Total hip arthroplasty with second generation dual mobility system as a treatment for primary coxarthrosis, medium-term results. / Artroplastia total de cadera con sistema de doble movilidad de segunda generación como tratamiento de coxartrosis primaria, resultados a mediano plazo.

INTRODUCTION: Osteoarthritis is a disabling pathology characterized by joint pain and stiffness. A prevalence of coxarthrosis of 7.4% is reported in our country. Total hip joint replacement is indicated in advanced stages, a procedure that is not free of complications, the most frequent being prosthetic dislocation, which can be prevented with dual mobility systems. The following study aims to determine the rate of complications and clinical outcomes in dual mobility systems in primary coxarthrosis. MATERIALS AND METHODS: A retrospective study included 120 cases in 114 patients diagnosed with grade III coxarthrosis, mean age was 62.43 years, with a mean follow-up of 4.5 years. Joint replacement was performed by Hardinge approach. All cases were assessed clinically using the Harris Hip Score (HHS) and radiologically to demonstrate mid-term results. RESULTS: The preoperative value on the HHS scale had a mean of 56.45, postoperative at one month 74.23; 6 months 85.40; 1 year 94.01 and at 5 years 94.84 points, representing a functional improvement of 17.78 postoperative month; 28.95 at 6 months postoperative; 37.56 at one year postoperative and 38.39 points at 5 years postoperative. A complication rate of 3.44%; 0.86% of complications were associated with the prosthetic components. CONCLUSION: The dual mobility system should be considered as a therapeutic option in primary hip joint replacement due to excellent functional results and low complication rates. Evidence level IV. Retrospective observational case series study.

Efectos sobre los procesos cognitivos del entrenamiento basado en doble tarea en personas con enfermedad de Parkinson: una revisión sistemática / Effects on cognitive processes of dual-task training in people with Parkinson’s disease: a systematic review

Introducción: La doble tarea es una intervención no farmacológica en personas con condiciones neurodegenerativas, utilizada en la enfermedad de Parkinson (EP), principalmente para favorecer el desempeño motor. El objetivo de esta revisión es reunir la evidencia actual sobre cómo el entrenamiento de doble tarea afecta a los procesos cognitivos en personas que presenten EP. Material y métodos. Se desarrolló una revisión sistemática, aplicando las directrices de PRISMA, incluyendo artículos obtenidos en las bases de datos de PubMed, Web of Science, Science Direct y Springer Link. La calidad metodológica se evaluó mediante PEDro y ROBINS-I. Resultados: Doce artículos cumplieron con los criterios de inclusión y exclusión: nueve de ellos corresponden a ensayos controlados aleatorizados y los tres restantes fueron estudios no aleatorizados. Se identificaron mejoras en la atención y las funciones ejecutivas, aunque la diversidad en enfoques y duración dificulta llegar a conclusiones definitivas. Conclusiones: Es crucial expandir la investigación, estandarizando los programas de intervención. Del mismo modo, es importante llevar a cabo estudios longitudinales y controlados aleatorizados en muestras representativas que permitan llegar a conclusiones aplicables a otros contextos.(AU)

Introduction: Dual-tasking is a non-pharmacological intervention in people with neurodegenerative conditions, and is used in Parkinson’s disease (PD), primarily to enhance motor performance. The aim of this review is to compile the current evidence on how dual-task training affects cognitive processes in people with PD. Material and methods: A systematic review was undertaken, applying PRISMA guidelines, which included articles obtained from the PubMed, Web of Science, Science Direct and Springer Link databases. Methodological quality was assessed using PEDro and ROBINS-I. Results: Twelve articles met the inclusion and exclusion criteria: nine of them were randomized controlled trials, and the remaining three were non-randomized studies. Improvements in attention and executive functions were identified, although the diversity of approaches and duration means that reaching definitive conclusions is difficult. Conclusions: Increased research and standardized intervention programmes are essential. Longitudinal and randomized controlled studies in representative samples which provide conclusions that are applicable to other contexts are also important.(AU)

Aplicación clinicorradiológica del uso de la tomografía computarizada craneal de tecnología espectral en el manejo del ictus isquémico agudo tras trombectomía mecánica / Clinicoradiological application of the use of spectral cranial computed tomography in the management of acute ischemic stroke after mechanical thrombectomy

Introducción El ictus isquémico agudo es una de las principales causas globales de morbimortalidad. La trombectomía mecánica ha mejorado el pronóstico funcional de esta patología; sin embargo, la transformación hemorrágica es una complicación frecuente. La tomografía computarizada (TC) de tecnología espectral, como prueba de neuroimagen de control, diferencia la extravasación de contraste de la transformación hemorrágica gracias al diferente comportamiento de los materiales a la energía dual, y esta distinción es de utilidad en su manejo clinicoterapéutico. Material y métodos. Estudio unicéntrico, observacional y retrospectivo, en el cual se investigó, mediante el acceso a una base de datos disociada y a la historia clínica, la presencia de una serie de variables clínicas, radiológicas y terapéuticas en los pacientes con ictus isquémico agudo que fueron tratados con trombectomía mecánica en nuestro hospital entre julio de 2022 y marzo de 2023.ResultadosDe los 155 pacientes incluidos, se realizó una TC craneal espectral en 63 y convencional en 75. En el grupo de TC espectral se detectaron 21 imágenes hiperdensas y en el grupo de TC convencional fueron 28. En el 42,8% de los casos en los que se detectó una hiperdensidad en el grupo de TC convencional no se pudo distinguir entre extravasación de contraste y transformación hemorrágica, en comparación con el 4,8% del grupo de TC espectral (p < 0,001).ConclusionesLa TC espectral confiere una gran confianza diagnóstica al radiólogo para establecer el tipo de hiperdensidad detectada y, por ello, proporciona también una gran confianza terapéutica al neurólogo para reiniciar precozmente la anticoagulación. (AU)

