PRENSA MEDICA ESPAÑOLA DE ENTREGUERRAS: "LEVANTE MEDICO" (MURCIA). 1928-1932

Levante Médico is a part of the medical journalism in the Murcia of the beginning of XX century. It was a monthly publication edited in Murcia from 1928 as the second phase of Revista de Tisiología y Especialidades. Both journals were founded and directed by the phthisiologist Juan Antonio Martínez Ladrón de Guevara. Moreover, the journal became is the official publication of the Medical Body for Municipal Welfare in February, 1930. In the present paper we study its structure and content, and make a detailed bibliometrical analysis from which we obtain 247 works published in the journal, including original papers, not original papers, papers proceeding from speeches and communications, and bibliographical reviews. The predominant thematic content corresponds to microbiology and infectious and parsitic diseases, analyzed from the perspective of the clinic and of the epidemiology.Levante Médico forma parte del periodismo médico murciano de principios del siglo XX. Era una publicación mensual editada en Murcia a partir de 1928, como segunda época de la Revista de Tisiología y Especialidades, ambas fundadas y dirigidas por el tisiólogo murciano Juan Antonio Martínez Ladrón de Guevara. Además la revista se convirtió en el órgano oficial del Cuerpo Médico de la Beneficencia Municipal desde febrero de 1930. En el presente artículo estudiamos su estructura y contenido, y realizamos un análisis bibliométrico detallado, del que resultan 247 trabajos publicados en la revista, que comprenden artículos originales, artículos no originales, artículos procedentes de discursos y comunicaciones, y reseñas bibliográficas. El contenido temático predominante es el referido a microbiología y enfermedades infecciosas y parasitarias, analizados desde la perspectiva de la clínica y de la epidemiología

Aplicación de comités de expertos en el modelado del comportamiento humano en situaciones de distorsión visuo-motora

En este trabajo se presenta una aplicación de las arquitecturas neuronales basadas en comités de expertos en donde dan una buena solución en un problema de modelado del comportamiento visuomotor humano. La intención de este artículo ha sido la de mostrar la validez de las redes en comités sobre una aplicación de modelado de sistemas biológicos. Se trata por tanto de mostrar un modelo del comportamiento psicofísico humano, es decir, del comportamiento de las arquitecturas neuronales biológicas mediante redes neuronales artificiales en donde las redes en comité de expertos forman parte de la arquitectura global del modelo

Remote monitoring and automatic analysis of phonocardiographic signals in climbing of high mountains

The climbing of high mountains, like the Himalayas, comes accompanied, as result of the deficit of oxygen, of certain changes of the hemodynamics, that can derive sometimes in High Altitude Pulmonary Edema (HAPE). With the objective to analyze the cardiological effects of that hemodynamics changes, a satellite monitoring of phonocardiographic (PCG) signals and pulseoxymetric data of a mountain climber was made during the development of the climbing to the Broad Peak, of 8,047 meters, located in the mountain range of the Karakorum, in Pakistan. Using an electronic estethoscope, signals were registered and sent to the hospital medical staff in Murcia by means of satellite phone, to be compared with basal registers. Different techniques for analysis in frequency and time domains were developed, mainly to detect and measure the first and second heart sounds and to observe possible modifications in the phonocardiographic patterns related to the altitude and pulseoxymetric data.This work has been partially supported by Ministerio de Ciencia y Tecnología of Spain, under grant TIC2003- 09400-C04-02

TNFα Impairs Rhabdoviral Clearance by Inhibiting the Host Autophagic Antiviral Response.

