25 anys d'història de l'Escola d'Infermeria de la Universitat d'Andorra

El present article és un resum del llibre 25 anys d’Història de l’Escola d’infermeria de la Universitari d’Andorra, que reflexa la història de la sanitat d’Andorra i de l’escola d’infermeria. Aquest, va néixer l’any 2008 quan se’ns va encarregar a les dues assignatures: Història, Models infermers i Metodologia de recerca. Cercant documentació per les assignatures ens vam adonar que la major part de la documentació que existia tant de la història de la sanitat com la història de la pròpia escola no estava escrita si no que estava en la memòria de la gent que l’havia viscut. Fruit d’aquestacerca és una part del resultat de les següents paraules.El presente artículo es un resumen del libro 25 años de Historia de la Escuela de enfermería de la Universidad de Andorra, que refleja la historia de la sanidad de Andorra y de la escuela. Este libro nació en el año 2008 cuando se nos encargó dos materias: Historia, Modelos enfermeros y metodología de investigación. Buscando documentación para las materias nos dimos cuenta de que la mayor parte de la documentación que existía tanto de la historia de la sanidad como la historia de la propia escuela no estaba escrita sino que estaba en la memoria de la gente que la había vivido. Fruto de esta búsqueda es el resultado de las siguientes palabras

Defective IL-10 production in severe phenotypes of Crohn’s disease

et al.Loss of tolerance toward commensal bacteria has been invoked as a mechanism for Crohn's disease. IL-10 is a key anti-inflammatory cytokine that plays a role in induction and maintenance of tolerance. The aim of this study is to determine IL-10 production in response to bacterial components in Crohn's disease patients, who were classified according to their phenotypes as stricturing, penetrating, or inflammatory. Peripheral blood was obtained from Crohn's disease patients and healthy controls. Cytokine production was measured in whole blood cultures, isolated CD4(+) cells, and monocyte-derived dendritic cells (MDDCs). Under unstimulated conditions, IL-10, but not IL-12, was down-regulated significantly in blood cultures of patients with severe phenotypes, compared with inflammatory, nonpenetrating, nonstricturing Crohn's disease patients. In response to LPS, IL-10 was up-regulated more significantly in patients with no fistulae or fibrosis. Study of IL-10 production by isolated cell subsets showed that DCs, but not CD4(+) T cells, from penetrating Crohn's disease produced significantly less IL-10 in response to LPS. Differences were not associated with the 1082A/G polymorphism in the IL-10 gene promoter. We show a defect in IL-10 production in whole blood cell cultures and MDDCs in patients with severe forms of Crohn's disease. This defect in IL-10 production by a group of Crohn's disease patients may represent a mechanism mediating more severe manifestations of the disease. We propose that treatment with IL-10 or IL-10-inducing therapies could be of particular benefit to these group of patientsThis work was supported by Grant SAF2005-03755 from the Ministerio de Educación y Ciencia, Spain.Peer reviewe

Perception gaps between patients with ulcerative colitis and healthcare professionals: An online survey

Background: The purpose of this study was to examine the differing perspectives and perceptual gaps relating to ulcerative colitis (UC) symptoms and their management between patients and healthcare professionals (HCPs). Methods: Structured, cross-sectional, Web-based questionnaires designed to assess a variety of disease indices were completed by adult patients with UC and HCPs involved in the care of patients with UC from Canada, France, Germany, Ireland, Spain, and the United Kingdom. Results: Surveys were completed by 775 patients, 475 physicians, and 50 nurses. Patient self-reported classification of disease severity revealed generally greater severity (mild, 32%; moderate, 53%) compared with physician and nurse estimates of UC severity among their caseloads (mild, 52% and 49%; moderate, 34% and 37%, respectively). Patients reported that an average of 5.5 (standard deviation, 11.0) flares (self-defined) occurred over the past year, compared with 3.4 and 3.8 flares per year estimated by physicians and nurses. Perceived flare triggers differed between patients (stress ranked first) and HCPs (natural disease course ranked first). Fifty-five percent of patients stated that UC symptoms over the past year had affected their quality of life, while physicians and nurses estimated that 35% to 37% of patients would have a reduced quality of life over the same period. Patients ranked urgency and pain as the most bothersome symptoms, while physicians and nurses ranked urgency and stool frequency highest. About half of patients (47%) defined remission as experiencing no symptoms; by comparison, 62% to 63% of HCPs defined remission as requiring the complete absence of symptoms. HCPs (doctors/nurses in general practice and/or hospital) were regarded by patients as their main source of UC information by 72%; however, 59% reported not arranging regular visits to see their HCPs. Conclusions: This large survey identified important differences between patients' and HCPs' perceptions of the impact of UC symptoms on patients' lives. Notably, HCPs may underestimate the effect of specific UC symptoms on patients and may fail to recognize issues that are important to patients. © 2015, In House Publications. All rights reserved

