Comparación entre la morbilidad y la mortalidad por COVID-19, asociada a factores de riesgo metabólicos en población no indígena e indígena de México / Comparison between morbidity and mortality from COVID-19, associated with metabolic risk factors in non-indigenous and indigenous populations of Mexico

Introducción. La investigación sobre la pandemia de COVID-19, se ha estudiado en tiempo real, ha sido y sigue siendo reveladora. Objetivo. Analizar la morbilidad y la mortalidad por COVID-19, asociadas a factores de riesgo metabólicos en población no indígena e indígena de México. Materiales y métodos. Utilizamos la Base Nacional de Datos COVID-19, durante los años críticos 2020-2021- 2022. Se trabajó con 5.380.247 casos que representaron la población total de positivos al SARS-CoV-2. Se analizaron las discrepancias entre las prevalencias de población no indígena, población indígena, defunción y no defunción. Se definió población indígena, con la clasificación oficial de auto-identificación. Se aplicó el modelo de regresión logística para determinar el riesgo de morir para cada variable: enfermedades cardiovasculares, hipertensión, diabetes, obesidad, sexo, edad y condición indígena. El análisis de multicolinealidad se analizó a través de la prueba de asociación Phi para variables dicotómicas y a través del ajuste de Nagelkerke. Resultados. En los positivos totales 99,2% fue población no indígena y 0,8% indígenas, mientras su porcentaje de letalidad fue de 5,8% y 11,1% respectivamente. En ambos grupos, murieron más hombres (61,5%) que mujeres (38,5%) y las edades de mayor defunción fueron 60 a 79 años. La mortalidad por enfermedades cardiovasculares fue la de mayor incidencia, 26,6% en población general y 32,3% en indígena; por diabetes 22,1% y 27,9%; hipertensión 20,0% y 26,7%y la obesidad 11, 3% y 17,4% respectivamente. Los análisis de regresión logística se ajustaron por sexo, edad y condición indígena. El condicionante de mayor riesgo de muerte, fueron las comorbilidades metabólicas y el de menor riesgo, la condición indígena. Conclusiones. El impacto de la pandemia por COVID-19 fue más grave cuando hubo padecimientos metabólicos tanto en la población no indígena como en la indígena(AU)

Introduction. Research on the COVID-19 pandemic, studied in real time, has been and continues to be revealing. Objective. To analyze morbidity and mortality from COVID-19, associated with metabolic risk factors in non-indigenous and indigenous populations of Mexico. Materials and methods. We use the National COVID-19 Database, during the critical years 2020-2021-2022. We worked with 5,380,247 cases that represented the total population of SARS-CoV-2 positives. The discrepancies between the prevalence of non-indigenous population, indigenous population, death and non-death were analyzed. The indigenous population was defined, with the official self-identification classification. The logistic regression model was applied to determine the risk of dying for each variable: cardiovascular diseases, hypertension, diabetes, obesity, sex, age and indigenous status. The multicollinearity analysis was analyzed through the Phi association test for dichotomous variables and through the Nagelkerke adjustment. Results. Of the total positives, 99.2% were non-indigenous people and 0.8% were indigenous, while their fatality percentage was 5.8% and 11.1% respectively. In both groups, more men (61.5%) than women (38.5%) died and the ages of greatest death were 60 to 79 years. Mortality from cardiovascular diseases was the one with the highest incidence, 26.6% in the general population and 32.3% in the indigenous population; due to diabetes 22.1% and 27.9%; hypertension 20.0% and 26.7% and obesity 11.3% and 17.4% respectively. Logistic regression analyzes were adjusted for sex, age, and indigenous status. The condition with the highest risk of death was metabolic comorbidities and the lowest risk was indigenous status. Conclusions. The impact of the COVID-19 pandemic was more serious when there were metabolic disorders in both the non-indigenous and indigenous populations(AU)

Insights on the Evolutionary History and Genetic Patterns of Octopus vulgaris Cuvier, 1797 in the Northeastern Atlantic Using Mitochondrial DNA.

Octopus vulgaris is one of the most harvested octopus species in the world. In the Iberian Peninsula, there are several small-scale fisheries that have a long-term tradition of harvesting octopus. The Asturias fleet (in Northern Spain) has an internationally recognized MSC label for its exploitation. Of concern, genetic assessments of exploited stocks are currently scarce, which could prevent the implementation of adequate managing strategies. We use two mitochondrial regions (cytochrome oxidase subunit 1 and control region) to analyze the genetic status and evolutionary events that conditioned octopus populations' characteristics in the Northeastern Atlantic. A total of 90 individuals were sampled from three different localities in the Iberian Peninsula as well as a location in Macaronesia. Temporal genetic analyses on Asturias and Algarve populations were also performed. Results indicated the absence of fine spatial genetic structuring but showed the Canary Islands (in Macaronesia) as the most distinct population. Our analyses detected two distinct clades, already described in the literature, but, for the first time, we confirmed the presence of the α-southern haplogroup in the Northern Iberian Peninsula. This result indicates a more continuous cline for the distribution of these two haplogroups than previously reported. Temporal changes in the distribution of both haplogroups in contact zones were also detected.

