Thorough assessment of the effectiveness of belimumab in a large Spanish multicenter cohort of systemic lupus erythematosus patients.

OBJECTIVES: To provide an overview on the current use of belimumab (BLM) in SLE patients in clinical practice and to examine its efficacy in terms of standardized outcomes, drug survival, as well as patient and safety profiles. METHODS: A longitudinal retrospective multicentre cohort including SLE patients treated with BLM at 18 Spanish centers. Data was collected upon initiation of BLM, at 6 and 12 months after initiation, and at the last recorded visit. Changes in SLEDAI-2K, the proportion of patients who achieved LLDAS and DORIS 2021, and number of flares were compared between visits. Changes in damage, glucocorticoids use and employment status pre-BLM and post-BLM were also assessed. RESULTS: A total of 324 patients were included with a mean follow-up of 3.8 (±2.7) years. LLDAS was attained by 45.8%, 62% and 71% of patients, and DORIS by 24%, 36.2% and 52.5% on successive visits, respectively. Twenty-seven-point two percent of patients were in DORIS ≥ 50% of the visits and a 46% in LLDAS-50. Flares and number of flares were significantly lower one year after treatment with BLM and no changes in damage accrual were observed. Mean (±SD) prednisone dose was significantly reduced over time, with 70 (24%) patients discontinuing GC. CONCLUSION: Our study not only demonstrates belimumab´s efficacy in attaining treat-to-target goals in SLE patients, but also confirms its GC-sparing effect, and its prevention of flares and organ damage accrual.

Role of climatic variability in shaping intraspecific variation of thermal tolerance in Mediterranean water beetles.

The climatic variability hypothesis (CVH) predicts that organisms in more thermally variable environments have wider thermal breadths and higher thermal plasticity than those from more stable environments. However, due to evolutionary trade-offs, taxa with greater absolute thermal limits may have little plasticity of such limits (trade-off hypothesis). The CVH assumes that climatic variability is the ultimate driver of thermal tolerance variation across latitudinal and altitudinal gradients, but average temperature also varies along such gradients. We explored intraspecific variation of thermal tolerance in three typical Mediterranean saline water beetles (families Hydrophilidae and Dytiscidae). For each species, we compared two populations where the species coexist, with similar annual mean temperature but contrasting thermal variability (continental vs. coastal population). We estimated thermal limits of adults from each population, previously acclimated at 17, 20, or 25 °C. We found species-specific patterns but overall, our results agree with the CVH regarding thermal ranges, which were wider in the continental (more variable) population. In the two hydrophilid species, this came at the cost of losing plasticity of the upper thermal limit in this population, supporting the trade-off hypothesis, but not in the dytiscid one. Our results support the role of local adaptation to thermal variability and trade-offs between basal tolerance and physiological plasticity in shaping thermal tolerance in aquatic ectotherms, but also suggest that intraspecific variation of thermal tolerance does not fit a general pattern among aquatic insects. Overlooking such intraspecific variation could lead to inaccurate predictions of the vulnerability of aquatic insects to global warming.

Association of triclosan and human infertility: A systematic review.

Triclosan (TCS) is a chemical compound, which has antibacterial, antiviral, and antifungal properties. TCS is considered an endocrine-disrupting chemical, which has been shown to interfere with developmental, behavioral, and reproductive outcomes in biological models and cell cultures. However, implications about exposure to TCS and human infertility are rare. Thus, the main of this review is summarize the available evidence of the association between triclosan exposure on human infertility. For this, systematic review was conducted following the recommendations established in Report of Systematic Reviews and Meta-Analyses guide (PRISMA). Initially, an electronic search in MEDLINE (via PubMed) and Science direct was performed. The methodological quality of the included studies was verified through the Joanna Briggs Institute (JBI) checklists. All selection and data extraction processes were carried out independently by two reviewers. The evidence was organized and presented using tables and narrative synthesis. There is lacking evidence about the association between triclosan and human infertility. Overall, no association between triclosan and infertility was found. However, semen quality and ovarian reserve are susceptible to triclosan exposure. Thus, future studies are still needed to better elucidate the associations between triclosan and infertility outcomes.

