First-line therapy with palbociclib in patients with advanced HR+/HER2- breast cancer: The real-life study PALBOSPAIN.

PURPOSE: To evaluate the efficacy and safety of first-line therapy with palbociclib in a Spanish cohort treated after palbociclib approval. METHODS: PALBOSPAIN is an observational, retrospective, multicenter study evaluating real-world patterns and outcomes with 1 L palbociclib in men and women (any menopausal status) with advanced HR+/HER2- BC diagnosed between November 2017 and November 2019. The primary endpoint was real-world progression-free survival (rw-PFS). Secondary endpoints included overall survival (OS), the real-world response rate (rw-RR), the clinical benefit rate, palbociclib dose reduction, and safety. RESULTS: A total of 762 patients were included. The median rw-PFS and OS were 24 months (95% CI 21-27) and 42 months (40-not estimable [NE]) in the whole population, respectively. By cohort, the median rw-PFS and OS were as follows: 28 (95% CI 23-39) and 44 (95% CI 38-NE) months in patients with de novo metastatic disease, 13 (95% CI 11-17) and 36 months (95% CI 31-41) in patients who experienced relapse < 12 months after the end of ET, and 31 months (95% CI 26-37) and not reached (NR) in patients who experienced relapse > 12 months after the end of ET. rw-PFS and OS were longer in patients with oligometastasis and only one metastatic site and those with non-visceral disease. The most frequent hematologic toxicity was neutropenia (72%; grade ≥ 3: 52.5%), and the most common non-hematologic adverse event was asthenia (38%). CONCLUSION: These findings, consistent with those from clinical trials, support use of palbociclib plus ET as 1 L for advanced BC in the real-world setting, including pre-menopausal women and men. TRIAL REGISTRATION NUMBER: NCT04874025 (PALBOSPAIN). Date of registration: 04/30/2021 retrospectively registered.

[Fungal infection by Cladophialophora bantiana and development of cerebral phaeohyphomycosis. A systematic review of 58 case reports]. / Infección micótica por Cladophialophora bantiana y desarrollo de feohifomicosis cerebral. Revisión sistemática de 58 informes de caso.

INTRODUCTION: Cladophialophora bantiana is a filamentous fungus, known as a dematiaceous fungus because of the presence of melanin. This fungus is of clinical importance because it is neurotropic and causes cerebral phaeohyphomycosis. MATERIAL AND METHODS: The available scientific information on the development of cerebral phaeohyphomycosis caused by Cladophialophora bantiana was analysed by selecting articles from the PubMed, Scopus and Google Scholar databases that describe case reports of fungal infection by C. bantiana in adults, taking into account the analysis of the patients' symptomatology, clinical history and neuroanatomical damage, in addition to considering the mortality of the condition. RESULTS: India and United States were the countries with most case reports, with 32 and 11 cases respectively. Moreover, in terms of neuroanatomical lesions, the majority of patients suffered mixed lesions (29%) and frontal lobe lesions (22%). In accordance with the patients' condition, the pathology has a mortality rate of 62%. CONCLUSIONS: It is concluded that cerebral phaeohyphomycosis has a high mortality rate, there is no standardised treatment and, in most cases, the fungal infection of the brain is mixed and affects several different parts of it. Furthermore, if not diagnosed and treated in time, it can lead to the patients' death.

TITLE: Infección micótica por Cladophialophora bantiana y desarrollo de feohifomicosis cerebral. Revisión sistemática de 58 informes de caso.Introducción. Cladophialophora bantiana es un hongo filamentoso, denominado hongo dematiáceo por la presencia de melanina. Este hongo tiene importancia clínica por ser neurotrópico y causar feohifomicosis cerebral. Material y métodos. Se analizó la información científica disponible sobre el desarrollo de feohifomicosis cerebral provocada por Cladophialophora bantiana, seleccionando artículos de las bases de PubMed, Scopus y Google Scholar, que describen informes de caso sobre infección micótica de C. bantiana en adultos, considerando el análisis de la sintomatología, el historial clínico y los daños neuroanatómicos de los pacientes, además de considerar la mortalidad de la patología. Resultados. La India y Estados Unidos fueron los países con más informes de caso, 32 y 11 casos, respectivamente. Asimismo, en cuanto a las lesiones neuroanatómicas, en su mayoría, los pacientes sufrieron lesiones mixtas (29%) y del lóbulo frontal (22%). De acuerdo con el estado de los pacientes, la patología tiene una mortalidad del 62%. Conclusiones. Se concluye que la feohifomicosis cerebral tiene una alta mortalidad, no existe un tratamiento estandarizado y, en la mayoría de los casos, la infección fúngica del cerebro es mixta y afecta a varias partes del cerebro; además, si no se diagnostica y trata a tiempo, puede ocasionar la muerte de los pacientes.

