Immunoparesis recovery in newly diagnosed transplant ineligible multiple myeloma patients, an independent prognostic factor that complements minimal residual disease.

Information on the prognostic value of immunoparesis (IP) recovery in multiple myeloma (MM) patients has been only generated in some observational and retrospective studies. We have evaluated the prognostic impact of IP recovery and its association with minimal residual disease (MRD) in a series of 113 newly diagnosed transplant-ineligible (NDTI) patients, that received fix duration treatment (18 cycles of VMP/lenalidomide-dexamethasone) within the PETHEMA/GEM2010MAS65 trial and who achieved CR or VGPR. Immunoglobulin levels were measured at diagnosis, at the end of treatment (after cycle 18th) and during subsequent follow up whereas MRD was analyzed only at the end of the treatment (after cycle 18th). We found that patients who had IP at diagnosis and recovered it during or after treatment had longer progression free survival (PFS) [p < 0.001; HR 0.32 (0.19-0.52)] and longer overall survival (OS) [p = 0.007; HR 0.40 (0.20-0.80)] compared to those who failed to recover it. When we analyzed IP recovery in MRD negative patients, we found that those cases with IP recovery had longer PFS [p = 0.007; HR 0.31 (0.13-0.76)] and longer OS [p = 0.012; HR 0.21 (0.06-0.80)] as compared to MRD negative patients but without IP recovery. In conclusion, IP recovery confers better prognosis in NDTI-MM patients with fixed duration treatment who achieve CR or VGPR and the prognostic value of MRD can be complemented when combined with IP recovery.

Comparative features between recombinant lipases CALA-like from U. maydis and CALA from C. antarctica in thermal stability and selectivity.

OBJECTIVES: Ustilago maydis lipase A (UMLA) expressed in Pichia pastoris was compared with Candida antarctica lipase A (CALA) to study its biochemical properties such as thermostability and selectivity. RESULTS: UMLA had similar behavior to its homologue CALA regarding the effect of pH and temperature on enzymatic activity, substrate preference and selectivity. Both lipases were active on insoluble triglycerides as well as natural oils and hydrolyzed preferably esters with short and medium acyl and alkyl chains. Both enzymes were slightly selective for the (S)-glycidyl butyrate enantiomer and had a remarkable preference for the sn-2 position of triglycerides. The optimal activity was 40 and 50 °C for UMLA and CALA, respectively. However, temperature had a greater effect on the stability of UMLA compared to CALA, observing a half-life at 50 °C of 2.07 h and 12.83 h, respectively. CONCLUSIONS: UMLA shares some biochemical properties with CALA such as the sn-2 preference on triglyceride hydrolysis and transesterification. However, the high thermostability attributed to CALA was not observed in UMLA; this can be due to the lack of stabilization via AXXXA motifs in helices and fewer proline residues at the surface.

Spectrophotometric assay for the screening of selective enzymes towards DHA and EPA ethyl esters hydrolysis.

Polyunsaturated fatty acids (PUFAs), such as docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), hold notable significance due to their pharmaceutical relevance. Obtaining PUFAs from diverse sources like vegetables, fish oils, and algae poses challenges due to the mixed fatty acid (FA) composition. Therefore, focusing on particular FAs necessitates purification and resolution processes. To address this, we propose a continuous assay for screening lipases selective for ethyl EPA (E-EPA) or ethyl DHA (E-DHA). Utilizing microplate spectrophotometry, the method enables quantification of liberated fatty acids from ethyl esters (E-EPA or E-DHA). This involves assessing enzyme selectivity by measuring the release of FAs through p-nitrophenolate protonation, either separately for each substrate or in competition with a reference substrate, resorufin acetate. Ten lipases underwent screening, revealing Burkholderia cepacia lipase's (BCL) preference for ethyl DHA hydrolysis (E-EPA/E-DHA = 0.82 ± 0.07 and the lipase selectivity ratio (S) for E-EPA/E-DHA = 0.13 ± 0.04) and Candida antarctica lipase B's (CALB) high specific activity towards both E-EPA and E-DHA (531.14 ± 37.76 and 281.79 ± 2.79 U/mg, respectively) and E-EPA preference (E-EPA/E-DHA = 1.86 ± 0.15 and S E-EPA/E-DHA = 2.59±0.15). Candida rugosa recombinant isoform 4 (rCRLip4) and commercial Candida rugosa lipase (CRL) exhibited significant preference for E-EPA hydrolysis (E-EPA/E-DHA = 2.18 ±0.51 and 2.26 ±0.36, respectively; and S E-EPA/E-DHA = 7.59 ± 1.59 and 7.88 ± 2.13, respectively). Docking analyses of rCRLip4, BCL, and CALB demonstrated no statistically significant differences in activation energies or distances to the catalytic serine; however, they agreed with the experimental results. These findings suggest potential mutagenesis or directed evolution strategies for CALB to enhance E-EPA selectivity, with rCRLip4 emerging as a promising candidate for further investigation. This assay offers a valuable tool for identifying lipases with desired substrate selectivity, with broad implications for pharmaceutical and biotechnological applications.

