Prevalencia y factores de riesgo de la neoplasia intraepitelial anal en una cohorte de pacientes infectados por VIH

Tesis doctoral inédita leída en la Universidad Autónoma de Madrid. Facultad de Medicina, Departamento de Medicina. Fecha de lectura: 18 de Mayo de 2012

Social Media Fingerprints of Unemployment

Anexo: Supporting Information. This file contains Figures A-I, Tables A-F and Sections A-I.Recent widespread adoption of electronic and pervasive technologies has enabled the study of human behavior at an unprecedented level, uncovering universal patterns underlying human activity, mobility, and interpersonal communication. In the present work, we investigate whether deviations from these universal patterns may reveal information about the socio-economical status of geographical regions. We quantify the extent to which deviations in diurnal rhythm, mobility patterns, and communication styles across regions relate to their unemployment incidence. For this we examine a country-scale publicly articulated social media dataset, where we quantify individual behavioral features from over 19 million geo-located messages distributed among more than 340 different Spanish economic regions, inferred by computing communities of cohesive mobility fluxes. We find that regions exhibiting more diverse mobility fluxes, earlier diurnal rhythms, and more correct grammatical styles display lower unemployment rates. As a result, we provide a simple model able to produce accurate, easily interpretable reconstruction of regional unemployment incidence from their social-media digital fingerprints alone. Our results show that cost-effective economical indicators can be built based on publicly-available social media datasets.Partial funding came from the Spanish Ministry of Economy and Competitiveness through grant FIS2013-47532-C3-3-P, the Australian Government, and the Australian Research Council. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

Improving the Management and Follow-up of Atopic Dermatitis: A Delphi Process Report of Consensus Between Hospital Dermatologists and Pharmacists

[spa] El control de la dermatitis atópica (DA), una de las dermatosis más frecuentes, es en muchas ocasiones un reto terapéutico. En el presente estudio se ha utilizado la metodología Delphi con el objetivo de poner en común las perspectivas del dermatólogo y del farmacéutico hospitalario ante el manejo de la DA y establecer una serie de recomendaciones de actuación adaptadas a las diferentes situaciones que plantea la enfermedad. El cuestionario Delphi ha sido definido por un comité científico y se ha dividido en 2 bloques: (1) valoración de la respuesta al tratamiento del paciente con DA y (2) cooperación entre Dermatología y Farmacia Hospitalaria (FH). Como resultado del estudio, se ha alcanzado un consenso total del 86%. Se concluye que el dermatólogo y el farmacéutico hospitalario deben tener una buena comunicación y trabajar coordinados para conseguir optimizar el manejo del paciente con DA y su respuesta al tratamiento.[eng] Managing atopic dermatitis, one of the most common dermatologic conditions, is often challenging. To establish consensus on recommendations for responding to various situations that arise when treating atopic dermatitis, a group of hospital pharmacists and dermatologists used the Delphi process. A scientific committee developed a Delphi survey with 2 blocks of questions to explore the group's views on 1) evaluating response to treatment in the patient with atopic dermatitis and 2) cooperation between the dermatology department and the hospital pharmacy service. The experts achieved an overall rate of consensus of 86% during the process. Conclusions were that dermatologists and hospital pharmacists must maintain good communication and coordinate their interventions to optimize the management of atopic dermatitis and patients' responses to treatment

Promoting clinical pharmacy services through advanced medication review in the emergency department

Objectives: To determine if an advanced medication review carried out in the emergency departmen t (ED) increases the number of pharmacotherapy recommendations (PR) and the severity of the detected prescribing errors.Methods: We designed an analytic observational prospective cohort study with preintervention assessment (PRE) and postintervention assessment (POST). In PRE, prescription review was done by pharmacists located in the pharmacy department; they took into account only the information provided by the computerised physician order entry system. In POST, pharmacists were physically present in the ED and performed an advanced medication review. The main variables were number of PR and the severity of detected prescribing errors according to the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) severity index. Clinical variables were number of calls to physicians on duty during the first 48 hours of admission, readmissions at 30 days, visits to the ED at 30 days, inhospital mortality and length of stay.Results: The study population comprised 102 patients (51 in PRE and 51 in POST). In PRE, the number of PR per patient was 1.1; in POST, this value increased by 53% (1.7 PR per patient; P=0.014), especially in the case of PR related to home medications. The severity of prescribing errors was higher in POST (P=0.004). There was a trend towards better results for all clinical outcomes in POST although statistical significance was not reached.Conclusions: An advanced medication review in the ED increases the number of PR and the severity of the detected prescribing errors

Efficacy and safety of topical roflumilast for the treatment of psoriasis: A systematic review and meta-analysis of randomized controlled trials