[Differences by socioeconomic and school level in food acquisition of Mexican population]. / Diferencias por nivel socioeconómico y escolar en la adquisición de alimentos de la población mexicana.

Introduction: Introduction: social or school factors influence the acquisition and selection of foods to be consumed. Objective: identifying the socioeconomic or school level that has the greatest weight in the acquisition of food in Mexican households. Methods: cross-sectional, retrospective and comparative study based on the database of the 2018 National Household Expenditure-Income Survey of Mexico. We worked with the national total of 73,274 Mexican households. The variables considered were: expenditure module of food and beverages, school grade of the head of the family and socioeconomic status to which the household belongs. For the statistical analysis, the following tests were used: linear regression analysis, as well as variance analysis, Snedecor's F test, post-hoc test and Schefé's confirmatory test. Results: socioeconomic status has a greater weight (p < .001) for food acquisition. Sugary drinks were the most widely acquired in all social and school levels. The lowest social level is the one who acquires the most cereals, fats, sugars and legumes, while for high school levels animal foods and processed meats are the ones most frequently acquired. Conclusion: the socioeconomic level has a great weight in the acquisition and variety of foods, although this does not mean that foods obtained are the healthiest. Therefore, public policies are urgently required in favor of nutritional education at all school levels, which promote the purchase of healthy foods and compete with commercial advertising strategies.

Introducción: Introducción: los factores sociales o escolares influyen en la adquisición y selección de alimentos a consumir. Objetivo: identificar el nivel socioeconómico o escolar que tenga mayor peso en la adquisición de alimentos en hogares mexicanos. Métodos: estudio transversal, retrospectivo y comparativo a partir de la base de datos de la Encuesta Nacional de Ingreso-Gasto en Hogares de México de 2018. Se trabajó con el total nacional de 73.274 hogares mexicanos. Las variables consideradas fueron: módulo de gasto de alimentos y bebidas, grado escolar del jefe de familia y condición socioeconómica a la que pertenece el hogar. Para el análisis estadístico se utilizó análisis de regresión lineal, así como análisis de varianza, prueba F de Snedecor, prueba post-hoc y confirmatoria de Schefé. Resultados: el nivel socioeconómico tiene un mayor peso (p < ,001) para la adquisición de los alimentos. Las bebidas azucaradas fueron las de mayor adquisición en todos los niveles sociales y escolares. El nivel social más bajo es el que adquiere la mayor cantidad de cereales, grasas, azucares y leguminosas, mientras que en los niveles escolares altos son los alimentos de origen animal y carnes procesadas los más adquiridos. Conclusión: el nivel socioeconómico tiene mayor peso en la adquisición y variedad de los alimentos, aunque esto no quiere decir que por ello se obtengan los más saludables. Por lo tanto, se requiere urgentemente de políticas públicas en favor de una educación nutricional en todos los niveles escolares, que promueva la compra de alimentos saludables y que compita con las estrategias publicitarias comerciales.

Phylogenetic Analysis of the Complete Mitochondrial Genomes in the Ten Rupicapra Subspecies and Implications for the Existence of Multiple Glacial Refugia in Europe.

The current distribution of populations in Europe is marked by the effects of glaciations that occurred during the Pleistocene. Temperate species were isolated in glacial refugia that were the sources of postglacial recolonization. The traditional glacial refuge areas were the Iberian, the Italian and the Balkan peninsulas. Here we revisit the evolutionary history of chamois (Rupicapra genus) to evaluate other sites in continental Europe and Anatolia that have been suggested as potential refuges. We have obtained the complete mitochondrial sequence of seven chamois, including the subspecies parva, carpatica, caucasica, and asiatica whose mitochondrial genome had not been yet reported. These, together with the other fourteen sequences already in the GenBank, represent the different geographical populations of the Rupicapra genus. The phylogenetic analysis showed the three old clades, dating from the early Pleistocene, already reported: mtW in the Iberian Peninsula, mtC in the Appenines and the Massif of Chartreuse, and mtE comprising all the population from the Alps to the east. The genomes within each of the clades mtW and mtE, showed divergence times larger than 300 thousand years. From here, it can be argued that the present-day lineages across Europe are very old and their split dates back to the middle Pleistocene.

¿Cómo valorar la atención centrada en la persona según los profesionales? Un estudio Delphi / How to assess Person-Centered Care according to professionals? A Delphi study

