Consensus of experts from the Spanish pharmacogenetics and pharmacogenomics society and the Spanish society of medical oncology for the genotyping of DPYD in cancer patients who are candidates for treatment with fluoropyrimidines

5-Fluorouracil (5-FU) and oral fluoropyrimidines, such as capecitabine, are widely used in the treatment of cancer, especially gastrointestinal tumors and breast cancer, but their administration can produce serious and even lethal toxicity. This toxicity is often related to the partial or complete deficiency of the dihydropyrimidine dehydrogenase (DPD) enzyme, which causes a reduction in clearance and a longer half-life of 5-FU. It is advisable to determine if a DPD deficiency exists before administering these drugs by genotyping DPYD gene polymorphisms. The objective of this consensus of experts, in which representatives from the Spanish Pharmacogenetics and Pharmacogenomics Society and the Spanish Society of Medical Oncology participated, is to establish clear recommendations for the implementation of genotype and/or phenotype testing for DPD deficiency in patients who are candidates to receive fluoropyrimidines. The genotyping of DPYD previous to treatment classifies individuals as normal, intermediate, or poor metabolizers. Normal metabolizers do not require changes in the initial dose, intermediate metabolizers should start treatment with fluoropyrimidines at doses reduced to 50%, and poor metabolizers are contraindicated for fluoropyrimidinesThis project has been financed with SEOM and SEFF resource

Evaluación preliminar de una técnica molecular para el diágnostico bacteriológico de sepsis. Estudio comparativo hemocultivo-magicplex sepsis

La elevada morbimortalidad de la sepsis requiere terapia empírica inminente, el retraso es un determinante de mortalidad La detección temprana del patógeno es crucial. Se evalua una PCR a tiempo real para la detección cualitativa de microorganismos relacionados con la sepsis frente al cultivo

Malformaciones venosas orofaciales de bajo flujo: esclerosis endoluminal con láser de diodo

ResumenIntroducciónLas anomalías vasculares son procesos frecuentes que se localizan en más del 50% de los casos en la región de la cabeza y el cuello. Las técnicas clásicas de tratamiento, tales como la cirugía y la esclerosis química, han dado paso a modernas técnicas menos invasivas, tales como el láser Nd:YAG. Por otra parte, se ha utilizado con éxito el láser de diodo (980 nm) para el tratamiento de varices mediante esclerosis endoluminal. Nuestra propuesta es la utilización del láser de diodo (λ 980 nm) para provocar una esclerosis por fotocoagulación intralesional de las malformaciones venosas de bajo flujo dada la capacidad de este láser de ser transmitido por fibra óptica.ObjetivoExponer nuestros resultados en el tratamiento de malformaciones venosas de bajo flujo (MVBF) orofaciales mediante la terapéutica de esclerosis endoluminal con láser de diodo.Material y métodosRevisamos 84 pacientes que presentaban MVBF orofaciales tratados con láser de diodo. Describimos la técnica de realización y se muestran los resultados postoperatorios a corto plazo.ResultadosTras un periodo de seguimiento no inferior a 12 meses se constató curación en el 95,24% aplicando una o dos sesiones y solamente en 4 casos se objetivó recidiva. Concluimos que la técnica de esclerosis endoluminal con láser de diodo de MVBF en el área orofacial se constituye como una nueva técnica de tratamiento, mínimamente invasiva, ambulatoria, y que permite la resolución de los casos sin tener que recurrir a cirugías más agresivas y con excelentes resultados funcionales y estéticos.AbstractBackgroundVascular anomalies are common processes that involve the head and neck region in more than 50% of the cases. Traditional treatment options such as surgery and chemical sclerosis have given way to modern less-invasive techniques, including Nd:YAG laser treatment. On the other hand, 980 nm laser diode has been successfully used for the endovenous sclerosis of varicose veins. Our proposal is the usage of diode laser (λ = 980 nm) to induce the sclerosis of low-flow venous malformations by intralesional photocoagulation, given this laser's ability to deliver the beam via a fiber optic cable.ObjectiveTo report our results in the treatment of orofacial low-flow venous malformations (LFVM) with diode laser endovenous sclerosis (DLES).Material and methods: The clinical records from 84 patients presenting with orofacial LFVM treated with DLES were collected. The technique used and short-term postoperative results were revised.ResultsAfter a follow-up period of at least 12 months after one or two DLES sessions, healing was observed in 95.24% of the cases. Only 4 cases showed relapse.ConclusionsThe DLES technique is a new therapeutic option for the treatment of orofacial LFVM, is minimally-invasive, allows an outpatient setting and achieves excellent functional and esthetic results avoiding more aggressive procedures

