Works pending to be submitted

Summary
Familial partial lipodystrophy type 2 (FPLD2) is a rare condition, but that doesn't mean its diagnosis isn't important. It´s a disease that is mostly inherited in a dominant manner, the diagnosis should be as high in women as men. However, there is a clear imbalance in favor of the women, and in the case of the men, a large proportion of the diagnoses are due to female relatives. Due to this, different variables were analyzed, comparing men already diagnosed with those susceptible to the condition. The aim was to create a scoring system that would allow rapid, simple and highly specific diagnosis of men. Furthermore, the problem men were genetically studied using Sanger gene typing and NGS to verify the presence or absence of any diagnostic variant. Imaging tests, such as bone densitometry, were also analyzed to assess adipose tissue distribution and determine whether there were significant abnormalities. It is concluded that a scoring system was designed, which allows to identify, with a 90% specificity, those men with clinical suspicion.

Direction
ARAUJO VILAR, DAVID (Tutorships)

Summary
Background: Langerhans cell histiocytosis (LCH) is a rare neoplasm of dendritic myeloid cells CD1a+ and CD207+, caused by activating mutations in the MAPK pathway, mainly BRAFV600E. It can appear at any age and involve multiple organs. The use of MAPK pathway-targeted therapies and the prognostic role of the BRAFV600E mutation are being investigated. Materials and methods: A narrative literature review about LCH was conducted and the cases diagnosed between 2014 and 2024 in the University Hospital Complex of Santiago de Compostela (CHUS) were identified. The collected data were compared with what has been reported in the literature. Results: The series consists of 15 cases with ages ranging from 17 days to 79 years, and a male-to-female ratio of 2:1. The most frequently affected sites were the skeleton, the skin and the lymph nodes. 4 patients had multisystem disease, 2 with risk organ involvement. Anatomopathological examination showed large histiocytes with indented nuclei and positivity for CD207 and CD1a. Molecular analysis of the MAPK pathway was performed in 5 patients, with the BRAFV600E mutation identified in 3 of them. Treatments used included systemic chemotherapy, local therapies and observation. 3 patients died due to other neoplasms. Conclusions: LCH is a rare disease, with a highly variable clinical presentation. The immunohistochemical markers essential for its diagnosis are CD207 and CD1a. Testing for the BRAFV600E mutation is recommended, if negative, other alterations in the MAPK pathway should be investigated. LCH treatment must be tailored depending on the disease location and risk. While overall survival is very favourable, relapses and permanent sequelae are relatively common. Recent studies with BRAF and MEK inhibitors have shown promising results.

Direction
FRAGA RODRIGUEZ, MAXIMO FRANCISCO (Tutorships)

Court
AGUILAR BLANCO, MARIA FE (Chairman)
BALEATO GONZALEZ, SANDRA (Secretary)
SOPEÑA PEREZ-ARGÜELLES, BERNARDO (Member)

Summary
Context Anorexia nervosa (AN) is an eating disorder with severe physical and psychological consequences, being one of the leading causes of morbidity and mortality among psychiatric disorders. Its global prevalence varies according to sex and age. - In women, the lifetime prevalence is estimated to be between 0.1% and 2%, being more common in adolescents and young women. - In men, the prevalence is significantly lower, with estimates ranging from 0.2% to 0.3%. Regarding the current global incidence, there are also differences between sexes and age groups, as reflected by the following data: - Adolescent women: The annual incidence varies between 8 and 13 new cases per 100,000 people. - Young women (15-24 years): The incidence is higher in this group, reaching up to 200 cases per 100,000 people per year. - Men: Approximately 1 to 5 new cases per 100,000 people per year. In this context, the gut microbiota has emerged as a key factor in the regulation of metabolism, the immune system, and the gut-brain axis. Recent research has shown that AN patients exhibit alterations in their microbiota composition, which may influence appetite regulation, mood, and the inflammatory response, contributing to the maintenance of the disease. Understanding the interaction between gut microbiota and AN not only broadens our perspective on its pathophysiology but also opens new therapeutic opportunities, such as dietary modulation or the use of probiotics, to improve patient recovery and well-being. Objectives The main objective of this study is to explore the relationship between the composition and function of the gut microbiota and the development of AN. Additionally, the effects of prebiotic and probiotic interventions on the disease will be analyzed. Methodology A systematic review of articles published in the last 10 years was conducted using the PubMed, Cochrane Library, and Scopus databases, following the PRISMA methodology recommendations. After applying inclusion and exclusion filters, the most relevant publications related to the study objectives were identified. Results The analyzed studies provide evidence of the role of gut microbiota in the pathophysiology of AN, as well as differences in microbiota composition between individuals with the disorder and healthy individuals. There is some correlation between these findings and changes in the immune system, the serotonergic pathway, and the production of short-chain fatty acids, which are implicated in the disease's pathogenesis, among other factors. Conclusions Although recent evidence suggests a crucial role of gut microbiota in the pathogenesis of AN, more rigorous and longitudinal studies are still required to determine whether microbial alterations are a cause or a consequence of the disorder.

Direction
OLIVARES DIEZ, JOSE MANUEL (Tutorships)
Gómez Ramiro, Marta (Co-tutorships)

Court
MARTINEZ OLMOS, MIGUEL ANGEL (Chairman)
GAMBORINO CARAMES, ELENA (Secretary)
Rey Brandariz, Julia (Member)

Summary
Endometrial cancer (EC) is the most common gynecological malignancy in developed countries and shows a progressive increase in incidence. Although the majority of cases are diagnosed at early stages, a significant proportion progresses to advanced or metastatic stages, where therapeutic options are limited and survival is poorer. This work presents a systematic review of the current evidence on the role of immunotherapy in the treatment of metastatic endometrial cancer, with special attention to the tumor's molecular classification and its usefulness in selecting personalized treatments. The main immunotherapeutic drugs used in this context , Pembrolizumab, Dostarlimab, and Durvalumab, are analyzed both as monotherapy and in combination with chemotherapy or PARP inhibitors (Olaparib), through the most relevant clinical trials (RUBY, NRG-GY018, DUO-E, ATTEND and KEYNOTE-775). To this end, a bibliographic search was conducted in the PubMed database, and 36 articles were included in the review. The results show that immunotherapy significantly improves progression-free survival in patients with microsatellite instability-high (MSI-H) tumors or mismatch repair deficiency (dMMR), and also offers moderate benefits in tumors with microsatellite stability (pMMR) when combined with targeted therapies. The approval by the FDA and EMA of several of these treatments supports their efficacy in selected subgroups. Despite these advances, significant challenges remain, such as the identification of more accurate predictive biomarkers, the toxicity associated with certain therapeutic combinations, and the need to mature overall survival data. Immunotherapy represents a paradigm shift in the management of metastatic endometrial cancer and is emerging as a key pillar in the development of personalized oncology.

Direction
LOPEZ LOPEZ, RAFAEL (Tutorships)
Fernández Sobrado, Ignacio (Co-tutorships)

Court
CARRACEDO ALVAREZ, ANGEL MARIA (Chairman)
FERNANDEZ LOPEZ, FERNANDO (Secretary)
RODRIGUEZ ARES, MARIA TERESA (Member)

Summary
Refractory childhood epilepsy represents a significant clinical challenge; the patients do not achieve seizure control with conventional antiepileptic drug therapy. The ketogenic diet has re-emerged as an effective therapeutic alternative, characterized by a high fat content, low carbohydrate intake, and moderate protein levels, inducing a state of ketosis with potential antiepileptic effects. This study presents a literature review evaluating the effectiveness of the ketogenic diet in treating refractory epilepsy in children. A total of 25 studies published between 2020 and 2024 were analyzed, focusing on seizure frequency and intensity reduction, adverse effects, and improvements in quality of life. Most patients experienced a greater than 50% reduction in seizure frequency, with greater effectiveness observed in genetic epilepsy and syndromes such as Dravet and GLUT-1 deficiency. Although the diet may lead to side effects, gastrointestinal and metabolic, these were generally mild and manageable. Less restrictive dietary variants, such as the modified Atkins diet and low glycemic index treatment, demonstrated good tolerability and comparable efficacy. A trend toward reduced antiepileptic drug use. In conclusion, the ketogenic diet, when applied under multidisciplinary supervision, constitutes a useful and safe tool in the management of refractory childhood epilepsy.

Direction
López González, Francisco Javier (Tutorships)
Rodríguez Osorio, Xiana (Co-tutorships)

Court
FREIRE-GARABAL NUÑEZ, MANUEL (Chairman)
Barge Caballero, Eduardo (Secretary)
SANTOS PEREZ, SOFIA MARIA SOLEDAD (Member)

Summary
Introduction: We call caregiver to that person who has something or someone under his or her care. This task can have a great impact on the caregiver’s quality of life, afecting his or her physical, mental and emotional health. Due to the organizational model we have as a society and the stablished education, this is and has historically been a task developed mostly by women. Therefore these effects on health can be seen on them with higher frequency. Objectives: To asses the evolution of health related quality of life (HRQoL) in caregivers compared to non-caregivers over a five-year period, using SF-36 questionnaire in a representative sample of a rural population. Matherial and methods: Population-based study carried out in three phases in the municipality of A Estrada (Pontevedra), focusing on health-related quality of life in people caregivers. In phase 1 (2012-2015) a random sample of 3500 individuals was selected from the Health Card registry; 1512 people were finally included. In phase 2 (2020) the evolution of HRQoL was assessed using a new SF-36 questionnaire, including 164 participants (82 caregivers and 82 non-caregivers, matched by age and sex). Phase 3 (April 2025) consists of a brief telephone interview with caregivers to assess changes in their status during the time between phases 1 and 2. Results: Caregivers were more prevalently women and had lower educational levels. No significant differences were observed in HRQOL at baseline, but after five years caregivers (81.6% of whom had stopped being caregivers during follow-up) improved in the emotional role and maintained a better self-perception of health than non-caregivers. Conclusion: Care work is subject to clear gender and socio-economic inequalities, making caregivers a large and vulnerable social group. According to our study, health-related quality of life may improve over time, especially when caregiving is relinquished. The most affected spheres-emotional role and self-perception of health-were also the most sensitive to time evolution.

Direction
Fernández Merino, María del Carmen (Tutorships)
Fernández de Córdoba Alonso, Inés (Co-tutorships)

Court
ZALVIDE TORRENTE, JUAN BAUTISTA (Chairman)
Anibarro García, Luís (Secretary)
MARTIN CORA, FRANCISCO JAVIER (Member)

Summary
Tibial shaft fractures are a common pathology in the trauma department. Intramedullary nailing is the standard surgical treatment for most of these fractures. Although tibial nails have traditionally been inserted through an infrapatellar approach(IP) with the patient's leg hanging, in recent years there has been growing interest in approaches performed with the knee in a semiextended position,either through the suprapatellar approach (SP), which passes through the quadriceps tendon, or the parapatellar approach (PP), in which the patella is displaced to one side, avoiding penetration of the joint. The objective of this undergraduate thesis is to evaluate the advantages and disadvantages of each of these approaches based on a thorough review of the literature.

Direction
DIEZ ULLOA, MAXIMO ALBERTO (Tutorships)
Señarís Rodríguez, José (Co-tutorships)

Court
FRAGA RODRIGUEZ, MAXIMO FRANCISCO (Chairman)
ARROJO ROMERO, MANUEL (Secretary)
SÁNCHEZ SELLERO, INÉS (Member)

Summary
Introduction: The invasion by Vespa velutina has posed a diagnostic and therapeutic challenge. Patients with anaphylaxis from Vespa velutina show a high recognition to the poison of Vespula spp., which is proposed as the primary sensitizer and a candidate for immunotherapy selection. The controlled sting challenge test is the “gold standard” to confirm the efficacy of immunotherapy with hymenoptera poison. Objectives: A literature review of the methodology of the sting challenge test with hymenoptera. Describe the methodology and protocol of our center for the sting challenge test with Vespa velutina and its application in patients with anaphylaxis from Vespa velutina and immunotherapy with Vespula spp. Material and methods: Narrative review of the sting challenge procedures with hymenoptera. Use of the StingReady device for capturing and transporting live insects, and its safety in a hospital environment. The sting challenge procedure protocol was approved by the CEIC. The test was performed in the ICU of the Hospital de Conxo between June and October 2024. Patient selection: 4 patients with anaphylaxis from Vespa velutina and immunotherapy with Vespula spp. (median of 49 months-long, range 38-60), who have not experienced spontaneous stings. Results: The traditional procedure involves physical intervention on the insect, increasing the risk of partial poison loss, which could result in an incomplete injection. The use of the StingReady device minimizes this risk, reduces technical complexity for healthcare professionals, and is safely applicable in a hospital setting. The sting challenge test with Vespa velutina confirmed the protection obtained with the use of Vespula spp. immunotherapy. Conclusions: The controlled sting challenge procedure with Vespa velutina is accessible and safe for clinical use. The test results support the decision to use immunotherapy with Vespula spp. poison in patients with anaphylaxis from Vespa velutina.

Direction
Rodríguez Vázquez, Virginia María (Tutorships)
Armisén Gil, Margarita (Co-tutorships)

Court
ARCE VAZQUEZ, VICTOR MANUEL (Chairman)
Concheiro Guisán, Ana (Secretary)
CORTIÑAS DIAZ, JULIO ANTONIO (Member)

Summary
A study was conducted on a clinical sample of patients with dual pathology to compare the efficacy and safety of 2 long-acting antipsychotic drugs over a 10-year period. The drugs under study are Aripiprazole and Paliperidone. Methods: We analyzed the history of 210 patients with dual pathology of the Asociación Ciudadana de Lucha contra la Droga de A Coruña, in which we studied the evolution with long-acting antipsychotics. To evaluate the quality of the treatments, we use the CGI scale, the SMARTS criteria, or the number of visits to the emergency room and admissions to hospital services, as well as abstinence from toxic substances and permanence in the program. Results: long-acting antipsychotics show efficacy and safety in patients with dual pathology. We observed a significant improvement in pre and post CGI in both treatments, as well as a reduction in the number of emergency room visits and admissions. In addition, a high rate of permanence in the program with the two APLDs is demonstrated.

Direction
GAGO AGEITOS, ANA MARIA (Tutorships)

Summary
Epilepsy is a highly prevalent neurological disorder characterized by abnormal neuronal discharges that originate in specific regions of the brain and propagate to others, leading to epileptic seizures. These discharges are considered reflex when they are triggered by external stimuli, such as music, in which case the condition is known as musicogenic epilepsy, a disorder of extremely low prevalence and poorly understood pathophysiology. This work systematically reviews the most recent literature on this disease and also explores other possible relationships between epilepsy and music, such as the therapeutic use of specific musical pieces, musical ictal phenomena like humming or singing during seizures, and possible alterations in musical perception in patients with epilepsy. Regarding musicogenic epilepsy, the review addresses the most frequently reported ictal focus (temporal), its recent association with anti-glutamic acid decarboxylase antibodies (anti-GAD), and the emotional, cognitive or sensory nature of the triggering stimuli. This review highlights the clinical heterogeneity of the reported cases and the need for further clinical and neurophysiological research to better understand this rare but clinically relevant phenomenon.

Direction
López González, Francisco Javier (Tutorships)
Rodríguez Osorio, Xiana (Co-tutorships)

Court
GONZALEZ VINAGRE, SALUSTIANO (Chairman)
PUBUL NUÑEZ, VIRGINIA (Secretary)
VAZQUEZ TORRES, MATEO (Member)

Summary
This study examines the relationship between Borderline Personality Disorder (BPD) and criminal behavior, highlighting key factors such as impulsivity, emotional dysregulation, and instability in interpersonal relationships. Through a large literature review and detailed jurisprudential analysis, the study reveals both the high prevalence of BPD in prison contexts and the legal difficulties it poses concerning criminal responsibility. The analysis underscores the need for an integrated and multidisciplinary evaluation of the disorder to improve understanding and legal and clinical management of criminal behaviors associated with BPD.

Direction
VICENTE ALBA, FRANCISCO JAVIER (Tutorships)

Court
ARCE VAZQUEZ, VICTOR MANUEL (Chairman)
Concheiro Guisán, Ana (Secretary)
CORTIÑAS DIAZ, JULIO ANTONIO (Member)

Summary
INTRODUCTION This study analyzes the presence of key palliative care elements through case reviews of death (exitus) reports for patients with heart failure created between 2020 and 2024 in the Pontevedra Hospital Complex. These key elements in palliative care were defined based on patterns identified in scientific literature and the practice of palliative care specialists. The literature review shows a low level of standardization in the recording of key palliative care elements. A well-crafted death report positively reflects on care quality, enhances interdisciplinary communication, and serves as an epidemiological resource that captures aspects related to end-of-life care information not included in death certificates. The aim of this study is to measure the frequency with which key palliative care elements are documented in death reports and to verify the proposed hypothesis: that the analyzed death reports do not surpass the 45 percent threshold for documentation of the studied variables. The secondary objective measures the number of reports available at the time of analysis and proposes improvements in their drafting. OBJECTIVES To analyze the presence of key palliative care elements in death reports of patients who died from heart failure between January 1, 2020, and December 31, 2024. METHODOLOGY This is an observational, retrospective, descriptive study based on case reviews. The study variables measure the presence of quality indicators in basic administrative records and those focused on end-of-life care. RESULTS The sample size includes 29 deceased patients with a death report, representing 25 percent of the total deaths from heart failure during this period. The current trend shows an increase in the drafting of reports, with 2020 being the year with the lowest registration rate at 11 percent and 2024 the highest at 50 percent. The reports with the highest percentage of variable documentation were created by the Internal Medicine Service and the Palliative Care Unit. Internal Medicine was the department that wrote the highest absolute number of death reports. Only one report recorded terminal heart failure as the cause of death, coded I50.84 in ICD 10. CONCLUSIONS The prevalence of drafted death reports, at 25 percent, is lower than expected. A notable fluctuation in the documentation of various variables was observed, revealing a lack of standardization in the records, with administrative variables prevailing over those related to end of life care.

Direction
Anibarro García, Luís (Tutorships)
Said Criado, Ismael (Co-tutorships)

Court
ARCE VAZQUEZ, VICTOR MANUEL (Chairman)
Concheiro Guisán, Ana (Secretary)
CORTIÑAS DIAZ, JULIO ANTONIO (Member)

Summary
INTRODUCTION: Deprescribing antidepressants in patients with major depressive disorder is a complex clinical process that seeks to reduce or suspend the prolonged use of these drugs when they are no longer strictly necessary. Prolonged pharmacological treatments can generate very significant adverse effects and withdrawal symptoms after withdrawal, impacting the patient's quality of life and clinical management. Therefore, this procedure should be carried out carefully and based on clinical evidence. OBJECTIVE: To examine the available evidence on the effectiveness, safety, and clinical feasibility of antidepressant deprescribing in adults with a diagnosis of mayor depression, as well as to identify relevant barriers and facilitators to bring this process to a successful conclusion. MATERIALS AND METHODS: A literature search was conducted by the author in indexed databases such as PubMed/MEDLINE, Cochrane Library and ScienceDirect. Specific inclusion and exclusion criteria were established based on clinical diagnosis, study design, and relevance to the topic. To assess the quality and validity of the selected studies, the PRISMA criteria were applied. Likewise, the risk of bias was analyzed with the NICE Public Health Guidance tool. RESULTS: Initially, 168 potentially relevant articles were identified. After eliminating duplicates and discarding unrelated articles, 40 were left for full review. After detailed review, 12 studies were included. Deprescription is feasible and safe when performed gradually (tapering), showing lower rates of relapse and withdrawal symptoms. Key factors such as the type of antidepressant, the minimum recommended treatment time and the importance of a flexible dosage adapted to the patient are highlighted. In addition, complementary psychological support through cognitive therapies, such as MBCT and CBT. CONCLUSION: Antidepressant deprescribing in patients with major depression is a safe and effective therapeutic strategy when carried out in an individualized and supervised manner. It is recommended to continue developing standardized clinical guidelines and training programs aimed at health professionals to unify and optimize the management of deprescribing, as well as additional studies in more diverse and representative populations to further reinforce current clinical recommendations.

Direction
ALVAREZ ARIZA, MARÍA (Tutorships)

Court
AGUILERA GUIRAO, ANTONIO (Chairman)
Cinza Sanjurjo, Sergio (Secretary)
COSTA BESADA, MARIA ALICIA (Member)

Summary
Hysterectomy is one of the most common gynecological procedures in women of reproductive age. Although it has long been considered a safe procedure, in recent years there has been increasing interest in understanding its long-term effects, especially when performed before menopause and the ovaries are preserved. The idea of this review is that, even without oophorectomy, hysterectomy could affect a woman's hormonal balance and vascular profile, increasing her risk of heart disease. The studies we reviewed showed that patients who undergo hysterectomy tend to have more cardiovascular risk factors, such as hypertension, diabetes, or obesity. Furthermore, women who undergo surgery before age 50 have a significantly increased risk of stroke, coronary artery disease, or heart failure. Some studies also indicated that these women often have stiffer arteries, even when their ovaries are left intact. However, other studies have not found significant differences, which may be due to preexisting factors such as overall health or the reason for the procedure. In conclusion, current evidence suggests that performing a hysterectomy in women before menopause could have a negative impact on their cardiovascular health, especially if performed at a young age. Still, it is important to conduct further research with more studies that better control for other factors to confirm this relationship and better define strategies for prevention and managing the health of these women.

Direction
ARIAS BALTAR, MARIA EFIGENIA (Tutorships)
López Casal, Susana (Co-tutorships)

Court
MUÑOZ BARUS, JOSE IGNACIO (Chairman)
GAGO AGEITOS, ANA MARIA (Secretary)
VAZQUEZ ILLANES, MARIA DOLORES (Member)

Summary
Introduction: Health literacy (HL) is the ability of an individual to obtain, process and understand information necessary to make health care decisions and to develop in the health care setting, which can improve the effectiveness of health care processes. Breast cancer is the most prevalent cancer in the female population, demonstrating that one of the main factors related to survival is early diagnosis. Objective: To establish the level of SAA of women diagnosed with breast cancer, the characteristics that determine it and to evaluate the relationship between SAA and diagnostic delay. Methods: An observational, cross-sectional, analytical study was designed. The target population was women diagnosed with breast cancer treated in the public health system through the Medical Oncology Service (SOM) of the University Hospital Complex of Ourense (CHUO) using the HLS/EU/Q47 questionnaire. Educational level, age, place of residence and social support were collected. Results: Twenty-two patients were included in the study and four others declined to participate. The mean age was 55.3 (SD 14.3) years (CI95 49.0 / 61.7), with a minimum of 32 years and a maximum of 84 years. 59.1% of the population had an inadequate AeS, 54% of which was inadequate and 46% problematic. Conclusions: Almost 60% of the population had inadequate AeS, associated with a longer diagnostic delay in their neoplastic disease. The AeS of these patients was significantly and inversely associated with age and years of schooling.

Direction
Fernández González, Angel Luis (Tutorships)
Díaz Gravalos, Gabriel (Co-tutorships)

Court
MARTINEZ OLMOS, MIGUEL ANGEL (Chairman)
GAMBORINO CARAMES, ELENA (Secretary)
Rey Brandariz, Julia (Member)

Summary
This final degree project focuses on pemphigus vulgaris (PV), a rare autoimmune blistering disease that mainly affects the skin and mucous membranes, posing additional challenges during pregnancy due to its potential effects on both mother and fetus. The main objective of this study was to conduct a systematic review of the literature to analyze the clinical management of PV in pregnant women and the associated maternal-fetal outcomes. Through an exhaustive search of scientific databases, relevant articles were selected that included cases of pregnant women diagnosed with PV, evaluating the treatments used, the course of the disease during pregnancy, and both maternal and fetal outcomes. Rigorous inclusion and exclusion criteria were applied to ensure the quality and relevance of the studies considered. The results show that the treatment of choice often includes systemic corticosteroids, such as prednisone, which have proven to be relatively safe during pregnancy. In some cases, immunosuppressants such as azathioprine were used, with special precautions. Adequate disease control in the mother is associated with better obstetric outcomes, although the risk of complications such as preterm birth or intrauterine growth restriction may increase if PV is not well managed. In conclusion, pemphigus vulgaris during pregnancy requires a multidisciplinary approach that balances disease control with fetal safety. Although evidence remains limited due to the low prevalence of the condition, the available studies suggest that, with appropriate management, favorable maternal-fetal outcomes can be achieved. This work highlights the need for further research into safe and effective treatments for pregnant women with PV and for the development of evidence-based clinical protocols.

Direction
ARIAS BALTAR, MARIA EFIGENIA (Tutorships)
Barreiro García, Jesús Manuel (Co-tutorships)

Court
MUÑOZ PATIÑO, ANA MARIA (Chairman)
Portela Romero, Manuel (Secretary)
Aran Echabe, Eduardo (Member)

Summary
Introduction: anterior ankle impingement syndrome, also known as footballers ankle is an injury that consists of inflammation in the anterior area of the joint between the tibia and the talus, with reactive synovitis and usually formation of osteophytes or bony outgrowths on the anterior edge of the tibia and the neck of the talus, producing anterior pain and stiffness with loss of ankle extension or dorsiflexion. Objectives: to carry out a systematic review of the scientific literature on anterior ankle impingement syndrome, its natural history, clinical criteria for suspected diagnosis, diagnostic process with examination and complementary tests and treatment, with emphasis on the comparative evaluation of the different treatments used (conservative vs. surgical) and within the surgical treatment (open vs. arthroscopic approach). Methods: a search was carried out in PubMed, Scielo and Cochrane. The following search strategy was used in all of bases: anterior ankle impingement, selecting the most relevant studies in terms of our topic and objectives. In all databases, studies performed from 2015 to 2025 were used. Results: the results of this review show that anterior ankle impingement represents a wellcharacterized entity in clinical practice, especially among athletes who perform repetitive dorsiflexion and impact movements, such as in soccer. Current evidence strongly supports arthroscopic treatment as an effective and safe treatment option, allowing precise removal of osteophytes, inflamed synovial tissue and other structures contributing to impingement with significant functional improvement and a high rate of rapid return to sporting activity. Conclusions: arthroscopy has proven to be an effective and safe option, especially in patients who do not respond to conservative treatment. Arthroscopy allows for precise, minimally invasive surgery with good functional results and a high rate of return to sports activity. Current evidence supports its use, but further research with higher-quality studies is needed to optimize treatment criteria and improve long-term outcomes.

Direction
DIEZ ULLOA, MAXIMO ALBERTO (Tutorships)
Santín Mon, Daniel (Co-tutorships)

Court
ARCE VAZQUEZ, VICTOR MANUEL (Chairman)
Concheiro Guisán, Ana (Secretary)
CORTIÑAS DIAZ, JULIO ANTONIO (Member)

Summary
Introduction: Inhibitory immune checkpoints, such as PD-1, regulate lymphocyte activity, decreasing the immune response. Nivolumab and pembrolizumab are monoclonal antibodies that block the interaction between PD-1 and its ligand, reactivating immunity against tumor cells. Since their approval in 2014, they have shown efficacy in various types of cancers. Despite their effectiveness, they are associated with immunorelated adverse effects, highlighting cutaneous ones. They require specialized management, balancing tumor control with patient safety. Objectives: To perform a systematic review of the medical literature on cutaneous adverse events associated with the use of PD-1 inhibitors in oncology, with special emphasis on their clinical characteristics, prognostic implications and management strategies. Methods: A systematic review was performed following the PRISMA methodology, with an exhaustive search in PubMed using the terms (checkpoint inhibitor OR checkpoint inhibitors OR pembrolizumab OR nivolumab OR PD-1) AND (cutaneous toxicity OR skin toxicity OR cutaneous immune-related adverse events OR skin toxicities OR cutaneous toxicities). We selected the most relevant articles published between January 2015 and December 2024 on cutaneous effects of anti PD-1, covering clinical, management and possible relationship with tumor response. Results: The most frequent skin toxicities were maculopapular rash, pruritus, vitiligo and alopecia. Serious reactions such as toxic epidermal necrolysis (TEN) and DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms) syndrome, which are less common but potentially fatal, were also described. Some papers suggest a correlation between certain skin toxicities and a better oncologic prognosis, although these observations require cautious interpretation. Management strategies include specific measures for each clinical picture and recommendations for deciding the continuity of immunotherapy treatment. Conclusion: PD-1 inhibitors are associated with a wide range of skin toxicities, the understanding of which is key to ensure the safety and efficacy of treatment. Further research is needed to consolidate the relationship between these toxicities and tumor prognosis and to optimize their management.

Direction
GINARTE VAL, MANUEL JAVIER (Tutorships)

Court
COSTOYA PUENTE, JOSE ANTONIO (Chairman)
DIEZ ULLOA, MAXIMO ALBERTO (Secretary)
DOMINGUEZ MEIJIDE, ANTONIO (Member)

Summary
Introduction: Type 1 diabetes mellitus (T1DM) is one of the most prevalent chronic autoimmune diseases in children. Its origin is based on the presence of activated T lymphocytes against pancreatic islets and the presence of autoantibodies that manifest themselves in a genetic predisposition. These antibodies can be detectable in presymptomatic stages, years before the clinical onset of T1DM. Therefore, screening strategies have been proposed in recent years with the aim of detecting diabetes in the presymptomatic phase. However, the implementation of these tests poses challenges in terms of their accuracy, accessibility, and applicability in asymptomatic individuals. Objectives: To analyze the available evidence on the efficacy and usefulness of current screening methods based on the measurement of autoantibodies as predictors of the development of T1DM in presymptomatic stages and the risk of clinical progression. To analyze the advantages and limitations of current screening programs and their potential population-based applications. To review and compare the efficacy of drugs that could delay the onset of T1DM in its early stages. Methodology: A systematic search was conducted in the PubMed, Cochrane Library, and Web of Science databases, selecting randomized clinical trials, clinical trials (Phase I, II, III, and IV), multicenter studies, reviews, systematic reviews, meta-analyses, prospective cohort studies, and cross-sectional studies published between 2015 and 2025. Results: A total of 16 studies were included: 12 on T1D screening through autoantibody detection and 4 based on pharmacological treatments that could delay the onset of T1D. The reviewed studies show that detecting autoantibodies at early ages allows for the identification of presymptomatic phases of T1D, enabling a more controlled diagnosis with a lower risk of ketoacidosis and the inclusion of patients in trials of immunomodulatory treatments that can slow the clinical progression of T1D. Conclusions: Autoantibody screening strategies allow for the identification of presymptomatic phases of T1D in childhood, reduce complications at diagnosis, and facilitate early access to immunotherapies. Their implementation is feasible, but requires strategies tailored to the age of seroconversion and overcoming logistical, ethnic, and economic barriers.

Direction
Concheiro Guisán, Ana (Tutorships)
González Cabaleiro, Iris (Co-tutorships)

Court
DOMINGUEZ MUÑOZ, JUAN ENRIQUE (Chairman)
Fernández Rodríguez, Mª Isabel (Secretary)
SANCHEZ IGLESIAS, SOFIA (Member)

Summary
Introduction: Hepatitis E virus (HEV) infection is an infectious liver disease with high prevalence and incidence in Europe and is one of the leading causes of acute hepatitis worldwide. The infection, which has a high zoonotic component, can occur in the immunocompetent individuals and in immunocompromised patients, the latter of whom often experience a more severe clinical course. HEV infection should be considered within the differential diagnosis of acute viral hepatitis, where it can sometimes present extrahepatic manifestations. Objectives: to review and synthesize the extrahepatic manifestations of HEV infection in the context of a clinical case, while also addressing aspects related to the epidemiology, diagnosis, treatment and prevention of infection by this virus in our environment. Material and methods: a literature review of extrahepatic manifestations of HEV infection was conducted based on a case report of a patient from the Santiago de Compostela Health Area from 2010 to the present. Results: approximately 20 extrahepatic manifestations of HEV infection were found, the most common of which were neuralgic amyotrophy and Guillain-Barré Syndrome. This disease is more prevalent in male patients, particularly those with underlying chronic liver disease and immunocompromised patients. Conclusions: screening for HEV infection should be conducted in patients presenting with specific manifestations, such as neuralgic amyotrophy and Guillain-Barré Syndrome, even in the absence of elevated liver enzymes, and in those presenting with acute hepatitis of unknown origin, regardless of their travel history or age.

Direction
AGUILERA GUIRAO, ANTONIO (Tutorships)

Court
Gonzalez Quintela, Arturo (Chairman)
BRAÑAS GONZALEZ, ANTIA (Secretary)
Sierra Paredes, German (Member)

Summary
Introduction: Autoimmune hepatitis is a chronic inflammatory liver disease that is relatively uncommon. It is characterized by elevated serum transaminases and IgG immunoglobulin levels, interface hepatitis on liver histopathology, the presence of autoantibodies, and a good response to immunosuppressive treatment. Objectives: The main objectives are to identify and classify the different therapeutic approaches available for the disease, evaluate the efficacy and safety of the drugs used, and analyze emerging therapies. Methods: An exhaustive analysis of the existing scientific literature was conducted through a search in the PubMed database. Results: After reviewing various studies, 33 were included in this review, of which 15 focus on the results section. These studies compared the use of glucocorticoids plus azathioprine with glucocorticoids plus mycophenolate mofetil, showing the superiority of the latter therapy in several studies. Other therapies based on immunosuppressants and monoclonal antibodies were also investigated, showing promising results, although the number of studies is limited and further research is needed. Conclusion: The analysis of the studies shows that the combination of glucocorticoids with mycophenolate mofetil offers higher remission rates and greater tolerability than the traditional azathioprine-based regimen. Alternative therapies such as tacrolimus, rituximab, or infliximab have also proven useful in refractory cases. These findings support the use of mycophenolate mofetil as a first-line therapy and reinforce a personalized approach to treatment.

Direction
RIVERA GALLEGO, ALBERTO JOSE (Tutorships)

Court
CARRACEDO ALVAREZ, ANGEL MARIA (Chairman)
FERNANDEZ LOPEZ, FERNANDO (Secretary)
RODRIGUEZ ARES, MARIA TERESA (Member)

Summary
Major Depressive Disorder (MDD) is a highly prevalent mental disorder with complex characteristics, whose etiology remains largely unclear. In recent years, there has been growing interest in the potential role of the gut microbiota in the pathophysiology of mental disorders, including depression. This study aims to analyze the possible impact of the gut microbiota on the pathophysiology of MDD, by exploring both the compositional and functional alterations observed in affected individuals, as well as the effects of complementary therapeutic interventions, particularly the use of probiotics. Additionally, the main mechanisms involved in the bidirectional interaction of the gut-brain axis are addressed. Through a review of the most recent scientific literature, this work compiles and discusses evidence supporting a significant association between the gut microbiota and the onset or exacerbation of depressive symptoms. Furthermore, potential therapeutic implications are considered, such as the use of probiotics or fecal microbiota transplantation (FMT) as complementary strategies in the management of MDD. The reviewed studies reveal that patients with MDD exhibit relevant alterations in the composition and function of their gut microbiota compared to healthy individuals. This work aims to contribute to a deeper understanding of the mechanisms involved in the etiopathogenesis of depression and to promote new lines of research oriented towards the development of more specific and personalized therapeutic options.

Direction
VICENTE ALBA, FRANCISCO JAVIER (Tutorships)
Serrano Cartón, María del Carmen (Co-tutorships)

Court
ARCE VAZQUEZ, VICTOR MANUEL (Chairman)
Concheiro Guisán, Ana (Secretary)
CORTIÑAS DIAZ, JULIO ANTONIO (Member)

Summary
Aim: This study aimed to investigate and compare factors associated with mean platelet volume (MPV) and mean red blood cell corpuscular volume (RBC-MCV) in the general adult population. Methods: We conducted a cross-sectional study on 1504 individuals (44.5% men; median age 52 years, range 18-91 years) randomly sampled from the general adult population. We measured MPV and RBC-MCV and determined their relationship with demographic (age and sex), lifestyle (physical exercise, alcohol and tobacco consumption), and metabolic (body mass index, metabolic syndrome, and diabetes or prediabetes diagnosis) variables. Results: After adjusting for potential confounders, smoking was positively associated with both MPV and RBC-MCV. Diabetes and prediabetes were positively associated with MPV, but not with RBC-MCV. Additional factors positively associated with RBC-MCV (but not with MPV) were alcohol consumption, age, and female sex. Additional factors negatively associated with RBC-MCV (but not with MPV) were moderate physical activity and high body mass index. Conclusions: MPV is increased in smokers and in patients with diabetes. With the exception of smoking, which is also associated with increased RBC-MCV, the factors associated with MPV and RBC- MCV differ in the adult population.

Direction
Gonzalez Quintela, Arturo (Tutorships)
González Vidal, Tomás (Co-tutorships)

Court
FREIRE-GARABAL NUÑEZ, MANUEL (Chairman)
Barge Caballero, Eduardo (Secretary)
SANTOS PEREZ, SOFIA MARIA SOLEDAD (Member)

Summary
Subarachnoid hemorrhage (SAH) is a condition in which bleeding occurs in the subarachnoid space. It primarily affects a young adult population between 50 and 60 years of age and is associated with high morbidity and mortality. Its etiology can be traumatic or non-traumatic,known as spontaneous, which will be the focus of our study. This condition is mainly caused by aneurysmal rupture. Rapid management following established protocols, as well as the early use of severity scales, is recommended to improve patient outcomes. The aim of the study is to describe the clinical characteristics of patients who have suffered a spontaneous subarachnoid hemorrhage at the University Clinical Hospital of Santiago de Compostela, seeking to determine the incidence of the condition, its associated complications, and the patient’s long-term functional status. Among the secondary objectives is the assessment of the relationship between the initial severity scores and the prognosis in our study population. The study results allow us to conclude that the incidence of SAH in the sample is slightly higher than the global average. It is also concluded that there is no statistically significant difference between the type of technique used for aneurysm repair and mortality. The importance of using the Hunt and Hess, Fisher, and WFSN severity scales as useful tools for the initial prognosis of the patient is emphasized.

Direction
Gonzalez Quintela, Arturo (Tutorships)
RODRIGUEZ RUIZ, EMILIO (Co-tutorships)

Court
RUANO RAVIÑA, ALBERTO (Chairman)
Gándara Cortés, Marina (Secretary)
VILLAR CHEDA, MARIA BEGOÑA (Member)

Summary
Preoperative anxiety in pediatric patients is a common issue with significant clinical and emotional implications. Its effective management is key to optimizing the child’s hospital experience and improving postoperative outcomes. Virtual reality (VR) has recently emerged as an innovative, non-pharmacological intervention to reduce pediatric anxiety in surgical settings. This study aims to assess the effectiveness of VR as a non-pharmacological strategy for managing preoperative anxiety in children undergoing major ambulatory surgery. A systematic review was conducted following PRISMA guidelines. Searches were performed in PubMed, Scopus, and Google Scholar, covering studies published between 2013 and 2025. Fifteen studies (14 randomized controlled trials and one pilot study) were included, analyzing the use of VR in pediatric populations aged 3 to 17 years during the preoperative period. Data were extracted regarding study design, type of intervention, assessment tools used (m-YPAS, ICC, VAS, among others), and main outcomes. Fourteen of the fifteen studies reported a significant reduction in preoperative anxiety in the VR groups compared to standard care. The most effective interventions combined interactive playful content or virtual tours of the hospital environment tailored to the child's developmental level. Additional benefits included improved cooperation during anesthetic induction, reduced pain perception, and high acceptance by patients, families, and healthcare professionals. Overall, the findings support VR as an effective, safe, and well-tolerated tool for reducing preoperative anxiety in pediatric patients. Its implementation in clinical protocols could substantially enhance care quality and promote more humanized perioperative experiences in pediatric outpatient surgery.

Direction
Leis Trabazo, María Rosaura (Tutorships)
Del Cerro Rodríguez, David (Co-tutorships)

Court
AGUILERA GUIRAO, ANTONIO (Chairman)
Cinza Sanjurjo, Sergio (Secretary)
COSTA BESADA, MARIA ALICIA (Member)

Summary
Introduction: Radiotherapy after mastectomy has an increasing number of indications as it has been shown to reduce local recurrence in breast cancer. It is therefore important to analyze the influence of the different types of breast reconstruction and sequences on the occurrence of complications in these patients. Objective: The objective of this work is to determinate the influence of radiotherapy on the different types of breast reconstruction. Methods: A systematic review of the literature was performed using a search strategy in the Pubmed database. Meta analyses, systematic reviews and observational studies were included. 35 studies were finally eligible. Results: The studies showed higher rates of complications and reconstructive failure associated with radiotherapy in patients who underwent alloplastic reconstruction in relation to those who underwent autologous reconstruction. The higher failure rates were associated with the sequence in which the radiation was delivered over the tissue expander. The use of polyurethane covers in reconstructions with implants is associated with a lower rate of complications in relation to silicone covers. Conclusions: In relation to radiotherapeutic treatment after mastectomy, autologous reconstruction presents better results in terms of reconstructive failure and occurrence of complications, whether adjuvant therapy is administrated before or after reconstruction.

Direction
TABOADA SUAREZ, ANTONIO (Tutorships)
Couto González, Iván (Co-tutorships)

Court
RUANO RAVIÑA, ALBERTO (Chairman)
Gándara Cortés, Marina (Secretary)
VILLAR CHEDA, MARIA BEGOÑA (Member)

Summary
Introduction: Microscopic colitis is a type of inflammatory bowel disease that has recently experiencing an increase in incidence. It predominantly affects women, mostly over the age of 50, and its main clinical manifestation is chronic, non-bloody watery diarrhoea, often accompanied by other gastrointestinal symptoms that impair patients' quality of life. Two histological subtypes are distinguished through biopsy during colonoscopy with macroscopically normal mucosa: lymphocytic colitis and collagenous colitis. Its pathophysiology and pathogenesis remain fields to be explored in greater depth, as does the potential use of biomarkers for simpler diagnosis and better differentiation from other inflammatory bowel diseases when making differential diagnoses. Treatment is primarily based on the use of a topical corticosteroid, although biological therapies have been used in certain refractory cases. Objective: The aim of this literature review is to attempt to summarise the main known features of microscopic colitis and to raise awareness and highlight the various areas in which questions remain to be resolved; pathogenesis, diagnosis and treatment. Material and methods: A search was carried out in the PubMed database using a keyword search strategy and Boolean operators OR and AND. Results: Fourteen articles were finally included in this literature review. Of these, ten are literature reviews, two systematic reviews and three randomised clinical trials. Conclusion: Microscopic colitis continues to be an underdiagnosed disease despite its increasing incidence, so more studies are needed on various aspects of the disease that are still poorly understood, such as etiopathogenesis and the use of non-invasive biomarkers, as well as more clinical trials to optimise its treatment through effective and safe pharmacological therapies to improve the quality of life of patients.

Direction
BARREIRO DE ACOSTA, MANUEL FRANCISCO (Tutorships)
Bastón Rey, Iria (Co-tutorships)

Court
COUCE PICO, MARIA DE LA LUZ (Chairman)
Eirís Puñal, Jesús Manuel (Secretary)
Cimadevila García, Antonio (Member)

Summary
Cellular pluripotency is a key tool in regenerative medicine, yet its in vitro manipulation still faces significant challenges. Understanding the molecular and metabolic mechanisms governing this state is essential for optimizing therapeutic strategies based on stem cells. This study investigates the role of cellular metabolism and the histone acetyltransferase HAT1 in the transition of embryonic stem cells (ESCs) towards a totipotent-like state resembling the 2-cell embryo stage (2C-like, or 2CLC). Our findings identify HAT1 as a crucial epigenetic regulator of endogenous retroviruses (ERVs), which are characteristic markers of the 2CLC state. Treatment with compounds that increase intracellular availability of acetyl-CoA (sodium acetate, PS48, and GW9662) significantly expanded the 2CLC subpopulation under standard pluripotency culture conditions. However, this effect was completely abolished in HAT1-deficient cells, indicating that HAT1 is essential for mediating the metabolic induction of cellular plasticity. Overall, these results support a model in which HAT1 acts as a functional bridge between carbon metabolism and epigenetic regulation during cell reprogramming. This connection suggests that the combination of targeted metabolic and epigenetic interventions could enhance the generation of developmentally potent cell states, paving the way for new biomedical applications.

Direction
FIDALGO PEREZ, MIGUEL ANGEL (Tutorships)

Court
LABANDEIRA GARCIA, JOSE LUIS (Chairman)
FERREIROS LOPEZ, ALBA (Secretary)
TABERNERO DUQUE, MARIA JESÚS (Member)

Summary
Introduction: early-onset cancer, defined as cancer diagnosed in individuals under 50 years of age, is of increasing interest in the scientific community due to reports indicating a rise in the incidence of certain types, such as colorectal and breast cancer. This potential trend represents an emerging public health challenge that requires special attention because of its particular clinical, epidemiological, and psychosocial implications, which demand a differentiated approach. Objectives: to conduct a systematic review of the published literature on the evolution of the incidence of early-onset cancer, with special attention to colorectal and breast cancers. Epidemiological trends and underlying etiological factors will be analyzed with the purpose of providing information that facilitates future research and the implementation of timely intervention strategies. Material and methods: An exhaustive search was conducted in the PubMed (MEDLINE), ScienceDirect (Elsevier) and Google Scholar databases, selecting observational studies, systematic reviews, and meta-analyses published between 2013 and 2025. Results: between 1990 and 2019, the incidence of early-onset cancer increased by 79.1 % globally, while associated mortality grew by 29 %. This increase was mainly observed in types such as colorectal and breast cancer, which exhibited differentiated clinical and molecular characteristics, often more aggressive. Regions with medium and medium-high sociodemographic indices experienced the greatest increases in incidence, whereas mortality was higher in areas of lower development, reflecting geographic disparities and inequalities in access to diagnosis and treatment. Trends also vary according to sex and cancer type, with growth projected for the coming decades. Conclusions: the data show a concerning increase in early-onset cancer cases, mainly associated with lifestyle-related risk factors such as unhealthy diets, physical inactivity, overweight, and harmful habits. At the same time, new determinants are emerging, such as current reproductive patterns in breast cancer and gut dysbiosis in colorectal cancer. This phenomenon presents significant challenges that require deeper research and the development of coordinated strategies, including active health policies, early detection programs, and advances in innovative treatments. It is essential that healthcare focuses on the patient’s overall well-being, incorporating psychosocial support and considering sensitive aspects such as fertility preservation. Finally, it is crucial to make progress in reducing inequalities in access to healthcare services, ensuring equitable coverage for the entire population.

Direction
LOPEZ LOPEZ, RAFAEL (Tutorships)

Court
FREIRE-GARABAL NUÑEZ, MANUEL (Chairman)
Barge Caballero, Eduardo (Secretary)
SANTOS PEREZ, SOFIA MARIA SOLEDAD (Member)

Summary
INTRODUCTION: Melanoma is a malignant cancer derived from an atypical melanocytic proliferation, primarily cutaneous and potentially curable if detected at early stages, approximately in 77% of cases [1]. Although stages IIB and IIC represent an intermediate phase with more conservative approaches, long-term survival rates and recurrence reduction show significant improvements in more advanced stages, such as stage III [2]. Given this reality, we will explore the impact of incorporating adjuvant immunotherapy in stages IIB and IIC, evaluating the risk/benefit and potential key factors in decision-making. AIM AND JUSTIFICATION: We will analyz the published literature with the highest evidence on survival, recurrence, and toxicity of current and alternative strategies in IIB and IIC melanomas to identify clinicopathological characteristics associated with a higher probability of relapse, and to assess the impact of adjuvant treatment. We will study the role of adjuvant checkpoint inhibitors in high-risk stage II patients, trying to classify the possibilities of relapse with parameters additional to traditional staging. METHODOLOGY: We performed a systematic review, with searches in PubMed, Cochrane, and Embase, without language limits. We prioritize studies from recent years due to the field’s constant updates. After an initial reading of 21 articles, we analyzed 9 in depth, finally including 4. RESULTS AND DISCUSSION: With 1766 patients evaluated, the trials showed consistent favorable results for PD-1 inhibitors in various histopathological subgroups. These findings, presented through the PRISMA flow diagram, support the benefit of immunotherapy, although it is necessary to await updates and preliminary results from ongoing trials. CONCLUSIONS: Adjuvant treatment in intermediate stages of melanoma is effective in limiting undetectable micrometastases, with an acceptable safety profile. However, studies with larger sample sizes and different therapeutic schemes are required to strengthen the available data.

Direction
López de los Reyes, Ramón Andrés (Tutorships)
Vílchez Simo, Rocío (Co-tutorships)

Court
MUÑOZ PATIÑO, ANA MARIA (Chairman)
Portela Romero, Manuel (Secretary)
Aran Echabe, Eduardo (Member)

Summary
Phenylethylamines are a group of synthetic compounds that include the three main drugs of abuse: amphetamines, methamphetamines, and MDMA. Their use, although not epidemiologically comparable to other drugs such as tobacco, alcohol, or cannabis, leads to significant emotional, psychological, psychiatric, physical, and social problems for both users and their families. This Final Degree Project aims to review, study, and compare recent scientific literature on the neurotoxicity of phenylethylamines and, specifically, to explain how our brain reacts molecularly, microscopically, and macroscopically to the use of these substances, their clinical consequences, and the available therapeutic options. A bibliographic review of scientific articles published from 2020 to the present was conducted, using the PubMed, Cochrane Library, and Web of Science databases as sources of information. FEN increase synaptic release and inhibit the reuptake of monoamine neurotransmitters in the HPA axis, which is associated with anxiety or depressive symptoms. In the short term, MDMA use produces alterations in serotonergic pathways that lead to memory failure. Alterations in dopamine levels in the prefrontal cortex explain possible impairments in working memory. Chronic use of FEN damages serotonergic and dopaminergic systems. In the acute phase of withdrawal, a neuroinflammatory response occurs. Although some of the symptoms can be previous, FEN consumption is associated with emotional dysregulation, behavioral disorders, cognitive impairment in domains such as memory, depressive symptoms, anxiety, and psychosis. Cognitive-behavioral therapy has shown the best results in achieving abstinence. Further research on the FEN neurotoxicity and its treatment, with more standardized populations, is still needed to achieve more robust results.

Direction
BERMEJO BARRERA, ANA MARIA (Tutorships)

Summary
Schwannoma is a benign mesenchymal tumor derived from Schwann cells, which form part of the myelin sheath of peripheral nerves. Although its preferred location is intracranial, this thesis will address this cystic mass in an atypical location: the retroperitoneum, specifically the retropancreatic region. Throughout this document, the clinical case of an asymptomatic patient will be presented. An incidental mass was found on an imaging test performed for another purpose. The preoperative diagnosis was a cystic mass involving the pancreas, which is why surgical treatment was decided upon. The tumor turned out to be completely independent of the organ, as confirmed by pathological anatomy. This is why emphasis will be placed on the main differential diagnoses of cystic masses in this location, in order to avoid, whenever possible, surgical removal of the mass, due to the significant risk of complications associated with pancreatic surgery, including pancreatic fistula and postoperative hemorrhage.

Direction
Fernández Pérez, José Aquilino (Tutorships)

Court
GONZALEZ VINAGRE, SALUSTIANO (Chairman)
PUBUL NUÑEZ, VIRGINIA (Secretary)
VAZQUEZ TORRES, MATEO (Member)

Summary
Objectives: Crohn’s disease is a chronic condition in which most patients eventually require surgery during their illness, yet many of these patients experience postoperative recurrence shortly thereafter. The aim of these systematic review is to gather scientific evidence regarding the relationship between the achievement of mucosal healing after surgery and the probability of postoperative recurrence. Methods: A search was conducted in the PubMed and Web of Science databases. Human studies analysing postoperative endoscopic recurrence and the progression to clinical recurrence were included. Results: Five observational studies and one clinical trial were included. All studies concluded that mucosal healing (Rutgeerts i0 or i1) was associated with lower risk of both endoscopic and clinical recurrence, whereas a score of greater than or equal to i2 was associated with higher probability of recurrence. Therapeutic escalation based on endoscopic findings was shown to reduce lesion progression and improve disease control. Furthermore, systematic endoscopic monitoring allows for the early detection of recurrences, enabling treatment adjustments to prevent disease progression. Conclusion: In Crohn’s disease, mucosal healing should be established as a primary therapeutic target after surgery. The implementation of endoscopic surveillance protocols and early therapeutic escalation constitutes an effective strategy to reduce recurrence rates and improve long-term clinical outcomes.

Direction
BARREIRO DE ACOSTA, MANUEL FRANCISCO (Tutorships)

Summary
Introduction: immunotherapy with checkpoint inhibitors (ICIs) has revolutionized cancer treatment, although it is associated with the appearance of serious immune-mediated adverse effects (irAEs). Immune-mediated pancreatitis is an infrequent toxicity, whose incidence in clinical practice, characteristic manifestations, and therapeutic management are not clearly defined. Objective: To estimate the incidence of ICI-induced immune-mediated pancreatitis in cancer patients in clinical practice, as well as to describe its clinical manifestations, optimal clinical management, and associated complications. Methods: A systematic search was carried out in PubMed/MEDLINE, Web of Science and Google Scholar, selecting observational studies, from 2010 to 2025, in oncology population undergoing treatment with ICIs and reporting cases of immune-mediated pancreatitis. The selection and evaluation were carried out following the methodology of the PRISMA 2020 guide. Methodological quality was assessed using the Newcastle-Ottawa Scale (NOS), in studies with a control group, and the JBI Critical Appraisal Checklist for Case Series tool, in studies without a comparator group. The risk of bias was assessed using the ROBINS-I tool, studies with a control group, and through a qualitative narrative evaluation, studies without a control group. We assessed the certainty of the evidence according to the GRADE approach, adapted to observational studies. Results: Of the 1065 studies identified, 4 observational studies were included, with a combined total of 9597 patients. The incidence of pancreatitis ranged from 1.6% to 5.7%. The predominant clinical forms were mild to moderate, although severe cases were described. Treatment consisted of discontinuation of ICIs, fluid therapy, and use of corticosteroids, with resolution rates greater than 96%. No fatal cases attributable to pancreatitis were reported. Chronic complications such as atrophy, exocrine pancreatic insufficiency (PID), and Diabetes Mellitus were observed in up to 44%. Reintroduction of immunotherapy was possible in selected cases. Conclusions: Despite its low frequency, ICI-induced immune-mediated pancreatitis is a clinically significant entity, currently underdiagnosed and at high risk of chronic sequelae. The current available evidence has significant limitations, so higher quality prospective studies are required to optimize its identification and therapeutic management.

Direction
DOMINGUEZ MUÑOZ, JUAN ENRIQUE (Tutorships)

Court
Martín Martín, Carlos Santiago (Chairman)
PEÑA GIL, CARLOS (Secretary)
LOPEZ LOPEZ, ANDREA (Member)

Summary
Introduction. Bowed string players are at high risk for performance-related musculoskeletal disorders (PRMDs). Playing an instrument involves repetitive movements and awkward postures that can cause muscle strain due to the load and frequency of performance. Objective. The main objective of this study is to analyze the incidence of the musculoskeletal disorders that most frequently affect bowed string players. Material and Method. An observational, cross-sectional epidemiological study was conducted using a self-designed online survey specifically for professional bowed string players. The questionnaire was developed following the guidelines of the CHERRIES (Checklist for Reporting Results of Internet E-Surveys). Statistical analysis was performed using the latest version of IBM SPSS. Results. A total of 89 bowed string players were included in this study. The results showed that 85.7% of musicians reported injuries that interfered with their playing, with a higher prevalence among players aged 36 to 55 (61.3%). These professionals often work in painful postures (70.8%) with the prevalence of muscle and/or tendon injuries at 53.9%, being tendonitis the most common injury (44.5%). Most musicians reported tingling or loss of sensation (75.3%). 67.16% reported symptoms in three or more different anatomical areas, with the most prevalent locations being the shoulder and upper back. Thus, 48.3% of musicians reported pain or injury during their work in the last month and 68.5% reported having suffered from it during the last year. Conclusion. This study confirms a high prevalence of musculoskeletal disorders among professional bowed string players, the most common being muscle and/or tendon injuries. PRMDs significantly impact professional performance. There is a statistically significant association between the development of PRMDs and sex and the instrument played, primarily the violin and viola. No significant causal relationship was found with age, years of experience, playing posture (sitting or standing), or weekly practice time.

Direction
PINO MINGUEZ, JESUS (Tutorships)
Jorge Mora, María Teresa (Co-tutorships)

Court
SUAREZ QUINTANILLA, JUAN ANTONIO (Chairman)
ABRALDES LOPEZ-VEIGA, MAXIMINO JOSE (Secretary)
GUDE SAMPEDRO, FRANCISCO (Member)

Summary
Metformin is a drug of the biguanide family that is used in type 2 diabetes mellitus mainly for its insulin-sensitising action and the regulation of blood glucosa levels by reducing its absorption in the intestine. Polycystic Ovary Syndrome (PCOS) is an endocrine-gynecological pathology with a high prevalence in women of childbearing age. Insulin resistance is a fairly common sign among women with PCOS and may be the precipitating cause of the other signs and symptoms, it is very difficult to fin dan effective treatment for most of its manifestations. For this reason, metformin has begun to be introduced as a posible treatment for PCOS despite the fact that it is not listed in the technical data sheet.