Infección micótica por Cladophialophora bantiana y desarrollo de feohifomicosis cerebral. Revisión sistemática de 58 informes de caso / Fungal infection by Cladophialophora bantiana and development of cerebral phaeohyphomycosis. A systematic review of 58 case reports

Introducción: Cladophialophora bantiana es un hongo filamentoso, denominado hongo dematiáceo por la presencia de melanina. Este hongo tiene importancia clínica por ser neurotrópico y causar feohifomicosis cerebral. Material y métodos. Se analizó la información científica disponible sobre el desarrollo de feohifomicosis cerebral provocada por Cladophialophora bantiana, seleccionando artículos de las bases de PubMed, Scopus y Google Scholar, que describen informes de caso sobre infección micótica de C. bantiana en adultos, considerando el análisis de la sintomatología, el historial clínico y los daños neuroanatómicos de los pacientes, además de considerar la mortalidad de la patología.ResultadosLa India y Estados Unidos fueron los países con más informes de caso, 32 y 11 casos, respectivamente. Asimismo, en cuanto a las lesiones neuroanatómicas, en su mayoría, los pacientes sufrieron lesiones mixtas (29%) y del lóbulo frontal (22%). De acuerdo con el estado de los pacientes, la patología tiene una mortalidad del 62%.ConclusionesSe concluye que la feohifomicosis cerebral tiene una alta mortalidad, no existe un tratamiento estandarizado y, en la mayoría de los casos, la infección fúngica del cerebro es mixta y afecta a varias partes del cerebro; además, si no se diagnostica y trata a tiempo, puede ocasionar la muerte de los pacientes. (AU)

INTRODUCTION: Cladophialophora bantiana is a filamentous fungus, known as a dematiaceous fungus because of the presence of melanin. This fungus is of clinical importance because it is neurotropic and causes cerebral phaeohyphomycosis. Material and methods. The available scientific information on the development of cerebral phaeohyphomycosis caused by Cladophialophora bantiana was analysed by selecting articles from the PubMed, Scopus and Google Scholar databases that describe case reports of fungal infection by C. bantiana in adults, taking into account the analysis of the patients’ symptomatology, clinical history and neuroanatomical damage, in addition to considering the mortality of the condition.RESULTSIndia and United States were the countries with most case reports, with 32 and 11 cases respectively. Moreover, in terms of neuroanatomical lesions, the majority of patients suffered mixed lesions (29%) and frontal lobe lesions (22%). In accordance with the patients’ condition, the pathology has a mortality rate of 62%.CONCLUSIONSIt is concluded that cerebral phaeohyphomycosis has a high mortality rate, there is no standardised treatment and, in most cases, the fungal infection of the brain is mixed and affects several different parts of it. Furthermore, if not diagnosed and treated in time, it can lead to the patients’ death. (AU)

Ventilación controlada por flujo y gafas nasales de alto flujo en cirugía láser de estenosis subglótica grado III / Flow-controlled ventilation and hi-flow nasal oxygen in laser surgery for a grade III subglottic stenosis patient

Paciente de 49 años (IMC 29,4 kg/m2 y ASA III) con estenosis subglótica (ES) de más de 70% (grado III) intervenida mediante resección láser y posterior dilatación. Durante la resección láser se empleó ventilación controlada por flujo utilizando el respirador Evone®, que permite controlar todo el ciclo respiratorio regulando tanto el flujo inspiratorio como el espiratorio sin comprometer el intercambio gaseoso a pesar de administrar FIO2 máxima de 0,3 por riesgo de ignición. Antes de proceder a la dilatación endoscópica, se retiró el tubo endotraqueal láser de 4,5 mm de diámetro interno y se inició terapia con gafas nasales de alto flujo (GNAF) para prolongar la oxigenación apneica. El tiempo total de apnea fue de 11 minutos, manteniendo en todo momento SpO2 > 98% y End Tidal de CO2 máximo de 60 mmHg.(AU)

A 49-year old patient (BMI 29.4 kg/m2 and ASA III) with grade III subglottic stenosis (> ventilator in flow controlled ventilation mode, which allowed us to regulate both inspiratory and expiratory flow without compromising gas exchange despite maintaining peak FIO2 at 0.3 due to the risk of ignition. Before proceeding with endoscopic dilation, the 4.5 mm laser endotracheal tube was withdrawn and high flow nasal cannula oxygenation was started in order to prolong apnoeic oxygenation. Total apnoea time was 11 minutes, maintaining SpO2 > 70%) underwent laser resection followed by dilation. During resection he was ventilated by the Evone > ventilator; high flow nasal cannula therapy; apnoeic oxygenation-98% and peak EtCO2 60 mmHg throughout the procedure.(AU)

Flow-controlled ventilation and hi-flow nasal oxygen in laser surgery for a grade III subglottic stenosis patient.

