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Introduction Myasthenia gravis (MG) is a chronic autoimmune disorder increasingly affecting older adults, with rising prevalence and comorbidity burden across Europe. Contemporary nationwide data describing MG-related hospital utilisation in European healthcare systems remain limited. We examined temporal trends and severity-related hospital outcomes in Spain between 2016 and 2022. Methods We conducted a retrospective, population-based analysis using the Spanish Minimum Basic Data Set, including all adult hospital episodes with a primary diagnosis of MG (ICD-10-ES G70.00, G70.01). Hospital admissions, day-hospital visits and emergency department (ED) encounters were evaluated. Variables included demographics, intensive care unit (ICU) admission, myasthenic crisis, in-hospital mortality and comorbidities. Temporal trends were analysed using segmented negative binomial regression models incorporating a breakpoint in 2018. Results A total of 20,251 MG-related episodes corresponding to 6,308 unique patients were identified. Following 2018, hospital admissions declined by 5.4% annually (95% CI − 8.4 to − 2.4), whereas day-hospital and ED utilisation increased markedly, particularly among older adults. In-hospital mortality remained low and stable (mean 2.6%). ICU admissions increased from 8.2% to 13.7% of hospitalised patients. Myasthenic crisis accounted for 4.5% of admissions and was strongly associated with ICU utilisation, representing 39% of all ICU stays. Conclusions MG care in Spain is undergoing a sustained transition toward ambulatory management without evidence of worsening short-term hospital outcomes. Despite an ageing patient population and rising ICU utilisation, in-hospital mortality remained stable, supporting the safety of outpatient-based MG care models. These findings highlight the need for integrated clinical data to inform future healthcare planning in MG.

To identify and quantify associations between baseline characteristics on hospital admission and mortality in patients with COVID-19 at a tertiary hospital in Spain. This retrospective case series included 238 patients hospitalized for COVID-19 at Hospital Universitario Clínico San Cecilio (Granada, Spain) who were discharged or who died. Electronic medical records were reviewed to obtain information on sex, age, personal antecedents, clinical features, findings on physical examination, and laboratory results for each patient. Associations between mortality and baseline characteristics were estimated as hazard ratios (HR) calculated with Cox regression models. Series mortality was 25.6%. Among patients with dependence for basic activities of daily living, 78.7% died, and among patients residing in retirement homes, 80.8% died. The variables most clearly associated with a greater hazard of death were age (3% HR increase per 1-year increase in age; 95%CI 1-6), diabetes mellitus (HR 2.42, 95%CI 1.43-4.09), SatO2/FiO2 ratio (43% HR reduction per 1-point increase; 95%CI 23-57), SOFA score (19% HR increase per 1-point increase, 95%CI 5-34) and CURB-65 score (76% HR increase per 1-point increase, 95%CI 23-143). The patients residing in retirement homes showed great vulnerability. The main baseline factors that were independently associated with mortality in patients hospitalized for COVID-19 were older age, diabetes mellitus, low SatO2/FiO2 ratio, and high SOFA and CURB-65 scores.

Antimicrobial resistance is a growing global health problem. Patients living in care homes are a vulnerable high-risk population colonized by multidrug-resistant organisms (MDRO). We identified a case series of 116 residents of care homes from a cohort of 540 consecutive patients admitted to the internal medicine service of our hospital. We performed early diagnostic tests of MDRO through anal exudates in our sample. The prevalence of MDRO colonization was 34.5% of residents and 70% of them had not been previously identified in the clinical records. Previous hospitalizations and in-hospital antibiotic administration were significantly associated with the presence of MDRO. Our results emphasize the need to consider care homes in the planning of regional and national infection control measures and for implementing surveillance systems that monitor the spread of antimicrobial resistance in Spain. Systematic early testing upon admission to hospital services with a high prevalence of patients with MDRO colonization (e.g., internal medicine) could contribute to the adoption of adequate prevention measures. Specific educational programs for care home staff should also be implemented to address this increasing problem.

