Tenofovir vs lamivudine plus adefovir in chronic hepatitis B: TENOSIMP-B study

AIM To demonstrate the non-inferiority (15% non-inferiority limit) of monotherapy with tenofovir disoproxil fumarate (TDF) vs the combination of lamivudine (LAM) plus adefovir dipivoxil (ADV) in the maintenance of virologic response in patients with chronic hepatitis B (CHB) and prior failure with LAM. METHODS This study was a Phase IV prospective, randomized, open, controlled study with 2 parallel groups (TDF and LAM+ADV) of adult patients with hepatitis B e antigen (HBeAg)-negative CHB, prior failure with LAM, on treatment with LAM+ADV for at least 6 mo, without prior resistance to ADV and with an undetectable viral load at the start of the study, in 14 Spanish hospitals. The follow-up time for each patient was 48 wk after randomization, with quarterly visits in which the viral load, biochemical and serological parameters, adverse effects, adherence to treatment and consumption of hospital resources were analysed. RESULTS Forty-six patients were evaluated [median age: 55.4 years (30.2-75.2); 84.8% male], including 22 patients with TDF and 24 with LAM+ADV. During study development, hepatitis B virus DNA (HBV-DNA) remained undetectable, all patients remained HBeAg negative, and hepatitis B surface antigen (HBsAg) positive. Alanine aminotransferase (ALT) values at the end of the study were similar in the 2 groups (25.1 ± 7.65, TDF vs 24.22 ± 8.38, LAM+ADV, P = 0.646). No significant changes were observed in creatinine or serum phosphorus values in either group. No significant differences between the 2 groups were noted in the identification of adverse effects (AEs) (53.8%, TDF vs 37.5%, LAM+ADV, P = 0.170), and none of the AEs which occurred were serious. Treatment adherence was 95.5% and 83.3% in the TDF and the LAM+ADV groups, respectively (P = 0.488). The costs associated with hospital resource consumption were significantly lower with the TDF treatment than the LAM+ADV treatment (€4943 ± 1059 vs €5811 ± 1538, respectively, P < 0.001). CONCLUSION TDF monotherapy proved to be safe and not inferior to the LAM+ADV combination therapy in maintaining virologic response in patients with CHB and previous LAM failure. In addition, the use of TDF generated a significant savings in hospital costs

Evaluation of the effects of a hydrogen sulfide donor on neural plasticity.

The aging brain can exhibit significant modifications related with a progressive atrophy. Previous studies have shown that this atrophy may result from a combination of dendritic regression and neuronal death (1). Age-related memory and cognitive decline have been shown to coincide frequently with morphological changes which affect the neural plasticity and number of dendritic spines in the brains of both humans and animals (2). Furthermore, many neuropathologic conditions and neurodegenerative diseases exhibit abnormalities in dendritic tree structure. Animal studies have shown that even mild prolonged stress has been observed to induce the shrinkage of dendritic fields and the loss of dendritic spines (3).Recent evidence suggest that H2S is a gasotransmitter with neuroprotective properties. In addition, a few sulfur donors have shown beneficial therapeutic effects in experimental models of neurodegenerative diseases (4). Moreover, previous research in our lab suggests that a pharmacological treatment aimed at increasing intracellular H2S improves physical and metabolic health in mice. Nonetheless, the specific properties of these compounds maintaining neuron homeostasis and plasticity remain unknown.Here we aim to investigate whether modulation of intracellular H2S by a pharmacological intervention can improve neuronal plasticity in terms of morphological changes at the level of dendritic arborization and dendritic spine density. To this purpose, we will perform analyses in murine primary neuron cultures that will be treated with increasing concentrations of drug “δ”. Experimental conditions will be: untreated (0, vehicle solution), 10 μM, 50 μM, and 100 μM. Cells will be maintained for 12-14 days in culture, and will be treated with compound “δ” for 48 hours. Then cells will be fixed and MAP2 immunocytochemistry analyses will be performed. Photos will be taken under a fluorescence microscope and analyzed using software ImageJ to determine the percentage of arborized area and the dendritic spine density. The results will provide us with an insight into the potential of drug “δ” as a neuroprotective agent to prevent age-related loss of neuroplasticity

Factores Pedagógicos que Favorecen el Éxito Escolar en Estudiantes de Enseñanza Postobligatoria

