Consensus statement of the Spanish Society of Neurology on the treatment of multiple sclerosis and holistic patient management in 2023.

The last consensus statement of the Spanish Society of Neurology's Demyelinating Diseases Study Group on the treatment of multiple sclerosis (MS) was issued in 2016. Although many of the positions taken remain valid, there have been significant changes in the management and treatment of MS, both due to the approval of new drugs with different action mechanisms and due to the evolution of previously fixed concepts. This has enabled new approaches to specific situations such as pregnancy and vaccination, and the inclusion of new variables in clinical decision-making, such as the early use of high-efficacy disease-modifying therapies (DMT), consideration of the patient's perspective, and the use of such novel technologies as remote monitoring. In the light of these changes, this updated consensus statement, developed according to the Delphi method, seeks to reflect the new paradigm in the management of patients with MS, based on the available scientific evidence and the clinical expertise of the participants. The most significant recommendations are that immunomodulatory DMT be started in patients with radiologically isolated syndrome with persistent radiological activity, that patient perspectives be considered, and that the term "lines of therapy" no longer be used in the classification of DMTs (> 90% consensus). Following diagnosis of MS, the first DMT should be selected according to the presence/absence of factors of poor prognosis (whether epidemiological, clinical, radiological, or biomarkers) for the occurrence of new relapses or progression of disability; high-efficacy DMTs may be considered from disease onset.

The mediating role of reflective functioning in the association between childhood trauma and suicide attempt.

BACKGROUND: Childhood trauma is intimately related with suicidal behaviour. Patients who have suffered childhood trauma develop impaired Reflective Functioning (RF), which refers to the capacity to understand ourselves and others in terms of intentional mental states. An improvement in RF has been associated with a reduction in suicidal attempts, but the mediating role of RF between childhood trauma and suicidal behaviour has not been addressed so far. OBJECTIVE: We aim to examine the potential mediating effect of RF among childhood trauma and suicide attempts. METHOD: We included 748 patients who had attempted suicide at least once. They were asked to complete the Reflective Functioning Questionnaire (RFQ-8), the Columbia-Suicide Severity Rating scale (CSSRS), and the Childhood Trauma Questionnaire-Short Form (CTQ-SF). We conducted linear regressions by simple mediating model to examine the role of RF in the indirect association between childhood trauma and the number of suicide attempts. RESULTS: Our results show significant indirect effects through hypo and hypermentalizing between Emotional Abuse (EA) and Sexual Abuse (SA) in childhood and the number of suicide attempts in lifetime. These results indicate that ineffective RF significantly mediates the association between childhood trauma and suicidality. CONCLUSION: This is the first study supporting the mediational role of RF in the relationship between EA and SA, and the number of suicide attempt in lifetime. These findings have important implications for reducing suicide rates and preventing future re-attempts. Further studies analysing this mediating role and focusing efforts on increasing RF-based interventions are required.

Tromboprofilaxis en COVID-19. Nuevas evidencias / COVID-19 thromboprophylaxis: New evidences

Recientes publicaciones han puesto en duda la eficacia de la utilización de dosis terapéuticas o intermedias de heparina de bajo peso molecular (HBPM) en pacientes COVID-19, especialmente en los pacientes más graves. Con el objetivo de actualizar estas recomendaciones se ha realizado una revisión no sistemática en las principales bases de datos médicas. Se seleccionaron un total de 14 ensayos clínicos aleatorizados, 14 metaanálisis y las recomendaciones de 12 sociedades científicas, estratificadas según el tipo de paciente (ambulatorio, hospitalizado, ingresado en cuidados críticos o post-alta). Se ha analizado la eficacia de HBPM y también de otras aproximaciones terapéuticas (rivaroxabán, apixabán, sulodexida, ácido acetilsalicílico e inhibidores P2Y12). Los hallazgos recomiendan utilizar dosis estándar de HBPM como tromboprofilaxis en los pacientes COVID-19 hospitalizados críticos y dosis terapéutica en hospitalizados no críticos si el riesgo de sangrado es bajo. En los pacientes ambulatorios y dados de alta del hospital podría utilizarse HBPM a dosis profiláctica si existen factores de riesgo trombótico y el riesgo hemorrágico es bajo. No se recomienda asociar antiagregantes plaquetarios a la HBPM salvo indicación previa.(AU)

