Body mass index and disease activity in chronic inflammatory rheumatic diseases: results of the Cardiovascular in Rheumatology (Carma) Project

Objective: Since obesity has been associated with a higher inflammatory burden and worse response to therapy in patients with chronic inflammatory rheumatic diseases (CIRD), we aimed to confirm the potential association between body mass index (BMI) and disease activity in a large series of patients with CIRDs included in the Spanish CARdiovascular in rheuMAtology (CARMA) registry. Methods: Baseline data analysis of patients included from the CARMA project, a 10-year prospective study of patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS), and psoriatic arthritis (PsA) attending outpatient rheumatology clinics from 67 Spanish hospitals. Obesity was defined when BMI (kg/m2) was >30 according to the WHO criteria. Scores used to evaluate disease activity were Disease Activity Score of 28 joints (DAS28) in RA, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) in AS, and modified DAS for PsA. Results: Data from 2234 patients (775 RA, 738 AS, and 721 PsA) were assessed. The mean ± SD BMI at the baseline visit were: 26.9 ± 4.8 in RA, 27.4 ± 4.4 in AS, and 28.2 ± 4.7 in PsA. A positive association between BMI and disease activity in patients with RA (β = 0.029; 95%CI (0.01- 0.05); p = 0.007) and PsA (β = 0.036; 95%CI (0.015-0.058); p = 0.001) but not in those with AS (β = 0.001; 95%CI (-0.03-0.03); p = 0.926) was found. Disease activity was associated with female sex and rheumatoid factor in RA and with Psoriasis Area Severity Index and enthesitis in PsA. Conclusions: BMI is associated with disease activity in RA and PsA, but not in AS. Given that obesity is a potentially modifiable factor, adequate control of body weight can improve the outcome of patients with CIRD and, therefore, weight control should be included in the management strategy of these patients

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Líneas principales de acción socioeducativa con niños delincuentes en Extremadura (1900-1950)

Se analizan las principales líneas de acción socio-educativa con niños delincuentes en Extremadura. Se divide en tres partes diferenciadas: en primer lugar se examinan las circunstancias determinantes de la génesis de la delincuencia en Extremadura; a continuación se aborda la lucha contra situaciones carenciales y la protección socio-educativa a niños delincuentes (primer periodo); por último los Tribunales Tutelares de Menores en Extremadura y la protección socio-educativa .NavarraUniversidad Pública de Navarra. Biblioteca; Campus de Arrosadía; 31006 Pamplona; Tel. +34948169060; Fax +34948169069; [email protected]

A nucleotide-dependent conformational switch controls the polymerization of human IMP dehydrogenases to modulate their catalytic activity

36 p.-6 fig.+inf. supl.18 p.-8 fig.-2 tab.Inosine 5'-monophosphate dehydrogenase (IMPDH) catalyzes the rate-limiting step in the de novo GTP biosynthetic pathway and plays essential roles in cell proliferation. As a clinical target, IMPDH has been studied for decades, but it has only been within the last years that we are starting to understand the complexity of the mechanisms of its physiological regulation. Here, we report structural and functional insights into how adenine and guanine nucleotides control a conformational switch that modulates the assembly of the two human IMPDH enzymes into cytoophidia and allosterically regulates their catalytic activity. In vitro reconstituted micron-length cytoophidia-like structures show catalytic activity comparable to unassembled IMPDH but, in turn, are more resistant to GTP/GDP allosteric inhibition. Therefore, IMPDH cytoophidia formation facilitates the accumulation of high levels of guanine nucleotides when the cell requires it. Finally, we demonstrate that most of the IMPDH retinopathy-associated mutations abrogate GTP/GDP-induced allosteric inhibition and alter cytoophidia dynamics.This work was supported by the Spanish Ministerio de Ciencia, Innovación y Universidades (grants BFU2016-79237-P to R.M.B. and BIO2014-56930-P to J.L.R.).Peer reviewe

Programa 'Completa tu mochila en el kiosko' : plan para el fomento de la lectura y el desarrollo de la comprensión lectora a través de la prensa

Tercer premio nacional de Fomento de la Lectura de la Prensa del CIDE, 2007Se expone la actividad 'Comprende, juzga, transforma', para nivel de bachillerato, dentro del plan 'Completa tu mochila en el kiosko'. Los objetivos son: considerar la prensa como material escolar; utilizar la prensa como información complementaria de los contenidos curriculares; desarrollar las competencias básicas a través de los medios gráficos; motivar la creación de medios de información escrita en entorno escolar; pontenciar la elaboración de trabajos de investigación y creación que se sirvan de la prensa para relacionar los conceptos aprendidos con la experiencia del presente; educar la actitud crítica; fomentar los valores; y propiciar actitudes de participación en las transformaciones sociales, culturales y naturales. La metodología es como sigue: los primeros cursos se dedican a recopilación, recorte y archivo del periódico; en el segundo ciclo se trata el comentario, la transformación textual, la crítica, y se realizan ciertas actividades creativas; y en bachillerato se toma la prensa como medio de investigación, además de creación estética y lugar de fusión interdisciplinar. De los objetivos propuestos no todos se han conseguido, pero se alega que en próximos cursos estos resultados se verán mejorados paulatinamente, de manera que la valoración final es positiva, a pesar de que el alumnado carece de la iniciativa de hacer uso de la prensa, sobre todo en los cursos inferiores.Castilla y LeónBiblioteca de Educación del Ministerio de Educación, Cultura y Deporte; Calle San Agustín, 5 - 3 Planta; 28014 Madrid; Tel. +34917748000; Fax +34917748026; [email protected]

Asma : proceso asistencial integrado

Este Proceso (2012) integra los dos publicados anteriormente de Asma en la edad pediátrica (2003) y Asma en la edad adulta (2004). Fichero en formato pdf, publicado en la página web de la Consejería de Salud y Bienestar Social: www.juntadeandalucia.es/salud (Consejería de Salud y Bienestar Social / Profesionales / Nuestro Compromiso por la Calidad / Procesos Asistenciales Integrados)YesConjunto de actuaciones por las que se le presta atención a personas que consultan por síntomas sugestivos de asma, donde se establecen los mecanismos para la detección precoz, diagnóstico, clasificación de gravedad, tratamiento ajustado a gravedad y edad, actividades educativas dirigidas a la prevención y estrategias de automanejo y seguimiento; todo ello, encaminado a asegurar una calidad de vida óptima, garantizando la continuidad asistencial, la coordinación entre los diferentes profesionales y la corresponsabilidad de los profesionales y el paciente