Hospital Infanta Research Articles

Acute zonal occult outer retinopathy as a luetic ocular manifestation

Aims/Purpose: Based on a clinical case seen in our setting, the purpose of this communication is to describe a case of ocular syphilis with an uncommon initial manifestation as well as its clinical and imaging features, diagnosis, treatment and evolution.Methods: We selected a case seen at the University Hospital Infanta Sofía in 2023. A 54‐year‐old male with Acquired Inmune Deficiency Syndrome (AIDS) under antiretroviral (ARV) treatment, diagnosed with cataract, who 1 month after surgery presented a paradoxical worsening of baseline visual acuity (VA) bilaterally accompanied by nyctalopia.Results: During the exam, we found VA from right eye (RE) of 0.03 and from left eye (LE) of 0.03. Fundus examination showed a bilateral central vitreous organization. Macular OCT from both eyes showed preserved foveal profile with pachychoroid associated with patchy absence of external limiting membrane, evident focal loss of ellipsoid zone and cysts in outer layers of the RE. Campimetry with practically abolished fields, neuroimaging study, complete serology including antirecoverin antibodies, and vitreous sample for microbiology were performed. From this study, it was found that the patient had a positive luetic seroconversion within a maximum period of five years. With these data, we oriented the differential diagnosis of the described retinopathy towards an infectious or toxic aetiology due to ARV drugs as the most probable causes. The patient was treated with intravenous penicillin with great improvement of vision and nyctalopia.Conclusions: Ocular syphilis is the great simulator par excellence and although infrequent, it can debut with atypical forms of uveitis.

Analysis of the applicability of the mHealth ALIBIRD platform and its impact on the follow-up of patients with lung cancer.

e24050 Background: Lung cancer is associated with a wide symptom burden. Often, patient's symptoms are inadequately captured during routine visits. For this reason, there is an increasing interest in developing effective approaches for patient-reported symptom management at home. Emerging evidence suggests that this strategy should lead to reducing toxicity and emergency room visits and improving quality of life. In the context of the ALIBIRD2020-CM project, we developed the mHealth ALIBIRD platform (mHAP) to remotely monitoring cancer patients. Methods: The mHAP implemented consists of a mobile application for patients and a web tool for the clinical team. Through the mobile application, patients record symptoms, toxicities, and lifestyle variables such as diet, physical activity and sleep through Fitbit wearables. Based on patient-reported outcomes (PRO), patient-reported outcome measures (PROM), patient gut microbiome and nutrigenomics data, this platform provides personalised recommendations and advice. Clinicians can visualise patient data, resolve symptom alerts, and make clinical-therapeutic decisions. A single-branch interventional pilot study was carried out at Hospital Infanta Sofía and approved by the Ethics Committee (HULP PI-4735). The primary outcome was to assess the mHAP, usability. The secondary outcome was to assess the clinical impact of the tool. Results: Twenty patients with stage IV thoracic neoplasms under active treatment participated for 6 months with 10 face-to-face visits for oncological and nutritional control. Anthropometric parameters were measured at each nutritional control, and muscle ultrasound was performed on visits 1, 5, and 10. Our results demonstrate a high level of user satisfaction with mHAP. A total of 679 symptoms were captured by mHAP, 96 alerts were detected and resolved (only 3 patients were referred to ER) and an early detection of a progression was done. The two main categories of severe toxicities recorded through the PROCTCAE questionnaire were the sensation of pain (25%) and asthenia and quality of rest (23%). There was an increase in the trend of moderate physical activity and adherence to the Mediterranean diet (21.4%) from baseline. Nutrigenetic analyses have led to the detection of 5 lactose intolerant patients and 4 patients with intermediate tolerance to gluten. Preliminary results from gut microbiome analysis indicate that 75% of the patients have dysbiosis. At the last visit, the HADS questionnaire showed 7% of cases with anxiety problems and 14% with depression. Conclusions: The findings obtained so far relate the mHAP to a favourable clinical impact, high usability and satisfaction. mHAP promotes healthy lifestyle and patient´empowerment, and supports clinicians for personalized recommendations, therapeutic adjustments in medication and nutritional supplementation as well as referrals to other specialists.