Recent publications have questioned the efficacy of using therapeutic or intermediate doses of low molecular weight heparin (LMWH) in COVID-19 patients, especially in the most severe patients. In order to update these recommendations, a non-systematic review has been carried out in the main medical databases. A total of 14 randomized clinical trials, 14 meta-analyses and the recommendations of 12 scientific societies were selected, stratified according to the type of patient (outpatient, hospitalized, admitted to critical care or post-discharge). The efficacy of LMWH and other therapeutic approaches (rivaroxaban, apixaban, sulodexide, acetylsalicylic acid and P2Y12 inhibitors) has been analyzed. The findings recommend using standard doses of LMWH as thromboprophylaxis in critically hospitalized COVID-19 patients and therapeutic doses in non-critically hospitalized patients with low bleeding risk. In outpatients and those discharged from the hospital, LMWH could be used at a prophylactic dose if there are thrombotic risk factors, and the bleeding risk is low. It is not recommended to associate antiplatelet agents with LMWH unless previously indicated.(AU)

COVID-19 thromboprophylaxis. New evidence.

Recent publications have questioned the efficacy of using therapeutic or intermediate doses of low molecular weight heparin (LMWH) in COVID-19 patients, especially in the most severe patients. In order to update these recommendations, a non-systematic review has been carried out in the main medical databases. A total of 14 randomized clinical trials, 14 meta-analyses and the recommendations of 12 scientific societies were selected, stratified according to the type of patient (outpatient, hospitalized, admitted to critical care or post-discharge). The efficacy of LMWH and other therapeutic approaches (rivaroxaban, apixaban, sulodexide, acetylsalicylic acid and P2Y12 inhibitors) has been analyzed. The findings recommend using standard doses of LMWH as thromboprophylaxis in critically hospitalized COVID-19 patients and therapeutic doses in non-critically hospitalized patients if the risk of bleeding is low. In outpatients and those discharged from the hospital, LMWH could be used at a prophylactic dose if there are thrombotic risk factors, and the bleeding risk is low. It is not recommended to associate antiplatelet agents with LMWH unless previously indicated.

Transdiagnostic inflammatory and oxidative biomarkers with predictive capacity of self-injurious behavior in impulsive and unstable disorders.

INTRODUCTION: Alterations in inflammatory processes have previously been reported in impulsive and unstable disorders, as well as in other psychiatric conditions. In order to investigate transdiagnostic biomarkers associated with various phenotypic features of these disorders, this study is designed to identify biomarkers of inflammatory and oxidative endophenotypes related to autolytic behavior. METHODS: Peripheral blood mononuclear cells were collected from 35 patients with borderline personality disorder (BPD), 29 patients with restrictive eating disorder (rED), 21 patients with purging eating disorder (pED) and 23 control subjects. Plasma levels of different inflammatory and oxidative factors were measured by ELISA and the expression of selected proteins was by Western Blot. Principal component analysis (PCA) was performed to categorize the different inflammatory factors. Additionally, Ancova was performed to observe the differences in the principal components among the different groups and logistic regression analysis was conducted to assess the predictive capacity of these components for autolytic behaviors. RESULTS: We found two inflammatory/oxidative components were associated with BPD, characterized by high levels of JNK and ERK and low levels of GPx, SOD and Keap1; and two other inflammatory/oxidative components were linked to pED, associated with more JNK, TBARS and TNF-α and less GPx and SOD. Two components, with more JNK and ERK and less GPx, SOD and Keap1, predicted non-suicidal self-injury and three components, with higher JNK, TBARS and TNF-α levels and lower GPx, SOD and iNOS levels, predicted suicide attempts. CONCLUSIONS: These results strongly support the endophenotypic characterization of impulsivity and the identification of transdiagnostic inflammatory/oxidative biomarkers relevant to autolytic behavior in impulsive and unstable disorders. These dates lay the groundwork for developing of screening tests for these biomarker components to rapidly detect biological risk factors for specific impulse control disorders and future self-injurious behaviors.

Decreased oxytocin plasma levels and oxytocin receptor expression associated with aggressive behavior in aggressive-impulsive disorders.

