Sexualized Drug Use and Chemsex among Men Who Have Sex with Men in Europe: A Systematic Review and Meta-Analysis.

Background: In recent years, in Europe, there has been a growing concern about the use of sexualized drugs among men who have sex with men (MSM), due to its possible link to an increase in sexually transmitted infections. The aim of this review is to study the prevalence of chemsex, and the sexualized drug used in Europe, describing both different consumption patterns and other sexual behaviors considered risky and their possible relationship with positivity in diagnoses of sexually transmitted infections, including human immunodeficiency virus. Methods: We conducted a literature review in the main scientific databases (PubMed, Embase, Scopus, Cochrane Library, Web of Science), filtering for articles published between January 2018 and April 2023 that collect information on sexualized drug use and sexual practices conducted in European countries among men who have sex with men, including whether these behaviors can lead to diagnoses of sexually transmitted infections. Results: The definition of drugs included in chemsex is not clearly defined and shows heterogeneity between study publications; the three drugs presented in all manuscripts are mephedrone, GHB/GBL, and crystal methamphetamine. The prevalence of chemsex in Europe is 16% [11-21%] among MSM. The most frequent risky sexual behavior associated with chemsex practice was unprotected sex with a high number of partners. The log risk ratio of STIs was 0.86 (95% CI: 0.49 to 1.23). Conclusions: Adherence to definitions, stringent research methodologies, and focused interventions are needed to tackle the intricate relationship between substance use, sexual behavior, and the risk of HIV/STI transmission in MSM.

Influential Social Determinants of Adherence to Preventive and Health Promotion Activities during Pregnancy and the First Year of Life: Systematic Review.

Effective monitoring throughout pregnancy and the first year of life is a crucial factor in achieving lower rates of maternal and infant mortality. Currently, research on socioeconomic factors that influence the lack of adherence to preventive and control measures during pregnancy and the first year of life is limited. The objective of this review is to examine the available evidence on social determinants that influence participation in health promotion and preventive activities throughout the pregnancy journey and in infants during their first year of life. We performed a systematic review of the literature searching in the major scientific databases (PubMed, Scopus, EMBASE, WOS, and Cochrane Library) for articles from February 2017 to May 2023 containing information on health inequities that impact participation in health promotion and preventive measures from pregnancy through the first year of an infant's life. A total of 12 studies were selected; these studies were performed in ten different countries on five different continents. The selected studies cover preventive measures during maternal care, vaccination, and immunization during pregnancy and the first year of life, newborn screening, and follow-up of the first 12 months of life. The social factors associated with low adherence to health promotion activities during pregnancy and the first year of life include education, income, ethnicity, place of residence, and family characteristics. Despite the diverse geographical distribution, it is observed that there are common social factors linked to a decrease in the adherence to preventive measures during pregnancy and in the early years of life.

Risk Factors and Environmental Preventive Actions for Aspergillosis in Patients with Hematological Malignancies.

(1) Background: Aspergillus spp. is a widely distributed filamentous fungus in the environment due to its high sporulation capacity. Currently, invasive aspergillosis (IA) is the most common invasive fungal infection in patients with hematologic malignancies, with high rates of mortality and morbidity. The multifactorial nature of the disease requires appropriate risk stratification to enable the most appropriate preventive measures to be adapted and implemented according to the characteristics of the patient. In this sense, the present research aims to identify recent risk factors and environmental control measures against invasive aspergillosis to establish preventive actions to reduce the incidence of invasive aspergillosis in hospitals. (2) Methods: We conducted a qualitative systematic review of the scientific literature on environmental risk factors and preventive measures for invasive aspergillosis in patients with hematologic malignancies. The Medline, Cochrane, and Scopus databases were consulted, following the PRISMA and STROBE guidelines. (3) Results: Adequate implementation of environmental control measures is presented as the most efficient intervention in terms of prevention to decrease the incidence of invasive aspergillosis in hospitals. Neutropenia, fungal contamination, insufficient environmental control measures in hospital and home settings, length of hospital stay, and anemia, are identified as independent risk factors. We show that HEPA, LAF, and Plasmair® systems are suitable methods to reduce the concentration of airborne fungal spores. Antifungal prophylaxis did not significantly influence IA reduction in our study. (4) Conclusions: Proper professional training and environmental control measures in hospitals are essential for the prevention of invasive aspergillosis. We should optimize risk stratification for patients with hematologic malignancies. Antifungal prophylaxis should be complementary to environmental control measures and should never be substituted for the latter. Studies should also be undertaken to evaluate the efficiency of environmental control measures against IA at patients' homes.

Development of a Novel Prediction Model for Red Blood Cell Transfusion Risk in Cardiac Surgery.

BACKGROUND: Cardiac surgery is a complex and invasive procedure that often requires blood transfusions to replace the blood lost during surgery. Blood products are a scarce and expensive resource. Therefore, it is essential to develop a standardized approach to determine the need for blood transfusions in cardiac surgery. The main objective of our study is to develop a simple prediction model for determining the risk of red blood cell transfusion in cardiac surgery. METHODS: Retrospective cohorts of adult patients who underwent cardiac surgery between 2017 and 2019 were studied to identify hypothetical predictors of blood transfusion. Finally, a multivariable logistic regression model was developed to predict the risk of transfusion in cardiac surgery using the AUC and the Hosmer-Lemeshow goodness-of-fit test. RESULTS: We included 1234 patients who underwent cardiac surgery. Of the entire cohort, 875 patients underwent a cardiac procedure 69.4% [CI 95% (66.8%; 72.0%)]; 119 patients 9.6% [CI 95% (8.1%; 11.4%)] underwent a combined procedure, and 258 patients 20.9% [CI 95% (18.7; 23.2)] underwent other cardiac procedures. The median perioperative hemoglobin was 13.0 mg/dL IQR (11.7; 14.2). The factors associated with the risk of transfusion were age > 60 years OR 1.37 CI 95% (1.02; 1.83); sex female OR 1.67 CI 95% (1.24; 2.24); BMI > 30 OR 1.46 (1.10; 1.93); perioperative hemoglobin < 14 OR 2.11 to 51.41 and combined surgery OR 3.97 CI 95% (2.19; 7.17). The final model shows an AUC of 80.9% for the transfusion risk prediction [IC 95% (78.5-83.3%)]; p < 0.001]. CONCLUSIONS: We have developed a model with good discriminatory ability, which is more parsimonious and efficient than other models.

