Application of CMO (capacity, motivation, and opportunity) methodology in pharmaceutical care to optimize the pharmacotherapy in older people living with HIV. DISPIMDINAC project.

OBJECTIVE: To determine the effectiveness of a pharmaceutical intervention, based on the CMO methodology (capacity, motivation and opportunity), to decrease the prevalence of the PIMDINAC concept (potentially inappropriate medication+drug interactions+non-adherence to concomitant medication) in people living with HIV infection. METHODS: Longitudinal prospective multicenter study, conducted between October 2021 and October 2022. Patients living with HIV older than 65 years, on antiretroviral treatment and concomitant drug prescription were included. Demographic, clinical, and pharmacotherapeutic variables were collected. Pharmaceutical care was provided for6 months according to the CMO model in each patient. The main variable was the percentage of patients who simultaneously fulfilled the PIMDINAC concept, comparing the baseline value with the same value at the end of the study. In addition, the percentage of patient's adherent to concomitant and antiretroviral treatment and the percentage of patients meeting the pharmacotherapeutic targets established for the prescribed medicationat 24 weeks of follow-up were compared. RESULTS: Sixty-eight patients were included. Seventy-two percent were men, with a median age of 68 years. The median number of concomitant drugs was 7. A 60.6% of the patients had polypharmacy. The prevalence of the presence of the PIMDINAC concept decreased significantly (10.3 vs. 0%). In isolation, each of the aspects also decreased significantly (p<0.031). The percentage of patients who met the objectives improved significantly from 48,5 at baseline to 88.2 (p<0.001). CONCLUSIONS: The pharmaceutical intervention based onarmaceutical intervention based on the CMO methodology significantly decreased the prevalence of the PIMDINAC concept and increased the number of patients who achieved the objectives, optimising their pharmacotherapy.

Gravedad de los pacientes ingresados por EPOC agudizada en el ensayo clínico SLICE / Severity of patients admitted for acute COPDin the SLICE clinical trial

Introducción: Hay poca información actualizada sobre las características clínicas y la gravedad de los pacientes con EPOC que ingresan por una agudización. Nuestro objetivo fue caracterizar a los pacientes que ingresan por agudización de EPOC según la limitación al flujo aéreo: obstrucción leve (Volumen Espiratorio Forzado en el primer segundo [VEF1] ≥ 80%); moderada (VEF1 50 - 79%); grave (VEF1 30 - 49%); o muy grave (VEF1 <3 0%).Métodos: Realizamos un análisis post-hoc del ensayo clínico multicéntrico SLICE (Significance of Pulmonary Embolism in COPD Exacerbations), que reclutó pacientes consecutivos con agudización de EPOC que requirieron ingreso en 18 hospitales españoles en el periodo comprendido entre septiembre de 2014 y julio de 2020.Resultados: Incluimos 737 pacientes, con una edad media (DE) de 70,2 ± 9,9 años, y un predominio de hombres (73,5%). La espirometría clasificó a los pacientes con obstrucción leve, moderada, grave o muy grave en el 8%, 31,5%, 45% y el 15,5%, respectivamente. Al comparar a los pacientes de acuerdo al grado de obstrucción, observamos que los pacientes con mayor obstrucción al flujo aéreo eran más jóvenes (leve: 71,7 ± 8,8, moderada: 72,4 ± 10, grave: 70,2 ± 9,8, muy grave: 66,6 ± 9,2; p < 0,001), presentaban más insuficiencia respiratoria crónica (37,3% vs. 30,2% vs. 44,9% vs. 64,3%; p < 0,001), presentaban más cianosis (5,8% vs. 5,9% vs. 8,5% vs. 15,3%; p < 0,001), presentaron mayor porcentaje de agudizaciones y estaban más taquicárdicos a su llegada al centro hospitalario (92 ± 16 latidos por minuto [lpm] vs. 94 ± 18 vs. 96 ± 18 lpm vs. 99 ± 18 lpm; p < 0,001). Además, la gasometría arterial al ingreso mostraba un pH menor y una pCO2 mayor cuanto más grave era la obstrucción al flujo aéreo (p < 0,001). Conclusión: La gravedad de la obstrucción al flujo aéreo se asocia con la forma de presentación y el resultado de la gasometría arterial del paciente con agudización de EPOC que requiere ingreso hospitalario. (AU)

