The Effectiveness of Mindfulness-Based Cognitive Therapy in Primary Care and the Role of Depression Severity and Treatment Attendance

Altres ajuts: Acord transformatiu CRUE-CSICEvidence suggests the efficacy of mindfulness-based cognitive therapy (MBCT) to prevent depression relapse and decrease depressive symptoms during the acute phase. However, the effectiveness of MBCT in real-world heterogeneous samples treated in clinical health settings, including primary care, has received little attention. This study had two aims: (1) to evaluate the effectiveness of MBCT delivered in primary care considering pre-treatment depression scores and (2) to explore the role of participants' characteristics on symptom improvement. Data were obtained from 433 individuals who received MBCT. Participants completed the Personality Inventory for ICD-11 (PiCD) pretreatment and the Beck Depression Inventory (BDI-II) pre- and post-treatment. Sixty percent presented moderate-to-severe depression according to scores on the BDI-II, 18.1% presented mild depression, and 21.7% were in the non-depressed range. The severity of pre-treatment depressive symptoms was associated with outcomes. Most individuals who lacked depressive symptoms at baseline remained in the non-clinical range after the treatment. Those in the severe group benefited the most from the intervention, since 35.6% were considered recovered. Rates of deterioration ranged from 2.1 to 2.7%, depending on the depression-baseline scores. Depression severity at the entrance, attendance, and age, but not personality traits, appear to be related to symptom improvement. According to our results, MBCT can be effectively and safely delivered in primary care

Use of Eculizumab in Pediatric Patients With Transplant Associated Thrombotic Microangiopathy

Complement inhibitor; Eculizumab; Hematopoietic stem cell transplant (HSCT)Inhibidor del complemento; Eculizumab; Trasplante de células madre hematopoyéticas (TCMH)Inhibidor del complement; Eculizumab; Trasplantament de cèl·lules mare hematopoètiques (HSCT)Background: Transplant-associated thrombotic microangiopathy (TA-TMA) is a serious complication of hematopoietic stem cell transplantation (HSCT) associated with high morbidity and mortality. High-risk TA-TMA (hrTA-TMA) is characterized by multifactorial endothelial damage caused by environmental stressors, dysregulation of the complement system, and genetic predisposition. Complement inhibitors have significantly decreased mortality and are the current treatment of choice. In this article, we describe our experience with the use of eculizumab in pediatric patients diagnosed with hrT-TMA after HSCT. Method: Retrospective study of pediatric patients with hrTA-TMA treated with eculizumab between January 2016 and December 2020. Results: Four pediatric patients aged 1, 12, 14, and 17 years at the time of HSCT were diagnosed with hrTA-TMA and treated with eculizumab during the study. At diagnosis, they all had renal impairment with proteinuria, and hypertension under treatment with at least two antihypertensive drugs. The patient who presented multisystemic involvement died instead of treatment. The three patients with exclusive renal involvement achieved TA-TMA resolution after treatment with eculizumab for 65, 52, and 40.6 weeks and were able to stop treatment. The two patients with follow-up data one year after eculizumab withdrawal sustained a favorable response. Eculizumab was well tolerated, and with adequate vaccination and antibiotic prophylaxis, did not increase the risk of infection. Conclusions: Eculizumab appears to be both safe and effective for the treatment of hrTA-TMA in patients with renal impairment. Early diagnosis and initiation of treatment may improve response. Eculizumab withdrawal can be contemplated in patients who achieve laboratory and clinical resolution of TA-TMA

Microbiological quality of treated water by solar-driven oxidation processes

info:eu-repo/semantics/publishedVersio

energy retrofit and environmental sustainability improvement of a historical farmhouse in southern italy

Abstract This paper proposes an integrated rehabilitation project of an abandoned farmhouse in a rural area in Southern Italy. The building underwent a functional recovery to become a tourist accommodation. The use of natural materials can reduce energy consumption and carbon footprints considering environmental sustainability aspects. A proper selection of interventions targeted for the specific warm climate has led to benefits for heating, cooling and lighting in the interior spaces. The project also includes the integration of hydraulic facilities and landscaping, such as planting hedges, green barriers and native trees

Patterns of care for brachytherapy in Europe (PC BE) in Spain and Poland: Comparative results

