GRABACIÓN Y ARCHIVO DE ENDOSCOPIAS PARA INVESTIGACIÓN EN ENDOMAPPER

El uso de endoscopios atravesando cavidades endoluminales, es habitual para el diagnóstico y tratamiento de enfermedades gastrointestinales. En los últimos años, gracias al avance de la Inteligencia Artificial han surgido nuevos colonoscopios que han permitido un gran avance en el diagnóstico y tratamiento endoscópico. Sin embargo, estos instrumentos carecen de capacidad para realizar una cartografía en tiempo real de las cavidades por donde navegan, y de su ubicación respecto de esa cartografía. El seguimiento y mapeo real de estructuras se basa en la tecnología v-SLAM, sin embargo, esta tecnología está diseñada para mapear estructuras rígidas, no deformables. El objetivo principal de nuestro trabajo de investigación será rediseñar esta tecnología v-SLAM para cavidades no rígidas y deformables como el tracto gastrointestinal.El resultado de este trabajo será un nuevo paradigma de investigación que denominaremos EndoMapper y que permitirá abordar la localización y el mapeo en tiempo real de cavidades del cuerpo humano, utilizando solo el video de un endoscopio monocular estándar.Nuestra metodología de investigación incluirá la explotación masiva de las imágenes obtenidas a partir de endoscopias que se realizan rutinariamente en Servicio de Endoscopias del Hospital Clínico Lozano Blesa de Zaragoza. Por una parte, estas grabaciones permitirán la inclusión de técnicas de aprendizaje profundo (Deep Learning) en EndoMapper y por otra parte para la validación experimental de los resultados obtenidos. <br /

Risk of cancer in patients with inflammatory bowel diseases and keys for patient management

Chronic inflammation in patients with Inflammatory Bowel Disease (IBD) leads to an increased risk of colorectal cancer, small bowel cancer, intestinal lymphoma and cholangiocarcinoma. However, treatments for IBD have also been associated with an increased risk of neoplasms. Patients receiving Thiopurines (TPs) have an increased risk of hematologic malignancies, non-melanoma skin cancer, urinary tract neoplasms and cervical cancer. Anti-TNFs have been associated with a higher risk of neoplasms, mainly lymphomas and melanomas; however, the data are controversial, and some recent studies do not confirm the association. Nevertheless, other biologic agents, such as ustekinumab and vedolizumab, have not shown an increased risk of any neoplasm to date. The risk of malignancies with tofacitinib exists, but its magnitude and relationship with previous treatment with TPs is not defined, so more studies from daily clinical practice are needed. Although biologic therapy seems to be safe for patients with current cancer or a prior history of cancer, as has been demonstrated in other chronic inflammatory conditions, prospective studies in this specific population are needed. Until that time, it is crucial to manage such conditions via the combined clinical expertise of the gastroenterologist and oncologist

Liver fibrosis in non-alcoholic fatty liver disease and progression to hepatocellular carcinoma in patients with inflammatory bowel disease: a systematic review

The aim of the systematic review is to assess the prevalence and risk factors of liver fibrosis in patients with Inflammatory Bowel Disease (IBD) and Non-Alcoholic Fatty Liver Disease (NAFLD) and to discuss the role of liver fibrosis in the progression to hepatocellular carcinoma (HCC). We performed a structured search in PubMed, Web of Science, Embase, and Scopus up to 3 March 2023 to identify observational studies reporting liver fibrosis in patients with NAFLD and IBD. Quality of studies was assessed using the Newcastle-Ottawa Scale (NOS) score. A total of 23 studies met our inclusion criteria, including 629,781 patients. A total of 10 cross-sectional, 3 case-control, and 10 cohort studies were included. Fourteen studies had a NOS score ≥ 7 points. NAFLD was diagnosed in 2162/6332 (34.1%) IBD participants. However, NAFLD diagnosis was established in 924/2962 (31.2%) healthy individuals without IBD. Advanced liver fibrosis was found in 116 (11.6%) of 992 IBD patients with NAFLD. Most studies found an association between NAFLD and classic cardiovascular risk factors such as older age, male sex, higher BMI, diabetes, hypertension and dyslipidemia. In addition, metabolic syndrome features were also associated with an increased risk of significant and advanced liver fibrosis. Although no strong association between NAFLD and IBD therapy was reported, some studies associated NAFLD with IBD diagnosis, Crohn’s Disease, a complicated course of IBD, disease activity, and IBD duration. Advanced liver fibrosis was also associated with Crohn’s disease in several studies. In conclusion, NAFLD and advanced liver fibrosis are prevalent and clinically relevant extraintestinal manifestations, so its diagnosis and potential progression to HCC should be carefully considered in daily clinical practice

