Relevance of new therapies in the current treatment of adult penile curvature (Peyronie's disease)

RESUMEN: Introducción: La Enfermedad de Peyronie (EP) condiciona la actividad sexual reduciendo la calidad de vida de los pacientes. En su fase crónica, los únicos tratamientos con evidencia son la cirugía y el tratamiento intralesional con Colagenasa de Clostridium Histolyticum (CCH). Objetivo: Evaluar la efectividad y seguridad del uso en situación de práctica clínica habitual de CCH y su comparación indirecta con el tratamiento quirúrgico. Material y métodos: Estudio de cohortes retrospectivo de pacientes con EP en fase estable candidatos a tratamiento con CCH o cirugía, entre ene/2016 y dic/2018 en un hospital de tercer nivel. Análisis descriptivo y estadístico empleando como variable principal de eficacia los grados de disminución de la curvatura peneana. Como variable de seguridad se registraron los eventos adversos relacionados con el tratamiento (EART). Resultados: Se incluyeron 61 pacientes: 35 candidatos a CCH y 26 a tratamiento quirúrgico. La curvatura se redujo -16,45⁰ ( IC 95% -21,19 - -11,71) con CCH y -46,87⁰ ( IC 95% -56,42 - -37,33) tras cirugía. Se registraron 4 EART graves (hematomas), 3 tras CCH y 1 tras cirugía. Conclusión: El tratamiento con CCH es efectivo y seguro en condiciones de práctica clínica habitual permitiendo ampliar las opciones de tratamiento activo en pacientes con EP.ABSTRACT: Introduction: Peyronie's disease (PD) impairs sexual activity reducing patient´s quality of life. In its chronic phase, the only treatments with evidence are surgery and local treatment with Collagenase of Clostridium Histolyticum (CCH). Purpose: To evaluate the effectiveness and safety of the use of CCH in clinical practice and its indirect comparison with surgical treatment. Material and methods: Retrospective cohort study of patients with stable phase PE selected to receive treatment with CCH or surgery, between Jan/2016 and Dec/2018 in a tertiary referral center. Descriptive and statistical analysis using degree of reduction of penile curvature as the main variable of effectiveness. As safety variable, adverse events related to treatment (AERT) were recorded. Results: 61 patients were included: 35 candidates for CCH and 26 for surgical treatment. The curvature was reduced -16.45⁰ (95% CI -21.19 - -11.71) with CCH and -46.87⁰ (95% CI -56.42 - -37.33) after surgery. There were 4 severe EART (hematoma), 3 after CCH and 1 after surgery. Conclusion: The treatment with CCH is effective and safe under conditions of usual clinical practice allowing to expand the options of active treatment in patients with PD.Grado en Medicin

Delayed Use of the Recombinant Human IL-1 Receptor Antagonist Anakinra in Five COVID-19 Patients with Pulmonary Fibrosis and Persistent Hypoxaemia: A Preliminary Report

Coronavirus disease 2019 (COVID-19) is currently a major public health problem. The development of pulmonary fibrosis secondary to acute respiratory distress syndrome (ARDS) is one of the expected sequelae. In this case series, we describe five instances of the use of anakinra in late-phase COVID-19 pneumonia in hospitalized patients with pulmonary fibrosis and refractory respiratory failure fulfilling ARDS criteria. The study demonstrates that anakinra has promising efficacy and safety in late-phase COVID-19 infection in patients with ARDS and refractory hypoxaemia, and suggests its potential application as antifibrotic therapy in these patients. Learning points: Up to one third of patients with severe COVID-19 pneumonia progress to acute respiratory distress syndrome (ARDS).Pulmonary fibrosis is a known consequence of ARDS.Our study shows promising results regarding the efficacy and safety of anakinra used in late-phase COVID-19 infection in patients with pulmonary fibrosis secondary to ARDS

Impacto dos níveis de pólen na utilização de serviços de saúde em Santiago de Compostela

