Genetic polymorphisms to identify patients with an optimal response to tildrakizumab in psoriasis patients from real-life clinical practice.

Detecting the association of genetic variants to the response of biological therapy represents an important advance in developing a personalized therapy. The aim of this work was to study the association of polymorphisms with an optimal response to tildrakizumab in patients with psoriasis in a real-life clinical practice. Ninety patients with plaque psoriasis recruited from-Spanish hospitals receiving tildrakizumab for at least 24 weeks were genotyped for 180 polymorphisms. Optimal response to tildrakizumab was evaluated by absolute PASI ≤1 at 6 and 12 months. Polymorphisms corrected for weight and disease duration with an FDR <0.15 were included in a multiple regression model. Sixty three percent of patients achieved an absolute PASI ≤1 at 6 months, while 71% did so after 12 months. Disease duration (>27 years) and weight (>76 kg) were associated with treatment response; after correcting by these factors, no association (FDR >0.15) was found for any polymorphism and response to tildrakizumab at 6 months. The analysis at 12 months identified the genotype GG for rs610604 (TNFAIP3), CT for rs9373839 (ATG5), and delCTGT/delCTGT for rs72167053 (PDE4D) as risk factors to not achieve an optimal response (PASI ≤1), while CT for rs708567 (IL17RC) was protective, independently of weight and disease duration (FDR <0.15). The final multivariable model at 12 months showed an AUC of 0.90 (95% CI 0.82 to -0.98). We identified a set of polymorphisms that could be helpful to identify psoriatic patients with an optimal response to tildrakizumab at 12 months in real-world practice conditions.

[Advanced Surgical Techniques in Forehead Feminization and Hairline Redefinition]. / Techniques chirurgicales avancées dans la féminisation du front et la redéfinition de la ligne des cheveux chez les patientes transgenres.

Facial Gender-Affirming Surgery (FGAS) has emerged as a transformative option for individuals who wish to align their external appearance with their asserted gender identity. This article delves into the surgical techniques employed in forehead feminization and hairline redefinition, highlighting the nuanced approaches used to modify specific facial characteristics to achieve the desired feminizing outcomes. Our extensive experience, encompassing over 2300 forehead feminization surgeries conducted over the past 16 years, provides a robust foundation for understanding the complexities and intricacies of these procedures. This knowledge is crucial for maxillofacial and plastic surgeons, as well as other healthcare professionals involved in comprehensive gender-affirming care, ensuring they are well-equipped to deliver optimal results for their patients.

[Inhaled levodopa: from evidence to experience]. / Levodopa inhalada: de la evidencia a la experiencia.

Most patients with Parkinson's disease experience motor fluctuations or 'off' periods, which impact on their daily activities, increase their disability and diminish their quality of life. They suffer from these fluctuations despite multiple adjustments to the schedules, doses and intake of medication. In this context, on-demand or rescue treatments are necessary to attempt to improve 'off' periods, with drugs that have the pharmacokinetic advantage of a much faster onset of action because their routes of administration are not oral. There are currently three on-demand therapies for the treatment of fluctuations: subcutaneous apomorphine, inhaled levodopa and sublingual apomorphine. Of the three alternatives, subcutaneous apomorphine generally has the fastest onset of action, sublingual apomorphine provides the longest clinical effect, and inhaled levodopa has the most favourable side effect profile. Each of these drugs has its own characteristics: the time before onset of action, the duration of action and different side effect profiles. The choice for each patient will depend on their individual needs and circumstances. To mark the first year of the introduction of inhaled levodopa, we review these therapies, focusing on the experience with this new dosage form of levodopa.