Introduction. Acute ischemic stroke is one of the leading global causes of morbidity and mortality. Mechanical thrombectomy has improved the functional prognosis of this condition; however, hemorrhagic transformation is a common complication. Spectral computed tomography (CT) imaging, as a neuroimaging control test, distinguishes contrast extravasation from hemorrhagic transformation due to the differential behavior of materials at dual energy levels. This distinction is valuable in its clinical therapeutic management.Material and methods. A single-center, observational, retrospective study was conducted in which the presence of various clinical, radiological, and therapeutic variables in patients with acute ischemic stroke treated with mechanical thrombectomy at our hospital between July 2022 and March 2023 was investigated using access to a dissociated database and medical records.Results. Out of 155 included patients, spectral cranial CT was performed in 63, and conventional cranial CT in 75. In the spectral CT group, 21 hyperdense images were detected, compared to 28 in the conventional CT group. In 42.8% of cases where hyperdensity was detected in the conventional CT group, it was not possible to distinguish between contrast extravasation and hemorrhagic transformation, in contrast to the 4.8% in the spectral CT group (p < 0.001).Conclusions. Spectral CT provides high diagnostic confidence to the radiologist in identifying the type of detected hyperdensity, thereby offering significant therapeutic confidence to the neurologist in early resuming anticoagulation therapy. (AU)

Total hip arthroplasty with second generation dual mobility system as a treatment for primary coxarthrosis, medium-term results. / Artroplastia total de cadera con sistema de doble movilidad de segunda generación como tratamiento de coxartrosis primaria, resultados a mediano plazo.

INTRODUCTION: Osteoarthritis is a disabling pathology characterized by joint pain and stiffness. A prevalence of coxarthrosis of 7.4% is reported in our country. Total hip joint replacement is indicated in advanced stages, a procedure that is not free of complications, the most frequent being prosthetic dislocation, which can be prevented with dual mobility systems. The following study aims to determine the rate of complications and clinical outcomes in dual mobility systems in primary coxarthrosis. MATERIALS AND METHODS: A retrospective study included 120 cases in 114 patients diagnosed with grade III coxarthrosis, mean age was 62.43 years, with a mean follow-up of 4.5 years. Joint replacement was performed by Hardinge approach. All cases were assessed clinically using the Harris Hip Score (HHS) and radiologically to demonstrate mid-term results. RESULTS: The preoperative value on the HHS scale had a mean of 56.45, postoperative at one month 74.23; 6 months 85.40; 1 year 94.01 and at 5 years 94.84 points, representing a functional improvement of 17.78 postoperative month; 28.95 at 6 months postoperative; 37.56 at one year postoperative and 38.39 points at 5 years postoperative. A complication rate of 3.44%; 0.86% of complications were associated with the prosthetic components. CONCLUSION: The dual mobility system should be considered as a therapeutic option in primary hip joint replacement due to excellent functional results and low complication rates. EVIDENCE LEVEL: IV. Retrospective observational case series study.

Timing of coronary angiography and use of antiplatelet pretreatment in patients with NSTEACS in Spain.

INTRODUCTION AND OBJECTIVES: The optimal timing of coronary angiography in patients admitted with non-ST-segment elevation acute coronary syndrome (NSTEACS) as well as the need for pretreatment are controversial. The main objective of the IMPACT-TIMING-GO registry was to assess the proportion of patients undergoing an early invasive strategy (0-24hours) without dual antiplatelet therapy (no pretreatment strategy) in Spain. METHODS: This observational, prospective, and multicenter study included consecutive patients with NSTEACS who underwent coronary angiography that identified a culprit lesion. RESULTS: Between April and May 2022, we included 1021 patients diagnosed with NSTEACS, with a mean age of 67±12 years (23.6% women). A total of 87% of the patients were deemed at high risk (elevated troponin; electrocardiogram changes; GRACE score>140) but only 37.8% underwent an early invasive strategy, and 30.3% did not receive pretreatment. Overall, 13.6% of the patients underwent an early invasive strategy without pretreatment, while the most frequent strategy was a deferred angiography under antiplatelet pretreatment (46%). During admission, 9 patients (0.9%) died, while major bleeding occurred in 34 (3.3%). CONCLUSIONS: In Spain, only 13.6% of patients with NSTEACS undergoing coronary angiography received an early invasive strategy without pretreatment. The incidence of cardiovascular and severe bleeding events during admission was low.

Tiempos de cateterismo y uso de pretratamiento antiagregante plaquetario en pacientes con SCASEST en España / Timing of coronary angiography and use of antiplatelet pretreatment in patients with NSTEACS in Spain

Introducción y objetivos El momento óptimo para un cateterismo en el síndrome coronario agudo sin elevación del segmento ST (SCASEST) y la necesidad de pretratamiento son motivo de controversia. El objetivo principal del registro IMPACT-TIMING-GO es conocer el porcentaje de pacientes examinados con una coronariografía precoz (0-24 h) y que no recibieron doble antiagregación plaquetaria antes del cateterismo (estrategia sin pretratamiento) en España. Métodos Estudio observacional, prospectivo y multicéntrico, que incluyó a pacientes consecutivos con diagnóstico de SCASEST sometidos a cateterismo en los que se evidenció enfermedad coronaria ateroesclerótica causal. Resultados Entre abril y mayo de 2022 se incluyó a 1.021 pacientes (media de edad, 67±12 años; el 23,6% mujeres). El 86,8% de los pacientes cumplían criterios de alto riesgo (elevación de troponina, cambios electrocardiográficos o puntuación GRACE>140); sin embargo, únicamente el 37,8% se sometió a una estrategia invasiva precoz, y el 30,3% no recibió pretratamiento. Globalmente, solo el 13,6% de los pacientes se sometieron a una estrategia invasiva precoz sin un segundo antiagregante plaquetario, y la estrategia diferida con pretratamiento fue la más utilizada (46%). Durante el ingreso, 9 pacientes (0,9%) fallecieron y 34 (3,3%) presentaron una hemorragia grave. Conclusiones En España, solo el 13,6% de los pacientes con SCASEST sometidos a cateterismo reciben una estrategia invasiva precoz sin pretratamiento. La incidencia de eventos cardiovasculares y hemorragias graves en el ingreso es baja. (AU)