BackgroundCancer incidence and its mortality depend on a number of factors, including age, socio-economic status and geographic situation, and its incidence is growing around the world [1]. Cancer incidence in Europe is now about 4000 patients per million per year and due to the ageing population a yearly increase of 1–1.5% in cancer cases is estimated in the next two decades [2–4]. Most of the cancer treatments will include external beam radiotherapy or brachytherapy. Brachytherapy has increased its use as a radical or palliative treatment and become more sophisticated with the spread of pulsed dose rate and high dose rate afterloading machines, and the use of new planning systems has additionally improved quality of treatment [5–14]AimThe aim of the present study was to compare two countries (Poland and Spain) and to report the differences in the use of brachytherapy in these countries. For this reason, several characteristics related to brachytherapy were compared.Materials/MethodsThe data used were collected using a website questionnaire for the year 2002 where every centre that participated in the survey could introduce, change or update the information requested. Hospitals included in the study were those that provided data on brachytherapy, because our objective was to compare the brachytherapy facilities between Poland and Spain.ResultsData were available for 22 centres in Poland and 39 centres in Spain that provided brachytherapy in 2002. Spain having more centres that applied brachytherapy (1.0 centre per 1,000,000 inhabitants in Spain vs. 0.6 centre per 1,000,000 inhabitants in Poland), the average number of brachytherapy patients per centre is lower in Spain than in Poland, 137 and 382 respectively. The 5 main tumour sites treated with brachytherapy in Poland were: gynaecological (73.7%), bronchus (13.0%), breast (2.8%), prostate (2.4%) and head and neck (1.6%). In Spain they were: gynaecological (59.7%), breast (15.4%), prostate (12.8%), head and neck (4.2%) and bronchus (1.5%). Statistically significant differences were found in the number of gynaecological, bronchial and breast brachytherapy patients between the countries.ConclusionsAlthough both countries belong to the European Union, there were observed several differences in the use of brachytherapy. We also found some differences in the brachytherapy techniques used in prostate and head and neck cancers

A novel targeted RNA-Seq panel identifies a subset of adult patients with acute lymphoblastic leukemia with BCR-ABL1-like characteristics

BCR-ABL1-like B-cell precursor acute lymphoblastic leukemia (BCP-ALL) remains poorly characterized in adults. We sought to establish the frequency and outcome of adolescent and adult BCR-ABL1-like ALL using a novel RNA-Seq signature in a series of patients with BCP-ALL. To this end, we developed and tested an RNA-Seq custom panel of 42 genes related to a BCR-ABL1-like signature in a cohort of 100 patients with BCP-ALL and treated with risk-adapted ALL trials. Mutations related to BCR-ABL1-like ALL were studied in a panel of 33 genes by next-generation sequencing (NGS). Also, CRLF2 overexpression and IKZF1/CDKN2A/B deletions were analyzed. Twenty out of 79 patients (12-84 years) were classified as BCR-ABL1-like (25%) based on heatmap clustering, with significant overexpression of ENAM, IGJ, and CRLF2 (P ≤ 0.001). The BCR-ABL1-like subgroup accounted for 29% of 15-60-year-old patients, with the following molecular characteristics: CRLF2 overexpression (75% of cases), IKZF1 deletions (64%), CDKN2A/B deletions (57%), and JAK2 mutations (57%). Among patients with postinduction negative minimal residual disease, those with the BCR-ABL1-like ALL signature had a higher rate of relapse and lower complete response duration than non-BCR-ABL1-like patients (P = 0.007). Thus, we have identified a new molecular signature of BCR-ABL1-like ALL that correlates with adverse prognosis in adult patients with ALL

A novel targeted RNA-Seq panel identifies a subset of adult patients with acute lymphoblastic leukemia with BCR-ABL1-like characteristics

BCR-ABL1-like B-cell precursor acute lymphoblastic leukemia (BCP-ALL) remains poorly characterized in adults. We sought to establish the frequency and outcome of adolescent and adult BCR-ABL1-like ALL using a novel RNA-Seq signature in a series of patients with BCP-ALL. To this end, we developed and tested an RNA-Seq custom panel of 42 genes related to a BCR-ABL1-like signature in a cohort of 100 patients with BCP-ALL and treated with risk-adapted ALL trials. Mutations related to BCR-ABL1-like ALL were studied in a panel of 33 genes by next-generation sequencing (NGS). Also, CRLF2 overexpression and IKZF1/CDKN2A/B deletions were analyzed. Twenty out of 79 patients (12-84 years) were classified as BCR-ABL1-like (25%) based on heatmap clustering, with significant overexpression of ENAM, IGJ, and CRLF2 (P <= 0.001). The BCR-ABL1-like subgroup accounted for 29% of 15-60-year-old patients, with the following molecular characteristics: CRLF2 overexpression (75% of cases), IKZF1 deletions (64%), CDKN2A/B deletions (57%), and JAK2 mutations (57%). Among patients with postinduction negative minimal residual disease, those with the BCR-ABL1-like ALL signature had a higher rate of relapse and lower complete response duration than non-BCR-ABL1-like patients (P = 0.007). Thus, we have identified a new molecular signature of BCR-ABL1-like ALL that correlates with adverse prognosis in adult patients with ALL