The Barriers to Deprescription in Older Patients: A Survey of Spanish Clinicians.

BACKGROUND AND OBJECTIVE: There are barriers to deprescription that hinder its implementation in clinical practice. The objective of this study was to analyse the main barriers and limitations of the deprescription process perceived by physicians who care for multipathological patients. MATERIALS AND METHODS: The "deprescription questionnaire of elderly patients" was adapted to an online format and sent to physicians in geriatrics. Question 1 is a reference to establish agreement or disagreement with this practice. The influence of different aspects of deprescription was analysed via the demographic characteristics of the clinicians and perceptions of the various barriers (questions 2-9) by means of bivariate analysis. Based on the latter, a multivariate model was carried out to demonstrate the relationship between barriers and the degree of deprescription agreement among respondents. RESULTS: Of the 72 respondents, 72.2% were in favour of deprescribing. Regarding the analyses, the demographic characteristics did not influence rankings. The deprescription of preventive drugs and consensus with patients were associated with a positive attitude towards deprescribing, while withdrawing drugs prescribed by other professionals, time constraints and patient reluctance emerged as possible barriers. The only factor independently associated with deprescribing was lack of time. CONCLUSIONS: Time was found to be the main barrier to deprescription. Training, the creation of multidisciplinary teams and integrated health systems are key facilitators.

Prognosis Factors of Patients Undergoing Renal Replacement Therapy.

BACKGROUND: Survival in patients with end-stage kidney disease (ESKD) on renal replacement therapy (RRT) is less than that of the general population of the same age, and depends on patient factors, the medical care received, and the type of RRT used. The objective of this study is to analyze the factors associated with survival in patients undergoing RRT. METHODS: We conducted a retrospective observational study of adult patients with an incident of ESKD on RRT in Andalusia from 1 January 2008 to 31 December 2018. Patient characteristics, nephrological care received, and survival from the beginning of RRT were evaluated. A survival model for the patient was developed according to the variables studied. RESULTS: A total of 11,551 patients were included. Median survival was 6.8 years (95% CI (6.6; 7.0)). After starting RRT, survival at one year and five years was 88.7% (95% CI (88.1; 89.3)) and 59.4% (95% CI (58.4; 60.4)), respectively. Age, initial comorbidity, diabetic nephropathy, and a venous catheter were independent risk factors. However, non-urgent initiation of RRT and follow-up in consultations for more than six months had a protective effect. It was identified that renal transplantation (RT) was the most influential independent factor in patient survival, with a risk ratio of 0.13 (95% CI (0.11; 0.14)). CONCLUSIONS: The receiving of a kidney transplant was the most beneficial modifiable factor in the survival of incident patients on RRT. We consider that the mortality of the renal replacement treatment should be adjusted, taking into account both modifiable and nonmodifiable factors to achieve a more precise and comparable interpretation.

Effectiveness and Safety of Cannabinoids as an Add-On Therapy in the Treatment of Resistant Spasticity in Multiple Sclerosis: A Systematic Review.

Background: Spasticity continues to be a very prevalent, highly invalidating, and difficult-to-manage symptom in patients with multiple sclerosis (MS). The aim of this systematic review is to evaluate the effectiveness of the use of cannabis and cannabinoids in these patients, evaluating its use as an additional therapy. Methods: We performed a systematic review of the literature searching in the major scientific databases (PubMed, Scopus, EMBASE, WOS, and Cochrane Library) for articles from January 2017 to May 2022 containing information about the effectiveness of cannabis and cannabinoids in patients with insufficient response to first-line oral antispastic treatment. Results: A total of five medium high-quality articles were selected to be part of the study and all evaluated the effectiveness of the tetrahydrocannabinol (THC) and cannabidiol (CBD) spray. The effectiveness of this drug and the significant improvements are produced on the patient-related spasticity assessment scales, obtaining improvement up to 45%; and on quality of life, producing a decrease in the appearance of symptoms related to spasticity, as well as an increase in the development of basic activities of daily living. The average dose is 5-7 sprays/day. The discontinuation rate for these treatments is around 40% due to lack of effectiveness and adverse events. All reported adverse effects are mild to moderate in severity and their incidence is ∼17%, although this figure tends to decrease with drug use. Conclusions: Adding the THC:CBD sprays have been shown to be more effective in treating MS spasticity than optimizing the dose of first-line antispastic drugs in selected responders patients. The safety and tolerability profiles remain in line with those obtained in other trials. More patients would benefit from treatment if the initial response search period was extended.

Prevalence of Potentially Inappropriate Medications in Patients With Multimorbidity According to LESS-CHRON and STOPPFrail Criteria.

