Real-World Treatment Patterns, Resource Use and Costs in Adult Patients With Atopic Dermatitis Receiving Systemic Treatment: Derma-Atopic Study in Spain. / [Artículo traducido] Características de los pacientes, patrones de tratamiento, uso de recursos y costes en adultos con dermatitis atópica moderada-grave en la práctica habitual en España: Estudio Derma-Atopic.

BACKGROUND: Moderate-severe atopic dermatitis (AD) has a significant impact on patients' lives, with many requiring systemic treatment to manage symptoms (e.g., pruritus). Several drugs are used off-label to treat AD. This study describes sociodemographic/clinical characteristics, treatment patterns, health resource use (HRU) and costs in adults with AD who initiated systemic treatment or phototherapy in routine practice. METHODS: This retrospective observational study of electronic medical records in the BIG-PAC database identified adults with prior diagnosis of AD (ICD-9: 691.8 or 692.9) starting oral corticosteroids, immunosuppressants, biologics or phototherapy between 01/01/2012 and 31/12/2016. Patients were followed for 3 years from treatment initiation, up to 31/12/2019. Data on patient characteristics, treatment patterns, HRU and costs were analyzed descriptively. RESULTS: Patients (N = 1995) had a mean age of 60 years, 64% were female, with a mean time of 23 years since diagnosis (84% were ≥18 years at AD onset). Main comorbidities were anxiety (38%), arterial hypertension (36%) and dyslipidemia (35%). Most patients used oral corticosteroids as first systemic (84%; median duration 29 days) and immunosuppressants in 13% of patients (median duration 117 days, 5% cyclosporine and 4% methotrexate). Half of patients required a second line systemic and 12% a third line. The use of immunosuppressants and biologics increased with treatment lines. About 13% of patients received systemic treatments continuously over the 3-year follow-up. The average 3-year per patient cost was 3835 euros, with an average annual cost of 1278 euros. CONCLUSIONS: Results suggest a high comorbidity and economic burden in this real-world adult population with AD, and the need for systemic treatments indicated for use in AD.

Real-World Treatment Patterns, Resource Use and Costs in Adult Patients With Atopic Dermatitis Receiving Systemic Treatment: Derma-Atopic Study in Spain.

BACKGROUND: Moderate-severe atopic dermatitis (AD) has a significant impact on patients' lives, with many requiring systemic treatment to manage symptoms (e.g., pruritus). Several drugs are used off-label to treat AD. This study describes sociodemographic/clinical characteristics, treatment patterns, health resource use (HRU) and costs in adults with AD who initiated systemic treatment or phototherapy in routine practice. METHODS: This retrospective observational study of electronic medical records in the BIG-PAC database identified adults with prior diagnosis of AD (ICD-9: 691.8 or 692.9) starting oral corticosteroids, immunosuppressants, biologics or phototherapy between 01/01/2012 and 31/12/2016. Patients were followed for 3 years from treatment initiation, up to 31/12/2019. Data on patient characteristics, treatment patterns, HRU and costs were analyzed descriptively. RESULTS: Patients (N=1995) had a mean age of 60 years, 64% were female, with a mean time of 23 years since diagnosis (84% were ≥18 years at AD onset). Main comorbidities were anxiety (38%), arterial hypertension (36%) and dyslipidemia (35%). Most patients used oral corticosteroids as first systemic (84%; median duration 29 days) and immunosuppressants in 13% of patients (median duration 117 days, 5% cyclosporine and 4% methotrexate). Half of patients required a second line systemic and 12% a third line. The use of immunosuppressants and biologics increased with treatment lines. About 13% of patients received systemic treatments continuously over the 3-year follow-up. The average 3-year per patient cost was 3835 euros, with an average annual cost of 1278 euros. CONCLUSIONS: Results suggest a high comorbidity and economic burden in this real-world adult population with AD, and the need for systemic treatments indicated for use in AD.

Feasibility evaluation of a mindfulness-based stress reduction program for primary care professionals in Brazilian national health system.