Coronavirus Disease 2019 in Rheumatic Patients with Inflammatory Disorders: A Descriptive Study from a High Infection Incidence Region of Northern Spain.

BACKGROUND: Since the first confirmed case of severe acute respiratory syndrome coronavirus 2 in Spain in January 2020, the susceptibility of patients with rheumatic disease has remained unclear. In this report, we will describe the main features of coronavirus disease 2019 (COVID-19) that occurred in rheumatic patients with inflammatory disorders and try to identify features associated with severe disease. METHODS: We included all rheumatic patients with immune-mediated diseases followed at 6 centers belonging to the public healthcare system in the Basque Country (Spain) and diagnosed with COVID-19 from March 1, 2020, to May 31, 2020. RESULTS: In total, 131 patients were included in this study. The most frequent rheumatic disease was rheumatoid arthritis (46.6%), and the main comorbidities were arterial hypertension (45%). Fortyseven percent were taking glucocorticoids (GC) (62 patients), 61.8% were under treatment with conventional synthetic disease-modifying antirheumatic drugs (csDMARD), and 25 patients (19.1%) were receiving targeted therapies (TT). Thirty-eight percent of patients required hospital admission, 2.3% required transfer to intensive care uni, and the rate of mortality was 9.2%. Associated factors in univariate analysis for a bad outcome were older age, use of GC, obesity, previous cardiovascular disease, and lymphopenia. Use of GC and lymphopenia remained within the multivariate model. CONCLUSION: The frequency of COVID-19 seems to be similar in rheumatic patients as in the general population. Advanced age, obesity, heart disease, glucocorticoids, and low levels of lymphocytes were more common among the patients with a bad outcome. Neither exposure to csDMARD nor TT was associated with severe cases.

More Than Three Years for Normalisation of Routine Laboratory Values after Gluten Withdrawal in Paediatric Coeliac Patients.

The assessment of the nutritional and inflammatory status of paediatric patients with coeliac disease is an interesting approach to early diagnosis and functional follow-up. Most authors agree that the normalisation of symptoms takes about one year. The aim of the study was to evaluate the clinical manifestation and normalisation of routine analytics in Spanish children diagnosed with celiac disease. METHODS: We performed a retrospective case-control study in Spanish paediatric patients, including 21 celiac patients and 20 healthy controls. The 21 patients selected in the case-control study were followed for 5 years after starting a gluten-free diet (GFD). All patients had type 3 villous atrophy according to the Marsh-Oberhuber classification. A total of 39 blood samples were taken before the start of the GFD, and 109 were taken after. Twenty control sera from healthy donors were used for comparison. RESULTS: We found that patients had a subclinical but statistically significant increase in blood calcium, transaminases, and white blood cells, and a decrease in serum iron, at the time of diagnosis. Our study also shows that analytical values normalise within five years on a gluten-free diet. CONCLUSIONS: The use of a combination of subclinical changes, including low iron, high calcium, elevated leukocytes, lymphocytes, and ALT levels in blood samples, together with a low growth percentile, is pertinent in detecting coeliac disease. This set of parameters could help in the diagnosis of patients without clinical symptoms. We can also show that the levels of Fe, Ca, transaminases, and leucocytes remain subclinically altered after 3 years, despite the gluten-free diet.

EUSEDcollab: a network of data from European catchments to monitor net soil erosion by water.

As a network of researchers we release an open-access database (EUSEDcollab) of water discharge and suspended sediment yield time series records collected in small to medium sized catchments in Europe. EUSEDcollab is compiled to overcome the scarcity of open-access data at relevant spatial scales for studies on runoff, soil loss by water erosion and sediment delivery. Multi-source measurement data from numerous researchers and institutions were harmonised into a common time series and metadata structure. Data reuse is facilitated through accompanying metadata descriptors providing background technical information for each monitoring station setup. Across ten European countries, EUSEDcollab covers over 1600 catchment years of data from 245 catchments at event (11 catchments), daily (22 catchments) and monthly (212 catchments) temporal resolution, and is unique in its focus on small to medium catchment drainage areas (median = 43 km2, min = 0.04 km2, max = 817 km2) with applicability for soil erosion research. We release this database with the aim of uniting people, knowledge and data through the European Union Soil Observatory (EUSO).