miniBELEN: a modular neutron counter for (a, n) reactions

miniBELEN is a modular and transportable neutron moderated counter with a nearly flat neutron detection efficiency up to 10 MeV. Modularity implies that the moderator can be reassembled in different ways in order to obtain different types of response. The detector has been developed in the context of the Measurement of Alpha Neutron Yields (MANY) collaboration, which is a scientific effort aiming to carry out measurements of (a, n) production yields, reaction cross-sections and neutron energy spectra. In this work we present and discuss several configurations of the miniBELEN detector. The experimental validation of the efficiency calculations using 252Cf sources and the measurement of the 27Al(a, n) 30P reaction is also presented.This work has been supported by the Spanish Ministerio de Economía y Competitividad under grants FPA2017-83946- C2-1 & C2-2 and PID2019-104714GB-C21 & C22, the Generalitat Valenciana Grant PROMETEO/2019/007, both cofounded by FEDER (EU), and the SANDA project funded under H2020-EURATOM-1.1 Grant No. 847552. The authors acknowledge the support from Centro de Microanálisis de Materiales (CMAM) - Universidad Autónoma de Madrid, for the beam time proposal (Comissioning of neutron detector systems for (a,݊n) reaction measurements) with code P01156, and its technical staff for their contribution to the operation of the accelerator.Article signat per 41 autors/es: N. Mont-Geli, A. Tarifeño-Saldivia, L.M. Fraile, S. Viñals, A. Perea, M. Pallàs, G. Cortés, E. Nácher, J.L. Tain, V. Alcayne, A. Algora, J. Balibrea-Correa, J. Benito, M.J.G. Borge, J.A. Briz, F. Calviño, D. Cano-Ott, A. De Blas, C. Domingo-Pardo, B. Fernández, R. Garcia, G. García, J. Gómez-Camacho, E.M. González-Romero, C. Guerrero, J. Lerendegui-Marco, M. Llanos, T. Martínez, E. Mendoza, J.R. Murias, S.E.A. Orrigo, A. Pérez de Rada, V. Pesudo, J. Plaza, J.M. Quesada, A. Sánchez, V. Sánchez-Tembleque, R. Santorelli, O. Tengblad, J.M. Udías and D. Villamarín.Postprint (published version

Effects of an Exercise Program on Brain Health Outcomes for Children With Overweight or Obesity. The ActiveBrains Randomized Clinical Trial

