Occupational injuries in workers of a Spanish bank.

BACKGROUND: In 2017, 69 108 work-related traffic injuries with medical leave were documented, constituting 12% of all occupational injuries (OI) in Spain. AIMS: The aim of this study was to describe OI within a Spanish bank company during 2017. METHODS: A cross-sectional analysis was conducted using the company's mandatory OI records, presenting data in both absolute (n) and relative (%) frequencies. The chi-square test was employed for comparisons. RESULTS: Among the company's 10 399 employees, 176 OI cases were recorded. Most were minor musculoskeletal incidents, with one severe myocardial infarction and one mild anxiety episode. Lower limb injuries were the most prevalent. Injuries of the trunk (P < 0.001), neck (P < 0.05), and upper limbs (P < 0.001) were linked to workplace factors. Approximately 62% of OI occurred outside the workplace and resulted in more extended medical leave (P < 0.01). Traffic-related injuries accounted for 39% of OI cases and caused 49% of days lost due to OI (P < 0.001).Female gender (P < 0.001) and age over 40 years (P < 0.05) were significantly associated with OI. CONCLUSIONS: In our study, musculoskeletal injuries were the most common, with a single cardiovascular event being the most severe. OI occurring outside the workplace was more frequent and led to longer medical leaves. Notably, traffic-related injuries were especially significant, exceeding official statistics 4-fold.

Morphological and ultrasonographic characterization of the three zones of supratesticular region of testicular artery in Assaf rams.

To fully understand the histological, morphometrical and heamodynamic variations of different supratesticular artery regions, 20 mature and healthy Assaf rams were examined through ultrasound and morphological studies. The testicular artery images of the spermatic cord as shown by B-mode analysis indicated a tortuous pattern along its course toward the testis, although it tends to be less tortuous close to the inguinal ring. Doppler velocimetric values showed a progressive decline in flow velocity, in addition to pulsatility and vessel resistivity when entering the testis, where there were significant differences in the Doppler indices and velocities among the different regions. The peak systolic velocity, pulsatility index and resistive index were higher in the proximal supratesticular artery region, followed by middle and distal ones, while the end diastolic velocity was higher in the distal supratesticular region. The total arterial blood flow and total arterial blood flow rate reported a progressive and significant increase along the testicular cord until entering the testis. Histological examination revealed presence of vasa vasorum in the tunica adventitia, with their diameter is higher in the proximal supratesticular zone than middle and distal ones. Morphometrically, the thickness of the supratesticular artery wall showed a significant decline downward toward the testis; meanwhile, the outer arterial diameter and inner luminal diameter displayed a significant increase distally. The expression of alpha smooth muscle actin and vimentin was higher in the tunica media of the proximal supratesticular artery zone than in middle and distal ones.

Noncoding RNAs as potential biomarkers for DIPG diagnosis and prognosis: XIST and XIST-210 involvement

Purpose Diffuse intrinsic pontine gliomas (DIPGs) are the most fatal primary brainstem tumors in pediatric patients. The identification of new molecular features, mediating their formation and progression, as non-coding RNAs (ncRNAs), would be of great importance for the development of effective treatments. Methods We analyzed the DIPGs transcriptome with the HTA2.0 array and it was compared with pediatric non-brainstem astrocytoma expression profiles (GSE72269). Results More than 50% of the differentially expressed transcripts were ncRNAs and based on this, we proposed a DIPGs ncRNA signature. LncRNAs XIST and XIST-210, and the HBII-52 and HBII-85 snoRNA clusters were markedly downregulated in DIPGs. qPCR assays demonstrated XIST downregulation in all non-brainstem astrocytomas, in a gender, age, and brain location-independent manner, as well as in DIPGs affecting boys; however, DIPGs affecting girls showed both downregulation and upregulation of XIST. Girls’ with longer survival positively correlated with XIST expression. Conclusions The involvement of ncRNAs in DIPGs is imminent and their expression profile is useful to differentiate them from non-neoplastic tissues and non-brain stem astrocytomas, which suggests their potential use as DIPG biomarkers. In fact, XIST and XIST-210 are potential DIPG prognostic biomarkers (AU)

Diagnostic agreement between video capsule endoscopy and single and double balloon enteroscopy for small bowel bleeding at a tertiary care hospital in Bogota, Colombia. / Concordancia diagnóstica entre la videocápsula endoscópica y enteroscopia mono y de doble balón en la hemorragia de intestino delgado en un hospital de alta complejidad en Bogotá, Colombia.