Impacto de la infección por COVID 19 durante la gestación

Objective: to analyse the impact of the infection by SARS-CoV-2 in pregnant women, in terms of obstetric and perinatal consequences. Method: a descriptive, longitudinal, observational and retrospective study conducted in the Hospital Infanta Cristina (Parla, Madrid) with pregnant women infected with COVID-19 during the second half of their pregnancy and/or labour, since the start of the pandemic in Spain in March until December 2020. The association between the need for hospital admission and sociodemographic, anthropometric and pregnancy variables was analysed with the Student’s T test, Mann Whitney U test, Pearson’s Chi Squared and Fisher’s Exact Test, with a p< 0.05 significance.Results: the study included 46 women; 37% of them were Spanish, and their mean age was 31.3 years. The mean Body Mass Index (BMI) of the pregnant women was of 25.9 kg/m2, the majority were multiparous, and there was a predominance of asymptomatic pregnancies (54.23%) followed by symptoms such as cough and dyspnea (13%) and fever (13%). Four women required hospital admission, and one of them required Intensive Care. No significant differences were found according to hospital admission, although the gestational age at the time of delivery was lower among hospitalized women (38 vs. 39.5 weeks; p= 0.095) and their BMI was higher (29.7 vs. 25 kg/m2; p= 0.559). There were no perinatal deaths. Conclusions: infection by COVID19 does not seem to have any impact on pregnancy evolution or perinatal survival, although further research is required.

Variables that may affect the traditional signs of perinatal asphyxia

The objective of this study was to prove if certain variables related to labour affect the traditional signs of perinatal asphyxia (cardiotocography records, Apgar score and the umbilical artery pH). This is an observational, multicentric, longitudinal, analytical, cohort study in pregnant women at term admitted to the delivery room of Hospital Infanta Cristina, Hospital de Fuenlabrada and Hospital Puerta de Hierro Majadahonda. Of all the variables under scrutiny, the onset of labour, parity, clamping the umbilical cord, gestational age, type of delivery, newborn weight and neonatal resuscitation have a significant relationship with the three signs of perinatal asphyxia. This study showed a relationship between the three signs and some of the studied variables, therefore recommending assessing them in the perinatal asphyxia diagnosis. Key words: Cardiotocography records, umbilical pH, Apgar score, perinatal asphyxia.

Incorporation of biochemical parameters and diagnostic algorithms in the laboratory computer system for the early detection of lipid abnormalities from the lipid units

IntroductionThe combination of biochemical markers, together with the design and implementation of diagnostic algorithms in laboratory computer systems could become very powerful tools in the stratification of cardiovascular risk. ObjectivesTo implement new biochemical markers and diagnostic algorithms not yet available, in order to provide an estimation of cardiovascular risk and the diagnostic orientation of lipid alterations. Material and methodsStudy of the implementation of Apolipoprotein B and Lipoprotein (a), as well as the inclusion of different diagnostic algorithms. This was carried out jointly by the different Lipid Units of the Spanish Society of Atherosclerosis, Hospital Virgen Macarena in Seville, Hospital Juan Ramon Jiménez, Hospital Infanta Elena, and Hospital de Rio Tinto during 2018 and 2019. ResultsThe four diagnostic algorithms entered into the Laboratory Information System (LIS), showed a total of 9985 patients with c-LDL >200 mg/dL. The diagnostic algorithm was extended to include Apo B, with 8182 determinations showing an Apolipoprotein B > 100 mg/dL). A total of 747 lipoprotein (a) were determined, of which 30.65% were >50 mg/dL. More than two-thirds (71.80%) showed results compatible with small and dense LDL particles. ConclusionsThe implementation of new analytical parameters and algorithms in Primary Care laboratory results can identify a considerable number of patients with different alterations in lipid metabolism. This, together with the classic risk factors, could contribute to a correct risk stratification in preventing the progression of CVD.

Editorial introductions.

Editorial introductions.

Retrospective study of patients admitted form March to January 2021 by COVID-19 in hospital Infanta Elena (Huelva).

