Generalized pustulosis following Covid 19 vaccination in a patient in treatment with adalimumab

Dear Editors, Adalimumab is a tumor necrosis factor (TNF)-α inhibitor commonly used for multiple autoimmune diseases. Paradoxical cutaneous reactions under anti-TNF-α drugs have been described in the literature, predominantly linked to adalimumab.1 Although this adverse effect is widely known, mechanisms underlying its induction, as well as possible risk factors, are still unknown. Here we report a case of papulopustular psoriasis induced by a second dose of Covid vaccine in a patient treated with adalimumab. The patient was a 52-year-old woman with history of HLA B27(–) spondylarthritis. No personal or family history of psoriasis was reported. During the previous 9 months she had been in treatment with adalimumab (40 mg) subcutaneously every 2 weeks. No other treatment was initiated during this period. However, she had received the second Covid vaccine the previous week (1st dose: Janssen, 2nd dose: Moderna). The patient presented with an abruptly developed generalized papulopustular reaction that had initiated as a palmoplantar pustulosis (Figure 1). A biopsy was performed and revealed generalized pustulosis (Figure 2). Adalimumab was discontinued and daily topical application of clobetasol propionate 0.05% plus urea 20% resulted in progressive improvement of the lesions. However, although clinical improvement was noted after the use of topical corticosteroids, the patient did not present with complete remission of the lesions

Mediterranean lifestyle index and 24-h systolic blood pressure and heart rate in community-dwelling older adults

Specific foods, nutrients, dietary patterns, and physical activity are associated with lower blood pressure (BP) and heart rate (HR), but little is known about the joint effect of lifestyle factors captured in a multidimensional score. We assessed the association of a validated Mediterranean-lifestyle (MEDLIFE) index with 24-h-ambulatory BP and HR in everyday life among community-living older adults. Data were taken from 2,184 individuals (51% females, mean age: 71.4 years) from the Seniors-ENRICA-2 cohort. The MEDLIFE index consisted of 29 items arranged in three blocks: 1) Food consumption; 2) Dietary habits; and 3) Physical activity, rest, and conviviality. A higher MEDLIFE score (0-29 points) represented a better Mediterranean lifestyle adherence. 24-h-ambulatory BP and HR were obtained with validated oscillometric devices. Analyses were performed with linear regression adjusted for the main confounders. The MEDLIFE-highest quintile (vs Q1) was associated with lower nighttime systolic BP (SBP) (-3.17 mmHg [95% CI: -5.25, -1.08]; p-trend = 0.011), greater nocturnal-SBP fall (1.67% [0.51, 2.83]; p-trend = 0.052), and lower HR (-2.04 bpm [daytime], -2.33 bpm [nighttime], and -1.93 bpm [24-h]; all p-trend < 0.001). Results were similar for each of the three blocks of MEDLIFE and by hypertension status (yes/no). Among older adults, higher adherence to MEDLIFE was associated with lower nighttime SBP, greater nocturnal-SBP fall, and lower HR in their everyday life. These results suggest a synergistic BP-related protection from the components of the Mediterranean lifestyle. Future studies should determine whether these results replicate in older adults from other Mediterranean and non-Mediterranean countries

Purpose Trends Report (January 2024)

In this report, we want to synthesize the most relevant about corporate purpose published in January 2024. For this aim, we did a content search (using selected keywords) in Scopus and Google Scholar for academic publications; and diffusion magazines and other trusted sites for articles and reports. We selected relevant publications about organizational purpose, purpose alignment, and personal purpose. Also, we include successful cases that show how corporate purpose has been implemented. Bellow, we present statistics about the selected literature

Grupos de trabajo internacionales para facilitar una perspectiva reflexiva sobre el papel de la empresa para un mundo más sostenible. Una experiencia “COIL” para integrar el aprendizaje de los ODS en la formación de empresa

El proyecto se enfocó en facilitar a los alumnos la oportunidad de colaborar en equipos distribuidos, compuestos por miembros de universidades de diferentes países. Estos equipos llevaron a cabo un análisis de casos reales de empresas que destacan en sostenibilidad económica, social y medioambiental, reflexionando sobre el papel de la empresa en la sociedad. A través de un proyecto de aprendizaje colaborativo internacional (COIL), estudiantes de la Universidad de Navarra trabajaron en equipos mixtos con sus pares de las universidades de Guelph (Ontario, Canadá), IPMI (Jakarta, Indonesia) y Dominican University (River Forest, EEUU)