INTRODUCTION: Video capsule endoscopy and balloon-assisted enteroscopy are complementary diagnostic methods in the study of small bowel bleeding, and different factors can affect their diagnostic yield. AIMS: To define the level of agreement between video capsule endoscopy and enteroscopy in small bowel bleeding, according to the type of lesion, in a cohort of patients at a tertiary care referral center. MATERIALS AND METHODS: A retrospective study was conducted that included 428 capsule endoscopies performed within the time frame of 2011 and 2019 at our healthcare institution. Seventy-four video capsule endoscopies, followed by enteroscopy, in 71 patients suspected of presenting with small bowel bleeding, were analyzed. RESULTS: Mean patient age was 63.9 ± 13.5 years and 42 patients were women. The two diagnostic procedures were performed. Overall diagnostic yield of positive findings between video capsule endoscopy and enteroscopy was 86.5% vs. 58.1%, respectively (p = 0.0527). Agreement between video capsule endoscopy and enteroscopy for positive pathologic findings was weak (Ik = 0.17, 95% CI: -0.0097-0.3543), but according to lesion type, it was good for inflammatory lesions (Ik = 0.71, 95% CI: 0.5182-0.9119) and moderate for angiectasias (Ik = 0.45, 95% CI: 0.2469-0.6538) and tumors (Ik = 0.40, 95% CI: 0.1217-0.6794). The results between the two methods differed in 38 patients (51.3%). There was complete intestinal capsule retention in one patient (1.4%) and active bleeding in 13 (17.6%). CONCLUSIONS: The present study showed that the two techniques had a similar overall detection rate for small bowel lesions, but the type of lesion was the main factor that could modify diagnostic agreement.

Noncoding RNAs as potential biomarkers for DIPG diagnosis and prognosis: XIST and XIST-210 involvement.

PURPOSE: Diffuse intrinsic pontine gliomas (DIPGs) are the most fatal primary brainstem tumors in pediatric patients. The identification of new molecular features, mediating their formation and progression, as non-coding RNAs (ncRNAs), would be of great importance for the development of effective treatments. METHODS: We analyzed the DIPGs transcriptome with the HTA2.0 array and it was compared with pediatric non-brainstem astrocytoma expression profiles (GSE72269). RESULTS: More than 50% of the differentially expressed transcripts were ncRNAs and based on this, we proposed a DIPGs ncRNA signature. LncRNAs XIST and XIST-210, and the HBII-52 and HBII-85 snoRNA clusters were markedly downregulated in DIPGs. qPCR assays demonstrated XIST downregulation in all non-brainstem astrocytomas, in a gender, age, and brain location-independent manner, as well as in DIPGs affecting boys; however, DIPGs affecting girls showed both downregulation and upregulation of XIST. Girls' with longer survival positively correlated with XIST expression. CONCLUSIONS: The involvement of ncRNAs in DIPGs is imminent and their expression profile is useful to differentiate them from non-neoplastic tissues and non-brain stem astrocytomas, which suggests their potential use as DIPG biomarkers. In fact, XIST and XIST-210 are potential DIPG prognostic biomarkers.

Recovery & identification of human Y-STR DNA from immatures of chrysomya albiceps (Diptera: Calliphoridae). Simulation of sexual crime investigation involving victim corpse in state of decay.