IMPORTANCE Pediatric overweight and obesity are highly prevalent across the world, with implications for poorer cognitive and brain health. Exercise might potentially attenuate these adverse consequences. OBJECTIVES To investigate the effects of an exercise program on brain health indicators, including intelligence, executive function, academic performance, and brain outcomes, among children with overweight or obesity and to explore potential mediators and moderators of the main effects of exercise. DESIGN, SETTING, AND PARTICIPANTS All preexercise and postexercise data for this 20-week randomized clinical trial of 109 children aged 8 to 11 years with overweight or obesity were collected from November 21, 2014, to June 30, 2016, with neuroimaging data processing and analyses conducted between June 1, 2017, and December 20, 2021. All 109 children were included in the intention-to-treat analyses; 90 children (82.6%) completed the postexercise evaluation and attended 70%or more of the recommended exercise sessions and were included in per-protocol analyses. INTERVENTIONS All participants received lifestyle recommendations. The control group continued their usual routines, whereas the exercise group attended a minimum of 3 supervised 90-minute sessions per week in an out-of-school setting. MAIN OUTCOMES AND MEASURES Intelligence, executive function (cognitive flexibility, inhibition, andworking memory), and academic performancewere assessed with standardized tests, and hippocampal volume was measured with magnetic resonance imaging. RESULTS The 109 participants included 45 girls (41.3%); participants had a mean (SD) body mass index of 26.8 (3.6) and a mean (SD) age of 10.0 (1.1) years at baseline. In per-protocol analyses, the exercise intervention improved crystallized intelligence, with the exercise group improving from before exercise to after exercise (mean z score, 0.62 [95%CI, 0.44-0.80]) compared with the control group (mean z score, –0.10 [95%CI, –0.28 to 0.09]; difference between groups, 0.72 SDs [95%CI, 0.46-0.97]; P < .001). Total intelligence also improved significantly more in the exercise group (mean z score, 0.69 [95%CI, 0.48-0.89]) than in the control group (mean z score, 0.07 [95% CI, –0.14 to 0.28]; difference between groups, 0.62 SDs [95%CI, 0.31-0.91]; P < .001). Exercise also positively affected a composite score of cognitive flexibility (mean z score: exercise group, 0.25 [95% CI, 0.05-0.44]; control group, –0.17 [95%CI, –0.39 to 0.04]; difference between groups, 0.42 SDs [95%CI, 0.13-0.71]; P = .005). These main effects were consistent in intention-to-treat analyses and after multiple-testing correction. There was a positive, small-magnitude effect of exercise on total academic performance (mean z score: exercise group, 0.31 [95%CI, 0.18-0.44]; control group, 0.10 [95%CI, –0.04 to 0.24]; difference between groups, 0.21 SDs [95%CI, 0.01-0.40]; P = .03), which was partially mediated by cognitive flexibility. Inhibition, working memory, hippocampal volume, and other brain magnetic resonance imaging outcomes studied were not affected by the exercise program. The intervention increased cardiorespiratory fitness performance as indicated by longer treadmill time to exhaustion (mean z score: exercise group, 0.54 [95%CI, 0.27-0.82]; control group, 0.13 [95%CI, –0.16 to 0.41]; difference between groups, 0.42 SDs [95%CI, 0.01-0.82]; P = .04), and these changes in fitness mediated some of the effects (small percentage of mediation [approximately 10%-20%]). The effects of exercise were overall consistent across the moderators tested, except for larger improvements in intelligence among boys compared with girls. CONCLUSIONS AND RELEVANCE In this randomized clinical trial, exercise positively affected intelligence and cognitive flexibility during development among children with overweight or obesity. However, the structural and functional brain changes responsible for these improvementswere not identified.Spanish Government DEP2013-47540 DEP2016-79512-R DEP2017-91544-EXPEuropean Commission European Commission European Commission Joint Research Centre 667302Alicia Koplowitz FoundationERDF (FEDER in Spanish) B-CTS-355-UGR18University of Granada, Plan Propio de Investigacion, Visiting Scholar grantsJunta de AndaluciaUnit of Excellence on Exercise, Nutrition and Health (UCEENS)European Commission SOMM17/6107/UGREXERNET Research Network on Exercise and Health DEP2005-00046/ACTIHigh Council of Sports 09/UPB/19Spanish Government FPU 14/06837 FPI-BES-2014-068829 FJC2018-037925-I FJCI-2014-19563 IJCI-2017-33642 RYC2019-027287-I FPU15/02645 FJCI-2017-33396 IJC2019-041916-IJunta de AndaluciaNational Agency for Research and Development (ANID)/BECAS Chile 72180543Ramon Areces Foundatio

Implementation of Classroom of Pharmacy at the Faculty of Health Sciences

El Espacio Europeo de Educación Superior (EEES) supone un cambio en nuestras metodologías docentes, que deben orientarse hacia una mayor participación del alumno en el proceso de enseñanzaaprendizaje, así como a satisfacer la necesidad de formación del mundo laboral. Por ello, y en base a la necesidad de nuestra Universidad de adaptar la docencia de Farmacia al Espacio Europeo de Educación Superior, la Facultad de Ciencias de la Salud de la Universidad CEU Cardenal Herrera, ha desarrollado un proyecto para implantar un aula que simule una Oficina de Farmacia. Entre los perfiles laborales del farmacéutico, el de Oficina de Farmacia es el más frecuente, por ser esta la ocupación laboral mayoritaria. La labor en las farmacias comunitarias consiste básicamente en la conservación, dispensación, asesoramiento y elaboración de medicamentos. Todo ello, unido al ejercicio de la atención farmacéutica, conlleva una gran carga de responsabilidad, un conocimiento y vigilancia de la legislación establecida al respecto y una base científica y técnica importante. La farmacia es, a su vez, un centro de educación y prevención sanitaria, dietética y cosmética. Con el objetivo de que nuestros alumnos desarrollen todas las competencias necesarias para el farmacéutico en la Facultad de Salud se implantó el Aula de la Farmacia.The European Higher Education Area (EHEA) represents a shift in our teaching methodology, which should now be steered towards a greater participation of students in the teaching-learning process and should satisfy the employment market’s need for trained professionals. In this context, our university has sought to adapt its pharmacy teaching programme to the EHEA, and so the Faculty of Health Sciences of the CEU Cardenal Herrera University has developed a project to create a space that simulates a working pharmacy. Among the different professional profiles within the discipline of pharmacy, a position in a chemist’s/drugstore is the most common, as the majority of pharmacists are employed as such. The work of community pharmacies basically consists of the storing, dispensing and preparation of medication. These tasks, combined with the pharmaceutical care provided to patients and customers, involve a great deal of responsibility that depends on knowledge and safeguarding of the current legislation and a solid scientific and technical training. A pharmacy is, at the same time, a centre of education and prevention in health, diet and cosmetics. With all of this in mind, the Pharmacy Room was created by the Health Sciences Faculty with the objective of allowing our students to develop all the skills expected of a pharmacist