OBJECTIVE: LESS-CHRON (List of Evidence-Based Deprescribing for Chronic Patients) and STOPPFrail (Screening Tool of Older Persons' Prescriptions in Frail adults with limited life expectancy) are criterion-based deprescribing tools. This study aimed to identify the prevalence of potentially inappropriate medications (PIMs) with these tools in an outpatient, polymedicated, older population with multimorbidity. DESIGN: Single-center cross-sectional observational study. SETTING AND PARTICIPANTS: PIMs and criteria subject to deprescribing identified by each tool were collected in patients who were being followed up on outpatient internal medicine consultation. METHODS: PIMs were identified by STOPPFrail and LESS-CHRON criteria reviewing medical histories and pharmacologic treatments of the patients in the electronic health card system. Sociodemographic, clinical, and pharmacologic variables were recorded. A correlation analysis between treatment tools and clinical values was performed using the nonparametric Spearman rho correlation. RESULTS: Eighty-three patients with a median of 14.4 (interquartile range 12-17) prescribed drugs were included. The total number of PIMs identified with LESS-CHRON was 158 vs 127 with STOPPFrail. Eight of the 27 criteria (29.6%) for LESS-CHRON and 15 of the 25 for STOPPFrail were found to be not applicable. A significant correlation was obtained for both tools with the number of prescribed drugs at the time of inclusion. The Profund, Barthel, and Frail-VIG index only showed a significant correlation with LESS-CHRON. CONCLUSION AND IMPLICATIONS: Both tools have shown the capacity to identify PIMs that can be deprescribed in the population studied. However, LESS-CHRON appears to have a greater detection potential in the subgroup of patients analyzed. STOPPFrail brings a certain complementarity in other areas of therapy not covered by LESS-CHRON.

Outpatient pharmaceutical care satisfaction survey through Telepharmacy during COVID-19 pandemic in Spain.

OBJECTIVE: To present the results of a survey about the Telemedicine outpatients experience and satisfaction of a pharmaceutical care  program through Telepharmacy, carried out from hospital pharmacy  departments in Spain during COVID-19 Pandemic (ENOPEX survey), and  identify differences across regions in Spain. METHOD: An analysis of results of the national survey ENOPEX on outpatient Telepharmacy services during the lockdown due to the COVID­19 pandemic, analyzed by autonomous community in Spain. Data was collected in relation to point of delivery; pharmacotherapeutic follow-up; patient's opinion and satisfaction with Telemedicine; confidentiality; future development of pharmaceutical care, through Telepharmacy services;  and coordination with the patient care team. Four multilevel regressions were performed to evaluate the differences between Spanish regions on the most relevant variables of the study, using the R version 4.0.3 software. RESULTS: A total of 8,079 interviews were valid, 52.8% of respondents were  female, age was 41-65 years in 54.3% of participants; 42.7% had been  receiving treatment for more than 5 years; 42.8% lived 10-50 km  from the  hospital; the journey to hospital took more than one hour for 60.2% of  participants. Globally, 85.7% received medicines at home. However, medicines  were delivered at a community pharmacy in some communities, such as  Cantabria (95.8%), or at primary care centers as in Castile La Mancha  (16.5%). In total, 96.7% of participants were satisfied or very satisfied with  Telemedicine pharmaceutical care, through Telepharmacy services, with  differences across communities, with users in Andalusia reporting the highest  satisfaction (OR = 1.58), and users in Castile-León being less satisfied with  Telepharmacy services (OR = 0.66). Users in Catalonia are the ones more  clearly in favor of Telemedicine pharmaceutical care, through Telepharmacy  services as a complementary service, with an OR = 5.85 with respect to other  users. The Telemedicine most frequently mentioned advantage was that  Telepharmacy services avoided visits, especially in Cantabria (92.5%) and  Extremadura (88.4%). Most patients prefer informed delivery of medicines at  home when they do not have an appointment at the hospital: total of 75.6 %,  from 50.1% of users in Cantabria to 96.3% in Catalonia (p < 0.001). The users  less willing to pay for Telepharmacy services were the ones from Castile- León and Galicia, with users in Catalonia and Navarra showing higher  willingness. CONCLUSIONS: In general terms, patients were satisfied with Telemedicine pharmaceutical care, through Telepharmacy services during the COVID­19 pandemic, being mostly in favor of maintaining these services to avoid travels.

OBJETIVO: Describir los resultados de la encuesta sobre experiencia y  atisfacción de la Telemedicina en pacientes externos relativo a un programa de  atención farmacéutica a través de la Telefarmacia, realizado desde los servicios de farmacia durante la pandemia COVID-19 (encuesta ENOPEX) e identificar  las diferencias entre las comunidades autónomas de España.Método: Se analizaron los resultados de la encuesta nacional ENOPEX sobre  Telefarmacia en pacientes externos durante el confinamiento debido a la  pandemia COVID-19, realizado en las diferentes comunidades autónomas de  España. Se recogieron datos relativos a lugar de entrega, seguimiento farmacoterapéutico, opinión y satisfacción del paciente con la  Telefarmacia, confidencialidad, desarrollo futuro de la atención farmacéutica a  través de los servicios de Telefarmacia, y coordinación con el equipo de atención al paciente. Se realizaron cuatro regresiones multinivel para  evaluar las diferencias entre comunidades autónomas sobre las variables más relevantes del estudio por medio del software R versión 4.0.3. RESULTADOS: Un total de 8.079 entrevistas fueron válidas: el 52,8% eran mujeres, el 54,3% tenía entre 41-65 años, el 42,9% estaban en  tratamiento  prodesde hacía más de 5 años, el 42,8% vivía a 10-50 km del  hospital y el 60,2%  tardaba más de una hora en acudir al hospital.  globalmente, el 85,7% recibieron medicación a domicilio, aunque hubo  comunidades autónomas en las que se optó también por las oficinas de  farmacia, como en Cantabria (95,8%), o los centros de atención primaria,  como en Castilla­La Mancha (16,5%). El 96,7% de los pacientes refirieron estar satisfechos o muy satisfechos con la Telemedicina en la atención farmacéutica  mediante el uso de la Telefarmacia, detectándose variabilidad en cuanto a la  opinión entre comunidades, desde la mejor opinión en Andalucía (odds ratio  =1,58) y la menos favorable en Castilla y León (odds ratio = 0,66). Por su  parte, Cataluña es la comunidad que estaría más claramente a favor de la  Telemedicina en la atención farmacéutica de usar la Telefarmacia como  actividad complementaria, con una odds ratio de 5,85 respecto al resto. Las  ventajas más mencionadas de la Telemedicina fue que los servicios de  Telefarmacia evitaban desplazamientos, especialmente en Cantabria (92,5%) y Extremadura (88,4%). Los pacientes mayoritariamente prefieren el  acercamiento y entrega informada de la medicación a domicilio cuando no  tienen que acudir al hospital, el 75,6% globalmente, desde el 50,1% de  pacientes de Cantabria al 96,3% en Cataluña (p < 0,001). Las comunidades  autónomas menos dispuestas a pagar por el servicio de Telefarmacia fueron  Castilla y León y Galicia, y las que más, Cataluña y Navarra. CONCLUSIONES: En líneas generales, los pacientes están satisfechos con la  Telemedicina aplicada a la atención farmacéutica a través de los servicios de  Telefarmacia durante la pandemia COVID-19, estando mayoritariamente a  favor de mantenerla para evitar desplazamientos.