TITLE: Levodopa inhalada: de la evidencia a la experiencia.La mayoría de los pacientes con enfermedad de Parkinson sufren fluctuaciones motoras o períodos off, que impactan en sus actividades cotidianas, aumentan su discapacidad y empeoran su calidad de vida. A pesar de realizar múltiples ajustes en los horarios, en las dosis y en las tomas de medicación, no se consigue que estén libres de estas fluctuaciones. Es en este contexto en el que son necesarios los tratamientos a demanda o de rescate para tratar de mejorar los períodos off, con fármacos que tienen la ventaja farmacocinética de un inicio de acción mucho más rápido debido a que sus vías de administración no son orales. En la actualidad existen tres terapias a demanda para el tratamiento de las fluctuaciones: apomorfina subcutánea, levodopa inhalada y apomorfina sublingual. En general, la apomorfina subcutánea tiene un inicio de efecto más rápido, la apomorfina sublingual ofrece el efecto clínico más prolongado y la levodopa inhalada tiene el perfil de efectos secundarios más favorable entre las tres opciones. Cada uno de estos medicamentos tiene características únicas: tiempo de inicio, duración de acción y diferentes perfiles de efectos secundarios. La elección para cada paciente dependerá de sus necesidades y circunstancias individuales. Aprovechando el primer año de la introducción de la levodopa inhalada, revisamos estas terapias, centrándonos en la experiencia acumulada con esta nueva presentación galénica de levodopa.

The upside of cumulative conceptual interference on exemplar-level mnemonic discrimination.

Although long-term visual memory (LTVM) has a remarkable capacity, the fidelity of its episodic representations can be influenced by at least two intertwined interference mechanisms during the encoding of objects belonging to the same category: the capacity to hold similar episodic traces (e.g., different birds) and the conceptual similarity of the encoded traces (e.g., a sparrow shares more features with a robin than with a penguin). The precision of episodic traces can be tested by having participants discriminate lures (unseen objects) from targets (seen objects) representing different exemplars of the same concept (e.g., two visually similar penguins), which generates interference at retrieval that can be solved if efficient pattern separation happened during encoding. The present study examines the impact of within-category encoding interference on the fidelity of mnemonic object representations, by manipulating an index of cumulative conceptual interference that represents the concurrent impact of capacity and similarity. The precision of mnemonic discrimination was further assessed by measuring the impact of visual similarity between targets and lures in a recognition task. Our results show a significant decrement in the correct identification of targets for increasing interference. Correct rejections of lures were also negatively impacted by cumulative interference as well as by the visual similarity with the target. Most interestingly though, mnemonic discrimination for targets presented with a visually similar lure was more difficult when objects were encoded under lower, not higher, interference. These findings counter a simply additive impact of interference on the fidelity of object representations providing a finer-grained, multi-factorial, understanding of interference in LTVM.

Influence of abiotic factors on diapause termination and temperature requirements for postdiapause development in the European red mite, Panonychus ulmi (Acari: Tetranychidae).

The European red mite Panonychus ulmi (Koch) is widely distributed and it can severely affect pome fruit crops, particularly apple. Pest outbreaks are related to an overuse of non-selective pesticide treatments that lead to the development of resistance and the absence of natural enemies in the orchard. A key aspect to optimize the use of pesticide treatments in the context of IPM is to increase the knowledge on the biology and ecology of the pest to better predict population dynamics and outbreaks. For the European red mite, knowledge on the conditions that lead to diapause breaking by winter eggs is essential to model population dynamics. To increase this knowledge, winter eggs were collected during field surveys in northen Spain during three years and egg hatching was monitored under controlled temperature and photoperiod conditions in the laboratory. The "number of days exposed to cold temperatures" was the most significant factor that positively affected hatching of overwintering eggs. The time required for 50% of the egg population to hatch (T50%) was also negatively modulated by the duration of exposure to cold temperature. The temperature threshold for postdiapause eggs development collected from the field was estimated between 5 and 6 ºC in 2005 and 2007, respectively. Moreover, the degree-days required for post diapause development were estimated between 263.2 and 270.3, depending on the year of collection. Collectively, we provide additional information on the diapause termination and postdiapause development of the European red mite that may effectively contribute to optimize pest population models.

Differential effects of intrinsic properties of natural scenes and interference mechanisms on recognition processes in long-term visual memory.

