From Messengers to Receptors in Psoriasis: The Role of IL-17RA in Disease and Treatment.

The paradigm of psoriasis as a Th17-driven disease has evolved in the last years towards a much deeper knowledge of the complex pathways, mechanisms, cells, and messengers involved, highlighting the crucial role played by the IL-17 family of cytokines. All IL-17 isoforms signal through IL-17R. Five subunits of IL-17R have been described to date, which couple to form a homo- or heteroreceptor complex. Characteristically, IL-17RA is a common subunit in all hetero-receptors. IL-17RA has unique structural—containing a SEFIR/TILL domain—and functional—requiring ACT-1 for signaling—properties, enabling Th17 cells to act as a bridge between innate and adaptive immune cells. In psoriasis, IL-17RA plays a key role in pathogenesis based on: (a) IL-17A, IL-17F, and other IL-17 isoforms are involved in disease development; and (b) IL-17RA is essential for signaling of all IL-17 cytokines but IL-17D, whose receptor has not been identified to date. This article reviews current evidence on the biology and role of the IL-17 family of cytokines and receptors, with focus on IL-17RA, in psoriasis and some related comorbidities, and puts them in context with current and upcoming treatments.post-print1.096 K

Correction: Vidal et al. From Messengers to Receptors in Psoriasis: The Role of IL-17RA in Disease and Treatment. Int. J. Mol. Sci. 2021, 22, 6740.

post-print599 K

Complicación inesperada tras cirugía de Bentall

The occurrence of pseudoaneurysm in non-ischemic and non-manipulated areas during cardiac surgery is unknown. We report a case of a 63 year old man who underwent Bentall surgery. The echocardiographic control demonstrated a cavity and a systolic fl ow next to the apex suggesting a new pseudoaneurysm. Cardiovascular magnetic resonance and computerized tomography confi rmed an apical pseudoaneurysm and the presence of surgical material in the epicardium. We hypothesize that hypothermia during surgery might have increased the stiff ness of the extracorporeal circulation cannula causing the injury in this area.La formación de pseudoaneurismas en zonas sin isquemia y no manipuladas durante la cirugía cardíaca resulta una incógnita. Presentamos a un varón de 63 años sometido a cirugía tipo Bentall que en la ecografía control presenta en ápex de ventrículo izquierdo un fl ujo sistólico hacia un posible pseudoaneurisma. La cardiorresonancia y la tomografía computarizada permiten confi rmar el pseudoaneurisma apical además de material quirúrgico en epicardio. Se ha planteado que la hipotermia quirúrgica podría incrementar la rigidez de las cánulas de circulación extracorpórea y justifi car lesiones en zonas no manipuladas por los cirujanos, lo que contribuiría a nuevos cuidados durante la intervención

Reduced Intellectual Development in Children with Prenatal Lead Exposure

OBJECTIVE: Low-level postnatal lead exposure is associated with poor intellectual development in children, although effects of prenatal exposure are less well studied. We hypothesized that prenatal lead exposure would have a more powerful and lasting impact on child development than postnatal exposure. DESIGN: We used generalized linear mixed models with random intercept and slope to analyze the pattern of lead effect of the cohort from pregnancy through 10 years of age on child IQ from 6 to 10 years. We statistically evaluated dose–response nonlinearity. PARTICIPANTS: A cohort of 175 children, 150 of whom had complete data for all included covariates, attended the National Institute of Perinatology in Mexico City from 1987 through 2002. EVALUATIONS/MEASUREMENTS: We used the Wechsler Intelligence Scale for Children–Revised, Spanish version, to measure IQ. Blood lead (BPb) was measured by a reference laboratory of the Centers for Disease Control and Prevention (CDC) quality assurance program for BPb. RESULTS: Geometric mean BPb during pregnancy was 8.0 μg/dL (range, 1–33 μg/dL), from 1 through 5 years was 9.8 μg/dL (2.8–36.4 μg/dL), and from 6 through 10 years was 6.2 μg/dL (2.2–18.6 μg/dL). IQ at 6–10 years decreased significantly only with increasing natural-log third-trimester BPb (β = −3.90; 95% confidence interval, −6.45 to −1.36), controlling for other BPb and covariates. The dose–response BPb–IQ function was log-linear, not linear–linear. CONCLUSIONS: Lead exposure around 28 weeks gestation is a critical period for later child intellectual development, with lasting and possibly permanent effects. There was no evidence of a threshold; the strongest lead effects on IQ occurred within the first few micrograms of BPb. RELEVANCE TO CLINICAL PRACTICE: Current CDC action limits for children applied to pregnant women permit most lead-associated child IQ decreases measured over the studied BPb range

