Epidemiología de la enfermedad celiaca en Aragón de 2016 a 2021. Aspectos nutricionales y vivencias de las personas afectadas

El objetivo del estudio es conocer el impacto que tiene esta enfermedad en Aragón en elperiodo 2016-2020, medido a través de los sistemas de información sanitaria establecidosen atención primaria (BDCAP) y especializada (RAE-CMBD).En atención primariaseleccionaremos todos aquellos episodios con un código CIAP: D99.01, mientras que enatención especializada seleccionaremos aquellos con un código CIE 10-ES de K90.0.De estos sistemas de información podremos conocer el perfil clínico y personal de laspersonas afectadas, así como la evolución de esta enfermedad.Un segundo aspecto del estudio se centra en conocer la disponibilidad de alimentos deventa on-line para personas celiacas en las grandes superficies de Aragón.Finalmente mediante un cuestionario ad-hoc, que distribuiremos a través de asociacionesde pacientes celiacos, conoceremos aspectos personales y sociologicos de como estaspersonas viven su enfermedad. Al recoger datos individualizados, será necesaria laautorización preceptiva del CEICA.<br /

factores que justifican la mortalidad al año de pacientes ingresados en una unidad de agudos de geriatría.

RESUMEN Objetivos: Determinar aquellos factores que puedan justificar de manera independiente la mortalidad al año en pacientes ingresados en una unidad de agudos de Geriatría. Material y métodos: Estudio analítico retrospectivo de pacientes ingresados en el servicio de Geriatría, en la unidad de agudos del Hospital Nuestra Señora de Gracia, durante los meses de junio y noviembre de 2014, con seguimiento al año de su fecha de alta. Como variable resultado se analizó la asociación entre distintas características biográficas, clínicas y patológicas, parámetros analíticos y otros factores asociados, con la mortalidad al año del alta. Resultados: Se estudiaron 318 pacientes, con una edad media de 87 años, cuyo antecedente médico más frecuente era la patología cardiovascular (82’39%), seguida de la neurológica (40’25%). En el ingreso fallecieron el 15’41% de los pacientes, durante los primeros 6 meses de seguimiento el 26’30%, y a los 12 meses el 10’15%. La estancia media del 50% de los pacientes fue de 9 días. Al ingreso el 77’99% presentaba polifarmacia y el 22’96% polifarmacia extrema. Los parámetros analíticos determinaron que: el 33’33% de los pacientes presentó prolactina elevada, el 68’14% anemia, el 46’47% proteínas totales <5 g/dl, el 25’40% valores de albumina <2g/dl. El 52% de los pacientes presentaban algún grado de demencia (GDS), el 23’7% un grado de dependencia total (Índice de Barthel); y el 67’3% obtuvieron puntuaciones 5 para el índice de comorbilidad de Charlson ajustado por edad. En el análisis multivariante, los antecedentes de infección (OR 2.124, IC 95% 1.089-4.166); índice de Barthel <60 (OR 4.04, IC 95% 1.771-9.26); anemia (OR 2.26, IC 95% 1.120-4.354); y polifarmacia (OR 2.26, IC 95% 1.057-4.831) se asociaron de forma independiente con mayor riesgo de mortalidad al año. La presencia de cirugía (OR 0.114, IC 95% 0.03-0.410) y de niveles altos de albumina (OR 0.049, IC 95% 0.253-0.796) lo hicieron como factores de buen pronóstico. Conclusiones: La anemia, la hipoalbuminemia, la polifarmacia y un índice de Bartthel <60, presentan asociación independiente con mayor mortalidad al año