Stroke is the leading cause of disability and the second cause of death worldwide. The increasing burden of stroke underscores the importance of optimising rehabilitation protocols. Virtual reality (VR) can improve poststroke prognosis. A VR software combining gamification, full immersion and stroke specificity (ie, the Development and validation of a novel viRtual rEality software for improving diSability and quality of lifE in patients with sTroke (RESET) software) might substantially improve disability and quality of life (QoL). However, this technology is still very scarce. The RESET trial aims to assess the effects of an early 10-week gamified, fully immersive and stroke-specific VR intervention (ie, starting at week 3 poststroke) on disability and QoL in people with stroke in the subacute phase. People with ischaemic or haemorrhagic stroke (n=94) aged ≥18 years will be randomised to receive (1) usual care (UC), (2) commercial VR or (3) gamified, fully immersive and stroke-specific VR (RESET). The three groups will receive UC (ie, three sessions/week of 90 min of standard rehabilitation). The VR groups will additionally receive three VR sessions of 20 min per week. The outcome measures will be assessed at baseline (week 2 from stroke occurrence), week 13 (approximately 90 days from the event) and week 26 (approximately 6 months from the event). The primary outcome is disability measured with the Barthel Index. Secondary outcomes include QoL, upper-extremity and lower-extremity motor function, gross manual dexterity, handgrip strength and cognitive function. This study will unravel the effects of a gamified, fully immersive and stroke-specific VR software on disability and QoL in patients with stroke in the early subacute phase.NCT06132399.

Cognitive reserve is an increasingly studied concept. According to this framework, individuals with higher reserve can better cope with pathology, delaying symptom onset. The Cognitive Reserve Questionnaire (CRQ) is a brief (<2 min) eight-item scale validated in the Spanish population. Recently, it has been used to create normative data for a screening cognitive test (TMA-93), showing greater variability in scores than the isolated education level. This study aimed to explore sex differences in cognitive reserve, as measured by the CRQ, in a biologically-confirmed Alzheimer's disease (AD) cohort enriched with illiterate individuals from southern Spain. Cross-sectional study, including patients from the Outpatient Memory Clinic at Torrecárdenas Hospital in Almería (2023-2024), diagnosed with AD based on CSF biomarkers (p-tau 181/Aβ42 < 0.023; Elecsys automated platform). Baseline sociodemographic data (age, sex, education, Fototest score) and biomarker levels (Aβ42, p-tau 181, t-tau) were collected, along with CRQ scores, reported by a reliable informant. We analyzed sex differences in total CRQ scores (Mann-Whitney U test) and examined the distribution of each CRQ item score across sexes. 53 AD patients (median age: 70 years, IQR: 66-75) were included (31 females, 22 males). No significant differences were found between sexes in age, education level, Fototest score, or biomarker levels (Table). Notably, only 37.7% of participants had education beyond primary school. Both sexes exhibited low cognitive reserve (median CRQ score: 7/25, IQR: 4-11), with significantly lower scores in females (Figure 1; W = 212; p = 0.01977). At the item level, males scored higher across all items (Figure 2A, 2B), with notable differences in occupation, reading, skills development courses, and languages spoken. Cognitive reserve, which moderates the relationship between brain pathology and cognitive outcomes, may be influenced by sex. Developing feasible cognitive reserve assessments applicable to illiterate individuals, which also account for sex differences, is essential. Women may have lower cognitive reserve, particularly in populations with a high prevalence of illiteracy. Future studies are needed to explore the sex-specific moderating effects of AD pathology on cognition and the potential generational changes in cognitive reserve across sexes.

