Effectiveness and Safety of the Sequential Use of a Second and Third Anti-TNF Agent in Patients With Inflammatory Bowel Disease: Results From the Eneida Registry

Background: The effectiveness of the switch to another anti-tumor necrosis factor (anti-TNF) agent is not known. The aim of this study was to analyze the effectiveness and safety of treatment with a second and third anti-TNF drug after intolerance to or failure of a previous anti-TNF agent in inflammatory bowel disease (IBD) patients. Methods: We included patients diagnosed with IBD from the ENEIDA registry who received another anti-TNF after intolerance to or failure of a prior anti-TNF agent. Results: A total of 1122 patients were included. In the short term, remission was achieved in 55% of the patients with the second anti-TNF. The incidence of loss of response was 19% per patient-year with the second anti-TNF. Combination therapy (hazard ratio [HR], 2.4; 95% confidence interval [CI], 1.8-3; P < 0.0001) and ulcerative colitis vs Crohn's disease (HR, 1.6; 95% CI, 1.1-2.1; P = 0.005) were associated with a higher probability of loss of response. Fifteen percent of the patients had adverse events, and 10% had to discontinue the second anti-TNF. Of the 71 patients who received a third anti-TNF, 55% achieved remission. The incidence of loss of response was 22% per patient-year with a third anti-TNF. Adverse events occurred in 7 patients (11%), but only 1 stopped the drug. Conclusions: Approximately half of the patients who received a second anti-TNF achieved remission; nevertheless, a significant proportion of them subsequently lost response. Combination therapy and type of IBD were associated with loss of response. Remission was achieved in almost 50% of patients who received a third anti-TNF; nevertheless, a significant proportion of them subsequently lost response

Immigrant IBD Patients in Spain Are Younger, Have More Extraintestinal Manifestations and Use More Biologics Than Native Patients

BackgroundPrevious studies comparing immigrant ethnic groups and native patients with IBD have yielded clinical and phenotypic differences. To date, no study has focused on the immigrant IBD population in Spain. MethodsProspective, observational, multicenter study comparing cohorts of IBD patients from ENEIDA-registry who were born outside Spain with a cohort of native patients. ResultsWe included 13,524 patients (1,864 immigrant and 11,660 native). The immigrants were younger (45 +/- 12 vs. 54 +/- 16 years, p < 0.001), had been diagnosed younger (31 +/- 12 vs. 36 +/- 15 years, p < 0.001), and had a shorter disease duration (14 +/- 7 vs. 18 +/- 8 years, p < 0.001) than native patients. Family history of IBD (9 vs. 14%, p < 0.001) and smoking (30 vs. 40%, p < 0.001) were more frequent among native patients. The most prevalent ethnic groups among immigrants were Caucasian (41.5%), followed by Latin American (30.8%), Arab (18.3%), and Asian (6.7%). Extraintestinal manifestations, mainly musculoskeletal affections, were more frequent in immigrants (19 vs. 11%, p < 0.001). Use of biologics, mainly anti-TNF, was greater in immigrants (36 vs. 29%, p < 0.001). The risk of having extraintestinal manifestations [OR: 2.23 (1.92-2.58, p < 0.001)] and using biologics [OR: 1.13 (1.0-1.26, p = 0.042)] was independently associated with immigrant status in the multivariate analyses. ConclusionsCompared with native-born patients, first-generation-immigrant IBD patients in Spain were younger at disease onset and showed an increased risk of having extraintestinal manifestations and using biologics. Our study suggests a featured phenotype of immigrant IBD patients in Spain, and constitutes a new landmark in the epidemiological characterization of immigrant IBD populations in Southern Europe

Virtual rounds as an alternative to conventional hospital internships. A new teaching model.

Como consecuencia de la pandemia global a raíz del Covid-19, las prácticas hospitalarias de los estudiantes de medicina, así como del resto de carreras sanitarias fueron primeramente anuladas y, posteriormente, mermadas. Ante esta situación, distintas universidades han establecido rotaciones virtuales con el fin de compensar estas carencias formativas. La Universidad de Miami, en concreto la Miller School of Medicine ha sido pionera en este programa. Para valorar la calidad de este modelo de enseñanza, así como para estar en la vanguardia de la educación médica, la Universidad Francisco de Vitoria ha decidido apoyar este proyecto, brindando la oportunidad a distintos estudiantes de formar parte del mismo, asistiendo a rotaciones virtualesen el servicio de medicina interna de los hospitales de la Universidad de Miami. Con esto se ha buscado una alternativa ante la cancelación de prácticas internacionales, fomentando la formación en un ambiente multicultural, la posibilidad de poder observar casos clínicos fuera de lo común, la asistencia a seminarios compartidos con residentes de dicha especialidad y la oportunidad de conocer de primera mano un modelo de enseñanza en el marco del devenir de la educación médica. La evaluación de los participantes a través de su experiencia puso de manifiesto la satisfacción con el programa, el amplio aprendizaje, un nivel de conocimientos a la misma altura del adquirido en prácticas presenciales (excepto en el contacto con el paciente) y un balance positivo dirigido a complementar las prácticas convencionales con dicho modelo de enseñanza.Because of the global pandemic, hospital internships for medical students, as well as for other health careers, were first cancelled and subsequently reduced. In response to this situation, several universities have established virtual rounds to offset these training shortcomings. The University of Miami, specifically the Miller School of Medicine, has been a pioneer in this program. To assess the quality of thisteaching model, as well as to be at the forefront of medical education, Francisco de Vitoria University has decided to support this project, giving the opportunity to different students to be part of it, attending virtual rounds in the internal medicine service of the hospitals of the University of Miami. This has been an alternative in the face of the cancellation of international internships, allowing us to promote medical training in a multicultural environment, enabling the possibility of observing clinical cases out of the ordinary, attending seminars shared with residents of this specialty and the opportunity to learn first-hand about a teaching model in the context of the future of medical education. The evaluation of the participants through their experience showed significant satisfaction with the program, extensive learning, a level of knowledge at the same level as it is acquired in classroom practice (except for patient contact) and a positive balance aimed at complementing conventional practices with this teaching model

