Efectos de un programa de prevención sobre las adicciones tecnológicas y disposiciones cognitiva-afectivas en universitarios

Objective: The effects of an online prevention program on technological addictions and cognitive-affective dispositions in university students during the COVID-19 pandemic were evaluated. Methods: Forty-two students participated in the sample, of which 21 formed the experimental group (EG) and the other 21 students the control group (CG). Academic efficacy and academic engagement scales were used, as well as cell phone, internet and video game addiction tests. Results: The application of the program significantly reduced the internet addiction, cell phone and video games and at the same time significantly increased the positive assessment of academic engagement and academic efficacy; comparisons between the study groups (GE versus GC) according to the effect sizes (.30 < d >. 50) evidenced important practical differences in the internet addiction, cell phone and video games, for the three variables the GE showed lower averages than the GC; on the other hand the comparisons between GE and GC resulted with effect size differences between medium (d >.50) and large (d >.80) in academic efficacy and academic engagement respectively, in these two variables the GE showed higher averages. Conclusion: the prevention program has reduced technological addictions, as well as increased cognitive-affective dispositions in students.Objetivo: Se evaluó los efectos de un programa de prevención en línea sobre las adicciones tecnológicas y disposiciones cognitiva-afectivas en universitarios durante la pandemia COVID-19. Método: Participaron en la muestra 42 estudiantes, de los cuales 21 conformaron el grupo experimental (GE) y los otros 21 estudiantes el control (GC). Se utilizaron las escalas de eficacia académica y engagement académico, así como los test de adicción al teléfono móvil, al internet y a los videojuegos. Resultados: La aplicación del programa redujo significativamente la adicción al internet, teléfono móvil y videojuegos y a la vez aumentó significativamente la valoración positiva del compromiso académico y la eficacia académica; las comparaciones entre los grupos de estudio (GE versus GC) de acuerdo con los tamaños de efecto (.30 < d >.50) evidenciaron diferencias prácticas importantes  en cuanto al uso adictivo de internet, del teléfono móvil y los videojuegos, para las tres variables el GE mostró menores promedios que el GC; de otra parte las comparaciones entre GE y GC resultaron con diferencias de magnitudes de efecto entre mediano (d >.50) y grande (d >.80) en eficacia académica y compromiso académico respectivamente, en estas dos variables el GE mostró mayores promedios. Conclusión: el programa de prevención ha reducido las adicciones tecnológicas, así como incrementó las disposiciones cognitiva-afectivas en el estudiantado

Efectos de un programa de prevención sobre las adicciones tecnológicas y disposiciones cognitiva-afectivas en universitarios

Objective: The effects of an online prevention program on technological addictions and cognitive-affective dispositions in university students during the COVID-19 pandemic were evaluated. Methods: Forty-two students participated in the sample, of which 21 formed the experimental group (EG) and the other 21 students the control group (CG). Academic efficacy and academic engagement scales were used, as well as cell phone, internet and video game addiction tests. Results: The application of the program significantly reduced the internet addiction, cell phone and video games and at the same time significantly increased the positive assessment of academic engagement and academic efficacy; comparisons between the study groups (GE versus GC) according to the effect sizes (.30 < d >. 50) evidenced important practical differences in the internet addiction, cell phone and video games, for the three variables the GE showed lower averages than the GC; on the other hand the comparisons between GE and GC resulted with effect size differences between medium (d >.50) and large (d >.80) in academic efficacy and academic engagement respectively, in these two variables the GE showed higher averages. Conclusion: the prevention program has reduced technological addictions, as well as increased cognitive-affective dispositions in students.Objetivo: Se evaluó los efectos de un programa de prevención en línea sobre las adicciones tecnológicas y disposiciones cognitiva-afectivas en universitarios durante la pandemia COVID-19. Método: Participaron en la muestra 42 estudiantes, de los cuales 21 conformaron el grupo experimental (GE) y los otros 21 estudiantes el control (GC). Se utilizaron las escalas de eficacia académica y engagement académico, así como los test de adicción al teléfono móvil, al internet y a los videojuegos. Resultados: La aplicación del programa redujo significativamente la adicción al internet, teléfono móvil y videojuegos y a la vez aumentó significativamente la valoración positiva del compromiso académico y la eficacia académica; las comparaciones entre los grupos de estudio (GE versus GC) de acuerdo con los tamaños de efecto (.30 < d >.50) evidenciaron diferencias prácticas importantes  en cuanto al uso adictivo de internet, del teléfono móvil y los videojuegos, para las tres variables el GE mostró menores promedios que el GC; de otra parte las comparaciones entre GE y GC resultaron con diferencias de magnitudes de efecto entre mediano (d >.50) y grande (d >.80) en eficacia académica y compromiso académico respectivamente, en estas dos variables el GE mostró mayores promedios. Conclusión: el programa de prevención ha reducido las adicciones tecnológicas, así como incrementó las disposiciones cognitiva-afectivas en el estudiantado