Maladaptive Consequences of Mental Intrusions with Obsessive, Dysmorphic, Hypochondriac, and Eating-disorders Related Contents: Cross-cultural Differences.

BACKGROUND/OBJECTIVE: Unwanted mental intrusions (UMIs) with contents related to Obsessive-Compulsive Disorder (OCD), Body Dysmorphic Disorder (BDD), Illness Anxiety Disorder (IAD), and Eating Disorders (EDs) are highly prevalent, independently of the cultural and/or social context. Cognitive-behavioral explanations for these disorders postulates that the escalation from common UMIs to clinically relevant symptoms depends on the maladaptive consequences (i.e., emotions, appraisals, and control strategies) of experiencing UMIs. This study examines, from a cross-cultural perspective, the cognitive-behavioral postulates of the maladaptive consequences of having UMIs. METHOD: Non-clinical 1,473 participants from Europe, the Middle-East, and South America completed the Questionnaire of Unpleasant Intrusive Thoughts to assess the maladaptive consequences of experiencing highly disturbing OCD, BDD, IAD, and EDs-related UMIs. RESULTS: Findings revealed main effects for both the country and the consequences associated with the four UMI contents. Interaction effects between the consequences of each UMI content and the sample location were also observed. CONCLUSIONS: Cognitive-Behavioral models for OCD, BDD, IAD, and EDs should be implemented along with socio-cultural variables that increase the understanding of the role of these variables in the phenomenology of UMIs and their associated consequences.

INTRODUCCIÓN/OBJETIVO: Las intrusiones mentales no deseadas (IM) de contenidos relacionados con el Trastorno Obsesivo-Compulsivo (TOC), el Trastorno Dismórfico Corporal (TDC), la Ansiedad por la Enfermedad (AE), y los Trastornos Alimentarios (TAs) son muy prevalentes, independientemente de la cultura y/o el contexto social. Las explicaciones cognitivo-conductuales de esos trastornos postulan que la escalada de IM normales a síntomas clínicamente relevantes depende de las consecuencias desadaptativas (i.e., emociones, valoraciones y estrategias de control) de las IM. Este estudio examina los planteamientos sobre dichas consecuencias desde una perspectiva transcultural. MÉTODO: 1.473 participantes de Europa, Oriente Medio y Suramérica completaron el Inventario de Pensamientos Intrusos Desagradables para evaluar las consecuencias desadaptativas de experimentar IM muy molestas con contenidos de TOC, TDC, AE y TAs. RESULTADOS: Se obtuvieron efectos principales tanto para el país como para las consecuencias asociadas con los cuatro contenidos de IM, así como efectos de interacción entre las consecuencias de cada modalidad de IM y la localización de la muestra. CONCLUSIONES: Los modelos cognitivo-conductuales sobre el TOC, el TDC, la AE y los TAs deben complementarse con variables socioculturales que aumenten la comprensión del papel de esas variables en la fenomenología de las IM y sus consecuencias asociadas.

Suicide Presentations to an Emergency Department Pre and During the COVID Lockdown, March-May 2020, in Spain.