Serum Amyloid A as a potential biomarker for disease activity in chronic spontaneous urticaria

Background: Chronic spontaneous urticaria (CSU) is an inflammatory skin disease with a complex physiopathology. Serum amyloid A (SAA), an acute-phase reactant, has been proposed as a potential biomarker in urticaria but has yet to be studied in a population with CSU or correlated with disease activity as indicated by the Urticaria Activity Score summed over 7 days (UAS7). Objective: We sought to determine SAA-1 levels in patients with CSU and correlate them with its activity and control, as well as with clinical features of CSU and other potential blood biomarkers. Methods: We conducted a retrospective multicenter study of 67 patients with CSU, from whom we obtained demographic and clinical data, UAS7 as an indicator of CSU activity, and blood and serum markers. Results: SAA-1 levels positively correlated with UAS7 (rs = 0.47, P 6) CSU than in those with controlled (UAS ≤ 6) CSU (P < .001) and were also higher in patients with concomitant angioedema (P = .003) or delayed pressure urticaria (P = .003). Conclusion: We propose SAA-1 as a potential biomarker for activity in CSU. Further studies are required to evaluate its potential role as a biomarker for other CSU outcomes, such as response to treatment

Clinical management of plant food allergy in patients sensitized to lipid transfer proteins is heterogeneous: identifying the gaps

Background and objective: Patients sensitized to lipid transfer protein (LTP) present a wide clinical variability. The lack of practical diagnostic and therapeutic guidelines complicate their management. The aim of the study was to describe the clinical approach of Spanish allergists to this pathology using a survey designed by PICO method and subsequent Delphi approach validation. Methods: Designed survey was answered by 224 allergists (75% women; 57.1% with >20 years of professional experience). Homogeneity regarding clinical practice on the main points of LTP allergy diagnosis was observed, except for patients with suspected NSAID hypersensitivity (44.6% frequently include LTP skin testing). Oral food challenges were not frequently performed (63.6% occasionally to never), and they were generally (75.5%) used to confirm tolerance. It was common to recommend fruit skins avoidance (77.2%) and maintaining consumption of foods to which patients are sensitised but tolerant (99.1%). Results: There was heterogeneity on other dietary indications, modifications due to co-factors, or traces avoidance. Peach sublingual immunotherapy (SLIT) was considered very/quite effective by 55.9% of allergists. The majority (79.5%) consider SLIT indicated in <25% of LTP allergic patients, based on severity (95.2%), frequency of reactions (99.4%), allergy to multiple food families (97.4%), and the quality of life/nutrition impairment (91.5%). There was different practice on SLIT prescription based on co-factor involvement. Conclusion: These data suggest that there is a need to increase evidence to reduce the clinical practice heterogeneity in the management of LTP allergy

Calibración de equipos climáticos en modelos energéticos detallados (Caja blanca)

