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1.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-36584754

RESUMO

BACKGROUND AND AIM: Patients with chronic kidney disease (CKD) and hepatitis C infection can be safely and effectively treated with direct-acting antivirals (DAAs). However, there is scarce data on the long-term impact of hepatitis C cure on CKD. The aim of this study was to assess the long-term mortality, morbidity and hepatic/renal function outcomes in a cohort of HCV-infected individuals with CKD treated with DAAs. METHODS: 135 HCV patients with CKD stage 3b-5 who received ombitasvir/paritaprevir/ritonavir±dasabuvir in a multicenter study were evaluated for long-term hepatic and renal outcomes and their associated mortality. RESULTS: 125 patients achieved SVR and 66 were included. Prior to SVR, 53 were under renal replacement therapy (RRT) and 25 (37.8%) had liver cirrhosis. After a follow-up of 4.5 years, 25 (38%) required kidney transplantation but none combined liver-kidney. No changes in renal function were observed among the 51 patients who did not receive renal transplant although eGFR values improved in those with baseline CKD stage 3b-4. Three (5.6%) subjects were weaned from RRT. Eighteen (27.3%) patients died, mostly from cardiovascular events; 2 developed liver decompensation and 1 hepatocellular carcinoma. No HCV reinfection was observed. CONCLUSIONS: Long-term mortality remained high among end-stage CKD patients despite HCV cure. Overall, no improvement in renal function was observed and a high proportion of patients required kidney transplantation. However, in CKD stage 3b-4 HCV cure may play a positive role in renal function.

2.
Sci Rep ; 12(1): 18756, 2022 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-36335225

RESUMO

Deciphering the human spatial cognition system involves the development of simple tasks to assess how our brain works with shapes and forms. Prior studies in the mental rotation field disclosed a clockwise rotation bias on how basic stimuli are perceived and processed. However, there is a lack of a substantial scientific background for complex stimuli and how factors like sex or aging could influence them. Regarding the latter point, it is well known that our spatial skills tend to decline as we grow older. Hence, the hippocampal system is especially sensitive to aging. These neural changes underlie difficulties for the elderly in landmark orientation or mental rotation tasks. Thus, our study aimed to check whether the effect of clockwise and anticlockwise rotations in the spatial recognition of complex environments could be modulated by aging. To do so, 40 young adults and 40 old adults performed the ASMRT, a virtual spatial memory recognition test. Results showed that young adults outperformed old adults in all difficulty conditions (i.e., encoding one or three boxes positions). In addition, old adults were affected more than young adults by rotation direction, showing better performance in clockwise rotations. In conclusion, our study provides evidence that aging is particularly affected by the direction of rotation. We suggest that clockwise bias could be linked with the cognitive decline associated with aging. Future studies could address this with brain imaging measures.


Assuntos
Disfunção Cognitiva , Reconhecimento Psicológico , Adulto Jovem , Humanos , Idoso , Envelhecimento/psicologia , Cognição , Percepção Espacial
4.
Am J Gastroenterol ; 117(1): 138-146, 2022 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-34817975

RESUMO

INTRODUCTION: Despite the direct-acting antiviral therapy has dramatically decreased the likelihood of having liver-related complications and extrahepatic outcomes, the risk of developing hepatocellular carcinoma (HCC) is not totally eliminated after sustained virological response (SVR). We aimed to develop an easy-to-apply strategy to be adopted in clinical practice for accurately classifying the HCC risk in hepatitis C virus patients after SVR. METHODS: Prospective and multicenter study enrolling hepatitis C virus patients with advanced fibrosis (transient elastography [TE] > 10 kPa) or cirrhosis by ultrasound showing SVR. They were followed up until HCC, liver transplantation, death, or until October 2020, which occurred first, with a minimum follow-up period of 6 months after SVR (follow-up: 49 [interquartile range 28-59] months). RESULTS: Patients with cirrhosis by ultrasound represented 58% (611/1,054) of the overall cohort. During the study, HCC occurrence was 5.3% (56/1,054). Multivariate analyses revealed that Fibrosis-4 (FIB-4) > 3.25 (hazard ratio [HR] 2.26 [1.08-4.73]; P = 0.030), TE (HR 1.02 [1.00-1.04]; P = 0.045) and cirrhosis by ultrasound (HR 3.15 [1.36-7.27]; P = 0.007) predicted HCC occurrence. Baseline HCC screening criteria (TE > 10 kPa or cirrhosis) identified patients at higher risk of HCC occurrence in presence of FIB-4 > 3.25 (8.8%; 44/498) vs FIB-4 < 3.25 (2.4%; 12/506), while those with only FIB > 3.25 had no HCC (0%; 0/50) (logRank 22.129; P = 0.0001). A combination of baseline FIB-4 > 3.25 and HCC screening criteria had an annual incidence >1.5 cases per 100 person-years, while the rest of the groups remained <1 case. Patients who maintained post-treatment FIB-4 > 3.25 and HCC screening criteria remained at the highest risk of HCC occurrence (13.7% [21/153] vs 4.9% [9/184]; logRank 7.396, P = 0.007). DISCUSSION: We demonstrated that a two-step strategy combining FIB-4, TE, and ultrasound could help stratify HCC incidence risk after SVR.


