Mechanisms modulating foam cell formation in the arterial intima: exploring new therapeutic opportunities in atherosclerosis.

In recent years, the role of macrophages as the primary cell type contributing to foam cell formation and atheroma plaque development has been widely acknowledged. However, it has been long recognized that diffuse intimal thickening (DIM), which precedes the formation of early fatty streaks in humans, primarily consists of lipid-loaded smooth muscle cells (SMCs) and their secreted proteoglycans. Recent studies have further supported the notion that SMCs constitute the majority of foam cells in advanced atherosclerotic plaques. Given that SMCs are a major component of the vascular wall, they serve as a significant source of microvesicles and exosomes, which have the potential to regulate the physiology of other vascular cells. Notably, more than half of the foam cells present in atherosclerotic lesions are of SMC origin. In this review, we describe several mechanisms underlying the formation of intimal foam-like cells in atherosclerotic plaques. Based on these mechanisms, we discuss novel therapeutic approaches that have been developed to regulate the generation of intimal foam-like cells. These innovative strategies hold promise for improving the management of atherosclerosis in the near future.

Bloqueo bilateral del grupo de nervios pericapsulares (PENG) como analgesia en cirugía de cadera infantil / Bilateral pericapsular nerves group (PENG) block for analgesia in pediatric hip surgery

En la enfermedad quirúrgica de cadera es esencial el manejo y el control efectivo del dolor peri y postoperatorio que minimice el uso de opioides y sus efectos adversos. Una de las dificultades de la analgesia regional eficaz para el control del dolor de cadera es la compleja inervación de la articulación que procede de múltiples nervios. Las técnicas regionales comúnmente realizadas se asocian en ocasiones a complicaciones, entre las que se han descrito la anestesia parcial, la hipotensión o la debilidad de los miembros inferiores. Presentamos el caso de una niña de 5 años con antecedentes de parálisis cerebral infantil que fue intervenida de osteotomía derrotativa y varizante de ambas caderas y tenotomía de los aductores por luxación paralitica a la que se le realizó un bloqueo PENG bilateral asociado al bloqueo del nervio femorocutáneo, por ser una técnica sencilla que no requiere de punciones múltiples para cubrir cada uno de los nervios implicados en la inervación sensitiva de la cápsula articular.(AU)

Effective management and control of peri- and postoperative pain in hip surgery is essential in order to minimize the use of opioids and their adverse effects. Effective regional analgesia for hip pain is made particularly challenging by the complex innervation of the hip joint. Standard regional techniques can be associated with complications, including incomplete anesthesia, hypotension, or lower limb weakness. We present the case of a 5-year-old girl with a history of infantile cerebral palsy who underwent bilateral varus derotation osteotomy and adductor tenotomy due to paralytic dislocation. She received bilateral PENG block and femoral cutaneous nerve block - a simple technique that covers all the nerves involved in the sensory innervation of the joint capsule without the need for multiple injections.(AU)

Bilateral pericapsular nerves group (PENG) block for analgesia in pediatric hip surgery.

Effective management and control of peri- and postoperative pain in hip surgery is essential in order to minimize the use of opioids and their adverse effects. Effective regional analgesia for hip pain is made particularly challenging by the complex innervation of the hip joint. Standard regional techniques can be associated with complications, including incomplete anesthesia, hypotension, or lower limb weakness. We present the case of a 5-year-old girl with a history of infantile cerebral palsy who underwent bilateral varus derotation osteotomy and adductor tenotomy due to paralytic dislocation. She received bilateral PENG block and femoral cutaneous nerve block-a simple technique that covers all the nerves involved in the sensory innervation of the joint capsule without the need for multiple injections.

Acute pulmonary embolism: Appropriateness of emergency department management according to clinical guidelines.

