Core data set para la generación de datos de la vida real en esclerosis múltiple: adaptación de una iniciativa global para América Latina / Core data set for real world data in multiple sclerosis: customization for latin america from a global task force recommendation

Introducción: Los objetivos primarios del core data set son reducir la heterogeneidad y promover la armonización entre las fuentes de datos en la esclerosis múltiple (EM), reduciendo así el tiempo necesario para ejecutar esfuerzos en la recolección de datos de vida real. Recientemente, un grupo liderado por la Multiple Sclerosis Data Alliance ha desarrollado un core data set para la recolección de datos del mundo real en EM a nivel global. Nuestro objetivo ha sido adaptar y consensuar este conjunto de datos globales a las necesidades de América Latina para que pueda ser implementado por los registros ya desarrollados y en proceso de desarrollo en la región. Material y métodos. Se conformó un grupo de trabajo regionalmente y se adaptó el core data set creado globalmente (proceso de traducción al español, incorporación de variables regionales y consenso sobre variables que se iban a utilizar). El consenso se obtuvo a través de la metodología Delphi remoto de ronda de cuestionarios y discusión a distancia de las variables del core data set. Resultados: Veinticinco profesionales de América Latina llevaron adelante el proceso de adaptación entre noviembre de 2022 y julio de 2023. Se estableció un acuerdo sobre un core data set de nueve categorías y 45 variables, versión 2023, con la sugerencia de implementarlo en registros desarrollados o en vías de desarrollo y cohortes de EM en la región. Conclusión: El core data set busca armonizar las variables recolectadas por los registros y las cohortes de EM en América Latina con el fin de facilitar dicha recolección y permitir una colaboración entre fuentes. Su implementación facilitará la recolección de datos de vida real y la colaboración en la región.(AU)

Introduction: The primary objective of the core data set is to reduce heterogeneity and promote harmonization among data sources in EM, thereby reducing the time needed to execute real life data collection efforts. Recently, a group led by the Multiple Sclerosis Data Alliance has developed a core data set for collecting real-world data on multiple sclerosis (MS) globally. Our objective was to adapt this global data set to the needs of Latin America, so that it can be implemented by the registries already developed and in the process of development in the region. Material and methods: A working group was formed regionally, the core data set created globally was adapted (translation process into Spanish, incorporation of regional variables and consensus on variables to be used). Consensus was obtained through the remote Delphi methodology of a round of questionnaires and remote discussion of the core data set variables. Results: A total of 25 professionals from Latin America carried out the adaptation process between November 2022 and July 2023. Agreement was established on a core data set of nine categories and 45 variables, version 2023 to suggest its implementation in developed or developing registries, and MS cohorts in the region. Conclusion: The core data set seeks to harmonize the variables collected by registries and cohorts in MS in Latin America in order to facilitate said collection and allow collaboration between sources. Its implementation will facilitate real life data collection and collaboration in the region.(AU)

Estudio de prevalencia, conocimiento y control de la hipertensión arterial en barrios vulnerables de Argentina / Prevalence, knowledge and control of arterial hypertension in vulnerable neighborhoods of Argentina: A Cross-sectional Study

Introducción: La hipertensión arterial (HTA) representa el principal factor de riesgo individual, con mayor carga a nivel mundial de enfermedades cardiovasculares (ECV). En nuestro país, algunos trabajos epidemiológicos han mostrado marcadas diferencias en las prevalencias de estos factores de riesgo de acuerdo con la población evaluada. Sin embargo, no hay estudios epidemiológicos de evaluación de factores de riesgo cardiovascular exclusivos referentes a barrios vulnerables con muy bajos recursos económicos, socioculturales y poca accesibilidad a los sistemas de salud. Materiales y métodos: Estudio observacional de corte transversal multicéntrico en habitantes de comunas vulnerables de muy bajos recursos, como asentamientos populares y barrios carenciados con muestreo aleatorizado simple de casas. Se realizaron tomas de presión arterial (PA), medidas antropométricas, así como cuestionarios epidemiológicos, económicos y socioculturales. Se describen los hallazgos: prevalencia, conocimiento y control de la PA en las distintas regiones. Se efectuó una regresión logística para determinar las variables independientes a los resultados principales. Resultados: Se analizaron 989 participantes. La prevalencia de HTA global fue de 48,2%. Un total de 82% tenía un índice de masa corporal (IMC) >25 kg/m2. De estos pacientes, 45,3% tenían menos de seis años de educación. Este último aspecto se asoció a mayor prevalencia de HTA de forma independiente. De los hipertensos, 44% desconocían su padecimiento y solo en 17,2% estaba controlado, asociándose esto a tener obra social (OS) y mayor nivel educativo. Únicamente 24% estaban bajo tratamiento combinado. Conclusión: La prevalencia de HTA en barrios vulnerables es elevada, superando a la de otros estratos sociales con niveles de conocimiento, tratamiento y control de la HTA bajos, similar a otras poblaciones. Se detectó un uso insuficiente de la terapia combinada.

Introduction: Hypertension (HTN) represents the primary individual risk factor, contributing significantly to the global burden of cardiovascular diseases (CVD). In our country, epidemiological research has highlighted substantial variations in the prevalence of these risk factors across different populations. However, there is a lack of epidemiological studies assessing exclusive cardiovascular risk factors within vulnerable neighborhoods characterized by extremely limited economic resources, sociocultural challenges, and inadequate healthcare access. Methods: A multicenter cross-sectional observational study was conducted among individuals residing in economically deprived and marginalized communities, including informal settlements and underprivileged neighborhoods. Simple random sampling of households was employed. Blood pressure measurements, anthropometric assessments, and epidemiological, economic, and sociocultural questionnaires were administered. Results encompass prevalence rates, awareness levels, and blood pressure control across diverse regions. Logistic regression was utilized to identify independent variables influencing primary outcomes. Results: A total of 989 participants were analyzed. The overall prevalence of hypertension was 48.2%. About 82% had a body mass index (BMI) >25. Approximately 45.3% had less than 6 years of formal education. Independent association was established between education levels below 6 years and higher hypertension prevalence Among hypertensive individuals, 44% were unaware of their condition, with only 17.2% achieving control, correlated with having health insurance and a higher educational background. Merely 24% were receiving combined therapy. Conclusion: The prevalence of hypertension within vulnerable neighborhoods is alarmingly high, surpassing rates in other social strata. Knowledge, treatment, and control levels of hypertension are suboptimal, comparable to other populations... (AU)

