HISTÒRIA DEL COLLSACABRA (II)

(Extreta d'una llibreta d'un pagès de Pruit

Plantes del Collsacabra

Fotos:Anna Borbone

Història del Collsacabra

(extreta d' una llibreta d'un pagès de Pruit

La restauración del claustro de la Catedral de Barcelona: recuperar el vínculo entre arquitectura, vegetación y agua

[EN] Cloisters are often transition spaces between the interior and exterior of the temple, and, especially in the Cathedral of Barcelona, clearly linked to the city, were once the vital center of these heritage sites. Any intervention in the garden of a central space of this category must ensure that it does not dissociate itself from the building, that it is read together with it, as a vertebral, complementary and therefore unique space, as it was conceived. The fragility of these spaces is high, mainly due to the dynamic process of their own nature. They are spaces prone to abandonment, and even to segregation, whether due to modification of uses, ignorance or loss of interest. The heritage protection must include and value these open spaces, which complement the monuments, contain them or accompany them in an indissoluble way. Beyond the traditional enjoyment of the senses in a garden space, society also values now green spaces in terms of quality of life: health and well-being, as spaces of spirituality and peace, as spaces where to develop an artistic dimension and of course, as part of the commitment to a more sustainable world.[ES] Los claustros, a menudo espacios de transición entre el interior y el exterior del templo, y, de forma especial en la Catedral de Barcelona, claramente vinculado a la ciudad, fueron en su momento el centro vital de estos conjuntos patrimoniales. Cualquier intervención en un espacio central ajardinado de esta categoría ha de conseguir que no se desvincule del edificio, que se lea de forma conjunta al mismo, como espacio vertebrador, complementario y por ello único, tal y como fue concebido. La fragilidad de dichos espacios es elevada, principalmente por el carácter dinámico de su propia naturaleza. Son espacios proclives al abandono, e incluso a la segregación ya sea por la modificación de usos, por desconocimiento o por pérdida de interés. La protección patrimonial debe incluir y valorar estos espacios abiertos, que complementan a los monumentos, los contienen o los acompañan de forman indisoluble. Más allá del disfrute tradicional de los sentidos en un espacio ajardinado, como sociedad se valoran ahora también los espacios verdes en términos de calidad de vida: de salud y bienestar, como espacios de espiritualidad y de paz, como espacios donde desarrollar una dimensión artística y cómo no, como parte del compromiso con un mundo más sostenible.Bassa Garrido, V.; Vives De Delàs, R. (2021). La restauración del claustro de la Catedral de Barcelona: recuperar el vínculo entre arquitectura, vegetación y agua. En I Simposio anual de Patrimonio Natural y Cultural ICOMOS España. Editorial Universitat Politècnica de València. 323-330. https://doi.org/10.4995/icomos2019.2019.11738OCS32333

Reporting reimbursement price decisions for onco-hematology drugs in Spain

Health technology assessment; Onco-hematologic prices; Price and reimbursement systemsAvaluació de tecnologies sanitàries; Preus onco-hematològics; Sistemes de preus i reemborsamentEvaluación de tecnologías sanitarias; Precios oncohematológicos; Sistemas de precios y reembolsosIntroduction: Even using well-established technology assessment processes, the basis of the decisions on drug price and reimbursement are sometimes perceived as poorly informed and sometimes may be seen as disconnected from value. The literature remains inconclusive about how Health Technology Assessment Bodies (HTAb) should report the determinants of their decisions. This study evaluates the relationship between oncology and hematology drug list prices and structured value parameters at the time of reimbursement decision in Spain. Methods: The study includes all new onco-hematological products (22), with a first indication authorized between January 2017 and December 2019 in Spain and pricing decisions published up until October 2022. For each product, 56 contextual and non-contextual indicators reflecting the structured multiple criteria decision analysis (MCDA) – Evidence-based Decision-Making (EVIDEM) framework were measured. The relationship between prices and the MCDA-EVIDEM framework was explored using univariate statistical analyses. Results: Higher prices were observed when the standard of care included for combinations, if there were references to long-lasting responses, for fixed-duration treatment compared to treatment until progression and treatment with lower frequencies of administration; lower prices were observed for oral administration compared to other routes of administration. Statistically significant associations were observed between prices and the median duration of treatment, the impact on patient autonomy, the ease of use of the drug, and the recommendations of experts. Discussion: The study suggests that indicators related to the type of standard of care, references to long-lasting responders, the convenience of the use of the drug, and the impact of treatment on patient autonomy, as well as contextual indicators such as the existence of previous clinical consensus, are factors in setting oncology drug prices in Spain. The implementation of MCDA-EVIDEM methodologies may be useful to capture the influence on pricing decisions of additional factors not included in legislation or consolidated assessment frameworks such as the European Network for Health Technology Assessment (EunetHTA) core model. It may be opportune to consider this in the upcoming revision of the Spanish regulation for health technology assessments and pricing and reimbursement procedures

Outpatient multimodal intravenous analgesia in patients undergoing day-case surgery : description of a three year experience