Objective. To find out the impact of grass pollen levels on the use of primary care consultations for episodes of allergic rhinitis and asthma in Santiago de Compostela throughout a year.Method. A descriptive ecological study was carried out. The dichotomous variable “overconsultation” (weeks with a higher than expected number of consultations) was compared with pollen levels. In addition, episodes of asthma or allergic rhinitis were correlated with pollen counts, air pollutants and atmospheric conditions. The variables that were found to be associated were analysed by logistic regression.Results. “Overconsultation” caused by allergic rhinitis was significantly associated with high levels of grass pollen. A strong direct association was found between the number of episodes of allergic rhinitis and both pollen count and ozone levels. Pollen levels significantly influenced the existence of “overconsultation”, but no relationship was found between “overconsultation” and ozone levels. There was a significantly higher number of visits for asthma when grass pollen levels were high. A strong direct association was observed between episodes of asthma and both pollen count and ozone levels. These two factors significantly influenced the existence of “overconsultation”, but no relationship was found between “overconsultation” and grass pollen levels.Conclusions. The grass pollen level appears to increase the likelihood of primary care “overconsultation” for allergic rhinitis. However, no evidence was found that high grass pollen levels increase the number of primary care consultations caused by asthma.Objetivo. Conocer el impacto de los niveles de polen de gramíneas en la utilización de las consultas de atención primaria por episodios de rinitis alérgica y asma en Santiago de Compostela durante un año.Método. Se realizó un estudio ecológico descriptivo. Se comparó la variable dicotómica “sobreconsulta” (semanas con un número de consultas mayor al esperado) con los niveles de polen. Además, se correlacionaron los episodios de asma o rinitis alérgica con los recuentos de polen, los contaminantes atmosféricos y las condiciones atmosféricas. Las variables que mostraron asociación se analizaron mediante regresión logística.Resultados. Las sobreconsultas por rinitis alérgica se asocian significativamente con los niveles altos de gramíneas. Existe fuerte asociación directa del número de episodios de rinitis alérgica con el recuento de polen y con los niveles de ozono. Los niveles de polen influyen significativamente en la existencia de sobreconsultas pero no existe relación entre estas y los niveles de ozono. Existe un número significativamente mayor de consultas por asma cuando los niveles de polen de gramíneas son altos. Se observa fuerte asociación directa de los episodios de asma con el polen y con los niveles de ozono. Estos influyen significativamente en la existencia de sobreconsultas pero no existe relación entre estas y los niveles de gramíneas.Conclusiones. El nivel de polen de gramíneas parece aumentar la probabilidad de sobreconsultas en atención primaria por rinitis alérgica. No existe evidencia de que los niveles de polen de gramíneas aumenten el número de consultas en atención primaria por asma.Objetivo: Conhecer o impacto dos níveis de pólen de gramíneas na utilização de consultas de cuidados primários de saúde por episódios de rinite alérgica e asma, em Santiago de Compostela durante um ano.Método: Foi realizado um estudo ecológico descritivo. Comparou-se a variável dicotómica sobreconsulta (semanas com um número de consultas superior ao esperado) com os níveis de pólen. Também, se correlacionaram os episódios de asma ou rinite alérgica com a contagem de pólen, os contaminantes atmosféricos e as condições atmosféricas. As variáveis que comprovaram associação foram analisadas por regressão logística.Resultados: As sobreconsultas por rinite alérgica estão significativamente associadas com os altos níveis de gramíneas. Existe uma forte associação direta do número de episódios de rinite alérgica com a contagem de pólen e os níveis de ozono. Os níveis de pólen influenciam significativamente a existência de sobreconsultas mas não existe relação entre estas e os níveis de ozono. Existe um número significativamente maior de consultas para a asma quando os níveis de pólen de gramíneas são elevados. Observa-se uma forte associação direta dos episódios de asma com os níveis de pólen e com os níveis de ozono. Estes influenciam significativamente a existência de sobreconsultas mas não existe nenhuma relação entre estas e os níveis e gramíneas.Conclusões: O nível de pólen de gramíneas parece aumentar a probabilidade de sobreconsultas por rinite alérgica, nos cuidados primários de saúde. Não existe evidência de que os níveis de pólen de gramíneas aumentem o número de consultas, por asma, nos cuidados primários de saúde