La incidència de diabetis mellitus de tipus 1 durant la pandèmia de COVID-19 a Catalunya

Coronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Diabetis mellitus de tipus 1; Malaltia crònicaCoronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Diabetes mellitus de tipo 1; Enfermedad crónicaCoronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Type 1 diabetes mellitus; Chronic diseaseIntroducció: la diabetis de tipus 1 és una malaltia crònica que es caracteritza per la falta de producció d’insulina per part del pàncrees, el que provoca un augment dels nivells de glucosa en sang. En alguns països s’ha reportat un increment en la incidència de diabetis de tipus 1 durant la pandèmia de COVID-19. Objectiu: comprovar si ha augmentat la incidència de diabetis de tipus 1 durant la pandèmia de COVID-19 a Catalunya. Mètodes: estimació de la incidència esperada de diabetis de tipus 1 per als anys 2020-2021 a través d’una regressió Poisson, i comparació amb la incidència observada. La incidència observada es va obtenir a partir del registre poblacional de diabetis de tipus 1 del programa PADRIS d’analítica de dades d’AQuAS. Resultats: de forma agregada, l’any 2020 la incidència no va augmentar significativament respecte a l’any anterior, però per a l’any 2021 va augmentar significativament en un 28 %. Els majors augments, en tots dos anys, es van donar entre les persones menors de 18 anys i les dones. Conclusions i discussió: durant la pandèmia de COVID-19 es va produir un augment notable i estadísticament significatiu de la incidència de casos de DM1 a Catalunya, encara que no és possible establir una relació de causalitat entre la pandèmia i la diabetis. Es requereixen més estudis per investigar els possibles mecanismes biològics o socials que podrien explicar aquest fenomen i les seves implicacions clíniques i sanitàries.Introducción: la diabetes tipo 1 es una enfermedad crónica que se caracteriza por la falta de producción de insulina por parte del páncreas, lo que provoca un aumento de los niveles de glucosa en sangre. En algunos países se ha reportado un incremento en la incidencia de diabetes tipo 1 durante la pandemia de COVID-19. Objetivo: comprobar si ha aumentado la incidencia de diabetes tipo 1 durante la pandemia de COVID-19 en Cataluña. Métodos: estimación de la incidencia esperada de diabetes tipo 1 para los años 2020-2021 a través de una regresión Poisson, y comparación con la incidencia observada. La incidencia observada se obtuvo a partir del registro poblacional de diabetes tipo 1 del programa PADRIS de analítica de datos de AQuAS. Resultados: de forma agregada, en el año 2020 la incidencia no aumentó significativamente respecto al año anterior, pero para el año 2021 aumentó significativamente en un 28%. Los mayores aumentos, en ambos años, se dieron entre las personas menores de 18 años y las mujeres. Conclusiones y discusión: durante la pandemia de COVID-19 se produjo un aumento notable y estadísticamente significativo de la incidencia de casos de DM1 en Cataluña, aunque no es posible establecer una relación de causalidad entre la pandemia y la diabetes. Se requieren más estudios para investigar los posibles mecanismos biológicos o sociales que podrían explicar este fenómeno y sus implicaciones clínicas y sanitarias.Introduction: Type 1 diabetes (T1D) is a chronic disease characterized by insufficient insulin production by the pancreas, leading to high blood glucose levels. Some countries have reported an increase in the incidence of T1D during the COVID-19 pandemic. Objective: To examine whether the incidence of T1D has increased during the COVID-19 pandemic in Catalonia. Methods: We estimated the expected incidence of T1D for 2020-2021 using a Poisson regression model based on historical data from 2010 to 2019. We compared the expected incidence with the observed incidence obtained from the population-based T1D registry of the PADRIS data analysis program of AQuAS. Results: In 2020, there was no significant increase in incidence compared to 2019, but in 2021 there was a significant increase of 28%. The largest increases occurred among people under 18 years old and women. Conclusions and discussion: There was a notable and statistically significant increase in T1D cases in Catalonia during the COVID-19 pandemic, although a causal relationship between the pandemic and diabetes cannot be established. Further studies are needed to explore the possible biological or social mechanisms that could explain this phenomenon and its clinical and health implications

