Evaluation of the Efficacy of a New Dichoptic Digital Platform to Treat the Anisometropic and Isometropic Amblyopia

The aim of the current study was to evaluate the results of a novel dichoptic training program using an online platform in a group of subjects with refractive amblyopia, performing a comparative analysis of unilateral and bilateral amblyopic cases. For this purpose, a retrospective study analysis of data of 161 children (4–13 years) who underwent dichoptic treatment with the Bynocs® platform (Kanohi Eye Pvt. Ltd., India) was performed. In all cases, the therapy protocol consisted of sessions of training of 30 min daily 5 times a week for 6 weeks. Best corrected visual acuity (BCVA) in the non-dominant eye improved significantly with the treatment, with a mean change of 0.39 logMAR in the whole sample (p < 0.001). Regarding binocularity, the binocular function (BF) score also experienced a significant improvement (p < 0.001), with a mean change of 1.55 with therapy in the whole sample. The BCVA of the dominant eye only improved significantly (p < 0.001) in the isometropic amblyopic subgroup. In conclusion, the use of the dichoptic therapy with the digital platform evaluated allows an effective restoration of visual acuity and binocular function in children with anisometropic and isometropic amblyopia.The author David P Piñero has been supported by the Ministry of Economy, Industry and Competitiveness of Spain within the program Ramón y Cajal, RYC‐2016‐20471

Neck circumference and clustered cardiovascular risk factors in children and adolescents: Cross-sectional study.

OBJECTIVE: Early detection of cardiovascular disease (CVD) risk factors, such as obesity, is crucial to prevent adverse long-term effects on individuals' health. Therefore, the aims were: (1) to explore the robustness of neck circumference (NC) as a predictor of CVD and examine its association with numerous anthropometric and body composition indices and (2) to release sex and age-specific NC cut-off values to classify youths as overweight/obese. DESIGN: Cross-sectional study. SETTING: 23 primary schools and 17 secondary schools from Spain. PARTICIPANTS: 2198 students (1060 girls), grades 1-4 and 7-10. MEASURES: Pubertal development, anthropometric and body composition indices, systolic and diastolic blood pressure (SBP and DBP, respectively), cardiorespiratory fitness, blood sampling triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-c), low-density lipoprotein cholesterol (LDL-c), glucose and inflammatory markers. Homoeostasis model assessment (HOMA-IR) and cluster of CVD risk factors were calculated. RESULTS: NC was negatively associated with maximum oxygen consumption (R2=0.231, P<0.001 for boys; R2=0.018, P<0.001 for girls) and adiponectin (R2=0.049, P<0.001 for boys; R2=0.036, P<0.001 for girls); and positively associated with SBP, DBP, TC/HDL-c, TG, HOMA, complement factors C-3 and C-4, leptin and clustered CVD risk factor in both sexes (R2 from 0.035 to 0.353, P<0.01 for boys; R2 from 0.024 to 0.215, P<0.001 for girls). Moreover, NC was positively associated with serum C reactive protein and LDL-c only in boys (R2 from 0.013 to 0.055, P<0.05). CONCLUSION: NC is a simple, low-cost and practical screening tool of excess of upper body obesity and CVD risk factors in children and adolescents. Paediatricians can easily use it as a screening tool for overweight/obesity in children and adolescents. For this purpose, sex and age-specific thresholds to classify children and adolescents as normal weight or overweight/obese are provided.This work was supported by the DEP 2010 21662 C04 00 (DEP 2010 21662 C04 01: DEP 2010 21662 C04 02: DEP 2010 21662 C04 03: DEP 2010 21662 C04 04) grant from the National Plan for Research: Development and Innovation (R+D+i) MICINN

Follow-up in healthy schoolchildren and in adolescents with DOWN syndrome: psycho-environmental and genetic determinants of physical activity and its impact on fitness, cardiovascular diseases, inflammatory biomarkers and mental health; the UP&DOWN Study