The impact of the COVID-19 pandemic and lockdown may affect suicide risk and behavior. We compared suicide-related presentations during the national quarantine with pre-COVID data. This observational incidence study compared all suicide-related presentations at the University Hospital Reina Sofia emergency department (ED) in Cordoba, Spain, for the lockdown period from 15 March to 15 May 2020, with the same period in 2019. Descriptive and inferential analyses of case characteristics between 2019 and 2020 periods were conducted, and a multivariable logistic regression model developed. Results: Despite a decrease in overall ED cases during the lockdown, the number of suicide-related presentations stayed the same and represented a significantly larger proportion of cases in comparison to the pre-COVID period (0.42 vs. 0.87%, in 2019 and 2020, respectively; p < .001). The number presenting alone more than doubled during the COVID lockdown, increasing to 42.9% compared with 19.4% in 2019 (p = .002). An increase in presentations with a family history of suicide was also found. Conclusions: Suicide cases represented an increased proportion of ED cases during the lockdown. Presenting to ED alone, having a family history of suicide, habitual drug consumption, and hospital admission to ICU differentiated cases between pre and during COVID periods. These findings should be considered in light of the second wave and further implementation of lockdown measures.

The cross-cultural and transdiagnostic nature of unwanted mental intrusions.

BACKGROUND/OBJECTIVE: Unwanted mental intrusions (UMIs), typically discussed in relation to Obsessive-Compulsive Disorder (OCD), are highly prevalent, regardless of the specific nationality, religion, and/or cultural context. Studies have also shown that UMIs related to Body Dysmorphic Disorder (BDD), Illness anxiety/Hypochondriasis (IA-H), and Eating Disorders (EDs) are commonly experienced. However, the influence of culture on these UMIs and their transdiagnostic nature has not been investigated. METHOD: Participants were 1,473 non-clinical individuals from seven countries in Europe, the Middle-East, and South America. All the subjects completed the Questionnaire of Unpleasant Intrusive Thoughts, which assesses the occurrence and discomfort of four UMI contents related to OCD, BDD, IA-H, and EDs, and symptom questionnaires on the four disorders. RESULTS: Overall, 64% of the total sample reported having experienced the four UMIs. The EDs intrusions were the most frequently experienced, whereas hypochondriacal intrusions were the least frequent but the most disturbing. All the UMIs were significantly related to each other in frequency and disturbance, and all of them were associated with clinical measures of OCD, BDD, IA-H, and EDs. CONCLUSIONS: UMIs are a common phenomenon across different cultural contexts and operate transdiagnostically across clinically different disorders.

INTRODUCCIÓN/OBJETIVO: Las intrusiones mentales no deseadas (IM), clásicamente estudiadas en relación con el trastorno obsesivo-compulsivo (TOC), tienen una prevalencia elevada independientemente de la nacionalidad, religión, y/o el contexto cultural. Las investigaciones muestran que también es habitual experimentar IM sobre contenidos relacionados con el trastorno dismórfico corporal (TDC), la ansiedad por la enfermedad/hipocondría (AE-H) y los trastornos alimentarios (TCA). Sin embargo, la influencia de la cultura sobre estas IM y su naturaleza transdiagnóstica no se han investigado. MÉTODO: Participaron 1.473 personas de siete países de Europa, Oriente Medio y Suramérica. Todas completaron el Cuestionario de Pensamientos Intrusos Desagradables, que evalúa la ocurrencia y malestar asociados a cuatro contenidos de IM relacionados con TOC, TDC, AE-H y TCA, y cuestionarios sobre síntomas de los cuatro trastornos. RESULTADOS: El 64% de la muestra total había experimentado las cuatro modalidades de IM. Las IM-TCA fueron las más frecuentes y las hipocondríacas las menos, pero las más molestas. Todas las IM mantuvieron relaciones entre sí, tanto en frecuencia como en molestia, y todas se asociaron con las medidas clínicas de TOC, TDC, AE-H y TCA. CONCLUSIONES: Las IM son una experiencia habitual en diferentes contextos culturales y operan de modo transdiagnóstico en trastornos clínicamente distintos.

Incertidumbres y progresos en la vacunación contra la COVID-19 / No disponible

No disponible

Benefit Finding in Cardiac Patients: Relationships with Emotional Well-Being and Resources after Controlling for Physical Functional Impairment.