Background Cognitive reserve is an increasingly studied concept. According to this framework, individuals with higher reserve can better cope with pathology, delaying symptom onset. The Cognitive Reserve Questionnaire (CRQ) is a brief (<2 min) eight‐item scale validated in the Spanish population. Recently, it has been used to create normative data for a screening cognitive test (TMA‐93), showing greater variability in scores than the isolated education level. This study aimed to explore sex differences in cognitive reserve, as measured by the CRQ, in a biologically‐confirmed Alzheimer's disease (AD) cohort enriched with illiterate individuals from southern Spain. Method Cross‐sectional study, including patients from the Outpatient Memory Clinic at Torrecárdenas Hospital in Almería (2023–2024), diagnosed with AD based on CSF biomarkers (p‐tau 181/Aβ42 < 0.023; Elecsys automated platform). Baseline sociodemographic data (age, sex, education, Fototest score) and biomarker levels (Aβ42, p‐tau 181, t‐tau) were collected, along with CRQ scores, reported by a reliable informant. We analyzed sex differences in total CRQ scores (Mann‐Whitney U test) and examined the distribution of each CRQ item score across sexes. Result 53 AD patients (median age: 70 years, IQR: 66–75) were included (31 females, 22 males). No significant differences were found between sexes in age, education level, Fototest score, or biomarker levels (Table). Notably, only 37.7% of participants had education beyond primary school. Both sexes exhibited low cognitive reserve (median CRQ score: 7/25, IQR: 4–11), with significantly lower scores in females (Figure 1; W = 212; p = 0.01977). At the item level, males scored higher across all items (Figure 2A, 2B), with notable differences in occupation, reading, skills development courses, and languages spoken. Conclusion Cognitive reserve, which moderates the relationship between brain pathology and cognitive outcomes, may be influenced by sex. Developing feasible cognitive reserve assessments applicable to illiterate individuals, which also account for sex differences, is essential. Women may have lower cognitive reserve, particularly in populations with a high prevalence of illiteracy. Future studies are needed to explore the sex‐specific moderating effects of AD pathology on cognition and the potential generational changes in cognitive reserve across sexes.

Abstract Background and aims To describe the design and development of NeuroRehab VR, a fully immersive, specific and gamified virtual reality (VR) software aimed at improving the quality of life and reducing disability in post-stroke patients. Methods The project was structured into three phases (preproduction, production, and postproduction) following SCRUM methodology. Periodic focus groups and testing sessions were conducted every one to two months with patients in the subacute phase of stroke. During the preproduction phase, core design concepts were defined, establishing three virtual environments (home, nature, and science fiction) and five types of activities targeting upper limb rehabilitation: fine motor skills, gross motor skills, balance, rhythmic movements, and movement speed. Personalization features and adaptive progression elements were also incorporated. Results NeuroRehab VR integrates fully immersive virtual reality, advanced hand tracking technology, and adaptive gamification systems that automatically adjust task difficulty based on patient performance. During the production phase, these components were consolidated into a functional prototype. In the postproduction phase, minor technical issues and usability aspects were refined to improve activity responsiveness and optimize user experience for both patients and clinicians. Conclusions NeuroRehab VR is a promising tool for integration into post-stroke rehabilitation programs and is currently being evaluated in a clinical trial. In addition, this public–private, multidisciplinary collaboration model has proven to be an effective framework for developing technologically driven solutions applicable to clinical rehabilitation settings. Conflict of interest Dr. Laura Amaya Pascasio will deliver the oral presentation of this work.

It is recommended that continued education in pain should be supported using information and communication technologies (ICTs), but there are gaps about the previous competencies of health professionals, especially in low- and middle-income countries. This study characterized the competencies of professionals in the Colombian Caribbean, the circumstances that favor and hinder the development of appropriate care, as well as the preferences, expectations and attitudes toward an educational intervention supported by ICTs. We used a qualitative, phenomenological approach, combining documentary review and data obtained through observation, an online survey and two focus groups involving 55 healthcare professionals (physicians, nurses and psychologists) of varying experience. For the analysis and integration of results, the Capacity, Opportunity, Motivation and Behavior model and the Theoretical Domains Framework were used as references. The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist guided the reporting of this study. Competency deficits were found regardless of the profession and experience, which are related to inadequacies in undergraduate and post-graduate training. Structural problems in Colombian society and healthcare service organization were also discovered, which were considered unmodifiable barriers and have been aggravated by the social, economic and health effects of the pandemic. The main modifiable barriers found were as follows: pain underestimation and under-treatment of older adults, as well as stereotypes regarding old age and pain, lack of knowledge of the psychosocial determinants of pain and of techniques for its assessment and treatment, overestimation of pharmacological treatment and failure to update pharmacological and non-pharmacological techniques. Recommendations for the design of the educational intervention were established as follows: favoring non-synchronous resources, facilitating synchronous activities of short duration, facilitating permanent access to information and resources and generating incentives for continuing education, such as certification, institutional recognition and encouraging popular recognition.