Humans display remarkable long-term visual memory (LTVM) processes. Even though images may be intrinsically memorable, the fidelity of their visual representations, and consequently the likelihood of successfully retrieving them, hinges on their similarity when concurrently held in LTVM. In this debate, it is still unclear whether intrinsic features of images (perceptual and semantic) may be mediated by mechanisms of interference generated at encoding, or during retrieval, and how these factors impinge on recognition processes. In the current study, participants (32) studied a stream of 120 natural scenes from 8 semantic categories, which varied in frequencies (4, 8, 16 or 32 exemplars per category) to generate different levels of category interference, in preparation for a recognition test. Then they were asked to indicate which of two images, presented side by side (i.e. two-alternative forced-choice), they remembered. The two images belonged to the same semantic category but varied in their perceptual similarity (similar or dissimilar). Participants also expressed their confidence (sure/not sure) about their recognition response, enabling us to tap into their metacognitive efficacy (meta-d'). Additionally, we extracted the activation of perceptual and semantic features in images (i.e. their informational richness) through deep neural network modelling and examined their impact on recognition processes. Corroborating previous literature, we found that category interference and perceptual similarity negatively impact recognition processes, as well as response times and metacognitive efficacy. Moreover, images semantically rich were less likely remembered, an effect that trumped a positive memorability boost coming from perceptual information. Critically, we did not observe any significant interaction between intrinsic features of images and interference generated either at encoding or during retrieval. All in all, our study calls for a more integrative understanding of the representational dynamics during encoding and recognition enabling us to form, maintain and access visual information.

Pharmacogenetic biomarkers for secukinumab response in psoriasis patients in real-life clinical practice.

BACKGROUND: Prediction of the response to a biological treatment in psoriasis patients would allow efficient treatment allocation. OBJECTIVE: To identify polymorphisms associated with secukinumab response in psoriasis patients in a daily practice setting. METHODS: We studied 180 SNPs in patients with moderate-to-severe plaque psoriasis recruited from 15 Spanish hospitals. Treatment effectiveness was evaluated by absolute PASI ≤3 and ≤1 at 6 and 12 months. Individuals were genotyped using a custom Taqman array. Multiple logistic regression models were generated. Sensitivity, specificity and area under the curve (AUC) were analysed. RESULTS: A total of 173 patients were studied at 6 months, (67% achieved absolute PASI ≤ 3 and 65% PASI ≤ 1) and 162 at 12 months (75% achieved absolute PASI ≤ 3 and 64% PASI ≤ 1). Multivariable analysis showed the association of different sets of SNPs with the response to secukinumab. The model of absolute PASI≤3 at 6 months showed best values of sensitivity and specificity. Four SNPs were associated with the capability of achieving absolute PASI ≤ 3 at 6 months. rs1801274 (FCGR2A), rs2431697 (miR-146a) and rs10484554 (HLCw6) were identified as risk factors for failure to achieve absolute PASI≤3, while rs1051738 (PDE4A) was protective. AUC including these genotypes, weight of patients and history of biological therapy was 0.88 (95% CI 0.83-0.94), with a sensitivity of 48.6% and specificity of 95.7% to discriminate between both phenotypes. CONCLUSION: We have identified a series of polymorphisms associated with the response to secukinumab capable of predicting the potential response/non-response to this drug in patients with plaque psoriasis.

Niveles de vitamina D en sangre materna y su relación con el consumo de pescado y los parámetros antropométricos de los recién nacidos en una cohorte de parejas madre/hijos de Sevilla / Vitamin D levels in maternal blood and its relationship with fish consumption and anthropometric parameters of newborns in a cohort of mother/child couples from Seville

Introducción: Comparar los niveles de vitamina D maternos con la zona de residencia o el consumo de pescado, así como su relación con el peso, la longitud y el perímetro craneal de los bebés. Materiales y métodos: Cohorte de 100 parejas madre-hijo (n=100) de la provincia de Sevilla (Hospital Universitario Virgen del Rocío y Hospital Universitario de Valme). En muestras de sangre materna (edad gestacional≥40 semanas) se han medido los niveles de 25(OH)D mediante quimioluminiscencia. Las medidas antropométricas de los bebés se realizaron mediante métodos estándares. Resultados: Con relación a los niveles de vitamina D, 54% presentaban valores deficientes, 26% insuficientes y 20% valores suficientes. Tras un análisis de regresión múltiple, se observa que no hay diferencia significativa entre niveles de vitamina D maternos, la longitud y el perímetro cefálico de los bebés, sin embargo, sí con el peso al nacer (p<0,05). Al aplicarse la T-Student y el test Wilcoxon, no hay relación entre niveles de vitamina D y el área de residencia ni con el consumo de pescado materno (ambos p>0,05). Conclusiones: El 80% de madres presentan valores deficientes e insuficientes de vitamina D. No hay correlación entre este parámetro y la longitud y perímetro cefálico del bebé, observándose correlación negativa con el peso al nacer. Tampoco se observa correlación entre la zona de residencia o el consumo de pescado y niveles de vitamina D en madres. Sugerimos complementos en dieta de madres gestantes y seguimiento de los niveles de vitamina D en los bebés.(AU)