The Involvement of Polyunsaturated Fatty Acids in Apoptosis Mechanisms and Their Implications in Cancer.

Cancer is a significant global public health issue and, despite advancements in detection and treatment, the prognosis remains poor. Cancer is a complex disease characterized by various hallmarks, including dysregulation in apoptotic cell death pathways. Apoptosis is a programmed cell death process that efficiently eliminates damaged cells. Several studies have indicated the involvement of polyunsaturated fatty acids (PUFAs) in apoptosis, including omega-3 PUFAs such as alpha-linolenic acid, docosahexaenoic acid, and eicosapentaenoic acid. However, the role of omega-6 PUFAs, such as linoleic acid, gamma-linolenic acid, and arachidonic acid, in apoptosis is controversial, with some studies supporting their activation of apoptosis and others suggesting inhibition. These PUFAs are essential fatty acids, and Western populations today have a high consumption rate of omega-6 to omega-3 PUFAs. This review focuses on presenting the diverse molecular mechanisms evidence in both in vitro and in vivo models, to help clarify the controversial involvement of omega-3 and omega-6 PUFAs in apoptosis mechanisms in cancer.

Influencia de la musicoterapia en la disminución de cifras tensionales moderadamente altas

Fundamento la hipertensión arterial es una enfermedad con alta prevalencia a nivel mundial. Entre las alternativas para su tratamiento, la musicoterapia resulta eficaz junto al tratamiento farmacológico. Objetivo describir la influencia de la musicoterapia en la disminución de cifras tensionales moderadamente altas. Métodos se realizó un estudio observacional, analítico, de casos y controles, con pacientes (n=100) que acudieron al Cuerpo de guardia del Policlínico Rolando Ricardo Estrada, del municipio de Báguanos (Holguín), en el período 2021-2022, seleccionados mediante un muestreo no probabilístico intencional. Fueron creados dos grupos de 50 pacientes cada uno. El grupo de casos fue expuesto a la musicoterapia, no así el de control. Resultados en ambos grupos predominaron los pacientes con edades entre 40 y 59 años (41 %), del sexo femenino (55 %) y con diagnóstico previo de hipertensión arterial (58 %). En el momento de acudir al policlínico, en los dos grupos predominó la presión sistólica entre 140 y 159 mmHg (62 %). Luego de haber transcurrido una hora, en la mayoría de los pacientes del grupo de casos las cifras bajaron hasta 120 y 139 mmHg (32 %). En el grupo control se evidenció una leve disminución, pero se mantuvo mayor porcentaje de pacientes con 140 a 159 mmHg (25 %). Conclusión los pacientes expuestos a la musicoterapia evidenciaron una disminución más marcada de las cifras tensionales moderadamente elevadas, en comparación con los no expuestos.

Background arterial hypertension is a disease with a high prevalence worldwide. Among the alternatives for its treatment, music therapy is effective together with pharmacological treatment. Objective to describe the music therapy influence in the reduction of moderately high blood pressure figures. Methods an observational, analytical, case-control study was carried out with patients (n=100) who attended the Rolando Ricardo Estrada Polyclinic's Emergency Room, in the Báguanos municipality (Holguín), from 2021 to 2022, selected through purposive non- probabilistic sampling. Two groups of 50 patients each were created. The case group was exposed to music therapy, but not the control group. Results in both groups, patients aged between 40 and 59 years (41%), female (55%) and with a previous diagnosis of arterial hypertension (58%) predominated. At the time of going to the polyclinic, systolic pressure between 140 and 159 mmHg (62%) predominated in both groups. After one hour had elapsed, in most of the patients in the case group the figures dropped to 120 and 139 mmHg (32%). In the control group, a slight decrease was observed, but a higher percentage of patients with 140 to 159 mmHg (25%) remained. Conclusion patients exposed to music therapy showed a more marked decrease in moderately elevated blood pressure figures, compared to those not exposed.

Sustained COVID-19 community transmission and potential super spreading events at neglected afro-ecuadorian communities assessed by massive RT-qPCR and serological testing of community dwelling population.