Direction
MARTINEZ OLMOS, MIGUEL ANGEL (Tutorships)
Villar Taibo, Rocío (Co-tutorships)
Rodríguez Carnero, María Gemma (Co-tutorships)

Court
LABANDEIRA GARCIA, JOSE LUIS (Chairman)
FERREIROS LOPEZ, ALBA (Secretary)
TABERNERO DUQUE, MARIA JESÚS (Member)

Summary
Introduction: Total knee arthroplasty (TKA) is one of the most commonly performed orthopedic procedures in Spain. Although it generally achieves good functional outcomes and high patient satisfaction, up to 15% of patients may require revision surgery. Proper soft tissue coverage and preservation are essential to avoid serious complications and ensure prosthesis survival. In this context, collaboration between orthopedic and plastic surgery teams plays a key role in achieving adequate coverage in complex cases. Materials and methods: A retrospective, observational, descriptive study was conducted including 131 patients who underwent primary TKA between 2020 and 2024 at Álvaro Cunqueiro Hospital (Vigo, Spain). The prevalence of soft tissue reconstruction and the techniques used were analyzed using anonymized clinical and surgical data. The sample size was calculated to estimate an 8% proportion with a 4.65% margin of precision. Results: Of the 131 TKA patients, 12 (9.16%) developed soft tissue complications, and 11 (8.4%) required reconstruction. These patients had a mean age of 69.6 years and a mean BMI of 32.5. Among them, 18.2% had diabetes and 27.3% had a history of smoking. The main causes were wound dehiscence or necrosis (72.7%) and infection (27.3%). All reconstructions were performed as delayed procedures, with a median time of 175 days post- TKA. A medial gastrocnemius flap was used in 72.7% of cases, dermal matrix or skin grafts in 18.2%, and a free flap in 9.1%. Two postoperative complications were recorded, with no amputations. Discussion: The prevalence of reconstruction after primary TKA in our center is consistent with previous reports, although minor non-surgical cases may have been underreported. Obesity, diabetes, and smoking were identified among reconstructed patients, in line with known risk factors for wound complications. Technical aspects matched current evidence, with the medial gastrocnemius flap being the most frequently used and yielding excellent outcomes. The retrospective nature and small sample size were the main limitations of the study. Conclusions: TKA is a safe and well-established procedure, though not exempt from soft tissue complications. In such cases, reconstructive surgery plays a crucial role in preserving both the prosthesis and the limb. Our findings highlight the importance of comprehensive preoperative evaluation to identify high-risk patients and plan appropriate strategies. Further studies with larger samples are needed to confirm these results.

Direction
Concheiro Guisán, Ana (Tutorships)
GAGO VIDAL, BRUNO (Co-tutorships)
Barandela Rey, Noemí (Co-tutorships)

Court
GONZALEZ VINAGRE, SALUSTIANO (Chairman)
PUBUL NUÑEZ, VIRGINIA (Secretary)
VAZQUEZ TORRES, MATEO (Member)

Summary
Introduction: The use of anabolic steroids in sports represents a highly relevant issue due to its implications for athletes' health and its impact on the integrity and fairness of competitions. These substances, used secretly to enhance physical performance and muscular appearance, carry both acute and chronic health risks. Objectives: To study the prevalence, incidence, and current status of steroid use in sports. To review their pharmacological properties, as well as the acute and chronic effects on health, with special focus on metabolic, cardiovascular, endocrine, and psychological consequences. To explore the current regulatory framework, evaluating its effectiveness in doping prevention and its impact on sports. Methodology: A bibliographic search was conducted for scientific articles published from 2020 to the present in the PubMed and Web of Science databases, in addition to using textbooks, online resources, legal regulations, and official documents. Results and discussion: A high prevalence of anabolic androgenic steroid use has been observed in various sports disciplines, including among young populations and non-professional athletes. This represents a significant threat to health, due to its ability to induce both acute and chronic adverse effects on the cardiovascular, endocrine, metabolic, and neuropsychological systems. Despite advances in detection and control methods, such as chromatography coupled to mass spectrometry, carbon isotope ratio (CIR) analysis, and the Athlete Biological Passport, the continuous development of new doping substances presents considerable challenges. The World Anti-Doping Code, Organic Law 11/2021 on the fight against doping in sport, and its implementing regulation (Royal Decree 792/2023) form the regulatory framework on this matter. Conclusions: It is necessary to strengthen prevention, awareness, and regulatory control strategies at both national and international levels.

Direction
BERMEJO BARRERA, ANA MARIA (Tutorships)

Summary
This cohort study was conducted including 971 patients diagnosed of aortic stenosis at the Complexo Hospitalario Universitario de Santiago de Compostela whom were enrolled in three alternatives of treatment: transcatheter aortic valve intervention (TAVI) (488), surgical aortic valve replacement (SAVR) (421) and conservative medical treatment (62). Data compilation was done including demographic, clinical and analytical data, both peri and postintervention complications and statistical analyses were performed in order to compare the characteristics of the three treatment groups and the main results. Patients with greater comorbidity, poorer functional situation and with greater advanced valvular heart disease concluded to belong in the conservative treatment group, followed by the TAVI group. Furthermore, majority of the patients were symptomatic in the moment of the intervention. While need of a pacemaker was the more frequent intervention difficulty in the TAVI group, the surgical group presented more cases of atrial fibrillation and need of reintervention. Mortality rates were found to be similar between groups, although slightly upper in the TAVI group. Data analysis of our conclusive cohort goes in accordance with current scientific evidence on the use of transcatheter aortic valve intervention, focusing on an individual approach by considering key decisive factors such as age and patients’ comorbidity. In order to make evidence-based decisions, it was necessary to meet both clinical characteristics and interventions’ results of patients with aortic stenosis who were treated in our health area.

Direction
PEÑA GIL, CARLOS (Tutorships)
González Salvado, Violeta (Co-tutorships)

Court
RUANO RAVIÑA, ALBERTO (Chairman)
Gándara Cortés, Marina (Secretary)
VILLAR CHEDA, MARIA BEGOÑA (Member)

Summary
With this work, I aim to investigate the social and health impact of diseases considered rare today. The objective is to analyze the needs of these patients, the resources they consume and require, the obstacles these create in their daily lives, and how all this affects society and the economy in general. A secondary objective is to assess possible actions that can be taken to improve the situation of these patients and how to maximize resources.

Direction
COUCE PICO, MARIA DE LA LUZ (Tutorships)
Martín López-Pardo, Beatriz María (Co-tutorships)

Court
ZALVIDE TORRENTE, JUAN BAUTISTA (Chairman)
Anibarro García, Luís (Secretary)
MARTIN CORA, FRANCISCO JAVIER (Member)

Summary
Robotic surgery represents an evolution of minimally invasive surgery that has transformed the surgical management of numerous pathologies, especially in the field of Otolaryngology and Head and Neck Surgery. This work is a systematic review that analyzes the role of robotic technology in the ENT department, describing the main procedures performed using the da Vinci system. Initially, robotic surgery is contextualized by detailing how the robot works, its historical development, core components, and its advantages and limitations compared to conventional approaches. Its main benefits include greater surgical precision, less invasiveness, fewer postoperative complications, and improved functional and aesthetic outcomes. The review then examines the application of the robotic system in four types of procedures: transoral robotic surgery (TORS) for oropharyngeal squamous cell carcinoma, robotic treatment of obstructive sleep apnea, and the transoral approach to thyroid pathology. It also presents the concept of remote-access robotic surgery for approaching the thyroid gland. For each technique, indications, contraindications, surgical technique, complications, and outcomes are analyzed in comparison with the traditional approach. Finally, the future applications of robotic surgery in ENT are discussed, highlighting the importance of careful patient selection, ongoing technological development of robotic platforms and the creation of specialized training programs to reduce the learning curve. Emphasis is placed on the need for a progressive implementation and long-term follow-up studies to validate its effectiveness and safety.

Direction
CABANAS RODRIGUEZ, EDUARDO RODRIGO (Tutorships)
Arán González, Ismael (Co-tutorships)

Court
Martín Martín, Carlos Santiago (Chairman)
PEÑA GIL, CARLOS (Secretary)
LOPEZ LOPEZ, ANDREA (Member)

Summary
Objetives: To characterize multidrug-resistant bacterial (MDR) infections in patients with hematologic malignancies (HM), a highly vulnerable population due to immunosuppression related to the disease itself and its treatments. Methods: A systematic review was conducted using the PubMed database, selecting 34 relevant studies published from 1994 onward. Results: Findings showed a high prevalence of MDR infections, particularly in cases of acute myeloid leukemia, severe and prolonged neutropenia or hematopoietic stem cell transplantation (HSCT) recipients. Prior antibiotic use, especially fluoroquinolone prophylaxis, was significantly associated with an increased risk of MDR infections. A high rate of inappropriate empirical antibiotic therapy (IEAT) was also observed, leading to worse clinical outcomes. Other contributing factors included prior colonization with MDR bacteria, the presence of central venous catheters, ICU admissions and prolonged hospitalization. MDR infections were associated with increased mortality, which highlights the importance of early detection and targeted antibiotic therapy. Conclusions: Preventive strategies, early diagnosis, and rational antibiotic use are essential to mitigate the impact of MDR infections in this high-risk population.

Direction
PERNAS SOUTO, BERTA (Tutorships)

Court
MUÑOZ PATIÑO, ANA MARIA (Chairman)
Portela Romero, Manuel (Secretary)
Aran Echabe, Eduardo (Member)

Summary
Introduction: Cutaneous lupus erythematosus (CLE) is a prevalent manifestation of lupus, a chronic inflammatory autoimmune disease with a significant impact on patients' quality of life, both physically and emotionally. The management of CLE remains a clinical challenge due to the limited efficacy and adverse effects associated with conventional therapies. Anifrolumab, a monoclonal antibody that blocks the type I interferon receptor, is presented as an effective alternative for refractory cases of cutaneous disease. Methods: A systematic review of the available scientific evidence in the PubMed, Scopus, Medline, and Cochrane databases was conducted, selecting the most recent studies on the use of anifrolumab in cutaneous lupus, meeting the established inclusion and exclusion criteria. Results: A total of 285 articles were identified, of which 40 were included. These articles evaluated the effect of anifrolumab in patients with DLE, SCLE, and other less common or atypical forms of cutaneous lupus. Data from 160 patients were analyzed, of whom 43.12% achieved a complete response and 31.87% a partial response. The remainder showed significant improvement, although this was not assessed using the CLASI score. Conclusions: Anifrolumab could be an effective, safe, and rapid option to improve the quality of life of patients with CLE, especially in cases refractory to conventional therapy. Randomized, placebo-controlled clinical trials using objective measures are needed to confirm the indication of anifrolumab for the treatment of CLE.

Direction
CARREIRA VILLAMOR, JOSE MARTIN (Tutorships)
Sueiro Delgado, Diana (Co-tutorships)

Court
AGUILAR BLANCO, MARIA FE (Chairman)
BALEATO GONZALEZ, SANDRA (Secretary)
SOPEÑA PEREZ-ARGÜELLES, BERNARDO (Member)

Summary
Neonatal congenital hearing loss is one of the most prevalent chronic conditions at birth. In most developed countries, neonatal screening programs enable early detection in order to prevent delays in speech and cognitive development in the child. The diagnosis of hearing loss involves the search for an underlying etiology, with early diagnosis and treatment being crucial to avoid future sequelae in the child. Once the diagnosis is established, therapeutic decision-making follows, along with monitoring of clinical progress and prevention of future complications, including genetic counseling. The aim of this paper is to conduct a systematic review of the literature on neonatal congenital hearing loss, including various diagnostic techniques and possible treatments.

Direction
PALLAS PALLAS, ESTRELLA (Tutorships)

Court
Gonzalez Quintela, Arturo (Chairman)
BRAÑAS GONZALEZ, ANTIA (Secretary)
Sierra Paredes, German (Member)

Summary
The medicinal and recreational properties of cannabis have been used worldwide for several centuries. With its recent therapeutic recognition, its potential limitations due to adverse effects on different systems of the human body have been raised. The aim of this study is to identify and recognize the main effects of cannabis use on the cardiovascular system, as well as its pathophysiology. To this end, a comprehensive and updated bibliographic review of the scientific literature in English and Spanish from 2018 to 2024 was conducted in the PubMed and Web of Science databases, following the PRISMA method. There is considerable scientific evidence supporting the association between cannabis use and the onset of cardiovascular adverse effects, including myocardial infarction, arrhythmias (especially atrial fibrillation), and strokes. The CB1 receptor has been associated with a significant portion of these events, due to its effects on heart rate and blood pressure. The vasoconstrictive capability of THC, one of the main active compounds in cannabis, has also been involved in its pathophysiology. The increase in the frequency of cannabis use is linked to an increase in the incidence and severity of cardiovascular effects, especially in young adults, with smoked cannabis being the form of consumption most commonly associated with these effects. Further research is needed using different models and forms of consumption, and across all types of individuals, to better understand these effects.

Direction
BERMEJO BARRERA, ANA MARIA (Tutorships)

Summary
Robotic total hip arthroplasty is an effective technique, increasingly in use at the current moment. The study of their results compared to those obtained using conventional techniques focuses on the radiological parameters of the intervention, with less data on other factors. The decision to use one technique or another is currently based on economic factors, availability, the surgeons knowledge, preferences and suitability of the patient. Possible differences in postoperative complications could help in this decision-making. We do not have enough information to say that specific complications are more or less frequent in RTHA. More studies are needed to conclude whether there are differences in the complication rates between techniques.

Direction
PINO MINGUEZ, JESUS (Tutorships)
GUALILLO , ORESTE (Co-tutorships)

Court
ARCE VAZQUEZ, VICTOR MANUEL (Chairman)
Concheiro Guisán, Ana (Secretary)
CORTIÑAS DIAZ, JULIO ANTONIO (Member)

Summary
Introduction: Inflammatory bowel disease (IBD), whose main phenotypes are Crohn's disease (CD) and ulcerative colitis (UC), is characterized by a chronic inflammation of the gastrointestinal tract with a variable and progressive clinical course. The etiology is multifactorial and includes genetic, environmental, and aberrant immune response factors. Despite the development of new biologic drugs, these are not free of side effects, and sometimes the response is incomplete. Objective: To analyze the available evidence on apheresis as a treatment for IBD. Methods: A systematic review was conducted to identify randomized clinical trials evaluating the efficacy of apheresis as a treatment for IBD. Studies published up to February 10, 2025, in Spanish and English were considered. Results: Seventy-three articles were identified, of which 13 met the inclusion criteria. The studies compared apheresis in induction (versus conventional treatments or placebo) and as maintenance therapy combined with background treatment. Only one study included patients with CD. Comparable results were observed in induction versus conventional treatment, except for a decrease in the DAI score and a higher percentage of steroid-free remission at week 12. Compared with placebo, a higher percentage of relapses were avoided in patients on low-dose steroids. As maintenance treatment, apheresis showed a higher rate of endoscopic remission. All studies concluded that apheresis is a well-tolerated treatment with a good safety profile. Conclusions: There is limited evidence of the efficacy of apheresis as a treatment for UC. This therapy appears to be well-tolerated and with few side effects. Further studies are needed to evaluate its efficacy in combination with biologic agents and to identify predictors of response.

Direction
Moreno Álvarez, Ana (Tutorships)
SOLAR BOGA, ALFONSO JESUS (Co-tutorships)

Court
ARCE VAZQUEZ, VICTOR MANUEL (Chairman)
Concheiro Guisán, Ana (Secretary)
CORTIÑAS DIAZ, JULIO ANTONIO (Member)

Summary
Introduction: developmental dysplasia of the hip (DDH) is a common pediatric hip abnormality in which the femoral head and acetabulum fail to develop and articulate properly. It ranges from mild dysplasia to irreducible dislocations. Early detection is essential to avoid serious functional sequelae, such as early osteoarthritis or the need for surgery in adulthood. Ultrasound has revolutionized the early diagnosis of this pathology by allowing detailed and dynamic visualization of the cartilaginous structures of the hip during the first months of life. Objective: to carry out a systematic review of the published literature on the role of ultrasound in the diagnosis of DDH, placing value on interdisciplinary care, and to propose a selective ultrasound screening protocol. Methodology: a literature search was carried out in databases such as PubMed and search engines such as Google Scholar, following a structured strategy in PICO format. Clinical practice guidelines, systematic reviews, websites and doctoral theses published between 2019 and 2024 were selected. Results: after initial screening and critical reading, a total of 21 relevant publications were included out of 49 search results. Conclusions: ultrasonography has been established as the technique of choice for diagnostic confirmation of DDH in infants younger than 6 months, especially using the Graf classification and the minimum standard of dynamic examination. A selective ultrasound screening protocol based on risk factors and clinical findings is recommended, with the coordinated involvement of pediatricians, radiologists and orthopedists. This strategy based on comprehensive and interdisciplinary patient care improves prognosis and avoids unnecessary complications.

Direction
VAZQUEZ CASTELO, JOSE LUIS (Tutorships)

Court
Leis Trabazo, María Rosaura (Chairman)
GARCIA FIGUEIRAS, ROBERTO (Secretary)
Varela Calviño, Rubén (Member)

Summary
INTRODUCTION: In resectable locally advanced non-small cell lung cancer (NSCLC), the standard treatment used to be surgery followed by adjuvant chemotherapy. Since 2023, based on the results of the Checkmate 816 trial, the new standard of care has become neoadjuvant chemotherapy plus immunotherapy followed by surgery, as it demonstrated improved survival and pathological response rates. However, up to 50% of patients experience locoregional or metastatic progression. Specifically within metastasic disease, oligometastatic progression, characterized by limited number and location of metastases, is associated with better survival compared to systemic progression. OBJECTIVES:This study aims to compare progression-free survival and identify potential differences in progression patterns in patients with NSCLC, divided into two treatment groups: one receaving chemotherapy alone and the other chemotherapy plus inmunotherapy. A cohort of patients treated at the Complexo Hospitalario Universitario de A Coruña (CHUAC) between 2018 and 2023 was analyzed. MATERIALS AND METHODS: A single-center, retrospective, observational, and descriptive study was conducted. A total of 61 patients with resectable NSCLC in localized or locally advanced stages were included, distributed into two treatment groups A database was constructed including demographic and clinical variables; data were obtained from the IANUS system and analyzed using SPSS. RESULTS:The group treated with chemotherapy plus immunotherapy showed a higher rate of complete pathological response (58.3% vs. 5.6%) and a lower rate of progression (26.7% vs. 60.9%; p = 0.021), with significant differences in progression patterns between the two groups (p = 0.019). Median progression-free survival was longer in the chemotherapy plus immunotherapy group (45 vs. 19 months), without achieving statistical significance. CONCLUSIONS: In patients with resectable NSCLC, neoadjuvant chemoimmunotherapy is associated with a higher complete pathological response rates, lower progression rates, and a tendency toward oligometastasic progression. There was also an observed tendency toward longer progression-free survival, which was similarly observed in patients with more limited progression, although statistical significance was not achieved.

Direction
FRAGA RODRIGUEZ, MAXIMO FRANCISCO (Tutorships)
Silva Díaz, Sofía (Co-tutorships)

Court
LOPEZ CASTROMAN, JORGE (Chairman)
MAZON RAMOS, MARIA DEL PILAR (Secretary)
ALONSO PENA, MARIA (Member)

Summary
BACKGROUND: Neuropathic pain arises as a direct consequence of an injury or disease affecting the somatosensory pain transmission system. It can affect both the central and peripheral nervous systems, with a prevalence that, although difficult to estimate, ranges between 3 and 17%. It is currently a healthcare problem of increasing relevance, not only due to the number of patients affected, but also due to the resulting impairment in quality of life. It is associated with a high prevalence of depression, sleep disorders, and high labour costs. Given the marked subjectivity inherent to pain and the lack of verbal descriptors, its diagnosis can become a real challenge. AIMS: Since the management of neuropathic pain remains a challenge today, with enormous variability and availability of alternatives, this study intends to carry out a bibliographic review of documented information to better clarify the initial management available in relation to diagnosis and treatment. MATERIALS AND METHODS: A bibliographic search was conducted in the Pubmed database, including the terms “neuropathic pain” with “diagnosis” and “screening” and “questionnaires” with “treatment” and “therapeutic approaches” and “drugs”, RESULTS AND DISCUSSION: Regarding diagnosis, the three reviewed questionnaires have high sensitivity and specificity. The DN4 is more sensitive and specific than the LANSS and allows for the detection of atypical neuropathic pain, it is more comprehensive than PainDetect, requiring a physical examination, but less convenient due to its operator-dependence. In respect of the available first-line treatments, all are highly effective and safe. Thus, amitriptyline has a greater number of adverse effects and a substantially greater increase in sleep quality than pregabalin and duloxetine, with the same efficacy. Duloxetine is effective in chemotherapy-induced neuropathic pain and chronic back radiculopathy. Regarding the use of monotherapy versus combination therapy of an antidepressant (amitriptyline or duloxetine) with a gabapentinoid (pregabalin or gabapentin), the use of monotherapy is recommended as an initial strategy, and, in case of insufficient response, the addition of a second treatment must be considered. CONCLUSIONS: the diagnosis and treatment must be individualized based on the clinical characteristics, depending on the particularities of each patient and the entity causing the neuropathic disorder.

Direction
Varela Durán, Marina (Tutorships)

Summary
Introduction: Child and adolescent mental health have experienced significant transformations during last years, especially since de COVID 19 pandemic. Globally, around 1 in 7 young people between 10 and 19 suffers from some type of mental health issue, being anxiety and depression the most prevalent, followed by ADHD, ASD, conduct disorders and psychosis. Following the high prevalence of mental disorders among young people, it is considered necessary to improve and increase care programs aimed at addressing their needs. This includes ensuring continuity of care when transitioning to adult mental health services, or, if necessary, reintegrating individual into the system after a period of discharge. In response to these challenges, the Spanish Ministry of Health has developed the National Health Strategy 2022-2026, which includes several strategic lines, the fifth one focusing on the mental health of children and adolescents. At the regional level, in Galicia, a complementary plan has also been implemented, with one of tis core strategies centred on the promotion, protection and restoration of mental health with a particular emphasis on the younger populations. Methodology A review of the existing literature in scientific data bases (Scopus, PubMed) will be carried out, focusing on the transition to care between child and adolescent mental health services (CAMHS) and adult mental health services (AMHS). Aims: To analyse the current context of the transition to adult care in mental health services, identifying barriers leading to discontinuity of care, as well as proposing strategies to achieve successful transitions. Results: Following the literature review, it is observed that the overall view of the transition process is similar across different countries and among various healthcare professionals and patients, who share common perspectives. Some of the most frequently mentioned obstacles are the lack of evidence-based protocols and clinical guidelines that are both effective and applicable, as well as the poor communication between the child and adolescent mental health services and adult services. It also highlights the different approaches used by each service in terms of how patients are supported and guided through the transition process. Mental disorders most associated with long-term follow-up, like ADHD and ASD, are also most frequently associated with falling through the gap. In contrast, more severe mental illnesses, such as schizophrenia, usually maintain continuity of care. Conclusions: Different European countries come up with similar conclusions. There is knowledge about obstacles and facilitators of the transition, but there is a need for creating a program based on scientific evidence and improve regarding guidelines. Investigations are still needed.

Direction
Gómez-Reino Rodríguez, Ignacio (Tutorships)
Tajes Alonso, María (Co-tutorships)

Court
CARRACEDO ALVAREZ, ANGEL MARIA (Chairman)
FERNANDEZ LOPEZ, FERNANDO (Secretary)
RODRIGUEZ ARES, MARIA TERESA (Member)

Summary
The gut microbiota, a community of microorganisms residing in the gastrointestinal tract, is crucial for host physiology, and its composition is significantly influenced by diet. Alteration of this microbiota, or dysbiosis, is implicated in the development of prediabetes, a state of chronic hyperglycemia that predisposes individuals to type 2 diabetes, often linked to insulin resistance. Specific changes in the abundance of various bacterial groups have been observed in individuals with metabolic alterations, with a decrease in certain beneficial bacteria being associated with increased insulin resistance. This dysbiosis can compromise the intestinal barrier, leading to low-grade systemic inflammation, a key factor in insulin resistance. A systematic review of the scientific literature was conducted. The information search included randomized controlled trials and meta-analyses that investigated the effects of probiotic supplementation in adults with prediabetes or with risk factors for type 2 diabetes, such as insulin resistance. Intervention studies show inconsistent outcomes. Some report improvements in glycemic parameters (fasting glucose, HbA1c, insulin resistance), while others find no significant benefits. Effects on lipid profiles are scarce and variable. Changes in gut microbial composition and inflammatory markers were observed in some trials, albeit with high interindividual variability. Probiotics alone showed no consistent impact on anthropometric measures. Long-term follow-up demonstrated no reduction in progression from prediabetes to type 2 diabetes.

Direction
MARTINEZ OLMOS, MIGUEL ANGEL (Tutorships)
Villar Taibo, Rocío (Co-tutorships)
Rodríguez Carnero, María Gemma (Co-tutorships)

Court
LIMA RODRIGUEZ, LUIS JESUS (Chairman)
PALLAS PALLAS, ESTRELLA (Secretary)
VARELA LEMA, MARIA LEONOR (Member)

Summary
Introduction: Toxoplasmosis is a disease caused by the parasite Toxoplasma gondii, which affects a large portion of the global population, being humans the intermediate hosts. Congenital toxoplasmosis can cause severe damage to several organs, including the eye. It may appear at birth or in early ages, however, sometimes the first symptoms manifest during adolescence, needing long-term follow-up. This review aims to analyze the ocular impact of congenital toxoplasmosis. Materials and Methods: To prepare this systematic review, a search was conducted for articles published between january 2000 and december 2024 on the ocular effects of congenital toxoplasmosis. Results: Retinochoroiditis was the primary ocular complication, with higher incidence and severity in Brazil compared to Europe, and the possibility of recurrences years later. Most children in Europe had good visual acuity, except in cases with bilateral macular lesions. Neurological complications were also described, normally associated with ocular symptoms, which can influence the prognosis or quality of life of affected children. Conclusions: The late presentation of chorioretinitis requires long-term follow-up for proper management of congenital toxoplasmosis cases. Prenatal treatment appears to reduce the severity of lesions; however, further studies with control groups are needed to confirm this outcome.

Direction
Concheiro Guisán, Ana (Tutorships)
CAMPO GESTO, ANA (Co-tutorships)

Court
GONZALEZ VINAGRE, SALUSTIANO (Chairman)
PUBUL NUÑEZ, VIRGINIA (Secretary)
VAZQUEZ TORRES, MATEO (Member)

Summary
INTRODUCTION: Advanced-stage ALK-positive non-small cell lung cancer represents a well-defined clinical entity with specific therapeutic options due to the development of ALK inhibitors. However, although clinical trials have demonstrated their efficacy in selected populations, it remains essential to assess their effectiveness, safety, and treatment patterns under real-world clinical practice conditions, in order to optimize therapeutic decision-making and contribute to a more personalized approach to this disease. OBJECTIVES: This study aims to assess the clinical outcomes of ALK inhibitor therapy in a series of patients with advanced ALK-positive NSCLC (stage IV) who received first-line therapy with an ALK inhibitor at the Hospital Clínico Universitario de Santiago (CHUS), since 2018. Specifically, the goal is to obtain data on treatment response, progression-free survival (PFS), overall survival (OS), and associated toxicities, with the purpose of providing additional evidence on the real-world efficacy and safety of these therapies. MATERIAL AND METHODS: A retrospective compilation of relevant clinical parameters was conducted in patients treated with an ALK tyrosine-kinase inhibitor as first-line therapy for the advanced disease, based on data extracted from their electronic medical records. This data was used to build a database including relevant clinical and demographic variables such as age, sex, molecular profile, treatment start and end dates, treatment response, prior and/or concomitant therapies, toxicities and tumor progression. RESULTS: The mean age of our sample was 53 years, with 15 women and 8 men, of whom 52,17% were non-smokers. The predominant histology was adenocarcinoma (20 cases), followed by squamous cell carcinoma (2 cases), and the most frequent fusion partner was EML4. Regarding first-line treatment, 9 patients received Alectinib, 4 Lorlatinib, 3 Brigatinib, and 2 Crizotinib. Response evaluation revealed 1 complete response, 13 partial responses, 4 cases of stable disease, and only 1 progression, resulting in an overall response rate of 73,7% and a disease control rate of 94,3%. Median OS and PFS were both 45,8 months. Most adverse events were mild, with hypercholesterolemia, anemia, and hepatic toxicity being the most frequent. CONCLUSIONS: ALK inhibitors proved to be highly effective and well tolerated in our clinical setting, even in patients with heterogeneous clinical characteristics. The retrospective analysis is consistent with previous studies and reinforces the need for further research in real-world contexts.

Direction
LEON MATEOS, LUIS ANGEL (Tutorships)
Francisco Fernández, Alejandro (Co-tutorships)

Court
GONZALEZ VINAGRE, SALUSTIANO (Chairman)
PUBUL NUÑEZ, VIRGINIA (Secretary)
VAZQUEZ TORRES, MATEO (Member)

Summary
Descemet membrane endothelial keratoplasty (DMEK) is an advanced surgical technique that allows the selective replacement of the Descemet membrane and damaged endothelial cells by a healthy donor graft, preserving the outermost layers of the cornea. Since its introduction in 2006, this technique has revolutionized the field of corneal transplantation thanks to its multiple advantages, such as a faster visual recovery, superior optical quality and a lower incidence of immune rejection compared to alternative procedures such as automated endothelial keratoplasty with Descemet peeling and penetrating keratoplasty. As a result, DMEK has been established as the treatment of choice for endothelial pathologies such as Fuchs' dystrophy and bullosa keratopathy. However, the application of this technique in more complex scenarios remains a challenge. This work focuses on evaluating the efficacy and complications of DMEK in complex cases, such as vitrectomized eyes, patients with glaucoma or drainage devices, previous penetrating keratoplasty, anterior-camera intraocular lenses, and iris defects. The presence of these conditions increases the technical difficulty of the intervention and increases the risk of intraoperative as well as postoperative complications.

Direction
DE ROJAS SILVA, MARIA VICTORIA (Tutorships)

Summary
Lynch syndrome (LS) is one of the most prevalent etiologies associated with colorectal and endometrial carcinoma, among other neoplastic lineages, predominantly affecting the digestive tract, the gynaecological system, and the urinary tract. It currently accounts for 10% to 15% of all cancers with deficient DNA mismatch repair (MMR) genes, as well as approximately 3% of all colorectal and endometrial cancers overall. In this study, we analyse data from 74 patients diagnosed with LS and followed by the Oncology Service of the University Clinical Hospital of Santiago de Compostela. Following the protocols of the Prospective Lynch Syndrome Da-tabase, we examine the incidence of cancers associated with LS, the corresponding genetic variants, surgical treatment and prophylactic measures, the cohort's polyp burden, and survival outcomes.

Direction
LEON MATEOS, LUIS ANGEL (Tutorships)
Ruiz Bañobre, Juan (Co-tutorships)

Court
MUÑOZ BARUS, JOSE IGNACIO (Chairman)
GAGO AGEITOS, ANA MARIA (Secretary)
VAZQUEZ ILLANES, MARIA DOLORES (Member)

Summary
Introduction: Autism Spectrum Disorder (ASD) is a highly prevalent neurodevelopmental disorder with an increasing incidence. Children with this disorder often suffer from diseases that require them to access healthcare services more frequently than other children of the same age. These hospital visits, especially if they are for a surgery, are extremely stressful for the patient, their caregivers and the healthcare staff who will take care of them. Objective: to identify and analyze the available evidence on the most effective strategies to reduce anxiety, improve the surgical experience and optimize communication in children with Autism Spectrum Disorder (ASD) who must undergo surgery. Material and methods: a systematic review was conducted using the MEDLINE and PsycInfo databases, including articles published between January 2009 and December 2024, in English, French or Spanish, that addressed the management of pediatric surgery in children with ASD or effective communication strategies with these patients. Only primary studies with open access were included. Results and conclusions: after applying the inclusion and exclusion criteria, eight articles were selected and analyzed in this review. The results were divided into two main areas: hospitalization and communication. Regarding hospitalization, the strong need for individualized care was highlighted, and identified several useful strategies for application in the surgical settings. Regarding communication, the use of Augmentative and Alternative Communication (both high and low technology) was recommended to explain the surgical process to patients in an understandable way to children with ASD.

Direction
GAGO AGEITOS, ANA MARIA (Tutorships)

Summary
Introduction: Adolescent idiopathic scoliosis is a spinal deformity in all three planes, defined by a coronal curvature of more than 10 degrees using Cobb angle measurement. Double curves (Lenke types 3 and 6) account for 11% of cases, with the standard treatment being posterior spinal instrumentation and fusion of both the thoracic and lumbar curves. Among surgeons, there is heterogeneity in approaches when planning the surgical strategy for the same patient, with spinal balance often prioritized over the degree of correction achieved. Objective: To compare the percentage of curve correction in adolescent idiopathic scoliosis with double curves, with a primary component in the thoracic spine (Lenke 3), according to the different reduction maneuvers used. Materials and methods: A bibliographic review was conducted through a systematic search of articles published in various online databases (PubMed, SciELO, Dialnet, The Cochrane Library, and Science Direct). Results: A total of 132 articles were found, from which 5 were selected, involving surgery on 143 patients. Additionally, an ambispective study by Dr. Máximo Alberto Diez Ulloa is included, covering 16 patients operated on by him between 2017 and 2025 at the University Clinical Hospital of Santiago de Compostela. Conclusions: No surgical technique proved superior to others. There were no statistically significant differences in thoracic or lumbar curve correction percentages among the different surgical groups analyzed (Kruskal-Wallis: p bigger than 0.05 in both cases). It is recommended to analyze other parameters that may influence surgical outcomes, such as sagittal and coronal balance, surgical complications, and the sagittal profile, to reach more accurate and comprehensive conclusions.

Direction
DIEZ ULLOA, MAXIMO ALBERTO (Tutorships)
Domínguez Barreiro, Henrique (Co-tutorships)

Court
SUAREZ QUINTANILLA, JUAN ANTONIO (Chairman)
ABRALDES LOPEZ-VEIGA, MAXIMINO JOSE (Secretary)
GUDE SAMPEDRO, FRANCISCO (Member)

Summary
Objectives: Compare direct osteosynthesis (OD) with posterior spinal fusion (PSF) in the treatment of type II odontoid fractures in the elderly in terms of surgical and functional outcomes to determine which technique is better for the patient. Methods: A systematic search of articles on the PubMed platform has been conducted using a series of eligibility criteria, for the subsequent data extraction from those valid and available articles. Results: 12 valid articles were obtained for the review. Results were collected across the three main variables of interest (complications, bone consolidation, and mortality). Operating and hospital stay times were shorter in direct osteosynthesis. Consolidation was superior in posterior spinal fusion. Mortality was matched in both series. Conclusion: Both direct osteosynthesis and posterior spinal fusion are valid and effective techniques in the treatment of this pathology; however, there is none that stands out above the other globally, recommending the choice of one or the other to be individualized depending on each patient's situation.

Direction
DIEZ ULLOA, MAXIMO ALBERTO (Tutorships)

Court
CARRACEDO ALVAREZ, ANGEL MARIA (Chairman)
FERNANDEZ LOPEZ, FERNANDO (Secretary)
RODRIGUEZ ARES, MARIA TERESA (Member)

Summary
Objectives: to compare the efficacy of laparoscopic Heller’s myotomy (LHM) versus peroral endoscopic myotomy (POEM) in the treatment of primary achalasia, with symptomatic improvement measured by the Eckardt Score as the main variable; in addition, other aspects such as complications, recurrences and perioperative variables were evaluated. Methods: a systematic search of articles was carried out in PubMed, Web of Science and Cochrane library databases for subsequent reading and extraction of information from those who met the eligibility criteria. Results: a total of 15 studies were selected to be part of this review. Therapeutic success was achieved in both groups in all studies. Complication and recurrence rates were variable. There was a higher incidence of gastroesophageal reflux disease in the POEM group. Intervention and hospital stay times were significantly shorter in POEM. Conclusion: LHM associated with fundoplication and POEM are two techniques with an effectiveness in symptomatic relief of similar primary achalasia, however, POEM offers earlier recovery times, at the expense of slightly higher rates of gastroesophageal reflux disease later.

Direction
DOMINGUEZ MUÑOZ, JUAN ENRIQUE (Tutorships)

Court
CORDERO SANTAMARIA, OSCAR JAVIER (Chairman)
ABDULKADER NALLIB, IHAB (Secretary)
RODRIGUEZ PEREZ, ANA ISABEL (Member)

Summary
Introduction: Arnold-Chiari malformation type (MC-I) is a congenital condition characterized by the descent of the cerebellar tonsils 5 mm or more through the occipito-cervical junction. This malformation is often associated with syringomielia and may cause symptomps such as headache, sensory disturbances, motor deficits, among others. Currently, magnetic resonancia imagin (MRI) is the diagnostic method of choice. The most common surgical treatment consists of posterior fossa descompression with C1 laminectomy, with or without duraplasty. Objectives: The aim of this Degree Project is to analyze the clinical and radiological outcomes in patients with CM-I associated with syringomielia, depending on the surgical technique used. It seek to determine whether these techniques lead to clinical improvement, radiological improvement, or both , as well as to assess the need for postoperative imaging follow-up. Methodology: A literature review was conducted using the PubMed database, selecting comparative and observational studies published between 2011 and 2025. In addition, clinical records from the University Clinical Hospital of Santiago de Compostela were reviewed. Results: Following an initial screening and critical reading of the literatura, three articles were selected, along with 15 clinical cases from the University Clinical Hospital of Santiago, comparing the surgical techniques employed. Conclusion: The findings show that the most commonly used surgical technique was posterior fossa descompression with C1 laminectomy and duraplasty, applied to patients across a wide age range and with varying degrees of tonsillar descent. Better clinical and radiological outcomes were observed in patients who underwent duraplasty, with a more significant reduction in syringomielia size. Although clinical improvement did not always correlate with radiological changes, most cases with syrinx reduction also showed symptomatic improvement. The lack of postoperative MRI limits objectivde evaluatiom, highlighting the need to include it in follow-up.

Direction
Aran Echabe, Eduardo (Tutorships)

Court
RUANO RAVIÑA, ALBERTO (Chairman)
Gándara Cortés, Marina (Secretary)
VILLAR CHEDA, MARIA BEGOÑA (Member)

Summary
INTRODUCTION:: Palliative care is a fundamental component of the comprehensive management of serious illnesses, addressing the four dimensions of the person: pshychological, social, spiritual and physical, thereby offering support to both the patient and their environment. MAIN OBJECTIVE: To define key aspects relevant to palliative care patients, with the aim of improving symptom control and provide effective support for both the patient and their caregivers. MATERIAL AND METHODS: A systematic review of the scientific literature was conducted through searches in PubMed, the Cochrane Library, SciELO, Dialnet and IBECS. Predefined inclusion and exclusion criteria were applied. Studies published between 2002 and 2024, in Spanish and English, that addressed emotional, existential, and clinical aspects of suffering in palliative care patients were selected. RESULTS AND DISCUSSION: The review reveals a limited understanding of the desire to die and the distinction between pain and suffering. It underscores the importance of the multidisciplinary team in delivering comprehensive care. However, it also highlights the lack of clear protocols and specific training. Consequently, most of the included studies are narrative or reflective in nature, with a notable scarcity of empirical research using rigorous methodology. CONCLUSION: The lack of systematic and high-quality studies in this field limits the ability to establish strong recommendations, underscoring the need for further research and professional training. The desire to die and the experience ofsuffering are complex phenomena that require specific and multidimensional attention. To improve the quality of life of patients and their caregivers, a humanized, interdisciplinary, and ethically grounded approach is essential.

Direction
POSE REINO, ANTONIO DOMINGO (Tutorships)
Hermida Porto, María Leticia (Co-tutorships)

Court
SEOANE PRADO, RAFAEL (Chairman)
VIDAL MILLARES, MARIA (Secretary)
FIDALGO PEREZ, MIGUEL ANGEL (Member)

Summary
Introduction: Helicobacter pilory is a Gam-negative, helical-shaped and microaerophile bacillus. This microorganism has a high predisposition for the gastric mucous, where it remains, and can cause several symptoms and pathologies, being the chronic gastritis the most common. This infection is mostly transmitted between humans and his reservoir is the human being. The infection with the Helicobacter pilory happens during pediatric ages and it has a big prevalence worldwide. That is why it is important to know the main differences from adults when we must manage this infection in pediatric patients. Objectives: To carry out a bibliographic review of the available scientific evidence about the management of this infection in pediatric ages, focusing on important points about the clinical evidence and the diagnosis, as well as the treatment, with the goal of achieve a common practical guide to know how to deal with this bacterium when it infects a pediatric patient and describe the main differences when we manage this infection in adults or in children. Methods and materials: For doing this bibliographic review we will do the online research in different database such as PubMed and Dialnet, physic research will be done as well in different public libraries of the Santiago de Compostela University. We will revise different articles that are written in English or Spanish and that were published in the las 5 years using some selection standards to select the articles that most fit the objective of this paperwork. Conclusion: The Helicobacter pylori infection in pediatric patients is a relevant topic nowadays, above all in the developing countries, where the prevalence of this infection is very high. Children with this bacterium normally are asymptomatic or they manifest very unspecific symptoms. The diagnosis of this infection in children is different from the adults, in kids, we need to use a gastric endoscopy to obtain some biopsies from the gastric mucous, this samples are used to do the culture and the PCR, which are the gold standard for the diagnosis of the infection in pediatric patients, because they let us detect if there is antibiotic resistances as well; not invasive methods can be used to follow the patient after the eradication. The treatment of the pediatric patients must be done attending the results of the culture or the PCR basing our treatment in the antibiogram of the child, if we don´t have this information we must follow the geographic antibiotic resistances and try to eliminate the bacterium with the first treatment; the test and treat strategy that is used in adults, is not recommended in children. We must keep investigating about this infection in kids to know how it is spread and prevent it, to achieve improvements in the diagnosis methods so they can be less invasive, or to develop new treatments that can elevate the tase of eradication of this bacterium.

Direction
Leis Trabazo, María Rosaura (Tutorships)
Fernández Cebrián, Santiago Andrés (Co-tutorships)

Court
LOPEZ CASTROMAN, JORGE (Chairman)
MAZON RAMOS, MARIA DEL PILAR (Secretary)
ALONSO PENA, MARIA (Member)

Summary
Introduction: Shoulder arthroplasty is an increasingly common surgical procedure, especially in elderly patients with complex proximal humerus fractures. One of the most serious complications associated with this procedure is periprosthetic infection, which entails high morbidity and therapeutic complexity. This systematic review analyzes current strategies for managing this complication, focusing on the efficacy and functionality of different therapeutic options. Objectives: The main objective is to systematically review the scientific literature to evaluate the effectiveness of various therapeutic strategies for shoulder arthroplasty infections in fracture patients. Materials and Methods: A systematic review of the scientific literature published between 2015 and 2025 was conducted using the PubMed database. Articles in English or Spanish that were randomized clinical trials, systematic reviews, or meta-analyses were selected. Filters were applied to narrow the selection to the most relevant studies. The PRISMA methodology was used for the selection process. Results: After applying the search methodology, 11 articles were selected for full critical review. The results show that DAIR (debridement, antibiotics, and implant retention) is useful in acute infections due to its less invasive nature and good functional outcomes, despite its higher reinfection rate (30%). In chronic infections, one- or two-stage interventions are the most effective, achieving eradication rates around 90%, with a slight advantage of the one-stage procedure in terms of functionality, cost, and lower complication rates. Other options, such as prosthesis resection, permanent spacers, or suppressive antibiotic therapy, are useful in selected cases. Conclusions: There is no definitive consensus on the ideal treatment for shoulder arthroplasty infections. DAIR remains a valuable option for acute infections. One- and two-stage revisions are the preferred treatments for subacute and chronic infections, with a possible superiority of one-stage revisions, although further studies are needed to confirm this. Alternative therapies should be reserved for special cases with high comorbidity or surgical contraindications.

Direction
Concheiro Guisán, Ana (Tutorships)
Quinteiro Antolín, Tomás Luis (Co-tutorships)

Court
Leis Trabazo, María Rosaura (Chairman)
GARCIA FIGUEIRAS, ROBERTO (Secretary)
Varela Calviño, Rubén (Member)

Summary
Introduction: Closed-loop insulin systems are a highly effective tool for managing patients with insulin-dependent Diabetes Mellitus. They consist of a continuous glucose monitor and an insulin pump that, through an algorithm, adjusts the insulin dose based on sensor data. Objectives: To assess patient satisfaction with the change in treatment from multiple daily insulin injections to closed-loop systems, evaluate changes in metabolic control parameters and analyze the correlation between both variables. Methods: A retrospective observational study was conducted in 35 patients with type 1 diabetes using closed-loop systems, who had previously been treated with insulin pens. Satisfaction with the change in treatment was assessed using the DTSQc questionnaire, and changes in glycemic control were analyzed using parameters obtained from continuous glucose monitoring during the 15 days prior to starting treatment with the closed-loop system and the 15 days prior to the first follow-up visit. Results: Satisfaction with the treatment change was high, with a median score of 15 points (range 7-18). Metabolic control improved significantly: %TIR increased (63% vs 78%), %CV decreased (36% vs 31%), %GMI decreased (7.2% vs 6.7%), and %TAR was reduced (34% vs 19%). %TBR also decreased, although this was not statistically significant (2% vs 1%, p=0.062). A significant positive correlation was observed between satisfaction and %TIR (r=0.428), as well as a significant negative correlation between satisfaction and %CV (r=0.349). Conclusions: The use of closed-loop insulin systems improves glycemic control parameters and patient satisfaction compared to MDI treatment. In this study, satisfaction was significantly correlated with improvements in glycemic control (increase in %TIR and decrease in %CV).

Direction
Fernández Rodríguez, Eva (Tutorships)
Seoane Cruz, Inés (Co-tutorships)

Court
CORDERO SANTAMARIA, OSCAR JAVIER (Chairman)
ABDULKADER NALLIB, IHAB (Secretary)
RODRIGUEZ PEREZ, ANA ISABEL (Member)

Summary
Objectives: The objective of this study was the realization of a literature review of the long-term effect of the BOPT technique on the clinical parameters of periodontal health. Study design: Scoping review. Methodes: All the literature found in MEDLINE via PubMed, Science Direct and Cochrane Central Library was used. Prospective and randomized clinical trials published in indexed journals, written in english, spanish or italian were included if they researched the evolution of periodontal health after a BOPT treatment. Outcomes: A total of 6 studies were included with a high score after their methodological quality assessment for their risk of bias. All the studies show high percentages of gingival stability, with three of them showing an absence of recession in 100% of their sample, as well as low levels of probing depth and gingival inflamation in general, despite the negative outcomes obtained in one of the studies in this regard. Besides, a noticeable thickening of the keratinized mucosa was found during the first two years of treatment. Conclusions: Despite lacking further research with longer follow-up periods and larger samples, the BOPT technique seems to obtain good initial results in terms of periodontal management, generating little recession in comparison to the previously documented for horizontal preparations and an apparent stability sustained in time.

Direction
Santana Mora, Urbano Alejandro (Tutorships)
López Solache, Alicia (Co-tutorships)

Court
SEOANE LESTON, JUAN MANUEL (Chairman)
LIÑARES GONZALEZ, ANTONIO (Secretary)
MAREQUE BUENO, SANTIAGO (Member)

Summary
Objectives: This triple-blind randomized clinical trial evaluated whether the UltraEZ desensitizing gel (3% potassium nitrate and 0,25% sodium fluoride) applied 30 minutes before at-home bleaching reduces tooth sensitivity. And studied its duration, intensity, time of appearance and type. Material and methods: Thirty-two patients were randomly selected and assigned in two groups: UltraEZ and placebo. The treatment protocol consisted of applying desensitizer/placebo on a preformed tray 30 minutes before at-home bleaching with 16% carbamide peroxide for 3 weeks. The sensitivity was recorded with a daily 5-point Numeric Rating Scale. Colour samples were evaluated with a spectrophotometer and positioning trays and analysed using the CIEDE200 formula. Results: The UltraEZ group had an absolute risk of sensitivity of 37.6%, compared to 87.5% in the placebo group, statistically differences were found between the two groups. No significant differences were found in level of intensity. Regardless of group, of the 20 patients reporting sensitivity, 5 had sensitivity between 25-50% of the days, 6 between 50-75% and 9 in more than 75%. Regarding the time of appearance, 95% occurred post-treatment and 5% during bleaching. Regarding the type, 50% of patients experienced spontaneous sensitivity, while the other 50% presented stimulated sensitivity. The colour change was similar in both groups. Conclusions: The application of UltraEZ desensitizing gel 30 minutes before the whitening agent significantly reduces the absolute and relative risk of tooth sensitivity without compromising colour change or patient satisfaction.

Direction
CASTELO BAZ, PABLO (Tutorships)
Pereira Lores, Patricia (Co-tutorships)

Court
SEOANE LESTON, JUAN MANUEL (Chairman)
LIÑARES GONZALEZ, ANTONIO (Secretary)
MAREQUE BUENO, SANTIAGO (Member)

Summary
The osseointegration is a key factor in dental implant success/failure. The effective bond between an implant and the surrounding bone is created by different mechanical factors. We know that one of the prerequisites for such bone healing is primary stability, which is defined as the initial mechanical resistance of the implant to micromovement in the bone bed after surgical insertion. The other fundamental prerequisite is the correct distribution of stress, thus avoiding micro-movements that lead to fibrous tissue formation and early implant failure. Albrektsson (1981) identified multiple factors that influence the osseointegration of implants such as the biocompatibility of the material, the micro and macro characteristics of the implant surface, the surgical site, the surgical technique, the healing phase and the subsequent prosthetic design and loading phase, as these elements pose a significant biomechanical challenge (5). Macrodesign includes thread, body shape and thread design (e.g. thread geometry, face angle, thread pitch, thread depth (height), thread thickness (width) or thread helix angle). The improvements in these macro-design elements have been created to promote cellular activity and facilitate bone apposition, positively and directly affecting bone-implant contact (BIC). Therefore, the aim of this narrative review is to describe the influence of the different elements of the macro-design of dental implants on the achievement of bone stability.

Direction
Batalla Vázquez, María Pilar (Tutorships)
NOVOA GARRIDO, LOURDES (Co-tutorships)

Court
VARELA CENTELLES, PABLO IGNACIO (Chairman)
CASTELO BAZ, PABLO (Secretary)
Rivas Mundiña, Berta (Member)

Summary
In Spain, approximately 50,000 cardiac arrests are recorded each year, 30,000 of which occur outside the hospital. It has been shown that combining conventional resuscitation maneuvers with early defibrillation using a Semi-Automated External Defibrillator (AED) increases the survival of these patients. The main objective of this study was to analyze the knowledge and skills of Dentistry students in the use of AEDs in a simulated practical setting, after intentionally modifying the message transmitted by the defibrillator and to determine whether the results improved on those previously obtained with the conventional message. Fifth-year students of the Dentistry Degree at the University of Santiago de Compostela (n=39) completed an individualized training exercise, which consisted of performing a defibrillation procedure (simulated, without shock) on a mannequin using an AED (Philips Ibérica, Madrid, Spain). Using a qualitative assessment template, data was collected on each student's performance during the exercise, analyzing 10 items distributed across three sections: Preparation, Positioning and Shock, and Post-Shock. The percentage of participants who correctly completed the assessed items was generally significantly better than with the conventional message, with the exception of the following: Administer the shock when indicated by the AED, Immediately restart CPR unless contraindicated by the AED, and Check the AED test again after 2 minutes. The mean time to shock was 27 seconds shorter than among students in the previous study who received the conventional message. The addition of a more pedagogical and intuitive audio guide improves understanding of AED messages and reduces reaction times among dental students, critical factors when it comes to time-sensitive interventions such as defibrillation.

Direction
DIZ DIOS, PEDRO (Tutorships)
García Mato, Eliane (Co-tutorships)

Court
VARELA CENTELLES, PABLO IGNACIO (Chairman)
CASTELO BAZ, PABLO (Secretary)
Rivas Mundiña, Berta (Member)

Summary
Oral candidiasis (OC) or oral candidosis is an infectious disease caused by the proliferation of Candida spp. colonies and their penetration into oral tissues. It can be presented in a wide range of clinical forms (acute or chronic), including pseudomembranous, erythematous, chronic hyperplastic, angular cheilitis, median rhomboid glossitis, and perioral dermatitis. Current therapeutic approaches focus on oral and systemic antifungal antifungals; however, the increase in resistance and the species heterogeneity justify the need for more individualized therapies. Based on results obtained with the autovaccine Vacucis Candida in the treatment of candidal vulvovaginitis, the hypothesis proposed is that its use could be effective in treating persistent and refractory oral candidiasis. The objective of this study is to evaluate its efficacy in the reduction/ elimination of episodes and/or clinical signs and symptoms. This pilot study comprises a sample of 9 subjects who received the autovaccine as a daily dose of two sublingual actuations sprays for a seven- week period. Follow up evaluations were performed at 3-, 6-, and 12-months post-treatment. Saliva samples were cultured to quantify Colony Forming Units (CFU) of Candida spp. and measure the global salivary rate. The evolution of clinical parameters was recorded through scales and questionnaires: Analog Scale (VAS), Oral Health Impact Profile (OHIP), Global Saliva Test I and II (TSGI and TSGII), and Xerostomy Inventory (XI). Results show a reduction in CFU/mL after the autovaccine administration, as well as clinical improvement in candidiasis related symptoms, pain, and perceived quality of life. These findings support the autovaccine as a viable and promising treatment option for persistent and refractory oral candidiasis. The success of this study suggests the need for a future randomized controlled clinical trial to gather further data on the application protocol.

Direction
Pérez-Sayáns García, Mario (Tutorships)

Court
DA SILVA DOMINGUEZ, JOSE LUIS (Chairman)
LOPEZ CASTRO, GONZALO (Secretary)
GANDARA VILA, PILAR (Member)

Summary
This Final Degree Project reviewed the application of artificial intelligence in the dental field. The main objective was to analyze and collect relevant information on its current applications, its main advantages and limitations, and its future prospects. A search was conducted in the bibliographic databases PubMed and Scopus from 2020 to 2025. 1,020 articles were found, of which 34 were included after applying the determined inclusion and exclusion criteria. It was observed that most of the study units were related to general diagnosis, caries detection and both periodontal and orthodontic practices, that the most widely used modality is 2D technology, and that the most predominant system is CNN. It was concluded that this technology is a tool that is revolutionizing dentistry and that it presents great future potential, but that it also requires more up-to-date and rigorous scientific studies to ensure its use in an ethical and safe manner.

Direction
POSE RODRIGUEZ, JOSE MANUEL (Tutorships)
OTERO CASAL, MARIA DE LA PAZ (Co-tutorships)

Court
TOMAS CARMONA, INMACULADA (Chairman)
SEOANE ROMERO, JUAN MANUEL (Secretary)
RILO POUSA, BENITO (Member)

Summary
Background and aims: Serum levels of carbohydrate-deficient transferrin (CDT, the sum of its asialylated and disialylated glycoforms) are a commercial marker of alcohol abuse. The aim of this was to investigate, the potential influence of metabolic factors on serum CDT levels and the predictive value of transferrin glycoforms for the development of diabetes mellitus in a general adult population. Methods: Serum CDT levels were measured by capillary electrophoresis in 1516 individuals (median age 52 years; 55.3% women) randomly selected from the general adult population of a municipality. Results: Insulin resistance and the associated body mass index and diabetes mellitus modified the effect of alcohol consumption on CDT levels, i.e., CDT in heavy drinkers was lower in individuals with obesity than in lean counterparts and was also lower in people with diabetes than in normoglycemic individuals. The relative abundance of transferrin glycoforms was not significantly associated with the development of diabetes mellitus after a mean follow-up of 7.4 of years. Conclusions: There is an interaction between alcohol consumption and factors associated with insulin resistance in relation to transferrin sialylation. The diagnostic value of CDT for detecting heavy alcohol consumption may be limited in patients with obesity or diabetes mellitus.

Direction
Gonzalez Quintela, Arturo (Tutorships)
González Vidal, Tomás (Co-tutorships)

Court
FREIRE-GARABAL NUÑEZ, MANUEL (Chairman)
Barge Caballero, Eduardo (Secretary)
SANTOS PEREZ, SOFIA MARIA SOLEDAD (Member)

Summary
Introduction and Objectives: Cholangiocarcinoma (CCA) is the second most common primary malignant tumor of the liver, surpassed only by hepatocellular carcinoma. It is significantly more frequent in individuals with primary sclerosing cholangitis and in certain regions of the world. CCA accounts for 13% of deaths caused by malignant neoplasms. It has poor survival rates, which vary depending on its location and the stage at diagnosis. Its treatment remains a major challenge, with surgical resection being the current standard. This study aims to analyze the role of liver transplantation (LT) in the treatment of hilar cholangiocarcinoma (also known as Klatskin tumor), compare the outcomes of other treatments used alongside the standard approach, and evaluate the technical, logistical, and ethical implications of transplant oncology in relation to hilar CCA. Materials and Methods: A literature review was conducted following the PRISMA guidelines. Searches were carried out in PubMed and Cochrane. Results: A total of 65 articles were identified, of which 13 were selected for final inclusion in the study. Conclusions: Liver transplantation (LT) can be an effective treatment for hilar cholangiocarcinoma (hCCA) in carefully selected patients who meet strict criteria and are able to complete the neoadjuvant chemoradiotherapy (CRT) regimen. However, further studies are needed to establish it as a routine treatment for this indication. Combined chemotherapy with gemcitabine or cisplatin, as well as endoscopic photodynamic therapy (EPDT), brachytherapy (BT), or portal vein resection may be beneficial in selected patients, whereas hepatic vein resection is not routinely recommended. Minimally invasive surgery (MIS) requires further studies before it can be recommended as an alternative to traditional open surgery. The use of normothermic machine perfusion, reduced-size grafts, or the implementation of the RAPID technique may be helpful as strategies to expand the liver donor pool.

