02.03. Área de Salud III Lorca

The use of immersive technologies in learning about postpartum hemorrhage: Protocol for a systematic review and meta-analysis

Thu, 18 Jun 2026 00:00:00 GMT

The use of immersive technologies in learning about postpartum hemorrhage: Protocol for a systematic review and meta-analysis Montiel-Bravo, María-José; Ferrandini-Price, Mariana; Pardo-Ríos, Manuel; Sánchez-Gómez, Marina; Piuvezam, Grasiela; Silva-de-Medeiros, Gidyenne-Christine-Bandeira; López-López, Carmen-Amalia Postpartum hemorrhage is one of the leading causes of maternal morbidity and mortality worldwide, and its proper management requires both technical and non-technical skills. This study describes the protocol for a systematic review evaluating the effectiveness of immersive technologies in training healthcare professionals in the management of this obstetric emergency. This protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database (CRD420250614446). The search will be performed in the following databases: PubMed, Embase, Scopus, ScienceDirect, Web of Science, Cochrane Library, LILACS, Enfispo and CUIDEN. Intervention studies (clinical trials - randomized or non-randomized) and quasi-experimental studies will be included. The risk of bias will be assessed using appropriate tools according to study design: the Risk of Bias 2 (ROB 2) tool for randomized controlled trials and the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool for non-randomized and quasi-experimental studies. Two independent researchers will conduct all assessments, and any disagreements will be consulted with a third reviewer. The data analysis and synthesis will be performed using Review Manager software version 5.4. We will conduct the study in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) guidelines. The review will summarize the current evidence on the use of virtual reality, augmented reality, and mixed reality in education and training for postpartum hemorrhage management. The planned systematic review will identify and synthesize the available evidence on how immersive technologies may improve learning about postpartum hemorrhage.

Workplace difficulties in early-stage relapsing-remitting multiple sclerosis with low physical disability

Wed, 01 Apr 2026 00:00:00 GMT

Workplace difficulties in early-stage relapsing-remitting multiple sclerosis with low physical disability Pérez-Sempere, Ángel; García-Arcelay, Elena; Caruncho, Jacobo; Candeliere-Merlicco, Antonio; Orviz, Aida; Martin-Martínez, Jesús; Pinar-Morales, Raquel; Álvarez-Rodríguez, Elena; Pacheco, Eva-M; Borrega, Laura; Casanova, Ignacio; Caminero, Ana-Belén; Sánchez-Menoyo, José-L; Gómez-Gutiérrez, Montserrat; Carmona, Olga; Calles, Carmen; Hernández, Miguel-Ángel; López-Muñoz, Pablo; González-Suárez, Inés; Joly, Heloise; Maurino, Jorge This study evaluated perceived workplace difficulties in 128 individuals with early-stage relapsing-remitting multiple sclerosis and low physical disability. Significant workplace challenges were reported by 40.6% of participants. External barriers, including workplace inflexibility and professional-domestic life imbalance (median 23-item multiple sclerosis (MS) Work Difficulties Questionnaire-MSWDQ-23 score: 31.3, interquartile range 6.3-56.3), represented the highest burden. Women reported higher difficulty scores than men (mean MSWDQ-23 total scores: 29.9 vs. 21.2, p = 0.010). Multivariable analysis identified fatigue (OR 1.37, 95% CI 1.17-1.61) and anxiety (OR 1.21, 95% CI 1.05-1.38) as the only independent predictors of significant workplace difficulty (p < 0.001). These findings demonstrate a significant dissociation between physical disability and functional outcomes. Vocational vulnerability is driven by non-motor symptoms rather than overt neurological impairment. Proactive clinical screening for these factors is essential to mitigate work instability and preserve long-term professional trajectories.

Longitudinal Phenotypic Trajectories in GNAO1-Related Disorders: Defining Disease Progression and Clinical Profiles