Effects of alirocumab on types of myocardial infarction: insights from the ODYSSEY OUTCOMES trial

Aims  The third Universal Definition of Myocardial Infarction (MI) Task Force classified MIs into five types: Type 1, spontaneous; Type 2, related to oxygen supply/demand imbalance; Type 3, fatal without ascertainment of cardiac biomarkers; Type 4, related to percutaneous coronary intervention; and Type 5, related to coronary artery bypass surgery. Low-density lipoprotein cholesterol (LDL-C) reduction with statins and proprotein convertase subtilisin–kexin Type 9 (PCSK9) inhibitors reduces risk of MI, but less is known about effects on types of MI. ODYSSEY OUTCOMES compared the PCSK9 inhibitor alirocumab with placebo in 18 924 patients with recent acute coronary syndrome (ACS) and elevated LDL-C (≥1.8 mmol/L) despite intensive statin therapy. In a pre-specified analysis, we assessed the effects of alirocumab on types of MI. Methods and results  Median follow-up was 2.8 years. Myocardial infarction types were prospectively adjudicated and classified. Of 1860 total MIs, 1223 (65.8%) were adjudicated as Type 1, 386 (20.8%) as Type 2, and 244 (13.1%) as Type 4. Few events were Type 3 (n = 2) or Type 5 (n = 5). Alirocumab reduced first MIs [hazard ratio (HR) 0.85, 95% confidence interval (CI) 0.77–0.95; P = 0.003], with reductions in both Type 1 (HR 0.87, 95% CI 0.77–0.99; P = 0.032) and Type 2 (0.77, 0.61–0.97; P = 0.025), but not Type 4 MI. Conclusion  After ACS, alirocumab added to intensive statin therapy favourably impacted on Type 1 and 2 MIs. The data indicate for the first time that a lipid-lowering therapy can attenuate the risk of Type 2 MI. Low-density lipoprotein cholesterol reduction below levels achievable with statins is an effective preventive strategy for both MI types.For complete list of authors see http://dx.doi.org/10.1093/eurheartj/ehz299</p

Atrasentan and renal events in patients with type 2 diabetes and chronic kidney disease (SONAR): a double-blind, randomised, placebo-controlled trial

Background: Short-term treatment for people with type 2 diabetes using a low dose of the selective endothelin A receptor antagonist atrasentan reduces albuminuria without causing significant sodium retention. We report the long-term effects of treatment with atrasentan on major renal outcomes. Methods: We did this double-blind, randomised, placebo-controlled trial at 689 sites in 41 countries. We enrolled adults aged 18–85 years with type 2 diabetes, estimated glomerular filtration rate (eGFR)25–75 mL/min per 1·73 m 2 of body surface area, and a urine albumin-to-creatinine ratio (UACR)of 300–5000 mg/g who had received maximum labelled or tolerated renin–angiotensin system inhibition for at least 4 weeks. Participants were given atrasentan 0·75 mg orally daily during an enrichment period before random group assignment. Those with a UACR decrease of at least 30% with no substantial fluid retention during the enrichment period (responders)were included in the double-blind treatment period. Responders were randomly assigned to receive either atrasentan 0·75 mg orally daily or placebo. All patients and investigators were masked to treatment assignment. The primary endpoint was a composite of doubling of serum creatinine (sustained for ≥30 days)or end-stage kidney disease (eGFR <15 mL/min per 1·73 m 2 sustained for ≥90 days, chronic dialysis for ≥90 days, kidney transplantation, or death from kidney failure)in the intention-to-treat population of all responders. Safety was assessed in all patients who received at least one dose of their assigned study treatment. The study is registered with ClinicalTrials.gov, number NCT01858532. Findings: Between May 17, 2013, and July 13, 2017, 11 087 patients were screened; 5117 entered the enrichment period, and 4711 completed the enrichment period. Of these, 2648 patients were responders and were randomly assigned to the atrasentan group (n=1325)or placebo group (n=1323). Median follow-up was 2·2 years (IQR 1·4–2·9). 79 (6·0%)of 1325 patients in the atrasentan group and 105 (7·9%)of 1323 in the placebo group had a primary composite renal endpoint event (hazard ratio [HR]0·65 [95% CI 0·49–0·88]; p=0·0047). Fluid retention and anaemia adverse events, which have been previously attributed to endothelin receptor antagonists, were more frequent in the atrasentan group than in the placebo group. Hospital admission for heart failure occurred in 47 (3·5%)of 1325 patients in the atrasentan group and 34 (2·6%)of 1323 patients in the placebo group (HR 1·33 [95% CI 0·85–2·07]; p=0·208). 58 (4·4%)patients in the atrasentan group and 52 (3·9%)in the placebo group died (HR 1·09 [95% CI 0·75–1·59]; p=0·65). Interpretation: Atrasentan reduced the risk of renal events in patients with diabetes and chronic kidney disease who were selected to optimise efficacy and safety. These data support a potential role for selective endothelin receptor antagonists in protecting renal function in patients with type 2 diabetes at high risk of developing end-stage kidney disease. Funding: AbbVie

