Hospital Obispo Polanco

Geological data of the region indicate that the Canary Islands have not been connected to the mainland before. However, fossil evidence suggests some kind of faunal exchange with Africa during the late Neogene. After extensive field work during past years, a re-evaluation of the fossil remains of the first terrestrial vertebrates that settled and thrived on the Canary Islands is presented, with special attention to the long-debated identity of birds that laid large-sized eggs, reported some decades ago on Lanzarote Island. The age of the eggshell-bearing deposits has been recently updated as Early Pliocene (ca. 4 Ma). The dispersal mode of these terrestrial birds to reach the island was an unsolvable challenge in previous studies because the regional geography of the sea bottom was neglected, as well as the chronological succession of events in the formation of the Canary Eastern Ridge, which increased attention to a unique case of arrival of ratites on an island never before united with the mainland. The few animals found in northern Lanzarote (ratites, snakes, turtles, terrestrial snails and bite marks on eggshells pointing to a jagged and unknown large predator) probably made the sea crossing from the mainland in different ways. Two scenarios are contemplated. In both, the circumstances facilitating the faunal transit from Africa to the Canaries ceased after the early Pliocene, around 4 Ma, since these animals have never managed to cross the Canary Channel again.

La pupila tónica de Adie es una condición neurológica rara caracterizada por una dilatación pupilar con pobre respuesta a la luz y acomodación. Se diagnostica por exclusión y pruebas con pilocarpina diluida. Aunque suele ser idiopática, debe descartarse una causa subyacente. Se presenta un caso sobre esta patología.

Background: Sex differences in type 2 diabetes (T2D) are a growing area of diabetes research. No data have been reported on sex differences with oral semaglutide (oSEMA) in a real-world setting. Methods: We included people with T2D who started treatment with oSEMA in routine clinical practice between November 2021 and November 2022, with at least one report of clinical follow-up (FU) data at 3 months. We evaluated in women with T2D (WWT2D) the clinical effectiveness of oSEMA and factors associated with clinical response and persistence. We also analyzed differences in baseline characteristics, clinical effectiveness, persistence rates and safety according to biological sex. Results: Of the 1018 subjects [median age: 63 years, body mass index (BMI): 33.8 kg/m2, HbA1c: 7.8%], 469 were WWT2D. In WWT2D, oSEMA reduced HbA1c by 0.7% [−0.1 to −1.3] and 0.9% [−0.2 to −1.5] at the 6- and 12-month FU visits, while weight decreased by 4.6% [2.0 to 7.9] and 7.2% [2.5 to 10.9], respectively. Weight loss was >10% in 29.8% of WWT2D (95% CI 25.8 to 34.1); meanwhile, the combined endpoint (HbA1c decrease ≥ 1% + weight reduction ≥ 5%) was achieved in 23.5% (95% CI 19.8 to 27.5%) of WWT2D at the 12-month FU visit. Achievement of glycaemic targets was similar in women and men (59.3% vs. 61.1%). We found no sex differences in weight loss (6.9% vs. 6.8%), oSEMA maintenance dose, persistence rate (76.3% vs. 77.3%), or adverse events. Conclusions: oSEMA was effective and safe in WWT2D in a real-world setting, with nearly one-third of patients reporting weight loss >10% and more than two-thirds achieving HbA1c < 7%. oSEMA showed no sex bias in terms of effectiveness and safety.