Assuntos
Antivirais/efeitos adversos , Técnicas de Imagem por Elasticidade/métodos , Hepacivirus , Hepatite C/tratamento farmacológico , Neoplasias Hepáticas/diagnóstico , Ultrassonografia/métodos , Antivirais/uso terapêutico , Feminino , Seguimentos , Hepatite C/virologia , Humanos , Neoplasias Hepáticas/induzido quimicamente , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos
5.
Front Behav Neurosci ; 15: 765290, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34867229

RESUMO

In the present study, event-related potentials (ERPs) were registered during a semantic negative priming (NP) task in participants with higher and lower working memory capacity (WMC). On each trial participants had to actively ignore a briefly presented single prime word, which was followed either immediately or after a delay by a mask. Thereafter, either a semantically related or an unrelated target word was presented, to which participants made a semantic categorization judgment. The ignored prime produced a behavioral semantic NP in delayed (but not in immediate) masking trials, and only for participants with a higher-WMC. Both masking type and WMC also modulated ERP priming effects. When the ignored prime was immediately followed by a mask (which impeded its conscious identification) a reliable N400 modulation was found irrespective of participants' WMC. However, when the mask onset following the prime was delayed (thus allowing its conscious identification), an attenuation of a late positive ERP (LPC) was observed in related compared to unrelated trials, but only in the higher-WMC group showing reliable behavioral NP. The present findings demonstrate for the first time that individual differences in WMC modulate both behavioral measures and electrophysiological correlates of semantic NP.

6.
Sci Rep ; 11(1): 23048, 2021 11 29.
Artigo em Inglês | MEDLINE | ID: mdl-34845255

RESUMO

Schizotypy can be defined as a combination of traits qualitatively similar to those found in schizophrenia, but milder in their expression, that can be found in clinical and non-clinical populations. In this research, we explore, to our knowledge, for the first time, whether schizotypal personality traits may affect the acquisition of conditioned fear by social means only. Apart from being an essential capacity to ensure learning in safe environments, social fear learning shares important characteristics with direct fear acquisition, which also makes it a great candidate for developing successful extinction procedures. Undergraduate students (n = 72) performed a task of social fear learning. In this task, participants watched a video of a person that simulated to receive electric shocks (unconditioned stimulus; US) paired with a coloured square (conditioned stimulus plus; CS+), while another coloured square was never paired (conditioned stimulus minus; CS-) with the shock. After that, they were presented with a similar sequence of coloured screens. Their Skin Conductance Responses (SCRs) were registered during the whole process. Once they finished, they completed the Schizotypal Personality Questionnaire (SPQ). Our results revealed that participants with a low score in the Cognitive-Perceptual factor of the SPQ exhibited higher SCRs when they saw the US than when they saw the CS- (all ps < 0.01) during the learning phase. Nevertheless, those with higher scores did not present any difference in their SCRs toward both stimuli (all ps > 0.05), a pattern that has been similarly found in schizophrenia. During the final trials of the test phase, participants with the highest scores in the Disorganized factor were the only ones that maintained a higher SCR towards the CS+ than towards the CS- (p = 0.006), which could be associated with an impairment in their extinction processes.


