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PURPOSE: To evaluate the short-term clinical outcomes of a specific toric diffractive trifocal intraocular lens (IOL) implanted following an optimized clinical protocol in a large population. METHODS: Retrospective analysis of 337 eyes of 231 patients (mean age, 62.2 years) undergoing cataract surgery with implantation of the trifocal diffractive IOL AT.LISA tri toric 939M/MP (Carl Zeiss Meditec). A strict and careful clinical protocol was followed, including an accurate measurement of corneal astigmatism, use of a latest generation IOL power calculator, photography-based method intraoperative control of IOL alignment and IOL reposition at 1 week postoperatively if needed. Clinical outcomes in terms of visual acuity, refraction, efficacy of astigmatic correction analysed by vector analysis and patient satisfaction were evaluated during a 3-month follow-up. RESULTS: A total of 82% and 98% of eyes achieved a postoperative uncorrected distance visual acuity of 0.00 and 0.10 logMAR or better, respectively. Furthermore, 99.7%, and 100.0% of eyes showed a postoperative spherical equivalent within ± 0.50 D and ± 1.00 D, with 97.9% of eyes having a postoperative cylinder ≤ 0.50 D. Uncorrected near and intermediate visual acuities were 0.2 logMAR or better in 89.0% and 99.1% of eyes, respectively. Mean difference vector, magnitude of error and angle of error were 0.02 ± 0.14 D, 0.02 ± 0.13 D and 0.11 ± 1.18°. Patient satisfaction was referred as high or very high by 97.6% of patients. CONCLUSIONS: The implantation of the trifocal toric IOL evaluated following a careful clinical protocol provides an efficacious visual rehabilitation and astigmatic correction, leading to high levels of patient satisfaction.

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It is unknown whether hospital-based medical professionals in Spain educate patients about advance directives (ADs). The objective of this research was to determine the frequency of hospital-based physicians' and nurses' engagement in AD discussions in the hospital and which patient populations merit such efforts. A short question-and-answer-based survey of physicians and nurses taking care of inpatients was conducted at a university hospital in Madrid, Spain. In total, 283 surveys were collected from medical professionals, of whom 71 per cent were female, with an average age of thirty-four years. Eighty-four per cent had never educated patients about ADs because of lack of perceived responsibility, time, or general knowledge of ADs. Patient populations that warranted AD discussions included those with terminal illnesses (77 per cent), chronic diseases (61 per cent), and elderly patients (43 per cent). Regarding degree of AD understanding in medical professionals: 57 per cent of medical professionals claimed sufficient general knowledge of ADs, 19 per cent understood particulars regarding AD document creation, and 16 per cent were aware of AD regulatory policies. Engagement in AD discussions was considered important by 83 per cent of medical professionals, with 79 per cent interested in participating in such discussions themselves. The majority of hospital physicians and nurses do not educate their patients about ADs, despite acknowledging their importance. Patient populations of highest priority included those with terminal diseases or chronic illness or who are of advanced age.

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BACKGROUND: Mutations causing Leber hereditary optic neuropathy are usually homoplasmic, show incomplete penetrance, and many of the affected positions are not well conserved through evolution. A large percentage of patients harbouring these mutations have no family history of disease. Moreover, the transfer of the mutation in the cybrid model is frequently not accompanied by the transfer of the cellular, biochemical and molecular phenotype. All these features make difficult their classification as the etiologic factors for this disease. We report a patient who exhibits typical clinical features of Leber hereditary optic neuropathy but lacks all three of the most common mitochondrial DNA mutations. METHODS: The diagnosis was made based on clinical studies. The mitochondrial DNA was completely sequenced, and the candidate mutation was analysed in more than 18 000 individuals around the world, its conservation index was estimated in more than 3100 species from protists to mammals, its position was modelled in the crystal structure of a bacteria ortholog subunit, and its functional consequences were studied in a cybrid model. RESULTS: Genetic analysis revealed an m.3472T>C transition in the MT-ND1 gene that changes a phenylalanine to leucine at position 56. Bioinformatics, molecular-genetic analysis and functional studies suggest that this transition is the etiological factor for the disorder. CONCLUSIONS: This mutation expands the spectrum of deleterious changes in mitochondrial DNA-encoded complex I polypeptides associated with this pathology and highlights the difficulties in assigning pathogenicity to new homoplasmic mutations that show incomplete penetrance in sporadic Leber hereditary optic neuropathy patients.

