Dismantling stereotypes: Sexual orientation and risk for substance use in adolescence. / Desmontando estereotipos: Orientación sexual y riesgo para el consumo de sustancias en la adolescencia.

Substance use and abuse is a major public health problem. Research has generally shown that sexual minority groups such as lesbian, gay, bisexual, transgender and other (LGBT+) people are among the most at-risk vulnerable groups for substance use. However, research in the Spanish context is very scarce and has not analyzed these issues. This research, therefore, aimed to analyze substance use in young people according to their sexual orientation through two studies using representative samples of adolescents. The analyses revealed only some differences in substance use by sexual minority groups. Bisexual adolescents showed a higher frequency of use in some indicators of tobacco, cannabis and alcohol, and lesbians showed a higher frequency of heavy alcohol use but no other indicators of differential use. Questioning adolescents, on the other hand, had the lowest rates of use compared to the other groups on many indicators. Results derived from both studies could indicate, at least with these samples and indicators, that there is no generalized and more frequent use of substances by people of sexual minority groups, which could suggest the existence of a stereotype rather than a fact.

El uso y abuso de sustancias es un importante problema de salud pública. La investigación generalmente ha mostrado que los grupos de personas de minorías sexuales como lesbianas, gais, bisexuales, transexuales y otros (LGBT+) se ubican entre los grupos vulnerables de mayor riesgo de consumo. Sin embargo, la investigación en el contexto español es muy escasa y no ha analizado esta cuestión. Esta investigación, por lo tanto, pretendió analizar el consumo de sustancias en jóvenes según su orientación sexual a través de dos estudios utilizando muestras representativas de adolescentes. Los análisis revelaron únicamente algunas diferencias en el consumo de sustancias por parte de los grupos de minorías sexuales. Los y las adolescentes bisexuales presentaron una frecuencia mayor de consumo en algunos indicadores de tabaco, cannabis y alcohol y las lesbianas mostraron una mayor frecuencia de consumo intensivo de alcohol, pero no otros indicadores de consumo diferencial. Por su parte, los adolescentes questioning presentaron las tasas de consumo más bajas en comparación con los otros grupos en muchos indicadores. Los resultados de ambos estudios podrían indicar, al menos con estas muestras y con estos indicadores, que no existe un uso generalizado y más frecuente de sustancias por parte de personas de minorías sexuales, lo que podría sugerir la existencia de un estereotipo y no tanto responder a un hecho.

IL-10 indirectly modulates functional activity of CD4+CD28null T-lymphocytes through LFA-3 and HLA class II inhibition.

Expansion of CD4+CD28null T-lymphocytes is common in chronic heart failure (CHF) patients. Its ability to produce high levels of proinflammatory cytokines is probably the key role of these cells in CHF. IL-10 is a candidate for limiting CD4+CD28null T-lymphocyte responses, whereas tumour necrosis factor (TNF) is the cytokine most closely involved in the loss of CD28 expression. Serum levels of TNF and IL-10 were measured in 65 CHF patients (mean age, 65.2 ± 13.84 years). Patients with an IL-10/TNF ratio ≥1 had significantly lower levels of CD4+CD28null T-lymphocytes than those with a ratio <1. In vitro, IL-10 reduced the frequency of proliferative CD4+CD28null T-lymphocytes stimulated with anti-CD3. Pre-treatment with IL-10 before anti-CD3 stimulation was required for the cytokine to inhibit TNF production by CD4+CD28null T-lymphocytes. In addition to the previously described effect of IL-10 on HLA-DR and ICAM-1 expression, LFA-3 protein and mRNA levels were reduced in the presence of the cytokine in monocytes. IL-10 inhibition on CD4+CD28null T-lymphocytes may be mediated by a reduction in HLA class II and LFA-3 expression because blocking interactions with these costimulators has similar effects to those of IL-10 treatment. Moreover, costimulation through CD2/LFA-3 interaction is enough to induce proliferation and cytokine production in CD4+CD28null T-lymphocytes.

Review of the allocation criteria for heart transplant in Spain in 2023. SEC-Heart Failure Association/ONT/SECCE consensus document.