Assuntos
Condicionamento Clássico , Extinção Psicológica/fisiologia , Medo/psicologia , Transtorno da Personalidade Esquizotípica/fisiopatologia , Aprendizado Social , Adolescente , Adulto , Cognição , Cor , Feminino , Resposta Galvânica da Pele , Humanos , Aprendizagem , Masculino , Neurociências , Valor Preditivo dos Testes , Software , Estudantes , Inquéritos e Questionários , Adulto Jovem
7.
Biomedicines ; 9(7)2021 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-34209386

RESUMO

Non-alcoholic fatty liver disease (NAFLD), which affects about a quarter of the global population, poses a substantial health and economic burden in all countries, yet there is no approved pharmacotherapy to treat this entity, nor well-established strategies for its diagnosis. Its prevalence has been rapidly driven by increased physical inactivity, in addition to excessive calorie intake compared to energy expenditure, affecting both adults and children. The increase in the number of cases, together with the higher morbimortality that this disease entails with respect to the general population, makes NAFLD a serious public health problem. Closely related to the development of this disease, there is a hormone derived from adipocytes, leptin, which is involved in energy homeostasis and lipid metabolism. Numerous studies have verified the relationship between persistent hyperleptinemia and the development of steatosis, fibrinogenesis and liver carcinogenesis. Therefore, further studies of the role of leptin in the NAFLD spectrum could represent an advance in the management of this set of diseases.

8.
Front Behav Neurosci ; 15: 736778, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34539360

RESUMO

Human spatial memory research has significantly progressed since the development of computerized tasks, with many studies examining sex-related performances. However, few studies explore the underlying electrophysiological correlates according to sex. In this study event-related potentials were compared between male and female participants during the performance of an allocentric spatial recognition task. Twenty-nine university students took part in the research. Results showed that while general performance was similar in both sexes, the brain of males and females displayed a differential activation. Males showed increased N200 modulation than females in the three phases of memory process (encoding, maintenance, and retrieval). Meanwhile females showed increased activation of P300 in the three phases of memory process compared to males. In addition, females exhibited more negative slow wave (NSW) activity during the encoding phase. These differences are discussed in terms of attentional control and the allocation of attentional resources during spatial processing. Our findings demonstrate that sex modulates the resources recruited to performed this spatial task.

9.
Biol Psychol ; 157: 107987, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33137414

RESUMO

The simple manipulation of pairing specific outcomes with the sample stimuli strongly affects discriminative learning and memory processes. This procedure has been named the Differential Outcomes Procedure (DOP) and is usually compared to a control condition (the non-differential procedure, NOP) consisting in the random administration of the outcomes after each correct response. Recent research has revealed that the DOP effect arises even under unconscious conditions. In this study, we explored the temporal dynamics of short-term memory processes in both the DOP and the NOP in the absence of awareness of either the outcome (Experiment 1A) or the initial sample stimulus (Experiment 1B) through the evoked-related potentials technique. Results showed distinctive electrophysiological activation patterns in the DOP compared with the NOP at encoding, maintenance and retrieval phases. The present findings provide electrophysiological evidence of implicit-prospective processes involved in the DOP. They elucidate the processes that result in improved visual recognition memory.


Assuntos
Aprendizagem por Discriminação , Potenciais Evocados , Memória de Curto Prazo , Fenômenos Eletrofisiológicos , Humanos , Estudos Prospectivos , Reconhecimento Psicológico
10.
Front Psychol ; 11: 1227, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32581977

RESUMO

The aim of this study is to examine the link between working memory capacity and the ability to exert cognitive control. Here, participants with either high or low working memory capacity (WMC) performed a semantic negative priming (NP) task as a measure of cognitive control. They were required to ignore a single prime word followed by a pattern mask appearing immediately or after a delay. The prime could be semantically related or unrelated to an upcoming target word where a forced-choice categorization was required. Each type of mask (immediate vs. delayed) appeared randomly from trial to trial. Results demonstrated that, when the ignored prime was immediately followed by the mask, neither of the groups (high or low WMC) showed reliable NP. In clear contrast, when the mask onset was delayed responses latencies were reliably slower for semantically related trials than for unrelated trials (semantic NP), but only for the high WMC group. The present results clearly demonstrate that semantic NP from single ignored primes depends on both the masking pattern that follows the prime (immediate vs. delayed mask), and on working memory capacity.

