Clinical Approach to Patients with Moderate-to-Severe Atopic Dermatitis: A Spanish Delphi Consensus.

Despite emerging evidence and advances in the management of atopic dermatitis there a lack of consensus regarding the diagnostic criteria, therapeutic approach, method to assess severity, and patient follow-up for this condition. An expert consensus study was conducted to provide recommendations on the management of patients with moderate-to-severe atopic dermatitis. The study used Delphi-like methodology based on a literature review, a summary of the scientific evidence, and a 2-round survey. The agreement of 60 panellists on 21 statements was evaluated. Consensus was pre-defined as ≥ 80% agreement of all respondents. In the first round 6 statements reached consensus. Unanimous consensus was achieved regarding therapeutic goals and patient satisfaction (maintained in the long term and periodic goals reassessment recommended every 3-6 months). In the second round, half of the statements reached consensus, all related to patient follow-up, treatment goals, and atopic comorbidities. The statements that did not reach consensus were related to diagnosis (biomarkers, allergy, and food testing) and starting patients on conventional systemic treatment rather than advanced treatment. The study assessed expert opinion regarding a variety of topics related to the clinical approach to patients with moderate-to-severe atopic dermatitis, in order to provide guidance on the diagnosis and management of patients with atopic dermatitis.

Uveítis e inflamaciones oculares asociadas a COVID-19

La enfermedad por el coronavirus 2019 (COVID-19) es causada por el coronavirus 2 del síndrome de distrés respiratorio del adulto (SARS-CoV-2). Esta se declaró enfermedad pandémica por la Organización Mundial de la Salud el 11 de enero de 2020. Dentro de sus manifestaciones clínicas oftalmológicas destacan las afecciones en la superficie ocular, de ellas la conjuntivitis folicular, como la de mayor incidencia encontradas en los pacientes infectados. De igual manera, las uveítis, escleritis y epiescleritis han sido reportadas en sus diversas formas de presentación precediendo o acompañando las manifestaciones clínicas generales de la enfermedad, así como en el período pos-COVID-19. El objetivo de esta revisión fue realizar una búsqueda de información para establecer la relación entre uveítis y COVID-19, a pesar de no haber sido reconocida como una de las manifestaciones oculares reportadas con más frecuencia.

Coronavirus 2019 (COVID-19) disease is caused by adult respiratory distress syndrome coronavirus 2 (SARS-CoV-2). It was declared a pandemic disease by the World Health Organization on January 11, 2020. Among its ophthalmologic clinical manifestations, ocular surface disorders stand out, of which follicular conjunctivitis is the most frequent found in infected patients. Similarly, uveitis, scleritis and episcleritis have been reported in their various forms of presentation preceding or accompanying the general clinical manifestations of the disease, as well as in the post-COVID-19 period. The aim of this review was to search for information to establish the relationship between uveitis and COVID-19, although it has not been recognized as one of the most frequently reported ocular manifestations.

Análisis del sistema XIDE en la gestión de la sobredemanda asistencial / Analysis of the XIDE system in the management of overdemand for care

Objetivo Valorar el impacto y la idoneidad del sistema de citación XIDE en la gestión de la sobredemanda asistencial del centro de salud de Monforte de Lemos (Lugo). Material y métodos Estudio descriptivo, transversal, observacional y analítico. La población de estudio estuvo formada por los pacientes añadidos a la agenda ordinaria como «forzado» o «forzado urgente». La muestra poblacional se obtuvo durante el periodo del 15 de julio al 15 de agosto de 2022. El análisis comparativo se realizó con periodos previos a la implantación del XIDE y la concordancia XIDE/observadores se estimó mediante el cálculo del índice κ de Cohen. Resultados Observamos un aumento de la presión asistencial, tanto en número de consultas/día como en la proporción de consultas forzadas, que han aumentado en un 30-34%. El grupo mayor de 85 años y las mujeres son los mayoritarios en la sobredemanda. El 83,04% de las consultas urgentes fueron citadas mediante el sistema XIDE. El motivo de consulta más frecuente fue el de sospecha de COVID (24,64%), con una concordancia del 51,4% en este grupo y del 65,5% de forma global. Apreciamos un elevado sobretriaje en los tiempos de atención asignados, incluso cuando coincide el motivo de consulta, con una pobre concordancia estadística con los observadores. Destaca la elevada proporción en la sobredemanda de pacientes pertenecientes a otros cupos del centro de salud, por lo que una adecuada gestión de los recursos humanos con una cobertura adecuada de las ausencias lograría reducirla en un 48,5%, mientras que el sistema XIDE (en el supuesto ideal de una concordancia absoluta) solo lograría reducirla en un 43%. Conclusiones La escasa fiabilidad del XIDE se debe fundamentalmente al triaje inadecuado, más que al fracaso en el objetivo de disminuir la sobredemanda, por lo que no puede sustituir a un sistema de triaje realizado por personal sanitario (AU)

