Predictive factors for decompensating events in patients with cirrhosis with primary biliary cholangitis under different lines of therapy.

BACKGROUND AND AIMS: The landscape in primary biliary cholangitis (PBC) has changed with the advent of second-line treatments. However, the use of obeticholic acid (OCA) and fibrates in PBC-related cirrhosis is challenging. We assessed the impact of receiving a second-line therapy as a risk factor for decompensated cirrhosis in a real-world population with cirrhosis and PBC, and identify the predictive factors for decompensated cirrhosis in these patients. APPROACH AND RESULTS: Multicenter study enrolling 388 patients with PBC-cirrhosis from the Spanish ColHai registry. Biopsy (20%), ultrasound (59%), or transient elastography (21%) defined cirrhosis, and the presence of varices and splenomegaly defined clinically significant portal hypertension (CSPH). Paris-II and PBC OCA international study of efficacy criteria determined the response to ursodeoxycholic acid (UDCA), fibrates (n=93), and OCA (n=104). The incidence of decompensated cirrhosis decreased for UDCA versus OCA or fibrates in the real-world population, but they were similar considering the propensity score-matched cohort (UDCA 3.77 vs. second-line therapy 4.5 100 persons-year, respectively), as patients on second-line therapy exhibited advanced liver disease. Consequently, GGT, albumin, platelets, clinically significant portal hypertension, and UDCA response were associated with a decompensating event. OCA response (achieved in 52% of patients) was associated with bilirubin (OR 0.21 [95% CI: 0.06-0.73]) and AST (OR 0.97 [95% CI: 0.95-0.99]), while fibrate response (achieved in 55% of patients) with AST [OR 0.96 (95% CI: 0.95-0.98]). In patients treated with OCA, drug response (sHR 0.23 [95% CI: 0.08-0.64]), diabetes (sHR 5.62 [95% CI: 2.02-15.68]), albumin (sHR 0.34 [95% CI: 0.13-0.89]), and platelets (sHR 0.99 [95% CI: 0.98-1.00]) were related to decompensation. In patients treated with fibrate, drug response (sHR 0.36 (95% CI: 0.14-0.95]), albumin (sHR 0.36 (95% CI: 0.16-0.81]), and clinically significant portal hypertension (sHR 3.70 (95% CI: 1.17-11.70]) were associated with decompensated cirrhosis. CONCLUSIONS: Advanced PBC, rather than OCA and fibrates, was found to be associated with decompensating events. Therefore, biochemical and clinical variables should be considered when making decisions about the management of these drugs. Moreover, a positive response to OCA and fibrates reduced the risk of decompensation.

A randomized controlled pilot study of a cognitive-behavioral video game intervention for the promotion of active aging.

Background: Due to the accessibility barriers of in-person programs for active aging, the development of programs that use innovative technologies is needed. Video games can be an engaging tool for disseminating active aging interventions. Objective: The objective of this pilot study was to analyze the feasibility of a cognitive-behavioral intervention to promote active aging administered through a video game. Methods: Fifty-five participants (63.6% women, mean age = 53.0 years) were randomly assigned to a cognitive-behavioral intervention to promote active aging administered through an interactive multimedia online video game with a complementary app (CBI-V; n = 29) or to a control group that received nonspecific online information (CG; n = 26). Results: Only 3.6% of the participants dropped out of the study (6.9% in CBI-V and 0.0% in CG; without significant differences between groups). The mean number of modules completed was 7.6 (SD = 0.9) out of 8 in the CBI-V and 7.9 (SD = 0.5) in the control group (CG), without significant between-group differences. In the CBI-V, the mean total time dedicated to the game was 516.8 min (SD = 94.3), including 143.2 min (SD = 31.6) of cognitive training tasks, and the mean of completed tasks was 206.2 (SD = 33.7) out of 259. Participants were highly engaged (M = 39.9, SD = 8.6) and satisfied (M = 25.8, SD = 4.5) with the intervention. After the intervention, the CBI-V group significantly improved on SF-36 dimensions of General Health (p = .0386), Vitality (p = .0283), Social Functioning (p = .0130), and Physical Summary Index (p = .0370) compared to the CG, with medium effect sizes (d = 0.56-0.75). Conclusions: The results demonstrate the feasibility of the video game intervention to promote active aging and encourage conducting a large-scale randomized controlled trial.