Introduction and objectives The optimal timing of coronary angiography in patients admitted with non–ST-segment elevation acute coronary syndrome (NSTEACS) as well as the need for pretreatment are controversial. The main objective of the IMPACT-TIMING-GO registry was to assess the proportion of patients undergoing an early invasive strategy (0-24hours) without dual antiplatelet therapy (no pretreatment strategy) in Spain. Methods This observational, prospective, and multicenter study included consecutive patients with NSTEACS who underwent coronary angiography that identified a culprit lesion. Results Between April and May 2022, we included 1021 patients diagnosed with NSTEACS, with a mean age of 67±12 years (23.6% women). A total of 87% of the patients were deemed at high risk (elevated troponin; electrocardiogram changes; GRACE score>140) but only 37.8% underwent an early invasive strategy, and 30.3% did not receive pretreatment. Overall, 13.6% of the patients underwent an early invasive strategy without pretreatment, while the most frequent strategy was a deferred angiography under antiplatelet pretreatment (46%). During admission, 9 patients (0.9%) died, while major bleeding occurred in 34 (3.3%). Conclusions In Spain, only 13.6% of patients with NSTEACS undergoing coronary angiography received an early invasive strategy without pretreatment. The incidence of cardiovascular and severe bleeding events during admission was low. (AU)

Falta de adherencia a ticagrelor frente a clopidogrel y riesgo de eventos en pacientes con SCA. Resultados del registro CREA-ARIAM / Nonadherence to ticagrelor versus clopidogrel and clinical outcomes in patients with ACS. Results from the CREA-ARIAM registry

Introduction and objectives Prior studies have not determined whether the effect of dual antiplatelet therapy (DAPT) cessation on the subsequent risk of major adverse cardiac events (MACE) varies by the choice of P2Y12-inhibitor after acute coronary syndrome (ACS). Methods We performed a prespecified subanalysis of a multicenter, prospective registry of ACS patients discharged on ticagrelor or clopidogrel between 2015 and2019. Nonadherence to DAPT was categorized as physician-guided discontinuation and disruption due to adverse effects, nonadherence, or bleeding. The association between DAPT cessation and 1-year MACE was analyzed using multivariate time-updated Cox models with inverse probability of censoring weighted estimators. Results Out of 2180 patients, 174 (8.3%) prematurely discontinued DAPT (physician-guided, n=126; disruption, n=48). Nonadherent patients were older and had more comorbidities than those on DAPT. Compared with physician-guided discontinuation, disruption occurred earlier after discharge and was more frequent with ticagrelor than with clopidogrel. In time-varying analysis, DAPT cessation was associated with an increased risk of MACE (adjusted HR, 1.32, 95%CI, 1.10-1.76), largely driven by disruption (adjusted HR, 1.47, 95%CI, 1.22-1.73). There was an exponential increase in MACE risk after DAPT cessation within 90 days after ACS, especially after disruption of ticagrelor compared with clopidogrel (Pinteraction<.001). After adjustment for DAPT duration, this interaction was not statistically significant on the additive scale (relative excess risk due to interaction 0.12, 95%CI,−0.99-1.24). Conclusions In this all-comers registry, 1 in 12 patients prematurely discontinued DAPT within 1 year after ACS. Compared with physician-recommended discontinuation, disruption resulted in a significantly higher risk of MACE. After adjustment for DAPT duration, this association was not moderated by the choice of P2Y12-inhibitor (AU)

Introducción y objetivos Una baja adherencia al tratamiento antiagregante plaquetario doble (TAPD) condiciona peor pronóstico tras un síndrome coronario agudo (SCA). Se analizó si el riesgo de eventos adversos cardiovasculares mayores (MACE) tras la interrupción prematura del TAPD varía según el inhibidor del P2Y12. Métodos Análisis preespecificado de pacientes con SCA tratados con ticagrelor o clopidogrel entre 2015 y 2019 dentro de un registro prospectivo multicéntrico. Se categorizó la suspensión prematura como indicada por el médico o como interrupción por hemorragia, efectos secundarios o incumplimiento del paciente. La asociación entre la suspensión del TAPD y los MACE se analizó mediante modelos multivariantes de Cox dependientes del tiempo, con estimadores robustos ponderados por probabilidad inversa de censura. Resultados De 2.180 pacientes, 174 (8,3%) suspendieron el TAPD precozmente (126 por indicación médica y 48 por disrupción). Los pacientes incumplidores tenían más edad y más comorbilidad que los adherentes. Frente a la suspensión indicada por el médico, la disrupción del TAPD fue más precoz y frecuente con el ticagrelor que con el clopidogrel. La suspensión del TAPD condicionó mayor riesgo de MACE (HRajustada=1,32; IC95%, 1,10-1,76), principalmente en caso de la disrupción (HRajustada=1,47; IC95%, 1,22-1,73). Este riesgo aumentó exponencialmente en los 90 días posteriores al SCA y fue más evidente con ticagrelor (pinteracción<0,001). Tras considerar la duración del TAPD, esta interacción no resultó significativa en la escala aditiva (exceso de riesgo debido a interacción=0,12; IC95%, –0,99 a 1,24)(AU)

Nonadherence to ticagrelor versus clopidogrel and clinical outcomes in patients with ACS. Results from the CREA-ARIAM registry.

INTRODUCTION AND OBJECTIVES: Prior studies have not determined whether the effect of dual antiplatelet therapy (DAPT) cessation on the subsequent risk of major adverse cardiac events (MACE) varies by the choice of P2Y12-inhibitor after acute coronary syndrome (ACS). METHODS: We performed a prespecified subanalysis of a multicenter, prospective registry of ACS patients discharged on ticagrelor or clopidogrel between 2015 and2019. Nonadherence to DAPT was categorized as physician-guided discontinuation and disruption due to adverse effects, nonadherence, or bleeding. The association between DAPT cessation and 1-year MACE was analyzed using multivariate time-updated Cox models with inverse probability of censoring weighted estimators. RESULTS: Out of 2180 patients, 174 (8.3%) prematurely discontinued DAPT (physician-guided, n=126; disruption, n=48). Nonadherent patients were older and had more comorbidities than those on DAPT. Compared with physician-guided discontinuation, disruption occurred earlier after discharge and was more frequent with ticagrelor than with clopidogrel. In time-varying analysis, DAPT cessation was associated with an increased risk of MACE (adjusted HR, 1.32, 95%CI, 1.10-1.76), largely driven by disruption (adjusted HR, 1.47, 95%CI, 1.22-1.73). There was an exponential increase in MACE risk after DAPT cessation within 90 days after ACS, especially after disruption of ticagrelor compared with clopidogrel (Pinteraction<.001). After adjustment for DAPT duration, this interaction was not statistically significant on the additive scale (relative excess risk due to interaction 0.12, 95%CI,-0.99-1.24). CONCLUSIONS: In this all-comers registry, 1 in 12 patients prematurely discontinued DAPT within 1 year after ACS. Compared with physician-recommended discontinuation, disruption resulted in a significantly higher risk of MACE. After adjustment for DAPT duration, this association was not moderated by the choice of P2Y12-inhibitor. Clinical trial registered at ClinicalTrials.gov (Identifier: NCT02500290).