Background and Aims: To describe the epidemiological characteristics of patients admitted for COVID19 from March 2020 to January 2021 in our hospital under treatment with statins. Methods: Retrospective descriptive study of a cohort of all patients with COVID-19 admitted to the Infectious Diseases Service at Hospital Infanta Elena from March 2020 to January 2021. Those patients with SARS CoV2 infection documented by PCR of the nasopharyngeal exudate and radiological involvement with risk factors and statin treatment were analyzed. Among these factors are: age over 60 years, chronic cardiovascular and respiratory diseases, type 2 Diabetes Mellitus (DM 2), chronic kidney disease and oncohematological diseases. Results: A cohort of 65 patients was analyzed, of which 23.08% were on statin treatment, with a mean age of 74 + 10.48 sd years, of which 66.7% were men and 33.3% were women. Of the patients taking statins, 86% were smokers and 13.13% were non-smokers. Regarding the rest of the cardiovascular factors, 93.3% were hypertensive, 40% type 2 DM, 20% had a history of coronary disease, 33.3% heart failure, 6.7% COPD, 13.3% chronic kidney disease and 6.7% active neoplasia. In the group that did not take statins, there were 5 deaths (12.2%) and had a median of 10 days of admission, compared to 3 deaths (21.4%) and 11 days of admission in the group that took statins. Conclusions: In our healthcare setting, patients undergoing treatment with statins were admitted less, had less mortality, and their most frequent comorbidities were hypertension, DM2, heart failure and coronary disease.

Incorporación de parámetros bioquímicos y algoritmos diagnósticos en el sistema informático de laboratorio para la detección precoz de alteraciones lipídicas desde las unidades de lípidos

IntroductionThe combination of biochemical markers, together with the design and implementation of diagnostic algorithms in laboratory computer systems could become very powerful tools in the stratification of cardiovascular risk. ObjectivesTo implement new biochemical markers and diagnostic algorithms not yet available, in order to provide an estimation of cardiovascular risk and the diagnostic orientation of lipid alterations. Material and methodsStudy of the implementation of apolipoprotein B and lipoprotein (a), as well as the inclusion of different diagnostic algorithms. This was carried out jointly by the different Lipid Units of the Spanish Society of Atherosclerosis, Hospital Virgen Macarena in Seville, Hospital Juan Ramón Jiménez, Hospital Infanta Elena, and Hospital de Río Tinto during 2018 and 2019. ResultsThe 4diagnostic algorithms entered into the Laboratory Information System, showed a total of 9,985 patients with c-LDL>200mg/dl. The diagnostic algorithm was extended to include Apo B, with 8,182 determinations showing an apolipoprotein B>100mg/dl). A total of 747 lipoprotein (a) were determined, of which 30.65% were> 50mg/dl. More than 2/3 (71.80%) showed results compatible with small and dense LDL particles. ConclusionsThe implementation of new analytical parameters and algorithms in Primary Care laboratory results can identify a considerable number of patients with different alterations in lipid metabolism. This, together with the classic risk factors, could contribute to a correct risk stratification in preventing the progression of cardiovascular disease.

Características de los partos de inicio espontáneo en fase de luna llena y fase de luna nueva

Objective: to understand the number of births and the characteristics of labours with spontaneous onset on full moon phase and new moon phase. Method: a retrospective study conducted in the Hospital Infanta Cristina (Parla, Madrid) in the 2009-2015 period, where 11,948 labours were managed in total. Inclusion criteria: pregnant women with spontaneous-onset labour during the full moon and new moon phases (according to the moon phases determined by the National Geographic Institute); natural or instrumental delivery, or urgent caesarean section; full-term gestation (≥ 37 weeks and ≤ 42 weeks). Data were collected from the Register of Births. There was a descriptive analysis of variables. Results: in total, 4,086 labours were spontaneously initiated in the two moon phases studied: 2,035 (49.8%) in full moon phase and 2,051 (50.2%) in new moon phase. During the new moon phase, 1,005 (49.02%) were primiparous and 1,046 (50.98%) were multiparous. The mean (SD) weeks of gestation in the full moon sample were 39,31 (1.12), and in the new moon phase, 39,27 weeks. (1.10). No significant differences were detected between labours in the full moon and new moon phases. Conclusions: the number of births and the characteristics of labours with spontaneous onset are similar in the full moon and the new moon phases.

