Cutaneous graft-versus-host disease after hematopoietic stem cell transplant - a review

Graft-versus-host disease (GVHD) is a major complication of allogeneic hematopoietic stem cell transplants (allo-HSCT) associated with significant morbidity and mortality. The earliest and most common manifestation is cutaneous graft-versus-host disease. This review focuses on the pathophysiology, clinical features, prevention and treatment of cutaneous graft-versus-host disease. We discuss various insights into the disease’s mechanisms and the different treatments for acute and chronic skin graft-versus-host disease

Muscle Activation and Distribution during Four Test/Functional Tasks: A Comparison between Dry-Land and Aquatic Environments for Healthy Older and Young Adults

Background: The use of rehabilitation protocols carried out in water has been progressively increasing due to the favorable physical properties of the water. Electromyography allows one to register muscle activity even under water. Aim: To compare muscle activity between two groups (healthy young adults (HYA) and healthy older adults (HOA)) in two different environments (dry land and aquatic) using surface electromyography during the execution of four different test/functional movements. Methods: Analytical cross-sectional study. HYA and HOA carried out four functional tasks (Step Up and Down, Sit TO Stand test, Gait Initiation and Turns During Gait) in two different environments (dry land and aquatic). Absolute and relative muscle activation was compared between each group and between each environment. In addition, the stability of the measured was calculated through a test-retest (ICC 2:1). Results: Within the same environment there were significant differences between young and older adults in three of the four functional tasks. In contrast, in the gait initiation, hardly any significant differences were found between the two groups analysed, except for the soleus and the anterior tibial. Measurement stability ranged from good to excellent. Conclusions: Level of the musculature involvement presents an entirely different distribution when the test/functional task is performed on dry land or in water. There are differences both in the relative activation of the musculature and in the distribution of the partition of the muscles comparing older and young adults within the same environment

Composición Arquitectónica 5 y 6

La presente Memoria culmina el trabajo colaborativo del área de conocimiento de Composición Arquitectónica por lo que respecta a las materias de Grado en (Fundamentos en) Arquitectura, al haber definido sus contenidos, sus métodos de aprendizaje y sus sistemas de evaluación para el conjunto de la titulación. Ahora se concretan las dos últimas asignaturas de 5º curso: CA5 y CA6. Por un lado está CA5, cuyo eje fundamental es la definición de criterios para el ejercicio de la crítica de arquitectura, una vez que se ha construido una base de información histórica y teórica en los estudiantes a lo largo de cuatro cursos. Una crítica entendida tanto como sistema de contextualización sobre las obras ejecutadas (del presente o del pasado) y, a la vez, como marco de referencia para someter a evaluación las soluciones que se proponen desde proyecto (desde el presente hacia el futuro). Así pues, crítica entendida como herramienta de análisis tanto como de prospección. Por otro lado está CA6, en la que el eje fundamental es la intervención sobre el patrimonio arquitectónico, sea o no monumental, entendido como una realidad ineludible pues gran parte del trabajo de los arquitectos transita sobre preexistencias en sus muy diversos grados

Entorno extensible para la monitorización y detección de síntomas de depresión

La depresión es una enfermedad silenciosa que está aumentando de forma alarmante debido al ritmo de vida de la sociedad. Los propios síntomas de la depresión hacen que los pacientes se enfrenten a barreras psicológicas que dificultan la búsqueda de tratamiento. Actualmente, los dispositivos móviles están siendo usados para monitorizar el comportamiento de las personas y, así, identificar si presentan distintas enfermedades. En este artículo se presenta un conjunto de aplicaciones que detectan síntomas de depresión de forma pasiva para el usuario, reduciendo los posibles obstáculos para la identificación de esta enfermedad. Estas aplicaciones han sido desarrolladas para que los datos monitorizados puedan ser reutilizados por otros sistemas, sin que ello conlleve un incremento en el consumo de recursos.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

Effect of pharmacological pupil dilation on measurements and iol power calculation made using the new swept-source optical coherence tomography-based optical biometer