Brazilian Dialysis Survey 2022 / Censo Brasileiro de Diálise 2022

Abstract Introduction: The Brazilian Dialysis Survey (BDS) is an annual national survey about patients on chronic dialysis that contributes to health policies. Objective: To report the 2022 epidemiological data from the BDS of the Brazilian Society of Nephrology (BSN). Methods: A survey was carried out in Brazilian chronic dialysis centers using an online questionnaire that included clinical and epidemiological aspects of patients on chronic dialysis, dialysis therapy data, and dialysis center characteristics. Results: Overall, 28% (n = 243) of the centers answered the questionnaire. In July 2022, the estimated total number of patients on dialysis was 153,831. The estimated prevalence and incidence rates of patients per million population (pmp) were 758 and 214, respectively. Of the prevalent patients, 95.3% were on hemodialysis (HD, 4.6% of these on hemodiafiltration) and 4.7% on peritoneal dialysis (PD). Only 1.3% of patients were not vaccinated against COVID-19. The prevalence of anemia (Hb < 10g/dL) was 27% and hyperphosphatemia (P > 5.5mg/dL) reached 30%. The estimated overall crude annual mortality rate was 17.1%. Conclusions: The absolute number and prevalence rate of patients on chronic dialysis continue to increase. A growing number of patients were receiving hemodiafiltration. The mortality rate decreased, probably due to the end of COVID-19 pandemic. The conclusions were drawn in the context of relatively low voluntary participation, which imposed methodological limitations on our estimates.

Resumo Introdução: O Censo Brasileiro de Diálise (CBD) é uma pesquisa nacional anual sobre pacientes em diálise crônica que contribui para as políticas de saúde. Objetivo: Informar os dados epidemiológicos de 2022 do CBD da Sociedade Brasileira de Nefrologia (SBN). Métodos: Foi realizada uma pesquisa em centros brasileiros de diálise por meio de um questionário online que incluiu aspectos clínicos e epidemiológicos de pacientes em diálise crônica, dados da terapia dialítica e características do centro de diálise. Resultados: No total, 28% (n = 243) dos centros de diálise ativos cadastrados na SBN responderam ao questionário. Em julho de 2022, o número total estimado de pacientes em diálise era de 153.831. As taxas estimadas de prevalência e incidência de pacientes por milhão (ppm) de habitantes foram 758 e 214, respectivamente. Dos pacientes prevalentes, 95,3% estavam em hemodiálise (HD; 4,6% desses em hemodiafiltração) e 4,7% em diálise peritoneal (DP). Apenas 1,3% dos pacientes não foram vacinados contra a COVID-19. A prevalência de anemia (Hb < 10g/dL) foi de 27% e de hiperfosfatemia (P > 5,5mg/dL) alcançou 30%. A taxa bruta total anual de mortalidade estimada foi de 17,1%. Conclusões: O número absoluto e a taxa de prevalência de pacientes em diálise crônica continuam a aumentar. Um número crescente de pacientes estava em hemodiafiltração. A taxa de mortalidade diminuiu, provavelmente devido ao fim da pandemia da COVID-19. As conclusões foram de um contexto de participação voluntária relativamente baixa, o que impõe limitações metodológicas às nossas estimativas.

[Prevalence of burnout syndrome in physicians working in Spain: systematic review and meta-analysis]. / Prevalencia del síndrome de burnout en médicos que trabajan en España: revisión sistemática y metaanálisis.

OBJECTIVE: To analyze the prevalence of burnout syndrome in physicians working in Spain through a systematic review with meta-analysis METHOD: We searched PubMed/MEDLINE, Embase, and PsycINFO (up to June 2023). Observational studies conducted in Spain reporting the prevalence of burnout in physicians were included. From each study, methodological characteristics and results were extracted, and their quality was evaluated. We performed a narrative synthesis with random effects meta-analysis to calculate proportions. RESULTS: Sixty-seven studies with 16,076 participants were included. For the primary outcome, the meta-analysis revealed a global prevalence of burnout in physicians of 24% (95%CI: 19%-29%; 46 studies; 8821 participants; I2=97%). From subgroup analysis, differences were observed depending on the diagnostic criteria used: 18% (95%CI: 13%-23%) for three dimensions of burnout, 29% (95%CI: 24%-34%) for two dimensions and 51% (95%CI: 42%-60%) for one dimension. The heterogeneity between studies could not be fully explained through additional analyses where non-statistically significant differences were found with other variables (e.g., study quality, setting, professional category or medical specialty). CONCLUSIONS: A high prevalence of burnout syndrome was found in physicians working in Spain. These results can contribute to estimating the burden associated with burnout in physicians at a national level and to the design of future studies. Strategies appear to be necessary to prevent and mitigate this situation. PROTOCOL REGISTRATION: Open Science Framework: https://osf.io/b2h4m/.

Total hip arthroplasty with second generation dual mobility system as a treatment for primary coxarthrosis, medium-term results. / Artroplastia total de cadera con sistema doble movilidad de segunda generación como tratamiento de coxartrosis primaria, resultados a mediano plazo.

Osteoarthritis is a disabling pathology characterized by joint pain and stiffness. A prevalence of coxarthrosis of 7.4% is reported in our country. Total hip joint replacement is indicated in advanced stages, a procedure that is not free of complications, the most frequent being prosthetic dislocation, which can be prevented with dual mobility systems. The following study aims to determine the rate of complications and clinical outcomes in dual mobility systems in primary coxarthrosis. MATERIALS AND METHODS: A retrospective study included 120 cases in 114 patients diagnosed with grade III coxarthrosis, mean age was 62.43 years, with a mean follow-up of 4.5 years. Joint replacement was performed by Hardinge approach. All cases were assessed clinically using the Harris Hip Score (HHS) and radiologically to demonstrate mid-term results. RESULTS: The preoperative value on the HHS scale had a mean of 56.45, postoperative at one month 74.23; 6 months 85.40; 1 year 94.01 and at 5 years 94.84 points, representing a functional improvement of 17.78 postoperative month; 28.95 at 6 months postoperative; 37.56 at one year postoperative and 38.39 points at 5 years postoperative. A complication rate of 3.44%; 0.86% of complications were associated with the prosthetic components. CONCLUSION: The dual mobility system should be considered as a therapeutic option in primary hip joint replacement due to excellent functional results and low complication rates. EVIDENCE LEVEL: IV. Retrospective observational case series study.

