The Assessment of Myocardial Longitudinal Strain in a Paediatric Spanish Population Using a New Software Analysis

Two-dimensional speckle-tracking echocardiography (2DSTE) has been present for years. However, it is underutilized due to the expertise and time requirements for its analysis. Our aims were to provide strain values in a paediatric Spanish population and to assess the feasibility and reproducibility of a new strain software analysis in our environment. Methods: A cross-sectional study of 156 healthy children aged 6 to 17 years. Longitudinal strain (LS) analysis of the left ventricle, right ventricle, and left atrium was performed. Feasibility and reproducibility were assessed. The associations of clinical and echocardiographic variables with strain values were investigated by multivariate analysis. Results: Mean age was 11 ± 3 years (50% female). Feasibility of LS measurement ranged from 94.2% for left ventricle global LS (LVGLS) to 98.1% for other chamber strain parameters. Strain values were 26.7 ± 2.3% for LVGLS; 30.5 ± 4.4% and 26.9 ± 4% for right ventricle free wall LS (RVFWLS) and four chambers view LS (RV4CLS) respectively; and 57.8 ± 10.5%, 44.9 ± 9.5%, and 12.9 ± 5.5% for left atrium LS reservoir phase (LALSr), conduct phase (LALScd) and contraction phase (LALSct), also respectively. Body surface area (BSA) and age presented a negative correlation with strain values. Higher values were found in females than in males, except for LALScd. Excellent intra- and inter-observer reproducibility were found for right and left ventricular strain measurement, with intraclass correlation coefficients (ICC) ranging from 0.88 to 0.98, respectively. In conclusion, we described strain values in a healthy Spanish paediatric population. LS assessment by this new strain analysis software by semi-automatic manner was highly feasible and reproducible

Executive summary of the Consensus Document of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) and of the Spanish Association of Surgeons (AEC) in antibiotic prophylaxis in surgery

[ES] La profilaxis antibiótica en cirugía es una de las medidas más eficaces para la prevención de la infección de localización quirúrgica, aunque su uso es con frecuencia inadecuado, pudiendo incrementar el riesgo de infección, toxicidades y resistencias bacterianas. Debido al avance en las técnicas quirúrgicas y la emergencia de microorganismos multirresistentes las actuales pautas de profilaxis precisan ser revisadas. La Sociedad Española de Enfermedades Infecciosas (SEIMC), conjuntamente con la Asociación Española de Cirujanos (AEC) ha revisado y actualizado las recomendaciones de profilaxis antimicrobiana para adaptarlas a cada tipo de intervención quirúrgica y a la epidemiología actual. En este documento se recogen las recomendaciones de los antimicrobianos utilizados en profilaxis en los diferentes procedimientos, las dosis, la duración, la profilaxis en huéspedes especiales, y en situación epidemiológica de multirresistencia, de tal forma que permitan un manejo estandarizado, un uso racional, seguro y efectivo de los mismos en la cirugía electiva.[EN] Antibiotic prophylaxis in surgery is one of the most effective measures for preventing surgical site infection, although its use is frequently inadequate and may even increase the risk of infection, toxicities and antimicrobial resistance. As a result of advances in surgical techniques and the emergence of multidrug-resistant organisms, the current guidelines for prophylaxis need to be revised. The Sociedad Española de Enfermedades Infecciosas (Spanish Society of Infectious Diseases and Clinical Microbiology) (SEIMC) together with the Asociación Española de Cirujanos (Spanish Association of Surgeons) (AEC) have revised and updated the recommendations for antibiotic prophylaxis in surgery to adapt them to any type of surgical intervention and to current epidemiology. This document gathers together the recommendations on antimicrobial prophylaxis in the various procedures, with doses, duration, prophylaxis in special patient groups, and in epidemiological settings of multidrug resistance to facilitate standardized management and the safe, effective and rational use of antibiotics in elective surgery

Genotype, environment and their interaction on olive

Resumen del trabajo presentado en la 6th International Conference on the Olive Tree and Olive Products, celebrada en Sevilla (España) del 15 al 19 de octubre de 2018.The wide olive genetic patrimony has revealed high variability for most of the agronomic and oil quality traits of interest in olive growing. Few studies, however, have addressed the interaction of this variability with the environment, a subject of particular interest considering the natural high instability of the Mediterranean climate and the challenge of the predicted climate change. The current work presents results on the interaction between genotype and environment from multi-environment trials of olive cultivars and breeding selections, planted in different edaphoclimatic conditions of Andalusia, Southern Peninsular Spain and Canary Islands. For most of the agronomic and oil quality characters evaluated (flowering phenology, flower quality, pattern of oil accumulation, fatty acid composition and phenol content and composition), significant genotype and environment effects have been observed. For example, olive cultivars grown in Tenerife under much milder winter temperatures than in the Iberian Peninsula showed substantially earlierflowering and oil accumulation. Only in the case of flowering phenology was no significant genotype effect found. Furthermore, a strong genotype x environment effect was highly consistent in all characters considered. Regarding resistance to disease, such as Verticillium wilt, the variability of results from both natural and artificial inoculations also tends to indicate a considerable environmental effect and the need for careful testing of disease evolution. All this information strongly suggests the necessity of comparative trials of olive cultivars for both adequate choice of cultivar and final selection in breeding programs