Objective To assess the impact and suitability of the XIDE citation system in the management of over-demand for care at the Monforte de Lemos Health Center (Lugo, Spain). Material and methods Descriptive, cross-sectional, observational and analytical study. The study population was the patients with appointments to the elderly in the ordinary agenda as «forced» or «urgent forced». The population sample was obtained during the period from July 15 to August 15, 2022. The comparative analysis was performed with periods prior to the implementation of XIDE and the XIDE/observer concordance was estimated by calculating Cohen's kappa index. Results We observed an increase in care pressure, both in the number of consultations/day and in the proportion of forced consultations, which have increased by 30-34%. The group over 85 years of age and women are the majority in excess demand. The 83.04% of urgent consultations were cited through the XIDE system, the most frequent reason for consultation being «suspected COVID» (24.64%), with a concordance of 51.4% in this group and 65.5% globally. We appreciate a high overtriage in the assigned attention times, even when the reason for consultation coincides, with a poor statistical concordance with the observers. The high proportion in the overdemand of patients belonging to other places in the health center stands out, so that adequate management of human resources with adequate coverage of absences would reduce it by 48.5%, while the XIDE system (in the ideal assumption of absolute concordance) would only manage to reduce it by 43%. Conclusions The low reliability of the XIDE is mainly due to inadequate triage, rather than the failure to reduce overdemand, so it cannot replace a triage system performed by health personnel (AU)

Caracterización clínico-epidemiológica de la toxocariasis ocular

Objetivo: Caracterizar clínica y epidemiológicamente la toxocariasis ocular. Métodos: Se realizó un estudio observacional, descriptivo, de corte transversal con pacientes diagnosticados de toxocariasis ocular, atendidos en el Instituto Cubano de Oftalmología Ramón Pando Ferrer en el período de abril de 2019 a diciembre de 2022. Resultados: Predominó el sexo masculino (53,7 %) y el grupo etario de 0 a 10 años (73,1 %). El 56,1 % de los pacientes vivían en área rural. La convivencia con animales domésticos representó el 75,6 %. El síntoma más referido fue la disminución de la agudeza visual (48,8 %). La forma de presentación más frecuente fue el granuloma periférico de forma unilateral en ojo derecho (52,4 %). La complicación más observada fue el desprendimiento de retina (58,5 %). Conclusiones: La infección ocular por Toxocara spp. es una enfermedad prevenible e incapacitante que limita el desenvolvimiento educacional, laboral y de la vida en general de los pacientes afectados, particularmente la población infantil, el sexo masculino y los que residen en área rural en convivencia con animales domésticos, en especial perros.

Objective: To characterize ocular toxocariasis clinically and epidemiologically. Methods: An observational, descriptive and cross-sectional study was conducted with patients diagnosed with ocular toxocariasis, attended at the Instituto Cubano de Oftalmología Ramón Pando Ferrer in the period from April 2019 to December 2022. Results: The male sex predominated (53.7 %), together with the age group 0-10 years (73.1 %). 56.1 % of the patients lived in rural areas. Cohabitation with domestic animals accounted for 75.6 %. The most frequently reported symptom was decreased visual acuity (48.8 %). The most frequent form of presentation was peripheral granuloma in the right eye (52.4 %). The most observed complication was retinal detachment (58.5 %). Conclusions: Ocular infection by Toxocara spp. is a preventable, as well as incapacitating, disease that limits the educational, occupational and general life development of affected patients, particularly children, males and those living in rural areas cohabitating with domestic animals, especially dogs.