Infectious keratitis associated with contact lens wear: REGINFECOR multicenter study.

This 32-centre multicentre study addresses the lack of knowledge about the prevalence and significance of microbial keratitis (MK) associated with contact lens (CL) wear in Spain. A total of 304 cases recruited from 32 hospitals were studied and showed that infectious keratitis associated with contact lens wear mainly affects young women during the summer months. In this study, soft lenses with monthly replacement and single solution cleaning were most commonly used, purchased and fitted in opticians' shops. Common risk factors were identified among users, such as topping off solutions, prolonging the life of lenses, and frequently sleeping, swimming and showering with lenses. Overnight lens wear was significantly associated with a higher incidence of corneal opacities, and the presence of Pseudomonas aeruginosa in bacterial cultures was associated with more severe sequelae and a greater need for corneal transplantation. Although most cases were benign, the time taken to heal was long, which poses a problem for working patients. This study provides valuable epidemiological, microbiological and risk factor information and estimates the incidence of CL related MK in Spain to be approximately 1 case per 30,000 inhabitants per year.

Epidemiología molecular de la colonización nasofaríngea neumocócica en niños de Sevilla, tras la implementación del programa de vacunación con VNC13 en Andalucía (España) / Molecular epidemiology of pneumococcal carriage in children from Seville, following implementation of the PCV13 immunization program in Andalusia, Spain

Introducción: El programa de vacunación universal con la vacuna antineumocócica conjugada 13-valente (VNC13) se implantó en Andalucía en diciembre de 2016. Métodos: Estudio transversal de colonización nasofaríngea por Streptococcus pneumoniae. Se seleccionó a 397 niños sanos en centros de atención primaria de Sevilla durante los periodos 1/4/2018-28/2/2020 y 1/11/2021-28/2/2022 (periodo VNC13). Se utilizó una colección histórica de un estudio de colonización desarrollado en niños sanos y con infección respiratoria superior entre el 1/01/2006 y el 30/06/2008 (periodo VNC7) para comparar las distribuciones de serotipos/genotipos y las tasas de resistencias antibióticas. Resultados: Un total de 76 (19%) niños estaban colonizados con S. pneumoniae en el periodo VNC13 y se dispuso de 154 aislamientos del periodo VNC7. La colonización por serotipos incluidos en VNC13 disminuyó significativamente entre los periodos VNC13 y VNC7 (11 vs. 38%; p=0,0001); los serotipos 19F (8%), 3 (1%) y 6B (1%) fueron los únicos serotipos vacunales circulantes. Los serotipos 15B/C y 11A fueron los serotipos no VNC13 más prevalentes durante el periodo VNC13 (14% y 11%, respectivamente); este último se incrementó de forma significativa entre periodos de tiempo (p=0,04). El serotipo 11A solo se asoció en el periodo VNC13 con variantes resistentes a la ampicilina del clon Spain9V-ST156 (ST6521 y genéticamente relacionado ST14698), no detectados en el periodo anterior. Conclusiones: Hubo una circulación muy residual de los serotipos vacunales durante el periodo VNC13, con excepción del serotipo19F. El serotipo 11A se incrementó de forma significativa entre los periodos VNC13 y VNC7 por expansión clonal del genotipo resistente a la ampicilina ST6521.(AU)

Background: The 13-valent pneumococcal conjugate vaccine (PCV13) universal vaccination program was introduced in December 2016 in Andalusia. Methods: A cross-sectional study was conducted on the molecular epidemiology of pneumococcal nasopharyngeal colonization. A total of 397 healthy children were recruited from primary healthcare centres in Seville for the periods 1/4/2018 to 28/2/2020 and 1/11/2021 to 28/2/2022 (PCV13 period). Data from a previous carriage study conducted among healthy and sick children from 1/01/2006 to 30/06/2008 (PCV7 period) were used for comparison of serotype/genotype distributions and antibiotic resistance rates. Results: Overall, 76 (19%) children were colonized with S. pneumoniae during the PCV13 period and there were information available from 154 isolates collected during the PCV7 period. Colonization with PCV13 serotypes declined significantly in the PCV13 period compared with historical controls (11 vs. 38%, P=0.0001), being serotypes 19F (8%), 3 (1%) and 6B (1%) the only circulating vaccine types. Serotypes 15B/C and 11A were the most frequently identified non-PCV13 serotypes during the PCV13 period (14% and 11%, respectively); the later one increased significantly between time periods (P=0.04). Serotype 11A was exclusively associated in the PCV13 period with ampicillin-resistant variants of the Spain9V-ST156 clone (ST6521 and genetically related ST14698), not detected in the preceding period. Conclusions: There was a residual circulation of vaccine types following PCV13 introduction, apart from serotype 19F. Serotype 11A increased between PCV13 and PCV7 periods due to emergence and clonal expansion of ampicillin-resistant genotype ST6521.(AU)

Cribado poblacional de aneurismas de la aorta abdominal. Estudio piloto en Salamanca / Population screening for abdominal aortic aneurysms. Pilot study in Salamanca