Introduction: There is little up-to-date information on the clinical characteristics and severity of COPD patients admitted for an exacerbation. Our objective was to characterize patients admitted due to COPD exacerbation according to airflow limitation: mild obstruction (Forced Expiratory Volume in 1 second [FEV1] ≥ 80%); moderate (FEV1 50 - 79%); severe (FEV1 30 - 49%); or very severe (FEV1 <3 0%).Methods: We performed a post-hoc analysis of the multicenter clinical trial SLICE (Significance of Pulmonary Embolism in COPD Exacerbations), which recruited consecutive patients with COPD exacerbation who required admission to 18 Spanish hospitals in the period between September 2014 and July 2020.Results: We included 737 patients, with a mean (SD) age of 70.2 ± 9.9 years, and a predominance of men (73.5%). Spirometry classified patients with mild, moderate, severe, or very severe obstruction in 8%, 31.5%, 45%, and 15.5%, respectively. When comparing the patients according to the degree of obstruction, we observed that the patients with greater airflow obstruction were younger (mild: 71.7 ± 8.8, moderate: 72.4 ± 10, severe: 70.2 ± 9.8, very severe: 66.6 ± 9.2; p < 0.001), had more chronic respiratory failure (37.3% vs. 30.2% vs. 44.9% vs. 64.3%; p < 0.001), had more cyanosis (5.8% vs. 5.9% vs. 8.5% vs. 15.3%; p < 0.001), had a higher percentage of exacerbations and were more tachycardic on arrival at the center hospital (92 ± 16 beats per minute [bpm] vs. 94 ± 18 vs. 96 ± 18 bpm vs. 99 ± 18 bpm; p < 0.001). In addition, arterial blood gases on admission showed a lower pH and a higher pCO2 the more severe the airflow obstruction was (p < 0.001).Conclusion: The severity of the airflow obstruction is associated with the form of presentation and the result of the arterial blood gases of the patient with COPD exacerbation who requires hospital admission. (AU)

Public health response to an outbreak of SARS-CoV2 infection in a Barcelona prison.

An outbreak of SARS-CoV2 infection in a Barcelona prison was studied. One hundred and forty-eight inmates and 36 prison staff were evaluated by rt-PCR, and 24.1% (40 prisoners, two health workers and four non-health workers) tested positive. In all, 94.8% of cases were asymptomatic. The inmates were isolated in prison module 4, which was converted into an emergency COVID unit. There were no deaths. Generalised screening and the isolation and evaluation of the people infected were key measures. Symptom-based surveillance must be supplemented by rapid contact-based monitoring in order to avoid asymptomatic spread among prisoners and the community at large.

Helminth Fauna of Scomberomorus Sierra (Actinopterygii: Scombridae) in Southeastern Gulf of California, Mexico.

From January to May 2015, a sample of 50 individuals of the Pacific sierra Scomberomorus sierra Jordan and Starks, 1895 captured off Mazatlán (southeastern Gulf of California, Mexico) were reviewed for helminths. A total of 6, 255 parasitic worms belonging to 11 species (9 in adult stage and 2 larvae) were obtained. Trematoda was the best represented group with 6 species of Didymozoidae Monticelli, 1888 and 1 of Bucephalidae Poche, 1907. In addition, 2 monogenean species and 2 of Nematoda were collected. In this study, the first molecular sequences for didymozoid species in Mexico were generated, and for Glomeritrema sp. at worldwide level. The most prevalent species were Didymocylindrus sp. (92 %) and Didymocystis scomberomori (MacCallum & MacCallum, 1916) (88 %), whereas the monogenean Thoracocotyle crocea MacCallum, 1913 reached the highest value of mean intensity (75.2). The coincidence between the helminthological composition established in our study and that reported for the same scombrid in 4 localities from the Mexican South Pacific (sharing 10 species) suggests that this group of species persistently parasitize S. sierra throughout its distribution along the Mexican Pacific coast; furthermore, due to the richness of didymozoids and the affinity of Thoracocotylidae species for S. sierra, both groups can be considered typical parasites of this fi sh.