BACKGROUND AND AIMS: To evaluate the frequency of acute pulmonary embolism, the use of clinical probability scores, and the appropriateness of the management of patients for whom computed tomography angiography (CTA) was requested from the emergency department for suspected acute pulmonary embolism. MATERIALS AND METHODS: This was a retrospective observational study of CTA studies requested from the emergency department to rule out acute pulmonary embolism. We analyzed clinical variables and the explicit use of clinical probability scores. We determined the appropriateness of management according to the Wells Score and Geneva Score and the simplified versions of these two scores, calculated retrospectively. RESULTS: We included 534 patients (52.8% women; mean age, 73 years). The frequency of acute pulmonary embolism was 23.0% and the Wells Score was explicitly used in 15.2%. The appropriateness of the management varied depending on the clinical probability score used to assess it (54.5%-75.8%) and on whether the standard d-dimer or age-adjusted d-dimer was used. CONCLUSIONS: The failure to use the Wells Scores in all cases does not necessarily imply inappropriate management, and the performance of global clinical judgment can be similar to that of clinical probability scores; however, specific studies are necessary to confirm this hypothesis.

Ictus isquémico por oclusión de la arteria basilar en una paciente puérpera con infección por SARS-CoV-2 / Ischaemic stroke due to basilar artery occlusion in a puerperal patient with SARS-CoV-2 infection

Introducción: La infección por coronavirus de tipo 2 (SARS-CoV-2), causante del síndrome respiratorio agudo grave (COVID-19), produce complicaciones tromboembólicas, incluyendo casos de enfermedad cerebrovascular aguda. Debido al estado de hipercoagulabilidad que acompaña al embarazo, el riesgo trombótico en estas pacientes puede ser especialmente relevante. Caso clínico: Presentamos el caso de una mujer de 41 años, gestante de 34 + 1 semanas, diagnosticada de neumonía intersticial bilateral, SARS-CoV-2. La paciente presentó insuficiencia respiratoria grave, por lo que se decidió la realización de una cesárea urgente y se trasladó a la unidad de cuidados intensivos. Durante su estancia en ésta, la paciente presentó un episodio brusco de disminución del nivel de consciencia, y se evidenció por angiorresonancia magnética una trombosis en la arteria vertebral izquierda y en la arteria basilar, con presencia de infarto isquémico agudo en ambos hemisferios cerebelosos y afectación bilateral del tronco del encéfalo. Conclusión: La enfermedad grave por el SARS-CoV-2 produce un estado protrombótico que se correlaciona con el pronóstico de la enfermedad. El último trimestre del embarazo y el puerperio son factores de riesgo protrombóticos conocidos. Las recomendaciones del manejo de anticoagulación en pacientes embarazadas con COVID-19 se basan en una evidencia limitada. Éste es el primer caso publicado en España de trombosis arterial cerebral en una paciente embarazada con infección por el SARS-CoV-2.(AU)

Introduction: Infection by coronavirus type 2, which is the cause of severe acute respiratory syndrome (SARS-CoV-2), gives rise to thromboembolic complications, including acute cerebrovascular disease. Due to the hypercoagulable state that accompanies pregnancy, the thrombotic risk in these patients may be particularly significant. Case report: We report the case of a 41-year-old woman, 34+1 weeks pregnant, diagnosed with bilateral interstitial pneumonia, caused by coronavirus disease 2019 (COVID-19). The patient presented with severe respiratory failure, and so the decision was made to perform an emergency caesarean section and she was transferred to the intensive care unit. During her stay in hospital, the patient suffered a sudden episode of decreased level of consciousness, and magnetic resonance angiography revealed thrombosis in the left vertebral artery and in the basilar artery, with the presence of acute ischaemic infarction in both cerebellar hemispheres and bilateral involvement of the brainstem. Conclusion: Severe SARS-CoV-2 disease results in a prothrombotic state that correlates with the prognosis of the disease. The last trimester of pregnancy and the puerperium are known prothrombotic risk factors. Recommendations for anticoagulation management in pregnant patients with COVID-19 are based on limited evidence. This is the first case to be published in Spain involving cerebral arterial thrombosis in a pregnant patient with SARS-CoV-2 infection.(AU)

[Ischaemic stroke due to basilar artery occlusion in a puerperal patient with SARS-CoV-2 infection]. / Ictus isquémico por oclusión de la arteria basilar en una paciente puérpera con infección por SARS-CoV-2.