El foco del presente estudio ha sido el éxito escolar: la continuidad, la permanencia en el sistema educativo, lo cual implica transitar de forma adecuada por sus diversas etapas y modalidades formativas. En particular, hemos buscado conocer qué factores pedagógicos -vinculados a los procesos de enseñanza-aprendizaje y a la relación profesor/a-alumno/a- constituyen condiciones favorables para el éxito y la continuidad escolar de chicas y de chicos de enseñanza secundaria postobligatoria (Bachillerato y Ciclos Formativos). Hemos tratado de visibilizar el éxito escolar de chicos y de chicas en la educación secundaria, de analizar las experiencias y las trayectorias de estudiantes que, más allá del periodo obligatorio, dan continuidad a su vida escolar con éxito académico, de prestar atención a las diferencias entre estudiantes de Bachillerato y Ciclos Formativos y, por último, de analizar de forma diferenciada la experiencia de las chicas y de los chicos, indagando en los elementos de la construcción de la subjetividad en ambos sexos. Para ello, hemos trabajado con una muestra intencional de 26 estudiantes (12 chicas y 14 chicos), 16 de Bachillerato y 10 de Ciclos Formativos, seleccionados por sus docentes, en 12 centros urbanos y semiurbanos de Málaga, Sevilla, Granada, Cádiz y Almería. Los datos han sido recogidos a través de entrevistas semiestructuradas, con el apoyo de la técnica de foto-lenguaje y un cuestionario de contexto.Fundación Centro de Estudios Andaluces - [PRY031/11

Revisiting the epidemiology of bloodstream infections and healthcare-associated episodes: results from a multicentre prospective cohort in Spain (PRO-BAC Study)

PROBAC REIPI/GEIH-SEIMC/SAEI Group.The epidemiology of bloodstream infections (BSIs) is dynamic as it depends on microbiological, host and healthcare system factors. The aim of this study was to update the information regarding the epidemiology of BSIs in Spain considering the type of acquisition. An observational, prospective cohort study in 26 Spanish hospitals from October 2016 through March 2017 including all episodes of BSI in adults was performed. Bivariate analyses stratified by type of acquisition were performed. Multivariate analyses were performed by logistic regression. Overall, 6345 BSI episodes were included; 2510 (39.8%) were community-acquired (CA), 1661 (26.3%) were healthcare-associated (HCA) and 2056 (32.6%) hospital-acquired (HA). The 30-day mortality rates were 11.6%, 19.5% and 22.0%, respectively. The median age of patients was 71 years (interquartile range 60–81 years) and 3656 (58.3%; 95% confidence interval 57.1–59.6%) occurred in males. The proportions according to patient sex varied according to age strata. Escherichia coli (43.8%), Klebsiella spp. (8.9%), Staphylococcus aureus (8.9%) and coagulase-negative staphylococci (7.4%) were the most frequent pathogens. Multivariate analyses confirmed important differences between CA and HCA episodes, but also between HCA and HA episodes, in demographics, underlying conditions and aetiology. In conclusion, we have updated the epidemiological information regarding patients’ profiles, underlying conditions, frequency of acquisition types and aetiological agents of BSI in Spain. HCA is confirmed as a distinct type of acquisition.This work was financed by grants from Plan Nacional de I+D+i 2013–2016, Instituto de Salud Carlos III, Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Ciencia, Innovación y Universidades [PI16/01432] and the Spanish Network for Research in Infectious Diseases (REIPI) [RD16/0016/0001; RD16/0016/0008], co‐financed by the European Development Regional Fund ‘A way to achieve Europe’, Operative program Intelligent Growth 2014–2020

Prediction of poor outcome in clostridioides difficile infection: A multicentre external validation of the toxin B amplification cycle

Producción CientíficaClassification of patients according to their risk of poor outcomes in Clostridioides difficile infection (CDI) would enable implementation of costly new treatment options in a subset of patients at higher risk of poor outcome. In a previous study, we found that low toxin B amplification cycle thresholds (Ct) were independently associated with poor outcome CDI. Our objective was to perform a multicentre external validation of a PCR-toxin B Ct as a marker of poor outcome CDI. We carried out a multicentre study (14 hospitals) in which the characteristics and outcome of patients with CDI were evaluated. A subanalysis of the results of the amplification curve of real-time PCR gene toxin B (XpertTM C. difficile) was performed. A total of 223 patients were included. The median age was 73.0 years, 50.2% were female, and the median Charlson index was 3.0. The comparison of poor outcome and non–poor outcome CDI episodes revealed, respectively, the following results: median age (years), 77.0 vs 72.0 (p = 0.009); patients from nursing homes, 24.4% vs 10.8% (p = 0.039); median leukocytes (cells/μl), 10,740.0 vs 8795.0 (p = 0.026); and median PCR-toxin B Ct, 23.3 vs 25.4 (p = 0.004). Multivariate analysis showed that a PCR-toxin B Ct cut-off <23.5 was significantly and independently associated with poor outcome CDI (p = 0.002; OR, 3.371; 95%CI, 1.565–7.264). This variable correctly classified 68.5% of patients. The use of this microbiological marker could facilitate early selection of patients who are at higher risk of poor outcome and are more likely to benefit from newer and more costly therapeutic options