Factors Associated with the Prescribing of High-Intensity Statins

In this study, we investigated the relationship between sociodemographic, clinical, anthropometric, and lifestyle characteristics and the type of statin prescribed for primary prevention of cardiovascular disease (CVD). We conducted an observational study in workers who began statin treatment. Statin therapy was categorized as "high-intensity" or "low-moderate-intensity". Workers were classified according to the alignment of their statin therapy with the recommended management practices. Logistic regression models were used to evaluate the association between the different variables studied and the probability of being prescribed high-intensity statins. The only variables associated with a higher probability of being treated with high-intensity statins were increased physical activity (>40 versus = 155 mg/dL versus <155 mg/dL; OR, 4.96; 95%CI, 1.29-19.10). The model that best predicted treatment intensity included LDL-C, diabetes, hypertension, smoking, and age (area under the Receiver Operating Characteristic curve (AUC), 0.620; 95%CI, 0.574-0.666). The prescribing and type of statin used in primary CVD prevention did not correspond with the indications in current guidelines. The probability of receiving high-intensity statins was higher in diabetics with high LDL-C levels and in more physically active individuals. These findings underscore the great variability and uncertainty in the prescribing of statins

La producción informal de viviendas: caso Maracaibo, Venezuela

In housing production in Venezuela and particularly in Maracaibo, we can recognize two main sectors: the "formal" sector production carried out by private and national enterprises, and the "informal" sector, which produces houses in marginal areas and uncontrolled suburbs in town. The production in this sector has become larger than the formal one. In act, in Maracaibo more than 60% of population is living in these types of suburbs. These people have resolved their housing need accordingly to their low income and outside of offer sector of formal production. This paper analyses the house from a physical point of view by studying the constructives components in relation to the socioeconomical aspects of the families and their direct participation in building and financing their house. Four stages of the physical consolidation of housing in suburbs were distinguish. This contribution as an analytic description of the physical situation of housing in studied areas, concluded giving some recommendations for the improvement of the informal process of housing production in Maracaibo.En la producción de viviendas en Maracaibo (Venezuela) existen dos sectores: el SECTOR FORMAL se refiere a la producción de la empresa privada más la producción estatal y el SECTOR INFORMAL que es la producción de viviendas en las áreas de barrios; la producción de este sector es mayor que la formal, llegando a ser el 60% de la población de Maracaibo. En Latinoamérica este fenómeno se presenta en la mayoría de las grandes ciudades. Este trabajo analiza la vivienda desde el punto de vista físico, relacionando los aspectos constructivos con los socioeconómicos, de participación en la construcción y del financiamiento. Se establecieron 4 etapas de consolidación de la vivienda de producción informal, caracterizando cada una de las etapas de acuerdo a los promedios y porcentajes obtenidos. Es un trabajo analítico-descriptivo cuya finalidad es conocer los patrones de consolidación de estas viviendas, con el objeto de realizar recomendaciones para el proceso y producción de la vivienda informal en Maracaibo

