Effectiveness and safety of guselkumab for the treatment of psoriasis in real-world settings at 24 weeks : A retrospective, observational, multicentre study by the Spanish Psoriasis Group

Altres ajuts: Acord transformatiu CRUE-CSICData on the effectiveness and safety of a drug in real-world clinical practice complement the evidence from clinical trials, which are carried out in a different setting. Little has been published on the effectiveness and safety of guselkumab in the treatment of psoriasis in clinical practice. The ojective of this study was to assess the effectiveness and safety of guselkumab at 24 weeks in patients with moderate to severe plaque psoriasis in routine clinical practice. A retrospective, multicentre study of adult patients with moderate to severe plaque psoriasis treated with guselkumab for at least 24 weeks was carried out in Spain. We studied 343 patients, 249 of whom were followed for 24 weeks. By week 24, the mean (SD) psoriasis area severity index (PASI) had decreased from 11.1 (7.3) to 1.7 (2.8) (−9.3; [−10.2;-8.4]), 85.9% of the patients had achieved PASI score of 4 or less and 77.9% a PASI score of 2 or less. In terms of relative PASI response, 59.4% of the patients achieved a PASI-90 response and 49.0% a PASI-100 response. On multivariate analysis, two factors reduced the probability of a PASI of 2 or less at 24 weeks: a BMI ≥30 (OR, 0.44; 95% CI, 0.22-0.88) and a greater previous exposure to biologic therapy (OR, 0.69; 95% CI, [0.56-0.84]). Adverse events were rare (9.9%) and led to withdrawal from treatment in only nine patients (2.6%) by the end of the follow-up period. The results of this study confirm the high efficacy and safety of guselkumab indicated by the clinical trial data. In clinical practice, the absolute PASI score appears to be a better marker of response to treatment than the relative value

Associations between eating speed, diet quality, adiposity, and cardiometabolic risk factors

Objective: To assess the associations between eating speed, adiposity, cardiometabolic risk factors, and diet quality in a cohort of Spanish preschool-children. Study design: A cross-sectional study in 1371 preschool age children (49% girls; mean age, 4.8 ± 1.0 years) from the Childhood Obesity Risk Assessment Longitudinal Study (CORALS) cohort was conducted. After exclusions, 956 participants were included in the analyses. The eating speed was estimated by summing the total minutes used in each of the 3 main meals and then categorized into slow, moderate, or fast. Multiple linear and logistic regression models were fitted to assess the β-coefficient, or OR and 95% CI, between eating speed and body mass index, waist circumference, fat mass index (FMI), blood pressure, fasting plasma glucose, and lipid profile. Results: Compared with participants in the slow-eating category, those in the fast-eating category had a higher prevalence risk of overweight/obesity (OR, 2.9; 95% CI, 1.8-4.4; P < .01); larger waist circumference (β, 2.6 cm; 95% CI, 1.5-3.8 cm); and greater FMI (β, 0.3 kg/m2; 95% CI, 0.1-0.5 kg/m2), systolic blood pressure (β, 2.8 mmHg; 95% CI, 0.6-4.9 mmHg), and fasting plasma glucose levels (β, 2.7 mg/dL, 95% CI, 1.2-4.2 mg/dL) but lower adherence to the Mediterranean diet (β, −0.5 points; 95% CI, −0.9 to −0.1 points). Conclusions: Eating fast is associated with higher adiposity, certain cardiometabolic risk factors, and lower adherence to a Mediterranean diet. Further long-term and interventional studies are warranted to confirm these associations

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

La fibra en nutrición enteral: revisión sistemática de la literatura

Se ha sugerido que añadir fibra a las fórmulas de nu-trición enteral (NE) consigue una normalización del funcionamiento del tracto gastrointestinal, disminuyen-do la incidencia de diarrea y de estreñimiento. Sin em-bargo, esta suposición está basada en el efecto demos-trado de la fibra en la alimentación natural. Hasta la fecha no existen recomendaciones firmes sobre el uso, la cantidad ni el tipo de fibra más aconsejable en NE. Objetivo: Establecer la evidencia científica que existe sobre el beneficio de la adición de fibra a las fórmulas de NE comparado con el uso de fórmulas sin fibra. Material y métodos: Búsqueda bibliográfia en Pub-Med, en el registro de Estudios Prospectivos Aleatoriza-dos (EPA) de la Biblioteca Cochrane y búsqueda manual. Criterio de inclusión: EPA que comparen fór-mulas sin fibra con fórmulas isocalóricas e isonitrogena-das con fibra en NE total. Cuatro revisores indepen-dientes revisan las referencias seleccionadas. Para el análisis de los datos se utiliza el programa RevMan 4.1 de la Biblioteca Cochrane. Resultados: De 286 referencias 25 cumplen el criterio de inclusión. Los datos se agrupan por población y por variable de resultado. La adición de fibra fermentable a las fórmulas de NE tiende a disminuir la incidencia de diarrea en pacientes críticos y postquirúrgicos (OR = 0,66; IC 95% 0,46-0,95; p = 0,19). El uso de fórmulas con fibra insoluble parece aumentar la frecuencia de de-posiciones y disminuir la necesidad de laxantes en pa-cientes inmovilizados con NE a largo plazo pero los da-tos son insuficientes. En personas con función gastrointestinal normal la frecuencia de las deposiciones es similar usando fórmulas con y sin fibra (DPM = -0,07; IC 95% -0,12-0,02, p < 0,0001). Conclusión: En la actualidad no existe suficiente evi-dencia para recomendar el uso sistemático de fórmulas con fibra en NE total. No obstante, en pacientes críticos y postquirúrgicos la utilización de fórmulas con fibra fermentable tiende a reducir la incidencia de diarrea. Aunque todavía faltan datos, las fórmulas con fibra in-soluble parecen disminuir el estreñimiento en NE cróni-ca, mientras que en otras situaciones, cuando el tubo di-gestivo funciona adecuadamente, no se ha demostrado beneficio. Es necesario aumentar el número y calidad de los estudios antes de poder establecer recomendaciones firmes sobre el uso de fórmulas de NE con fibra

