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

Aims Longitudinal data on the mental health impact of the coronavirus disease 2019 (Covid-19) pandemic in healthcare workers is limited. We estimated prevalence, incidence and persistence of probable mental disorders in a cohort of Spanish healthcare workers (Covid-19 waves 1 and 2) -and identified associated risk factors. Methods 8996 healthcare workers evaluated on 5 May–7 September 2020 (baseline) were invited to a second web-based survey (October–December 2020). Major depressive disorder (PHQ-8 ≥ 10), generalised anxiety disorder (GAD-7 ≥ 10), panic attacks, post-traumatic stress disorder (PCL-5 ≥ 7), and alcohol use disorder (CAGE-AID ≥ 2) were assessed. Distal (pre-pandemic) and proximal (pandemic) risk factors were included. We estimated the incidence of probable mental disorders (among those without disorders at baseline) and persistence (among those with disorders at baseline). Logistic regression of individual-level [odds ratios (OR)] and population-level (population attributable risk proportions) associations were estimated, adjusting by all distal risk factors, health care centre and time of baseline interview. Results 4809 healthcare workers participated at four months follow-up (cooperation rate = 65.7%; mean = 120 days S.D. = 22 days from baseline assessment). Follow-up prevalence of any disorder was 41.5%, (v. 45.4% at baseline, p < 0.001); incidence, 19.7% (S.E. = 1.6) and persistence, 67.7% (S.E. = 2.3). Proximal factors showing significant bivariate-adjusted associations with incidence included: work-related factors [prioritising Covid-19 patients (OR = 1.62)], stress factors [personal health-related stress (OR = 1.61)], interpersonal stress (OR = 1.53) and financial factors [significant income loss (OR = 1.37)]. Risk factors associated with persistence were largely similar. Conclusions Our study indicates that the prevalence of probable mental disorders among Spanish healthcare workers during the second wave of the Covid-19 pandemic was similarly high to that after the first wave. This was in good part due to the persistence of mental disorders detected at the baseline, but with a relevant incidence of about 1 in 5 of HCWs without mental disorders during the first wave of the Covid-19 pandemic. Health-related factors, work-related factors and interpersonal stress are important risks of persistence of mental disorders and of incidence of mental disorders. Adequately addressing these factors might have prevented a considerable amount of mental health impact of the pandemic among this vulnerable population. Addressing health-related stress, work-related factors and interpersonal stress might reduce the prevalence of these disorders substantially. Study registration number: NCT04556565post-print338 K

Metástasis Vertebrales

La incidencia de las metástasis en columna vertebral está aumentando por el incremento de la población anciana, la mayor esperanza de vida y las mejores en el tratamiento de los pacientes con cáncer. Revi - samos el diagnóstico y tratamiento de estos pacientes.The incidence of spinal metastases is increasing with increasingly older populations, longer life expectancy and improvements in medical treatment of the patients with cancer. So, metastases to the spine repre - sent a challenging problem. We review diagnosis and treatment these patients

Cognitive Effects of Combined Amisulpride and Quetiapine Treatment in Patients With Refractory Schizophrenia: A Naturalistic, Prospective Study.