The number of sexual crimes in Brazil, as in several other countries, is very high. In many of these crimes the women raped are murdered and their bodies are found days later, in an advanced state of decomposition, with intense cadaverous fauna. Forensic Entomology studies insects and other arthropods that can be used in the expert analysis of various types of crimes. Diptera, the order of insects that comprises the two-winged or true flies, represents one of the largest known groups of insects and is the principal source of cadaveric entomofauna. Members of its Calliphoridae family are observed in cadavers in all phases of decomposition. The retrieval and identification of human Y-STR DNA from the gastrointestinal tract of Calliphoridae species Chrysomya albiceps maggots and pupae can provide a good tool for the gathering of evidence in sexual crime investigations involving rape and death, in which the abandoned victim's body is found in a putrefied state. In this study, the animal model used was a female pig, Sus scrofa, which was sacrificed in a forested area with three shots from a 0.40 calibre Taurus pistol, and inoculated with semen to its anal and vaginal regions, simulating rape and homicide. During decomposition, 20-80 maggots were collected every 24 h and preserved in 70 % alcohol, totalling 289 maggots and 157 pupae (446 immatures) over a period of 14 days (336 h) of decomposition. Each maggot was then dissected for removal of the digestive tract, which was placed in extraction buffer. The molecular phase proceeded with extraction, quantification, amplification and capillary electrophoresis of samples, testing 16 STR loci of the Y chromosome. It was possible to establish a partial Y-STR DNA profile, with the amplification of up to eight sites, by considering a combination of the samples taken at hours 144 h, 168 h, 192 h, 216 h, 240 h, 288 h, 312 h and 336 h.

Comparison of epidemiological, clinical and microbiological characteristics of bloodstream infection in children with solid tumours and haematological malignancies.

Bloodstream infection (BSI) is a serious complication in immunocompromised hosts. This study compares epidemiological, clinical and microbiological characteristics of BSI among children with haematological malignancies (HM) and solid tumours (ST). The study was conducted from October 2012 through to November 2015 at a referral hospital for cancer care and included the first BSI episode detected in 210 patients aged 18 years or less. BSI cases were prospectively detected by daily laboratory-based surveillance. The Centers for Disease Control and Prevention definitions for primary or secondary BSI were used. A higher proportion of use of corticosteroids (P = 0.02), chemotherapy (P = 0.01) and antibiotics (P = 0.05) before the BSI diagnosis; as well as of neutropenia (P < 0.001) and mucositis (P < 0.001) at the time of BSI diagnosis was observed in patients with HM than with ST. Previous surgical procedures (P = 0.03), mechanical ventilation (P = 0.01) and bed confinement (P < 0.001) were more frequent among children with ST. The frequency of use of temporary (P = 0.01) and implanted vascular lines (P < 0.01) was significantly higher in children with ST than with HM while the tunnelled line (P = 0.01) use was more frequent in children with HM as compared to ST. Most (n = 181) BSI cases were primary BSI. BSI associated with a tunnelled catheter was more frequent in children with HM (P < 0.01), whereas BSI associated with an implanted (P < 0.01) or temporary central line (P < 0.02) was more common in patients with ST. BSI associated with mucosal barrier injury was more frequent (P = 0.01) in children with HM. Indication for intensive care was more frequent in children (P = 0.05) with ST. Mortality ratio was similar in children with ST and HM, and length of hospital stay after BSI was higher in patients with HM than with ST (median of 19 vs. 13 days; P = 0.02). Infection caused by Gram-negative bacteria (P = 0.04) and polymicrobial infections (P = 0.05) due to Gram-positive cocci plus fungus was more common in patients with HM. These findings suggest that the characteristics of BSI acquisition and mortality can be cancer-specific.

Risk factors for early onset prosthetic valve endocarditis: a case-control study.