Assessment for English language education on the programs at the Agricultural Engineering School of Madrid

The convergence process among European academic degrees pursues the exchange of graduate students and the adaptation of university programs to social demand. Within the framework of the European Higher Education, European universities will need to be more competitive not only by increasing or maintaining the student enrolment, but also in their academic performance. Thus, the reinforcing of English language education within the University Programs might play an important role to reach these objectives. In this sense, a complete survey was accomplished at the Agricultural Egineering School of Madrid (ETSIA ) addressing issues such as: identification the needs for bilingual instruction at ETSIA, identification resources needed and interest and background in English language of students and professors (San José et al., 2013). The conclusions and recommendations to promote the bilingual instruction in the ETSIA, taking into account the approaches followed by other Spanish universities, are presented in this work

Association Between Preexisting Versus Newly Identified Atrial Fibrillation and Outcomes of Patients With Acute Pulmonary Embolism

Background Atrial fibrillation (AF) may exist before or occur early in the course of pulmonary embolism (PE). We determined the PE outcomes based on the presence and timing of AF. Methods and Results Using the data from a multicenter PE registry, we identified 3 groups: (1) those with preexisting AF, (2) patients with new AF within 2 days from acute PE (incident AF), and (3) patients without AF. We assessed the 90-day and 1-year risk of mortality and stroke in patients with AF, compared with those without AF (reference group). Among 16 497 patients with PE, 792 had preexisting AF. These patients had increased odds of 90-day all-cause (odds ratio [OR], 2.81; 95% CI, 2.33-3.38) and PE-related mortality (OR, 2.38; 95% CI, 1.37-4.14) and increased 1-year hazard for ischemic stroke (hazard ratio, 5.48; 95% CI, 3.10-9.69) compared with those without AF. After multivariable adjustment, preexisting AF was associated with significantly increased odds of all-cause mortality (OR, 1.91; 95% CI, 1.57-2.32) but not PE-related mortality (OR, 1.50; 95% CI, 0.85-2.66). Among 16 497 patients with PE, 445 developed new incident AF within 2 days of acute PE. Incident AF was associated with increased odds of 90-day all-cause (OR, 2.28; 95% CI, 1.75-2.97) and PE-related (OR, 3.64; 95% CI, 2.01-6.59) mortality but not stroke. Findings were similar in multivariable analyses. Conclusions In patients with acute symptomatic PE, both preexisting AF and incident AF predict adverse clinical outcomes. The type of adverse outcomes may differ depending on the timing of AF onset.info:eu-repo/semantics/publishedVersio

Subclassification of B-acute lymphoblastic leukemia according to age, immunophenotype and microenvironment, predicts MRD risk in Mexican children from vulnerable regions

The decisive key to disease-free survival in B-cell precursor acute lymphoblastic leukemia in children, is the combination of diagnostic timeliness and treatment efficacy, guided by accurate patient risk stratification. Implementation of standardized and high-precision diagnostic/prognostic systems is particularly important in the most marginalized geographic areas in Mexico, where high numbers of the pediatric population resides and the highest relapse and early death rates due to acute leukemias are recorded even in those cases diagnosed as standard risk.This work was supported by grants from the National Council of Humanities, Science and Technology (CONAHCYT) FORDECYT-PRONACES 302994 to RP, FORDECYT-PRONACES 302941 to SP-T, and Investigadoras e Investigadores por México CONAHCYT to DC-A.Peer reviewe

Handbook of Active Ageing and Quality of Life: From Concepts to Applications

La edición de este libro estuvo a cargo de Fermina Rojo-Pérez y Gloria Fernández-Mayoralas.El documento adjunto contiene la cubierta, portada e índice del libro.This handbook presents an overview of studies on the relationship of active ageing and quality of life. It addresses the new challenges of ageing from the paradigm of positive ageing (active, healthy and successful) for a better quality of life. It provides theoretical perspectives and empirical studies, including scientific knowledge as well as practical experiences about the good ageing and the quality of later life around the world, in order to respond to the challenges of an aged population. The handbook is structured in 4 sections covering theoretical and conceptual perspectives, social policy issues and research agenda, methods, measurement instrument-scales and evaluations, and lastly application studies including domains and geographical contexts.Peer reviewe