Background: Neglected ethnic minorities from underserved rural populations in Latin America are highly vulnerable to coronavirus disease 2019 (COVID-19) due to poor health infrastructure and limited access to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) diagnosis. Esmeraldas is a mainly rural province of the Coastal Region of Ecuador characterized by a high presence of Afro-Ecuadorian population living under poverty conditions. Objective: We herein present a retrospective analysis of the surveillance SARS-CoV-2 testing in community-dwelling population from Esmeraldas carried out by our university laboratory in collaboration with regional health authorities during the first week of October 2020, in a region where no public SARS-CoV-2 detection laboratory was available at that time. Results: A total number of 1,259 people were tested for SARS-CoV-2 by Reverse Transcription quantitative Polimerasa Chain Reaction (RT-qPCR), resulting in an overall infection rate of 7.7% (97/1259, 95% CI: [6.32-9.35%]) for SARS-CoV-2, up to 12.1% in some communities. Interestingly, community-dwelling super spreaders with viral loads over 108 copies/ml represented 6.2% of the SARS-CoV-2-infected population. Furthermore, anti-SARS-CoV-2 IgG serological tests were applied to the same study group, yielding an overall seroprevalence of 11.68% (95% CI: [9.98-13.62%]) but as high as 24.47% at some communities. Conclusion: These results support active COVID-19 community transmission in Esmeraldas province during the first semester of the COVID-19 pandemic as it has been shown for other rural communities in the Ecuadorian Coastal Region.

Amputación digital en una paciente con úlcera del pie diabético / Digital amputation in a patient with diabetic foot ulcer

Este artículo consta solo de imágenes(AU)

Brain fog in neuropathic postural tachycardia syndrome may be associated with autonomic hyperarousal and improves after water drinking.

Background: Brain fog is a common and highly disturbing symptom for patients with neuropathic postural tachycardia syndrome (POTS). Cognitive deficits have been measured exclusively in the upright body position and mainly comprised impairments of higher cognitive functions. The cause of brain fog is still unclear today. This study aimed to investigate whether increased autonomic activation might be an underlying mechanism for the occurrence of brain fog in neuropathic POTS. We therefore investigated cognitive function in patients with neuropathic POTS and a healthy control group depending on body position and in relation to catecholamine release as a sensitive indicator of acute stress. The second aim was to test the effect of water intake on cardiovascular regulation, orthostatic symptoms, cognitive function and catecholamine release. Methods: Thirteen patients with neuropathic POTS and 15 healthy control subjects were included. All participants completed a total of four rounds of cognitive testing: two before and two after the intake of 500 ml still water, each first in the supine position and then during head-up tilt. At the end of each cognitive test, a blood sample was collected for determination of plasma catecholamines. After each head-up tilt phase participants were asked to rate their current symptoms on a visual analogue scale. Results: Working memory performance in the upright body position was impaired in patients, which was associated with self-reported symptom severity. Patients had elevated plasma norepinephrine independent of body position and water intake that increased excessively in the upright body position. The excessive increase of plasma norepinephrine was related to heart rate and symptom severity. Water intake in patients decreased norepinephrine concentrations and heart rate, and improved symptoms as well as cognitive performance. Conclusion: Brain fog and symptom severity in neuropathic POTS are paralleled by an excessive norepinephrine secretion. Bolus water drinking down-regulates norepinephrine secretion and improves general symptom severity including brain fog.

Exhaustive diagnosis of breast implants with capsular contracture: The microbiology laboratory as a major support.