INTRODUCTION: Infection by coronavirus type 2, which is the cause of severe acute respiratory syndrome (SARS-CoV-2), gives rise to thromboembolic complications, including acute cerebrovascular disease. Due to the hypercoagulable state that accompanies pregnancy, the thrombotic risk in these patients may be particularly significant. CASE REPORT: We report the case of a 41-year-old woman, 34+1 weeks pregnant, diagnosed with bilateral interstitial pneumonia, caused by coronavirus disease 2019 (COVID-19). The patient presented with severe respiratory failure, and so the decision was made to perform an emergency caesarean section and she was transferred to the intensive care unit. During her stay in hospital, the patient suffered a sudden episode of decreased level of consciousness, and magnetic resonance angiography revealed thrombosis in the left vertebral artery and in the basilar artery, with the presence of acute ischaemic infarction in both cerebellar hemispheres and bilateral involvement of the brainstem. CONCLUSION: Severe SARS-CoV-2 disease results in a prothrombotic state that correlates with the prognosis of the disease. The last trimester of pregnancy and the puerperium are known prothrombotic risk factors. Recommendations for anticoagulation management in pregnant patients with COVID-19 are based on limited evidence. This is the first case to be published in Spain involving cerebral arterial thrombosis in a pregnant patient with SARS-CoV-2 infection.

TITLE: Ictus isquémico por oclusión de la arteria basilar en una paciente puérpera con infección por SARS-CoV-2.Introducción. La infección por coronavirus de tipo 2 (SARS-CoV-2), causante del síndrome respiratorio agudo grave (COVID-19), produce complicaciones tromboembólicas, incluyendo casos de enfermedad cerebrovascular aguda. Debido al estado de hipercoagulabilidad que acompaña al embarazo, el riesgo trombótico en estas pacientes puede ser especialmente relevante. Caso clínico. Presentamos el caso de una mujer de 41 años, gestante de 34 + 1 semanas, diagnosticada de neumonía intersticial bilateral, SARS-CoV-2. La paciente presentó insuficiencia respiratoria grave, por lo que se decidió la realización de una cesárea urgente y se trasladó a la unidad de cuidados intensivos. Durante su estancia en ésta, la paciente presentó un episodio brusco de disminución del nivel de consciencia, y se evidenció por angiorresonancia magnética una trombosis en la arteria vertebral izquierda y en la arteria basilar, con presencia de infarto isquémico agudo en ambos hemisferios cerebelosos y afectación bilateral del tronco del encéfalo. Conclusión. La enfermedad grave por el SARS-CoV-2 produce un estado protrombótico que se correlaciona con el pronóstico de la enfermedad. El último trimestre del embarazo y el puerperio son factores de riesgo protrombóticos conocidos. Las recomendaciones del manejo de anticoagulación en pacientes embarazadas con COVID-19 se basan en una evidencia limitada. Éste es el primer caso publicado en España de trombosis arterial cerebral en una paciente embarazada con infección por el SARS-CoV-2.

Tromboembolismo pulmonar agudo: adecuación del manejo de pacientes según las guías de práctica clínica en el servicio de urgencias / Acute pulmonary embolism: appropriateness of emergency department management according to clinical guidelines

Antecedentes y objetivo: Evaluar la frecuencia de tromboembolismo pulmonar agudo (TEPA), el uso de escalas de probabilidad clínica (EPC) y la adecuación del manejo de los pacientes a los que se solicitó angiografía pulmonar por tomografía computarizada (angio-TC) por sospecha de TEPA desde el servicio de urgencias. Materiales y métodos: Estudio observacional retrospectivo de las angio-TC solicitadas desde el servicio de urgencias para descartar TEPA. Se analizaron variables clínicas y el uso explícito de EPC. Se determinó la adecuación del manejo en función de las escalas de Wells (EW) y Ginebra (EG) y sus versiones simplificadas (EWs y EGs), calculadas retrospectivamente. Resultados: Se incluyeron 534 pacientes (52,8% mujeres, mediana de edad: 73 años). La frecuencia de TEPA fue del 23,0% y el uso explícito de la EW, del 15,2%. La adecuación del manejo fue variable dependiendo de la EPC (54,5-75,8%) y del dímero D estándar o ajustado por edad. Conclusiones: La baja utilización explícita de la EW no conlleva un manejo inadecuado, y el juicio clínico global puede ofrecer un rendimiento similar a las EPC, pero es necesario realizar estudios específicos para comprobar esta hipótesis.(AU)