Predictores clínicos y ecocardiográficos del síndrome de bajo gasto cardiaco en la cirugía valvular cardiaca

Objetivo: Determinar los posibles elementos predictores clínicos y ecocardiográficos asociados a la aparición del síndrome de bajo gasto cardiaco. Materiales y métodos: Se realizó un estudio analítico de casos y controles en pacientes con síndrome de bajo gasto cardiaco posoperatorio atendidos en el Centro de Cardiología y Cirugía Cardiovascular del Hospital Provincial Docente Saturnino Lora de Santiago de Cuba, desde enero 2019 a diciembre 2021. Ambos grupos de estudio formaron parte de la misma población de pacientes operados de cirugía cardiovascular, diferenciados por presentar o no síndrome de bajo gasto cardiaco postoperatorio al ingreso. La variable dependiente fue la presencia de bajo gasto cardiaco; las variables independientes, factores clínicos, hemodinámicos y ecocardiográficos. Resultados: En la serie predominaron los pacientes menores de 65 años tanto en el grupo de casos como de controles (51,2 % y 73,5 %, respectivamente). La fibrilación auricular, la función sistólica del ventrículo derecho y la hemorragia periprocedimiento (p = 0,008) presentaron alta significación estadística p 50 % (102 [91,10 %; p = 0,047]), así como amplio dominio de pacientes (76 [45,24 %; p ≤ 0,05; OR: 2,14]) con cirugías de emergencia. Se realizó una regresión logística, y se determinó que las variables clínicas y ecocardiográficas tales como la edad superior a 65 años, la función de ventrículo derecho deprimida, la circulación extracorpórea ≥90 minutos y la presión sistólica de arteria pulmonar elevada tuvieron una asociación estadísticamente significativa. El AUC mostró que variables como la edad, el tiempo de circulación extracorpórea y la hemorragia perioperatoria tuvieron capacidad predictiva. Conclusiones: Se observó que algunos elementos clínicos y ecocardiográficos, como la edad, la presencia de fibrilación auricular, la función sistólica del ventrículo derecho deprimida y la cirugía de emergencia, se asociaron como predictores de síndrome de bajo gasto cardíaco.

Objective: To determine the possible clinical and echocardiographic predictors associated with the onset of low cardiac output syndrome. Materials and methods: An analytical case-control study was conducted in patients with postoperative low cardiac output syndrome treated at Centro de Cardiología y Cirugía Cardiovascular of Hospital Provincial Docente Saturnino Lora in Santiago de Cuba from January 2019 to December 2021. Both study groups were part of the same population of patients who underwent a cardiovascular surgery but differed in the fact that, at admission, some suffered from postoperative low cardiac output syndrome and others did not. The dependent variable was the presence of low cardiac output and the independent variables were clinical, hemodynamic and echocardiographic factors. Results: In the series, patients under 65 years of age prevailed in both case and control groups (51.2 % and 73.5 %, respectively). Atrial fibrillation, right ventricular systolic function and perioperative bleeding (p = 0.008) were statistically significant (p 50 % and a large number of patients (76 [45.24 %; p ≤ 0.05; OR: 2.14]) had undergone emergency surgeries. A logistic regression analysis determined that the clinical and echocardiographic variables, such as age over 65 years, depressed right ventricular function, extracorporeal circulation ≥ 90 minutes and elevated pulmonary artery systolic pressure, had a statistically significant association. The area under the curve (AUC) showed that variables including age, extracorporeal circulation time and perioperative bleeding had predictive capability. Conclusions: It was observed that some clinical and echocardiographic elements, such as age, atrial fibrillation, depressed right ventricular systolic function and emergency surgery, were associated as predictors of low cardiac output syndrome.

[Analysis of the XIDE system in the management of overdemand for care]. / Análisis del sistema XIDE en la gestión de la sobredemanda asistencial.

OBJECTIVE: To assess the impact and suitability of the XIDE citation system in the management of over-demand for care at the Monforte de Lemos Health Center (Lugo, Spain). MATERIAL AND METHODS: Descriptive, cross-sectional, observational and analytical study. The study population was the patients with appointments to the elderly in the ordinary agenda as «forced¼ or «urgent forced¼. The population sample was obtained during the period from July 15 to August 15, 2022. The comparative analysis was performed with periods prior to the implementation of XIDE and the XIDE/observer concordance was estimated by calculating Cohen's kappa index. RESULTS: We observed an increase in care pressure, both in the number of consultations/day and in the proportion of forced consultations, which have increased by 30-34%. The group over 85 years of age and women are the majority in excess demand. The 83.04% of urgent consultations were cited through the XIDE system, the most frequent reason for consultation being «suspected COVID¼ (24.64%), with a concordance of 51.4% in this group and 65.5% globally. We appreciate a high overtriage in the assigned attention times, even when the reason for consultation coincides, with a poor statistical concordance with the observers. The high proportion in the overdemand of patients belonging to other places in the health center stands out, so that adequate management of human resources with adequate coverage of absences would reduce it by 48.5%, while the XIDE system (in the ideal assumption of absolute concordance) would only manage to reduce it by 43%. CONCLUSIONS: The low reliability of the XIDE is mainly due to inadequate triage, rather than the failure to reduce overdemand, so it cannot replace a triage system performed by health personnel.