Objetivos: Conocer la perspectiva de profesionales sobre aspectos y dimensiones que deberían formar parte indispensable de la Atención Centrada en la Persona (ACP).DiseñoTécnica Delphi.EmplazamientoAtención Primaria.ParticipantesSetenta y cuatro expertos médicos especialistas en medicina familiar y comunitaria (MF), tutores docentes, psicólogos y sociólogos distribuidos por todo el territorio nacional (enero-junio 2015).MétodosRespondieron a tres cuestionarios: primero sobre aspectos que debería tener en cuenta un MF para realizar ACP en todas sus dimensiones. En el segundo se preguntó sobre el grado de acuerdo con cada ítem y dimensión en que lo clasificaba. Las respuestas se priorizaron en un tercer cuestionario (escala Likert, rango de puntuación 1-10).ResultadosLa tasa de respuesta (TR) al primer cuestionario fue de 54,05%, obteniéndose 84 ítems, los más frecuentes Respeto y Atención Integral. El 2.° cuestionario con TR=48,6%, obtuvo 52 ítems con acuerdo superior al 75%. La TR del tercer cuestionario fue de 52,7%, obteniendo 21 ítems con puntuación >9. Los valores más altos correspondieron a aspectos esenciales de la ACP: respeto, atención integral, enfoque biopsicosocial, autonomía del paciente y participación en la toma de decisiones.ConclusionesSe identificaron nuevas dimensiones: Prevención y promoción de la salud, Gestión de Recursos y Competencia Clínica; añadidas a las previamente descritas: Perspectiva biopsicosocial, Médico como persona, Paciente como persona, Relación médico-paciente y Poder y Responsabilidad compartidas.El respeto, la atención integral, el enfoque biopsicosocial, la autonomía del paciente y su participación en la toma de decisiones, son los aspectos más valorados entre los seleccionados por los profesionales participantes.

Objectives: To know the perspective of professionals on aspects and dimensions that should be an indispensable part of Person-Centered Care (PCA).DesignDelphi Technique.LocationPrimary Care.Participants74 medical experts specializing in family and community medicine (FM), teaching tutors, psychologists and sociologists distributed throughout the national territory (January-June 2015).MethodsThey responded to three questionnaires: first, on aspects that a FP should take into account to carry out PCA in all its dimensions. In the second, they asked about the degree of agreement with each item and dimension in which it was classified. The responses were prioritized in a third questionnaire (Likert scale, score range 1-10).ResultsThe response rate (RR) to the 1st questionnaire was 54.05%, obtaining 84 items, the most frequent Respect and Comprehensive Attention. The 2nd questionnaire with RR = 48.6%, obtained 52 items with a degree of agreement greater than 75%. The RR of the 3rd questionnaire was 52.7%, obtaining 21 items with a score> 9. The highest values corresponded to essential aspects of PCA: respect, comprehensive care, biopsychosocial approach, patient autonomy, and participation in decision-making.

[How to assess Person-Centered Care according to professionals? A Delphi study]. / ¿Cómo valorar la atención centrada en la persona según los profesionales? Un estudio Delphi.

OBJECTIVES: To know the perspective of professionals on aspects and dimensions that should be an indispensable part of Person-Centered Care (PCA). DESIGN: Delphi Technique. LOCATION: Primary Care. PARTICIPANTS: 74 medical experts specializing in family and community medicine (FM), teaching tutors, psychologists and sociologists distributed throughout the national territory (January-June 2015). METHODS: They responded to three questionnaires: first, on aspects that a FP should take into account to carry out PCA in all its dimensions. In the second, they asked about the degree of agreement with each item and dimension in which it was classified. The responses were prioritized in a third questionnaire (Likert scale, score range 1-10). RESULTS: The response rate (RR) to the 1st questionnaire was 54.05%, obtaining 84 items, the most frequent Respect and Comprehensive Attention. The 2nd questionnaire with RR = 48.6%, obtained 52 items with a degree of agreement greater than 75%. The RR of the 3rd questionnaire was 52.7%, obtaining 21 items with a score> 9. The highest values corresponded to essential aspects of PCA: respect, comprehensive care, biopsychosocial approach, patient autonomy, and participation in decision-making. CONCLUSIONS: New dimensions were identified: Prevention and health promotion, Resource Management and Clinical Competence, added to those previously described: Biopsychosocial perspective, Doctor as a person, Patient as a person, Doctor-patient relationship and Shared Power and Responsibility. Respect, comprehensive care, the biopsychosocial approach, the patient's autonomy and their participation in decision-making, are the most valued aspects among those selected by the participating professionals.

Cuestionarios de atención centrada en la persona en atención primaria. Una revisión sistemática / Questionnaires of person centered care in primary care. A systematic review

OBJETIVO: Pese a la importancia de la «atención centrada en la persona» (ACP), hay evidentes limitaciones para valorarla y medirla, debidas probablemente a la dificultad para definirla. El objetivo del estudio fue identificar herramientas validadas que midiesen la ACP o algunos de sus aspectos en el ámbito de la atención primaria. DISEÑO: Revisión sistemática. Fuentes de datos: MEDLINE, Embase, Cochrane, PSYCinfo, IME-Biomedicina, LILACS y TESEO hasta del 31 de mayo de 2018. SELECCIÓN DE ESTUDIOS: Los criterios de inclusión fueron: a) estudios de validación de cuestionarios, revisiones sistemáticas sobre estudios de validación u otros estudios descriptivos, b) realizados todos ellos en el ámbito de la atención primaria y c) que midieran aspectos de la ACP en profesionales y/o pacientes. Dos investigadores revisaron de forma independiente los artículos y sus discrepancias fueron resueltas por un tercer investigador. Extracción de datos: Se recogieron datos sobre los aspectos de la ACP medidos, población a la que se dirige, tipo de cuestionario, y datos sobre validez y fiabilidad. RESULTADOS: Se localizaron 1.415 artículos a los que se añadieron 54 referencias adicionales identificadas a través de referencias de los artículos de la revisión sistemática. Tras una depuración finalmente fueron 75 los artículos que cumplieron todos los criterios y 39 las herramientas identificadas y clasificadas según las dimensiones analizadas. CONCLUSIONES: Debido a la dificultad de medir la ACP en su conjunto, la mayor parte de los artículos hacen referencia solo a alguno de sus aspectos o dimensiones, predominando la perspectiva del paciente frente a la del profesional. Estas herramientas son, no obstante, un importante punto de partida para futuros cuestionarios que intenten valorar de forma integral la ACP