A 49-year old patient (BMI 29.4kg/m2 and ASA III) with grade III subglottic stenosis (> ventilator in flow controlled ventilation mode, which allowed us to regulate both inspiratory and expiratory flow without compromising gas exchange despite maintaining peak FIO2 at 0.3 due to the risk of ignition. Before proceeding with endoscopic dilation, the 4.5mm laser endotracheal tube was withdrawn and high flow nasal cannula oxygenation was started in order to prolong apnoeic oxygenation. Total apnoea time was 11min, maintaining SpO2>70%) underwent laser resection followed by dilation. During resection he was ventilated by the Evone>ventilator; high flow nasal cannula therapy; apnoeic oxygenation-98% and peak EtCO2 60mmHg throughout the procedure.

Elimination of Interface Energy Barriers Using Dendrimer Polyelectrolytes with Fractal Geometry.

In this work we study conjugated polyelectrolyte (CPE) films based on polyamidoamine (PAMAM) dendrimers of generations G1 and G3. These fractal macromolecules are compared to branched polyethylenimine (b-PEI) polymer using methanol as the solvent. All of these materials present a high density of amino groups, which protonated by methoxide counter-anions create strong dipolar interfaces. The vacuum level shift associated to these films on n-type silicon was 0.93 eV for b-PEI, 0.72 eV for PAMAM G1 and 1.07 eV for PAMAM G3. These surface potentials were enough to overcome Fermi level pinning, which is a typical limitation of aluminium contacts on n-type silicon. A specific contact resistance as low as 20 mΩ·cm2 was achieved with PAMAM G3, in agreement with the higher surface potential of this material. Good electron transport properties were also obtained for the other materials. Proof-of-concept silicon solar cells combining vanadium oxide as a hole-selective contact with these new electron transport layers have been fabricated and compared. The solar cell with PAMAM G3 surpassed 15% conversion efficiency with an overall increase of all the photovoltaic parameters. The performance of these devices correlates with compositional and nanostructural studies of the different CPE films. Particularly, a figure-of-merit (Vσ) for CPE films that considers the number of protonated amino groups per macromolecule has been introduced. The fractal geometry of dendrimers leads to a geometric increase in the number of amino groups per generation. Thus, investigation of dendrimer macromolecules seems a very good strategy to design CPE films with enhanced charge-carrier selectivity.

The Relationship between Photoluminescence Emissions and Photocatalytic Activity of CeO2 Nanocrystals.

In this work, we focus on understanding the morphology and photocatalytic properties of CeO2 nanocrystals (NCs) synthesized via a microwave-assisted solvothermal method using acetone and ethanol as solvents. Wulff constructions reveal a complete map of available morphologies and a theoretical-experimental match with octahedral nanoparticles obtained through synthesis using ethanol as solvent. NCs synthesized in acetone show a greater contribution of emission peaks in the blue region (∼450 nm), which may be associated with higher Ce3+ concentration, originating shallow-level defects within the CeO2 lattice while for the samples synthesized in ethanol a strong orange-red emission (∼595 nm) suggests that oxygen vacancies may originate from deep-level defects within the optical bandgap region. The superior photocatalytic response of CeO2 synthesized in acetone compared to that of CeO2 synthesized in ethanol may be associated with an increase in long-/short-range disorder within the CeO2 structure, causing the Egap value to decrease, facilitating light absorption. Furthermore, surface (100) stabilization in samples synthesized in ethanol may be related to low photocatalytic activity. Photocatalytic degradation was facilitated by the generation of ·OH and ·O2- radicals as corroborated by the trapping experiment. The mechanism of enhanced photocatalytic activity has been proposed suggesting that samples synthesized in acetone tend to have lower e'─h· pair recombination, which is reflected in their higher photocatalytic response.

Compassion fatigue and anxiety in critical care emergency nurses: In between efficiency and humanity.

