Use of gonadotropins in ovarian stimulation in Spain: Delphi consensus

Ovarian stimulation; In vitro fertilisation; Poor responderEstimulació ovàrica; Fecundació in vitro; Resposta pobreEstimulación ovárica; Fecundación in vitro; Respuesta pobreTwo-round Delphi study carried out in Spain. Three theme-based blocks were set out: 1) Patient profiles: therapeutic goal and parameters to be analysed according to POSEIDON patient profiles; 2) Ovarian stimulation protocols with antagonists: monotherapy (FSH) vs combined therapy (FSH + LH/HMG); 3) Safety and effectiveness of the devices. The antral follicle count and the anti-Müllerian hormone level were considered indicators that can be used to predict ovarian response. More than 80% of the participants agreed that FSH monotherapy is the recommended regimen in normal/hyper-responsive patients of < 35 years of age; that 150–300 IU is the dose to be used in ovarian stimulation in monotherapy depending on clinical parameters; and that FSH monotherapy improves patients’ comfort compared to two combined drugs. It was unanimously considered that the type of device used by the patient influences the comfort of the treatment.This project has been funded by Gedeon Richter. The sponsor took no part in designing, implementing, interpreting or writing the document. All the authors have accepted the participation in the group and give their consent for the publication of the document

Relationship between the place of living and mortality in patients with advanced heart failure

Social and environmental factors in advanced heart failure (HF) patients may be crucial to cope with the end stages of the disease. This study analyzes health inequalities and mortality according to place of residence (rural vs urban) in HF patients at advanced stages of the disease. Population-based cohort study including 1148 adult patients with HF attended in 279 primary care centers. Patients were followed for at least 1 year after reaching New York Heart Association IV functional class, between 2010 and 2014. Data came from primary care electronic medical records. Cox regression models were applied to determine the hazard ratios (HR) of mortality. Mean age was 81.6 (SD 8.9) years, and 62% were women. Patients in rural areas were older, particularly women aged > 74 years (p = 0.036), and presented lower comorbidity. Mortality percentages were 59 and 51% among rural and urban patients, respectively (p = 0.030). Urban patients living in the most socio-economically deprived neighborhoods presented the highest rate of health service utilization, particularly with primary care nurses (p-trend < 0.001). Multivariate analyses confirmed that men (HR 1.60, 95% confidence interval (CI) 1.34-1.90), older patients (HR 1.05, 95% CI 1.04-1.06), Charlson comorbidity index (HR 1.16, 95% CI 1.11-1.22), and residing in rural areas (HR 1.35, 95% CI 1.09 to 1.67) was associated with higher mortality risk. Living in rural areas determines an increased risk of mortality in patients at final stages of heart failure