OBJECTIVE: Despite the acknowledged importance of 'Person Centered Care' (PCC), there are obvious limitations for its determination and measurement due to the difficulty of its exact definition. The objective of our review is to identify valid tools that measure the PCC or some of its aspects in the field of Primary Health Care. DESIGN: Systematic review Data sources: MEDLINE, Embase, Cochrane, PSYCinfo, IME-Biomedicine, LILACS and TESEO until May 31, 2018. Selection of studies: The inclusion criteria were: validation studies of questionnaires, systematic reviews of validation or other descriptive studies, all of which were carried out in the context of the Primary Health Care and that measured aspects of the PCC in professionals and/or patients. Two investigators independently reviewed the articles and their discrepancies were resolved by a third investigator. Data extraction: Data were collected on the measured ACP aspects, target population, type of questionnaire, and data on validity and reliability. RESULTS: 1,415 articles were located, to which 54 additional references were subsequently added via cross references. Finally, there were 75 articles that fulfilled all the criteria and there were 39 which had the tools identified and classified according to the dimensions analyzed. CONCLUSIONS: Due to the difficulty of measuring PCC as a whole, most of the articles refer only to one of its aspects or dimensions, with the patient's perspective prevailing over that of the professional. All these tools are, nevertheless, an important starting point for future questionnaires that attempt an integral approach to the PCC

Eficacia y seguridad de la terapia combinada con fármacos modificadores de la enfermedad sintéticos en la artritis reumatoide: revisión sistemática de la literatura / Efficacy and safety of combined therapy with synthetic disease-modifying antirheumatic drugs in rheumatoid arthritis: systematic literature review

OBJETIVO: 1) Revisar sistemática y críticamente la evidencia sobre eficacia y seguridad de la terapia combinada con fármacos modificadores de la enfermedad (FAME) sintéticos en la artritis reumatoide (AR); 2) Emitir recomendaciones prácticas sobre su uso. MÉTODOS: Se realizó una revisión sistemática de la literatura con una estrategia de búsqueda bibliográfica sensible en Medline, Embase y Cochrane Library. Se seleccionaron ensayos clínicos aleatorizados que analizasen la eficacia y/o seguridad de 1) la terapia combinada con FAME sintéticos comparada con la terapia secuencial con FAME sintético en la AR de inicio; y 2) la combinación metotrexato+leflunomida o la triple terapia de FAME sintéticos en la AR establecida refractaria a FAME sintéticos. Dos revisores realizaron la primera selección por título y abstract y 11 la selección tras lectura en detalle y la recogida de datos. La calidad se evaluó con la escala de Jadad. En una reunión de grupo nominal en base sus resultados se consensuaron una serie de recomendaciones. RESULTADOS: Finalmente no se incluyó ningún artículo en la RSL. Del análisis de los artículos revisados se encontró la eficacia en las AR de inicio del tratamiento precoz con FAME sintéticos siguiendo una estrategia «treat to target» y en AR establecidas refractarias a FAME sintéticos la de la terapia combinada con FAME sintéticos. Con ello se generaron 5 recomendaciones sobre la terapia combinada con FAME sintéticos. CONCLUSIONES: Estas recomendaciones pretenden facilitar la toma de decisiones con el uso de la terapia combinada con FAME sintéticos en la AR

OBJECTIVE: 1) To systematically and critically review the evidence of combined therapy with synthetic disease-modifying antirheumatic drugs (DMARD) in rheumatoid arthritis (RA); 2) To design practical recommendations on their use. METHODS: A systematic literature review (SLR) was performed with a sensitive bibliographic search strategy in Medline, EMBASE and Cochrane Library. We selected randomized clinical trials that analyzed the efficacy and/or safety of 1) combined therapy of synthetic compared with sequential therapy of synthetic DMARD in early RA; and 2) combination of methotrexate+leflunomide or triple therapy with synthetic DMARD in established RA refractory to synthetic DMARD. Two reviewers made the first selection by title and abstract and 11 performed the selection after detailed review of the articles and data collection. The quality of the studies was evaluated with the Jadad scale. Based on the results, related recommendations were agreed upon in a nominal group meeting. RESULTS: Ultimately, no articles were included in the SLR. The analysis of the reviewed articles demonstrated the effectiveness of the treatment with synthetic DMARD following a "treat to target" strategy in early RA patients, and of combination therapy of synthetic DMARD in established RA refractory to synthetic DMARD. This resulted in 6 recommendations concerning combination therapy with synthetic DMARD. CONCLUSIONS: These recommendations aim to facilitate decision-making with the use of combined therapy with DMARD in RA

Efficacy and Safety of Combined Therapy With Synthetic Disease-modifying Antirheumatic Drugs in Rheumatoid Arthritis: Systematic Literature Review. / Eficacia y seguridad de la terapia combinada con fármacos modificadores de la enfermedad sintéticos en la artritis reumatoide: revisión sistemática de la literatura.