Editorial introductions

Editorial introductions

ApoB/ApoA1 ratio and non-HDL-cholesterol/HDL-cholesterol ratio are associated to metabolic syndrome in patients with type 2 diabetes mellitus subjects and to ischemic cardiomyopathy in diabetic women

Background and aimPresence of metabolic syndrome (MS) in patients with type 2 diabetes mellitus (T2DM) involves an increased risk of cardiovascular disease and death. Markers such as ApoB/ApoA1 and non-HDL-cholesterol/HDL-cholesterol ratios have been used to predict this risk with conflicting results. The study objective was to establish the relationship between the apoB/apoA1 and non-HDL-cholesterol/HDL-cholesterol ratios and MS in T2DM patients from a Madrid (Spain) district. Patients and methodsOne hundred patients with T2DM who attended University Hospital Infanta Leonor (Vallecas, Madrid, Spain) between January 2014 and June 2017 were enrolled. A blood sample was taken every 6 months from all patients to measure the different lipid parameters and to calculate ApoB/ApoA1 and non-HDL-cholesterol/HDL-cholesterol ratios. A Mann–Whitney's U test to compare means and a Spearman's correlation test for correlations between variables were used, and a multivariate regression analysis was performed to determine the association between MS and the ApoB/ApoA1 and non-HDL-cholesterol/HDL-cholesterol ratios. Values of p<0.05 were considered significant. ResultsAssociations were found between MS and ApoA1 (R2=0.164, p=0.028), ApoB/ApoA1 (R2=0.187, p=0.001), and non-HDL-cholesterol/HDL-cholesterol (R2= 0.269, p=0.0001) ratios and, in women with MS, between ApoB/ApoA1 ratio and ischemic cardiomyopathy (IC) (R2=0.160, p=0.032). Associations remained after adjusting for comorbidities and risk factors. ConclusionsIn the T2DM patients studied, MS was independently associated to ApoA1 and the ApoB/ApoA1 and non-HDL-cholesterol/HDL-cholesterol ratios. Both ratios were better predictors of MS in T2DM subjects that its components alone. The ApoB/ApoA1 ratio could be used as a cardiovascular risk marker in women with MS.

Editorial introductions

Editorial introductions

ApoB/ApoA1 ratio and non-HDL-cholesterol/HDL-cholesterol ratio are associated to metabolic syndrome in patients with type 2 diabetes mellitus subjects and to ischemic cardiomyopathy in diabetic women

Background and aimPresence of metabolic syndrome (MS) in patients with type 2 diabetes mellitus (T2DM) involves an increased risk of cardiovascular disease and death. Markers such as ApoB/ApoA1 and non-HDL-cholesterol/HDL-cholesterol ratios have been used to predict this risk with conflicting results. The study objective was to establish the relationship between the apoB/apoA1 and non-HDL-cholesterol/HDL-cholesterol ratios and MS in T2DM patients from a Madrid (Spain) district. Patients and methodsOne hundred patients with T2DM who attended University Hospital Infanta Leonor (Vallecas, Madrid, Spain) between January 2014 and June 2017 were enrolled. A blood sample was taken every 6 months from all patients to measure the different lipid parameters and to calculate ApoB/ApoA1 and non-HDL-cholesterol/HDL-cholesterol ratios. A Mann–Whitney's U test to compare means and a Spearman's correlation test for correlations between variables were used, and a multivariate regression analysis was performed to determine the association between MS and the ApoB/ApoA1 and non-HDL-cholesterol/HDL-cholesterol ratios. Values of p<0.05 were considered significant. ResultsAssociations were found between MS and ApoA1 (R2=0.164, p=0.028), ApoB/ApoA1 (R2=0.187, p=0.001), and non-HDL-cholesterol/HDL-cholesterol (R2= 0.269, p=0.0001) ratios and, in women with MS, between ApoB/ApoA1 ratio and ischemic cardiomyopathy (IC) (R2=0.160, p=0.032). Associations remained after adjusting for comorbidities and risk factors. ConclusionsIn the T2DM patients studied, MS was independently associated to ApoA1 and the ApoB/ApoA1 and non-HDL-cholesterol/HDL-cholesterol ratios. Both ratios were better predictors of MS in T2DM subjects that its components alone. The ApoB/ApoA1 ratio could be used as a cardiovascular risk marker in women with MS.

