Creación de un Cuerpo de Alienistas (1926).

La reorganización de los servicios de asistencia de los alienados exige que se cree en España el Cuerpo de Alienistas. El establecimiento de dicho Cuerpo facilitaría en todo caso la importante labor que en el transcurso de algunos años debe modificar radicalmente el actual estado de cosas; reuniría las iniciativas de los competentes, concretándolas en proyectos beneficiosos; serviría para organizar,  reglamentándolos, los servicios de inspección, tan necesarios; permitiría disponer, en condiciones que podrían señalarse como deberes inherentes a las categorías o puestos respectivos, la enseñanza de la Medicina mental; garantizaría en todo  momento la pericia del personal técnico, o, lo que es lo mismo, la eficiencia y el rendimiento de su trabajo; nos colocaría, en fin, en circunstancias análogas a las de los países que en el mundo civilizado se distinguen por el esmero con que atienden a todos los aspectos de la Sanidad y de la Beneficencia públicas

Creación de un Cuerpo de Alienistas (1926).

La reorganización de los servicios de asistencia de los alienados exige que se cree en España el Cuerpo de Alienistas. El establecimiento de dicho Cuerpo facilitaría en todo caso la importante labor que en el transcurso de algunos años debe modificar radicalmente el actual estado de cosas; reuniría las iniciativas de los competentes, concretándolas en proyectos beneficiosos; serviría para organizar,  reglamentándolos, los servicios de inspección, tan necesarios; permitiría disponer, en condiciones que podrían señalarse como deberes inherentes a las categorías o puestos respectivos, la enseñanza de la Medicina mental; garantizaría en todo  momento la pericia del personal técnico, o, lo que es lo mismo, la eficiencia y el rendimiento de su trabajo; nos colocaría, en fin, en circunstancias análogas a las de los países que en el mundo civilizado se distinguen por el esmero con que atienden a todos los aspectos de la Sanidad y de la Beneficencia públicas

Real-World Management and Clinical Outcomes of Stroke Survivors With Atrial Fibrillation: A Population-Based Cohort in Spain

Antiplatelets; Atrial fibrillation; Treatment strategiesAntiplaquetarios; Fibrilación auricular; Estrategias de tratamientoAntiplaquetàries; Fibril·lació auricular; Estratègies de tractamentObjective: Despite the continuous update of clinical guidelines, little is known about the real-world management of patients with atrial fibrillation (AF) who survived a stroke. We aimed to assess patterns of therapeutic management of stroke survivors with AF and clinical outcomes using data from routine practice in a large population-based cohort. Methods: A population-based retrospective cohort study of all patients with AF who survived a stroke, from January 2010 to December 2017 in the Valencia region, Spain (n = 10,986), was carried out. Treatment strategies and mean time to treatment initiation are described. Temporal trends are shown by the management pattern during the study period. Factors associated with each pattern (including no treatment) vs. oral anticoagulant (OAC) treatment were identified using logistic multivariate regression models. Incidence rates of clinical outcomes (mortality, stroke/TIA, GI bleeding, and ACS) were also estimated by the management pattern. Results: Among stroke survivors with AF, 6% were non-treated, 23% were prescribed antiplatelets (APT), 54% were prescribed OAC, and 17% received OAC + APT at discharge. Time to treatment was 8.0 days (CI 7.6–8.4) for APT, 9.86 (CI 9.52–10.19) for OAC, and 16.47 (CI 15.86–17.09) for OAC + APT. Regarding temporal trends, management with OAC increased by 20%, with a decrease of 50% for APT during the study period. No treatment and OAC + APT remained relatively stable. The strongest predictor of no treatment and APT treatment was having the same management strategy pre-stroke. Those treated with APT had the highest rates of GI bleeding and recurrent stroke/TIA, and untreated patients showed the highest rates of mortality. Conclusion: In this large population-based cohort using real-world data, nearly 30% of AF patients who suffered a stroke were untreated or treated with APT, which overall is not recommended. Treatment was started within 2 weeks as recommended, except for OAC + APT, which was started later. The strong association of APT treatment or non-treatment with the same treatment strategy before stroke occurrence suggests a strong therapeutic inertia and opposes recommendations. Patients under these two strategies had the highest rates of adverse outcomes. An inadequate prescription poses a great risk on patients with AF and stroke; thus monitoring their management is necessary and should be setting-specific.CR-B was funded at the start of this work by the Instituto de Salud Carlos III, Spanish Ministry of Health, co-financed by the European Regional Development Fund (grant number RD16/0001/0011) and currently through a competitive grant (Sara Borrell CD19/00137). FS-S was funded by the Instituto de Salud Carlos III, Spanish Ministry of Health through the REDISSEC network (grant number RD16/0001/0011). The views presented here are those of the authors and not necessarily those of the FISABIO Foundation, the Valencia Ministry of Health or the study sponsors

