were anaphylactic. Overall, polysensitization to nuts was detected by skin prick testing in 64.9% of patients, although this rate was lower among walnut-allergic children (54.7%) and peanut-allergic children (54.1%) (P<.0001). Sensitization to 2S albumins was predominant (75%), especially Jug r 1 (52.8%), whereas sensitization to lipid transfer proteins was less relevant (37%). CONCLUSION: In the population we assessed, the onset of nut allergy occurred around 6 years of age, slightly later than that reported in English-speaking countries. Walnut was the main trigger, followed by peanut. 2S albumin storage proteins, especially Jug r 1, were the most relevant allergens. This study will help guide management and may contribute to preventive strategies in pediatric nut allergy.

Onset of Nut Allergy in a Pediatric Cohort: Clinical and Molecular Patterns in the AFRUSEN Study

Background: Nut allergy is a growing problem, yet little is known about its onset in children. Objective: To characterize the onset of nut allergy in children in southern Europe. Methods: The study population comprised consecutive patients up to 14 years of age who visited allergy departments with an initial allergic reaction to peanut, tree nut, or seed. The allergy work-up included a clinical history, food challenge, skin prick testing, determination of whole-extract sIgE, and ImmunoCAP ISAC-112 assay. Results: Of the 271 children included, 260 were first diagnosed with nut allergy at a mean age of 6.5 years and at a mean (SD) of 11.8 (21.2) months after the index reaction. The most common culprit nuts at onset were walnut (36.5%), peanut (28.5%), cashew (10.4%), hazelnut (8.5%), pistachio (5.4%), and almond (5%). Onset of peanut allergy was more frequent in children ≤6 years and walnut in those aged >6 years (P=.032). In 65% of cases, the allergic reaction occurred the first time the patient consumed the nut, and 35% of reactions were anaphylactic. Overall, polysensitization to nuts was detected by skin prick testing in 64.9% of patients, although this rate was lower among walnut-allergic children (54.7%) and peanut-allergic children (54.1%) (P<.0001). Sensitization to 2S albumins was predominant (75%), especially Jug r 1 (52.8%), whereas sensitization to lipid transfer proteins was less relevant (37%). Conclusion: In the population we assessed, the onset of nut allergy occurred around 6 years of age, slightly later than that reported in English-speaking countries. Walnut was the main trigger, followed by peanut. 2S albumin storage proteins, especially Jug r 1, were the most relevant allergens. This study will help guide management and may contribute to preventive strategies in pediatric nut allergy (AU)

Antecedentes: La alergia a frutos secos es un problema creciente. Sin embargo, existe poca información relativa al inicio de su establecimiento en la población infantil. Objetivos: Describir el debut de alergia a frutos secos en niños del sur de Europa. Métodos: Se incluyeron pacientes de hasta 14 años que acudieron de forma consecutiva a la consulta de alergia debido a una reacción inicial con cacahuete, frutos secos o semillas. El estudio alergológico incluyó realización de historia clínica, provocación oral, prueba intraepidérmica (SPT), determinación de IgE específica para extracto completo y mediante ImmunoCAP ISAC-112. Resultados: De los 271 niños incluidos, 260 se diagnosticaron de alergia a frutos secos por primera vez a los 6,5 años de media, habiendo tenido la reacción índice 11,8 (±21,2SD) meses antes. Los frutos secos responsables en el debut fueron nuez (36,5%), cacahuete (28,5%), anacardo (10,4%), avellana (8,5%), pistacho (5,4%) y almendra (5%). La instauración de la alergia a cacahuete fue más frecuente en niños ≤6 años y para nuez en >6 años (p=0,032). En el 65% de los casos, la reacción alérgica sucedió en la primera vez en que el paciente consumía el fruto seco, y el 35% de las reacciones fueron anafilaxia. En conjunto, la polisensibilización a frutos secos se identificó en el 64,9% de los pacientes, aunque este porcentaje fue significativamente inferior en niños alérgicos a nuez (54,7%) y cacahuete (54,1%) (p<0,0001). La sensibilización a albúminas 2S fue predominante (75%), especialmente a Jug r 1 (52,8%), mientras que la identificación de LTP fue menos relevante (37%). Conclusión: En nuestra población, el debut de alergia a frutos secos sucedió alrededor de los 6 años de edad, ligeramente más tardío al reportado en países anglosajones. La nuez fue el principal desencadenante, seguido de cacahuete, y las albúminas de almacenamiento 2S, especialmente Jug r 1, fueron los alérgenos más relevantes (AU)