Encuesta de satisfacción en pacientes externosde la atención farmacéutica mediante Telefarmaciadurante la pandemia COVID-19 en España / Outpatient pharmaceutical care satisfaction survey through Telepharmacy during COVID-19 pandemic in Spain

Objetivo: Describir los resultados de la encuesta sobre experiencia y satisfacción de la Telemedicina en pacientes externos relativo a un programade atención farmacéutica a través de la Telefarmacia, realizado desde losservicios de farmacia durante la pandemia COVID-19 (encuesta ENOPEX)e identificar las diferencias entre las comunidades autónomas de España.Método: Se analizaron los resultados de la encuesta nacional ENOPEXsobre Telefarmacia en pacientes externos durante el confinamiento debidoa la pandemia COVID-19, realizado en las diferentes comunidades autónomas de España. Se recogieron datos relativos a lugar de entrega, seguimiento farmacoterapéutico, opinión y satisfacción del paciente con la Telefarmacia, confidencialidad, desarrollo futuro de la atención farmacéuticaa través de los servicios de Telefarmacia, y coordinación con el equipo deatención al paciente. Se realizaron cuatro regresiones multinivel para evaluar las diferencias entre comunidades autónomas sobre las variables másrelevantes del estudio por medio del software R versión 4.0.3.Resultados: Un total de 8.079 entrevistas fueron válidas: el 52,8% eranmujeres, el 54,3% tenía entre 41-65 años, el 42,9% estaban en tratamiento desde hacía más de 5 años, el 42,8% vivía a 10-50 km del hospital y el 60,2%tardaba más de una hora en acudir al hospital. Globalmente, el 85,7% recibieron medicación a domicilio, aunque hubo comunidades autónomas en lasque se optó también por las oficinas de farmacia, como en Cantabria (95,8%),o los centros de atención primaria, como en Castilla-La Mancha (16,5%). El96,7% de los pacientes refirieron estar satisfechos o muy satisfechos con laTelemedicina en la atención farmacéutica mediante el uso de la Telefarmacia,detectándose variabilidad en cuanto a la opinión entre comunidades, desde lamejor opinión en Andalucía (odds ratio =1,58) y la menos favorable en Castillay León (odds ratio = 0,66). (AU)

Objective: To present the results of a survey about the Telemedicineoutpatients experience and satisfaction of a pharmaceutical care programthrough Telepharmacy, carried out from hospital pharmacy departments inSpain during COVID-19 Pandemic (ENOPEX survey), and identify differences across regions in Spain.Method: An analysis of results of the national survey ENOPEX on outpatient Telepharmacy services during the lockdown due to the COVID-19pandemic, analyzed by autonomous community in Spain. Data wascollected in relation to point of delivery; pharmacotherapeutic follow-up;patient’s opinion and satisfaction with Telemedicine; confidentiality; futuredevelopment of pharmaceutical care, through Telepharmacy services; andcoordination with the patient care team. Four multilevel regressions wereperformed to evaluate the differences between Spanish regions on themost relevant variables of the study, using the R version 4.0.3 software.Results: A total of 8,079 interviews were valid, 52.8% of respondentswere female, age was 41-65 years in 54.3% of participants; 42.7% hadbeen receiving treatment for more than 5 years; 42.8% lived 10-50 km from the hospital; the journey to hospital took more than one hour for60.2% of participants. Globally, 85.7% received medicines at home.However, medicines were delivered at a community pharmacy in somecommunities, such as Cantabria (95.8%), or at primary care centers as inCastile La Mancha (16.5%). In total, 96.7% of participants were satisfiedor very satisfied with Telemedicine pharmaceutical care, through Telepharmacy services, with differences across communities, with users in Andalusia reporting the highest satisfaction (OR = 1.58), and users in CastileLeón being less satisfied with Telepharmacy services (OR = 0.66). (AU)

Biomarkers of Venous Thromboembolism Recurrence after Discontinuation of Low Molecular Weight Heparin Treatment for Cancer-Associated Thrombosis (HISPALIS-Study).

