RESOLUCIÓN DE UN CASO CLÍNICO COMPLEJO RELACIONADO CON ENFERMEDAD HEPÁTICA GRASA ASOCIADA A DISFUNCIÓN METABÓLICA (MAFLD). DECISIONES BASADAS EN LA MEJOR EVIDENCIA DISPONIBLE

Introducción: La enfermedad hepática grasa asociada a disfunción metabólica ha aumentado su prevalecía en los últimos años, llegando a alcanzar el 25% en Europa. La etiología de esta enfermedad se basa fundamentalmente en los malos hábitos alimentarios típicos de la dieta occidental y el sedentarismo. El tratamiento debe ser abordado por un equipo multidisciplinar, teniendo como pilares la dieta y el ejercicio. La MAFLD se trata de una condición fisiopatológica reversible, sin embargo puede evolucionar a cirrosis si no es intervenida a tiempo. Objetivos: Reflejar la función del dietista-nutricionista en el abordaje de un caso hipotético de MAFLD que atraviesa distintos escenarios complejos para acabar en una cirrosis descompensada e indicación de trasplante. Material y Métodos: Se han consultado las guías de práctica clínica de la Sociedad Europea de nutrición Parenteral y enteral (ESPEN) y la sociedad europea para el estudio del hígado. (EASL). También se han revisado aquellos metaanálisis recientes y revisiones expertas encontradas en PubMed y Web Of Science.Desarrollo: Se desarrolla un caso de MAFLD que progresa al estado de cirrosis descompensada, pasando por estos 3 estadios: a) paciente con enzimas hepáticas alteradas, hepatomegalia y depósito graso en el hígado reflejado por pruebas de imagen. b) 5 años después ingresa por hemorragia digestiva alta con signos de encefalopatía hepática y valores analíticos que reflejan una disfunción hepática. c) Vuelve a ingresar meses más tarde por infección espontánea del líquido ascítico y se observan signos de desnutrición grave. Conclusión: La enfermedad hepática crónica puede llegar a presentar escenarios complejos en los cuales la participación del dietista-nutricionista es fundamental. Palabras clave: Enfermedad hepática grasa asociada a disfunción metabólica, Cirrosis, hepatopatía crónica, Nutrición clínica, cribado nutricional. <br /

Protocolo nutricional de dietas bajas en salicilatos para pacientes con enfermedad respiratoria exacerbada por AINEs

En el contexto de la medicina moderna, los antiinflamatorios no esteroideos, también conocidos como AINES, son una de las clases de medicamentos más utilizadas para el tratamiento de la inflamación, el dolor y la fiebre. Sin embargo, en algunas personas, el uso de AINEs puede provocar una exacerbación de los síntomas de enfermedades respiratorias, como el asma. Dado que estos medicamentos son comúnmente utilizados, surge la necesidad de buscar alternativas terapéuticas para tratar la enfermedad respiratoria exacerbada por AINEs, conocida con las siglas EREA. Se plantea una revisión bibliográfica del tema, junto a la propuesta de un protocolo nutricional para pacientes con EREA, mediante el uso de dietas bajas en salicilatos, que han demostrado ser de utilidad para la mejora de la sintomatología de estos pacientes, tales como la tos, la congestión nasal, la dificultad respiratoria, la inflamación de las vías respiratorias y la poliposis nasal.<br /

