Diagnóstico precoz de melanoma con dermatoscopia

La dermatoscopia es una técnica diagnóstica de amplio uso en dermatología, que fue inicialmente diseñada para el diagnóstico precoz de melanoma y se ha extendido a la patología tumoral benigna y la patología inflamatoria. Recientemente se ha publicado una muy importante revisión Cochrane sobre la dermatoscopia, con y sin inspección visual, para el diagnóstico de melanoma en adultos que indica que es más exacta cuando se interpreta con el paciente presente. Existen diferentes equipos y tipos de luz, polarizada y no polarizada. Aunque existen aplicaciones de la dermatoscopia en patología inflamatoria y tumoral benigna, nos centraremos en la mejoría diagnóstica del melanoma pues un retraso diagnóstico de una lesión que es un melanoma puede conllevar un retraso en la extirpación, mayor espesor de Breslow y un peor pronóstico con riesgo de metátasis y fallecimiento. Se han descrito los diferentes criterios dermatoscópicos para los diferentes tipos de melanomas (extensión superficial, nodular, lentigo maligno melanoma, lentiginoso acral, subungueal, de mucosas, nevoide y melanoma sobre nevus congénito). Se debe tener especial cuidado con la detección de melanomas en cuero cabelludo, por su peor pronóstico. En pacientes de alto riesgo de melanoma, con múltiples nevusatípicos y o antecedentes de varios melanomas en familiares; se aconsejan las pruebas de seguimiento con fotografía corporal total y dermatoscopia digital.Dermoscopyis a widely used diagnostic technique in dermatology, initially designed for early diagnosis of melanoma extended to diagnosis of benigns tumors and inflammatory pathology. Recently a very important Cochrane about dermoscopy, with and without visual inspection, has been published; indicating that dermoscopy is more accurate for diagnosis of melanoma when patient is present. There are different types of dermoscopy, polarized and non polarized. Although there are applications of dermoscopy for inflammatory and benign pathology, we will concentrate on improvement on diagnosis of melanoma. A delay in diagnosis of melanoma will lead to delay in surgery, greater Breslow thickness and worse prognosis with risk of metastasis and death. Criteria for different types of melanoma have been described (superficial spreading, nodular, lentigo maligno melanoma, acral lentiginous, subungueal, mucosa, nevoid and melanoma in congenital nevus). Detection of scalp melanoma may be taken into consideration due to worse prognosis. In high risk patients for melanoma, total photography and digital dermoscopy are recommended

Switching to Glycerol Phenylbutyrate in 48 Patients with Urea Cycle Disorders: Clinical Experience in Spain

Background and objectives: Glycerol phenylbutyrate (GPB) has demonstrated safety and efficacy in patients with urea cycle disorders (UCDs) by means of its clinical trial program, but there are limited data in clinical practice. In order to analyze the efficacy and safety of GPB in clinical practice, here we present a national Spanish experience after direct switching from another nitrogen scavenger to GPB. Methods: This observational, retrospective, multicenter study was performed in 48 UCD patients (age 11.7 ± 8.2 years) switching to GPB in 13 centers from nine Spanish regions. Clinical, biochemical, and nutritional data were collected at three different times: prior to GPB introduction, at first follow-up assessment, and after one year of GPB treatment. Number of related adverse effects and hyperammonemic crisis 12 months before and after GPB introduction were recorded. Results: GPB was administered at a 247.8 ± 102.1 mg/kg/day dose, compared to 262.6 ± 126.1 mg/kg/day of previous scavenger (46/48 Na-phenylbutyrate). At first follow-up (79 ± 59 days), a statistically significant reduction in ammonia (from 40.2 ± 17.3 to 32.6 ± 13.9 μmol/L, p < 0.001) and glutamine levels (from 791.4 ± 289.8 to 648.6 ± 247.41 μmol/L, p < 0.001) was observed. After one year of GPB treatment (411 ± 92 days), we observed an improved metabolic control (maintenance of ammonia and glutamine reduction, with improved branched chain amino acids profile), and a reduction in hyperammonemic crisis rate (from 0.3 ± 0.7 to less than 0.1 ± 0.3 crisis/patients/year, p = 0.02) and related adverse effects (RAE, from 0.5 to less than 0.1 RAEs/patients/year p < 0.001). Conclusions: This study demonstrates the safety of direct switching from other nitrogen scavengers to GPB in clinical practice, which improves efficacy, metabolic control, and RAE compared to previous treatments.This study was funded by AECOM (Spanish Association for the Study of Inborn Errors of Metabolism). Immedica Pharma Spain funded medical writing support and article processing charges

