Treatment with fostamatinib in patients with immune thrombocytopenia: Experience from the Andalusian region in Spain-The Fostasur Study.

Immune thrombocytopenia (ITP) is characterized by low platelet counts (PLTs) and an increased risk of bleeding. Fostamatinib, a spleen tyrosine kinase inhibitor, has been approved as a second-line treatment for ITP. Real-world data on fostamatinib are lacking. This observational, retrospective, multicentre study, conducted in the Andalusia region of Spain, evaluated 44 adult primary ITP patients (47.7% female; median age 58 years; newly diagnosed ITP 6.8%; persistent 13.6%; chronic 79.5%; median four prior treatments) after ≥ 4 weeks of fostamatinib therapy. The median PLT at the initiation of fostamatinib was 15 × 109/L. Common reasons for starting fostamatinib were refractoriness or intolerance to prior therapy, oral medication preference, history of thrombosis and cardiovascular risk. Dosing was individualized based on efficacy and tolerance. After 2 weeks, global response rate was 56.8% (response and complete response). Response rates were 70.5%, 62.5% and 64% at 4 weeks, 12 weeks and at the end of the study respectively. Adverse events were mild, and no patients discontinued as a result. This real-world study demonstrated a response rate similar to fostamatinib as seen in the pivotal clinical trials while including newly diagnosed patients and allowing for individualized dosing.

Outpatient Antipsychotic Use and Severe COVID-19: Avoiding the Impact of Age in a Real-World Data Study.

BACKGROUND: The association between use of antipsychotics and COVID-19 outcomes is inconsistent, which may be linked to use of these drugs in age-related diseases. Furthermore, there is little evidence regarding their effect in the nongeriatric population. We aim to assess the association between antipsychotic use and risk of disease progression and hospitalization due to COVID-19 among the general population, stratifying by age. METHODS: We conducted a population-based, multiple case-control study to assess risk of hospitalization, with cases being patients with a PCR(+) test who required hospitalization and controls being individuals without a PCR(+) test; and risk of progression to hospitalization, with cases being the same as those used in the hospitalization substudy and controls being nonhospitalized PCR(+) patients. We calculated adjusted odds-ratios (aOR) and 95% confidence intervals (CI), both overall and stratified by age. RESULTS: Antipsychotic treatment in patients younger than 65 years was not associated with a higher risk of hospitalization due to COVID-19 (aOR 0.94 [95%CI = 0.69-1.27]) and disease progression among PCR(+) patients (aOR 0.96 [95%CI = 0.70-1.33]). For patients aged 65 years or older, however, there was a significant, increased risk of hospitalization (aOR 1.58 [95% CI = 1.38-1.80]) and disease progression (aOR 1.31 [95% CI = 1.12-1.55]). CONCLUSIONS: The results of our large-scale real-world data study suggest that antipsychotic use is not associated with a greater risk of hospitalization due to COVID-19 and progression to hospitalization among patients younger than 65 years. The effect found in the group aged 65 years or older might be associated with off-label use of antipsychotics.

Marked increase in cryptosporidiosis cases, Spain, 2023.

BackgroundBy mid-September 2023, several event notifications related to cryptosporidiosis had been identified from different regions in Spain. Therefore, a request for urgent notification of cryptosporidiosis cases to the National Surveillance Network was launched.AimWe aimed at assessing the extent of the increase in cases, the epidemiological characteristics and the transmission modes and compared to previous years.MethodsWe analysed data on case notifications, outbreak reports and genotypes focusing on June-October 2023 and compared the results to 2016-2022.ResultsIn 2023, 4,061 cryptosporidiosis cases were notified in Spain, which is an increase compared to 2016-2022. The cumulative incidence was 8.3 cases per 100,000 inhabitants in 2023, sixfold higher than the median of 1.4 cases per 100,000 inhabitants 2016-2022. Almost 80% of the cases were notified between June and October. The largest outbreaks were related to contaminated drinking water or swimming pools. Cryptosporidium hominis was the most common species in the characterised samples (115/122), and the C. hominis IfA12G1R5 subtype, previously unusual in Spain, was detected from 76 (62.3%) of the 122 characterised samples.ConclusionsA substantial increase in cryptosporidiosis cases was observed in 2023. Strengthening surveillance of Cryptosporidium is essential for prevention of cases, to better understand trends and subtypes circulating and the impact of adverse meteorological events.