Direction
Fernández Castroagudin, Javier (Tutorships)

Court
Leis Trabazo, María Rosaura (Chairman)
GARCIA FIGUEIRAS, ROBERTO (Secretary)
Varela Calviño, Rubén (Member)

Summary
Background: Combined tears of the subscapularis (SC) and supraspinatus (SE) tendon are a common cause of shoulder pain and dysfunction. These lesions can be post-traumatic or degenerative, the latter being the most frequent. The surgical indication is established by virtue of certain parameters such as the patient's age, traumatic history, time of evolution, muscle atrophy or poor response to conservative treatment, among other factors. The present study evaluates the clinical outcomes of patients who underwent surgery for anterosuperior rotator cuff injuries, performing arthroscopic repair. Methods: A prospective study was conducted with 53 patients undergoing arthroscopic repair of combined CS and SE lesions between 2017 and 2023. Variables such as active range of mobility, muscle strength, pain and functionality were evaluated using the scales: Constant-Murley Score (CMS), Simple Shoulder Test (SST), Subjective Shoulder Value (SSV) and Visual Analog Scale (VAS). The data were statistically analyzed by comparing pre- and postoperative values. Results: Significant improvements were observed in active forward flexion (29.5 degrees), abduction (37.9 degrees) and internal rotation, but no significant changes were observed in external rotation. Muscle strength improved significantly in all directions evaluated. Pain was markedly reduced (mean difference of 5.9 in VAS) and functional scales (CMS, SST, SSV) showed clinically relevant improvements. Conclusions: Arthroscopic repair is effective in improving shoulder range of motion and muscle strength, as well as reducing pain in patients with combined SC and SE tears. It is recommended to continue with this protocol, although it is suggested to investigate strategies to optimize recovery of external rotation and personalize rehabilitation.

Direction
GARCIA GARCIA, MANUEL (Tutorships)
Fernández Cortiñas, Ana Belén (Co-tutorships)

Court
COSTOYA PUENTE, JOSE ANTONIO (Chairman)
DIEZ ULLOA, MAXIMO ALBERTO (Secretary)
DOMINGUEZ MEIJIDE, ANTONIO (Member)

Summary
Introduction: Bronchopulmonary dysplasia (BPD) is one of the most common complications in premature newborns. Advances in neonatal care have changed the concept and etiopathogenesis of this condition. However, up to 25% of newborns with less than 32 weeks' gestational age continue to suffer from BPD, making preventive measures and strategies increasingly important. Vitamin A is a form of postnatal prevention; although research has been conducted, doubts and debates remain regarding its efficacy and certainty in preventing this condition. The objective of this study is to conduct a systematic review to evaluate the efficacy of vitamin A supplementation in preventing BPD in premature newborns with less than 32 weeks, comparing the incidence of this lung disorder between newborns who receive such supplementation and those who do not. Methods: A systematic review was conducted, following the criteria of the PRISMA guidelines, of studies dealing with vitamin A supplementation in premature neonates in relation to the incidence of bronchopulmonary dysplasia. Results: This review is composed of three articles adjusted to the imposed inclusion and exclusion criteria, studies published between 2004 and 2024, accessible in both English and Spanish, being the study population very premature infants (with less than 32 weeks), having as primary or secondary outcome the incidence of bronchopulmonary dysplasia and being clinical trials, as well as observational studies of children and clinical cases. Two of the included studies demonstrated a clinical improvement as a primary outcome in addition to a possible decrease in the incidence of bronchopulmonary dysplasia. All included studies demonstrated an increase in serum with this supplementation in the study population. Conclusions: The number of studies and available information are insufficient to establish clear evidence for the use of vitamin A to reduce the incidence of bronchopulmonary dysplasia, so further studies are needed to reach a clear conclusion.

Direction
AVILA ALVAREZ, ALEJANDRO (Tutorships)

Court
LOPEZ CASTROMAN, JORGE (Chairman)
MAZON RAMOS, MARIA DEL PILAR (Secretary)
ALONSO PENA, MARIA (Member)

Summary
Obstetric hemorrhage represents one of the leading causes of maternal morbidity and mortality worldwide. This Bachelor's Thesis addresses the application of Patient Blood Management (PBM) as a multidisciplinary strategy aimed at optimizing blood management in the context of pregnancy, childbirth, and the puerperium. Through a literature review of recent scientific literature, the fundamental pillars of PBM are analyzed: the optimization of erythrocyte mass, the reduction of blood loss, and the improvement of anemia tolerance. Interventions such as proactive correction of iron-deficiency anemia, rational use of transfusions, pharmacological prophylaxis (tranexamic acid, uterotonics), and conservative surgical techniques (intrauterine balloon, compressive sutures) are evaluated. The thesis highlights the need for implementing individualized, evidence-based protocols that ensure safe and effective care for the pregnant woman, especially in high-risk hemorrhagic scenarios. It also examines the ethical, legal, and organizational implications of implementing PBM in clinical practice, as well as its benefits in terms of reducing complications, costs, and improving postpartum recovery. Finally, recommendations for clinical practice and future research directions are proposed, aimed at strengthening the preventive, personalized, and sustainable approach to managing maternal blood.

Direction
Varela Durán, Marina (Tutorships)

Summary
The everyday nature of performing manual ventilation leads to the assumption that it is being done correctly according to the patient's characteristics and needs, even by the most experienced nurses and doctors. This is a completely uncontrolled and operator-dependent technique. This everyday practice results in a significant number of errors, translating into suboptimal treatment for our patients. This study aims first to evaluate the quality of ventilation performed by both doctors and nurses in the ICU when done blindly, and then to perform the same ventilation by the same professional using a real-time feedback device, comparing the results.

Direction
Gonzalez Quintela, Arturo (Tutorships)
RODRIGUEZ RUIZ, EMILIO (Co-tutorships)

Court
MUÑOZ PATIÑO, ANA MARIA (Chairman)
Portela Romero, Manuel (Secretary)
Aran Echabe, Eduardo (Member)

Summary
INTRODUCTION: Gastric Cancer is currently one of the most common cancers worldwide and in Spain. Some of the most relevant risk factors for its development in-clude Helicobacter pylori infection, smoking, alcohol consumption, and diet, among others. The average age at diagnosis is 70 years. There are no real incidence rates for Gastric Cancer in our territory. OBJECTIVES: The main objective is to determine the incidence of gastric cancer in the adult population of the Vigo healthcare area, as well as to obtain the epidemiological and clinical char-acteristics of patients with this cancer. Additionally, the study aims to evaluate whether the cur-rent screening protocol is adequate for this population. MATERIAL AND METHODS: Prospective observational epidemiological study, regional multicenter and population based. The inclusion period was 12 months (March 2023 - March 2024). The clinical and epidemiological characteristics of patients diagnosed with gastric cancer during this period were collected in the hospitals of the Vigo Healthcare Area. RESULTS: We analyzed 108 patients distributed between two hospitals and found that the incidence specifically, the age-standardized rate for both sexes is 20.02 per 100,000 inhabit-ants/year, which reflects an intermediate risk of gastric cancer, as opposed to the low risk ob-served in Spain overall. Additionally, the incidence was found to be three times higher in men than in women. The median age at diagnosis was 74 years and 60% of the patients had intestinal type gastric cancer. CONCLUSIONS: Although the incidence of gastric cancer in Spain is low, it is higher in our study area. These results indicate that preventive and screening measures should be reassessed for our population, as the current guidelines are not adapted to this intermediate risk for Gastric Cancer in the Vigo health care area.

Direction
DE CASTRO PARGA, MARIA LUISA (Tutorships)
Fernández Fernández, Nereida (Co-tutorships)

Court
AGUILAR BLANCO, MARIA FE (Chairman)
BALEATO GONZALEZ, SANDRA (Secretary)
SOPEÑA PEREZ-ARGÜELLES, BERNARDO (Member)

Summary
Introduction The successful integration of orthopedic implants depends on the interaction between the biomaterial and the biological environment. In this context, Laser Induced Periodic Surface Structures (LIPSS) have emerged as a promising technique to optimize the properties of titanium, enhancing osseointegration without the need for chemical coatings. These structures allow modification of the surface topography at the nanometric scale, positively influencing cell adhesion, proliferation, and differentiation. Objectives This study addresses the need to implement effective, reproducible, and clinically viable surface treatments in biomedical implants. Its main objectives were: to design a protocol to generate LIPSS on titanium discs using a femtosecond laser; to analyze their effect on the inflammatory response induced by LPS; to evaluate their influence on the osteoblastic and adipogenic differentiation of human mesenchymal stem cells; and to determine the optimal parameters to maximize osseointegration without the use of external agents or coatings, with a view toward future clinical application in 3D printed implants. Materials and Methods An in vitro study was conducted using ASTM 23 titanium discs treated with a femtosecond laser, varying the energy between 30 and 100 mJ to generate surfaces with different roughness levels. Inflammatory and osteo/adipogenic differentiation markers were assessed using cultured human mesenchymal stem cells. Inflammation assays with LPS and osteogenic and adipogenic differentiation assays were performed in programmed cycles, with results analyzed using qPCR and ANOVA statistical testing. Conclusion Surfaces treated with LIPSS, particularly at 50 mJ of energy, significantly promoted osteoblastic differentiation, reduced LPS induced inflammation, and decreased the expression of adipogenic markers. Without the use of drugs or additional coatings. These findings position LIPSS as an effective strategy to enhance bone integration and prevent complications such as aseptic loosening in personalized implants, laying the groundwork for future clinical implementation in orthopedics and dentistry.

Direction
PINO MINGUEZ, JESUS (Tutorships)
Jorge Mora, Alberto Agustín (Co-tutorships)

Court
MARTINEZ OLMOS, MIGUEL ANGEL (Chairman)
GAMBORINO CARAMES, ELENA (Secretary)
Rey Brandariz, Julia (Member)

Summary
Vertigo and vestibular disorders are a very frequent and disabling symptom in the general population, causing a significant impact on quality of life of patients. Fortunately, in children, vertigo is a less common entity compared to adults, although with a probably underestimated prevalence. Both the origin, different from that of adults, and the symptoms that are often not well interpreted, can make diagnosis and treatment difficult, with the anxiety that this entails for the patient and their family. In recent years, the diagnostic criteria for childhood vertigo and its approach have been reviewed and updated.

Direction
SOTO VARELA, ANDRES (Tutorships)
PALLAS PALLAS, ESTRELLA (Co-tutorships)

Court
ARCE VAZQUEZ, VICTOR MANUEL (Chairman)
Concheiro Guisán, Ana (Secretary)
CORTIÑAS DIAZ, JULIO ANTONIO (Member)

Summary
INTRODUCTION: Mild TBIs are the most common type of traumatic brain injuries and can have serious complications despite their seemingly benign nature. The prognosis also depends on factors such as age, comorbidities, and the mechanism of trauma. The management of mild TBI in the emergency department is controversial, as existing clinical guidelines and scales have low predictive capacity. Therefore, decisions often rely on clinical judgment and the presence of risk factors. This leads to the overuse of CT scans, the practice of defensive medicine, and an urgent need for standardized protocols to avoid unnecessary radiation exposure and reduce healthcare costs. Biomarkers such as GFAP and UCH-L1 have shown promise in detecting acute brain injury in mild TBI, helping to reduce unnecessary CT use in the emergency setting. Both biomarkers are released during the acute phase post-trauma and demonstrate high sensitivity and negative predictive value, supporting safe and efficient clinical decision-making. Their use is protocolized in patients with mild TBI, provided it occurs within 12 hours after the trauma. Although their implementation improves care and optimizes resource use, challenges remain, including the need for staff training and overcoming resistance to change. OBJECTIVES: This systematic review aims to analyze the published literature on mild TBI and its management in the Emergency Departments. The purpose is to study the contribution of biomarkers of brain damage in hospital emergency settings. Additionally, it seeks to conclude whether their measurement in these patients is a valid tool to discriminate the indication or not for performing a radiological imaging test. METHODS: Systematic review in which a search of the published literature on biomarkers of brain damage in MEDLINE (PubMed) has been conducted from 2020 to the present. RESULTS: The measurement in serological samples of GFAP and UCH-L1 after a mild TBI within the first 12 hours post-trauma and their combined interpretation have a sensitivity and NPV of 100% for ruling out acute brain injury in CT. Therefore, it is an excellent screening test in hospital emergency departments to ensure the absence of abnormalities in radiological imaging tests, or conversely, to determine the need to perform one. CONCLUSIONS: The implementation of the rapid biomarker test in emergency departments would allow for resource optimization, avoiding the performance of additional tests on patients who really do not need them. It would also result in significant economic savings for the hospital, as it is a cheaper test than CT. For the patient, it would mean the absence of radiation if not strictly necessary, as well as reducing their time in the emergency department due to the quick nature of the test.

Direction
MARTINEZ ROLAN, ROSA MARIA (Tutorships)
Pichel Loureiro, Ángel (Co-tutorships)
Maza Vera, María Teresa (Co-tutorships)

Court
Leis Trabazo, María Rosaura (Chairman)
GARCIA FIGUEIRAS, ROBERTO (Secretary)
Varela Calviño, Rubén (Member)

Summary
Introduction Borderline Personality Disorder (BPD) is a psychiatric condition characterized by a persistent pattern of instability in affect regulation, impulse control, interpersonal relationships, self-image, and a high risk of suicide. Traditionally, the management of BPD has included both pharmacological treatment and psychotherapeutic interventions. However, recent scientific evidence suggests that Dialectical Behavior Therapy (DBT), developed by Marsha Linehan, may be more effective than pharmacotherapy alone across multiple clinical domains. Objectives To review the current evidence and compare the efficacy of Dialectical Behavior Therapy with that of pharmacological treatment in the management of Borderline Personality Disorder, considering side effects, treatment adherence, and overall functional outcomes of both therapeutic approaches. Methodology A systematic review of the available scientific literature on therapeutic approaches to Borderline Personality Disorder was conducted using the PubMed database, following the PRISMA guidelines. Inclusion criteria were: studies published in English, Spanish, or Portuguese; publication date between January 2000 and April 2025 (a broad timeframe to include long-term studies); randomized controlled clinical trials, retrospective cohort studies, studies conducted in humans, studies involving an adult population (greater than or equal to 18 years) previously diagnosed with BPD according to DSM-5 criteria; investigations including relevant therapeutic interventions, specifically pharmacological treatment or dialectical behavior therapy, and studies reporting clinical outcome measures such as symptom reduction, decrease in self harming behaviors, functional improvement, or quality of life (in order to compare clinically significant results). Results Data from a total of 12 articles were analyzed. The selected studies agree that DBT not only improves core symptoms of BPD but also significantly reduces suicidal and self-injurious behaviors one of the most challenging aspects of the disorder, whereas pharmacotherapy appears to have a more limited effect and, in many cases, offers only partial or nonspecific symptomatic benefits. Conclusions The results demonstrate a clear superiority of DBT over pharmacological treatment in reducing core symptoms of BPD, such as impulsivity, emotional instability, and self-harming behavior.

Direction
VICENTE ALBA, FRANCISCO JAVIER (Tutorships)

Court
MARTINEZ OLMOS, MIGUEL ANGEL (Chairman)
GAMBORINO CARAMES, ELENA (Secretary)
Rey Brandariz, Julia (Member)

Summary
Introduction. Asthma is a chronic inflammatory disease that, besides physiological factors, is associated with mental disorders, particularly anxiety and depression. Recently, the relevance of Post-Traumatic Stress Disorder (PTSD) in asthma patients has been recognized, although fewer studies specifically address this relationship. PTSD, characterized by symptoms such as intrusion, avoidance, cognitive and mood alterations, and hyperarousal, can arise after various traumatic events. The prevalence of PTSD in the general population is 4-5%, while in victims of violence it can exceed 50%. The need to identify and measure PTSD in asthma patients is crucial, highlighting tools such as the PCL-5, IES-R, and CAPS-5. Objectives. Objective 1. Identify the instruments used for diagnosing post-traumatic stress disorder in publications addressing asthma and PTSD. Objective 2. Identify the traumatic events reported in published studies on PTSD in asthma. Method. A literature search was conducted in PubMed up to February 15, 2025, using the described keywords. Randomized and non-randomized clinical trials, post hoc studies, observational studies, and case series were included. Two investigators (J.F.B. and M.B.A.) verified the inclusion/exclusion criteria. Filters applied included: human studies, English and Spanish language. The results were expressed in percentages. Results. Of the 156 identified articles, 66 and 82 were included in the analyses of the two objectives. The most frequently used tool to detect PTSD was the PCL (37,88 %), followed by the IES-R (12,12 %) and CAPS (9,09 %). The most frequent traumatic events associated with PTSD were the 9/11 attacks, wars, and interpersonal violence. Asthma exacerbations were also significant events, with high psychiatric comorbidity observed. Conclusions. 1) There is a wide variety of questionnaires used in the literature for the diagnosis of PTSD 2) Although the CAPS-5 is the gold standard, we observed that its use is limited in studies probably because it requires trained interviewers and the time needed for completion. 3) The most commonly used tools were the PCL-5 and the IES-R, both validated and adapted to various populations. 4) Most PTSD studies have been conducted in the context of war conflicts and catastrophes, but it has been little studied in other stressful circumstances 5) The systematization of PTSD assessment in asthma and the selection of appropriate instruments are key challenges for clinical practice.

Direction
González Barcala, Francisco Javier (Tutorships)
Blanco Aparicio, Marina (Co-tutorships)

Court
Leis Trabazo, María Rosaura (Chairman)
GARCIA FIGUEIRAS, ROBERTO (Secretary)
Varela Calviño, Rubén (Member)

Summary
The history of nutritional support dates back to around 3500 b.C., when Egyptians and Greeks began using rectally administered solutions to treat people with intestinal conditions. Over the centuries, various studies and research have led to significant advancements in this field, such as the development of improved materials , the optimization of methods to access the gastrointestinal tract, the discovery of nutrients and their role in the body, as well as a better understanding of digestion and absorption processes. It is important to highlight that while progress was made in one area, advancements were also achieved in others, such as the refinement of nutrition techniques and the identification of essential amino acids. Nowadays, enteral nutrition is primarily used in patients whose oral intake is insufficient to maintain adequate nutritional and hydration status. However, this was not always its main application. For example, diets developed for space programs laid the foundation for the use of elemental diets, which were later adapted for therapeutic purposes. These advancements have transformed clinical nutrition, and the use of clinical nutrition has expanded worldwide, significantly improving the prognosis of many patients.

Direction
Leis Trabazo, María Rosaura (Tutorships)
BAUTISTA CASASNOVAS, ADOLFO LAUREANO (Co-tutorships)

Court
SALAS ELLACURIAGA, ANTONIO (Chairman)
FIGUEROA RODRIGUEZ, JESUS (Secretary)
Aguiar Fernández, Pablo (Member)

Summary
Introduction: In contact sports such as rugby and american football, cervical spine injuries are more frequents than in other types of activities. These injuries can range from paresthesias to permanent spinal cord damage. Although these injuries are not highly prevalent, their consequences are significant. Therefore, this study analyzes the variation in their incidence based on the strategies implemented thanks to medical advances. Objetive: To conduct a systematic review of various published aricles on the preventive measures implemented thanks to the medicine to avoid, or reduce, the risk of cervical injuries in rugby and american football. Material and methods: A search was performed in the MEDLINE/PubMed and WOS database, applying inclusion and exclusion criteria to select the most relevante studies from randomized clinical trials, reviews, systematic reviews and meta-analyses. After the initial search, a criticar reading of the remaining articles was carried out, and ten studies were selected for the systematic review. Results: The analyzed articles show a decrease in the incidence of spinal cord injuries after the implementation of various preventive measures. Among these, improvements in protective equipment and regulatory changes in tackling and scrum are highlighted. Conclusions: Medicine has marked a turning point in reducing the incidence of cervical injuries in both sports. Thanks to it, measures were implemented in rugby, such as the crouch, bind, set method, and in American football, such as the ban on spear tackle. However, it is important to emphasize that it is still necessary to research and update preventive measures to achieve increasingly better results.

Direction
DIEZ ULLOA, MAXIMO ALBERTO (Tutorships)

Court
MARTINEZ OLMOS, MIGUEL ANGEL (Chairman)
GAMBORINO CARAMES, ELENA (Secretary)
Rey Brandariz, Julia (Member)

Summary
Acute respiratory infections (ARIs) are a major cause of morbidity and mortality worldwide, with SARS-CoV-2, the influenza virus, and the respiratory syncytial virus (RSV) being three of the main agents involved in recent years. The COVID-19 pandemic significantly altered the usual dynamics of these viruses' circulation, both through biological mechanisms and the implementation of non-pharmacological interventions (NPIs), creating a new epidemiological scenario. This literature review primarily aims to assess whether these infections occur in isolation or together, as well as the frequency and characteristics of their coinfection. An analysis of recent studies revealed that, while the joint circulation of SARS-CoV-2, influenza, and RSV is evident during winter periods, coinfection among them is not particularly common. The reported coinfection rate ranged from 0.1% to 1.5%, with higher prevalence among hospitalized patients and vulnerable populations, such as infants or individuals with pre-existing comorbidities. However, when coinfection does occur, especially between SARS-CoV-2 and influenza, it appears to be associated with greater clinical severity, including higher risks of ICU admission and the need for mechanical ventilation. Conversely, evidence on coinfection with SARS-CoV-2 and RSV and its impact on adults remains limited. Additionally, various experimental studies and mathematical models suggest the existence of viral interference among these pathogens, which could partially explain the low frequency of coinfections observed. In conclusion, it is evident that understanding these viral interactions is essential to improving diagnostic, therapeutic, and preventive strategies in a context of multiple viral circulation in the future.

Direction
Antela López, Antonio Rafael (Tutorships)

Court
AGUILERA GUIRAO, ANTONIO (Chairman)
Cinza Sanjurjo, Sergio (Secretary)
COSTA BESADA, MARIA ALICIA (Member)

Summary
Background: This scoping review analysed the tools used to evaluate in situ simulation in Paediatric (PICU) and Neonatal (NICU) Intensive Care Units, and their relationship with the levels of Kirkpatrick's model. Objectives: The aim was to identify the tools used to evaluate in situ simulation in PICU and NICU, examining their correspondence with the four levels of Kirkpatrick’s model: reac-tion, learning, behaviour, and results. Eligibility Criteria: Eight studies were included, mostly quasi-experimental, which im-plemented in situ simulation in PICU and NICU and mentioned or described the evaluation tools used. Sources of Evidence: The studies were selected through a systematic search in the PubMed, Scopus, and CINAHL databases. Data Extraction Methods: Fourteen evaluation tools were identified. Of these, six had been previously validated, three were modified versions of existing instruments, and five were created ad hoc. These tools assessed both technical skills (ventilatory management, resuscitation, drug administration) and non-technical skills (teamwork, communication, self-confidence). Results: Tools focused on non-technical skills predominated, reflecting the increasing importance of these competencies in critical contexts. Most instruments evaluated levels 1 (reaction) and 2 (learning) of Kirkpatrick’s model, while only a few studies addressed level 3 (behaviour) and none evaluated level 4 (results). Additionally, significant methodological heterogeneity and a lack of validation in several tools were observed. Conclusions: There is a need to develop validated and specific instruments for PICU and NICU that address all four levels of Kirkpatrick’s model. In situ simulation demonstrates high formative potential by reproducing critical clinical situations in a safe and realistic environ-ment. Therefore, this review lays the foundation for standardising future evaluations and justifying the systematic use of simulation in PICU and NICU.

Direction
Moreno Álvarez, Ana (Tutorships)
Ogando Martínez, Alicia (Co-tutorships)

Court
Gonzalez Quintela, Arturo (Chairman)
BRAÑAS GONZALEZ, ANTIA (Secretary)
Sierra Paredes, German (Member)

Summary
INTRODUCTION: Schizophrenia is a psychotic disorder that affects 1% of the global population. It typically appears during adolescence and is characterized by episodes of psychosis, as well as cognitive and social impairments, among other symptoms. To date, various etiological hypotheses have been proposed, including complications during the fetal period. influenza is one of the most common viral infections globally, and during different epidemics throughout history, exposure to the virus during pregnancy has been observed to potentially cause fetal damage and consequently increase the risk of developing schizophrenia. OBJECTIVES: A review of the scientific evidence is conducted with the primary objective of examining the potential association between prenatal exposure to the influenza virus and the subsequent development of schizophrenia. Secondary objectives include analysing major influenza epidemics and their impacts, as well as exploring potential preventive measures. METHODS: A systematic search was performed in the following databases: Embase, PsycInfo, Web of Science (WoS), Scopus and Pubmed, covering all available records up to October 15, 2024. RESULTS: The initial search yielded a total of 937 articles. After applying inclusion and exclusion criteria, and conducting screening first by title and abstract, and subsequently by full-text review, 25 articles were included in this review. Of these, twelve support the proposed causal association, seven refute it, and six are inconclusive. However, none of the studies found statistically significant differences. CONCLUSIONS: This review suggests that exposure to the influenza virus during pregnancy could have significant evidence in the subsequent development of schizophrenia. Nevertheless, it is unlikely to be a causal factor on its own, but part of an interaction with other risk factors. Although some authors advocate for this causal link, there is no consistent evidence to confirm it, and therefore, it should remain a subject of further study.

Direction
VICENTE ALBA, FRANCISCO JAVIER (Tutorships)
Ortega Ruibal, Francisco José (Co-tutorships)

Court
GONZALEZ VINAGRE, SALUSTIANO (Chairman)
PUBUL NUÑEZ, VIRGINIA (Secretary)
VAZQUEZ TORRES, MATEO (Member)

Summary
Small cell lung cancer is a rare neoplasm with a high rate of morbidity and mortality. Moreover, the majority of cases are diagnosed at an advanced stage, due to the absence of symptoms, with extended metastasis to brain and other organs, therefore limiting the therapeutic approach and chances of recovery or even chronification. Given its particular characteristics (aggresive dedifferentiated histology, the easy development of chemotherapy resistance and lack of knowledge about its genetics and molecular routes), there has not been any significative advancement in the management over the last decades: the first line therapy still consists as of today of etoposide and platinum-based chemotherapy. The recent introduction of immunotherapy has completely revolutionized the current oncologic paradigm, while small cell lung cancer remains, among other tumors also difficult to treat, aside from the farmaceutical advances.

Direction
LEON MATEOS, LUIS ANGEL (Tutorships)
Mosquera Martínez, Joaquín (Co-tutorships)

Court
ZALVIDE TORRENTE, JUAN BAUTISTA (Chairman)
Anibarro García, Luís (Secretary)
MARTIN CORA, FRANCISCO JAVIER (Member)

Summary
Introduction: Advanced solid tumors show significant resistance and toxicity to currently available treatments. In this context, antibody-drug conjugates (ACF) emerge as an innovative targeted therapy, combining the specificity of monoclonal antibodies with the potency of cytotoxic agents. Objectives: To compare the efficacy and safety of ACF against standard chemotherapy and immunotherapy schemes in patients with solid tumors, analyzing progression-free survival (SLP) and overall survival (SG). Methodology: A systematic review of phase III randomized clinical trials identified in PubMed and Web of Science was performed. Studies in adults with solid tumors were incorporated, applying methodological assessment tools (PEDro) and risk of bias (RoB 2). Results: 16 trials were included. Most of them showed significant improvements in SLP and SG in favor of ACF, highlighting its use especially in breast cancer and, more recently, in ovarian and urothelial neoplasms. Lung cancer has not shown such promising results and even one study, TAHOE, had to be discontinued due to lower efficacy and associated toxicity. In general, ADCs presented fewer adverse effects than conventional chemotherapy and, those that appeared, were considered manageable. Conclusions: ACFs have established themselves as an effective and tolerable targeted therapy in solid tumors, especially in breast cancer. Recent scientific evidence supports their inclusion as part of advanced oncologic treatment, improving SLP, SG and control of toxicity related to their application compared to available therapeutic schemes. It is also important to continue investigating its usefulness in other neoplasms.

Direction
CARREIRA VILLAMOR, JOSE MARTIN (Tutorships)
García Mata, Jesús (Co-tutorships)

Court
ZALVIDE TORRENTE, JUAN BAUTISTA (Chairman)
Anibarro García, Luís (Secretary)
MARTIN CORA, FRANCISCO JAVIER (Member)

Summary
Introduction: Type 2 diabetes mellitus is a chronic disorder characterized by hyperglycemia due to a defect in insulin action and/or a deficiency in insulin production. It is associated with numerous acute and chronic complications that lead to increased mortality and morbidity, as well as a decrease in quality of life. Objectives: 1) To investigate whether there are differences in health-related quality of life and its 5-year evolution in people with and without diabetes. 2) To compare the evolution of health-related quality of life (HRQoL), measured using the SF-36 questionnaire, in diabetic and non-diabetic individuals over a 5-year period. Material and methods: A longitudinal observational study with a 5-year follow-up was conducted. Of the study participants, 156 individuals were finally included (78 with diabetes and 78 without), matched by age and sex. Quality of life was assessed using the SF-36 questionnaire, both at baseline and after 5 years of follow-up. Results: At baseline, no significant differences were found in quality of life between the two groups. After 5 years, patients with diabetes showed a significant decline in general health, and an improvement in bodily pain, physical functioning, and vitality. Conclusion: HRQoL in patients with type 2 diabetes remains relatively stable, with deterioration in some dimensions. These findings highlight the importance of evaluating not only clinical parameters but also the patient’s subjective perception.

Direction
GUDE SAMPEDRO, FRANCISCO (Tutorships)
Díaz Louzao, Carla (Co-tutorships)

Court
COUCE PICO, MARIA DE LA LUZ (Chairman)
Eirís Puñal, Jesús Manuel (Secretary)
Cimadevila García, Antonio (Member)

Summary
Background: Myeloid sarcoma (MS), also known as granulocytic sarcoma, is an extramedullary hematological neoplasm of immature myeloid cells that manifests as a solid mass of soft tissue. This disease is most often associated with acute myeloid leukemia (AML) and other myeloproliferative neoplasms. This study pretends to characterize the tumors diagnosed in the healthcare area of Santiago de Compostela between 2014 and 2024. Materials and Methods: A literature review and descriptive study were conducted based on a case series of 16 patients diagnosed with MS at CHUS. Inclusion criteria encompassed all patients with MS and a completed diagnostic process between 2014 and 2024. Clinicalpathological information was obtained in close collaboration with the Biobank and the Pathology Service of CHUS, ensuring compliance with all ethical protocols. Results: The case series studied revealed that the majority of patients were elderly adults with an average age of 70-80 years. Women predominated over men. The most common locations were the skin and soft tissues, followed by those affecting bone and, finally, those involving internal organs. The presentation of symptoms was very variable due to the various locations of the neoplasm. The diagnostic methods employed included CT, PET-CT, BAAG, bone marrow aspiration, and biopsy, as well as immunohistochemistry (IHC), flow cytometry, and molecular analysis. The treatments administered included chemotherapy in all cases where there was an intention to control the tumor (7 cases), complementary radiotherapy (2 cases), allogeneic transplant (3 cases), and targeted therapies (3 cases). The patients who received chemotherapy with transplantation showed a very good outcome with complete remissions and long-term disease absence. Conclusions: In our area (CHUS), MS is a rare hematological malignancy, with 16 diagnosed cases, the vast majority associated with AML. It is considered a true diagnostic challenge that requires a comprehensive workup that includes imaging tests and a pathological study supported by IHC, flow cytometry and molecular analysis. Treatment primarily involves chemotherapy and allogeneic transplantation. Targeted therapies are emerging as promising options for patients with specific molecular characteristics.

Direction
FRAGA RODRIGUEZ, MAXIMO FRANCISCO (Tutorships)

Court
AGUILERA GUIRAO, ANTONIO (Chairman)
Cinza Sanjurjo, Sergio (Secretary)
COSTA BESADA, MARIA ALICIA (Member)

Summary
INTRODUCTION: behavior, rather than genes, is the major modifiable cardiovascular risk factor: smoking, obesity, sedentary lifestyle and poor medication adherence. However, after a myocardial infarction, fewer than 30% of the patients are able to change their behavior, even when enrolled in rehabilitation programs. Willpower and motivation are key drivers of behavior change. There are also medicines that can influence behavior, although their effectiveness is controversial. OBJECTIVE: the effectiveness of psychological techniques in changing behaviors that contribute to cardiovascular risk factors will be reviewed, specifically focusing on smoking, obesity, sedentary lifestyle and adherence to pharmacological treatment. For each of these factors, the effectiveness of Psychology versus Pharmacology will be compared. The best possible plan will be designed to achieve a reduction in cardiovascular risk factors. MATERIAL AND METHOD: selection of articles related to the psychological and pharmacological treatment of smoking, obesity and therapeutic adherence. Consulted sources include Harrison´s Internal Medicine, Miller´s Motivational Interviewing, UpToDate, Cochrane Database, Medscape and PubMed. RESULTS: in smoking cessation, cognitive behavioral therapy showed a 14% effectiveness rate in maintaining abstinence one year after treatment. Drugs like bupropion, varenicline and nicotine also prove to be effective, with varenicline and the combination of therapies with nicotine being more effective than bupropion and therapy with a single form of nicotine (short or long acting). All these drugs have been shown to be safe at a cardiovascular level. On the other hand, in obesity, behavioral therapies, which include weight measurements during consultations, documenting progress, or setting weight goals, among others, are shown to be effective in the long term, with average weight reductions of 2.4 Kg at 12-18 months. Semaglutide and tirzepatida achieved weight reductions of 13.7% and 20.2% respectively at 72 weeks, although they exhibit a rebound effect after discontinuation and have gastrointestinal side effects. Regarding therapeutic adherence, a good doctor-patient relationship is essential, and it is important that different professionals provide consistent messages. The combination of medications in polypills is also effective in improving patient adherence. CONCLUSIONS: the combination of medications and psychotherapy is the most effective approach for helping patients quit smoking and lose weight. Medications are more effective in initiating change, whereas behavioral therapies are more effective in maintaining it over the long term. In the case of therapeutic adherence, a good doctor-patient relationship remains the foundation of adherence, with options such as polypills being helpful in maintaining it.

Direction
Nicolás Miguel, Ricardo (Tutorships)

Court
ZALVIDE TORRENTE, JUAN BAUTISTA (Chairman)
Anibarro García, Luís (Secretary)
MARTIN CORA, FRANCISCO JAVIER (Member)

Summary
Since their introduction to the European market in 1987, energy drinks have experienced a considerable increase in consumption, similar to the improper use of psychoactive drugs over the past centuries. In this context, young people have proven to be particularly vulnerable. It is estimated that 2.7% of the world population are university students and that this figure will increase of 30 million annually. This rise in the university student population, along with the growing consumption of energy drinks and the improper use of psychoactive drugs, as well as the scarcity of studies focused on this population, justify the present study.Using a questionnaire based on the KAP model (Knowledge, Attitudes, and Practices), cross-sectional data were collected from 357 students at the Faculty of Medicine of the University of Santiago de Compostela (USC) during the 2024/2025 academic year. The students showed a low perception of the risks associated with occasional consumption of energy drinks or psychoactive drugs, such as anxiolytics.The main reasons for consuming energy drinks were to enhance academic performance and combat fatigue. In the case of anxiolytics, the most frequent reason was to manage anxiety related to academic life. Although anxiolytics represented the most consumed pharmacological category, their use was surpassed by that of energy drinks. Various forms of misuse were identified, the most common being the storage of leftover medication without proper disposal at SIGRE collection points. This practice increases the risk of later use without a prescription. These results highlight the importance of dispensing only the necessary amount of medication to minimize the risk of non-prescribed consumption.

Direction
MARTINON TORRES, FEDERICO (Tutorships)
MALLAH NASRALLAH, NARMEEN (Co-tutorships)

Court
FREIRE-GARABAL NUÑEZ, MANUEL (Chairman)
Barge Caballero, Eduardo (Secretary)
SANTOS PEREZ, SOFIA MARIA SOLEDAD (Member)

Summary
INTRODUCTION: Intervertebral disc degeneration is a common pathological condition with a high prevalence that significantly affects the quality of life of individuals. Despite advances in conservative and surgical treatments, therapeutic options to restore disc functionality are limited. This systematic review explores the pathogenesis of degeneration and various emerging strategies for intervertebral disc regeneration. OBJECTIVE: The aim of this work is to analyze the existing literature on current regenerative therapies for the treatment of degenerative disc disease and potential future research avenues. MATERIALS AND METHODS: A systematic review was conducted on the scientific evidence generated in relation to the study question (PICO). A search was performed through the PubMed and Scopus databases using the terms: (“intervertebral disc” OR “intervertebral disk” OR “spinal disc” OR “spinal disk”) AND (“regeneration” OR “repair” OR “restoration” OR “regenerative therapy” OR “stem cell” OR “biomaterial”). RESULTS: From an initial selection of 165 articles, 9 were finally eligible based on the inclusion criteria for the review. Of these, 5 were systematic reviews and 4 were narrative reviews. In total, more than 200 clinical trials involving both animals and humans were included. None of these trials identified a technique that fully restored the anatomy and physiology of a healthy intervertebral disc, although improvements in certain parameters were observed. CONCLUSIONS: Regenerative therapies based on biomaterials, stem cells, and PRP show promising results in the treatment of disc degeneration, primarily improving pain and functionality. However, none of the therapies achieved full recovery of the disc prior to degeneration. Larger clinical trials with greater sample sizes, long-term follow-up, and better standardization are required.

Direction
DIEZ ULLOA, MAXIMO ALBERTO (Tutorships)
Pazos Mohri, Alba (Co-tutorships)

Court
AGUILERA GUIRAO, ANTONIO (Chairman)
Cinza Sanjurjo, Sergio (Secretary)
COSTA BESADA, MARIA ALICIA (Member)

Summary
Background: Accurate lung isolation is critical for successful thoracic surgery and patient safety. While clinical parameters such as lung auscultation have traditionally been used to verify lung isolation, ultrasound has emerged as a promising alternative. However, there is limited comparative evidence on the efficacy of ultrasound versus clinical parameters in this context. Objective: To compare the diagnostic accuracy of thoracic ultrasound versus traditional clinical parameters in verifying lung isolation in patients undergoing thoracic surgery with double lumen endotracheal tubes (DLTs). Methods: We conducted a randomized, double-blind clinical study including 168 assessments in 14 adult patients undergoing thoracic surgery at the University Hospital of Santiago de Compostela between August 28th and September 18th, 2024. After DLT placement, lung isolation was verified using both clinical exploration (auscultation and chest wall movement) and thoracic ultrasound by a blinded anaesthesiologist. Fibreoptic bronchoscopy was used to confirm the DLT position. Sensitivity, specificity, predictive values, and overall accuracy were calculated for each technique. Verification time was also compared. Results: Clinical exploration demonstrated superior diagnostic accuracy compared to thoracic ultrasound, with a sensitivity of 96.43%, specificity of 94.64%, and overall accuracy of 95.24%. In contrast, ultrasound had a sensitivity of 78.57%, specificity of 85.71%, and accuracy of 83.33%. These differences were statistically significant for most metrics. Ultrasound accuracy was significantly influenced by laterality (lower for left lung), presenting approximately 5 times higher risk of error than in the right lung, and BMI showed an inverse relationship, with each unit increase associated with a 20% reduction in error risk. Similarly, age showed a positive association with diagnostic error, increasing the risk of making an error by 4.5% for each additional year. Clinical exploration was more robust to these factors. Ultrasound also required significantly longer verification times. Conclusions: In this surgical context, traditional clinical exploration demonstrated superior diagnostic accuracy compared to thoracic ultrasound for verifying lung isolation. These findings highlight the continued validity of clinical techniques and the need to consider individual patient characteristics when selecting verification methods. Further research with larger, more diverse samples is warranted to validate these results and guide clinical practice.

Direction
Álvarez Escudero, Julián (Tutorships)
FERNANDEZ RODRIGUEZ, JORGE (Co-tutorships)

Court
FREIRE-GARABAL NUÑEZ, MANUEL (Chairman)
Barge Caballero, Eduardo (Secretary)
SANTOS PEREZ, SOFIA MARIA SOLEDAD (Member)

Summary
Non-alcoholic fatty liver disease is defined by fatty infiltration of the liver affecting more than 5% of hepatocytes, in the absence of excessive alcohol consumption. It is the most prevalent cause of chronic liver disease globally. Objective. Determine the prevalence of hepatic steatosis in subjects from the general population in Primary Care without known chronic liver disease who have risk factors for developing NAFLD. Method. A cross-sectional, descriptive, population-based study was conducted in the first phase of the study, in patients aged 18 to 75 years with risk factors for NAFLD who had an assigned doctor at the Concepción Arenal, A Estrada, O Milladoiro, Outes and Muros Health Centers in the Santiago de Compostela area. In a second phase, the subjects recruited in the first phase will be followed up for a period of at least one year. Results. A total of 98 eligible patients were included. 46.9% were women, with a mean age of 61.2 years. 54.1% were active workers. The mean BMI was 30.7 kg/m2, and 55.1% met the criteria for obesity and 42.9% for overweight. The most common risk factors were dyslipidemia, metabolic syndrome, sedentary lifestyle, and type 2 diabetes mellitus. The prevalence of non-alcoholic fatty liver disease was 75.3%. Conclusions. Almost the entire sample was obese or overweight, and peripheral insulin resistance was present in almost half of the patients. Although we did not observe statistically significant differences, we did observe a higher prevalence of diabetes, a sedentary lifestyle, and greater adherence to the Mediterranean diet in patients diagnosed with NAFLD.

Direction
Portela Romero, Manuel (Tutorships)
Sánchez Varela, Nerea (Co-tutorships)

Court
COSTOYA PUENTE, JOSE ANTONIO (Chairman)
DIEZ ULLOA, MAXIMO ALBERTO (Secretary)
DOMINGUEZ MEIJIDE, ANTONIO (Member)

Summary
INTRODUCTION: Fabry disease (FD) is a hereditary, multisystemic lysosomal disorder that can affect various organs, including the heart. FD-related cardiomyopathy represents one of the main causes of morbidity and mortality in these patients. Therefore, identifying sensitive and specific biomarkers for the early detection of myocardial damage is crucial. In this context, troponins emerge as a potential diagnostic tool. OBJECTIVES: To evaluate the role of troponins as biomarkers in the detection and monitoring of cardiomyopathy in patients with FD. METHODS: A systematic review of the literature was conducted following PRISMA guidelines, using three databases (PubMed, Scopus, and Web of Science). Original studies meeting the specified inclusion criteria were selected. Additionally, two clinical cases from Álvaro Cunqueiro Hospital involving patients treated with enzyme replacement therapy (ERT) and chaperones were analyzed. RESULTS: Ten studies analyzing the utility of troponin I or T in FD patients were included. Most studies found a correlation between elevated troponin levels and signs of myocardial damage, such as fibrosis or left ventricular hypertrophy, detected by cardiac magnetic resonance imaging. In some cases, enzyme elevation was observed even before imaging abnormalities appeared. CONCLUSION: Troponins appear to be a useful biomarker for the early detection and monitoring of FD-related cardiomyopathy. Their potential use in combination with imaging techniques could improve clinical management of affected patients.

Direction
FERNANDEZ MARTIN, JORGE JULIAN (Tutorships)

Court
Martín Martín, Carlos Santiago (Chairman)
PEÑA GIL, CARLOS (Secretary)
LOPEZ LOPEZ, ANDREA (Member)

Summary
Introduction: Small intestinal bacterial overgrowth is an underdiagnosed clinical condition characterized by an excess of abnormal bacterial load in the small intestine. In pediatrics, it is associated with heterogeneous digestive symptoms and nutritional repercussions, but its diagnosis and treatment remain controversial due to the lack of standardized criteria and specific evidence in children. Objectives: The main objective of this study is to evaluate the effectiveness of SIBO treatment in the pediatric population, and secondly, to describe its prevalence and risk factors according to the available literature. Material and methods: A systematic review was carried out following PRISMA guidelines. We included analytical studies of patients aged 0-18 years with a diagnosis of SIBO and treatment with antibiotics or probiotics. The search was conducted in MEDLINE (PubMed) until November 2024, with no date or language restrictions. Results: 5 studies were selected out of 124 identified. SIBO prevalence ranged from 23.8% to 91%. Associated risk factors were low socioeconomic status, chronic abdominal pain, intestinal failure, irritable bowel syndrome and cystic fibrosis. Rifaximin was effective in two of the three studies in which it was evaluated, with no superiority over placebo in the third. The combination of trimethoprim-sulfamethoxazole with metronidazole was effective, and targeted therapy in patients with intestinal failure led to clinical and nutritional improvement. All treatments were well tolerated in the short term. Conclusions: SIBO is an underdiagnosed disease in pediatrics, but frequent in certain risk groups. Although rifaximin and other antibiotics appear promising, evidence is limited and heterogeneous. Robust, multicentre clinical trials are needed to develop specific diagnostic and therapeutic algorithms for this population.

Direction
Moreno Álvarez, Ana (Tutorships)
Fernández González, Sara María (Co-tutorships)

Court
MUÑOZ BARUS, JOSE IGNACIO (Chairman)
GAGO AGEITOS, ANA MARIA (Secretary)
VAZQUEZ ILLANES, MARIA DOLORES (Member)

Summary
Introduction: Bronchial complications following lung transplantation continue to represent a major clinical challenge due to their significant morbidity and mortality. Several risk factors have been identified, with ischemic compromise at the bronchial anastomosis being one of the most important in developing airway complications. The most commonly reported complication is bronchial stenosis. Other possible complications include bronchial dehiscence, bronchomalacia and fistulas. Diagnosis is primarily based on bronchoscopy, while computed tomography (CT) provides added value in diagnostic evaluation and pre-surgical planning. Treatment options range from endoscopic procedures to surgical approaches. Objective:To conduct a systematic review of the literature on current strategies for the treatment of bronchial complications in lung transplant recipients. The aim is to identify and analyze the available therapeutic options, including pharmacological, surgical, and endoscopic interventions, assess their clinical effectiveness based on potential scientific evidence, evaluate the potential adverse effects of these interventions, and finally propose evidence-based recommendations for clinical management. Materials and Methods:A systematic review was conducted in February 2025, including articles published between 2005 and 2025 from the PubMed database. Results:The initial search identified 237 articles. After applying inclusion and exclusion criteria, 30 articles were selected for final analysis. Conclusions: There is high heterogeneity in therapeutic strategies, reflecting the lack of standardized protocols. Balloon dilation is the treatment of choice for stenosis, although it has a high recurrence rate. Endobronchial stents are effective but associated with adverse effects. SEMS stand out as a treatment option for dehiscence. The management of bronchomalacia is generally conservative and/or endoscopic. Fistulas require a stepwise approach and early diagnosis. There is a clear need for high-quality comparative studies and for exploring innovative therapeutic alternatives.

Direction
RIVO VAZQUEZ, JOSE EDUARDO (Tutorships)
Fernández Prado, Ricardo (Co-tutorships)
Delgado Roel, María (Co-tutorships)

Court
LOPEZ CASTROMAN, JORGE (Chairman)
MAZON RAMOS, MARIA DEL PILAR (Secretary)
ALONSO PENA, MARIA (Member)

Summary
Metastatic colorectal cancer (mCRC) is one of the leading causes of morbidity and mortality worldwide, with an unfavorable prognosis due to its high incidence and limited survival rates. In recent years, clinical outcomes have improved thanks to advances in chemotherapy, immunotherapy, and targeted therapies, but there is still a need for the development of more specific and effective treatments that do not negatively impact the patient's quality of life. Fruquintinib, a selective inhibitor of vascular endothelial growth factor receptor (VEGFR) -1, -2, and -3 tyrosine kinases, has shown promising results in terms of efficacy and safety. Designed to block tumor angiogenesis, fruquintinib has been primarily evaluated in patients with mCRC who have exhausted standard therapeutic options, demonstrating its efficacy in clinical trials. This thesis proposes a systematic review of the scientific literature published in the last 10 years with the aim of evaluating the efficacy and safety of fruquintinib, focusing especially on its application in the treatment of mCRC. The primary objectives of the included studies cover progression-free survival (PFS), overall survival (OS), and the safety profile of the drug compared to placebo or other targeted agents.

Direction
LOPEZ LOPEZ, RAFAEL (Tutorships)
ANIDO HERRANZ, URBANO (Co-tutorships)

Court
CORDERO SANTAMARIA, OSCAR JAVIER (Chairman)
ABDULKADER NALLIB, IHAB (Secretary)
RODRIGUEZ PEREZ, ANA ISABEL (Member)

Summary
Tooth loss due to dental or periodontal diseases leads to alterations in both hard and soft tissues. Following a dental extraction, alveolar healing and bone resorption occur simultaneously, resulting in a reduction of bone volume both horizontally and vertically. The rehabilitation of patients with dental loss requires an aesthetic and functional approach that often involves guided bone regeneration (GBR) techniques. Alveolar Preservation Techniques (APT) aim to maintain bone volume after extraction, facilitating the future placement of dental implants. These techniques include minimally traumatic extractions, the use of membranes to protect the bony defect, stabilization of the blood clot with biomaterials that act as scaffolds for bone growth, and primary wound closure to minimize infection and trauma to the bone bed. This Final Degree Project presents a clinical case in which autologous demineralized dentin obtained using the Tooth Transformer device is used as a biomaterial for alveolar preservation post-extraction. Additionally, it is combined with autologous concentrated growth factors (CGF) to enhance healing and bone regeneration. The surgical protocol, biomaterial processing, and postoperative outcomes are described, emphasizing the effectiveness of the applied technique.

Direction
SUAREZ QUINTANILLA, JOSE MARIA (Tutorships)
QUEVEDO BISONNI, MIGUEL RICARDO (Co-tutorships)

Court
DA SILVA DOMINGUEZ, JOSE LUIS (Chairman)
LOPEZ CASTRO, GONZALO (Secretary)
GANDARA VILA, PILAR (Member)

Summary
Introduction: Breastfeeding is recognized as the best way to feed children in the first stage of life. Therefore, the WHO recommends exclusive breastfeeding until 6 months and complementary breastfeeding until the age of two years. However, some authors suggest that breastfeeding could increase the risk of caries. Furthermore, it is known to be linked to malocclusions. Aim: To determinate the relationship between breastfeeding and oral health in children. To analyse the relationship between the duration and exclusivity of breastfeeding and the development of malocclusions. To describe the association between bottle-feeding and oral health. To understand the relationship between non-nutritive sucking habits and breastfeeding. Methods: A search was conducted in the PubMed, Scielo, Dialnet and Scopus databases, including articles published between 2014 and 2024. PRISMA guidelines were followed for this systematic review. Results: Of the 472 articles found, 23 that met the inclusion criteria were selected: 14 cross- sectional studies and 9 cohort studies. Oral health is influenced by the presence and duration of breastfeeding. The studies found a relationship between prolonged breastfeeding and an increased risk of caries, while intermediate durations appear to reduce this risk. A protective effect of breastfeeding against malocclusions and parafunctional habits was found. Conclusions: Breastfeeding has numerous benefits for both general and oral health. Compliance with the WHO guidelines should be promoted, as should the control of other factors that may influence the presence of caries and malocclusion.

Direction
RODRÍGUEZ FERNÁNDEZ, Mª DE LA ALMUDENA (Tutorships)
MULERO DE CASO, MARTA (Co-tutorships)

Court
SEOANE LESTON, JUAN MANUEL (Chairman)
LIÑARES GONZALEZ, ANTONIO (Secretary)
MAREQUE BUENO, SANTIAGO (Member)

Summary
Introduction: Bioceramic sealants have been one of the greatest advances in modern endodontics thanks to their bioactive and biocompatible properties. They allow for periapical tissue repair through stimulation of hydroxyapatite, providing a hermetic seal and reducing the risk of bacterial reinfection, improving treatment outcomes. These materials are used in root canal filling and perforation sealing, among other processes, as they are notable for their dimensional and chemical stability, as well as their durability. Therefore, this advancement has transformed endodontic treatment, establishing itself as a superior option compared to traditional cements. Objectives: To evaluate the properties, advantages, and disadvantages of bioceramic sealers in endodontics compared to traditional cements through a review of scientific literature. Materials and methods: This study is based on a review of scientific literature, including original scientific articles published in the last five years in the PubMed and Web of Science databases, using predefined inclusion and exclusion criteria to select the most relevant studies on bioceramic in endodontics. Results: Bioceramic sealants are biocompatible and effective in pulpotomies and pulp revitalization, among other treatments, thanks to their apical sealing and antibacterial properties. However, their slow setting and difficulties in retreatment require specialized protocols and training. Conclusions: Bioceramic sealants advance endodontic treatments by being biocompatible. Overcoming clinical challenges, especially in retreatment, requires standardized protocols and new tools. Continued training and scientific evidence will improve tooth survival and consolidate these materials as the benchmark in endodontics.

Direction
MARTIN BIEDMA, BENJAMIN JOSE (Tutorships)
Anache D´Abate, Marcos Anibal (Co-tutorships)

Court
SEOANE LESTON, JUAN MANUEL (Chairman)
LIÑARES GONZALEZ, ANTONIO (Secretary)
MAREQUE BUENO, SANTIAGO (Member)

Summary
Objectives: Describe the benefit of probiotics in the prevention and treatment of gingivitis and periodontitis, evaluating their effects on periodontal, microbiological, immunobiochemical and metabolic parameters, analyze the most effective formulations and routes of administration and propose a clinical usage protocol. Materials and Methods: This systematic review was conducted following the PRISMA guidelines. Randomized clinical trials (2019/2024) in an adult population with gingivitis and/or periodontitis, published in English or Spanish that evaluated probiotics by any route of administration were included, reviews, observational studies, case series, pilot studies, and in vitro or animal studies were excluded. The search was conducted in PubMed and Scopus using the following filters: Last 5 years, Clinical Trial, Randomized Controlled Trial, Review, Limited to Dentistry. The remaining trials were reviewed in Rayyan until the 25 randomized clinical trials included in the review were defined. Results: From the 394 articles found, 25 trials were finally selected. The consumption of probiotics is beneficial in the improvement of clinical, microbiological, immunochemical and metabolic indicators related to gingivitis and periodontal disease. There are different strains and routes of administration. The one that provided the best results was the combination of subgingival application of Lactobacillus reuteri with orodispersible tablets, this being dependent on its concentration in the bag and time, offering the most optimal results in deep pockets after scaling and smoothing. Conclusions: The combination of subgingival application of Lactobacillus reuteri with orodispersible tablets proved to be the most effective combination among those studied, highlighting its high adherence and absence of adverse events. Further research is required in this field.

Direction
RODRÍGUEZ FERNÁNDEZ, Mª DE LA ALMUDENA (Tutorships)
MULERO DE CASO, MARTA (Co-tutorships)

Court
DA SILVA DOMINGUEZ, JOSE LUIS (Chairman)
LOPEZ CASTRO, GONZALO (Secretary)
GANDARA VILA, PILAR (Member)

Summary
Three-dimensional obturation of the root canal system is essential for the long-term success of endodontic treatment, with a hermetic seal being fundamental to prevent reinfection. Sealers are responsible for promoting this aspect, making it crucial that they are biocompatible, stable, radiopaque, and capable of effectively adhering to the dentin structure. This systematic review and meta-analysis comparatively analyse the dentin adhesion capacity of two types of endodontic sealers: calcium silicate-based hydraulic cements and epoxy resins, materials commonly used in the obturation process of the root canal system. To this end, a search was conducted in two databases to find the best available evidence. Twenty in vitro studies were included, evaluating the bond strength of both materials using the most representative sealers from each group. The study highlights that both materials are viable options for endodontic filling, so the choice should be based on case characteristics and operator’s preferences. Overall, no statistically significant differences in bond strength were observed between the groups compared. However, the heterogeneity among studies and the diversity of protocols used limit the strength of the conclusions. Therefore, further research is needed to reach a consensus and ensure that the arguments and results are fully clear and supported by evidence.

Direction
GARCIA VARELA, SANDRA (Tutorships)
Teule Trull, Miriam (Co-tutorships)

Court
TOMAS CARMONA, INMACULADA (Chairman)
SEOANE ROMERO, JUAN MANUEL (Secretary)
RILO POUSA, BENITO (Member)

Summary
This bibliographic review aims to determine the most appropriate restorative approach for maxillary premolars following endodontic treatment, analyzing the frequency and causes of fracture, as well as the indications and advantages of direct restorations (with or without post), cuspal coverage, indirect restorations, and endocrowns.