Prácticas de Aprendizaje-servicio a través de la literatura y el cine en el Grado de Estudios Ingleses: Creación de un archivo virtual de pedagogías y acciones disidentes contra los discursos de miedo

Memoria ID-067 Ayudas de la Universidad de Salamanca para la innovación docente, curso 2020-2021

Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy:Study protocol of a cluster randomized clinical trial (Multi-PAP project)

This study was funded by the Fondo de Investigaciones Sanitarias ISCIII (Grant Numbers PI15/00276, PI15/00572, PI15/00996), REDISSEC (Project Numbers RD12/0001/0012, RD16/0001/0005), and the European Regional Development Fund ("A way to build Europe").Background: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT02866799Publisher PDFPeer reviewe

Biblioterapia: lecturas saludables.

O obxectivo deste documento é difundir o proxecto de biblioterapia entre pacientes e público en xeral. Este proxecto xurdiu durante unha colaboración da Consellería de Sanidade con pacientes afectados por depresión e as súas familias. Con este punto de partida, a Axencia Galega para a Xestión do Coñecemento en Saúde comezou a traballar na articulación dunha iniciativa para revisar a evidencia científica dispoñible sobre o uso dos libros con fins terapéuticos e na implementación do proxectoEl objetivo de este documento es difundir el proyecto de biblioterapia entre pacientes y público en general. Este proyecto surgió durante una colaboración de la Consellería de Sanidad con pacientes afectados por depresión y sus familias. Con este punto de partida, la Agencia Gallega para la Gestión del Conocimiento en Salud comenzó a trabajar en la articulación de una iniciativa para revisar la evidencia científica disponible sobre el uso de los libros con fines terapéuticos y en la implementación del proyect

El derecho de propiedad y el acceso a la vivienda ante un nuevo escenario inmobiliario: Retos y problemas. Libro de resúmenes del VI Congreso Iberoameriano de Derecho Inmobiliario