Introduction: To compare maternal vitamin D levels with the area of residence or the consumption of fish, as well as its relationship with the weight, length and cranial perimeter of babies. Materials and methods: Cohort of 100 mother–child pairs (n=100) from the province of Seville (Virgen del Rocío University Hospital and Valme University Hospital). In maternal blood samples (gestational age≥40 weeks) 25(OH)D levels have been measured by chemiluminescence. Anthropometric measurements of the babies were made using standard methods. Results: Regarding vitamin D levels, 54% had deficient values, 26% insufficient and 20% sufficient values. After a multiple regression analysis, it is observed that there is no significant difference between maternal vitamin D levels, the length and the cephalic perimeter of the babies, however, there is a difference with the birth weight (P<.05). When applying the t-Student and the Wilcoxon test, there is no relationship between vitamin D levels and the area of residence or with maternal fish consumption (both P>.05). Conclusions: Eighty percent of mothers present deficient and insufficient values of vitamin D. There is no correlation between this parameter and the length and cephalic perimeter of the baby, observing a negative correlation with birth weight. No correlation was observed between the area of residence or the consumption of fish and vitamin D levels in mothers. We suggest dietary supplements for pregnant mothers and monitoring of vitamin D levels in babies.(AU)

Typicality in the brain during semantic and episodic memory decisions.

Concept typicality is a key semantic dimension supporting the categorical organization of items based on their features, such that typical items share more features with other members of their category than atypical items, which are more distinctive. Typicality effects manifest in better accuracy and faster response times during categorization tasks, but higher performance for atypical items in episodic memory tasks, due to their distinctiveness. At a neural level, typicality has been linked to the anterior temporal lobe (ATL) and the inferior frontal gyrus (IFG) in semantic decision tasks, but patterns of brain activity during episodic memory tasks remain to be understood. We investigated the neural correlates of typicality in semantic and episodic memory to determine the brain regions associated with semantic typicality and uncover effects arising when items are reinstated during retrieval. In an fMRI study, 26 healthy young subjects first performed a category verification task on words representing typical and atypical concepts (encoding), and then completed a recognition memory task (retrieval). In line with previous literature, we observed higher accuracy and faster response times for typical items in the category verification task, while atypical items were better recognized in the episodic memory task. During category verification, univariate analyses revealed a greater involvement of the angular gyrus for typical items and the inferior frontal gyrus for atypical items. During the correct recognition of old items, regions belonging to the core recollection network were activated. We then compared the similarity of the representations from encoding to retrieval (ERS) using Representation Similarity Analyses. Results showed that typical items were reinstated more than atypical ones in several regions including the left precuneus and left anterior temporal lobe (ATL). This suggests that the correct retrieval of typical items requires finer-grained processing, evidenced by greater item-specific reinstatement, which is needed to resolve their confusability with other members of the category due to their higher feature similarity. Our findings confirm the centrality of the ATL in the processing of typicality while extending it to memory retrieval.

Comparison between pollutants found in breast milk and infant formula in the last decade: A review.

Since ancient times, breastfeeding has been the fundamental way of nurturing the newborn. The benefits of breast milk are widely known, as it is a source of essential nutrients and provides immunological protection, as well as developmental benefits, among others. However, when breastfeeding is not possible, infant formula is the most appropriate alternative. Its composition meets the nutritional requirements of the infant, and its quality is subject to strict control by the authorities. Nonetheless, the presence of different pollutants has been detected in both matrices. Thus, the aim of the present review is to make a comparison between the findings in both breast milk and infant formula in terms of contaminants in the last decade, in order to choose the most convenient option depending on the environmental conditions. For that, the emerging pollutants including metals, chemical compounds derived from heat treatment, pharmaceutical drugs, mycotoxins, pesticides, packaging materials, and other contaminants were described. While in breast milk the most concerning contaminants found were metals and pesticides, in infant formula pollutants such as metals, mycotoxins, and packaging materials were the most outstanding. In conclusion, the convenience of using a feeding diet based on breast milk or either infant formula depends on the maternal environmental circumstances. However, it is important to take into account the immunological benefits of the breast milk compared to the infant formula, and the possibility of using breast milk in combination with infant formula when the nutritional requirements are not fulfilled only with the intake of breast milk. Therefore, more attention should be paid in terms of analyzing these conditions in each case to be able to make a proper decision, as it will vary depending on the maternal and newborn environment.