Background and aims: To evaluate the frequency of acute pulmonary embolism, the use of clinical probability scores, and the appropriateness of the management of patients for whom computed tomography angiography (CTA) was requested from the emergency department for suspected acute pulmonary embolism. Materials and methods: This was a retrospective observational study of CTA studies requested from the emergency department to rule out acute pulmonary embolism. We analyzed clinical variables and the explicit use of clinical probability scores. We determined the appropriateness of management according to the Wells Score and Geneva Score and the simplified versions of these two scores, calculated retrospectively. Results: We included 534 patients (52.8% women; mean age, 73 years). The frequency of acute pulmonary embolism was 23.0% and the Wells Score was explicitly used in 15.2%. The appropriateness of the management varied depending on the clinical probability score used to assess it (54.5%-75.8%) and on whether the standard D-dimer or age-adjusted D-dimer was used. Conclusions: The failure to use the Wells Scores in all cases does not necessarily imply inappropriate management, and the performance of global clinical judgment can be similar to that of clinical probability scores; however, specific studies are necessary to confirm this hypothesis.(AU)

Mental impact of Covid-19 among Spanish healthcare workers. A large longitudinal survey.

AIMS: Longitudinal data on the mental health impact of the coronavirus disease 2019 (Covid-19) pandemic in healthcare workers is limited. We estimated prevalence, incidence and persistence of probable mental disorders in a cohort of Spanish healthcare workers (Covid-19 waves 1 and 2) -and identified associated risk factors. METHODS: 8996 healthcare workers evaluated on 5 May-7 September 2020 (baseline) were invited to a second web-based survey (October-December 2020). Major depressive disorder (PHQ-8 ≥ 10), generalised anxiety disorder (GAD-7 ≥ 10), panic attacks, post-traumatic stress disorder (PCL-5 ≥ 7), and alcohol use disorder (CAGE-AID ≥ 2) were assessed. Distal (pre-pandemic) and proximal (pandemic) risk factors were included. We estimated the incidence of probable mental disorders (among those without disorders at baseline) and persistence (among those with disorders at baseline). Logistic regression of individual-level [odds ratios (OR)] and population-level (population attributable risk proportions) associations were estimated, adjusting by all distal risk factors, health care centre and time of baseline interview. RESULTS: 4809 healthcare workers participated at four months follow-up (cooperation rate = 65.7%; mean = 120 days s.d. = 22 days from baseline assessment). Follow-up prevalence of any disorder was 41.5%, (v. 45.4% at baseline, p < 0.001); incidence, 19.7% (s.e. = 1.6) and persistence, 67.7% (s.e. = 2.3). Proximal factors showing significant bivariate-adjusted associations with incidence included: work-related factors [prioritising Covid-19 patients (OR = 1.62)], stress factors [personal health-related stress (OR = 1.61)], interpersonal stress (OR = 1.53) and financial factors [significant income loss (OR = 1.37)]. Risk factors associated with persistence were largely similar. CONCLUSIONS: Our study indicates that the prevalence of probable mental disorders among Spanish healthcare workers during the second wave of the Covid-19 pandemic was similarly high to that after the first wave. This was in good part due to the persistence of mental disorders detected at the baseline, but with a relevant incidence of about 1 in 5 of HCWs without mental disorders during the first wave of the Covid-19 pandemic. Health-related factors, work-related factors and interpersonal stress are important risks of persistence of mental disorders and of incidence of mental disorders. Adequately addressing these factors might have prevented a considerable amount of mental health impact of the pandemic among this vulnerable population. Addressing health-related stress, work-related factors and interpersonal stress might reduce the prevalence of these disorders substantially. Study registration number: NCT04556565.

Four-month incidence of suicidal thoughts and behaviors among healthcare workers after the first wave of the Spain COVID-19 pandemic.