The most appropriate duration of anticoagulant treatment for cancer-associated venous thromboembolism (CAT) remains unclear. We have conducted a prospective multicenter study in CAT patients with more than 6 months of anticoagulant treatment to predict the risk of venous thromboembolism (VTE) recurrence after anticoagulation discontinuation. Blood samples were obtained when patients stopped the anticoagulation, at 21 days and at 90 days. In each sample we assessed different coagulation-related biomarkers: D-dimer (DD), high-sensitivity C-reactive protein (hs-CRP), P-selectin (PS), phospholipids, soluble tissue factor, factor VIII and the thrombin generation test. It was evaluated 325 CAT patients and 166 patients were included in the study, mean age 64 ± 17 years. VTE recurrence until 6 months after stopping anticoagulation treatment was 9.87% [95% confidence interval (CI): 6−15]. The biomarkers sub-distribution hazard ratios were 6.32 for ratio DD basal/DD 21 days > 2 (95% CI: 1.82−21.90), 6.36 for hs-CRP > 4.5 (95% CI: 1.73−23.40) and 5.58 for PS > 40 (95% CI: 1.46−21.30) after 21 days of stopping anticoagulation. This is the first study that has identified the DD ratio, hs-CRP and PS as potential biomarkers of VTE recurrence in cancer patients after the discontinuation of anticoagulation treatment. A risk-adapted strategy may allow the identification of the optimal time to withdraw the anticoagulation in each CAT patient.

Factors associated with mortality in patients hospitalized for COVID-19 in Spain. Data from the RERFAR registry.

OBJECTIVE: To determine the baseline characteristics associated with higher  mortality at 42 days in patients hospitalized for COVID-19 in Spain. METHOD: The study analyzed a prospective cohort of hospitalized COVID-19  patients. The dependent variable was 42-day mortality. Data on the subjects'  demographic and clinical characteristics, comorbidities, usual therapy and  supportive interventions and treatments was collected within 48 hours from  admission. To determine the potential association of the data with mortality, a  multivariate analysis was performed using logistic regression. RESULTS: 15,628 patients were included, 18.2% of whom (n = 2,806) died  during the study period. According to the multivariate analysis, the variables  that were significantly associated (p < 0.05) with mortality upon admission  were: being referred from a nursing home (OR 1.9); having a high respiratory  rate (OR 1,5); having moderate (OR 1.7) or severe (OR 2.9) pneumonia  (CURB-65); aspartate aminotransferase transaminase ≥ 100 IU/l (OR 2.1);  lactate dehydrogenase ≥ 360 IU/L (OR 1.6); procalcitonin > 0.5 ng/mL (OR  1.8); creatine kinase ≥ 294 U/L (OR 1.5); D-dimer > 3,000 ng/mL (OR 1.5);  hemoglobin < 11.6 g/dL (OR 1.4) and C-reactive protein > 120 mg/L (OR 1.2;  requiring respiratory support within the first 48 hours (oxygen therapy [OR  2.0], non-invasive ventilation [OR 2.8], and mechanical ventilation [OR 3.5]);  and being treated with interferon-beta (OR 1.5). On the contrary, being under  80 years of age was associated with lower mortality. CONCLUSIONS: The analysis, based on the data in the RERFAR registry, showed that the factors associated with poorer prognosis were older age,  assessed using the CURB-65 scale, level of respiratory support required,  severe pneumonia (CURB-65), hypertransaminasemia, elevated creatine  kinase, lactate dehydrogenase, and D-dimer levels, anemia, and elevated  respiratory rate.

OBJETIVO: Determinar las características basales que se asocian a una mayor  mortalidad a los 42 días en aquellos pacientes hospitalizados por COVID-19 en  España.Método: Cohorte prospectiva de pacientes COVID-19 hospitalizados. La  variable dependiente fue la mortalidad a los 42 días. Además, se recogieron  características demográficas, clínicas, comorbilidades, tratamiento habitual,  intervenciones de soporte y tratamientos en las primeras 48 horas del ingreso.  Para determinar la asociación con la mortalidad, se realizó un análisis  multivariante mediante regresión logística. Resultados: Se incluyeron 15.628 pacientes, de ellos falleció el 18,2% (n =  2.806). El análisis multivariante mostró que las variables asociadas significativamente (p < 0,05) con la mortalidad al ingreso fueron:  proceder de un centro sociosanitario (odds ratio OR 1,9), frecuencia  respiratoria (odds ratio 1,5), gravedad de neumonía (CURB-65) moderada  (odds ratio 1,7) o alta (odds ratio 2,9), transaminasa aspartato  aminotransferasa ≥ 100 UI/l (odds ratio 2,1), lactato-deshidrogenasa ≥ 360  UI/l (odds ratio 1,6), procalcitonina > 0,5 ng/ml (odds ratio 1,8), creatina- quinasa ≥ 294 U/l (odds ratio 1,5), dímero D > 3.000 ng/ml (odds ratio 1,5),  hemoglobina < 11,6 g/dl (odds ratio 1,4) y proteína C reactiva > 120 mg/l  (odds ratio 1,2), necesidad de soporte respiratorio en las primeras 48 horas  (odds ratio 2,0 de oxigenoterapia; odds ratio 2,8 ventilación no invasiva y odds ratio 3,5 ventilación mecánica) y tratamiento con interferón-beta (odds ratio  1,5). Por el contrario, ser menor de 80 años se asoció a una menor mortalidad. Conclusiones: El análisis del Registro Español de Resultados de  farmacoterapia frente a COVID-19 muestra que los factores asociados a peor pronóstico son: mayor edad, valoración mediante la escala CURB­65, el nivel de requerimiento de soporte respiratorio, neumonía grave (CURB­65), hipertransaminasemia, elevación de creatina-quinasa, lactato- deshidrogenasa, y dímero-D, anemia y elevación de la frecuencia respiratoria.