BACKGROUND: Early onset prosthetic valve endocarditis (EO-PVE) is an infrequent complication of cardiac valve surgery. It is considered a healthcare-associated infection due to contamination of the prosthesis during the implant or in the early postoperative period. AIM: To evaluate which factors may be related to the acquisition of EO-PVE. METHODS: A nested case-control study was conducted from 2006 to 2016. Cases were patients who had definite prosthetic endocarditis by the modified Duke criteria up to 12 months of heart valve replacement. Cases and controls were matched by age, gender, date and type of surgery. FINDINGS: There were 26 cases and 78 controls, in 2496 valve surgeries. The median incidence of EO-PVE was 1.1%. Risk factors identified during surgery were: use of ≥2 cryoprecipitate units (odds ratio (OR): 5.95; 95% confidence interval (CI): 1.31-27.0) and ≥2 plasma units (OR: 2.73; 95% CI: 1.0-7.5). In the postoperative period, associated factors were bloodstream infection (OR: 14.00; CI: 1.49-131.77), pneumonia (4.38; 1.21-15.84), any infection (4.46; 1.63-12.21), central line for ≥2 weeks (5.33; 2.06-13.78), presence of dialysis catheter (3.22; 1.15-9.03), and new open chest surgery (3.89; 1.28-11.78). Mortality at 12 months was 34.6% in cases and 6.4% in controls (OR: 7.73; CI: 2.3-26.06). CONCLUSION: Cases had more infections, invasive procedures and surgical re-interventions in the early postoperative period, which favoured contamination of the newly implanted prosthesis. A preventive approach, with reinforcement of infection control practices, may curb the incidence of this condition.

La reparación mediante TEVAR de disecciones agudas de aorta promueve su remodelación a largo plazo en los segmentos stentados comparados con segmentos no tratados de la aorta / TEVAR of acute aortic dissections promotes long-term remodelling across the stented segment compared to untreated segments of the aorta

Objetivo: Evaluar el efecto anatómico a largo plazo de la reparación endovascular de la aorta torácica (TEVAR) en disecciones tipo B complicadas en comparación con segmentos no tratados de la aorta. Material y métodos: Entre enero de 2008 y septiembre de 2015, 18 pacientes con disección de aorta complicada tipo B se trataron mediante TEVAR con al menos un año de seguimiento en imágenes. Se realizaron angio-TC a los 3, 6, 12 meses y anualmente (media 25,25 ± 22,9 meses) a partir de entonces y se compararon con las angio-TC preoperatorias. Se registraron las medidas de mayor diámetro de la aorta, de la luz verdadera y de la luz falsa (LF) a nivel del segmento stentado, así como en segmentos no tratados de la aorta torácica y de la aorta abdominal supracelíaca. El análisis estadístico se realizó con un análisis de la varianza de efecto mixto para medidas repetidas. Resultados: La edad media fue de 57,67 años y un 88,9% eran hombres. La indicación de TEVAR fue: 5,6% síndrome de malperfusión, 27,8% hipertensión refractaria, 11,1% diámetro > 40mm, 50% dolor persistente y 5,6% hematoma periaórtico. El mayor diámetro de la aorta permaneció estable durante el seguimiento (p = 0,230), el diámetro de la luz verdadera en el segmento tratado aumentó (p = 0,005), y el diámetro de la LF disminuyó (p = 0,020). La trombosis completa de la LF se consiguió mediante la liberación de coils en aquellos casos con permeabilidad de LF y aumento del mayor diámetro de la aorta durante el seguimiento. Conclusiones: El tratamiento mediante TEVAR de disecciones agudas de aorta promueve la remodelación a largo plazo de los segmentos tratados en detrimento del diámetro de la LF en comparación con segmentos no tratados de la aorta. El uso de coils asocia trombosis a largo plazo de la LF y la estabilización del diámetro aórtico (AU)

Objective: To evaluate the long-term anatomical effect of thoracic endovascular aortic repair (TEVAR) in acute type B aortic dissection in comparison with untreated segments of the aorta. Material and methods. A total of 18 patients with complicated type B aortic dissection were treated with TEVAR between January 2008 and September 2015, and had over one-year follow-up imaging. Computed tomography angiograms obtained at 3, 6, and 12 months and long-term (mean 25.25 ± 22.9 months) were compared with baseline scans. The largest diameters of the stented thoracic aorta, stented true lumen, and stented false lumen (FL) were recorded at each time point, as well as the values in the unstented distal thoracic aorta and the abdominal aorta (supracoeliac). Changes over time were evaluated by a mixed effect analysis of variance model of repeated measurements. Results: The mean age of the patients was 57.67 years, and 88.9% were male. Indications for TEVAR were: 5.6% malperfusion, 27.8% refractory hypertension, 11.1% diameter > 40 mm, 50% persistent pain, and 5.6% peri-aortic haematoma. The maximum diameter of the stented thoracic aorta was stable (P = .230), the diameter of the stented true lumen increased (P = .005), and the diameter of the stented FL decreased (P = .020). Complete FL obliteration was achieved more significantly by liberating coils in those cases with residual patency of the FL and an increase in aortic diameter during follow-up. Conclusions: TEVAR of acute aortic dissection promotes long-term remodelling across the stented segment, with a significant long-term decrease of false lumen diameter compared to untreated segments of the aorta. The use of coils is significantly associated with long-term obliteration of the FL and stabilisation of aortic diameter (AU)