Neandertal roots: Cranial and chronological evidence from Sima de los Huesos

The Sima de los Huesos site in Atapuerca, northern Spain, is a rich source of fossil hominin specimens. The site has now yielded further skull specimens that illuminate patterns of human evolution in Europe nearly half a million years ago. Arsuaga et al. studied 17 crania, including 7 that are new specimens and 6 that are more complete than before (see the Perspective by Hublin). This assemblage of specimens reveals the cranial, facial, and dental features of the Atapuerca hominins, which allows more precise evolutionary positioning of these Neandertal ancestors

Stop Hypertension with SLP/UCM I

El Proyecto Stop Hipertensión con ApS/UCM pretende aportar nuestro granito de arena a la lucha contra la hipertensión arterial (HTA), utilizando una herramienta educativa de aprendizaje en servicio (ApS), que permita a los estudiantes de los Grados en ciencias de la salud de la UCM aprender a la vez que realizan un servicio público. La hipertensión arterial (HTA) es un problema de salud pública y un importante factor de riesgo de padecer enfermedades cardiovasculares (ECV). Su diagnóstico está determinado por la medida de la presión arterial (PA) por lo que es de extrema importancia asegurar una medida fiable y válida. La automedida de la PA (AMPA) consiste en la medida de la PA por el propio paciente o un familiar, habitualmente en su domicilio, y es una herramienta útil para el diagnóstico y control de la HTA. Pero ¿sabemos medirnos de forma correcta la PA? ¿Usamos bien los tensiómetros? ¿Sabemos interpretar los registros de la PA y cuándo consultar al médico? Realizar AMPA correctamente no es fácil y exige un esfuerzo extraordinario de recursos humanos y económicos por parte de los profesionales de Atención Primaria. Por ello son necesarias nuevas estrategias para capacitar a la población en AMPA. Con este Proyecto nos proponemos luchar contra la HTA a través de la metodología educativa de aprendizaje-servicio que combina objetivos académicos con el servicio comunitario. El alumnado de los grados de Ciencias de la Salud de la UCM forman a la población en la correcta AMPA, asesorándoles sobre el uso correcto de los tensiómetros, enseñándoles a interpretar los resultados y alertándoles de cuándo acudir al médico. En el curso 2022-2023, el servicio público se ha dirigido principalmente al colectivo de mayores por ser especialmente vulnerables a padecer ECV en los Ayuntamientos de Coslada, Alcobendas y Alcorcón, y en las residencias Afanias y Neurovida, y a la población general que acuda a la Facultad durante la Semana de la Ciencia CAM/UCM 2022, a la Feria de la Salud de Coslada y a la campaña contra la HTA de la UCM junto con el Servicio de Medicina del Trabajo. Hemos demostrado que este proyecto es una herramienta rentable y efectiva en la lucha contra la HTA, vinculando la salud pública, los recursos de los ayuntamientos y la universidad. Se cubre así una necesidad y servicio social que podría salvar muchas vidas con recursos de bajo costo, cumpliendo con los objetivos del desarrollo sostenible y con los objetivos de la Sociedad Española de Hipertensión (SEH-LELHA) y de la estrategia HEARTS de la OPS/OMS. Los estudiantes se dan cuenta de la realidad de la Salud pública al tener contacto directo con la población, realizando un servicio a la sociedad, y desarrollándose profesionalmente. Agrademos su colaboración a: Los ayuntamientos de Coslada, Alcorcón y Alcobendas de Madrid. Las residencias de mayores Afanias y Neurovida. Las Sociedades científicas SEH-LELHA, SECF y SEAPEC. El Dr. Orduñez, lider de la estrategia HEARTS PAHO/WHO Los colegios profesionales COFM y CODEM. Las empresas River International S.L. (Beurer) and Peroxfarma S.L. (Omrom)Oficina APS UCMDepto. de FisiologíaFac. de FarmaciaTRUEunpu