Resilience as a protective factor against depression in informal caregivers.

Introduction: Although previous research has demonstrated that resilience can be protective against various mental health conditions such as depression, existing studies examining the relationship between resilience and depression have limitations. To our knowledge, the moderators of the relationship have not been examined. The aim of this study was to determine whether resilience acts as a protective factor against depression in informal caregivers and to examine potential moderators of the relationship between these variables. Methods: In this cross-sectional study, 554 randomly selected informal caregivers participated (86.8% women, average age = 55.3 years). Major depressive episode, depressive symptomatology, resilience, positive environmental reward, negative automatic thoughts, self-efficacy, and personality were assessed. Results: A total of 16.1% of informal caregivers met criteria for a depressive episode and 57.4% were at risk of developing depression. The average resilience score was 26.3 (SD = 7.6); 62.6% of participants were in the lower quartile of the resilience scale. The gender of the informal caregiver and self-efficacy acted as moderating variables in the relationship between resilience and depression. The impact of resilience on depressive symptoms was more pronounced in female informal caregivers, and increased as self-efficacy increased. Discussion: Based on these findings, programs aimed at preventing depression in informal caregivers should focus on promoting resilience, especially in women, and introduce strategies to enhance self-efficacy to increase their impact.

Long-term surveillance of the feline leukemia virus in the endangered Iberian lynx (Lynx pardinus) in Andalusia, Spain (2008-2021).

Feline leukemia virus (FeLV) infection is considered one of the most serious disease threats for the endangered Iberian lynx (Lynx pardinus) Over 14 years (2008-2021), we investigated FeLV infection using point-of-care antigen test and quantitative real-time TaqMan qPCR for provirus detection in blood and tissues in lynxes from Andalusia (Southern Spain). A total of 776 samples from 586 individuals were included in this study. The overall prevalence for FeLV antigen in blood/serum samples was 1.4% (5/360) (95% CI: 0.2-2.6), FeLV proviral DNA prevalence in blood samples was 6.2% (31/503) (95% CI: 4.1-8.6), and FeLV proviral DNA in tissues samples was 10.2% (34/333) (95% CI: 7-13.5). From a subset of 129 longitudinally sampled individuals, 9.3% (12/129) PCR-converted during the study period. Our results suggest that FeLV infection in the Andalusian population is enzootic, with circulation of the virus at low levels in almost all the sampling years. Moreover, since only one viremic individual succumbed to the infection, this study suggests that lynxes may therefore control the infection decreasing the possibility of developing a more aggressive outcome. Although our results indicate that the FeLV infection in the Iberian lynx from Andalusia tends to stay within the regressive stage, continuous FeLV surveillance is paramount to predict potential outbreaks and ensure the survival of this population.

Tratamiento de la depresión comórbida después de un síndrome coronario agudo: metaanálisis de ensayos controlados aleatorizados / Treatment of comorbid depression after acute coronary syndrome: meta-analysis of randomized controlled trials