Conditions associated with REM sleep behaviour disorder: description of a hospital series

IntroductionREM sleep behaviour disorder (RBD) is characterised by violent behaviours (screaming, kicking, vivid dreams) during REM sleep. It has a prevalence of 1% to 2% of the general population and is especially frequent in men and the population older than 60. In the last decade, RBD has been suggested to be a prodrome of neurodegenerative disease. We analysed associated neurological diseases and responses to drug treatment in 33 patients with RBD treated in the multidisciplinary sleep disorders unit at Hospital Infanta Sofía. Patients and methodsWe conducted an observational descriptive retrospective analysis of patients diagnosed with RBD and treated in our multidisciplinary sleep disorders unit between October 2012 and December 2015. We recorded age, sex, associated diseases, and treatments administered to these patients. ResultsA total of 365 patients were attended at our unit, including 33 with RBD: 13 women (40%) and 20 men (60%). Mean age was 62.72 years. An associated disorder was identified in 48%, with the most common being mild cognitive impairment (69%). The percentage of patients with RBD and an associated disorder among patients older than 60 was 68%. Eighty-two percent of the patients required treatment. The most commonly used drug was clonazepam (76%), followed by melatonin (9%), gabapentin (6%), and trazodone (3%). DiscussionIn our series, 48% of the patients had an associated disorder. The likelihood of detecting an associated disorder increases with patients’ age. The vast majority of patients required drug treatment due to symptom severity; the most frequently administered drug was clonazepam (76%).

Clinical aspects of foot health and their influence on quality of life among breast cancer survivors: a case-control study.

PurposeThe aim of this study was to analyze and compare foot health and general health in a sample of women divided into two groups: 1) those with breast cancer and undergoing chemotherapy treatment and 2) healthy women without breast cancer and with normalized reference values.MethodsA case–control observational study was performed. Two-hundred women with a mean age of 51.00±8.75 years were recruited from podiatric medicine and surgery clinics from the University of Extremadura (Plasencia, Spain) and the Hospital Infanta Cristina (Badajoz, Spain). The women were divided into case and control groups (undergoing chemotherapy treatment and healthy women, respectively). The Foot Health Status Questionnaire was used to assess foot health domain scores.ResultsSignificant differences between both groups were seen for foot pain (P=0.003), foot function (P<0.001), physical activity (P<0.001), social capacity (P<0.001), and vigor (P=0.001). The remaining domains (footwear, general health, and foot health) did not show significant differences between the two groups (P≥0.01).ConclusionWomen with breast cancer presented a lower foot health-related quality of life. Clinical aspects with emphasis on foot pain and disability were increased. Furthermore, physical activity, social capacity, and vigor were affected. Therefore, general health care and foot problem prevention for breast cancer survivors should be given more consideration.

Hierro intravenoso, recuperación funcional y delirium en pacientes con fractura de cadera. Estudio FEDEREF. Ensayo clínico unicéntrico aleatorizado, controlado con placebo, doble ciego. Número EudraCT: 2014-001923-53

IntroductionThere are no previous studies evaluating the effect of intravenous iron therapy on functional and cognitive status of patients with hip fracture (HF). Material and methodsA single-centre randomised, placebo-controlled, double-blind and parallel treatment, clinical trial has been designed to assess the efficacy of intravenous iron therapy during the peri-operative period in elderly patients suffering from a HF. Blinding will be ensured by the packaging of the drug infusion system. On days 1, 3, and 5 from admission, the intervention group will receive 200mg Venofer® (iron sucrose) diluted in 100ml saline, and the control group 100ml saline, also on days 1, 3 and 5. Patients will received conventional treatment in ortho-geriatric unit of the Hospital Infanta Sofia. Functional variables (activities of daily living and walking), cognitive (cognitive status and delirium), surgical, demographic and clinical characteristics will be collected during admission in order to assess the impact of treatment. A safety analysis of the treatment will also performed. Patients will be followed-up at 3, 6, and 12 months. ResultsThe study will attempt to provide evidence on the impact of the intravenous iron administration on functional recovery. It will be determined whether iron therapy negatively affects the incidence of post-operative delirium. Finally, report will be presented on the safety data of intravenous iron in elderly HF patients, as well as the impact on allogenic blood transfusion savings. ConclusionsThe inclusion of elderly HF patients admitted to an ortho-geriatric unit, in a clinical trial, will help to improve the knowledge of the treatment impact on a usual scenario, and provide useful data for use in other units.