OBJECTIVES: To determine the emotional impact of permanent proximity to trauma and death in the Emergency and ICU's nurses establishing prevalence of Compassionate Fatigue (burnout and Secondary Traumatic Stress) and anxiety. Analyze its relationship with sociodemographic, training, workplace and psychological variables. METHODS: Descriptive, cross-sectional and multicentre study. The validated ProQOL v. IV and STAI scales and an ad-hoc questionnaire with the variables of the second objective were used in 710 nurses from nine highly complex hospitals in Catalonia (Spain). RESULTS: In both units, the prevalence of professionals affected with high scores of burnout was higher than 20%, on Secondary Traumatic Stress was 30% and, 12% on anxiety. Each subscale was significantly associated with the intention to leave units and the career. 97% of participants stated that they needed to be trained in emotional management. CONCLUSION: The prevalence of burnout and Secondary Traumatic Stress were higher in our study than those offered in the reference literature in emergency and ICU nurses. The prevalence of each construct was individually related to the desire to leave work units and career. This fact, together with the participants' desire to be better trained in emotional management exposes the need to establish educational plans, as well as institutional measures to prevent and support nurses for Compassion Fatigue.

Multidisciplinary approach of the sequelae one month after hospital discharge in patients with severe bilateral COVID-19 pneumonia, are there differences depending on the respiratory therapy used during admission to intensive care?

OBJECTIVE: To describe the sequelae one month after hospital discharge in patients who required admission to Intensive Care for severe COVID 19 pneumonia and to analyze the differences between those who received therapy exclusively with high-flow oxygen therapy compared to those who required invasive mechanical ventilation. DESIGN: Cohort, prospective and observational study. SETTING: Post-intensive care multidisciplinary program. PATIENTS OR PARTICIPANTS: Patients who survived admission to the intensive care unit (ICU) for severe COVID 19 pneumonia from April 2020 to October 2021. INTERVENTIONS: Inclusion in the post-ICU multidisciplinary program. MAIN VARIABLES OF INTEREST: Motor, sensory, psychological/psychiatric, respiratory and nutritional sequelae after hospital admission. RESULTS: 104 patients were included. 48 patients received high-flow nasal oxygen therapy (ONAF) and 56 invasive mechanical ventilation (IMV). The main sequelae found were distal neuropathy (33.9% IMV vs 10.4% ONAF); brachial plexopathy (10.7% IMV vs 0% ONAF); decrease in grip strength: right hand 20.67kg (±8.27) in VMI vs 31.8kg (±11.59) in ONAF and left hand 19.39kg (±8.45) in VMI vs 30.26kg (±12.74) in ONAF; and limited muscle balance in the lower limbs (28.6% VMI vs 8.6% ONAF). The differences observed between both groups did not reach statistical significance in the multivariable study. CONCLUSIONS: The results obtained after the multivariate study suggest that there are no differences in the perceived physical sequelae one month after hospital discharge depending on the respiratory therapy used, whether it was high-flow nasal oxygen therapy or prolonged mechanical ventilation, although more studies are needed to be able to draw conclusions.

Fatiga por compasión y ansiedad en enfermeras de cuidados críticos y emergencias. Entre eficiencia y humanidad / Compassion fatigue and anxiety in critical care emergency nurses: In between efficiency and humanity

Objetivos: Determinar el impacto emocional de la proximidad al trauma y la muerte en enfermeras de urgencias y de UCI mediante las prevalencias de fatiga de compasión (burnout y estrés traumático secundario) y ansiedad. Analizar su relación con variables de tipo sociodemográfico, formativas, laborales y psicológicas. Método: Estudio descriptivo, transversal y multicéntrico. Se utilizaron las escalas validadas ProQOL v.IV y STAI y un cuestionario ad-hoc con las variables del segundo objetivo, en 710 enfermeras de nueve hospitales de alta complejidad de Cataluña (España). Resultados: En ambas unidades, la proporción de profesionales afectados en alto grado de burnout fue superior al 20%, al 30% en estrés traumático secundario y al 12% en ansiedad. Cada subescala se asoció con la intención de abandonar la unidad y la profesión. El 97% de participantes manifestaron que era necesario recibir formación en gestión emocional. Conclusiones: Las prevalencias de burnout y de estrés traumático secundario fueron superiores en nuestro estudio respecto a la literatura de referencia en las enfermeras de urgencias y en las de UCI. La prevalencia de cada constructo se relacionó individualmente con el deseo de abandono de las enfermeras de sus unidades y de su profesión. Este hecho, junto al deseo de recibir formación de los participantes, expone la necesidad de establecer planes formativos, así como medidas institucionales de prevención y apoyo para la fatiga por compasión.(AU)