Heart transplant (HT) remains the best therapeutic option for patients with advanced heart failure (HF). The allocation criteria aim to guarantee equitable access to HT and prioritize patients with a worse clinical status. To review the HT allocation criteria, the Heart Failure Association of the Spanish Society of Cardiology (HFA-SEC), the Spanish Society of Cardiovascular and Endovascular Surgery (SECCE) and the National Transplant Organization (ONT), organized a consensus conference involving adult and pediatric cardiologists, adult and pediatric cardiac surgeons, transplant coordinators from all over Spain, and physicians and nurses from the ONT. The aims of the consensus conference were as follows: a) to analyze the organization and management of patients with advanced HF and cardiogenic shock in Spain; b) to critically review heart allocation and priority criteria in other transplant organizations; c) to analyze the outcomes of patients listed and transplanted before and after the modification of the heart allocation criteria in 2017; and d) to propose new heart allocation criteria in Spain after an analysis of the available evidence and multidisciplinary discussion. In this article, by the HFA-SEC, SECCE and the ONT we present the results of the analysis performed in the consensus conference and the rationale for the new heart allocation criteria in Spain.

International Consensus Recommendations on the Aesthetic Usage of Ready-to-Use AbobotulinumtoxinA (Alluzience).

Alluzience (abobotulinumtoxinA RTU; Ipsen, Paris, France and Galderma SA, Lausanne, Switzerland) is the first ready-to-use (RTU) botulinum toxin type A liquid solution approved for the treatment of glabellar lines in Europe. In this article, the authors provide consensus recommendations on the aesthetic usage of abobotulinumtoxinA RTU. Members of the International Board on Alluzience convened to develop consensus on the treatment of glabellar lines as well as other facial wrinkles based on their own extensive experience. Consensus recommendations were developed to provide practical guidelines for injection of abobotulinumtoxinA RTU. General guidance on proper assessment, treatment planning, and patient education is provided, as well as specific injection guidelines per indication. Indications covered include glabellar lines, crow's feet, horizontal forehead lines, lateral eyebrow lift, lower eyelid wrinkles, bunny lines, drooping nasal tip, perioral wrinkles, drooping mouth corners, masseter hypertrophy, hollow cheek lines, dimpled chin, and platysmal bands. These guidelines provide a practical framework to support routine injection of facial muscles with Alluzience.

Incidence and Prognosis of Colorectal Cancer After Heart Transplantation: Data From the Spanish Post-Heart Transplant Tumor Registry.

In this observational and multicenter study, that included all patients who underwent a heart transplantation (HT) in Spain from 1984 to 2018, we analyzed the incidence, management, and prognosis of colorectal cancer (CRC) after HT. Of 6,244 patients with a HT and a median follow-up of 8.8 years since the procedure, 116 CRC cases (11.5% of noncutaneous solid cancers other than lymphoma registered) were diagnosed, mainly adenocarcinomas, after a mean of 9.3 years post-HT. The incidence of CRC increased with age at HT from 56.6 per 100,000 person-years among under 45 year olds to 436.4 per 100,000 person-years among over 64 year olds. The incidence rates for age-at-diagnosis groups were significantly greater than those estimated for the general Spanish population. Curative surgery, performed for 62 of 74 operable tumors, increased the probability of patient survival since a diagnosis of CRC, from 31.6% to 75.7% at 2 years, and from 15.8% to 48.6% at 5 years, compared to patients with inoperable tumors. Our results suggest that the incidence of CRC among HT patients is greater than in the general population, increasing with age at HT.

Toll-like receptor agonists enhance HIV-specific T cell response mediated by plasmacytoid dendritic cells in diverse HIV-1 disease progression phenotypes.

BACKGROUND: Plasmacytoid dendritic cells (pDCs) sense viral and bacterial products through Toll-like receptor (TLR)-7 and -9 and translate this sensing into Interferon-α (IFN-α) production and T-cell activation. The understanding of the mechanisms involved in pDCs stimulation may contribute to HIV-cure immunotherapeutic strategies. The objective of the present study was to characterize the immunomodulatory effects of TLR agonist stimulations in several HIV-1 disease progression phenotypes and in non HIV-1 infected donors. METHODS: pDCs, CD4 and CD8 T-cells were isolated from 450 ml of whole blood from non HIV-1 infected donors, immune responders (IR), immune non responders (INR), viremic (VIR) and elite controller (EC) participants. pDCs were stimulated overnight with AT-2, CpG-A, CpG-C and GS-9620 or no stimuli. After that, pDCs were co-cultured with autologous CD4 or CD8 T-cells and with/without HIV-1 (Gag peptide pool) or SEB (Staphylococcal Enterotoxin B). Cytokine array, gene expression and deep immunophenotyping were assayed. FINDINGS: pDCs showed an increase of activation markers levels, interferon related genes, HIV-1 restriction factors and cytokines levels after TLR stimulation in the different HIV-disease progression phenotypes. This pDC activation was prominent with CpG-C and GS-9620 and induced an increase of HIV-specific T-cell response even in VIR and INR comparable with EC. This HIV-1 specific T-cell response was associated with the upregulation of HIV-1 restriction factors and IFN-α production by pDC. INTERPRETATION: These results shed light on the mechanisms associated with TLR-specific pDCs stimulation associated with the induction of a T-cell mediated antiviral response which is essential for HIV-1 eradication strategies. FUNDING: This work was supported by Gilead fellowship program, the Instituto de Salud Carlos III (Fondo Europeo de Desarrollo Regional, FEDER, "a way to make Europe") and the Red Temática de Investigación Cooperativa en SIDA and by the Spanish National Research Council (CSIC).