Factores asociados a la mortalidad en pacienteshospitalizados por COVID-19 en España. Datos del Registro Español de Resultadosde Farmacoterapia frente a COVID-19 (RERFAR) / Factors associated with mortality in patients hospitalized for COVID-19 in Spain. Data from the RERFAR registry

Objetivo: Determinar las características basales que se asocian a unamayor mortalidad a los 42 días en aquellos pacientes hospitalizados porCOVID-19 en España.Método: Cohorte prospectiva de pacientes COVID-19 hospitalizados.La variable dependiente fue la mortalidad a los 42 días. Además, serecogieron características demográficas, clínicas, comorbilidades, tratamientohabitual, intervenciones de soporte y tratamientos en las primeras48 horas del ingreso. Para determinar la asociación con la mortalidad, serealizó un análisis multivariante mediante regresión logística.Resultados: Se incluyeron 15.628 pacientes, de ellos falleció el 18,2%(n = 2.806). El análisis multivariante mostró que las variables asociadassignificativamente (p < 0,05) con la mortalidad al ingreso fueron: procederde un centro sociosanitario (odds ratio OR 1,9), frecuencia respiratoria (oddsratio 1,5), gravedad de neumonía (CURB-65) moderada (odds ratio 1,7) oalta (odds ratio 2,9), transaminasa aspartato aminotransferasa ≥ 100 UI/l(odds ratio 2,1), lactato-deshidrogenasa ≥ 360 UI/l (odds ratio 1,6), procalcitonina > 0,5 ng/ml (odds ratio 1,8), creatina-quinasa ≥ 294 U/l (odds ratio1,5), dímero D > 3.000 ng/ml (odds ratio 1,5), hemoglobina < 11,6 g/dl(odds ratio 1,4) y proteína C reactiva > 120 mg/l (odds ratio 1,2), necesidadde soporte respiratorio en las primeras 48 horas (odds ratio 2,0 deoxigenoterapia; odds ratio 2,8 ventilación no invasiva y odds ratio 3,5 ventilaciónmecánica) y tratamiento con interferón-beta (odds ratio 1,5). Por elcontrario, ser menor de 80 años se asoció a una menor mortalidad. Conclusiones: El análisis del Registro Español de Resultados de Farmacoterapiafrente a COVID-19 muestra que los factores asociados a peorpronóstico son: mayor edad, valoración mediante la escala CURB‑65, elnivel de requerimiento de soporte respiratorio, neumonía grave (CURB‑65),hipertransaminasemia, elevación de creatina-quinasa, lactato-deshidrogenasa,

Objective: To determine the baseline characteristics associated withhigher mortality at 42 days in patients hospitalized for COVID-19 inSpain.Method: The study analyzed a prospective cohort of hospitalizedCOVID-19 patients. The dependent variable was 42-day mortality. Dataon the subjects’ demographic and clinical characteristics, comorbidities,usual therapy and supportive interventions and treatments was collectedwithin 48 hours from admission. To determine the potential associationof the data with mortality, a multivariate analysis was performed usinglogistic regression.Results: 15,628 patients were included, 18.2% of whom (n = 2,806)died during the study period. According to the multivariate analysis, thevariables that were significantly associated (p < 0.05) with mortality uponadmission were: being referred from a nursing home (OR 1.9); havinga high respiratory rate (OR 1,5); having moderate (OR 1.7) or severe(OR 2.9) pneumonia (CURB-65); aspartate aminotransferase transaminase ≥ 100 IU/l (OR 2.1); lactate dehydrogenase ≥ 360 IU/L (OR 1.6);procalcitonin > 0.5 ng/mL (OR 1.8); creatine kinase ≥ 294 U/L (OR 1.5);D-dimer > 3,000 ng/mL (OR 1.5); hemoglobin< 11.6 g/dL (OR 1.4) andC-reactive protein > 120 mg/L (OR 1.2; requiring respiratory support withinthe first 48 hours (oxygen therapy [OR 2.0], non-invasive ventilation [OR 2.8],and mechanical ventilation [OR 3.5]); and being treated with interferon-beta(OR 1.5). On the contrary, being under 80 years of age was associated withlower mortality. Conclusions: The analysis, based on the data in the RERFAR registry, showedthat the factors associated with poorer prognosis were older age, assessedusing the CURB-65 scale, level of respiratory support required, severe pneumonia(CURB-65), hypertransaminasemia, elevated creatine kinase, lactatedehydrogenase, and D-dimer levels, anemia, and elevated respiratory rate.

Years of Potential Life Lost on Renal Replacement Therapy: Retrospective Study Cohort.

BACKGROUND: Chronic kidney disease is the non-communicable disease with the highest growth in morbidity and mortality. Renal transplantation (RT) is the first option of renal replacement in end-stage kidney disease (ESKD) and dialysis is an alternative. However, there is no objective quantification of the impact of both options on a patient's overall survival. The purpose of our study is to assess the potential years of life lost by patients on renal replacement therapy. METHODS: Retrospective study cohort conducted from 2008 to 2018 based on autonomic data registry. RESULTS: 11,551 patients included who received renal replacement therapy (RRT) in a range of age from 15 to 94 years. The mean age at the time of onset was 62.7 years, 95% confidence interval (95% CI) (62.4; 63.0). The mortality rate of RRT patients was 42.2%, 95% CI (41.5; 43.3) and the mean age at death was 72.7 years, 95% CI (72.4; 73.1). The number of patients with ESKD treated with RT was 3776, 32.7% of the total, 95% CI (31.8; 33.5). The total amount of years of potential life lost (YPLL) in the entire cohort was 77,831.3 years, 48,010.1 years in men, and 29,821.2 years in women. The mean number of YPLL per patient with RRT was 6.74 years in both sexes, 6.95 years in women, and 6.61 years in men. The mean number of potential years of life lost in dialysis patients was 9.0 years in both sexes, 8.8 years in men, and 9.2 years in women, while among kidney transplant recipients this figure decreased to 2.2 years in both men and women. CONCLUSIONS: End-stage chronic kidney disease in renal replacement therapy by dialysis causes an average of 9.0 years of life potentially lost for each patient on dialysis treatment, while having received a kidney transplant reduces this figure by 75.6%.