Resúmenes del VI Congreso Iberoamericano de Derecho Inmobiliario celebrado del 29 de septiembre al 1 de octubre de 2021 en Madrid organizado por la Cátedra UC3M - UCEN de Derecho Inmobiliario y la Universidad Francisco de Vitoria.Grabación de la primera jornada 29 septiembre 2021: https://www.youtube.com/watch?v=PD98tXgvMwI .-- Gabración de la segunda jornada 30 septiembre 2021: https://www.youtube.com/watch?v=Wo0dlkzHFQE . -- Grabación de la tercera jornada 1 octubre 2021: https://www.youtube.com/watch?v=hJigjXBB04YEl trabajo "La propiedad superficiaria, la propiedad temporal y la propiedad compartida como formas alternativas para la adquisición de vivienda" de Chantal Moll de Alba forma parte del Proyecto de investigación financiado por el Ministerio de Ciencia, Innovación y Universidades “Consumidor y vivienda: acceso, financiación y resolución de conflictos” (2019-2021) PGC2018-096260-B-C21.El fenómeno de la okupación en Chile / Francisco Javier Talep Pardo (p. 9). -- El Derecho Civil en la encrucijada: la progresiva influencia de los derechos fundamentales y humanos en la "okupación de viviendas" / Héctor Simón Moreno (p. 10- ). -- Ocupación y desahucios. Problemática procesal civil y propuestas de Lege Ferenda / Alejandro Fuentes-Lojo Ríus (p. 11). -- El papel del registro de la propiedad ante la "okupación" / José Blas Pau Echave-Sustaeta (p. 12). -- Régimen jurídico del suelo y expropiación en España / Antonio Descalzo González (pp. 14-15). -- Unicidad vs estanqueidad. La unicidad de valores como criterio justo y coherente en las valoraciones para la Administración: principio general de la buena fe / Antonio Eduardo Humero Martín (p. 16). -- La permuta real forzosa como medio indirecto de expropiación / Gilberto Mendoza de Maestro (p. 17). -- El tratamiento de la ocupación ilegal en la ejecución sobre bienes inmuebles: la experiencia española / Antonio Martínez Santos (p. 19). -- Límites a la propiedad inmobiliaria en las leyes sobre vivienda. (La función social de la vivienda) / Remedios Aranda Rodríguez (pp. 20-21). -- Propiedad, propiedades y su afectación por la función social / Mónica Muñoz-Alonso López (p. 22). -- Las comunidades de propietarios ante la ocupación ilegal de una vivienda / María Rosario Martín Briceño (p. 24). -- El fenómeno "okupa" y la vulneración de los derechos fundamentales / Carmen Iglesias Martín (pp. 25-26). -- Propiedad privada y derecho natural en la Escuela Kantiana / Jesús Miguel Santos Román (p. 27). -- La Administración Pública ante los casos de ocupación ilegal de inmuebles. Procedimientos de recuperación posesoria / Elena Sánchez Utrilla (p. 28). -- El alquiler social / Emilio Murcia Quintana (p. 31). -- Modelos de gestión de vivienda social en clave europea / Nuria Lambea Llop (p. 32). -- La protección del arrendamiento de vivienda y el registro de propiedad / Pilar Verdejo García (p. 33). -- La posesión sin título habilitante en el DL. 2695 de 1979 en Chile / Santiago Zárate González (p. 35). -- Diáspora habitacional en el entorno rural / Manuel Ignacio Feliú Rey (p. 36). -- La propiedad superficiaria, la propiedad temporal y la propiedad compartida como formas alternativas para la adquisición de vivienda / Chantal Moll de Alba (pp. 37-38). -- Soluciones habitacionales en derecho comparado / Ana María de la Encarnación (p. 39). -- El derecho de propiedad y vivienda: perfiles constitucionales legales / Ángel Juárez Torrejón (pp. 41-42). -- Medidas fiscales y vivienda: una perspectiva comparada / Sofía Borgia Sorrosal (p. 43). -- Creando un mercado para la eficiencia energética de los edificios: medidas tributarias de apoyo / Zulema Calderón Corredor (p. 44). -- El fideicomiso inmobiliario como instrumento para mitigar el déficit habitacional en Iberoamérica / Maridalia Rodríguez-Padilla (pp. 46-47). -- Fomento del alquiler residencial: medidas de incentivo y garantías al propietario arrendador / Beatriz Sáenz de Jubera Higuero (pp. 48-49). -- Derecho de propiedad y normativa urbanística en relación con el patrimonio arquitectónico rural andaluz / Elena Romero Cañabate y Gema Ramírez Pacheco (p. 50). -- Registro de la propiedad y nuevas tecnologías / Javier Gómez Gálligo (pp. 52-53). -- El documento electrónico notarial / Marco Antonio Sepúlveda Larroucau (p. 55). -- Tokenización y activos físicos inmobiliarios / Jesús Sieira y Jimena Campuzano (p. 56). -- La contratación inmobiliaria en plataformas / Teresa Rodríguez de las Heras Ballell (p. 57). -- La financiación de la actividad inmobiliaria a través de plataformas de crowdfunding inmobiliario / Teresa Asunción Jiménez París (p. 59). -- El fideicomiso como mecanismo para la mitigación de riesgo en el crowdfunding inmobiliario en México / Eduardo Rocha Núñez (p. 60). -- Transmisión propiedad inmobiliaria y nuevas tecnologías / María Goñi Rodríguez de Almeida (p. 62). -- La garantía funcional de los edificios inteligentes / Alejandro Zornoza Somolinos (p. 63). -- Ciudades inteligentes y la tributación al desarrollo / Diego Bisi Almada (p. 65). -- Blockchain y tokenización para la inversión inmobiliaria / Pedro Barreda García y Gema Ramírez Pacheco (p. 66). -- El futuro de la valoración inmobiliaria. Big data y modelos AVM / Andrea San José Cabrero (p. 67). -- Reflexiones sobre la contratación con plataformas digitales intermediarias en el sector inmobiliario / Pastora de Artíñano Marra (pp. 68)

Toxicity of Asciminib in Real Clinical Practice: Analysis of Side Effects and Cross-Toxicity with Tyrosine Kinase Inhibitors