La depresión postsíndrome coronario agudo (post-SCA) aumenta el riesgo cardíaco; sin embargo, la eficacia de las terapias antidepresivas para su tratamiento no está suficientemente demostrada. Nuestro objetivo es metaanalizar ensayos controlados con muestras homogéneas que permitan explicar la inconsistencia de los resultados obtenidos hasta el momento. Tras revisar 1525 artículos, dos revisores independientes identificaron 7 estudios que cumplían criterios muy restrictivos para asegurar la homogeneidad de las muestras. Los resultados indicaron que los pacientes tratados con intervenciones de eficacia demostrada para la depresión reducen sus niveles de trastorno depresivo significativamente más que los sujetos sin este tratamiento, y que existen diferencias significativas en el número de pacientes que reducen los síntomas depresivos de forma clínicamente relevante. Además, se observaron menos eventos cardiovasculares adversos durante el tratamiento, aunque esta diferencia fue mínimamente significativa y no se mantuvo tras el seguimiento. Estos resultados sugieren que la inconsistencia de los datos actualmente disponibles podría deberse a dificultades metodológicas que evidencian la necesidad de nuevas investigaciones que aclaren el efecto del tratamiento de la depresión sobre el pronóstico post-SCA.(AU)

Depression post-acute coronary syndrome (ACS) increases the cardiac risk;however, the efficacy of antidepressant therapies for its treatment has not beensufficiently demonstrated. Our aim is to meta-analyze controlled trials withhomogeneous samples that allow us to explain the inconsistency of the resultsobtained so far. After reviewing 1525 articles, two independent reviewersidentified 7 studies that met very restrictive criteria to ensure homogeneity of thesamples. The results indicated that patients treated with interventions of provenefficacy for the depression, reduce their levels of depressive disorder significantlymore than subjects without this treatment and that there are significantdifferences in the number of patients who reduce depressive symptoms in clinically relevant way. In addition, fewer adverse cardiovascular events wereobserved during treatment, although this difference was minimally significant andwas not maintained after the follow-up. These results suggest that theinconsistency of the currently available data could be due to methodologicaldifficulties evidencing the need for further research to clarify the effect ofdepression treatment on post-ACS prognosis.K EY WORDS : coronary heart disease, acute coronary syndrome, depressiontreatment, meta-analysis.(AU)

Riesgo de la obesidad en pacientes con Insuficiencia Cardiaca / Risk of obesity in patients with Heart Failure

OBJETIVO: Analizar la relación del Índice de Masa Corporal (IMC) con la Insuficiencia cardiaca en un área de salud. MÉTODO: Estudio descriptivo observacional de los 161 pacientes que habían sido diagnosticados en el Area de Salud entre Enero de 2014 y diciembre de 2016. Entre otros datos demográficos, clínicos, y analíticos, se analizó el IMC a partir del peso y la talla en la primera visita a la unidad, mediante la fórmula: peso (en kilogramos) / cuadrado de la talla (en metros). Una vez obtenido se evaluó la relación entre el IMC y la supervivencia a 2 años. Se analizó a 4 subgrupos de pacientes, en función de su IMC, a partir de los criterios definidos por la Organización Mundial de la Salud (OMS) en 1999 (Technical Report Series, n.o 854; Ginebra: 1999): bajo peso (IMC < 20,5), peso normal (IMC de 20,5 a < 25,5), sobrepeso (IMC de 25,5 a < 30) y obesidad (IMC ≥ 30). El análisis estadístico se realizó mediante el paquete estadístico SPSS® 24.0 para Windows. La asociación entre el IMC como variable continua y la mortalidad a 2 años. RESULTADOS: De los participantes 81 eran obesos (50,8%), siendo 33 hombres y 48 mujeres. La edad media de los obesos es de 80,32 +/-9,23 años. Las principales causas de Insuficiencia Cardiaca en un 62,2% tenían diagnosticado algún tipo de cardiopatía, siendo: 29,2% Cardiopatía Isquémica, 46,6% Arritmias cardiacas y 20,5% Valvulopatías. El IMC como variable continua se asoció de forma significativa con la mortalidad (p < 0,001), la edad (0,002), la enfermedad isquémica (0,001), sexo (0,004), HTA (0,002), Diabetes (0,003) y dislipemia (0,004). También se ha visto relación del IMC con el uso de tratamientos Digoxina, Diuréticos de Asa y Espironolactona a mayor IMC más utilización. EL IMC también está asociada con el número de ingresos, mayor número de enfermedades crónicas concomitantes y mortalidad. Las puntuaciones obtenidas en el cuestionario de calidad de vida MLWHFQ en la visita inicial; los pacientes con bajo peso fueron los que mayor puntuación obtuvieron, que corresponde a una peor calidad de vida. No hubo diferencias significativas entre las puntuaciones obtenidas por los pacientes de peso normal, con sobrepeso y obesos, si bien éstos mostraron cierta tendencia a obtener puntuación más alta. CONCLUSIONES: El IMC empeora la mortalidad, la enfermedad isquémica, el sexo, la HTA, diabetes y dislipemia en pacientes con insuficiencia cardiaca