Dependencia a los dispositivos móviles: revisión sistemática en Latinoamérica y Cuba durante la última década / Dependence on mobile devices: systematic review in Latin America and Cuba during the last decade

Introducción: la adicción a los dispositivos móviles se caracteriza por la dependencia patológica hacia estos, puede llegar a ocasionar ansiedad, estrés, baja competencia social y dificultades en la concentración. Resulta de suma importancia la revisión teórica de los principales resultados sobre el tema como punto de partida para la elaboración de estrategias de desarrollo. Objetivo: realizar una revisión sistemática de las principales investigaciones relacionadas con la adicción a los dispositivos móviles en Latinoamérica y particularmente, en Cuba. Métodos: se realizó una revisión sistemática para analizar los principales resultados en Latinoamérica y Cuba, se consideraron artículos originales publicados entre 2012 y 2022. Fueron utilizadas las pautas de revisiones sistemáticas PRISMA. Tras la identificación de los estudios en las bases de datos consultadas se realizó la lectura del título, resumen y contenido para determinar su relación con los objetivos del estudio. Desarrollo: se constató que existen pocos estudios en materia de adicciones a los dispositivos móviles en el contexto latinoamericano y cubano; las investigaciones muestran el impacto negativo sobre la salud mental de quienes padecen esta adicción, se destaca su influencia negativa en estudiantes universitarios, así como la validación de instrumentos que permitirán profundizar en esta temática. Conclusiones: se destaca la calidad de los estudios y la validez de los resultados científicos y se sugiere emplearlos como base para el desarrollo de proyectos de carácter terapéutico.

Background: addiction to mobile devices is characterized by pathological dependence on them, it can cause anxiety, stress, low social competence, and difficulties in concentration. The theoretical review of the main results on the subject is extremely important as a starting point for the elaboration of development strategies. Objective: to carry out a systematic review of the main investigations related to addiction to mobile devices in Latin America and particularly, in Cuba. Methods: a systematic review was carried out to echnol the main results in Latin America and Cuba, original articles published from 2012 to 2022 were considered. PRISMA systematic review guidelines were used. After identifying the studies in the consulted databases, the title, abstract and content were read to determine their relationship with the objectives of the study. Development: it was found that there are few studies on addictions to mobile devices in the Latin American and Cuban context; Research shows the negative impact on the mental health of those who suffer from this addiction, its negative influence on university students stands out, as well as the validation of instruments that will allow us to delve into this subject. Conclusions: the quality of the studies and the validity of the scientific results stand out and it is suggested to use them as a basis for the development of projects of a therapeutic nature.

Bienestar psicológico y ansiedad en adultos mayores con osteoartrosis de rodilla / Psychological well-being and anxiety in older adults with knee osteoarthritis

Introducción: El envejecimiento poblacional en Cuba ha incrementado los casos de osteoartrosis de rodilla. Como alternativa terapéutica se utiliza el plasma rico en plaquetas autólogo, en aras de potenciar el bienestar físico y psicológico de los pacientes. Objetivo: Caracterizar la relación entre el bienestar psicológico y la ansiedad de los adultos mayores con osteoartrosis de rodilla tratados con plasma rico en plaquetas autólogo. Métodos: Se utilizó un enfoque cuantitativo, con un alcance descriptivo-correlacional, y un diseño expost-facto retrospectivo simple. El muestreo fue intencional, no probabilístico, y quedó conformado por 300 pacientes. Se aplicó la Adaptación de la Escala de Bienestar Psicológico de Ryff y el Inventario de Ansiedad Rasgo-Estado. Para el análisis de los datos se realizaron tres cortes: antes del tratamiento regenerativo y a los tres y seis meses de evolución. Resultados: Hubo cambios de niveles medio-bajo a niveles altos de bienestar psicológico. Disminuyeron los niveles de ansiedad estado, pero no los de ansiedad rasgo. El bienestar psicológico no se correlacionó con la ansiedad rasgo y la relación estadística positiva fue muy débil con la ansiedad estado. Conclusiones: Se identificaron cambios favorables del bienestar psicológico y de la ansiedad estado, con persistencia de niveles altos de ansiedad rasgo(AU)