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Introducción. Las consultas en neurología por quejas de memoria se han incrementado en los últimos años, tanto en mayores como en jóvenes. Se han realizado pocos estudios sobre las variables que influyen en las quejas en adultos jóvenes. Objetivo. Analizar en esta población la relación de las quejas con el rendimiento objetivo de memoria, con la depresión y la ansiedad, con la edad, el sexo y el nivel de estudios. Sujetos y métodos. Muestra de 582 individuos trabajadores sin deterioro cognitivo y edad de 2-64 años. Los materiales utilizados fueron listas de palabras y escenas de familia de la escala de memoria de Wechsler, tercera edición, cuestionario de fallos de memoria de la vida diaria (MFE), y escala de depresión y ansiedad de Goldberg. Resultados. No se encontró asociación estadísticamente significativa entre la valoración subjetiva de la memoria y el rendimiento objetivo inmediato o demorado, ni en la memoria visual ni en la verbal. La depresión y la ansiedad fueron las variables con mayor correlación con la puntuación global del MFE. En el análisis de regresión, las variables significativas fueron: la depresión, con el mayor tamaño de efecto, la edad, los estudios universitarios y el sexo. Conclusión. Las personas jóvenes que manifestaron más olvidos cotidianos no presentaron un rendimiento menor en las pruebas objetivas de memoria. Las variables más importantes que intervinieron en las quejas fueron la depresión y la ansiedad. Las personas más jóvenes, las que tenían estudios universitarios y los varones manifestaron menos quejas de memoria (AU)

Introduction. Neurological consultations due to memory complaints have increased in recent years in both older and younger people. Few investigations have studied the variables related to memory complaints in young adults. Aim. To analyze, in a sample of young adults, the relationship between memory complaints and objective memory performance, depressive and anxiety symptoms, age, sex and level of studies. Subjects and methods. The study included 582 healthy workers, without cognitive impairment, aged 22-64 years. Assessment: Word List and Family Scenes of Wechsler Memory Scale-III, Memory Failures of Everyday Questionnaire (MFE) and Goldberg Anxiety and Depression Scale. Results. We did not find any significant association between subjective assessment of memory and objective performance, both immediate and delayed in verbal and visual memory. Depression and anxiety had the highest correlation with MFE. The significant variables in the multiple regression analysis were: depression, with the largest effect size, age, college studies and sex. Conclusion. In young adults, those which had a greater perception of daily forgetfulness were not those with lesser memory performance. The most important variables involved in memory complaints were depression and anxiety. Younger people, people with college education and men reported less memory complaints (AU)

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INTRODUCTION: Neurological consultations due to memory complaints have increased in recent years in both older and younger people. Few investigations have studied the variables related to memory complaints in young adults. AIM: To analyze, in a sample of young adults, the relationship between memory complaints and objective memory performance, depressive and anxiety symptoms, age, sex and level of studies. SUBJECTS AND METHODS: The study included 582 healthy workers, without cognitive impairment, aged 22-64 years. ASSESSMENT: Word List and Family Scenes of Wechsler Memory Scale-III, Memory Failures of Everyday Questionnaire (MFE) and Goldberg Anxiety and Depression Scale. RESULTS: We did not find any significant association between subjective assessment of memory and objective performance, both immediate and delayed in verbal and visual memory. Depression and anxiety had the highest correlation with MFE. The significant variables in the multiple regression analysis were: depression, with the largest effect size, age, college studies and sex. CONCLUSION: In young adults, those which had a greater perception of daily forgetfulness were not those with lesser memory performance. The most important variables involved in memory complaints were depression and anxiety. Younger people, people with college education and men reported less memory complaints.

TITLE: Relacion de las quejas de memoria con el rendimiento de memoria, el estado de animo y variables sociodemograficas en adultos jovenes.Introduccion. Las consultas en neurologia por quejas de memoria se han incrementado en los ultimos años, tanto en mayores como en jovenes. Se han realizado pocos estudios sobre las variables que influyen en las quejas en adultos jovenes. Objetivo. Analizar en esta poblacion la relacion de las quejas con el rendimiento objetivo de memoria, con la depresion y la ansiedad, con la edad, el sexo y el nivel de estudios. Sujetos y metodos. Muestra de 582 individuos trabajadores sin deterioro cognitivo y edad de 22-64 años. Los materiales utilizados fueron listas de palabras y escenas de familia de la escala de memoria de Wechsler, tercera edicion, cuestionario de fallos de memoria de la vida diaria (MFE), y escala de depresion y ansiedad de Goldberg. Resultados. No se encontro asociacion estadisticamente significativa entre la valoracion subjetiva de la memoria y el rendimiento objetivo inmediato o demorado, ni en la memoria visual ni en la verbal. La depresion y la ansiedad fueron las variables con mayor correlacion con la puntuacion global del MFE. En el analisis de regresion, las variables significativas fueron: la depresion, con el mayor tamaño de efecto, la edad, los estudios universitarios y el sexo. Conclusion. Las personas jovenes que manifestaron mas olvidos cotidianos no presentaron un rendimiento menor en las pruebas objetivas de memoria. Las variables mas importantes que intervinieron en las quejas fueron la depresion y la ansiedad. Las personas mas jovenes, las que tenian estudios universitarios y los varones manifestaron menos quejas de memoria.