OBJECTIVE: To analyze the relationship of the Body Mass Index (BMI) with heart failure in a health area. METHOD: Observational descriptive study of the 161 patients who had been diagnosed in the Health Area between January 2014 and December 2016. Among other demographic, clinical and analytical data, the BMI was analyzed based on weight and height at the first visit to the unit, using the formula: weight (in kilograms) / square of height (in meters). Once obtained, the relationship between BMI and 2-year survival was evaluated. Four subgroups of patients were analyzed, based on their BMI, based on the criteria defined by the World Health Organization (WHO) in 1999 (Technical Report Series, No. 854, Geneva: 1999): low weight (BMI < 20.5), normal weight (BMI of 20.5 to <25.5), overweight (BMI of 25.5 to <30) and obesity (BMI ≥ 30). Statistical analysis was carried out using the statistical package SPSS® 24.0 for Windows. The association between BMI as a continuous variable and 2-year mortality. RESULTS: Of the participants, 81 were obese (50.8%), being 33 men and 48 women. The average age of the obese is 80.32 +/- 9.23 years. The main causes of heart failure in 62.2% had diagnosed some type of heart disease, being: 29.2% Ischemic heart disease, 46.6% cardiac arrhythmias and 20.5% valvulopathies. BMI as a continuous variable was significantly associated with mortality (p <0.001), age (0.002), ischemic disease (0.001), gender (0.004), hypertension (0.002), diabetes (0.003) and dyslipidemia (0.004). ). The relation of BMI with the use of Digoxin, Asa Diuretics and Spironolactone treatments has also been seen with higher BMI plus utilization. BMI is also associated with the number of admissions, greater number of concomitant chronic diseases and mortality. The scores obtained in the MLWHFQ quality of life questionnaire at the initial visit; the patients with low weight were those who obtained the highest score, which corresponds to a worse quality of life. There were no significant differences between the scores obtained by patients of normal weight, overweight and obese, although these showed a tendency to obtain a higher score. CONCLUSIONS: BMI has been shown to be associated with mortality, ischemic disease, sex, hypertension, diabetes and dyslipidemia in patients with heart failure

Insomnia in female family caregivers of totally dependent patients with dementia: an exploratory study / Insomnio en cuidadoras familiares de pacientes con demencia totalmente dependientes: un estudio exploratorio

The aim of this study was to estimate the prevalence of primary insomnia in female family caregivers of totally dependent patients with dementia, and to examine the relation between this sleep disorder and a number of characteristics of the caregivers, care recipients, and caregiving situations. The participants were 134 female caregivers, who answered a diagnostic interview according to DSM-IVTR diagnostic criteria. The functional status of the dependent person was assessed through the Barthel Index, and sociodemographic and related caring variables were collected through an ad hoc questionnaire. The prevalence of primary insomnia was 41.0%. Caregivers over 55, with more than eight years providing care and more than 12 daily hours of care, had a higher risk of developing insomnia. Multivariate analysis through binary logistic regression analysis showed that the factors more strongly associated with this diagnosis were the years of care duration (Wald= 4.02, p= .045, adjusted OR= 2.12, 95% CI= 1.02-4.42) and the daily hours of care (Wald= 4.07, p= .044, adjusted OR= 5.01, 95% CI= 1.05-23.92). Health care professionals should carefully check sleep complaints in female caregivers