Arthroscopic rotator cuff repair using a single or double row technique: A meta-analysis of randomized clinical trial. / Reparación artroscópica del manguito rotador mediante una técnica de hilera simple o doble hilera: un metaanálisis de los ensayos clínicos aleatorizados.

PURPOSE: To compare the double row technique versus the single row technique for arthroscopic rotator cuff repair, in order to assess whether there are clinical differences. METHODS: Systematic review of randomized clinical trials comparing the clinical results of the double-row technique versus the single-row technique in arthroscopic rotator cuff repair. Demographic, clinical, and surgical variables were analyzed, including functional scores, tendon healing rate, and re-tear rate. RESULTS: Thirteen randomized clinical trials were selected. 437 patients in the single row group (50.7%) and 424 patients in the double row group (49.3%) were analyzed. No significant differences were found between the two groups in terms of age (P=.84), sex (P=.23) and loss to follow-up (P=.52). Significant differences were found for the better results of the double row technique at the UCLA level (P=.01). No significant differences were found on the Constant-Murley scale (P=.87) or on the ASES scale (P=.56). Similarly, there was a higher healing rate (P=.006) and less risk of rotator cuff re-tears with the double row technique (P=.006). CONCLUSIONS: In rotator cuff repair, the double row technique was found to be superior to the single row technique in terms of better UCLA score, better tendon healing rate, and lower re-tear rate. No clinically significant differences were found on the Constant-Murley scale or on the ASES scale.

Caracterización de aislamientos de Klebsiella pneumoniae doble productores de carbapenemasas en un hospital universitario / Phenotypic and genotypic characterization of double carbapenemase producing Klebsiella pneumoniaeisolates in a University Hospital

La emergencia de aislamientos de Klebsiella pneumoniaedoble productores de carbapenemasas (KPC y NDM) es una de las consecuencias de la pandemia causada por SARS-CoV-2 que ha causado un impacto significativo en las tasas de resistencia a los antimicrobianos en las infecciones intrahospitalarias por esta enterobacteria. Estos aislamientos representan un desafío para los servicios de salud, por su detección y caracterización y posterior tratamiento. En este trabajo se describen los aislamientos portadores de KPC y NDM recuperados durante 2022 aislados de distintas muestras clínicas de pacientes internados en un hospital universitario de la Ciudad de Buenos Aires, se los caracteriza fenotípicamente y genotípicamente como portadores de ambas carbapenemasas y se destaca la excelente actividad in vitro de la combinación ceftazidima-avibactam y aztreonam en el tratamiento de estas infecciones en donde las alternativas terapéuticas estarían limitadas a antibióticos no ß-lactámicos con porcentajes de resistencia que superan el 70%

The emergence of double-carbapenemase (KPC and NDM) producing Klebsiella pneumoniae isolates is one of the consequences derived from the SARS CoV-2 pandemic, which has caused significant impact on the antimicrobial resistance rates in hospital acquired infections. These isolates represent a real challenge for Health Services due to their difficult detection and characterization and subsequent treatment. In the present work we describe the double carbapenemase producing isolates recovered during the year 2022 from clinical samples belonging to hospitalized patients at a University Hospital in Buenos Aires city, we report their phenotypic and genotypic characterization and the excellent "in vitro" activity of the ceftazidime-avibactam-aztreonam combination in the treatment of infections in which the therapeutical options are restricted to non ß- lactamic antimicrobials which hold resistance rates higher than 70%

Pronóstico a largo plazo de la extensión de la TAPD en una cohorte consecutiva de pacientes con IAMCEST / Long-term outcomes of extended DAPT in a real-life cohort of consecutive STEMI patients

Introducción y objetivos: La duración adecuada de la doble terapia antiagregante (DAPT) después de un infarto de miocardio con elevación del segmento ST (IAMCEST) está todavía en discusión. Métodos: Analizamos el efecto de la DAPT extendida a 5 años sobre la mortalidad global, mortalidad cardiovascular y reingreso o mortalidad cardiovascular, en una cohorte multicéntrica de pacientes con IAMCEST supervivientes al año. Resultados: Se incluyeron 3.107 pacientes hospitalizados por IAMCEST de los que el 93% recibió DAPT al alta. A los 5 años se mantenía en 275 pacientes con un perfil alto de gravedad. La mortalidad cardiovascular de los pacientes con antiagregación simple (SAPT) frente a DAPT a 5 años fue de 1,4 y 3,6% (p <0,01), respectivamente. La mortalidad no-cardiovascular fue del 3,3 frente a 5,8% (p=0,049) a 5 años, respectivamente. La incidencia del evento combinado a un año fue del 14,6% en SAPT frente a 11,8% en DAPT (p=0,496), y del 11,4 frente a 46,5% (p <0,001) a 5 años, respectivamente. El mantenimiento de la DAPT hasta los 5 años se asoció de forma independiente a mayor mortalidad: por cualquier causa (HR=2,16; IC95%, 1,40-3,33), cardiovascular (HR=2,83; IC95%, 1,37-5,84) y rehospitalización cardiovascular y mortalidad (HR=5,20; IC95%, 3,96-6,82). Un análisis emparejado por puntuación de propensión, y uno con ponderación de probabilidad inversa, confirman estos resultados. Conclusiones: Nuestros resultados sugieren la hipótesis de que, en supervivientes a un año de IAMCEST, alargar la DAPT hasta 5 años en pacientes de alto riesgo no mejora su pronóstico a largo plazo. (AU)