Benefit finding (BF) is defined as the individual's perception of positive change as a result of coping with an adverse life event. The beneficial effects of BF on well-being could be because BF favors the improvement of resources like self-efficacy, social support and effective coping. The main objective of this longitudinal 8 week study was to explore, in a sample of cardiac patients (n = 51), the combined contribution of BF and these resources to the positive affect. Moreover, we wanted to check whether these resources were derived from BF or, on the contrary, these resources were antecedents of BF. Results showed that after controlling for functional capacity, only effective coping could predict the positive affect at Time 1 (ß = .32, p < .05), while the BF predicted it at Time 2 (ß = .23, p < .001). Only social support predicted BF (ß = .26, p < .05), but not the opposite. We discussed the desirability of promoting these processes to improve the emotional state of cardiac patients.

A retrospective analysis of myelodysplastic syndromes with thrombocytosis: reclassification of the cases by WHO proposals.

Myelodysplastic syndromes (MDS) show occasionally thrombocytosis, common feature of myeloproliferative diseases (MPD), with the overlapping of both disorders. Classically, thrombocytosis has been associated with some MDS subtypes: refractory anaemia with ringed sideroblasts (RARS), 5q- syndrome and those MDS with 3q chromosome rearrangements. The recent WHO classification recognises an unclassifiable MDS/MPD category including some of these disorders. Our aim is to determine the frequency of presentation, subtype classification and chromosome abnormalities of MDS with thrombocytosis diagnosed in our institution. Between 1990 and 2003 we studied 317 SMD patients according to FAB and WHO revised classifications and identified 22 cases presenting thrombocytosis associated with dysplasia, that are analysed in this article.

The cross-cultural and transdiagnostic nature of unwanted mental intrusions / Expresión transcultural y naturaleza transdiagnóstica de las intrusiones mentales no deseadas

Background/Objective: Unwanted mental intrusions (UMIs), typically discussed in relation to Obsessive-Compulsive Disorder (OCD), are highly prevalent, regardless of the specific nationality, religion, and/or cultural context. Studies have also shown that UMIs related to Body Dysmorphic Disorder (BDD), Illness anxiety/Hypochondriasis (IA-H), and Eating Disorders (EDs) are commonly experienced. However, the influence of culture on these UMIs and their transdiagnostic nature has not been investigated. Method: Participants were 1,473 non-clinical individuals from seven countries in Europe, the Middle-East, and South America. All the subjects completed the Questionnaire of Unpleasant Intrusive Thoughts, which assesses the occurrence and discomfort of four UMI contents related to OCD, BDD, IA-H, and EDs, and symptom questionnaires on the four disorders. Results: Overall, 64% of the total sample reported having experienced the four UMIs. The EDs intrusions were the most frequently experienced, whereas hypochondriacal intrusions were the least frequent but the most disturbing. All the UMIs were significantly related to each other in frequency and disturbance, and all of them were associated with clinical measures of OCD, BDD, IA-H, and EDs. Conclusions: UMIs are a common phenomenon across different cultural contexts and operate transdiagnostically across clinically different disorders

Introducción/Objetivo: Las intrusiones mentales no deseadas (IM), clásicamente estudiadas en relación con el trastorno obsesivo-compulsivo (TOC), tienen una prevalencia elevada independientemente de la nacionalidad, religión, y/o el contexto cultural. Las investigaciones muestran que también es habitual experimentar IM sobre contenidos relacionados con el trastorno dismórfico corporal (TDC), la ansiedad por la enfermedad/hipocondría (AE-H) y los trastornos alimentarios (TCA). Sin embargo, la influencia de la cultura sobre estas IM y su naturaleza transdiagnóstica no se han investigado. Método: Participaron 1.473 personas de siete países de Europa, Oriente Medio y Suramérica. Todas completaron el Cuestionario de Pensamientos Intrusos Desagradables, que evalúa la ocurrencia y malestar asociados a cuatro contenidos de IM relacionados con TOC, TDC, AE-H y TCA, y cuestionarios sobre síntomas de los cuatro trastornos. Resultados: El 64% de la muestra total había experimentado las cuatro modalidades de IM. Las IM-TCA fueron las más frecuentes y las hipocondríacas las menos, pero las más molestas. Todas las IM mantuvieron relaciones entre sí, tanto en frecuencia como en molestia, y todas se asociaron con las medidas clínicas de TOC, TDC, AE-H y TCA. Conclusiones: Las IM son una experiencia habitual en diferentes contextos culturales y operan de modo transdiagnóstico en trastornos clínicamente distintos