Direction
ALONSO DE LA PEÑA, VICTOR (Tutorships)

Court
DA SILVA DOMINGUEZ, JOSE LUIS (Chairman)
LOPEZ CASTRO, GONZALO (Secretary)
GANDARA VILA, PILAR (Member)

Summary
Introduction. Localised juvenile spongiotic gingival hyperplasia (LJSGH) is a rare and recently described lesion characterised by a non-plaque-induced gingival overgrowth with distinctive clinicopathological features, controversial pathogenesis, and unknown aetiology. No clear gender predilection has been established. Objectives. This study aims to evaluate the recurrence rate of spongiotic hyperplasia following surgical excision and to describe the associated risk factors. Materials and methods. A systematic review was conducted using the MEDLINE (via PubMed), SCOPUS, and WHO databases, including articles published up to January 2025. The quality of the included studies was assessed using the Joanna Briggs Institute (JBI) checklists and the ROBINS-I tool, according to the design of each study. Results. Fifteen studies were included, primarily consisting of case reports and case series. Recurrence rates after surgical excision ranged from 5.8% to 25% in the largest series. Several studies reported no recurrence; however, many did not specify the duration of postoperative follow-up. The overall risk of bias was moderate. Discussion. Surgical excision was the most frequently reported and generally effective treatment. Nonetheless, recurrence occurred in some cases, potentially due to incomplete resection or limited follow-up. The heterogeneity of study designs and the lack of methodological standardisation limit the interpretability of the findings. Conclusion. Spongiotic gingival hyperplasia may present a risk of recurrence following surgical treatment. Future prospective studies with larger sample sizes and standardised follow-up are necessary to develop evidence-based clinical guidelines.

Direction
Pérez-Sayáns García, Mario (Tutorships)

Court
DA SILVA DOMINGUEZ, JOSE LUIS (Chairman)
LOPEZ CASTRO, GONZALO (Secretary)
GANDARA VILA, PILAR (Member)

Summary
The use of botulinum toxin type A in dentistry has gained popularity in recent years, offering a minimally invasive approach to the management of various orofacial conditions such as gummy smile, sialorrhea, bruxism, and temporomandibular disorders. Its application is based both on the understanding of its neuromuscular mechanism of action and on the growing demand from patients for functional, aesthetic, and innovative treatments. Objective: To conduct a bibliographic review of the literature published over the last ten years on the efficacy, therapeutic applications, and safety profile of botulinum toxin type A in dentistry. Materials and Methods: A bibliographic review was carried out between January and April 2025 using the PubMed and Scopus databases. Combined search strategies were applied with the terms “botulinum toxin”, “gummy smile”, “sialorrhea”, “bruxism”, “temporomandibular dysfunction”, “orofacial pain”, and “efficacy”. Articles in English or Spanish published in the last decade with full-text availability were included. Results: After applying inclusion and exclusion criteria, 64 studies out of 208 identified were selected, including meta-analyses, systematic reviews, and clinical trials. Discussion: The reviewed studies support the efficacy and safety of botulinum toxin in the treatment of various orofacial disorders. Conclusions: Botulinum toxin type A represents an effective and safe therapeutic alternative in dentistry. However, standardized protocols regarding dosage, injection sites, and reinjection frequency are still needed to optimize its application in clinical practice.

Direction
OTERO CASAL, MARIA DE LA PAZ (Tutorships)

Court
VARELA CENTELLES, PABLO IGNACIO (Chairman)
CASTELO BAZ, PABLO (Secretary)
Rivas Mundiña, Berta (Member)

Summary
Infectious diseases are one of the most important causes of morbidity and mortality in the pediatric population. The differential diagnosis between bacterial and viral infections poses a real clinical challenge. The MeMed BV score is a diagnostic test based on blood levels of specific biomarkers. It uses a combination of three proteins found in different concentrations depending on the type of infection: TRAIL (TNF-related apoptosis-inducing ligand), IP-10 (Interferon gamma-induced protein 10), and CRP (C-reactive protein). This new tool helps to distinguish patients who would benefit from antibiotic treatment, thereby avoiding inappropriate use, which can lead to adverse effects and the development of antimicrobial resistance.

Direction
Concheiro Guisán, Ana (Tutorships)
González Durán, María Luisa (Co-tutorships)

Court
RUANO RAVIÑA, ALBERTO (Chairman)
Gándara Cortés, Marina (Secretary)
VILLAR CHEDA, MARIA BEGOÑA (Member)

Summary
The prevalence of heart failure has been growing over the last years. This pathology can end up being very limiting, so to improve these patients’ life quality has become one of the principal goals. To do so, one of the therapeutic options to treat advanced (or end stage) heart failure are the left ventricular assist devices (LVAD), which, as every other therapy, is not free of adverse events or complications; one of them is gastrointestinal bleeding (GIB), process that can put the patient’s life at risk. Aims: The case report posed the research question for this study, which sought to review and synthesize the evidence on pharmacological therapies used for the primary and secondary prevention of gastrointestinal bleeding in patients with LVADs. Methods: A systematic review of the literature was conducted in the PubMed and Cochrane databases, including studies in English and Spanish published between 2000 and 2024. Reviews and meta-analyses, among others, were primarily excluded. The preliminary search yielded a total of 236 articles, of which 17 were ultimately included in the systematic review. Results: Octreotide, tamoxifen, PPIs, ACE inhibitors/ARBs, omega-3, thalidomide, bevacizumab, danazol, and digoxin represent therapeutic options with potential to prevent gastrointestinal bleeding (GIB), especially in the context of vascular lesions such as AVMs/angiodysplasia Conclusions: Although the previously described pharmacological therapies show some success, the evidence is limited and inconsistent. A better understanding of the pathophysiology is key to moving toward more effective and personalized therapies, supported by well-designed prospective studies.

Direction
Barge Caballero, Eduardo (Tutorships)
López Canoa, José Nicolás (Co-tutorships)

Court
MUÑOZ BARUS, JOSE IGNACIO (Chairman)
GAGO AGEITOS, ANA MARIA (Secretary)
VAZQUEZ ILLANES, MARIA DOLORES (Member)

Summary
Introduction Rectal cancer accounts for 35% of colorectal cancers, one of the most frequent tumors worldwide. Extramural vascular invasion (EMVI) is an anatomic-radiologic feature present in rectal cancer associated with poor prognosis, which is not always systematically assessed in staging, despite its clinical relevance. Aim and justification The main objective of this review is to evaluate the recent evidence on the prognostic value of EMVI in rectal cancer and to propose its inclusion in the TNM classification. Methods A systematic review was performed following the PRISMA guidelines, based on the PICO question. We included randomized clinical trials published between 2020 and 2024 in English or Spanish. 55 articles were analyzed, of which a total of 7 were finally included. The studies were evaluated using the Newcastle-Ottawa Scale (NOS). Results and discussion The incidence of EMVI+ was 40.4%. It was significantly associated with lower disease-free survival (hazard ratio up to 2.55) and lower overall survival. It was also associated with a higher rate of locoregional recurrence, lower complete response, higher frequency of positive resection margins and worse histopathologic response to treatment. One of the studies demonstrated a correlation between EMVI and TP53 mutations. EMVI was shown to be an independent risk factor in most of the included studies. Conclusions EMVI has a clear prognostic value in rectal cancer, so its systematic evaluation in staging MRI is recommended. Its inclusion in the TNM classification could improve the choice of treatment and prognosis of patients.

Direction
López de los Reyes, Ramón Andrés (Tutorships)
Suárez Pazos, Natalia (Co-tutorships)

Court
SALAS ELLACURIAGA, ANTONIO (Chairman)
FIGUEROA RODRIGUEZ, JESUS (Secretary)
Aguiar Fernández, Pablo (Member)

Summary
Introduction: Essential tremor is one of the most frequently diagnosed movement disorders. Its diagnosis is based on clinical evaluation and neurological examination. Although first-line treatment is pharmacological, it is only effective in approximately half of the patients. The use of magnetic resonance guided focused ultrasound targeting the Ventral Intermediate Nucleus (Vim) of the thalamus has emerged as the preferred surgical treatment for patients who are refractory to pharmacological therapy. Objective: The main objective of this bibliographic review is to analyze the current evidence regarding the existence of significant differences in the treatment of essential tremor using HIFU targeting different areas within the Vim nucleus, as well as to compare the outcomes with the published by the Complejo Universitario de Santiago de Compostela (CHUS). Materials and methods: The biobliographic search was performed across the PubMed, Elsevier and SciElo databases. Results: A total of eleven articles were obtained for the literature review. The results of the set of studies that used Brainlab software for image análisis were compared with the articles that did not use it. Conclusions: The use of Brainlab software for target localization may be associated with grater precisión and, consequently, increased therapeutic efficacy, optimizing the outcomes of sonicacions on the ventral intermediate nucleus of the thalamus. The total number of complications reported at the end of the follow-up was lower in the studies that used Brainlab software, although the most common type of complication was the same in both groups.

Direction
Aran Echabe, Eduardo (Tutorships)

Court
AGUILAR BLANCO, MARIA FE (Chairman)
BALEATO GONZALEZ, SANDRA (Secretary)
SOPEÑA PEREZ-ARGÜELLES, BERNARDO (Member)

Summary
Alcohol consumption poses a serious public health problem, as it is associated with various pathologies. In patients with alcohol use disorder (AUD), reducing or stopping alcohol intake can trigger a withdrawal syndrome that may be severe or even life-threatening. Therefore, to manage symptoms and prevent serious complications, a detoxification process is carried out, which can take place either in a hospital or outpatient setting. This review aims to update the existing scientific evidence on the efficacy and safety of outpatient alcohol detoxification from 2005 to the present. To this end, a comprehensive search was conducted in the PubMed, Cochrane, and WOS databases, resulting in a total of 11 documents after a selection process. These articles provided information on medications and therapeutic methods. As a novelty, Levetiracetam and Pregabalin are proposed, including combinations with Tiapride. In addition, the introduction of a Directly Observed Therapy (DOT) modality is suggested. Although not all studies included patients with severe symptoms, there are indications that outpatient detoxification is a safe option for these individuals. Furthermore, appropriate scales to assess symptom severity (CIWA-Ar and SAWS) are identified, as well as risk factors for developing severe withdrawal syndromes and criteria for patient hospitalization. Finally, a therapeutic algorithm is proposed for outpatient alcohol detoxification.

Direction
Mosquera Nogueira, Jacinto José (Tutorships)

Court
MARTINEZ OLMOS, MIGUEL ANGEL (Chairman)
GAMBORINO CARAMES, ELENA (Secretary)
Rey Brandariz, Julia (Member)

Summary
The main advantages of intracorporeal ileocolic anastomosis after laparoscopic right hemicolectomy are to avoid mesentery traction and transverse colon mobilization and to allow the location of the surgical piece extraction wound in the area The superhuman, Avoiding the difficulties posed by obese patients with extracorporeal technique. However, the intracorporeal technique requires mechanical and manual intracorporeal sutures, adding some technical complexity to the procedure. Robot-assisted surgery increases the precision of laparoscopic surgery by allowing a wider range of movements, three-dimensional vision and articulated instruments. In addition, some studies found lower conversion rate to laparotomy, a decrease in prolonged ileum, and shorter hospital stay. The objective of this study is to analyze the results and morbidity and mortality of the surgical technique of intracorporeal ileocolic anastomosis in the minimally invasive right hemicolectomy for cancer after the implantation of a program of colorectal robotic surgery in the University Hospital of Pontevedra (CHUP) in October 2021. A retrospective observational study of consecutive patients who underwent right hemicolectomy with intracorporeal ileocolic anastomosis by robotic or laparoscopic surgery was conducted from October 2021 and included prospectively in a legitimized database. 122 patients were included, 59 (48.36%) undergoing laparoscopic surgery and 63 (51.64%) robotic. Robotic surgery was associated with a higher frequency of D3 lymphadenectomy (19.05% vs 3.40%; p=0.011), use of perfusion test with GCI (98.4% vs 67.8%; p0.001) and longer surgical duration (250 56 min vs 207 52 min; p0.001). Differences were observed in the distribution of tumor stage: all metastatic cases (stage IV) were treated by laparoscopy, while the robotic group presented a higher proportion of stages III (38.10% vs 20.30%; p=0.042). Throughout the study period, there was an improvement in surgical times and a reduction in complications in the robotic group, with no significant differences in the overall rate of these. Intracorporeal ileocolic anastomosis in right oncologic hemicolectomy is a safe and effective technique, both via laparoscopic and robotic approaches. Robotic surgery offered technical advantages and was associated with a higher proportion of D3 lymphadenectomies and more advanced loco-regional stages, without being linked to higher complication rates once robotic surgery was established. The clinical benefits became more evident as the learning curve was overcome.

Direction
Parajó Calvo, Alberto Eduardo (Tutorships)

Court
LABANDEIRA GARCIA, JOSE LUIS (Chairman)
FERREIROS LOPEZ, ALBA (Secretary)
TABERNERO DUQUE, MARIA JESÚS (Member)

Summary
The aim of this study is to assess the impact of intense exercise during pregnancy on neonatal and perinatal outcomes, comparing studies published in articles from recent years. We know that physical exercise during pregnancy was widely recommended to improve both maternal and fetal health, but this study aims to evaluate the specific effects of high-intensity or high-impact exercise. An attempt will be made to identify how intense exercise can influence parameters such as the course of pregnancy, birth weight, risk of premature birth or spontaneous abortion; as well as the risk of complications that may arise during pregnancy or labour and neonatal diseases. The results will be compared with the effects of lower-intensity, moderate and continuous training, following the most current recommendations and guides.

Direction
ARIAS BALTAR, MARIA EFIGENIA (Tutorships)
Fraga Blanco, Paula (Co-tutorships)

Court
SUAREZ QUINTANILLA, JUAN ANTONIO (Chairman)
ABRALDES LOPEZ-VEIGA, MAXIMINO JOSE (Secretary)
GUDE SAMPEDRO, FRANCISCO (Member)

Summary
Introduction: Dravet syndrome (DS) is a genetic developmental epileptic encephalopathy. Approximately 80% of diagnosed patients carry some type of alteration (deletion or mutation) in the SCN1A gene. It is characterized by difficult-to-control epilepsy that is frequently associated with intellectual disability, motor and behavioral problems, and a high risk of sudden death. Treatment of DS is a therapeutic challenge given that conventional anti-seizure drugs (AEDs) are ineffective in most patients. In recent years, we have seen significant progress in targeted therapies for this disease. Objectives: The objective of this review is to analyze the efficacy of conventional anti-seizure drugs and other therapies in patients with DS. To identify treatments that allow for improved seizure control and DS comorbidities. Methodology: The scientific literature search was conducted using databases such as Medline (PubMed) and Cochrane. Results: Fifteen articles were obtained for the systematic review. All articles show positive results with treatment with conventional anti-seizure drugs. Conclusions: Conventional anti-seizure drugs are the most widely used and most effective in the treatment of Dravet syndrome, allowing a reduction in epileptic seizures as well as an improvement in associated comorbid disorders. Although new therapies have demonstrated efficacy in various studies, further research is needed to validate long-term results.

Direction
GOMEZ LADO, MARIA DEL CARMEN (Tutorships)

Court
Gonzalez Quintela, Arturo (Chairman)
BRAÑAS GONZALEZ, ANTIA (Secretary)
Sierra Paredes, German (Member)

Summary
Introducción: We define dental aesthetics like the branch of the odontology that commissions of the studio and treatment to achieve a facial harmony. Inside the multiple factors that compose the aesthetics stands out the dental colour and his big importance inside the final success of any treatment. Is indispensable to show good capacities determining the colour by means of visual methods in the clinical practice, since the visual criterion of the professional influences directly in the results when having a big importance inside the perception of a smile. However, numerous studios have showed the big subjective component of the colour, that besides is modified by diverse personal factors. Therefore, his identification has to to be trained and studied to improve the results in the clinic. Objectives: The aim of this research study is to measure the capacity and criteria of the dental students of the University of Santiago de Compostela to evaluate the dental color, as well as their own perception of oral esthetics. Material and methods: A cross-sectional study was carried out designed to evaluate the ability of students to differentiate chromatic alterations in tooth color and other factors associated with esthetics. The final number of participants was 97, we used the SPSS package as a database, Chi-square tests of independence were used, including the analysis and basic description of the sample as well as bivariate and multivariate models. Conclusion: Students with more academic background demonstrate greater ability to detect chromatic changes. In addition, together with the low percentages of correctness, they show the need to improve training techniques. Although there were no significant differences in self-perception according to variables such as gender, it was shown that the use of esthetic treatments such as whitening is related to a lower satisfaction of the participant with his or her own dental esthetics.

Direction
Rivas Mundiña, Berta (Tutorships)
Souto Míguez, Alfonso (Co-tutorships)

Court
TOMAS CARMONA, INMACULADA (Chairman)
SEOANE ROMERO, JUAN MANUEL (Secretary)
RILO POUSA, BENITO (Member)

Summary
INTRODUCTION: The Spanish Society of Periodontics (SEPA) has established a protocol for the early detection of high blood pressure (HBP) and diabetes in dental clinics (PROMOSALUD), based on standardized recording of blood pressure and application of the Findrisk Test to patients attending the office. The aim of this preventive healthcare project is screening people attending dental offices by analyzing healthy behaviors, anthropometric parameters, and blood pressure to assess risk of cardiovascular disease. OBJECTIVE: Patients from the USC University Dental Clinic were searched by PROMOSALUD protocol. Comparative analysis of data was performed. METHODOLOGY: A cross-sectional, observational, descriptive study was conducted with voluntary participation of 64 individuals. Three blood pressure measurements were taken following the PROMOSALUD guidelines. The Findrisk Test was also used to calculate the risk of developing diabetes in the next 10 years. Finally, variables highly relevant to the development of cardiometabolic events, such as smoking, alcohol consumption, daily stress levels, systemic diseases, and medication, were collected. RESULTS: 28,1% of the sample showed an at or very high risk of diabetes on the Findrisk test. 20,3% of patients had elevated blood pressure. A significant statistical correlation was observed between BP values and age, the Findrisk test, waist circumference, and body mass index, consistent with data from other studies. CONCLUSION: The PROMOSALUD protocol is a useful resource for assessing the risk of diabetes and cardiovascular disease in patients attending a dental office.

Direction
ABELEIRA PAZOS, MARIA TERESA (Tutorships)

Summary
The placement of extra-alveolar mini-implants in orthodontics, specifically in the infrazygomatic crest (IZC) and buccal shelf (BS) regions, has become an effective technique to achieving skeletal anchorage without relying on dental support. Its clinical success depends on adequate primary stability and precise anatomical analysis of the available bone, both essential for safe and predictable insertion. The incorporation of these anchorage devices has transformed the therapeutic approach in orthodontics, shifting the paradigm of dentofacial orthopedics in adult patients and enabling treatments that were previously considered unfeasible.

Direction
Suárez Quintanilla, David (Tutorships)
OTERO CASAL, MARIA DE LA PAZ (Co-tutorships)

Court
TOMAS CARMONA, INMACULADA (Chairman)
SEOANE ROMERO, JUAN MANUEL (Secretary)
RILO POUSA, BENITO (Member)

Summary
Approximately 60% of oral cancer (OC) cases are diagnosed in advanced stages, associated with a poor prognosis. This necessitates the development of new strategies to improve early detection and minimally invasive monitoring of OC. The search for new biomarkers through liquid biopsies has demonstrated the potential of circulating cell-free DNA (ccfDNA), as a tumor biomarker. Objectives: i) To determine the concentrations of ccfDNA in a cohort of patients with OC and healthy controls; ii) To characterize the size of ccfDNA fragments in patients with OC; iii) To evaluate the diagnostic potential of cfDNA; iv) To longitudinally explore the concentrations of cfDNA in serial plasma samples from patients with OC. Material and methods: 41 patients with a primary diagnosis of OC (stages I IV) and 40 healthy controls were included. Total plasma cfDNA concentration was quantified by fluorometry in samples collected at baseline and during clinical follow-up, and cfDNA fragment sizes were characterized by electrophoresis. Descriptive statistical analyses and ROC curves were performed to assess diagnostic accuracy. Results: cfDNA concentrations were significantly higher in OC patients compared to healthy controls. Higher cfDNA concentrations were also observed in early and advanced stages. Tumor plasma samples presented cfDNA peaks of ~165, ~350, ~565 base pairs. ROC curve analysis showed area under the curve values of 0.709 (95% CI: 0.5096-0.8275), 0.846 (95% CI: 0.7012-0.9898), and 0.655 (95% CI: 0.5072-0.8017) to discriminate OC patients (I-IV), stages I-II, and stages III-IV from healthy controls, respectively. Variations in plasma cfDNA concentrations were observed during treatment and follow-up of the disease. Conclusions: Quantification of cfDNA has potential value as a biomarker for the early detection and monitoring of OC. However, larger, multicenter cohort studies are needed to define the clinical utility of cfDNA in the management of OC.

Direction
MORA BERMUDEZ, MARIA JESUS JOSE (Tutorships)
Rapado González, Óscar (Co-tutorships)

Court
DA SILVA DOMINGUEZ, JOSE LUIS (Chairman)
LOPEZ CASTRO, GONZALO (Secretary)
ABELEIRA PAZOS, MARIA TERESA (Member)

Summary
In modern dentistry, 3D printed surgical guides are key tools in the planning and execution of guided dental procedures, such as implants and guided endodontics. They increase the dimensional accuracy and safety of the procedure to ensure a correct fit and improved clinical functionality. Thanks to 3D technology, it is possible to manufacture customized splints in which different accessories are inserted, such as the sleeve in guided endodontics, and which adapt with great accuracy to the patient's anatomy, minimizing human error and improving clinical results. Furthemore, the use of these splints reduces the operative time and reduces the risk of complications, contributing to a more predictable and simple treatment for both the professional and the patient.

Direction
RUIZ PIÑON, MANUEL CARLOS (Tutorships)
Seoane Camino, Luísa María (Co-tutorships)

Court
VARELA CENTELLES, PABLO IGNACIO (Chairman)
CASTELO BAZ, PABLO (Secretary)
Rivas Mundiña, Berta (Member)

Summary
In recent years, dental aligners have become established as an aesthetic and comfortable alternative to traditional braces. Made from transparent thermoplastic polymers, they allow for progressive and controlled tooth movement. However, their traditional production, based on 3D-printed physical models, is time-consuming, material-intensive, and expensive. This paper analyzes the potential of direct aligner printing, which dispenses with the traditional physical model, to optimize time, reduce costs, and improve patient-fitting accuracy. Objectives: to evaluate the impact of direct printing on process efficiency, clinical accuracy, and viability compared to conventional methods. Materials and methods: a literature review of recent studies on 3D printing applied to aligners was conducted, comparing traditional techniques with direct printing based on intraoral scans and SLA/DLP technologies. Results: studies show that direct printing improves fit accuracy, reduces cumulative errors, and shortens manufacturing time, in addition to reducing logistical and material costs. Conclusion: direct printing represents a substantial improvement in digital orthodontics, with clinical and economic benefits that could make it the new standard for custom aligner manufacturing.

Direction
OTERO CASAL, MARIA DE LA PAZ (Tutorships)

Court
VARELA CENTELLES, PABLO IGNACIO (Chairman)
CASTELO BAZ, PABLO (Secretary)
Rivas Mundiña, Berta (Member)

Summary
Abstract . Introduction: The use of platelet concentrates has revolutionized the field of regeneration in dentistry, improving healing and tissue regeneration. PRP (platelet-rich plasma), PRGF (plasma rich in growth factors), and L-PRF (leukocyte and platelet rich fibrin) an stand out, each with its own characteristics. L-PRF (leukocyte and platelet rich fibrin), due to its composition, offers mechanical and immunological advantages. Various parameters such as hematocrit, fibrinogen, and sex could influence the quality of the membranes obtained. . Objective: The objective of the present study was to analyze how blood parameters (hematocrit, fibrinogen, etc.) and biological sex affect the macroscopic properties of L-PRF (leukocyte and platelet rich fibrin) membranes, more specifically their size, and the possible correlation between them. . Materials and methods: Twenty students from the Faculty of Dentistry at the University of Santiago de Compostela were selected. They were half male and half female and were systemically healthy. They were not taking anticoagulant drugs and did not have a systemic condition that would prevent blood collection. Blood tests were performed and a second blood sample was drawn to obtain the L-PRF (leukocyte and platelet rich fibrin) membranes. The data on membrane dimensions (length and width) and blood parameter values were used for statistical analysis. . Results: Membrane length was found to be longer in women, with this difference being significant. Furthermore, a significant negative correlation was found between hematocrit and membrane length (-0.585). Furthermore, a significant difference was observed in hematocrit, which was higher in men. . Conclusions: The size of L-PRF (leukocyte and platelet rich fibrin) membranes is significantly larger in women and is negatively correlated with hematocrit.

Direction
BLANCO CARRION, JUAN (Tutorships)
NOVOA GARRIDO, LOURDES (Co-tutorships)

Court
SEOANE LESTON, JUAN MANUEL (Chairman)
LIÑARES GONZALEZ, ANTONIO (Secretary)
MAREQUE BUENO, SANTIAGO (Member)

Summary
Introduction: Dementia is a chronic neurodegenerative disorder. Progressively, cognitive and intellectual abilities, as well as areas related to memory and language, are affected to the point that they influence the development of daily activities and the autonomy of the person who suffers from it.. The most common cause is the well-known Alzheimer’s disease, but there is a broad range of types grouped under the general term of dementia. There is no treatment that can prevent the progression of the disease, but there are therapies that can reduce its secondary symptoms, including neuropsychiatric symptoms such as depression, agitation, stress, and discomfort. To avoid the excessive use of these types of medications and, consequently, reduce their side effects, more and more research is exploring the implementation of non-pharmacological treatments in clinical practice. Among these treatments, music therapy stands out. Objectives: Conduct a systematic review of the published literature to provide information on the effects and efficacy of music therapy in patients with dementia. Methods: I conducted a search in the PubMed and Web of Science databases, selecting publications from 2019 to 2025 that contain relevant information on the effects of music therapy on dementia. Results: After screening based on inclusion and exclusion criteria, as well as a critical reading, a total of 11 articles were included in this review, focusing on the effects of different forms of music therapy implementation in elderly patients with dementia. Conclusions: Music therapy, in its various forms, appears to demonstrate clear efficacy in alleviating neuropsychiatric symptoms and improving the quality of life for patients with dementia. This intervention proves to be easy to implement by nursing staff, also enhancing the caregiver-patient relationship. Its low cost could be an advantage in terms of integrating this intervention into daily practice by different governments and healthcare systems.

Direction
VICENTE ALBA, FRANCISCO JAVIER (Tutorships)
Barrio Díez, Isabel (Co-tutorships)

Court
SUAREZ QUINTANILLA, JUAN ANTONIO (Chairman)
ABRALDES LOPEZ-VEIGA, MAXIMINO JOSE (Secretary)
GUDE SAMPEDRO, FRANCISCO (Member)

Summary
The aim of this review is to examine the available scientific evidence regarding Mindfulness-Based Cognitive Therapy (MBCT) in order to assess its effectiveness in the treatment of anxious-depressive symptoms. The search was conducted through PubMed and Scopus, initially yielding 884 results. After screening and selection, 30 articles were included in this review. Among the selected articles, there are 8 meta-analyses (3 of which include associated systematic reviews), 12 randomized controlled trials (RCTs), and 10 other types of studies, ranging from non-randomized controlled trials to retrospective case analyses. Based on the reviewed literature, it can be concluded that MBCT is effective in reducing depressive symptoms, both in cases of partial or complete remission and in current episodes, as well as in preventing relapse. Preliminary evidence also suggests potential benefits for the treatment of anxiety symptoms; however, more robust and conclusive scientific research is needed to support stronger claims in this area.

Direction
VICENTE ALBA, FRANCISCO JAVIER (Tutorships)

Court
FRAGA RODRIGUEZ, MAXIMO FRANCISCO (Chairman)
ARROJO ROMERO, MANUEL (Secretary)
SÁNCHEZ SELLERO, INÉS (Member)

Summary
Postoperative acute pain is one of the main complications following surgical procedures and represents a constant challenge for healthcare professionals. Its effective management is essential to reduce patient suffering, promote faster functional recovery, and prevent the development of chronic pain. This paper presents an updated review of the current therapeutic strategies used in the treatment of postoperative pain, with special attention to the multimodal analgesia model, the differences in its implementation across various healthcare settings, and the emerging role of technology in its management. In addition, the institutional, organizational, and educational factors that influence its management are analyzed, and proposals for improvement are identified to achieve a more equitable, safe, and patient-centered care model.

Direction
Varela Durán, Marina (Tutorships)

Summary
Introduction and objectives: Evidence on the use of GnRH receptor antagonists for the treatment of compressive symptoms is limited. This therapy may reduce uterine size and thereby decrease compression-related symptoms and potentially facilitate or avoid surgical intervention. Therefore, the aim of this review is to determine the relationship between the administration of this treatment and the reduction in uterine or fibroid volume, as well as the reduction of compression on adjacent structures, which often causes bothersome symptoms and leads many patients to undergo more aggressive treatments such as surgery. Material and methods: A systematic review of the available scientific literature was conducted to identify studies analyzing the efficacy of GnRH receptor antagonists (Elagolix, Relugolix, Linzagolix) in reducing the size of uterine fibroids. Searches were performed in the PubMed and Cochrane Library databases, with the last search conducted on March 21, 2025. Results: A total of 116 articles were identified, of which 7 were included in this review. Conclusions: In the analyzed studies, a reduction in uterine volume was observed in women treated with GnRH receptor antagonists. This reduction was greater in the groups that did not receive hormonal add-back therapy. The results regarding fibroid volume were more variable. The use of GnRH antagonists combined with hormonal add-back improves treatment tolerability, but is associated with a less pronounced reduction in uterine or fibroid volume, or even stabilization or an increase in fibroid volume in the long term. This evidence is based on studies with small sample sizes, that evaluated fibroid or uterine volume as secondary endpoints, and that present methodological heterogeneity and short follow-up periods. There is a clinical need for more trials specifically designed to assess the relationship between compressive symptoms or uterine/fibroid volume and GnRH antagonists, over the long term, either as an alternative to surgery or as a pre-surgical strategy.

Direction
ARIAS BALTAR, MARIA EFIGENIA (Tutorships)
Veiga González, Marta (Co-tutorships)

Court
LOPEZ CASTROMAN, JORGE (Chairman)
MAZON RAMOS, MARIA DEL PILAR (Secretary)
ALONSO PENA, MARIA (Member)

Summary
The first psychotic episode (FEP) represents a critical stage in the development of severe psychiatric disorders such as schizophrenia. This study examines the utility of various biomarkers in the diagnosis and prognosis of FEP, aiming to improve diagnostic accuracy and treatment personalization. A systematic review and meta-analysis were conducted using the PubMed, Scopus, and Cochrane databases, evaluating studies published in the last decade that investigate inflammatory biomarkers (IL-6), hormonal biomarkers (cortisol and prolactin), and neuroimaging findings. The results reveal that elevated levels of IL-6 and cortisol are significantly associated with greater symptom severity and poor treatment response, suggesting their diagnostic and prognostic utility. Prolactin, especially elevated in untreated patients, emerges as a potentially useful biomarker for distinguishing different states within the psychotic spectrum. Structural and functional abnormalities observed in neuroimaging studies, such as reduced gray matter volume and altered brain activity, complement these findings and provide a comprehensive view of neurobiological alterations in FEP. Limitations include variability in biomarker levels and heterogeneity in measurement methods. Standardizing protocols and conducting large-scale, multicenter longitudinal studies are recommended to validate these biomarkers and explore their integration into clinical practice. This study concludes that IL-6, cortisol, and prolactin, along with neuroimaging findings, are promising tools for early diagnosis and treatment personalization in FEP. Implementing clear and standardized guidelines for the use of these biomarkers could significantly transform the clinical management of psychosis, improving long-term outcomes for patients.

Direction
OLIVARES DIEZ, JOSE MANUEL (Tutorships)
Rivera Baltanás, Tania (Co-tutorships)

Court
MARTINEZ OLMOS, MIGUEL ANGEL (Chairman)
GAMBORINO CARAMES, ELENA (Secretary)
Rey Brandariz, Julia (Member)

Summary
INTRODUCTION: Angiodysplasias are acquired vascular malformations commonly found in the gastrointestinal tract, particularly in the small intestine and colon. Gastrointestinal bleeding due to intestinal angiodysplasia may present intermittently or chronically, with anemia being its only clinical manifestation in some cases, which complicates both diagnosis and management. Current treatment includes supportive measures such as iron supplementation (oral or intravenous) and blood transfusions, depending on the severity of the anemia, as well as endoscopic and even surgical interventions in the most severe cases. In this context, pharmacological therapy has gained importance as an alternative aimed at reducing bleeding recurrence and improving patients’ quality of life. AIM: To evaluate the efficacy of different pharmacological treatments in the management of digestive bleeding due to intestinal angiodysplasias through a structured bibliographic review of the literature, as well as to analyze their clinical impact, main limitations, and usefulness in contexts where other therapeutic approaches, such as surgery or endoscopic intervention, are contraindicated or ineffective. METHODS: An exploratory bibliographic review was conducted of the evidence collected from PubMed and UpToDate regarding the pharmacological treatment of gastrointestinal bleeding due to intestinal angiodysplasias. A descriptive analysis of the included studies was performed, with particular emphasis on comparing the most effective pharmacological treatments and their impact on patients' health. RESULTS: The evidence shows that, although several pharmacological options exist for the treatment of gastrointestinal bleeding due to intestinal angiodysplasias, there is no clear consensus on the treatment of choice. Somatostatin analogues and angiogenesis inhibitors appear to be the most promising, but further long-term, controlled studies are needed to confirm their efficacy and safety. Treatments should be individualized according to patient characteristics and the severity of bleeding, considering a multidisciplinary approach that includes endoscopy and, in some cases, surgical intervention. Furthermore, constant monitoring is essential to detect potential side effects and adjust treatment as necessary. CONCLUSIONS: Pharmacological treatment emerges as a promising option in the management of gastrointestinal bleeding caused by intestinal angiodysplasia, particularly in light of the limitations of conventional therapies, which often involve invasive procedures, multiple hospitalizations, and a high consumption of healthcare resources, negatively impacting patients’ quality of life, especially in those with significant comorbidities. Current evidence presents important limitations, such as small sample sizes, the lack of multicenter clinical trials, and variability in therapeutic protocols. Many of the available studies are observational in nature and lack a robust methodological design capable of reliably determining the long-term efficacy and safety of the pharmacological agents in question. This highlights the urgent need for new research that not only provides more data on the effectiveness of pharmacological treatments but also enables the identification of biomarkers that may predict individual patient response. Only through this approach will it be possible to move towards a standardized and personalized treatment for gastrointestinal bleeding due to intestinal angiodysplasia.

Direction
Nicolás Miguel, Ricardo (Tutorships)
Vieito Porto, David (Co-tutorships)

Court
LABANDEIRA GARCIA, JOSE LUIS (Chairman)
FERREIROS LOPEZ, ALBA (Secretary)
TABERNERO DUQUE, MARIA JESÚS (Member)

Summary
1. Introduction: Atrial fibrillation (AF) is associated with a significantly increased risk of stroke and systemic embolism, especially in elderly patients. However, anticoagulation in frail elderly patients represents a challenge due to their high comorbidity and vulnerability to adverse events, particularly major bleeding. Although direct oral anticoagulants (DOACs), such as edoxaban, have demonstrated an improved safety and efficacy profile compared to warfarin in patients over 75 years of age, there is little specific information on their use in the elderly and frail population, as they are underrepresented in large clinical trials. The objectives of this study were to evaluate the safety and efficacy of edoxaban in daily clinical practice in a cohort of elderly patients with NVAF who met frailty criteria, as well as the safety and efficacy of edoxaban according to chronic kidney disease (CKD) stage and in patients receiving the 30 mg dose.

Direction
Hermida Ameijeiras, Álvaro (Tutorships)
Vázquez Agra, Néstor (Co-tutorships)

Court
CARRACEDO ALVAREZ, ANGEL MARIA (Chairman)
FERNANDEZ LOPEZ, FERNANDO (Secretary)
RODRIGUEZ ARES, MARIA TERESA (Member)

Summary
Introduction: Prostate cancer is one of the most common malignancies in men worldwide. It can be associated with mutations in BRCA genes, which are involved in DNA repair and maintaining genomic stability. In recent years, targeted therapies have been developed to address this disease. Objectives: To evaluate the relationship between BRCA mutations and prostate cancer, as well as the impact of these alterations on the aggressiveness and prognosis of the malignancy, and the use of PARP inhibitors as targeted therapy. Methods: A systematic search of the existing literature was conducted, analyzing the PubMed database. Results: Of the 480 studies identified, 12 were included in this review. Regarding the clinical trials analyzed, all observed an increase in radiological progression-free survival with the use of PARP inhibitors. The included systematic reviews highlight the role of BRCA genes in the aggressiveness and poor prognosis of prostate cancer. Conclusions: The findings suggest that BRCA mutations decrease the survival of patients with prostate cancer and predict earlier progression. In this context, PARP inhibitors are beneficial for the treatment of metastatic castration-resistant prostate cancer, especially those with BRCA1/2 mutations.

Direction
LEON MATEOS, LUIS ANGEL (Tutorships)
Sacristán Santos, Víctor (Co-tutorships)

Court
Gonzalez Quintela, Arturo (Chairman)
BRAÑAS GONZALEZ, ANTIA (Secretary)
Sierra Paredes, German (Member)

Summary
Background: Pancreatic cancer is often diagnosed at advanced stages, and it is associated with high mortality. In 1931, the first relationship between prodromal depressive symptoms and the subsequent development of the disease was established, which laid the foundation for further research to determine the impact of these symptoms on the initial clinical approach to pancreatic cancer patients. Objective: To analyse and describe the available scientific evidence on depressive symptoms prior to the diagnosis of pancreatic cancer. Material and methods: Exploratory systematic search using the PRISMA 2020 guidelines for reporting systematic reviews and search strategies adapted for PubMed, Scopus, WOS, Embase and PsycInfo. Results: A total of 19 publications were included corresponding to case reports (n=4), case series (n=2), case-control studies (n=2), longitudinal studies (n=2), retrospective cohort studies (n=3), observational comparative cluster study (n=1), prospective cohort study (n=1), systematic reviews (n=1), literature reviews (n=1) and case reports associated with subsequent literature reviews (n=2). Conclusion: The presence of depressive symptoms could be an early marker for the diagnosis of pancreatic cancer in individuals with risk factors for its development. It is necessary to develop new lines of research that establish a clear relationship between depression and this neoplasia, which could improve both the treatment and survival of these patients.

Direction
VICENTE ALBA, FRANCISCO JAVIER (Tutorships)
Ortega Ruibal, Francisco José (Co-tutorships)

Court
COUCE PICO, MARIA DE LA LUZ (Chairman)
Eirís Puñal, Jesús Manuel (Secretary)
Cimadevila García, Antonio (Member)

Summary
Introduction Artificial intelligence is a set of digital tools that, through the use of algorithms, performs predictions, tasks and associations, simulating human intelligence. The main algorithms used are machine learning, deep learning, natural language processing and convolutional neural networks. These can be applied in different areas, from the test ordering to the communication of results. Objective To investigate the evidence available for the application of these techniques, focusing on the diagnostic test ordering process and how to prioritize the most important results, taking into account their application in clinical practice and the limitations they have. Material and methods A systematic review of the literature published in PubMed in English or Spanish over the last five years was conducted, applying inclusion and exclusion criteria, resulting in a total of 16 results, the bibliography of the articles is reviewed, using 34 publications for the entire investigation. Conclusion The set of available algorithms can be used in all parts of the diagnostic test performance, for the selection of the appropriate image test, screening, detection of contraindications, workflow optimization, and prioritization and reporting of findings such as intracranial hemorrhage or pneumothorax. Furthermore, being aware of their disadvantages, solutions can be sought that favor their development and implementation.

Direction
CARREIRA VILLAMOR, JOSE MARTIN (Tutorships)
Domínguez Conde, Diego (Co-tutorships)

Court
GARRIDO GIL, PABLO (Chairman)
GARCIA SEARA, FRANCISCO JAVIER (Secretary)
VALENZUELA LIMIÑANA, RITA (Member)

Summary
1.1 BACKGROUND Cardiovascular disease is one of the leading causes of mortality worldwide and its main traditional risk factors have been extensively studied. However, in recent years, noise pollution has emerged as a possible modifiable risk factor. This paper explores the scientific evidence on the association between the development of cardiovascular disease and exposure to noise pollution. 1.2 OBJECTIVES The purpose of this study is to analyze the association between the development of cardiovascular diseases, especially ischemic heart disease and stroke, and exposure to noise pollution based on a systematic review of the literature. 1.3 METHODS Articles indexed in the Pubmed database describing associations between stroke cases and ischemic heart disease and exposure to noise pollution were selected from the first one published in 2015 to the last one published in 2025. 1.4 RESULTS Sixteen articles with different samples of adult population aged 18 years or older exposed to high noise levels were evaluated. The results indicate that prolonged exposure to noise pollution, especially from road traffic, increases the risk of both stroke and ischemic heart disease, especially at noise levels above 55 dB. The risk is greater with continuous noise exposure and with nocturnal exposure. Furthermore, it has been shown that this risk is higher in people over 65 years of age. Exposure to noise pollution has also been associated with increased all-cause mortality. 1.5 CONCLUSIONS Although more studies are needed, the evidence confirms that chronic exposure to noise, especially from road traffic, is significantly associated with the risk of stroke and ischemic heart disease, so it is necessary to consider environmental noise as a modifiable risk factor and to implement preventive measures.

Direction
Barge Caballero, Eduardo (Tutorships)
Barge Caballero, Gonzalo (Co-tutorships)

Court
DOMINGUEZ MUÑOZ, JUAN ENRIQUE (Chairman)
Fernández Rodríguez, Mª Isabel (Secretary)
SANCHEZ IGLESIAS, SOFIA (Member)

Summary
Lung cancer has a high mortality rate in Spain, as well as a significant reduction in patients’ quality of life. We currently have various therapeutic management options available, and as with other tumors, physical exercise practice is increasingly becoming an important part of the multidisciplinary treatment. This study aims to evaluate the benefits that sports practice after surgery can bring to patients diagnosed with early-stage non-small cell lung cancer (NSCLC). The impact of exercise on the functional capacity, physical endurance and mental health of patients will be studied, with the aim of evaluating the physical exercise practice as a possible effective therapeutic intervention in the treatment and improvement of the quality of life of these patients.

Direction
LEON MATEOS, LUIS ANGEL (Tutorships)

Court
RUANO RAVIÑA, ALBERTO (Chairman)
Gándara Cortés, Marina (Secretary)
VILLAR CHEDA, MARIA BEGOÑA (Member)

Summary
Borderline personality disorder (BPD) is a mental illness with an estimated prevalence from 0.7 to 2.7% in the general population. It is characterized by a persistent pattern of marked emotional and affective instability, accompanied by chronic feelings of emptiness and poor impulse control. Suicide rates are around 10%, and it is estimated that over 75% of individuals with BPD engage in self injurious behaviors, resulting in high demand for medical services. In addition, BPD is frequently comorbid with other psychiatric disorders such as major depression and bipolar disorder. Despite its significant impact on social and occupational functioning, no pharmacological treatments have proven substantially effective for core symptoms, with psychotherapy remaining the first line treatment. The etiology of BPD is still uncertain, and it is considered a complex and multifactorial condition, resulting from the interaction of genetic and environmental factors, with heritability estimated between 30 to 67%. However, the scientific community has shown relatively less interest in studying the genetic architecture of BPD compared to other psychiatric disorders with similar heritability. The aim of this study is to conduct a systematic review of the current state of genomic research on BPD. The PRISMA 2020 guidelines were followed to identify articles that investigated BPD at the genomic level without prior hypotheses, excluding those focused on personality traits or candidate genes. The findings reflect a highly polygenic and pleiotropic genetic architecture for BPD, shared with multiple phenotypes, which supports the need for more dimensional diagnostic approaches in psychiatry. These results may serve as a starting point for continued scientific research to better understand the genetic basis of the disorder, potentially opening new avenues for the development of treatments and advancing toward precision medicine.

Direction
ARROJO ROMERO, MANUEL (Tutorships)
Facal Molina, Fernando (Co-tutorships)

Court
Leis Trabazo, María Rosaura (Chairman)
GARCIA FIGUEIRAS, ROBERTO (Secretary)
Varela Calviño, Rubén (Member)

Summary
Endobronchial brachytherapy (BEB) is an antineoplastic treatment that involves placing radiation sources in close proximity to the tumor. One of its main indications is the curative treatment of endobronchial lesions in early stages (radiographically occult carcinoma, in situ, stage I), either as a sole treatment or in combination with external beam radiotherapy. Available studies offer very promising results, with local control rates of around 60/70% at 2 years. However, clinical outcomes are limited and, in some cases, outdated, which highlights the need for further research in this field. The purpose of this study is to evaluate the potential clinical benefit of curative-intent endobronchial BEB in patients with confirmed malignant endobronchial disease. We will describe the outcomes and experience with this technique since its implementation in the Bronchopleural Techniques Unit of a tertiary hospital and will conduct a review of the literature.

Direction
REPRESAS REPRESAS, CRISTINA (Tutorships)
Botana Rial, María Isabel (Co-tutorships)

Court
FREIRE-GARABAL NUÑEZ, MANUEL (Chairman)
Barge Caballero, Eduardo (Secretary)
SANTOS PEREZ, SOFIA MARIA SOLEDAD (Member)

Summary
Introduction: nAMD is a chronic eye disease that affects people over 50 years of age and leads to central vision loss. Diagnosis is made using various imaging techniques, including OCT. The first line of treatment is based on intravitreal injections of endothelial growth factor inhibitors (anti-VEGF) in various treatment regimens. Objectives: To describe the long-term outcome of a group of patients with neovascular AMD after one year of treatment with intravitreal ranibizumab. Clinical parameters during treatment, as well as the development of clinical complications, will be assessed. Materials and methods: A prospective, observational study was conducted in a group of patients (n=50) treated at the Medical Retina Unit of the Ophthalmology Department of the Santiago de Compostela University Hospital Complex. All patients received three intravitreal ranibizumab injections in the study eye, known as the loading phase dose, and were subsequently examined and treated based on their functional and morphological response. The study period was from 2019 to 2024. Results and conclusions: Our patient profile was female, 79 years of age, with a mean follow-up of 33 months and a median of 14 intravitreal injections. The results obtained show a good long-term functional response, and parameters assessed by OCT show a reduction in activity-related retinal fluid. Treatment intensification is associated with maintaining fibrosis-free disease.

Direction
FERNANDEZ RODRIGUEZ, MARIA ISABEL (Tutorships)
Almuiña Varela, Pablo (Co-tutorships)

Court
MUÑOZ PATIÑO, ANA MARIA (Chairman)
Portela Romero, Manuel (Secretary)
Aran Echabe, Eduardo (Member)

Summary
OBJECTIVES/METHODS: To evaluate the safety and efficacy in terms of survival of vericiguat use in an elderly and comorbid population with HFrEF. Retrospective single-center study conducted in a monographic heart failure outpatient clinic of Internal Medicine. RESULTS: A total of 20 individuals were included: 65% men and 35% women. Mean age was 81.4. Associated comorbidities: 60% HTN, 45% T2DM, 65% DL, 65% AF, and 100% CKD. Patients were receiving treatment with ARNI in 75%, MRA in 70%, beta-blockers BB in 95%, and SGLT2i in 100%. Adverse events occurred in 20% of patients. Only one patient discontinued treatment due to intolerance. At 6 months from treatment initiation, 25% of patients required hospitalization. During follow-up, 3 patients died, representing 15% of the population; 10% died within the first 6 months. A survival analysis by subgroups showed that being female and ARNI use were associated with better survival, while hypertension was associated with lower survival. No statistically significant differences were found regarding T2DM, DL, AF/flutter, or age groups. CONCLUSION: Vericiguat use appears to be safe and effective in an elderly, comorbid population. Being female, concomitant ARNI use, and absence of HTN were associated with a better prognosis.

Direction
de la Iglesia Martínez, Fernando Antonio (Tutorships)
Rodríguez Osorio, Iria (Co-tutorships)
Seoane González, Beatriz Alicia (Co-tutorships)

Court
LIMA RODRIGUEZ, LUIS JESUS (Chairman)
PALLAS PALLAS, ESTRELLA (Secretary)
VARELA LEMA, MARIA LEONOR (Member)

Summary
Vascular malformations are congenital disorders that encompass a wide range of conditions, from visible marks to disorders that may pose a threat to the patient's life. They present a diagnostic challenge, with a clear difficulty in properly labelling and treating them. The malformations are highly varied: capillary, lymphatic, venous, arteriovenous, combined, or associated with a syndrome, they may be localized to a specific area of the body or diffuse, adding an additional level of complexity depending on the structures involved and their exact location. The diagnosis and treatment of vascular malformations require a highly personalized approach, as each case is unique and presents different challenges. There are multiple therapeutic approaches: medical (sirolimus), minimally invasive (sclerotherapy, laser, or embolization), and surgical. Slowly, endovascular therapy and medications are surpassing surgery in centres with specialized units, due to their high effectiveness, low complication rates, and shorter recovery times compared to traditional surgery. Sclerotherapy, in particular, has become one of the most effective treatments for low-flow malformations. This treatment involves the percutaneous injection of a sclerosing substance, which causes a chemical abrasion that inflames the affected area and subsequently reduces the size of the malformation through scarring. This paper presents a retrospective study of sclerotherapy treatment in low-flow vascular malformations, focusing on a serie of cases treated in the Pediatric Surgery Department of the Hospital Materno Infantil in A Coruña. In these cases, doxycycline and etoxysclerol foam or ethanol were used for the percutaneous treatment of lymphatic and venous malformations, respectively, and are compared with other potential substances used in the most recent literature.

Direction
Leis Trabazo, María Rosaura (Tutorships)
Del Cerro Rodríguez, David (Co-tutorships)

Court
CORDERO SANTAMARIA, OSCAR JAVIER (Chairman)
ABDULKADER NALLIB, IHAB (Secretary)
RODRIGUEZ PEREZ, ANA ISABEL (Member)

Summary
Introduction. The COVID-19 pandemic presented itself as an unprecedented global crisis, testing the capacity of an already deficient healthcare system. The imbalance between resource supply and growing demand was accentuated in Intensive Care Units (ICUs), where healthcare professionals had to make complex decisions to manage limited resources. These interventions could have been influenced by the ethical climate. Objectives. To analyse the relationship between the ethical climate perceived by ICU healthcare professionals and their approach to resource prioritization in situations of scarcity, exploring its possible association with the intention to leave work. Methods. A cross-sectional observational study based on a self-administered online questionnaire, aimed at healthcare professionals in ICUs in two regions in Spain and three in Germany. The questionnaire included an expanded version of the Ethical Decision-Making Climate Questionnaire (EDMCQ), to which the research team added five specific items on resource prioritization in contexts of scarcity. Results. A total of 215 professionals were recruited. Most respondents agreed with the five items on prioritization, although only one -the one that valued ordering care based on survival probabilities-was significantly associated with a more positive ethical climate. Forty percent of respondents considered leaving their job, with significantly lower scores on the expanded EDMCQ scale. Conclusions. A favourable ethical climate facilitates acceptance of triage in situations of scarcity. Furthermore, it can mitigate the desire to leave work. A complex ethical attitude is perceived regarding prioritization decisions, combining a utilitarian ethical approach with humanitarian treatment and clinical responsibility.

Direction
Gonzalez Quintela, Arturo (Tutorships)
RODRIGUEZ RUIZ, EMILIO (Co-tutorships)

Court
COUCE PICO, MARIA DE LA LUZ (Chairman)
Eirís Puñal, Jesús Manuel (Secretary)
Cimadevila García, Antonio (Member)

Summary
Introduction: When a patient arrives at the Emergency Department, there is often diagnostic uncertainty, including the possibility of a contagious disease such as pulmonary tuberculosis. If hospital admission is required, a decision must be made while awaiting a definitive diagnosis whether to admit the patient to an isolation room (which implies a higher economic cost) or to a shared room (which carries a risk of disease transmission if the patient is infected). This study aims to efficiently identify patients with pulmonary tuberculosis who arrive at the Emergency Department, in order to assess the indication for admission to respiratory isolation rooms and to maximize the cost-benefit ratio for the Galician Health Service. Objectives: To design a score that identifies patients with a high likelihood of having pulmonary tuberculosis and who require hospital admission, in order to determine who should be placed in respiratory isolation rooms. Materials and Methods: This is a case-control research study based on patients admitted with suspected pulmonary tuberculosis in the healthcare area of Pontevedra and O Salnés, covering the years 2017 to 2024. Cases were defined as those patients who were admitted and ultimately diagnosed with pulmonary tuberculosis confirmed by microbiological testing; whereas controls were those whose cultures were negative and whose final diagnosis was different from tuberculosis. A series of clinical, radiological, and laboratory variables available in the Emergency Department were compared between each group in order to establish a predictive score for the final diagnosis of pulmonary tuberculosis. Results: A total of 222 patients were included in the study (74 cases and 148 controls). In the multivariate analysis, the following factors were identified as independent predictors of pulmonary tuberculosis, with their corresponding point assignments: high-risk occupation (1 point), constitutional syndrome (2 points), night sweats (1 point), pathological chest X-ray upon Emergency Department admission (2.5 points), age less than 55 years (1 point), leukocyte count less than or equal to 10 750/mm3 (1 point), and lymphocyte count less than or equal to 1 450/mm3 (1 point). Conclusions: When applying a threshold of 5,5 points, the score achieved a sensitivity of 82% and a specificity of 82%, providing an appropriate balance between identifying patients who require respiratory isolation and minimizing unnecessary isolations.

Direction
Anibarro García, Luís (Tutorships)

Court
SUAREZ QUINTANILLA, JUAN ANTONIO (Chairman)
ABRALDES LOPEZ-VEIGA, MAXIMINO JOSE (Secretary)
GUDE SAMPEDRO, FRANCISCO (Member)

Summary
Background: The high prevalence of drug use in our society during the reproductive age may pose a serious problem regarding birth rates, as well as potential malformations and fetal complications. The main substances of abuse studied in relation to fertility are alcohol, nicotine, and cannabis derivatives. Therefore, we will conduct a literature review with the aim of understanding the effects these drugs have on reproduction. Materials and Methods: A literature review was conducted following the PRISMA guidelines. A bibliographic search was carried out in PubMed, Cochrane, and Google Scholar, identifying a total of 542 articles. Results: After reviewing 542 articles, 9 were selected for our review. To evaluate the effect of drugs on reproductive techniques, parameters such as ovarian reserve, implantation rate per embryo transfer, pregnancy rate, number of live births, and number of pregnancy losses were analyzed. Conclusions: The study reveals that assisted reproductive techniques appear to be influenced by the use of the three substances examined in this review (marijuana, tobacco, and alcohol), although their exact mechanisms of action remain unclear.

Direction
SAMPAYO MONTENEGRO, MARIA VICTORIA (Tutorships)
Veiga González, Marta (Co-tutorships)

Court
AGUILERA GUIRAO, ANTONIO (Chairman)
Cinza Sanjurjo, Sergio (Secretary)
COSTA BESADA, MARIA ALICIA (Member)

Summary
The inositol molecule, specifically in its form of mioinositol (MI), participates in key celular processes such as celular signalling and glucosa metabolism. Its use has shown benefits in female fertility by improving the function and quality of oocytes, especially in women with PCOS. In men, MI can increase sperm motility and reduce DNA fragmentation. Although it is a safe supplement, more studies are needed to demostrate this effectiveness.

Direction
ARIAS BALTAR, MARIA EFIGENIA (Tutorships)
Fernández Baltar, Carlos (Co-tutorships)

Court
Leis Trabazo, María Rosaura (Chairman)
GARCIA FIGUEIRAS, ROBERTO (Secretary)
Varela Calviño, Rubén (Member)

Summary
Lipoprotein(a) [Lp(a)] is an independent cardiovascular risk factor that can cause damage to various organs and is therefore closely related to multiple cardiovascular diseases at the systemic level. Among the most notable pathologies to which it contributes directly are aortic stenosis, peripheral vascular disease and coronary artery disease. It is estimated that between 20-25% of the world's population has elevated levels, with values of 30 mg/dL or 75nmol/L being the most standardized for establishing the cut-off point. Despite the growing interest in the development and study of effective therapeutic alternatives, there are currently no marketed drugs available that are effective in reducing their levels, many of which are still in different phases of clinical trials. Therefore, treatment involves correcting other modifiable cardiovascular risk factors with emphasis on reducing LDL cholesterol. The aim of the present study is to analyze Lp(a) levels in patients seen in 2023 in the cardiology service of the Hospital Clínico Universitario de Santiago de Compostela, since greater knowledge of the complications, clinical markers, and other associated characteristics will allow us to improve the health care currently received by persons with elevated Lp(a) levels. The results of our study show that in a small number of lipid profiles Lp(a) determination is also requested, with endocrinology being the major requesting service. Furthermore, the prevalence of levels above 75nmol/l in the sample studied is greater than the described in the world population. Patients with higher percentile values showed greater associated cardiovascular complications.