Introduction and objectives: Dual antiplatelet therapy (DAPT) duration after ST-segment elevation myocardial infarction (STEMI) remains a matter of debate. Methods: We analyzed the effect of DAPT on 5-year all-cause mortality, cardiovascular mortality, and cardiovascular readmission or mortality in a cohort of 1-year survivor STEMI patients. Results: A total of 3107 patients with the diagnosis of STEMI were included: 93% of them were discharged on DAPT, a therapy that persisted in 275 high-risk patients at 5 years. Cardiovascular mortality in patients on single antiplatelet therapy vs DAPT at 5 years was 1.4% vs 3.6% (P <.01), respectively, whereas noncardiovascular mortality was 3.3% vs 5.8% (P=.049) at 5 years. Cardiovascular readmission or mortality in patients with single antiplatelet therapy vs DAPT was 11.4% vs 46.5% (P <.001). Extended DAPT was independently associated with worse 5-year all-cause mortality (HR, 2.16; 95%CI, 1.40-3.33), cardiovascular mortality (HR, 2.83; 95%CI, 1.37-5.84), and cardiovascular readmission or mortality (HR, 5.20; 95%CI, 3.96-6.82). These findings were confirmed in propensity score matching and inverse probability weighting analyses. Conclusions: Our results suggest the hypothesis that, in 1-year STEMI survivors, extending DAPT up to 5 years in high-risk patients does not improve their long-term prognosis. (AU)

Considerações ético-legais sobre a sedação paliativa: a discussão que a pandemia trouxe à tona no norte do Brasil / Ethical and legal considerations for palliative sedation: the debate sparked by the pandemic in northern Brazil / Consideraciones ético-legales sobre la sedación paliativa: la discusión que la pandemia trajo a la luz en el norte de Brasil

Objetivo: analisar o cabimento ético-legal da sedação paliativa, distinguindo-a de condutas que possam ser consideradas eutanásicas e, portanto, penalmente vedadas pelo ordenamento jurídico pátrio e tradicionalmente rechaçadas pelos Códigos de Ética profissionais. Metodologia: mediante pesquisa exploratória bibliográfica, a partir de obras doutrinárias especializadas no tema dos conceitos associados a fim de vida e da disciplina normativa vigente, o estudo buscou cotejar o uso da sedação paliativa com outras condutas e situações relacionadas a terminalidade e morte, de sorte a procurar identificar com maior clareza a qualificação ética e jurídica da prática, sua relevância e licitude no campo dos cuidados paliativos. Resultados: verificou-se que, em meio à crise pandêmica, situações de mistanásia por carência de recursos nas unidades de saúde do estado do Amazonas levaram a uma indevida confusão na compreensão social entre sedação paliativa e eutanásia, impondo-se a necessidade de esclarecer os conceitos e limites entre as condutas. Conclusão: constatou-se a possibilidade jurídica de sedação paliativa como conduta ética e legal, desde que exercida dentro das exigências da boa prática clínica, sem intenção de deliberado encurtamento vital.

Objective: to examine the ethical-legal significance of palliative sedation and to distinguish it from acts that can be described as euthanasia and are therefore prohibited by law in the national legal system and generally rejected by professional ethical Codes. Methods:an exploratory literature review based on textbooks on end-of-life concepts and current normative discipline was conducted to further determine the ethical and legal qualifications of the practice, its relevance and legality in the field of palliative care. Results: The findings revealed that, during the pandemic crisis, misthanasia due to lack of resources in health facilities in the state of Amazonas has led to an undue confusion in social understanding of palliative sedation and euthanasia, so that clarification of the concepts and boundaries between conducts is necessary. Conclusion: the legality of palliative sedation has been confirmed as an ethical and legal behavior, provided it is used within the parameters of good clinical practice and without the intention of deliberately shortening life.

Objetivo: evaluar las implicaciones éticas y legales de la sedación paliativa, diferenciándola de acciones que podrían ser consideradas eutanásicas y, por lo tanto, prohibidas por la ley nacional y tradicionalmente rechazadas por los Códigos de Ética profesional. Metodología: a través de una investigación bibliográfica exploratoria, basada en trabajos doctrinales especializados en el tema de los conceptos asociados al final de la vida y la disciplina normativa actual, el estudio buscó comparar el uso de la sedación paliativa con otras conductas y situaciones relacionadas con la terminalidad y la muerte, con el fin de buscar identificar más claramente la calificación ético-legal de la práctica, su pertinencia y legalidad en el campo de los cuidados paliativos. Resultados: durante la crisis pandémica, las situaciones de mistanasia en las unidades de salud del estado de Amazonas debido a la falta de recursos causaron una confusión indebida en el entendimiento social entre la sedación paliativa y la eutanasia , imponiendo la necesidad de esclarecer los conceptos y límites entre conductas. Conclusión: la sedación paliativa es legal y ética si se realiza dentro de las normas de la buena práctica clínica y sin la intención de reducir deliberadamente la vida.

Changes in food habits and food-related satisfaction before and during the COVID-19 pandemic in dual-earner families with adolescents

Introduction: Food habits have been associated with positive outcomes during the COVID-19 pandemic. Family members may share protective factors, but each member may also respond differently to the pandemic. Aim: To examine food habits in different-sex dual-earner parents with adolescents, comparing reports from late 2019 before the pandemic (T1) and mid- 2020 during the pandemic (T2) in Temuco, Chile. Method: A sample of 193 families composed of mother, father, and one adolescent aged 10 to 15 responded to a questionnaire at T1 and T2. Non-parametric tests were used to compare family food-related habits and the satisfaction with food-related life of each family member at T1 and T2. An Actor-Partner Interdependence Model was conducted to explore relations between T1 and T2 variables and between family members. Results: Frequency of family meals increased during the pandemic, and mothers increased their cooking hours. All family members improved their diet quality during the pandemic. Perceived family meal atmosphere and satisfaction with food-related life did not change. T1 food habits were not associated with T2 satisfaction with food-related life. Conclusion: These families changed their food-related habits during the pandemic, but their food-related life assessment was similar before and during the pandemic.

Introducción: Las prácticas alimentarias se han asociado con mayor bienestar durante la pandemia por COVID-19. Aunque en una familia se comparten condiciones de vida, cada miembro puede responder de modo diferente a la pandemia. Objetivo: Examinar las prácticas alimentarias en parejas con doble ingreso e hijos adolescentes, comparando reportes antes de la pandemia (finales de 2019, T1) y durante la pandemia (mediados de 2020, T2) en Temuco, Chile. Método: 193 familias compuestas por madre, padre y un hijo adolescente de 10 a 15 años respondieron un cuestionario en T1 y T2. Se utilizaron pruebas no-paramétricas para comparar hábitos alimentarios y satisfacción con la alimentación para cada miembro de la familia en T1 y T2. Se exploraron las relaciones entre variables en T1 y T2, y entre miembros de la familia usando el modelo de interdependencia de actor-compañero. Resultados: La frecuencia de las comidas familiares y las horas que la madre dedicó diariamente a cocinar aumentaron durante la pandemia. Los tres miembros de la familia mejoraron la calidad de su dieta durante la pandemia. La atmósfera percibida de comidas familiares y la satisfacción con la alimentación no cambiaron. Los hábitos alimentarios del T1 no incidieron en la satisfacción con la alimentación en T2. Conclusión: Los hábitos alimenticios de estas familias cambiaron durante la pandemia, pero la evaluación de su vida alimentaria fue similar antes y durante la pandemia.

