Multirefractory primary immune thrombocytopenia; targeting the decreased sialic acid content.

Patients with multirefractory immune thrombocytopenia (ITP) have limited treatment options. Recent data suggest that specific anti-platelet antibodies may cause destruction of platelets by favoring platelet loss of sialic acid. In this multicenter study 35 patients with ITP, including 16 with multirefractory disease, were analyzed for antiplatelet-antibodies, thrombopoietin (TPO) levels, and platelet desialylation. In selected cases, responses to a novel treatment strategy using oseltamivir were tested. We found that antibodies against GPIbα were overrepresented in multirefractory patients compared to responders (n = 19). In contrast to conventional ITP patients, multirefractory patients exhibited a significant increased platelet activation state (granule secretion) and desialylation (RCA-1 binding) (p < 0.05), and a trend toward higher plasma TPO concentrations. The decreased sialic acid content seemed to be restricted to platelet glycoproteins, since other plasma proteins were not hypoglycosylated. A total of 10 patients with multirefractory ITP having remarkable loss of platelet terminal sialic acids were given oseltamivir phosphate. When the antiviral drug was combined with TPO receptor agonists (TPO-RAs) or with immunosuppressant drugs, platelet responses were observed in 66.7% of patients. All responding patients presented with antibodies reactive only against GPIbα. These findings suggest that desialylation may play a key pathogenic role in some multirefractory ITP patients, and provide diagnostic tools for the identification of such patients. Furthermore, we show that sialidase inhibitor treatment in combination with therapies that help to increase platelet production can induce sustained platelet responses in some patients with anti-GPIbα -mediated thrombocytopenia that have failed previous therapies.

[Prevalence in the performance of mammographies in Spain: Analysis by Communities 2006-2014 and influencing factors]. / Prevalencia en la realización de mamografías en España: análisis por comunidades 2006-2014 y factores que influyen.

OBJECTIVE: To determine the frequency of the performance of mammography with preventive purpose of the screening of breast cancer in Spanish women, the evolution between the years 2006-2014, the sociodemographic profile of the women who undergo the mammography and to analyze the factors that influence in their adhesion. DESIGN: Transversal study. SITES: Spain. PARTICIPANTS: A total of 53.628 women over 15 years old that are surveyed in the National Health Survey in Spain 2006 and 2011/12 and the European Health Survey in Spain 2009 and 2014. MEASUREMENTS: The following variables were used: mammography, frequency of mammography performance and the reason for the realization, as well as sociodemographic variables. Social class was obtained from the last occupation of the main family supporter. A logistic regression analysis was performed with sociodemographic variables. RESULTS: The prevalence of mammography has been increasing from 2006 to 2014, and also for the reason that the participants had received a letter, they were telephoned or offered in their Health Center to undergo this test. There are significant differences in the performance of mammography in the different autonomous communities. CONCLUSIONS: Performing mammography has increased significantly from 2006 to 2014, although there are still differences between autonomous communities, with Ceuta and Melilla being the least percentage of performed mammography. The factors that are related to greater performed mammography are: higher educational level, higher social class, married civil status, Spanish nationality and age.

[USE OF NNN LANGUAGE IN LOCAL CARE OF BURN INJURIES]. / Lenguaje NNN en los cuidados locales de las quemaduras.

Burn injuries are tissue injuries originated as a result of a physical or chemical trauma. They can cause from a mild skin affectation to the total destruction of the affected tissues, depending on various levels of severity. Moreover, if the affected body surface is very large, patient life can seriously be compromised. In this chapter, the intention is to clarify the nursing care for the affected area, once patient's life risk is stabilized and controlled. This care should be based on an adequate approach to local handling of burn injuries, after their severity and prognosis have been stated. To do this, it will be used the standardized nursing language NNN, referring to Nursing Diagnosis NANDA (North American Nursing Diagnosis Association), Nursing Outcomes Classification (NOC) and Nursing Interventions Classification (NIC). This taxonomy is very useful to describe the Nursing clinical practice of burns care because it can easily be used by nurses participating in the care of this type of patients. Nursing plans using the NNN taxonomy can be designed using existing software applications.