Impact of prior antihypertensive treatment on COVID-19 outcomes, by active ingredient.

OBJECTIVES: To assess the impact of prior chronic treatment with angiotensin-converting enzyme inhibitors (ACEIs)/ angiotensin-receptor blockers (ARBs), both as a group and by active ingredient, on severity (risk of hospitalization and mortality), progression of and susceptibility to COVID-19. METHODS: We conducted a multiple population-based case-control study in Galicia (north-west Spain). The study data were sourced from medical, administrative and clinical databases. We assessed: (1) risk of hospitalization, by selecting all patients hospitalized due to COVID-19 with PCR + as cases, and a random sample of subjects without a PCR + as controls; (2) COVID-19 mortality risk; (3) risk of disease progression; and (4) susceptibility to SARS-CoV-2, considering all patients with PCR + as cases, and the same subjects used in the previous model as controls. Adjusted odds ratios (aORs) were calculated. RESULTS: ACEIs and ARBs were shown to decrease the risk of hospitalization (aOR = 0.78 [95%CI 0.69-0.89] and aOR = 0.80 [95%CI 0.72-0.90] respectively), risk of mortality (aOR = 0.71 [95%CI 0.52-0.98] and aOR = 0.69 [95%CI 0.52-0.91] respectively), and susceptibility to the virus (aOR = 0.88 [95%CI 0.82-0.94] and aOR = 0.92 [95%CI 0.86-0.97] respectively). By active ingredient: use of enalapril was associated with a significantly lower risk of hospitalization (aOR = 0.72 [95%CI 0.61-0.85]), mortality (aOR = 0.59 [95%CI 0.38-0.92]) and susceptibility to COVID-19 (aOR = 0.86 [95%CI 0.79-0.94]); and use of candesartan was associated with a decreased risk of hospitalization (aOR = 0.76 [95%CI 0.60-0.95]), mortality (aOR = 0.36 [95%CI 0.17-0.75]) and disease progression (aOR = 0.73 [95%CI 0.56-0.95]). CONCLUSION: This large-scale real-world data study suggest that enalapril and candesartan are associated with a considerable reduction in risk of severe COVID19 outcomes.

Characterization of wound infections among patients injured during the Ruso-Ukrainian war in a Role 4 hospital.

INTRODUCTION: The management of infections in war wounds is a problem aggravated by the presence of multiresistant bacteria and requires a combined approach with surgery. Literature has identified the risks and patterns of antibiotic resistance in previous armed conflicts, but the Russian-Ukrainian conflict has required the study of specific bacterial resistance patterns. METHODS: We included war-injured patients from the Russian-Ukrainian conflict transferred for treatment to the General Defense Hospital of Zaragoza from May 2022 to October 2023. Epidemiological data, factors related to the injury, presence of infection and microbiological results were collected; These data were subsequently analyzed statistically. RESULTS: Fifty-three patients were included in the study, with a mean age of 35.6 years; 83% were injured by an explosive mechanism and all received antibiotic therapy prior to transfer. Seventeen patients had skin, soft tissue or joint infection. Correlation was demonstrated with the presence of bone lesion (p 0.03), skin coverage defect (p 0.000) and presence of foreign bodies (p 0.006). Nine patients had monomicrobial cultures, and the most frequently isolated microorganisms were Gram negative bacilli (GNB) and Staphylococcus aureus. Virtually all GNB presented some resistance mechanism. CONCLUSION: Our work shows the correlation of war wound infection with the presence of foreign bodies and affected tissues. Likewise, the presence of polymicrobial wounds is emphasized, with a predominance of GNB and multidrug-resistant S. aureus.

Population-based disease-group analysis of Spanish excess mortality in the early COVID-19 pandemic period.