TNFα is a pleiotropic pro-inflammatory cytokine with a key role in the activation of the immune system to fight viral infections. Despite its antiviral role, a few viruses might utilize the host produced TNFα to their benefit. Some recent reports have shown that anti-TNFα therapies could be utilized to treat certain viral infections. However, the underlying mechanisms by which TNFα can favor virus replication have not been identified. Here, a rhabdoviral infection model in zebrafish allowed us to identify the mechanism of action by which Tnfa has a deleterious role for the host to combat certain viral infections. Our results demonstrate that Tnfa signals through its receptor Tnfr2 to enhance viral replication. Mechanistically, Tnfa does not affect viral adhesion and delivery from endosomes to the cytosol. In addition, the host interferon response was also unaffected by Tnfa levels. However, Tnfa blocks the host autophagic response, which is required for viral clearance. This mechanism of action provides new therapeutic targets for the treatment of SVCV-infected fish, and advances our understanding of the previously enigmatic deleterious role of TNFα in certain viral infections

Oral fosfomycin for the treatment of lower urinary tract infections among kidney transplant recipients—Results of a Spanish multicenter cohort

Preliminary results of this study were presented at the 29th European Congress of Clinical Microbiology and Infectious Diseases (ECCMID), held in Amsterdam, The Netherlands, from 13 to 16 April, 2019 (oral communication O‐0699).Oral fosfomycin may constitute an alternative for the treatment of lower urinary tract infections (UTIs) in kidney transplant recipients (KTRs), particularly in view of recent safety concerns with fluroquinolones. Specific data on the efficacy and safety of fosfomycin in KTR are scarce. We performed a retrospective study in 14 Spanish hospitals including KTRs treated with oral fosfomycin (calcium and trometamol salts) for posttransplant cystitis between January 2005 and December 2017. A total of 133 KTRs developed 143 episodes of cystitis. Most episodes (131 [91.6%]) were produced by gram‐negative bacilli (GNB), and 78 (54.5%) were categorized as multidrug resistant (including extended‐spectrum β‐lactamase‐producing Enterobacteriaceae [14%] or carbapenem‐resistant GNB [3.5%]). A median daily dose of 1.5 g of fosfomycin (interquartile range [IQR]: 1.5‐2) was administered for a median of 7 days (IQR: 3‐10). Clinical cure (remission of UTI‐attributable symptoms at the end of therapy) was achieved in 83.9% (120/143) episodes. Among those episodes with follow‐up urine culture, microbiological cure at month 1 was achieved in 70.2% (59/84) episodes. Percutaneous nephrostomy was associated with a lower probability of clinical cure (adjusted odds ratio: 10.50; 95% confidence interval: 0.98‐112.29; P = 0.052). In conclusion, fosfomycin is an effective orally available alternative for treating cystitis among KTRs.This study was supported by Plan Nacional de I+D+i 2013‐2016 and Instituto de Salud Carlos III, Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Ciencia, Innovación y Universidades, Spanish Network for Research in Infectious Diseases (REIPI RD16/0016)—cofinanced by the European Development Regional Fund “A way to achieve Europe”; the Group for Study of Infection in Transplantation and the Immunocompromised Host (GESITRA‐IC) of the Spanish Society of Clinical Microbiology and Infectious Diseases (SEIMC); and the Spanish Network for Research in Renal Diseases (REDInREN RD16/0009). MFR holds a research contract “Miguel Servet” (CP 18/00073) from the Spanish Ministry of Science, Innovation and Universities, Instituto de Salud Carlos III

Sistema de ayuda al telediagnóstico de enfermedades cardiovasculares basado en el análisis de fonocardiogramas

Gracias a los recientes avances producidos en electrónica y telecomunicaciones, la fonocardiografía se presenta actualmente, tras muchos años en el olvido, como un método sencillo, rápido, barato y no invasivo capaz de obtener un diagnóstico remoto y objetivo del estado funcional del corazón mediante sistemas electrónicos que procesen los sonidos cardíacos de forma adecuada. En este trabajo se presenta un sistema de ayuda al telediagnóstico de patologías cardiovasculares a partir del registro y procesamiento de sonidos cardíacos. El sistema es capaz de detectar los eventos que componen el ciclo cardíaco (sonidos y soplos), y transmitir a distancia tanto el informe del análisis realizado como las señales registradas íntegras, para obtener de forma remota el diagnóstico del médico especialista. La transmisión de las señales se realiza comprimiéndolas con un algoritmo especialmente desarrollado para señales fonocardiográficas, que produce tasas de compresión superiores a las de otros métodos de compresión de audio.Este trabajo ha sido financiado parcialmente por la Fundación Séneca de la Región de Murcia y el Ministerio de Ciencia y Tecnología, mediante la concesión de proyectos PB/63/FS/02 y TIC2003-09400-C04-02, respectivamente.Escuela Técnica Superior de Ingeniería de Telecomunicació