Introduction: The population aging in Cuba has caused the increase of osteoarthrosis of the knee in the elderly. As a therapeutic alternative, it was used the clinical use of autologous platelet-rich plasma, in order to promote well-being, not only physical, but also psychological. Objective: To characterize the relationship between psychological well-being and anxiety state and feature of elderly adults with osteoarthrosis of the knee, who are subjected to regenerative treatment with autologous platelet-rich plasma. Methods: A quantitative research approach was used, with a descriptive-correlational scope, and a simple retrospective expost-fact design. Sampling was intentional, non-probabilistic and consisted of 300 older adults. The Adaptation of the Ryff Psychological Well-Being Scale and the Trait-State Anxiety Inventory were applied. For the analysis of the data, three cuts were made: before the regenerative treatment, and after three and six months of evolution. Results: There were changes from medium-low levels to high levels of psychological well-being. Levels of state anxiety decreased, but trait anxiety did not. Psychological well-being did not correlate with trait anxiety and there was a weak positive statistical relationship with state anxiety. Conclusions: Changes were identified that favor psychological well-being and trait anxiety, with persistent high levels of trait anxiety(AU)

Glaucoma y queratoplastia pediátrica / Glaucoma and Pediatric Keratoplasty

Introducción: La indicación de la queratoplastia en niños, el pronóstico y los factores de riesgo asociados a la supervivencia del injerto continúan en discusión hoy en día. Objetivo: Describir si existe relación entre factores pre- y posqueratoplastia con la presencia de glaucoma pediátrico. Métodos: Se realizó un estudio observacional, descriptivo longitudinal retrospectivo de serie de casos, en pacientes operados de queratoplastia en edad pediátrica. Las variables estudiadas fueron: edad, sexo, tiempo de seguimiento, ojo afectado, antecedentes patológicos oculares preoperatorios, causa de la queratoplastia, complicaciones posoperatorias, momento del fallo del injerto, líneas de visión ganadas, estado del injerto y realización de evisceración y uso de prótesis ocular. Resultados: Se estudiaron 24 ojos operados de queratoplastia en 22 pacientes menores de 18 años. La media de edad fue de 8,5 años y del tiempo de seguimiento, 8,1 años. El 100 por ciento de los pacientes con glaucoma tenían menos de 10 años de edad, el 80 por ciento de los pacientes con opacidad corneal congénita tuvo glaucoma. Los pacientes con glaucoma preoperatorio mostraron mayor probabilidad de descompensación de la tensión ocular tras la queratoplastia (83,3 por ciento), injerto opaco (50 por ciento); además, ambliopía (83,3 por ciento) y baja visión (66,6 por ciento) tras la queratoplastia. Conclusiones: La presencia de glaucoma preoperatorio influye negativamente en los resultados de la queratoplastia pediátrica. Futuros estudios prospectivos son necesarios para profundizar en los resultados de la queratoplastia en niños y sus factores de riesgo de fallo del injerto(AU)

Introduction: The indication for keratoplasty in children, prognosis and risk factors associated with graft survival remain under discussion today. Objective: To describe if there is a relationship between pre- and post-keratoplasty factors with the presence of pediatric glaucoma. Methods: An observational, descriptive, longitudinal, retrospective study of case series was performed in patients who underwent keratoplasty in pediatric age. The variables studied were: age, gender, follow-up time, affected eye, preoperative ocular pathologic history, cause of keratoplasty, postoperative complications, time of graft failure, lines of sight gained, graft status, evisceration and use of ocular prosthesis. Results: Twenty-four keratoplasty-operated eyes were studied in 22 patients under 18 years of age. The average age was 8.5 years and the average follow-up time was 8.1 years. One hundred percent of patients with glaucoma were less than 10 years of age; 80 percent of patients with congenital corneal opacity had glaucoma. Patients with preoperative glaucoma showed higher probability of ocular pressure decompensation after keratoplasty (83.3 percent), opaque graft (50 percent); in addition, amblyopia (83.3 percent) and low vision (66.6 percent) after keratoplasty. Conclusions: The presence of preoperative glaucoma negatively influences pediatric keratoplasty outcomes. Future prospective studies are needed to further investigate the outcomes of keratoplasty in children and its risk factors for graft failure(AU)

High baseline expression of IL-6 and IL-10 decreased CCR7 B cells in individuals with previous SARS-CoV-2 infection during BNT162b2 vaccination.