BACKGROUND AND AIM: Increased mortality during the COVID-19 pandemic is not explained exclusively by COVID-19 infection and its complications. We analysed non-COVID-19 causes of mortality in a population analysis based on data from the Spanish National Institute of Statistics. METHODS: Using monthly mortality data in Spain (January 2010-December 2020), we analysed deaths associated with cancer, blood, endocrine, mental, nervous, cardiovascular, respiratory and digestive diseases and explored the COVID-19 impact using a difference-in-difference strategy. We calculated monthly interannual variations in mortality and computed percentage change in terms of the log of deaths in month h of year t minus the log of deaths in month h in the previous year t-1. RESULTS: In 2020 in Spain, mortality increased 17.9% compared with 2019. COVID-19 was the leading cause of death (n=60 358), followed by ischaemic heart disease (n=29 654). Throughout 2020, monthly interannual variations in cardiovascular mortality showed an average upward trend of 1.7%, while digestive, cancer and blood diseases showed a downward trend. CONCLUSIONS: During the COVID-19 pandemic in Spain in 2020, excess mortality was primarily related to cardiovascular mortality while mortality associated with digestive, cancer and blood diseases was reduced.

Sistema web para la gestión de los enlaces de conectividad en el nodo Infomed de Villa Clara, Cuba / Connectivity Links Management Web System in the Infomed Node of Villa Clara, Cuba

La red Infomed se creó en Cuba para proporcionar el acceso a la información y el conocimiento a las personas e instituciones de la Salud Pública. La red posee un grupo de productos y servicios desplegados en las redes de nodos territoriales a lo largo del país. El Nodo provincial de Infomed de Villa Clara tiene dentro de sus funciones la gestión de los enlaces de conectividad para todas las instituciones de la provincia. En este proceso se identificaron problemáticas que evidencian que el mecanismo utilizado para la solicitud y procesamiento de los enlaces de conectividad no es eficiente, lo cual genera errores en los datos, duplicidad de información, así como una gestión lenta sujeta a vulnerabilidades. La presente investigación propone la solución a la problemática planteada a partir del desarrollo de una aplicación web para la gestión de los enlaces de conectividad que proporcione la optimización de la gestión de la información. Para la implementación de la aplicación se utilizó la metodología de desarrollo de software OpenUP. Se seleccionó el framework de desarrollo de software Django para la realización de la aplicación web con Python en la lógica de servidor. Como motor de la base de datos se empleó Mariadb, sobre un sistema operativo Linux en un entorno de virtualización utilizando Proxmox. Para la validación de la investigación se realizaron pruebas de funcionalidad(AU)

To provide access to information and knowledge for people and Public Health institutions, the Infomed network was created in Cuba. The network has a group of products and services deployed in the territorial node networks throughout the country. Within its functions, the Infomed Provincial Node of Villa Clara manages the connectivity links for all the institutions of the province, problems were identified in this area showing that the mechanism used for the request and processing of the connectivity links is not efficient, generating errors in the data, duplication of information, as well as a slow management and vulnerabilities. This research proposes the solution to the problem providing the development of a web application that makes optimal information management of connectivity. For the implementation of the application, the OpenUP software development methodology was used. The Django software development framework was selected for the realization of the web application with Python in the server logic. Mariadb was used as the database engine, on a Linux operating system in a virtualization environment using Proxmox. For the validation of the research, functionality tests were carried out(AU)

Prevalencia de patología endometrial detectada por histeroscopia en un centro de tercer nivel / Prevalence of endometrial pathology by hysteroscopy among infertile patients in a tertiary referral hospital