Objectives: To determine the emotional impact of permanent proximity to trauma and death in the Emergency and ICU's nurses establishing prevalence of Compassionate Fatigue (burnout and secondary traumatic stress) and anxiety. Analyze its relationship with sociodemographic, training, workplace and psychological variables. Methods: Descriptive, cross-sectional and multicentre study. The validated ProQOL v.IV and STAI scales and an ad-hoc questionnaire with the variables of the second objective were used in 710 nurses from nine highly complex hospitals in Catalonia (Spain). Results: In both units, the prevalence of professionals affected with high scores of burnout was higher than 20%, on secondary traumatic stress was 30%, and 12% on anxiety. Each subscale was significantly associated with the intention to leave units and the career. 97% of participants stated that they needed to be trained in emotional management. Conclusion: The prevalence of burnout and secondary traumatic stress were higher in our study than those offered in the reference literature in emergency and ICU nurses. The prevalence of each construct was individually related to the desire to leave work units and career. This fact, together with the participants’ desire to be better trained in emotional management exposes the need to establish educational plans, as well as institutional measures to prevent and support nurses for Compassion Fatigue.(AU)

[Multidisciplinary approach of the sequelae one month after hospital discharge in patients with severe bilateral COVID-19 pneumonia, are there differences depending on the respiratory therapy used during admission to intensive care?] / Valoración multidisciplinar de las secuelas al mes del alta hospitalaria por neumonía grave COVID-19, ¿existen diferencias en función de la terapia respiratoria empleada durante su ingreso en Cuidados Intensivos?

Objective: To describe the sequelae one month after hospital discharge in patients who required admission to intensive care for severe COVID-19 pneumonia and to analyze the differences between those who received therapy exclusively with high-flow oxygen therapy compared to those who required invasive mechanical ventilation. Design: Cohort, prospective and observational study. Setting: Post-intensive care multidisciplinary program. Patients or participants: Patients who survived admission to the intensive care unit (ICU) for severe COVID-19 pneumonia from April 2020 to October 2021. Interventions: Inclusion in the post-ICU multidisciplinary program. Main variables of interest: Motor, sensory, psychological/psychiatric, respiratory and nutritional sequelae after hospital admission. Results: One hundred and four patients were included. 48 patients received high-flow nasal oxygen therapy (ONAF) and 56 invasive mechanical ventilation (IMV). The main sequelae found were distal neuropathy (33.9% IMV vs. 10.4% ONAF); brachial plexopathy (10.7% IMV vs. 0% ONAF); decrease in grip strength: right hand 20.67 kg (± 8.27) in VMI vs. 31.8 kg (± 11.59) in ONAF and left hand 19.39 kg (± 8.45) in VMI vs. 30.26 kg (± 12.74) in ONAF; and limited muscle balance in the lower limbs (28.6% VMI vs. 8.6% ONAF). The differences observed between both groups did not reach statistical significance in the multivariable study. Conclusions: The results obtained after the multivariate study suggest that there are no differences in the perceived physical sequelae one month after hospital discharge depending on the respiratory therapy used, whether it was high-flow nasal oxygen therapy or prolonged mechanical ventilation, although more studies are needed to be able to draw conclusions.

Amoebicidal activity of cationic carbosilane dendrons derived with 4-phenylbutyric acid against Acanthamoeba griffini and Acanthamoeba polyphaga trophozoites and cysts.

Amoebae from the genus Acanthamoeba are important pathogens responsible for severe illnesses in humans such as Acanthamoeba keratitis and granulomatous amoebic encephalitis. In the last few decades, AK diagnoses have steadily increased. Most patients suffering from AK were contact lens users and the infection was related to poor hygiene. However, therapy is not yet well established, and treatments may last for several months due to resistance. Moreover, these treatments have been described to generate cytotoxicity. Therefore, there is an urgent need to develop new therapeutic strategies against AK. In this study, the amoebicidal activity of different generation cationic carbosilane dendrons derived with 4-phenylbutyric acid was demonstrated against Acanthamoeba polyphaga and Acanthamoeba griffini trophozoites and cysts. In addition, the combination of chlorhexidine digluconate and the most effective dendron (ArCO2G2(SNMe3I)4) showed an in vitro effect against Acanthamoeba trophozoites and cysts, reducing the minimal trophozoite amoebicidal concentration as well as concentrations with cysticidal activity.

Robust but weak winter atmospheric circulation response to future Arctic sea ice loss.