Real-world effectiveness of caplacizumab vs the standard of care in immune thrombotic thrombocytopenic purpura

Immune thrombotic thrombocytopenic purpura (iTTP) is a thrombotic microangiopathy caused by anti-ADAMTS13 antibodies. Caplacizumab is approved for adults with an acute episode of iTTP in conjunction with plasma exchange (PEX) and immunosuppression. The objective of this study was to analyze and compare the safety and efficacy of caplacizumab vs the standard of care and assess the effect of the concomitant use of rituximab. A retrospective study from the Spanish TTP Registry of patients treated with caplacizumab vs those who did not receive it was conducted. A total of 155 patients with iTTP (77 caplacizumab, 78 no caplacizumab) were included. Patients initially treated with caplacizumab had fewer exacerbations (4.5% vs 20.5%; P <.05) and less refractoriness (4.5% vs 14.1%; P <.05) than those who were not treated. Time to clinical response was shorter when caplacizumab was used as initial treatment vs caplacizumab used after refractoriness or exacerbation. The multivariate analysis showed that its use in the first 3 days after PEX was associated with a lower number of PEX (odds ratio, 7.5; CI, 2.3-12.7; P <.05) and days of hospitalization (odds ratio, 11.2; CI, 5.6-16.9; P <.001) compared with standard therapy. There was no difference in time to clinical remission in patients treated with caplacizumab compared with the use of rituximab. No severe adverse event was described in the caplacizumab group. In summary, caplacizumab reduced exacerbations and refractoriness compared with standard of care regimens. When administered within the first 3 days after PEX, it also provided a faster clinical response, reducing hospitalization time and the need for PEX

Real-world effectiveness of caplacizumab vs the standard of care in immune thrombotic thrombocytopenic purpura

Immune thrombotic thrombocytopenic purpura (iTTP) is a thrombotic microangiopathy caused by anti-ADAMTS13 antibodies. Caplacizumab is approved for adults with an acute episode of iTTP in conjunction with plasma exchange (PEX) and immunosuppression. The objective of this study was to analyze and compare the safety and efficacy of caplacizumab vs the standard of care and assess the effect of the concomitant use of rituximab. A retrospective study from the Spanish TTP Registry of patients treated with caplacizumab vs those who did not receive it was conducted. A total of 155 patients with iTTP (77 caplacizumab, 78 no caplacizumab) were included. Patients initially treated with caplacizumab had fewer exacerbations (4.5% vs 20.5%; P < .05) and less refractoriness (4.5% vs 14.1%; P < .05) than those who were not treated. Time to clinical response was shorter when caplacizumab was used as initial treatment vs caplacizumab used after refractoriness or exacerbation. The multivariate analysis showed that its use in the first 3 days after PEX was associated with a lower number of PEX (odds ratio, 7.5; CI, 2.3-12.7; P < .05) and days of hospitalization (odds ratio, 11.2; CI, 5.6-16.9; P < .001) compared with standard therapy. There was no difference in time to clinical remission in patients treated with caplacizumab compared with the use of rituximab. No severe adverse event was described in the caplacizumab group. In summary, caplacizumab reduced exacerbations and refractoriness compared with standard of care regimens. When administered within the first 3 days after PEX, it also provided a faster clinical response, reducing hospitalization time and the need for PEX

Unraveling the effect of silent, intronic and missense mutations on VWF splicing : contribution of next generation sequencing in the study of mRNA