Measure of adherence to direct-acting antivirals as a predictor of the effectiveness of hepatitis C treatment.

Background Adherence to direct-acting antivirals could be a predictor response to these treatments in hepatitis C. Objective To assess the ability of three methods of measuring adherence to direct-acting antivirals [pill counts, pharmacy dispensing record and Simplified Medication Adherence Questionnaire (SMAQ)] as predictors of their effectiveness. Setting Study conducted by the pharmacy department of the hospital. Methods: A retrospective study was performed. Patients ≥ 18 years with hepatitis C that started and completed treatment with direct-acting antivirals between the 1st-April-2015 and 28st-February-2016 were enrolled. To evaluate the predictive ability to obtain a response to treatment, Chi squared test, Mann-Whitney-U test and ROC-curves were used. Main outcome measure Adherence to antivirals was assessed by three methods and response to treatment, which was defined as obtaining a viral load of hepatitis C virus ≤ 15UI/ml at week 12 after the end of treatment. Results 128 patients were enrolled. The overall average adherence obtained with SMAQ (99.09%) was similar to the pill counts (96.40%, p = 0.043) and pharmacy dispensing record (91.10%, p = 0.02). There was no correlation between the percentage of patients considered as adherent by SMAQ (99.09%) and the achievement of response to treatment (96.40%, p = 0.999). The ROC-curve obtained for the pill count method shows a global area under the curve of 0.53. For pharmacy dispensing record method, patients with an adherence ≤ 66.66% have a high probability of not achieving response (sensitivity and specificity of 79.00% and 100.00%, respectively). Conclusions Pharmacy dispensing record is shown as the best indicator of adherence to predict therapeutic failure in our study.

Implementation of a pharmaceutical care program for patients with hepatitis C treated with new direct-action antivirals.

Background A pharmaceutical care program is necessary to improve the management of direct-acting antivirals in hepatitis C. Objective Describe health outcomes obtained with the implementation of a pharmaceutical care program in Hepatitis C patients treated with direct-acting antivirals. Setting This study was performed in a pharmacy department of a university hospital. Methods Retrospective study between 1st-April 2015 and 28st-February 2016. Hospital pharmacists implemented interventional measures for validation of antivirals prescriptions, detection of drug-interaction, adverse drug events, education and patient´s adherence to antiviral regimen. Main outcome measure Health and quality outcomes of the implementation of the pharmaceutical care program. Results A total 128 patients were enrolled. The overall sustained virologic response at week 12 post-treatment rate was 96.1% (95% CI 92.7-99.5). Adverse drug events occurred in 90.6% of the patients, and the majority were grade 1-2. Pharmacists made 334 pharmaceutical interventions. 35.5% of these interventions were aimed to resolve negative results of drugs. 80.9% of the negative results of drugs improved or were eliminated with the application of the measures proposed by the pharmacists (p ≤ 0.001). Pharmacists carried out 175 preventive interventions to avoid negative results of drugs. 97.3% of these interventions were accepted and managed to prevent the appearance of negative results of drugs (p = 0.453). Conclusion The implementation of a pharmaceutical care program in patients with hepatitis C treated with direct-acting antivirals has improved the safety in the use of these drugs.

IHDIP: a controlled randomized trial to assess the security and effectiveness of the incremental hemodialysis in incident patients.

BACKGROUND: Most people who make the transition to renal replacement therapy (RRT) are treated with a fixed dose thrice-weekly hemodialysis réegimen, without considering their residual kidney function (RKF). Recent papers inform us that incremental hemodialysis is associated with preservation of RKF, whenever compared with conventional hemodialysis. The objective of the present controlled randomized trial (RCT) is to determine if start HD with one sessions per week (1-Wk/HD), it is associated with better patient survival and other safety parameters. METHODS/DESIGN: IHDIP is a multicenter RCT experimental open trial. It is randomized in a 1:1 ratio and controlled through usual clinical practice, with a low intervention level and non-commercial. It includes 152 incident patients older than 18 years, with a RRF of ≥4 ml/min/1.73 m2, measured by renal clearance of urea (KrU). The intervention group includes 76 patients who will start with incremental HD (1-Wk/HD). The control group includes 76 patients who will start with thrice-weekly hemodialysis régimen. The primary outcome is assessing the survival rate, while the secondary outcomes are the morbidity rate, the clinical parameters, the quality of life and the efficiency. DISCUSSION: This study will enable to know the number of sessions a patient should receive when starting HD, depending on his RRF. The potentially important clinical and financial implications of incremental hemodialysis warrant this RCT. TRIAL REGISTRATION: U.S. National Institutes of Health, ClinicalTrials.gov . Number: NCT03239808 , completed 13/04/2017. SPONSOR: Foundation for Training and Research of Health Professionals of Extremadura.

Left-sided infective endocarditis caused by Streptococcus agalactiae: rare and serious.