Impact of lockdown on the addictive behavior of university students in La Rioja. / Impacto del confinamiento en la conducta adictiva de los universitarios riojanos.

One of the consequences of the COVID-19 health crisis was the general lockdown. Research shows that lockdown situations may cause changes in addictive behaviors. The objective of the present study was to analyze the impact of lockdown on the addiction pattern of university students in order to design interventions adjusted to the students' needs. The study was conducted through a non-probabilistic sample of 540 students, with a mean age of 22.3 years and a proportion of women of 69.3%. The results indicated a significant decrease in the consumption of tobacco, alcohol, and psychotropic drugs during the participants' lockdown, both in the number of users and in the amounts consumed. Regarding behaviors related to behavioral addictions, participants showed a significant increase in problematic Internet use and use of video games and eSports, although the level of gambling decreased. Despite the fact that consumption patterns were reduced due to changes in the leisure and free time patterns of this population subgroup, it was possible to identify some indicators that deserve attention due to their increase, such as relapses in smoking, an increase in the number of participants who drank alcohol on a daily basis and an increase in the level of discomfort related to the use of technology. The implications of the results are analyzed and possible actions demanded by the students are examined.

Una de las implicaciones de la crisis sanitaria de la COVID-19 ha sido el confinamiento de la población. La investigación previa muestra que las situaciones de confinamiento provocan cambios en las conductas adictivas. El objetivo del presente estudio fue conocer el impacto del confinamiento en el patrón de las adicciones de los y las estudiantes universitarios con la intención de diseñar intervenciones ajustadas a las necesidades de esta población. La muestra no probabilística estuvo compuesta por 540 estudiantes de la Universidad de La Rioja, con una media de edad de 22,3 años y una proporción de mujeres del 69,3%. Los resultados indicaron un descenso significativo en el consumo de tabaco, alcohol y psicofármacos durante el confinamiento de los y las participantes tanto en el número de consumidores como en las cantidades consumidas. Respecto a las conductas relacionadas con las adicciones comportamentales, los y las participantes indicaron un aumento significativo del uso problemático de Internet y de videojuegos y eSports, aunque descendió el nivel de juego de apuestas. A pesar de que los patrones de consumo se vieron reducidos por el impacto que el confinamiento tuvo en los patrones de ocio y tiempo libre de este subgrupo poblacional, se identificaron algunos indicadores merecedores de atención por su aumento, como recaídas en el consumo de tabaco, aumento del número de participantes que consumen alcohol a diario y aumento en el nivel de malestar relacionado con el uso de Internet. Se analizan las implicaciones de los resultados y se examinan posibles acciones demandadas por el estudiantado.

Results of heart retransplantation: subanalysis of the Spanish Heart Transplant Registry.

INTRODUCTION AND OBJECTIVES: Heart retransplantation (ReHT) is controversial in the current era. The aim of this study was to describe and analyze the results of ReHT in Spain. METHODS: We performed a retrospective cohort analysis from the Spanish Heart Transplant Registry from 1984 to 2018. Data were collected on donors, recipients, surgical procedure characteristics, immunosuppression, and survival. The main outcome was posttransplant all-cause mortality or need for ReHT. We studied differences in survival according to indication for ReHT, the time interval between transplants and era of ReHT. RESULTS: A total of 7592 heart transplants (HT) and 173 (2.3%) ReHT were studied (median age, 52.0 and 55.0 years, respectively). Cardiac allograft vasculopathy was the most frequent indication for ReHT (42.2%) and 59 patients (80.8%) received ReHT >5 years after the initial transplant. Acute rejection and primary graft failure decreased as indications over the study period. Renal dysfunction, hypertension, need for mechanical ventilation or intra-aortic balloon pump and longer cold ischemia time were more frequent in ReHT. Median follow-up for ReHT was 5.8 years. ReHT had worse survival than HT (weighted HR, 1.43; 95%CI, 1.17-1.44; P<.001). The indication of acute rejection (HR, 2.49; 95%CI, 1.45-4.27; P<.001) was related to the worst outcome. ReHT beyond 5 years after initial HT portended similar results as primary HT (weighted HR, 1.14; 95%CI, 0.86-1.50; P<.001). CONCLUSIONS: ReHT was associated with higher mortality than HT, especially when indicated for acute rejection. ReHT beyond 5 years had a similar prognosis to primary HT.