[Background] An objective diagnosis of sedentary behaviour as well as of the physical activity and fitness levels in youth and to better understand how lifestyle is associated with cardiovascular disease risk factors and other phenotypes is of clinical and public health interest, and might be informative for developing intervention studies focused on the promotion of physical activity in these population. The aim of this methodological paper is to describe the design and assessment in the UP&DOWN study. [Methods/Design] The UP&DOWN study is a multi-center follow-up design where 2225 Spanish primary and secondary schoolchildren from Cadiz and Madrid, respectively, as well as 110 Spanish adolescents with Down syndrome from Madrid and Toledo were recruited to be assessed. Nine main measurement categories are assessed: i) socio-demographic and early determinants; ii) environmental determinants; iii) physical activity and sedentary behaviour; iv) health-related fitness; v) blood pressure and resting heart rate; vi) mental health; vii) dietary patterns; viii) blood samples; and ix) genetic analysis. During the 3-yr follow-up study, socio-demographic and early determinants, and genetic analysis are only assessed in the first year. Blood sampling is assessed in the first year and the third year (2nd follow-up), and all the other measurements are assessed every year. [Discussion] The findings of the UP&DOWN study may help the Health Information Systems and policy makers to identify the target population for primary prevention and health promotion policies, and to develop and test preventive strategies. Moreover, these data will allow following the trends at population level, as well as to modify/adapt/create new evidence-based physical activity guidelines at national level. The findings will also serve as a scientific platform for interventional studies.This study was supported by the DEP 2010-21662-C04-00 (DEP 2010-21662-C04-01, DEP 2010-21662-C04-02, DEP 2010-21662-C04-03, DEP 2010-21662-C04-04) RYC-2010-05957 grants from the National Plan for Research, Development and Innovation (R + D + i) MICINN

Longitudinal reallocations of time between 24-h movement behaviours and their associations with inflammation in children and adolescents: the UP&DOWN study

Purpose The aims of this study were to advance knowledge on physical activity (PA) and sedentary behaviour (SB) policies in China and to highlight related gaps and opportunities in the Chinese policy landscape. Methods Literature and web-based searches were performed to identify national PA and SB policies in China. We assessed which of the 17 elements of the Health Enhancing Physical Activity Policy Audit Tool (HEPA PAT, version 2) are included in each of the policy documents and whether and how they address the ‘cornerstones’ of PA and SB policy: PA and SB guidelines, targets, surveillance and monitoring, and public education programmes. Results We found 60 national PA and SB policies, of which 54 focused on PA only and 6 focused on both PA and SB. There was a rapid increase in the number of policies issued between 2002 and 2021. In totality, the policies include all 17 key elements for a successful national policy approach to PA promotion according to the HEPA PAT. The policies reflect engagement from a range of sectors and encompass PA targets, recommendations for PA and SB, mandates and recommendations for school-related PA, plans for public education on PA, and plans for surveillance and monitoring of PA and SB. Conclusion Our findings demonstrate that there has been increasing focus on PA and SB policies in China, which reflects efforts by policymakers to address the health burden of insufficient PA and excessive SB. More emphasis may be placed on SB in Chinese policy, particularly in terms of setting specific targets for population SB. Policymakers and other relevant public health stakeholders in China could also consider developing or adopting the 24-hour movement guidelines, in accordance with recent trends in several other countries. Collaboration and involvement of different sectors in the development and implementation of Chinese PA and SB policies should continue to be facilitated as part of a whole-of-system approach to health promotion

Prevalence of Lynch Syndrome among Patients with Newly Diagnosed Endometrial Cancers

Background: Lynch syndrome (LS) is a hereditary condition that increases the risk for endometrial and other cancers. The identification of endometrial cancer (EC) patients with LS has the potential to influence life-saving interventions. We aimed to study the prevalence of LS among EC patients in our population. Methods: Universal screening for LS was applied for a consecutive series EC. Tumor testing using microsatellite instability (MSI), immunohistochemistry (IHC) for mismatch-repair (MMR) protein expression and MLH1-methylation analysis, when required, was used to select LS-suspicious cases. Sequencing of corresponding MMR genes was performed. Results: One hundred and seventy-three EC (average age, 63 years) were screened. Sixty-one patients (35%) had abnormal IHC or MSI results. After MLH1 methylation analysis, 27 cases were considered suspicious of LS. From these, 22 were contacted and referred for genetic counseling. Nineteen pursued genetic testing and eight were diagnosed of LS. Mutations were more frequent in younger patients (<50 yrs). Three cases had either intact IHC or MSS and reinforce the need of implement the EC screening with both techniques. Conclusion: The prevalence of LS among EC patients was 4.6% (8/173); with a predictive frequency of 6.6% in the Spanish population. Universal screening of EC for LS is recommended.This study was supported by Conselleria Sanidad Comunidad Valenciana, Spain (AP/177/10) (http://www.san.gva.es/); Biomedical Research Foundations of the Alicante University Hospital (PI14/2006 and NI02/2011) (http://www.dep19.san.gva.es/); and the Elche University Hospital, Spain (FIBElx-CO11/03) (http://www.dep20.san.gva.es/)

From colorectal cancer pattern to the characterization of individuals at risk: Picture for genetic research in Latin America