Background and Objective: Plaque psoriasis is commonly treated topically with glucocorticoids and vitamin D derivatives. However, potential side effects such as skin atrophy underscore the need for safe and effective alternative topical therapies. Recently, the US Food and Drug Administration (FDA) and Health Canada approved roflumilast 0.3% cream as an option for treating this disease. A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted to assess the efficacy and safety of topical roflumilast 0.3% compared with vehicle for plaque psoriasis. Methods: PubMed, Embase, ClinicalTrials.gov, and Cochrane databases were searched from inception to 1 May 2024, assessing the outcomes of Investigator’s Global Assessment (IGA) or body-IGA success (clear or almost clear status plus an at least 2-grade improvement from baseline), Psoriasis Area and Severity Index (PASI)-50, PASI-75, PASI-90, intertriginous-IGA success (clear or almost clear status on the intertriginous-IGA plus an at least 2-grade improvement from baseline), and adverse events (AEs). Statistical analysis was performed using Review Manager, R software, and RStudio. Heterogeneity was determined using the Cochran Q test and I2 statistics. Results: Four RCTs were included, comprising a total of 1403 patients, of whom 885 (63.1%) received topical roflumilast 0.3% and 518 (36.9%) received vehicle. At week 8, the achievement of IGA or body-IGA success was significantly higher among those treated with topical roflumilast than in the vehicle group [relative risk (RR) 5.07; 95% confidence interval (CI) 3.55–7.23; p < 0.01]. Similar findings were observed at week 8 for PASI-50 (RR 2.73; 95% CI 2.27–3.29; p < 0.01), PASI-75 (RR 4.48; 95% CI 2.26–8.89; p < 0.01), and PASI-90 (RR 5.61; 95% CI 2.57–12.25; p < 0.01). Corresponding outcomes were found at weeks 2, 4, and 6. Additionally, a higher percentage of patients treated with topical roflumilast 0.3% once daily achieved intertriginous-IGA success, compared with those receiving vehicle, at week 8 (71.9% versus 20.5%; RR 3.32; 95% CI 2.11–5.22; p < 0.01), with similar findings at weeks 2, 4, and 6. While a significant difference was observed in the overall incidence of AEs between the topical roflumilast and vehicle groups, there was no difference in treatment-related AEs, serious AEs, or AEs leading to study discontinuation. Conclusion: These findings support the superiority of topical roflumilast 0.3% over vehicle and suggest its use as a valuable asset for the treatment of plaque psoriasis. Protocol registration: International Prospective Register of Systematic Reviews (PROSPERO), CRD4202345649

Real-world Performance of a New Strategy for Off-Label Use of Guselkumab in Moderate to Severe Psoriasis: Super-Responder Patients as the Epitome of Efficacy and Optimisation

Background Guselkumab is a drug used to treat moderate to severe plaque psoriasis. However, real-life clinical data on its of-label use are limited, especially regarding the optimal drug dosage regimen for diferent patient profles. Objective The main objective of this real-world, single-centre, retrospective study was to identify the of-label guselkumab dosing regimen used in clinical practice. The study also aimed to evaluate the drug's efcacy, safety, and survival, as well as the proportion of super-responders (SR) based on a newly proposed defnition. Methods The study included 69 patients who started treatment with guselkumab between March 2019 and July 2021. Patients were followed up until April 2022, during which time their efcacy, safety, persistence, and use of guselkumab were recorded. Patients were aged ≥ 18 years and had moderate to severe plaque psoriasis. Results The mean disease duration was 18.6 years, and 59% of patients had received at least one biologic treatment before guselkumab with a mean of 1.3 biologics per patient. The initial absolute Psoriasis Area and Severity Index (PASI) was 10.1 and decreased to 2.1 between Week 11–20 without signifcant changes in the PASI value throughout the 90 weeks of followup. The cumulative probability of drug survival was 93.5% at Week 52. No diferences were found in terms of efcacy and survival associated with the of-label drug dosage regimens compared to the doses described in the Summary of Product Characteristics (SmPC). The greatest adjustments in the drug administration regimen were achieved in the subgroups of bionaïve and SR patients, with a reduction in the number of administrations by 40% and 47% compared to the regimen described in the SmPC. Super-response to guselkumab was mainly associated with patients naïve to previous biologic treatment. Conclusion The study demonstrated that of-label use of guselkumab was safe and efective in real-life clinical practice. The fndings suggest that adjustments to the drug administration regimen may be necessary to optimise its use in diferent patient profles, especially in SR and bio-naïve patients. Further studies are needed to confrm these fnding

Malaria por Plasmodium ovale

Malaria is a life-threatening parasitic disease caused by the Plasmodium-infected Anopheles mosquito. Infections caused by P. ovale represent a minority and can occur late due to quiescence of the parasite in the host’s body. These infections are usually light; however, they can also be presented with severe manifestations such as splenic infarcts or pulmonary involvement. We present a case of P. ovale malaria with pulmonary involvement and splenic infarcts 6 months after a trip to Ghana. In the differential diagnosis of a travelling patient with febrile syndromes, it is very important to consider tropical diseases, such as malaria, despite the time elapsed since exposure.La malaria es una enfermedad parasitaria potencialmente mortal producida por el mosquito Anopheles infectado por Plasmodium. Las infecciones por Plasmodium ovale representan una minoría y pueden aparecer de forma tardía por la quiescencia del parásito en el huésped. Habitualmente dichas infecciones se asocian a sintomatología leve; sin embargo, pueden manifestarse de forma grave con presencia de infartos esplénicos o afectación pulmonar. Describimos un caso de malaria por P. ovale con afectación pulmonar e infartos esplénicos a los 6 meses de regresar de viaje a Ghana. En el diagnóstico diferencial de un paciente viajero con síndromes febriles, es muy importante tener en cuenta las enfermedades tropicales, como la malaria, a pesar del tiempo transcurrido desde su exposición

C9orf72-mediated ALS and FTD: multiple pathways to disease

The discovery that repeat expansions in the C9orf72 gene are a frequent cause of amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD) has revolutionized our understanding of these diseases. Substantial headway has been made in characterizing C9orf72-mediated disease and unravelling its underlying aetiopathogenesis. Three main disease mechanisms have been proposed: loss of function of the C9orf72 protein and toxic gain of function from C9orf72 repeat RNA or from dipeptide repeat proteins produced by repeat-associated non-ATG translation. Several downstream processes across a range of cellular functions have also been implicated. In this article, we review the pathological and mechanistic features of C9orf72-associated FTD and ALS (collectively termed C9FTD/ALS), the model systems used to study these conditions, and the probable initiators of downstream disease mechanisms. We suggest that a combination of upstream mechanisms involving both loss and gain of function and downstream cellular pathways involving both cell-autonomous and non-cell-autonomous effects contributes to disease progression