Bicyclo[2.2.2]octane-1,4-dicarboxylic acid: towards transparent metal-organic frameworks.

The preparation of transparent porous materials can offer a different access towards the study of molecules under solid confined space. Metal-organic frameworks represent a unique opportunity due to their tunable pore size, however aromatic linkers present strong absorption and reduce the transparency. Herein, we report the first example of a MOF with bicyclic organic dicarboxylic linkers and its use as a solid solvent.

Evaluation of the bioaccessible gastric and intestinal fractions of heavy metals in contaminated soils by means of a simple bioaccessibility extraction test.

A study is made to evaluate the bioaccessibility of heavy metals in contaminated soils through a simple bioaccessibility extraction test (SBET), applied to the analysis of both the gastric and intestinal phases. Soils with high metal content of the Mapocho, Cachapoal, and Rancagua series were studied; they are located in suburban areas of large cities in the central valley of Chile. The bioaccessible concentrations of Cd, Cr, Cu, Ni, Pb, and Zn were related to the main physicochemical characteristics of the soils and to the chemical forms obtained by sequential extraction. The elements Cd, Cu, Ni, and Zn are distributed in the soils between the exchangeable fractions, bound to oxides, to organic matter, and in the residual fraction. On the other hand, Cr and Pb are found mainly in the fractions bound to organic matter and in the residual fraction. The three soils have a high Cu content, (640-2060 mg/kg), in the order Cachapoal > Rancagua > Mapocho. The SBET test allowed establishing a different bioaccessibility for the elements in the soil. Cu was notoriously bioaccessible in both the gastric and intestinal phases in the three soils, reaching more than 50% in the Cachapoal and Rancagua soils. The other elements, regardless of the soil, were bioaccessible only in one of the phases, more frequently in the gastric phase. The multiple correlation study indicates that the metal forms have a higher incidence than the soil's physicochemical factors on the extractability to evaluate the human oral bioaccessibility of the metals.

Resolution of hydrops fetalis caused by atrioventricular block: good postnatal evolution with terbutaline treatment.

INTRODUCTION: Complete atrioventricular block (CAVB) is rarely seen, as it occurs in only 1:11 000 to 1:20 000 newborns. There is a serious risk of mortality in CAVB, mainly in those cases associated with hydrops, fetal cardiac frequency ≤ 55 beats/minute, and premature delivery. CASE REPORT: Case of complete atrioventricular block with a poor prognosis (hydrops fetalis and foetal cardiac frequency < 5 beats/minute) caused by anti-La and anti-Ro antibodies. Intrauterine symptoms improved after treatment with terbutaline, permit- ting foetal viability and successful postnatal treatment with a cardiac pacemaker. DISCUSSION: In case of complete atrioventricular block of cause autoimmune with poor prognosis should be treated with positive inotropic drugs, anticholinergics or b-mimetic in the attempt to maintain adequate ventricular frequency, and thus prevent hydrops fetalis from occurring.

Outcome measures in European patients with haemophilia: Survey of implementation in routine clinical practice, perception of relevance and recommendations by European treaters in the EHTSB.