Composición y función salival en niños con labio con/sin paladar hendido no sindrómico / Salivary composition and function in children with non-syndromic cl w/wo p / Composição e função salivar em crianças com fissuras labiais e/ou palatinas não sindrômicas

Resumen Introducción y Objetivo: La saliva cumple una importante función en la homeostasis oral, aunque no es evaluada rutinariamente en pacientes con labio con/sin paladar hendido (LH±PH). Este estudio pretendió comparar las características salivares de niños con LH±PH no sindrómico vs. niños sin esta diferencia craneofacial. Materiales y métodos: Se incluyeron 17 niños con LH±PH no sindrómico y 25 niños sin LH±PH, de los cuales se colectaron muestras de saliva estimulada (SE) y no estimulada (SNE). Se realizaron pruebas fisicoquímicas, cuantificación de iones (Ca, Mg y P), proteína total y recuento de streptococcus mutans en ambos grupos para ambas muestras de saliva. Para establecer comparaciones entre grupos se realizó la prueba no paramétrica de Mann-Whitney. Resultados: Hubo diferencias estadísticamente significativas en el pH de SE y SNE, así como en proteína total y capacidad amortiguadora de SNE. El pH (p=0,002) y capacidad amortiguadora (p=0,023) de SNE de los niños con LH±PH fueron menores, mientras que la concentración de proteína total (p=0,003) fue mayor con respecto al grupo control. Se encontró mayor proporción de estreptococo mutans en SNE de niños con LH±PH (6,39x104 UFC mL-1) respecto al grupo control (2,21x104 UFC mL-1), aunque sin detectar diferencias estadísticamente significativas (p=0,243). Conclusiones: Estos hallazgos sugieren una alteración en la función y composición de la SNE en pacientes con LH±PH no sindrómico, que correspondería a una alteración en la formación y función de las glándulas salivales en estos individuos que requiere ser investigada.

Abstract Introduction and objective: Saliva plays an important role in oral homeostasis, although it is not routinely evaluated in patients with CL±P. This study aimed to compare these characteristics in children with non-syndromic CL±P vs. children without this craniofacial difference. Materials and methods: This descriptive study included 17 children with non-syndromic CL±P from Fundación Clínica Noel and 25 children without CL±P. Stimulated (SS) and non-stimulated saliva (NSS) from both groups were collected for physicochemical tests, quantification of ions (Ca, Mg and P), total protein and streptococcus mutans count. Results: There were statistically significant differences in pH of SS and NSS, as well as in total protein concentration and buffer capacity in NSS. The pH (p = 0.002) and buffering capacity (p = 0.023) of NSS of CL±P children decreased, while total protein concentration (p = 0.003) increased compared to the control group. A higher streptococcus mutans count was found in NSS of CL±P children (6.39x104 CFU UFC mL-1) compared to the control group (2.21x104 UFC mL-1), although without detecting statistically significant differences (p = 0.243). Conclusions: These findings suggest an alteration in the function and composition of NSS in patients with non-syndromic CL±P; which could possibly be explained from the genetic/biological point of view by an alteration in the salivary glands formation and function in these individuals that requires further investigation.

Resumo Introdução e objetivo: A saliva desempenha um papel fundamental na homeostase oral, não é avaliada rotineiramente em pacientes com FL/P. Portanto, este estudo objetivou indagar essas características em crianças com FL/P não sindrômico. Materiais e métodos: 17 crianças com FL/P não sindrômico da Fundación Clínica Noel, e 25 crianças sem FL/P foram incluídas neste estudo. Amostras de saliva estimulada (SE) e saliva não estimulada (SNE) foram coletadas para realização de testes físico-químicos, quantificação de íons (Ca, Mg e P), proteína total e contagem de streptococcus mutans. Resultados: Houve diferenças estatisticamente significativas no pH de SE e SNE, bem como na concentração de proteína total e capacidade tampão de SNE. O pH (p=0,002) e a capacidade tampão (p=0,023) de SNE de crianças com FL/P foram menores, enquanto a concentração de proteína total (p=0,003) foi maior, quando comparado ao grupo controle. Um contagem maior de streptococcus mutans foi encontrada na saliva não estimulada de crianças com FL/P (6,39x104 UFC mL-1) em comparação ao grupo controle (2,21x104 UFC mL-1), embora sem detectar diferenças estatisticamente significativas (p=0,243). Conclusão: Esses achados sugerem uma alteração na função e composição da SNE em pacientes com FL/P não sindrômico; isso possivelmente poderia ser explicado do ponto de vista genético/biológico por uma alteração na formação e função das glândulas salivares nesses indivíduos que requer investigação.