Gram-negative enterobacteria induce tolerogenic maturation in dexamethasone conditioned dendritic cells

Dendritic cells have been investigated in clinical trials, predominantly with the aim of stimulating immune responses against tumours or infectious diseases. Thus far, however, no clinical studies have taken advantage of their specific immunosuppressive potential. Tolerogenic DCs may represent a new therapeutic strategy for human immune-based diseases, such as Crohn's disease, where the perturbations of the finely tuned balance between the immune system and the microflora result in disease. In the present report, we describe the generation of tolerogenic DCs from healthy donors and Crohn's disease patients using clinical-grade reagents in combination with dexamethasone as immunosuppressive agent and characterize their response to maturation stimuli. Interestingly, we found out that dexamethasone-conditioned DCs keep their tolerogenic properties to Gram-negative bacteria. Other findings included in this study demonstrate that the combination of dexamethasone with a specific cytokine cocktail yielded clinical-grade DCs with the following characteristics: a semi-mature phenotype, a pronounced shift towards anti-inflammatory versus inflammatory cytokine production and low T-cell stimulatory properties. Importantly, in regard to their clinical application, the tolerogenic phenotype of DCs remained stable after the elimination of dexamethasone and after a second stimulation with LPS or bacteria. All these properties make this cell product suitable to be tested in clinical trials of inflammatory conditions including Crohn's disease

Proyecto de formación ambiental en el municipio de Concepción Las Minas : Concepción Las Minas, Chiquimula, Guatemala

El presente trabajo pretende implantar un proyecto de formación ambiental y, a la vez, crear el marco físico y social para que así sea. De esta forma, se darán a conocer y mejorarán los conocimientos ambientales en la población del municipio de Concepción Las Minas, con el fin de que puedan mejorar sus técnicas a la hora de gestionar su territorio y, a la vez, ampliar sus conocimientos ambientales, útiles en el campo de la educación. Para realizar estas capacitaciones fue necesaria una descripción del territorio junto con un análisis de las principales problemáticas ambientales municipales. Se realizaron sondeos a la población para valorar su nivel de conocimientos ambientales. Con toda la información recogida, se planificaron una serie de sesiones formativas destinadas a maestros, niños y técnicos ambientales. Las sesiones trataban de formar y a la vez concienciar sobre temas generadores tales como el recurso hídrico, forestal, gestión de residuos, etc. Estas capacitaciones se dieron tanto a nivel teórico como a nivel práctico. La valoración global de las capacitaciones es positiva. Cabe destacar un alto grado de participación por parte de los maestros y los alumnos de las escuelas municipales, mostrando una gran implicación en las distintas sesiones. Contrariamente, no se obtuvo el mismo resultado con el colectivo de técnicos municipales, ya que faltó tiempo y planificación.El present treball pretén implantar un projecte de formació ambiental i, alhora, crear el marc físic i social perquè així sigui. D'aquesta manera, es donaran a conèixer i milloraran els coneixements ambientals de la població del municipi de Concepción Las Minas, amb la intenció que puguin millorar les seves tècniques a l'hora de gestionar el seu territori i, també, ampliar els coneixements en matèria de medi ambient fent-ne un ús en el camp de l'educació. Per a realitzar les capacitacions va ser necessària una descripció prèvia de l'estat del municipi, descripció del territori i anàlisi de les principals problemàtiques que l'afecten. Es van realitzar enquestes a la població per tal de determinar el nivell general de coneixements ambientals present. Un cop recopilada aquesta informació, es van planificar les sessions de formació a mestres, nens i tècnics municipals. Aquestes sessions pretenien donar una formació i també conscienciar sobre temàtiques com ara els recursos hídrics, la gestió forestal i de residus, etc. Les capacitacions es van donar tant a nivell teòric com pràctic. La valoració global de les capacitacions és positiva. S'ha de destacar l'alt grau de participació per part dels mestres i dels alumnes de les escoles, els quals van mostrar una gran implicació. En canvi, les formacions als tècnics municipals no varen ser tan satisfactòries ja que va mancar temps i organització.Our objective was to start an environmental formation project in the village of Concepción Las Minas, in order to provide them environmental knowledge and skills, so that they could be able to improve the management of their territory and natural resources. First, it was necessary to analyze all characteristics of the area (geographical, biological, social…) so that we could recognize the environmental and social impacts. Once gathered all this information, we planned different environmental formation sessions (theoretical and practical) directed to children, professors, and municipal technicians, in order to form and make them aware about environmental issues as hydrological resources, forest and residues management, etc. Our general assessment of the formation is positive. The professors and children assistance was significant, showing great interest and involvement. On the other hand, we didn't accomplish what we expected with the municipal technicians due to a lack of time and organization