Colorectal cancer (CRC) is one of the most common cancers in Latin America and the Caribbean, with the highest rates reported for Uruguay, Brazil and Argentina. We provide a global snapshot of the CRC patterns, how screening is performed, and compared/contrasted to the genetic profile of Lynch syndrome (LS) in the region. From the literature, we find that only nine (20%) of the Latin America and the Caribbean countries have developed guidelines for early detection of CRC, and also with a low adherence. We describe a genetic profile of LS, including a total of 2,685 suspected families, where confirmed LS ranged from 8% in Uruguay and Argentina to 60% in Peru. Among confirmed LS, path_MLH1 variants were most commonly identified in Peru (82%), Mexico (80%), Chile (60%), and path_MSH2/EPCAM variants were most frequently identified in Colombia (80%) and Argentina (47%). Path_MSH6 and path_PMS2 variants were less common, but they showed important presence in Brazil (15%) and Chile (10%), respectively. Important differences exist at identifying LS families in Latin American countries, where the spectrum of path_MLH1 and path_MSH2 variants are those most frequently identified. Our findings have an impact on the evaluation of the patients and their relatives at risk for LS, derived from the gene affected. Although the awareness of hereditary cancer and genetic testing has improved in the last decade, it is remains deficient, with 39%–80% of the families not being identified for LS among those who actually met both the clinical criteria for LS and showed MMR deficiency.Fil: Vaccaro, Carlos Alberto. Hospital Italiano; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: López Kostner, Francisco. No especifíca;Fil: Adriana, Della Valle. Hospital Fuerzas Armadas; UruguayFil: Inez Palmero, Edenir. Hospital de cáncer de Barretos, FACISB; BrasilFil: Rossi, Benedito Mauro. Hospital Sirio Libanes; BrasilFil: Antelo, Marina. Gobierno de la Ciudad de Buenos Aires. Hospital de Gastroenterología "Dr. Carlos B. Udaondo"; Argentina. Universidad Nacional de Lanús; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Solano, Angela Rosario. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Biomédicas. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Biomédicas; ArgentinaFil: Carraro, Dirce Maria. No especifíca;Fil: Forones, Nora Manoukian. Universidade Federal de Sao Paulo; BrasilFil: Bohorquez, Mabel. Universidad del Tolima; ColombiaFil: Lino Silva, Leonardo S.. Instituto Nacional de Cancerologia; MéxicoFil: Buleje, Jose. Universidad de San Martín de Porres; PerúFil: Spirandelli, Florencia. No especifíca;Fil: Abe Sandes, Kiyoko. Universidade Federal da Bahia; BrasilFil: Nascimento, Ivana. No especifíca;Fil: Sullcahuaman, Yasser. Universidad Peruana de Ciencias Aplicadas; Perú. Instituto de Investigación Genomica; PerúFil: Sarroca, Carlos. Hospital Fuerzas Armadas; UruguayFil: Gonzalez, Maria Laura. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Medicina Traslacional e Ingeniería Biomédica - Hospital Italiano. Instituto de Medicina Traslacional e Ingeniería Biomédica.- Instituto Universitario Hospital Italiano de Buenos Aires. Instituto de Medicina Traslacional e Ingeniería Biomédica; ArgentinaFil: Herrando, Alberto Ignacio. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Medicina Traslacional e Ingeniería Biomédica - Hospital Italiano. Instituto de Medicina Traslacional e Ingeniería Biomédica.- Instituto Universitario Hospital Italiano de Buenos Aires. Instituto de Medicina Traslacional e Ingeniería Biomédica; ArgentinaFil: Alvarez, Karin. No especifíca;Fil: Neffa, Florencia. Hospital Fuerzas Armadas; UruguayFil: Galvão, Henrique Camposreis. Barretos Cancer Hospital; BrasilFil: Esperon, Patricia. Hospital Fuerzas Armadas; UruguayFil: Golubicki, Mariano. Gobierno de la Ciudad de Buenos Aires. Hospital de Gastroenterología "Dr. Carlos B. Udaondo"; ArgentinaFil: Cisterna, Daniel. Gobierno de la Ciudad de Buenos Aires. Hospital de Gastroenterología "Dr. Carlos B. Udaondo"; ArgentinaFil: Cardoso, Florencia C.. Centro de Educación Medica E Invest.clinicas; ArgentinaFil: Tardin Torrezan, Giovana. No especifíca;Fil: Aguiar Junior, Samuel. No especifíca;Fil: Aparecida Marques Pimenta, Célia. Universidade Federal de Sao Paulo; BrasilFil: Nirvana da Cruz Formiga, María. No especifíca;Fil: Santos, Erika. Hospital Sirio Libanes; BrasilFil: Sá, Caroline U.. Hospital Sirio Libanes; BrasilFil: Oliveira, Edite P.. Hospital Sirio Libanes; BrasilFil: Fujita, Ricardo. Universidad de San Martín de Porres; PerúFil: Spirandelli, Enrique. No especifíca;Fil: Jimenez, Geiner. No especifíca;Fil: Santa Cruz Guindalini, Rodrigo. Universidade de Sao Paulo; BrasilFil: Gondim Meira Velame de Azevedo, Renata. No especifíca;Fil: Souza Mario Bueno, Larissa. Universidade Federal da Bahia; BrasilFil: dos Santos Nogueira, Sonia Tereza. No especifíca;Fil: Piñero, Tamara Alejandra. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Medicina Traslacional e Ingeniería Biomédica - Hospital Italiano. Instituto de Medicina Traslacional e Ingeniería Biomédica.- Instituto Universitario Hospital Italiano de Buenos Aires. Instituto de Medicina Traslacional e Ingeniería Biomédica; Argentin