INTRODUCTION: This study aims to enhance the understanding of the association between the phenotypic and endophenotypic characteristics of impulsive-aggressive disorders, through the study of plasma oxytocin (OXT) and oxytocin receptor (OXTR) levels in patients with borderline personality disorder (BPD) and patients with eating disorders (ED), as well as to examine the relationship of OXT system with aggressive behavior in these disorders. METHODS: 68 patients with BPD, 67 patients with ED and 57 healthy control subjects were examined for plasma oxytocin levels and protein expression of OXTR in blood mononuclear cells. Aggressive behavior was assessed using the State-Trait Anger Expression Inventory (STAXI-2). Other self and hetero-aggressive behaviors were also evaluated through interviews. RESULTS: BPD and ED patients exhibited significantly lower plasma oxytocin levels than control subjects. Furthermore, BPD patients demonstrated significantly reduced expression of OXTR compared to controls. Plasma oxytocin levels negatively correlated with verbal aggression, while OXTR expression was inversely associated with the STAXI trait subscale. CONCLUSIONS: The findings validate the existence of oxytocin system dysfunction in impulsive-aggressive disorders. They also support the link between low OXT levels in plasma and OXTR expression and the impulsive-aggressive behavior that characterizes these patients in both state and trait situations.

Using birth-death processes to infer tumor subpopulation structure from live-cell imaging drug screening data.

Tumor heterogeneity is a complex and widely recognized trait that poses significant challenges in developing effective cancer therapies. In particular, many tumors harbor a variety of subpopulations with distinct therapeutic response characteristics. Characterizing this heterogeneity by determining the subpopulation structure within a tumor enables more precise and successful treatment strategies. In our prior work, we developed PhenoPop, a computational framework for unravelling the drug-response subpopulation structure within a tumor from bulk high-throughput drug screening data. However, the deterministic nature of the underlying models driving PhenoPop restricts the model fit and the information it can extract from the data. As an advancement, we propose a stochastic model based on the linear birth-death process to address this limitation. Our model can formulate a dynamic variance along the horizon of the experiment so that the model uses more information from the data to provide a more robust estimation. In addition, the newly proposed model can be readily adapted to situations where the experimental data exhibits a positive time correlation. We test our model on simulated data (in silico) and experimental data (in vitro), which supports our argument about its advantages.

Human femur fracture by mechanical compression: Towards the repeatability of bone fracture acquisition.

The increase in life expectancy combined with greater bone fragility over the years is causing a rise in the bone fracture cases. Femur fractures are the most important due to their high mortality rate. This multidisciplinary work is carried out in this context and focuses on the experimental reproduction of human femur fractures by compression. We describe a sequence of steps supervised by orthopaedic surgeons for the correct arrangement of specimens on the system set up to perform the experiment. The device applies force by compression until the human bone is fractured. All tests performed have been monitored and evaluated from different knowledge perspectives. The results obtained have demonstrated the repeatability of the fracture type in a controlled environment as well as identifying the main features involved in this process. In addition, the fractured bones have been digitized to analyze the fracture zone to recreate and evaluate future simulations.

Influencia de la anhedonia en la evolución clínica del trastorno depresivo / Influence of anhedonia on the clinical course of depressive disorder

La anhedonia es la ausencia o capacidad reducida para experimentar placer. Es un síntoma importante en la depresión y un síntoma negativo de la esquizofrenia. Se presenta un estudio descriptivo prospectivo (diciembre 2018 a julio de 2020) con un seguimiento de seis meses, desarrollado en las Consultas Externas de Psiquiatría del Hospital Central de la Defensa Gómez Ulla. Para cuantificar la anhedonia se ha empleado la escala SHAPS y para el seguimiento de la clínica depresiva el cuestionario CET-DE. Se aplican también otras escalas como la escala CGI (impresión subjetiva gravedad/mejoría por parte del psiquiatra) y la EVA modificada (impresión subjetiva del paciente de su estado de gravedad). De 60 pacientes reclutados, 48 completaron el protocolo del estudio (2 visitas), siendo 60 % mujeres con una media de edad de 48 años. En la visita basal el porcentaje de anhedónicos fue del 67 %, de los cuales el 48 % fue considerado grave por parte del profesional sanitario. La presencia de anhedonia se relacionó con mayor puntuación en la escala CET-DE. Tras la intervención psicoterapéutica, en la visita final el porcentaje de anhedónicos fue del 29 % y se clasificaron como graves por parte del profesional sanitario un 25 % de los pacientes. La persistencia de anhedonia en la visita final fue un factor de mala evolución clínica, pudiendo concluir que es un componente de la sintomatología residual de la depresión y un indicador de mal pronóstico. (AU)