The ERA Registry Annual Report 2021: a summary

[EN] Background The European Renal Association (ERA) Registry collects data on kidney replacement therapy (KRT) in patients with end-stage kidney disease (ESKD). This paper is a summary of the ERA Registry Annual Report 2021, including a comparison across treatment modalities.Methods Data was collected from 54 national and regional registries from 36 countries, of which 35 registries from 18 countries contributed individual patient data and 19 registries from 19 countries contributed aggregated data. Using this data, incidence and prevalence of KRT, kidney transplantation rates, survival probabilities and expected remaining lifetimes were calculated.Result In 2021, 533.2 million people in the general population were covered by the ERA Registry. The incidence of KRT was 145 per million population (pmp). In incident patients, 55% were 65 years or older, 64% were male, and the most common primary renal disease (PRD) was diabetes (22%). The prevalence of KRT was 1040 pmp. In prevalent patients, 47% were 65 years or older, 62% were male, and the most common PRDs were diabetes and glomerulonephritis/sclerosis (both 16%). On 31 December 2021, 56% of patients received haemodialysis, 5% received peritoneal dialysis, and 39% were living with a functioning graft. The kidney transplantation rate in 2021 was 37 pmp, a majority coming from deceased donors (66%). For patients initiating KRT between 2012-2016, 5-year survival probability was 52%. Compared to the general population, life expectancy was 65% and 68% shorter for males and females receiving dialysis, and 40% and 43% shorter for males and females living with a functioning graft.The ERA Registry is funded by the European Renal Association (ERA). This article was written by B.A. Boerstra et al. on behalf of the ERA Registry, which is an official body of the ERA. P.B. reports payments from AstraZeneca and Takeda. S.B. reports consulting fees from GSK, Bayer, and AstraZeneca. A.C.A. reports payments from Diaverum Spain. F.J. reports payments from AstraZeneca, Boehringer Ingelheim, Servier, and Merck; and support for attending meetings and/or travel from Servier, AstraZeneca, Pfizer, and Fresenius. J.M. reports receiving support for attending meetings and/or travel from CSL Vifor. M.F.S.-R. reports receiving consulting fees from Baxter, Fresenius, and Nipro; payments from Baxter and Fresenius; and support for attending meetings and/or travel from Vifor, Fresenius, and Palex. I.Z. reports consulting fees from Astellas, Pharma, and Bayer; and payments from AstraZeneca, Bayer, Behringer Ingelheim, Norameda, and Swixx Biopharma. A.O. reports receiving grants from Sanofi; and consultancy or speaker fees or travel support from Advicciene, Astellas Pharma, AstraZeneca, Amicus, Amgen, Boehringer Ingelheim, Fresenius Medical Care, GSK, Bayer, Sanofi-Genzyme, Menarini, Mundipharma, Kyowa Kirin, Lilly, Alexion, Freeline, Idorsia, Chiesi, Otsuka, Novo-Nordisk, Sysmex, and Vifor Fresenius Medical Care Renal Pharma. K.J.J. reports receiving funds from ERA during the conduct of the study and grants from ESPN. V.S.S. reports receiving funds from ERA.Boerstra, BA.; Boenink, R.; Astley, ME.; Bonthuis, M.; Elhafeez, SA.; Arribas Monzón, F.; Asberg, A.... (2024). The ERA Registry Annual Report 2021: a summary. Clinical Kidney Journal. 17(2). https://doi.org/10.1093/ckj/sfad28117

Effectiveness of Protease Inhibitor Monotherapy versus Combination Antiretroviral Maintenance Therapy: A Meta-Analysis

The unparalleled success of combination antiretroviral therapy (cART) is based on the combination of three drugs from two classes. There is insufficient evidence whether simplification to ritonavir boosted protease inhibitor (PI/r) monotherapy in virologically suppressed HIV-infected patients is effective and safe to reduce cART side effects and costs

A combined analysis of the short-term effects of photochemical air pollutants on mortality within the EMECAM project.

In recent years, some epidemiologic studies have attributed adverse effects of air pollutants on health not only to particles and sulfur dioxide but also to photochemical air pollutants (nitrogen dioxide and ozone). The effects are usually small, leading to some inconsistencies in the results of the studies. Furthermore, the different methodologic approaches of the studies used has made it difficult to derive generic conclusions. We provide here a quantitative summary of the short-term effects of photochemical air pollutants on mortality in seven Spanish cities involved in the EMECAM project, using generalized additive models from analyses of single and multiple pollutants. Nitrogen dioxide and ozone data were provided by seven EMECAM cities (Barcelona, Gijón, Huelva, Madrid, Oviedo, Seville, and Valencia). Mortality indicators included daily total mortality from all causes excluding external causes, daily cardiovascular mortality, and daily respiratory mortality. Individual estimates, obtained from city-specific generalized additive Poisson autoregressive models, were combined by means of fixed effects models and, if significant heterogeneity among local estimates was found, also by random effects models. Significant positive associations were found between daily mortality (all causes and cardiovascular) and NO(2), once the rest of air pollutants were taken into account. A 10 microg/m(3) increase in the 24-hr average 1-day NO(2)level was associated with an increase in the daily number of deaths of 0.43% [95% confidence interval (CI), -0.003-0.86%] for all causes excluding external. In the case of significant relationships, relative risks for cause-specific mortality were nearly twice as much as that for total mortality for all the photochemical pollutants. Ozone was independently related only to cardiovascular daily mortality. No independent statistically significant relationship between photochemical air pollutants and respiratory mortality was found. The results in this study suggest that, given the present levels of photochemical pollutants, people living in Spanish cities are exposed to health risks derived from air pollution