Direction
LAGE FERNANDEZ, RICARDO (Tutorships)
Seijas Amigo, José (Co-tutorships)
Rodríguez Carnero, María Gemma (Co-tutorships)

Court
SUAREZ QUINTANILLA, JUAN ANTONIO (Chairman)
ABRALDES LOPEZ-VEIGA, MAXIMINO JOSE (Secretary)
GUDE SAMPEDRO, FRANCISCO (Member)

Summary
Introduction: Trigeminal neuralgia is a neuropathic facial pain derived from an injury or pathology of the trigeminal nerve affecting one or more of its branches. It is a paroxysmal pain described as an electric or stabbing shock lasting from seconds to minutes at most. It is characterized by the presence of trigger points that trigger crises. There are three types: classic, caused by neurovascular compression; idiopathic, without objective cause; secondary to another underlying cause, mainly tumours. Aims: To study the potential benefit of stereotactic radiosurgery for the treatment of idiopathic trigeminal neuralgia, considering dose, indications, and treatment site. To compile and analyze a series of clinical cases of patients from the Santiago de Compostela Health Area, comparing them with the results obtained in the medical literature. Methods: A systematic review of the medical literature and a comparative analysis with cases collected at the University Hospital of Santiago were performed. Results: The optimal dose range, with fewer side effects, is between 80-90 Gy. The most used site of action is the trigeminal neuralgia entry zone in the pons of the brainstem, in the nerve transition zone, using a single isocenter. Better results are achieved if the trigeminal neuralgia has typical pain characteristics, if no previous surgical procedures have been performed, if there are no previous sensory disturbances, as well as a shorter pain duration and the presence of sensory changes after radiosurgery. Conclusions: Stereotaxic radiosurgery is an appropriate treatment technique for patients with idiopathic trigeminal neuralgia, leading beneficial clinical results and a lower complication rate than vascular microdecompression. Patients treated at the University Hospital of Santiago obtained similar results to those included in the medical literature reviewed, with no notable differences observed.

Direction
Aran Echabe, Eduardo (Tutorships)

Court
AGUILERA GUIRAO, ANTONIO (Chairman)
Cinza Sanjurjo, Sergio (Secretary)
COSTA BESADA, MARIA ALICIA (Member)

Summary
Introduction: Allergic bronchopulmonary aspergillosis (ABPA) is a lung disease caused by hypersensitivity reactions to Aspergillus fumigatus (AF). It frequently affects patients with cystic fibrosis (CF), a genetic disease characterized by recurrent respiratory infections and lung deterioration. In pediatric patients with CF, there is still no international consensus on the most appropriate diagnosis and treatment for ABPA. Objectives: To determine the prevalence of ABPA, review diagnostic criteria, evaluate available therapies, and identify risk factors for its development. Methods: A systematic review was conducted using the PRISMA-ScR methodology. The search was conducted in MEDLINE and included articles published between January 2015 and March 2025, with patients under 18 years of age diagnosed with CF and ABPA. Results: 24 were analyzed. The prevalence of ABPA ranged from 1% to 8%. Specific IgE testing against recombinant Aspergillus antigens (rAsp f4 and f6), basophil activation test (BAT), computed tomography (CT), and magnetic resonance imaging (MRI) were considered useful for diagnosis, with specific findings. Regarding treatment, new antifungals such as posaconazole and biologic drugs such as omalizumab showed promising results. Risk factors included coinfection with Pseudomonas aeruginosa, prolonged use of dornase alfa and inhaled corticosteroids, and contact with pets. Conclusions: Early detection and treatment of ABPA are key to preventing lung deterioration. Despite recent advances, there is an urgent need to unify diagnostic criteria and conduct studies evaluating the impact of new therapies in the pediatric CF population.

Direction
Moreno Álvarez, Ana (Tutorships)
González Torres, Ana Lucía (Co-tutorships)

Court
Gonzalez Quintela, Arturo (Chairman)
BRAÑAS GONZALEZ, ANTIA (Secretary)
Sierra Paredes, German (Member)

Summary
The objective of this systematic review is to study the influence of the sociocultural factors of each region in the development and presentation of eating disorders. It seeks to identify differences between Western and non-Western countries with the highest prevalence. Special emphasis is placed on understanding the body ideals of each region, the level of demands placed on the population to meet this standard of beauty, and the dietary norms and attitudes toward food in different cultures. The results are consistent with the belief that sociocultural environments that promote an idealized standard of feminine beauty and virtue, characterized by an unrealistically thin or athletic body shape, foster eating disorders.

Direction
OLIVARES DIEZ, JOSE MANUEL (Tutorships)
Nistal Franco, Icia María (Co-tutorships)

Court
Leis Trabazo, María Rosaura (Chairman)
GARCIA FIGUEIRAS, ROBERTO (Secretary)
Varela Calviño, Rubén (Member)

Summary
Introduction: Atopic dermatitis (AD) is a chronic inflammatory skin disease, predominantly driven by a type 2 immune response. In recent years, the management of moderate-to-severe cases has changed significantly with the introduction of targeted therapies, such as biologics and oral JAK inhibitors. Objective: This work aims to review and compare the efficacy and safety profiles of the main current systemic treatments for AD, focusing especially on biologics (dupilumab, tralokinumab, lebrikizumab) and JAK inhibitors (abrocitinib, baricitinib, upadacitinib), based on the most recent scientific literature. Methods: A narrative review was conducted of scientific articles published since 2022. Clinical trials, metaanalyses, and systematic reviews were included, analyzing clinical efficacy, safety, ideal patient profiles, and regulatory aspects of the selected treatments. Results: Biologic treatments targeting the IL-4/13 pathway (such as dupilumab) and IL-13 (tralokinumab,lebrikizumab) have shown high efficacy and sustained safety, making them particularly useful for chronic management. JAK inhibitors provide a rapid and effective response, although their use requires individualized assessment due to a more restrictive safety profile. Most available studies compare these drugs to placebo, and there is still limited data on direct comparisons between different treatments. Conclusions: New systemic therapies for AD have brought a significant shift in disease management. Choosing the most appropriate treatment should be based on each patient’s clinical characteristics, comorbidities, desired speed of response, and individual safety profile. Despite recent advances, more direct comparative studies and greater consensus are needed to optimize clinical decisionmaking.

Direction
GINARTE VAL, MANUEL JAVIER (Tutorships)
Flórez Menéndez, María Ángeles (Co-tutorships)

Court
AGUILAR BLANCO, MARIA FE (Chairman)
BALEATO GONZALEZ, SANDRA (Secretary)
SOPEÑA PEREZ-ARGÜELLES, BERNARDO (Member)

Summary
Background: The aging of the population is causing the increase of some degenerative diseases, such as aortic stenosis. The treatment of choice for patients older than 75 years is, according to the latest guidelines, the implantation of an aortic valve by catheter (TAVI) as long as it can be performed via transfemoral access (TF). However, in up to 20% of patients this access is not feasible, so alternative access routes such as transapical (TA), transcarotid (TC) or transaxillary (Tax) should be considered. Evidence is scarce on the results of these access routes in the older cohorts, so this study seeks to evaluate the efficacy and safety of non-TF approaches in nonagenarian patients. Materials and methods: A total of 459 patients undergoing non-TF TAVI were studied by the Cardiac Surgery Service (CCA) of the A Coruña Hospital Complex (CHUAC) between 2009 and 2024. This sample was divided into two age groups, 90 years or older (n equals 40) and younger than 90 years (n equals 419). Results: Both groups had similar surgical risk (EuroSCORE 2: 5,8 compared to 6), with a higher frequency of comorbidities in the younger group. Intrathoracic transapical access was used in 61 percent of cases, although nonagenarians underwent extrathoracic approaches significantly more often (55 percent compared to 37,7 percent). Procedural success was high in both groups (97,5 percent compared to 90,2 percent), wirh comparable rates of postoperative complications (20 percent compared to 18,9 percent) and in hospital mortality (2,5 percent compared to 7,1 percent). One year survival was 93,5 percent in the nonagenarian group and 94 percent in the younger cohort. Conclusion: Non-transfemoral TAVI performed in patient older than 90 years provides results comparable to those in younger cohorts, highlighting the importance of preoperative comorbidity and the choice of less invasive approaches, such as extrathoracic access.

Direction
Mosquera Rodríguez, Víctor Xesús (Tutorships)

Court
FRAGA RODRIGUEZ, MAXIMO FRANCISCO (Chairman)
ARROJO ROMERO, MANUEL (Secretary)
SÁNCHEZ SELLERO, INÉS (Member)

Summary
Background: Electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS) are safe and effective neuromodulation therapies, primarily indicated for the treatment of depressive disorders. Currently, depression is the leading cause of disability and sick leave worldwide, and it contributes significantly to the global burden of disease. In this context, it seems necessary to establish effective therapeutic protocols to reverse the situation, as well as to raise awareness of both the condition and the available treatment options. Objective: To review and synthesize the current literature comparing the usefulness of ECT and TMS in the treatment of patients with depression. To compare the efficacy, risks, costs, and benefits of both techniques. Material and methods: A literature review was carried out between November 2024 and February 2025, including studies published from 2019 to 2025 in the PubMed database. Included were clinical trials, observational studies, cost-utility analyses, systematic reviews, and clinical case reports that investigate and compare both neuromodulation therapies in patients diagnosed with depression. Results: The initial search yielded 574 studies, of which 8 met the predefined inclusion and exclusion criteria and were ultimately selected. There was some heterogeneity among the articles due to notable differences in study type, design, treatment protocols, and follow-up duration. Conclusions: The results of this literature review suggest that both ECT and TMS are effective in reducing depressive symptoms. ECT is considered a more invasive technique and is associated with a greater negative cognitive impact; it is usually preferred in acute and severe cases due to its faster onset of action. TMS, on the other hand, is less invasive and better tolerated, showing greater patient acceptance and higher cost-effectiveness.

Direction
ARROJO ROMERO, MANUEL (Tutorships)
Veiga Ramos, Iria (Co-tutorships)

Court
LIMA RODRIGUEZ, LUIS JESUS (Chairman)
PALLAS PALLAS, ESTRELLA (Secretary)
VARELA LEMA, MARIA LEONOR (Member)

Summary
The treatment of profound unilateral hearing loss represents a major clinical challenge due to its effects on the patient's quality of life, especially with regard to binaural hearing, sound location and speech understanding in noisy environments. Historically underappreciated, this condition can lead to social isolation, auditory fatigue and persistent tinnitus. Although some conventional hearing solutions have been used over time, they have failed to restore binaural hearing or provide comprehensive and sustained improvement. This is a literature review of the most recent scientific evidence on the efficacy of cochlear implantation in patients with profound unilateral hearing loss. Studies published in the last decade were analyzed. That studies evaluated its effects in restoring binaural hearing, reducing tinnitus and improving auditory perception and quality of life. The findings reveal that cochlear implantation provides significant improvements in speech understanding, especially in noisy environments, in spatial location of sound and in subjective perception of auditory well-being. In addition, a substantial reduction in tinnitus is observed in a high percentage of patients. Furthermore, the benefits of the implant tend to be maintained and even increase over time due to brain plasticity and auditory rehabilitation. Although the impact may change according to different factors, the data suggest that it could also be considered for use in prelocutives as a preventive measure against hearing impairment in the healthy ear. This study concludes that, despite the ethical and methodological challenges that limit classical clinical trials in this field, the current evidence supports the cochlear implant as an effective therapeutic option, with real capacity to improve the autonomy, well-being and hearing of people with profound unilateral hearing loss.

Direction
SOTO VARELA, ANDRES (Tutorships)

Court
AGUILAR BLANCO, MARIA FE (Chairman)
BALEATO GONZALEZ, SANDRA (Secretary)
SOPEÑA PEREZ-ARGÜELLES, BERNARDO (Member)

Summary
Introduction Neovascular age-related macular degeneration (nAMD) is a disease with a significant impact on patients' life. Its treatment is currently challenging due to the variability in response. Optical coherence tomography (OCT) is very useful for monitoring the evaluation. Objective To study the changes that occur in the GC and DVRE using OCT and OCTA in patients with nAMD in real-life clinical practice at the Ophthalmology department of CHUS. To study the possible changes that occur in the GC and DVRE based on factors such as age, previous GC and DVRE values, MVN type and response to treatment. Material and methods Patients with nAMD undergoing treatment with intravitreal ranibizumab were studied with SS-OCT before, 4 months, and 1 year after the start of treatment. A 6x6 mm scan was used to measure choroidal thickness (CT), and OCTA examination was used to calculate vascular index (VI) in the outer retina layer (ORL). Results Forty-seven eyes of 43 patients were included. The mean CT decreased at 4 months and 1 year after starting treatment (p less than 0.037). No significant changes in VI were found after treatment (p greater than 0.144). There was a correlation between the previous CT and VI and the decrease in CT and VI at 1 year after starting treatment (r greater than 0.311, p less than 0.034). There was a correlation between the decrease in CT and VI in the macular neovascularization (NVM) sector at 4 months of treatment (r=-0.339, p=0.023). No significant changes were found in CT between different types of NVM (p greater than 0.489) or in the response to treatment (p greater than 0.162). There are differences in VI changes between type 2 and type 3 NVM (p=0.037), and a better response to treatment is observed with a lower baseline VI (p=0.048). Conclusions CT can be considered a potential biomarker in patients with nAMD, as it reflects the effect of intravitreal ranibizumab treatment. These changes do not correlate with those in VI of the ORL, which shows high variability with treatment.

Direction
FERNANDEZ RODRIGUEZ, MARIA ISABEL (Tutorships)
Almuiña Varela, Pablo (Co-tutorships)

Court
SUAREZ QUINTANILLA, JUAN ANTONIO (Chairman)
ABRALDES LOPEZ-VEIGA, MAXIMINO JOSE (Secretary)
GUDE SAMPEDRO, FRANCISCO (Member)

Summary
Introduction: Continuous home antibiotic infusion (TADE) is emerging as an alternative to hospital-based treatment for complicated and long-lasting infections in selected patients. This is particularly pertinent in the context of increasing antibiotic resistance and an ageing population. Objective: Through a narrative review, we analysed the safety and efficacy of continuous antimicrobial infusion in an outpatient setting. We also compared it with intermittent administration. Methods: The PubMed, Cochrane and Google Scholar databases were used to select articles. Articles published between 2000 and 2025, focusing on populations over 11 years of age, were included. Systematic reviews, clinical trials and observational studies evaluating the efficacy and safety of continuous home antibiotic administration were included. Results: Twenty-one articles that met the inclusion criteria were included. Adverse event rates were low, with mostly mild to moderate events associated with either the drug or the route of administration. Cure rates ranged from 74% to 100%. The drugs used were mostly time-dependent, such as beta-lactams. The main types of infection treated were osteoarticular infections, endovascular infections (such as endocarditis and bacteraemia), and skin and soft tissue infections. Conclusion: Continuous outpatient antimicrobial stewardship is an effective and safe approach. However, the existing literature is very heterogeneous, which limits the extrapolation of studies. Further research following well-established protocols is needed to improve the approach and ensure external validity.

Direction
NOVO VELEIRO, IGNACIO (Tutorships)
Beceiro Abad, María del Carmen (Co-tutorships)

Court
FRAGA RODRIGUEZ, MAXIMO FRANCISCO (Chairman)
ARROJO ROMERO, MANUEL (Secretary)
SÁNCHEZ SELLERO, INÉS (Member)

Summary
Introduction and objectives: Chronic pancreatitis is a common disease whose main symptom is intense, constant abdominal pain. This pain has two origins: on the one hand, pain caused by tissue damage resulting from the inflammation to which the pancreas is subjected; and on the other, neuropathic pain caused by damage to the nerve fibers. This dual origin of pain complicates its management, markedly reducing the quality of life of patients suffering from this disease. In this context, pregabalin,a drug that modulates neuronal hyperexcitability, emerges as a promising alternative to classical treatments due to its ability to relieve neuropathic pain, having demonstrated its efficacy in other conditions characterized by this type of pain. The present study seeks to evaluate the efficacy of pregabalin in reducing the abdominal pain caused by chronic pancreatitis. Materials and methods: In this study, a systematic review was conducted following the PRISMA guidelines. The databases used were PubMed, Cochrane, and Web of Science (WOS). Results: A total of 63 articles were identified, of which 3 were included in the systematic review. Conclusions: 1. Pregabalin, alone or combined with antioxidants, significantly reduces the intensity and frequency of abdominal pain caused by chronic pancreatitis, thereby positioning itself as a promising option to optimize the symptomatic treatment of this disease. 2. Pregabalin provides a multidimensional benefit by decreasing the number of pain days per month, hospital admissions for pain, and the need for opioids to manage pain. It also increases the percentage of patients who achieve complete pain remission. 3. The quality of the available evidence is limited; additional studies with more patients and longer follow-up are needed to strengthen the evidence and assess the adverse effects and long-term efficacy of pregabalin treatment.

Direction
DOMINGUEZ MUÑOZ, JUAN ENRIQUE (Tutorships)

Court
MUÑOZ BARUS, JOSE IGNACIO (Chairman)
GAGO AGEITOS, ANA MARIA (Secretary)
VAZQUEZ ILLANES, MARIA DOLORES (Member)

Summary
1.1 BACKGROUND Physical activity plays a fundamental role in the prevention and treatment of cardiovascular disease, the benefits of which are widely supported and recognized. However, recent studies indicate that prolonged, high-volume endurance exercise may increase rather than reduce the risk of developing coronary atherosclerosis. 1.2 OBJECTIVES The purpose of this paper is to analyse the results of published studies based on a systematic review of the literature. 1.3 METHODS Articles indexed in the PubMed database were selected in which the presence of coronary atherosclerosis in athletes was studied, from the first publication in 2008 up to February 2025. We assessed the frequency of various clinically relevant variables by means of a simple aggregation of the results from the reviewed studies. Coronary atherosclerosis prevalence was defined using several criteria, including the presence of coronary artery calcium (CAC) with different thresholds (greater than 0, greater than 100, and greater than 400), the presence of greater than or equal to 1 atherosclerotic plaque, and the presence of greater than or equal to 50% luminal stenosis. 1.4 RESULTS The literature search yielded eight studies, comprising a total of 1,599 participants. Of these, 1,534 (95.9%) were male and 75 (4.1%) were female. The mean age of participants ranged from 52 to 61 years, with an overall average of 55.3 years. Among athletes, the prevalence of coronary atherosclerosis according to CAC greater than 0 was 63.8% (95% Confidence Interval (CI): 60.7% ; 67.1%), according to CAC greater than 100 was 20.4% (95% CI: 17.8% ; 23.2%), and according to CAC greater than 400 was 5.9% (95% CI: 4.4% ; 7.9%). In control subjects, the prevalence according to CAC greater than 0 was 52.5% (95% CI: 48.2% ; 56.8%), according to CAC greater than 100 was 16.5% (95% CI: 13.5% ; 19.9%), and according to CAC greater than 400 was 2.1% (95% CI: 1.0% ; 4.3%). Pooled data analysis showed a statistically significant difference in the prevalence of coronary atherosclerosis between athletes and controls according to the CAC greater than 0 criterion (p = 0.004) and the CAC greater than 400 criterion (p = 0.005), but not for the CAC greater than 100 threshold (p = 0.075). According to the criterion of greater than or equal to 1 atherosclerotic plaque, the prevalence of coronary atherosclerosis was 55.6% (95% CI: 50.5% ; 63.1%) in athletes and 41.2% (95% CI: 35.7% ; 47.0%) in controls. The combined analysis of the included studies demonstrated a statistically significant difference (p less than 0.001). Regarding the presence of significant coronary luminal stenosis (greater than or equal to 50%), the prevalence was 7.9% (95% CI: 5.9% ; 9.9%) among athletes and 4.9% (95% CI: 2.9% ; 8.1%) among controls. The pooled analysis did not reveal a statistically significant difference (p = 0.113). 1.5 CONCLUSIONS This study suggests that sustained high-intensity and high-volume physical exercise may be associated with a higher prevalence of coronary atherosclerosis in endurance athletes compared to non-athletic individuals. These findings prompt further discussion regarding the potential cardiovascular effects of extreme exercise.

Direction
Barge Caballero, Eduardo (Tutorships)
Yáñez Wonenburguer, Juan Carlos (Co-tutorships)

Court
SEOANE PRADO, RAFAEL (Chairman)
VIDAL MILLARES, MARIA (Secretary)
FIDALGO PEREZ, MIGUEL ANGEL (Member)

Summary
Crohn’s disease is a chronic inflammatory bowel condition that primarily affects young adults, with a significant impact on quality of life and increasing healthcare costs. This systematic review, conducted according to PRISMA guidelines, aimed to evaluate the efficacy and safety of interleukin-23 (IL-23) inhibitors in patients with moderate to severe Crohn’s disease. Five studies were included: three randomized controlled trials (RCTs) and two open-label observational studies. The RCTs yielded mixed results: Feagan et al. (2017) demonstrated significantly higher clinical remission with risankizumab compared to placebo, along with reductions in inflammatory biomarkers and a favorable safety profile. Sands et al. (2017) also showed a significant clinical response with MEDI2070, while Sandborn et al. (2017) found a non-significant trend toward clinical improvement with briakinumab. The observational studies (D’Haens et al., 2020 and 2022) reported sustained clinical and endoscopic remission with long-term risankizumab treatment, without new serious adverse events. However, the absence of a control group limits the certainty of these findings. Endoscopic remission was only assessed in open-label studies, reducing the strength of the evidence. All included studies reported an acceptable safety profile, with no significant increase in serious adverse events, although some results were imprecise. The overall quality of the evidence, assessed using the GRADE system, was rated as low for clinical remission and very low for endoscopic remission and long-term safety, mainly due to risk of bias, imprecision, and potential publication bias. In conclusion, IL-23 inhibitors, particularly risankizumab, appear to be a promising therapeutic option for patients with moderate to severe Crohn’s disease. Nevertheless, further well-designed, controlled studies with larger sample sizes and longer follow-up are needed to strengthen the available evidence and support more definitive clinical recommendations.

Direction
DOMINGUEZ MUÑOZ, JUAN ENRIQUE (Tutorships)

Court
SALAS ELLACURIAGA, ANTONIO (Chairman)
FIGUEROA RODRIGUEZ, JESUS (Secretary)
Aguiar Fernández, Pablo (Member)

Summary
Introduction: Cardiovascular diseases (CVD) continue to be the leading cause of morbidity and mortality worldwide. Hypercholesterolemia is among the main modifiable risk factors. Therefore, proper management of cholesterol levels is a fundamental strategy in primary and secondary prevention. Although statins have been the gold standard for lipid-lowering therapy, their use faces limitations. A significant percentage of patients fail to achieve therapeutic goals, and this has prompted the development of new lipid-lowering treatments, such as PCSK9 inhibitors, bempedoic acid, and inclisiran, revolutionizing the available therapeutic options and proving to be promising alternatives. Objectives: The main goal of this study is to evaluate the impact of new lipid-lowering treatments on cardiovascular prevention, also analyzing their safety and efficacy in clinical practice. Materials and methods: A literature search was conducted in the PubMed and Cochrane databases, including studies published between 2019 and 2025 comparing evolocumab, alirocumab, inclisiran, and bempedoic acid with statins and ezetimibe for cardiovascular prevention. Discussion: 23 articles were included for further review and analysis of data, finding that the new lipid-lowering agents constitute an effective and safe option to improve lipid control in patients with high cardiovascular risk who do not achieve therapeutic objectives with conventional treatments. However, its implementation in clinical practice remains limited, and its cost represents a challenge. It is essential to carry out an individualized assessment based on the clinical characteristics of each patient to optimize the time of introduction of these treatments.

Direction
FERNANDEZ RODRIGUEZ, Ma DEL PILAR (Tutorships)

Court
Martín Martín, Carlos Santiago (Chairman)
PEÑA GIL, CARLOS (Secretary)
LOPEZ LOPEZ, ANDREA (Member)

Summary
Background: orbital floor fractures (OFF) represent a frequent entity within maxillofacial trauma, with possible functional and aesthetic sequelae, such as enophtalmos, diplopia or ocular dystopia. Various implant materials are used for surgical reconstruction; however, the absence of agreed, standardized guidelines and protocols on the specific indications for each material makes it difficult to make an appropriate choice. Objective: description and analysis of the diagnosis and treatment of OFF, with special focus on reconstruction material choice. Methods: based on a literature search in PubMed, a systematic review of the literature published between 2020 and 2025 on implant materials in the treatment of OFF was carried out. In addition, three representative cases illustrating the reconstruction process using three commonly employed materials are presented. Results: after screening and critical reading, 10 publications were included in the review. The selected clinical cases used autologous bone graft, conventional titanium mesh and customized titanium mesh as reconstruction materials. Conclusions: autologous bone grafts have historically been the most widely used material in OFF repair, benefiting from their high biocompatibility; however, they have the disadvantage of unpredictable long-term results. On the other hand, xenografts (of non-human origin) are poorly represented in the current literature. In contemporary clinical practice, alloplastic (synthetic) materials are more frequently used. Among these, resorbable materials provide temporary support, which may lead to long-term complications, while non-absorbable materials, such as titanium, provide permanent rigid support. The combination of these materials with the novel custom implant design technologies allows for highly accurate reconstructions with optimal results.

Direction
GONZALEZ VINAGRE, SALUSTIANO (Tutorships)
Megías Barrera, Joaquim (Co-tutorships)

Court
LABANDEIRA GARCIA, JOSE LUIS (Chairman)
FERREIROS LOPEZ, ALBA (Secretary)
TABERNERO DUQUE, MARIA JESÚS (Member)

Summary
Adolescence is a key stage for the early detection and prevention of mental health problems. One of the most relevant factors in this context is the willingness to seek help when facing emotional or psychological difficulties. This Final Degree Project assesses that willingness using the GHSQ-V (General Help-Seeking Questionnaire, validated in Chile) in a representative sample of 2,435 Galician students in the 3rd year of ESO. The study is part of the randomized clinical trial of the Youth Aware of Mental Health (YAM) program, focused on promoting mental health and preventing suicide in school settings. The analysis is based on pre-intervention data and aims to identify adolescents’ preferred sources of help, how these preferences vary depending on the type of issue (anxiety, depression, stress, suicidal ideation, and substance abuse), and whether there are gender differences. Both informal sources (friends, family, partner) and formal ones (health professionals, teachers, helplines) are considered. Results show a generally high intention to seek help, especially in cases of anxiety and depression. Informal sources are the most valued, with friends and parents as the preferred options. Formal sources receive lower scores, although mental health professionals stand out in more severe situations. The most striking finding is that boys show a greater willingness to seek help than girls across all types of problems and most sources, including professional support. This contrasts with most previous literature, which usually finds higher help-seeking intentions among girls, and suggests the presence of specific cultural or contextual factors in this population. This work provides valuable insights for designing more effective and better-adapted school-based interventions to meet the real needs of students.

Direction
Gómez-Reino Rodríguez, Ignacio (Tutorships)
GARCIA CABALLERO, ALEJANDRO ALBERTO (Co-tutorships)

Court
RUANO RAVIÑA, ALBERTO (Chairman)
Gándara Cortés, Marina (Secretary)
VILLAR CHEDA, MARIA BEGOÑA (Member)

Summary
Long-acting antiretroviral therapy (LD-ART) is presented as an innovative alternative compared to daily oral treatments in the management of HIV. Spaced administration via injectable or subcutaneous formulations offers clinical and psychosocial advantages, especially in populations with adherence problems. This study examines its effect in terms of virological efficacy, safety, patient satisfaction and health viability. The objectives are to critically examine the recent scientific evidence on LD-ART, assessing its efficacy, safety profile, level of patient acceptance, and its use in both HIV treatment and prophylaxis. Likewise, it seeks to explore its role in therapeutic simplification and health equity.

Direction
Antela López, Antonio Rafael (Tutorships)

Court
SALAS ELLACURIAGA, ANTONIO (Chairman)
FIGUEROA RODRIGUEZ, JESUS (Secretary)
Aguiar Fernández, Pablo (Member)

Summary
Dementia, and in particular Alzheimer's disease (AD), represent a growing concern due to their global impact and high prevalence, especially in older age. In this context, blood biomarkers have emerged as an innovative tool for early diagnosis and management of these diseases. Their accessible, non-invasive and potentially cheaper nature makes them a promising complementary alternative to traditional methods such as cerebrospinal fluid analysis or neuroimaging. Among the most promising biomarkers are phosphorylated tau protein (including p-Tau181, p-Tau217 and p-Tau231 subtypes), neurofilament light chain (NfL) and glial fibrillary acid protein (GFAP). These markers not only allow changes to be detected at earlier stages, but could also facilitate a more accurate diagnosis between different types of dementia. Recent technological advances have enabled the development of assays with high sensitivity and specificity, increasing the concordance between blood biomarkers and conventional techniques. However, widespread implementation faces challenges such as standardisation of protocols, validation in diverse populations, and interpretation of results in a clinical setting. Despite these obstacles, blood biomarkers are laying the groundwork for more accessible and earlier diagnosis of dementia, to the benefit of the quality of life of patients and their caregivers.

Direction
PRIETO GONZALEZ, JOSE MARIA OSCAR (Tutorships)

Court
AGUILAR BLANCO, MARIA FE (Chairman)
BALEATO GONZALEZ, SANDRA (Secretary)
SOPEÑA PEREZ-ARGÜELLES, BERNARDO (Member)

Summary
The human discomfort that the animal suffering produces has led to an intense social debate about the treatment and use that we make of them, that is why the biomedical investigation has joint the change. We have multiple alternatives to animal experimentation and testing, however, effectively there are still a lot of procedures done with animals as we have not yet been able to conduct a study without animals from beginning to end. In this review, we recollect and analyze the advantages that the alternatives do animal testing present in contrast to the limitations that do not make it possible for them to become a reality. After carrying out various searches on the subject, I have selected 7 systematic reviews of the most relevant alternatives, in addition to taking legal documents, statistics and articles in which these techniques are used. After completing this bibliographical review I see that the point at which we are is hopeful given the decrease in the use of animals with respect to 15 years ago and the development of new techniques and improvement of those already being applied. However, it is a recent field of research and still needs to overcome important limitations that mean that studies using zero animals are not yet being carried out.

Direction
LEON MATEOS, LUIS ANGEL (Tutorships)
Fernández Bruno, Manuel (Co-tutorships)

Court
MUÑOZ BARUS, JOSE IGNACIO (Chairman)
GAGO AGEITOS, ANA MARIA (Secretary)
VAZQUEZ ILLANES, MARIA DOLORES (Member)

Summary
Heart failure is one of the main health problems, affecting millions of people. In recent years, medical therapy has been implemented for patients with heart failure and reduced ejection frac-tion, improving their prognosis and morbidity. Currently, treatment consists of four pharmaco-logical pillars, in which the goal is to optimize the dosage to the maximum tolerated by the pa-tient. This titration phase is already being carried out in many centers by a specialized nursing team, always after evaluation by cardiology. The aim of this study is to analyze the early titration of a group of low-risk patients with ventricular dysfunction at the Álvaro Cunqueiro Hospital in Vigo, prior to assessment in a heart failure outpatient clinic. This is a retrospective, observational, single-center study involving patients over 18 years of age diagnosed with de novo heart failure and meeting low-risk criteria. The study period ranged from November 2022 to October 2024. This study demonstrates that prognostic medication titration in de novo, low-risk heart failure patients can be performed safely and effectively by a specialized nursing team, without the need for an initial in-person evaluation by a heart failure cardiologist. These results contribute to re-ducing healthcare workload and titration times, thereby helping to shorten waiting lists and low-er costs.

Direction
Concheiro Guisán, Ana (Tutorships)
Melendo Viu, María (Co-tutorships)

Court
DOMINGUEZ MUÑOZ, JUAN ENRIQUE (Chairman)
Fernández Rodríguez, Mª Isabel (Secretary)
SANCHEZ IGLESIAS, SOFIA (Member)

Summary
Introduction. The field of child and adolescent psychiatry is growing and faces major challenges, such as the personalization of therapy for its patients. This review aims to determine the importance of genes like CYP2D6 and its variants in the response to treatments such as risperidone in children with ASD. Materials and Methods. A systematic review was conducted, analyzing a total of seven articles selected according to PRISMA guidelines and the PICO model. These studies were published in the last five years, in both English and Spanish. They addressed the core concept of pharmacogenetics, specifically CYP2D6, in pediatric patients with ASD undergoing psychopharmacological treatment. Results. The results showed that genetic variability influenced the response to drugs such as risperidone, both in terms of efficacy and the experience of adverse effects such as hyperprolactinemia. Individuals were classified as ultrarapid, normal, intermediate, or poor metabolizers, with the aim of adjusting dosages to meet each patient's needs and thus optimize therapy. Conclusion. Integrating pharmacogenetics into the field of child and adolescent psychiatry may improve therapeutic efficacy, reduce adverse effects, and contribute to a safer and more personalized approach to medicine for such a vulnerable group as the pediatric population already is.

Direction
OLIVARES DIEZ, JOSE MANUEL (Tutorships)
López García, Marta (Co-tutorships)

Court
DOMINGUEZ MUÑOZ, JUAN ENRIQUE (Chairman)
Fernández Rodríguez, Mª Isabel (Secretary)
SANCHEZ IGLESIAS, SOFIA (Member)

Summary
Frontotemporal dementia (FTD) is the leading cause of neurodegenerative dementia in patients under 65 years of age, and the third most common overall. It is frequently associated with significant behavioral disturbances. This, along with its high heritability (up to 30% of cases are familial, and up to 60% when associated with motor neuron disease), makes it a 7 serious public health issue. Our purpose is to describe the epidemiology, pathogenesis, clinical manifestations, diagnosis, and management of frontotemporal dementia. Within this general context, we present an exceptional case of FTD associated with a mutation in the SQSTM1 gene, which encodes the p62 protein. This gene has been pathogenically linked to cases of amyotrophic lateral sclerosis and Paget’s disease, and is also a very rare cause of FTD. We will also describe the clinical and neuroimaging findings of this case in light of a systematic review of the literature on FTD and SQSTM1.

Direction
LEIRA MUIÑO, ROGELIO MANUEL (Tutorships)
Pías Peleteiro, Juan Manuel (Co-tutorships)
POUSO DIZ, JESSICA MARIA (Co-tutorships)

Court
COUCE PICO, MARIA DE LA LUZ (Chairman)
Eirís Puñal, Jesús Manuel (Secretary)
Cimadevila García, Antonio (Member)

Summary
Background: COVID19 is a disease with a very heterogeneous clinical presentation, ranging from asymptomatic infections to multi organ failure. It is associated with complications such as arterial and venous thromboembolism, which can be fatal. Vaccines developed against this infection have also been associated with thrombotic events. Antiphospholipid syndrome (APS) is an autoimmune disease that occurs in the presence of one or more antiphospholipid antibodies (anticardiolipin antibodies, lupus anticoagulant, and antibody against beta2 glycoprotein I) and the occurrence of thrombotic events (e.g., pulmonary thromboembolism, stroke) or spontaneous abortions. Several studies have been published attempting to establish an association between antiphospholipid syndrome (APS) and COVID19, based on the similar pathophysiological characteristics of thrombosis in both diseases. VITT (vaccine-induced immune thrombotic thrombocytopenia) is a rare autoimmune response that has been primarily associated with COVID19 replicating adenovirus vaccines. Parallels have often been drawn between VITT, HIT (heparin induced thrombocytopenia), and FAS (fatal acute thrombosis), as these are antibody mediated processes linked to thromboembolic manifestations. Objective: The main objective of our systematic review is to evaluate the possible association between antiphospholipid antibody positivity and COVID-19 vaccination. Material and Methods: A systematic review was conducted to explore the potential relationship between thrombotic phenomena and COVID19 vaccines. The search included the following databases: PubMed and the Cochrane Library, using the combination of the search terms, COVID vaccine and antiphospholipid antibody. The search period covered September 2021 to October 15, 2024. Titles and abstracts were reviewed, selecting articles of interest, and then the full texts were analyzed. Results, conclusions: Although some studies suggest an increase in aPL positivity with viral vector vaccines, it appears to be a transient event; therefore, a cause and effect relationship between COVID19 vaccination and aPL positivity cannot be established.

Direction
MERA VARELA, ANTONIO JOSE (Tutorships)
Sueiro Delgado, Diana (Co-tutorships)

Court
SEOANE PRADO, RAFAEL (Chairman)
VIDAL MILLARES, MARIA (Secretary)
FIDALGO PEREZ, MIGUEL ANGEL (Member)

Summary
Introduction Recently, significant advances have been made in the research of acute kidney injury. Acute kidney injury is mainly identified by two indicators: an increase in serum creatinine and a decrease in urine output. This definition is controversial, particularly the diagnosis based on an increase in serum creatinine of at least 0.3 mg/dL within 48 hours. Many experts believe this increase is not sufficient. Creatinine represents a weakness in current AKI definitions. The emergence and development of tools for the identification of new biomarkers is especially important in an era of growing interest in more personalized and specific medicine. Objectives: To analyze whether the implementation of NGAL is useful as a diagnostic tool compared to traditional biomarkers depending on the clinical context; to assess its current implementation and clinical impact. Materials and Methods A systematic review was carried out including retrospective and prospective observational studies published between 2018 and 2025, written in English or Spanish. A search was conducted in PubMed, Embase, and Scopus. Results After applying inclusion and exclusion criteria, 7 observational studies were selected. Only primary studies were included. Most of the studies agree on the usefulness of NGAL as a tool in clinical practice for the early diagnosis of AKI and risk stratification. Conclusions The use of NGAL holds great potential, both for the early diagnosis of acute kidney injury and for risk stratification. The use of this tool aligns with the rise of a personalized approach to medicine. However, larger studies are needed to assess the real clinical impact of NGAL, along with cost-effectiveness analysis and the standardization of cutoff points.

Direction
LOPEZ LAGO, ANA MARIA (Tutorships)
Mejuto Montero, Natalia (Co-tutorships)

Court
GARRIDO GIL, PABLO (Chairman)
GARCIA SEARA, FRANCISCO JAVIER (Secretary)
VALENZUELA LIMIÑANA, RITA (Member)

Summary
Introduction: Hereditary nonpolyposis colorectal cancer (HNPCC), also known as Lynch syndrome (LS), is a disease that is inherited in an autosomal dominant pattern and is the leading cause of hereditary colorectal cancer (CRC) in the world. Surgical treatment plays a crucial role in the management of colorectal cancer in people with Lynch syndrome, both as a therapeutic strategy in diagnosed cases and in the context of prevention in high-risk patients. Objectives: To carry out a systematic review that tries to answer the following question: What is the most recommended surgical option, based on evidence, for the treatment of colorectal cancer in patients with Lynch syndrome? The objective is to make a comparison in terms of surgical techniques and their results both in the short and long term (surgical act, postoperative, quality of life, recurrence, appearance of second neoplasms...). Methodology: A search was carried out in the PubMed, Up to Date and Scopus databases, selecting studies related to surgical treatment in Lynch syndrome published between 2010 and 2025. Results: Of the 320 studies found, 17 were selected after applying the inclusion and exclusion criteria to finally included in this review. Conclusions: Surgical treatment is a key tool in the management of Lynch syndrome, both therapeutically and preventively. Total colectomy reduces the risk of metachronous colorectal cancer, but has a greater functional impact on the patient. Segmental colectomy is a valid option for appropriately selected patients. There is no surgical treatment applicable to all cases; the decision must be individualized, taking into account the patient's age, genetic profile, comorbidities, and preferences

Direction
PAREDES COTORE, JESUS PEDRO (Tutorships)

Court
DOMINGUEZ MUÑOZ, JUAN ENRIQUE (Chairman)
Fernández Rodríguez, Mª Isabel (Secretary)
SANCHEZ IGLESIAS, SOFIA (Member)

Summary
Introduction. In real clinical practice in public medicine, with the high demand for healthcare services, the time available for the care of each patient is limited. This time also includes not only purely medical activity, but also encompasses all those tasks that are not strictly medical that must be carried out in order for that care to be provided. Objective. The aim of the study was to determine how much time (total and percentage) is allocated to administrative tasks in the context of a general consultation in the specialty of dermatology at the Complexo Hospitalario Universitario de Santiago. Methods. Total consultation time and time spent on administrative tasks during 202 general dermatology consultations were timed separately. Based on the data obtained, the percentage spent on administrative operations was calculated, both overall and by consultation modality. Outcomes. On average, dermatologists spent 21,5% of their general consultation time on administrative tasks. Analyzing first visits and check-ups separately, this percentage varies, being 15.7% for first visits and 26,4% for check-up patients. Discussion. The time spent on administrative tasks in dermatology consultations, tasks that are not specific to medical work, is very significant. Relieving the physician of these tasks would result in more time for patients, even being able to attend to an even greater number of patients and therefore improve waiting lists.

Direction
GINARTE VAL, MANUEL JAVIER (Tutorships)

Court
SALAS ELLACURIAGA, ANTONIO (Chairman)
FIGUEROA RODRIGUEZ, JESUS (Secretary)
Aguiar Fernández, Pablo (Member)

Summary
Complicated urinary tract infections (cUTIs) caused by multidrug-resistant microorganisms represent a growing challenge in clinical practice due to the limited efficacy of conventional antibiotics and high bacterial resistance rates. The aim of this study is to review and synthesize current scientific evidence on the treatment of cUTIs caused by resistant microorganisms, identifying the most frequently involved pathogens, describing available therapeutic options, and analyzing the efficacy and safety of new alternatives. This review includes updated clinical guidelines, clinical trials, and recent systematic reviews. New antibiotics such as ceftazidime/avibactam and oral tebipenem are highlighted, as well as the rational use of older antibiotics like nitrofurantoin and fosfomycin. Emerging therapies such as bacteriophages and complementary strategies like telemedicine are also discussed.

Direction
Varela Durán, Marina (Tutorships)

Summary
Introduction: Transoral CO2 laser surgery is being consolidated as an effective and minimally invasive technique compared to traditional treatments for T3 glottic cancer. This surgical approach allows preservation of laryngeal function, which is key to maintaining a good quality of life. Objectives: The purpose of this work is to review the most current scientific evidence to assess to what extent CO2 laser can be effective in patients with T3 glottic tumors, both in terms of tumor control and survival, as well as functional laryngeal preservation. Material and methods: A bibliographic review of scientific articles extracted from databases such as PubMed, Web of Science, and Google Scholar was carried out. After applying selection criteria, 16 studies that met the established requirements were analyzed. Results: The reviewed studies report overall survival rates around 80-88%, with similarly high local tumor control. In more than 85% of cases, laryngectomy was avoided. In addition, most patients maintained good vocal function, with no need for permanent tracheostomy and with few serious complications after the procedure. Conclusions: CO2 laser microsurgery appears to be a useful and safe alternative in well-selected T3 tumors, provided that the surgical team is experienced and appropriate follow-up is ensured. Although the results are very promising, it is still necessary to deepen the evidence with broader studies to define its limits and exact indications.

Direction
Martín Martín, Carlos Santiago (Tutorships)
Vázquez Barro, Juan Carlos (Co-tutorships)

Court
MARTINEZ OLMOS, MIGUEL ANGEL (Chairman)
GAMBORINO CARAMES, ELENA (Secretary)
Rey Brandariz, Julia (Member)

Summary
This Final degree project focuses on the direct comparison of two types of central venous access devices: peripherally inserted central catheters (PICC) and totally implantable subcutaneous ports (PORT or port-a-cath). Specifically, it examines the differing safety profiles, impact on quality of life, and associated healthcare costs of each device. In patients requiring prolonged intravenous treatment, such as those undergoing chemotherapy for cancer, PICC lines and PORTs have gained prominence due to their less invasive nature, higher patient tolerance, and reduced risk of complications compared to conventional central venous access methods. The study is based on a structured review of recent scientific literature, with systematic searches conducted in databases such as PubMed and Scopus. It focuses on comparative studies published since 2015. A total of twelve studies were selected that met strict inclusion criteria, encompassing both adult and paediatric populations, as well as a range of neoplastic conditions. The findings indicate a clear trend in favour of subcutaneous ports, showing lower rates of complications and higher patient acceptance. This work provides valuable evidence to support clinical decision-making regarding catheter selection, highlighting the importance of prioritising patient safety, comfort, and long-term treatment sustainability in oncological care.

Direction
DIAZ PEROMINGO, JOSE ANTONIO (Tutorships)

Summary
Tuberculosis is still, even today, a disease that affects millions of people around the world. The eradication of the tuberculosis epidemic is amongst the World Health Organization’s sustainable development goals . Historically, tuberculosis has represented a major threat, claiming the lives of millions of people. Such was its epidemiological significance that it came to be known as the White Plague. It was not until 1955, with the development of isoniazid, that a global reduction in cases began. This paper provides a historical overview of the organization of the anti-tuberculosis campaign, which became a key element in healthcare planning, with a specific focus on the province of Ourense. The historical period covered spans from the early 20th century, when the Municipal Charity was the main body responsible for the fight, up until the inauguration of the Piñor Anti-Tuberculosis Sanatorium in 1949, reviewing the major milestones of the anti-tuberculosis effort in this province.

Direction
Simón Lorda, David (Tutorships)

Court
FRAGA RODRIGUEZ, MAXIMO FRANCISCO (Chairman)
ARROJO ROMERO, MANUEL (Secretary)
SÁNCHEZ SELLERO, INÉS (Member)

Summary
Osteoarchaeological study and experimental approach to neurosurgery. Recreation of three cranial surgeries described in historical medical catalogs (Neolithic trepanation, crown-point brace trepanation, and small-drill trepanation) using dissection cadavers and archaeological replica instruments. These trepanations are then characterized from a medical and paleopathological perspective by obtaining and microscopically analyzing high-resolution silicone molds. This allows us to assess the degree of similarity between the trepanations performed and those described in historical catalogs, thus expanding our knowledge of the history of craniotomy and, ultimately, of the history of medicine. This type of microscopic characterization is essential for correctly characterizing not only our experiments but also any trepanation remains found in the future.

Direction
SUAREZ QUINTANILLA, JUAN ANTONIO (Tutorships)
CAMAROS PEREZ, EDGARD (Co-tutorships)

Court
COSTOYA PUENTE, JOSE ANTONIO (Chairman)
DIEZ ULLOA, MAXIMO ALBERTO (Secretary)
DOMINGUEZ MEIJIDE, ANTONIO (Member)

Summary
Generative artificial intelligence, particularly language models such as ChatGPT and Gemini, is playing an increasingly prominent role in the automated production of content, including clinical and informational documents. This study aimed to analyze and compare the content quality and readability of four documents commonly used in pediatric dental practice: an informational poster, a document on pacifier use, an informed consent form, and a clinical protocol. For each document, three versions were evaluated: the institutional version and two generated by ChatGPT and Gemini. Content quality was assessed by five experts using a four point scale, while readability was measured using the Fernández Huerta and INFLESZ indices. The results showed that the AI generated versions, especially those produced by Gemini were able to achieve levels of quality comparable to the reference documents. ChatGPT yielded better results in brief informational documents aimed at the general public, while Gemini demonstrated greater conceptual consistency in complex clinical texts. In terms of readability, the institutional documents were more accessible in normative and legally sensitive formats, whereas the AI generated versions stood out for their clarity in shorter texts. These findings suggest that language models can play a valuable complementary role in the drafting of health related materials, particularly in educational or informational contexts. However, their use requires expert review and a regulatory framework to ensure the quality, accuracy, and safety of the information conveyed.

Direction
Limeres Posse, Jacobo (Tutorships)
VARELA ANEIROS, IVAN (Co-tutorships)

Court
SEOANE LESTON, JUAN MANUEL (Chairman)
LIÑARES GONZALEZ, ANTONIO (Secretary)
MAREQUE BUENO, SANTIAGO (Member)

Summary
Introduction: Multiple Myeloma is a complex hematological malignancy characterized by the uncontrolled proliferation of malignant plasma cells in the bone marrow. Chimeric Antigen Receptor T-cell (CAR-T) therapy involves the genetic reprogramming of T lymphocytes to target tumor cells expressing specific antigens. This approach has emerged as a powerful alternative, particularly for patients refractory to conventional treatments. In addition to assessing clinical efficacy and adverse effects, this systematic review explores the current challenges and future research prospects in this innovative immunotherapy. Main Objective: The aim of this systematic review is to explore recent and relevant studies on the efficacy of CAR-T therapy, focusing on clinical outcomes, safety profile, and advancements in its development, as well as to understand and delve deeper into the heterogeneity and behavior of Multiple Myeloma. Material and methods: A systematic review is conducted to assess the available evidence on the efficacy and safety of CAR-T therapy in patients with refractory or relapsed multiple myeloma, following the guidelines of the PRISMA framework (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), ensuring a structured and transparent methodology in the selection, analysis, and synthesis of the included studies. A literature search was conducted in the Medline database, using its main search engine PubMed, as well as Dialnet, Cochrane, and SciELO. Outcomes: In recent years, CAR-T therapy has gained prominence for its ability to specifically target malignant cells, achieving significant remission rates in patients with refractory disease. Despite the observed benefits, CAR-T therapy faces significant limitations, such as severe side effects, notably cytokine release syndrome and neurotoxicity, which restrict its widespread applicability and highlight the need for specialized management. Conclusion: The findings presented may contribute to improving clinical protocols and consolidating the role of CAR-T therapy in the treatment of multiple myeloma, as it has shown remarkable results in improving response rates. However, significant challenges related to its safety remain. This research aims to provide clarity on the feasibility of this therapeutic strategy in a challenging clinical context, highlighting its potential impact on the management of Multiple Myeloma.

Direction
POSE REINO, ANTONIO DOMINGO (Tutorships)
González Pérez, Marta Sonia (Co-tutorships)

Court
MUÑOZ PATIÑO, ANA MARIA (Chairman)
Portela Romero, Manuel (Secretary)
Aran Echabe, Eduardo (Member)

Summary
Introduction: Hearing loss and cognitive decline represent one of the main public health challenges in our society. These are two conditions that have significant medical, social, and economic consequences due to their close relationship with the aging population. Therefore, adequate prevention, diagnosis, and treatment are important. Objective: The objective of this literature review is to analyze the relationship between hearing loss and cognitive decline, determine whether the correction of hearing loss reduces or improves cognitive decline, and identify the most effective strategies as a preventive measure against cognitive decline. Materials and methods: A literature search was conducted in two databases: PubMed and Web of Science. Consequently, 108 articles were found that met the inclusion criteria described in this review. Results: After the selection process, 11 articles were selected for this review because they met the proposed objectives. These articles discussed the hypotheses about the mechanisms of association between hearing loss and cognitive decline, therapeutic strategies options, and their effectiveness. Conclusions: Hearing loss and cognitive decline have been shown to have a significant relationship, but due to a lack of research, the mechanism of association between them remains unclear. Hearing aids and cochlear implants, along with other preventive measures, have their benefits, but it is still unknown whether correcting hearing loss reduces or improves the development of cognitive decline. For this reason, it is essential to promote research in this area and conduct a greater number of trials to answer these questions.

Direction
SOTO VARELA, ANDRES (Tutorships)
LIROLA DELGADO, ANTONIO GUSTAVO (Co-tutorships)

Court
COUCE PICO, MARIA DE LA LUZ (Chairman)
Eirís Puñal, Jesús Manuel (Secretary)
Cimadevila García, Antonio (Member)

Summary
Introduction: Alcohol relapse affects graft and liver transplant recipient survival. The average rate has been estimated at 22% for general relapse and 14% for severe relapse. Alcohol related cirrhosis on the liver graft has a very poor prognosis in the medium term. Aim: 1.- To establish the post-transplant alcohol relapse rate among patients who underwent liver transplantation in our institution: Complejo Hospitalario Universitario de Santiago (CHUS). 2.-To assess the impact that recurrence has on survival. 3.-To identify the sociodemographic and medical variables associated with recurrence. Methods: A retrospective study was carried out in the ONT database from July-1994 to December-2022 corresponding to CHUS. Post-transplant alcohol relapses were defined as mild, moderate or severe according to the impact on liver function and survival. In addition, an analysis of sociodemographic and medical variables associated with relapse was performed. Results: A total of 503 patients diagnosed with alcoholic cirrhosis at the time of transplantation were included. The relapse rate was 13.4%. Relapse is more common in younger patients and there are no differences with gender, previous psychiatric visit or presence of hepatocarcinoma. Hepatic complications are the main cause of death in relapsing patients. The median survival in our series was 13.55 years. Severe relapse drops the rate to 10.07 years. Conclusions: In our series the general recurrence was 13%. The severe recurrences decrease the overall survival by 4 years.

Direction
TOME MARTINEZ DE RITUERTO, SANTIAGO JOAQUIN (Tutorships)

Court
CORDERO SANTAMARIA, OSCAR JAVIER (Chairman)
ABDULKADER NALLIB, IHAB (Secretary)
RODRIGUEZ PEREZ, ANA ISABEL (Member)

Summary
Study type: Literature review. Introduction: Pulmonary hypertension (PH) is defined by a mean pulmonary arterial pressure (mPAP) greater than 20 mmHg, measured by right heart catheterization. Depending on the etiology, hemodynamic profile, and clinical characteristics, it can be classified into 5 groups. Pulmonary arterial hypertension (PAH) belongs to group 1, and chronic thromboembolic pulmonary hypertension (CTEPH) to group 4. PAH is a chronic progressive disease characterized by an increase in pulmonary vascular resistance (PVR) and mean pulmonary arterial pressure, leading to progressive overload of the right ventricle and, subsequently, its dysfunction. PAH is a rare disease with an estimated prevalence in various registries ranging from 15 to 26 cases per million inhabitants. Despite improvements in pharmacological treatment, PAH remains a disease associated with high morbidity and mortality, with a 5 year survival rate of 65% in our setting. Lung transplantation is indicated in cases of patients with severe PAH refractory to pharmacological treatment and in CTEPH that cannot be treated with pulmonary thromboendarterectomy, or when residual PH persists after the procedure and continues to progress. Objectives and methods: The objective of this study was to review the available scientific literature on lung transplantation in patients with pulmonary arterial hypertension, especially in group 1 (idiopathic, heritable, connective tissue disease associated, etc.) and group 4 (chronic thromboembolic pulmonary hypertension). A bibliographic review was conducted through a search in PubMed between 2014 and 2025. Original studies were included if they analyzed adult patients with confirmed PAH diagnosis undergoing bilateral lung or heart and lung transplantation and reported relevant clinical data. Studies were excluded if they involved pediatric patients, single lung transplants, or lacked transplant/PAH related clinical variables. A total of 15 studies met the inclusion criteria. Results: Most transplanted patients had idiopathic or heritable PAH, with a mean age of 41.9 years and female predominance. Bilateral lung transplantation was the most used technique (94%). Hemodynamic parameters showed a mean mPAP of 58.6 mmHg, elevated PVR (more than 10 Wood units), and low pulmonary capillary pressure, consistent with a precapillary PAH profile. ECMO was frequently used postoperatively. Postransplant survival was 93.4% at 30 days, 91.3% at 90 days, 84.6% at 1 year, and 50% at 5 years. Conclusion: Lung transplantation is a valid therapeutic option for patients with advanced PAH refractory to medical treatment. Hemodynamic profile, age, and PAH subtype influence prognosis and transplant eligibility. While short and midterm outcomes are encouraging, long term survival remains a challenge. The limited number of focused studies highlights the need for more specific and methodologically robust research.

Direction
González Barcala, Francisco Javier (Tutorships)
Otero González, María Isabel (Co-tutorships)

Court
Martín Martín, Carlos Santiago (Chairman)
PEÑA GIL, CARLOS (Secretary)
LOPEZ LOPEZ, ANDREA (Member)

Summary
Psychotic disorders represent one of the most severe forms of mental illness. They typically begin in adolescence or early adulthood and are associated with substantial personal suffering, functional impairment, and economic burden. Childhood maltreatment (including physical, sexual, emotional abuse, neglect, and bullying), is a social problem that affects millions of children worldwide and has long-term negative consequences for their health and well-being of its victims. The relationship between these two has been the subject of numerous studies, which suggest that individuals who experience some form of trauma during childhood may have a significantly increased risk of developing a psychotic disorder.

Direction
OLIVARES DIEZ, JOSE MANUEL (Tutorships)
Cruz Dávila, Alberto de la (Co-tutorships)

Court
FRAGA RODRIGUEZ, MAXIMO FRANCISCO (Chairman)
ARROJO ROMERO, MANUEL (Secretary)
SÁNCHEZ SELLERO, INÉS (Member)

Summary
The West Nile Virus (WNV) is an Arbovirus belonging to the Flaviviridae family, with the mosquito of the Culex family as its primary vector. Generally, in immunocompetent individuals, it presents as a febrile syndrome or in asymptomatic forms. However, immunocompromised patients represent a vulnerable group and are at higher risk of developing severe clinical forms, such as meningitis or encephalitis, which has been associated with increased morbidity and mortality. The study's objective is to conduct a systematic review to characterize WNV infection in immunocompromised patients, analyzing clinical, diagnostic, therapeutic, and prognostic aspects based on the type and degree of immunosuppression. To achieve this, a bibliographic search was performed in the PubMed database. For the search, the keywords “West Nile Virus” and “immunosuppression” were used, combined with the Boolean operator “AND.” Articles published up to December 31, 2024, were identified; the search was limited to adult patients. Fifteen articles describing cases of WNV infection were included, covering patients with solid organ transplants (with kidney transplant being the most frequent), patients with hematological malignancy, patients with multiple sclerosis, and one patient with solid organ cancer. The most frequent clinical presentation was neuroinvasive disease, although cases of WNV fever or even asymptomatic patients have been described. The diagnostic methods used were serology, in both serum and CSF, and molecular diagnosis. Treatment primarily involved supportive therapy and intravenous immunoglobulins. Recovery with neurological sequelae and death were frequent.