Anhedonia is the absence or reduced ability to experience pleasure. It is a major symptom of depression and a negative symptom of schizophrenia. We present a prospective descriptive study (December 2018 to July 2020) with a 6-month follow-up, developed in the Psychiatric Outpatient Clinic of the “Hospital Central de la Defensa, Gómez Ulla”. The SHAPS scale was used to quantify anhedonia and the CET-DE questionnaire was used to monitor clinical depression. Other scales such as the CGI scale (subjective impression of severity/improvement was use by the psychiatrist) and the modified VAS (patient’s subjective impression of his or her state of severity) were also applied. Out of 60 patients recruited, 48 completed the study protocol (2 visits), 60 % were women with a mean age of 48 years. At the firts visit the percentage of anhedonia was 67 %, with 48 % considered severe by the physician. The presence of anhedonia was related to a higher score on the CET-DE scale. After the psychotherapeutic intervention, the percentage of anhedonia at the last visit was 29% in general and 25% of patients were classified as severe by the health professional. The persistence of anhedonia at the final visit was a factor of poor clinical evolution and we can conclude that it is a component of the residual symptomatology of depression and an indicator of poor prognosis. (AU)

Influencia de la anhedonia en la evolución clínica del trastorno depresivo / Influence of anhedonia on the clinical course of depressive disorder

La anhedonia es la ausencia o capacidad reducida para experimentar placer. Es un síntoma importante en la depresión y un síntoma negativo de la esquizofrenia. Se presenta un estudio descriptivo prospectivo (diciembre 2018 a julio de 2020) con un seguimiento de seis meses, desarrollado en las Consultas Externas de Psiquiatría del Hospital Central de la Defensa Gómez Ulla. Para cuantificar la anhedonia se ha empleado la escala SHAPS y para el seguimiento de la clínica depresiva el cuestionario CET-DE. Se aplican también otras escalas como la escala CGI (impresión subjetiva gravedad/mejoría por parte del psiquiatra) y la EVA modificada (impresión subjetiva del paciente de su estado de gravedad). De 60 pacientes reclutados, 48 completaron el protocolo del estudio (2 visitas), siendo 60 % mujeres con una media de edad de 48 años. En la visita basal el porcentaje de anhedónicos fue del 67 %, de los cuales el 48 % fue considerado grave por parte del profesional sanitario. La presencia de anhedonia se relacionó con mayor puntuación en la escala CET-DE. Tras la intervención psicoterapéutica, en la visita final el porcentaje de anhedónicos fue del 29 % y se clasificaron como graves por parte del profesional sanitario un 25 % de los pacientes. La persistencia de anhedonia en la visita final fue un factor de mala evolución clínica, pudiendo concluir que es un componente de la sintomatología residual de la depresión y un indicador de mal pronóstico. (AU)

Anhedonia is the absence or reduced ability to experience pleasure. It is a major symptom of depression and a negative symptom of schizophrenia. We present a prospective descriptive study (December 2018 to July 2020) with a 6-month follow-up, developed in the Psychiatric Outpatient Clinic of the “Hospital Central de la Defensa, Gómez Ulla”. The SHAPS scale was used to quantify anhedonia and the CET-DE questionnaire was used to monitor clinical depression. Other scales such as the CGI scale (subjective impression of severity/improvement was use by the psychiatrist) and the modified VAS (patient’s subjective impression of his or her state of severity) were also applied. Out of 60 patients recruited, 48 completed the study protocol (2 visits), 60 % were women with a mean age of 48 years. At the firts visit the percentage of anhedonia was 67 %, with 48 % considered severe by the physician. The presence of anhedonia was related to a higher score on the CET-DE scale. After the psychotherapeutic intervention, the percentage of anhedonia at the last visit was 29% in general and 25% of patients were classified as severe by the health professional. The persistence of anhedonia at the final visit was a factor of poor clinical evolution and we can conclude that it is a component of the residual symptomatology of depression and an indicator of poor prognosis. (AU)

Differences in Longevity and Temperature-Driven Extrinsic Incubation Period Correlate with Varying Dengue Risk in the Arizona-Sonora Desert Region.