A Cell Cycle Role for the Epigenetic Factor CTCF-L/BORIS

CTCF is a ubiquitous epigenetic regulator that has been proposed as a master keeper of chromatin organisation. CTCF-like, or BORIS, is thought to antagonise CTCF and has been found in normal testis, ovary and a large variety of tumour cells. The cellular function of BORIS remains intriguing although it might be involved in developmental reprogramming of gene expression patterns. We here unravel the expression of CTCF and BORIS proteins throughout human epidermis. While CTCF is widely distributed within the nucleus, BORIS is confined to the nucleolus and other euchromatin domains. Nascent RNA experiments in primary keratinocytes revealed that endogenous BORIS is present in active transcription sites. Interestingly, BORIS also localises to interphase centrosomes suggesting a role in the cell cycle. Blocking the cell cycle at S phase or mitosis, or causing DNA damage, produced a striking accumulation of BORIS. Consistently, ectopic expression of wild type or GFP- BORIS provoked a higher rate of S phase cells as well as genomic instability by mitosis failure. Furthermore, downregulation of endogenous BORIS by specific shRNAs inhibited both RNA transcription and cell cycle progression. The results altogether suggest a role for BORIS in coordinating S phase events with mitosis

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to <90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], >300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

A new potential cell cycle functions of epigenetic CTCF factors in human skin

Trabajo presentado como póster al "XIII Congreso Nacional de la Asociación Española de Investigación sobre el Cáncer" celebrado en Salamanca del 21 al 23 de septiembre de 2011.Peer Reviewe

Impacto de los niveles de polen en la utilización de los servicios sanitarios en Santiago de Compostela Impact of pollen levels on the use of health services in Santiago de Compostela Impacto dos níveis de pólen na utilização de serviços de saúde em Santiago de Compostela

Objetivo. Conocer el impacto de los niveles de polen de gramíneas en la utilización de las consultas de atención primaria por episodios de rinitis alérgica y asma en Santiago de Compostela durante un año.Método. Se realizó un estudio ecológico descriptivo. Se comparó la variable dicotómica “sobreconsulta” (semanas con un número de consultas mayor al esperado) con los niveles de polen. Además, se correlacionaron los episodios de asma o rinitis alérgica con los recuentos de polen, los contaminantes atmosféricos y las condiciones atmosféricas. Las variables que mostraron asociación se analizaron mediante regresión logística.Resultados. Las sobreconsultas por rinitis alérgica se asocian significativamente con los niveles altos de gramíneas. Existe fuerte asociación directa del número de episodios de rinitis alérgica con el recuento de polen y con los niveles de ozono. Los niveles de polen influyen significativamente en la existencia de sobreconsultas pero no existe relación entre estas y los niveles de ozono. Existe un número significativamente mayor de consultas por asma cuando los niveles de polen de gramíneas son altos. Se observa fuerte asociación directa de los episodios de asma con el polen y con los niveles de ozono. Estos influyen significativamente en la existencia de sobreconsultas pero no existe relación entre estas y los niveles de gramíneas.Conclusiones. El nivel de polen de gramíneas parece aumentar la probabilidad de sobreconsultas en atención primaria por rinitis alérgica. No existe evidencia de que los niveles de polen de gramíneas aumenten el número de consultas en atención primaria por asma.Objective. To find out the impact of grass pollen levels on the use of primary care consultations for episodes of allergic rhinitis and asthma in Santiago de Compostela throughout a year.Method. A descriptive ecological study was carried out. The dichotomous variable “overconsultation” (weeks with a higher than expected number of consultations) was compared with pollen levels. In addition, episodes of asthma or allergic rhinitis were correlated with pollen counts, air pollutants and atmospheric conditions. The variables that were found to be associated were analysed by logistic regression.Results. “Overconsultation” caused by allergic rhinitis was significantly associated with high levels of grass pollen. A strong direct association was found between the number of episodes of allergic rhinitis and both pollen count and ozone levels. Pollen levels significantly influenced the existence of “overconsultation”, but no relationship was found between “overconsultation” and ozone levels. There was a significantly higher number of visits for asthma when grass pollen levels were high. A strong direct association was observed between episodes of asthma and both pollen count and ozone levels. These two factors significantly influenced the existence of “overconsultation”, but no relationship was found between “overconsultation” and grass pollen levels.Conclusions. The grass pollen level appears to increase the likelihood of primary care “overconsultation” for allergic rhinitis. However, no evidence was found that high grass pollen levels increase the number of primary care consultations caused by asthma.Objetivo: Conhecer o impacto dos níveis de pólen de gramíneas na utilização de consultas de cuidados primários de saúde por episódios de rinite alérgica e asma, em Santiago de Compostela durante um ano.Método: Foi realizado um estudo ecológico descritivo. Comparou-se a variável dicotómica sobreconsulta (semanas com um número de consultas superior ao esperado) com os níveis de pólen. Também, se correlacionaram os episódios de asma ou rinite alérgica com a contagem de pólen, os contaminantes atmosféricos e as condições atmosféricas. As variáveis que comprovaram associação foram analisadas por regressão logística.Resultados: As sobreconsultas por rinite alérgica estão significativamente associadas com os altos níveis de gramíneas. Existe uma forte associação direta do número de episódios de rinite alérgica com a contagem de pólen e os níveis de ozono. Os níveis de pólen influenciam significativamente a existência de sobreconsultas mas não existe relação entre estas e os níveis de ozono. Existe um número significativamente maior de consultas para a asma quando os níveis de pólen de gramíneas são elevados. Observa-se uma forte associação direta dos episódios de asma com os níveis de pólen e com os níveis de ozono. Estes influenciam significativamente a existência de sobreconsultas mas não existe nenhuma relação entre estas e os níveis e gramíneas.Conclusões: O nível de pólen de gramíneas parece aumentar a probabilidade de sobreconsultas por rinite alérgica, nos cuidados primários de saúde. Não existe evidência de que os níveis de pólen de gramíneas aumentem o número de consultas, por asma, nos cuidados primários de saúde.</p