Relevance:Cataract surgery is practically inevitable in the general population. Accurate intraocular lens (IOL) power calculation is crucial to achieving optimal postoperative outcomes. The increasing incidence of cataract surgery following previous refractive procedures, due to lens sclerosis, compromises visual acuity and quality of life. Improving prediction formulas is essential to restore visual function effectively in these patients. Purpose:To evaluate the accuracy and predictability of intraocular lens (IOL) power calculation formulas in cataract patients previously treated with refractive surgery (both myopic and hyperopic LASIK), and to analyze the correlation between the amount of corrected refractive error and the precision of IOL power prediction. Methods:A retrospective, non-randomized study was conducted on patients from Sectors I and II of Zaragoza who had undergone cataract surgery after previous refractive surgery. Data collected included pre- and post-refractive surgery keratometry, axial length, implanted IOL power, and IOL constants (a0, a1, a2). IOL power was recalculated using the Haigis-L formula with an estimated keratometry value derived from linear regression models according to ranges of refractive error. Inclusion and exclusion criteria were applied to define the study cohort. Results:Seventy-one cases were analyzed and classified into hyperopia (n=13 cases), low myopia (n=17), moderate myopia (n=14), high myopia (n=16), and extreme myopia (n=11).Using the Haigis-L formula, the mean prediction errors were −1.52 ± 1.15 D for myopic eyes and 0.09 ± 0.72 D for hyperopic eyes.Regression models tailored to refractive error ranges improved prediction accuracy, yielding errors of −0.21 ± 2.0 D for myopic eyes and 0.6 ± 1.44 D for hyperopic eyes.A specific regression model including myopias greater than 7.5 D achieved a mean error of −0.27 ± 1.31 D for myopic eyes. Conclusions:The Haigis-L formula demonstrated superior accuracy for hyperopic patients. A low myopia regression model performed best up to −2.5 D, whereas a broader myopia regression model, including higher myopic corrections, was preferable for the remaining cases. Further optimization of the latter model is recommended to minimize myopic prediction errors.

Gastrointestinal stromal tumors (GISTs) are the most common sarcoma subtype. Patients with unresectable or metastatic GISTs harboring the D842V mutation in the PDGFRA gene have a poor prognosis due to intrinsic resistance to imatinib and all other approved tyrosine kinase inhibitors. Avapritinib, targeting this mutation, is the first agent approved for patients with unresectable or metastatic GIST that have the PDGFRA D842V mutation. This study assesses the effectiveness and safety of avapritinib in real-world clinical scenarios involving Spanish patients with this mutation. The AVARWE study is a descriptive, retrospective, multicenter observational study of 21 patients treated with avapritinib across 13 Spanish centers from June 9, 2023, to December 18, 2023. Data collected included patient demographics, disease characteristics, treatment history, and response rates based on RECIST criteria. The main outcomes, progression-free survival (PFS) and overall survival (OS), were measured, with safety assessed through adverse events documentation according to CTCAE criteria. Median PFS 35.6 was months and median OS was 42.2 months, with survival rates at 1, 5, and 3 years demonstrating avapritinib effectiveness. The objective response rate was 76.2% for partial response and 4.8% for complete response. Avapritinib enabled surgical intervention in previously unresectable cases and was generally well-tolerated, with manageable adverse events. Avapritinib extends PFS and OS among patients with PDGFRA D842V-mutant GIST in real-world practice, mirroring pivotal trial outcomes. Its substantial activity supports its use as a first-line therapy for this subgroup. The manageable safety profile reinforces avapritinib viability for routine use. Given the rarity of these cases, it is advised to consult sarcoma-expert units.

Low back pain (LBP) is a potential complication after total hip arthroplasty (THA). However, some studies suggest that THA not only alleviates joint pain but also resolves LBP in up to 88.2% of patients. Most of these observations are limited to short-term follow-ups. This study investigates the long-term relationship between THA and LBP, challenging the notion that THA resolves LBP. A retrospective review was conducted on 236 patients who underwent THA (2010–2020). Multiple statistical models were applied, including unadjusted unmatched, adjusted unmatched, adjusted matched, and target trial emulation with 7887 subjects, to evaluate LBP incidence. Of the 236 patients, 119 developed postoperative LBP. The unadjusted unmatched analysis showed a relative risk (RR) of 2.23 (95%CI: 1.5–3.2). Adjusting for age, sex, body mass index (BMI), and recruitment period reduced the RR to 1.64 (95%CI: 1.0–2.6). The adjusted matched analysis showed an RR of 1.09 (95%CI: 0.4–3.0), while the target trial emulation simulated an RR of 1.03 (95%CI: 0.7–1.8), indicating no significant differences. Despite an apparent initial association, adjusted analyses do not support a significant long-term relationship between THA and LBP. No reduction in postoperative LBP incidence was observed, suggesting THA is safe regarding LBP risk but lacks a curative effect. Rigorous confounding adjustment is essential in retrospective studies.