Large studies in von Willebrand disease patients, including Spanish and Portuguese registries, led to the identification of >250 different mutations. It is a challenge to determine the pathogenic effect of potential splice site mutations on VWF mRNA. This study aimed to elucidate the true effects of 18 mutations on VWF mRNA processing, investigate the contribution of next-generation sequencing to in vivo mRNA study in von Willebrand disease, and compare the findings with in silico prediction. RNA extracted from patient platelets and leukocytes was amplified by RT-PCR and sequenced using Sanger and next generation sequencing techniques. Eight mutations affected VWF splicing: c.1533+1G>A, c.5664+2T>C and c.546G>A (p.=) prompted exon skipping; c.3223-7_3236dup and c.7082-2A>G resulted in activation of cryptic sites; c.3379+1G>A and c.7437G>A) demonstrated both molecular pathogenic mechanisms simultaneously; and the p.Cys370Tyr missense mutation generated two aberrant transcripts. Of note, the complete effect of three mutations was provided by next generation sequencing alone because of low expression of the aberrant transcripts. In the remaining 10 mutations, no effect was elucidated in the experiments. However, the differential findings obtained in platelets and leukocytes provided substantial evidence that four of these would have an effect on VWF levels. In this first report using next generation sequencing technology to unravel the effects of VWF mutations on splicing, the technique yielded valuable information. Our data bring to light the importance of studying the effect of synonymous and missense mutations on VWF splicing to improve the current knowledge of the molecular mechanisms behind von Willebrand disease. identifier:02869074

Efficacy and Safety of Oral Fosfomycin for Asymptomatic Bacteriuria in Kidney Transplant Recipients: Results from a Spanish Multicenter Cohort

Current guidelines recommend against systematic screening for or treating asymptomatic bacteriuria (AB) among kidney transplant (KT) recipients, although the evidence regarding episodes occurring early after transplantation or in the presence of anatomical abnormalities is inconclusive. Oral fosfomycin may constitute a good option for the treatment of posttransplant AB, particularly due to the emergence of multidrug-resistant (MDR) uropathogens. Available clinical evidence supporting its use in this specific setting, however, remains scarce. We performed a retrospective study in 14 Spanish institutions from January 2005 to December 2017. Overall, 137 episodes of AB diagnosed in 133 KT recipients treated with oral fosfomycin (calcium and trometamol salts) with a test-of-cure urine culture within the first 30 days were included. Median time from transplantation to diagnosis was 3.1 months (interquartile range [IQR], 1.1 to 10.5). Most episodes (96.4% [132/137]) were caused by Gram-negative bacteria (GNB), and 56.9% (78/137) were categorized as MDR (extended‐spectrum β‐lactamase‐producing Enterobacterales [20.4%] and carbapenem‐resistant GNB [2.9%]). Rate of microbiological failure at month 1 was 40.1% (95% confidence interval [CI], 31.9% to 48.9%) for the whole cohort and 42.3% (95% CI, 31.2% to 54.0%) for episodes due to MDR pathogens. Previous urinary tract infection (odds ratio [OR], 2.42; 95% CI, 1.11 to 5.29; P value = 0.027) and use of fosfomycin as salvage therapy (OR, 8.31; 95% CI, 1.67 to 41.35; P value = 0.010) were predictors of microbiological failure. No severe treatment-related adverse events were detected. Oral fosfomycin appears to be a suitable and safe alternative for the treatment (if indicated) of AB after KT, including those episodes due to MDR uropathogens.This study was supported by Plan Nacional de I+D+i 2013‐2016 and Instituto de Salud Carlos III (ISCIII), Subdirección General de Redes y Centros de Investigación Cooperativa, Ministry of Science and Innovation, Spanish Network for Research in Infectious Diseases (REIPI RD16/0016), and Spanish Network for Research in Renal Diseases (REDInREN RD16/0009) and cofinanced by the European Development Regional Fund entitled A way to achieve Europe. M.F.-R. holds a research contract (Miguel Servet, CP18/00073), from the Spanish Ministry of Science and Innovation, ISCIII.Peer reviewe