Soluble Transferrin Receptor as Iron Deficiency Biomarker: Impact on Exercise Capacity in Heart Failure Patients

The soluble transferrin receptor (sTfR) is a marker of tissue iron status, which could indicate an increased iron demand at the tissue level. The impact of sTfR levels on functional capacity and quality of life (QoL) in non-anemic heart failure (HF) patients with otherwise normal systemic iron status has not been evaluated. We conducted an observational, prospective, cohort study of 1236 patients with chronic HF. We selected patients with normal hemoglobin levels and normal systemic iron status. Tissue iron deficiency (ID) was defined as levels of sTfR > 75th percentile (1.63 mg per L). The primary endpoints were the distance walked in the 6 min walking test (6MWT) and the overall summary score (OSS) of the Minnesota Living with Heart Failure Questionnaire (MLHFQ). The final study cohort consisted of 215 patients. Overall QoL was significantly worse (51 +/- 27 vs. 39 +/- 20, p-value = 0.006, respectively), and the 6 MWT distance was significantly worse in patients with tissue ID when compared to patients without tissue ID (206 +/- 179 m vs. 314 +/- 155, p-value < 0.0001, respectively). Higher sTfR levels, indicating increased iron demand, were associated with a shorter distance in the 6 MWT (standardized beta = -0.249, p < 0.001) and a higher MLHFQ OSS (standardized fi = 0.183, p-value = 0.008). In this study, we show that in patients with normal systemic iron parameters, higher levels of sTfR are strongly associated with an impaired submaximal exercise capacity and with worse QoL

Characteristics and outcomes of adult patients in the PETHEMA registry with relapsed or refractory FLT3-ITD mutation-positive acute myeloid leukemia

This retrospective study investigated outcomes of 404 patients with relapsed/refractory (R/R) FMS-like tyrosine kinase 3 (FLT3)-internal tandem duplication (ITD) acute myeloid leukemia (AML) enrolled in the PETHEMA registry, pre-approval of tyrosine kinase inhibitors. Most patients (63%) had received first-line intensive therapy with 3 + 7. Subsequently, patients received salvage with intensive therapy (n = 261), non-intensive therapy (n = 63) or supportive care only (n = 80). Active salvage therapy (i.e., intensive or non-intensive therapy) resulted in a complete remission (CR) or CR without hematological recovery (CRi) rate of 42%. More patients achieved a CR/CRi with intensive (48%) compared with non-intensive (19%) salvage therapy (p < 0.001). In the overall population, median overall survival (OS) was 5.5 months; 1- and 5-year OS rates were 25% and 7%. OS was significantly (p < 0.001) prolonged with intensive or non-intensive salvage therapy compared with supportive therapy, and in those achieving CR/CRi versus no responders. Of 280 evaluable patients, 61 (22%) had an allogeneic stem-cell transplant after they had achieved CR/CRi. In conclusion, in this large cohort study, salvage treatment approaches for patients with FLT3-ITD mutated R/R AML were heterogeneous. Median OS was poor with both non-intensive and intensive salvage therapy, with best long-term outcomes obtained in patients who achieved CR/CRi and subsequently underwent allogeneic stem-cell transplant.This study was supported by Centro de Investigación Biomédica en Red Cáncer (CIBERONC), Valencia, Spain [CB16/12/00284]

Evaluation of transparent 20L polyproylene buckets for household solar water disinfection (SODIS) of drinking water in resource-poor environments.

Solar water disinfection (SODIS) is an appropriate technology for treating drinking water in developing communities, as it is effective, low- or zero-cost, easy to use. The WHO recognises SODIS as an appropriate intervention to provide drinking water after manmade or natural disasters. Nevertheless, uptake is low due partially to the burden of using small volume polyethylene terephthalate (PET) bottles (1.5-2 L). A major challenge is to develop a low cost transparent container for disinfecting larger volumes of water. This study examines the capability of transparent polypropylene (PP) buckets of 5 and 20 litres volume, as SODIS containers using three waterborne pathogen indicator organisms: E. coli, MS2-phage and Cryptosporidium parvum oocysts