Introducción: una estrategia para reducir la mortalidad de los aneurismas de la aorta abdominal es conocer su existencia en fase asintomática. Así podremos clasificar los pacientes, en función del tamaño del aneurisma, en candidatos a cirugía programada o a seguimiento periódico. Objetivos: conocer la eficacia, la seguridad y la aceptabilidad de un programa piloto de cribado de aneurismas de la aorta abdominal mediante ecografía abdominal realizada en una población de riesgo. Material y métodos: programa organizado por la Real Academia de Medicina y el Instituto de Investigación Biomédica y ejecutado por el Servicio de Angiología, Cirugía Vascular y Endovascular del Hospital Universitario de Salamanca. El cribado se realizó hace un año, en dos carpas situadas en una céntrica plaza de Salamanca. El análisis incluyó a 295 varones ≥ 65 años, residentes en Salamanca capital, de forma libre y gratuita. Se excluyeron aquellos con aneurisma aórtico conocido. Se realizaron: 1) registro de datos; 2) eco Doppler color por especialistas en angiología y cirugía vascular, y 3) encuesta de satisfacción. Todos firmaron un consentimiento informado. Resultados: el diámetro transversal medio de la aorta abdominal fue de 1,81 ± 0,36 cm. Se detectaron 2 aneurismas (diámetro mayor: ≥ 3,0 cm; 3,1 y 4,7 cm) y 3 ectasias aórticas (diámetro ≥ 2,5 y < 3,0 cm). El 98,3 % (290 varones) no presentó ectasia o aneurisma (aorta < 2,5 cm). Tres individuos (obesidad o aire intrabdominal) fueron reevaluados posteriormente. Se analizaron los factores de riesgo y los antecedentes de la población cribada. 180 participantes del cribado (61,0 %) rellenaron anónimamente una encuesta de satisfacción, con resultados muy positivos. Conclusión: si bien el rendimiento de detección fue bajo, la estrategia y el método empleado fueron satisfactorios para el equipo explorador y la población explorada. Este estudio piloto nos permitirá planificar y organizar un segundo cribado más amplio y de nuevos objetivos.(AU)

Introduction: a strategy to reduce the mortality of abdominal aortic aneurysms is to know their existence in theasymptomatic phase. This way we can classify patients, mainly according to the size of the aneurysm, into candi-dates for scheduled elective surgery or periodic follow-up.Objectives: to determine the effectiveness, safety, and acceptability of a pilot screening program for abdominalaortic aneurysms, using abdominal ultrasound, performed in a risk population.Material and methods: program organized by the Royal Academy of Medicine and the Biomedical ResearchInstitute, and carried out by the Angiology and Vascular Surgery service of the University Hospital of Salamanca.The screening was carried out a year ago, in two tents located in a central square in Salamanca. The study included295 men over 65 years of age, residents of Salamanca capital, free of charge. Those with known aortic aneurysmwere excluded. The following were carried out: 1) data recording; 2) color echo-Doppler, by specialists in angiologyand vascular surgery; and 3) satisfaction survey. All signed an informed consent.Results: the mean transverse diameter of the abdominal aorta was 1.81 ± 0.36 cm. Two aneurysms were detect-ed (largest diameter ≥ 3.0 cm; 3.1 and 4.7 cm), and 3 aortic ectasias (diameter ≥ 2.5 and < 3.0 cm). The 98.3 %(290 men) did not present ectasia or aneurysm (aorta < 2.5 cm). Three individuals (obesity or intra-abdominal air) weresubsequently re-evaluated. The risk factors and background of the screened population were analyzed. A satisfactionsurvey was completed freely and anonymously by 180 screening participants (61.0 %) with very positive results.Conclusion: although the detection performance was low, the strategy and method used were satisfactory for theexploring team and the population explored. The present pilot study will allow us to plan and organize a second,broader screening with new objectives.(AU)

Uso de antipsicóticos en los pacientes con demencia en España: comparación con la prescripción de los inhibidores de la acetilcolinesterasa y de la memantina, y análisis de las asociaciones / Use of antipsychotics in patients with dementia in Spain: Comparison with prescription of acetylcholinesterase inhibitors and memantine and analysis of associations

Objetivo: Se ha analizado la prevalencia de antipsicóticos, inhibidores de la acetilcolinesterasa (IACE) y memantina en pacientes con demencia en España y la influencia de estas asociaciones en su prescripción. Método: Estudio descriptivo, retrospectivo y transversal de la base BIFAP de 2017 en los mayores de 65 años con demencia. Se recogieron las prescripciones de antipsicóticos, los IACE y la memantina. Para los antipsicóticos también se recogieron, la duración del tratamiento y el tiempo desde el diagnóstico de demencia, al de prescripción. Resultados: Se recuperaron 1.327.792 sujetos, 89.464 (6,73%) con demencia. El 31,76% tuvieron prescritos antipsicóticos; los más frecuentes: quetiapina (58,47%), risperidona (21%) y haloperidol (19,34%). Las prescripciones de IACE y memantina fueron más frecuentes en los menores de 84 años y las de antipsicóticos en los mayores de 85 años (p<0,001). Los antipsicóticos se mantuvieron una media de 1.174,5 días. En el 26,4% de los casos se prescribieron aislados, OR: 0,61 (IC 95%: 0,59-0,62), en el 35,85% asociados a IACE, OR: 1,26 (IC 95%: 1,22-1,30) y en el 42,4% a memantina, OR: 1,69 (IC 95%: 1,62-1,78); p<0,000). Desde el diagnóstico de demencia transcurrieron de 461 días (±1.576,5) cuando se prescribieron aislados; 651 días (±1.574,25) asociados a IACE y 1.224 (±1.779) a memantina. Conclusiones: Una tercera parte de los pacientes con demencia tuvieron prescritos antipsicóticos, mayoritariamente atípicos, más frecuentemente en los mayores de 85 años y durante periodos prolongados. La prescripción de IACE y memantina se asoció al incremento del riesgo de uso de antipsicóticos, pero paradójicamente, a la prolongación del tiempo hasta su prescripción.(AU)

ObjectiveWe have analyzed the prevalence of antipsychotics in patients with dementia in Spain, their age distribution and the influence of treatment with IACEs and memantine on their prescription. Method: Descriptive, retrospective and cross-sectional study of the 2017 BIFAP database in over 65 years of age with dementia. Prescriptions of antipsychotics, IACEs and memantine were collected. For antipsychotics were also collected, the duration of treatment and time from dementia diagnosis to prescription. Results: A total of 1,327,792 subjects were retrieved, 89,464 (6.73%) with dementia. Antipsychotics were prescribed in 31.76%; by frequency: quetiapine (58.47%), risperidone (21%) and haloperidol (19.34%). Prescriptions of IACEs and memantine were clustered in those younger than 84 years and antipsychotics in those older than 85 (P<.001). Antipsychotics were maintained for a mean of 1174.5 days. In 26.4% of cases they were prescribed alone, OR 0.61 (95% CI: 0.59-0.62), in 35.85% associated with IACEs, OR 1.26 (95% CI: 1.22-1.30) and in 42.4% with memantine, OR 1.69 (95% CI: 1.62-1.78) (P<.000). From the diagnosis of dementia, 461 days (±1576.5) elapsed when isolated drugs were prescribed; 651 days (±1574.25) associated with IACEs and 1224 (±1779) with memantine. Conclusions: One third of patients with dementia were prescribed antipsychotics, mostly atypical, more frequently in those older than 85 years and for prolonged periods. IACEs and memantine were associated with the risk of antipsychotic prescription, but paradoxically, with prolonged time to onset.(AU)