Assessing the impact of COVID-19 on liver cancer management (CERO-19).

BACKGROUND & AIMS: The coronavirus disease 2019 (COVID-19) pandemic has posed unprecedented challenges to healthcare systems and it may have heavily impacted patients with liver cancer (LC). Herein, we evaluated whether the schedule of LC screening or procedures has been interrupted or delayed because of the COVID-19 pandemic. METHODS: An international survey evaluated the impact of the COVID-19 pandemic on clinical practice and clinical trials from March 2020 to June 2020, as the first phase of a multicentre, international, and observational project. The focus was on patients with hepatocellular carcinoma or intrahepatic cholangiocarcinoma, cared for around the world during the first COVID-19 pandemic wave. RESULTS: Ninety-one centres expressed interest to participate and 76 were included in the analysis, from Europe, South America, North America, Asia, and Africa (73.7%, 17.1%, 5.3%, 2.6%, and 1.3% per continent, respectively). Eighty-seven percent of the centres modified their clinical practice: 40.8% the diagnostic procedures, 80.9% the screening programme, 50% cancelled curative and/or palliative treatments for LC, and 41.7% modified the liver transplantation programme. Forty-five out of 69 (65.2%) centres in which clinical trials were running modified their treatments in that setting, but 58.1% were able to recruit new patients. The phone call service was modified in 51.4% of centres which had this service before the COVID-19 pandemic (n = 19/37). CONCLUSIONS: The first wave of the COVID-19 pandemic had a tremendous impact on the routine care of patients with liver cancer. Modifications in screening, diagnostic, and treatment algorithms may have significantly impaired the outcome of patients. Ongoing data collection and future analyses will report the benefits and disadvantages of the strategies implemented, aiding future decision-making. LAY SUMMARY: The coronavirus disease 2019 (COVID-19) pandemic has posed unprecedented challenges to healthcare systems globally. Herein, we assessed the impact of the first wave pandemic on patients with liver cancer and found that routine care for these patients has been majorly disrupted, which could have a significant impact on outcomes

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Transformaciones del cenobio de San Martín de Castañeda: intervenciones contemporáneas y criterios contemplados