Background: There are different treatment options, but little support of evidence in the treatment of patients with resistant schizophrenia. In this study we used antipsychotic polypharmacy (AP) comprising 1200 mg of amisulpride and 600 mg of quetiapine, using neurocognitive evaluations to measure clinical change. Study Question: The AP of amisulpride and quetiapine implicará una mejoría clínica en pacientes with resistant schizophrenia que reflejará especialmente en una mejoría cognitiva. Study Design: Naturalistic and prospective study. 26 patients with no biological response to medication, high social maladjustment, a long history of the disease, to whom Kane's and Brenner's criteria for treatment-resistant schizophrenia were applied and assessed by a battery of neurocognitive evaluations desde a pre-treatment baseline y a los six months treatment. Measures and Outcomes: La mejoría cognitiva implicara una mejora significativa in the cognitive test: Stroop test, WAIS Coding Subtest, Continuous Trail Making Test (CTMT) desde la línea base y los 6 meses de tratamiento. También implicará mejoría en las escalas de Calgary Depression Scale (CDS), Simpson-Angus Scale (SAS) and a Visual Analogue Scale (EVA) con las que fueron evaluados en línea base, a los 3 meses y a los 6 meses. Results: Subjects, after six months treatment with amisulpride and quetiapine, did statistically significant difference in the assessed areas: WAIS Coding Subtest (P <0.001), CTMT A & B (CTMTA P< 0,034; CTMTB P< 0,000) and in Stroop tests: Word (P< 0,001), word-color (P< 0,007) and interference (P< 0,039). Furthermore they showed a statistically significant difference in CDS (P< 0,002), SAS (P< 0,019), and EVA (P < 0.001). Conclusion: The results of this report show a cognitive and clinical improvement in refractory patients after the administration of amisulpride and quetiapine.pre-print523 K

Cognitive and Neuropsychiatric Features of Orthostatic Tremor: A Case-Control Comparison.

Introduction Evidence suggests that the cerebellum could play a role in the pathophysiology of orthostatic tremor. The link between orthostatic tremor and the cerebellum is of interest, especially in light of the role the cerebellum plays in cognition, and it raises the possibility that orthostatic tremor patients could have cognitive deficits consistent with cerebellar dysfunction. Our aim was to examine whether orthostatic tremor patients had cognitive deficits and distinct personality profiles when compared with matched controls. Methods Sixteen consecutive orthostatic tremor patients (65.7 ± 13.3 years) and 32 healthy matched controls underwent a neuropsychological battery and the Personality Assessment Inventory. In linear regression models, the dependent variable was each one of the neuropsychological test scores or the Personality Assessment Inventory subscales and the independent variable was orthostatic tremor vs. control. Results Adjusted for age in years, sex, years of education, comorbidity index, current smoker, and depressive symptoms, diagnosis (orthostatic tremor vs. healthy control) was associated with poor performance on tests of executive function, visuospatial ability, verbal memory, visual memory, and language tests, and on a number of the Personality Assessment Inventory subscales (somatic concerns, anxiety related disorders, depression, and antisocial features). Older-onset OT (> 60 years) patients had poorer scores on cognitive and personality testing compared with their younger-onset OT counterparts. Conclusion Orthostatic tremor patients have deficits in specific aspects of neuropsychological functioning, particularly those thought to rely on the integrity of the prefrontal cortex, which suggests involvement of frontocerebellar circuits. Cognitive impairment and personality disturbances could be disease-associated nonmotor manifestations of orthostatic tremor.pre-print426 K

Concordancia diagnóstica entre Atención Primaria y Salud Mental.

tención Primaria (AP) y Salud Mental (SM). Metodología. Estudio descriptivo y retrospectivo realizado en el Centro de SM de Villaverde, Madrid, España. La muestra está conformada por 1050 pacientes adultos nuevos consecutivos derivados desde AP a SM desde enero a diciembre del año 2016. Se registraron las siguientes variables: Centro de AP de origen de la derivación, edad, sexo, tipo de actividad solicitante en la derivación (Psiquiatría o Psicología), diagnóstico establecido por AP y diagnóstico establecido por SM. Resultados. La concordancia diagnóstica entre AP y SM presentó un coeficiente de kappa global de 0,383 (IC 95 % 0,333-0,433). Los grupos diagnósticos con menor concordancia fueron el trastorno adaptativo (kappa: 0,200), el trastorno de ansiedad (kappa: 0,242) y el trastorno afectivo depresivo (kappa: 0,340). Los grupos diagnósticos con mayor concordancia fueron el trastorno bipolar (kappa: 0,816) y el trastorno psicótico (kappa: 0,689). El trastorno adaptativo fue el diagnóstico más frecuentemente diagnosticado en SM entre los no coincidentes con AP (38,99 %). Conclusiones. La concordancia diagnóstica entre AP y SM es baja, lo cual podría afectar a la calidad asistencial ofrecida a los pacientes. Se considera necesario el planteamiento de nuevas estrategias que permitan aumentar esta concordancia.post-print143 K