BACKGROUND AND PURPOSE: In the last decades, an increasing body of scientific studies has shown mindfulness-based interventions as efficacious for reducing stress, including among primary care professionals. Despite the strength of the evidence, mindfulness-based interventions still are not widely adopted as a clinical practice in national health systems. The aim of the present study was to conduct a feasibility evaluation of a mindfulness-based stress reduction program for primary care professionals in Brazilian national health system. MATERIALS AND METHODS: A pilot mindfulness program was conducted through the course of four weekly encounters in the municipality of Biguaçu with the participation of 26 primary care professionals. Data was collected through direct observations and four self-report questionnaires. The information was used to complete an evaluation matrix and reach a value judgment about the feasibility level of the components of the mindfulness-based program. RESULTS: The subdimensions Integration, Demand, and Acceptability were judged as "Highly Feasible", the subdimension Practicality was judged as "Feasible" and the subdimension Adaptation was judged as "Lowly Feasible". The results indicated that there is a high demand for stress-reduction interventions within the context of primary care and the acceptability by the stakeholders (participants and management) was excellent. However, the two main barriers found were the need for a brief version of the program to accommodate the restrictive timetable of the primary care professionals and the low retention rates. CONCLUSION: The implementation of a mindfulness-based program for primary care professionals in Brazilian national health system was judged as "Feasible". Further studies need to conduct the feasibility evaluation in other municipalities and with larger sample sizes to ensure the generalizability of these results.

Microbiologic contamination of intraoperative blood salvaged during liver transplantation.

Bacterial contamination is one of the potential risks of blood salvage and reinfusion during orthotopic liver transplantation (OLT) because cell-saver machines lack antibacterial protection devices. This study was designed to analyze the potential bacterial contamination of blood salvaged during OLT; a secondary end point was to evaluate whether reinfusion of potentially contaminated blood may have been responsible for clinically manifested infective complications in the same patient. After induction of anesthesia, a blood sample was drawn from the central venous catheter (CVC) immediately after its positioning, to exclude potential coexisting hematic contamination of the recipient. During the procedure, 2 other samples of salvaged blood were collected for bacteriological analysis. Twenty-six of 38 samples of salvaged blood were positive for microorganisms, whereas 12 did not reveal the presence of infectious agents. In 19 of 26 positive samples, Staphylococcus species (73%) were isolated with only 2 of 38 samples drawn from CVC being contaminated. Candida Albicans was cultured in 2 samples. The high percentage (73%) of coagulase-negative Staphylococci indicates that blood contamination could have been caused by microorganisms from the air or suctioned from contact surfaces and the surgical field. Although almost 70% of processed and reinfused units tested positive for microbes, none of the postoperative blood cultures (at day 1 and day 3) revealed growth of the same species, not even in the 2 patients who had positive CVC cultures after induction of anesthesia.

Dietary chromic oxide does not affect the utilization of organic compounds but can alter the utilization of mineral salts in gilthead sea bream Sparus aurata.

This study was conducted to determine whether the level of chromic oxide supplemented to diets containing gelatinized starch as the carbohydrate source affects digestibility, body composition, growth performances, and liver enzyme activities in gilthead sea bream, Sparus aurata. Gilthead sea bream fingerlings were fed diets containing gelatinized corn starch as the carbohydrate source and several levels of chromic oxide (0, 5, 10 and 20 g/kg) for 6 wk. No effect of dietary chromium level was detected on carbon, nitrogen, or dry matter digestibility. Calcium and phosphorus digestibility were higher in fish fed the diet supplemented with 5 g/kg chromic oxide than in fish fed the other supplemented diets. Dietary chromium did not affect dry matter, carbon, nitrogen, protein, or lipid concentrations in fish. However, fish fed 5 g/kg chromic oxide generally had higher levels of calcium, phosphorus, and ash than fish fed the other Cr-containing diets. Chromium concentration was significantly higher in fish fed the diets with 0.5 and 1% chromic oxide than in fish fed the control diet. Chromium supplementation of the diets did not affect the specific growth rate, the food efficiency ratio, the protein efficiency ratio, or, protein or nitrogen retention of the fish. Blood glucose and the activity of several liver enzymes involved in carbohydrate metabolism were unaffected by dietary chromic oxide. Alanine aminotransferase was lower in the fish fed the diet with 10 g/kg of chromic oxide than in unsupplemented controls. Our results indicate that chromic oxide can be used as a neutral marker in fish nutrition studies involving organic compounds, but not mineral salts.