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to &lt;90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], &gt;300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of &lt;15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P&lt;0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P&lt;0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Effect of alirocumab on mortality after acute coronary syndromes. An analysis of the ODYSSEY OUTCOMES randomized clinical trial

Background: Previous trials of PCSK9 (proprotein convertase subtilisin-kexin type 9) inhibitors demonstrated reductions in major adverse cardiovascular events, but not death. We assessed the effects of alirocumab on death after index acute coronary syndrome. Methods: ODYSSEY OUTCOMES (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab) was a double-blind, randomized comparison of alirocumab or placebo in 18 924 patients who had an ACS 1 to 12 months previously and elevated atherogenic lipoproteins despite intensive statin therapy. Alirocumab dose was blindly titrated to target achieved low-density lipoprotein cholesterol (LDL-C) between 25 and 50 mg/dL. We examined the effects of treatment on all-cause death and its components, cardiovascular and noncardiovascular death, with log-rank testing. Joint semiparametric models tested associations between nonfatal cardiovascular events and cardiovascular or noncardiovascular death. Results: Median follow-up was 2.8 years. Death occurred in 334 (3.5%) and 392 (4.1%) patients, respectively, in the alirocumab and placebo groups (hazard ratio [HR], 0.85; 95% CI, 0.73 to 0.98; P=0.03, nominal P value). This resulted from nonsignificantly fewer cardiovascular (240 [2.5%] vs 271 [2.9%]; HR, 0.88; 95% CI, 0.74 to 1.05; P=0.15) and noncardiovascular (94 [1.0%] vs 121 [1.3%]; HR, 0.77; 95% CI, 0.59 to 1.01; P=0.06) deaths with alirocumab. In a prespecified analysis of 8242 patients eligible for ≥3 years follow-up, alirocumab reduced death (HR, 0.78; 95% CI, 0.65 to 0.94; P=0.01). Patients with nonfatal cardiovascular events were at increased risk for cardiovascular and noncardiovascular deaths (P<0.0001 for the associations). Alirocumab reduced total nonfatal cardiovascular events (P<0.001) and thereby may have attenuated the number of cardiovascular and noncardiovascular deaths. A post hoc analysis found that, compared to patients with lower LDL-C, patients with baseline LDL-C ≥100 mg/dL (2.59 mmol/L) had a greater absolute risk of death and a larger mortality benefit from alirocumab (HR, 0.71; 95% CI, 0.56 to 0.90; Pinteraction=0.007). In the alirocumab group, all-cause death declined wit h achieved LDL-C at 4 months of treatment, to a level of approximately 30 mg/dL (adjusted P=0.017 for linear trend). Conclusions: Alirocumab added to intensive statin therapy has the potential to reduce death after acute coronary syndrome, particularly if treatment is maintained for ≥3 years, if baseline LDL-C is ≥100 mg/dL, or if achieved LDL-C is low. Clinical Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01663402