Spanish research on mathematics education

The writing of this text has been partly developed within several research projects: RTI2018-101153-B-C21 and RTI2018-101153-A-C22 (M. Bosch and B. Barquero); PID2019-105601GB-I00 (C. Batanero, M. M. Gea and J.D. Godino); ProID2021010018 (M. Camacho-Machín); EDU2016-75771-P and PID2020-113601GB-I00 (M. C. Cañadas and Enrique Castro); PGC2018-100758-B-I00 (J. M. Chamoso); RTI2018-096547-B-I00 (L. C. Contreras); EDU2017-84979-R (T. F. Blanco); 2021/FQM-226 and PPIIV.4/2021/005 (V. Martín-Molina); PID2020-116514GB-I00 (M. Moreno)

Imported malaria in pregnancy in Madrid

<p>Abstract</p> <p>Background</p> <p>Malaria in pregnancy is associated with maternal and foetal morbidity and mortality in endemic areas, but information on imported cases to non-endemic areas is scarce.</p> <p>The aim of this study was to describe the clinical and epidemiological characteristics of malaria in pregnancy in two general hospitals in Madrid, Spain.</p> <p>Methods</p> <p>Retrospective descriptive study of laboratory-confirmed malaria in pregnant women at the Fuenlabrada University Hospital and the Príncipe de Asturias University Hospital, in Madrid, over a six- and 11-year period, respectively. Relevant epidemiological, clinical and laboratory data was obtained from medical records.</p> <p>Results</p> <p>There were 19 pregnant women among 346 malaria cases (5.4%). The average age was 27 years. The gestational age (trimester) was: 53% 3^rd, 31% 1st, 16% 2^nd. All but one were multigravidae. Three were HIV positive. All were sub-Saharan immigrants: two were recently arrived immigrants and seventeen (89%) had visited friends and relatives. None had taken prophylaxis nor seeked pre-travel advice. Presentation: 16 symptomatic patients (fever in fourteen, asthenia in two), three asymptomatic. Median delay in diagnosis: 7.5 days. Laboratory tests: anaemia (cut off Hb level 11 g/dl) 78.9% (mild 31.6%, moderate 31.6%, severe 15.8%) thrombocytopaenia 73.7%, hypoglycaemia 10.5%. All cases were due to <it>Plasmodium falciparum</it>, one case of hyperparasitaemia. Quinine + clindamycin prescribed in 84%. Outcomes: no severe maternal complications or deaths, two abortions, fifteen term pregnancies, no low-birth-weight newborns, two patients were lost to follow-up.</p> <p>Conclusions</p> <p>Though cases of malaria in pregnancy are uncommon, a most at risk group is clearly defined: young sub-Saharan mothers visiting friends and relatives without pre-travel counselling and recently-arrived immigrants. The most common adverse maternal and foetal effects were anaemia and stillbirth. Given that presentation can be asymptomatic, malaria should always be considered in patients with unexplained anaemia arriving from endemic areas. These findings could help Maternal Health programme planners and implementers to target preventive interventions in the immigrant population and should create awareness among clinicians.</p

Dietary Vitamin E and/or Hydroxytyrosol Supplementation to Sows during Late Pregnancy and Lactation Modifies the Lipid Composition of Colostrum and Milk