Follow-up study to evaluate the long-term safety and efficacy of darvadstrocel (mesenchymal stem cell treatment) in patients with perianal fistulizing crohn’s disease: ADMIRE-CD phase 3 randomized controlled trial

BACKGROUND: Darvadstrocel is an expanded allogeneic adipose-derived mesenchymal stem cell therapy for the treatment of complex perianal fistulas in patients with Crohn’s disease. Safety and efficacy outcomes from the clinical trial known as “Adipose derived mesenchymal stem cells for induction of remission in perianal fistulizing Crohn’s disease,” or ADMIRE-CD (NCT01541579), from up to 52 weeks posttreatment were previously reported. Here, the outcomes from an extended 104-week follow-up are reported. OBJECTIVE: The goal of this study was to assess the long-term safety and efficacy of darvadstrocel at 2 years post-treatment in patients with Crohn’s disease and complex perianal fistulas. DESIGN: This was a phase 3 double-blind randomized controlled study (ADMIRE-CD) in patients with perianal fistulizing Crohn’s disease. SETTINGS: This study extension was conducted in multiple hospitals across 7 European countries and Israel. PATIENTS: Forty patients entered the extended follow-up period: 25 patients in the darvadstrocel treatment group and 15 in the control group. INTERVENTIONS: Darvadstrocel or saline solution (control group) was administered once, locally, after fistula tract curettage and internal opening closure (with previous seton placement). All patients were permitted to continue ongoing medical treatments for fistulas. MAIN OUTCOME MEASURES: Treatment-emergent serious adverse events were recorded through week 104. Clinical remission, defined as closure of all treated external openings that were draining at baseline despite gentle finger compression, was assessed at week 104. RESULTS: Of 40 patients, 37 completed the extended follow-up. Through week 104, 7 treatment-emergent serious adverse events were reported, of which 4 occurred between weeks 52 and 104. At week 104, clinical remission was reported in 14/25 (56%) patients in the darvadstrocel group and 6/15 (40%) patients in the control group. LIMITATIONS: Limitations include the small number of patients who entered the extended follow-up period, and no imaging examinations were performed at the 104-week time point. CONCLUSIONS: Darvadstrocel was well tolerated and clinical remission after treatment with darvadstrocel may be sustained for up to 104 weeks in patients with perianal fistulizing Crohn’s diseaseThis study was sponsored by Takeda Pharmaceuticals International Co. Medical writing support was provided by Sally McTaggart, PhD, of Oxford PharmaGenesis, Oxford, UK, and was funded by Takeda Pharmaceuticals International C

Health-Related Quality of Life Outcomes With Tofacitinib Treatment in Patients With Ulcerative Colitis in the Open-Label Extension Study, OCTAVE Open