Locations of objects are better remembered than their identities in naturalistic scenes: An eye-tracking experiment in mild cognitive impairment.

OBJECTIVE: Retaining the identity or location of decontextualized objects in visual short-term working memory (VWM) is impaired by healthy and pathological ageing, but research remains inconclusive on whether these two features are equally impacted by it. Moreover, it is unclear whether similar impairments would manifest in naturalistic visual contexts. METHOD: 30 people with mild cognitive impairment (MCI) and 32 age-matched control participants (CPs) were eye-tracked within a change detection paradigm. They viewed 120 naturalistic scenes, and after a retention interval (1 s) asked whether a critical object in the scene had (or not) changed on either: identity (became a different object), location (same object but changed location), or both (changed in location and identity). RESULTS: MCIs performed worse than CP but there was no interaction with the type of change. Changes in both were easiest while changes in identity alone were hardest. The latency to first fixation and first-pass duration to the critical object during successful recognition was not different between MCIs and CPs. Objects that changed in both features took longer to be fixated for the first time but required a shorter first pass compared to changes in identity alone which displayed the opposite pattern. CONCLUSIONS: Locations of objects are better remembered than their identities; memory for changes is best when involving both features. These mechanisms are spared by pathological ageing as indicated by the similarity between groups besides trivial differences in overall performance. These findings demonstrate that VWM mechanisms in the context of naturalistic scene information are preserved in people with MCI. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Ensayo clínico aleatorizado, controlado con placebo y doble ciego para evaluar la eficacia y la seguridad del ácido tranexámico tópico en el ahorro de pérdidas sanguíneas en pacientes tratados mediante cirugía protésica de rodilla / Randomized, placebo-controlled, double-blind clinical trial to evaluate efficacy and safety of topical tranexamic acid in saving blood loss in patients undergoing prosthetic knee surgery

Antecedentes y objetivo: Durante la artroplastia de rodilla se produce una pérdida sanguínea importante. El objetivo de nuestro estudio es valorar la eficacia y la seguridad de la administración tópica de 3 g de ácido tranexámico (TXA) en cuanto a la reducción de pérdidas sanguíneas en artroplastia de rodilla. Material y método: Se ha realizado un ensayo clínico aleatorizado, fase iii, doble ciego, controlado con placebo. Se incluyó a 150 pacientes en 2grupos paralelos de tratamiento (75 por brazo). La solución se administró de forma tópica intraarticular tras la cementación y previo al cierre capsular. Se realizaron determinaciones analíticas antes y después de la cirugía. Resultados: La pérdida total de sangre media para el grupo placebo fue de 831,5ml y 662,3ml para el grupo TXA con una diferencia entre ambos de 169,2ml, lo que supone un ahorro del 20,4%, siendo estadísticamente significativa (p<0,001). No se obtuvieron diferencias en el inicio de la deambulación, días de ingreso o escala visual analógica al mes de la cirugía. Se retiró a 10pacientes por infección del tracto urinario prequirúrgico, alergia a metales, fallo de selección, debilitamiento rotuliano, inestabilidad protésica, fractura tibial intraquirúrgica, cambio de indicación a prótesis unicompartimental y una pérdida de seguimiento. Hubo una única complicación no relacionada con el fármaco (globos vesicales de repetición). Conclusión: La administración de TXA de forma tópica tras la cementación de los componentes protésicos en artroplastia de rodilla en una única dosis demuestra que es segura y eficaz.(AU)