Purpose: to determine whether pupil dilation affects biometric measurements and intraocular lens (IOL) power calculation made using the new swept-source optical coherence tomography-based optical biometer (IOLMaster 700©; Carl Zeiss Meditec, Jena, Germany). Procedures: eighty-one eyes of 81 patients evaluated for cataract surgery were prospectively examined using the IOLMaster 700© before and after pupil dilation with tropicamide 1%. The measurements made were: axial length (AL), central corneal thickness (CCT), aqueous chamber depth (ACD), lens thickness (LT), mean keratometry (MK), white-to-white distance (WTW) and pupil diameter (PD). Holladay II and SRK/T formulas were used to calculate IOL power. Agreement between measurement modes (with and without dilation) was assessed through intraclass correlation coefficients (ICC) and Bland-Altman plots. Results: mean patient age was 75.17 ± 7.54 years (range: 57–92). Of the variables determined, CCT, ACD, LT and WTW varied significantly according to pupil dilation. Excellent intraobserver correlation was observed between measurements made before and after pupil dilation. Mean IOL power calculation using the Holladay 2 and SRK/T formulas were unmodified by pupil dilation. Conclusions: the use of pupil dilation produces statistical yet not clinically significant differences in some IOLMaster 700© measurements. However, it does not affect mean IOL power calculation

Dehydroepiandrosterone supplementation improves reproductive outcomes in women of the POSEIDON IV group

Background: The decrease in ovarian reserve has become one of the main causes of infertility. Recent studies have sought to improve the reproductive outcomes of these women through adjuvant treatments. In patients undergoing assisted reproduction treatments, exogenous Dehydroepiandrosterone (DHEA) or prasterone acts as a precursor to testosterone in the follicular fluid, which increases steroidogenesis and the number of primary and antral follicles. Methods: A quantitative, quasi-experimental case series study was carried out in the clinical area of assisted reproduction from August 2021 to March 2022. All women included were over 34 years and categorized as POSEIDON IV. They were supplemented with 100 mg of DHEA one month prior to the follicular capture. Data was collected from the records of the patients who met the inclusion criteria, including the antral follicle count on the first three days of the menstrual period before the supplementation and one month after. Finally, the number of metaphase II oocytes and blastocysts obtained were analyzed. Results: There were 22 women underwent controlled ovarian stimulation; there was a difference in antral follicle count from 5±2.1 SD to 8.23​±4.29 SD (p=0.004) and MII oocytes 3.25±2.31 to 4.53±3.27 (p=0.04) before DHEA and after DHEA, respectively. Conclusions: DHEA or prasterone supplementation can be used as an adjuvant treatment in women of the POSEIDON IV group one month before the ovarian stimulation to improve their reproductive outcome

Outcome of Enterococcus faecalis infective endocardits according to the length of antibiotic therapy: Prelininary data from a cohort of 78 patients.

Background International guidelines recommend 4 weeks of treatment with ampicillin plus gentamicin (A+G) for uncomplicated native valve Enterococcus faecalis infective endocarditis (EFIE) and 6 weeks in the remaining cases. Ampicillin plus ceftriaxone (A+C) is always recommended for at least 6w, with no available studies assessing its suitability for 4w. We aimed to investigate differences in the outcome of EFIE according to the duration (4 versus 6 weeks) of antibiotic treatment (A+G or A+C). Methods Retrospective analysis from a prospectively collected cohort of 78 EFIE patients treated with either A+G or A+C. Results 32 cases (41%) were treated with A+G (9 for 4w, 28%) and 46 (59%) with A+C (14 for 4w, 30%). No significant differences were found in 1-year mortality according to the type of treatment (31% and 24% in A+G and A+C, respectively; P = 0.646) or duration (26% and 27% at 4 and 6w, respectively; P = 0.863). Relapses were more frequent among survivors treated for 4w than in those treated for 6w (3/18 [17%] at 4w and 1/41 [2%] at 6w; P = 0.045). Three out of 4 (75%) relapses occurred in cirrhotic patients. Conclusions A 4-week course of antibiotic treatment might not be suitable neither for A+G nor A+C for treating uncomplicated native valve EFIE