Consumo de sustancias psicoactivas en población peruana durante la pandemia COVID-19

Introduction: The study aimed to determine the prevalence of psychoactive substance use in Peruvian population during the pandemic.&nbsp; Method: The research was a quantitative descriptive, non-experimental cross-sectional design. The sample consisted of 1932 subjects of both sexes, aged between 18 and 65 years. For the collection of information, a survey was elaborated with questions related to the consumption of psychoactive substances, work and family information during the pandemic. Results: In the results it was found that people who telework consume more alcohol, tobacco, energizers, tranquilizers and marijuana; those who work remotely have a higher consumption of tranquilizers. Alcohol is the most consumed legal drug, followed by tobacco and marijuana. Substance use decreased during the quarantine period. People who consume alcohol presented higher percentages of contagion and loss of a family member. They also consider that they have support from their family or friends to cope with a COVID-19 contagion. Conclusions: It is concluded that in the Peruvian population the consumption of alcohol, tobacco and marijuana prevails, there is a decrease in the consumption of psychoactive substances; however, consumption continues despite the restrictions established but the Peruvian state and the risks produced by consumption.Introducción: El estudio tuvo como objetivo determinar la prevalencia de consumo de sustancias psicoactivas en pobladores peruanos durante la pandemia. &nbsp;Método: La investigación fue de tipo cuantitativa descriptiva, diseño no experimental de corte transversal, la muestra estuvo constituida por 1932 sujetos de ambos sexos, las edades oscilan entre los 18 - 65 años. Para la recolección de información se elaboró una encuesta con preguntas relacionadas al consumo de sustancias psicoactivas, información laboral y familiar durante la pandemia. Resultados: En los resultados se encontró que las personas que realizan teletrabajo consumen más el alcohol, tabaco, energizantes, tranquilizantes y marihuana; quienes laboran de manera remota presentan mayor consumo de tranquilizantes. El alcohol es la droga legal más consumida, seguida del tabaco y marihuana. Se halló disminución del consumo de sustancias durante la cuarentena. Las personas que consumen alcohol presentaron mayores porcentajes de contagio y pérdida de un familiar. Asimismo, consideran que tiene apoyo de sus familiares o amigos para hacer frente a un contagio del COVID-19. Conclusiones: Se concluye que en la población peruana prevale el consumo de alcohol, tabaco y marihuana, se presenta disminución del consumo de sustancias psicoactivas; sin embargo, se sigue consumiendo a pesar de las restricciones establecidas pero el estado peruano y los riesgos que produce el consumo

Sintomatología psicopatológica como mediador entre las emociones negativas y satisfacción con la vida en población peruana en el contexto de la COVID-19

Introduction: The objective was to establish an explanatory model of life satisfaction as a function of negative emotions mediated by the psychopathological severity index, as well as to describe and compare psychopathological symptomatology as a function of sociodemographic variables. Methodology: The research design was non-experimental, cross-sectional, descriptive and structural equation modeling. The sample consisted of 1965 Peruvians of both sexes aged 17 to 71 years. The instruments used were the Depression, Anxiety and Stress Abbreviated Scale (DASS 21), Symptom Assessment-45 Questionnaire (SA-45) and Satisfaction with Life Scale (SWLS). Results: The structural regression model shows that negative emotions have a positive effect (R2 = 64%) on the global severity index (GSI) of psychopathological symptomatology and in turn the latter has a negative impact (R2 = 23%) on the life satisfaction of Peruvians. Among the psychopathological symptoms, psychoticism (19.64%), followed by phobic anxiety (19.44%) and depression (19.03%) stand out. In the macroregions, the GSI varied between 12.54% and 19.32%, with the lowest GSI in the northeastern macroregion and the highest in the north. Conclusions: Significant differences in psychopathological symptomatology were found according to macroregions, sex, age, having children, having a family member infected or deceased by COVID-19.Introducción: El objetivo fue establecer un modelo explicativo de la satisfacción de la vida en función de las emociones negativas mediadas por el índice de severidad psicopatológica, así como, describir y comparar la sintomatología psicopatológica en función de variables sociodemográficas. Metodología: El diseño de investigación fue no experimental, transversal, descriptivo y de modelamiento de ecuaciones estructurales. La muestra estuvo conformada por 1965 peruanos de ambos sexos con edades de 17 a 71 años. Los instrumentos usados fueron la Escala Abreviada de depresión, ansiedad y estrés (DASS 21), Symptom Assessment-45 Questionnaire (SA-45) y Escala de Satisfacción con la vida (SWLS). Resultados: El modelo de regresión estructural muestra que las emociones negativas tienen un efecto positivo (R2 = 64%) sobre el índice global de severidad (IGS) de la sintomatología psicopatológica y a su vez este último impacta negativamente (R2 = 23%) en la satisfacción con la vida de los peruanos. El 15.72% de la población peruana presentó sintomatología psicopatológica severa, respecto a los síntomas psicopatológicos destaca psicoticismo (19.64%), seguido por ansiedad fóbica (19.44%) y depresión (19.03%). En las macroregiones el IGS varía entre 12.54% a 19.32%, resultando con menor IGS la macrorregión nororiental y mayor en el norte. Conclusiones: Se evidenciaron diferencias significativas en la sintomatología psicopatológica según macroregiones, sexo, edad, tener hijos, tener un familiar contagiado o fallecido por la COVID-19