BACKGROUND Tofacitinib is an oral small molecule Janus kinase inhibitor for the treatment of ulcerative colitis. We report health-related quality of life (HRQoL) outcomes in patients with ulcerative colitis in the phase 3 open-label, long-term extension study, OCTAVE Open. METHODS The Inflammatory Bowel Disease Questionnaire (IBDQ), EuroQoL-5 Dimensions Health Questionnaire, and 36-Item Short Form Survey scores were analyzed up to month (M) 72 in 4 subpopulations: patients in remission at baseline (maintenance remitters) assigned tofacitinib 5 mg twice daily and patients not in remission at baseline (maintenance nonremitters, maintenance treatment failures, and induction nonresponders [IndNRs]) assigned tofacitinib 10 mg twice daily in OCTAVE Open. Data were analyzed overall and stratified by corticosteroid use at baseline, prior tumor necrosis factor inhibitor failure, and prior immunosuppressant failure. RESULTS Among maintenance remitters and nonremitters, HRQoL outcomes were maintained up to M72: 80.0% and 100.0% of patients had an IBDQ total score ≥170, respectively. At baseline, 7.4% of maintenance treatment failures had an IBDQ total score ≥170, and this increased to 54.3% and 75.0% at M2 and M72, respectively. Corresponding values for IndNRs were 22.6%, 51.0%, and 86.0%. HRQoL outcomes were independent of treatment history. Among patients not in remission at baseline, improvement in EuroQoL-5 Dimensions Health Questionnaire and 36-Item Short Form Survey scores was maintained or achieved by M2, and steady to M72 or M33, with maintenance treatment failures and IndNR subpopulations undergoing the biggest improvements from baseline. CONCLUSIONS A continued favorable impact on HRQoL was revealed with long-term tofacitinib treatment in OCTAVE Open, regardless of baseline remission status or treatment history. (ClinicalTrials.gov; number: NCT01470612)

Tofacitinib, an oral janus kinase inhibitor, in active ulcerative colitis

Background: ulcerative colitis is a chronic inflammatory disease of the colon for which current treatments are not universally effective. One additional treatment may be tofacitinib (CP-690,550), an oral inhibitor of Janus kinases 1, 2, and 3 with in vitro functional specificity for kinases 1 and 3 over kinase 2, which is expected to block signaling involving gamma chain-containing cytokines including interleukins 2, 4, 7, 9, 15, and 21. These cytokines are integral to lymphocyte activation, function, and proliferation. Methods: in a double-blind, placebo-controlled, phase 2 trial, we evaluated the efficacy of tofacitinib in 194 adults with moderately to severely active ulcerative colitis. Patients were randomly assigned to receive tofacitinib at a dose of 0.5 mg, 3 mg, 10 mg, or 15 mg or placebo twice daily for 8 weeks. The primary outcome was a clinical response at 8 weeks, defined as an absolute decrease from baseline in the score on the Mayo scoring system for assessment of ulcerative colitis activity (possible score, 0 to 12, with higher scores indicating more severe disease) of 3 or more and a relative decrease from baseline of 30% or more with an accompanying decrease in the rectal bleeding subscore of 1 point or more or an absolute rectal bleeding subscore of 0 or 1. Results: the primary outcome, clinical response at 8 weeks, occurred in 32%, 48%, 61%, and 78% of patients receiving tofacitinib at a dose of 0.5 mg (P=0.39), 3 mg (P=0.55), 10 mg (P=0.10), and 15 mg (P1) at 8 weeks occurred in 13%, 33%, 48%, and 41% of patients receiving tofacitinib at a dose of 0.5 mg (P=0.76), 3 mg (P=0.01), 10 mg (P<0.001), and 15 mg (P<0.001), respectively, as compared with 10% of patients receiving placebo. There was a dose-dependent increase in both low-density and high-density lipoprotein cholesterol. Three patients treated with tofacitinib had an absolute neutrophil count of less than 1500. Conclusions: patients with moderately to severely active ulcerative colitis treated with tofacitinib were more likely to have clinical response and remission than those receiving placebo. (Funded by Pfizer; ClinicalTrials.gov number, NCT00787202)

Review article: defining remission in ulcerative colitis

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/87130/1/j.1365-2036.2011.04701.x.pd