First report of a primitive neuroectodermal tumor of the bladder in a newborn.

Primitive neuroectodermal tumor (PNET) is part of the Ewing sarcoma family of tumors. The present case reports a primitive neuroectodermal tumor (PNET) of rare location in the bladder in a newborn. It was evaluated with prenatal ultrasound and postnatal tomography that revealed a mass in the posterior wall of the bladder. The patient underwent partial cystectomy with subsequent analysis of the surgical piece removed, the histopathological study indicated a tumor of mesenchymal origin, and immunohistochemical staining confirmed the diagnosis of PNET of the bladder. Satisfactory result and short-term follow-up.

[Control of SARS-CoV-2 in prisons]. / El control de la infección por SARS-CoV-2 en prisiones.

OBJECTIVE: Review of control and management of SARS-CoV-2 infection in penitentiary institutions in Spain and other countries. MATERIAL AND METHODS: A systematic review a comprehensive literature search in Global Health, SCOPUS, Medline and EMBASE was performed using relevant keywords and medical descriptors (MeSH) related to the coronavirus disease (COVID-19) and prisons. National and international recommendations and guides were examined as well as documents published by some countries. RESULTS: The key points of the guides are discussed. The vast majority of recommendations coincide with respect to the measures and procedures that should be used, except for some discrepancy regarding the population screening. Until now, most industrialized countries (except the US and some specific scenarios) have controlled successfully the epidemic in prisons. Less data is found as regards to socioeconomically more disadvantaged countries. CONCLUSIONS: Prisons are prone to a high risk of SARS-CoV-2 transmission due to their space limitations and sometimes poor environmental and hygienic conditions. The recommendations of the control and management of SARS-CoV-2 infection must be the same as those outside the prison, but must be adapted to the peculiarities of the prison. The recommendations must be issued by the health administration in coordination with the prison administration. Finally, must be abide by the Mandela Rules or by the Standard Minimum Rules for the treatment of United Nations prisoners.

Implication of heat shock proteins in rotavirus entry into Reh cells.

The mechanisms of rotavirus entry into the target cell are described as a multi-step event in which the virions are bound to sialic acid (SA), followed by interaction with heat shock cognate protein 70 (Hsc70), some integrins and protein disulfide isomerase (PDI). However, the cell surface receptor molecules facilitating the entry of tumor cell-adapted rotavirus are not completely characterized. Using infection blocking assays with antibodies to some heat shock proteins (HSPs) and also some inhibitors of these cellular proteins, we were able to identify the cell surface Hsp90, Hsp70, Hsc70, Hsp60, Hsp40, PDI and integrin ß3 as receptors of tumor cell-adapted rotavirus in Reh cells. Furthermore, the results also indicated that these rotavirus receptors are associated with lipid microdomains (rafts). Our findings provide evidence that rotavirus tropism for these human acute lymphocytic leukemia cells is explained by the relatively high expression of some HSPs in rafts. The results shown here encourage further research aim at evaluating the potential use of rotaviruses as an oncolytic agent for the treatment of some cancers. Keywords: heat shock proteins; rotavirus; cell receptor; cancer; oncolytic virus.

EDIL3 promotes epithelial-mesenchymal transition and paclitaxel resistance through its interaction with integrin αVß3 in cancer cells.

Epithelial-mesenchymal transition (EMT) has recently been associated with tumor progression, metastasis, and chemotherapy resistance in several tumor types. We performed a differential gene expression analysis comparing paclitaxel-resistant vs. paclitaxel-sensitive breast cancer cells that showed the upregulation of EDIL3 (EGF Like Repeats and Discoidin I Like Domains Protein 3). This gene codifies an extracellular matrix protein that has been identified as a novel regulator of EMT, so we studied its role in tumor progression and paclitaxel response. Our results demonstrated that EDIL3 expression levels were increased in paclitaxel-resistant breast and prostate cancer cells, and in subsets of high-grade breast and prostate tumors. Moreover, we observed that EDIL3 modulated the expression of EMT markers and this was impaired by cilengitide, which blocks the EDIL3-integrin αVß3 interaction. EDIL3 knockdown reverted EMT and sensitized cells to paclitaxel. In contrast, EDIL3 overexpression or the culture of cells in the presence of EDIL3-enriched medium induced EMT and paclitaxel resistance. Adding cilengitide resensitized these cells to paclitaxel treatment. In summary, EDIL3 may contribute to EMT and paclitaxel resistance through autocrine or paracrine signaling in cancer cells. Blockade of EDIL3-integrin αVß3 interaction by cilengitide restores sensitivity to paclitaxel and reverts EMT in paclitaxel-resistant cancer cells. Combinations of cilengitide and taxanes could be beneficial in the treatment of subsets of breast and prostate cancers.