11.
Int J Psychophysiol ; 155: 184-193, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32599001

RESUMO

The differential outcomes procedure (DOP) consists in applying a specific outcome after each discriminative stimulus-correct response pairing, leading to improved performance in both memory and learning tasks (faster acquisition and/or higher response accuracy), compared to the non-differential outcomes procedure (NOP). The main aim of this study was to explore the electrophysiological correlates (ERPs) of the DOP in a visual short-term memory task, and to test whether a differential activation pattern would be observed depending on the outcomes condition (DOP vs. NOP). The ERP signals showed differences between both outcomes condition in all three phases of the short-term memory task: encoding, maintenance and retrieval. Our results are in accordance with the view that in the DOP condition the probe stimulus triggers a representation of the unique outcome, which remains active over the maintenance period (prospective process). In the NOP condition, in contrast, a representation of the probe stimulus is maintained (retrospective process). In addition, these results suggested that stimuli associated with unique outcomes captured attention involuntary at retrieval, decreasing the interference from distractor stimuli in the retrieval phase.


Assuntos
Aprendizagem , Memória de Curto Prazo , Potenciais Evocados , Humanos , Estudos Prospectivos , Estudos Retrospectivos
12.
PLoS One ; 15(4): e0231578, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32298362

RESUMO

BACKGROUND: Adherence to treatment is a crucial factor for patients who have chronic illnesses or multiple morbidities and polypharmacy, which is frequently found in older adults. The non-adherence to medications has important economic and social consequences as well as impacts on the health of the patients. One of the reasons that can explain the low adherence to treatment, is the memory deficits that are characteristics of this population and that are even more evident in cases that involve neurodegenerative diseases. METHODS AND FINDINGS: In this study, we explore whether the differential outcomes procedure (DOP), which has been shown to be useful in improving discriminative learning and memory in different populations, may facilitate learning and retention of medical recommendations in older adults who have been diagnosed with Alzheimer's disease. The results demonstrate that when this procedure was applied, the patients showed improvements in learning and long-term retention of two pill/time of day associations in a situation that simulates adherence to medical prescriptions. CONCLUSIONS: These findings contribute new data about the potential benefits of the DOP in patients with neurodegenerative disorders, highlighting the important role that this procedure could play in addressing important issues related to the health and quality of life of older adults, with or without neurodegenerative diseases, such as low adherence to medical treatments.


Assuntos
Doença de Alzheimer/tratamento farmacológico , Aprendizagem por Discriminação , Adesão à Medicação , Memória , Idoso , Idoso de 80 Anos ou mais , Aprendizagem por Discriminação/efeitos dos fármacos , Feminino , Humanos , Masculino , Memória/efeitos dos fármacos , Transtornos da Memória/prevenção & controle , Pessoa de Meia-Idade , Qualidade de Vida
13.
Pharmacy (Basel) ; 8(2)2020 Apr 07.
Artigo em Inglês | MEDLINE | ID: mdl-32272683

RESUMO

Introduction: Hospital pharmacists are increasingly playing a critical role in the care of patients with multiple sclerosis (MS). However, little is known about their preferences and perspectives towards different attributes of disease-modifying therapies (DMTs). The objective of this research was to assess pharmacists´ preferences for DMT efficacy attributes. Methods: A multicenter, non-interventional, cross-sectional, web-based study was conducted. Preventing relapses, delaying disease progression, controlling radiological activity, and preserving health-related quality of life (HRQoL) and cognition were the attributes selected based on a literature review and a focus group with six hospital pharmacists. Conjoint analysis was used to determine preferences in eight hypothetical treatment scenarios, combining different levels of each attribute and ranking them from most to least preferred. Results: Sixty-five hospital pharmacists completed the study (mean age: 43.5 ± 7.8 years, 63.1% female, mean years of professional experience: 16.1 ± 7.4 years). Participants placed the greatest preference on delaying disease progression (35.7%) and preserving HRQoL (21.6%) and cognition (21.6%). Importance was consistent in all groups of pharmacists stratified according to demographic characteristics, experience, research background, and volume of patients seen per year. Conclusions: Understanding which treatment characteristics are meaningful to hospital pharmacists may help to enhance their synergistic role in the multidisciplinary management of patients with MS.