Novas Estratégias para um Plano de Uso Eficiente da Energia Elétrica

Ante los reales problemas causados por el consumo cada vez mayor de energía eléctrica, el estado inadecuado de los segmentos que conforman la red eléctrica y el impacto ambiental negativo de las tradicionales fuentes de generación de electricidad, en este artículo se  propone un conjunto de estrategias para un nuevo plan de uso racional y eficiente de la energía eléctrica, aplicable a cualquier país y basado en la coexistencia de nuevas formas de generación de energía (generación alternativa, cogeneración, generación distribuida) con las formas de generación tradicional, así como en la incorporación de técnicas y metodologías de punta, tales como Smart Grid, DR (Dynamic Response), etc. Asimismo, el plan propuesto define una solución holística integral para abordar el uso racional de energía eléctrica promoviendo un cambio en el comportamiento del usuario del servicio. El plan establece objetivos concretos, estrategias y líneas de acción en catorce áreas de oportunidadDiante dos problemas reais produzidos pelo consumo cada vez maior de energia elétrica, o estado inadequado dos segmentos que compõem a rede elétrica e o impacto ambiental negativo das tradicionais fontes de geração de eletricidade, neste artigo se propõe um conjunto de estratégias para um novo plano de uso racional e eficiente da energia elétrica, aplicável a qualquer país e baseado na coexistência de novas formas de geração de energia (geração alternativa, cogeração, geração distribuída) com as formas de geração tradicional, assim como na incorporação de técnicas e metodologias de ponta, tais como redes inteligentes (Smart Grid), DR (Dynamic Response), etc. Além disso, o plano proposto define uma solução holística integral para a abordagem do uso racional de energia elétrica promovendo uma mudança no comportamento do usuário do serviço. O plano estabelece objetivos concretos, estratégias e linhas de ação em quatorze áreas de oportunidade.     

Extended use of dual antiplatelet therapy among older adults with acute coronary syndromes and associated variables: a cohort study

Current guidelines recommend extending the use of dual antiplatelet therapy (DAPT) beyond 1 year in patients with an acute coronary syndrome (ACS) and a high risk of ischaemia and low risk of bleeding. No data exist about the implementation of this strategy in older adults from routine clinical practice. Methods We conducted a Spanish multicentre, retrospective, observational registry-based study that included patients with ACS but no thrombotic or bleeding events during the first year of DAPT after discharge and no indication for oral anticoagulants. High bleeding risk was defined according to the Academic Research Consortium definition. We assessed the proportion of cases of extended DAPT among patients 65≥years that went beyond 1 year after hospitalisation for ACS and the variables associated with the strategy. Results We found that 48.1% (928/1,928) of patients were aged≥65 years. DAPT was continued beyond 1 year in 32.1% (298/928) of patients≥65; which was a similar proportion as with their younger counterparts. There was no significant correlation between a high bleeding risk and DAPT duration. Contrastingly, there was a strong correlation between the extent of coronary disease and DAPT duration (p<0.001). Other variables associated with extended DAPT were a higher left ventricle ejection fraction, a history of heart failure and a prior stent thrombosis. Conclusion: There was no correlation between age and extended use of DAPT beyond 1 year in older patients with ACS. DAPT was extended in about one-third of patients≥65 years. The severity of the coronary disease, prior heart failure, left ventricle ejection fraction and prior stent thrombosis all correlated with extended DAPT

Fluorometric Quantification of Total Cell-Free DNA as a Prognostic Biomarker in Non-Small-Cell Lung Cancer Patients Treated with Immune Checkpoint Blockade.

The present study aimed to investigate the potential of basal cell-free fluorometric DNA (cfDNA) quantification as a prognostic biomarker in advanced non-small cell lung cancer (NSCLC) patients treated with an Immune Checkpoint Blockade (ICB). A discovery and validation cohort of 61 and 31 advanced lung cancer patients treated with ICB were included in this study. Quantification of cfDNA concentration was performed before the start of the treatment and patients were followed up for a median of 34 (30–40) months. The prognostic predicted value of cfDNA was evaluated based on ROC, and Cox regression was conducted via univariate and multivariate analyses to estimate the hazard ratio. We observed that a cfDNA cut-off of 0.55 ng/ L before the ICB determines the overall survival of patients with a log rank p-value of 3.3 104. That represents median survivals of 3.8 vs. 17.5 months. Similar results were obtained in the validation cohort being the log rank p-value 3.8 102 with median survivals of 5.9 vs. 24.3. The univariate and multivariate analysis revealed that the cut-off of 0.55 ng/ L before ICB treatment was an independent predictive factor and was significantly associated with a better survival outcome. High cfDNA concentrations identify patients with advanced NSCLC who do not benefit from the ICB. The determination of cfDNA is a simple test that could select a group of patients in whom new therapeutic strategies are needed.Partial funding for open access charge: Universidad de Málag