90Y-Radioembolization After Failed Portal Vein Embolization for Colorectal Liver Metastases: A Case Report.

The main limiting factor for liver resection is insufficient future liver remnant (FLR). Portal vein embolization (PVE) is a standard of care treatment to induce FLR hypertrophy, but it is not always efficient. Radioembolization (RE) has a potential to induce liver hypertrophy for PVE-refractory patients. However, this was reported only for the patients with hepatocellular carcinoma. We described two cases of lobar RE after PVE failure for the patients with colorectal liver metastases. This enabled to reach sufficient FLR, provide good local disease control and bridge the patients to extended hepatectomy.

Evolución del manejo clínico de pacientes diagnosticados de trombosis venosa profunda aguda sintomática / No disponible

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Bone Mass Loss and Sarcopenia in Ecuadorian Patients.

OBJECTIVE: To study the association between osteoporosis and sarcopenia and determine the prevalence of osteosarcopenia in patients who attended a rheumatology center in Ecuador. METHODS: A cross-sectional study was conducted in a population of patients who had a densitometric study. The diagnosis of sarcopenia was determined by the DXA standard gold test, screening, and conventional methods (bioimpedance, anthropometric measurements, SARC-F, muscle function, and gait test). RESULTS: A total of 92 patients were studied. The median age was 66 ± 10, 90% females. Using the criteria of SMI, 65% had sarcopenia of which 9% had only sarcopenia and 56% had osteosarcopenia; 22% had only osteopenia/osteoporosis; and 13% none of these conditions. The prevalence of sarcopenia according to handgrip strength was 60%, gait speed 45%, and SARC-F score 40%. The prevalence of osteosarcopenia according to handgrip strength was 51%, gait speed 34%, and SARC-F score 32%. Osteoporosis was associated with a higher prevalence of sarcopenia using the criteria of SMI since 40% had sarcopenia in the normal DXA group, 64% in the osteopenia group, and 76% in the osteoporosis group (p=0.017). Of the women, 69% had sarcopenia compared to 33% of the men (p=0.034). The BMI was lower in the group with sarcopenia (25.1 ± 4.1 kg/m2) compared to the group without sarcopenia (29.4 ± 4.1 kg/m2, p < 0.001). Patients with osteosarcopenia and sarcopenia had lower BMI, handgrip strength, ASM, SMI, and total-body skeletal muscle mass than those with osteopenia/osteoporosis or normal patients. CONCLUSION: 65% of the studied population had sarcopenia. It is clear that the prevalence of sarcopenia is higher in patients with greater loss of bone mass. Identifying pathways that affect both bone and muscle could facilitate the development of treatments that simultaneously improve osteoporosis and sarcopenia.

New Records of Ticks of Genus Amblyomma Koch, 1844 (Acari: Ixodidae) for Ecuador.

PURPOSE: In Ecuador, knowledge of the diversity and geographic distribution of ticks, as well as their importance as vectors, is scarce. Within the family Ixodidae, the genus Amblyomma is the most diverse and parasitizes wild and domestic animals. This genus is represented by 19 species in Ecuador, 12 of which occur in the continental territory and 7 in the Galapagos Islands. In this way, the objective of this work was to update the diversity of ticks reported for Ecuador on wild and domestic animals. METHODS: The specimens were collected manually on mammals and birds, in four localities belonging to the Sierra and Amazon of Ecuador and were kept in tubes with 96% ethyl alcohol. After that, all specimens were separated into immatures, males and females and were identified using their morphological characters. RESULTS: This study records Amblyomma coelebs Neumann, 1899, Amblyomma longirostre (Koch, 1844) Neumann, 1905 and Amblyomma varium Koch, 1844 for the first time in Ecuador. Thus, the genus Amblyomma is currently represented by 22 species. In addition, their hosts, distribution, and importance are also discussed. CONCLUSIONS: Knowing the diversity of ticks that wildlife possesses, its interrelation with the domestic fauna, and the possible pathogens that could be transmitting could significantly contribute to wildlife's conservation.