El crecimiento de la población a nivel mundial y la persistente dependencia energética de los combustibles fósiles intensifican los impactos del cambio climático, los cuales están mayormente asociados a las emisiones de dióxido de carbono. Investigaciones demuestran que el consumo de energía en los edificios representa el 40 % del consumo global de energía primaria y contribuye al 36 % de las emisiones de carbono. A raíz de la tendencia actual, influenciada por diversos factores sociales, económicos y políticos, se estima que el consumo de energía y las emisiones podrían duplicarse o incluso triplicarse para el año 2050. Por lo tanto, la mejora de los edificios existentes puede generar un ahorro energético de entre el 50 % y el 90 % a nivel mundial. Es evidente que la reducción del consumo energético en los edificios resulta vital para optimizar la asignación de recursos en diferentes áreas críticas de desarrollo, tales como la salud, la educación y la reactivación económica, entre otras. Diversos países alrededor del mundo han optado por abordar este desafío, incorporando políticas energéticas en los códigos de construcción y estableciendo programas de certificación que establecen límites de consumo energético. Estas iniciativas tienen como objetivo encontrar soluciones que mejoren la eficiencia energética, reduzcan los costos de mantenimiento y disminuyan las emisiones de CO2. La realización de un estudio energético de los edificios se posiciona como una de las herramientas más efectivas para desarrollar una estrategia de ahorro energético, ya que permite evaluar el estado actual del edificio y proponer la implementación de medidas de conservación de energía, optimización de los sistemas de climatización y adopción de nuevas tecnologías. Por esta razón, resulta imperativo abordar adecuadamente el complejo problema de establecer el rendimiento energético real de un edificio. La obtención de un modelo de simulación energética de edificios que reduzca la brecha entre la simulación y la realidad constituye uno de los desafíos actuales. Un gemelo digital, capaz de representar de manera confiable la física del edificio en condiciones normales de operación, permite evaluar múltiples soluciones en un entorno no intrusivo y de bajo coste, como es el caso de la simulación. Si los estudios de conservación de energía pudieran respaldarse en un modelo energético calibrado, cuyo comportamiento energético se asemeje al del edificio real, la calidad de los resultados en ahorro energético y el rendimiento de dichas medidas de conservación mejorarían significativamente. Entre las numerosas ventajas de estos modelos, se encuentran la capacidad de identificar áreas críticas dentro del edificio que requieren mayor estudio, el diseño de estrategias de conservación de energía, el establecimiento de una línea base para contratos energéticos, la optimización del sistema de climatización, la puesta en marcha de equipos de climatización y la detección de fallos. La presente tesis de investigación se basa en el trabajo previo de Bandera, Ramos et al, quienes se enfocaron en calibrar la envolvente del edificio. Al conocer la cantidad de energía que se pierde a través de la envolvente, podemos determinar la demanda energética del edificio (Anexo 49). Una vez que la envolvente se encuentra calibrada, considerando las solicitudes y cargas (ocupación, equipos, iluminación, etc.), se obtiene una demanda energética que debe ser atendida exclusivamente por los sistemas de climatización del edificio. El objetivo de este trabajo es calibrar los parámetros de los diferentes componentes de los equipos del sistema de climatización, generando un modelo energético del edificio que correlacione las condiciones internas de temperatura con la demanda térmica y el consumo energético de los equipos de producción térmica (rendimiento de la instalación). Solo al realizar esta doble evaluación, manteniendo las condiciones de temperatura interior de los espacios y obteniendo un consumo energético similar al real, podremos hablar de un modelo térmico y energético completo del edificio (modelo calibrado)

Biological functions are causes, not effects: A critique of selected effects theories

The theory of Selected Effects (SE) is currently the most widely accepted etiological account of function in biology. It argues that the function of any trait is the effect that past traits of that type produced that contributed to its current existence. Its proper or etiological function is whatever effect was favoured by natural selection irrespective of the trait’s current effects. By defining function with respect to the effects of natural selection, the theory claims to eschew the problem of backwards causality and to ground functional normativity on differential reproduction or differential persistence. Traditionally, many have criticised the theory for its inability to envisage any function talk outside selective reproduction, for failing to account for the introduction of new functions, and for treating function as epiphenomenal. This article unveils four additional critiques of the SE theory that highlight the source of its critical problems. These critiques follow from the fact that natural selection is not a form of work, but a passive filter that merely blocks or permits prior functioning traits to be reproduced. Natural selection necessarily assumes the causal efficacy of prior organism work to produce the excess functional traits and offspring from which only the best fitted will be preserved. This leads to four new incapacities of the SE theory, which will be here analysed: (i) it provides no criterion for determining what distinguishes a proper from an incidental function; (ii) it cannot distinguish between neutral, incidental, and malfunctioning traits, thus treating organism benefit as irrelevant; (iii) it fails to account for the physical work that makes persistence and reproduction possible, and (iv) in so doing, it falls into a vicious regress. We conclude by suggesting that, inspired by Mills and Beatty’s propensity interpretation, the aporia of backward causation implicit in anticipatory accounts of function can also be avoided by a dispositional approach that defines function in terms of work that synchronously counters the ubiquitous tendency for organism entropy to increase in the context of far-fromequilibrium thermodynamics