14.
PLoS One ; 14(9): e0221567, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31550267

RESUMO

BACKGROUND AND AIMS: Limited data are available on the effectiveness and tolerability of direct-acting antivirals (DAAs) therapies in the real world for HCV-infected patients with comorbidities. This study aimed to describe the effectiveness of OBV/PTV/r ± DSV (3D/2D regimen) with or without ribavirin (RBV) in HCV or HCV/HIV co-infected patients with GT1/GT4 and CKD (IIIb-V stages), including those under hemodialysis and peritoneal dialysis in routine clinical practice in Spain in 2015. MATERIAL AND METHODS: Non-interventional, retrospective, multicenter data collection study in 31 Spanish sites. Socio-demographic, clinical variables, study treatment characteristics, effectiveness and tolerability data were collected from medical records. RESULTS: Data from 135 patients with a mean age (SD) of 58.3 (11.4) years were analyzed: 92.6% GT1 (81.6% GT1b and 17.6% GT1a) and 7.4% GT4, 14 (10.4%) HIV/HCV co-infected, 19.0% with fibrosis F3 and 28.1% F4 by FibroScan®, 52.6% were previously treated with pegIFN and RBV. 11.1%, 14.8% and 74.1% of patients had CKD stage IIIb, IV and V respectively. 68.9% of patients were on hemodialysis; 8.9% on peritoneal dialysis and 38.5% had history of renal transplant. A total of 125 (96.2%) of 135 patients were treated with 3D, 10 (7.4%) with 2D and 30.4% received RBV. The overall intention-to-treat (ITT) sustained virologic response at week 12 (SVR12) was 92.6% (125/135) and the overall modified-ITT (mITT) SVR12 was 99.2% (125/126). The SVR12 rates (ITT) per sub-groups were: HCV mono-infected (91.7%), HCV/HIV co-infected (100%), GT1 (92.0%), GT4 (100%), CKD stage IIIb (86.7%), stage IV (95%) and stage V (93%). Among the 10 non-SVR there was only 1 virologic failure (0.7%); 4 patients had missing data due lost to follow up (3.0%) and 5 patients discontinued 3D/2D regimen (3.7%): 4 due to severe adverse events (including 3 deaths) and 1 patient´s decision. CONCLUSIONS: These results have shown that 3D/2D regimens are effective and tolerable in patients with advanced CKD including those in dialysis with GT 1 or 4 chronic HCV mono-infection and HIV/HCV coinfection in a real-life cohort. The overall SVR12 rates were 92.6% (ITT) and 99.2% (mITT) without clinically relevant changes in eGFR until 12 weeks post-treatment. These results are consistent with those reported in clinical trials.


Assuntos
Antivirais/uso terapêutico , Coinfecção/tratamento farmacológico , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , HIV-1 , Hepatite C Crônica/complicações , Hepatite C Crônica/tratamento farmacológico , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/terapia , 2-Naftilamina , Idoso , Anilidas/uso terapêutico , Antivirais/administração & dosagem , Antivirais/efeitos adversos , Carbamatos/uso terapêutico , Ciclopropanos , Quimioterapia Combinada , Feminino , Genótipo , Hepacivirus/classificação , Hepacivirus/genética , Hepatite C Crônica/virologia , Humanos , Lactamas Macrocíclicas , Compostos Macrocíclicos/uso terapêutico , Masculino , Pessoa de Meia-Idade , Prolina/análogos & derivados , Diálise Renal , Estudos Retrospectivos , Ribavirina/uso terapêutico , Ritonavir/uso terapêutico , Espanha , Sulfonamidas/uso terapêutico , Resposta Viral Sustentada , Resultado do Tratamento , Uracila/análogos & derivados , Uracila/uso terapêutico , Valina
15.
J Hepatol ; 71(4): 666-672, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31203153