Background and objective: Knee arthroplasty is a major surgery with potential significant blood loss. Assess the efficacy and safety of topical administration of 3g of tranexamic acid (TXA) in terms of reducing blood loss in knee arthroplasty. Material and method: A randomized, phase III, double-blind, placebo-controlled clinical trial has been conducted. We included 150 patients in 2parallel treatment groups (75 per arm). The solution was administered topically intra-articular after cementation and prior to capsular closure. Analytical determinations were made before and after surgery to quantify blood loss. Results: Total blood loss for the placebo group was 831.5ml and 662.3ml for the TXA group. The difference between the 2groups was 169.2ml; which means a save of 20.4 per cent; this difference being statistically significant (P<.001). There were no differences in terms of the onset of ambulation, days of admission or Visual Analogue Scale at one month of surgery. Ten patients were rejected for presurgical urinary tract infection, metal allergy, selection failure, patellar weakening, prosthetic instability, intrasurgical tibial fracture, change of indication to unicompartimental prosthesis and a loss of follow-up. There was only one complication unrelated to the investigational drug (bladder balloon). Conclusion: The administration of TXA topically after cementation of the prosthetic components in total knee arthroplasty in a single dose has demonstrated being safe and effective.(AU)

[Translated article] Randomized, placebo-controlled, double-blind clinical trial to evaluate efficacy and safety of topical tranexamic acid in saving blood loss in patients undergoing prosthetic knee surgery / Ensayo clínico aleatorizado, controlado con placebo y doble ciego para evaluar la eficacia y la seguridad del ácido tranexámico tópico en el ahorro de pérdidas sanguíneas en pacientes tratados mediante cirugía protésica de rodilla

Antecedentes y objetivo: Durante la artroplastia de rodilla se produce una pérdida sanguínea importante. El objetivo de nuestro estudio es valorar la eficacia y la seguridad de la administración tópica de 3 g de ácido tranexámico (TXA) en cuanto a la reducción de pérdidas sanguíneas en artroplastia de rodilla. Material y método: Se ha realizado un ensayo clínico aleatorizado, fase iii, doble ciego, controlado con placebo. Se incluyó a 150 pacientes en 2grupos paralelos de tratamiento (75 por brazo). La solución se administró de forma tópica intraarticular tras la cementación y previo al cierre capsular. Se realizaron determinaciones analíticas antes y después de la cirugía. Resultados: La pérdida total de sangre media para el grupo placebo fue de 831,5ml y 662,3ml para el grupo TXA con una diferencia entre ambos de 169,2ml, lo que supone un ahorro del 20,4%, siendo estadísticamente significativa (p<0,001). No se obtuvieron diferencias en el inicio de la deambulación, días de ingreso o escala visual analógica al mes de la cirugía. Se retiró a 10pacientes por infección del tracto urinario prequirúrgico, alergia a metales, fallo de selección, debilitamiento rotuliano, inestabilidad protésica, fractura tibial intraquirúrgica, cambio de indicación a prótesis unicompartimental y una pérdida de seguimiento. Hubo una única complicación no relacionada con el fármaco (globos vesicales de repetición). Conclusión: La administración de TXA de forma tópica tras la cementación de los componentes protésicos en artroplastia de rodilla en una única dosis demuestra que es segura y eficaz.(AU)

Background and objective: Knee arthroplasty is a major surgery with potential significant blood loss. Assess the efficacy and safety of topical administration of 3g of tranexamic acid (TXA) in terms of reducing blood loss in knee arthroplasty. Material and method: A randomized, phase III, double-blind, placebo-controlled clinical trial has been conducted. We included 150 patients in 2parallel treatment groups (75 per arm). The solution was administered topically intra-articular after cementation and prior to capsular closure. Analytical determinations were made before and after surgery to quantify blood loss. Results: Total blood loss for the placebo group was 831.5ml and 662.3ml for the TXA group. The difference between the 2groups was 169.2ml; which means a save of 20.4 per cent; this difference being statistically significant (P<.001). There were no differences in terms of the onset of ambulation, days of admission or Visual Analogue Scale at one month of surgery. Ten patients were rejected for presurgical urinary tract infection, metal allergy, selection failure, patellar weakening, prosthetic instability, intrasurgical tibial fracture, change of indication to unicompartimental prosthesis and a loss of follow-up. There was only one complication unrelated to the investigational drug (bladder balloon). Conclusion: The administration of TXA topically after cementation of the prosthetic components in total knee arthroplasty in a single dose has demonstrated being safe and effective.(AU)

Plan de Intervención Comunitaria para el manejo de la EPOC estable: protocolo de coordinación asistencial y derivación entre farmacias comunitarias y centros de salud / Community Intervention Plan for the management of stable COPD: protocol for care coordination and referral between community pharmacies and health centres

La enfermedad pulmonar obstructiva crónica (EPOC) es una enfermedad frecuente y progresiva, pero prevenible y tratable. Sin embargo, se han detectado importantes áreas de mejora en su diagnóstico, tratamiento y seguimiento, así como en la adherencia terapéutica. Con el propósito de aumentar la detección precoz de la EPOC y su manejo adecuado en España, se ha diseñado un Plan de intervención comunitaria (PIC) para la colaboración entre farmacias comunitarias y centros de salud de atención primaria. El PIC incluye un procedimiento normalizado de trabajo (PNT), desarrollado por un grupo de profesionales de farmacia comunitaria, medicina de familia, neumología y enfermería de atención primaria. En él se describe el algoritmo que guiará la actuación de los farmacéuticos comunitarios, incluyendo las pruebas y dispositivos para el cribado poblacional de la EPOC, la evaluación de la enfermedad, la adhesión a inhaladores y la detección de errores críticos en el uso de inhaladores entre otros aspectos. El PNT incluye también un formulario para la derivación del paciente al centro de salud correspondiente, donde se llevarán a cabo una serie de acciones preestablecidas en el plan de actuación según el escenario clínico. Además, se propone evaluar la efectividad de la intervención con unos indicadores recogidos en el centro de salud y en farmacia comunitaria. Por último, se recomienda establecer un plan formativo en EPOC para la óptima implementación del plan y una encuesta a pacientes sobre su grado de satisfacción con la intervención. En conclusión, la implantación del PIC podría reducir el infradiagnóstico en EPOC y optimizar el manejo de los pacientes diagnosticados en España, donde los farmacéuticos comunitarios tendrían una función esencial en el abordaje de estos pacientes. (AU)

[Translated article] Randomized, placebo-controlled, double-blind clinical trial to evaluate efficacy and safety of topical tranexamic acid in saving blood loss in patients undergoing prosthetic knee surgery.

BACKGROUND AND OBJECTIVE: Knee arthroplasty is a major surgery with potential significant blood loss. Assess the efficacy and safety of topical administration of 3g of tranexamic acid (TXA) in terms of reducing blood loss in knee arthroplasty. MATERIAL AND METHOD: A randomized, phase III, double-blind, placebo-controlled clinical trial has been conducted. We included 150 patients in 2 parallel treatment groups (75 per arm). The solution was administered topically intra-articular after cementation and prior to capsular closure. Analytical determinations were made before and after surgery to quantify blood loss. RESULTS: Total blood loss for the placebo group was 831.5ml and 662.3ml for the TXA group. The difference between the 2 groups was 169.2ml; which means a save of 20.4%; this difference being statistically significant (p<.001). There were no differences in terms of the onset of ambulation, days of admission or visual analogue scale at one month of surgery. Ten patients were rejected for presurgical urinary tract infection, metal allergy, selection failure, patellar weakening, prosthetic instability, intrasurgical tibial fracture, change of indication to unicompartimental prosthesis and a loss of follow-up. There was only one complication unrelated to the investigational drug (bladder balloon). CONCLUSION: The administration of TXA topically after cementation of the prosthetic components in total knee arthroplasty in a single dose has demonstrated being safe and effective.

[Hand hygiene and pandemic. Controversies]. / Higiene de manos y pandemia. Controversias.

During the COVID-19 pandemic, the world's healthcare systems were extremely strained. Intensive care units were stretched to capacity and healthcare facilities were forced to set up spaces to care for critically ill patients. Professionals were required to work in strenuous conditions, completely disrupting their work routines.In this scenario, hand hygiene and the use of gloves by healthcare professionals became a critical point of transmission risk.The results of the ENVIN study in 2020 and 2021, corresponding to the pandemic period, showed worrying data on the increase in infection rates, with rates rising by 250% at the worst moments of the pandemic. This suggested that excessive risk situations were occurring for the patient. Any preventive strategy must place correct hand hygiene and proper use of gloves among its priority objectives. For this reason, the Project Zero Advisory Board made a series of adaptations and recommendations based on available evidence and expert opinion related to hand hygiene and glove use during the pandemic situation to promote best practice in extreme situations. This article reviews the key aspects of hand hygiene as part of the WHO safety strategy, the main barriers to compliance and the main adaptations proposed by the Advisory Board of the Zero projects.