Healthcare workers (HCW) are at high risk for suicide, yet little is known about the onset of suicidal thoughts and behaviors (STB) in this important segment of the population in conjunction with the COVID-19 pandemic. We conducted a multicenter, prospective cohort study of Spanish HCW active during the COVID-9 pandemic. A total of n = 4809 HCW participated at baseline (May-September 2020; i.e., just after the first wave of the pandemic) and at a four-month follow-up assessment (October-December 2020) using web-based surveys. Logistic regression assessed the individual- and population-level associations of separate proximal (pandemic) risk factors with four-month STB incidence (i.e., 30-day STB among HCW negative for 30-day STB at baseline), each time adjusting for distal (pre-pandemic) factors. STB incidence was estimated at 4.2% (SE = 0.5; n = 1 suicide attempt). Adjusted for distal factors, proximal risk factors most strongly associated with STB incidence were various sources of interpersonal stress (scaled 0-4; odds ratio [OR] range = 1.23-1.57) followed by personal health-related stress and stress related to the health of loved ones (scaled 0-4; OR range 1.30-1.32), and the perceived lack of healthcare center preparedness (scaled 0-4; OR = 1.34). Population-attributable risk proportions for these proximal risk factors were in the range 45.3-57.6%. Other significant risk factors were financial stressors (OR range 1.26-1.81), isolation/quarantine due to COVID-19 (OR = 1.53) and having changed to a specific COVID-19 related work location (OR = 1.72). Among other interventions, our findings call for healthcare systems to implement adequate conflict communication and resolution strategies and to improve family-work balance embedded in organizational justice strategies.

Bilateral pericapsular nerves group (PENG) block for analgesia in pediatric hip surgery. / Bloqueo bilateral del grupo de nervios pericapsulares (PENG) como analgesia en cirugía de cadera infantil.

Effective management and control of peri- and postoperative pain in hip surgery is essential in order to minimize the use of opioids and their adverse effects. Effective regional analgesia for hip pain is made particularly challenging by the complex innervation of the hip joint. Standard regional techniques can be associated with complications, including incomplete anesthesia, hypotension, or lower limb weakness. We present the case of a 5-year-old girl with a history of infantile cerebral palsy who underwent bilateral varus derotation osteotomy and adductor tenotomy due to paralytic dislocation. She received bilateral PENG block and femoral cutaneous nerve block - a simple technique that covers all the nerves involved in the sensory innervation of the joint capsule without the need for multiple injections.

Acute pulmonary embolism: appropriateness of emergency department management according to clinical guidelines. / Tromboembolismo pulmonar agudo: adecuación del manejo de pacientes según las guías de práctica clínica en el servicio de urgencias.

BACKGROUND AND AIMS: To evaluate the frequency of acute pulmonary embolism, the use of clinical probability scores, and the appropriateness of the management of patients for whom computed tomography angiography (CTA) was requested from the emergency department for suspected acute pulmonary embolism. MATERIALS AND METHODS: This was a retrospective observational study of CTA studies requested from the emergency department to rule out acute pulmonary embolism. We analyzed clinical variables and the explicit use of clinical probability scores. We determined the appropriateness of management according to the Wells Score and Geneva Score and the simplified versions of these two scores, calculated retrospectively. RESULTS: We included 534 patients (52.8% women; mean age, 73 years). The frequency of acute pulmonary embolism was 23.0% and the Wells Score was explicitly used in 15.2%. The appropriateness of the management varied depending on the clinical probability score used to assess it (54.5%-75.8%) and on whether the standard D-dimer or age-adjusted D-dimer was used. CONCLUSIONS: The failure to use the Wells Scores in all cases does not necessarily imply inappropriate management, and the performance of global clinical judgment can be similar to that of clinical probability scores; however, specific studies are necessary to confirm this hypothesis.

Towards a European health research and innovation cloud (HRIC).

The European Union (EU) initiative on the Digital Transformation of Health and Care (Digicare) aims to provide the conditions necessary for building a secure, flexible, and decentralized digital health infrastructure. Creating a European Health Research and Innovation Cloud (HRIC) within this environment should enable data sharing and analysis for health research across the EU, in compliance with data protection legislation while preserving the full trust of the participants. Such a HRIC should learn from and build on existing data infrastructures, integrate best practices, and focus on the concrete needs of the community in terms of technologies, governance, management, regulation, and ethics requirements. Here, we describe the vision and expected benefits of digital data sharing in health research activities and present a roadmap that fosters the opportunities while answering the challenges of implementing a HRIC. For this, we put forward five specific recommendations and action points to ensure that a European HRIC: i) is built on established standards and guidelines, providing cloud technologies through an open and decentralized infrastructure; ii) is developed and certified to the highest standards of interoperability and data security that can be trusted by all stakeholders; iii) is supported by a robust ethical and legal framework that is compliant with the EU General Data Protection Regulation (GDPR); iv) establishes a proper environment for the training of new generations of data and medical scientists; and v) stimulates research and innovation in transnational collaborations through public and private initiatives and partnerships funded by the EU through Horizon 2020 and Horizon Europe.