Efficacy of clozapine versus standard treatment in adult individuals with intellectual disability and treatment-resistant psychosis (CLOZAID): study protocol of a multicenter randomized clinical trial

BackgroundIntellectual disability (ID) affects approximately 1% of the worldwide population and individuals with ID have a higher comorbidity with mental illness, and specifically psychotic disorders. Unfortunately, among individuals with ID, limited research has been conducted since ID individuals are usually excluded from mental illness epidemiological studies and clinical trials. Here we perform a clinical trial to investigate the effectiveness of clozapine in the treatment of resistant psychosis in individuals with ID. The article highlights the complexity of diagnosing and treating psychopathological alterations associated with ID and advocates for more rigorous research in this field.MethodsA Phase IIB, open-label, randomized, multicenter clinical trial (NCT04529226) is currently ongoing to assess the efficacy of oral clozapine in individuals diagnosed with ID and suffering from treatment-resistant psychosis. We aim to recruit one-hundred and fourteen individuals (N=114) with ID and resistant psychosis, who will be randomized to TAU (treatment as usual) and treatment-with-clozapine conditions. As secondary outcomes, changes in other clinical scales (PANSS and SANS) and the improvement in functionality, assessed through changes in the Euro-QoL-5D-5L were assessed. The main outcome variables will be analyzed using generalized linear mixed models (GLMM), assessing the effects of status variable (TAU vs. Clozapine), time, and the interaction between them.DiscussionThe treatment of resistant psychosis among ID individuals must be directed by empirically supported research. CLOZAID clinical trial may provide relevant information about clinical guidelines to optimally treat adults with ID and treatment-resistant psychosis and the benefits and risks of an early use of clozapine in this underrepresented population in clinical trials.Trial registrationClinicaltrials.gov: NCT04529226. EudraCT: 2020-000091-37

Relationship between overweight and obesity and cardiac dimensions and function in a paediatric population.

Obesity in adults is associated with left ventricular hypertrophy, dilatation, and myocardial fibrosis, as well as heart failure and coronary heart disease. These associations have been studied to a lesser extent in the paediatric population. This study aims to investigate the relationship between obesity and cardiac structure and function in the paediatric population. In a southern Spanish village, we selected all inhabitants aged 6-17 years stratifying by age, gender, and educational centres. We performed a complete transthoracic echocardiogram evaluating all the cardiac morphological and functional parameters commonly measured in an echocardiographic study. There were 212 children and adolescents included. Of them, 48.1% were males. The mean age was 10.9 ± 3.0 years. A total of 106 (50%) were normal weight, 57 (26.9%) overweight, and 49 (23.1%) obese. Sex and age were similar in all three groups. Overweight and obesity were associated with larger left ventricular end-diastolic and end-systolic volumes (p  Childhood obesity is independently associated with larger heart chambers, greater left ventricle mass, and smaller left ventricle ejection fraction. • Childhood obesity is related to the development of cardiovascular risk factors and is considered an epidemic of the twenty-first century; its prevalence is rising. • Childhood overweight and obesity lead to changes in cardiac structure and function which, although not considered clinically pathological, are significant and a result of obesity, and which behave as unfavourable incipient alterations at an early age

Validity of Braden and EMINA’s scales for patients at home, include in the immobilized patients programmee