The most frequent complications of post-mastectomy reconstructions are breast implant (BI) infection and capsular contracture (CC). The diagnosis of BI colonization is based on cultures from the sonicated BI and from the capsule tissue. Therefore, we first aimed to assess the yield of conventional culture and molecular techniques in periprosthetic fluid, in addition to BI and capsular tissue. Moreover, we compare colonization and biofilm production between patients with and without CC. During 19 months, we prospectively included patients whose BIs had been removed and divided them into two groups: A (CC, Baker III-IV) and B (no CC). Samples were obtained for conventional culture, 16 s rRNA PCR, and MALDI-TOF. Biofilm production was also evaluated. We included 81 BIs from 69 patients with CC (22) and without CC (53). Forty-three (53.1%) of the 81 BIs had ≥1 positive culture. The culture was positive in 57.1% and 50.9% in groups A and B, respectively (p = 0.645). The highest 16 s rRNA PCR positivity rate was detected in capsular tissue (40.5%). MALDI-TOF was unable to detect colonization in any of the samples. High biofilm production was the following: high biomass: A, 29.8%; B, 39.7% (p = 0.293); high metabolic activity: A, 36.2%; B, 34.5% (p = 0.857). We confirm that cultures from different sites are mandatory to ensure a proper diagnosis of BI colonization. Our study is the first to demonstrate that CC was not associated with BI colonization or high biofilm production. The application of molecular techniques in BI samples was not substantially useful for predicting colonization.

Omega-6 Polyunsaturated Fatty Acids Enhance Tumor Aggressiveness in Experimental Lung Cancer Model: Important Role of Oxylipins.

Lung cancer is currently the leading cause of cancer death worldwide; it is often diagnosed at an advanced stage and bears poor prognosis. It has been shown that diet is an important environmental factor that contributes to the risk and mortality of several types of cancers. Intake of ω-3 and ω-6 PUFAs plays an important role in cancer risk and progression. Current Western populations have high consumption of ω-6 PUFAs with a ratio of ω-6/ω-3 PUFAs at 15:1 to 16.7:1 This high consumption of ω-6 PUFAs is related to increased cancer risk and progression. However, whether a diet rich in ω-6 PUFAs can contribute to tumor aggressiveness has not been well investigated. We used a murine model of pulmonary squamous cell carcinoma to study the aggressiveness of tumors in mice fed with a diet rich in ω-6 PUFAs and its relationship with oxylipins. Our results shown that the mice fed a diet rich in ω-6 showed a marked increase in proliferation, angiogenesis and pro-inflammatory markers and decreased expression of pro-apoptotic proteins in their tumors. Oxylipin profiling revealed an upregulation of various pro-tumoral oxylipins including PGs, HETEs, DiHETrEs and HODEs. These results demonstrate for the first time that high intake of ω-6 PUFAs in the diet enhances the malignancy of tumor cells by histological changes on tumor dedifferentiation and increases cell proliferation, angiogenesis, pro-inflammatory oxylipins and molecular aggressiveness targets such as NF-κB p65, YY1, COX-2 and TGF-ß.

Pénfigo vulgar / Pemphigus vulgaris

Imágenes

Hematological abnormalities in immunosuppressed patients with COVID-19: Evidence from a single center. A cross sectional study.

BACKGROUND: Changes in hematological parameters in patients with COVID-19 are emerging as important features of the disease in the general population. In the present study we aimed to explore the hematological characteristics and its prevalence proportion ratio in patients with immunosuppression with COVID-19. AIM: To explore the differences between immunosuppressed and non-immunosuppressed patients, with and without COVID-19 from a hematological perspective. METHODS: This cross-sectional study reports on the baseline complete blood count in patients attending the HHA Hospital, in Chile. The study reports descriptive characteristics of the population, including sex, age, ethnicity, corticoids and biological therapy scheme and a complete report of blood test results. A total of 476 patients were enrolled in this study from October of 2020 to April 2021. RESULTS: Findings revels a significant increment (p value ≤ 0.001) on the median of total neutrophils and leucocytes, and in platelet-lymphocyte ratio (PLR), neutrophil- lymphocyte ratio (NLR) and monocyte-lymphocyte ratio (MLR) in immunosuppressed patients with COVID-19 (IS(+)) and immunocompetent patients with COVID-19 (IC(+)) compared with their respective controls. By contrast, a significant reduction on the median of lymphocytes, and eosinophiles was observed in IS(+) individuals compared with its controls. Also, the red blood cell count, hemoglobin, hematocrit, and mean corpuscular hemoglobin concentration were significantly reduced in IS(+) patients, whereas red blood cell, distribution width and mean corpuscular volume, were significantly higher in patients with COVID-19. CONCLUSION: Rapid blood tests, including, neutrophil, lymphocytes count and PLR, NLR can be used for early assessment and management of patients with immunosuppression.