Direction
PERNAS SOUTO, BERTA (Tutorships)

Court
GARRIDO GIL, PABLO (Chairman)
GARCIA SEARA, FRANCISCO JAVIER (Secretary)
VALENZUELA LIMIÑANA, RITA (Member)

Summary
Introduction: A woman’s experience during childbirth can have lasting effects on her mental health and perception of motherhood. Although digital vaginal examination is widely used to assess labor progress, it is often perceived as invasive, painful, and lacking respect for the woman's privacy. In contrast, intrapartum ultrasound has emerged as a less invasive alternative with the potential to improve maternal experience. Objective: To review and synthesize the scientific literature regarding maternal perception of intrapartum ultrasound as a method for assessing labor progress, compared to digital vaginal examination. Methods: A systematic review was conducted following PRISMA guidelines. The search was carried out in the Medline/PubMed database, selecting studies published between 2013 and 2025 that explored the subjective experiences of women evaluated with ultrasound during the second stage of labor. Results: After screening and critical appraisal, six studies were included, comprising a total of 732 participants. Conclusions: Intrapartum ultrasound was consistently perceived more positively than digital vaginal examination: as less painful, less invasive, more respectful of privacy, and associated with greater overall satisfaction. These findings support its implementation as an effective and better-tolerated technique, contributing to more respectful, woman-centered obstetric care.

Direction
ARIAS BALTAR, MARIA EFIGENIA (Tutorships)
DUEÑAS CARAZO, MARIA BEGOÑA (Co-tutorships)

Court
Martín Martín, Carlos Santiago (Chairman)
PEÑA GIL, CARLOS (Secretary)
LOPEZ LOPEZ, ANDREA (Member)

Summary
Anaplastic thyroid carcinoma (ATC) is an undifferentiated tumor derived from the thyroid follicular epithelium and is one of the most aggressive human cancers, with a disease-specific mortality rate close to 100%. Due to its rapid progression, early diagnosis is essential. Recent advances in understanding the molecular and genetic basis of ATC have revealed new therapeutic targets. This systematic review analyzes current evidence on targeted therapies for ATC and their impact on patient morbidity and mortality.

Direction
VIDAL PARDO, JOSE IGNACIO (Tutorships)

Court
AGUILAR BLANCO, MARIA FE (Chairman)
BALEATO GONZALEZ, SANDRA (Secretary)
SOPEÑA PEREZ-ARGÜELLES, BERNARDO (Member)

Summary
Uveal melanoma (UM) is the most common intraocular malignant tumor in adults. It is characterized by a high metastasis rate, primarily hepatic metastases, which critically impacts the prognosis and survival of patients. Despite advances in diagnosis and local treatment, identifying non-invasive biomarkers to assess the risk of metastasis remains a key challenge in the management of this disease. A potential biomarker is the ME20S (Gp100) protein, which has been detected at elevated levels in the serum of UM patients and may be associated with tumor size and disease progression. At the same time, genetic studies have identified mutations and chromosomal alterations in genes such as BAP1, GNAQ, and GNA11 in tumor cells, which allow for patient stratification according to metastatic risk. This retrospective observational study includes a series of patients with identified tumor genotypes and their respective blood samples obtained at the time of treatment, along with a 2 to 3 year follow up to assess the risk of metastasis. The main objective of the study is to determine whether there is a correlation between serum levels of ME20S (Gp100) and tumor genetic characteristics in UM patients, evaluating its potential as a prognostic biomarker. The secondary objectives are to examine the association between serum levels of ME20S and mutations or chromosomal alterations in these patients, and to correlate ME20S levels with clinicopathological features such as tumor size and the risk of future progression to metastasis.

Direction
Bande Rodríguez, Manuel Francisco (Tutorships)
RODRIGUEZ ARES, MARIA TERESA (Co-tutorships)

Court
DOMINGUEZ MUÑOZ, JUAN ENRIQUE (Chairman)
Fernández Rodríguez, Mª Isabel (Secretary)
SANCHEZ IGLESIAS, SOFIA (Member)

Summary
Introduction: Neonatal screening is a process carried out for the early identification of disorders in newborns, enabling early diagnosis and treatment, as well as long-term follow-up. From its origin to the present day, a period spanning more than fifty years, it has evolved significantly, and today it includes the detection of metabolic, endocrine, immunological, and hematological disorders. Currently, in Spain, around 400,000 children benefit from these programs each year, making it a key tool in preventive medicine. Objectives: The main objective of this work is to present the different screening processes and their current relevance, as well as their evolution over the years, comparing their implementation across different periods (until 1999, from 2000 to 2015, and from 2016 to 2024). Methods: For the systematic review, the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, updated in 2020, were used as a reference. Several databases were used to gather information, including Dialnet, Cochrane Library, and PubMed, based on different inclusion and exclusion criteria. Additionally, other bibliographic sources, articles from the Ministry of Health, and institutional documents related to neonatal screening in Spain were used to include some articles. After manual review, 10 articles were finally included out of the 7421 articles identified in the search, published between January 1, 1960, and December 31, 2024. Results: The review shows that neonatal screening has significantly improved the early detection of treatable metabolic and genetic diseases, largely thanks to technological advances such as tandem mass spectrometry, which has enabled early interventions that reduce infant morbidity and mortality. Conclusions: This systematic review highlights the crucial role of neonatal screening in the early detection of metabolic and genetic diseases, which has significantly improved children's health and quality of life. Moreover, the incorporation of technologies such as tandem mass spectrometry and genetic analysis has expanded the scope of screening, allowing for the identification of more treatable conditions at very early stages. On the other hand, despite its benefits, challenges remain, including false positives and negatives, as well as disparities between countries in access to the system. The need to continue investing in research and professional training, as well as in educational strategies for parents, is emphasized.

Direction
COUCE PICO, MARIA DE LA LUZ (Tutorships)
Martín López-Pardo, Beatriz María (Co-tutorships)

Court
FRAGA RODRIGUEZ, MAXIMO FRANCISCO (Chairman)
ARROJO ROMERO, MANUEL (Secretary)
SÁNCHEZ SELLERO, INÉS (Member)

Summary
Introduction: Crohn's disease is defined as a chronic intestinal inflammation of unknown cause, characterized by flare-ups and remissions. This disease has no curative treatment; however, there have been advances in the control and prevention of flare-ups thanks to biological therapies, which have become the main treatment in advanced disease therapy. Objectives: This study aims to evaluate the current clinical and biological response to the advanced treatment used in an inflammatory bowel disease unit over the past year. Patients and Methods: The study includes all patients from the Inflammatory Bowel Disease Unit at CHUAC who either started or changed advanced treatment during 2023. The patient group was followed prospectively, collecting clinical activity data (PRO2) and biological data (CRP and fecal calprotectin), in addition to noting whether corticosteroid treatment was needed. A PRO2 less than 8 and normalization of CRP and fecal calprotectin will define clinical and biological remission of the disease. Results: A total of 71 patients were studied. Of these, 38 were naïve, meaning they had not previously received advanced treatment (53.52%). The median follow-up was 52 weeks (IQR 24-70). At week 12, steroid-free remission was observed in 40 patients (56.33%) and deep (clinical and biological) steroid-free remission in 26 patients (36.62%). At week 52, steroid-free remission was observed in 41 patients (57.75%) and deep steroid-free remission in 32 patients (45.07%). Conclusion: In this real-life study, we observed that advanced therapy is an effective therapeutic option for Crohn's disease. The clinical remission achieved through these drugs increases the likelihood of maintaining it long-term.

Direction
DELGADO BLANCO, MANUEL BENJAMIN (Tutorships)
Diz-Lois Palomares, María Teresa (Co-tutorships)

Court
LIMA RODRIGUEZ, LUIS JESUS (Chairman)
PALLAS PALLAS, ESTRELLA (Secretary)
VARELA LEMA, MARIA LEONOR (Member)

Summary
BACKGROUNG: Smoking is one of the leading causes of morbidity and mortality worldwide. Despite the decline in its prevalence thanks to preventive strategies, it continues to be a major public health challenge due to its addictive nature and the difficulties in quitting. Evaluating the efficacy and safety of available treatments is key to improving quit rates and the quality of life of smokers. OBJECTIVES: To analyse the efficacy and safety of the main drugs used for smoking cessation based on a systematic review of the scientific literature. METHODS: A literature search was conducted in PubMed, Scopus and WOS for systematic reviews and experimental studies published in the last 10 years. RESULTS: Out of 434 studies found, 9 were included in the review. Drug treatments such as varenicline, cytisine, bupropion and nicotine replacement therapy (NRT) were shown to be effective and safe, significantly increasing abstinence rates compared to placebo. Varenicline and NRT combinations were the most effective. Cytisine showed promising results. Although bupropion is useful, its efficacy is lower than that of other first-line treatments. Also, the combination of different therapies may offer additional benefits. CONCLUSIONS: This work suggests that smoking cessation medications have been shown to be effective in increasing quit rates, with favourable safety profiles.

Direction
Sousa Regueiro, María Dolores (Tutorships)
Iglesias Francesch, María Belén (Co-tutorships)

Court
Martín Martín, Carlos Santiago (Chairman)
PEÑA GIL, CARLOS (Secretary)
LOPEZ LOPEZ, ANDREA (Member)

Summary
Introduction: Haematological neoplasias have a high incidence and mortality, with an increasing number of patients requiring ICU admission. Although survival has improved thanks to advances in intensive care and oncological treatments, the administration of chemotherapy in this context remains controversial. Doubts persist about its safety and effectiveness in critically ill patients, so it is necessary to review the current evidence to guide clinical practice. Objectives: To evaluate the appropriateness of the use of chemotherapy in patients with haematological malignancies admitted to the ICU. In addition, prognostic factors, possible complications and long-term results associated with this intervention are analysed. Methodology: A systematic review was carried out following the PRISMA protocol. Studies published in English or Spanish in the last 25 years that analysed patients with haematological neoplasias treated with chemotherapy during their stay in the ICU were included. The search was carried out in PubMed, Scopus and Google Scholar. A total of 14 studies were finally selected. Results and discussion: The most frequent diseases in the ICU were acute leukaemia and non-Hodgkin's lymphoma, mostly treated with urgent chemotherapy and with curative intent. The main reasons for admission to the ICU were respiratory failure, septic shock and haematological complications. ICU mortality ranged from 12% to 48%, with a decreasing trend. In contrast, in-hospital and long-term mortality remained high. Factors such as use of life support, organ dysfunction and relapsed disease were associated with worse prognosis, while early admission and response to treatment improved outcomes. Conclusions: ICU chemotherapy may be beneficial in selected patients. Its application should be based on an individualised, dynamic and multidisciplinary assessment, prioritising coordination between haematologists and intensivists

Direction
FREIRE-GARABAL NUÑEZ, MANUEL (Tutorships)
Eiras Abalde, Fernando (Co-tutorships)

Court
ZALVIDE TORRENTE, JUAN BAUTISTA (Chairman)
Anibarro García, Luís (Secretary)
MARTIN CORA, FRANCISCO JAVIER (Member)

Summary
The Streptococcus anginosus group, also known as the Streptococcus milleri group, includes three distinct species: Streptococcus anginosus, Streptococcus intermedius, and Streptococcus constellatus. These species are found as commensals, forming part of the normal flora of the oral cavity, upper respiratory tract, and gastrointestinal tract. In patients with risk factors such as cirrhosis, diabetes, and immunodeficiency syndromes, they can lead to purulent infections, including abdominal abscesses, peritonitis, skin infections, arthritis, osteomyelitis, and empyema. Endocarditis caused by Streptococcus constellatus is extremely rare. In addition to the risk of valve destruction and the appearance of annular complications and embolisms, it has been observed that the polysaccharides of Streptococcus constellatus have the ability to cause platelet aggregation, which can lead to very large vegetations. The treatment of endocarditis caused by Streptococcus constellatus includes the administration of antibiotics and valve replacement surgery, especially in cases of annular involvement or mobile or large vegetations. The review allowed the analysis of 20 articles selected according to the criteria described in the methodology. A clinical case of a patient with endocarditis caused by Streptococcus constellatus is presented.

Direction
Fernández González, Angel Luis (Tutorships)

Court
COSTOYA PUENTE, JOSE ANTONIO (Chairman)
DIEZ ULLOA, MAXIMO ALBERTO (Secretary)
DOMINGUEZ MEIJIDE, ANTONIO (Member)

Summary
Every year, approximately 15 million central venous catheters and over 500 million peripheral venous catheters are placed worldwide, making intravenous therapy an indispensable therapeutic modality in modern medicine. Venous access is no longer limited to the infusion of drugs and blood products; it also allows for the administration of fluids, patient nutrition, and highly precise diagnostic studies through the introduction of contrast agents into the veins. For long-term treatments and in patients with fragile or difficult venous access, such as pediatric patients, the use of venous catheters like Peripherally Inserted Central Catheters (PICCs), midline catheters, or implanted ports becomes particularly important, as they reduce the need for frequent replacements, facilitate outpatient management, and minimize the number of punctures. For the placement of these types of catheters, the use of ultrasound as a supporting tool is increasingly common, helping to minimize procedural risks and facilitating successful placement. Through this project, a didactic overview of some of these catheters, which are in continuous development, will be presented, maintaining anatomical rigor and critically reviewing their limitations, achievements to date, and future challenges. Therefore, the objective of this TFG will be to conduct a literature review to assess the potential benefits of using ultrasound during long-term venous catheter placement in pediatric patients.

Direction
VAZQUEZ LOPEZ, MARIA ESTHER (Tutorships)
Moreno Leira, Daniel (Co-tutorships)

Court
MUÑOZ PATIÑO, ANA MARIA (Chairman)
Portela Romero, Manuel (Secretary)
Aran Echabe, Eduardo (Member)

Summary
This systematic review analyses the efficacy and safety of high-flow oxygen therapy (HFO) in infants under two years of age with acute respiratory failure, comparing it with conventional oxygen therapy (OE) and CPAP. Twenty-two studies published between 2014 and 2024, selected according to PRISMA methodology, were included. The evidence shows that HFO is more effective than EO, reducing treatment failure and improving clinical parameters, especially in mild to moderate conditions. Compared to CPAP, its efficacy is lower in severe cases, although it is better tolerated and requires less sedation. Therefore, HFO is positioned as a safe and useful alternative in a stepwise approach to respiratory support, especially in settings without access to intensive care. In conclusion, HFO offers clinical and logistical advantages over EO, although CPAP remains preferable in severe cases. Individualisation of treatment and further research with studies assessing relevant long-term clinical outcomes.

Direction
AVILA ALVAREZ, ALEJANDRO (Tutorships)
Yáñez Mesía, Sandra (Co-tutorships)

Court
SALAS ELLACURIAGA, ANTONIO (Chairman)
FIGUEROA RODRIGUEZ, JESUS (Secretary)
Aguiar Fernández, Pablo (Member)

Summary
Background: The use of electronic cigarettes (ECs) has increased alarmingly, especially among young people, due to their perception as a less harmful, modern, and socially accepted alternative to conventional tobacco. In Spain, more than half of students aged 14 to 18 have tried them. Objective: To identify the pathologies associated with EC use and propose preventive strategies to reduce its public health impact. Design: Systematic review of the scientific literature. Methods: Systematic review based on studies addressing diseases related to EC use and prevention strategies. Results: EC use has been linked to alterations in multiple body systems. In the respiratory system, mechanisms such as oxidative stress and chronic inflammation contribute to conditions like EVALI, bronchiolitis obliterans, and lung cancer. Cardiovascular effects include endothelial dysfunction, hypertension, and increased risk of ischemic events. Neurologically, nicotine exposure during development has been associated with cognitive impairment, brain development disorders, and addiction. Additional effects have been described in other systems, including insulin resistance, intestinal dysbiosis, uveitis, periodontal disease, and pregnancy complications, even from passive exposure. Moreover, ECs have shown limited effectiveness as a smoking cessation tool, and dual use with conventional tobacco remains a major concern. The most effective preventive strategies include regulating flavors, restricting advertising, raising prices, and implementing early education to challenge the false perception of harmlessness and reduce social normalization. Conclusion: ECs pose a significant risk to public health. Primary care plays a key role in prevention through health education, early detection, and monitoring of adverse effects. Alongside strict regulation and measures to limit access, these actions are essential to reduce their impact and protect vulnerable populations.

Direction
Mosquera Nogueira, Jacinto José (Tutorships)

Court
SEOANE PRADO, RAFAEL (Chairman)
VIDAL MILLARES, MARIA (Secretary)
FIDALGO PEREZ, MIGUEL ANGEL (Member)

Summary
Human endogenous retroviruses, also known as HERVs, they constitute between 5 and 8% of the genome. HERVs are evolutionary remnants of very ancient exogenous infections, having lost their ability to produce clinical manifestations during the course of evolution. In this thesis we will explain what HERVs are, how they were introduced into our genome and their relationship with human diseases. Finally, we will also discuss the possible therapeutic utility they could have in the future.

Direction
AGUILERA GUIRAO, ANTONIO (Tutorships)
Navarro de la Cruz, Daniel (Co-tutorships)

Court
LABANDEIRA GARCIA, JOSE LUIS (Chairman)
FERREIROS LOPEZ, ALBA (Secretary)
TABERNERO DUQUE, MARIA JESÚS (Member)

Summary
Introduction: The neuropathogenic mechanism of many neurodegenerative processes includes protein misfolding and aggregation, which are detectable even in preclinical stages, making them targets for early diagnosis. The RT-QuIC technique, which amplifies pathological proteins, has proven useful in distinguishing them from their native forms with high precision in different biological tissues, providing faster and more cost-effective results than other methodologies.The study of alpha-synuclein, associated with Lewy body disorders, and TDP-43, linked to diseases such as ALS, is key to improving diagnosis and understanding of these diseases, particularly when early detection may allow for disease-modifying treatments that slow progression. Objectives: To compile and synthesize the available evidence on the utility of the RT- QuIC technique in detecting alpha-synuclein and TDP-43, assessing its diagnostic accuracy and comparing it with other techniques, while acknowledging current methodological limitations and future perspectives. Materials and methods: A systematic literature review was performed in accordance with the PRISMA guidelines, based on a bibliographic research in PubMed and the inclusion of two additional articles, using a search strategy designed to prioritize the highest quality evidence. Results: After screening, 30 relevant publications were obtained from PubMed, with two additional articles added for in-depth analysis. Conclusions: RT-QuIC is a promising diagnostic tool for neurodegenerative diseases: high sensitivity and specificity, reproducibility in various biological samples and potential for early and differential diagnosis. However, although already validated for prion diseases, its application to synucleinopathies and other pathologies is still evolving, requiring further optimization for clinical use.

Direction
ARIAS RIVAS, SUSANA (Tutorships)
Minguillón Pereiro, Anxo Manuel (Co-tutorships)

Court
RUANO RAVIÑA, ALBERTO (Chairman)
Gándara Cortés, Marina (Secretary)
VILLAR CHEDA, MARIA BEGOÑA (Member)

Summary
INTRODUCTION: Schizophrenia is a disabling psychiatric illness that affects approximately 24 million people worldwide (0.32% of the population) with variations in incidence between sex and age. Current treatments, while effective against positive symptoms of the disease, are less effective in controlling and relying negative symptoms. In addition, due to the occupation of multiple receptors at the brain level, these drugs have a very negative side effect profile, which generates an abandonment of the medication and, therefore, a relapse. For these reasons, it is necessary to develop new molecules with a different pharmacodynamic profile that also act on negative symptoms while generating a more tolerable profile of side effects. OBJECTIVES: To conduct a systematic review of the current scientific literature that verifies the efficacy of the drugs roluperidone and lumateperone in the treatment of schizophrenia, as well as their side effect profile. MATERIAL AND METHODS: Review of the updated scientific literature following the PRISMA guidelines. Finally, 7 articles related to lumateperone and 8 articles related to roluperidone were selected. Resulting in a total of 15 articles included in this systematic review. RESULTS: Lumateperone has been shown to improve positive symptoms of schizophrenia measured through different scales such as the PANSS or the CGI-S scale at different doses, both in the short and long term. This drug has a very favorable side effect profile, with a very low incidence of extrapyramidal effects, weight gain or lengthening of the QT interval, among others. At the pharmacological level, lumateperone is associated with a lower occupation of the D2 receptor at the brain level, which could explain its acceptable side effect profile. Roluperidone, on the other hand, has clinical trials that offer very disparate data, not statistically significant. It seems that it could be effective against the positive symptoms of the disease, but more scientific evidence is needed to support it. In addition, roluperidone has been associated with worsening symptoms of the disease, calling into question its adverse effect profile. A clinical trial of psychiatric networks suggests that roluperidone could be very effective against abolition, a central symptom whose inactivation could be beneficial in controlling the rest of the symptoms. CONCLUSION: Lumateperone, with greater scientific evidence than roluperidone, has been shown to be a promising therapy for the treatment of schizophrenia, demonstrating control over positive symptoms while maintaining a good side effect profile. Roluperidone, on the other hand, needs more scientific research to support both its effect on disease symptoms and its safety.

Direction
ARROJO ROMERO, MANUEL (Tutorships)
Núñez Sande, Carmen (Co-tutorships)

Court
COSTOYA PUENTE, JOSE ANTONIO (Chairman)
DIEZ ULLOA, MAXIMO ALBERTO (Secretary)
DOMINGUEZ MEIJIDE, ANTONIO (Member)

Summary
INTRODUCTION Hereditary Hemorrhagic Telangiectasia (HHT) is a rare, autosomal dominant disease characterized by vascular malformations (VMs) in various organs. The mutations that cause the disease mainly affect the endoglin gene (ENG), leading to HHT1, and the activin receptor-like kinase 1 gene (ACVRL1), leading to HHT2. Diagnosis is based on the Curacao criteria, with genetic testing providing confirmation. Although clinical variations have been described according to genotype, there is frequent overlap between subtypes. OBJETIVES To determine the most prevalent genotype in HHT patients from the Healthcare Area and assess its association with clinical manifestations. PATIENTS AND METHODS Adult patients (more than 16 years old) with suspected HHT referred to a specific clinic at the Clinical Hospital of Santiago between September 1, 2015, and October 31, 2024, were prospectively evaluated. Those meeting Curacao criteria were included. Clinical, genetic, analytical, evolutionary, and radiological data were collected. RESULTS A total of 34 patients were evaluated, of whom 30 met the criteria for definite HHT, 14 were women (47%). The mean age at diagnosis was 44 years (range: from 7 to 81). 53% had been previously diagnosed. Genetic testing revealed 17 (58%) with ACVRL1 mutation and 10 (35%) with ENG mutation. In 2 cases, the mutation was not previously described. Pulmonary arteriovenous malformations were significantly more frequent in HHT1 (60% vs 18%, p=0,039). Hepatic VMs were present in both HHT1 and HHT2 (50% vs 76%, p=0,17). Pulmonary hypertension (PH) only occurred in patients with hepatic VMs. Mortality in PH was higher (45% vs 19%, p=0,127). CONCLUSIONS HHT2 was the most frequent variant (58%) in our Area. It was associated with more hepatic VMs and PH. Pulmonary VMs were significantly more frequent in HHT1. PH was the main cause of mortality.

Direction
SOPEÑA PEREZ-ARGÜELLES, BERNARDO (Tutorships)

Summary
The purpose of this paper is to analyze the utility of awake craniotomy, a multidisciplinary technique indicated for the treatment of glial tumors located in eloquent areas. Providing a global vision of its benefits, the possible complications, the resection that can be achieved and the surgical technique, as well as a comparison with the alternative approach: surgery under general anesthesia. The preoperative, intraoperative and postoperative evolutions were also studied. The literature review comprehends articles published between 2014 and 2024, and the papers included were reviews, meta-analyses, cohort studies and retrospective studies. A chapter from the book Greenberg’s Handbook of Neurosurgery was also used for an anatomical and functional overview of the mentioned tumor types. For a better understanding of the technique, a clinical case from CHU Vigo was used as an example. The findings obtained from the review indicated a greater extent of resection in awake craniotomy compared to general anesthesia in tumors located in eloquent areas. However, the results regarding overall survival and neurological deficits were heterogeneous. There is no clear standard for exclusion criteria in patients for this surgery, and there are still advances that must be made in terms of intraoperative cognitive evaluation. Most of these studies didn’t evaluate the psychosocial impact these tumors and this surgery have on the patient in the long term. Therefore, awake surgery is an effective and safe technique for treating both low- and high-grade diffuse gliomas located in eloquent brain regions, with good outcomes in morbidity and neurological deficits. Nevertheless, there’s a lack of a specific protocol about this kind of surgery. Currently, the approach is more focused on the patient’s neuroplasticity and the location of the tumor.

Direction
MARTINEZ ROLAN, ROSA MARIA (Tutorships)

Court
COSTOYA PUENTE, JOSE ANTONIO (Chairman)
DIEZ ULLOA, MAXIMO ALBERTO (Secretary)
DOMINGUEZ MEIJIDE, ANTONIO (Member)

Summary
Introduction and objectives: Surgery to treat an intracranial aneurysm is a challenge that requires technical expertise to achieve proximal flow control and maintain it distally after clipping. It is essential to preserve distal flow and avoid both stenosis of the vessel lumen and inadvertently trapping small perforating branches. Various techniques are available to verify adequate distal flow intraoperatively: monitoring tissue oxygen pressure, using a Doppler probe, visualizing intravascular contrast with infrared light, and so on. Objective: The objective of this study is to compare the Doppler probe with the contrast to observe whether there is an equivalence between the two, as well as to demonstrate that the surgical microscope is not an instrument that only allows visualization. Material and methods: A bibliographic review was carried out in search of the most current information on these methods of monitoring cerebral blood flow and subsequently intraoperative data were collected from 3 patients using both techniques to measure distal flows (i.e. M2 in an MCA aneurysm) before and after clip placement. The Transonic Doppler probe consists of a display screen that allows viewing and recording quantitative data (ml/min). Probes of different sizes are available, although the 1.5mm and 2mm probes have been mainly used. The Zeiss Kinevo 900 surgical microscope has an integrated function to visualize indocyanine green, used as an intravascular contrast, using infrared light. Subsequently, using a computer program called Flow 800, the microscope calculates various parameters (delay, intensity, and velocity) and generates a flow map. Discussion: Three cases of incidental intracranial aneurysms were included for analysis with both techniques. After the comparison of both methods it can be observed that they are complementary to each other and useful to improve security in this surgeries

Direction
PRIETO GONZALEZ, ANGEL JESUS (Tutorships)

Court
RUANO RAVIÑA, ALBERTO (Chairman)
Gándara Cortés, Marina (Secretary)
VILLAR CHEDA, MARIA BEGOÑA (Member)

Summary
Respiratory syncytial virus (RSV) is an RNA virus of great relevance in the medical field and healthcare setting, being the leading cause of hospital admission worldwide in patients under two years of age, due to complications such as bronchiolitis and lower respiratory tract infections. The development and implementation of a new monoclonal antibody for preventive use, nirsevimab, brings hope for reducing hospitalization rates and complications associated with RSV infection. This IgG1 monoclonal antibody has affinity for the RSV prefusion protein and binds to it, neutralizing the virus and inhibiting cell-to-cell fusion. General recommendations advise its use in all newborns and infants under 6 months of age during the RSV season, as well as in patients under two years old with underlying risk conditions. Prophylaxis was introduced for the first time in the 2023 immunization schedule in several autonomous communities and different countries around the world, being Galicia a pioneer in the campaign. The objective of this systematic review is to study the impact of nirsevimab and to compare different measures adopted by various communities and countries in relation to international health agency recommendations, as well as to assess its impact in terms of the number of hospitalizations and the severity of episodes.

Direction
MARTINON TORRES, FEDERICO (Tutorships)
MALLAH NASRALLAH, NARMEEN (Co-tutorships)

Court
LIMA RODRIGUEZ, LUIS JESUS (Chairman)
PALLAS PALLAS, ESTRELLA (Secretary)
VARELA LEMA, MARIA LEONOR (Member)

Summary
Background: Pain, according to the International Association for the Study of Pain (IASP), is an unpleasant sensory and emotional experience associated with actual or potential tissue damage. In neonates, its assessment poses a challenge, as they cannot verbalize it and its manifestation is complex. Adequate pain assessment and management in this population have been shown to positively influence neurodevelopment. Objectives: To analyze the effectiveness of two objective tools based on the evaluation of the autonomic nervous system: NIPE (Newborn Infant Parasympathetic Evaluation) and SCR (Skin Conductance Response). Additionally, extrinsic factors influencing the expression and detection of pain and comfort are examined. Methodology: A systematic review of studies published between 2010 and 2025 was conducted using the PubMed database, following PRISMA guidelines. After applying inclusion and exclusion criteria, 33 publications were identified. Results: The results of the systematic review highlight the relevant role of two objective tools in the assessment of neonatal pain: the NIPE index (Newborn Infant Parasympathetic Evaluation) and SCR (Skin Conductance Response). Both tools have been validated and are positioned as complementary methods to traditional behavioral scales, allowing for more precise monitoring of discomfort and pain in neonates. SCR demonstrated high sensitivity in identifying acute painful stimuli, showing immediate increases in skin conductance peaks. NIPE, on the other hand, was associated with the detection of prolonged pain or discomfort, being particularly useful in contexts of sedation or low levels of consciousness, and capable of reflecting comfort states through the analysis of heart rate variability. Since both tools explore different branches of the autonomic nervous system (sympathetic and parasympathetic), their combined use provides a more comprehensive and continuous evaluation of neonatal pain, facilitating individualized and timely clinical decisions. Conclusions: Although there is clear evidence supporting the usefulness of these tools in neonatal pain assessment, further studies including neonates of all gestational ages and analyzing the factors that modulate pain expression are needed, in order to develop comprehensive protocols for diagnosis, treatment, and follow-up.

Direction
COUCE PICO, MARIA DE LA LUZ (Tutorships)
Sevivas , Catarina (Co-tutorships)

Court
Gonzalez Quintela, Arturo (Chairman)
BRAÑAS GONZALEZ, ANTIA (Secretary)
Sierra Paredes, German (Member)

Summary
INTRODUCTION: Pancreatic cancer is the malignant neoplasm with the highest mortality rate in the country. The probability of curative treatment is less than 20% and tumour recurrence occurs in 80% of the cases within two years after surgical resection. Pancreatic head adenocarcinoma is the most common tumour in this location. The initial and most characteristic symptom is abdominal pain, located in the epigastrium which radiates to the lower back. Other common symptoms are weight loss, anorexia, nausea, choluria and hypocholuria. Computed tomography (CT) is the preferred method for diagnostic confimation of pancreatic cancer, with endoscopic ultrasonography (EUS). These tumours are mainly classified into 3 groups: potentially resectable, borderline and unresectable. Currently, surgery is the only curative treatment available for these patients, reserving chemotherapy for more advanced stages. OBJECTIVES: To conduct a systematic review of the literature published to date on the efficacy of neoadjuvant chemotherapy compared to upfront surgery in resectable pancreatic cancer treatment. METHODS: An advanced search was performed in two databases - PubMed and Web of Science - of the current comparative evidence between upfront surgery and neoadjuvant chemotherapy in the specific case of resectable pancreatic tumours. Then, a process of exclusion was conducted, eliminating articles that did not meet our criteria. Study quality was assessed using the Newcastle-Ottawa and Jadad scales. A risk of bias analysis was also carried out using the ROBINS-I and RoB-2 scales. RESULTS: Eleven articles were obtained for the analysis of this systematic review. Five of them are clinical trials, while the remaining six are observational studies. Six of the articles conclude that treatment with neoadjuvant chemotherapy increases overall survival in patients diagnosed with resectable pancreatic cancer, demonstrating differences up to 10 months in contrast to the upfront surgery group. Furthermore, all studies show a significant improvement in terms of R0 resection rate and number of lymph nodes affected after treatment. However, due to the limited evidence provided by these studies, it is difficult to demonstrate whether there are significant differences in disease-free survival or toxicity and adverse effects. CONCLUSION: Neoadjuvant chemotherapy appears to demonstrate an improvement in both patient survival and tumour histological response, with a higher R0 resection rate. However, due to the poor quality of the evidence and the limitations associated with this systematic review, we conclude that further studies are needed to demonstrate and agree on these results.

Direction
DOMINGUEZ MUÑOZ, JUAN ENRIQUE (Tutorships)

Court
SEOANE PRADO, RAFAEL (Chairman)
VIDAL MILLARES, MARIA (Secretary)
FIDALGO PEREZ, MIGUEL ANGEL (Member)

Summary
Glaucoma is an optic neuropathy that is the leading cause of irreversible blindness worldwide. Selective laser trabeculoplasty (SLT) is a treatment option for open-angle glaucoma (OAG) that helps reduce intraocular pressure (IOP) by improving aqueous humor (AH) drainage. It acts selectively on the pigmented cells of the trabecular meshwork (TM) without damaging the surrounding tissues. It is an effective alternative to pharmacological treatment, although its effect may diminish over time, making it necessary in some cases to repeat the procedure or combine it with other treatments.

Direction
RODRIGUEZ ARES, MARIA TERESA (Tutorships)
Prado Rodríguez, María (Co-tutorships)

Court
MARTINEZ OLMOS, MIGUEL ANGEL (Chairman)
GAMBORINO CARAMES, ELENA (Secretary)
Rey Brandariz, Julia (Member)

Summary
Introduction: Paget's disease of the vulva is a non squamous intraepithelial lesion associated with the apocrine structures of the underlying epidermis. It primarily affects patients between the ages of 60 and 70 and is characterized by a very high recurrence rate. Surgery is currently the standard treatment, however, it is aggressive and often not curative, frequently requiring reintervention. Therefore, this paper reviews the existing literature on potential future therapeutic alternatives. Methods: Articles were identified through searches in the PubMed and Cochrane Library databases. Additional publications were added through citation searches and those contributed by reviewers, always meeting the selection criteria. Results: After the search, 9 articles were reviewed, which included analyses of treatments such as topical imiquimod cream (with a complete response rate of 58.8%), surgery (with a 5 year survival rate between 50% and 100% of cases), radiotherapy (with a 5 year survival rate of 53.4%), and other treatments such as photodynamic therapy, immunotherapy, or chemotherapy, with no relevant data. Conclusions: Although surgery remains the most effective treatment nowadays, it is important to research new therapies that could be useful in reducing the recurrence rate and comorbidity associated with surgical techniques.

Direction
LEON MATEOS, LUIS ANGEL (Tutorships)
Palacios Ozores, Patricia (Co-tutorships)

Court
SUAREZ QUINTANILLA, JUAN ANTONIO (Chairman)
ABRALDES LOPEZ-VEIGA, MAXIMINO JOSE (Secretary)
GUDE SAMPEDRO, FRANCISCO (Member)

Summary
Introduction: Lupus nephritis is a severe complication of systemic lupus erythematosus that impairs renal function and increases morbidity. Although conventional therapies (cyclophosphamide and mycophenolate mofetil) have proven effective, they are limited by tolerability and variable response. Tacrolimus, a calcineurin inhibitor, may represent a viable therapeutic alternative; however, the available data remains sparse and heterogeneous. Objectives: To assess the efficacy and safety of tacrolimus in adults with lupus nephritis. Methods: We conducted a systematic review and metaanalysis using PubMed, Embase, Cochrane Library, and Web of Science. Only randomized clinical trials were included, evaluating remission rates, renal and immunological parameters, lupus activity index, and adverse events. Meta-analysis was performed under a random-effects model (DerSimonian-Laird). Clinical response prevalences were pooled as proportions, and continuous outcomes (serum creatinine, proteinuria, urinary protein/creatinine ratio) were expressed as standardized mean differences (SMD). Heterogeneity was assessed with I2 and publication bias was examined via funnel plots and Eggers test. Results: Eight studies including 596 patients were analyzed. Ninety percent of those treated with tacrolimus achieved a favourable clinical response (95% CI: 85-95%) without significant heterogeneity. There was a statistically significant reduction in proteinuria (SMD -2.16; 95% CI: -4.25 to -0.08; p = 0.042) and urinary protein/creatinine ratio (SMD -1.10; 95% CI: -1.37 to -0.82; p menor que 0.001). Serum creatinine remained unchanged. Tacrolimus demonstrated a lower incidence of leukopenia compared to cyclophosphamide, with only mild adverse effects (tremor and hyperglycemia). Conclusions: Tacrolimus is an effective and safe option for treating lupus nephritis. Nonetheless, larger, more diverse, and longer-term studies are needed to strengthen these findings.

Direction
PEREZ PAMPIN, EVA MARIA (Tutorships)
Dos Santos Sobrín, Raquel (Co-tutorships)

Court
AGUILAR BLANCO, MARIA FE (Chairman)
BALEATO GONZALEZ, SANDRA (Secretary)
SOPEÑA PEREZ-ARGÜELLES, BERNARDO (Member)

Summary
Introduction. Long-acting injectable formulations of aripiprazole and paliperidone are two atypical antipsychotics primarily used in the treatment of severe mental disorders. Both drugs are metabolized in the liver by cytochrome P450 enzymes, particularly CYP2D6 and CYP3A4. The marked allelic variability of these enzymes leads to interindividual differences in drug plasma levels, which in turn affects clinical outcomes. The study of genetic polymorphisms affecting these cytochromes contributes to the development of personalized medicine; combined with an injectable administration route, this enhances treatment adherence, reduces relapse rates, and facilitates therapeutic monitoring in patients who have difficulty maintaining daily oral intake. Objective. To assess and compare the clinical response and side-effect profiles of long-acting injectable aripiprazole and paliperidone, in relation to pharmacogenetic profiles and plasma drug concentrations. Materials and Methods. Prospective study involving 84 outpatients undergoing treatment with long-acting injectable aripiprazole or paliperidone in the Santiago de Compostela and Barbanza Healthcare Area. Results. Most patients receiving these treatments experienced side effects, particularly those with slow metabolizer phenotypes for CYP3A4, who are more prone to maintaining elevated drug levels and experiencing a greater number of adverse effects. However, this study did not demonstrate a clear association between CYP2D6 phenotype and increased side effect burden. Both aripiprazole and paliperidone were associated with metabolic syndrome risk factors, such as weight gain and sustained elevations in glucose and glycated hemoglobin (HbA1c) levels. Both medications proved effective, particularly in controlling positive symptoms, though less so for negative symptoms. Nevertheless, significant differences were observed in the Q-LES-Q scores, where quality of life was rated more negatively in patients on paliperidone compared to aripiprazole, which was generally well tolerated despite its side effects. Conclusions. Aripiprazole and paliperidone demonstrated acceptable safety profiles, although the impact of metabolizer phenotype on treatment response must be considered. Alterations in CYP3A4 appear to contribute to greater variability in treatment outcomes than CYP2D6. Aripiprazole was associated with side effects but was effective, well tolerated, and rated positively by patients. Conversely, while paliperidone was also effective, it received lower satisfaction ratings from patients. Therefore, it is essential to further investigate the role of pharmacogenetics in relation to drug plasma concentrations in order to promote a more personalized approach to medicine.

Direction
VIDAL MILLARES, MARIA (Tutorships)
Mondelo García, Cristina (Co-tutorships)

Court
FREIRE-GARABAL NUÑEZ, MANUEL (Chairman)
Barge Caballero, Eduardo (Secretary)
SANTOS PEREZ, SOFIA MARIA SOLEDAD (Member)

Summary
The anterior lumbar interbody fusion (ALIF) surgery is a spinal fusion technique used to treat various lumbar spine pathologies, such as disc degeneration and chronic low back pain. Traditionally, the anterior approach requires the patient to be in a supine position, which allows direct access to the lumbar spine through the abdomen. However, in recent years, the lateral decubitus position has emerged as a promising alternative in certain cases, offering potential benefits in terms of reduced complications, shorter surgical time, and avoiding patient repositioning during surgery. This study aims to analyze the advantages and disadvantages of using the ALIF technique in the lateral decubitus position, evaluating its impact on spinal stability, patient recovery, and the reduction of intraoperative risks. Through a review of the literature and the presentation of a case series, we hope to provide relevant data to assess this novel alternative to a classic approach and the possibility of combining it with other techniques.

Direction
GARCIA GARCIA, MANUEL (Tutorships)
Castro Castro, Julián (Co-tutorships)

Court
GARRIDO GIL, PABLO (Chairman)
GARCIA SEARA, FRANCISCO JAVIER (Secretary)
VALENZUELA LIMIÑANA, RITA (Member)

Summary
Background: The Planetary Health Diet proposes a dietary model that supports both human health and environmental sustainability. However, its implementation may benefit from alignment to existing traditional dietary patterns such as The Atlantic Diet. Objectives: This study had a dual aim: (1) to compare the similarities and differences between the Atlantic Diet and the Planetary Health Diet, and (2) to assess whether a comunity-based nutritional intervention grounded in the traditional Atlantic Diet could improve adherence to the Planetary Health Diet. Methods: A sencondary analysis was conducted using data from the GALIAT clinical trial, which included families from a rural Galician community. The intervention group received dietary counseling, educational materials, and food baskets based on the Atlantic Diet. Adherence to the Planetary Health Diet was measured using a specific index. A linear mixed model was used, adjusted for baseline values, age and sex, with the intervention condition considered as a fixed effect and family clusters as a random effect. Results: After six months, participants in the intervention group showed a significantly greater improvement in adherence to the Planetary Health Diet compared to the control group (adjusted mean difference: 6,1 points; 95% CI: 3,8-8,5; p«0,001). This was due to the increased intake of fruits, vegetables, legumes and fish, along with a reduction in red and processed meat. However, the adherence index did not fully capture some changes specific to the Atlantic Diet, such as the consumption of fermented dairy products or olive oil. Conclusions: A nutritional intervention based on the traditional Atlantic Diet can enhance adherence to the Planetary Health Diet. These findings highlight the value of traditional dietary patterns as culturally viable pathways toward more sustainable food systems.

Direction
GUDE SAMPEDRO, FRANCISCO (Tutorships)
Calvo Malvar, María del Mar (Co-tutorships)

Court
CARRACEDO ALVAREZ, ANGEL MARIA (Chairman)
FERNANDEZ LOPEZ, FERNANDO (Secretary)
RODRIGUEZ ARES, MARIA TERESA (Member)

Summary
Burn injuries represent a global public health problem, with a disproportionately high burden in low- and middle-income countries. These injuries result in significant morbidity, mortality, and disability, particularly affecting children, women, and individuals in vulnerable situations. This study aims to describe the epidemiology, etiology, sequelae, and management of burn injuries in resource-limited settings, and to propose a potential action plan tailored to their socio-economic and healthcare realities. To this end, a systematic review was conducted in accordance with the PRISMA 2020 guidelines, using searches in PubMed, Scopus, and Google Scholar, covering studies published between 2014 and 2025. A total of 22 original articles, 2 databases, and 2 websites of international organizations were selected. The results reveal a high incidence and mortality from burns in these regions, mainly associated with the unsafe use of cooking, heating, and lighting systems, the absence of effective preventive measures, and limited access to specialized medical care. Among the identified shortcomings are the shortage of trained personnel, limited healthcare infrastructure, and the lack of solid epidemiological records. Based on the collected data, an intervention proposal is presented, focused on primary prevention, community education, decentralization of healthcare services, and the adaptation of clinical protocols to low-resource settings. The author's direct clinical experience in a rural area of Guatemala underscores the urgency of implementing context-specific strategies that promote health equity and improve the quality of life for burn patients.

Direction
BREA GARCIA, BEATRIZ (Tutorships)
Fernández Quinto, Alejandro (Co-tutorships)

Court
GARRIDO GIL, PABLO (Chairman)
GARCIA SEARA, FRANCISCO JAVIER (Secretary)
VALENZUELA LIMIÑANA, RITA (Member)

Summary
Introduction: Basal cell carcinoma (BCC) is the most common malignant skin tumor in the Caucasian race. A significant percentage affects the periocular region, conferring a particular risk due to its location. This is where the importance of therapeutic strategies lies. Among them, surgical resection with free margins, Mohs surgery, radiotherapy, topical imiquimod, or photodynamic therapy stand out, among others. However, in cases of locally advanced BCC and in those where ocular involvement may exist, there are available alternatives such as Hedgehog pathway inhibitors: Vismodegib or Sonidegib. Objectives: Review the concept of basal cell carcinoma, its etiopathogenesis, prognostic factors, and focus on the therapeutic strategy for advanced periocular basal cell carcinoma. Materials and methods: A systematic review of publications obtained through the PubMed, Mendeley and Google Scholar platform were conducted, considering only works published since 2013 in English and Spanish. Specific restrictions were applied regarding the type of studies and minimum series size. The abstracts were initially reviewed, and, whenever needed, the full article was analyzed. Results: This systematic review included 10 articles, of which: 3 randomized clinical trials, 1 non- randomized clinical trial, 3 systematic reviews, and 3 retrospective case series. Conclusions: Hedgehog pathway inhibitors have been shown to be effective and safe in the treatment of locally advanced periocular BCC, achieving complete and partial responses over time. Adverse effects are common, mild to moderate, and manageable through therapeutic interruptions, without significant loss of efficacy. However, the lack of direct comparative studies and limited follow-up highlight the need for future research to assess new combined therapeutic strategies and to optimize individualized patient management.

Direction
GONZALEZ GARCIA, FRANCISCO (Tutorships)

Summary
Type of study: Bibliographic review. Introduction: The malignant stroke of the middle cerebral artery (MSMCA) is a kind of massive ischemic stroke. It is usually mortal if it is only treated with conventional medical therapy. If it is not treated its evolution becomes fatal due to the severe ischemia plus the significant mass effect (owing to the intense edema that is been produced). This condition is characterized by the occlusion more than 50% of the middle cerebral artery and also by midline shift due to this occlusion. This pathology presents with a fast progression, leading to symptoms such as neurological deficits, hemiplegia and decreased level of consciousness. Imaging studies play a fundamental role in diagnosis and subsequent patient monitoring. Aim and methods: The main objective from this bibliographic review is to analyze the benefits of the surgical treatment compared to the conventional medical therapy. Besides, to learn its potential complications and the prognosis based on the early diagnosis from this specific stroke. In order to do this, a review of 10 articles have been reviewed. Outcomes: Neurosurgical management should always be considered in this condition. Current available scientific evidence has demonstrated its benefits, including the prevention of potential loss of function in suitable patients. In patients who meet criteria for surgical intervention, isolated medical treatment increases mortality rates and often results in lower scores on prognostic scales assessing neurological deterioration. The combination of both therapeutic approaches, along with management by a multidisciplinary team improve patient survival with preserved functional outcomes and prevent further functional decline. Conclusions: The decision to perform a decompressive hemicraniectomy must be individualized, considering complications, risks and previous patients’ baseline conditions. Post-treatment neurorehabilitation is necessary in order to achieve better outcomes, in terms of autonomy and quality of life. In eligible cases, the use of surgery plus the conventional medical treatment increase survival rates and improve prognosis.

Direction
MARTINEZ ROLAN, ROSA MARIA (Tutorships)

Court
GARRIDO GIL, PABLO (Chairman)
GARCIA SEARA, FRANCISCO JAVIER (Secretary)
VALENZUELA LIMIÑANA, RITA (Member)

Summary
Based on data provided by the Clinical Documentation Service (approved by the Ethics Committee), we conducted a retrospective, hospital-based (2014-2023), observational, and descriptive study of patients admitted to Lucus Augusti University Hospital and discharged with a diagnosis of Lyme disease (LD). The influence of variables (area, habitat, sex, and age) on hospitalization rates/105 inhabitants (HR) was analyzed. Annual HRs (HRa) and specific HRs (HRaE) and their linear trends were calculated, as well as cumulative HRs (HRa) and specific HRs (HRaE). Using G2, the influence of variables on the different HRs was verified. HRa/105h ranged from 6.8/105 h (2014) to 3.3/105 h (2023), with a downward linear trend. The HbA was higher in patients from the Mountains (3.7-18.3/105 h) than in those from the Plateau (2.6-5.7/105 h), in rural areas (3.15-18.3/105 h) than in urban areas (2.2-6.9/105 h), in men (1.9-9.3/105 h) than in women (1.8-4.6/105 h), and in older patients (5.3-14.5/105 h). The HbA was 48.5/105 h and was significantly higher in: residents of the Mountains (108.9/105 h) than in those from the Plateau (39.7/105 h), in rural areas (94.3/105 h) than in urban areas (40.3/105 h), in men (63.9/105 h) than in women (34/105 h) and in older patients (87.3/105 h). Most LD cases were detected between June and November. The 95.2% of LD cases had clinical manifestations affecting only one system. Eighty percent of patients had neuroborreliosis, with meningoradiculitis being the most common presentation (58.3%). 13.3% had cardiac symptoms, with complete atrioventricular block being the most prevalent (57.4%). 10.5% had cutaneous manifestations (82% erythema migrans) and only 0.95% of patients presented with joint symptoms (chronic arthritis). The 3.8% of patients were pediatric, 50% presented with meningitis and facial paralysis, and the remainder presented with erythema migrans (25%) and chronic arthritis (25%).

Direction
VAZQUEZ LOPEZ, MARIA ESTHER (Tutorships)
MORRONDO PELAYO, MARÍA PATROCINIO (Co-tutorships)

Court
Gonzalez Quintela, Arturo (Chairman)
BRAÑAS GONZALEZ, ANTIA (Secretary)
Sierra Paredes, German (Member)

Summary
Introduction: The optimal management of high-grade squamous intraepithelial lesions (CIN2) in young women remains controversial, mainly due to concerns about overtreatment and its reproductive consequences. This systematic review evaluates current evidence on the effectiveness and safety of expectant management or active surveillance of CIN2. Methods: A systematic search was conducted in PubMed and MEDLINE from 2011 to 2024 following PRISMA guidelines. Studies evaluating regression, persistence or progression of CIN2 under active surveillance were included. Meta-analysis was not performed due to clinical and methodological heterogeneity. Results: Sixteen studies involving over 30.000 women were analyzed. Spontaneous regression rates ranged from 20 % to 87 %. Progression to CIN3 ranged from 1,6 % to 30 %, and invasive cancer was extremely rare. Patient selection, follow-up adherence, and factors such as age, HPV type, and smoking status significantly influenced outcomes. Conclusions: Active surveillance is a safe and effective alternative to immediate treatment in selected women with CIN2. It requires appropriate patient selection, structured monitoring, and shared decision-making.

Direction
ARIAS BALTAR, MARIA EFIGENIA (Tutorships)
Castro Díaz, María Covadonga (Co-tutorships)

Court
GARRIDO GIL, PABLO (Chairman)
GARCIA SEARA, FRANCISCO JAVIER (Secretary)
VALENZUELA LIMIÑANA, RITA (Member)

Summary
Artificial Intelligence (AI) has undergone significant developments in recent years and its application in the world of Radiology is now a reality. It poses many challenges, and to address them diligently, it is crucial to understand the perceptions of future professionals. The objective of this study is to evaluate the state-of-the-art, expectations and concerns of medical students and residents in Radiology in this topic. A survey was developed and distributed to this population between January and February 2025. A total of 351 responses were obtained (327 from students and 24 from residents). Participants were classified into three study groups: new students (2nd, 3rd, and 4th years of medical studies), senior students (5th and 6th years of medical studies), and residents. Most participants are optimistic and positive about AI applications in Radiology, and few of them believe that it could replace radiologists. However, a significant percentage of students (49% of the total number of students) do believe that it will reduce their job demands (compared to 25% of the residents’ group). In general, participants do not consider AI a determining factor when choosing Radiology as specialty (more than 70% in all three groups), although residents tend to consider it as a positive factor and students as a negative factor. The level of knowledge about AI is medium-low, which suggests that developing AI training programs at the undergraduate level would be interesting.

Direction
Souto Bayarri, José Miguel (Tutorships)
Barreiro Ares, Andrés (Co-tutorships)

Court
MARTINEZ OLMOS, MIGUEL ANGEL (Chairman)
GAMBORINO CARAMES, ELENA (Secretary)
Rey Brandariz, Julia (Member)

Summary
Pediatric inflammatory bowel disease (PIBD) is a chronic disease of multifactorial etiology characterized by inflammation of the gastrointestinal tract. It presents in the form of flare-ups, and the most common symptoms include abdominal pain, diarrhea and intestinal bleeding, all of which significantly impact patients’ quality of life. Currently, the disease is mainly monitored through invasive procedures such as endoscopy, imaging techniques such as magnetic resonance enterography (ERM) or computed axial tomography (CT) or by capsule endoscopy (CE).

Direction
Concheiro Guisán, Ana (Tutorships)
Mazaira Schreck, Teresa (Co-tutorships)

Court
SALAS ELLACURIAGA, ANTONIO (Chairman)
FIGUEROA RODRIGUEZ, JESUS (Secretary)
Aguiar Fernández, Pablo (Member)

Summary
Introduction: Squamous cell skin cancer is one of the most common neoplasms representing up to 20% of keratinocyte carcinoma. The prognosis is usually favorable, however, in about a 10% of cases the cancer extends to an advanced stage, where the classic treatments fail to erradicate it, creating the need of therapeutic alternatives as inmunotherapy. Methods: A literature search was conducted in Pubmed, Cochrane and Web of Science databases, selecting the ones that included information about the efficacy of the PD-1 inhibitors in the advanced squamous cell skin cancer, based on predifined inclusion and exclusión criteria. Results: A total of 193 articles were found and 12 were included to the review, 3 reported results of Pembrolizumab treatment, 4 reported results of Cemiplimab treatment and 5 reported results of some of these drugs within the same study, all of them included patients with locally advanced/metastatic cSCC. Response and survival rates were favorable and although the inmune related adverse eventes were very frequently observed, they were mostly low-grade ones. Conclusions: PD-1 inhibitors may represent a promising alternative for patients with advanced cSCC due to their efficacy and safety profile, further research and fase III clinical trials are needed to define the role of these inmunotherapy drugs.

Direction
SANCHEZ-AGUILAR Y ROJAS, MARIA DOLORES (Tutorships)

Court
Martín Martín, Carlos Santiago (Chairman)
PEÑA GIL, CARLOS (Secretary)
LOPEZ LOPEZ, ANDREA (Member)

Summary
Spinal tumor pathology is an uncommon finding, but it requires early diagnosis and treatment, which is preferably surgical due to its potential cure. However, surgical approaches to the spinal cord can lead to worse complications than the disease itself, thus minimizing their occurrence remains a key objective in this field. This study examines spinal cord tumors from three distinct perspectives: a bibliographic review to delve into current scientific literature; a descriptive, retrospective, and observational study on CSF leakages in patients from the Neurosurgery Department at Álvaro Cunqueiro Hospital in Vigo; and a case study to illustrate the good practice. This three-pronged approach provides a broad and comprehensive view of this pathology.

Direction
MARTINEZ ROLAN, ROSA MARIA (Tutorships)

Court
DOMINGUEZ MUÑOZ, JUAN ENRIQUE (Chairman)
Fernández Rodríguez, Mª Isabel (Secretary)
SANCHEZ IGLESIAS, SOFIA (Member)

Summary
Epilepsy has two peak incidence periods: childhood and old age. It is important to establish both a syndromic and etiological diagnosis of epilepsy to provide the most appropriate treatment. The most common causes in this age group are structural (cerebrovascular disease, tumours, trauma, etc.), metabolic, toxic, or infectious. In Alzheimer's disease, there is a known higher risk of developing epilepsy than in the general population. There is a group of patients with late-onset epilepsy of undetermined etiology whose onset has been associated with the subsequent development of cognitive impairment. This presen-tation has recently been termed epileptic variant of Alzheimer's disease. Patients do not present with cognitive impairment, but the onset of late-onset epilepsy requires an etiological diagnosis that could allow AD to be detected in the preclinical or earliest stages. Therefore, in the case of late-onset epilepsy of unknown etiology, studies aimed at diagnosing possible Alzheimer's disease should be considered (such as determining AD biomarkers in CSF, looking for decreased levels of Abeta42 and increased of p-tau and/or t-tau). This would allow for an early diagnosis of AD in patients whose only symptom is epilepsy, thereby enabling early initiation of appropriate therapeutic measures. This systematic review aims to study late-onset epilepsy of unknown etiology as a possible presentation of AD onset, reviewing the key pathophysiological aspects of this association.

Direction
ARIAS RIVAS, SUSANA (Tutorships)
Rodríguez Osorio, Xiana (Co-tutorships)

Court
CORDERO SANTAMARIA, OSCAR JAVIER (Chairman)
ABDULKADER NALLIB, IHAB (Secretary)
RODRIGUEZ PEREZ, ANA ISABEL (Member)

Summary
Background: Polycystic Ovary Syndrome (PCOS) is the most prevalent gynaecologic endocrinopathy in women of reproductive age, which also represents the most frequent cause of anovulatory infertility. Although the treatment algorithm for infertility in patients with PCOS is well-defined, the results achieved are not ideal. This makes the search for new treatment strategies that improve the reproductive outcomes of these patients a critical concern. N-acetylcysteine (NAC) is a drug that, thanks to its antioxidant effect, could be used as an adjuvant to current therapies in order to achieve this. Objectives: To evaluate the efficacy of the use of NAC as an adjuvant to clomiphene citrate (CC), and to compare its efficacy with metformin, a drug that is already being used for this purpose. Methods: A systematic review was conducted, following PRISMA guidelines, including clinical trials found in the Cochrane and PubMed databases, involving a total of 6 studies. Results and Conclusions: The results indicate that the use of NAC as an adjuvant to CC could improve both ovulation and pregnancy rates in PCOS patients, therefore improving their reproductive capacity. However, current evidence does not provide sufficient data on the superiority of NAC as an adjuvant compared to metformin.