Tratamiento antiagregante plaquetario doble tras la intervención coronaria percutánea del tronco coronario izquierdo / Dual antiplatelet therapy after percutaneous coronary intervention for left main coronary artery disease

Introducción y objetivos Son escasos los datos sobre la duración y el impacto pronóstico del tratamiento antiagregante plaquetario doble (TAPD) tras una intervención coronaria percutánea (ICP) del tronco coronario izquierdo (TCI) con stents farmacoactivos de segunda generación. El objetivo de este estudio es investigar los patrones de prescripción y el efecto pronóstico a largo plazo de la duración del TAPD en pacientes sometidos a ICP del TCI con stents farmacoactivos segunda generación. Métodos A partir de los datos individuales de los registros IRIS-MAIN y KOMATE, se incluyó a 1.827 pacientes sometidos a ICP del TCI con stents farmacoactivos de segunda generación de los que hubiese información válida sobre la duración del TAPD. El objetivo de eficacia fue la aparición de eventos cardiovasculares adversos mayores (MACE) (un combinado de muerte cardiaca, infarto de miocardio y trombosis del stent) y el de seguridad fue la presencia de hemorragia mayor según TIMI. Resultados Las duraciones del TAPD fueron <6 meses (n=273), de 6-12 meses (n=477), de 12-24 meses (n=637) y ≥ 24 meses (n=440). La mediana de la duración del seguimiento fue de 3,9 [intervalo intercuartílico, 3,01-5,00] años. El TAPD prolongado se asoció con menor incidencia de MACE. En el análisis de puntuación de propensión multigrupo, las HR ajustadas de los MACE fueron significativamente mayores con los TAPD de menos de 6 meses y de 6-12 meses (HR=4,51; IC95%, 2,96-6,88) frente al TAPD de 12-24 meses (HR=1,92; IC95%, 1,23-3,00). No hubo diferencias en la HR de hemorragia mayor entre los grupos evaluados. Conclusiones La duración del TAPD tras la ICP para la enfermedad del TCI es muy variable. Aunque debe considerarse en función de la situación clínica de cada paciente, un TAPD de menos de 12 meses se asoció con mayor incidencia de MACE (AU)

Introduction and objectives There are scarce data on the optimal duration and prognostic impact of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) with second-generation drug-eluting stents for left main coronary artery (LMCA) disease. The aim of this study was to investigate the practice pattern and long-term prognostic effect of DAPT duration in patients undergoing PCI with second-generation drug-eluting stents for LMCA disease. Methods Using individual patient-level data from the IRIS-MAIN and KOMATE registries, 1827 patients undergoing PCI with second-generation drug-eluting stents for LMCA disease with valid information on DAPT duration were included. The efficacy outcome was major adverse cardiovascular events (MACE, a composite of cardiac death, myocardial infarction, and stent thrombosis) and the safety outcome was TIMI major bleeding. Results DAPT duration was <6 months (n=273), 6 to 12 months (n=477), 12 to 24 months (n=637), and ≥ 24 months (n=440). The median follow-up duration was 3.9 [interquartile range, 3.01-5.00] years. Prolonged DAPT duration was associated with lower incidences of MACE. In multigroup propensity score analysis, adjusted HR for MACE were significantly higher for DAPT <6 months and DAPT 6 to 12 months than for DAPT 12 to 24 months (HR, 4.51; 95%CI, 2.96-6.88 and HR 1.92; 95%CI, 1.23-3.00). There was no difference in HR for major bleeding among the assessed groups. Conclusions DAPT duration following PCI for LMCA disease is highly variable. Although the duration of DAPT should be considered in the context of the clinical situation of each patient, <12 months of DAPT was associated with higher incidence of MACE. Registration identifiers: NCT01341327; NCT03908463 (AU)

Doble estimulación durante la fase folicular y lútea: una herramienta útil para bajas respondedoras / Dual stimulation during the follicular and luteal phase: a useful tool for low responders

Introducción: La baja respuesta ovárica tiene una incidencia del 5% al 24% y constituye un desafío para el profesional y puede ser motivo de frustración para los pacientes. El concepto de DuoStim o de doble estimulación en un mismo ciclo surge de implementar una estimulación durante la fase lútea a la convencional en fase folicular, con el objetivo de conseguir mayor respuesta ovárica y mayor número de ovocitos sin aumentar las tasas de complicaciones.Material y métodos: búsqueda bibliográfica en la literatura publicada sobre el protocolo de doble estimulación ovárica, enfocado sobre todo a aquellas mujeres que cumplen los criterios de Bolonia, publicados en los últimos 10 años; es decir, desde 2011 a 2021.Resultados: tabla de elaboración propia que recopila algunos de los artículos más interesantes sobre el tema tratado.Discusión: el protocolo DuoStim nos permite limitar el riesgo de cancelación del ciclo y maximiza el número de ovocitos por estimulación, siendo por tanto un procedimiento más costo-efectivo.Conclusiones: El protocolo de Shanghai proporciona una opción aceptable con un régimen de tratamiento más eficiente en el tiempo y menos costoso para los pacientes con baja respuesta ovárica. (AU)

Introduction:Low ovarian response has an incidence of 5% to 24% and is a challenge for the professio-nal and can be a source of frustration for patients. The concept of DuoStim or double stimulation in the same cycle arises from implementing a stimulation during the luteal phase to the conventional one in the follicular phase, with the aim of achieving greater ovarian response and a greater number of oocytes without increasing reaction rates.•Material and methods:bibliographic research in the literature published on the double ovarian stimulation protocol, focused on all those women who meet the Bologna criteria, published in the last 10 years; that is, from 2011 to 2021.•Results:self-made table that compiles some of the most interesting articles on the subject matter.•Discussion:the DuoStim protocol allows us to limit the risk of cycle cancellation and maximizes the number of oocytes per stimulation, thus being a more cost-effective procedure.•Conclusions: The Shanghai protocol provides an acceptable option with a more time-efficient and less expensive treatment regimen for patients with poor ovarian response. (AU)