Ritmos contemporáneos. Género, política y sociedad en los siglos XIX y XX

INTRODUCCIÓN. Laura Branciforte y Rocío Orsi Portalo (Universidad Carlos III de Madrid).- I. LOS CAMINOS DE LA MODERNIZACIÓN (SIGLOS XIX Y XX): CIENCIA, EDUCACIÓN Y ACTIVISMOS POLÍTICO: CAPÍTULO 1. Montserrat Huguet Santos (Universidad Carlos III de Madrid): La derrota del progreso. Especie y género en los discursos científicosociales (de los siglos XIX y XX).- CAPÍTULO 2. Elisa Povedano Marrugat (Universidad Carlos III de Madrid): Mujeres y Educación artística en el siglo XIX.- CAPÍTULO 3. María Luisa Rico Gómez (Instituto de Historia - CSIC): Mujeres, conciencia y profesión en España: 1880-1930.- CAPÍTULO 4. Sandra Souto Kustrín (Instituto de Historia - CSIC): Tradición, modernidad y necesidades bélicas: organización y movilización de la mujer joven en la República en guerra.- CAPÍTULO 5. Celia Valiente Fernández (Universidad Carlos III de Madrid): ¿Ha existido un movimiento feminista católico en España? Mujeres de Acción Católica durante el franquismo -- II. DIALÉCTICAS DEL FEMINISMO: CAPÍTULO 6. Irene Strazzeri (Università degli Studi di Foggia): Riconoscimento e sfera pubblica. La differenza fuori e dentro le istituzioni.- CAPÍTULO 7. Carmen González Marín (Universidad Carlos III de Madrid): Contra la institución del feminismo.- CAPÍTULO 7. Sonia Reverter Bañón (Instituto Universitario de Estudios Feministas y de Génerp - Universitat Jaume I de Castellón): Feminismo institucional ¿Un feminismo líquido?.- CAPÍTULO 8. Begonya Saez Tajafuerce (Departament de filosofía / Universitat Autònoma de Barcelona): Feminismos de frontera: memoria y representación.- CAPÍTULO 9. Rocío Orsi Portalo (Universidad Carlos III de Madrid): De las mujeres y otros monstruos. A propósito de la novela de Mary Wollstonecraft Shelle

Study protocol of a randomized controlled trial to assess safety of teleconsultation compared with face-to-face consultation: the ECASeT study

BackgroundThe use of remote consultation modalities has exponentially grown in the past few years, particularly since the onset of the COVID-19 pandemic. Although a huge body of the literature has described the use of phone (tele) and video consultations, very few of the studies correspond to randomized controlled trials, and none of them has assessed the safety of these consultation modalities as the primary objective. The primary objective of this trial was to assess the safety of remote consultations (both video and teleconsultation) in the follow-up of patients in the hospital setting.MethodsMulticenter, randomized controlled trial being conducted in four centers of an administrative healthcare area in Catalonia (North-East Spain). Participants will be screened from all individuals, irrespective of age and sex, who require follow-up in outpatient consultations of any of the departments involved in the study. Eligibility criteria have been established based on the local guidelines for screening patients for remote consultation. Participants will be randomly allocated into one of the two study arms: conventional face-to-face consultation (control) and remote consultation, either teleconsultation or video consultation (intervention). Routine follow-up visits will be scheduled at a frequency determined by the physician based on the diagnostic and therapy of the baseline disease (the one triggering enrollment). The primary outcome will be the number of adverse reactions and complications related to the baseline disease. Secondary outcomes will include non-scheduled visits and hospitalizations, as well as usability features of remote consultations. All data will either be recorded in an electronic clinical report form or retrieved from local electronic health records. Based on the complications and adverse reaction rates reported in the literature, we established a target sample size of 1068 participants per arm. Recruitment started in May 2022 and is expected to end in May 2024.DiscussionThe scarcity of precedents on the assessment of remote consultation modalities using randomized controlled designs challenges making design decisions, including recruitment, selection criteria, and outcome definition, which are discussed in the manuscript.Trial registrationNCT05094180. The items of the WHO checklist for trial registration are available in Additional file 1. Registered on 24 November 2021

Genetically predicted telomere length and Alzheimer’s disease endophenotypes: a Mendelian randomization study