Aortopexy for the management of paediatric tracheomalacia - the Alder Hey experience.

BACKGROUND: Whilst aortopexy is an accepted and established procedure, there remains considerable heterogeneity within the literature, with inconsistencies in both the approach taken and the technique employed. Furthermore, limited data exist on both patient selection and long-term outcomes. This study aimed to report the experience of managing severe tracheomalacia by way of aortopexy in a large UK paediatric centre. METHOD: A retrospective case note review was conducted. Mean follow up was five years. RESULTS: Twenty-five patients underwent aortopexy for severe tracheomalacia caused by external vascular compression. Acute life-threatening events precipitated investigation in 72 per cent of cases. Twenty-one patients initially presented to ENT services for investigation, which comprised upper airway endoscopy and imaging with computed tomography angiography. Post-operatively, the majority of patients demonstrated complete resolution of symptoms and were discharged from all associated services. Only four patients required a tracheostomy. CONCLUSION: Aortopexy offers an effective method of treating severe tracheomalacia due to vascular compression.

Is it possible to eliminate hepatitis C from the prisons of Catalonia, Spain, in 2021?

AIM: Predict the elimination of chronic hepatitis C in Catalan prisons. MATERIAL AND METHOD: We analyzed the trend of the prevalence of HCV-RNA and anti-hepatitis C treatments prescribed in Catalonia in the period 2002-2016. Using linear exponential smoothing from the historical values in the time series, we estimate the time required to eliminate hepatitis C as a public health problem in prisons (prevalence of hepatitis C virus RNA<1%). RESULTS: A total of 1264 treatments were administered by 12/31/2016. The prevalence of hepatitis C virus RNA was 31.2% in 2002, decreasing to 8.81% in 2016. We estimate that prevalence will reach 0-0.5% in 5 years (second half 2021; 95% CI: 2019-2025). DISCUSSION: Appropriate actions can eliminate hepatitis C infection in prisoners. We estimate that by 2021 hepatitis C infection will no longer be a public health problem in Catalonia prisons.

Renal Artery Dissection in a Young Woman: Diagnoses Beyond Fibromuscular Dysplasia.

A 31-year-old woman presented at the emergency room after experiencing colic pain in the right iliac fossa for 5 days. She had previously consulted another center, where deterioration of renal function had been identified and abdominal computed tomography (CT) angiography had shown a dissection of the right renal artery, with areas suggestive of infarction in the right kidney, as well as an aneurysm in the left renal artery and a smaller left kidney. The patient had no relevant family or personal history except posttraumatic carotid-cavernous fistula in 2014, which had been treated with embolization. In our hospital, the patient was hypertensive and acute renal failure was confirmed, accompanied by an increase in lactate dehydrogenase and isomorphic microhematuria. After a new CT Scan, in addition to the lesions described in the renal arteries, another aneurysm in the splenic artery and an aneurysm of the right femoral artery were identified. Antihypertensive treatment was initiated with calcium antagonists and anticoagulation. Subsequent renal arteriography confirmed the dissection of the right renal artery, which could not be repaired, and a coated stent was placed in the left renal artery to exclude the aneurysm. The splenic artery lesion was treated 2 months later. The etiological diagnosis in this young woman was challenging. The presence of visceral aneurysms suggested a differential diagnosis comprising fibromuscular dysplasia, vasculitis, and collagenopathies. Using a multidisciplinary approach and directed anamnesis, the presence of frequent sprains, joint hypermobility, and skin fragility was confirmed. Blood immunology and CT angiography including the thoracic and cervical territories were normal. Echocardiography revealed tricuspid insufficiency. All these data suggested the presence of a collagen-like Ehlers-Danlos syndrome (vascular form). The diagnosis was confirmed by the genetic study, which showed a pathogenic mutation in the COL3A1 gene. Currently, the patient is asymptomatic with recovered renal function following treatment with a beta-blocker and antiplatelet therapy.