Dengue transmission is determined by a complex set of interactions between the environment, Aedes aegypti mosquitoes, dengue viruses, and humans. Emergence in new geographic areas can be unpredictable, with some regions having established mosquito populations for decades without locally acquired transmission. Key factors such as mosquito longevity, temperature-driven extrinsic incubation period (EIP), and vector-human contact can strongly influence the potential for disease transmission. To assess how these factors interact at the edge of the geographical range of dengue virus transmission, we conducted mosquito sampling in multiple urban areas located throughout the Arizona-Sonora desert region during the summer rainy seasons from 2013 to 2015. Mosquito population age structure, reflecting mosquito survivorship, was measured using a combination of parity analysis and relative gene expression of an age-related gene, SCP-1. Bloodmeal analysis was conducted on field collected blood-fed mosquitoes. Site-specific temperature was used to estimate the EIP, and this predicted EIP combined with mosquito age were combined to estimate the abundance of "potential" vectors (i.e., mosquitoes old enough to survive the EIP). Comparisons were made across cities by month and year. The dengue endemic cities Hermosillo and Ciudad Obregon, both in the state of Sonora, Mexico, had higher abundance of potential vectors than non-endemic Nogales, Sonora, Mexico. Interestingly, Tucson, Arizona consistently had a higher estimated abundance of potential vectors than dengue endemic regions of Sonora, Mexico. There were no observed city-level differences in species composition of blood meals. Combined, these data offer insights into the critical factors required for dengue transmission at the ecological edge of the mosquito's range. However, further research is needed to integrate an understanding of how social and additional environmental factors constrain and enhance dengue transmission in emerging regions.

Inflammatory and oxidative endophenotypes in borderline personality disorder: A biomarker cluster analysis.

OBJECTIVES: This study is designed to search for aggrupation of inflammatory/oxidative biomarker alterations in borderline personality disorder (BPD) and their association with phenotypic features. METHODOLOGY: Inflammatory/nitrosative proteins were measures in plasma and peripheral blood mononuclear cells obtained from BPD patients. Patients were assessed on different clinical dimensions of BPD. Oxidative damage was tested by measuring TBARS, nitrites, catalase, GPx and SOD. Protein expression of IκBα, NFκB, iNOS, COX-2, PPARγ, Keap1, NQO1, Nrf2 and α7nAChR was also determined. Western blot and ELISA were used for measurements and a cluster analysis of inflammatory/oxidative biomarkers alterations was performed to investigate subgroups of patients with similar alterations and its relationship with clinical features of BPD. RESULTS: 69 patients were included in the study. Two inflammatory/nitrosative clusters of patients were found: Cluster 1 patients showed significantly higher levels of GPx, IκBα, keap1, NQO1, PPARγ, α7nAChR and Nrf2 than cluster 2 patients. These patients had significantly longer duration of illness, milder anxiety symptoms and lower prescription of antipsychotic drugs than cluster 2. CONCLUSIONS: Two clusters of BPD patients according to the inflammatory/nitrosative profiles were identified. Cluster 1 had increased antioxidant and anti-inflammatory biomarkers and was characterised by greater chronicity of illness but less acute symptomatic severity.

Evaluación positiva de medicamentos: noviembre y diciembre de 2022 y enero de 2023 / Positive assessment of drugs: from November and December of 2022 and January of 2023

Se reseñan los medicamentos evaluados y con dictamen positivo por comisión de expertos de la Agencia Española de Medicamentos y Productos Sanitarios o de la Agencia Europea del Medicamento hechos públicos de noviembre y diciembre de 2022 y enero de 2023, y considerados de mayor interés para el profesional sanitario. Se trata de opiniones técnicas positivas que son previas a la autorización y puesta en el mercado del medicamento. (AU)

The drugs assessed by the Spanish Agency for Medicines and Health Products or European Medicines Agency made public from November 2022 to January of 2023, and considered of interest to the healthcare professional, are reviewed. These are positive technical reports prior to the authorization and placing on the market of the product. (AU)

Severe rectus diastasis with midline hernia associated in males: high recurrence in mid-term follow-up of minimally invasive surgical technique.