Obsolescence in the neighbourhood of Nuestra Señora del Carmen

Actualmente, áreas urbanas donde habita un importantísimo sector poblacional están afectadas por una compleja problemática que se materializa en cuestiones arquitectónicas (desencaje tipológico, deficiencias técnicas, deterioro físico), urbanísticas (aislamiento, carencias funcionales, degradación del espacio público) y sociales (desempleo, segregación, conflictividad). El análisis del estado de obsolescencia de la barriada de El Carmen ha sido el punto de inicio de este trabajo de investigación. A partir de indicadores de obsolescencia socioeconómicos y físicos, anteriormente definidos por el proyecto de investigación «Intervención en barriadas residenciales obsoletas: manual de buenas prácticas» (G-GI3001/IDIH), financiado por la Unión Europea –Fondos FEDER– y gestionado por la Consejería de Fomento y Vivienda de la Junta de Andalucía, se ha establecido la situación de la barriada con referencia a valores máximos y mínimos, hallados a través del estudio de un número representativo de barriadas andaluzas. Tras la valoración del estado de obsolescencia de la barriada, se profundizó en su estudio a través de la comparación del cumplimiento de las recomendaciones establecidas como buenas prácticas en la publicación Intervención en barriadas residenciales obsoletas. Manual de buenas prácticas. Esta verificación permitió la elaboración de un diagnóstico pormenorizado basado en el análisis de los diferentes aspectos atendidos por las buenas prácticas, donde se evaluaban las deficiencias de El Carmen a escala urbana y arquitectónica, y dentro de estas, en diferentes categorías, siendo las urbanas: compacidad, conectividad, zonas verdes, funcionalidad, seguridad e inclusividad; y las arquitectónicas: hibridación, diversidad y flexibilidad, comunidad y accesibilidad. Esta evaluación detallada de las deficiencias y potencialidades de la barriada establecía los fundamentos para la definición de criterios y estrategias de intervención. Estos criterios de intervención tenían como base una selección de las buenas prácticas más adecuadas de acuerdo con las circunstancias halladas en la barriada, sistematizando las actuaciones que priorizan la atención de aspectos primordiales o que actúan mitigando carencias graves. Los criterios que se establecen son: sostenibilidad, la mejora de la calidad de vida de sus residentes y la atracción de nueva población a la barriada. Respondiendo a este estudio y la definición de criterios se proponen actuaciones estratégicas englobadas en cuatro líneas de trabajo: relación con la ciudad y su contexto, cualificación del espacio público y dotaciones existentes, cualificación de edificios existentes y actualización tipológica.Today, a number of high-occupancy urban areas are being affected by a complex problem that materialises in architectural issues (typological mismatch, technical deficiencies, physical deterioration), urban planning issues (isolation, functional inadequacies, deterioration of public space) and social issues (unemployment, segregation, conflict). Analysing the state of obsolescence of the neighbourhood of El Carmen was the starting point of this research project. Using socio-economic and physical obsolescence indicators established in an earlier research project–“Intervention in Obsolete Residential Neighbourhoods: Manual of Best Practices” (G-GI3001/IDIH), funded by the ERDF and managed by the Regional Ministry of Public Works and Housing of Andalusia–the situation of this neighbourhood was defined with reference to minimum and maximum values identified by studying a representative number of Andalusian neighbourhoods. After assessing the neighbourhood’s state of obsolescence, it was then studied to determine the degree of compliance with the best practices recommended in the publication Intervención en barriadas residenciales obsoletas. Manual de buenas prácticas. This verification made it possible to come up with a detailed diagnosis based on the analysis of different aspects addressed in that manual of best practices, evaluating the urban and architectural deficiencies of El Carmen and subdividing each into different categories. Urban deficiencies included compactness, connectivity, green areas, functionality, safety and inclusiveness; and architectural deficiencies were hybridisation, diversity, flexibility, community and accessibility. This detailed analysis of the neighbourhood’s shortcomings and potential improvements provided a solid foundation for defining intervention criteria and strategies. Those intervention criteria were based on a selection of the best practices deemed most appropriate in light of the neighbourhood’s current situation, systematising actions that address the most important aspects or attempt to mitigate serious deficiencies. The established criteria are as follows: sustainability, improving the residents’ quality of life, and bringing new residents to the neighbourhood. Based on this study and the defined criteria, strategic courses of action were proposed in four general areas: relationship with the city and its context, qualification of existing facilities and public spaces, qualification of existing buildings, and typological modernisation