INTRODUCTION: This study was conducted to evaluate the current implementation of outcome measures in routine clinical haemophilia practice and to explore and appreciate the perception of the relevance of such measures by treaters. METHODS: A survey was completed by 19 of the 26 physicians involved in the European Haemophilia Therapy Strategy Board (EHTSB). Employing an extensive inventory of outcome measures used in patients with haemophilia, information was collected about the frequency of data collection and the subjective appreciation of their importance during clinic review. RESULTS: The survey revealed that most treaters currently collect data that are mainly related to the haemostatic treatment (consumption of concentrates) and the bleeding symptoms (number and location of bleeds) in a non-uniform and non-standardized way. By contrast, functional, physical and quality of life scorings are rarely used and show considerable heterogeneity between treaters. Also, many disparities emerged between practice and perception, in particular quality of life data that are perceived as being important but for most of the time are not collected. CONCLUSIONS: This survey represents, in our view, the first attempt to evaluate the actual utilization of outcome measures in haemophilia care. While the value of outcome measures is appreciated, they are not assessed regularly. Therefore, there is a need to include appropriate performance indicators (outcome measures) of haemophilia care in routine clinical practice. Consensus recommendations to provide a framework for achieving this aim are provided.

Aortic Graft Mycotic Pseudoaneurysm as a Severe Complication After Multivisceral Transplantation: A Case Report.

BACKGROUND: Surgical complications in multivisceral transplantation (MVT) are frequent and always severe. Those related to technical issues are relevant as they have implications not only on the graft but also on patient survival. The aim of this study was to review our case-based data and experience with 5 MVT performed since December 2004. CASE REPORT: A 38 year-old woman presented with ultra-short bowel syndrome due to massive ischemia also affecting the celiac trunk. She also had moderate to severe hepatitis/steatosis with some degree of fibrosis on liver biopsy, due to long-term home parenteral nutrition (HPN). An MVT was carried out in September 2010 including the liver, stomach, pancreatoduodenal complex with the spleen, and small bowel. The postoperative course was complicated by a leak from the pyloromiotomy, requiring reoperation on postoperative day 13. She also had central line catheter infection and renal impairment, requiring renal replacement therapy, and was discharged on postoperative day 150. Fifteen days later she was hospitalized because of severe abdominal pain associated with an abdominal mass. Computed tomography showed an aortic donor graft pseudoaneurysm, so we decided to operate on the patient. A complete resection of the pseudoaneurysm using an interposed polytetrafluoroethylene graft was performed. Six months after the MVT, the patient died due to sepsis, despite a functional graft and complete digestive autonomy. CONCLUSIONS: Although this complication is rare, surgical complications in MVT are severe and may seriously impair graft and patient survival.

A segment of rbcL gene as a potential tool for forensic discrimination of Cannabis sativa seized at Rio de Janeiro, Brazil.

Cannabis sativa, known by the common name marijuana, is the psychoactive drug most widely distributed in the world. Identification of Cannabis cultivars may be useful for association to illegal crops, which may reveal trafficking routes and related criminal groups. This study provides evidence for the performance of a segment of the rbcL gene, through genetic signature, as a tool for identification for C. sativa samples apprehended by the Rio de Janeiro Police, Brazil. The PCR amplified and further sequenced the fragment of approximately 561 bp of 24 samples of C. sativa rbcL gene and showed the same nucleotide sequences, suggesting a possible genetic similarity or identical varieties. Comparing with other Cannabaceae family sequences, we have found 99% of similarity between the Rio de Janeiro sequence and three other C. sativa rbcL genes. These findings suggest that the fragment utilized at this study is efficient in identifying C. sativa samples, therefore, useful in genetic discrimination of samples seized in forensic cases.

Results of superficial fermoral artery stenting in patients with chronic steno-occlusive disease