Fibrosis avanzada asociada a esteatohepatitis no alcohólica (NASH) en España: resultados de un estudio Delphi / Advanced fibrosis associated with non-alcoholic steatohepatitis (NASH) in Spain: results of a Delphi study

Objetivo: Describir de manera detallada la epidemiología, diagnóstico, manejo clínico, opciones de tratamiento, impacto en la calidad de vida y necesidades no cubiertas de los pacientes con fibrosis hepática avanzada (F3-F4) asociada a esteatohepatitis no alcohólica (NASH) en España. Metodología: Estudio Delphi de dos rondas de consulta con 41 hepatólogos expertos de 16 comunidades autónomas para recoger su experiencia en práctica clínica. Resultados: La prevalencia estimada de pacientes adultos diagnosticados de fibrosis F3-F4 asociada a NASH en España es de 0,019% (intervalo de confianza [IC] 95%: 0,019-0,020%). Aproximadamente 7.588 adultos con este padecimiento están actualmente diagnosticados y son manejados en los Servicios de Aparato Digestivo de los hospitales españoles, y alrededor de 1.881 nuevos pacientes son diagnosticados cada año. El manejo es multidisciplinar e incluye las especialidades de Aparato Digestivo, Endocrinología y Medicina interna, considerando las frecuentes comorbilidades metabólicas asociadas (obesidad, diabetes mellitus tipo 2 o sobrecarga férrica dismetabólica). A pesar del claro impacto en la calidad de vida, este no se evalúa rutinariamente en la práctica clínica. Las técnicas diagnósticas no invasivas más utilizadas son la elastografía de transición y el índice de fibrosis hepática 4 (FIB-4). La ausencia de tratamientos eficaces y seguros se presenta como la principal necesidad no cubierta para el manejo de estos pacientes. Conclusiones: Este estudio proporciona una representación de la situación actual de los pacientes diagnosticados con fibrosis F3-F4 asociada a NASH en España, incrementando la evidencia disponible y contribuyendo a la toma de decisiones informadas por parte de los profesionales y el sistema sanitario. (AU)

Objective: To describe in detail the epidemiology, diagnosis, clinical management, treatment options, impact on quality of life and unmet needs of patients with advanced liver fibrosis (F3-F4) associated with non-alcoholic steatohepatitis (NASH) in Spain. Methodology: Delphi study of two rounds of consultation rounds with 41 expert hepatologists from 16 autonomous communities to collect their experience in clinical practice. Results: The estimated prevalence of adult patients diagnosed with F3-F4 fibrosis associated with NASH in Spain is 0.019% (95% confidence interval [CI]: 0.019-0.020%). Approximately 7,588 adults with this condition are currently diagnosed and managed in the Digestive System Services of Spanish hospitals, and around 1,881 new patients are diagnosed each year. Management is multidisciplinary and includes the specialties of Digestive System, Endocrinology and Internal Medicine, considering the frequently associated metabolic comorbidities (obesity, type 2 diabetes mellitus or dysmetabolic iron overload). Despite a clear impact on quality of life, this it is not routinely evaluated in clinical practice. The most widely used non-invasive diagnostic techniques are transitional elastography and liver fibrosis index 4 (FIB-4). The absence of effective and safe treatments appears as the main unmet need for the management of these patients. Conclusions: This study provides a representation of the current situation of patients diagnosed with F3-F4 fibrosis associated with NASH in Spain, increasing the evidence available and contributing to informed decision-making by professionals and the health system. (AU)

Epidemiology of thromboembolic events in children and adolescents with antiphospholipid syndrome: A systematic review with meta-analysis.

BACKGROUND AND AIM: This was a systematic review and meta-analysis of the prevalence of thromboembolic events in children and adolescents with antiphospholipid syndrome (APS). METHODS: We searched PubMed, EMBASE and Web of Science to select relevant articles published between 1 January 2000 and 27 February 2022. We used the random-effects meta-analysis to estimate pooled point prevalence rates of thromboembolic events in studies with a minimum sample size of 30. RESULTS: We included five studies reporting data of 336 children and adolescents with primary APS and secondary APS (SAPS). Pooled point prevalence rates of initial general thrombosis, arterial thrombosis, venous thrombosis and stroke in individuals with seropositive APS were 98.2% (95% confidence interval [CI] 87.5-100), 27.6% (95% CI 21.4-34.2), 51.1% (95% CI 38.2-63.9) and 13.4% 95% CI (6.3-22.7), respectively. Pooled point prevalence rates of initial arterial and venous thromboses in children and adolescents with SAPS were 45.7% (95% CI 21.1-71.6) and 29.2% (95% CI 14.8-46), respectively. CONCLUSION: Arterio-venous thromboembolism is highly frequent in children and adolescents with SAPS. More studies using thrombotic and non-thrombotic APS classification criteria are warranted to better assess the frequency and predictors of thromboembolism in age- and ancestry-diverse pediatric populations affected by different types of APS.

[Translated article] Approach to the Epidemiology, Disease Management, and Current Challenges in the Management of Generalized Pustular Psoriasis Through a Survey Conducted Among Spanish Dermatologists.