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Introducción y objetivos: Hay enfermedades degenerativas que pueden presentarse en adultos jóvenes y que afectan a la memoria; para ellas es importante un diagnóstico precoz. Las quejas subjetivas de memoria (QSM) son cada vez más frecuentes en adultos jóvenes, pero han sido o bjeto de pocos estudios. Nuestro objetivo es analizar la relación entre las QSM y el rendimiento objetivo de memoria, y determinar la asociación de las QSM con variables relacionadas con el estado de ánimo, los rasgos de personalidad y la percepción de la calidad de vida relacionada con la salud. Material y métodos: Estudiamos a 102 sujetos, de entre 23-64 años y sin deterioro cognitivo. Evaluación: Cuestionario de Fallos de Memoria, Escala de Memoria de Wechsler, Escala de Depresión-Ansiedad de Goldberg, Escala de Resiliencia y Cuestionario de Salud SF-12. Se realizaron correlaciones y regresión lineal jerárquica en tres bloques: variables sociodemográficas, de salud y de rendimiento de memoria. El tamaño del efecto se estudió con R2. Resultados: No hay correlación significativa entre QSM y edad, estudios, memoria auditiva y visual, ansiedad y resiliencia. Existe una correlación estadísticamente significativa con sintomatología depresiva (r=0,35; p<0,01) y percepción de salud (r=0,37; p<0,01). Varios factores del SF-12 y de personalidad se asociaron a las QSM. Entre todas las variables, la única con valor predictivo en la regresión fue Salud mental (F=3,561; p=0,004; R2=0,23). Conclusión: Nuestro estudio destaca el aspecto subjetivo de las QSM frente al objetivo. En adultos jóvenes que acuden a la consulta con QSM hay que valorar factores como la ansiedad la depresión, la falta de confianza en uno mismo y la calidad de vida, y no sólo el rendimiento de memoria(AU)

Introduction and aims: There are degenerative diseases in young adults that can affect memory; for these diseases an early diagnosis is important. Subjective memory complaints (SMC) are becoming more common in young adults but there are few studies on this topic. Our aim is to analyze the relationship between SMC and objective memory performance and to establish the association between SMC and mood, personality traits or perception of quality of life related to health. Methods: We studied 102 subjects, between 23-64 years without cognitive impairment. Assessment: Questionnaire of Memory Failures of Everyday, Wechsler Memory Scale, Goldberg Anxiety and Depression Scale, Resilience Scale and Health Survey (SF-12). Statistical analysis: Correlations and hierarchical linear regression in three blocks: sociodemographic factors, health factors and memory performance. The effect size was studied using R2. Results: No significant correlation between SMC and age, education, auditory and visual memory, anxiety and resilience, was found. There is a statistically significant correlation with depressive symptoms ('r' = 0.35, p<0.01) and health perception ('r' = 0.37, p<0.01). Several SF-12 and personality factors were associated with SMC. Among all variables, the only one with predictive value in the regression was 'Mental Health' (F=3.561, P=0.004, R2=0.23). Conclusion: Our study highlights the subjective aspect of the SMC against the objective one. Attending young adults with SMC we must evaluate factors such as anxiety, depression, lack of self-confidence and quality of life and not only memory performance(AU)

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BACKGROUND: High-level evidence to support the use of photoselective vaporization of the prostate (PVP) is limited. OBJECTIVE: Assess the efficacy and safety of GreenLight HPS 120-W laser PVP compared with transurethral resection of the prostate (TURP). DESIGN, SETTING, AND PARTICIPANTS: A randomized clinical trial was performed with 50 patients having lower urinary tract symptoms due to benign prostatic hyperplasia in each treatment arm. INTERVENTION: Random allocation to PVP or TURP. MEASUREMENTS: International Prostate Symptom Score (IPSS), quality of life (QoL), and changes in maximum flow rate (Qmax) were the main end points. Patients were evaluated at a follow-up time of 2 yr. Five patients were lost to follow-up. A last observation carried forward analysis was done. RESULTS AND LIMITATIONS: Both laser PVP and TURP resulted in the same IPPS reduction at 2 yr (-15.7 and -14.9, respectively; p=0.48) and in the same gain in Qmax (+14.5 ml/s and +13.1 ml/s, respectively; p=0.65). QoL was equivalent for both treatment modalities. These results were independent of prostate size, American Society of Anesthesiologists risk category, and prior indwelling catheter. No statistically significant differences were detected between arms in terms of complication rates. In the laser PVP group, three patients were readmitted to the hospital and two developed a urethral stricture. In the TURP group, two patients were readmitted, six developed a urethral stricture, and two developed bladder neck sclerosis. In-hospital stay and time to catheter removal were significantly shorter with PVP. Limitations are the potential lack of power to detect differences in the complications between groups and the lack of blindness due to the nature of the intervention. CONCLUSIONS: GreenLight HPS 120-W laser PVP is as effective as TURP for symptom reduction and improvement of QoL. No differences were seen in the response of storage and voiding symptoms. Laser PVP and TURP have the same complication rate. Length of stay is shorter for laser PVP group.