Prevalencia de variantes anatómicas nasosinusales evaluadas por tomografía computada en pacientes de la clínica internacional enero-diciembre 2019

Introducción: La tomografía computada (TC) ha ganado terreno como método de diagnóstico de patologías de la nariz y los senos paranasales, así como en el estudio prequirúrgico de los pacientes ya que brinda gran detalle de las estructuras óseas y variantes anatómicas de esta región. Materiales y métodos: Estudio observacional descriptivo transversal retrospectivo de los pacientes del Servicio de Otorrinolaringología de la Red de Clínica Internacional que fueron sometidos a TC entre enero-diciembre 2019, fueron evaluadas 11 categorías de variantes anatómicas: desviación septal, cornete medio, maxilar hipoplásico, inserción alta de la apófisis unciforme, celdas de Haller, celdas de Agger Nasi, celda de Onodi, índice de Keros, ausencia de seno frontal, celdas de Kuhn, dehiscencia del canal de la carótida. Resultados: El estudio incluyó tomografías computadas de 251 pacientes, de los cuales 118 fueron mujeres y 133 varones con un promedio de edad de 39 años (DE 13.16), las variantes anatómicas más prevalentes fueron la desviación septal (86.06%), presencia de la Celda de Agger Nasi (76.49%), inserción alta de la apófisis unciforme (46.61%), presencia de celdas de Kuhn (38.68%) y concha bullosa (35.06%). Conclusiones: Las variantes anatómicas de senos paranasales se presentan en gran medida, llegando a ser tan frecuentes como la desviación septal y la presencia de las celdas de Agger Nasi (más del 75% de los casos) o mucho más raras como la ausencia del seno frontal y la hipoplasia del seno maxilar (menos del 5% de los casos).

GEICAM Guidelines for the Management of Patients with Breast Cancer During the COVID-19 Pandemic in Spain

Breast cancer (BC) is the most common cancer in women in Spain. During the COVID-19 pandemic caused by the SARSCoV-2 virus, patients with BC still require timely treatment and follow-up; however, hospitals are overwhelmed with infected patients and, if exposed, patients with BC are at higher risk for infection and serious complications if infected. Thus, health care providers need to evaluate each BC treatment and in-hospital visit to minimize pandemic-associated risks while maintaining adequate treatment efficacy. Here we present a set of guidelines regarding available options for BC patient management and treatment by BC subtype in the context of the COVID-19 pandemic. Owing to the lack of evidence about COVID-19 infection, these recommendations are mainly based on expert opinion, medical organizations’ and societies’ recommendations, and some published evidence. We consider this a useful tool to facilitate medical decision making in this health crisis situation we are facing

