Recommendations by the Spanish Society of Rheumatology on risk management of biological treatment and JAK inhibitors in patients with rheumatoid arthritis.

OBJECTIVE: To present recommendations based on the available evidence and the consensus of experts, for risk management of biological treatment and JAK inhibitors in patients with rheumatoid arthritis. METHODS: Clinical research questions relevant to the purpose of the document were identified. These questions were reformulated in PICO format (patient, intervention, comparison, outcome or outcome) by a panel of experts, selected based on their experience in the area. A systematic review of the evidence was carried out, grading according to the GRADE criteria (Grading of Recommendations Assessment, Development, and Evaluation). Specific recommendations were then formulated. RESULTS: 6 PICO questions were proposed by the panel of experts based on their clinical relevance and the existence of recent information regarding the risk of occurrence of serious infections, the risk of reactivation of the hepatitis B virus, the risk of reactivation of the virus varicella-zoster, the risk of appearance of skin (melanoma and non-melanoma) or haematological cancer, the risk of appearance of thromboembolic disease and the risk of progression of the human papilloma virus. A total of 28 recommendations were formulated, structured by question, based on the evidence found and the consensus of the experts. CONCLUSIONS: The SER recommendations on risk management of treatment with biologic therapies and JAK inhibitors in rheumatoid arthritis are presented.

Guía de práctica clínica sobre la depresión mayor en la infancia y adolescencia: actualización / Clinical practice guide on major depression in childhood and adolescence: update

Objetivos: Mejorar la atención sanitaria prestada a los niños y adolescentes con depresión en el ámbito de la atención primaria y especializada. Ofrecer recomendaciones al profesional sanitario para la atención de estos pacientes. Desarrollar indicadores de evaluación de la calidad asistencial. Ayudar a los pacientes y a sus familiares a la toma de decisiones informada y a la mejora de la comunicación entre los pacientes y los profesionales. No se abordan otros servicios, como los sociales, educacionales o de tiempo libre. Aspectos contemplados Las áreas clínicas que contempla la guía son: - Criterios diagnósticos y caracterización de la depresión infanto-juvenil. - Factores de riesgo y de protección. - Evaluación. - Perspectivas de pacientes y familiares. - Cribado en atención primaria. - Opciones de tratamiento de la depresión: - Tratamiento psicológico (modalidades, numero de sesiones, duración). - Manejo farmacológico (indicación, dosis, duración, cese, efectos secundarios, toxicidad y ausencia de respuesta a la medicación). - Tratamiento combinado. - Prevención de recaídas/recurrencia. - Estrategias para la depresión que no responde al tratamiento. - Tratamiento de la depresión mayor con síntomas psicóticos. - Otras alternativas terapéuticas: ejercicio físico, intervenciones online y terapias alternativas. - El consentimiento informado desde el punto de vista legal en España. - Algoritmo terapéutico: criterios de derivación y manejo según gravedad. Aspectos no abordados en la GPC 1) Los trastornos distímico, bipolar, ni el adaptativo. 2) La prevención primaria de la depresión en la infancia y adolescencia. 3) La prevención de la conducta suicida, debido a que este aspecto se recoge en la GPC de Prevención y Tratamiento de la Conducta Suicida del Programa de GPC en el SNS, en su apartado especifico sobre infancia y adolescencia.

Effects of stimuli intensity and frequency on auditory p50 and n100 sensory gating.

Sensory gating is the brain's ability to adjust its sensitivity to incoming stimuli, i.e., to diminish its response to irrelevant or repetitive stimuli (gating out) and to increase it when a novel stimulus is presented (gating in). Most of the existing studies have investigated the gating out mechanism, giving little attention to the gating in function. Although both the P50 and N100 components of the auditory ERPs (event related potentials) show amplitude reductions to stimuli repetition, it is not clear if both components are part of a common gating system or if their sensory modulation is uncorrelated. In order to respond to these questions and to further characterize the sensory gating functions, we examined to what extent P50 and N100 are influenced by changes in the stimuli parameters and whether the sensory modulation of both components are interrelated. To this end, we obtained ERPs from 23 healthy volunteers using pairs of auditory stimuli which could be identical (S1 = S2), different in frequency (S1 = 1000 Hz; S2 = 2000 Hz) or different in intensity (S1 = 80 dB SPL; S2 = 100 dB SPL). As expected, the amplitudes of P50 and N100 decreased in response to the second stimuli of the identical pairs. With non-identical pairs, amplitude increases of P50 and N100 were observed only in pairs with different intensity, but not frequency. Thus, the results showed that both P50 and N100 are sensory modulated, showing that amplitude decreased to stimuli repetition (gating out) and increased when the two stimuli of a pair differed in intensity (gating in). A correlational analysis of the sensory gating indices (S2/S1 ratio and S1-S2 difference) obtained for P50 and N100 suggested that the sensory gating function of both components may be of a different nature. The reliability of the ratio and the difference indices of sensory gating is also discussed.