Factores relacionados con los conocimientos del profesorado sobre el trastorno por déficit de atención/hiperactividad / Factors related to teacher knowledge about attention-deficit/hyperactivity disorder

Introducción: En la bibliografía no abundan los estudios sobre los conocimientos del profesorado sobre el trastorno por déficit de atención/hiperactividad (TDAH). La escasa investigación realizada indica puntuaciones bajas o moderadas. Objetivo: Examinar los conocimientos acerca del TDAH del profesorado de educación infantil, primaria y secundaria, y estudiar posibles diferencias atribuibles a formación y experiencia previa en el trastorno y otras variables sociodemográficas. Sujetos y métodos: A una muestra de 130 profesores de la Región de Murcia (España) se le administró un cuestionario de conocimientos sobre el TDAH y se registraron las variables sociodemográficas. Resultados: Los docentes contestaron de manera correcta a más de la mitad de los ítems del cuestionario (63,9%). La escala de síntomas/diagnóstico alcanzó el porcentaje más alto de aciertos (69,1%) y la de etiología, el más bajo (32%). Las profesoras mostraron conocimientos superiores a los profesores en todas las dimensiones del cuestionario. Los docentes que habían recibido formación sobre el trastorno presentaron un nivel de conocimientos superior. Además, los profesores que habían tenido experiencia profesional previa manifestaron conocimientos superiores a los que carecían de dicha experiencia. Según la especialidad docente, no se obtuvieron diferencias estadísticamente significativas casi en ninguna de las dimensiones del cuestionario. El grupo de edad que mostró un nivel superior de conocimientos sobre el TDAH fue el de 27 a 32 años. Conclusión: Los resultados apuntan hacia la necesidad de una mejor formación en conocimientos y actitudes hacia el TDAH que facilite la detección temprana de estos casos y su atención especializada en los diferentes niveles educativos.(AU)

Introduction: Studies on teachers’ knowledge about attention deficit/hyperactivity disorder (ADHD) are not abundant in the literature. The little research done indicates low or moderate scores. Aim: To examine the knowledge of Childhood, Primary, and Secondary Education teachers on ADHD, as well as to study possible differences attributable to the previous training, the experience in the disorder and other sociodemographic variables. Subjects and methods: A sample of 130 teachers from the Region of Murcia (Spain) was administered a knowledge questionnaire about ADHD and sociodemographic variables were recorded. Results: The teachers answered correctly to more than half of the items in the questionnaire (63,9%). The Symptoms/Diagnostic scale reached the highest percentage of correct answers (69,1%) and the Etiology scale the lowest (32%). The female teachers showed superior knowledge to the male teachers in all dimensions of the questionnaire. Those teachers who had received training on the disorder presented a higher level of knowledge. In addition, teachers who had previous professional experience showed superior knowledge than those without such experience. According to the teaching specialty, no statistically significant differences were obtained almost in any of the dimensions of the questionnaire. The age group that showed a higher level of knowledge about ADHD was 27-32 years old. Conclusion: The results point to the need for better training on knowledge and attitudes of teachers towards ADHD that facilitate the early detection of these cases and their specialized care at different educational levels.(AU)

[Factors related to teacher knowledge about attention-deficit/hyperactivity disorder]. / Factores relacionados con los conocimientos del profesorado sobre el trastorno por déficit de atención/hiperactividad.