RESUMO

BACKGROUND & AIMS: Around 5% of patients with chronic hepatitis C virus (HCV) infection treated with direct-acting antiviral (DAA) agents do not achieve sustained virological response (SVR). The currently approved retreatment regimen for prior DAA failure is a combination of sofosbuvir, velpatasvir, and voxilaprevir (SOF/VEL/VOX), although there is little data on its use in clinical practice. The aim of this study was to analyse the effectiveness and safety of SOF/VEL/VOX in the real-world setting. METHODS: This was a prospective multicentre study assessing the efficacy of retreatment with SOF/VEL/VOX in patients who had experienced a prior DAA treatment failure. The primary endpoint was SVR 12 weeks after the completion of treatment (SVR12). Data on safety and tolerability were also recorded. RESULTS: A total of 137 patients were included: 75% men, 35% with liver cirrhosis. Most were infected with HCV genotype (GT) 1 or 3. The most common prior DAA combinations were sofosbuvir plus an NS5A inhibitor or ombitasvir/paritaprevir/r+dasabuvir. A total of 136 (99%) patients achieved undetectable HCV RNA at the end of treatment. Overall SVR12 was 95% in the 135 patients reaching this point. SVR12 was lower in patients with cirrhosis (89%, p = 0.05) and those with GT3 infection (80%, p <0.001). Patients with GT3 infection and cirrhosis had the lowest SVR12 rate (69%). Of the patients who did not achieve SVR12, 1 was reinfected and 7 experienced treatment failure (6 GT3, 1 GT1a). The presence of resistance-associated substitutions did not impact SVR12. Adverse effects were mild and non-specific. CONCLUSION: Real-world data show that SOF/VEL/VOX is an effective, safe rescue therapy for patients with prior DAA treatment failure despite the presence of resistance-associated substitutions. However, patients with liver cirrhosis infected by GT3 remain the most-difficult-to-treat group. LAY SUMMARY: Treatment with sofosbuvir/velpatasvir/voxilaprevir (SOF/VEL/VOX) for 12 weeks is the current recommendation for the 5% of patients infected with HCV who do not achieve eradication of the virus under treatment with direct-acting antivirals. In a Spanish cohort of 137 patients who failed a previous combination of direct-acting antivirals, a cure rate of 95% was achieved with SOF/VEL/VOX. Genotypic characteristics of the virus (genotype 3) and the presence of cirrhosis were factors that decreased the rate of cure. Treatment with SOF/VEL/VOX is an effective and safe rescue therapy due to its high efficacy and very good safety profile.


Assuntos
Carbamatos , Hepatite C Crônica , Compostos Heterocíclicos de 4 ou mais Anéis , Cirrose Hepática/diagnóstico , Compostos Macrocíclicos , Sofosbuvir , Sulfonamidas , Adulto , Ácidos Aminoisobutíricos , Antivirais/administração & dosagem , Antivirais/efeitos adversos , Carbamatos/administração & dosagem , Carbamatos/efeitos adversos , Ciclopropanos , Combinação de Medicamentos , Monitoramento de Medicamentos/métodos , Farmacorresistência Viral , Feminino , Hepacivirus/genética , Hepatite C Crônica/tratamento farmacológico , Hepatite C Crônica/epidemiologia , Hepatite C Crônica/virologia , Compostos Heterocíclicos de 4 ou mais Anéis/administração & dosagem , Compostos Heterocíclicos de 4 ou mais Anéis/efeitos adversos , Humanos , Lactamas Macrocíclicas , Leucina/análogos & derivados , Compostos Macrocíclicos/administração & dosagem , Compostos Macrocíclicos/efeitos adversos , Masculino , Pessoa de Meia-Idade , Prolina/análogos & derivados , Quinoxalinas , Sofosbuvir/administração & dosagem , Sofosbuvir/efeitos adversos , Espanha/epidemiologia , Sulfonamidas/administração & dosagem , Sulfonamidas/efeitos adversos , Resposta Viral Sustentada , Resultado do Tratamento
16.
Cognition ; 189: 181-187, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30991273

RESUMO

Does the explicit or implicit knowledge about the consequences of our choices shape learning and memory processes? This seems to be the case according to previous studies demonstrating improvements in learning and retention of symbolic relations and in visuospatial recognition memory when each correct choice is reinforced with its own unique and explicit outcome (the differential outcomes procedure, DOP). In the present study, we aim to extend these findings by exploring the impact of the DOP under conditions of non-conscious processing. To test for this, both the outcomes (Experiment 1A) and the sample stimuli (Experiment 1B) were presented under subliminal (non-conscious) and supraliminal conditions in a delayed visual recognition memory task. Results from both experiments showed a better visual recognition memory when participants were trained with the DOP regardless the awareness of the outcomes or even of the stimuli used for training. To our knowledge, this is the first demonstration that the DOP can be effective under unconscious conditions. This finding is discussed in the light of the two-memory systems model developed by Savage and colleagues to explain the beneficial effects observed on learning and memory when differential outcomes are applied.