Modifying the composition of a sow’s milk could be a strategy to improve the intestinal health and growth of her piglet during the first weeks of life. This study evaluated how dietary supplementation of vitamin E (VE), hydroxytyrosol (HXT) or VE+HXT given to Iberian sows from late gestation affected the colostrum and milk composition, lipid stability and their relationship with the piglet’s oxidative status. Colostrum from VE-supplemented sows had greater C18:1n−7 than non-supplemented sows, whereas HXT increased polyunsaturated (∑PUFAs), ∑n−6 and ∑n−3 fatty acids. In 7-day milk, the main effects were induced by VE supplementation that decreased ∑PUFAs, ∑n−6 and ∑n−3 and increased the Δ-6-desaturase activity. The VE+HXT supplementation resulted in lower desaturase capacity in 20-day milk. Positive correlations were observed between the estimated mean milk energy output and the desaturation capacity of sows. The lowest concentration of malondialdehyde (MDA) in milk was observed in VE-supplemented groups, whereas HXT supplementation increased oxidation. Milk lipid oxidation was negatively correlated with the sow’s plasma oxidative status and to a great extent with the oxidative status of piglets after weaning. Maternal VE supplementation produced a more beneficial milk composition to improve the oxidative status of piglets, which could promote gut health and piglet growth during the first weeks, but more research is needed to clarify this.This research was funded by the Spanish Agencia Estatal de Investigación (PID2019-108695RB-C32/AEI/10.13039/501100011033) co-funded by Fondo Europeo de Desarrollo Regional (FEDER). H.D.L. and G.G. received grants from the Spanish Government (FPI National Program grant: PRE2020-092891) and IRIAF-Sánchez Romero Carvajal Jabugo, S.A., agreement, respectively.Peer reviewe

Gaviota patiamarilla

Peer reviewe

Association Study Among Candidate Genetic Polymorphisms and Chemotherapy-Related Severe Toxicity in Testicular Cancer Patients

Testicular cancer is one of the most commonly occurring malignant tumors in young men with fourfold higher rate of incidence and threefold higher mortality rates in Chile than the average global rates. Surgery is the initial line of treatment for testicular cancers, and is generally followed by chemotherapy, usually with combinations of bleomycin, etoposide, and cisplatin (BEP). However, the adverse effects of chemotherapy vary significantly among individuals; therefore, the present study explored the association of functionally significant allelic variations in genes related to the pharmacokinetics/pharmacodynamics of BEP and DNA repair enzymes with chemotherapy-induced toxicity in BEP-treated testicular cancer patients. We prospectively recruited 119 patients diagnosed with testicular cancer from 2010 to 2017. Genetic polymorphisms were analyzed using PCR and/or qPCR with TaqMan®probes. Toxicity was evaluated based on the Common Terminology Criteria for Adverse Events, v4.03. After univariate analyses to define more relevant genetic variants (p &lt; 0.2) and clinical conditions in relation to severe (III–IV) adverse drug reactions (ADRs), stepwise forward multivariate logistic regression analyses were performed. As expected, the main severe ADRs associated with the non-genetic variables were hematological (neutropenia and leukopenia). Univariate statistical analyses revealed that patients with ERCC2 rs13181 T/G and/or CYP3A4 rs2740574 A/G genotypes are more likely to develop alopecia; patients with ERCC2 rs238406 C/C genotype may develop leukopenia, and patients with GSTT1-null genotype could develop lymphocytopenia (III–IV). Patients with ERCC2 rs1799793 A/A were at risk of developing severe anemia. The BLMH rs1050565 G/G genotype was found to be associated with pain, and the GSTP1 G/G genotype was linked infection (p &lt; 0.05). Multivariate analysis showed an association between specific ERCC1/2 genotypes and cumulative dose of BEP drugs with the appearance of severe leukopenia and/or febrile neutropenia. Grades III–IV vomiting, nausea, and alopecia could be partly explained by the presence of specific ERCC1/2, MDR1, GSTP1, and BLMH genotypes (p &lt; 0.05). Hence, we provide evidence for the usefulness of pharmacogenetics as a tool for predicting severe ADRs in testicular cancer patients treated with BEP chemotherapy