Eptinezumab for the preventive treatment of episodic and chronic migraine: a narrative review

Chronic migraine; Episodic migraine; Preventive treatmentMigraña crónica; Migraña episódica; Tratamiento preventivoMigranya crònica; Migranya episòdica; Tractament preventiuEptinezumab, a monoclonal antibody that targets calcitonin gene-related peptide (CGRP), was recently approved in Europe for the prophylactic treatment of migraine in adults who have at least four migraine days a month. Eptinezumab is administered by intravenous infusion every 12 weeks. During recent months, a considerable amount of evidence from eptinezumab trials has been published. The aim of this review is to describe the existing evidence on the tolerability, safety and efficacy of eptinezumab in patients with migraine. Data from randomized (PROMISE-1, PROMISE-2, RELIEF and DELIVER) and open-label (PREVAIL) phase 3 clinical trials have demonstrated the favorable effect of eptinezumab in migraine symptoms from first day of treatment. These studies showed that eptinezumab results in an overall reduction in mean monthly migraine days (MMDs), increases in the ≥50% and ≥ 75% migraine responder rates (MRRs) and improvements in patient-reported outcome measures in both patients with episodic migraine (EM) and with chronic migraine (CM), including patients who failed previous preventive treatments. The RELIEF trial also showed that eptinezumab, within 2 h of administration, reduced headache pain, migraine-associated symptoms and acute medication use when administered during a migraine attack. Eptinezumab benefits manifested as early as day 1 after dosing and with the subsequent doses lasted up to at least 2 years. Treatment-emergent adverse events reported by ≥2% of patients included upper respiratory tract infection and fatigue. Current evidence demonstrates that eptinezumab has a potent, fast-acting, sustained migraine preventive effect in patients with EM and CM. Eptinezumab has also shown to be well tolerated, supporting its use in the treatment of patients with migraine and inclusion in the current migraine therapeutic options.The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. Medical writing was funded by Lundbeck Spain in accordance with Good Publication Practice (GPP3) guidelines. Lundbeck Spain was not involved in the study design, collection, analysis, interpretation of data, or the decision to submit it for publication

Role of Circulating Angiotensin Converting Enzyme 2 in Left Ventricular Remodeling following Myocardial Infarction: A Prospective Controlled Study.

Angiotensin-converting enzyme 2 (ACE2) cleaves Angiotensin-II to Angiotensin-(1-7), a cardioprotective peptide. Serum soluble ACE2 (sACE2) activity is raised in chronic heart failure, suggesting a compensatory role in left ventricular dysfunction. Our aim was to study the relationship between sACE2 activity, infarct size, left ventricular systolic function and remodeling following ST-elevation myocardial infarction (STEMI). A contrast-enhanced cardiac magnetic resonance study was performed acutely in 95 patients with first STEMI and repeated at 6 months to measure LV end-diastolic volume index, ejection fraction and infarct size. Baseline sACE2 activities, measured by fluorescent enzymatic assay 24 to 48 hours and at 7 days from admission, were compared to that obtained in 22 matched controls. Patients showed higher sACE2 at baseline than controls (104.4 [87.4-134.8] vs 74.9 [62.8-87.5] RFU/µl/hr, p<0.001). At seven days, sACE2 activity significantly increased from baseline (115.5 [92.9-168.6] RFU/µl/hr, p<0.01). An inverse correlation between sACE2 activity with acute and follow-up ejection fraction was observed (r = −0.519, p<0.001; r = −0.453, p = 0.001, respectively). Additionally, sACE2 directly correlated with infarct size (r = 0.373, p<0.001). Both, infarct size (β = −0.470 [95%CI:−0.691:−0.248], p<0.001) and sACE2 at 7 days (β = −0.025 [95%CI:−0.048:−0.002], p = 0.030) were independent predictors of follow-up ejection fraction. Patients with sACE2 in the upper tertile had a 4.4 fold increase in the incidence of adverse left ventricular remodeling (95% confidence interval: 1.3 to 15.2, p = 0.027). In conclusion, serum sACE2 activity rises in relation to infarct size, left ventricular systolic dysfunction and is associated with the occurrence of left ventricular remodeling