The current pandemic generated by SARS-CoV-2 has led to mass vaccination with different biologics that have shown wide variations among human populations according to the origin and formulation of the vaccine. Studies evaluating the response in individuals with a natural infection before vaccination have been limited to antibody titer analysis and evaluating a few humoral and cellular response markers, showing a more rapid and intense humoral response than individuals without prior infection. However, the basis of these differences has not been explored in depth. In the present work, we analyzed a group of pro and anti-inflammatory cytokines, antibody titers, and cell populations in peripheral blood of individuals with previous SARS-CoV-2 infection using BNT162b2 biologic. Our results suggest that higher antibody concentration in individuals with an earlier disease could be generated by higher production of plasma cells to the detriment of the presence of memory B cells in the bloodstream, which could be related to the high baseline expression of cytokines (IL-6 and IL-10) before vaccination.

Facoemulsificación en pacientes con uveítis / Phacoemulsification in Patients with Uveitis

Objetivo: Describir el comportamiento de la cirugía de catarata mediante la técnica de facoemulsificación en pacientes con uveítis. Métodos: Se realizó un estudio descriptivo longitudinal prospectivo. La muestra la constituyeron todos los pacientes con uveítis sometidos a cirugía de catarata mediante la técnica de facoemulsificación, atendidos en el Instituto Cubano de Oftalmología "Ramón Pando Ferrer" en el período de septiembre 2018 a septiembre 2019. Resultados: El grupo etario que predominó corresponde a la séptima década de la vida, el sexo se comportó de forma equitativa, prevaleció el color de la piel blanca. Predominaron las cataratas secundarias a uveítis de etiologías no infecciosas y el glaucoma secundario fue la enfermedad ocular asociada más frecuente. Un preoperatorio adecuado influyó en la mejoría de los resultados visuales y en el control adecuado de la respuesta inflamatoria, un transoperatorio óptimo minimizó las complicaciones, redundando en menos inflamación y mejores resultados visuales, y un control adecuado de la respuesta inflamatoria durante el posoperatorio evitó que se perpetuaran o aparecieran complicaciones que incidieran en los resultados finales. Conclusiones: En la cirugía de catarata mediante la técnica de facoemulsificación existe una estrecha relación entre la preparación perioperatoria y los resultados finales(AU)

Objective: To describe the performance of cataract surgery using the phacoemulsification technique in patients with uveitis. Methods: A prospective longitudinal descriptive study was performed. The sample consisted of all patients with uveitis who underwent cataract surgery using the phacoemulsification technique, treated at the Cuban Institute of Ophthalmology "Ramón Pando Ferrer" in the period from September 2018 to September 2019. Results: The predominant age group corresponds to the seventh decade of life, gender behaved equally, white skin color prevailed. Cataracts secondary to uveitis of non-infectious etiologies predominated and secondary glaucoma was the most frequent associated ocular disease. An adequate preoperative period influenced the improvement of visual results and the adequate control of the inflammatory response, an optimal transoperative period minimized complications, resulting in less inflammation and better visual results, and an adequate control of the inflammatory response during the postoperative period prevented the perpetuation or appearance of complications that affected the final results. Conclusions: In cataract surgery using the phacoemulsification technique there is a close relationship between perioperative preparation and final results(AU)

Manifestaciones oftalmológicas en pacientes con enfermedades reumáticas en edades pediátricas / Ophthalmologic manifestations in patients with rheumatic diseases in pediatric ages

El diagnóstico de las enfermedades reumatológicas en los niños supone un gran impacto para el paciente, padres y familiares. Uno de cada 1.000 niños podría sufrir una enfermedad reumatológica. Los síntomas del sistema locomotor son un motivo de consulta frecuente. Las enfermedades reumáticas producen un gran número de manifestaciones sistémicas, muchas de ellas incapacitantes, entre las que se encuentran las alteraciones oftalmológicas que aparecen en un porciento elevado de casos. Para poder diagnosticarlas es fundamental en primer lugar conocerlas, su diagnóstico precoz permite el tratamiento adecuado para evitar complicaciones como la disminución o pérdida visual irreversible en muchos casos. En este trabajo se realizó una búsqueda automatizada con el objetivo de encontrar información actualizada sobre el tema y describir las lesiones oculares observadas en pacientes pediátricos con afecciones reumáticas e identificación temprana de signos predictivos del desarrollo de las mismas(AU)