OBJECTIVE: 1) To systematically and critically review the evidence of combined therapy with synthetic disease-modifying antirheumatic drugs (DMARD) in rheumatoid arthritis (RA); 2) To design practical recommendations on their use. METHODS: A systematic literature review (SLR) was performed with a sensitive bibliographic search strategy in Medline, EMBASE and Cochrane Library. We selected randomized clinical trials that analyzed the efficacy and/or safety of 1) combined therapy of synthetic compared with sequential therapy of synthetic DMARD in early RA; and 2) combination of methotrexate+leflunomide or triple therapy with synthetic DMARD in established RA refractory to synthetic DMARD. Two reviewers made the first selection by title and abstract and 11 performed the selection after detailed review of the articles and data collection. The quality of the studies was evaluated with the Jadad scale. Based on the results, related recommendations were agreed upon in a nominal group meeting. RESULTS: Ultimately, no articles were included in the SLR. The analysis of the reviewed articles demonstrated the effectiveness of the treatment with synthetic DMARD following a "treat to target" strategy in early RA patients, and of combination therapy of synthetic DMARD in established RA refractory to synthetic DMARD. This resulted in 6 recommendations concerning combination therapy with synthetic DMARD. CONCLUSIONS: These recommendations aim to facilitate decision-making with the use of combined therapy with DMARD in RA.

[Questionnaires of person centered care in primary care. A systematic review]. / Cuestionarios de atención centrada en la persona en atención primaria. Una revisión sistemática.

OBJECTIVE: Despite the acknowledged importance of 'Person Centered Care' (PCC), there are obvious limitations for its determination and measurement due to the difficulty of its exact definition. The objective of our review is to identify valid tools that measure the PCC or some of its aspects in the field of Primary Health Care. DESIGN: Systematic review DATA SOURCES: MEDLINE, Embase, Cochrane, PSYCinfo, IME-Biomedicine, LILACS and TESEO until May 31, 2018. SELECTION OF STUDIES: The inclusion criteria were: validation studies of questionnaires, systematic reviews of validation or other descriptive studies, all of which were carried out in the context of the Primary Health Care and that measured aspects of the PCC in professionals and/or patients. Two investigators independently reviewed the articles and their discrepancies were resolved by a third investigator. DATA EXTRACTION: Data were collected on the measured ACP aspects, target population, type of questionnaire, and data on validity and reliability. RESULTS: 1,415 articles were located, to which 54 additional references were subsequently added via cross references. Finally, there were 75 articles that fulfilled all the criteria and there were 39 which had the tools identified and classified according to the dimensions analyzed. CONCLUSIONS: Due to the difficulty of measuring PCC as a whole, most of the articles refer only to one of its aspects or dimensions, with the patient's perspective prevailing over that of the professional. All these tools are, nevertheless, an important starting point for future questionnaires that attempt an integral approach to the PCC.

Recomendaciones sobre el uso de metrotexato parenteral en enfermedades reumáticas / Recommendations for the use of parenteral methotrexate in rheumatic diseases

Objetivos. Desarrollar recomendaciones sobre el uso de metrotexato (MTX) parenteral en pacientes con enfermedades reumáticas, fundamentalmente en la artritis reumatoide, basadas en la mejor evidencia y experiencia. Métodos. Se seleccionó un grupo de 21 expertos reumatólogos en el manejo de MTX. El coordinador generó 13 preguntas sobre el uso de MTX parenteral (perfiles de indicación, eficacia, seguridad, costo-eficacia y biodisponibilidad) para ser contestadas mediante una revisión sistemática de la literatura. Con base en las preguntas se definieron los criterios de inclusión y exclusión, y las estrategias de búsqueda (en Medline, EMBASE y la Cochrane Library). Tres revisores seleccionaron los artículos resultantes de la búsqueda. Se generaron tablas de evidencia. Paralelamente se evaluaron abstracts de congresos de la European League Against Rheumatism (EULAR) y del American College of Rheumatology (ACR). Con toda esta evidencia el coordinador generó 13 recomendaciones preliminares que se evaluaron, discutieron y votaron en una reunión del grupo nominal con los expertos. Para cada recomendación se estableció el nivel de evidencia y grado de recomendación, y el grado de acuerdo mediante un Delphi. Se definió acuerdo si al menos el 80% de los participantes contestaron sí a la recomendación (sí o no). Resultados. La mayoría de la evidencia proviene de la artritis reumatoide. De las 13 recomendaciones preliminares se aceptaron 11 recomendaciones sobre el uso de MTX parenteral en reumatología. Dos no se llegaron a votar y se decidió no incluirlas, pero se comentan en el texto final. Conclusiones. Este documento pretende resolver algunos interrogantes clínicos habituales y facilitar la toma de decisiones con el uso de MTX parenteral