BACKGROUND: Generalized pustular psoriasis (GPP) is a rare and severe inflammatory skin disease characterised by recurrent or intermittent flares. Epidemiological and disease management data in Spain are limited. Our goal was to estimate the epidemiology of GPP, explore its management, and reach consensus on the current challenges faced in Spain. METHODS: An electronic survey was submitted to dermatologists from the Spanish Academy of Dermatology and Venereology Psoriasis Working Group. This group is experienced in the management of GPP. It included a Delphi consensus to establish the current challenges. RESULTS: A total of 33 dermatologists responded to the survey. A 5-year prevalence and incidence of 13.05 and 7.01 cases per million inhabitants, respectively, were estimated. According to respondents, the most common GPP symptoms are pustules, erythema, and desquamation, while 45% of patients present > 1 annual flares. A total of 45% of respondents indicated that flares often require a length of stay between 1 and 2 weeks. In the presence of a flare, 67% of respondents often or always prescribe a non-biological systemic treatment as the first-line therapy [cyclosporine (55%); oral retinoid (30%)], and 45% a biological treatment [anti-TNFα (52%); anti-IL-17 (39%)]. The dermatologists agreed that the main challenges are to define and establish specific therapeutic goals to treat the disease including the patients' perspective on the management of the disease. CONCLUSION: Our study describes the current situation on the management of GPP in Spain, increasing the present knowledge on the disease, and highlighting the current challenges faced at the moment.

De la epidemiología de la actividad física a la epidemiología crítica de las prácticas corporales: una propuesta desde Latinoamérica.

This essay aims to analyze the epidemiology of physical activity as a practical and epistemological field in dispute, based on the theoretical framework of international critical epidemiology. From this scientific point of view, the epidemiology of physical activity is radically marked by epistemological-health colonialism. This brand is expressed in the theoretical-practical distance from critical epidemiological thinking formulated in the global south, producing an artificial regional dependency and deep frustration in those who want to generate transformations in contemporary ways of living. It is suggested that a critical epidemiology of body practices is possible and necessary. In other words, the epidemiology developed in the countries of Latin America and the Caribbean can dialectically understand the determination, distribution and social reproduction of the phenomenon of bodily practices, since it resumes its critical formulations and intercultural science.

Epidemiology of primary cutaneous melanoma in the Migjorn health sector of Mallorca, Spain from 2003 through 2021. / Epidemiología del melanoma cutáneo primario en el sector Migjorn en la isla de Mallorca entre los años 2003-2021.

The study of the increasing incidence of melanoma over the past few decades is essential regarding prevention and optimization of health resources. We collected cases of melanoma from Hospital son Llàtzer from the Migjorn health sector of Mallorca, Spain from 2003 through 2021, and calculated the incidence of melanoma adjusted to the standard European population. In addition, other demographic and clinicopathological data were descriptively analyzed too. A total of 690 new cases of melanoma were detected with a progressive increase in the age-standardized incidence from 7.47 cases per 100 000 inhabitants/year in 2003 up to 23.84 in 2021 mainly due to early stages of the disease. The incidence of melanoma has increased significantly in Mallorca probably due to the increasing population coming from northern Europe (low phototypes), sun exposure habits (tourism, fishing, agriculture), and improved early diagnosis.

Melanoma Registry of the Spanish Academy of Dermatology and Venereology (REGESMEL): Description and Data in its First Year of Operation. / Registro de Melanoma de la Academia Española de Dermatología y Venereología (REGESMEL): descripción y datos en el primer año de funcionamiento.

INTRODUCTION: The incidence of melanoma is rising in Spain. The prognostic stages of patients with melanoma are determined by various biological factors, such as tumor thickness, ulceration, or the presence of regional or distant metastases. The Spanish Academy of Dermatology and Venereology (AEDV) has encouraged the creation of a Spanish Melanoma Registry (REGESMEL) to evaluate other individual and health system-related factors that may impact the prognosis of patients with melanoma. The aim of this article is to introduce REGESMEL and provide basic descriptive data for its first year of operation. METHODS: REGESMEL is a prospective, multicentre cohort of consecutive patients with invasive cutaneous melanoma that collects demographic and staging data as well as individual and healthcare-related baseline data. It also records the medical and surgical treatment received by patients. RESULTS: A total of 450 cases of invasive cutaneous melanoma from 19 participant centres were included, with a predominance of thin melanomas≤1mm thick (54.7%), mainly located on the posterior trunk (35.2%). Selective sentinel lymph node biopsy was performed in 40.7% of cases. Most cases of melanoma were suspected by the patient (30.4%), or his/her dermatologist (29.6%). Patients received care mainly in public health centers (85.2%), with tele-dermatology resources being used in 21.6% of the cases. CONCLUSIONS: The distribution of the pathological and demographic variables of melanoma cases is consistent with data from former studies. REGESMEL has already recruited patients from 15 Spanish provinces and given its potential representativeness, it renders the Registry as an important tool to address a wide range of research questions.

Basal Cell Carcinoma: Incidence and Trends in Valencia, Spain. / Carcinoma basocelular: incidencia y tendencias en Valencia (España).

BACKGROUND: There is a need for epidemiological and incidence data on the occurrence of basal cell carcinoma (BCC) in Spain. OBJECTIVES: Our study was designed to retrospectively retrieve cases from our computer databases from 2010 through 2016 to provide updated data on the actual incidence of BCC in Valencia, eastern Spain. MATERIAL AND METHODS: This was an epidemiological study on basal cell carcinoma conducted in Valencia, eastern Spain. We analyzed a total of 2171 patients and 4047 tumors, and gathered data to estimate the actual incidence of BBC in our region. RESULTS AND CONCLUSIONS: Our study confirmed that the incidence of BCC is much higher than previously reported. We calculated a crude incidence of 410.38 BCCs/100 000 person-years, an adjusted rate for the European population of 256.98 BCCs/100 000 person-years, and an adjusted rate for the world population of 196.26 BCCs/100 000 person-years. Risk is up to 29.49% higher for men (464.07 cases/100 000 person-years vs 358.40 cases/100 000 person-years for women). Incidence also increases by an annual 3.91% (a significantly higher annual incidence of 8.28% in women vs a 0.92% annual incidence in men). Overall, the lifetime risk for developing a BCC is 5.8% (5.02% in women and 7% in men).