The possibility that Arctic sea ice loss weakens mid-latitude westerlies, promoting more severe cold winters, has sparked more than a decade of scientific debate, with apparent support from observations but inconclusive modelling evidence. Here we show that sixteen models contributing to the Polar Amplification Model Intercomparison Project simulate a weakening of mid-latitude westerlies in response to projected Arctic sea ice loss. We develop an emergent constraint based on eddy feedback, which is 1.2 to 3 times too weak in the models, suggesting that the real-world weakening lies towards the higher end of the model simulations. Still, the modelled response to Arctic sea ice loss is weak: the North Atlantic Oscillation response is similar in magnitude and offsets the projected response to increased greenhouse gases, but would only account for around 10% of variations in individual years. We further find that relationships between Arctic sea ice and atmospheric circulation have weakened recently in observations and are no longer inconsistent with those in models.

An update on interstitial lung disease.

Interstitial lung diseases are a complex group of conditions that cause inflammation and scarring of the lung interstitium. This article discusses the diagnosis and management of common interstitial lung diseases including idiopathic pulmonary fibrosis, hypersensitivity pneumonitis, connective tissue disease associated-interstitial lung disease, sarcoidosis and drug-induced interstitial lung disease. A multidisciplinary approach to diagnosis of interstitial lung disease is the gold standard; key history and examination features, blood panel, pulmonary function tests, high resolution computed tomography imaging, and when required bronchoalveolar lavage and lung biopsy results are discussed to reach a multidisciplinary consensus diagnosis. Advances, including the development of the disease-modifying anti-fibrotic medications nintedanib and pirfenidone, continue to shape the future management of interstitial lung disease. A holistic approach to the care of patients with interstitial lung disease is paramount, as they often have a high symptom burden and considerable palliative care needs.

Gestación heterotópica abdominal tras fecundación in vitro y transferencia embrionaria. Reporte de un caso y discusión sobre el diagnóstico y manejo / Abdominal heterotopic pregnancy after IVF and embryo transfer. A case report and a review of the diagnosis and management

La coexistencia de una gestación intrauterina y una extrauterina se denomina gestación heterotópica. Es una condición poco frecuente, que ocurre en un 0,001-0,006% de las gestaciones espontáneas y hasta en un 1% de las gestaciones conseguidas mediante técnicas de reproducción asistida.Presentamos un caso de gestación heterotópica con implantación pélvica, una circunstancia extremadamente rara, y discutimos sobre su diagnóstico y su manejo clínico insistiendo en la necesidad de pensar en esta entidad aunque se objetive una gestación intrauterina tras una técnica de reproducción asistida y aunque no existan otros factores de riesgo. Un diagnóstico y tratamiento precoces serán claves para evitar las graves complicaciones asociadas a este tipo de gestación.(AU)

The coexistence of an intrauterine pregnancy and an extra-uterine one is called a heterotopic pregnancy. It is a rare condition that occurs in 0.001-0.006% of spontaneous pregnancies, and in up to 1% of pregnancies achieved through assisted reproduction treatments.The case is presented of a heterotopic pregnancy with pelvic implantation, an extremely uncommon event, followed by a discussion on its diagnosis and clinical management. There must be awareness of this disorder, even if an intra-uterine pregnancy is observed after an assisted reproduction treatment, and although there are no other risk factors.Early diagnosis and treatment is essential to avoid the serious complications associated with this type of pregnancy.(AU)

Multi- and single-reference methods for the analysis of multi-state peroxidation of enolates.

In spite of being spin-forbidden, some enzymes are capable of catalyzing the incorporation of O2(Σg-3) to organic substrates without needing any cofactor. It has been established that the process followed by these enzymes starts with the deprotonation of the substrate forming an enolate. In a second stage, the peroxidation of the enolate formation occurs, a process in which the system changes its spin multiplicity from a triplet state to a singlet state. In this article, we study the addition of O2 to enolates using state-of-the-art multi-reference and single-reference methods. Our results confirm that intersystem crossing is promoted by stabilization of the singlet state along the reaction path. When multi-reference methods are used, large active spaces are required, and in this situation, semistochastic heat-bath configuration interaction emerges as a powerful method to study these multi-configurational systems and is in good agreement with PNO-LCCSD(T) when the system is well-represented by a single-configuration.