Assuntos
Antecipação Psicológica/fisiologia , Conscientização/fisiologia , Prática Psicológica , Reconhecimento Psicológico/fisiologia , Percepção Visual/fisiologia , Adolescente , Adulto , Feminino , Humanos , Masculino , Estimulação Subliminar , Adulto Jovem
17.
J Viral Hepat ; 26(1): 55-64, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30265418

RESUMO

In randomized controlled trials of patients with chronic HCV infection, elbasvir/grazoprevir (EBR/GZR) demonstrated high cure rates and a good safety profile. This study assessed the effectiveness and safety of EBR/GZR, with and without ribavirin, in a real-world HCV patient cohort. HEPA-C is a collaborative, monitored national registry of HCV patients directed by the Spanish Association for the Study of the Liver and the Networked Biomedical Research Centre for Hepatic and Digestive Diseases. Patients entered into HEPA-C between December 2016 and May 2017, and treated with EBR/GZR with at least end-of-treatment response data, were included. Demographic, clinical and virologic data were analysed, and adverse events (AEs) recorded. A total of 804 patients were included in the study. The majority were male (57.9%), with a mean age of 60 (range, 19-92) years. Genotype (GT) distribution was GT 1, 86.8% (1a, 14.3%; 1b, 72.5%); GT 4, 13.2% and 176 patients (21.9%) were cirrhotic. Overall, among 588 patients with available data, 570 (96.9%) achieved sustained virologic response at 12 weeks post-treatment (SVR12). SVR12 rates by genotype were GT 1a, 97.7%; GT 1b, 98.6%; and GT 4, 98.1%. No significant differences in SVR12 according to fibrosis stage were observed. Eighty patients experienced an AE, resulting in treatment discontinuation in three. In this large cohort of patients with chronic HCV managed in a real-world setting in Spain, EBR/GZR achieved high rates of SVR12, comparable to those observed in randomized controlled trials, with a similarly good safety profile.


Assuntos
Antivirais/uso terapêutico , Benzofuranos/uso terapêutico , Hepatite C Crônica/tratamento farmacológico , Imidazóis/uso terapêutico , Quinoxalinas/uso terapêutico , Resposta Viral Sustentada , Adulto , Idoso , Idoso de 80 Anos ou mais , Antivirais/efeitos adversos , Benzofuranos/efeitos adversos , Estudos de Coortes , Combinação de Medicamentos , Quimioterapia Combinada , Feminino , Genótipo , Humanos , Imidazóis/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Quinoxalinas/efeitos adversos , Sistema de Registros , Estudos Retrospectivos , Ribavirina/efeitos adversos , Ribavirina/uso terapêutico , Espanha , Resultado do Tratamento
18.
Therap Adv Gastroenterol ; 11: 1756283X17743419, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29383024

RESUMO

BACKGROUND: Episodes of hepatic encephalopathy (HE) have been related to low survival rate. However, the relation between its clinical evolution and mortality has not been assessed. METHODS: A retrospective analysis of 245 cirrhotic patients admitted for an acute episode of HE (⩾grade 2) or who developed an HE episode after an upper gastrointestinal bleeding (UGIB) event was performed to assess the relation between time in HE and transplant-free survival. RESULTS: Median (IQR25-75) time in HE was 48 h (24-96 h) in the whole cohort. Patients who presented a longer time in HE (>48 h; n = 89) exhibited a lower transplant-free survival at 28 days (67.2% versus 88.9%, p < 0.001), 90 days (48.7% versus 73.8%, p < 0.001) and 365 days (30.3% versus 53.2%, p < 0.001), as compared to those with less time in HE (⩽48 h; n = 156). Survival rates remained significantly different, with lower percentages in the group with time in HE >48 h, when comparing patients according to baseline HE grade (2 versus ⩾3) or model for end-stage liver disease (MELD) function (⩽15 versus >15). Time in HE was also an independent risk factor for mortality at each time point, hazard ratio (HR) (95 CI%) 28 days 2.59 (1.39-4.84); 90 days 1.98 (1.28-3.1) and 365 days 1.5 (1.08-2.19). CONCLUSIONS: The duration of the acute HE episode determines survival in cirrhotic patients independently of liver function and baseline HE grade.