El monasterio de San Martin de Castañeda se encuentra en la población del mismo nombre con origen en las granjas de los monjes. Ubicado en la sierra zamorana, lleva desde el siglo X presidiendo el Lago de Sanabria. Desde que lo fundaron los monjes ha tenido varias etapas claramente distinguidas. Primero se construyó una iglesia mozárabe según el rito hispano. En el siglo XI se produjo una reforma a la norma benedictina y reconstruyeron la iglesia al estilo románico zamorano. No fué la última puesto que, doscientos años más tarde, se reformó al rito cisterciense. En el siglo XVI rehicieron sus claustros al estilo gótico. De ese claustro nada nos queda, pues la ley de desamortización obligó a los monjes a abandonarlo el s.XIX provocando el comienzo de su decadencia, en estos años el claustro desaparecerá casi por completo. En 1931 la iglesia, al borde de la ruina, fue declarada Monumento Nacional y comenzó un siglo de transformaciones. Primero Alejandro Ferrant Vázquez intervino en los años 30, tras la guerra civil, recogió el testigo Francisco Pons-Sorolla y Luis Menéndez- Pidal. Entre los años 40 y 60 estos arquitectos convirtieron la iglesia en lo que hoy conocemos. El ala del claustro que había sobrevivido fue reconstruida en los años 80 por Marco Antonio Garcés Desmaison y reconvertido en Casa del Parque Natural del Lago de Sanabria. En los años siguientes Pedro Lucas del Teso, actuó en el monasterio. Desde hace unos años y hasta la actualidad interviene la fundación Santa María La Real en todo el conjunto, además, desde el 2008 la iglesia, el claustro y su entorno son Bien de Interés Cultural. The monastery of San Martín de Castañeda is found in a village of the same name with origin in ancient Cistercian farms. Located in Zamora’s mountains, it is been since the tenth century looking over the Sanabria Lake. Since the monks founded it has had several stages clearly distinguished. First it was built a Mozarabic church that followed the Hispanic rite. The monks converted in the eleventh century to the Benedictine rite and then the church was rebuilt in the Romanic style. It wouldn’t be the last time because two hundred years later they will adopt the Cistercian order. In the XVI century the monks rebuilt the cloister in the gothic style. There is next to nothing left of this cloister due to the ecclesiastical confiscation that forced the monks to abandon the monastery in the XIX century, meaning the beginning of the ruin. In 1931 when the church was almost in ruins was declared Nacional Monument and started a century of transformations. Ferrant was the first who worked in the church in the 30s, after the civil war, Pons-Sorolla and Menéndez-Pidal continued with his project. These two architects, between the 40s an the 60s, transformed the church in what we know today. The surviving wing of the cloister was rebuilt in the 80s by Garcés Desmaison who converted it in the Casa del Parque Natural del Lago de Sanabria. In the following years Lucas del Teso worked in the monastery. From few years until now the Santa Mª la Real foundation has being working in the whole site, also from 2008 the monument and its surroundings are classified as asset of cultural interest (BIC)

Transformaciones del cenobio de San Martín de Castañeda: intervenciones contemporáneas y criterios contemplados

El monasterio de San Martin de Castañeda se encuentra en la población del mismo nombre con origen en las granjas de los monjes. Ubicado en la sierra zamorana, lleva desde el siglo X presidiendo el Lago de Sanabria. Desde que lo fundaron los monjes ha tenido varias etapas claramente distinguidas. Primero se construyó una iglesia mozárabe según el rito hispano. En el siglo XI se produjo una reforma a la norma benedictina y reconstruyeron la iglesia al estilo románico zamorano. No fué la última puesto que, doscientos años más tarde, se reformó al rito cisterciense. En el siglo XVI rehicieron sus claustros al estilo gótico. De ese claustro nada nos queda, pues la ley de desamortización obligó a los monjes a abandonarlo el s.XIX provocando el comienzo de su decadencia, en estos años el claustro desaparecerá casi por completo. En 1931 la iglesia, al borde de la ruina, fue declarada Monumento Nacional y comenzó un siglo de transformaciones. Primero Alejandro Ferrant Vázquez intervino en los años 30, tras la guerra civil, recogió el testigo Francisco Pons-Sorolla y Luis Menéndez- Pidal. Entre los años 40 y 60 estos arquitectos convirtieron la iglesia en lo que hoy conocemos. El ala del claustro que había sobrevivido fue reconstruida en los años 80 por Marco Antonio Garcés Desmaison y reconvertido en Casa del Parque Natural del Lago de Sanabria. En los años siguientes Pedro Lucas del Teso, actuó en el monasterio. Desde hace unos años y hasta la actualidad interviene la fundación Santa María La Real en todo el conjunto, además, desde el 2008 la iglesia, el claustro y su entorno son Bien de Interés Cultural. The monastery of San Martín de Castañeda is found in a village of the same name with origin in ancient Cistercian farms. Located in Zamora’s mountains, it is been since the tenth century looking over the Sanabria Lake. Since the monks founded it has had several stages clearly distinguished. First it was built a Mozarabic church that followed the Hispanic rite. The monks converted in the eleventh century to the Benedictine rite and then the church was rebuilt in the Romanic style. It wouldn’t be the last time because two hundred years later they will adopt the Cistercian order. In the XVI century the monks rebuilt the cloister in the gothic style. There is next to nothing left of this cloister due to the ecclesiastical confiscation that forced the monks to abandon the monastery in the XIX century, meaning the beginning of the ruin. In 1931 when the church was almost in ruins was declared Nacional Monument and started a century of transformations. Ferrant was the first who worked in the church in the 30s, after the civil war, Pons-Sorolla and Menéndez-Pidal continued with his project. These two architects, between the 40s an the 60s, transformed the church in what we know today. The surviving wing of the cloister was rebuilt in the 80s by Garcés Desmaison who converted it in the Casa del Parque Natural del Lago de Sanabria. In the following years Lucas del Teso worked in the monastery. From few years until now the Santa Mª la Real foundation has being working in the whole site, also from 2008 the monument and its surroundings are classified as asset of cultural interest (BIC)