Metrorragia disfuncional como primer síntoma de carcinoma de mama / Dysfunctional bleeding as the first symptom of breast carcinoma

Durante el periodo que denominamos perimenopausia en una mujer, con frecuencia se presentan alteraciones menstruales que consideramos dentro de la normalidad, no realizando estudios complementarios en la mayoría de las ocasiones y pautando tratamientos sintomáticos, si los precisa, hasta llegar el cese de la función ovárica. Presentamos un caso donde este tratamiento pautado tal vez intervino en el retraso diagnóstico del problema principal, el cáncer de mama lobulillar bilateral que, como primer síntoma, metastatizó en el endometrio provocando una metrorragia de difícil (AU)

During perimenopause, menstrual alterations are often considered within the normal range, and complementary studies are not usually performed. Symptomatic treatment is provided, if required, until cessation of ovarian function. We present the case of a woman in whom symptomatic treatment may have contributed to the delay in diagnosis of the main problem, bilateral lobular cancer, which presented as endometrial metastases, provoking difficult-to-control metrorrhagia (AU)

Benefit finding in cardiac patients: relationships with emotional well-being and resources after controlling for physical functional impairment

Benefit finding (BF) is defined as the individual’s perception of positive change as a result of coping with an adverse life event. The beneficial effects of BF on well-being could be because BF favors the improvement of resources like self-efficacy, social support and effective coping. The main objective of this longitudinal 8 week study was to explore, in a sample of cardiac patients (n = 51), the combined contribution of BF and these resources to the positive affect. Moreover, we wanted to check whether these resources were derived from BF or, on the contrary, these resources were antecedents of BF. Results showed that after controlling for functional capacity, only effective coping could predict the positive affect at Time 1 (β = .32, p < .05), while the BF predicted it at Time 2 (β = .23, p < .001). Only social support predicted BF (β = .26, p < .05), but not the opposite. We discussed the desirability of promoting these processes to improve the emotional state of cardiac patients (AU)

No disponible

Alternativas al tratamiento habitual de la hemocromatosis hereditaria / Alternatives to the current treatment of hereditary hemochromatosis

No disponible

Disfonía y lumbalgia como presentación de sarcoma granulocítico. Primera manifestación de leucemia mieloide aguda / Dysphonia and lumbago as signs of granulocytic sarcoma. Initial manifestation of acute myeloid leukaemia

El sarcoma granulocítico o cloroma es un tumor de células primitivas de la serie granulocítica que se desarrolla en una localización extramedular. Ha sido descrito en pacientes con leucemia aguda y en síndromes mieloproliferativos crónicos en transformación leucémica, en un porcentaje bajo de casos, generalmente como forma de presentación. Su diagnóstico se basa en la sospecha, casi siempre dificultosa si no se considera dentro del diagnóstico diferencial, dado que habitualmente sus manifestaciones clínicas se refieren a la zona afectada enmascarando la etiología de los mismos. Presentamos el caso de un varón de 78 años que es derivado al servicio de urgencias hospitalarias desde su centro de atención primaria para valoración de disfonía, lumbalgia y malestar general de un mes de evolución, sin respuesta a tratamiento convencional (AU)

Granulocytic sarcoma or chloroma is an extramedullar tumor consisting of primitive granulocytic cells. It has been described in patients with acute leukaemia and chronic myeloproliferative syndromes transforming into leukaemia. It is rare and generally an initial manifestation of leukaemia. Diagnosis is based on suspicion and is always difficult if it is not considered in the differential diagnosis procedure because the clinical manifestations in the affected area often mask their aetiology. We contribute the case of a 78 year old man who was referred to the hospital emergency department from his primary care centre for evaluation. He had suffered from dysphonia, lumbago and general malaise for a month and had not responded to conventional treatment (AU)

Salud cardiovascular en la mujer: el papel de la ira y su expresión / Cardiovascular health in women: The role of anger and its expression