Clinical and stabilometric monitoring in a case of cerebellar atrophy with vitamin E deficiency.

The authors describe a case of early onset ataxia with cerebellar atrophy and vitamin E deficiency, treated with alpha-tocopherol supplementation and physically rehabilitated by postural biofeedback. Clinical assessments, serum vitamin E levels and postural evaluation by means of a stabilometric platform continued for about 2 years and significant clinical improvement was recorded. Our study confirms that combined physical therapy and vitamin E supplementation may result in improvement of cerebellar function. Motor improvement is directly related to vitamin E serum levels, providing further confirmation that normal vitamin E levels are crucial for proper brain functions.

The precursor of pea ferredoxin-NADP+ reductase synthesized in Escherichia coli contains bound FAD and is transported into chloroplasts.

The precursor of the chloroplast flavoprotein ferredoxin-NADP+ reductase from pea was expressed in Escherichia coli as a carboxyl-terminal fusion to glutathione S-transferase. The fused protein was soluble, and the precursor could be purified in a few steps involving affinity chromatography on glutathione-agarose, cleavage of the transferase portion by protease Xa, and ion exchange chromatography on DEAE-cellulose. The purified prereductase contained bound FAD but displayed marginally low levels of activity. Removal of the transit peptide by limited proteolysis rendered a functional protease-resistant core exhibiting enzymatic activity. The FAD-containing precursor expressed in E. coli was readily transported into isolated pea chloroplasts and was processed to the mature size, both inside the plastid and by incubation with stromal extracts in a plastid-free reaction. Import was dependent on the presence of ATP and was stimulated severalfold by the addition of plant leaf extracts.

One-step purification of plant ferredoxin-NADP+ oxidoreductase expressed in Escherichia coli as fusion with glutathione S-transferase.

Complementary DNA sequences encoding the mature form of pea ferredoxin-NADP+ reductase were cloned in-frame at the 3' end of the Schistosoma japonicum glutathione S-transferase gene in the expression vector pGEX-3X (Smith and Johnson, Gene 67, 31-40, 1988). A spacer sequence linking the two genes was modified to provide a proteolytic site just before the first amino acid residue of mature pea reductase. When introduced into competent Escherichia coli cells and induced, the resulting plasmid (pGF205) directed the expression of a 60-kDa immunoreactive peptide that results from the fusion between glutathione S-transferase and ferredoxin-NADP+ reductase sequences. The fused protein could be purified in a single step by selective absorption onto glutathione-agarose beads, followed by elution with free glutathione. It showed both transferase and reductase activities. Removal of the transferase portion by cleavage with the restriction protease Xa rendered ferredoxin-NADP+ reductase electrophoretically homogeneous. The purified transgenic enzyme showed kinetic and spectroscopic properties that were similar to those reported for the plant flavoprotein, indicating that, even when fused to the 27-kDa transferase portion, the reductase was still able to assemble FAD and to acquire an active conformation in the bacterial host. The expression-purification protocol employed here allows the isolation of up to 1 mg of active ferredoxin-NADP+ reductase/g of transformed cells. The system is potentially useful for the purification of activity-impaired forms of the flavoprotein.

Hypersensitivity to mustard seed.

Two patients were studied. Both underwent a thorough clinical evaluation, including a comprehensive physical examination. Both were also prick tested for inhalants, pollens, and food (including fruit). A nasal provocation test, serum immunoglobulins, total IgE serum, specific IgE serum, and a histamine release test were also carried out. The results of all these tests were positive to mustard seed.