INTRODUCTION: Studies on teachers' knowledge about attention deficit/hyperactivity disorder (ADHD) are not abundant in the literature. The little research done indicates low or moderate scores. AIM: To examine the knowledge of Childhood, Primary, and Secondary Education teachers on ADHD, as well as to study possible differences attributable to the previous training, the experience in the disorder and other sociodemographic variables. SUBJECTS AND METHODS: A sample of 130 teachers from the Region of Murcia (Spain) was administered a knowledge questionnaire about ADHD and sociodemographic variables were recorded. RESULTS: The teachers answered correctly to more than half of the items in the questionnaire (63,9%). The Symptoms/Diagnostic scale reached the highest percentage of correct answers (69,1%) and the Etiology scale the lowest (32%). The female teachers showed superior knowledge to the male teachers in all dimensions of the questionnaire. Those teachers who had received training on the disorder presented a higher level of knowledge. In addition, teachers who had previous professional experience showed superior knowledge than those without such experience. According to the teaching specialty, no statistically significant differences were obtained almost in any of the dimensions of the questionnaire. The age group that showed a higher level of knowledge about ADHD was 27-32 years old. CONCLUSION: The results point to the need for better training on knowledge and attitudes of teachers towards ADHD that facilitate the early detection of these cases and their specialized care at different educational levels.

TITLE: Factores relacionados con los conocimientos del profesorado sobre el trastorno por déficit de atención/hiperactividad.Introducción. En la bibliografía no abundan los estudios sobre los conocimientos del profesorado sobre el trastorno por déficit de atención/hiperactividad (TDAH). La escasa investigación realizada indica puntuaciones bajas o moderadas. Objetivo. Examinar los conocimientos acerca del TDAH del profesorado de educación infantil, primaria y secundaria, y estudiar posibles diferencias atribuibles a formación y experiencia previa en el trastorno y otras variables sociodemográficas. Sujetos y métodos. A una muestra de 130 profesores de la Región de Murcia (España) se le administró un cuestionario de conocimientos sobre el TDAH y se registraron las variables sociodemográficas. Resultados. Los docentes contestaron de manera correcta a más de la mitad de los ítems del cuestionario (63,9%). La escala de síntomas/diagnóstico alcanzó el porcentaje más alto de aciertos (69,1%) y la de etiología, el más bajo (32%). Las profesoras mostraron conocimientos superiores a los profesores en todas las dimensiones del cuestionario. Los docentes que habían recibido formación sobre el trastorno presentaron un nivel de conocimientos superior. Además, los profesores que habían tenido experiencia profesional previa manifestaron conocimientos superiores a los que carecían de dicha experiencia. Según la especialidad docente, no se obtuvieron diferencias estadísticamente significativas casi en ninguna de las dimensiones del cuestionario. El grupo de edad que mostró un nivel superior de conocimientos sobre el TDAH fue el de 27 a 32 años. Conclusión. Los resultados apuntan hacia la necesidad de una mejor formación en conocimientos y actitudes hacia el TDAH que facilite la detección temprana de estos casos y su atención especializada en los diferentes niveles educativos.

Analyzing the Impact of COVID-19 Trauma on Developing Post-Traumatic Stress Disorder among Emergency Medical Workers in Spain.

The early stages of the COVID-19 pandemic presented the characteristics of a traumatic event that could trigger post-traumatic stress disorder. Emergency Medical Services workers are already a high-risk group due to their professional development. The research project aimed to analyse the impact of the COVID-19 pandemic on EMS professionals in terms of their mental health. For this purpose, we present a descriptive crosssectional study with survey methodology. A total of 317 EMS workers (doctors, nurses, and emergency medical technicians) were recruited voluntarily. Psychological distress, post-traumatic stress disorder, and insomnia were assessed. The instruments were the General Health Questionnaire-12 (GHQ-12), the Davidson Trauma Scale (DTS-8), and the Athens Insomnia Scale (AIS-8). We found that 36% of respondents had psychological distress, 30.9% potentially had PTSD, and 60.9% experienced insomnia. Years of work experience were found to be positively correlated, albeit with low effect, with the PTSD score (r = 0.133). Finally, it can be stated that the COVID-19 pandemic has been a traumatic event for EMS workers. The number of professionals presenting psychological distress, possible PTSD, or insomnia increased dramatically during the early phases of the pandemic. This study highlights the need for mental health disorder prevention programmes for EMS workers in the face of a pandemic.