Leveraging a nationwide infection surveillance program to implement a colorectal surgical site infection reduction bundle: a pragmatic, prospective and multicentre cohort study

Background: Bundled interventions usually reduce surgical site infection (SSI) when implemented at single hospitals, but the feasibility of their implementation at nationwide level and their clinical results are not well established. Materials and methods: Pragmatic interventional study to analyse the implementation and outcomes of a colorectal surgery care bundle within a nationwide quality improvement program. The bundle consisted of: antibiotic prophylaxis, oral antibiotic prophylaxis (OAP), mechanical bowel preparation (MBP), laparoscopy, normothermia, and a wound retractor. Control (CG) and Intervention (IG) groups were compared. Overall SSI, superficial (S-SSI), deep (D-SSI) and organ/space (O/S-SSI) rates were analysed. Secondary endpoints included microbiology, 30-day mortality and hospital stay (LOS). Results: A total of 37,849 procedures were included, 19,655 in the CG and 18,194 in the IG. In all, 5,462 SSIs (14.43%) were detected: 1,767 S-SSI (4.67%), 847 D-SSI (2.24%) and 2,838 O/S-SSI (7.5%). Overall SSI fell from 18.38% (CG) to 10.17% (IG), OR 0.503, [0.473-0.524]. O/S-SSI rates were 9.15% (CG) and 5.72% (IG), OR 0.602, [0.556-0.652]. The overall SSI rate was 16.71% when no measure was applied and 6.23% when all six were used. Bundle implementation reduced the probability of overall SSI (OR 0.331; CI95 0.242, 0.453), and also O/S-SSI rate (OR 0.643; CI95 0.416, 0.919). In the univariate analysis, all measures except normothermia were associated with a reduction in overall SSI, while only laparoscopy, OAP, and MBP were related with a decrease in O/S-SSI. Laparoscopy, wound retractor and OAP decreased overall SSI and O/S-SSI in the multivariate analysis. Conclusions: In this cohort study, the application of a specific care bundle within a nationwide nosocomial infection surveillance system proved feasible, and resulted in a significant reduction in overall and O/S-SSI rates in elective colon and rectal surgery. The OR for SSI fell between 1.5 and 3 times after the implementation of the bundle

Análisis exploratorio de la fidelidad y los principales conceptos relacionados en turismo: el caso de Ixtapa/Zihuatanejo-México

ABSTRACT This article analyzes the Loyalty to a beach resort and its relationship with the variables: Service quality, Perceived value, Satisfaction and Overall image. From relationship marketing from the perspective of current demand, the results of the study is that faithfulness to American tourists as Ixtapa-Zihuatanejo beach destination can be considered as a low level and that the variables: Quality of service, perceived value, and satisfaction overall picture shows a positive relationship with attitudinal loyalty.En este artículo se analiza la Fidelidad hacia un destino turístico de playa&nbsp; y su relación con las variables: Calidad del servicio, Valor percibido, Imagen global y Satisfacción. A partir del marketing de relaciones y desde la perspectiva de la demanda actual, de los resultados del estudio se destaca: que la fidelidad de los turistas norteamericanos hacia Ixtapa-Zihuatanejo como destino de playa, se puede considerar como de un bajo nivel y que las variables: Calidad del servicio, valor percibido, imagen global y satisfacción muestran una relación positiva con la fidelidad actitudinal.&nbsp;ABSTRACTThis article analyzes the Loyalty to a beach resort and its relationship with the variables: Service quality, Perceived value, Satisfaction and Overall image. From relationship marketing from the perspective of current demand, the results of the study is that faithfulness to American tourists as Ixtapa-Zihuatanejo beach destination can be considered as a low level and that the variables: Quality of service, perceived value, and satisfaction overall picture shows a positive relationship with attitudinal loyalty