Adaptation of antibiotic treatment to clinical practice guidelines in patients aged ⩾65 years hospitalised due to community-acquired pneumonia.

Early, conforming antibiotic treatment in elderly patients hospitalised for community-acquired pneumonia (CAP) is a key factor in the prognosis and mortality. The objective was to examine whether empirical antibiotic treatment was conforming according to the Spanish Society of Pulmonology and Thoracic Surgery guidelines in these patients. Multicentre study in patients aged ⩾65 years hospitalised due to CAP in the 2013-14 and 2014-15 influenza seasons. We collected socio-demographic information, comorbidities, influenza/pneumococcal vaccination history and antibiotics administered using a questionnaire and medical records. Bivariate analyses and multilevel logistic regression were made. In total, 1857 hospitalised patients were included, 82 of whom required intensive care unit (ICU) admission. Treatment was conforming in 51.4% (95% confidence interval (CI) 49.1-53.8%) of patients without ICU admission and was associated with absence of renal failure without haemodialysis (odds ratio (OR) 1.49, 95% CI 1.15-1.95) and no cognitive dysfunction (OR 1.71, 95% CI 1.25-2.35), when the effect of the autonomous community was controlled for. In patients with ICU admission, treatment was conforming in 45.1% (95% CI 34.1-56.1%) of patients and was associated with the hospital visits in the last year (<3 vs. ⩾3, OR 2.70, 95% CI 1.03-7.12) and there was some evidence that this was associated with season. Although the reference guidelines are national, wide variability between autonomous communities was found. In patients hospitalised due to CAP, health services should guarantee the administration of antibiotics in a consensual manner that is conforming according to clinical practice guidelines.

¿De qué colores es el vestido? Revisión de una ilusión óptica atípica / Which are the colors of the dress? Review of an atypical optic illusion

OBJETIVO: En 2015 la fotografía de un vestido se hizo viral. Un porcentaje amplio de la población veía el vestido blanco y dorado (ByD) en tanto que otra parte importante de la población lo veía azul y negro (AyN). El objetivo de este trabajo es revisar la bibliografía publicada en relación con este tema. MATERIAL Y MÉTODOS: Se realizó una búsqueda bibliográfica en Pubmed y Google. El algoritmo utilizado fue: (color OR colour) AND (dress OR #thedress). La búsqueda se limitó a los años 2015-2017. No se limitó la búsqueda a una lengua concreta. La bibliografía de los artículos localizados se utilizó de forma secundaria para ampliar la búsqueda. RESULTADOS: El algoritmo utilizado localizó un total de 23 artículos relacionados con el tema. La mayor parte de los trabajos han sido publicados en revistas del ámbito de la percepción y analizan la cuestión desde el punto de vista de la constancia cromática. Los factores genéticos parecen tener un bajo peso en el modo en el que la imagen es percibida. La potencial influencia de factores oculares ha sido poco estudiada. CONCLUSIÓN: Esta ilusión ha recibido poca atención por parte de las revistas del ámbito de la oftalmología. Aunque sin duda la constancia cromática está implicada, de momento no se ha elaborado una teoría capaz de explicar el carácter dicotómico de esta ilusión óptica

OBJECTIVE: In 2015 the picture of a dress went viral on social media. A significant proportion of the population saw it as golden and white (G&W), while another significant proportion saw it as blue and black (B&B). The aim of this article is to review the related literature. MATERIAL AND METHODS: Bibliographic search conducted in Pubmed and Google. The algorithm used was: (color OR colour) AND (dress OR #thedress). The search was limited to the years 2015-2017. No language restrictions were used. The references of the located articles were used to widen the search. RESULTS: The search algorithm retrieved 23 articles related to the topic. Most of the works have been published in journals in the field of perception. Most works address the topic from the point of view of chromatic constancy. Genetic factors seem to have a low weight in the way the dress is perceived. There are few studies on the potential influence of ocular factors. CONCLUSION: This illusion has gained little attention in ophthalmology journals. Although colour constancy is certainly involved, there is still no theory available to explain the dichotomous character of this optical illusion

Which are the colors of the dress? Review of an atypical optic illusion. / ¿De qué colores es el vestido? Revisión de una ilusión óptica atípica.