Aim: Verifying Braden and EMINA´s validity and select quantitative cut-off points to diferentiate Ulcer by Pressure threat in home-care patients. Method: group monitor progress and longitudinal examination of a cohort of patients during 6 months, evaluating three times, once every two months. Scope of application: Health Care Administration Este Málaga-Axarquía and Serranía, Málaga. Subject of study: Immobilized Programme patients without UPP. Resources: Authors’ questionnaire including among others: demographic data, hospital admission date, Braden and EMINA scales. Sample: 353 patients, simple random sampling. Result: The original scales support internal consistency with alpha superior to 0.7. Establishing new cut-off points discriminating patients with or without UPP threat, resulting sensitivity of 61%- 89% and specificity 64%-70%. The classified scales have a precission as a diagnostic method equal or superior to 65%. OR are significant, indicating existing differences under threat of UPP according to new cut-off points. Cut-off points’ selected resulted in: High sensitivity threat ≤10% ≥ 95%, Braden’s scale average ≤ 10, EMINA 12-15. Moderate threat 10%, <Sensitivity <83%, 64% <Specificity, <95 Braden scale average 11-15, EMINA 7-11. Minimum threat 83%, ≤ Sensitivity 100%, 0% Specificity ≤ 64%, Braden 16-22, EMINA 1-6. Non-existent threat sensitivity 100%, Specificity 0%, Braden 23, EMINA 0. Conclusion: Braden obtained a major consistency than EMINA in home-care patients. Existing a high interrelationship among both scales variables; threat being measured in similar ways. Both scales provide positive authenticity reasons in similar way, considering them equally as methods for threat diagnosis. Cut-off points established in this study are esteemed to discriminate among home-care patients with or without an ulcer: Braden 15 and EMINA 7.YesObjetivo: comprobar la validez de las escalas Braden y EMINA y seleccionar puntos de corte cuantitativos para discriminar el riesgo de úlcera por presión (UPP) en pacientes domiciliarios. Método: estudio longitudinal o de seguimiento de una cohorte de 6 meses de duración, con cuatro valoraciones, una cada 2 meses. Ámbito de estudio: áreas de gestión sanitaria Este de Málaga-Axarquía y Serranía, de Málaga. Sujetos de estudio: pacientes en programa de inmovilizados sin UPP. Cuestionario confeccionado por los autores que incluye entre otros: datos demográficos, ingreso hospitalario, escalas de Braden y EMINA. Muestra: 353 pacientes, usando muestreo aleatorio simple. Resultado: las escalas originales mantienen consistencia interna con alpha superior a 0,7. Se han establecido nuevos puntos de corte, discriminando pacientes con riesgo de UPP o sin él, resultando una sensibilidad del 61-89% y una especificidad del 64-70%. Las escalas categorizadas tienen exactitud como método diagnóstico igual o superior al 65%. Las odds ratio (OR) son significativas e indican que existen diferencias en el riesgo de UPP en función de nuevos puntos de corte. La determinación de los puntos de corte resultaron: riesgo alto: sensibilidad ≤ 10%, especificidad ≥ 95%, puntuación en la escala de Braden ≤ 10, EMINA 12-15; riesgo moderado: sensibilidad entre el 10% y el 83%, especificidad entre el 64% y el 95%, Braden 11-15 y EMINA 7-11; riesgo bajo: sensibilidad entre el 83% y el 100%, especificidad entre el 0% y el 64%, Braden 16-22 y EMINA 1-6; riesgo nulo: sensibilidad 100%, especificidad 0%, Braden 23, EMINA 0. Conclusiones: la escala de Braden resultó tener mayor consistencia que EMINA para población domiciliaria, existiendo alta correlación entre variables de ambas escalas; medición del riesgo: similar. Para ambas escalas las razones de verosimilitud positiva son similares, por lo que se validan ambas escalas por igual como métodos de diagnóstico del riesgo. Los puntos de corte definidos por este estudio son válidos para discriminar entre pacientes con y sin úlcera en domicilio: Braden 15 y EMINA 7

Fiabilidad de las escalas de Braden y EMINA en pacientes de atención domiciliaria incluidos en programa de inmovilizados

Objetivo: comprobar la fiabilidad de las escalas de Braden y EMINA (escalas de valoración del riesgo de úlceras por presión) en atención domiciliaria. Método: estudio observacional de tipo transversal. Ámbito de estudio: Área de Gestión Sanitaria Este de Málaga-Axarquía y Área de Gestión Sanitaria Serranía, ambas de Málaga. Sujetos de estudio: pacientes incluidos dentro del Programa de Inmovilizados sin úlceras por presión. Instrumentos: escalas de Braden y EMINA. Muestra: 30 pacientes, usando una técnica de muestreo aleatorio simple. Resultados: Escala de Braden: Alfa de Cronbach de 0,78 para ambos observadores. Coeficiente de correlación intraclase (CCI) para la puntuación total de la escala, 0,968. El índice kappa ponderado para cada uno de los 6 ítems de la escala oscila entre 0,685 que es el más bajo y corresponde a fricción y deslizamiento y 1,00 para el más alto, que corresponde a percepción sensorial. Escala EMINA: el Alfa de Cronbach oscila entre 0,69 y 0,73 entre observadores. Coeficiente de correlación intraclase para la puntuación total de la escala, 0,974. El índice kappa ponderado para cada uno de los 5 ítems de la escala oscila entre 0,750, el más bajo que corresponde a la actividad, y 1,00 para el más alto, que corresponde a nutrición. Conclusiones: la escala de Braden tiene mayor consistencia interna, aunque el grado de acuerdo cuando se utilizan las escalas de manera categórica es superior en la EMINA. Ambas escalas son instrumentos fiables para el uso en atención domiciliaria, aunque sería conveniente establecer nuevos puntos de corte, para definir o categorizar el riesgo en esta población