Resultados preliminares del estudio ADENI-UCI: análisis de las decisiones de no ingreso en unidades de cuidados intensivos como medida de limitación de los tratamientos de soporte vital; estudio multicéntrico, prospectivo y observacional / Preliminary results of the ADENI-ICU trial: Analysis of decisions of refuse admission in intensive care units as a limitation of life support treatments; multi-center, prospective, observational study

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Effect of chemical modification of titanium dioxide surface with dicarboxylic acid on the crystalline parameters and rheology behavior in polypropylene composites.

In this document, we present the effect of the surface modification of titanium dioxide particles with dicarboxylic acid on the rheological behavior of isotactic polypropylene composites. In addition to evaluating the effect of this type of modified fillers on the crystalline parameters such as long period, crystalline thickness and amorphous thickness, comparing it with unmodified fillers and pure polymer.

Catalan contribution in the European project MEntally Disturbed Inmates Care and Support (MEDICS).

OBJECTIVE: To know the criteria of penitentiary professionals about the causes, management methods and improvement proposal, in the attention and care of inmates suffering non-serious mental disorders. MATERIAL AND METHODS: Activity developed from March to May 2015. In Catalonia, three prisons participated. Seven different models of anonymous and written questionnaires were distributed, designed by Italy, and aimed at directors, treatment teams, correctional officers, teachers, doctors, nursing staff and volunteers. They presented the degree of participation, descriptive characteristics of groups and main answers given. To study the association between qualitative variables, the Chi squared and the exact Fisher test was used. RESULTS: Questionnaires distributed among the 744 employees and there were obtained 174 filled (23.4%). There was more participation among health staff and treatment teams (88% and 36%). About the age of participants, doctors were the most senior group with meaningful differences (p <0.001). 40.7% were men and 57.7% women. Among the non-health staff 70% of correctional officers held a degree. Most of the total (62.4%) had their work as their main sources of knowledge about mental health. The main answers given are presented. DISCUSSION: Almost 25% of penitentiary professionals participated in the MEDICS project. Most of them (67%) held a degree. There is a professional concern about mental disorders but not discrimination. Some groups (doctors and, specially, non-health professionals) believe as basic a continuing training and working in multidisciplinary teams.

Prevalence and predictors of depression and anxiety in adult patients with type 1 diabetes in tertiary care setting.

AIMS: To determine gender and age differences in the prevalence of depression and anxiety and their predictive factors in adult patients with type 1 diabetes (DM1). METHODS: Random sample of DM1 adult patients from a tertiary care hospital cohort. To evaluate the presence of depression and anxiety, psychological evaluation was performed using structured clinical interview (MINI). For the specific evaluation of fear of hypoglycemia (FH), FH-15 questionnaire was used. RESULTS: 339 patients [51.6% male; 38.5 ± 12.9 years; HbA1c 7.5 ± 1.1% (58.5 ± 14.2 mmol/mol); 20.1 ± 12.0 years of DM1] met the inclusion criteria. Prevalence of depression, anxiety, and FH in men vs. women was as follows (%): depression: 15.4 vs. 33.5 (p < 0.05); anxiety: 13.7 vs. 26.2 (p < 0.05); and FH: 42.8 vs. 46.0 (p = NS). Among midlife female patients, prevalence of depression and anxiety was higher compared to male. Moreover, comorbid depressive and anxious symptoms were also higher in midlife female patients compared to age-matched male patients (3.5 vs. 14%, p < 0.05). Apart from age-related vulnerability, female gender, poor glycemic control, and microvascular and macrovascular complications were predictive factors for depressive and anxious symptomatology. Unawareness hypoglycemia and anxiety-prone personality were predictor factors for FH. CONCLUSIONS: In adults with DM1, prevalence of depression and anxiety is higher in women. Midlife patients, in particular women, show a significantly higher prevalence of anxiety symptoms and comorbid depression and anxiety. The presence of secondary complications and sustained poor glycemic control should alert to the possibility of these mental disorders, especially in the most vulnerable age population; clinical, gender and age-related patterns could help to design more effective psychological assessment and support in adult patients with DM1.