La calidad peatonal como método para evaluar entornos de movilidad urbana

El creciente interés por integrar elementos de la estructura y el diseño de la ciudad en la evaluación y la gestión de la movilidad urbana ha contribuido al desarrollo de nuevos métodos e instrumentos que profundicen en este aspecto. La identificación de entornos de movilidad podría considerarse un avance conceptual y metodológico importante en este sentido, puesto que abre nuevas posibilidades para la generación de métodos que comprendan mejor la vinculación entre movilidad y entorno urbano desde una perspectiva que pueda ser útil en la práctica de la planificación. Este artículo se dirige a profundizar sobre la cuestión apuntada, particularizando en el caso específico de la movilidad peatonal. De este modo, se presenta el método de caracterización peatonal de entornos de movilidad (CPEM) como herramienta útil para evaluarlos desde el punto de vista de su calidad peatonal, utilizando los cuatro factores siguientes: accesibilidad, seguridad, confort y atracción. Para comprobar la consistencia y la utilidad de CPEM respecto a su objetivo inicial, éste ha sido aplicado al caso práctico de dos entornos de movilidad previamente identificados en un corredor del área metropolitana de Granada (España).El creixent interès per integrar elements de l'estructura i el disseny de la ciutat en l'avaluació i en la gestió de la mobilitat urbana ha contribuït a desenvolupar mètodes i instruments nous que aprofundeixin en aquest aspecte. La identificació d'entorns de mobilitat es podria considerar un avenç conceptual i metodològic important en aquest sentit, que obre noves possibilitats per a la generació de mètodes que comprenguin millor la vinculació entre mobilitat i entorn urbà des d'una perspectiva que pugui ser útil per practicar la planificació. Aquest article es dirigeix a aprofundir sobre la qüestió apuntada, particularitzant en el cas específic de la mobilitat de vianants. D'aquesta manera, es presenta el mètode de caracterització d'entorns de mobilitat per a vianants (CPEM) com a eina útil per avaluarne des del punt de vista de la qualitat que mostren per als vianants, utilitzant els quatre factors següents: accessibilitat, seguretat, confort i atracció. Per comprovar la consistència i la utilitat del CPEM respecte al seu objectiu inicial, aquest ha estat aplicat al cas pràctic de dos entorns de mobilitat prèviament identificats en un corredor de l'àrea metropolitana de Granada (Espanya).L'intérêt chaque fois plus grand, pour intégrer les éléments de la structure et le design de la ville en l'évaluation et aménagement de la mobilité urbaine, a contribué au développement de nouveaux méthodes et outils qui approfondissent cet aspect. L'identification des environnements de mobilité pourrait être considéré comme une avancée conceptuelle et méthodologique importante dans ce sens, ce qui ouvre de nouvelles possibilités pour générer des méthodes permettant de mieux comprendre le lien entre la mobilité et de l'environnement urbain dans une perspective qui peut être utile dans la pratique de planification. Cet article prétend approfondir cette question, en particularisant dans le cas spécifique de la mobilité piétonnière. De cette façon, on présente la méthode de Caractérisation Piétonnière d'Environnements de Mobilité (CPEM) comme une outil pour évaluer les environnements de mobilité dans le point de vue de sa qualité piétonnière, en utilisant les quatre facteurs suivants: accessibilité, sécurité, confort et attraction. Pour vérifier la consistance et l'utilité de CPEM par rapport à son objectif initial, on a appliqué au cas pratique de deux «environnements de mobilité» au préalable identifiés dans un corridor de l'agglomération urbaine de Grenade (Espagne).Over the last years there has been a growing interest to integrate structure, urban design and travel patterns. The incorporation of this knowledge into practice, namely mobility planning, has been positively affected by the development of new planning tools. Despite the innovation of mobility environment approach as a novel instrument for mobility planning, new methods seem to be needed. They aim to deepen our understanding of the relationships between urban structure and travel pattern through mobility environment concept. The article aims to gain insight into this problem using the particular case of pedestrian mobility. A method to characterize the pedestrian quality of mobility environments is presented here (CPEM). CPEM assesses the pedestrian quality through four walkability aspects: accessibility, security, comfort and attractiveness. To illustrate the worth of this method, a practical implementation to the context of the metropolitan area of Granada, Spain, is presented. The paper describes this case, explores the advantages and disadvantages of CPEM, and finally anticipates some issues for future research

Transmission of Similar Mcr-1 Carrying Plasmids among Different Escherichia coli Lineages Isolated from Livestock and the Farmer

Colistin use has mostly been stopped in human medicine, due to its toxicity. However, nowadays, it still is used as a last-resort antibiotic to treat hospital infections caused by multi-drug resistant Enterobacteriaceae. On the contrary, colistin has been used in veterinary medicine until recently. In this study, 210 fecal samples from pigs (n = 57), calves (n = 152), and the farmer (n = 1) were collected from a farm where E. coli harboring mcr-1-mcr-3 was previously detected. Samples were plated, and mcr-genes presence was confirmed by multiplex-PCR. Hybrid sequencing which determined the presence and location of mcr-1, other antibiotic resistance genes, and virulence factors. Eighteen colistin resistant isolates (13 from calves, four from pigs, and one from the farmer) contained mcr-1 associated with plasmids (IncX4, IncI2, and IncHI2), except for two that yielded mcr-1 in the chromosome. Similar plasmids were distributed in different E. coli lineages. Transmission of mcr-1 to the farmer most likely occurred by horizontal gene transfer from E. coli of calf origin, since plasmids were highly similar (99% coverage, 99.97% identity). Moreover, 33 virulence factors, including stx2 for Shiga toxin E. coli (STEC) were detected, highlighting the role of livestock as a reservoir of pathotypes with zoonotic potential.info:eu-repo/semantics/publishedVersio

Transmission of Similar Mcr-1 Carrying Plasmids among Different Escherichia coli Lineages Isolated from Livestock and the Farmer

Colistin use has mostly been stopped in human medicine, due to its toxicity. However, nowadays, it still is used as a last-resort antibiotic to treat hospital infections caused by multi-drug resistant Enterobacteriaceae. On the contrary, colistin has been used in veterinary medicine until recently. In this study, 210 fecal samples from pigs (n = 57), calves (n = 152), and the farmer (n = 1) were collected from a farm where E. coli harboring mcr-1-mcr-3 was previously detected. Samples were plated, and mcr-genes presence was confirmed by multiplex-PCR. Hybrid sequencing which determined the presence and location of mcr-1, other antibiotic resistance genes, and virulence factors. Eighteen colistin resistant isolates (13 from calves, four from pigs, and one from the farmer) contained mcr-1 associated with plasmids (IncX4, IncI2, and IncHI2), except for two that yielded mcr-1 in the chromosome. Similar plasmids were distributed in different E. coli lineages. Transmission of mcr-1 to the farmer most likely occurred by horizontal gene transfer from E. coli of calf origin, since plasmids were highly similar (99% coverage, 99.97% identity). Moreover, 33 virulence factors, including stx2 for Shiga toxin E. coli (STEC) were detected, highlighting the role of livestock as a reservoir of pathotypes with zoonotic potential