The diagnosis of rheumatologic diseases in children denotes a great impact for the patient, parents and relatives. One in every 1,000 children could suffer from a rheumatologic disease. Symptoms of the locomotor system are a frequent reason for consultation. Rheumatic diseases produce a large number of systemic manifestations, many of them disabling, including ophthalmologic alterations which appear in a high percentage of cases. In order to be able to diagnose them, it is essential to know them first of all, their early diagnosis allows the appropriate treatment, to avoid complications such as irreversible visual decrease or loss in many cases. In this work an exhaustive automated search was carried out in order to find updated information on the subject and to describe the ocular lesions observed in pediatric patients with rheumatic diseases and early identification of predictive signs of their development(AU)

Síndrome de úlceras en piernas de carácter familiar y comienzo precoz / Familial Leg Ulcer Syndrome of Early Onset

Introducción: Las úlceras en las piernas son llagas sin sanar o lesiones abiertas de etiología multifactorial. Constituyen una patología importante en la práctica diaria de los profesionales de la salud en todos los niveles de asistencia. Objetivo: Presentar un caso infrecuente con una afección genética hereditaria familiar que provocó lesiones ulcerosas en las extremidades inferiores. Presentación del caso: Paciente masculino de 30 años con lesiones ulcerosas en ambos miembros inferiores, de 18 años de años de evolución, muy dolorosas con signos de infección local severa. Presentó diagnóstico de úlceras inespecíficas en ambos miembros inferiores. Fue ingresado con toma de su estado general, gran limitación de la deambulación, dolor intenso en ambas piernas, lesiones abundantes ulcerosas sucias diseminadas en ambas piernas, de fondo amarillento, con secreción amarilla clara, muy fétida. Se realizó estudio clínico, humoral, imagenológico, microbiológico y anátomo-histopatológico. Conclusiones: Se diagnostica síndrome de úlceras en piernas de carácter familiar y comienzo precoz, de herencia recesiva ligada al cromosoma X. Se requieren estudios a mayor escala para evaluar las contribuciones de los factores genéticos en la génesis de esta enfermedad, los cuales podrían ser la clave para comprender mejor su desarrollo(AU)

Introduction: Leg ulcers are unhealed sores or open lesions of multifactorial etiology. They constitute an important pathology in the daily practice of health professionals at all levels of care. Objective: To report an infrequent case with a familial hereditary genetic condition that caused ulcerative lesions in the lower limbs. Case report: We report the case of a 30-year-old male patient with ulcerative lesions on both lower limbs, 18 years of evolution, very painful with signs of severe local infection. He had diagnosis of nonspecific ulcers in both lower limbs. He was admitted with poor general condition, great limitation of ambulation, intense pain in both legs, abundant dirty yellowish ulcerative lesions scattered on both legs, and light yellow, very foul-smelling discharge. A clinical, humoral, imaging, microbiological and anatomical-histopathological study was performed. Conclusions: The diagnosis was familial leg ulcer syndrome of early onset, recessive inheritance linked to the X chromosome, is diagnosed. Larger scale studies are required to assess the contributions of genetic factors in the genesis of this disease, which could be the key to better understand its development(AU)

Diagnostic Accuracy of Blood-Based Biomarker Panels: A Systematic Review.