[Assessment of pain in a patient with pressure ulcer]. / Valoración del dolor en una paciente con úlcera por presión (UPP).

This is a summary of a presentation made in the symposium "Improved Continuous Quality Care in Patients with Pressure Ulcers and Chronic Injuries", which was held in Toledo in 2009. A 76 year old woman had been assessed (she belonged to the age group that frequently suffers this condition). She lived in a social healthcare centre and had a III stage sacral pressure ulcer. Using Gordon's Functional Health Patterns for assessing "Acute pain", a nursing diagnosis is described and the nursing care plan has been presented according to NANDA, NIC, NOC taxonomy. The aim of this article is to show the importance of considering the pain in patients who suffer from this type of lesion, which, although almost always present, it is often undervalued by nursing staff, resulting in an even worse quality of life for the patient, due to both physical and psychological effects. This case shows how to assess pain in a patient with ulcers, and helps establish an individualised care plan with a priority on pain treatment and relief. As as result of the interventions carried out, a better perception of pain is achieved, thus helping to improve patient's mobility and night rest.

Acontecimientos vitales estresantes, estilo de afrontamiento y ajuste adolescente: un análisis longitudinal de los efectos de moderación / Stressful life events, coping style and adolescent adjustment: a longitudinal analysis of the moderation effects

El objetivo principal de este estudio fue analizar la relación entre la vivencia de los acontecimientos vitales estresantes y los problemas de ajuste emocional y comportamental durante la adolescencia, prestando atención al posible efecto moderador del estilo de afrontamiento. La muestra estuvo compuesta por 90 adolescentes que fueron seguidos durante seis años, desde su adolescencia media (15-16 años) hasta la adultez emergente (21-22 años). Completaron cuestionarios sobre su vivencia de acontecimientos vitales estresantes, su estilo de afrontamiento y sus problemas de ajuste tanto emocionales como comportamentales. En un diseño longitudinal se analizó la evolución de cada estilo de afrontamiento según el sexo y se efectuaron análisis de moderación de las distintas estrategias de afrontamiento en la relación entre estresores vitales y el ajuste adolescente. Los resultados mostraron que las estrategias más aproximativas (búsqueda de ayuda y resolución de problemas) aumentaron con la edad, mientras que las estrategias de evitación (cognitiva y conductual) disminuyeron, aunque sólo algunas trayectorias fueron estadísticamente significativas. Respecto al sexo, las chicas utilizaron con mayor frecuencia estrategias de búsqueda de ayuda. Por otro lado, los análisis de moderación revelaron que solamente los estilos de afrontamiento de evitación moderaron la relación entre la presencia de estresores y el ajuste, aunque el efecto moderador fue diferente en función del tipo de estrategia de evitación empleada. Estos resultados contribuyen a esclarecer el posible efecto de las estrategias de evitación en la adaptación del adolescente a los acontecimientos vitales estresantes y la importancia de seguir profundizando en su estudio.

The aim of this paper was to study the link between occurrence of stressful life events and adjustment problems during adolescence, paying attention to the possible moderator effect of adolescents' coping strategies. The sample was made up of 90 teenagers, who were studied longitudinally from middle adolescence (15-16 years old) until emerging adulthood (21-22 years old). They completed questionnaires about stressful life events, coping strategies and adjustment problems. In a longitudinal design the evolution of coping strategies over time were analyzed as well as possible differences associated with sex are considered. Also, in the present research moderation effects of different coping strategies in the relationship between life stressors and adolescent adjustment were analyzed. The results showed that the approximate strategies (help- seeking and problem solving) increased over time, meanwhile avoidance strategies (cognitive and behavioral) decreased, although only some trajectories were statistically significant. Related to sex differences, girls frequently used help-seeking strategies compared to boys. On the other hand, the moderation analysis revealed that only avoiding coping strategy moderated the relationship between stressful life events and adolescent adjustment. However, the moderation effect was different for cognitive and behavioural avoidance coping strategies. These results extend the knowledge we have about the impact of avoidance coping strategies over adolescent adjustment and underline the need for deeper study into this topic.