Dulaglutide as add-on therapy to SGLT-2 inhibitors in patients with inadequately controlled type 2 diabetes (AWARD-10): a 24-week, randomised , double-blind, placebo-controlled trial

BACKGROUND: The safety and efficacy of the once-weekly GLP-1 receptor agonist dulaglutide, added to an ongoing treatment regimen in patients inadequately controlled with SGLT2 inhibitors, with or without metformin was investigated. METHODS: This was a phase 3b, double-blind, placebo-controlled, 24-week study. Patients (≥18yrs), HbA1c ≥7.0% [53mmol/mol] and ≤9.5% [80mmol/mol]), BMI ≤45 kg/m2, stable doses of an SGLT2 inhibitor (±metformin) were randomly assigned (1:1:1) to dulaglutide 1.5 mg, dulaglutide 0.75 mg, or placebo. Patients and investigators were masked to treatment assignment (those assessing outcomes to study drug assignment). The primary objective was to test for the superiority of dulaglutide (1.5 mg or 0.75 mg) vs placebo for change in HbA1c from baseline to 24 weeks. RESULTS: 423 patients were randomly assigned to dulaglutide 1.5 mg (n=142), dulaglutide 0.75 mg (n=141), and placebo (n=140). Greater reduction in HbA1c at 24 weeks was seen in patients receiving dulaglutide (1.5 mg -1.34% [SE 0.06]/14.7 mmol/mol [0.6]; 0.75 mg -1.21% [0.06]/-13.2 mmol/mol [0.6]) than in patients receiving placebo (-0.54% [0.06]/-5.9 mmol/mol [0.6]; p<0.0001 for both groups vs placebo). Serious adverse events were reported for five patients in the dulaglutide 1.5 mg group, three in the dulaglutide 0.75 mg group, and five in the placebo group. Treatment-emergent adverse events were more common in patients treated with dulaglutide: nausea (21 [15%] patients in the dulaglutide 1.5 mg group vs seven [5%] in the dulaglutide 0.75 mg group vs five [4%] in the placebo group), diarrhoea (eight [6%] vs 14 [10%] vs four [3%]), and vomiting (five [4%] vs four [3%] vs one [1%]). One episode of severe hypoglycaemia was reported in the dulaglutide 0.75 mg group. CONCLUSIONS: Dulaglutide as add-on treatment to SGLT2 inhibitors (±metformin) resulted in significant and clinically relevant improvements in glycaemic control, with acceptable tolerability consistent with the established safety profile of dulaglutide

Epidemiological investigation of bovine tuberculosis herd breakdowns in Spain 2009/2011

We analyzed the most likely cause of 687 bovine tuberculosis (bTB) breakdowns detected in Spain between 2009 and 2011 (i.e., 22% of the total number of breakdowns detected during this period). Seven possible causes were considered: i) residual infection; ii) introduction of infected cattle from other herds; iii) sharing of pastures with infected herds; iv) contiguous spread from infected neighbor herds; v) presence of infected goats in the farm; vi) interaction with wildlife reservoirs and vii) contact with an infected human. For each possible cause a decision tree was developed and key questions were included in each of them. Answers to these key questions lead to different events within each decision tree. In order to assess the likelihood of occurrence of the different events a qualitative risk assessment approach was used. For this purpose, an expert opinion workshop was organized and ordinal values, ranging from 0 to 9 (i.e., null to very high likelihood of occurrence) were assigned. The analysis identified residual infection as the most frequent cause of bTB breakdowns (22.3%; 95%CI: 19.4-25.6), followed by interaction with wildlife reservoirs (13.1%; 95%CI: 10.8-15.8). The introduction of infected cattle, sharing of pastures and contiguous spread from infected neighbour herds were also identified as relevant causes. In 41.6% (95%CI: 38.0-45.4) of the breakdowns the origin of infection remained unknown. Veterinary officers conducting bTB breakdown investigations have to state their opinion about the possible cause of each breakdown. Comparison between the results of our analysis and the opinion from veterinary officers revealed a slight concordance. This slight agreement might reflect a lack of harmonized criteria to assess the most likely cause of bTB breakdowns as well as different perceptions about the importance of the possible causes. This is especially relevant in the case of the role of wildlife reservoirs