Objective: To analyse clinical outcome after failure of endovascular stenting of the superficial femoral artery (SFA) in patients with steno-occlusive lesions. Material: A prospective study including patients with atherosclerotic disease treated between January 2007 and December 2013 with self-expansible stents in the superficial femoral artery (n=194). Excluded patients with steno-occlusive lesions affecting also iliac arteries. Methods: Analyzed the demographic and hemodynamic characteristics before and after the procedure, and their clinical consequences on the limb. The following variables were taken into consideration: gender, clinical state (Leriche - La Fontaine Classification), location of lesion (TASC - II Classification), Ankle - Brachial Index (ABI) in preoperative and postoperative period, number of stents deployed and runoff (preoperative angiography). We identified failure of the procedure considering clinical worsening, ABI and dupplex techniques during follow up. Kaplan-Meier curves and multivariate survival analysis were applied on variables analyzed. Results: The mean time of follow up was 22,7 months, ranging between 1 and 84 months after SFA stenting. Mean period free of reintervention or thrombosis was 8,2 months, ranging between 1 day and 52 months after stenting. Limb salvage rate was up to 46,6%, in clinical state III and IV groups. Amputation rate was 5,67% of total patients. Although 50% of these patients had a clinical state III or IV, global patency rates reached up to 46,6% in these groups. A statistically significant difference on the outcome of stenting was found in the increased postoperative ankle-brachial index (p<0,01), runoff (p = 0,03) and number of stents (p<0,01). Conclusions: Failure of stenting in AFS was not associated with significant clinical deterioration, despite most patients with failure of primary endovascular treatment required secondary surgical procedures. The low incidence of thrombosis and reduced amputation rate suggest that these procedures are effective with acceptable patency rates and limb salvage

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Negative effects of chlorthalidone on sympathetic nervous system and insulin resistance in hypertensive patients may be avoided with spironolactone: further studies are still needed.

Chlorthalidone is commonly used for blood pressure control in hypertensive patients. However, it increases sympathetic nervous system activity and insulin resistance. Both conditions are related with an elevated number of complications and worsen patients' prognosis. Recently has been demonstrated that these adverse effects are avoided with spironolactone administration. Mechanisms to explain increasing sympathetic nervous activity and insulin resistance with chlorthalidone, but not with spironolactone are unclear and under investigation. It should be necessary to continue medical investigation on this field with long-term studies, a larger number of patients and associated comorbidities. The aim should be to establish whether the association of both drugs could be an effective and safety choice to be implemented extensively in clinical practice. That possibility could represent a new alternative for patients' management.

Estudio y caracterización óptica de un Carcinoma Basocelular mediante simulación láser numérica / Study and optical characterization of a Basal Cell Carcinoma by numerical laser simulation

ANTECEDENTES: Las simulaciones de Monte Carlo son una de las técnicas más utilizadas en el contexto de modelación de geometrías de sistemas heterogéneos, como puede ser la piel humana. Además uno de los principales retos modernos en biofotónica es la simulación del comportamiento óptico y la propagación de la luz en tejidos. OBJETIVOS: Analizar la respuesta óptica de la piel, y aportar información para el diagnóstico de posibles alteraciones en la piel con la presencia de un basalioma. Material y MÉTODO: Un programa comercial, contrastado y fiable de simulación basado en técnicas de Monte Carlo, que permite estudiar el comportamiento de la piel frente a una radiación óptica; la aproximación a la trayectoria que sigue la luz en su interacción con el tejido se obtiene a partir de las propiedades ópticas conocidas a priori. Piel modelada y simulación numérica. RESULTADOS: Los resultados expuestos son datos innovadores, hasta donde conocen los autores, sobre patrones de radiación en unidades de irradiancia como de reflectividad y transmitividad de la piel. CONCLUSIONES: Este trabajo ofrece un método para distinguir entre piel «sana» y piel con carcinoma basocelular, lo que podría facilitar un procedimiento de identificación de lesiones cancerosas de la piel

BACKGROUND: Monte Carlo simulations are one of the most used techniques in the context of modeling geometry such as human skin. One of the main challenges in biophotoncs is the simulation of light spread in biological tissues. OBJECTIVES: to analyze the optical response of the skin, and to contribute information for the diagnosis and treatment of possible alteration in the skin. MATERIAL AND METHODS: A commercial, proven and reliable simulation program based on Monte Carlo techniques, which allow studying the behavior of the skin from optical radiation. The approximation to the path followed by the light in its interaction with the tissue is obtained from known-optical properties. Modeling and numerical simulation of skin. RESULTS: The results presented are innovative data about radiation patterns in units of irradiance as reflectivity and transmissivity of the skin. CONCLUSIONS: This work provides a method to distinguish between 'healthy' skin and skin with basal cell carcinoma, which could provide a method for identifying skin cancer, allowing state that can later be extrapolated to other types of cancers and skin diseases. Finally, it is shown that the simulations allow having information prior to experimentation, reducing the cost thereof