Wed, 01 Jul 2026 00:00:00 GMT

Longitudinal Phenotypic Trajectories in GNAO1-Related Disorders: Defining Disease Progression and Clinical Profiles Domínguez-Carral, Jana; Domínguez-Cobo, Ana-María; Balsells, Sol; Aguilar-Ros, Anna; Chang, Chu-Ting; Ludlam, William-G; Yang, Kathryn; Bernardi, Katerina; Chinigioli, Micaela; Salazar-Villacorta, Ainara; Di-Pisa, Veronica; Lamagrande-Casanova, Nuria; González-Alguacil, Elena; de-la-Casa-fages, Beatriz; Okumura, Akihisa; Rodríguez, Josefina; Agarwal, Ayush; Muñoz-Chesta, Daniela; Reynoso-Osnayo, Carolina; Lin, Amy; Tabarki, Brahim; Parvin, Jobaida; Gallo, Adolfo-Alberto; Forno, Andreia; Maass, Fabian; Blanco, Johnny-Montiel; Nasif, Salome; Jennions, Elizabeth; Ramon-Gómez, Jorge-Luis; Verhelst, Helene; Nieto-Barceló, Juan-José; Petrovic, Dunja-Cokolic; García-Ruiz, Luz-Victoria; van-Riesen, Christoph; Rego-Sousa, Paulo; Sánchez, María-del-Pilar-Massaro; Khan, Husnea-Ara; Hakami, Wejdan; Friedman, Jennifer; Espinoza-Quinteros, Iván; Troncoso, Mónica; Garg, Divyani; Pauni, Micaela; Kurahashi, Hirokazu; Miranda-Herrero, María-Concepción; Duat-Rodríguez, Anna; Soliani, Luca; Kurian, Manju-A; Schteinschnaider, Ángeles; Srivastava, Siddharth; Ebrahimi-Fakhari, Darius; Martemyanov, Kirill-A; Ortigoza-Escobar, Juan-Dario OBJECTIVE: Pathogenic variants in GNAO1 cause a spectrum of epilepsy, movement disorders, and developmental impairment. Clinical heterogeneity complicates prognosis and therapeutic development. We present the first longitudinal natural history study of GNAO1-related disorders (GNAO1-RD) to delineate phenotypic trajectories. METHODS: Sixty-six individuals with GNAO1-RD were included in a cross-sectional analysis. Of these, 21 were enrolled in a prospective natural history arm (March 2021-December 2024), undergoing annual standardized evaluations with validated clinical scales to monitor phenotypic progression. RESULTS: Our cohort exhibited broad phenotypic and severity variability. GNAO1-RD severity scores ranged from 0.5 to 13. Neurodevelopmental impairment varied: 45.5% lacked head control, whereas 22.7% achieved independent walking; and 65% had no expressive language. Movement disorders were nearly universal (95.5%), with dyskinetic crises in 54.5%. Epilepsy affected 51.5%, with different seizure types. Individuals carrying recurrent variants showed consistent phenotypes and severity, supporting a genotype-phenotype correlation reinforced by molecular functional data. Molecular functional analysis for 20 of 31 missense variants correlated with severity scores. Longitudinal data from 21 patients in the natural history cohort showed overall stability or mild improvement across most functional domains. No significant deterioration was observed in global severity, motor function, cognition, or quality of life. However, severe patients experienced progressive worsening of movement disorder. INTERPRETATION: This largest GNAO1-RD cohort and first longitudinal natural history study provide insights into disease progression. GNAO1-RD generally follows a non-degenerative course, showing stability or mild improvements over time in cognition, language, adaptive skills, and motor function. Importantly, although global severity scores remained stable overall, severe cases showed cumulative functional burden driven by progressive movement disorder, rather than global neurodegeneration. Mortality occurred in a subset of patients because of complications from dyskinetic crises, infections, and epilepsy-related events. Genotype-phenotype data and the GNAO1-RD severity score support early risk stratification and personalized treatment development. ANN NEUROL 2026;100:154-170.

Trends in Hepatitis C Virus Infection Prevalence Among People With HIV in Spain Over 2 Decades (2002-2023)

Tue, 17 Mar 2026 00:00:00 GMT

Trends in Hepatitis C Virus Infection Prevalence Among People With HIV in Spain Over 2 Decades (2002-2023) Berenguer, Juan; Fanciulli, Chiara; Arcos, María-M; Vivancos, María-J; Domingo, Pere; Hernando, Asunción; Barrado, Julia; Ryan, Pablo; Navarro, Jordi; Palacios, Rosario; Morano-Amado, Luis-Enrique; Iribarren, José-A; Martínez, Rosa; Galindo, María-J; de-los-Santos, Ignacio; López-Cruz, Ian; Rivero, Antonio; Pérez-Latorre, Leire; Giner, Livia; Farinas, María-C; García, Coral; Montero-Alonso, Marta; Ferrero-Beneitez, Óscar-Luis; Villoslada, Aroa; Soler-González, Josefa-F; Sanz, José; Rodríguez, Sergio; Losa, Juan-E; Bernal-Morell, Enrique; Veloso, Sergio; Pérez-Martínez, Laura; Mateos, Fernando; Arbones, Laia; Franch, Raquel; Corps, Diana; Martín, Cristina; Alonso-García, Gerardo; Clavero-Olmos, Marta; Silvarino, Rafael; Teira, Ramón; Belinchon, Olga; de-Miguel, Marta; Jarrin, Inmaculada; González-García, Juan BACKGROUND: Hepatitis C virus (HCV) has significantly impacted people with human immunodeficiency virus (HIV). Harm reduction programs, changing transmission patterns, and direct-acting antivirals (DAAs) have profoundly altered HIV/HCV coinfection trends. This study evaluates HCV prevalence among people with HIV in Spain over 2 decades. METHODS: We conducted 9 cross-sectional studies (2002-2023) in 39-43 centers. Sampled individuals were randomly sampled from people with HIV actively followed up at these centers, with proportional allocation. Main outcomes included the prevalence of anti-HCV antibody and active HCV infection (HCV RNA--positive result). RESULTS: The reference population ranged from 31 800 to 47 006, with sample sizes of 1260-1867. HIV transmission patterns shifted from 2002 to 2023, with injection drug use decreasing from 55% to 21% and the proportion of men who have sex with men increasing from 17% to 46%. HCV seroprevalence fell from 60.8% to 27.4%, and active infection from 46.3% to 0.9%. In the DAA era (2015-2023), active HCV infection dropped by 100% in heterosexuals, 94% in people who inject drugs, and 71% in men who have sex with men. Treatment uptake increased from 23% in 2002 to 99% by 2023 with all-oral DAAs. The prevalence of cirrhosis among active HCV cases peaked at 23.1% in 2015 but fell to 0% by 2021. Among those achieving sustained virologic response, cirrhosis prevalence was 20.4% in 2023. CONCLUSIONS: HIV/HCV coinfection has drastically declined in Spain, with active HCV infection prevalence <1% since 2021. DAAs were pivotal in this achievement. However, cirrhosis remains a concern among those with sustained virologic response. Ongoing surveillance and prevention efforts are essential to sustain these gains and address residual risks.