The impact of temperature on lithium toxicity in the gastropod Tritia neritea.

The most important use of lithium (Li) is in rechargeable batteries. The growing use of Li, incorrect disposal of Li-based applications, and inefficient recycling strategies for their elimination will result in the release of this metal into the aquatic systems. Alongside with the impacts caused by pollutants, organisms in coastal ecosystems are also facing environmental changes as those related with climate change scenarios, namely, seawater temperature rise. In this context, the present study aimed to evaluate the influence of temperature on Li toxicity, using the Nassariid gastropod Tritia neritea as model species. Metabolism and oxidative stress related biomarkers were evaluated after a 28-day exposure period. The results demonstrated that temperature enhanced the toxic impacts of Li, most probably due to snail increased sensitivity when under warming conditions. As a consequence of inefficient antioxidant and biotransformation capacity, lipid peroxidation was observed in Li-contaminated snails at 21 ºC, demonstrating a significant interaction between both factors. Regarding snails' metabolic capacity, Li did not affect snails, but a clear decrease on their metabolism was observed at increased temperature (with or without Li) which may limit snail defense capacity. Overall, the present findings demonstrated the impacts derived from Li towards marine intertidal gastropods, evidencing enhanced threats under predicted warming conditions. Considering the role of T. neritea in the ecosystem functioning, impacts on this species may greatly affect other populations and eventually the entire community.

Treatment persistence and exacerbations in patients with asthma initiating treatment with inhaled corticosteroids and beta-adrenergic agonists: retrospective cohort study.

OBJECTIVE: To determine treatment persistence and exacerbations in patients initiating inhaler treatment with fixed-dose combinations of inhaled corticosteroids/long-acting beta-2-adrenergic agonists (ICS/LABA) for the treatment of asthma. DESIGN: Retrospective observational study conducted by review of electronic medical records (database: Fundación RediSS). SETTING: Retrospective cohort study. The follow-up period was 1 year. PARTICIPANTS: The study included patients aged ≥18 years who started treatment with ICS/LABA and met the inclusion/exclusion criteria. MAIN OUTCOMES AND MEASURES: The study groups were fluticasone propionate/salmeterol (FP/SAL), beclomethasone/formoterol (BDP/FORM), budesonide/formoterol (BUD/FORM), fluticasone furoate/vilanterol (FF/VI) and fluticasone propionate/formoterol (FP/FORM). The main measurements were persistence, medication possession ratio (MPR) and exacerbations. Statistical significance was established as p<0.05. RESULTS: In total, 3203 patients were recruited for the study. By groups, 31.1% FP/SAL, 28.6% BDP/FORM, 25.0% BUD/FORM, 8.2% FF/VI and 7.0% FP/FORM. The mean age was 52.2 years, 60.8% were female and 44.9% had persistent-moderate asthma. Treatment persistence was 61.7% (95% CI 60.0% to 63.4%) and by study group it was FP/SAL: 60.7%, BDP/FORM: 61.2%, BUD/FORM: 60.3%, FF/VI: 66.7% and FP/FORM: 67.6% (p=0.046). MPR by study group was FP/SAL: 74.3%, BDP/FORM: 73.8%, BUD/FORM: 74.6%, FF/VI: 79.4% and FP/FORM: 80.6% (p=0.028). The mortality rate was 2.9%. By treatment group, exacerbations were FP/SAL: 21.9% (95% CI 19.3% to 24.5%), BDP/FORM: 22.2% (95% CI 19.5% to 24.9%), BUD/FORM: 22.8% (95% CI 19.9% to 25.7%), FF/VI: 17.9% (95% CI 14.9% to 20.7%) and FP/FORM: 16.0% (95% CI 12.2% to 19.3%), p=0.036. CONCLUSIONS: Patients undergoing treatment with FP/FORM and FF/VI versus FP/SAL, BDP/FORM and BUD/FORM were associated with greater treatment adherence (persistence, MPR) and lower rates of exacerbations. However, further studies will be needed to strengthen the consistency of the results.