Resumen OBJETIVO: Describir la prevalencia de patología endometrial diagnosticada mediante histeroscopia en pacientes infértiles atendidas en un centro de tercer nivel. MATERIALES Y MÉTODOS: Estudio descriptivo, retrospectivo y observacional efectuado en pacientes con diagnóstico de infertilidad atendidas en el Departamento de Biología de la Reproducción Humana del Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Ciudad de México. Criterios de inclusión: pacientes infértiles entre 18 y 43 años a quienes se realizó histeroscopia. Criterios de exclusión: pacientes del servicio de Reproducción Humana a quienes no se les realizó histeroscopia o ésta fue fallida. Se utilizó el paquete estadístico para las ciencias sociales (SPSS Statistics) versión 20.0. El análisis estadístico fue descriptivo, con media, desviación estándar o porcentaje. RESULTADOS: Se analizaron los expedientes físicos de 440 pacientes infértiles a quienes se efectuó histeroscopia. Las características demográficas incluyeron edad, IMC, tipo y años de infertilidad. Los hallazgos histeroscópicos fueron: cavidad uterina normal 38.4% y anormal 61.6%, pólipo o endometrio polipoide en 34.3%, malformación mülleriana 13.4%, sinequias 10.7%, leiomioma 7.3%, hiperplasia endometrial 1.4%, adenomiosis 0.9%, cuerpo extraño 0.9%. El 7.5% consiguió el embarazo espontáneo y a 21.8% se les practicaron distintas técnicas de reproducción asistida y se logró el embarazo en 34.3%. CONCLUSIONES: La evaluación de la cavidad uterina es un requisito indispensable del estudio de las pacientes infértiles; en esta búsqueda más de la mitad tuvieron hallazgos histeroscópicos anormales.

Abstract OBJECTIVE: To describe the prevalence of endometrial pathology by hysteroscopy among infertile patients in a tertiary referral hospital, from January 2015 to December 2016. MATERIALS AND METHODS: This is a descriptive, retrospective and observational study. The inclusion criteria were patients between 18 and 43 years of age, who had a hysteroscopy due to infertility. The exclusion criteria were patients from Reproductive Science Department who did not undergo hysteroscopy or for whom it failed. We used the software Statistical Package for the Social Sciences (SPSS) version 20.0 Data in this study were analyzed using mean ± standard deviation or expressed as percentages. RESULTS: Four hundred forty infertile women underwent hysteroscopy. Data from physical patient records were retrieved. Demographic characteristics included age, BMI, type of infertility, years of infertility. Hysteroscopic findings were: normal uterine cavity 38.4%, abnormal 61.6%. Some patients had 2 or more findings: polyp or endometrial polypoid 34.3%, müllerian malformation 13.4%, synechia 10.7%, leiomyoma 7.3%, endometrial hyperplasia 1.4%, adenomyosis 0.9%, foreign body 0.9%. In 7.5%, spontaneous pregnancy occurred, 21.8% underwent assisted reproduction technique, achieving pregnancy in 34.3%. CONCLUSIONS: Assessing of uterine cavity should be an indispensable requirement of infertile patients, since in this study more than half of them had abnormal hysteroscopic findings.

Tasa acumulada de embarazo clínico y en curso en ciclos de inseminación intrauterina y análisis de los ciclos según la edad, conteo de folículos maduros y estimulación con antagonista de GnRH / Clinical and ongoing cumulative pregnancy rates in cycles of intrauterine insemination and analysis of the cycles according to age, follicular count and GnRH antagonist use

Resumen Objetivo: Determinar la tasa acumulada de embarazo clínico en ciclos de inseminación intrauterina en pacientes estimuladas con gonadotropinas según el número de folículos maduros desarrollados y edad, así como la influencia de los antagonistas de GnRH en su desarrollo y en la tasa de embarazo. Materiales y métodos: Estudio analítico, retrospectivo, en el que se evaluaron ciclos de inseminación intrauterina de pacientes con diferentes protocolos de gonadotropinas en un periodo de dos años. La muestra se dividió en grupos: menores de 35 y más o menos mayores de 35 años y uso o no de antagonista de GnRH. Resultados: Se evaluaron 229 ciclos de inseminación intrauterina en 172 pacientes; de éstas 64% eran menores de 34 años (grupo 1) y 36% mayores de 35 años. El 50% de las pacientes desarrolló de 2 a 3 folículos maduros y 10% de 4 a 6, con una tendencia en aumento de la tasa de embarazo con el desarrollo de hasta 4 folí culos maduros. El antagonista de GnRH no parece relacionarse con mejores tasas de embarazo clínico o en curso en ciclos con más de un folículo maduro. La tasa acumulada de embarazo clínico en tres ciclos fue de 40.6%, mientras que la tasa acumulada de embarazo en curso fue 26.1%. Conclusiones: Hubo relación proporcional entre el número de folículos maduros desarrollados y la tasa de embarazo clínico y en curso. La edad no parece haber tenido influencia en las tasas de em barazo y no pudo demostrarse la eficacia del antagonista en ciclos con desarrollo multifolicular.