Direction
ARIAS BALTAR, MARIA EFIGENIA (Tutorships)
Vázquez Del Río, Patricia (Co-tutorships)

Court
ZALVIDE TORRENTE, JUAN BAUTISTA (Chairman)
Anibarro García, Luís (Secretary)
MARTIN CORA, FRANCISCO JAVIER (Member)

Summary
Introduction: Juvenile systemic sclerosis (jSSc) is a rare immune-mediated connective tissue disease of unknown etiology and heterogeneous clinical presentation, primarily affecting girls. Its low prevalence, insidious onset, and nonspecific symptoms pose even greater diagnostic and therapeutic challenges than in adults. Initial symptoms may be subtle and often overlap with other autoimmune diseases, contributing to significant diagnostic delays, estimated between 0.7 and 2.8 years. The pathophysiology of the disease involves vascular dysfunction, immune system activation, and progressive fibrosis, leading to multisystemic involvement. Interleukin 6 (IL-6) plays a key role as an inflammatory mediator and fibrosis promoter. The broad clinical heterogeneity complicates disease management, and current treatments are limited to symptom control and managing associated complications. A better understanding of etiopathogenic mechanisms has paved the way for the development of biological therapies, such as tocilizumab, a humanized recombinant IgG1 monoclonal antibody targeting the IL-6 receptor, which shows promise for use in pediatric populations. Objective: To analyze the clinical efficacy of tocilizumab (TCZ), an IL-6 inhibitor, in the management of pediatric patients with jSSc. Materials and Methods: A systematic literature review was conducted using the databases Medline, Embase, Cochrane Library, and Web of Science. The results were synthesized using various meta-analyses under a random effects model. Results: A total of 1481 articles were identified, of which 5 met the inclusion criteria. A non-significant improvement in mean mRSS was observed [SMD -0.677; 95% CI -1.394 to 0.039; p = 0.064], along with a non-significant reduction in mean mLoSSI [SMD -0.809; 95% CI -2.650 to 1.031; p = 0.389]. For the Patient Global Assessment (PGA), a non-significant improvement trend was also noted [SMD -1.058; 95% CI -2.162 to 0.045; p = 0.060]. However, the proportion of patients showing improvement indicated a significant decrease in PGA in 93% of cases (95% CI 75%-100%). Regarding pulmonary function, 39% of patients showed improvement in FVC and DLCO (95% CI 20%-59%), and 52% demonstrated radiological improvement in high-resolution CT scans (95% CI 34%-69%). Conclusion: Tocilizumab may help delay functional decline in interstitial lung disease associated with jSSc, with potential additional benefits in skin involvement and overall patient status. Despite limitations and the small number of available studies, the results are promising and support the need for controlled clinical trials in pediatric populations to confirm its efficacy.

Direction
PEREZ PAMPIN, EVA MARIA (Tutorships)
MANEIRO FERNANDEZ, JOSE RAMON (Co-tutorships)
Dos Santos Sobrín, Raquel (Co-tutorships)

Court
SEOANE PRADO, RAFAEL (Chairman)
VIDAL MILLARES, MARIA (Secretary)
FIDALGO PEREZ, MIGUEL ANGEL (Member)

Summary
Introduction and Objectives: Extracorporeal membrane oxygenation (ECMO) has become a routine tool for life support and organ maintenance. Over the years, its applications have expanded, evolving from a technique limited to the field of cardiac surgery to a mechanism for organ protection in transplantation and respiratory support during the Covid-19 pandemic. This undergraduate thesis aims to provide a historical review of the principles of ECMO therapy and the evolution of its applications. Additionally, it descriptively presents the experience of the past eight years in our center, analyzing a database compiled from ninety-one ECMO records collected by the Perfusion Nursing Service. Access to clinical data was anonymized by a third party unrelated to this thesis. This review aims to offer a comprehensive overview of ECMO indications, applied techniques (venoarterial, venovenous), therapy duration, and patient outcomes (survival). Materials and Methods A retrospective descriptive study was conducted based on the analysis of 91 reports prepared by the Perfusion Nursing Service, corresponding to patients who underwent extracorporeal membrane oxygenation (ECMO) at the University Clinical Hospital of Santiago de Compostela from 2017 onwards, previously anonymized by a third party. The collected reports hold information on patients' quantitative and qualitative variables (weight, height, age, gender, diagnosis) as well as data on the perfusion system, including cannulation type, use of vasoactive agents, transfusion requirements, distal perfusion needs, and various complications or specific characteristics of each case. Results: A total of 91 patients treated with ECMO over eight years were analyzed. VA support was used in 74.7% of cases. Main indications were cardiac pathologies in VA and respiratory infections in VV. Bleeding and distal perfusion were more frequent in VA. Duration was longer in VV (median 6 vs. 4 days). Global mortality was 39.6%, with no significant differences by type. Transfusion, vasoactive drugs, and age were associated with higher mortality. Conclusions: ECMO is a valuable tool for advanced life support. In this study, VA type was most common. Overall mortality was 39.6%. Transfusion, vasoactive drug use, and advanced age were linked to worse outcomes. The type of support should be tailored to the patient's clinical profile. Multivariate analysis confirmed age as an independent predictor of mortality, with an odds ratio of 1.05 per year of age.

Direction
VEIRAS DEL RIO, SONIA (Tutorships)
Barreiro García, María Alejandra (Co-tutorships)

Court
SALAS ELLACURIAGA, ANTONIO (Chairman)
FIGUEROA RODRIGUEZ, JESUS (Secretary)
Aguiar Fernández, Pablo (Member)

Summary
Introduction: Artificial intelligence and Clinical Decision Support Systems (CDSS) are technological tools poised to transform healthcare service delivery and medical practice. Objectives: This work provides an overview of the role of CDSS in improving the management of patients with ischemic heart disease, analyzing the state of the art and their potential impact on clinical care. Methodology: First, a scientific literature review was conducted to identify experiences regarding the clinical benefit of CDSS in the cardiovascular field. Then, the commercial knowledge-based system Naevia Medical was used to perform a preclinical validation on fictional cases of patients after an acute coronary syndrome. The system’s behavior in generating diagnostic and therapeutic recommendations was evaluated. Finally, the potential impact of CDSS on improving adherence to scientific recommendations, care quality, and reduction of preventable medical errors was discussed. Results: A systematic review of 34 scientific articles on CDSS was conducted, along with a study of 19 fictional patient cases. The performance of the artificial intelligence was assessed according to clinical practice guideline recommendations. Conclusions: Despite some limitations, most studies show that CDSS have a positive clinical impact, improving adherence to clinical practice guidelines, medication optimization, and the reduction of cardiovascular complications.

Direction
PEÑA GIL, CARLOS (Tutorships)

Court
LIMA RODRIGUEZ, LUIS JESUS (Chairman)
PALLAS PALLAS, ESTRELLA (Secretary)
VARELA LEMA, MARIA LEONOR (Member)

Summary
Nephrotic syndrome is a clinical-analytical entity that serves as a common final pathway for a broad spectrum of diseases centered around the renal glomerulus. The diagnosis of these diseases relies primarily on the anatomopathological interpretation of samples obtained through kidney biopsy. However, advances in the understanding of the pathophysiology of glomerulopathies have opened the door to the serological detection of specific antibodies as a complement or even an alternative to biopsy. This systematic review aims to explore in depth the diagnostic and follow-up role of anti-nephrin antibodies detected in the serum of adult and pediatric patients (both with native and transplanted kidneys) with podocytopathy diagnosed by biopsy.

Direction
CORDAL MARTINEZ, TERESA (Tutorships)
Rodríguez Magariños, Catuxa (Co-tutorships)

Court
FREIRE-GARABAL NUÑEZ, MANUEL (Chairman)
Barge Caballero, Eduardo (Secretary)
SANTOS PEREZ, SOFIA MARIA SOLEDAD (Member)

Summary
Introduction: Patients who have experienced an Acute Coronary Syndrome (SCA) are at a higher risk of developing new cardiovascular events. To prevent this, cardiac rehabilitation programs (RHBc), based in specialized centers have been developed and have demonstrated a reduction in the incidence of such events. However, these models face significant limitations in achieving universal inclusion of these patients and ensuring proper adherence to the programs. As a result, alternative models, many of them remote, have been proposed to overcome these barriers. Objective: To compare whether a remote RHBc program based on a voice-operated Artificial Intelligence (IA) chatbot for patients who have suffered an SCA is superior to a conventional program in terms of cardiovascular mortality and hospital admissions. The latter is defined as a composite of hospitalizations due to any of the following: heart failure, recurrent SCA, or stroke. Materials and Methods: An open-label, evaluator-blinded randomized clinical trial, in which patients will be allocated to either an intervention group or a control group (conventional program). The intervention group will receive a remote, personalized RHBc program based on IA, delivered through a voice-controlled chatbot, addressing five key areas: diet, physical activity, cessation of harmful substances, adherence to medical treatment, and emotional well-being.

Direction
Barge Caballero, Eduardo (Tutorships)
Aldama López, Guillermo (Co-tutorships)

Court
FRAGA RODRIGUEZ, MAXIMO FRANCISCO (Chairman)
ARROJO ROMERO, MANUEL (Secretary)
SÁNCHEZ SELLERO, INÉS (Member)

Summary
- Introduction: Quality in the field of sedation is defined as the degree to which sedative procedures comply with established clinical standards, ensuring optimal outcomes in terms of safety, pharmacological efficacy, anxiety control, patient comfort, and minimization of adverse events. It also encompasses continuous monitoring of vital signs, the training and competencies of involved professionals, and the ongoing improvement of care processes. In this paper, in addition to evaluating the quality of sedation practices, a practical example is included in which the safety culture is analyzed within the context of sedation procedures performed at a Galician hospital accredited by the Joint Commission, whose seal represents a benchmark in healthcare quality. - Objectives: This systematic review aims to analyze the current quality of sedation procedures based on three key dimensions: process effectiveness, safety through the analysis of adverse events, and the degree of satisfaction reported by patients and/or endoscopists responsible for the procedure. - Materials and Methods: A systematic review was conducted following PRISMA guidelines, including clinical trials and prospective observational studies published between 2020 and 2025. The sedation procedures analyzed had to be performed within the hospital setting but outside the operating room, and administered by anesthesiologists. Pregnant women, pediatric patients, and individuals with a specific underlying condition were excluded. - Results: The initial search yielded a total of 5.350 articles. After removing duplicates and applying inclusion and exclusion criteria, 40 studies remained. These were thoroughly reviewed, and 14 were ultimately included in the analysis. The results were promising in terms of quality. No serious adverse events compromising patient health were reported; complications varied depending on the sedative agents used but were manageable by the anesthesiologists involved. The effectiveness of sedation was good and generally allowed the procedures to be completed successfully. Additionally, satisfaction reported by both physicians and patients was predominantly very positive. - Conclusion: Current sedation procedures are high-quality interventions that enable the successful completion of various types of procedures, with broad satisfaction among both healthcare providers and patients. Although not entirely risk-free, sedation performed outside the operating room by trained anesthesiology specialists can be considered safe. Providing patients with high-quality care should be the guiding principle of every physician throughout their professional career.

Direction
Álvarez Escudero, Julián (Tutorships)
Cabadas Avión, Rafael (Co-tutorships)

Court
CORDERO SANTAMARIA, OSCAR JAVIER (Chairman)
ABDULKADER NALLIB, IHAB (Secretary)
RODRIGUEZ PEREZ, ANA ISABEL (Member)

Summary
Introduction: Prurigo nodularis is a chronic pruritic dermatosis characterized by cutaneous nodules and intense, persistent itching, exacerbated by scratching. Its complex diagnosis often leads to underdiagnosis. Pathophysiologically, it involves an immunoneurological dysfunction with inflammatory responses (Th2, Th17, Th22) and neuronal sensitization that perpetuate the itch-scratch cycle. This condition severely impairs quality of life and is associated with anxiety, depression, and suicide risk. However, current therapeutic options are limited and often ineffective, highlighting the need for further research into more effective and specific treatments for prurigo nodularis. Objectives: To conduct a systematic review of the literature on recent advances in the treatment of chronic nodular prurigo. Methodology: A search was conducted in the Medline (via PubMed), Web of Science, and Scopus databases, selecting randomized clinical trials and clinical studies published between 2014 and 2024. Results: After initial screening and critical reading, a total of 8 articles were selected that address the use of various drugs in the treatment of patients with prurigo nodularis. Conclusions: Promising advances have been made in the treatment of nodular prurigo, particularly with the introduction of Dupilumab and Nemolizumab. Emerging drugs such as Vixarelimab and Abrocitinib show positive results, but further research is needed. Aprepitant did not demonstrate consistent clinical efficacy, and Serlopitant provided limited itch relief. Overall, these therapies open new possibilities, but it is essential to continue assessing their long-term efficacy, safety, and accessibility.

Direction
TABERNERO DUQUE, MARIA JESÚS (Tutorships)

Summary
Context: Major depressive disorder is a disease characterized by depressed mood, lack of interest or pleasure, altered sleep or appetite, or suicidal thoughts, leading to functional impairment. Dysbiosis is an alteration in microbiota diversity that generates functional changes and appears to be involved in the pathogenesis of depression and, at the same time, may offer new therapeutic targets. Objectives: To analyze the relationship between microbiota and major depressive disorder, its etiopathogenic implications, and possible pathophysiological mechanisms. Secondarily, to study the effect of probiotics, prebiotics, and postbiotics, dietary interventions, and fecal microbiota transplantation on depression. Finally, to explore the interactions between psychotropic drugs and microbiota. Methodology: A systematic review of the literature in databases (PubMed, MedLine, ScienceDirect, and Google Scholar) was conducted, defining search terms, filters, and inclusion and exclusion criteria following the PRISMA protocol. A narrative analysis of the results was then conducted. Results: There is evidence of the influence of microbiota alterations on the etiopathogenesis and clinical severity of depression, and vice versa. These primarily affect the Bacterioidetes/Firmicutes ratio, which tends to increase as depression clinically worsens. A decrease in anti-inflammatory genera (Firmicutes, Bifidobacterium, Lactobacillus, Clostridia, Croprococcus, Faecalobacterium, Ruminococcus) that produce short-chain fatty acids (SCFAs) has also been found. Numerous pathophysiological mechanisms are implicated in this relationship; the most notable are those demonstrated through therapeutic interventions targeting dysbiosis, such as the use of probiotics, which promote tryptophan availability. These therapeutic strategies also modify gene expression that regulate the immune system and circadian rhythm; they decrease levels of proinflammatory cytokines TLR-4, NF-kB, NLRP3, and CRP; The levels of short-chain fatty acids (acetate, propionate and butyrate) increase, as well as biomarkers of intestinal mucosal permeability and repair (Claudin-1, Zonulin-1, and Occludin). Conclusions: There is a clear relationship between microbiota and depression. Probiotics have been shown to be effective in treating depressive symptoms. There are clear interactions between psychotropic drugs and microbiota, evidenced by changes in the microbiota of patients treated with antidepressants and in related metabolomics.

Direction
FREIRE-GARABAL NUÑEZ, MANUEL (Tutorships)
Gómez Ramiro, Marta (Co-tutorships)

Court
CARRACEDO ALVAREZ, ANGEL MARIA (Chairman)
FERNANDEZ LOPEZ, FERNANDO (Secretary)
RODRIGUEZ ARES, MARIA TERESA (Member)

Summary
Introduction: eating disorders (EDs) are a group of disorders that originate from an interaction between biological, psychological and environmental factors. They are characterized by pathological behaviors related to food intake, which can be the cause of a variety of alterations with very serious consequences for the body. Methods: the article research was conducted using PubMed, WOS and Google Scholar databases, selecting evidence about the influence of maternal eating disorders on their children, meeting the established inclusion and exclusion criteria. Results: 107 studies were identified, of which 12 were selected, including 5 of mothers diagnosed with ED and 7 with mothers without a formal diagnosis, but with pathological behaviors. It demonstrates the different perspective mothers have on their children’s eating behaviors and self-awareness. Conclusions: mothers with EDs can influence the development of the disorder in their children through imitation and family environment: unstable families with perfectionist fathers and insecure mothers increase the risk, which grows over time. However, mothers who have been diagnosed tend to be more aware of the risk, while those with harmful behaviors may unintentionally promote unhealthy habits. The most effective prevention involves the whole family.

Direction
VICENTE ALBA, FRANCISCO JAVIER (Tutorships)

Court
COUCE PICO, MARIA DE LA LUZ (Chairman)
Eirís Puñal, Jesús Manuel (Secretary)
Cimadevila García, Antonio (Member)

Summary
Our proposal is to conduct an observational, retrospective study based on the historical cohort of heart transplant patients under follow-up at the Complexo Hospitalario Universitario de A Coruña. The rationale behind the study lies in the fact that the cardio-metabolic and renal benefits of GLP-1 receptor agonists (GLP-1ra) have been demonstrated in patients with type 2 diabetes mellitus, in patients with obesity and comorbidities, and more recently in heart failure or other pathologies, with increasingly broad evidence. However, their current use and safety in immunosuppressed heart transplant patients remain poorly understood, with limited published evidence. The development of complications in these patients is still unknown to date. In this study, a significant weight reduction was observed (96.1+-4.0 kg at the beginning of treatment vs 86.0+-3.5 kg after treatment; p less than 0.001), as well as a significant decrease in body mass index (34.3+-1.0 kg/m2 at the beginning of treatment vs 30.6+-0.9 kg/m2 at follow-up; p less than 0.001). Additionally, an improvement in HbA1c control was observed (7.5+-0.3% at the beginning of treatment vs 6.7+-0.2% at follow-up; p equal to 0.003). Regarding immunosuppression, no interactions were found with serum tacrolimus levels. Overall, the findings of this study suggest that GLP-1 receptor agonists are an effective and safe therapeutic option in heart transplant patients.

Direction
Barge Caballero, Eduardo (Tutorships)
Enríquez Vázquez, Daniel (Co-tutorships)

Court
Martín Martín, Carlos Santiago (Chairman)
PEÑA GIL, CARLOS (Secretary)
LOPEZ LOPEZ, ANDREA (Member)

Summary
The HACEK group, consisting of Haemophilus spp., Aggregatibacter spp., Cardiobacterium spp., Eikenella spp., and Kingella spp., comprises a set of gram-negative bacteria that are slow-growing and difficult to culture. Although less common than other causes of infective endocarditis (IE), these organisms are clinically relevant due to the challenges they pose in both diagnosis and treatment. Under normal conditions, HACEK microorganisms inhabit the human oral cavity and upper respiratory tract. However, under certain circumstances, they can become opportunistic pathogens, more frequently affecting the mitral and aortic valves, particularly in young patients. Endocarditis caused by this group typically follows a subacute clinical course and is often associated with embolic, vascular, and immune manifestations. Additionally, valvular vegetations are commonly observed in echocardiographic studies of affected patients. This study aims to describe the clinical and microbiological features of infections caused by the HACEK group and to analyze their evolutionary trend over time, assessing their current relevance in the context of infective endocarditis.

Direction
DIAZ PEROMINGO, JOSE ANTONIO (Tutorships)

Court
COSTOYA PUENTE, JOSE ANTONIO (Chairman)
DIEZ ULLOA, MAXIMO ALBERTO (Secretary)
DOMINGUEZ MEIJIDE, ANTONIO (Member)

Summary
Introduction: Proper management of neonatal pain in neonatal intensive care units (NICU) represents a clinical challenge due to the lack of self-reporting. Assessment relies on observational scales that combine physiological, behavioral, and contextual indicators, although no validated gold standard exists. The selection of evaluation instruments must be adapted to the type of pain, gestational age, and the characteristics of the healthcare environment. An ideal scale should ensure validity, reliability, sensitivity, and ease of implementation in daily clinical practice. Objectives: The primary objective of this systematic review was to analyze the available evidence on the reliability and validity of the main neonatal pain assessment scales in NICUs. As a secondary objective, the characteristics, applicability, and limitations of these scales in this clinical context are compared. Methodology: A systematic review was conducted according to PRISMA guidelines and the PICOS model. The databases PubMed/MEDLINE, Cochrane Library, and Embase/OVID were used for the search. Results: A total of 22 studies evaluating 14 pain scales in neonates admitted to NICUs were included. Most of the scales showed high internal consistency (Cronbach's alpha between 0.72 and 0.97) and excellent inter-rater reliability (ICC greater than 0.90 in 9 scales). Concurrent, construct, and discriminant validity were adequate in most instruments, with correlation values exceeding 0.70. Four studies confirmed high content validity, reinforcing the clinical utility of the evaluated scales. Conclusions: Although no scale was identified as the gold standard, NIAPAS, CPSPN, and BIIP stood out for their reliability, validity, and applicability in NICUs, making them valuable options while further validation of new approaches continues.

Direction
COUCE PICO, MARIA DE LA LUZ (Tutorships)
Ferrero Díaz, Ana (Co-tutorships)

Court
SEOANE PRADO, RAFAEL (Chairman)
VIDAL MILLARES, MARIA (Secretary)
FIDALGO PEREZ, MIGUEL ANGEL (Member)

Summary
Introduction: Abdominal aortic endograft infection is a rare but serious complication of endovascular aortic aneurysm repair (EVAR). Listeria monocytogenes, a pathogen commonly transmitted through contaminated food, is rarely associated with this type of infection, making diagnosis and treatment difficult. Clinical Case: We present the case of a patient with a late-onset abdominal aortic endograft infection caused by Listeria monocytogenes, confirmed by culture of the prosthetic site. The patient was treated with targeted antibiotic therapy and revascularization surgery, with a favorable outcome. Materials and Methods: A literature review was conducted in Medline (PubMed) and Google Scholar in Spanish and English, including articles published between 2015 and 2025. Ten microbiologically confirmed clinical cases of Listeria monocytogenes infection in abdominal aortic endografts were found. Clinical features, treatments, and outcomes were analyzed. Results: The results show high variability in clinical presentation, treatment, and outcomes. Most patients were treated with ampicillin and gentamicin, and nine of the eleven cases required surgical intervention. Although survival was high, complications were frequent. Conclusion: It is concluded that Listeria monocytogenes infection in aortic endografts, though rare, should be considered in patients with compatible symptoms and a history of EVAR. The combination of prolonged antibiotic therapy and personalized surgery appears to be the most effective strategy. This work contributes to the understanding of this underreported condition and highlights the need for specific clinical guidelines.

Direction
Fernández González, Angel Luis (Tutorships)
Fernández Noya, Jorge (Co-tutorships)

Court
SEOANE PRADO, RAFAEL (Chairman)
VIDAL MILLARES, MARIA (Secretary)
FIDALGO PEREZ, MIGUEL ANGEL (Member)

Summary
Introduction: Lung transplantation has become an established treatment for patients with end-stage pulmonary disease. Unlike other solid organ transplants, lung transplant recipients have a particularly high risk of infections. Invasive fungal infections, especially those caused by the genus Aspergillus, represent one of the main threats to both the graft and the patient’s life. In this context, transplant centers have employed various preventive strategies to avoid fungal infections. In our setting, the most widespread is universal prophylaxis with nebulized amphotericin. Objectives: To review the available evidence on the impact of nebulized amphotericin prophylaxis on colonization and development of disease caused by Aspergillus spp. in adult lung transplant recipients. Methods: A literature search was conducted in PubMed for articles published from January 2005 to April 30, 2025. Randomized and non-randomized clinical trials, post hoc analyses, cohort studies, observational studies, systematic reviews, and meta-analyses were included. Filters applied were: humans, English and Spanish languages. Results: Of the five selected studies, only two used nebulized amphotericin as monotherapy, while the remaining three administered it in combination with other systemic antifungals. The amphotericin formulations used included liposomal, lipid complex, and deoxycholate amphotericin. The duration of prophylaxis varied, ranging from short-term regimens to indefinite prophylaxis strategies. Four studies reported data on post-transplant colonization by Aspergillus spp., with rates ranging from 1.7% to 17%. Invasive aspergillosis rates varied between 0% and 5.3%. In most studies, the infection occurred after the active prophylaxis period had ended. Only one of the five studies included a control group, in which a significant reduction in invasive fungal infections was observed following the implementation of prophylaxis at the center. Nebulized amphotericin showed a good safety profile. Conclusions: Prophylaxis with nebulized amphotericin B was associated with a low incidence of invasive aspergillosis, especially during the active treatment period, and had a favorable safety profile. Randomized studies are needed to confirm its efficacy and to define standardized protocols.

Direction
González Barcala, Francisco Javier (Tutorships)
Sanjuán López, María del Pilar (Co-tutorships)

Court
Leis Trabazo, María Rosaura (Chairman)
GARCIA FIGUEIRAS, ROBERTO (Secretary)
Varela Calviño, Rubén (Member)

Summary
BACKGRAUND Atrial fibrillation is a disorganized tachyarrhythmia and is the most common arrhythmia in the general population. Atrial fibrillation and its serious complications result in high mortality and morbidity despite adequate treatment and high costs to the health care system. There are several known risk factors for developing it, some of which are modifiable and others not, such as age or sex. A good way to reduce the incidence of its appearance would be to address those factors that can be modified and among them is diet. Therefore, in this review we seek to find if there is a relationship between AF and coffee, since it is a beverage widely consumed by society, which is part of the daily life of many people. OBJECTIVES 1. To show whether there is a significant relationship between coffee and the incidence of atrial fibrillation. 2. To elucidate whether this relationship is positive or negative. 3. To show whether or not the relationship depends on the amount of dose consumed. We believe that knowing the real association between drink and disease could help to make population recommendations on its consumption and try to reduce the incidence of its appearance. METHODS We analyse prospective cohort studies obtained from PubMed from 2015 to the search date, January 2, 2025. RESULTS After applying the inclusion and exclusion criteria, we obtained a review of 7 prospective cohort studies. In all of them, the cohort was divided into several groups according to their level of coffee consumption and the analyses were adjusted for different possible confounding factors (including age, sex, DM, HT, smoking, BMI or alcohol consumption). The overall proportion of men and women is similar in all of them except in one cohort that only includes men. The mean follow-up time ranges from 4.4 to 14 years and the mean age of the participants from 37.5 to 67 years. Six of the seven studies obtained a statistically significant result in some of their subgroups, four of them found an inverse relationship between coffee and AF and two of them a positive relationship at certain levels of consumption of this beverage, these being the studies analysed with a greater number of limitations. CONCLUSIONS The review suggests an inverse relationship between coffee consumption and incidence of AF, with a lower incidence of the arrhythmia with an increasing coffee consumption, without being able to specify the exact doses at which this relationship occurs.

Direction
Barge Caballero, Eduardo (Tutorships)
Vidal Pérez, Rafael Carlos (Co-tutorships)

Court
CORDERO SANTAMARIA, OSCAR JAVIER (Chairman)
ABDULKADER NALLIB, IHAB (Secretary)
RODRIGUEZ PEREZ, ANA ISABEL (Member)

Summary
INTRODUCTION: Autonomic dysreflexia (AD) is a serious and potentially life-threatening complication that affects individuals with spinal cord injury, especially at or above the T6 level. It is caused by uncontrolled sympathetic overactivity due to the disconnection of supraspinal regulatory centers. AD can be triggered by various stimuli, such as bladder or bowel distension, and presents with symptoms such as severe hypertension, headache, sweating, and bradycardia. Its clinical management requires rapid identification and effective strategies for both treatment and prevention. AIMS: To evaluate the available scientific evidence on the treatment and prevention of autonomic dysreflexia in patients with spinal cord injury, identifying the most effective interventions. MATERIAL AND METHODS: A systematic review was conducted of studies published between January 1990 and December 2024 in the PubMed and COCHRANE databases. Included were clinical trials, observational studies, and case series addressing autonomic dysreflexia in patients with spinal cord injury. The search combined the terms “spinal cord injury,” “autonomic dysreflexia,” “management,” and “prevention” using the Boolean operators “AND” and “OR”. RESULTS AND DISCUSSION: Eighteen studies were analyzed (602 patients). Some treatments, such as nitroglycerin, prazosin, and fesoterodine, showed high efficacy. Others, such as lidocaine, showed contradictory results depending on the context. The lack of stratification by injury level and the overall low methodological quality limited study comparability. CONCLUSIONS: There are promising therapeutic options for AD, but higher-quality evidence is needed to establish solid recommendations and standardized treatment protocols.

Direction
FIGUEROA RODRIGUEZ, JESUS (Tutorships)
Montoto Marqués, Antonio (Co-tutorships)

Court
SUAREZ QUINTANILLA, JUAN ANTONIO (Chairman)
ABRALDES LOPEZ-VEIGA, MAXIMINO JOSE (Secretary)
GUDE SAMPEDRO, FRANCISCO (Member)

Summary
Migraine is a neurological condition that currently represents one of the most prevalent diseases in the pediatric population, significantly limiting the quality of life of those affected. Its diverse clinical presentation and the limited number of studies available for this age group make it a challenge for both patients and clinicians. Recent findings on its pathophysiology have enabled the development of new targeted treatments, such as anti-CGRP medications, which represent a breakthrough compared to previously used therapies.

Direction
BLANCO BARCA, MANUEL OSCAR (Tutorships)
Arias García, Laura (Co-tutorships)

Court
MUÑOZ BARUS, JOSE IGNACIO (Chairman)
GAGO AGEITOS, ANA MARIA (Secretary)
VAZQUEZ ILLANES, MARIA DOLORES (Member)

Summary
The intestinal microbiota plays an essential role in numerous physiological processes of the human body, including metabolic, immune, and intestinal epithelial protection functions. The use of antibiotics, although therapeutically necessary and often unavoidable in many infectious diseases, can cause deep and persistent changes in the composition and diversity of the intestinal microbiota, contributing to dysbiosis. This systematic review analyses studies published between 2015 and 2025 that assess the impact of different classes of antibiotics on the alpha and beta diversity of the gut microbiome, emphasizing the microbial responses according to the type of antibiotic, dosage, treatment duration, and the host's baseline profile. The findings show that, before prescribing antibiotics, it is essential to consider how and in which grade they affect the balance of the intestinal microbiota. Furthermore, a prudent and justified use of antibiotics should be promoted to minimize their negative effects, aiming to protect intestinal health and prevent long-term health issues related to dysbiosis.

Direction
DIAZ PEROMINGO, JOSE ANTONIO (Tutorships)

Court
CARRACEDO ALVAREZ, ANGEL MARIA (Chairman)
FERNANDEZ LOPEZ, FERNANDO (Secretary)
RODRIGUEZ ARES, MARIA TERESA (Member)

Summary
Background: Gender-based violence is an important public health problem that harms approximately 1 out of every 3 european women. Political and social characteristics of the environment greatly contribute to the risk of becoming a victim. This is why understanding Social Determinants of Health as the foundations of community well-being allows to promote political and cultural changes that erase discriminatory attitudes and demand specific protection strategies towards the most affected groups. Objectives: The aim is to make a systematic review that helps to identify socioeconomic patterns that increase gender violence and the most vulnerable demographic profiles, as well as to understand this phenomenon as a complex social issue. This work seeks to provide information for new community-intervention strategies that reduce the number of victims. Method: A search was made in the PubMED, Web of Science and Scopus databases, following the PRISMA guides and collecting the results published from 2015 to 2025 which evaluate the relationship between Social Determinants of Health and Intimate Partner Violence. Results: 15 publications were included: 3 cohort studies and 12 transversal studies, finally evaluating a 67074 population of adult europeans. Results were organized depending on each risk factor examined and its statistical value. Conclusions: Gender violence is a transversal issue to every European country, where Social Determinants of Health play a fundamental role. Reducing class and gender inequality, promoting family protection measures and women's health; addressing substance abuse or attacking traditional gender roles could reduce the percentage of victims of domestic violence in Europe. Future longitudinal research, preferably internationally-collaborative, is needed to further investigate the causes of partner violence and appropriate prevention strategies to curb it.

Direction
GUDE SAMPEDRO, FRANCISCO (Tutorships)
ALDECOA LANDESA, SUSANA (Co-tutorships)

Court
COUCE PICO, MARIA DE LA LUZ (Chairman)
Eirís Puñal, Jesús Manuel (Secretary)
Cimadevila García, Antonio (Member)

Summary
Study design: Analysis of a cohort. Introduction: Nowadays, HIV infection continues to be a global health challenge. Advances in HIV treatment have improved patients' quality of life, but prevention is still key to curbing this epidemic. Pre-exposure prophylaxis (PrEP) is the administration of antiretroviral therapy to people who are uninfected at risk of acquiring HIV infection. It has emerged as a preventive strategy in addition to the usual prevention strategies. This paper examines the use of the strategy. Justification: With PrEP already established in HIV prevention, there is a strong need to study the effectiveness, risk factors and other factors associated with its implementation. The use of actual patient data provides further evidence of significant benefit to vulnerable groups, in addition to a large number of trials showing the above. Objective: To identify the characteristics and patterns of the use of pre-exposure prophylaxis for HIV infection in vulnerable groups in our environment, identifying important factors such as socio-demographic profile, risk patterns, prophylaxis outcomes, as well as possible adverse effects of it. Methods: This is a prospective epidemiological study, based on the data of a cohort collected in a group of users attended at the Infectious Diseases Unit of the Hospital Clínico Universitario de Santiago de Compostela since December 2019 . The participants are included in the Pre-Exposure Prophylaxis Program and were selected in accordance to the criteria defined by the Implementation Protocol of pre-exposure prophylaxis against HIV infection in Galicia. Results: Data analysis evidences high adherence as well as 100% efficacy of PrEP among users seen at the Hospital Clínico Universitario de Santiago de Compostela. A low rate of side effects was observed, confirming a good safety profile. An increase in the diagnosis of other sexually transmitted infections was also detected, highlighting the need for a protocolised and comprehensive clinical follow-up. The results support the use of PrEP as a strategy for HIV prevention. Conclusions: In key populations, pre-exposure prophylaxis has established itself as an effective tool for HIV prevention. Its implementation in the health system is not only clinically effective but also cost-effective. PrEP should be part of a comprehensive strategy that includes educational measures and more accessible methods for the most vulnerable, as well as reducing stigma. The results observed in the study support that, with the necessary policy intervention and community support, the goal of zero new infections is an achievable target.

Direction
Antela López, Antonio Rafael (Tutorships)

Court
CORDERO SANTAMARIA, OSCAR JAVIER (Chairman)
ABDULKADER NALLIB, IHAB (Secretary)
RODRIGUEZ PEREZ, ANA ISABEL (Member)

Summary
Introduction: Kidney transplant recipients are at increased risk of developing cancer due to chronic immunosuppression. This review evaluates the impact of time and different immunosuppressive therapies on the development of malignancies. Methods: A review of the existing literature from the last 5 years was conducted in Cochrane and PubMed. Fourteen articles were included (8 systematic reviews, 2 randomized clinical trials, and 4 observational studies). All met the established selection criteria. Results: Kidney transplant recipients had a 2.5-fold higher incidence of cancer than the general population (SIR 2.56, 95% CI 2.31 - 2.84). Immunosuppressive therapy (tacrolimus/cyclosporine) was associated with an increased risk of skin cancer (OR 1.28) and Kaposi's sarcoma (79.6% with cyclosporine), while treatment with mTOR inhibitors showed a protective effect (RR 0.74) but with a higher risk of rejection and adverse effects (RR 1.58). Similarly, belatacept reduced the risk of cutaneous carcinoma by 40% compared with Immunosuppressive therapy (CNI). Cancer onset followed a bimodal pattern: virally associated neoplasias (lymphomas, KS) predominated early (0-3 years; SIR 195), while solid tumors appeared late (5 years). Non melanoma skin cancers accounted for 90% of cases. Conclusions: The choice of immunosuppressive therapy significantly affects oncological risk in transplant recipients. The use of mTOR and belatacept can reduce this risk, but their use requires individualized assessment. In general, intensive surveillance is recommended, especially for skin cancer.

Direction
BLANCO PARRA, MIGUEL ANGEL (Tutorships)

Court
ZALVIDE TORRENTE, JUAN BAUTISTA (Chairman)
Anibarro García, Luís (Secretary)
MARTIN CORA, FRANCISCO JAVIER (Member)

Summary
Introduction. Omega-3 fatty acids play a fundamental structural role in the central nervous system, being a key component of neuronal and retinal membranes. Their presence is essential for processes such as synaptogenesis, neurotransmission, brain plasticity and visual development. It is known that several factors during gestation can affect the availability of these nutrients to the foetus, one of the most relevant being the maternal diet. Therefore, it is of vital importance to know exactly what role their deficiency may play in neurodevelopment in the paediatric age. Objective. The aim of this review is to critically evaluate the effect of prenatal omega-3 supplementation on paediatric neurodevelopment, based on current scientific evidence. Methods. A systematic review has been carried out according to PRISMA guidelines of studies collected in the MEDLINE database, including a total of 18 double-blind randomised clinical trials. Results and conclusions. Although the number of clinical trials included in the review may be a limitation for its correct interpretation, there does not seem to be conclusive evidence on the role of prenatal omega-3 supplementation in improving global infant cognitive development. On the other hand, obstetric benefits were demonstrated (risk of preterm birth, birth weight) and in specific areas of neurodevelopment such as language, gross motor skills and early attention. These benefits do not appear to be consistently maintained in long-term neurological assessments. Although prenatal omega-3 supplementation is safe and potentially beneficial, it is recommended to individualise its indication according to maternal nutritional status, pregnancy risk profile and/or in specific populations susceptible to possible nutritional deficiencies. Omega-3 fatty acids, EPA, DHA, Supplementation, Neurodevelopment, Systematic Review.

Direction
Picáns Leis, Rosaura (Tutorships)

Summary
The traditional treatment for rectal cancer involves total mesorectal excision (TME), which compromises patient quality of life due to the multiple comorbidities inherent to this procedure. Surgery is effective but is associated with multiple comorbidities and negative long-term functional outcomes, such as bowel, sexual and urinary dysfunction. Recently, Watch-and-Wait (WW) therapy has emerged as an alternative for patients who achieve a complete clinical response (cCR) after neoadjuvant treatment. This approach involves strict follow-up without resorting to surgery, aiming to preserve the rectum and thus reduce the morbidity associated with surgery. A total of 136 articles on the WW technique for the treatment of rectal cancer were reviewed, including patient selection criteria for WW, follow-up protocols, tumor recurrence/regrowth rates, survival, and quality of life of patients undergoing this less invasive treatment method. The results presented suggest that WW is a safe and effective option in well-selected patients, primarily those with distal rectal tumors, small tumors and without lymph node involvement. The local regrowth rate is higher in WW, but most cases are recovered with salvage surgery. Overall survival and disease-free survival in WW are comparable to those of patients undergoing conventional treatment, with the advantage of better functional outcomes and a higher quality of life.

Direction
PAREDES COTORE, JESUS PEDRO (Tutorships)

Court
SUAREZ QUINTANILLA, JUAN ANTONIO (Chairman)
ABRALDES LOPEZ-VEIGA, MAXIMINO JOSE (Secretary)
GUDE SAMPEDRO, FRANCISCO (Member)

Summary
Introduction: Acute lymphoblastic leukemia (ALL) is the most common oncohematological disease in the pediatric age group. It is characterized by an abnormal, uncontrolled proliferation of immature lymphoblasts, which compromises the normal production of blood cells. The variety of symptoms (anemia, fatigue, susceptibility to infections…) reflects the aggressiveness of this disease. Despite a high overall survival rate with conventional treatments (chemotherapy, bone marrow transplantation…), approximately 10 % of patients, according to various series, either fail to achieve complete remission or relapse after doing so. In this context, chimeric antigen receptor T-cell (CAR-T) immunotherapy has emerged as a promising therapeutic strategy. It involves genetically modifying the patient’s own T lymphocytes to express a specific receptor capable of recognizing and destroying tumor cells. Objectives: The objective of this systematic review is to analyze the available scientific evidence on the efficacy and safety of CAR-T therapies by reviewing the literature published from 2014 to 2024. Methodology: A systematic review of the scientific literature available in different electronic databases (PubMed, Cochrane Library, Scopus and WOS-Medline) was conducted using the MeSH descriptors 'CAR-T', 'chimeric antigen receptor', 'acute lymphoblastic leukemia' and 'pediatric', combined with the operators AND/OR. Phase I-II clinical trials, meta-analyses, systematic reviews and observational studies in pediatric patients and young adults up to 24 years of age treated with CAR-T therapy for ALL are included. Results: This systematic review includes a total of 17 articles: 7 phase I-II clinical trials and 10 observational studies. Conclusions: Anti-CD19 CAR-T therapies represent a therapeutic option with overall survival rates exceeding 60 % at one year of treatment in refractory and/or relapsed pediatric B-ALL. Their implementation requires centers prepared to promptly detect and manage specific treatment-related complications such as CRS, ICANS, and infections. Baseline tumor burden and intensive bridging chemotherapy appear to be common poor prognostic factors in the published series, underscoring the critical importance of early referral of eligible patients and adequate disease control prior to infusion. However, further randomized trials with longer follow-up are needed to properly evaluate the efficacy, safety, and cost of this therapy compared with other salvage treatment options, as well as to develop standardized protocols for monitoring and managing complications.

Direction
Concheiro Guisán, Ana (Tutorships)
Ocampo Álvarez, Ana María (Co-tutorships)

Court
DOMINGUEZ MUÑOZ, JUAN ENRIQUE (Chairman)
Fernández Rodríguez, Mª Isabel (Secretary)
SANCHEZ IGLESIAS, SOFIA (Member)

Summary
Introduction: Current scientific evidence points to neuroinflammation as a possible factor in the pathogenesis of depression. This theory opens new lines of research for the treatment of this disease, especially for treatment-resistant depression Objective: To evaluate the efficacy and safety of adding anti-inflammatory or other immunomodulators as adjuvants to antidepressant treatment, assessing the improvement of affective symptoms. Methods: A systematic review of the scientific literature available in PubMed and the Cochrane Library was conducted, using MeSH terms from the last 10 years and in English and Spanish. The type of study was limited. Abstracts and, where relevant, full articles were reviewed. Results: A total of 133 results were obtained, but only 10 articles met the inclusion and exclusion criteria for this review.

Direction
OLIVARES DIEZ, JOSE MANUEL (Tutorships)
Rivera Baltanás, Tania (Co-tutorships)

Court
ZALVIDE TORRENTE, JUAN BAUTISTA (Chairman)
Anibarro García, Luís (Secretary)
MARTIN CORA, FRANCISCO JAVIER (Member)

Summary
Introduction Cerebrovascular disease (CVD) is one of the leading causes of mortality and disability worldwide. The concept of the gut-brain axis has recently emerged as a form of bidirectional communication, in which the gut microbiota participates. This has been linked to cerebrovascular disease and its risk factors and may constitute a new therapeutic strategy. Objectives This systematic review aims to synthesize the available evidence on the relationship between intestinal microbiota and cerebrovascular disease, as well as evaluate its usefulness as a potential therapeutic target. Methodology A systematic review was conducted in accordance with the PRISMA declaration. The research question was structured according to the PICoR format. From this, a search was initiated in the PubMed database, the results of which were screened using selection criteria. Results and Discussion Of a total of 788 articles, 25 were included. Most of these are reviews, which address the bidirectional relationship between stroke and intestinal dysbiosis, analyzing the relevance of structural components and microbial metabolites in its pathogenesis and pathophysiology. Therapeutic proposals that have emerged in response to this issue are also evaluated. Conclusions There is a possible association between the gut microbiota and the main risk factors for stroke, as well as with stroke severity and prognosis. It is hypothesized that the relationship is primarily through the immune system and inflammation, without overlooking the importance of microbial metabolites and their components. Further clinical studies are needed to address the following aspects: underlying mechanisms, species involved, and effects in humans.

Direction
ARIAS RIVAS, SUSANA (Tutorships)
Fernández Fraile, Sandra (Co-tutorships)

Court
Gonzalez Quintela, Arturo (Chairman)
BRAÑAS GONZALEZ, ANTIA (Secretary)
Sierra Paredes, German (Member)

Summary
Background: Irritable bowel disease (IBS) is defined by the presence of chronic abdominal pain associated with altered bowel habits. Linaclotide stands out among the therapeutic options. The objective of this systematic review was to evaluate the efficacy of linaclotide in terms of reduction in abdominal pain, constipation improvement, and the study of adverse events. Methods: An exhaustive search of scientific evidence in the databases PubMed and Cochrane Library was carried out. We included randomized clinical trials (RCT) and observational studies conducted in over 18-year-old patients diagnosed with IBS with constipation (IBS-C) that evaluated the efficacy and security of linaclotide 0.29 mg with a minimal duration of 12 weeks. Risk of bias assessment of the included studies was conducted using the ROBINS-I and RoB 2.0 tools. A meta-analysis was performed to synthesize the results of the RCT, and a qualitative synthesis was carried out for the results of the observational studies. Results: Four RCT (N = 3057) and three observational studies (N = 435) were included. The meta-analysis demonstrated the superiority of linaclotide over placebo in reducing abdominal pain (Mean difference (MD): -0.74; CI 95% (-0.88, -0.60); p 0.0001), and its efficacy in the secondary objectives. Linaclotide was associated with a bigger number of adverse events, with a bigger proportion of patients suffering from diarrhea (Relative risk (RR): 5.97; CI 95% (4.18, 8.53); p 0.0001). Observational studies results agree in the direction of the effect with RCT, but their results are of bigger magnitude. The quality of the evidence, evaluated by the GRADE system, ranged from moderate to very low. Discussion: Linaclotide is a safe and effective therapeutic alternative in symptom control in IBS-C patients. Additional diverse studies comparing linaclotide with other IBS-C treatments are warranted.

Direction
DOMINGUEZ MUÑOZ, JUAN ENRIQUE (Tutorships)

Court
Martín Martín, Carlos Santiago (Chairman)
PEÑA GIL, CARLOS (Secretary)
LOPEZ LOPEZ, ANDREA (Member)

Summary
Introduction: Hidradenitis Suppurativa (HS) is a chronic, recurrent, and disabling autoinflammatory disease due to its significant impact on physical, social, and emotional well-being. Treatment of HS includes medical and surgical therapies, with wide excision being shown to have a lower recurrence rate. The main objective of this study was to analyze wide excision surgery´s impact on patients' quality of life. Materials and methods: A single-center, ambispective, observational study was conducted including patients with HS treated with wide excision surgery in the Dermatology Department of the Complejo Hospitalario Universitario de Pontevedra between September 1, 2023, and October 31, 2024, with a minimum follow-up period of 6 months. Results: Fifteen patients were included (80% women) with a mean age of 36.52 +/- 11.39 years. There was a trend toward improvement in all the quality of life scales: DLQI, VAS pain, VAS odor, VAS pruritus, self-reported HS severity and EuroQol, but this was not statistically significant. 6.67% of patients experienced recurrence and 26.67% experienced postoperative complications. All patients were satisfied after surgery and would recommend it; 86.67% would repeat it and were satisfied with the esthetic result. Conclusions: Extensive excision surgery is an effective and well-rated option for patients with HS, with a low recurrence rate and moderate complications. Although the quality of life scales did not show significant improvements, a positive trend was observed. Despite the study's limitations, the results support its usefulness in disease management. Prospective studies with larger sample sizes and longer follow-up are needed to confirm these findings.

Direction
RODRIGUEZ BLANCO, MARIA ISABEL (Tutorships)
Abalde Pintos, MaríaTeresa (Co-tutorships)
Oro Ayude, Marcos (Co-tutorships)

Court
ARCE VAZQUEZ, VICTOR MANUEL (Chairman)
Concheiro Guisán, Ana (Secretary)
CORTIÑAS DIAZ, JULIO ANTONIO (Member)

Summary
Introduction: Normocalcaemic primary hyperparathyroidism (NPHPT) is a little-known condition, defined by elevated levels of parathyroid hormone (PTH) with normal concentrations of total and ionised serum calcium. Traditionally regarded as a benign variant of primary hyperparathyroidism, recent studies have highlighted its possible association with clinically relevant complications, increasing its significance in clinical practice. Rationale and objectives: This paper reviews recent scientific literature on NPHPT, addressing its pathophysiology, differential diagnosis, clinical features, and potential complications. Medical and surgical management options are discussed, along with associated clinical outcomes. Additionally, a local case of possible NPHPT is presented to contextualise its approach within regional clinical practice. Material and methods: A narrative review was conducted by searching scientific articles in databases such as PubMed, prioritising guidelines and recent relevant studies. Epidemiological, clinical, and therapeutic studies were also analysed, and comparative tables were created to aid understanding. Results: The prevalence of NPHPT varies due to differing diagnostic criteria and the incomplete exclusion of secondary causes. Most patients are postmenopausal women, possibly due to selection bias. Complications observed include bone (osteoporosis, fractures), renal (nephrolithiasis), and alterations in glycaemic metabolism, quality of life, and cardiovascular function. Therapeutic strategies are not standardised and include medical management and, potentially, surgery. However, surgical outcomes are less favourable than in hypercalcaemic primary hyperparathyroidism, being associated with a higher prevalence of multiglandular disease and an increased risk of postoperative hypoparathyroidism. Conclusion: NPHPT represents a diagnostic and therapeutic challenge. It requires rigorous assessment and individualised follow-up. Current evidence is insufficient to support firm recommendations, and longitudinal studies are needed to clarify its natural course and the benefits of treatment, particularly surgical intervention.

Direction
MARTINEZ OLMOS, MIGUEL ANGEL (Tutorships)
Ruano Vieitez, Belén (Co-tutorships)

Court
GONZALEZ VINAGRE, SALUSTIANO (Chairman)
PUBUL NUÑEZ, VIRGINIA (Secretary)
VAZQUEZ TORRES, MATEO (Member)

Summary
Cardiovascular diseases are the leading cause of morbidity and mortality worldwide. Due to their significant impact on both public health and healthcare systems, early recognition and diagnosis are essential, along with regular assessment of associated risk factors. A fundamental and widely used tool among healthcare professionals is the electrocardiogram (ECG). It is a simple, non-invasive test that records the heart’s electrical activity through electrodes placed on the skin surface.

Direction
GUDE SAMPEDRO, FRANCISCO (Tutorships)
Costa Lathan, Christian (Co-tutorships)

Court
LIMA RODRIGUEZ, LUIS JESUS (Chairman)
PALLAS PALLAS, ESTRELLA (Secretary)
VARELA LEMA, MARIA LEONOR (Member)

Summary
Background and aims: Under the premise that there is a great heterogeneity in the forms of presentation of psoriatic arthritis, a systematic review was proposed to determine the involvement of HLA in the axial involvement of this entity, evaluating whether it is possible to predict its appearance as well as to establish different patterns of involvement that can be observed in routine clinical practice. Methods: A systematic review of psoriatic arthritis cases published in Pub-med, Embase, Scopus and WOS was performed with a selection based on prespecified inclusion criteria and subsequent analysis of the evidence retrieved on the impact of HLA on axial involve- ment in psoriatic arthritis. A random-effects model was used for the metaanalysis and the risk of publication bias was assessed. Results: Finally, 53 articles were included in the systematic review and 26 in the metaanalysis. Several cohorts of patients were found that point to two predominant patterns of axial involvement. We also found a statistically significant relationship between HLAC08 and axial involvement of psoriatic arthritis, when compared with peripheral involvement (OR 3.614 CI95% 1.020-12.806), behaving like a risk factor in the presentation of this entity. The same occurred with HLAB27, compared on one hand with peripheral involvement (OR 3.620 CI95% 2.402-5.454) behaving as a risk factor; and with the rest of axial spondyloarthritis (OR 0.084 CI95% 0.056-0.125), showing that its influence is greater in this group of patients, which was to be expected based on the existing literature. Conclusion: Based on the results obtained, it appears that HLAC08 could be considered a risk factor in the axial involvement of psoriatic arthritis. Likewise, it appears in the literature the existence of two patterns of involvement in axial psoriatic arthritis, one symmetrical related to HLAB27, similar to other axial spondyloarthritis; and another asymmetrical, more characteristic of this entity, with a higher frequency of cervical involvement and isolated spondylitis, which could be related to HLAB08.

Direction
PEREZ PAMPIN, EVA MARIA (Tutorships)
MANEIRO FERNANDEZ, JOSE RAMON (Co-tutorships)
Dos Santos Sobrín, Raquel (Co-tutorships)

Court
RUANO RAVIÑA, ALBERTO (Chairman)
Gándara Cortés, Marina (Secretary)
VILLAR CHEDA, MARIA BEGOÑA (Member)

Summary
Introduction: The Tajogaite (Cumbre Vieja) volcano, located on the Spanish island of La Palma, began its eruption on September 19, 2021, remaining active for 85 days and inducing the urgent evacuation of the population due to the large amounts of ash particles and toxic gases emitted. Objectives: The objectives of this work were to determine the impact of the Tajogaite volcanic eruption on the use of healthcare services during and after the eruption in the exposed and non-exposed adult population, as well as to analyze its impact on quality of life and the use of anxiolytic drugs. Methods: Research with an ambispective cohort design, analytical and observational study with 472 subjects, forming three exposure groups: Group 1 (highly exposed), Group 2 (moderately exposed) and Group 3 (not exposed). Results: An increase in the use of health services use was found after the eruption in the exposed groups, compared to during the eruption. The most frequently consulted type of medical service was Primary Care. Women used health services more frequently. The exposed groups started to use anxiolytics in higher percentages than the non-exposed groups. The most frequent reasons for medical consultation varied according to group and the period of the study. The quality of life did not show significant differences between groups. Conclusions: An increase in visits to health services is observed, primarily among the exposed adult population, as well as a greater use of anxiolytics. The differences are noted between exposure groups, as well as between women and men. Implementing measures to strengthen health systems can serve to reduce the impact on the physical and mental health of the population in the event of natural disasters.

Direction
RUANO RAVIÑA, ALBERTO (Tutorships)
Candal Pedreira, Cristina (Co-tutorships)

Court
ZALVIDE TORRENTE, JUAN BAUTISTA (Chairman)
Anibarro García, Luís (Secretary)
MARTIN CORA, FRANCISCO JAVIER (Member)

Summary
Aim: to determinate the prognostic impact of cognitive impairment (CI) in patients with heart failure (HF). Methods: Systematic search of the databases MEDLINE and Scopus. Studies were the impact of cognitive impairment on mortality and hospital readmissions (because of HF or all causes) was analysed were selected. Results: 18 studies were included, over a total of 39 708 patients. Discussion: Despite the heterogeneity of the included studies, the presence of non-controlled confounding factors and the lack of consensus regarding the diagnostic tools of CI in HF, a common trend is observed toward an association between CI and an increased risk of readmission and mortality (due to HF and all causes). Conclusion: CI, apart from being a high prevalent syndrome between patients with HF, is proposed as one of the determining factors in patient prognosis. Early acknowledgement and identifying patients at risk of developing it should be included among the priorities of healthcare teams.

Direction
MAZON RAMOS, MARIA DEL PILAR (Tutorships)
Cerqueiro González, José Manuel (Co-tutorships)

Court
MUÑOZ BARUS, JOSE IGNACIO (Chairman)
GAGO AGEITOS, ANA MARIA (Secretary)
VAZQUEZ ILLANES, MARIA DOLORES (Member)

Summary
Rotator cuff injuries are a common condition that increases with age and overuse of the shoulder joint. These injuries are initially managed with medical treatment and rehabilitation. When conservative treatment fails or the injuries involve the entire thickness of the cuff, they must be treated surgically with tendon repair. In recent years, various biological treatments (morphogenetic proteins, mesenchymal cells, animal or human cellular matrices, etc.) have been evaluated to aid the healing of these types of injuries and reduce the rate of re-tears. Platelet-rich plasma (PRP) has been shown to provide a filling matrix for various injuries, serving as a basis for cell migration and proliferation and subsequent tissue remodeling. Thanks to this effect, PRP has proven useful in the treatment of shoulder tendon pathologies; however, there is no consensus on the type of PRP or treatment regimen to be used. The objective of this final graduation project will be to assess, through a systematic review of the scientific evidence available in the current scientific literature, the clinical efficacy of PRP therapy in the treatment of rotator cuff pathology and the type of PRP and dosage that offer the best results, evaluating whether its use is justified in routine clinical practice.

Direction
CAEIRO REY, JOSE RAMON (Tutorships)

Court
LOPEZ CASTROMAN, JORGE (Chairman)
MAZON RAMOS, MARIA DEL PILAR (Secretary)
ALONSO PENA, MARIA (Member)

Summary
Human metapneumovirus (hMPV) is one of the main causes of acute respiratory infections in children. This study focuses on analyzing the prevalence of hMPV in different settings, its relationship with other respiratory viruses, and its influence on bacterial colonization, all within a cohort of patients treated in pediatric emergency departments in hospitals across Spain and Portugal. It is a prospective study conducted in eight hospitals, including a total sample of 1,678 pediatric patients under 24 months of age, attended between January 2022 and April 2024, covering three consecutive epidemiological seasons. The results show that 12.4% of the patients were infected with hMPV. Patients with hMPV infection were more likely to be hospitalized and had longer hospital stays. Additionally, 67.1% of these patients also had other viral infections, with bocavirus being the most common, followed by rhinovirus. Regarding bacterial colonization, Haemophilus influenzae was the most frequently found among children with hMPV. Therefore, hMPV is a respiratory virus that causes lower respiratory tract infections of greater severity compared to other respiratory viruses.