Preclinical and clinical characterization of fibroblast-derived neuregulin-1 on trastuzumab and pertuzumab activity in HER2-positive breast cancer

[Purpose]: To characterize expression of neuregulin-1 (NRG1), an HER3 ligand, in HER2-positive breast cancer and its relation with the efficacy of trastuzumab with or without pertuzumab.[Experimental Design]: Characterization of NRG1 expression in tumor cell lines, in tumor specimens, and in cancer-associated fibroblasts (CAFs). Patient-derived CAFs were used to investigate NRG1 impact on the activity of trastuzumab with or without pertuzumab in HER2-positive breast cancer cells. The relationship between NRG1 expression and pathologic response to anti-HER2–based neoadjuvant therapy was assessed in a retrospective patient cohort and in the NeoSphere trial.[Results]: NRG1 was expressed in HER2-positive breast cancer–derived fibroblasts at significantly higher levels than in cancer cells. NRG1 and the conditioned media (CM) from CAFs phosphorylated HER3 and AKT in cancer cells and mediated trastuzumab resistance. Stable genetic depletion of NRG1 from CAFs overcame trastuzumab resistance. Pertuzumab effectively suppressed trastuzumab resistance mediated by either NRG1 or CAF's CM. NRG1 engaged an epithelial-to-mesenchymal transition that was prevented by trastuzumab and pertuzumab. In clinical samples, stromal and/or tumor cell expression of NRG1 determined by immunohistochemistry was uncommon (13.2%) yet significantly linked with residual disease following trastuzumab-based neoadjuvant therapy. In the NeoSphere trial, the magnitude of the difference of pathologic complete response rates favoring the pertuzumab arm was higher in the NRG1-high group.[Conclusions]: CAF-derived NRG1 mediates trastuzumab resistance through HER3/AKT, which might be reverted by pertuzumab. In patients with HER2-positive breast cancer, high expression of NRG1 was associated to poor response to trastuzumab, but not in combination with pertuzumab.This work is supported by ISCIII (CIBERONC CB16/12/00481, CB16/12/00241, PI18/00382, PI18/00006, PI18/01219 and by Generalitat de Catalunya (2017 SGR 507). S. Menendez is supported by Department de Salut, Generalitat de Catalunya (PERIS SLT006/17/00040). MARBiobanc is supported by ISCiii/FEDER (PT17/0015/0011) and by “Xarxa de Bancs de tumors” sponsored by Pla Director d’ Oncologia de Catalunya (XBTC) and Fundacion Jimenez Díaz Biobanks Platform by PT13/0010/0012 grant. Ministry of Economy and Competitiveness of Spain (BFU2015-71371-R) and the CRIS Cancer Foundation provides support to A. Pandiella. Work carried out in our laboratories receive support from the European Community through the Regional Development Funding Program (FEDER). J.C. Montero is funded by the ISCIII through a Miguel Servet program (CPII17/00015) and receives research support from the same institution (PI18/00796). J. Albanell is supported by Breast Cancer Research Foundation (BCRF20-08), Instituto de Salud Carlos III Project Reference number AC15/00062 and the EC under the framework of the ERA-NET TRANSCAN-2 initiative co-financed by FEDER, Instituto de Salud Carlos III (CB16/12/00449 and PI19/01181), and Asociacion Espanola Contra el Cáncer (AECC)

El reto de profesionalizar la salud pública

Somos profesionales de la salud pública, aunque nuestras familias siguen sin saber a qué nos dedicamos. No es lo contrario de la salud privada: es la salud de y para toda la población. Dada la complejidad que esta definición entraña y la confusión semántica inherente al adjetivo “público”, los profesionales de la salud pública nos enfrentamos con frecuencia al reto de tener que justificar nuestra existencia.N