Background: Because of high prevalence of Alzheimer's disease (AD) in low- and middle-income countries (LMICs), there is an urgent need for inexpensive and minimally invasive diagnostic tests to detect biomarkers in the earliest and asymptomatic stages of the disease. Blood-based biomarkers are predicted to have the most impact for use as a screening tool and predict the onset of AD, especially in LMICs. Furthermore, it has been suggested that panels of markers may perform better than single protein candidates. Methods: Medline/Pubmed was searched to identify current relevant studies published from January 2016 to December 2020. We included all full-text articles examining blood-based biomarkers as a set of protein markers or panels to aid in AD's early diagnosis, prognosis, and characterization. Results: Seventy-six articles met the inclusion criteria for systematic review. Majority of the studies reported plasma and serum as the main source for biomarker determination in blood. Protein-based biomarker panels were reported to aid in AD diagnosis and prognosis with better accuracy than individual biomarkers. Conventional (amyloid-beta and tau) and neuroinflammatory biomarkers, such as amyloid beta-42, amyloid beta-40, total tau, phosphorylated tau-181, and other tau isoforms, were the most represented. We found the combination of amyloid beta-42/amyloid beta-40 ratio and APOEε4 status to be most represented with high accuracy for predicting amyloid beta-positron emission tomography status. Conclusion: Assessment of Alzheimer's disease biomarkers in blood as a non-invasive and cost-effective alternative will potentially contribute to early diagnosis and improvement of therapeutic interventions. Given the heterogeneous nature of AD, combination of markers seems to perform better in the diagnosis and prognosis of the disease than individual biomarkers.

Neumatización detenida del seno esfenoidal: una condición benigna que simula lesiones patológicas / Arrested pneumatization of the sphenoid sinus: a benign condition that simulates pathological lesions

Resumen La neumatización detenida de los senos paranasales es una condición benigna poco conocida, que consiste en una variación de la neumatización normal, permaneciendo médula ósea grasa dentro de la cavidad, siendo más frecuente en el seno esfenoidal. Es generalmente asintomática y su diagnóstico suele ser incidental en el contexto de la realización de imágenes por otras causas, existiendo criterios imagenológicos definidos para esta condición. Su manejo es expectante y es esencial su distinción de otros diagnósticos diferenciales, con objeto de evitar procedimientos y tratamientos invasivos que solo aporten morbilidad. Presentamos dos casos de pacientes, de 15 y 16 años que, en estudio imagenológico por otra causa, se observan lesiones esfenoidales heterogéneas con focos de baja señal sugerentes de calcificaciones, con características compatibles con neumatización detenida del seno esfenoidal.

Abstract Arrested pneumatization of the paranasal sinuses is an under-recognized benign condition, which consists of a variation of the normal pneumatization, with fatty bone marrow remaining within the cavity, more frequent in the sphenoid sinus. It is generally asymptomatic, and its diagnosis is usually incidental in the context of imaging for other causes, with defined imaging criteria for this condition. Its management is expectant and its distinction from other differential diagnoses is essential, in order to avoid invasive procedures and treatments that only contribute morbidity. We present two cases of 15- and 16-year-old patients who, on imaging for another reason, show heterogeneous sphenoid lesions with low-signal foci suggestive of calcifications, with characteristics compatible with arrested pneumatization of the sphenoid sinus.

Thymic Polypeptide Fraction Biomodulina T Decreases Exhausted and Terminally Differentiated EMRA T Cells in Advanced Lung Cancer Patients Treated With Platinum-Based Chemotherapy.

Lung cancer is the second cause of cancer related deaths worldwide. Chemotherapy and immunotherapy represent the current standard of care for advanced NSCLC. Platinum-based chemotherapy expands late-differentiated T cell populations. Therefore, immune restoration after chemotherapy to adjuvate the immunotherapeutic potential could be crucial. The aim of this study was to evaluate the effect of Biomodulina T (BT), a thymic polypeptide fraction, on peripheral lymphocytes subpopulations in the context of cancer disease. Additionally, whether these effects might induce a better response to CIMAvax-EGF, an epidermal growth factor (EGF) depleting immunotherapy. Eighteen advanced NSCLC patients were evaluated after being treated with platinum-based chemotherapy. We found that the frequency of terminally differentiated effector T cells re-expressing CD45RA (EMRA) CD4+ (p=0.0031) and CD8+ (p=0.0372) T cells decreased with the administration of BT, whereas CD4+ naive T cells increase in more than 70% of the patients. Remarkably, CD4+ and CD8+ T lymphocytes expressing programmed cell death receptor-1 (PD1) significantly decreased after BT administration (p=0.0005 and p<0.0001, respectively). We also found an enhancement of the anti-EGF antibody response with a large percentage of patients treated with CIMAvax-EGF reaching the good antibody response condition after four vaccine doses. Moreover, the median overall survival of patients treated with CIMAvax-EGF was 16.09 months. In conclusion, our results suggest that the immunorestoration generated by the administration of BT after first-line chemotherapy may induce a better immune response to CIMAvax-EGF that could translate into the clinical benefit of patients diagnosed with advanced NSCLC.