Characteristics and prognosis of jejunoileal gastrointestinal stromal tumours (GISTs) in the era of imatinib: a comparative study with gastric GISTs

Backgroung Gastrointestinal stromal tumours (GISTs) located in the jejunum or ileum (JI-GIST) are considered worse prognosis compared to those of gastric (G-GIST) location. It has been suggested that this dogma should be revised. The aim of this study was to describe the characteristics of jejunoileal GISTs and its prognosis and to compare them with G-GISTs in the era of imatinib. Methods We retrospectively reviewed the clinical histories of all the patients diagnosed with GISTs between January 2000 and November 2016: Clinical and pathological data, as recurrence, metastatic state, disease-free survival (DFS) as well as overall survival (OS) rates of patients were reviewed. Results JI-GIST patients comprise 29 cases (37.7%). Compared to G-GIST, JI-GIST patients had undergone emergency surgery more frequently (37.9% vs. 10.4%, p = 0.007). According to the NIH-Fletcher classification, the low or very-low risk group represents 17.2% of JI-GISTs as opposed to 37.6% of G-GISTs (p < 0.005). When the AFIP-Miettinen system was used the low or very-low group represented 17.2% of JI-GISTs vs. 58.4% in the G-GISTs group (p < 0.001). Both local recurrence (24.1% vs. 12.5%, p < 0.05) and metastatic rate (34.5% vs. 22.9%, p < 0.05) were higher in the JI-GIST group than in G-GIST. 5- and 10-year DFS and 10-year OS rate were lower for JI-GIST (54.5% and 39.6% vs. 77.2% and 60.8%, and 57.9% vs. 65%, respectively, p < 0.05). Conclusions The observed differences between both groups in DFS and OS rates at long term could be attributed to the effect of imatinib (AU)

Characteristics and prognosis of jejunoileal gastrointestinal stromal tumours (GISTs) in the era of imatinib: a comparative study with gastric GISTs.

BACKGROUND: Gastrointestinal stromal tumours (GISTs) located in the jejunum or ileum (JI-GIST) are considered worse prognosis compared to those of gastric (G-GIST) location. It has been suggested that this dogma should be revised. The aim of this study was to describe the characteristics of jejunoileal GISTs and its prognosis and to compare them with G-GISTs in the era of imatinib. METHODS: We retrospectively reviewed the clinical histories of all the patients diagnosed with GISTs between January 2000 and November 2016: Clinical and pathological data, as recurrence, metastatic state, disease-free survival (DFS) as well as overall survival (OS) rates of patients were reviewed. RESULTS: JI-GIST patients comprise 29 cases (37.7%). Compared to G-GIST, JI-GIST patients had undergone emergency surgery more frequently (37.9% vs. 10.4%, p = 0.007). According to the NIH-Fletcher classification, the low or very-low risk group represents 17.2% of JI-GISTs as opposed to 37.6% of G-GISTs (p < 0.005). When the AFIP-Miettinen system was used the low or very-low group represented 17.2% of JI-GISTs vs. 58.4% in the G-GISTs group (p < 0.001). Both local recurrence (24.1% vs. 12.5%, p < 0.05) and metastatic rate (34.5% vs. 22.9%, p < 0.05) were higher in the JI-GIST group than in G-GIST. 5- and 10-year DFS and 10-year OS rate were lower for JI-GIST (54.5% and 39.6% vs. 77.2% and 60.8%, and 57.9% vs. 65%, respectively, p < 0.05). CONCLUSIONS: The observed differences between both groups in DFS and OS rates at long term could be attributed to the effect of imatinib.

Perceived changes in psychological and physical symptoms after hospital clown performances in a cancer setting.

Background: The therapeutic role of humor and hospital clowns has become a focus of interest in recent decades. Most of the research in the area has focused on children; here, we explore the influence of clown performances on adult cancer patients, their companions, and health-care staff.Methods: Ninety-nine cancer patients and 113 companions were assessed pre- and post-interventions performed by professional clowns; 31 health professionals were asked about the possible influence of the presence of clowns in hospital on their work.Results: Patients felt that clowning performances helped to reduce their level of psychological symptoms, but not their physical symptoms. Companions reported improvements in all the psychological symptoms explored. Health professionals reported that the presence of clowns in the workplace improved their well-being.Conclusions: Clowning performances helped to improve psychological functioning in all the populations studied, especially in companions. Adult hospitals should consider promoting clowning interventions to improve general well-being.