Objective. To develop recommendations for the use of parenteral methotrexate (MTX) in rheumatic diseases, mainly rheumatoid arthritis, based on best evidence and experience. Methods. A group of 21 experts on parenteral MTX use was selected. The coordinator formulated 13 questions about parenteral MTX (indications, efficacy, safety and cost-effectiveness). A systematic review was conducted to answer the questions. Using this information, inclusion and exclusion criteria were established, as were the search strategies (involving Medline, EMBASE and the Cochrane Library). Three different reviewers selected the articles. Evidence tables were created. Abstracts from the European League Against Rheumatism (EULAR) and American College of Rheumatology (ACR) were evaluated. Based on this evidence, the coordinator proposed preliminary recommendations that the experts discussed and voted in a nominal group meeting. The level of evidence and grade of recommendation were established using the Oxford Center for Evidence-Based Medicine and the level of agreement with the Delphi technique (2 rounds). Agreement was established if at least 80% of the experts voted yes (yes/no). Results. Most of the evidence involved rheumatoid arthritis. A total of 13 preliminary recommendations on the use of parenteral MTX were proposed; 11 of them were accepted. Two of the 13 were not voted and are commented on in the main text. Conclusions. The manuscript aims to solve frequent questions and help in decision-making strategies when treating patients with parenteral MTX

Recommendations for the use of parenteral methotrexate in rheumatic diseases. / Recomendaciones sobre el uso de metrotexato parenteral en enfermedades reumáticas.

OBJECTIVE: To develop recommendations for the use of parenteral methotrexate (MTX) in rheumatic diseases, mainly rheumatoid arthritis, based on best evidence and experience. METHODS: A group of 21 experts on parenteral MTX use was selected. The coordinator formulated 13 questions about parenteral MTX (indications, efficacy, safety and cost-effectiveness). A systematic review was conducted to answer the questions. Using this information, inclusion and exclusion criteria were established, as were the search strategies (involving Medline, EMBASE and the Cochrane Library). Three different reviewers selected the articles. Evidence tables were created. Abstracts from the European League Against Rheumatism (EULAR) and American College of Rheumatology (ACR) were evaluated. Based on this evidence, the coordinator proposed preliminary recommendations that the experts discussed and voted in a nominal group meeting. The level of evidence and grade of recommendation were established using the Oxford Center for Evidence-Based Medicine and the level of agreement with the Delphi technique (2 rounds). Agreement was established if at least 80% of the experts voted yes (yes/no). RESULTS: Most of the evidence involved rheumatoid arthritis. A total of 13 preliminary recommendations on the use of parenteral MTX were proposed; 11 of them were accepted. Two of the 13 were not voted and are commented on in the main text. CONCLUSIONS: The manuscript aims to solve frequent questions and help in decision-making strategies when treating patients with parenteral MTX.

Multilocus Intron Trees Reveal Extensive Male-Biased Homogenization of Ancient Populations of Chamois (Rupicapra spp.) across Europe during Late Pleistocene.

The inferred phylogenetic relationships between organisms often depend on the molecular marker studied due to the diverse evolutionary mode and unlike evolutionary histories of different parts of the genome. Previous studies have shown conflicting patterns of differentiation of mtDNA and several nuclear markers in chamois (genus Rupicapra) that indicate a complex evolutionary picture. Chamois are mountain caprine that inhabit most of the medium to high altitude mountain ranges of southern Eurasia. The most accepted taxonomical classification considers two species, R. pyrenaica (with the subspecies parva, pyrenaica and ornata) from southwestern Europe and R. rupicapra (with the subspecies cartusiana, rupicapra, tatrica, carpatica, balcanica, asiatica and caucasica) from northeastern Europe. Phylogenies of mtDNA revealed three very old clades (from the early Pleistocene, 1.9 Mya) with a clear geographical signal. Here we analyze a set of 23 autosomal introns, comprising 15,411 nucleotides, in 14 individuals covering the 10 chamois subspecies. Introns offered an evolutionary scenario that contrasts with mtDNA. The nucleotidic diversity was 0.0013± 0.0002, at the low range of what is found in other mammals even if a single species is considered. A coalescent multilocus analysis with *BEAST indicated that introns diversified 88 Kya, in the late Pleistocene, and the effective population size at the root was lower than 10,000 individuals. The dispersal of some few migrant males should have rapidly spread trough the populations of chamois, given the homogeneity of intron sequences. The striking differences between mitochondrial and nuclear markers can be attributed to strong female philopatry and extensive male dispersal. Our results highlight the need of analyzing multiple and varied genome components to capture the complex evolutionary history of organisms.