El objetivo de este estudio fue estimar la prevalencia de insomnio primario en cuidadoras familiares de pacientes con demencia totalmente dependientes y examinar la relación entre este trastorno y diversas características de las cuidadoras, los destinatarios de la atención y la situación de cuidado. Participaron 134 cuidadoras quienes contestaron a una entrevista diagnóstica según el DSM-IV-TR. El estado funcional de la persona dependiente se evaluó mediante el Índice de Barthel. La prevalencia de insomnio primario fue 41,0%. Las cuidadoras mayores de 55 años, con más de ocho años proporcionando cuidados y más de 12 horas diarias de dedicación a esta tarea presentaron un mayor riesgo de desarrollar insomnio. El análisis multivariado mediante regresión logística binaria mostró que los factores más asociados con este diagnóstico fueron los años de duración del cuidado (Wald= 4,02; p= ,045; OR ajustado= 2,12; IC 95%= 1,02-4,42) y las horas diarias de atención (Wald= 4,07; p= 0,044; OR ajustado= 5,01; IC 95%= 1,05-23,92). A tenor de estos resultados, los profesionales de la salud deben controlar cuidadosamente las quejas de sueño en las cuidadoras

Biofeedback treatment in chronically constipated patients with dyssynergic defecation / Biofeedback aplicado al tratamiento de pacientes con estreñimiento crónico debido a defecación disinérgica

The aim of this study was to evaluate the effects of electromyographic biofeedback training in chronically constipated patients with dyssynergic defecation. With this purpose, ten patients (4 males, 6 females) with dyssynergic defecation unresponsive to dietary corrections and fibre supplements were selected and enclosed in the study on the basis of fulfilled the Rome III criteria for this functional gastrointestinal disorder. The study was carried out following a series of defined phases: clinical and psychophysiological assessment prior to the treatment (4 weeks), EMG-biofeedback treatment (8 sessions, two per week) and follow-up (4 weeks) one month later. In all phases, four clinical variables were assessed through selfmonitoring (frequency of defecations per week, sensation of incomplete evacuation, difficulty evacuation level, and perianal pain at defecation); moreover, psychophysiological measures were obtained through electromyography (EMG) of the external anal sphincter. Results show significant improvements in psychophysiological measures (EMGactivity during straining to defecate and anismus index), as well as in clinical variables. Biofeedback's benefits were maintained at the follow-up period.

El objetivo de este estudio fue evaluar los efectos del entrenamiento en biofeedback-EMG en pacientes con estreñimiento crónico debido a defecación disinérgica. Con este propósito, 10 pacientes (4 varones, 6 mujeres) con defecación disinérgica que no respondían a correcciones dietéticas y suplementos de fibra, fueron seleccionados e incluidos en el estudio sobre la base de cumplir los criterios Roma III para el diagnóstico de este trastorno funcional gastrointestinal. El estudio se llevó a cabo a lo largo de una serie de fases definidas: evaluación psicofisiológica y clínica previa al tratamiento (4 semanas), tratamiento por medio de biofeedback-EMG (8 sesiones, a razón de dos sesiones semanales) y seguimiento (4 semanas) un mes más tarde. En todas las fases, cuatro variables clínicas fueron evaluadas a través de autorregistro (frecuencia de defecaciones semanales, sensación de evacuación incompleta, nivel de dificultad de la evacuación y dolor perianal en la defecación); además, se obtuvieron medidas psicofisiológicas a través de electromiografía (EMG) del esfínter anal externo. Los resultados muestran mejoras significativas en las medidas psicofisiológicas (actividad-EMG durante el esfuerzo para defecar e índice de anismus), así como en las variables clínicas. Los beneficios del biofeedback se mantuvieron en el período de seguimiento.