Background and objective Different factors may influence colonoscopy performance measures. We aimed to analyze procedure‐ and endoscopist‐related factors associated with detection of colorectal lesions and whether these factors have a similar influence in the context of different colonoscopy indications: positive fecal immunochemical test (+FIT) and post‐polypectomy surveillance colonoscopies. Methods This multicenter cross‐sectional study included adults aged 40–80 years. Endoscopists (N = 96) who had performed ≥50 examinations were assessed for physician‐related factors. Adenoma detection rate (ADR), adenomas per colonoscopy rate (APCR), advanced ADR, serrated polyp detection (SDR), and serrated polyps per colonoscopy rate (SPPCR) were calculated. Results We included 12,932 procedures, with 4810 carried out after a positive FIT and 1967 for surveillance. Of the 96 endoscopists evaluated, 43.8% were women, and the mean age was 41.9 years. The ADR, advanced ADR, and SDR were 39.7%, 17.7%, and 12.8%, respectively. Adenoma detection rate was higher in colonoscopies after a +FIT (50.3%) with a more than doubled advanced ADR compared to non‐FIT procedures (27.6% vs. 13.0%) and similar results in serrated lesions (14.7% vs. 13.5%). Among all the detection indicators analyzed, withdrawal time was the only factor independently related to improvement (p < 0.001). Regarding FIT‐positive and surveillance procedures, for both indications, withdrawal time was also the only factor associated with a higher detection of adenomas and serrated polyps (p < 0.001). Endoscopist‐related factors (i.e., weekly hours dedicated to endoscopy, annual colonoscopy volume and lifetime number of colonoscopies performed) had also impact on lesion detection (APCR, advanced ADR and SPPCR). Conclusions Withdrawal time was the factor most commonly associated with improved detection of colonic lesions globally and in endoscopies for + FIT and post‐polypectomy surveillance. Physician‐related factors may help to address strategies to support training and service provision. Our results can be used for establishing future benchmarking and quality improvement in different colonoscopy indications.

Breast cancer patients may express abnormal cellular immune responses affecting their immunological competence. The analysis of immunological parameters may be useful as indicators of T cell function. To determine the expression of lymphocyte activation proteins and cytokines in tumor and non-metastatic axillary lymph nodes, 30 breast cancer patients were monitored. CD3 polypeptides, PTKs (protein tyrosine kinases) and phosphorylated tyrosines were studied by Western Blot and cytokines mRNA expression was determined by RT-PCR (reverse transcription-polymerase chain reaction). This group of patient had shown high immunohistochemistry expression of IL-10 in tumors. Activation proteins were mainly expressed in involved lymph nodes comparing with their expression in tumors. The differences in expression of CD3 polypeptides and p56lck between both locations were significant. There was no statistical association between PTKs and IL-10 in the tumor but more than 50% of cases who express IL-10 lost p56lck, p59fyn. A direct association between IL-10 and CD3-polypeptides was observed, however 52.2% of patients who express IL-10 did not express 41 kDa CD3-ζ form. IL-10 mRNA was detected in more than 50% of tumors contrary to the prevalence of type 1 cytokines in regional nodes (40%). The lack of expression of lymphocyte activations proteins and the high expression of IL-10 suggest a downregulation on T cells function in the tumors. These results are useful in order to understand the local immune response that would be key in the control of the tumor progression.