PROPOSE: The present study aimed to assess clinical results, in terms of postoperative pain, functional recovery and recurrence rates of FESSA (Full Endoscopic Suprapubic Subcutaneous Access) technique compared to endoscopic anterior rectus sheaths plication and mesh, in male patients with midline ventral or incisional hernias and severe rectus diastasis (SRD) associated. Secondary aims were to identify intra- and postoperative complications associated with each technique. METHODS: Male patients with midline ventral or incisional hernia and severe rectus diastasis were included in a prospectively maintained databased and retrospectively analyzed from January 2017 to December 2020. From January 2017 to January 2019, male patients underwent to anterior rectus sheaths plication (ARSP) (Control group). From January 2019 to December 2020, male patients underwent to FESSA technique (FT) (Case group). RESULTS: 53 patients were finally included. 28 patients (52%) underwent to FT and 25 patients (48%) to ARSP. Regarding intraoperative complications, no significant differences were identified between the groups. Hospital stay was significantly improved in FT group when compared to ARSP group. No significant differences in terms of postoperative seroma or hematomas, were shown. FT group showed significantly less pain on 1st, 7th and 30th postoperative days than ARSP group. Functional recovery was significantly improved in FT group compared to ARSP group on the 30th day and no differences were observed on the 180th day after surgery. The mean follow-up was 17.3 ± 2.6 months in FT group and 24 ± 3 months in ARSP group. During the follow-up, 1(3%) and 9 (36%) diastasis recurrences were identified respectively, with significant differences in favor of FT group. CONCLUSION: In males with SRD and symptomatic midlines hernias, ARSP with onlay mesh placement shows high diastasis recurrence rate in mid-term follow-up. We propose FESSA technique in those patients, which decreases the excessive midline tension, improving the postoperative pain, functional recovery and recurrence rate, without increasing postoperative complications.

Evaluación positiva de medicamentos: julio, septiembre y octubre de 2022 / Positive assessment of drugs: July, September and October of 2022

Se reseñan los medicamentos evaluados y con dictamen positivo por comisión de expertos de la Agencia Europea del Medicamento, hechos públicos en julio, septiembre y octubre de 2022 y considerados de mayor interés para el profesional sanitario. Se trata de opiniones técnicas positivas que son previas a la autorización y puesta en el mercado del medicamento.(AU)

The drugs assessed by the European Medicines Agency made public in July, September and October of 2022, and considered of interest to the healthcare professional, are reviewed. These are positive technical reports prior to the authorization and placing on the market of the product.(AU)

Evaluación positiva de medicamentos: abril, mayo y junio 2022 / Positive assessment of drugs: from April, May and June of 2022

Se reseñan los medicamentos evaluados y con dictamen positivo por comisión de expertos de la Agencia Española de Medicamentos y Productos Sanitarios o de la Agencia Europea del Medicamento hechos públicos de abril a junio 2022, y considerados de mayor interés para el profesional sanitario. Se trata de opiniones técnicas positivas que son previas a la autorización y puesta en el mercado del medicamento. (AU)

The drugs assessed by the Spanish Agency for Medicines and Health Products or European Medicines Agency made public from April to June of 2022, and considered of interest to the healthcare professional, are reviewed. These are positive technical reports prior to the authorization and placing on the market of the product. (AU)

Estudio de utilización de linezolid en el Hospital Central de la Defensa «Gómez Ulla» / Study of the Linezolid usage at Hospital Central de la Defensa Gómez Ulla

El linezolid es un antimicrobiano del grupo de las oxazolidinonas, desarrollado en la década de 1990, siendo elprimero comercializado en su grupo a principios de los años 2000. Está indicado, según ficha técnica, en el tratamiento de la neumonía nosocomial y de la neumonía adquirida en la comunidad, cuando se conoce o se sospecha que está causada por bacteriasgram-positivas, y en el tratamiento de infecciones complicadas de piel y partes blandas (IPPBC) con certeza de microorganismosgram-positivos. Debido a su buena farmacocinética, rentabilidad e indicaciones anteriormente mencionadas ha cobrado especial importancia tanto en ámbito hospitalario como ambulatorio. Sujetos y métodos: Se llevó a cabo un estudio de utilizaciónde medicamentos (EUM) prescripción-indicación retrospectivo, en el Hospital Central de la Defensa (HCD) «Gómez Ulla»,durante el mes de septiembre de 2019, con el objetivo de conocer el patrón de uso de linezolid (indicaciones, adecuación o no aficha técnica, pauta posológica, vía de adminsitración utilizada, sospecha de reacciones adversas medicamentosas, características socio-demográficas y clínicas de los pacientes). El tipo de muestreo fue consecutivo no probabilístico. Se realizó un análisisestadístico descriptivo a través del programa informático SPSS 25.0. Resultados: Un total de 28 pacientes recibieron durante elmes de septiembre de 2019 al menos una dosis de linezolid. (AU)