Seguimiento de enfermería en el tratamiento de las verrugas genitales

In the last years, patients infected with human papillomavirus (HPV) are more frequently seen in a Dermatologic clinic. In many occasions, they require to be managed not only by the dermatologist but also by the nurse. We herein present the protocol which has been designed in our Dermatology department to treat and follow-up patients with this infection, and we would like to state the important role of the nurse staff applying treatments and explaining safe sexual practices to the population.Los pacientes con infección por VPH son clientes cada vez más frecuentes en la consulta de Dermatología. Esto requiere en la actualidad un manejo conjunto por parte de la enfermera y dermatólogo. A continuación presentamos el protocolo que hemos diseñado en nuestra unidad para su seguimiento, y el papel tan importante que desempeña enfermería tanto en el tratamiento como en la educación sexual

Procedimiento ante la fotodermatosis de contacto

La fotodermatosis de contacto es una enfermedad dermatológica que aparece como consecuencia del contacto con diversos alergenos seguido de exposición a luz ultravioleta (UV) o luz visible, lo que produce reacción cutánea. Para su diagnóstico se utilizan los fotoparches, colocando unos alergenos en la espalda del paciente por duplicado e irradiando un juego a las 48 h. con 5 J/cm2. Ésta lectura es realizada por Enfermería. Se realiza una segunda lectura por el Dermatólogo a las 96 h., y en función de los resultados, se diagnostica de dermatosis de contacto fotosensible o no. Es necesario crear protocolos estandarizados realizados por un equipo multidisciplinar. Enfermería está capacitada no sólo para la realización de la técnica, sino también para la lectura y registro de los resultados obtenidos

Microencapsulated Isoniazid-Loaded Metal–Organic Frameworks for Pulmonary Administration of Antituberculosis Drugs

Tuberculosis (TB) is an infectious disease that causes a great number of deaths in the world (1.5 million people per year). This disease is currently treated by administering high doses of various oral anti-TB drugs for prolonged periods (up to 2 years). While this regimen is normally effective when taken as prescribed, many people with TB experience difficulties in complying with their medication schedule. Furthermore, the oral administration of standard anti-TB drugs causes severe side effects and widespread resistances. Recently, we proposed an original platform for pulmonary TB treatment consisting of mannitol microspheres (Ma MS) containing iron (III) trimesate metal–organic framework (MOF) MIL-100 nanoparticles (NPs). In the present work, we loaded this system with the first-line anti-TB drug isoniazid (INH) and evaluated both the viability and safety of the drug vehicle components, as well as the cell internalization of the formulation in alveolar A549 cells. Results show that INH-loaded MOF (INH@MIL-100) NPs were efficiently microencapsulated in Ma MS, which displayed suitable aerodynamic characteristics for pulmonary administration and non-toxicity. MIL-100 and INH@MIL-100 NPs were efficiently internalized by A549 cells, mainly localized in the cytoplasm. In conclusion, the proposed micro-nanosystem is a good candidate for the pulmonary administration of anti-TB drugs