Malignancy following heart transplantation: differences in incidence and prognosis between sexes - a multicenter cohort study.

Male patients are at increased risk for developing malignancy postheart transplantation (HT); however, real incidence and prognosis in both genders remain unknown. The aim of this study was to assess differences in incidence and mortality related to malignancy between genders in a large cohort of HT patients. Incidence and mortality rates were calculated for all tumors, skin cancers (SCs), lymphoma, and nonskin solid cancers (NSSCs) as well as survival since first diagnosis of neoplasia. 5865 patients (81.6% male) were included. Total incidence rates for all tumors, SCs, and NSSCs were lower in females [all tumors: 25.7 vs. 44.8 per 1000 person-years; rate ratio (RR) 0.68, (0.60-0.78), P < 0.001]. Mortality rates were also lower in females for all tumors [94.0 (77.3-114.3) vs. 129.6 (120.9-138.9) per 1000 person-years; RR 0.76, (0.62-0.94), P = 0.01] and for NSSCs [125.0 (95.2-164.0) vs 234.7 (214.0-257.5) per 1000 person-years; RR 0.60 (0.44-0.80), P = 0.001], albeit not for SCs or lymphoma. Female sex was associated with a better survival after diagnosis of malignancy [log-rank p test = 0.0037; HR 0.74 (0.60-0.91), P = 0.004]. In conclusion, incidence of malignancies post-HT is higher in males than in females, especially for SCs and NSSCs. Prognosis after cancer diagnosis is also worse in males.

Gender differences in heart transplantation: Twenty-five year trends in the nationwide Spanish heart transplant registry.

The study of gender differences may lead into improvement in patient care. We have aimed to identify the gender differences in heart transplantation (HT) of adult HT recipients in Spain and their evolution in a study covering the years 1993-2017 in which 6740 HT (20.6% in women) were performed. HT indication rate per million inhabitants was lower in women, remaining basically unchanged during the 25-year study period. HT rate was higher in men, although this decreased over the 25-year study period. Type of heart disease differed in men versus women (p < .001): ischemic heart disease 47.6% versus 22.5%, dilated cardiomyopathy 41.3% versus 34.6%, or other 36% versus 17.8%, respectively. Men were more frequently diabetics (18% vs. 13.1% p < .001), hypertensives (33.1% vs. 24% p < .001), and smokers (21.7% vs. 12.9% p < .001), respectively. Women had more pre-HT malignancies (7.1% vs. 2.8% p < .001), and their clinical status was worse at HT due to renal function and mechanical ventilation. Adjusted survival (p = .198) and most of the mortality-related variables were similar in men and women. Death occurred more frequently in women due to rejection (7.9% vs. 5.1% p < .001) and primary failure (18.2% vs. 12.5% p < .001) and in men due to malignancies (15.1% vs. 6.6% p < .001).

Consensus document and recommendations on palliative care in heart failure of the Heart Failure and Geriatric Cardiology Working Groups of the Spanish Society of Cardiology.

Heart failure is a complex entity, with high morbidity and mortality. The clinical course and outcome are uncertain and difficult to predict. This document, instigated by the Heart Failure and Geriatric Cardiology Working Groups of the Spanish Society of Cardiology, addresses various aspects related to palliative care, where most cardiovascular disease will eventually converge. The document also establishes a consensus and a series of recommendations with the aim of recognizing and understanding the need to implement and progressively apply palliative care throughout the course of the disease, not only in the advanced stages, thus improving the care provided and quality of life. The purpose is to improve and adapt treatment to the needs and wishes of each patient, who must have adequate information and participate in decision-making.

Psychotic-like experiences and cannabis use in adolescents from the general population. / Experiencias psicóticas atenuadas y consumo de cannabis en adolescentes de la población general.