Comprehensive virtual screening of 4.8 k flavonoids reveals novel insights into allosteric inhibition of SARS-CoV-2 M^PRO

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado.SARS-CoV-2 main protease is a common target for inhibition assays due to its high conservation among coronaviruses. Since flavonoids show antiviral activity, several in silico works have proposed them as potential SARS-CoV-2 main protease inhibitors. Nonetheless, there is reason to doubt certain results given the lack of consideration for flavonoid promiscuity or main protease plasticity, usage of short library sizes, absence of control molecules and/or the limitation of the methodology to a single target site. Here, we report a virtual screening study where dorsilurin E, euchrenone a11, sanggenol O and CHEMBL2171598 are proposed to inhibit main protease through different pathways. Remarkably, novel structural mechanisms were observed after sanggenol O and CHEMBL2171598 bound to experimentally proven allosteric sites. The former drastically affected the active site, while the latter triggered a hinge movement which has been previously reported for an inactive SARS-CoV main protease mutant. The use of a curated database of 4.8 k flavonoids, combining two well-known docking software (AutoDock Vina and AutoDock4.2), molecular dynamics and MMPBSA, guaranteed an adequate analysis and robust interpretation. These criteria can be considered for future screening campaigns against SARS-CoV-2 main protease.Consejo Nacional de Ciencia, Tecnología e Innovación TecnológicaRevisión por pare

Triple-negative breast cancer in Peru: 2000 patients and 15 years of experience

BackgroundEpidemiological studies commonly identify the clinical characteristics and survival outcomes of patients with breast cancer at five years. Our study aims to describe the sociodemographic, clinicopathological characteristics and determine the long-term event-free survival (EFS) and overall survival (OS) of a Peruvian population with triple-negative breast cancer.MethodsWe reviewed the medical records of new cases treated at a single institution in the period 2000-2014. The survival analysis included patients with stages I-IV. Survival estimates at 10 years were calculated with the Kaplan-Meier method and compared with the Log-rank test. We further used multivariate Cox regression analysis to calculate prognostic factors of recurrence and mortality.ResultsAmong the 2007 patients included, the median age at diagnosis was 49 years (19-95 years). Most patients presented histologic grade III (68.7%), tumor stage II (34.2%), and III (51.0%) at diagnosis. Local and distant relapse was present in 31.9 and 51.4% of the patients, respectively. The most frequent sites of metastasis were the lungs (14.5%), followed by bone (9.7%), brain (9.6%), and liver (7.9%). The median follow-up was 153 months. At 3, 5, and 10 years, the EFS of the population was 55%, 49%, and 41%, respectively, while the OS was 64%, 56%, and 47%, respectively. Moreover, an N3 lymph node status was the most important prognostic factor for both disease relapse (HR: 2.54, 95% CI: 2.05-3.15) and mortality (HR: 2.51, 95% CI: 2.01-3.14) at ten years. An older age and higher T staging were associated with a worse OS, while patients who received radiotherapy and adjuvant chemotherapy had better survival rates.ConclusionThe sociodemographic features of Peruvian patients with TNBC are similar to those of other populations. However, our population was diagnosed at more advanced clinical stages, and thus, EFS and OS were lower than international reports while prognostic factors were similar to previous studies