Kidney Transplantation Group of the Spanish Society of Nephrology

Document publicat també en castellàThe Board of Directors of the Spanish Society of Nephrology (S.E.N.) approved at its ordinary meeting of 18 December 2012 the creation of a Transplantation Working Group (SENTRA). In accordance with the Regulations of the S.E.N. Working Groups, in promoting the establishment of a working group, four priority aspects must be addressed..

Determination of the crystal and magnetic structure of the DyCrO4-scheelite polymorph by neutron diffraction

Neutron diffraction data of DyCrO4 oxide, prepared at 4 GPa and 833 K from the ambient pressure zircon-type, reveal that crystallize with the scheelite-type structure, space group I41/a. Accompanying this structural phase transition induced by pressure the magnetic properties change dramatically from ferromagnetism in the case of zircon to antiferromagnetism for the scheelite polymorph with a T N= 19 K. The analysis of the neutron diffraction data obtained at 1.2 K has been used to determine the magnetic structure of this DyCrO4-scheelite oxide which can be described with a k = [0, 0, 0] as propagation vector, where the Dy and Cr moments are lying in the ab-plane of the scheelite structure. The ordered magnetic moments are 10 µB and 1 µB for Dy+3 and Cr+5 respectivel

Carotid atherosclerotic disease predicts cardiovascular events in hemodialysis patients: A prospective study

Background To evaluate the predictive value of carotid atherosclerotic disease (CAD) and intima-media thickness (IMT) on incident cardiovascular disease and mortality in hemodialysis patients. Methods Multicenter, observational, prospective study including 110 patients, followed-up to 6 years. Carotid doppler ultrasonographic findings were classified in 4 degrees of severity: 1) IMT 0.9 mm, 3) carotid plaque with stenosis 50%. The associations between IMT and CAD and cardiovascular events, total and cardiovascular mortality were assessed. Results 83% of the patients had atherosclerotic plaques (CAD degrees 3-4). During follow-up, 29.1% of patients experienced cardiovascular events, and 28.2% died, 38.7% of cardiovascular origin. The presence of plaques was associated with cardiovascular events (p = 0.03) while calcified plaques were associated with both cardiovascular events (p = 0.01), cardiovascular mortality (p = 0.03) and non-significantly with overall mortality (p = 0.08) in the survival analysis. Carotid IMT was not associated with outcomes. Cardiovascular events correlated with CAD severity (HR 2.27, 95% CI 1.13-4.54), age (HR 1.04, 1.01-1.06), previous cardiovascular disease (HR 1.75, 1.05-4.42), dyslipidemia (HR 2.25, 1.11-4.53), lipoprotein (a) (HR 1.01, 1.00-1.02), troponin I (HR 3.89, 1.07-14.18), fibrinogen levels (HR 1.38, 0.98-1.94) and antiplatelet therapy (HR 2.14, 1.04-4.4). In an age-adjusted multivariate model, cardiovascular events were independently associated with previous coronary artery disease (HR 3.29, 1.52-7.15) and lipoprotein (a) (HR 1.01, 1.00-1.02). Conclusions The presence of carotid plaques and, especially, calcified plaques, are predictors of new cardiovascular events and cardiovascular mortality in hemodialysis patients, while IMT was not. The prognostic value of calcified plaques should be confirmed in future studies

Validation of a survival benefit estimator tool in a cohort of European kidney transplant recipients