Uso de sulfato de magnesio relacionado con la reanimación neonatal en prematuros / Use of magnesium sulfate in the neonatal reanimation of prematures / Uso de sulfato de magnésio relacionado à ressuscitação neonatal em prematuros

RESUMEN Introducción: La neuroprotección farmacológica se utiliza en el período antenatal para ayudar a disminuir el riesgo de parálisis cerebral o disfunciones motoras en el recién nacido (RN). El sulfato de magnesio (MgSO4) es de gran utilidad por los beneficios que proporciona como tocolítico, neuroprotector fetal en prematuros menores a 32 semanas y en el manejo de la preeclampsia. Sin embargo, durante su uso se observaron efectos adversos a dosis dependientes tanto para la madre como para el RN, lo que genera gran importancia para el trabajo del profesional de obstetricia y enfermería. Objetivo: Determinar la frecuencia de reanimación neonatal en prematuros menores de 32 semanas según el uso de neuroprotección con MgSO4. Métodos: Estudio retrospectivo, observacional, realizado en un hospital de Santiago de Chile. Se realizó un muestreo aleatorio simple. Se incluyeron prematuros menores a 32 semanas de edad gestacional con o sin tratamiento de MgSO4 que hayan requerido o no reanimación neonatal. La información fue recogida a partir de fichas clínicas con un instrumento propio. Análisis de los datos por determinación de frecuencias absolutas y relativas de las variables y su comparación directa. Resultados: Del total de los RN que recibieron MgSO4, 61.7 % requirió reanimación neonatal al nacer, de los que no recibieron este neuroprotector, el 52.8 % necesitó reanimación neonatal. Conclusiones: La mayor frecuencia de reanimación neonatal está asociada al uso de la neuroprotección con MgSO4 y ocurre más probablemente en recién nacidos de edad gestacional menor que 32 semanas. Los resultados contribuyen a la toma de decisiones basadas en pruebas.

ABSTRACT Introduction: Diverse drug-related neuroprotections are used during the prenatal period to help reduce the risk of cerebral palsy or motor dysfunctions in the newborn. Magnesium sulfate (MgSO4) is useful as a fetal neuroprotector in prematures with less than 32 weeks, as well as in the management of preeclampsia. Nevertheless, some dose-dependent adverse effects both on the mother and the newborn have been reported. This situation is necessarily of concern to the nursing and obstetrics professional. Objective: To determine the frequency of neonatal reanimation en prematures with less than 32 weeks with MgSO4 neuroprotection. Methods: This is a retrospective and observational study conducted in a hospital in Santiago, Chile. Simple random sampling was used. Prematures with less than 32 weeks of gestational age, with or without MgSO4 treatment and who had or had not required neonatal reanimation, were included in the study. Data were collected from clinical records. Absolute and relative frequencies and their direct comparisons were calculated. Results: From the total of newborns who received MgSO4, 61.7% required neonatal reanimation, while from those who did not receive MgSO4, 52.8% required neonatal reanimation. Conclusions: The higher frequency of neonatal reanimation is associated with the received MgSO4 as a neuroprotection with and occurs more likely in neonates with a gestational age less than 32 weeks. The results contribute to evidence-based decision making.

RESUMO Introdução: A neuroproteção farmacológica é utilizada no período pré-natal para ajudar a reduzir o risco de paralisia cerebral ou disfunções motoras no recém-nascido (RN). O sulfato de magnésio (MgSO4) é muito útil devido aos benefícios que proporciona como tocolítico, neuroprotetor fetal em prematuros com menos de 32 semanas e no tratamento da pré-eclâmpsia. Porém, durante seu uso, foram registrados efeitos adversos em doses dependentes tanto para a mãe quanto para o recém-nascido, o que gera grande importância para o trabalho do profissional obstétrico e de enfermagem. Objetivo: Determinar a frequência de reanimação neonatal em prematuros com menos de 32 semanas de acordo com o uso de neuroproteção com MgSO4. Métodos: Estudo retrospectivo e observacional realizado em um hospital de Santiago de Chile. Foi realizada uma amostragem aleatória simples. Foram incluídos bebês prematuros com menos de 32 semanas de idade gestacional com ou sem tratamento com MgSO4 que exigia ou não a reanimação neonatal. Coletou-se informação de prontuários clínicos com um instrumento proprietário. Análise dos dados através da determinação das frequências absolutas e relativas das variáveis e sua comparação direta. Resultados: Do total dos RN que receberam MgSO4, 61,7% necessitaram de reanimação neonatal ao nascimento, dos que não receberam esse neuroprotetor, 52,8% necessitaram de reanimação neonatal. Conclusões: A frequência de reanimação neonatal foi maior em recém-nascidos com menos de 32 semanas de idade gestacional que receberam neuroproteção com MgSO4, situação semelhante em cada estrato de idade gestacional.