OBJECTIVE: In 2015 the picture of a dress went viral on social media. A significant proportion of the population saw it as golden and white (G&W), while another significant proportion saw it as blue and black (B&B). The aim of this article is to review the related literature. MATERIAL AND METHODS: Bibliographic search conducted in Pubmed and Google. The algorithm used was: (color OR colour) AND (dress OR #thedress). The search was limited to the years 2015-2017. No language restrictions were used. The references of the located articles were used to widen the search. RESULTS: The search algorithm retrieved 23 articles related to the topic. Most of the works have been published in journals in the field of perception. Most works address the topic from the point of view of chromatic constancy. Genetic factors seem to have a low weight in the way the dress is perceived. There are few studies on the potential influence of ocular factors. CONCLUSION: This illusion has gained little attention in ophthalmology journals. Although colour constancy is certainly involved, there is still no theory available to explain the dichotomous character of this optical illusion.

Outpatient vaginal hysterectomy: Comparison of conventional suture ligature versus electrosurgical bipolar vessel sealing.

OBJECTIVE: The aim of our study was to evaluate the feasibility of vaginal hysterectomy in an ambulatory care system and the best way to perform it between conventional and bipolar vessel sealing system ligatures. PATIENTS AND METHODS: This was a prospective study of 32 patients with vaginal hysterectomy at Lille University Hospital between December 2013 and May 2015. Two surgical techniques were compared: conventional suture ligature (CSL) and electrosurgical bipolar vessel sealing (BVS). Patients stayed in classical hospitalization but were managed how if they were in an ambulatory unit to evaluate their capacity to come back home the same evening of the surgery. The evaluation of same-day discharge was based on Post Anesthetic Discharge Scoring System (PADSS) score?9/10 and Visual Analogic Scale (VAS) score?4/10. Other data collected were: operative time, uterus weight, peroperative bleeding, PADSS score at the 8th postoperative hour, VAS score at the 4th, 6th, 8th, 12th and 24th postoperative hours, the presence of postoperative nausea/vomiting and rehospitalization. RESULTS: In the BVS group, 93.8% of patients validated the combined score (PADSS+VAS) on the evening of the intervention against 50% of patients in the CSL group (P<0.05). Hundred percent of BVS group patients were discharged on the day after surgery against 87.5% in the CSL group. The VAS was significantly lower in the BVS group at the 8th (1.4), 12th (1.2) and 24th (1.3) postoperative hours. Operative time was significantly shorter in the BVS group. We found more events such as nausea/vomiting in the CSL group. CONCLUSION: Vaginal hysterectomy is feasible in an ambulatory care system most of times. By reducing postoperative pain, electrosurgical bipolar vessel sealing would promote outpatient hospitalization.

Maculopatía por puntero láser. ¿Un nuevo problema de salud pública? / Laser pointer maculopathy. A new public health problem?

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Nonsurgical Procedures for Keratoconus Management.

OBJECTIVES: To describe the past 20 years' correction modalities for keratoconus and their visual outcomes and possible complications. METHODS: A review of the published literature related to the visual outcomes and possible complications in the context of keratoconus management using nonsurgical procedures for the last 20 years (glasses and contact lenses) was performed. Original articles that reported the outcome of any correction modalities of keratoconus management were reviewed. RESULTS: The most nonsurgical procedure used on keratoconus management is the contact lens fitting. Soft contact lenses and soft toric contact lenses, rigid gas-permeable contact lenses, piggyback contact lens system, hybrid contact lenses, and scleral and corneoscleral contact lenses form the contemporary range of available lens types for keratoconus management with contact lenses. All of them try to restore the vision, improve the quality of life, and delay surgical procedures in patients with this disease. Complications are derived from the intolerance of using contact lens, and the use of each depends on keratoconus severity. CONCLUSIONS: In the context of nonsurgical procedures, the use of contact lenses for the management of keratoconic patients represents a good alternative to restore vision and improve the quality of live in this population.