A comparative study of the behaviour of left-sided infective endocarditis (left-sided IE) due to Streptococcus agalactiae (GBS) with left-sided IE caused by Staphylococcus aureus (SA). A prospective, multicentre cohort study in eight public hospitals in Spain, from January 1984 to December 2015; comparative analysis and factors associated with mortality. In total, there were 1754 episodes of left-sided IE; 41 (2.3%) caused by GBS vs. 344 (19.6%) due to SA, definitive IE 39 vs. 324 cases, males, 25 vs. 213, respectively. There were no differences in age or comorbidity, and healthcare-associated acquirement was 10% vs. 43%, p 0.001. Transthoracic echocardiogram (TTE) was performed in 95% vs. 96.8% and a transesophageal echocardiogram (TEE) in 61% vs. 56%. Vegetations were detected in 80% and measured > 1 cm in a similar proportion. It affected native valves in 85.4% vs. 82.6% and late prosthetic valve in 14.6% vs. 9.6%. The course was acute in both groups. There were more skin manifestations in SA left-sided IE, 7.3% vs. 32%, p 0.001. Both groups had similar complications, but in SA, there was more renal failure, 24% vs. 45%, p 0.010. Surgical risk and operated patients were similar. Mortality was proportionally higher in the SA group, without significance 29% vs. 43% (150), p 0.09. Heart failure, septic shock and neurological deterioration conditioned mortality: HR 1.96, 1.69 and 1.37 (CI 95% 1.40-2.73; 1.19-2.39 and 0.99-1.88 respectively) and to a lesser degree SA as aetiology agent and age. Left-sided IE caused by GBS is similar in severity to left-sided IE caused by SA.

Justificación y diseño de DiPPI: un ensayo controlado aleatorizado para evaluar la seguridad y la efectividad de la hemodiálisis progresiva en pacientes incidentes / Rationale and design of DiPPI: A randomized controlled trial to evaluate the safety and effectiveness of progressive hemodialysis in incident patients

INTRODUCCIÓN: La hemodiálisis (HD) progresiva es una modalidad de inicio del tratamiento renal sustitutivo adaptada a las necesidades individuales de cada paciente. Está condicionada fundamentalmente por la función renal residual (FRR). En ella, la frecuencia de sesiones con las que el paciente inicia HD (una o 2 sesiones por semana) es menor que en la HD convencional (3 por semana). Dicha frecuencia aumenta (de una a 2, y de 2 a 3) con el declinar de la FRR. Metodología/diseño: DiPPI es un estudio abierto, multicéntrico, experimental, aleatorizado 1:1 y controlado con procedimiento de práctica clínica habitual, de bajo nivel de intervención y no comercial. Incluye 152 pacientes mayores de 18 años, con enfermedad renal crónica estadio 5, que inician HD como tratamiento renal sustitutivo; y la FRR, medida por aclaramiento renal de urea (KrU) es ≥ 4ml/min/1,73 m2. El estudio se basa en un grupo de intervención con 76 pacientes que iniciarán HD con una sola sesión por semana (modalidad progresiva) y un grupo control con 76 pacientes que comenzarán con 3 sesiones por semana. El objetivo primario es evaluar la supervivencia y los objetivos secundarios son la morbilidad (hospitalizaciones), los parámetros clínicos habituales, la calidad de vida y la eficiencia. DISCUSIÓN: Este estudio permitirá conocer, con la máxima evidencia científica, cuántas sesiones debe recibir un paciente al inicio del tratamiento con HD, dependiendo de su FRR. Registro: Registrado en U.S. National Institutes of Health, ClinicalTrials.gov con número NCT03239808

INTRODUCTION: Progressive haemodialysis (HD) is a starting regime for renal replacement therapy (RRT) adapted to each patient's necessities. It is mainly conditioned by the residual renal function (RRF). The frequency of sessions with which patients start HD (one or two sessions per week), is lower than that for conventional HD (three times per week). Such frequency is increased (from one to two sessions, and from two to three sessions) as the RRF declines. Methodology/DESIGN: IHDIP is a multicentre randomised experimental open trial. It is randomised in a 1:1 ratio and controlled through usual clinical practice, with a low intervention level and non-commercial. It includes 152 patients older than 18 years with chronic renal disease stage 5 and start HD as RRT, with an RRF of ≥ 4 ml/min/1.73 m2, measured by renal clearance of urea (KrU). The intervention group includes 76 patients who will start with one session of HD per week (progressive HD). The control group includes 76 patients who will start with three sessions per week (conventional HD). The primary purpose is assessing the survival rate, while the secondary purposes are the morbidity rate (hospital admissions), the clinical parameters, the quality of life and the efficiency. DISCUSSION: This study will enable us to know, with the highest level of scientific evidence, the number of sessions a patient should receive when starting the HD treatment, depending on his/her RRF. Trial registration: Registered at the U.S. National Institutes of Health, ClinicalTrials.gov under the number NCT03239808

Rationale and design of DiPPI: A randomized controlled trial to evaluate the safety and effectiveness of progressive hemodialysis in incident patients. / Justificación y diseño de DiPPI: un ensayo controlado aleatorizado para evaluar la seguridad y la efectividad de la hemodiálisis progresiva en pacientes incidentes.

INTRODUCTION: Progressive haemodialysis (HD) is a starting regime for renal replacement therapy (RRT) adapted to each patient's necessities. It is mainly conditioned by the residual renal function (RRF). The frequency of sessions with which patients start HD (one or two sessions per week), is lower than that for conventional HD (three times per week). Such frequency is increased (from one to two sessions, and from two to three sessions) as the RRF declines. METHODOLOGY/DESIGN: IHDIP is a multicentre randomised experimental open trial. It is randomised in a 1:1 ratio and controlled through usual clinical practice, with a low intervention level and non-commercial. It includes 152 patients older than 18 years with chronic renal disease stage 5 and start HD as RRT, with an RRF of ≥4ml/min/1.73m2, measured by renal clearance of urea (KrU). The intervention group includes 76 patients who will start with one session of HD per week (progressive HD). The control group includes 76 patients who will start with three sessions per week (conventional HD). The primary purpose is assessing the survival rate, while the secondary purposes are the morbidity rate (hospital admissions), the clinical parameters, the quality of life and the efficiency. DISCUSSION: This study will enable us to know, with the highest level of scientific evidence, the number of sessions a patient should receive when starting the HD treatment, depending on his/her RRF. TRIAL REGISTRATION: Registered at the U.S. National Institutes of Health, ClinicalTrials.gov under the number NCT03239808.