(1) Background: Despite the prognostic improvements achieved with tyrosine kinase inhibitors (TKIs) in chronic myeloid leukemia (CML), a minority of patients still fail TKIs. The recent introduction of asciminib may be a promising option in intolerant patients, as it is a first-in-class inhibitor with a more selective mechanism of action different from the ATP-competitive inhibition that occurs with TKIs. Therefore, our goal was to analyze toxicities shown with asciminib as well as to study cross-toxicity with previous TKIs. (2) Methods: An observational, multicenter, retrospective study was performed with data from 77 patients with CML with therapeutic failure to second-generation TKIs who received asciminib through a managed-access program (MAP) (3) Results: With a median follow-up of 13.7 months, 22 patients (28.5%) discontinued treatment: 32% (7/22) due to intolerance and 45% (10/22) due to resistance. Fifty-five percent of the patients reported adverse effects (AEs) with asciminib and eighteen percent grade 3&ndash;4. Most frequent AEs were: fatigue (18%), thrombocytopenia (17%), anemia (12%), and arthralgias (12%). None of the patients experienced cardiovascular events or occlusive arterial disease. Further, 26%, 25%, and 9% of patients required dose adjustment, temporary suspension, or definitive discontinuation of treatment, respectively. Toxicities under asciminib seemed lower than with prior TKIs for anemia, cardiovascular events, pleural/pericardial effusion, diarrhea, and edema. Cross-toxicity risk was statistically significant for thrombocytopenia, anemia, neutropenia, fatigue, vomiting, and pancreatitis. (4) Conclusion: Asciminib is a molecule with a good safety profile and with a low rate of AEs. However, despite its new mechanism of action, asciminib presents a risk of cross-toxicity with classical TKIs for some AEs

Toxicity of Asciminib in Real Clinical Practice: Analysis of Side Effects and Cross-Toxicity with Tyrosine Kinase Inhibitors

Simple Summary After the recent irruption of asciminib into the therapeutic arsenal for chronic myeloid leukemia, real-life data remain scarce to determine which patients may benefit most from this drug. Data on the efficacy of the drug in real-world setting have been reported, but a detailed analysis of the toxicity profile and the influence of prior intolerance to classical tyrosine kinase inhibitors (TKIs) has not been performed. The aim of the present analysis is to study in detail the toxicity profile of asciminib as well as to describe the risk of cross-toxicity with classical TKIs. These results may help to select the patient profile with the best chance of therapeutic success with asciminib monotherapy. (1) Background: Despite the prognostic improvements achieved with tyrosine kinase inhibitors (TKIs) in chronic myeloid leukemia (CML), a minority of patients still fail TKIs. The recent introduction of asciminib may be a promising option in intolerant patients, as it is a first-in-class inhibitor with a more selective mechanism of action different from the ATP-competitive inhibition that occurs with TKIs. Therefore, our goal was to analyze toxicities shown with asciminib as well as to study cross-toxicity with previous TKIs. (2) Methods: An observational, multicenter, retrospective study was performed with data from 77 patients with CML with therapeutic failure to second-generation TKIs who received asciminib through a managed-access program (MAP) (3) Results: With a median follow-up of 13.7 months, 22 patients (28.5%) discontinued treatment: 32% (7/22) due to intolerance and 45% (10/22) due to resistance. Fifty-five percent of the patients reported adverse effects (AEs) with asciminib and eighteen percent grade 3-4. Most frequent AEs were: fatigue (18%), thrombocytopenia (17%), anemia (12%), and arthralgias (12%). None of the patients experienced cardiovascular events or occlusive arterial disease. Further, 26%, 25%, and 9% of patients required dose adjustment, temporary suspension, or definitive discontinuation of treatment, respectively. Toxicities under asciminib seemed lower than with prior TKIs for anemia, cardiovascular events, pleural/pericardial effusion, diarrhea, and edema. Cross-toxicity risk was statistically significant for thrombocytopenia, anemia, neutropenia, fatigue, vomiting, and pancreatitis. (4) Conclusion: Asciminib is a molecule with a good safety profile and with a low rate of AEs. However, despite its new mechanism of action, asciminib presents a risk of cross-toxicity with classical TKIs for some AEs