Revisión sistemática sobre la influencia de la edad, el género y las variaciones estacionales en el absceso periamigdalino / Systematic review on the influence of age, gender and seasonal variations on peritonsillar abscess

Introducción y objetivo: El absceso periamigdalino (AP) es la complicación más frecuente de la amigdalitis aguda. Dadas las discrepancias observadas en la literatura, presentamos una revisión sistemática de la bibliografía, para analizar la prevalencia del AP en nuestro ámbito, en relación con tres factores epidemiológicos: la edad, el sexo y la climatología. Método: Se realizó una búsqueda bibliográfica sobre la influencia de la edad, el género y la estacionalidad en el AP. Las bases utilizadas fueron PubMed, Cochrane y Medline, sin restricción de tiempo, siguiendo la metodología PRISMA. El registro se llevó a cabo por tres revisores independientes, durante el mes de octubre de 2022. Resultados: Se obtuvieron, tras excluir duplicados, 289 artículos, de los que tras el cribado que se detalla en la metodología, seleccionamos 23, como parte de la revisión sistemática. Discusión: En la mayoría de los trabajos incluidos, se objetiva un predominio del AP en los hombres, con una ratio hombres/mujeres, variable de 1,16 a 3. Se desconocen las causas de esta diferencia de género. La edad media de aparición del AP varía, según el estudio, de los 22 a los 39 años. Aunque con resultados dispares, el AP no parece tener un predominio estacional, sin que podamos descartar una cierta influencia climática. Conclusiones: El AP es la complicación más frecuente de la amigdalitis aguda. En el adulto, predomina en hombres. La media de edad oscila entre los 22 y 39 años. No parece mostrar preferencia climática. (AU)

Introduction and objective: Peritonsillar abscess (PA) is the most frequent complication of acute tonsillitis. Given the discrepancies observed in the literature, we present a systematic review to analyse the prevalence of PA in our setting in relation to three epidemiological factors: age, gender, and climatology. Methods: A literature search was carried out on the influence of age, gender, and seasonality on PA. The databases used were PubMed, Cochrane, and Medline, without time restriction, following the PRISMA methodology. The registry was carried out by three independent reviewers during the month of October 2022. Results: After excluding duplicates, 289 articles were obtained, of which, after the screening detailed in the methodology, we selected 23 as part of the systematic review. Discussion: In most of the included papers, a predominance of PA in men is observed, with a male/female ratio varying from 1.16 to 3. The mean age of onset of PA varies, depending on the study, from 22 to 39 years. Although with disparate results, AP does not seem to have a seasonal predominance, without being able to rule out a certain climatic influence. Conclusions: AP is the most frequent complication of acute tonsillitis. In adults, it predominates in men. The mean age ranges between 22 and 39 years. It does not seem to show climatic preference. (AU)

Epidemiology of thromboembolic events in children and adolescents with antiphospholipid syndrome: A systematic review with meta-analysis / Epidemiología de los acontecimientos tromboembólicos en niños y adolescentes con síndrome antifosfolípido: una revisión sistemática con metaanálisis

Background and aim: This was a systematic review and meta-analysis of the prevalence of thromboembolic events in children and adolescents with antiphospholipid syndrome (APS). Methods: We searched PubMed, EMBASE and Web of Science to select relevant articles published between 1 January 2000 and 27 February 2022. We used the random-effects meta-analysis to estimate pooled point prevalence rates of thromboembolic events in studies with a minimum sample size of 30. Results: We included five studies reporting data of 336 children and adolescents with primary APS and secondary APS (SAPS). Pooled point prevalence rates of initial general thrombosis, arterial thrombosis, venous thrombosis and stroke in individuals with seropositive APS were 98.2% (95% confidence interval [CI] 87.5–100), 27.6% (95% CI 21.4–34.2), 51.1% (95% CI 38.2–63.9) and 13.4% 95% CI (6.3–22.7), respectively. Pooled point prevalence rates of initial arterial and venous thromboses in children and adolescents with SAPS were 45.7% (95% CI 21.1–71.6) and 29.2% (95% CI 14.8–46), respectively. Conclusion: Arterio-venous thromboembolism is highly frequent in children and adolescents with SAPS. More studies using thrombotic and non-thrombotic APS classification criteria are warranted to better assess the frequency and predictors of thromboembolism in age- and ancestry-diverse pediatric populations affected by different types of APS.(AU)

Antecedentes y objetivo: Se trata de una revisión sistemática y un metaanálisis de la prevalencia de acontecimientos tromboembólicos en niños y adolescentes con síndrome antifosfolípido (SAF). Métodos: Se realizaron búsquedas en PubMed, EMBASE y Web of Science para seleccionar los artículos pertinentes publicados entre el 1 de enero de 2000 y el 27 de febrero de 2022. Se utilizó el metaanálisis de efectos aleatorios para estimar las tasas de prevalencia puntual agrupadas de eventos tromboembólicos en estudios con un tamaño muestral mínimo de 30. Resultados: Se incluyeron cinco estudios con datos de 336 niños y adolescentes con APS primario y APS secundario (SAPS). Las tasas de prevalencia puntual agrupadas de trombosis general inicial, trombosis arterial, trombosis venosa e ictus en individuos con SAF seropositivo fueron de 98,2% (intervalo de confianza [IC] 95%: 87,5-100), 27,6% (IC 95%: 21,4-34,2), 51,1% (IC 95%: 38,2-63,9) y 13,4% (IC 95%: 6,3-22,7), respectivamente. Las tasas de prevalencia puntual agrupadas de trombosis arteriales y venosas iniciales en niños y adolescentes con SAF secundario fueron de 45,7% (IC 95%: 21,1-71,6) y de 29,2% (IC 95%: 14,8-46), respectivamente. Conclusión: La tromboembolia arteriovenosa es muy frecuente en niños y adolescentes con SAF. Se justifica la realización de más estudios que utilicen criterios de clasificación del SCA trombótico y no trombótico para evaluar mejor la frecuencia y los factores predictivos de la tromboembolia en poblaciones pediátricas de edad y ascendencia diversas afectadas por distintos tipos de SCA.(AU)

Cambios en las características epidemiológicas y en el pronóstico de la hepatitis crónica B en personas que viven con VIH / Epidemiological characteristic and prognosis changes in chronic hepatitis B in people living with HIV