Serum biomarkers in elderly asthma

Asthma is usually misdiagnosed and under-treated in the elderly population, resulting in complications and increased severity to the patient. In this review, we describe some of the most important serum markers of asthma studied so far, reporting their outcomes and possible prediction of asthma in the elderly population.info:eu-repo/semantics/publishedVersio

Copper-Containing Catalytic Amyloids Promote Phosphoester Hydrolysis and Tandem Reactions

Self-assembly of short de novo designed peptides gives rise to catalytic amyloids capable of facilitating multiple chemical transformations. We show that catalytic amyloids can efficiently hydrolyze paraoxon, which is a widely used, highly toxic organophosphate pesticide. Moreover, these robust and inexpensive metal-containing materials can be easily deposited on various surfaces, producing catalytic flow devices. Finally, functional promiscuity of catalytic amyloids promotes tandem hydrolysis/oxidation reactions. High efficiency discovered in a very small library of peptides suggests an enormous potential for further improvement of catalytic properties, both in terms of catalytic efficiency and substrate scope

Genetic variation in genes of the fatty acid synthesis pathway and breast cancer risk.

Fatty acid synthase (FAS) is the major enzyme of lipogenesis. It catalyzes the NADPH-dependent condensation of acetyl-CoA and malonyl-CoA to produce palmitic acid. Transcription of the FAS gene is controlled synergistically by the transcription factors ChREBP (carbohydrate response element-binding protein), which is induced by glucose, and SREBP-1 (sterol response element-binding protein-1), which is stimulated by insulin through the PI3K/Akt signal transduction pathway. We investigated whether the genetic variability of the genes encoding for ChREBP, SREBP and FAS (respectively, MLXIPL, SREBF1 and FASN) is related to breast cancer risk and body-mass index (BMI) by studying 1,294 breast cancer cases and 2,452 controls from the European Prospective Investigation on Cancer (EPIC). We resequenced the FAS gene and combined information of SNPs found by resequencing and SNPs from public databases. Using a tagging approach and selecting 20 SNPs, we covered all the common genetic variation of these genes. In this study we were not able to find any statistically significant association between the SNPs in the FAS, ChREBP and SREPB-1 genes and an increased risk of breast cancer overall and by subgroups of age, menopausal status, hormone replacement therapy (HRT) use or BMI. On the other hand, we found that two SNPs in FASN were associated with BMI

Tratamientos Psicológicos Empíricamente Apoyados Para la Infancia y Adolescencia: : Estado de la Cuestión

Background: The empirical evidence accumulated on the effi cacy, effectiveness, and effi ciency of psychotherapeutic treatments in children and adolescents calls for an update. The main goal of this paper objective was to carry out a selective review of empirically supported psychological treatments for a variety of common psychological disorders and problems in childhood and adolescence. Method: A review was carried out of the psychological treatments for different psychological disorders and problems in socialemotional or behavioral adjustment in the child-adolescent population according to the Spanish National Health System (Clinical Practice Guidelines) levels of evidence and degrees of recommendation. Results: The fi ndings suggest that psychological treatments have empirical support for addressing a wide range of psychological problems in these developmental stages. The degree of empirical support ranges from low to high depending on the phenomenon analyzed. The review suggests unequal progress in the different fi elds of intervention. Conclusions: From this update, psychologists will be able to make informed decisions when implementing those empirically supported treatments to address the problems that occur in childhood and adolescence.Antecedentes: la evidencia empírica acumulada en los últimos años sobre la efi cacia, efectividad y efi ciencia de los tratamientos psicológicos en la infancia y adolescencia reclama una actualización. El principal objetivo de este artículo es el de llevar a cabo una revisión de los tratamientos psicológicos empíricamente apoyados para una diversidad de problemas psicológicos habituales en la infancia y la adolescencia. Método: se revisan los tratamientos psicológicos para diferentes trastornos psicológicos y problemas en el ajuste socioemocional o conductual en población infanto-juvenil en función de los niveles de evidencia y grados de recomendación del Sistema Nacional de Salud de España (Guías de Práctica Clínica). Resultados: los hallazgos sugieren que los tratamientos psicológicos específi camente dirigidos a niños, niñas y adolescentes disponen de apoyo empírico para el abordaje de un amplio elenco de problemas psicológicos. Este grado de apoyo empírico oscila de bajo a alto en función del problema analizado. La revisión muestra un avance desigual en los diferentes campos de intervención. Conclusiones: a partir de esta actualización, los profesionales de la psicología podrán tomar decisiones informadas a la hora de implementar aquellas intervenciones psicológicas con apoyo empírico para el abordaje de los problemas en la infancia y la adolescenci