Metodologías de aprendizaje activo del Latín y la Cultura Clásica III

El presente proyecto, que es continuación de proyectos anteriores (Metodologías docentes innovadoras para la enseñanza y aprendizaje del Latín y la Cultura Clásica I, II y III y Metodologías de aprendizaje activo del Latín y la Cultura Clásica I y II), tiene como objetivo seguir avanzando en el diseño y desarrollo de metodologías innovadoras de enseñanza/aprendizaje de contenidos de lengua latina y cultura clásica, aplicables a diferentes contextos educativos y que fomenten el aprendizaje activo, así como establecer redes de trabajo, en el marco de la docencia en el Máster de Formación de Profesorado, con proyectos e iniciativas de innovación docente de centros de Educación Secundaria de la Comunidad de Madrid

Real-world effectiveness of caplacizumab vs the standard of care in immune thrombotic thrombocytopenic purpura

Immune thrombotic thrombocytopenic purpura (iTTP) is a thrombotic microangiopathy caused by anti-ADAMTS13 antibodies. Caplacizumab is approved for adults with an acute episode of iTTP in conjunction with plasma exchange (PEX) and immunosuppression. The objective of this study was to analyze and compare the safety and efficacy of caplacizumab vs the standard of care and assess the effect of the concomitant use of rituximab. A retrospective study from the Spanish TTP Registry of patients treated with caplacizumab vs those who did not receive it was conducted. A total of 155 patients with iTTP (77 caplacizumab, 78 no caplacizumab) were included. Patients initially treated with caplacizumab had fewer exacerbations (4.5% vs 20.5%; P <.05) and less refractoriness (4.5% vs 14.1%; P <.05) than those who were not treated. Time to clinical response was shorter when caplacizumab was used as initial treatment vs caplacizumab used after refractoriness or exacerbation. The multivariate analysis showed that its use in the first 3 days after PEX was associated with a lower number of PEX (odds ratio, 7.5; CI, 2.3-12.7; P <.05) and days of hospitalization (odds ratio, 11.2; CI, 5.6-16.9; P <.001) compared with standard therapy. There was no difference in time to clinical remission in patients treated with caplacizumab compared with the use of rituximab. No severe adverse event was described in the caplacizumab group. In summary, caplacizumab reduced exacerbations and refractoriness compared with standard of care regimens. When administered within the first 3 days after PEX, it also provided a faster clinical response, reducing hospitalization time and the need for PEX

Real-world effectiveness of caplacizumab vs the standard of care in immune thrombotic thrombocytopenic purpura

Immune thrombotic thrombocytopenic purpura (iTTP) is a thrombotic microangiopathy caused by anti-ADAMTS13 antibodies. Caplacizumab is approved for adults with an acute episode of iTTP in conjunction with plasma exchange (PEX) and immunosuppression. The objective of this study was to analyze and compare the safety and efficacy of caplacizumab vs the standard of care and assess the effect of the concomitant use of rituximab. A retrospective study from the Spanish TTP Registry of patients treated with caplacizumab vs those who did not receive it was conducted. A total of 155 patients with iTTP (77 caplacizumab, 78 no caplacizumab) were included. Patients initially treated with caplacizumab had fewer exacerbations (4.5% vs 20.5%; P < .05) and less refractoriness (4.5% vs 14.1%; P < .05) than those who were not treated. Time to clinical response was shorter when caplacizumab was used as initial treatment vs caplacizumab used after refractoriness or exacerbation. The multivariate analysis showed that its use in the first 3 days after PEX was associated with a lower number of PEX (odds ratio, 7.5; CI, 2.3-12.7; P < .05) and days of hospitalization (odds ratio, 11.2; CI, 5.6-16.9; P < .001) compared with standard therapy. There was no difference in time to clinical remission in patients treated with caplacizumab compared with the use of rituximab. No severe adverse event was described in the caplacizumab group. In summary, caplacizumab reduced exacerbations and refractoriness compared with standard of care regimens. When administered within the first 3 days after PEX, it also provided a faster clinical response, reducing hospitalization time and the need for PEX

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality