Syringes for intraocular administration: Systematic review. / Jeringas para administración intraocular: revisión sistemática.

OBJECTIVE: The off-label use in clinical practice of non-approved syringes for intravitreal drug administration has resulted in the detection of silicone oil drops in the vitreous of some patients. This situation derives from the lack of approved syringes for intraocular use in the Spanish market. The aim of this work is to review the use of syringes for intraocular administration, as well as to search for alternatives that meet the legal requirements for these unmet needs. METHOD: A systematic review was performed following the PRISMA 2020 Guidelines by searching PubMed with the descriptors: "silicone" AND "syringes" AND ("intraocular" OR "intravitreal") and filtering all existing publications from January 2006 to December 2023, including all those articles dealing with silicone oil release in intravitreal injections and analysing the possible consequences. RESULTS: Sixty-eight results were found, 23 of which were excluded because they did not deal with the subject under study, leaving a total of 45 articles for the systematic review. These were classified according to the conclusions obtained in 4 groups: the adverse reactions produced by silicone, the administration technique, the physicochemical aspects of silicone release, and the characteristics of the medical device. After reviewing the current manufacturers and technical data sheets of commercialized syringes, the existing syringes for this use have been collected, finding two that will probably be commercialized in Spain at the beginning of 2024: Zero Residual™ 0.2 ml SiO-free and VitreJect® Ophthalmic. CONCLUSIONS: From the results obtained, it can be interpreted that the use of syringes and needles with silicone for intravitreal use is a concern for health professionals due to the implications and consequences that may arise in patients, the most important being adverse reactions, so it is necessary to have silicone-free syringes on the market that are specific for intraocular use. Safety and legality in the use of intraocular syringes and needles is essential to guarantee ocular integrity and patient health.

On the formulation of disulfide herbicides based on aminophenoxazinones: polymeric nanoparticle formulation and cyclodextrin complexation to combat crop yield losses.

BACKGROUND: The resistance of weeds to herbicides is a significant issue in ensuring future food supply. Specific examples are Plantago lanceolata, Portulaca oleracea and Lolium rigidum, which mainly infect rice, wheat, barley and pastures, and cause high yield losses every year. In this regard, natural products and their mimics have provided new hope as a result of their different modes-of-action, activity at low concentrations and reduced pollution effects relative to conventional herbicides. However, the poor water solubility and physicochemical properties of these compounds limit their broad application. These problems can be addressed by formulation techniques, and encapsulation appears to be of great interest. RESULTS: Disulfide herbicides inspired by aminophenoxazinones have been formulated with 2-hydroxypropyl-ß-cyclodextrin (HP-ß-CD), γ-CD and polymeric nanoparticles (NPs). In silico studies were employed to identify which complexes would be generated and complex formation was confirmed by nuclear magnetic resonance spectroscopy. Solubility diagrams were generated to assess any improvement in water solubility, which was enhanced 2-13-fold. Scanning electron microscopy and energy-dispersive X-ray spectra confirmed the success of the formulation process for the nanoparticles. Formulated compounds were evaluated in an in vitro wheat coleoptile bioassay, with almost 100% elongation inhibition achieved using only water for the bioassay. Specific in vitro testing on weed phytotoxicity showed that the application of core/shell NPs is highly effective in the fight against P. lanceolata seed germination. CONCLUSIONS: The formulation of disulfide herbicides with CD complexes and NPs led to an enhancement in water solubility and bioactivity. These systems can be applied in pre-emergent mode against P. lanceolata, using only water to prepare the sample, and they showed better activity than the positive controls. © 2022 The Authors. Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

The study of neural antibodies in neurology: A practical summary.

The field of Autoimmune Neurology is expanding rapidly, with new neural antibodies being identified each year. However, these disorders remain rare. Deciding when to test for these antibodies, when and what samples are to be obtained, how to handle and study them correctly, and how to interpret test results, is complex. In this article we review current diagnostic techniques and provide a comprehensive explanation on the study of these patients, in an effort to help with correct diagnosis minimizing false positive and false negative results. We also propose routine storage of samples and referral of certain cases to specialized research laboratories.

Anti-Zic4 paraneoplastic cerebellar degeneration in a patient with EGFR-mutated NSCLC: a case report.

Paraneoplastic cerebellar degeneration (PCD) is one of the most prevalent neurological paraneoplastic syndromes, typically associated with small cell lung cancer (SCLC). PCD is thought to be caused by proteins expressed by tumor cells which trigger an antibody-mediated immune response. Despite PCD being commonly associated with anti-Yo, anti-Hu and anti-Tr/DNER antibodies, PCD is the most prevalent paraneoplastic syndrome in patients harboring anti-Zic4 antibodies. We report what, to our knowledge, is the first known case of anti-Zic4 mediated PCD in a patient with EGFR-mutated metastatic non-small cell lung cancer (NSCLC). Our patient was in complete response (CR) to targeted therapy and presented to the emergency room with drowsiness, unsteady gait and memory lapses. The diagnostic work-up revealed a diffuse cerebellar atrophy in the MRI, ruling out brain metastasis and leptomeningeal carcinomatosis. A body-CT scan showed no signs of recurrent disease. The cerebrospinal fluid (CSF) was within normal parameters. An onconeural antibody panel was conducted in a peripheral blood sample, detecting high levels of anti-Zic4 antibody by indirect immunofluorescence (IFI), results later confirmed by immunoblot testing. With the suspected diagnosis of an anti-Zic4 PCD, the case was discussed with the neurology department and treatment with high dose methylprednisolone was initiated. Considering the lack of substantial clinical benefit, the patient was then treated with intravenous immunoglobulins (IVIG) for 5 days, showing modest improvement. At this time, the patient presented minor disease relapse in the form of a sub-centimetric pulmonary nodule. Despite one cycle of chemotherapy, the patient's neurological condition deteriorated leading to fatal pneumonia secondary to progressive dysphagia. There is scarce evidence of paraneoplastic syndromes in EGFR-mutated NSCLC. Further research is warranted to stablish a possible association between anti-Zic4 and the EGFR molecular pathway.

Effectiveness and safety of erenumab and galcanezumab in the prevention of chronic and episodic migraine: A retrospective cohort study.

WHAT IS KNOWN AND OBJECTIVE?: Erenumab and galcanezumab have shown great results for migraine prevention. However, strict inclusion criteria, absence of concomitant medication and selective outcome report of clinical trials may sometimes be barely representative of the real-world daily practice. Therefore, this study was designed to evaluate effectiveness and safety of these two monoclonal antibodies targeting calcitonin gene-related peptide in real-world patients. METHODS: This observational, retrospective study evaluated the effectiveness and safety of erenumab 140 mg and galcanezumab 120 mg in 142 real-world patients who had previously not responded to three well-established pharmacological alternatives for migraine prevention. To do so, a combination of objective parameters (monthly headache days and acute migraine-specific medication days) and subjective measurements (Migraine Disability Assessment questionnaire, Headache Impact Test and Visual Analogue Scale), validated for clinical research in migraine, were assessed during clinical interview. RESULTS AND DISCUSSION: Findings here reported show that erenumab and galcanezumab reduced monthly headache days, acute migraine specific medication days per month, Headache Impact Test score, Migraine Disability Assessment Test score and Visual Analogue Scale score after 3 and 6 doses (p < 0.01). Additionally, more than 25% of the patients enrolled in the study experienced a reduction by a half in monthly headache days, and more than 50% of the patients also reported a reduction by a half in the number of migraine specific medication days. Both treatments exhibited a great safety profile, rarely leading to discontinuation because of poor tolerance. WHAT IS NEW AND CONCLUSIONS?: Altogether, these results support previous real-life studies regarding effectiveness and safety and provide an interesting insight in how these preventive therapies are also effective in patients diagnosed with difficult to treat migraine who have previously failed, at least, three different drug classes stablished by current neurology guidelines for migraine prevention. Moreover, these data may suggest that erenumab and galcanezumab are able to not only diminish frequency, but also migraine intensity, and that it should be also considered as an effectiveness measure in line with other authors suggestion.

Acute anti-Ma2 paraneoplastic encephalitis associated to pembrolizumab: a case report and review of literature.