Linezolid is an antimicrobial from the group of oxazolidinones, developed in the 1990s, being the first marketed inits group in the early 2000s. It is indicated, according to the data sheet, in the treatment of nosocomial pneumonia. and community-acquired pneumonia, when known or suspected to be caused by gram positive bacteria, and in the treatment of complicatedskin and soft tissue infections with certain gram positive organisms. Due to its good pharmacokinetics, profitability and aforementioned indications, it has gained special importance both in hospital and outpatient settings. Subjects and methods: A retrospectiveprescription-indication drug use study was carried out at the Central Defense Hospital (HCD) «Gómez Ulla», during the monthof September 2019, with the objective of knowing the pattern of use of linezolid (indications, adequacy or not to the data sheet,dosage regimen, route of administration used, suspected adverse drug reactions, sociodemographic and clinical characteristics ofthe patients). The type of test was non-probabilistic consecutive. A descriptive statistical analysis was performed using the SPSS 25.0computer program. Results: A total of 28 patients received at least one dose of linezolid during the month of September 2019. IPPBwas the most prevalent indication (53.5%) (15/28) followed by pneumonia (28.5%) (8/28). It was not adapted in 5 cases (17.8%) (5/28)to the indications of the data sheet: Complicated Urinary Tract Infection (3/5), Complicated Intra-abdominal Infection (1/5) andfebrile syndrome without source (1/5). (AU)

Evaluación positiva de medicamentos: enero, febrero y marzo de 2022 / Positive assessment of drugs: January, February and March of 2022

Se reseñan los medicamentos evaluados y con dictamen positivo por comisión de expertos de la Agencia Española de Medicamentos y Productos Sanitarios o de la Agencia Europea del Medicamento hechos públicos de enero a marzo de 2022, y considerados de mayor interés para el profesional sanitario. Se trata de opiniones técnicas positivas que son previas a la autorización y puesta en el mercado del medicamento. (AU)

Evaluación positiva de medicamentos: septiembre, octubre, noviembre y diciembre de 2021 / Positive evaluation of medicines: September, October, November and December 2021

Se reseñan los medicamentos evaluados y con dictamen positivo por comisión de expertos de la Agencia Española de MedicamentosSe reseñan los medicamentos evaluados y con dictamen positivo por comisión de expertos de la Agencia Española de Medicamentosy Productos Sanitarios o de la Agencia Europea del Medicamento hechos públicos de septiembre a diciembre de 2021, y considerados de mayor interés para el profesional sanitario. Se trata de opiniones técnicas positivas que son previas a la autorización y puestaen el mercado del medicamento. (AU)

The drugs assessed by the Spanish Agency for Medicines and Health Products or European Medicines Agency made public fromSeptember to December of 2021, and considered of interest to the healthcare professional, are reviewed. These are positive technicalreports prior to the authorization and placing on the market of the product. (AU)

Global Distribution of Key Features of Streamer Corona Discharges in Thunderclouds.

We present nighttime worldwide distributions of key features of Blue LUminous Events (BLUEs) detected by the Modular Multispectral Imaging Array of the Atmosphere-Space Interaction Monitor. Around 10% of all detected BLUEs exhibit an impulsive single pulse shape. The rest of BLUEs are unclear (impulsive or not) single, multiple or with ambiguous pulse shapes. BLUEs exhibit two distinct populations with peak power density <25 µWm-2 (common) and ≥25 µWm-2 (rare) with different rise times and durations. The altitude (and depth below cloud tops) zonal distribution of impulsive single pulse BLUEs indicate that they are commonly present between cloud tops and a depth of ≤4 km in the tropics and ≤1 km in mid and higher latitudes. Impulsive single pulse BLUEs in the tropics are the longest (up to ∼4 km height) and have the largest number of streamers (up to ∼3 × 109). Additionally, the analysis of BLUEs has turned out to be particularly complex due to the abundance of radiation belt particles (at high latitudes and in the South Atlantic Anomaly [SAA]) and cosmic rays all over the planet. True BLUEs can not be fully distinguished from radiation belt particles and cosmic rays unless other ground-based measurements associated with the optically detected BLUEs are available. Thus, the search algorithm of BLUEs presented in Soler et al. (2021), https://doi.org/10.1029/2021gl094657 is now completed with a new additional step that, if used, can considerably smooth the SAA shadow but can also underestimate the number of BLUEs worldwide.