Predictors of Source Memory Success and Failure in Older Adults

Source memory decline has been identified as one of the types of memory most seriously affected during older age. It refers to our capacity to recollect the contextual information in which our experiences take place. Although most elderly adults will be affected by progressive source memory decline, a subset of individuals will not follow this average pattern; instead, their source memory capabilities will remain functional. Likewise, a minority of individuals will manifest an extreme decay of their source memory abilities. The objective of the present study was to identify among 120 potential predictors that significantly contributed to these two extreme source memory outcomes. Spatial source memory was measured in a sample of 519 healthy individuals between 61 and 80 years old. Individuals who performed below the 20th and above the 80th percentiles in the source memory task were defined as individuals whose episodic memory failed and succeeded, respectively. Logistic models identified five and six significant predictors of source memory success and failure in older age, respectively. High source memory performance was mainly predicted by healthy cardiovascular markers and psychological traits, whereas low source memory performance was primarily predicted by consumption habits and by less engagement in mental activities. The models identified relevant biological and life experiences that underlie these unusual source memory outcomes in older age

Effects of a paediatric antimicrobial stewardship program on antimicrobial use and quality of prescriptions in patients with appendix-related intraabdominal infections

The effectiveness of antimicrobial stewardship programs (ASP) in reducing antimicrobial use (AU) in children has been proved. Many interventions have been described suitable for different institution sizes, priorities, and patients, with surgical wards being one of the areas that may benefit the most. We aimed to describe the results on AU and length of stay (LOS) in a pre-post study during the three years before (2014-2016) and the three years after (2017-2019) implementation of an ASP based on postprescription review with feedback in children and adolescents admitted for appendix-related intraabdominal infections (AR-IAI) in a European Referral Paediatric University Hospital. In the postintervention period, the quality of prescriptions (QP) was also evaluated. Overall, 2021 AR-IAIs admissions were included. Global AU, measured both as days of therapy/100 patient days (DOT/100PD) and length of therapy (LOT), and global LOS remained unchanged in the postintervention period. Phlegmonous appendicitis LOS (p = 0.003) and LOT (p < 0.001) significantly decreased, but not those of other AR-IAI diagnoses. The use of piperacillin-tazobactam decreased by 96% (p = 0.044), with no rebound in the use of other Gram-negative broad-spectrum antimicrobials. A quasisignificant (p = 0.052) increase in QP was observed upon ASP implementation. Readmission and case fatality rates remained stable. ASP interventions were safe, and they reduced LOS and LOT of phlegmonous appendicitis and the use of selected broad-spectrum antimicrobials, while increasing QP in children with AR-IAI

El reencuentro con la naturaleza: voces femeninas en el tiempo

Este texto contribuye al análisis científico de diferentes áreas del conocimiento la filosofía social, la educación para el cuidado del medio ambiente mediante la sustentabilidad que incide en diversas unidades de aprendizaje en Educación para la Salud y de la Maestria en Sociología de la SaludEl relato de las voces femeninas que se escuchan en el tiempo, narran las luchas por defender un ideal, con frecuencia en la organización de las mujeres que pugnan por estabilizar el equilibrio de la naturaleza, por medio de tácticas educativas que van recorriendo el bachillerato, la normal y la universidad