[Analysis of the demand for detection of SARSCoV-2 in a health area of Spain]. / Análisis de la demanda de detección de SARS-CoV-2 en un área de salud de España.

OBJECTIVE: Since the discovery of the SARS-CoV-2 virus, the polymerase chain reaction technique (RT-PCR) has become the fundamental method for diagnosing the disease in its acute phase. The objective is to describe the demand-based series of RT-PCR determinations received at a Microbiology Service at a third-level reference hospital for a health area for three months spanning from the onset of the epidemic by SARS-CoV-2. METHODS: A retrospective analysis of the total of the RT-PCR requested in the Microbiology Service analyzed from 02/25/2020 to 05/26/2020 (90 days) has been carried out. They have been grouped by epidemiological weeks and by the petitioner service. A descriptive analysis was carried out by age, gender and number of requests for each patient. In the tests carried out, a confidence level of 95% (p <0.05) was considered significant. RESULTS: A total of 27,106 requests was received corresponding to 22,037 patients. Median age 53.7 (RIC 40.9-71.7) years, women: 61.3%. Proportion of patients with any positive RT-PCR: 14%. Of the total requests for RT-PCR, positive 3,710. Week 13 had the highest diagnosis performance (39.0%). The primary care has been the service thar has made the most requests (15,953). Patients with 3 or more RT-PCR: 565, of them, 19 patients had a positive result after previously having a negative one. CONCLUSIONS: Requests have been increasing depending on the evolution of the epidemic. The RT-PCR has a high diagnostic performance in the phases of highest contagiousness and / or transmissibility of the virus.

Incidental Gastrointestinal Stromal Tumors (GISTs) and Bariatric Surgery: A Review.

The number of bariatric procedures has increased notably, with incidental findings such as gastrointestinal stromal tumors (GISTs) being observed in 2%. The number of studies dealing with incidental findings during bariatric surgery (BS), especially GISTs, is scarce. This review aims to summarize the evidence about GIST diagnosis during BS, and to establish recommendations for the management and follow-up of these patients. A systematic literature search from January 2000 to March 2020 was performed. Retrospective cohort studies, case series, case reports, reviews, and conference abstracts were considered eligible. The present systematic review focused on a descriptive analysis of the data included in the articles selected. The calculated incidence was 0.65%. A change in operative plan was observed in 5% of the cases. In 98% of the cases, GISTs were gastric, with a mean size of 10.3 mm. The mitotic index was < 5 in 99%. Accordingly, all patients were classified as having a very low or low risk of recurrence. R0 resection was achieved in 100% of cases. The incidence of GISTs in patients with MO submitted to BS is considerably higher than in the general population. The diagnosis is related to the depth of preoperative work, the exhaustiveness of the intraoperative examination, and the meticulousness of the histopathological analysis. Although GISTs have a low risk of recurrence and it was previously unnecessary to modify the surgical technique, we recommend that bariatric surgeons are aware of the diagnosis and management of incidental GISTs.

[Episodes of nontyphoidal salmonellosis in adult patients of the Valladolid West Area in 2017: Evaluation of the suitability of the microbiological culture request and the prescribed treatment]. / Episodios de salmonelosis no tifoidea en pacientes adultos del Área Valladolid Oeste en 2017: Evaluación de la idoneidad de la petición del cultivo microbiológico y del tratamiento pautado.