Introducción: La vacunación, los avances en el tratamiento frente al virus de la hepatitis B (VHB) y los cambios epidemiológicos producidos en España en las últimas décadas han podido modificar las características y el pronóstico de la hepatitis crónica B (HCB) en personas que viven con VIH (PVIH). Métodos: Estudio observacional retrospectivo donde se incluyeron PVIH-HCB en seguimiento en una unidad de referencia madrileña hasta el año 2019. Se comparó la incidencia y las características epidemiológicas y clínicas según el momento del diagnóstico (antes del año 2000 y posteriormente en periodos de cinco años). Además, se realizó un estudio longitudinal retrospectivo evaluando la tasa de mortalidad, descompensación hepática y factores asociados. Resultados: De 5.452 PVIH, 160 presentaban HCB en el momento basal (prevalencia 2,92%, IC 95%: 2,5-3,4), 85,6% hombres, edad mediana al diagnóstico 32,1 (27-37,2) años. La incidencia (2,4/100 pacientes-año) no varió en los diferentes periodos. Los pacientes diagnosticados antes del 2000 (n = 87) comparados con los diagnosticados entre 2015-2019 (n = 11) con mayor frecuencia eran nativos españoles (90,8 vs. 18,2%), habían consumido drogas intravenosas (55,2 vs. 0), tenían antecedentes de hepatitis C (40 vs. 9,1%) y delta (30,4 vs. 0) y mayor afectación hepática (24,1% cirróticos vs. 0). Tras un seguimiento de 20,4 años, 23 pacientes murieron (7,1/1.000 pacientes-año) y 19 presentaron descompensación hepática (4,9/1.000 pacientes-año), todos diagnosticados antes del año 2010. La mortalidad se asoció con mayor fibrosis hepática basal estimada por Fibroscan® (HR 1,06; IC 95%: 1,03-1,09). Conclusión: Las PVIH-HCB con diagnóstico previo al año 2000 son más frecuentemente de nacionalidad española, infectadas por vía parenteral y con mayor prevalencia de otras coinfecciones. Los pacientes diagnosticados antes del 2010 tienen peor pronóstico condicionado por presentar mayor grado de fibrosis hepática.(AU)

Introduction: Due to hepatitis B virus (HBV) treatment and vaccination during the last decades in Spain, epidemiological and prognosis of chronic hepatitis B (CHB) may have changed. Methods: Retrospective review of CHB–HIV coinfected patients in a single reference center in Madrid until year 2019. We compared incidence, epidemiological and clinical characteristics according diagnosis period (before 2000, 2000–2004, 2005–2009, 2010–2014, 2015–2019). A retrospective longitudinal study was done to assess mortality, related risk factors and hepatic decompensation. Results: Out of 5452 PLHIV, 160 had CHB (prevalence 2.92%; 95% CI: 2.5–3.4), 85.6% were men, median age 32.1 (27–37.2). Incidence rate did not change over the years (2.4/100 patients-year). PLHIV with CHB diagnosed before year 2000 (n = 87) compared with those diagnosed between 2015 and 2019 (n = 11) were more often native-Spanish (90.8% vs. 18.2%), had infected using intravenous drugs (55.2% vs. 0), were coinfected with hepatitis C (40% vs. 9.1%) or hepatitis delta virus (30.4% vs. 0) and had more severe liver disease (cirrhosis 24.1% vs. 0). After a median follow-up of 20.4 years, 23 patients died (7.1/1000 patients-year) and 19 had liver decompensation (4.9/1000 patients-year). All deaths and liver decompensation occurred in patients diagnosed before year 2010. Mortality was associated with higher liver fibrosis in Fibroscan® (HR 1.06, 95% CI: 1.03–1.09). Conclusion: The epidemiology of CHB in PLHIV in our cohort is changing with less native Spanish, more sexually transmitted cases and less coinfection with other hepatotropic virus. Patients diagnosed before 2010 have worst prognosis related to higher grades of liver fibrosis.(AU)

Suicidio consumado en Gran Canaria en el periodo 2017-2022 y su relación con antecedentes de trastorno mental / Consummated suicide in Gran Canaria in the period 2017-2022, and its relationship with a history of mental disorder

Introducción el suicidio sigue siendo una de las principales causas de muerte en todo el mundo. Debido a la relación entre la conducta suicida y el trastorno mental, nuestro objetivo es determinar el número de personas que recibían atención por la Red de Salud Mental entre el total de suicidios consumados entre 2017 y 2022 en Gran Canaria, así como las características de dicha población y de la atención recibida. Material y métodos estudio longitudinal observacional retrospectivo en el que la población de estudio fue extraída del total de suicidios de la base de datos del Instituto de Medicina Legal de Gran Canaria. Posteriormente, los datos fueron cotejados por las bases de datos de la Red de Salud Mental. Por último, se realizó un análisis estadístico univariante y los resultados fueron comparados en función del sexo y la atención en la Unidad de Salud Mental Comunitaria. Resultados solo un 39,4% había recibido atención por parte de la unidad de salud mental, siendo la mayoría mujeres (55,3% vs. 34,6%), con una media de edad de 50,9 años para ambos sexos. Los antecedentes de intentos previos fueron mucho más frecuentes en la población que recibía atención (45,4% vs. 7%), así como la atención en urgencias (42% vs. 5,7%) y los ingresos hospitalarios (25,3% vs. 0,7%). Conclusión menos de la mitad de las personas fallecidas tuvieron contacto con una unidad de salud mental comunitaria. Además, la atención por esta es mayor entre aquellas personas con intentos previos y entre el sexo femenino, siendo el diagnóstico más frecuente el de los trastornos afectivos monopolares. (AU)

Introduction Suicide remains one of the leading causes of death worldwide. Due to the relationship between suicidal behavior and mental disorder, our aim is to determine the number of people who received care by the Mental Health Network among the total number of suicides consummated between 2017 and 2022 in Gran Canaria, as well as the characteristics of that population and the care received. Material and methods Longitudinal observational retrospective study in which the study population was extracted from the total number of suicides in the database of the Legal Medicine Institute. Subsequently, the data were cross-checked by the Mental Health Network databases. Finally, a univariate statistical analysis was carried out and the results were compared according to sex and care in the Community Mental Health Unit. Results Only 39.4% had received care at the Mental Health Unit, the majority being women (55.3% vs. 34.6%), with a mean age of 50.9 years for both sexes. History of previous attempts was much more frequent in the population receiving care (45.4% vs. 7%), as well as emergency care (42% vs. 5.7%) and hospital admissions (25.3% vs. 0.7%). Conclusion Less than half of the deceased persons had contact with a Community Mental Health Unit. In addition, care by this unit was higher among those with previous attempts and among the female sex, with the most frequent diagnosis being monopolar affective disorders. (AU)