The purpose of this study was to analyze the relationship between psychotic-like experiences and cannabis use in a representative sample of adolescents from the general population. A total of 1,588 students (M=16.13 years, SD = 1.36), 739 men (46.5%), selected by stratified random sampling by conglomerates from 98 classes in 34 schools participated in the survey. The instruments used were the Prodromal Questionnaire-Brief, the Strengths and Difficulties Questionnaire, the Modified Substance Use Questionnaire, the Penn Matrix Reasoning Test, the Family Affluence Scale-II, and the Oviedo Infrequency Scale. Results showed that a percentage of adolescents reported psychotic-like experiences and/or cannabis use. Prior to controlling for multiple confounders (gender, age, socio-economic level, alcohol use, smoking, emotional and behavioral problems, and IQ), cannabis use was associated with psychotic-like experiences. After adjustment for confounders, psychotic-like experiences were not seen to be associated with cannabis use. Mediational analyses showed that emotional and behavioral problems mediate the relationship between cannabis use and risk of psychosis. It seems that once the effect of multiple confounding variables is controlled for, the use of cannabis increases the risk of comorbid psychopathology and this in turn increases the risk of psychosis. These results suggest that the relationships established between psychotic experiences and cannabis are complex and mediated by relevant variables. Further studies should examine this relationship in follow-up studies and gene-environmental designs.

El propósito de este estudio fue analizar la relación entre las experiencias psicóticas atenuadas y el consumo de cannabis en una muestra representativa de adolescentes de la población general. Un total de 1,588 estudiantes (M=16,13 años; DT = 1,36), 739 eran hombres (46,5%), pertenecientes a 34 escuelas y 98 aulas, seleccionados mediante muestreo aleatorio estratificado por conglomerados, fueron encuestados. Los instrumentos administrados fueron el Cuestionario de Pródromos de Psicosis-Breve, el Cuestionario de Capacidades y Dificultades, el Cuestionario de Consumo de Sustancias Modificado, el Penn Matrix Reasoning Test (PMRT), la Family Affluence Scale-II y la Escala Oviedo de Infrecuencia de Respuesta. Los resultados mostraron que un porcentaje de adolescentes informaron de experiencias psicóticas atenuadas y/o consumo de cannabis. Antes de controlar el efecto de múltiples covariables (género, edad, nivel socio-económico, consumo de tabaco, problemas emocionales y CI), los jóvenes consumidores de cannabis informaron de un mayor riesgo teórico de psicosis. Cuando se controló el efecto de las covariables, las experiencias psicóticas no se asociaron con el consumo de cannabis. El análisis mediacional indicó que los problemas en el ajuste emocional y comportamental mediaban en la relación entre consumo de cannabis y experiencias psicotiformes. Parece ser que, una vez controlado el efecto de las múltiples variables de confundido, el uso de cannabis aumenta el riesgo de psicopatología comórbida y esta a su vez el riesgo de psicosis (mayor frecuencia de experiencias psicóticas). Estos resultados sugieren que la relación que se establece entre las experiencias psicóticas y el cannabis es compleja y se encuentra mediada por variables relevantes. Futuros estudios deberán examinar las interacciones Gen x Ambiente en estudios longitudinales.

Use of Idarucizumab to reverse the anticoagulant effect of dabigatran in cardiac transplant surgery. A multicentric experience in Spain.

BACKGROUND: Anticoagulation in heart transplant (HT) recipients increases the risk of hemorrhagic complications, so correct reversal of anticoagulation is needed. Dabigatran, a direct thrombin inhibitor, is increasingly used for anticoagulation in patients with non-valvular atrial fibrillation (NVAF) whose effect can be reversed by idarucizumab. AIM: To present a nationwide experience using idarucizumab for the urgent reversal of dabigatran before HT. METHODS: Multicenter observational study in 12 Spanish centers to analyze the clinical outcomes after using idarucizumab before HT surgery. RESULTS: Fifty-three patients were included (81.1% male). 7.5% required re-operation in the immediate postoperative period to control bleeding and 66% transfusion of blood products. Median length of stay in the intensive care unit was 6 days and total hospital stay 24 days. 30-day survival was 92.4%. There were four deaths in the first month, all in the first 5 days post-HT. Only in one patient (transplanted due to a congenital heart disease, after sternotomy) who had surgical problems and right ventricular failure post-HT death was associated with bleeding. CONCLUSIONS: These results may support the use of dabigatran as an alternative to vitamin K antagonists in patients listed for HT requiring anticoagulation due to NVAF. More studies are needed to reaffirm these observations.

Gene variants in the NF-KB pathway (NFKB1, NFKBIA, NFKBIZ) and risk for early-onset coronary artery disease.