Hemocromatosis y rendimiento deportivo: una revisión sistemática / Hemochromatosis and sports performance: a systematic review / Hemocromatose e desempenho desportivo: uma revisão sistemática

INTRODUCCIÓN: La hemocromatosis hereditaria, al provocar hiperferritinemia, puede tener el potencial de aumentar la capacidad aeróbica y el rendimiento deportivo en atletas. Sin embargo, diversos estudios afirman que la sobrecarga de hierro podría afectar negativamente al rendimiento físico y la función muscular. OBJETIVO: Recopilar y analizar evidencias sobre la relación entre la hemocromatosis hereditaria y el rendimiento deportivo. MÉTODO: Se realizó una revisión sistemática, de acuerdo a los estándares PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), en las siguientes bases de datos: Scopus, Web of Science, PubMed y Dialnet. RESULTADOS: Tras aplicar los criterios de inclusión/exclusión, 13 artículos fueron incluidos y analizados. CONCLUSIONES: Existen variaciones en los genes que están relacionados con el estado de resistencia del atleta. Actualmente, el gen HFE no se sitúa entre los polimorfismos del ácido desoxirribonucleico que aumenten el rendimiento deportivo. Son mayoría las investigaciones en las que recalcan la necesidad de evaluar el estado de ingesta de hierro en el deportista

INTRODUCTION: Hereditary hemochromatosis, by causing hyperferritinemia, may have the potential to increase aerobic capacity and sports performance in athletes. However, various studies claim that iron overload could affect physical performance and muscle function negatively. OBJECTIVE: The aim of this review was to collect and analyze evidence on the relationship between hereditary hemochromatosis and sports performance. METHOD: A systematic review was carried out, according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) standards, in the following databases: Scopus, Web of Science, PubMed and Dialnet. RESULTS: After applying the inclusion / exclusion criteria, 13 articles were included and analyzed. CONCLUSIONS: There are variations in the genes which are related to the aerobic capacity of the athletes. Currently, the HFE gene is not among the deoxyribonucleic acid polymorphisms that increase sports performance. The vast majority of the studies analyzed emphasize the need to assess the state of iron intake in athletes

INTRODUÇÃO: A hiperferritinemia associada à hemocromatose hereditária, pode apresentar o potencial de aumentar a capacidade aeróbica e o desempenho desportivo em atletas. Contudo, vários estudos afirmam que a sobrecarga de ferro pode afetar negativamente o desempenho físico e a função muscular. OBJETIVO: Recolher e analisar evidências referentes à relação entre hemocromatose hereditária e desempenho desportivo. MÉTODO: Revisão sistemática de acordo com os padrões PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) através das seguintes bases de dados: Scopus, Web of Science, PubMed e Dialnet. RESULTADOS: Após a aplicação dos critérios de inclusão / exclusão, 13 artigos foram incluídos e analisados. CONCLUSÕES: Existem variações nos genes que estão relacionados com o estado de resistência do atleta. Atualmente, o gene HFE não está entre os polimorfismos de ácido desoxirribonucleico que aumentam o desempenho desportivo. A maioria dos estudos enfatiza a necessidade de avaliar o estado de ingestão de ferro em atletas

Performance of a deep neural network in teledermatology: a single-centre prospective diagnostic study.

BACKGROUND: The use of artificial intelligence (AI) algorithms for the diagnosis of skin diseases has shown promise in experimental settings but has not been yet tested in real-life conditions. OBJECTIVE: To assess the diagnostic performance and potential clinical utility of a 174-multiclass AI algorithm in a real-life telemedicine setting. METHODS: Prospective, diagnostic accuracy study including consecutive patients who submitted images for teledermatology evaluation. The treating dermatologist chose a single image to upload to a web application during teleconsultation. A follow-up reader study including nine healthcare providers (3 dermatologists, 3 dermatology residents and 3 general practitioners) was performed. RESULTS: A total of 340 cases from 281 patients met study inclusion criteria. The mean (SD) age of patients was 33.7 (17.5) years; 63% (n = 177) were female. Exposure to the AI algorithm results was considered useful in 11.8% of visits (n = 40) and the teledermatologist correctly modified the real-time diagnosis in 0.6% (n = 2) of cases. The overall top-1 accuracy of the algorithm (41.2%) was lower than that of the dermatologists (60.1%), residents (57.8%) and general practitioners (49.3%) (all comparisons P < 0.05, in the reader study). When the analysis was limited to the diagnoses on which the algorithm had been explicitly trained, the balanced top-1 accuracy of the algorithm (47.6%) was comparable to the dermatologists (49.7%) and residents (47.7%) but superior to the general practitioners (39.7%; P = 0.049). Algorithm performance was associated with patient skin type and image quality. CONCLUSIONS: A 174-disease class AI algorithm appears to be a promising tool in the triage and evaluation of lesions with patient-taken photographs via telemedicine.