Anti-Ma2 encephalitis is a rare neurological disorder with a predominant involvement of brainstem, limbic and diencephalic structures. Although an unspecific encephalopathy is the usual form of presentation, acute-onset neurologic symptoms and other atypical manifestations have been described and account for the challenging diagnosis of this entity. Despite being usually detected as a paraneoplastic syndrome in patients with early-stage tumors or without a previous history of malignancy, a growing concern has arisen from several cases reported in metastatic patients under treatment with immune checkpoint inhibitors. We report what to our knowledge is the first known case of anti-Ma2 encephalitis associated to pembrolizumab and presenting as an acute-onset focal neurological syndrome, consisting on acute global aphasia, right upper limb paresia, hypoacusia, sleep disorder, decreased conscious level and a motor focal status that was refractory to anticonvulsant therapy. A brain MRI scan showed a focal alteration of the cortical-subcortical signal on the left parietal lobe. CSF study found a significant hyperproteinorrhachia and electroencephalography showed lateralized periodic discharges (LPDs), suggestive of a diffuse encephalopathy. A positive result for anti-Ma2 antibodies was obtained both in blood and CSF samples through indirect immune-fluorescence (IFI) and later confirmed by western-blot technique. Our patient obtained a mild response to steroid therapy and a significant improvement after the administration of intravenous immunoglobulins. The hypothesis that checkpoint inhibitors may trigger the expression of previously subclinical paraneoplastic events, through the strengthening of cytotoxic T cells-mediated immune response, is supported by our finding of preexisting anti-Ma2 antibodies in preserved blood samples obtained before the initiation of pembrolizumab in our patient. Further research is needed to reveal if the detection of onconeural antibodies prior to a treatment with checkpoint inhibitors may be used as a predictive biomarker of neurologic immune-related high-grade toxicity.

Pénfigo paraneoplásico secundario a síndrome de Sézary: presentación de un caso / No disponible

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Estado actual del diagnóstico del síndrome antifosfolipídico / No disponible

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Propuesta de formación interprofesional en 4 programas de licenciatura de profesionales sanitarios / Proposal for interprofessional training in 4 healthcare professional degree programs

La formación de profesionales sanitarios ha evolucionado de manera sustantiva, desde que Flexner generó su reporte en el año 1910, pasando desde la formación exclusivamente por modelaje de expertos, a la integración de conocimientos científicos. Sin embargo, a más de 100 años de estas innovaciones, surgen nuevos desafíos para quienes trabajan en el ámbito sanitario. La evidencia señala que estos retos se surgen de los cambios epidemiológicos y demográficos por los que transitan los diferentes países. Agregando a estos cambios los aspectos ambientales y el desarrollo de la globalización que ha derribado barreras no solo en el ámbito económico o político, sino también en el ámbito sanitario. En esta línea, la formación profesional en salud no ha seguido el mismo ritmo de estos avances. Entre otros aspectos, por lo que implica la renovación curricular, el tiempo y esfuerzo que implica por parte de los profesores y la alta inversión a la «reforma científica» y muy baja a la reforma educacional de las escuelas de Medicina. El desafío actual es lograr la colaboración interprofesional para mitigar la crisis de personal sanitario y mejorar la atención de salud para la optimización de las competencias y la prestación de asistencia sanitaria holística, de alta calidad y centrada en las personas. Para dar respuesta a este desafío se propone establecer competencias comunes en las líneas de investigación, gestión y educación en salud en 4 programas de licenciatura, con el fin de potenciar la formación interprofesional para dar una atención de calidad y pertinentes al modelo de salud actual y a las necesidades de la comunidad

The training of health professionals has evolved substantively since Flexner generated their report in 1910. Moving from training exclusively by modeling by experts to the integration of scientific knowledge. However, after one hundred years of these innovations, new challenges have arisen for those working in the health field. The evidence indicates that these challenges arise from the epidemiological and demographic changes across the different countries. Adding to these changes, the environmental aspects and the development of the globalisation that has knocked down barriers, not only in the economic or political sphere, but also in the health field. Along this line, professional training in health care has not kept pace with these advances. Among other aspects involved in the renewing of the curricula, are the time and effort involved by the teachers, the high investment in scientific reform, and the very low investment in educational reform in Medical Schools. In order to respond to these problems, it is proposed to establish common competences in the lines of research, management and health education in 4 Undergraduate Programs, in order to promote interprofessional training to provide a quality and relevant health care to individuals and the community

Enfermedades ampollosas de la piel / No disponible

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Large Evaluation of Anti-Cardiolipin and anti-Beta2Glycoprotein I Assays: Results from the AutoimmunityWorkshop of the Spanish Society of Immunology

Despite their clinical utility and the importance that laboratory testshave in APS diagnosis, probably the most important drawback of suchtests is the elevated intra- and inter-laboratory variation. The aim of thepresent work was to assess the multilaboratory performance of aCL (..) (AU)

A pesar de la indudable utilidad clínica y de la importancia de laspruebas de laboratorio en el diagnóstico del síndrome antifosfolípido(APS), probablemente el mayor defecto de dichas pruebas es su elevadavariabilidad intra- e inter-laboratorio. El objetivo del presente trabajo fueevaluar el comportamiento de los ensayos (..) (AU)