Se analizaron las relaciones entre expresión de la ira (interiorizada, exteriorizada y controlada) y salud cardiovascular (malestar emocional, informe de síntomas cardiovasculares y conductas de prevención) en 327 mujeres (rango 17-60 años). Un año después, se registraron en la muestra los mismos criterios (N= 218), así como la presión sanguínea (PS) obtenida en revisiones médicas (N= 90). Se formaron cuatro grupos en función de las puntuaciones en ira interiorizada (ira-in) y en control de la ira, desde el más desadaptativo en su expresión de la ira (alta ira-in y bajo control) hasta el más adaptativo (baja irain y alto control). Los resultados mostraron que el grupo con una ira más desadaptativa presentaba peor salud cardiovascular que el resto de grupos, en ambos momentos temporales. Asimismo, la presencia de mujeres con niveles patológicos de PS fue mayor en los grupos altos en ira-in. Los datos apoyan el papel de la represión de la ira y la falta de su adecuada canalización o control, en la salud cardiovascular de la mujer desde un diseño prospectivo. Se concluye que una correcta regulación de los sentimientos de ira y la práctica de conductas preventivas pueden proteger a la mujer frente a la presencia de problemas cardiovasculares (AU)

The relationships between anger expression (in, out, and control) and cardiovascular health (emotional distress, cardiovascular symptoms reported, and preventive health behaviors) were analyzed in 327 women (range 17-60 years). The same criteria (N= 218), as well as blood pressure (BP) registered in medical checkups (N= 90) were recorded one year later. Four groups according to anger-in and anger-control scores, going from the most hostile (high anger-in and low anger-control) to the least hostile (low anger-in and high angercontrol) were considered. The results indicated that the most hostile group, with the least adaptive anger expression, presented worst cardiovascular health than the other three groups, at both temporal moments. Furthermore, the presence of women with pathological BP levels was higher in the groups of high anger-in. These data ratify the role of anger expression, especially its repression (anger-in) and the lack of adequate canalization or control in women’s cardiovascular health from a prospective design. Appropriate management of anger feelings and the practice of preventive health behaviors can protect women from cardiovascular problems (AU)

Implantación de una política de episiotomía selectiva en el Hospital de Baza. Resultados materno-fetales / Implantation of a selective episiotomy policy in the Hospital of Baza. Maternal and fetal outcomes

Objetivo. Valorar los resultados materno-fetales relacionados con el uso selectivo de episiotomía. Metodología. Estudio analítico retrospectivo de los partos asistidos en el Hospital de Baza (Granada). Resultados. Las tasas de episiotomía han descendido del 69% (89% de nulíparas y 51.75% de multíparas) al 20% (35.7% de nulíparas y 8.43% de multíparas). Los test de asociación muestran que la realización de episiotomía se relaciona con nuliparidad, edad materna avanzada en nulíparas, analgesia epidural, partos instrumentales y posición de litotomía. La episiotomía selectiva no afecta al test de Apgar del recién nacido. Posiciones distintas a litotomía reducen la realización de episiotomía y protegen de desgarros severos. La política de episiotomía selectiva incrementa los perinés íntegros, aunque incrementa los desgarros perineales de I y II grado. Conclusiones. La implantación de una política selectiva de episiotomía favorece el parto humanizado, conservando más perinés íntegros, sin empeorar los resultados materno-fetales (AU)

Objective. To evaluate maternal and fetal outcomes associated with the selective use of episiotomy. Methods. A retrospective analytical study of births attended in the Hospital of Baza (Granada, Spain). Results. Episiotomy rates fell from 69% (89% of nulliparas and 51.75% of multiparas) to 20% (35.7% of nulliparas and 8.43% of multiparas). Association tests showed that episiotomy was associated with nulliparity, maternal age in nulliparas, epidural analgesia, instrumental delivery and lithotomy position. Selective episiotomy did not affect neonatal Apgar scores. Different lithotomy positions reduced the performance of episiotomy and protected against severe lacerations. A selective episiotomy policy helped to preserve the perineum intact but also increased grade I and II perineal tears. Conclusions. The implementation of a selective episiotomy policy favors humanized birth and helps to preserve the perineum intact, without worsening maternal and fetal outcomes (AU)

Neumonía por Legionella longbeachae serogrupo 1 / Legionella longbeachae serogroup 1 pneumonia

No disponible