19.
J Hepatol ; 68(5): 940-948, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29288753

RESUMO

BACKGROUND & AIMS: Patients with advanced liver fibrosis remain at risk of cirrhosis-related outcomes and those with severe comorbidities may not benefit from hepatitis C (HCV) eradication. We aimed to collect data on all-cause mortality and relevant clinical events within the first two years of direct-acting antiviral therapy, whilst determining the prognostic capability of a comorbidity-based model. METHODS: This was a prospective non-interventional study, from the beginning of direct-acting antiviral therapy to the event of interest (mortality) or up to two years of follow-up, including 14 Spanish University Hospitals. Patients with HCV infection, irrespective of liver fibrosis stage, who received direct-acting antiviral therapy were used to build an estimation and a validation cohort. Comorbidity was assessed according to Charlson comorbidity and CirCom indexes. RESULTS: A total of 3.4% (65/1,891) of individuals died within the first year, while 5.4% (102/1,891) died during the study. After adjusting for cirrhosis, platelet count, alanine aminotransferase and sex, the following factors were independently associated with one-year mortality: Charlson index (hazard ratio [HR] 1.55; 95% CI 1.29-1.86; p = 0.0001), bilirubin (HR 1.39; 95% CI 1.11-1.75; p = 0.004), age (HR 1.06 95% CI 1.02-1.11; p = 0.005), international normalized ratio (HR 3.49; 95% CI 1.36-8.97; p = 0.010), and albumin (HR 0.18; 95% CI 0.09-0.37; p = 0.0001). HepCom score showed a good calibration and discrimination (C-statistics 0.90), and was superior to the other prognostic scores (model for end-stage liver disease 0.81, Child-Pugh 0.72, CirCom 0.68) regarding one- and two-year mortality. HepCom score identified low- (≤5.7 points: 2%-3%) and high-risk (≥25 points: 56%-59%) mortality groups, both in the estimation and validation cohorts. The distribution of clinical events was similar between groups. CONCLUSIONS: The HepCom score, a combination of Charlson comorbidity index, age, and liver function (international normalized ratio, albumin, and bilirubin) enables detection of a group at high risk of one- and two-year mortality, and relevant clinical events, after starting direct-acting antiviral therapy. LAY SUMMARY: The prognosis of patients with severe comorbidities may not benefit from HCV viral clearance. An algorithm to decide who will benefit from the treatment is needed to manage the chronic HCV infection better.


Assuntos
Antivirais/uso terapêutico , Hepatite C/tratamento farmacológico , Hepatite C/epidemiologia , Idoso , Algoritmos , Estudos de Coortes , Comorbidade , Feminino , Hepatite C/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Biológicos , Análise Multivariada , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Prognóstico , Modelos de Riscos Proporcionais , Estudos Prospectivos , Espanha/epidemiologia , Resposta Viral Sustentada
20.
Front Psychol ; 9: 2671, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30687154

RESUMO

It is well known that Alzheimer's disease (AD), the most common form of dementia, is associated with deficits in cognitive processes including visual memory impairments. One technique that might be used to ameliorate these impairments is the differential outcomes procedure (DOP) that involves associating each to-be-remembered stimulus with a specific outcome. Objective: Previous research has demonstrated that the DOP can be used to reduce or eliminate the learning and memory deficits associated with animal models of amnesia and dementia. Furthermore, this procedure has been shown to improve delayed facial recognition in healthy older adults as well as in patients diagnosed with AD. The main aim of the present study is twofold: to extend these findings to other types of visual stimulus and to investigate the effect of the DOP in memory retention in AD patients. Method: Ten patients diagnosed with AD and 10 healthy controls participated in this study. The experiment included two phases. In the first one, they had to perform a delayed matching-to-sample task. In the second phase, participants performed a recognition memory task, designed to assess long-term retention, 1 h and 1 week after the training. Results: Participants showed a better memory-based performance as well as a higher long-term retention of the information when trained under the differential outcomes condition, relative to the non-differential outcomes condition. Conclusions: The DOP seems to be an effective, easy-to-implement, technique to enhance visual memory in AD patients.

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