Sobre la variabilidad infraespecífica de Sideritis fruticulosa Pourr. (Labiatae)

The taxonomy, nomenclature, chorology and phytosociology of Sideritis fruticulosa (Labiatae) are reviewed. We propose the division of this taxon in four subspecies (subsp. fruticulosa, subsp. cavanillesii, subsp. ferreriana, and subsp. tarraconensis), one of which (subsp. ferreriana) is described in this paper. Besides, a new variety is proposed: S. fruticulosa subsp. cavanillesii var. illerdensis. The name Sideritis ×llenasii is lectotypifie

Simulation of electron transport and secondary emission in a photomultiplier tube and experimental validation

[EN] The electron amplification and transport within a photomultiplier tube (PMT) has been investigated by developing an in-house Monte Carlo simulation code. The secondary electron emission in the dynodes is implemented via an effective electron model and the Modified Vaughan¿s model, whereas the transport is computed with the Boris leapfrog algorithm. The PMT gain, rise time and transit time have been studied as a function of supply voltage and external magnetostatic field. A good agreement with experimental measurements using a Hamamatsu R13408-100 PMT was obtained. The simulations have been conducted following different treatments of the underlying geometry: three-dimensional, two-dimensional and intermediate (2.5D). The validity of these approaches is compared. The developed framework will help in understanding the behavior of PMTs under highly intense and irregular illumination or varying external magnetic fields, as in the case of prompt gamma-ray measurements during pencil-beam proton therapy; and aid in optimizing the design of voltage dividers with behavioral circuit models.This work was supported by Conselleria de Educación, Investigación, Cultura y Deporte (Generalitat Valenciana) under grant numbers CDEIGENT/2019/011 and CDEIGENT/2021/012. P. Martín-Luna is supported by the Ministerio de Universidades (Gobierno de España), Spain under Grant Number FPU20/04958. We thank Hamamatsu (V. Sánchez, D. Castrillo) for technical support and guidance; R. Carrasco (IFIC) and P. Wohlfahrt (Siemens Healthineers) for the CT scanning; D. Calvo and D. Real (KM3net-IFIC) for their LED test platform, the electronics and maintenance services at IFIC for excellent support; and K. Albiol, J. V. Casaña-Copado, A. Gallas Torreira, E. Lemos Cid, G. Pausch, A. Pazos Álvarez, E. Pérez Trigo, S. Rit, A. Ros, J. Roser, J. Stein, J. L. Taín and R. Viegas for useful discussions.Martín-Luna, P.; Esperante, D.; Fernández Prieto, A.; Fuster-Martínez, N.; García Rivas, I.; Gimeno, B.; Ginestar Peiro, D.... (2024). Simulation of electron transport and secondary emission in a photomultiplier tube and experimental validation. Sensors and Actuators A Physical. 365:1-10. https://doi.org/10.1016/j.sna.2023.11485911036

Educació farmacèutica en la prevenció de l'ictus

Treballs d'Educació Farmacèutica als ciutadans. Unitat Docent d'Estades en Pràctiques Tutelades. Facultat de Farmàcia, Universitat de Barcelona. Curs: 2018-2019. Tutors: Montserrat Iracheta i Marian March Pujol.Des de la farmàcia comunitària podem fer activitats assistencials per la millora en la qualitat de vida de les persones, sent les de caire preventiu de gran relevància. L’Ictus és l’alteració sobtada de la circulació de la sang al cervell així com la causant d’una gran discapacitat en la majoria de les persones que el pateixen. En aquest treball hem volgut apropar-nos a sanitaris (metges, infermers, farmacèutics) i pacients que estan relacionats amb aquest problema de salut, per que ens expliquessin que en pensen, com ho treballen i com ho viuen i el més important, com els farmacèutics comunitaris hi podem intervenir

Impact of the 2018 revised Pregnancy Prevention Programme by the European Medicines Agency on the use of oral retinoids in females of childbearing age in Denmark, Italy, Netherlands, and Spain: an interrupted time series analysis