Patologías asociadas al trastorno de conducta de sueño REM. Descripción de una serie hospitalaria

IntroductionREM sleep behaviour disorder (RBD) is characterised by violent behaviours (screaming, kicking, vivid dreams) during REM sleep. It has a prevalence of 1% to 2% of the general population and is especially frequent in men and the population older than 60. In the last decade, RBD has been suggested to be a prodrome of neurodegenerative disease. We analysed associated neurological diseases and responses to drug treatment in 33 patients with RBD treated in the multidisciplinary sleep disorders unit at Hospital Infanta Sofía. Patients and methodsWe conducted an observational descriptive retrospective analysis of patients diagnosed with RBD and treated in our multidisciplinary sleep disorders unit between October 2012 and December 2015. We recorded age, sex, associated diseases, and treatments administered to these patients. ResultsA total of 365 patients were attended at our unit, including 33 with RBD: 13 women (40%) and 20 men (60%). Mean age was 62.72 years. An associated disorder was identified in 48%, with the most common being mild cognitive impairment (69%). The percentage of patients with RBD and an associated disorder among patients older than 60 was 68%. Eighty-two percent of the patients required treatment. The most commonly used drug was clonazepam (76%), followed by melatonin (9%), gabapentin (6%), and trazodone (3%). DiscussionIn our series, 48% of the patients had an associated disorder. The likelihood of detecting an associated disorder increases with patients’ age. The vast majority of patients required drug treatment due to symptom severity; the most frequently administered drug was clonazepam (76%).

Immediate Reactions to More Than 1 NSAID Must Not Be Considered Cross-Hypersensitivity Unless Tolerance to ASA Is Verified.

Individuals who develop drug hypersensitivity reactions (DHRs) to chemically unrelated nonsteroidal anti-inflammatory drugs (NSAIDs) are considered cross-hypersensitive. The hallmark for this classification is that the patient presents a reaction after intake of or challenge with acetylsalicylic acid (ASA). Whether patients react to 2 or more NSAIDs while tolerating ASA remains to be studied (selective reactions, SRs). Objective: To identify patients with SRs to 2 or more NSAIDs including strong COX-1 inhibitors. Patients who attended the Allergy Service of Hospital Infanta Leonor, Madrid, Spain with DHRs to NSAIDs between January 2011 and December 2014 were evaluated. Those with 2 or more immediate reactions occurring in less than 1 hour after intake were included. After confirming tolerance to ASA, the selectivity of the response to 2 or more NSAIDs was demonstrated by in vivo and/or in vitro testing or by controlled administration. From a total of 203 patients with immediate DHRs to NSAIDs, 16 (7.9%) met the inclusion criteria. The patients presented a total of 68 anaphylactic or cutaneous reactions (mean [SD], 4.2 [2.1]). Most reactions were to ibuprofen and other arylpropionic acid derivatives and to metamizole. Two different NSAIDs were involved in 11 patients and 3 in 5 patients. Patients with NSAID-induced anaphylaxis or urticaria/angioedema should not be considered cross-hypersensitive unless tolerance to ASA is verified.

Psycopathology in overweight and obese patients

Introduction Overweight and obesity are considered as a pandemic disease with a worrying prevalence and still growing. According to the World Health Organization, in 2014 the 39% adults were overweight and 13% were obese. Although it is an objective fact that obesity is an abnormal or excessive accumulation of fat detrimental to health, causes that lead a person to be obese are multifactorial and not yet well known. Objective Examine the relationship between psychopathology and obesity. Deepen in this sense, allows us to understand obesity from a broader perspective, where not only the nutritional factors are involved in these patients, but also different profiles. Methods The emotional aspects of overweight and the obesity study Program of the University Hospital Infanta Leonor attends to these patients from a multi-modal perspective, to offer a multidisciplinary and effective treatment that results in a permanent lost weight. Descriptive data of the first 180 patients are presented. Results A large percentage of patients presented psychopathology, highlighting a 80.9% of patients with depressive symptomatology, a 56.39% with high anxiety trait, a 48.26% with high anxiety state, a 24.4% meet criteria for binge eating disorder, a 11.9% bulimia nervosa and a 17.3% post-traumatic stress disorder. Conclusion Our findings support the association between obesity and psychopathology and, therefore, the conception of obesity as a bio-psycho-social problem requiring a multidisciplinary approach that go beyond the traditional nutritional guidance.

ENDOSCOPIC TREATMENT OF INTERNAL CONCEALMENT OF ILLEGAL DRUGS

General Surgery Department Hospital Infanta Elena Huelva, Spain Correspondence to: Luis Tallón-Aguilar, PhD, MD, c/ Asunción 26 2A, 41011 Sevilla, Spain ([email protected]). The author declares no conflict of interest.