Producción CientíficaPre-transplant prognostic scores help to optimize donor/recipient allocation and to minimize organ discard rates. Since most of these scores come from the US, direct application in non-US populations is not advisable. The Survival Benefit Estimator (SBE), built upon the Estimated Post-Transplant Survival (EPTS) and the Kidney Donor Profile Index (KDPI), has not been externally validated. We aimed to examine SBE in a cohort of Spanish kidney transplant recipients. We designed a retrospective cohortbased study of deceased-donor kidney transplants carried out in two different Spanish hospitals. Unadjusted and adjusted Cox models were applied for patient survival. Predictive models were compared using Harrell’s C statistics. SBE, EPTS and KDPI were independently associated with patient survival (p ≤ 0.01 in all models). Model discrimination measured with Harrell’s C statistics ranged from 0.57 (KDPI) to 0.69 (SBE) and 0.71 (EPTS). After adjustment, SBE presented similar calibration and discrimination power to that of EPTS. SBE tended to underestimate actual survival, mainly among high EPTS recipients/high KDPI donors. SBE performed acceptably well at discriminating posttransplant survival in a cohort of Spanish deceased-donor kidney transplant recipients, although its use as the main allocation guide, especially for high KDPI donors or high EPTS recipients requires further testing.Rio Hortega contract (ISCIII-11453)Fondo de Investigaciones Sanitarias - Fondo Europeo de Desarrollo Regional (project PI16/0617)Redinren (project RD16/0009/001

Investigación e innovación educativa en espiritualidad y cuidados de enfermería

La presente memoria recoge los resultados del estudio “Integración de los cuidados espirituales en estudiantes de enfermería: una propuesta de intervención educativa” llevado a cabo por personal docente e investigador integrante de la Red de innovación educativa en espiritualidad y cuidados de enfermería. La Red se constituyó a principios del curso académico 2015-16 en el marco del Programa Redes impulsado por el Instituto de Ciencias de la Educación de la Universidad de Alicante. La Red planteó un doble objetivo, por un lado, mejorar la percepción del estudiante de enfermería sobre el cuidado espiritual y, por otro, valorar sus recursos y competencias para detectar, explorar y atender las necesidades espirituales del paciente. La metodología de trabajo se fundamentó en la participación activa en red del personal docente e investigador de las asignaturas vinculadas. Se diseñó y aplicó una actividad docente (grupo de discusión y cuestionamiento abierto) sobre la atención espiritual en la práctica de enfermería utilizando una muestra disponible de 185 estudiantes matriculados en las asignaturas vinculadas al proyecto. La efectividad de la actividad docente se valoró mediante un cuestionario autoadministrado de 25 ítems. Los resultados encontrados han puesto de manifiesto un cambio positivo y significativo en los conocimientos y actitudes de los estudiantes participantes en el estudio como resultado de la intervención educativa en espiritualidad

Integración de los cuidados espirituales en estudiantes de enfermería: una propuesta de intervención educativa

Pese a la evidencia empírica que documenta que la atención espiritual es un elemento indispensable en los cuidados de enfermería, encontramos poca investigación sobre la formación de los profesionales en este campo. Los propios profesionales sanitarios reconocen un gran desconocimiento de la dimensión espiritual y señalan la necesidad de una formación específica. En respuesta a esta demanda el presente estudio persigue un doble objetivo, por un lado, mejorar la percepción del personal de enfermería sobre el cuidado espiritual y, por otro, dotar de recursos y competencias para detectar, explorar y atender las necesidades espirituales del paciente. Para ello, en una primera fase, se ha diseñado y aplicado una actividad docente (grupo de discusión y cuestionamiento abierto) sobre la atención espiritual en la práctica de enfermería utilizando una muestra disponible de estudiantes matriculados en las dos asignaturas vinculadas al proyecto. En una segunda fase se ha valorado la eficacia de la intervención educativa mediante un cuestionario autoadministrado. Los resultados esperables pondrán de manifiesto un cambio positivo en los estudiantes participantes en el estudio en relación a los conocimientos y competencias sobre el cuidado espiritual ante diferentes situaciones de salud

Competencias básicas para la aplicación de la medicina regenerativa en la clínica de pequeños animales

Depto. de Medicina y Cirugía AnimalFac. de VeterinariaFALSEsubmitte