Telomere length (TL) is associated with biological aging, consequently influencing the risk of age-related diseases such as Alzheimer's disease (AD). We aimed to evaluate the potential causal role of TL in AD endophenotypes (i.e., cognitive performance, N = 2233; brain age and AD-related signatures, N = 1134; and cerebrospinal fluid biomarkers (CSF) of AD and neurodegeneration, N = 304) through a Mendelian randomization (MR) analysis. Our analysis was conducted in the context of the ALFA (ALzheimer and FAmilies) study, a population of cognitively healthy individuals at risk of AD. A total of 20 single nucleotide polymorphisms associated with TL were used to determine the effect of TL on AD endophenotypes. Analyses were adjusted by age, sex, and years of education. Stratified analyses by APOE-epsilon 4 status and polygenic risk score of AD were conducted. MR analysis revealed significant associations between genetically predicted longer TL and lower levels of CSF A beta and higher levels of CSF NfL only in APOE-epsilon 4 non-carriers. Moreover, inheriting longer TL was associated with greater cortical thickness in age and AD-related brain signatures and lower levels of CSF p-tau among individuals at a high genetic predisposition to AD. Further observational analyses are warranted to better understand these associations

Risk Factors for COVID-19 in Inflammatory Bowel Disease: A National, ENEIDA-Based Case–Control Study (COVID-19-EII)

(1) Scant information is available concerning the characteristics that may favour the acquisition of COVID-19 in patients with inflammatory bowel disease (IBD). Therefore, the aim of this study was to assess these differences between infected and noninfected patients with IBD. (2) This nationwide case-control study evaluated patients with inflammatory bowel disease with COVID-19 (cases) and without COVID-19 (controls) during the period March-July 2020 included in the ENEIDA of GETECCU. (3) A total of 496 cases and 964 controls from 73 Spanish centres were included. No differences were found in the basal characteristics between cases and controls. Cases had higher comorbidity Charlson scores (24% vs. 19%; p = 0.02) and occupational risk (28% vs. 10.5%; p < 0.0001) more frequently than did controls. Lockdown was the only protective measure against COVID-19 (50% vs. 70%; p < 0.0001). No differences were found in the use of systemic steroids, immunosuppressants or biologics between cases and controls. Cases were more often treated with 5-aminosalicylates (42% vs. 34%; p = 0.003). Having a moderate Charlson score (OR: 2.7; 95%CI: 1.3-5.9), occupational risk (OR: 2.9; 95%CI: 1.8-4.4) and the use of 5-aminosalicylates (OR: 1.7; 95%CI: 1.2-2.5) were factors for COVID-19. The strict lockdown was the only protective factor (OR: 0.1; 95%CI: 0.09-0.2). (4) Comorbidities and occupational exposure are the most relevant factors for COVID-19 in patients with IBD. The risk of COVID-19 seems not to be increased by immunosuppressants or biologics, with a potential effect of 5-aminosalicylates, which should be investigated further and interpreted with caution

Incidence, Clinical Characteristics and Management of Inflammatory Bowel Disease in Spain : Large-Scale Epidemiological Study

(1) Aims: To assess the incidence of inflammatory bowel disease (IBD) in Spain, to describe the main epidemiological and clinical characteristics at diagnosis and the evolution of the disease, and to explore the use of drug treatments. (2) Methods: Prospective, population-based nationwide registry. Adult patients diagnosed with IBD-Crohn's disease (CD), ulcerative colitis (UC) or IBD unclassified (IBD-U)-during 2017 in Spain were included and were followed-up for 1 year. (3) Results: We identified 3611 incident cases of IBD diagnosed during 2017 in 108 hospitals covering over 22 million inhabitants. The overall incidence (cases/100,000 person-years) was 16 for IBD, 7.5 for CD, 8 for UC, and 0.5 for IBD-U; 53% of patients were male and median age was 43 years (interquartile range = 31-56 years). During a median 12-month follow-up, 34% of patients were treated with systemic steroids, 25% with immunomodulators, 15% with biologics and 5.6% underwent surgery. The percentage of patients under these treatments was significantly higher in CD than UC and IBD-U. Use of systemic steroids and biologics was significantly higher in hospitals with high resources. In total, 28% of patients were hospitalized (35% CD and 22% UC patients, p < 0.01). (4) Conclusion: The incidence of IBD in Spain is rather high and similar to that reported in Northern Europe. IBD patients require substantial therapeutic resources, which are greater in CD and in hospitals with high resources, and much higher than previously reported. One third of patients are hospitalized in the first year after diagnosis and a relevant proportion undergo surgery