Impact of previous tobacco use with or without cannabis on first psychotic experiences in patients with first-episode psychosis

Objective: There is high prevalence of cigarette smoking in individuals with first-episode psychosis (FEP) prior to psychosis onset. The purpose of the study was to determine the impact of previous tobacco use with or without cannabis on first psychotic experiences in FEP and the impact of this use on age of onset of symptoms, including prodromes. Methods: Retrospective analyses from the naturalistic, longitudinal, multicentre, “Phenotype-Genotype and Environmental Interaction. Application of a Predictive Model in First Psychotic Episodes (PEPs)” Study. The authors analysed sociodemographic/clinical data of 284 FEP patients and 231 matched healthy controls, and evaluated first psychotic experiences of patients using the Symptom Onset in Schizophrenia Inventory. Results: FEP patients had significantly higher prevalence of tobacco, cannabis, and cocaine use than controls. The FEP group with tobacco use only prior to onset (N = 56) had more sleep disturbances (42.9% vs 18.8%, P = 0.003) and lower prevalence of negative symptoms, specifically social withdrawal (33.9% vs 58%, P = 0.007) than FEP with no substance use (N = 70), as well as lower prevalence of ideas of reference (80.4% vs 92.4%, P = 0.015), perceptual abnormalities (46.4% vs 67.4%, P = 0.006), hallucinations (55.4% vs 71.5%, P = 0.029), and disorganised thinking (41.1% vs 61.1%, P = 0.010) than FEP group with previous tobacco and cannabis use (N = 144). FEP patients with cannabis and tobacco use had lower age at first prodromal or psychotic symptom (mean = 23.73 years [SD = 5.09]) versus those with tobacco use only (mean = 26.21 [SD = 4.80]) (P = 0.011). Conclusions: The use of tobacco alone was not related to earlier age of onset of a first psychotic experience, but the clinical profile of FEP patients is different depending on previous tobacco use with or without cannabis. © 2021 The Author

Carbapenem-resistant Citrobacter spp. isolated in Spain from 2013 to 2015 produced a variety of carbapenemases including VIM-1, OXA-48, KPC-2, NDM-1 and VIM-2

Objectives: There is little information about carbapenemase-producing (CP) Citrobacter spp.We studied the molecular epidemiology and microbiological features of CP Citrobacter spp. isolates collected in Spain (2013-15). Methods: In total, 119 isolates suspected of being CP by the EUCAST screening cut-off values were analysed. Carbapenemases and ESBLs were characterized using PCR and sequencing. The genetic relationship among Citrobacter freundii isolates was studied by PFGE. Results: Of the 119 isolates, 63 (52.9%) produced carbapenemases, of which 37 (58.7%) produced VIM-1, 20 (31.7%) produced OXA-48, 12 (19%) produced KPC-2, 2 (3.2%) produced NDM-1 and 1 (1.6%) produced VIM- 2; 9 C. freundii isolates co-produced VIM-1 plus OXA-48. Fourteen isolates (22.2%) also carried ESBLs: 8 CTX-M-9 plus SHV-12, 2 CTX-M-9, 2 SHV-12 and 2 CTX-M-15. Fifty-seven isolates (90.5%) were C. freundii, 4 (6.3%) were Citrobacter koseri, 1 (1.6%) was Citrobacter amalonaticus and 1 (1.6%) was Citrobacter braakii. By EUCAST breakpoints, eight (12.7%) of the CP isolates were susceptible to the four carbapenems tested. In the 53 CP C. freundii analysed by PFGE, a total of 44 different band patterns were observed. Four PFGE clusters were identified: cluster 1 included eight isolates co-producing VIM-1 and OXA-48; blaVIM-1 was carried in a class 1 integron (intI-blaVIM-1 - aacA4-dfrB1-aadA1-catB2-qacE¿1/sul1) and blaOXA-48 was carried in a Tn1999.2 transposon. Conclusions: We observed the clonal and polyclonal spread of CP Citrobacter spp. across several Spanish geographical areas. Four species of Citrobacter spp. produced up to five carbapenemase types, including coproduction of VIM-1 plus OXA-48. Some CP Citrobacter spp. isolates were susceptible to the four carbapenems tested, a finding with potential clinical implications