The nuclear-factor kappa-beta (NF-KB) is a driver of inflammation, and plays an important role in the pathogenesis of atherosclerosis and coronary artery disease (CAD). Early-onset CAD is defined as a coronary ischaemic episode at an age ≤55 years, and in our population was strongly associated with male sex and smoking. Our aim was to determine whether common variants in three NF-KB genes were associated with early-onset CAD. We studied 609 patients with early-onset CAD and 423 healthy controls, all male. Allele and genotype frequencies for the NFKB1 rs28362491 (-94 delATTG) and NFKBIA rs8904 were not significantly different between the two groups. For the NFKBIZ rs3217713, the deletion allele was significantly more frequent in the patients than in controls (0.27 vs. 0.22; p = 0.004). Deletion-carriers were more frequent in the patients (p < 0.001), with an OR = 1.48 (95%CI = 1.15-1.90). We performed a multiple logistic regression (linear generalized model) with smoking, hypercholesterolemia, type 2 diabetes, hypertension, and the rs3217713 deletion carriers remained significantly associated with early-onset CAD (p = 0.01). In our population, the NFKBIZ variant was an independent risk factor for developing early-onset CAD.

High CD8 T cell percentage and HCV replication control are common features in HIV-1 controllers and HTLV-2-co-infected patients with a history of injection drug use.

HTLV-2/HIV-1-coinfected patients and HIV-infected patients with natural HIV-1 control show an immune capacity that allows some control of viral infections. These two groups of patients have showed an immune capacity that allows them to have some control over viral infections, very strong control of HIV-1 replication in the case of HIV-1 controllers. The purpose of this retrospective cross-sectional study was to compare viral and immunologic parameters between three cohorts of Caucasian adult HIV-1-infected patients, including HIV-1 controllers (29 patients), HTLV-2/HIV-1 chronic progressors (56 patients), and HIV-1 chronic progressors (101 patients), followed in two different tertiary University Hospitals in Spain. Demographic parameters, nadir CD4 T cell count, CD4 and CD8 T cell counts and percentage, anti-HCV antibodies, HCV RNA load, HCV genotype, HIV-1 RNA loads, and anti-HTLV-2 antibodies were analyzed. HIV-1 controllers and HTLV-2/HIV-1 chronic progressors were younger and with shorter time since HIV-1 diagnosis compared to HIV-1 chronic progressors. HIV-1 controllers and HTLV-2/HIV-1 chronic progressors had significantly higher CD8 T cell percentage (p = 0.002 and p = 0.016, respectively) and lower levels of HCV RNA loads (0.015 and 0.007, respectively) compared to that of HIV-1 chronic progressors. Multivariate analyses showed that gender and HTLV-2 infection were independently associated to HCV RNA load, while only HTLV-2 infection was independently associated to CD8 T cell percentage. The implication of HTLV-2 infection in the control of HIV-1 and HCV infections is worth being further analyze.

Implementación y evaluación de la eficacia de un programa de educación emocional en adolescentes con diagnóstico de TDAH / Implementtion and evaluation of the efficiency of an emotional education program in teenagers diagnosed with ADHD

Las habilidades socioemocionales en jóvenes con diagnóstico de Trastorno por Déficit de Atención e Hiperactividad (TDAH) son esenciales en su desarrollo psicológico y bienestar personal. Sin embargo, a pesar del reconocimiento general de la necesidad de dotar a estos jóvenes de recursos y estrategias que no están ni atendidas ni contempladas en el currículo académico, son escasos los trabajos que muestren la validez de programas de educación emocional en este colectivo. El objetivo del trabajo fue triple: a) la adaptación e implementación de un programa de educación emocional (denominado INTEMO), b) la evaluación de su eficacia, y c) el análisis de la satisfacción con el programa de usuarios y familiares. Se utilizó un grupo de tratamiento (n=24) y un grupo de comparación (n=24) de estudiantes con diagnóstico de TDAH, que fueron evaluados en dos momentos temporales. Los resultados evidenciaron que los participantes que recibieron el programa mejoraron de forma estadísticamente significativa en la dimensión de problemas con los compañeros y en regulación emocional, respecto al grupo de comparación. No se observaron diferencias estadísticamente significativas entre los grupos en autoestima y empatía. Los usuarios del programa indicaron una alta satisfacción con la intervención. Los resultados obtenidos indican la necesidad de continuar con el análisis de la eficacia de este programa y se discute la necesidad de potenciar las competencias socioemocionales en esta etapa, con el fin de mejorar el bienestar personal, familiar, académico y social de la población infantojuvenil con TDAH.