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AIM: To analyze whether the presence of anti-HBs in liver transplant recipients is effective in preventing HBV infection. METHODS: Twenty-three patients receiving anti-HBc positive liver were studied. Nine recipients were anti-HBc positive as a result of previous HBV infection. Of them, one also received HBV vaccine during the pre-liver transplantation period. Fourteen recipients were anti-HBs positive due to HBV vaccine administered during the pre-transplant period. Liver biopsy was obtained in 10/14 anti-HBc negative/anti-HBs positive recipients and in 4/9 anti-HBc positive recipients. RESULTS: After a mean follow-up period of 46 months, 1 recipient with protective serum anti-HBs levels developed de novo HBV infection as a consequence of immune escape HBV mutants. Among the 14 vaccinated anti-HBc negative/anti-HBs positive recipients, 1/10 patients with available liver biopsy (10%) had liver HBV-DNA at 13 mo post-liver transplantation without serum viral markers and did not develop de novo HBV infection. The vaccinated anti-HBc positive recipient without HBV vaccine response was HBV-DNA positive in serum and liver, viral DNA was continuously negative in the following tests, so a spontaneous seroconversion was diagnosed. CONCLUSION: The presence of anti-HBs as a result of HBV vaccine or past HBV infection seems to be effective at protecting patients receiving livers from anti-HBc positive donors. However, the emergence of immune escape HBV mutants, which can evade the anti-HBs protection, should be considered as a risk of HBV infection.

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En el Hospital General de Requena se instauró en el año 1997 un programa de ingresos hospitalarios por problemas relacionados con la medicación (IPRM), Para la detección de casos de IPRM se realiza la revisión sistemática del libra de Admisión de Puertos de Urgencias analizándose de forma retrospectiva, sobre la historia clínica, los diagnósticos alertantes que motivaron el ingreso, Se establece un sistema de comunicación al médico de cabecera y al farmacéutico comunitario correspondiente de aquellos cosos presuntamente evitables que por sus características así lo aconsejen, En los cuatro años que se revisan en este trabajo se detectaron 437 IPRM, lo que supone una incidencia de un 0,45% de las visitas a puertas de urgencias del Hospital. Los casos detectados se clasifican en hemorragias digestivas altas por antiinflamatorios noesteroideos (138 casos), sobredosificaciones (34 cosos), infradosisficaciones (21 casos), ingesta occidental por niños (15 casos), ingesta accidental adultos (2 casos) IPRM con digoxina (30 casos), intentos de autolisis con fármacos (65 casos), interacciones farmacológicas (23 casos), Reacciones Adversos a Medicamentos (RAMs) (109 cosos). El establecimiento de un "feed-back" sobre médicos de familia y farmacéuticos comunitarios hace del programa IPRM una buena herramienta para mejorar el uso racional de los medicamentos (AU)

In 1997 the Requena General Hospital started a program on hospital admissions due to drug-related problem (HA-DRP). To detect cases of HA-DRP we reviewed the hospital admission log book lookíng for alerts which motivated hospitalization and analyzing cases in the clinical record. We communicated pertinent cases, especially those considered as preventable to the general practitioner and the pharmacist. During the four-year period, 437 cases of HA-DRP were detected, which represents 0,45% overall visits to the hospital admission service. The detected cases we classified as follows; 138 cases of digestive hemorrhage were caused by non steroid anti-inflammatory drugs (NSAID), 34 by overdose, 21 by infra-dose, 15 by child accidental drug intake, 2 by adult accidental drug intake, 30 cases of HA-DRP were related to digoxin intoxication, 65 cases to suicide attempts, 23 by drug interaction and finally 109 related to adverse drug reactions. The feedback from physicians and pharmacist made the HA-DRP program o good tool to achieve a safer drug use (AU)

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