Recomendaciones para el uso de metotrexato en artritis reumatoide establecida: monoterapia y combinación con otros fármacos modificadores de la enfermedad sintéticos o biológicos / Recommendations for the use of methotrexate in established rheumatoid arthritis: monotherapy and combination with other synthetic or biological DMARDs

El metotrexato, utilizado a dosis bajas semanales, es actualmente el tratamiento de referencia en la artritis reumatoide. No se conoce con exactitud el mecanismo de acción en esta enfermedad, pero se han descrito diversas acciones antiproliferativas, antiinflamatorias e inmunorreguladoras que pueden contribuir a su efecto terapéutico. Diversos ensayos clínicos demostraron en la década de los ochenta del siglo pasado su eficacia clínica, así como su efecto enlentecedor del daño anatómico. En los últimos años se ha visto además que llegar a dosis más altas de las inicialmente utilizadas, entre 25 y 30 mg/semanales, puede maximizar sus efectos. En pacientes resistentes, el metotrexato también puede ser útil en terapia combinada con otros fármacos modificadores de la enfermedad, sintéticos o biológicos. Habitualmente, el metotrexato es bien tolerado, pero puede tener efectos adversos a diversos niveles (hematológico, digestivo, hepático, neurológico o pulmonar), alguno de los cuales pueden ser graves, por lo que requiere una cuidadosa monitorización clínica y analítica (AU)

The aim of this document is to describe the optimal use of: a) methotrexate (MTX) monotherapy in established RA in readministration after a previous effective cycle, and b) MTX combination with synthetic and biological DMARD. Clinical questions were proposed and a systematic literature search was conducted. Recommendations were developed and then discussed and validated in a working session with fifteen experts. After an effective cycle, MTX will be restarted with the same dose and route of administration than previously, following an intensive strategy if the dose were insufficient or the patient had poor prognostic factors. When sustained remission, MTX may be reduced gradually, with a close monitoring of the patient. Before starting a combination therapy with other synthetic or biologic DMARD, full doses of MTX should be reached and the use of the parenteral route evaluated. In established RA, when starting the combination of MTX with a biological DMARD, the same dose and route of administration of MTX than previously used should be maintained. In patients in remission for at least 6 months and in combination therapy with a biological, it is recommended to reduce the dose of the biological agent or increase its administration period before reducing the dose of MTX, unless side effects due to MTX. This document pretends to solve some frequent clinical questions on the use of MTX in monotherapy and/or in combination therapy with other synthetic or biological DMAR (AU)

The shared mitochondrial genome of Rupicapra pyrenaica ornata and Rupicapra rupicapra cartusiana: old remains of a common past.

Mitochondrial DNA (mtDNA) has largely been used for species delimitation. However, mtDNA introgression across species boundaries can lead to inconsistent phylogenies. Partial sequences of the mitochondrial genome in the chamois, genus Rupicapra, show the presence of three well differentiated clades, West (mtW), Central (mtC) and East (mtE), each with a geographically restricted distribution. The complete mtDNAs of the clades mtW and mtE (main representatives of the two currently considered species R. pyrenaica and R. rupicapra respectively) have been reported. In the present study, we sequenced the clade mtC present in populations from both species inhabiting the central area of Europe: the Apennines (R. pyrenaica ornata) and the Chartreuse Mountains (R. rupicapra cartusiana). The phylogenetic comparison with the genomes of Caprini highlights the ancient presence of chamois in Europe relative to the fossil record, and the old age of the chamois clade mtC that was split from the clade mtW in the early Pleistocene. The separation of R. pyrenaica ornata and R. rupicapra cartusiana female lineages was recent, dating of the late Pleistocene. Our data represent an example of mtDNA introgression of resident females of Chartreuse Mountains into immigrant males of R. rupicapra due to male-biased migration and female phylopatry.

Evolution of the melanocortin-1 receptor gene (MC1R) in chamois (Rupicapra spp.).

The taxonomy of chamois and the effects of historical and evolutionary events on its diversification are still under discussion given that different morphological and genetic features presented partially discordant views. One of the morphological features that differentiate the two currently considered species, Rupicapra pyrenaica (southern chamois) and R. rupicapra (northern chamois) is coat color pattern. The melanocortin-1 receptor gene (MC1R) is related with differences in coloration in different mammals and was analyzed here in a sample of 25 chamois covering the 10 subspecies recognized, three in R. pyrenaica, (parva, pyrenaica and ornata) and seven in R. rupicapra (cartusiana, rupicapra, tatrica, carpatica, balcanica, asiatica and caucasica). Comparison with other caprinae showed that the MC1R gene has evolved under strong purifying selection. Three well differentiated haplotypes were identified: one shared by the seven subspecies of R. rupicapra, other common to the two Iberian chamois, both of the species R. pyrenaica, and a third haplotype, basal in the phylogenetic tree, unique to the subspecies from the Apennines, R. pyrenaica ornata. This pattern of variation, with three conspicuous clades, concurs with previous findings on microsatellites and mtDNA and argues in favor of the old classifications that distinguished the species R. ornata.