Socio-emotional skills in teenagers diagnosed with Attention-deficit/hyperactivity disorder (ADHD) are essential for their psychological development and subjective well-being. However, despite the general recognition for the need to provide young people diagnosed with ADHD with resources and strategies, that are neither addressed nor contemplated in the academic curriculum, there is a lack of studies that shed a light on the effects of emotional intelligence programs in this group. The objective of this work was threefold: a) the adaptation and implementation of an emotional intelligence program (named INTEMO), b) the evaluation of its effectiveness, and c) the analysis of satisfaction of participants and their families with the program. An experimental group was set up (n=24) together with a comparison group (n=24) of students diagnosed with ADHD, and both were evaluated at two different points. The results obtained demonstrated that, after three months of intervention, the experimental group showed significantly higher scores with regard to peer problems and emotional regulation, compared to the comparison group. No significant results were found on empathy and self-esteem. The participants of the program expressed high satisfaction with the intervention. The results indicate the need to continue with the analysis of the effectiveness of this program, with the aim of promoting the socio-emotional competences at this stage in order to improve well-being in personal, family, academic and social spheres among the infant-juvenile population with ADHD.

Fibrilación auricular. Panorámica sobre un tema actualizado / Atrial fibrillation. An update review

La fibrilación auricular (FA) es la arritmia más común en el mundo, con altas mortalidad y morbilidad. Es la primera causa de eventos embólicos como: el deterioro cognitivo, los episodios de insuficiencia cardíaca y la disminución de la calidad de vida, con repercusión socioeconómica y sanitaria. Hoy, se conoce que la FA comienza por ráfagas de descargas eléctricas anormales, que activan rápida e irregularmente las aurículas. La reciente clasificación de la FA en paroxística, persistente o permanente, refleja el deterioro evolutivo de la arritmia. En la actualidad, existe una amplia gama de fármacos para tratar esta patología. Sobresalen los antiarrítmicos y anticoagulantes, aunque la técnica moderna de la ablación con catéter se ha incluido en las guías clínicas, como alternativa o complemento de los fármacos antiarrítmicos, en pacientes seleccionados con FA.

Atrial fibrillation (FA) it is the most common arrhythmia today, presenting high mortality and morbility levels. It is the first cause of embolic events and episodes of heart inadequacy, cognitive deteriorate and poor life quality. It also brings socioeconomic and sanitary consecuences. Today, FA trigers blasts of abnormal electric discharges, which activate auricles quickly and irregularly. Recent classification of the FA as sudden, persistent and permanent lead to an evolving arrhythmia deterioration. In present times, this pathology is treated using a wide range of drugs. Antiarrhythmics and anticoagulants stand out, although the modern technique of ablation with catheter has been included in the clinical guides, either alternative or complement of antiarrhythmics, in patients affected by FA.

Eradication of Hepatitis C Virus (HCV) Reduces Immune Activation, Microbial Translocation, and the HIV DNA Level in HIV/HCV-Coinfected Patients.

Background: There are contradictory data about the influence that hepatitis C virus (HCV) has on immune activation and inflammation in patients coinfected with human immunodeficiency virus (HIV) and HCV. Methods: HIV/HCV-coinfected patients receiving antiretroviral treatment who achieved a sustained virological response with interferon-free regimens were consecutively enrolled in a prospective study. The following factors were assessed before, immediately after the end of, and 1 month after the end of therapy: expression of HLA-DR/CD38, PD-1, and CD57 on CD4+ and CD8+ T-cells; measurement of the total HIV DNA load in peripheral blood mononuclear cells; and determination of plasma levels of soluble CD14 (sCD14), lipopolysaccharide (LPS), 16S ribosomal DNA (rDNA), interleukin 6 (IL-6), D-dimers, and high-sensitivity C-reactive protein (hsCRP). Results: Ninety-seven patients were consecutively included. At the end of therapy and 1 month later, there were significant reductions in the expression of HLA-DR and CD38 in CD4+ and CD8+ T cells, as well as levels of proviral HIV DNA, sCD14, LPS, 16S rDNA, and D-dimer (P < .001). By contrast, the expression of PD-1 and CD57 in CD4+ and CD8+ T cells and levels of IL-6 and hsCRP did not change. The improvement in levels of immune activation markers, proviral HIV DNA, and microbial translocation markers did not translate into an increased CD4+ T-cell count or increased ratio of the CD4+ T-cell count to the CD8+ T-cell count. Conclusions: HCV eradication in HIV/HCV-coinfected patients results in significant decreases in levels of immune activation markers, proviral HIV DNA load, microbial translocation markers, and D-dimers. These findings support the use of HCV treatment for all HIV/HCV-coinfected patients, even those with low-grade fibrosis.