Abstract Objective: To determine the cumulative clinical pregnancy rate in cycles of intrauterine insemination with gonadotropin stimulation in relation to number of mature follicles and age and the use of GnRH antagonist on its development. Materials and methods: Analytical, retrospective study in which intrauterine insemination cycles of patients with different gonadotropin protocols were evaluated over a period of two years. The patients were divided in two groups: <35 and ≥35 years old and the use of GnRH antagonist. Results: We evaluated 229 cycles of intrauterine insemination in 172 patients; Of these 64% were under 34 years old (group 1) and 36% over 35 years. The use of antGnRH did not appear to have relation with better clinical and ongoing pregnancy rates in cycles with more than one mature follicle. The cumulative pregnancy rate in three cycles was 40.6%, and cumulative ongoing pregnancy rates was 26.1%. Conclusions: The more mature follicle developed the higher clinical and ongoing pregnancy rates. The age did not appear to have influence in the pregnancy rates, there is no better pregnancy rates with use of antGnRH in cycles with multifolicular developed.

Effect of Swimming Training on the Rectus Abdominis Muscle of rats: Morphological and Histochemical Aspects / Efecto de la Natación Sobre el Músculo Recto del Abdomen de la Rata: Aspectos Morfológicos e Histoquímicos

We investigated the effect of swimming training in rats on morphological characteristics, hypertrophy levels and metabolic and contractile adaptations of different fiber types in rat the rectus abdominis muscle. Rats were randoverly assigned to one of three groups (N = 5 each): a) swimming training for 1 h, twice a week (2x/w), b) 1 h five times a week (5x/w) for 9 consecutive weeks, or c) without any swimming training (Control). Body weight increased in 2x/w rats and decreased in the 5x/w ones. Muscle fiber diameters increased in both trained groups, with higher values in the 2x/w group. Aerobic exercise increased slow oxidative (SO) + fast-oxidative-glycolytic (FOG) fibers and decreased fast glycolytic (FG) fibers. In addition, SO fibers were increased and FOG + FG fibers were decreased in trained rats. Small and angulated atrophic fibers were also observed. These results corroborate that swimming exercise increases aerobic metabolism and thus oxidative and low contraction fibers. However, the used protocol induced, to a variable degree, changes in the muscle fiber morphology.

Se estudió el efecto de la natación en las características morfológicas, niveles de hipertrofia y las adaptaciones metabólicas y contráctiles de diferentes tipos de fibras en el músculo recto del abdomen de ratas. Las ratas fueron asignadas en tres grupos (N = 5 cada uno): a) natación por 1 hora dos veces a la semana (2x/s), b) 1 hora, cinco veces por semana (5x/s) por nueve semanas consecutivas y c) sin natación (control). El peso corporal se incrementó en las ratas 2x/s y disminuyó en 5x/s. El diámetro de las fibras musculares aumentó en ambos grupos entrenados, con mayores valores en las ratas 2x/s. El ejercicio aeróbico incrementó las fibras de oxidación lenta (OL) + las fibras de glicólisis oxidativa rápida (GOR) y disminuyeron las fibras de glicólisis rápida (GR). Además, las fibras OL aumentaron y las fibras GOR y GR disminuyeron en las ratas entrenadas. Se observó una pequeña atrofia y deshidratación de las fibras. Estos resultados corroboran que la práctica de la natación incrementa el metabolismo aeróbico, las fibras de contracción lenta y la oxidación. Sin embargo, el protocolo utilizado induce cambios en grado variable en la morfología de las fibras musculares.