Background: In March 2018, the European pregnancy prevention programme for oral retinoids was updated as part of risk minimisation measures (RMM), emphasising their contraindication in pregnant women.Objective: To measure the impact of the 2018 revision of the RMMs in Europe by assessing the utilisation patterns of isotretinoin, alitretinoin and acitretin, contraceptive measures, pregnancy testing, discontinuation, and pregnancy occurrence concomitantly with a retinoid prescription.Methods: An interrupted time series (ITS) analysis to compare level and trend changes after the risk minimisation measures implementation was conducted on a cohort of females of childbearing age (12–55 years of age) from January 2010 to December 2020, derived from six electronic health data sources in four countries: Denmark, Netherlands, Spain, and Italy. Monthly utilisation figures (incidence rates [IR], prevalence rates [PR] and proportions) of oral retinoids were calculated, as well as discontinuation rates, contraception coverage, pregnancy testing, and rates of exposed pregnancies to oral retinoids, before and after the 2018 RMMs.Results: From 10,714,182 females of child-bearing age, 88,992 used an oral retinoid at any point during the study period (mean age 18.9–22.2 years old). We found non-significant level and trend changes in incidence or prevalence of retinoid use in females of child-bearing age after the 2018 RMMs. The reason of discontinuation was unknown in >95% of cases. Contraception use showed a significant increase trend in Spain; for other databases this information was limited. Pregnancy testing was hardly recorded thus was not possible to model ITS analyses. After the 2018 RMM, rates of pregnancy occurrence during retinoid use, and start of a retinoid during a pregnancy varied from 0.0 to 0.4, and from 0.2 to 0.8, respectively.Conclusion: This study shows a limited impact of the 2018 RMMs on oral retinoids utilisation patterns among females of child-bearing age in four European countries. Pregnancies still occur during retinoid use, and oral retinoids are still prescribed to pregnant women. Contraception and pregnancy testing information was limited in most databases. Regulators, policymakers, prescribers, and researchers must rethink implementation strategies to avoid any pregnancy becoming temporarily related to retinoid use

ECMO for COVID-19 patients in Europe and Israel

Since March 15th, 2020, 177 centres from Europe and Israel have joined the study, routinely reporting on the ECMO support they provide to COVID-19 patients. The mean annual number of cases treated with ECMO in the participating centres before the pandemic (2019) was 55. The number of COVID-19 patients has increased rapidly each week reaching 1531 treated patients as of September 14th. The greatest number of cases has been reported from France (n = 385), UK (n = 193), Germany (n = 176), Spain (n = 166), and Italy (n = 136) .The mean age of treated patients was 52.6 years (range 16–80), 79% were male. The ECMO configuration used was VV in 91% of cases, VA in 5% and other in 4%. The mean PaO2 before ECMO implantation was 65 mmHg. The mean duration of ECMO support thus far has been 18 days and the mean ICU length of stay of these patients was 33 days. As of the 14th September, overall 841 patients have been weaned from ECMO support, 601 died during ECMO support, 71 died after withdrawal of ECMO, 79 are still receiving ECMO support and for 10 patients status n.a. . Our preliminary data suggest that patients placed on ECMO with severe refractory respiratory or cardiac failure secondary to COVID-19 have a reasonable (55%) chance of survival. Further extensive data analysis is expected to provide invaluable information on the demographics, severity of illness, indications and different ECMO management strategies in these patients

Impact of the 2018 revised Pregnancy Prevention Programme by the European Medicines Agency on the use of oral retinoids in females of childbearing age in Denmark, Italy, Netherlands, and Spain: an interrupted time series analysis

Background: In March 2018, the European pregnancy prevention programme for oral retinoids was updated as part of risk minimisation measures (RMM), emphasising their contraindication in pregnant women. Objective: To measure the impact of the 2018 revision of the RMMs in Europe by assessing the utilisation patterns of isotretinoin, alitretinoin and acitretin, contraceptive measures, pregnancy testing, discontinuation, and pregnancy occurrence concomitantly with a retinoid prescription. Methods: An interrupted time series (ITS) analysis to compare level and trend changes after the risk minimisation measures implementation was conducted on a cohort of females of childbearing age (12-55 years of age) from January 2010 to December 2020, derived from six electronic health data sources in four countries: Denmark, Netherlands, Spain, and Italy. Monthly utilisation figures (incidence rates [IR], prevalence rates [PR] and proportions) of oral retinoids were calculated, as well as discontinuation rates, contraception coverage, pregnancy testing, and rates of exposed pregnancies to oral retinoids, before and after the 2018 RMMs. Results: From 10,714,182 females of child-bearing age, 88,992 used an oral retinoid at any point during the study period (mean age 18.9-22.2 years old). We found non-significant level and trend changes in incidence or prevalence of retinoid use in females of child-bearing age after the 2018 RMMs. The reason of discontinuation was unknown in >95% of cases. Contraception use showed a significant increase trend in Spain; for other databases this information was limited. Pregnancy testing was hardly recorded thus was not possible to model ITS analyses. After the 2018 RMM, rates of pregnancy occurrence during retinoid use, and start of a retinoid during a pregnancy varied from 0.0 to 0.4, and from 0.2 to 0.8, respectively. Conclusion: This study shows a limited impact of the 2018 RMMs on oral retinoids utilisation patterns among females of child-bearing age in four European countries. Pregnancies still occur during retinoid use, and oral retinoids are still prescribed to pregnant women. Contraception and pregnancy testing information was limited in most databases. Regulators, policymakers, prescribers, and researchers must rethink implementation strategies to avoid any pregnancy becoming temporarily related to retinoid use