A simple double differential centrifugation-wash procedure to rapidly obtain bacterial identification and direct antimicrobial susceptibility testing from positive blood cultures / Método sencillo basado en una doble centrifugación diferencial para obtener una identificación bacteriana y sensibilidad a antibióticos rápida a partir de hemocultivos positivos

Introduction: This study proposes a simple and rapid method for both bacterial identification and direct antimicrobial susceptibility testing (AST) by using MALDI-TOF and a double differential centrifugation-wash procedure from positive blood cultures. Methods: Fifty-two positive blood cultures (37 gramnegative bacilli and 15 grampositive cocci) were studied by two methods for identification and AST: a reference method, and the rapid MALDI-TOF method obtaining a purified pellet by using a double differential centrifugation procedure. Results : A total of 1101 MIC values (mg/l) were interpreted according to EUCAST clinical breakpoints and compared using the two methods simultaneously. Discrepancies in 81 MIC values (7.35%) were detected. By analyzing standard parameters, we obtained 98.28% essential agreement and 92.65% categorical agreement considering all isolates tested. Conclusion: This method provides rapid bacterial identification and AST, offering definitive results 24–48h earlier than the conventional method (p<0.001) and improving the turnaround time in blood culture diagnostics, especially in laboratories without 24-h on-call.(AU)

Introducción: Este trabajo propone un método sencillo, rápido y barato de identificación bacteriana y sensibilidad antibiótica utilizando MALDI-TOF y una doble centrifugación diferencial a partir de hemocultivo positivo. Métodos: Se estudiaron 52 hemocultivos positivos (37 bacilos gramnegativos y 15 cocos grampositivos). Se compararon 2 métodos: un método convencional de identificación y determinación de sensibilidad a antibióticos automatizada partiendo de colonia crecida, y un método rápido utilizando MALDI-TOF, caracterizado por la obtención de un pellet purificado procedente de un hemocultivo positivo, mediante un procedimiento basado en una doble centrifugación diferencial. Resultados: Se analizaron y compararon 1.101 valores de CMI (mg/l) de acuerdo con los criterios establecidos por EUCAST y obtenidos por ambos métodos. Se detectaron discrepancias en 81 valores de CMI (7,35%). Considerando todos los aislados, la concordancia esencial fue del 98,28% y la concordancia categórica del 92,65%. Conclusión: Este método proporciona resultados de identificación y sensibilidad a antibióticos definitivos 24-48h antes que un método convencional (p<0,001), mejorando el tiempo de respuesta en el diagnóstico microbiológico de bacteriemias, especialmente en laboratorios sin servicio de guardias de 24h.(AU)

Accuracy in body composition scanning by adult half-body DXA scanning.

Introduction: Introduction: dual-energy X-ray absorptiometry (DXA) is the gold standard method, although one limitation is the size of the scan area. Objective: the objective was to verify the accuracy of body composition (BC) scanning through half-body DXA scanning compared to standard total body scanning. Methods: a study was conducted on 145 volunteers. Weight and height were assessed. Body mass index (BMI) was calculated. DXA was used for whole-body scan (WBS) and half-body scan (HBS). WBS was used as the reference method and the following indicators were extracted: bone mineral content (BMC), fat mass (FM), lean soft tissue (LST) and percentage fat mass (%FM). Results: no differences were observed in the body composition indicators (BMC, FM, LST and %FM) when compared between the reference WBS scanner and the HBS scanner. The predictive power between both scans ranged in both sexes between R2 = 0.94 and 0.98. The DRI desirable reproducibility index values defining the degree of agreement between both scans ranged from 0.97 to 0.99, and the values for precision (0.97 to 0.99) and accuracy (0.99) were high. Conclusion: HBS scanning by DXA evidenced agreement, and high values of accuracy and precision to assess body composition indicators (BMC, FM, LST and %FM).

Introducción: Introducción: la absorciometría de rayos X de doble energía (DXA) es el método de referencia, aunque una limitación es el tamaño del área de exploración. Objetivo: el objetivo fue verificar la precisión de la exploración de la CB mediante la exploración DXA de medio cuerpo en comparación con la exploración estándar de todo el cuerpo. Métodos: se realizó un estudio con 145 voluntarios. Se evaluaron el peso y la altura. Se calculó el índice de masa corporal (IMC). Se utilizó la DXA para la exploración de cuerpo entero (WBS) y la exploración de medio cuerpo (HBS). Se utilizó la PEP como método de referencia y se extrajeron los siguientes indicadores: contenido mineral óseo (CMO), masa grasa (MG), tejido blando magro (TBL) y porcentaje de masa grasa (%MG). Resultados: No se observaron diferencias en los indicadores de composición corporal (BMC, FM, LST y %FM) cuando se compararon entre el escáner WBS de referencia y el escáner HBS. El poder predictivo entre ambos escáneres osciló en ambos sexos entre R2 = 0,94 y 0,98. Los valores del índice de reproducibilidad deseable DRI que definen el grado de acuerdo entre ambas exploraciones oscilaron entre 0,97 y 0,99, y los valores de precisión (0,97 a 0,99) y exactitud (0,99) fueron altos. Conclusión: la exploración de HBS mediante DXA evidenció concordancia y altos valores de exactitud y precisión para evaluar los indicadores de composición corporal (BMC, FM, LST y %FM).

Microfluidic sperm sorting improves ICSI outcomes in patients with increased values of Double-Strand Breaks in sperm DNA / La selección espermática mediante un dispositivo microfluídico mejora los resultados de ICSI en pacientes con valores elevados de fragmentación de cadena doble en el ADN espermático

Background: Delays in embryo kinetics, implantation failures in ICSI treatments and recurrent miscarriages have been associated with high values of Double-Strand Breaks (DSB) in sperm DNA. While conventional methods for semen preparation have been shown to be inefficient reducing DSB values, Microfluidic Sperm Sorting (MSS) devices are promising tools to reduce this damage. Objective: To study the clinical utility of an MSS device in ICSI treatments when the male partner presents increased DSB values, as compared to the use of conventional methods based on sperm motility. Methods: This retrospective cohort study included 28 infertile couples undergoing ICSI treatments. Only couples where the male partner presented increased values of DSB were included. DSB values were evaluated in semen samples by the Neutral Comet assay. Couples performed a first ICSI cycle using conventional methods for semen preparation (Density Gradients and Swim-up) and a second ICSI cycle using the ZyMōt™ICSI (formerly named FertileChip®) microfluidic device. Embryology and clinical outcomes were compared between ICSI cycles. Results: Semen parameters and the number of obtained and fertilized oocytes did not show differences between ICSI rounds. Clinical outcomes were statistically better when MSS was used: the biochemical pregnancy rate increased 28.31%; the clinical pregnancy rate increased 35.56% and the number of live births increased 35.29%, as compared to the first ICSI cycle in this group of patients. (AU)