Direction
MARTINON TORRES, FEDERICO (Tutorships)
Dacosta Urbieta, Ana Isabel (Co-tutorships)

Court
SALAS ELLACURIAGA, ANTONIO (Chairman)
FIGUEROA RODRIGUEZ, JESUS (Secretary)
Aguiar Fernández, Pablo (Member)

Summary
Introduction and objectives: Routine appendectomy as part of the treatment for borderline ovarian tumors has been a subject of debate due to its questionable benefit in improving overall patient survival. A systematic review was conducted to evaluate the advantages of this procedure and its impact on recurrence rates and overall survival in these women. Material and methods: A systematic search was conducted in PubMed from September 2024 including articles that explored the benefit of routine appendectomy as a part of borderline ovarian tumors´treatment. Studies published in English with patients that underwent through primary surgery were included. Results: 1928 articles were identified, 9 (n= 2467 patients) were included in this review. The sample characteristics of interest were extracted. Conclusions: In the studies analyzed, no significant impact was observed on recurrence rates or overall survival in cases where routine appendectomy was performed. Similarly, in cases where appendectomy was conducted only when the macroscopic appearance of the appendix was abnormal (and omitted when the appendix appeared normal) no impact was observed on recurrence or survival outcomes. However, the need for randomized clinical trials is evident due to the limited scientific evidence currently available on this topic.

Direction
PEÑA FERNANDEZ, MAITE (Tutorships)

Summary
Introduction: The EEG is a diagnostic test used in both clinical and research fields and has few limitations. Epilepsy is a common pathology of significant social and economic relevance. Different types are distinguished based on the site of onset and progression, as well as the extent of involvement. Specifically, frontal lobe epilepsy is usually focal, although it can spread; seizures are frequently short-lived and tend to manifest during sleep. Its clinical characteristics can present a challenge for physicians in clarifying a diagnosis. Due to the number of symptoms expressed by the patient, the differential diagnosis is very broad, with the two most frequently identified pathologies being PNES and parasomnias. Objectives: To conduct a systematic review of the literature to synthesize the evidence on the role of the EEG in this pathology and analyze whether it is appropriate to continue considering it as the gold standard. Materials and methods: A systematic review was conducted, searching for information in bibliographic sources in databases such as PubMed and Scopus. Various filters were applied, and inclusion and exclusion criteria were established to identify the most appropriate articles related to the objectives. A final selection of the filtered articles was also made. Results: The study of the evidence on the effectiveness of this technique for this pathology and its differential diagnoses, defining typical clinical manifestations and more complex characteristics, as well as characteristic electrical alterations during a seizure or during intercritical activity, demonstrates the validity of EEG as a diagnostic method, the most widely used and reliable. Discussion: After analyzing the results, the associations between clinical symptoms and the site of frontal lobe seizure onset have been characterized. However, although this relationship provides sensitivity to the EEG result, it does not appear to be sufficient on its own to reach a reliable diagnosis. Neither does the use of sEEG or serological tests. The cost-effectiveness of the study increases if it is long-term and includes a sleep study, as well as combined use with video and also machine learning. Conclusions: The EEG is the gold standard for diagnosing frontal lobe seizures and ruling out their differential diagnoses. The identification of defined typical symptoms and a long-term study that includes a sleep study increase the test's sensitivity. Combining the test with video provides a much better diagnosis, and combining the EEG with machine learning improves diagnostic performance. The evidence in children remains limited, but appropriate treatmentleads to clinical improvement.

Direction
RELOVA QUINTEIRO, JOSE LUIS (Tutorships)
Fra Mosquera, Valeria (Co-tutorships)
Soria Soriano, Beatriz (Co-tutorships)

Court
FRAGA RODRIGUEZ, MAXIMO FRANCISCO (Chairman)
ARROJO ROMERO, MANUEL (Secretary)
SÁNCHEZ SELLERO, INÉS (Member)

Summary
Introduction: Eosinophilic esophagitis is a chronic immune-mediated disease, associated with a Th2-type immune response. This immunological mechanism, along with enviromental factors, causes this clinicopathological entity characterized by mucosal infiltration of eosinophils and symptoms of esophageal dysfunction. Justification and objetives: The aim of this thesis is to review recent literature on pediatric EoE, focusing on its clinical presentation, diagnostic methods and therapeutic management. Sencondarily, we explore new diagnostic tools and emerging therapies, currently under investigation. Materials and methods: For this review, we conducted a search in PubMed and Dialnet using the terms “Eosinophilic esophagitis” AND “Children”, resulting in 2099 articles. Filters were applied for date (2020-2025), language (English and Spanish) and study type, and specific exclusion criteria were set, ultimately selecting 19 articles. Articles referenced in the selected studies were also reviewed, and some of them were included as part of the bibliography of this review. Discussion: Pediatric EoE presents both diagnostic and therapeutic challenges due to its age-dependent clinical variability. The gold standard for diagnosis remains endoscopy with biopsy, although less invasive methods, such as biomarkers, are under investigation. First-line treatment includes PPIs, elimination diets and topical corticosteroids, all of which have shown efficacy, but do not achieve full remission. Biological therapies are being studied, and Dupilumab is already implemented in clinical practice. A complete understanding of EoE is essential for optimizing its clinical management and preventing future complications. Conclusions: Pediatric EoE presents diagnostic and therapeutic challenges due to its clinical variability. Treatment includes PPIs, exclusion diets and topical corticosteroids, but biological therapies emerge as a promising option.

Direction
Leis Trabazo, María Rosaura (Tutorships)
Fernández Cebrián, Santiago Andrés (Co-tutorships)

Court
GONZALEZ VINAGRE, SALUSTIANO (Chairman)
PUBUL NUÑEZ, VIRGINIA (Secretary)
VAZQUEZ TORRES, MATEO (Member)

Summary
Introduction: Anthracyclines are chemotherapy agents used in pediatric oncology due to their high efficacy. However, their administration is associated with cardiotoxic effects, which are of particular concern in children due to their cardiac immaturity and longer life expectancy. Dexrazoxane (DRZ) has been proposed as a cardioprotective agent intended to attenuate this toxicity without compromising the efficacy of antitumor treatment. Objectives: To evaluate the efficacy and safety of dexrazoxane in preventing anthracycline-induced cardiotoxicity in pediatric patients, analyzing clinical studies comparing its use versus non-use. Methodology: A systematic review was conducted according to the PRISMA guidelines. Clinical trials published between 2005 and 2025, in English, Spanish, or Portuguese, and focused on the pediatric population were included. Databases such as PubMed, the Cochrane Library, and Scopus were searched using MeSH terms related to dexrazoxane, anthracyclines, cardiotoxicity, and children. Eight clinical trials were selected after applying predefined inclusion and exclusion criteria. Results: The use of dexrazoxane reduces the incidence of heart failure and left ventricular dysfunction without significantly increasing the occurrence of secondary malignancies or compromising oncological efficacy. Several studies showed improvements in key echocardiographic parameters in patients treated with DRZ compared to those who did not. Discussion: Dexrazoxane has been shown to have a cardioprotective effect in pediatric patients treated with anthracyclines, improving functional outcomes without altering the relapse rate or overall survival. However, some subclinical effects may persist, so long-term research with larger sample sizes is needed to confirm its safety profile. Conclusion: Dexrazoxane is an effective and safe tool for preventing anthracycline-induced cardiotoxicity in the pediatric oncology population. Its use should be considered especially in patients with cardiovascular risk factors or those exposed to high doses of anthracyclines.

Direction
MARTINEZ SOTO, MARIA ISABEL (Tutorships)

Court
Gonzalez Quintela, Arturo (Chairman)
BRAÑAS GONZALEZ, ANTIA (Secretary)
Sierra Paredes, German (Member)

Summary
Introduction: Chronic obstructive pulmonary disease (COPD) is a chronic respiratory pathology with a considerable impact on public health. Its exacerbations increase mortality and worsen the quality of life of these patients. Many patients have reduced levels of vitamin D (VD), a vitamin that could have a positive influence on the reduction of these exacerbations. This study analyzes whether its supplementation can help to prevent them. Objective: The main objective of this work is to review the available scientific literature from 2019 2024 on whether VD supplementation can reduce the frequency or severity of COPD exacerbations. Methodology: A systematic review was carried out according to the PRISMA guidelines. Databases such as PubMed, Medline, Embase, Cochrane and WOS were consulted and ten investigations that met the inclusion criteria stipulated in the PICoR table were selected. Results: Most of the reviewed studies found that COPD patients tend to have RV deficiency, which is associated with more exacerbations, worse lung function and more hospitalizations. However, the impacts of VD supplementation were varied with certain investigations evidencing clear benefits, while others did not identify significant improvements. Discussion: The clinical impact of VD supplementation remains controversial. Even so, most research agrees that there is a correlation between its insufficiency and a worse prognosis in COPD, with VD being able to influence the lung and muscle functions of patients. Conclusion: VD deficiency is frequent and is associated with an increase in the clinical severity of COPD. Evaluation of this vitamin could be integrated into the clinical management of the COPD patient but further research is still required to corroborate its efficacy as a conventional intervention.

Direction
CAMPOS FRANCO, JOAQUIN (Tutorships)

Court
Gonzalez Quintela, Arturo (Chairman)
BRAÑAS GONZALEZ, ANTIA (Secretary)
Sierra Paredes, German (Member)

Summary
Cardiac blood cysts were described by Elsasser in 1844. Bood cysts are primarily located at the atrioventricular valves of newborns and in most cases they regress spontaneously. Cardiac blood cysts are rare in adults and are mostly asymptomatic and incidental findings during imaging tests. However, they can occasionally lead to complications such as embolisms, valvular regurgitation, syncope, and sudden death. Diagnostic methods for cardiac blood cysts in adults include ultrasound, CT, and MRI, although definitive diagnosis is done by pathology. This paper presents a systematic review of the literature covering the last 30 years of articles on cardiac blood cysts in adults located in the right atrium. A total of 17 articles were identified, all of which were clinical cases. Each article is analyzed. Finally, the clinical case of an asymptomatic 80 year old woman with a blood cyst in the right atrium who underwent surgery at the University Clinical Hospital of Santiago is presented.

Direction
CAICEDO VALDES, DIEGO JESUS (Tutorships)

Court
LABANDEIRA GARCIA, JOSE LUIS (Chairman)
FERREIROS LOPEZ, ALBA (Secretary)
TABERNERO DUQUE, MARIA JESÚS (Member)

Summary
Introduction: Knee osteoarthritis is one of the most common chronic and degenerative diseases worldwide, representing a major cause of disability. Currently, treatment strategies have evolved considerably, with two minimally invasive therapies: platelet-rich plasma (PRP) and hyaluronic acid (HA) standing out, both aimed at reducing pain and improving joint function. Objectives: To evaluate the therapeutic efficacy of platelet-rich plasma compared to hyaluronic acid viscosupplementation in knee osteoarthritis. Methods: A literature review was conducted using PubMed, Web of Science, and Cochrane databases. A total of 295 articles were found and screened according to relevant inclusion and exclusion criteria. Results: Fourteen systematic reviews and meta-analyses and one retrospective observational study were included. Of these, four analyzed the efficacy of dual therapy (PRP+HA) versus PRP alone, and eleven compared PRP to HA. Treatment efficacy was assessed using WOMAC, IKDC, KOOS, VAS, EQ-VAS, and Lequesne Index scales. Additionally, safety and the inci-dence of adverse events were analyzed. Conclusions: Dual therapy (PRP+HA) showed superior results compared to HA alone in the conservative treatment of knee osteoarthritis. Likewise, PRP appears to be a safer and more ef-fective long-term alternative when compared to HA. However, further high-quality studies are needed.

Direction
PINO MINGUEZ, JESUS (Tutorships)
GUALILLO , ORESTE (Co-tutorships)

Court
COSTOYA PUENTE, JOSE ANTONIO (Chairman)
DIEZ ULLOA, MAXIMO ALBERTO (Secretary)
DOMINGUEZ MEIJIDE, ANTONIO (Member)

Summary
Cardiovascular diseases are the leading cause of morbimortality worldwide and despite the increasingly effective detection and treatment of cardiovascular risk factors (CVRFs), there is still a residual risk. In this context, lipoprotein (a) (Lp(a)), given the relationship described with the genesis of these diseases, constitutes a potential therapeutic target for the reduction of this risk. To ascertain the current situation of the therapeutic landscape in Lp(a) and its translation to the effects of cardiovascular risk modification, a narrative review was carried out by introducing a search equation in the PubMed database, selecting from among the results found those reviews, systematic reviews, meta-analyses or clinical trials that best reflected the objective of the review. The high genetic regulation to which Lp(a) is subject has a direct impact on the limited effectiveness of classic strategies such as diet and exercise. Likewise, none of the lipid-lowering drugs available produce a substantial change in the levels of this lipoprotein and apheresis, in general terms, is not considered advisable due to its acceptability. For this reason, the effect of different drugs specifically targeting Lp(a), including pelacarsen, an antisense oligonucleotide, different siRNAs, including olpasiran, zerlasiran and lepodisiran, and finally, muvalaplin, an oral agent, are currently being evaluated. In addition, CRISPR/Cas9 technology represents a possible therapeutic strategy to be developed in the future. The extent to which Lp(a) reduction will decrease cardiovascular risk cannot be defined until phase III trials of these drugs are completed, but the evidence available, coming mainly from epidemiological studies, provides optimism. In the meantime, minimization of the remaining CVRF remains as the most feasible strategy to reduce the risk attributable to Lp(a).

Direction
VIDAL PARDO, JOSE IGNACIO (Tutorships)

Court
LABANDEIRA GARCIA, JOSE LUIS (Chairman)
FERREIROS LOPEZ, ALBA (Secretary)
TABERNERO DUQUE, MARIA JESÚS (Member)

Summary
Introduction and Objectives. This study aims to evaluate the kidney histopathological changes within murine models deficient in seipin, a deficiency resulting from variants in the BSCL2 gene. Alterations in this gene have been associated with various pathologies, such as Berardinelli-Seip syndrome type 2 and progressive encephalopathy with or without lipodystrophy (PELD). Furthermore, this study seeks to analyze patterns of renal impairment based on genotype, as well as to try to establish correlations with other pertinent biochemical parameters. Methods. This experimental study investigates the histopathological renal consequences in transgenic mice generated through Cre-loxP technology. Five cohorts of mice were established: homozygous Bscl2-/-, homozygous Bscl2Celia/Celia, heterozygous Bscl2Celia/-, heterozygous Bscl2+/-, and wild- type (WT) controls Bscl2+/+, all of which were subsequently necropsied at an age of 9.5 months. Histopathological characteristics of the kidney were documented. Serum biochemical parameters were also measured in all of groups. Statistical analyses included Fisher’s exact test, Chi-square test, Kruskal-Wallis, and Mann-Whitney tests. Results. The Bscl2-/- and Bscl2Celia/Celia mice exhibited increased renal involvement characterized by mesangial patterns, in comparison to the WT group and heterozygous mice. Homozygous groups also demonstrated statistically significant differences in sodium, calcium, urea, glucose, and phosphorus levels relative to the WT and heterozygous groups. Additionally, the Bscl2Celia/Celia cohort displayed more pronounced interstitial and microvascular renal involvement than the WT cohort. Conclusions. Inactivation of the BSCL2 gene or human Celia-seipin transgene insertion in mice induces the development of renal impairment, with more severe damage observed in those carrying the human abnormal transgene. This renal damage affects the glomerulus, interstitium, and renal vasculature.

Direction
SANCHEZ IGLESIAS, SOFIA (Tutorships)

Summary
Oropharyngeal squamous cell carcinoma has experienced a significant increase in its incidence, mainly due to the higher prevalence of Human Papillomavirus (HPV), which has led to a huge shift in the clinical and demographic profile of patients. This study aims to compare the oncological and functional outcomes of Transoral Robotic Surgery (TORS) versus Radiotherapy (RT), through a systematic review of the available scientific evidence to date. After applying the bibliographic search criteria, ten studies that met the pre-established inclusion and exclusion criteria were selected, and their methodological quality was assessed. These studies provide data on survival rates, possible complications, quality of life, and functional recovery, allowing for an evaluation of the advantages and disadvantages of both therapeutic modalities. The results show that TORS may offer benefits in terms of better functional recovery, lower toxicity, and greater preservation of quality of life in selected patients, especially in early stages. However, RT remains an effective alternative, with good oncological outcomes, particularly in locally advanced cases or when the patient is not a candidate for surgery. Overall survival and disease-free survival rates are similar between both therapeutic options, although they depend on factors such as patient comorbidities, individual preferences, medical team experience, tumour location and extension and baseline function of critical organs. The conclusion is that both, TORS and RT, are equally valid options for the treatment of oropharyngeal squamous cell carcinoma, and their choice should be based on an individualized approach and joint decision-making between the patient and their specialist, being the main difference between both treatments the side effects and associated toxicities. The need for prospective studies and controlled clinical trials is highlighted to strengthen the evidence and guide future therapeutic decisions.

Direction
SUAREZ QUINTANILLA, JUAN ANTONIO (Tutorships)
López-Cedrún Cembranos, José Luis (Co-tutorships)
Sánchez Ortega, Helena (Co-tutorships)

Court
GARRIDO GIL, PABLO (Chairman)
GARCIA SEARA, FRANCISCO JAVIER (Secretary)
VALENZUELA LIMIÑANA, RITA (Member)

Summary
Background and aims. In recent years, robotic surgery has emerged as a promising alternative within minimally invasive surgery, offering potential technical advantages over laparoscopy, such as greater precision, tremor suppression, enhanced ergonomics, and improved three- dimensional visualization. This study aims to conduct a systematic review of the literature to compile and assess the available evidence on outcomes following distal pancreatectomy performed via open, laparoscopic or robotic approaches. Methods. A systematic review was conducted using PubMed and Web of Science, for studies published between January 2016 and January 2025 in English or Spanish. Eligible studies included over 35 patients per surgical group and reported outcomes stratified by approach. Data were extracted on baseline patient characteristics, and perioperative, pathological, and postoperative outcomes. Additionally, information on adjuvant chemotherapy and survival of oncological patients, the influence of surgical experience on outcomes and cost analysis, was analyzed when available. Results. A total of 16 studies comprising 5360 patients were included. The robotic approach was associated with reduced blood loss, lower conversion rates to open surgery and greater spleen preservation, at the expense of longer operative times. No significant differences were observed in postoperative outcomes or oncologic radicality between approaches. All studies assessing cost reported a higher total cost for robotic surgery, though some authors suggest it may be cost-effective. Conclusions. Robotic distal pancreatectomy is a safe and feasible technique that offers intraoperative advantages and maintains comparable oncologic outcomes to laparoscopic and open approaches. Its main limitation remains the higher associated cost.

Direction
ESTEVEZ FERNANDEZ, SERGIO MANUEL (Tutorships)

Court
COUCE PICO, MARIA DE LA LUZ (Chairman)
Eirís Puñal, Jesús Manuel (Secretary)
Cimadevila García, Antonio (Member)

Summary
Acute bronchiolitis is an infection of the lower respiratory tract that affects children under two years and represents a significant burden on children’s health, generating significant morbidity and mortality. The most common etiological agent of acute bronchiolitis is respiratory syncytial virus (RSV) and its circulation is seasonal, causing epidemics between the months of November and February. Since 2023, prophylaxis with the monoclonal antibody nirsevimab against RSV has been introduced in Spain, which has demonstrated great efficacy and safety in studies. The main objective is to describe the epidemiological and clinical characteristics of the patients admitted to the hospital for acute bronchiolitis. The secondary objective is to determine the effectiveness of the vaccination with nirsevimab in preventing severe RSV disease. This project consists in a retrospective descriptive observational study on cases of acute bronchiolitis admitted to a tertiary level hospital during the different RSV seasons. The following data were collected: age in months, sex, presence of risk factors, O2 saturation on arrival at the emergency room, results of microbiological tests, prophylaxis with nirsevimab, the severity of the disease, duration of admission and need for admission to ICU. The results confirm the predominant involvement of RSV in acute bronchiolitis and highlight the effectiveness of the use of nirsevimab as a preventive measure. Furthermore, the data show a greater involvement of infants under 6 months of age, with this group accounting for 80% of the sample.

Direction
Moreno Álvarez, Ana (Tutorships)
Barrueco Ramos, Clara (Co-tutorships)

Court
AGUILERA GUIRAO, ANTONIO (Chairman)
Cinza Sanjurjo, Sergio (Secretary)
COSTA BESADA, MARIA ALICIA (Member)

Summary
The use of electronic cigarettes (ECs) has increased significantly in recent years, under the perception that they represent a less harmful alternative to conventional cigarettes (t-Cig). However, their long-term impact on lung health remains to be fully studied. This Final Degree Project aims to carry out a systematic review of existing in vitro studies that analyze the possible relationship between the use of these new nicotine delivery devices and the risk of lung cancer. By analyzing cellular models, especially human pulmonary epithelial cell lines such as BEAS-2B or A549, various cytotoxic and genotoxic effects have been identified as a result of exposure to EC aerosols. Moreover, significant heterogeneity has been observed depending on the type of device, the presence of nicotine, and the added flavorings, many of which appear to enhance cellular toxicity. Although the levels of cellular damage observed with electronic cigarettes are generally lower than those caused by conventional tobacco smoke, in vitro results suggest that continued use of these devices is not without risk.

Direction
REPRESAS REPRESAS, CRISTINA (Tutorships)
Fernández Villar, José Alberto (Co-tutorships)

Court
CORDERO SANTAMARIA, OSCAR JAVIER (Chairman)
ABDULKADER NALLIB, IHAB (Secretary)
RODRIGUEZ PEREZ, ANA ISABEL (Member)

Summary
Introduction: The levonorgestrel-releasing intrauterine system (LNG-IUD) is a method of local hormone therapy frequently used as a contraceptive and for the treatment of certain gynecological pathologies. Breast cancer is a hormone-dependent neoplasia whose incidence correlates with multiple personal and reproductive risk factors. In particular, previous studies have linked the administration of systemic progestogen. Objective: To analyze the impact of the use of levonorgestrel-releasing intrauterine device on breast cancer risk. Methodology: A systematic review of biomedical databases and sources, including Pubmed, Cochrane Library, Medline and Google Scholar, was conducted from 2014 to 2024. Finally, after the selection process of articles through inclusion and exclusion criteria, 9 articles were accepted for the study. Results: A total of 9 studies have been included and 8 of them found significant positive associations. The average age of risk increase was around 45-50 years, with menopause established or close to it. However, although the main years of risk appear to be the first 5 years of hormonal exposure, not all articles were able to determine a significant causal relationship between time of use and possible pre-menopausal effect. Conclusions: In 8 of the 9 articles, a statistically significant association has been found between women over 45 years old and an increased risk of breast cancer by about 20%. Since the data are observational studies, their characteristics do not allow a definitive causal relationship to be established, without being able to exclude interference from confounding factors. More studies are needed to determine the nature of the association between LNG-IUD and breast cancer risk.

Direction
ARIAS BALTAR, MARIA EFIGENIA (Tutorships)

Court
SALAS ELLACURIAGA, ANTONIO (Chairman)
FIGUEROA RODRIGUEZ, JESUS (Secretary)
Aguiar Fernández, Pablo (Member)

Summary
Introduction: Schizophrenia is a chronic and severe mental disorder with significant clinical, social, and economic impact. Current antipsychotics, based on dopamine D2 receptor antagonism, present important limitations, particularly in controlling negative and cognitive symptoms, as well as in their tolerability profile. Objective: To conduct a systematic review of the available scientific evidence on ulotaront, a novel TAAR1 receptor agonist with no affinity for D2 receptors, as a potential therapeutic alternative in the treatment of schizophrenia. Materials and Methods: A systematic search was conducted in the PubMed and Cochrane databases following the PRISMA guidelines. Clinical trials and systematic reviews published up to April 2025 were included. Methodological characteristics, outcomes, safety profile, and the drug’s mechanism of action were analyzed. Results: A key phase 2 study showed statistically significant efficacy of ulotaront compared to placebo, with excellent tolerability and absence of extrapyramidal side effects. However, phase 3 trials did not reach statistical significance in terms of efficacy, likely due to a high placebo response. Conclusions: Ulotaront represents the first innovative therapeutic target in the treatment of schizophrenia in over 75 years. Its mechanism of action and favorable safety profile position it as a potential therapeutic advance. Nevertheless, further studies are needed to confirm its efficacy and define its role in clinical practice.

Direction
ARROJO ROMERO, MANUEL (Tutorships)
Núñez Sande, Carmen (Co-tutorships)

Court
AGUILAR BLANCO, MARIA FE (Chairman)
BALEATO GONZALEZ, SANDRA (Secretary)
SOPEÑA PEREZ-ARGÜELLES, BERNARDO (Member)

Summary
Background: Middle aorta syndrome (MSA) is a rare vascular entity characterized by segmental or diffuse narrowing of the distal or abdominal thoracic aorta, often involving visceral branches (celiac trunk, superior mesenteric artery, renal arteries and inferior mesenteric artery). This is 0.5-2% of aortic coarctations. This condition may be congenital (associated with genetic syndromes or problems in embryogenesis), idiopathic, acquired, and usually clinically manifested in childhood or adolescence with severe arterial hypertension, heart failure, intermittent claudication or symptoms of visceral ischemia. Objective: To present an update on the clinical picture, diagnosis and treatment by collecting and analyzing of the cases studied in adult patients. Method: A bibliographic search was performed in the databases (Pubmed, Cinahl/Medline and Web of Science) based on the PICO format and subsequently analyzed. Results: It is observed that affects more the female sex, the most frequent etiology is the idiopathic, the anatomical zone most affected is at the adrenal level and with involvement of visceral branches, the most frequent complications is refractory arterial hypertension followed by organ damage, the most used diagnostic approach is physical examination and CT-angiography and finally the treatment is usually combined: medical and open surgery (the latter being the most effective and definitive to cure the disease). Conclusion: AMS is a very rare adult disease, which despite existing diagnostic techniques and treatments follows this underdiagnosis, It is necessary for them to continue their research by opening up new early diagnostic fronts and new lines of definitive treatment.

Direction
Fernández González, Angel Luis (Tutorships)

Court
FREIRE-GARABAL NUÑEZ, MANUEL (Chairman)
Barge Caballero, Eduardo (Secretary)
SANTOS PEREZ, SOFIA MARIA SOLEDAD (Member)

Summary
Suicide is one of the main causes of death in people with schizophrenia, with the period following hospital discharge being particularly critical, especially during the first week. This systematic review analyzed 15 relevant studies and identified that the risk of suicide increases significantly during the first five days after discharge. The main risk factors found were: being male, young age, depressive symptoms, history of suicide attempts, social isolation, poor treatment adherence, and limited outpatient follow-up. It is concluded that it is essential to establish transitional measures and intensive follow-up during this period, including risk assessments and psychosocial support.

Direction
GAGO AGEITOS, ANA MARIA (Tutorships)
Ortega Ruibal, Francisco José (Co-tutorships)

Court
CARRACEDO ALVAREZ, ANGEL MARIA (Chairman)
FERNANDEZ LOPEZ, FERNANDO (Secretary)
RODRIGUEZ ARES, MARIA TERESA (Member)

Summary
Introduction: Cystic fibrosis (CF) is an autosomal recessive genetic disease caused by mutations in the CFTR gene. The alteration of the CFTR protein disrupts ion transport at the epithelial level, resulting in thick secretions that lead to abnormal mucus production, primarily affecting the respiratory and digestive systems. In recent years, the development of CFTR modulators has made it possible to modify the pathophysiology of the disease. This represents a new therapeutic strategy that improves lung function and enhances the quality of life of patients. The combination of elexacaftor/tezacaftor/ivacaftor has proven to be one of the most effective therapies for patients with at least one F508del mutation and was approved in Spain in 2024 for patients aged two years and older. Objectives: To conduct a systematic review on the efficacy and safety of triple therapy with elexacaftor, tezacaftor, and ivacaftor in pediatric patients with cystic fibrosis carrying at least one F508del mutation, analyzing its impact on lung function, quality of life, and reduction of exacerbations compared to previous treatments. Methodology: A systematic search was conducted in the Medline/PubMed and Cochrane Library databases, selecting randomized clinical trials, systematic reviews, and metaanalyses published between 2014 and 2024. Studies included in the review evaluated the efficacy of the triple combination of CFTR modulators in terms of lung function (FEV1), lung clearance index (LCI), sweat chloride reduction, and quality of life, as well as the safety of the treatment. Results: After the screening process and critical appraisal, a total of 10 studies were included: 5 randomized clinical trials comparing the efficacy of elexacaftor/tezacaftor/ivacaftor versus placebo or dual therapy, 4 open-label phase III clinical trials, and 1 systematic review/meta-analysis evaluating the safety and effectiveness of the triple combination in populations with F508del mutations. Conclusions: Triple therapy with elexacaftor, tezacaftor, and ivacaftor significantly improves lung function, nutritional status, and quality of life in pediatric patients with cystic fibrosis and at least one F508del mutation. It shows a favorable safety profile, with predominantly mild or moderate adverse events. The available evidence supports its use as a disease-modifying treatment in this population.

Direction
Concheiro Guisán, Ana (Tutorships)
del Campo García, Aida (Co-tutorships)

Court
AGUILERA GUIRAO, ANTONIO (Chairman)
Cinza Sanjurjo, Sergio (Secretary)
COSTA BESADA, MARIA ALICIA (Member)

Summary
The use of the four pharmacological pillars (4PF) in patients with heart failure (HF) and reduced left ventricular ejection fraction (LVEF) has been shown to improve morbidity and mortality. Recently, it has been demonstrated that early initiation after diagnosis indicates improvement in combined mortality outcomes and a reduction in HF hospital admissions. The elderly and frail population is characterized by a higher incidence of chronic kidney disease (CKD), as well as more frequent clinical toxicities from various treatments, making adherence to clinical practice guidelines very difficult and labor-intensive.

Direction
de la Iglesia Martínez, Fernando Antonio (Tutorships)
Rodríguez Osorio, Iria (Co-tutorships)
Seoane González, Beatriz Alicia (Co-tutorships)

Court
SEOANE PRADO, RAFAEL (Chairman)
VIDAL MILLARES, MARIA (Secretary)
FIDALGO PEREZ, MIGUEL ANGEL (Member)

Summary
INTRODUCTION: Psoriasis is a chronic, multifactorial inflammatory disease mediated by the immune system that especially affects the skin and joints. It is associated with an increased risk of developing other disorders, such as cerebrovascular disease, which is defined as a sudden interruption of cerebral blood flow (ischemic or haemorrhagic) and is one of the leading causes of morbidity and mortality. An increasing relationship has been observed between chronic inflammatory diseases and the risk of stroke. For this reason, it has been hypothesized that psoriasis could be considered a risk factor. OBJECTIVES: The aim of this systematic review is to synthesize the available evidence on the relationship between having psoriasis and an increased risk of cerebrovascular disease. Additionally, secondary objectives include comparing the role of moderate and severe psoriasis in the development of the disease and determining whether the increased risk is significant enough to be considered an independent risk factor. METHODOLOGY: A comprehensive search was conducted in PubMed, the Cochrane Library, and Embase with a deadline date of 01/01/2000. Clinical studies in English or Spanish were prioritized. After applying the inclusion criteria and a preliminary screening of titles and abstracts, 24 studies were identified, of which 10 were included. RESULTS: A total of 15,614,371 patients were studied: 391,575 cases and 15,223,066 controls. Most of the studies showed results supporting the association between the two conditions, apart from two articles that opposed it. CONCLUSION: Psoriasis is associated with a proinflammatory state that could explain the increased cardiovascular risk due to shared underlying mechanisms. This association is more evident in patients with moderate to severe psoriasis and in younger individuals, while no such association was found in mild cases.

Direction
ARIAS RIVAS, SUSANA (Tutorships)
Moreiras Arias, Noelia (Co-tutorships)

Court
GARRIDO GIL, PABLO (Chairman)
GARCIA SEARA, FRANCISCO JAVIER (Secretary)
VALENZUELA LIMIÑANA, RITA (Member)

Summary
Introduction: Major depression is a mood disorder characterized by sadness, loss of interest and pleasure, and other symptoms that affect the person's personal, social, and professional functioning. Despite advances in the treatment of this disorder, it is estimated that approximately 40% of patients do not respond adequately to existing medications, presenting with what is known as treatment-resistant depression (TRD). Therefore, the STAR-D study, one of the largest clinical trials in this field, observed the high complexity required to achieve improvement in these cases, highlighting the need for broader and more comprehensive management tailored to the real needs of these patients. Objectives: To explore the management of TRD from five fundamental perspectives: pharmacological, psychological, specialized nursing, nutritional, and exercise, with the aim of providing a more complete view of effective interventions. Materials and methods: Systematic review following the PRISMA model. A bibliographic search was conducted in the PubMed database. Due to the similarity of the results obtained, articles from other databases were not included. Fourteen articles were selected from a total of 13,093. Results and discussion: Regarding pharmacological strategies, it was evident that ECT was more effective in patients with severe to very severe depression, and in hospital settings, esketamine showed a more rapid response, starting from the first week of treatment. Strategies such as rTMS, augmentation with antipsychotics, and atypical antidepressants were evaluated, which improved symptoms more modestly in TRD patients, although they presented fewer cognitive and physical risks and adverse effects than esketamine and ECT. CBT showed slightly greater sustained efficacy than IPT and MBCT, although all three were effective in improving depressive symptoms, remission rates, and improved quality of life when added to pharmacotherapy. Nursing interventions optimized adherence, follow-up, resilience, and community integration. Mediterranean diet-based nutrition and aerobic exercise had complementary benefits in improving mood and cognition that were superior to medication alone. Conclusions: Most studies have methodological limitations due to limited evidence, but overall, the results support a multidimensional, personalized, and sustained approach that combines conventional and integrative therapies to address the clinical complexity of TRD

Direction
TORRES IGLESIAS, ANGELA JUANA (Tutorships)
NUÑEZ ARIAS, DANIEL (Co-tutorships)

Court
DOMINGUEZ MUÑOZ, JUAN ENRIQUE (Chairman)
Fernández Rodríguez, Mª Isabel (Secretary)
SANCHEZ IGLESIAS, SOFIA (Member)

Summary
Introduction: the lung cancer TNM classification and its organization in tumoral stages represented an important breakthrough in establishing groups of patients with similar prognosis and treatment. This task was carried out by the Union for International Cancer Control (UICC) and the American Joint Committee on Cancer (AJCC). Since the first edition published by the UICC in 1968 and by the AJCC in 1977, said classification kept changing in an effort to achieve better adjustment to the real behavior of these patients. Knowing the methodology used in the elaboration of these classifications, and the changes they went through, will help to better interpret the evolution that ended in the last classification that will come out in January 2025. Objectives: making a retrospective revision of the lung cancer TNM classifications and their evolution through history, analyzing in depth the changes it suffered in all these years. To review the methodology, both for the previous classifications and for the most imminent 9th edition. And, analyzing the prognostic and therapeutic implications that the new classification involves in the management of these patients. Methods: systematic review of the medical literature. Results: a detailed study of the articles published by the IASLC as analysis of the proposal for the ninth edition of the lung cancer TNM classification was made. The proposed changes showed a better stratification and prognostic discrimination, while being consistent with the previous classification. Conclusion: it was proposed to keep the eight classification descriptors for the ninth edition of the lung cancer TNM classification, which showed good discrimination in the analysis with the ninth edition data set, with the addition of the N2a, N2b, M1c1 and M1c2 subcategories.

Direction
CAÑIZARES CARRETERO, MIGUEL ANGEL (Tutorships)

Court
FRAGA RODRIGUEZ, MAXIMO FRANCISCO (Chairman)
ARROJO ROMERO, MANUEL (Secretary)
SÁNCHEZ SELLERO, INÉS (Member)

Summary
Introduction: The indwelling pleural catheter (IPC) has become a first-line treatment for the management of malignant pleural effusion (MPE). It is also the preferred option for patients in cases of trapped lung or significant comorbidities. The main advantage of the IPC over traditional pleurodesis is that it enables outpatient management of MPE. Major studies have shown that both approaches are equally effective and safe. However, there is still a lack of evidence regarding the impact of IPC insertion on hospitalization rates or specific follow-up visits in patients with MPE. Objective: To analize the healthcare impact of IPC-related care activities after catheter insertion in patients with MPE treated at a Pleural Pathology Unit within a tertiary care hospital. Methods: Patients who underwent IPC placement from April 2022 to November 2024 were included. Healthcare impact was assessed by tracking hospital admissions and specific follow-up visits required post-procedure. Results: A total of 41 IPCs were included, age of 73 years (66.5 to 80.5) and 21 patients (51%) were male. The most common cause of MPE was lung adenocarcinoma, accounting for 20 cases (48%). In 26 patients (63.4%), the IPC was placed on an outpatient basis. The median duration the catheter remained in place was 51 days (range 28 to 96). In 21 cases (51.2%), the catheter was removed due to successful pleurodesis. Only 3 patients (7.3%) were followed up in the Pleural Unit, while 30 (73.2%) also had follow-up in Oncology. Complications occurred in 7 patients (17.1%): 2 cases of organized pleural effusion requiring hospitalization and VATS, 1 case of catheter obstruction that required admission and a therapeutic thoracentesis, and 4 cases of cellulitis (only one of which required hospitalization). The median number of follow-up visits was 3 (1 to 4), with a median of 2 (0 to 3) medical visits and 1 (0 to 1.25) nursing visit. The number of follow-up visits was higher in the group with complications [5 (3 to 8) vs 2 (1 to 3.25); p = 0.006] and in the group whose catheters were placed on an outpatient basis [3 (1 to 4.25) vs 2 (0 to 3); p = 0.06]. Conclusions: The management of MPE with IPC involves a notable volume of clinical follow-up consultations, particularly among patients who experience complications and are at risk of hospitalization. Respiratory Medicine departments need to establish clear protocols to ensure appropriate care and support for this group of patients.

Direction
REPRESAS REPRESAS, CRISTINA (Tutorships)
Botana Rial, María Isabel (Co-tutorships)

Court
LOPEZ CASTROMAN, JORGE (Chairman)
MAZON RAMOS, MARIA DEL PILAR (Secretary)
ALONSO PENA, MARIA (Member)

Summary
INTRODUCTION: cancer represents a global health issue, with increasing incidence and significant medical, social, and economic impact on the population. To mitigate these effects, strategies such as early detection and diagnosis, alongside advances in treatment, are employed. Currently, several screening programs are established for early cancer diagnosis (breast, colon, and cervix). New techniques are under investigation, and one of the most promising is liquid biopsy OBJECTIVES: to conduct a systematic and up-to-date review of the role of liquid biopsy in early cancer detection, as well as to explore potential development pathways and its current limitations. MATERIAL AND METHODS: a comprehensive search was conducted in recognized databases. The PICoR framework was used to define specific inclusion and exclusion criteria. Study selection followed the PRISMA methodology. Data were organized into categories, and study quality was assessed using the GRADE tool. RESULTS: the initial search yielded a total of 539 results, from which six relevant studies were selected: PATHFINDER, DETECT-A, K-DETEK, CCGA-3, SYMPLIFY, and Nguyen (2023). All evaluated the performance and feasibility of different MCED tests, with particular attention to their ability to identify tumors in asymptomatic or very early stages. Overall specificity exceeded 97%, and sensitivity ranged from 27.1% to 70.83%. The negative predictive value remained above 97%, while the positive predictive value ranged between 19.4% and 75.5%. Additionally, the cancer signal origin was successfully detected in a range between 52% and 88.7%. CONCLUSION: liquid biopsy holds promising potential as an early detection tool. Although it is not yet ready to replace conventional screening, it shows potential to complement it. Further evidence is needed to explore and validate all its clinical, technical, and ethical aspects.

Direction
LOPEZ LOPEZ, RAFAEL (Tutorships)

Court
LOPEZ CASTROMAN, JORGE (Chairman)
MAZON RAMOS, MARIA DEL PILAR (Secretary)
ALONSO PENA, MARIA (Member)

Summary
Objective The present Final Degree Project (TFG) seeks to enhance knowledge for the optimal management of patients with Autoimmune Hepatitis (AIH) that does not respond to standard treatment, referred to as Refractory Autoimmune Hepatitis. Key aspects such as epidemiology, clinical manifestations, pathogenesis, diagnosis, and therapeutic options based on drug response are addressed. Results The case of a 53-year-old male patient was used as a reference, whose clinical course was monitored by the Hepatology Unit of the Gastroenterology Department at the University Hospital Complex of A Coruña. The patient was diagnosed in 2018 with type I autoimmune hepatitis, presenting intolerance to standard therapy with azathioprine and an insufficient biochemical response to prednisone, which led to the introduction of second-line therapies. The patient achieved biochemical stability without significant adverse effects with a triple therapy regimen consisting of prednisone, mycophenolate mofetil and tracolimus. The management of the described case highlights the importance of close follow-up and a gradual, stepwise adjustment of therapy, emphasizing the role of more potent immunosuppressive drugs in current clinical practice. A multidisciplinary approach, aligned with current guidelines, is essential for preventing disease progression and improving the patient's quality of life. Conclusions Autoimmune hepatitis (AIH) is considered a rare disease due to its low incidence. Its diagnosis is based on biochemical, immunological and histopathological criteria. First-line therapy includes prednisone and azathioprine. In cases of treatment failure or intolerance, mycophenolate mofetil (MMF) is used. Furthermore, the combination of tracolimus, MMF, and prednisone can induce biochemical remission and improve long-term prognosis. Delayed initiation of treatment promotes disease progression to cirrhosis and its complications.

Direction
DELGADO BLANCO, MANUEL BENJAMIN (Tutorships)

Court
COUCE PICO, MARIA DE LA LUZ (Chairman)
Eirís Puñal, Jesús Manuel (Secretary)
Cimadevila García, Antonio (Member)

Summary
Cervical cancer represents a major public health problem, and its management during pregnancy poses a complex clinical challenge. In this context, laparoscopic pelvic lymphadenectomy is considered a key technique for lymph node staging in pregnant women diagnosed with cervical cancer, allowing it to guide therapeutic decisions without significantly compromising maternal and fetal safety. This work consists of a systematic review aimed at evaluating the feasibility, safety, and prognostic implications of laparoscopic pelvic lymphadenectomy performed during pregnancy. Eight studies (case reports and case series) published between 2001 and 2022 were analyzed, with a total of 65 pregnant patients diagnosed with cervical cancer at various stages and undergoing this procedure between weeks 6 and 32 of pregnancy. The results reflect that the technique is largely safe and technically feasible, with no serious maternal or fetal complications attributable to the procedure. Most patients with negative lymph nodes were able to continue their pregnancies until fetal maturity, and after delivery, they received definitive cancer treatment. In cases with positive lymph nodes, maternal treatment was prioritized, usually with abortion. Maternal survival was favorable in the absence of lymph node metastasis, while cases with lymph node involvement had a worse prognosis.

Direction
ARIAS BALTAR, MARIA EFIGENIA (Tutorships)
Justo Alonso, Olaia (Co-tutorships)

Court
FREIRE-GARABAL NUÑEZ, MANUEL (Chairman)
Barge Caballero, Eduardo (Secretary)
SANTOS PEREZ, SOFIA MARIA SOLEDAD (Member)

Summary
Introduction. Motion sickness or movement disease is a physiological response that occurs due to excessive stimulation of an unusual perception of movement due to contradictory signals between the visual, vestibular and proprioceptive systems. Its high prevalence, as well as the functional impact it generates in patients is a clinical challenge. The use of new technologies such as virtual reality and optokinetic stimulation are opening up promising new therapeutic lines. Objective. The aim of this final degree project is to perform a review of the most recent scientific literature in order to evaluate the usefulness of vestibular rehabilitation in the treatment of patients with kinetosis. Material and methods. A systematic search was carried out in the PubMed and Web of Science databases for scientific literature between 2015 and now. Results. 10 papers were selected from the total number of articles found in the databases, 9 of which are experimental studies and the other is a systematic review. The data analyzed show that virtual reality has promising results, but with less standardized methodologies and protocols. Conclusions. The literatura found is scarce and heterogeneous, which makes it difficult to draw firm conclusions. Although virtual reality appears to be useful in reducing motion sickness symptoms, it is not without side effects. This calls for further research and the development of protocols that clearly define the use of virtual reality.

Direction
SOTO VARELA, ANDRES (Tutorships)

Court
FRAGA RODRIGUEZ, MAXIMO FRANCISCO (Chairman)
ARROJO ROMERO, MANUEL (Secretary)
SÁNCHEZ SELLERO, INÉS (Member)

Summary
The Primary sclerosing cholangitis (PSC) is a condition of unknown etiology characterized clinicopathologically by fibrosis and stenosis of the intrahepatic and extrahepatic bile ducts, often associated with cholestasis and complications related to bile duct obstruction. Due to its low prevalence and incidence, PSC is considered a rare disease. Its treatment remains a challenge, given the limited scientific evidence available to provide clear practical guidance. Objectives: to present the clinical, analytical, and evolutionary characteristics of a series of seven patients diagnosed with PSC. The aim is to establish a prototype patient to improve clinical management of this disease. In addition, comparisons are made with other patient series published in scientific literature in order to identify common or differential features that may enhance the understanding of this condition. Patients and methods: retrospective study conducted in a hepatology outpatient clinic of the Digestive Diseases Department at the University Hospital of A Coruña, between July 1, 2005, and March 28, 2025, including seven patients diagnosed with PSC. Their characteristics are described and compared with those reported in the literature. Statistical analysis was carried out by the Research Support Unit of the A Coruña-Cee Health Area. Results: Seven patients with confirmed diagnosis of primary sclerosing cholangitis were included, 71.4% of whom were male. The mean age was 56.6 years. A total of 71.4% had associated inflammatory bowel disease, while the presence of hypertension and dyslipidemia was lower. Digestive symptoms (42.9%) and pruritus (28.6%) were the most common complaints. The most frequent complication was cholestasis (85.7%). Diagnosis was mainly established through liver biopsy and MRCP. FibroScan evaluation of liver fibrosis showed normal values in the assessed patients. All patients were treated with ursodeoxycholic acid, and none required liver transplantation during follow-up. Conclusion: Primary sclerosing cholangitis is a rare disease that predominantly affects men in their fifth decade of life. In our series, a clear association with inflammatory bowel disease was observed, and the most common symptoms were gastrointestinal. Diagnosis was confirmed by MRCP and liver biopsy. Only one patient presented significant bile duct stenosis, and no oncologic complications were observed. Multicenter studies with a larger number of cases are needed to further investigate the characteristics and evolution of this disease in our population.

Direction
DELGADO BLANCO, MANUEL BENJAMIN (Tutorships)

Court
GONZALEZ VINAGRE, SALUSTIANO (Chairman)
PUBUL NUÑEZ, VIRGINIA (Secretary)
VAZQUEZ TORRES, MATEO (Member)

Summary
Objectives: To evaluate the effectiveness of the modified anterolateral Lemaire extra-articular graft combined with intra-articular ACL reconstruction in reducing residual rotational instability. Methods: A systematic review of clinical studies analyzing the effectiveness of combined ACL reconstruction with modified Lemaire extra-articular graft was conducted. Six studies with a minimum follow-up of 12 months were included, encompassing clinical trials, cohort studies, and case series. Inclusion criteria were patients diagnosed with ACL tears and moderate to high physical activity levels, particularly athletes. Results: The studies show that the combined technique significantly improves rotational stability, especially in the lateral compartment of the knee. A reduction in graft failure rates and the need for surgical reinterventions was observed. Furthermore, patients receiving the extra- articular graft achieved faster functional recovery and an earlier return to sports activities, especially in pivoting sports. Conclusions: The combination of ACL reconstruction with modified Lemaire extra-articular graft appears to be an effective strategy for improving rotational stability in patients with significant residual instability. This technique provides functional and clinical improvements, especially in athletes, without a notable increase in severe complications. It is crucial to individualize the surgical indication, selecting patients at higher risk of instability, and to conduct more controlled, long-term studies to optimize the implementation of the technique.

Direction
SUAREZ QUINTANILLA, JUAN ANTONIO (Tutorships)
Jorge Mora, Alberto Agustín (Co-tutorships)

Court
MUÑOZ PATIÑO, ANA MARIA (Chairman)
Portela Romero, Manuel (Secretary)
Aran Echabe, Eduardo (Member)

Summary
Introduction: Knee prostheses represent one of the most significant advances in modern orthopedic surgery, and their use is progressively increasing worldwide. This study explores whether prosthetic component design influences clinical and functional outcomes, analyzing aspects such as fixation (cemented vs cementless), posterior cruciate ligament preservation (preserving vs sacrificing), platform type (mobile vs fixed), and tibial component material (all-polyethylene vs metal-backed). Objective: To evaluate whether knee prosthetic component design affects postoperative outcomes, including function, implant survival, complication rates, and patient satisfaction. Methods: A systematic search of the existing literature from the last 3 years was conducted, analyzing the PubMed database. Results: No significant differences in survival or clinical outcomes were found between cemented and cementless prostheses, although the cementless showed a possible lower number of complications. Those that sacrificed the posterior cruciate ligament may have a greater range of flexion, but without clinically relevant differences in satisfaction or function. Those that preserved the posterior cruciate ligament may have shown greater long-term survival. There were no significant differences in function or complications between fixed and mobile bearing, although some studies reported better functional scores with mobile bearing. Both designs, all-polyethylene and metal-backed tibial component, showed similar results, with better cost-effectiveness for polyethylene. Conclusions: There is no clearly superior design for knee prostheses. The choice should be individualized based on patient characteristics, surgeon experience, and available resources.

Direction
PINO MINGUEZ, JESUS (Tutorships)
Señarís Rodríguez, José (Co-tutorships)

Court
ARCE VAZQUEZ, VICTOR MANUEL (Chairman)
Concheiro Guisán, Ana (Secretary)
CORTIÑAS DIAZ, JULIO ANTONIO (Member)

Summary
Cancer represents one of the leading causes of morbidity and mortality, as well as a significant burden on healthcare systems, both due to the costs associated with diagnosis and the various treatments involved, among which drug therapy plays a prominent role. The trend in recent decades towards personalized medicine has raised the possibility that home-based chemotherapy (HBC) could be a safe and reliable alternative in the treatment of various neoplasms, while the benefit of antineoplastic treatment, measured by its impact on health-related quality of life (HRQoL) has been gaining interest. Objectives: To conduct a systematic review of the available literature following the PRISMA-P protocol (Preferred Reporting Items for Systematic Review and Meta-analysis Protocols) in order to evaluate the impact of HBC on HRQoL in adult oncologic patients, and to define the advantages and limitations of the home-based model. Additionally, to provide a foundation for future clinical and organizational decisions. Methodology: A systematic research was conducted across the MEDLINE (via PubMed), Cochrane Library, Web of Science and Clinical Key databases. A total of 10 studies published up to January 2025 were included (6 randomized controlled trials and 4 cohort studies). The methodological quality and validity of the studies were assessed using the CAPSe tool. Results: A total of 860 references were retrieved and, after applying the inclusion and exclusion criteria, 10 studies were selected. Methodological heterogeneity prevented the performance of a meta-analysis, leading to a narrative synthesis. The most commonly used specific questionnaire was the EORT QLQ-C30. Only one study showed an improvement in HRQoL with HBC; another reported a decline, with no clear causal relationship. In the remaining studies, HRQoL remained stable. Additionally, data on patient-reported satisfaction and preferences were identified, supporting a positive evaluation of the home-based care model. Conclusions: HBC does not lead to a significant deterioration in HRQoL compared to hospital-based treatment. Patients highlight benefits such as shorter hospital stays, greater comfort, and reduced infections. Current HRQoL measurement tools may not adequately capture the nuances of the oncological patient experience, making it necessary to develop alternative instruments.

Direction
Mosquera Nogueira, Jacinto José (Tutorships)

Court
MUÑOZ PATIÑO, ANA MARIA (Chairman)
Portela Romero, Manuel (Secretary)
Aran Echabe, Eduardo (Member)

Summary
Antecedentes: Synucleinopathies, such as Parkinson’s disease (PD), dementia with Lewy bodies (DLB), and multiple system atrophy (MSA), are characterized by pathological accumulation of alpha- synuclein. Early and accurate clinical diagnosis remains a challenge. The detection of pathological alpha-synuclein in skin biopsies has emerged as a promising non-invasive tool. Objectives: To evaluate the diagnostic utility of skin biopsy for detecting pathological alpha-synuclein as a clinical biomarker in patients with suspected synucleinopathy. Methods: A systematic review was conducted following the PRISMA guidelines. PubMed, Scopus, and Web of Science were searched without date restrictions. Studies assessing the sensitivity, specificity, or diagnostic value of detecting pathological alpha-synuclein in skin using techniques such as immunohistochemistry, RT-QuIC, or PMCA were included. Non-original studies, animal studies, or those lacking clinical comparison were excluded. Results: After removing duplicates, 410 studies were identified, of which 14 met inclusion criteria. Techniques varied, with immunohistochemistry and RT-QuIC being the most common. Sensitivity ranged from 85% to 98%, and specificity from 83% to 100%, depending on the method and biopsy site. Several studies demonstrated utility in prodromal phases such as REM sleep behavior disorder. Conclusions: Skin biopsy is a promising tool for the clinical diagnosis of synucleinopathies, offering high sensitivity and specificity, particularly when seed amplification assays are applied. Its implementation could improve early diagnosis and patient stratification in clinical and research settings.

Direction
PRIETO GONZALEZ, JOSE MARIA OSCAR (Tutorships)
Marey Lopez, José Manuel (Co-tutorships)

Court
COSTOYA PUENTE, JOSE ANTONIO (Chairman)
DIEZ ULLOA, MAXIMO ALBERTO (Secretary)
DOMINGUEZ MEIJIDE, ANTONIO (Member)

Summary
Introduction: Being one of the major causes of women morbimortality, breast cancer incidence rate continues to grow steadily. For this reason, it has taken centre stage for the prevetion systems and early diagnosis in the National Health System. In the same way, oral contraceptives are widely spread among the population because of their key role not only in reproduction but also in hormonal treatments. However, this is a matter of long-standing concern due to its possible adverse effects over time, for instance its impact on the development of hormonodependent breast cancer. Objectives: This systematic review aims to determine whether the use of oral contraceptives may modify breast cancer incidence. Additionally, the incidence variation associated with other hormonal contraceptives and the histological tumour subtype will be analysed. Materials and Methods: Systematic search has been made on PubMed, Cochrane and Google Scholar database, including reports which have tackled this issue for the last 10 years. Finally, 12 of these articles were selected to shed light on our analysis. Results: It was observed that the relative risk of suffering this disease increases significantly for those women who took combined contraceptives for over 5 years. However, when the intake is suspended, the possibilities equate to the general population, especially in the subtype of tumours with positive hormonal receptors. Similarly, a higher relative risk has been detected in hormonal DIU users. Nevertheless, no conclusive evidence has been obtained about contraceptives obtaining only progestagens. Conclusions: According to the findings in this study, combined oral contraceptives can be considered a reversible risk factor for the development of breast cancer, in particular the subtype hormonodependent. What is more, it seems that the use of DIUs follows the same pattern, despite the lack of an in-depth study on this matter. Finally, the role of progestagens is to yet to be determined so a comprehensive analysis would be necessary to clarify their repercussion in the future.

Direction
SAMPAYO MONTENEGRO, MARIA VICTORIA (Tutorships)
Señarís López, Ana (Co-tutorships)

Court
AGUILERA GUIRAO, ANTONIO (Chairman)
Cinza Sanjurjo, Sergio (Secretary)
COSTA BESADA, MARIA ALICIA (Member)

Summary
Introduction: Total laryngectomy (TL), commonly indicated in advanced stages of laryngeal cancer, results in the irreversible loss of natural voice, significantly affecting patients’ quality of life and communication. In this context, voice rehabilitation becomes a clinical priority. Tracheoesophageal speech, achieved through fistula creation and voice prosthesis insertion, has proven to be the most acoustically and functi onally effective alternative. Objectives: To critically and comparatively analyse the main complications associated with Provox voice prostheses, integrating qualitative and quantitative data to assess their frequency, clinical impact and implications for treatment efficacy. Materials and methods: A structured literature review was conducted focusing on studies published between 2014 and 2024, selected through databases such as PubMed and Google Scholar. The screening process included critical evaluation of titles, abstracts, and full texts, applying predefined inclusion and exclusion criteria. Ten studies were ultimately included, which qualitatively analysed complications associated with the use of Provox voice prostheses; six of them also provided quantifiable data, allowing an assessment of complication frequency. The integration of both methodological perspectives enabled a more comprehensive understanding of the topic. Results: The most frequently reported complications were leakage through the prosthesis, periprosthetic leakage, and Candida spp. colonization, all with direct impact on device function. Additional issues such as prosthesis extrusion, granulation tissue formation, phonatory difficulties, skin irritation, and infections were also identified. Considerable methodological heterogeneity was observed across studies, particularly regarding the definition and quantification of complications. Conclusions: Although effective in restoring voice, Provox prostheses are associated with a relevant profile of complications that require close and sustained clinical monitoring. The lack of standardized criteria for documentation limits comparison between studies and the development of unified clinical guidelines. Therefore, prosthesis selection should be individualized, balancing expected functional benefits against potential risks in each patient’s context.

Direction
Martín Martín, Carlos Santiago (Tutorships)
Vázquez Barro, Juan Carlos (Co-tutorships)

Court
MUÑOZ BARUS, JOSE IGNACIO (Chairman)
GAGO AGEITOS, ANA MARIA (Secretary)
VAZQUEZ ILLANES, MARIA DOLORES (Member)