Fenómenos anómalos episódicos usualmente asociados con el sueño REM / Episodic abnormal phenomena usually associated with REM sleep

Las parasomnias usualmente asociadas con el sueño REM incluyen las pesadillas, el trastorno comportamental del sueño REM y la parálisis del sueño aislada recurrente. Estos fenómenos anómalos de naturaleza episódica son, por lo general, paroxísticos en cuanto a su presentación y predecibles en cuanto a su ocurrencia en el ciclo de sueño, pudiendo presentarse a lo largo de todo el ciclo vital, si bien el tipo y presentación difieren con la edad. El objetivo de este trabajo es la descripción pormenorizada de las manifestaciones clínicas, características polisomnográficas, epidemiología, diagnóstico diferencial y tratamiento de estas disfunciones, siguiendo tanto la conceptualización y criterios diagnósticos aportados por la segunda edición de la Clasificación Internacional de los Trastornos del Sueño, como los resultados de la investigación realizada en este campo en los últimos años. (AU)

REM sleep related parasomnias include nightmares, REM sleep behaviour disorder and recurrent isolated sleep paralysis. These episodic phenomena tend to aparoxysmal presentation. Their occurrence is predictable in the sleep cycle and they can occur throughout all the life cicle, although the type and presentation differ with age. The aim of this paper is a detailed description of the clinical features, polysomnographic characteristics, epidemiology, differential diagnosis and treatment of these dysfunctions, following both the conceptualization and diagnostic criteria of the International Classification of Sleep Disorders, Second Edition, and findings obtaiend in this field in recent years (AU)

Depresión, género y manifestaciones sistémicas en las enfermedades inflamatorias crónicas del intestino / Depression, gender and systemic manifestations in chronic inflammatory bowel diseases

El propósito de este trabajo fue evaluar la relación existente entre depresión, género y manifestaciones sistémicas en las enfermedades inflamatorias crónicas del intestino. Con esta finalidad, 106 pacientes (57 con enfermedad de Crohn y 49 con colitis ulcerosa) fueron divididos en 4 grupos: varones con manifestaciones extraintestinales (n= 10), varones sin manifestaciones extraintestinales (n= 36), mujeres con manifestaciones extraintestinales (n= 15) y mujeres sin manifestaciones extraintestinales (n= 45). La evaluación de la depresión se llevó a cabo mediante el Inventario de Depresión de Beck. Los resultados obtenidos muestran la existencia de efectos significativos tanto en el factor manifestaciones sistémicas (F= 28,33; p<0,01), como en la interacción entre manifestaciones sistémicas y género (F= 5,2; p<0,05); el factor género, por el contrario, no resultó significativo (F= 0,28; p>0,05). El hallazgo de niveles superiores de depresión en los pacientes con manifestaciones sistémicas, particularmente en los varones, pone de relieve la necesidad de una intervención psicológica dirigida a su detección y tratamiento eficaz(AU)

The purpose of this study was to assess the relation between depression, gender and systemic manifestations in chronic inflammatory bowel diseases. With this aim, 106 patients (57 with Crohn disease and 49 with ulcerative colitis) were divided into 4 groups: men with extraintestinal manifestations (n= 10), men without extraintestinal manifestations (n= 36), women with extraintestinal manifestations (n= 15), and women without extraintestinal manifestations (n= 45). Depression was assessed with the Beck Depression Inventory. The results reveal significant effects both in the systemic manifestations factor (F= 28,33; p<0.01), and in the interaction between systemic manifestations and gender (F= 5,2; p<0.05); the gender factor, in contrast, was nonsignificant (F= 0,28; p>0.05). The finding of higher levels of depression in patients with systemic manifestations, particularly in men, underlines the need for psychological intervention aimed at detection and effective treatment.(AU)