Antecedentes: Valores elevados de fragmentación de cadena doble (DSB) en el ADN de los espermatozoides se han asociado con retrasos en la cinética embrionaria, fallos de implantación en ciclos de ICSI y con abortos de repetición. Actualmente no hay evidencias de que los métodos convencionales para la preparación del semen puedan reducir los niveles de DSB. Por el contrario, los nuevos dispositivos microfluídicos de selección espermática (MSS) han mostrado resultados prometedores en cuanto a la reducción de la fragmentación. Objetivo: Evaluar el uso de un dispositivo MSS en ciclos de ICSI donde el varón presenta niveles elevados de DSB, en comparación con el uso de métodos convencionales basados en la selección por motilidad. Métodos: Este estudio retrospectivo ha incluido a 28 parejas infértiles que han realizado ciclos de ICSI y donde se han detectado valores elevados de DSB en la muestra seminal del varón. Los niveles de DSB se han analizado mediante el test Cometa Neutro. Las parejas realizaron un primer ciclo de ICSI utilizando métodos convencionales para la preparación del semen (gradientes de densidad y Swim-up). Posteriormente, las parejas realizaron un segundo ciclo de ICSI utilizando el dispositivo microfluídico ZyMōt™ICSI (antes FertileChip®). Se han comparado los resultados de embriología y los resultados clínicos entre ambos tratamientos. Resultados: No se han encontrado diferencias entre ambos ciclos de ICSI en cuanto a parámetros seminales y el número de ovocitos obtenidos y fecundados. Los resultados clínicos fueron mejores cuando se usó el dispositivo MSS: se observó un incremento del 28,31% en la tasa de embarazo bioquímico, del 35,56% en la tasa de embarazo clínico y del 35,29% en la tasa de nacidos vivos, en comparación con el uso de métodos convencionales. (AU)

Actitudes sexuales y violencia en estudiantes de la Universidad de Huelva / Sexual attitudes and violence in students of the University of Huelva

Introducción: Las actitudes sexuales están relacionadas con las normas y costumbres que se consideran adecuadas según la época en la que se vive; suelen ser más restrictivas para las mujeres. Objetivo: El objetivo de este estudio es analizar de qué forma las actitudes sexuales (erotofilia-erotofobia y doble moral sexual) pueden predisponer hacia la violencia sexual (actitudes favorables a la violación). Material y métodos: La muestra está formada por 868 estudiantes de la Universidad de Huelva (723 mujeres y 145 hombres), con edades comprendidas entre los 17 y los 57 años. Se ha utilizado la Escala de Doble Moral, la Escala de Actitud Favorable a la Violación y la Encuesta Revisada de Opinión Sexual. Resultados: Las personas que se muestran más erotofílicas son las bisexuales (x̄=99,10) y las personas que se consideran de izquierda en política (x̄=96,91). Las puntuaciones más altas en doble moral las obtienen los hombres (x̄=18,50), estudiantes de máster (x̄=18,58), asexuales (x̄=20,50) y personas que se consideran de centro (x̄=18,24). En cuanto a actitudes favorables a la violación, se destacan los hombres (x̄=37,72), heterosexuales (x̄=33,29) y personas que se consideran de derecha (x̄=37,35). Las diferencias encontradas entre los grupos son estadísticamente significativas. Conclusiones: Se confirma que las actitudes sexuales pueden predisponer a la violencia sexual, lo que muestra la necesidad de seguir trabajando en esta línea para así fomentar experiencias sexuales placenteras. (AU)

Introduction: Sexual attitudes are related to the norms and customs that are considered appropriate according to the era in which one lives, usually showing themselves more restrictive for women. Objective: The aim of this study is to analyze how sexual attitudes (erotophilia-erotophobia and sexual double standards) may predispose to sexual violence (attitudes in favor of rape).Material and methods: The sample consisted of 868 students from the University of Huelva (723 women and 145 men), aged between 17 and 57 years. The Double Moral Scale, the Rape Favorable Attitude Scale and the Revised Sexual Opinion Survey were used. Results: People who are more erotophilic are bisexuals (x̄=99.10) and people who consider themselves left-wing in politics (x̄=96.91). The highest double standards scores are obtained by men (x̄=18.50), master's students (x̄=18.58), asexuals (x̄=20.50) and people who consider themselves centrist (x̄=18.24). In terms of pro-rape attitudes, men (x̄=37.72), heterosexuals (x̄=33.29) and people who consider themselves right-wing (x̄=37.35) stand out. The differences found between the groups are statistically significant. Conclusions: It is confirmed that sexual attitudes can predispose to sexual violence, which shows the need to continue working in this line in order to promote pleasurable sexual experiences. (AU)

A simple double differential centrifugation-wash procedure to rapidly obtain bacterial identification and direct antimicrobial susceptibility testing from positive blood cultures.

INTRODUCTION: This study proposes a simple and rapid method for both bacterial identification and direct antimicrobial susceptibility testing (AST) by using MALDI-TOF and a double differential centrifugation-wash procedure from positive blood cultures. METHODS: Fifty-two positive blood cultures (37 gramnegative bacilli and 15 grampositive cocci) were studied by two methods for identification and AST: a reference method, and the rapid MALDI-TOF method obtaining a purified pellet by using a double differential centrifugation procedure. RESULTS: A total of 1101 MIC values (mg/l) were interpreted according to EUCAST clinical breakpoints and compared using the two methods simultaneously. Discrepancies in 81 MIC values (7.35%) were detected. By analyzing standard parameters, we obtained 98.28% essential agreement and 92.65% categorical agreement considering all isolates tested. CONCLUSION: This method provides rapid bacterial identification and AST, offering definitive results 24-48h earlier than the conventional method (p<0.001) and improving the turnaround time in blood culture diagnostics, especially in laboratories without 24-h on-call.