OBJECTIVE: Gastroenteritic salmonellosis is still the second cause diagnosed of infectious diarrhea, most of these clinical pictures are mild and self-limited and therefore the use of antibiotics is limited to few cases. The aim of the study was to describe the episodes of diarrhea caused by Salmonella enterica subsp. enterica, assessing the suitability of the request and the use of antibiotics according to the criteria included in the methodology. METHODS: A retrospective, descriptive, observational study was conducted, collecting data from the clinical history. RESULTS: A total of 122 episodes were included. The reason for consultation was diarrhea, which generated a greater demand in the Hospital Emergency Services (42.6%). The most frequent serotypes isolated were Enteritidis (53.3%), and Typhimurium (40.2%). The adequate request of the stool was 90.2%. Antibiotic was prescribed in 64.6% (79) of the episodes, most patients under 65 years (58 episodes), the average age was 48.43 years. They were treated mainly with ciprofloxacin and azithromycin, in 57 and 14 episodes, respectively. The average duration of antibiotic treatment was 6 days. There was an adequate use of antibiotics in 49.1% of episodes. When the origin of the request was the Hospital Emergency Service, it was inadequate in 63.5% (33) of them. It was inadequate in 60.0% (39) of episodes when ser. Enteritidis was isolated. Almost half, 48.85% (42) of the 58 episodes in which antibiotics were prescribed among those under 65 (86), were treated without being indicated. CONCLUSIONS: Training actions should be implemented focused on optimizing the management of antibiotics in this entity.

Utility of Basal Regional Oximetry Saturation for the Diagnosis of Acute Tubular Necrosis in the Early Postoperative Period Following Kidney Transplantation.

INTRODUCTION: Adequate perfusion and oxygenation to a renal graft after transplantation are essential for its viability. Regional renal oximetry (RSrO2) through near-infrared spectroscopy shows real-time oxygen content of the graft. METHODS: A prospective study was conducted. We enrolled consecutive patients undergoing renal transplant from deceased donors from January 2015 to February 2016. RSrO2 was continuously measured for 24 hours, analyzed, and correlated with other clinical data such as hemoglobin, mixed central venous oxygen saturation (ScvO2), blood pressure, central venous pressure, diuresis, and blood lactate. Severity disease scales, cold and warm ischemia times were also measured, as well as the pulsatility index (PI) and resistive index (RI) by Doppler-dúplex ultrasound (DUS) at 24 hours. A statistical analysis with IBM SPSS version 22 (IBM, Armonk, NY) using a Pearson correlation was carried out. RESULTS: RSrO2 could anticipate serious arterial and bleeding events showing a maintained decrease >10% from basal data. A significant correlation was found between RSrO2 with lactate at 8 and 24 hours (P = .005 and P = .000 respectively), as well as with initial diuresis at hour 3 (P = .010), initial ScvO2 (P = .010), Sequential Organ Failure Assessment (P = .015), and warm ischemia (P = .035). A significant correlation was also detected between cold ischemia, RI, and diuresis (P = .037 and P = .049 respectively). No correlation was found between RSrO2 and DUS data. CONCLUSION: RSrO2 is a useful tool for initial kidney transplant grafts monitoring and could give early warnings regarding bleeding and arterial thrombosis. RSrO2 is found to have a correlation with initial diuresis, blood lactate, and ScvO2. No matching data with Doppler was found.

Additional malignancies in patients with gastrointestinal stromal tumors (GIST): incidence, pathology and prognosis according to a time of occurrence-based classification.

BACKGROUND: The aim of the study is to clarify if a classification based on the time of occurrence of associated malignancies in GIST patients can help in the understanding of the clinical controversies observed in these patients. METHODS: We retrospectively reviewed all the patients diagnosed with GIST tumors between January 1999 and October 2016. They were divided into GIST patients associated with other tumors (A-GIST) and those not associated (NA-GIST). A-GIST patients were also divided into four types according to the proposed classification. RESULTS: Of 104 GIST patients, 32 (30.7%) (A-GIST group) had at least one additional primary malignancy. The most frequent location of the associated malignancy was the GI tract (26%). Compared to NA-GIST, A-GIST were more often asymptomatic with a lower risk of recurrence. The main cause of death in NAGIST was GIST itself, being associated tumors the main cause of death in A-GIST group. No differences were found in DFS and OS between A-GIST and NA-GIST. CONCLUSIONS: The use of the proposed classification classifies GIST patients with associated malignancies in different subtypes that differ substantially in terms of incidence, type of neoplasms associated, cause of the association and prognosis.

Safe and successful protocol for desensitization to abiraterone

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