Neuroblastoma anaplásico del bulbo olfatorio con áreas de diferenciación rabdomioblástica. Descripción de un caso / Anaplastic olfactory neuroblastoma with areas of rhabdomyoblastic differentiation. A case report

El neuroblastoma de bulbo olfatorio es un tumor de células pequeñas y origen neuroectodérmico que aparece en el área superior de la cavidad nasal en la región de la lámina cribosa y puede mostrar un patrón de agresividad y afectar a estructuras intracraneales. Presentamos el caso de un paciente de 25 años de edad con una masa a nivel de fosas nasales que invade la órbita y muestra afectación intracraneal extracerebral. Fue intervenido mediante un abordaje combinado por neurocirugía y cirugía maxilofacial, siendo el diagnóstico de neuroblastoma. Al mes de realizarse esta cirugía radical se produjo una recidiva muy agresiva fundamentalmente a nivel intracerebral, que es nuevamente intervenida, mostrando en el estudio histopatológico áreas de diferenciación rabdomioblástica dentro del neuroblastoma. A pesar de lo infrecuente de la aparición de áreas rabdomioblásticas en el seno de un neuroblastoma, la existencia de este dato anatomopatológico confiere al neuroblastoma un grado de agresividad y capacidad de recidiva extremadamente elevado. La cirugía debe ser lo más radical posible, lo cual no garantiza una supervivencia prolongada(AU)

Olfactory neuroblastoma is a small-cell tumour of neuroectodermal origin occurring in the upper nasal cavity in the region of the cribriform plate, which can show aggressive behaviour and affect intracranial structures. We report a case of a 25 year old male with a mass at the level of nasal cavity that invaded the orbit and the intracranial extracerebral compartment. The mass was removed using a combined neurosurgical and maxillofacial approach and a neuroblastoma was diagnosed. One month later, the patient had an aggressive, mostly intracerebral, recurrence. He underwent further surgery and the neuroblastoma was found to contain areas of rabdomyoblastic differentiation. Although rabdomyoblastic areas within neuroblastoma are extremely rare, when they are present the degree of aggressivity and possibility of recurrence are greatly increased. Thus, surgery should be as radical as possible, even though it does not guarantee long term survival(AU)

Genetic diversity of sheep breeds from Albania, Greece, and Italy assessed by mitochondrial DNA and nuclear polymorphisms (SNPs).

We employed mtDNA and nuclear SNPs to investigate the genetic diversity of sheep breeds of three countries of the Mediterranean basin: Albania, Greece, and Italy. In total, 154 unique mtDNA haplotypes were detected by means of D-loop sequence analysis. The major nucleotide diversity was observed in Albania. We identified haplogroups, A, B, and C in Albanian and Greek samples, while Italian individuals clustered in groups A and B. In general, the data show a pattern reflecting old migrations that occurred in postneolithic and historical times. PCA analysis on SNP data differentiated breeds with good correspondence to geographical locations. This could reflect geographical isolation, selection operated by local sheep farmers, and different flock management and breed admixture that occurred in the last centuries.

Y-chromosome phylogeny in the evolutionary net of chamois (genus Rupicapra).

BACKGROUND: The chamois, distributed over most of the medium to high altitude mountain ranges of southern Eurasia, provides an excellent model for exploring the effects of historical and evolutionary events on diversification. Populations have been grouped into two species, Rupicapra pyrenaica from southwestern Europe and R. rupicapra from eastern Europe. The study of matrilineal mitochondrial DNA (mtDNA) and biparentally inherited microsatellites showed that the two species are paraphyletic and indicated alternate events of population contraction and dispersal-hybridization in the diversification of chamois. Here we investigate the pattern of variation of the Y-chromosome to obtain information on the patrilineal phylogenetic position of the genus Rupicapra and on the male-specific dispersal of chamois across Europe. RESULTS: We analyzed the Y-chromosome of 87 males covering the distribution range of the Rupicapra genus. We sequenced a fragment of the SRY gene promoter and characterized the male specific microsatellites UMN2303 and SRYM18. The SRY promoter sequences of two samples of Barbary sheep (Ammotragus lervia) were also determined and compared with the sequences of Bovidae available in the GenBank. Phylogenetic analysis of the alignment showed the clustering of Rupicapra with Capra and the Ammotragus sequence obtained in this study, different from the previously reported sequence of Ammotragus which groups with Ovis. Within Rupicapra, the combined data define 10 Y-chromosome haplotypes forming two haplogroups, which concur with taxonomic classification, instead of the three clades formed for mtDNA and nuclear microsatellites. The variation shows a west-to-east geographical cline of ancestral to derived alleles. CONCLUSIONS: The phylogeny of the SRY-promoter shows an association between Rupicapra and Capra. The position of Ammotragus needs a reinvestigation. The study of ancestral and derived characters in the Y-chromosome suggests that, contrary to the presumed Asian origin, the paternal lineage of chamois originated in the Mediterranean, most probably in the Iberian Peninsula, and dispersed eastwards through serial funding events during the glacial-interglacial cycles of the Quaternary. The diversity of Y-chromosomes in chamois is very low. The differences in patterns of variation among Y-chromosome, mtDNA and biparental microsatellites reflect the evolutionary characteristics of the different markers as well as the effects of sex-biased dispersal and species phylogeography.