The use of elastomeric devices for ambulatory intravenous pain treatment in Major Ambulatory Surgery (MAS) has been described to improve postoperative pain management. The objective of the study was to describe the first 3 years experience of the use of elastomeric devices for ambulatory intravenous pain treatment in MAS implemented at our site since 2010. Data were retrieved from the medical records for all patients who, between January 2010 and March 2014, underwent surgical procedures at the ambulatory surgical centre at our hospital and were prescribed a home-based continuous intravenous analgesia. Data were retrieved from the medical records of 1128 patients. The most frequent surgical interventions included orthopedic and proctology surgeries. 80 % of patients were discharged home without pain; during the first 48 h after discharge roughly 40 % of subjects were completely free of pain, 50 % reported mild pain (VAS 1 to 3) and 9 % reported higher pain scores (4 and above). Peripheral nerve block was associated to better pain control in the immediate postoperative period. Vomiting in the first 24 h was 4.6 % before introducing haloperidol into the drug schemes, and 2.6 % thereafter. Complications related with the intravenous route required treatment withdrawal in 1.1 % cases. Only 3.5 % of patients returned to the hospital in the first 72 h, mainly for non-pain related reasons. Overall, 99.5 % of patients were satisfied with the treatment received at home. Our initial experience suggest that outpatient multimodal intravenous analgesia in patients undergoing day-case surgery is a feasible alternative in our setting, that allows an effective management of postoperative pain with a small rate of adverse events and complications requiring readmission

Dermatitis atópica: ¿cómo tratarla?

Dermatitis atòpica; Corticoides tòpics; Immunosupressors; DupilumabDermatitis atópica; Corticoides tópicos; Inmunosupresores; DupilumabAtopic dermatitis; Topical corticosteroids; Immunosuppressants; DupilumabLa dermatitis atòpica (DA) és una dermatosi inflamatòria, pruriginosa, d’evolució crònica o recurrent. La major part de les vegades debuta poc després del naixement o durant la primera infància, i pot persistir o començar en l’edat adulta. Es caracteritza per la presència de pruïja, lesions eczematoses amb una distribució característica, xerosi i liquenificació. El seu diagnòstic es basa principalment en aspectes clínics de la malaltia, i per determinar-ne la gravetat es poden utilitzar diverses escales. La base del tractament de la DA en les formes lleus i moderades és l’ús d’emol·lients per combatre la xerosi, mesures higienicodietètiques i l’aplicació d’antiinflamatoris tòpics per tractar l’èczema. Els antiinflamatoris de primera elecció són els corticoides tòpics. Per a la DA lleu i en infants, s’usen els corticoides de potència baixa a moderada, mentre que els de potència alta s’utilitzen per a la DA moderada i greu, en aquest darrer cas, com a complement de tractaments sistèmics. Malgrat això, en l’elecció de la potència s’ha de tenir en compte també l’edat del pacient i la localització de les lesions. Els inhibidors de la calcineurina tòpics (tacrolimús i pimecrolimús) són una alternativa als corticoides tòpics, amb una eficàcia comparable als de potència baixa a moderada, però sense potencial atrofogènic local, i se solen reservar per a zones sensibles com la cara. En els casos de DA en què no s’aconsegueix controlar la malaltia amb tractaments tòpics i/o fototeràpia, i en general en casos greus, cal emprar immunosupressors sistèmics. Tot i que es fan servir diversos immunosupressors convencionals, la ciclosporina és l’únic aprovat per a la DA greu. Presenta bones propietats antiinflamatòries a curt termini, però el seu perfil de seguretat en condiciona l’ús a llarg termini. Per als casos més greus que no responen als immunosupressors sistèmics o en pacients que no els poden rebre, hi ha disponible dupilumab, un fàrmac biològic que inhibeix la senyalització d’IL-4/IL-13.La dermatitis atópica (DA) es una dermatosis inflamatoria, pruriginosa, de evolución crónica o recurrente. La mayoría de veces debuta poco después del nacimiento o durante la primera etapa de la infancia y puede persistir o comenzar en la edad adulta. Se caracteriza por la presencia de prurito, lesiones eccematosas con una distribución característica, xerosis y liquenificación. Su diagnóstico se basa principalmente en aspectos clínicos de la enfermedad y para determinar su gravedad se pueden utilizar diferentes escalas. La base del tratamiento de la DA en las formas leves y moderadas es el uso de emolientes para combatir la xerosis, las medidas higiénico-dietéticas y la aplicación de antiinflamatorios tópicos para tratar el eccema. Los antiinflamatorios de primera elección son los corticoides tópicos. Para la DA leve y en niños se usan los corticoides de potencia baja a moderada, mientras que los de potencia alta se utilizan para la DA moderada y grave, en este último caso, como complemento de tratamientos sistémicos. A pesar de esto, en la elección de la potencia se debe tener en cuenta también la edad del paciente y la localización de las lesiones. Los inhibidores de la calcineurina tópicos (tracolimus y pimecrolimus) son una alternativa a los corticoides tópicos, con una eficacia comparable a los de potencia baja a moderada pero sin potencial atrofogénico local, y se suelen reservar para zonas sensibles como la cara. En los casos de DA en los que no se consigue controlar la enfermedad con tratamientos tópicos y/o fototerapia, y en general en casos graves, se deben utilizar inmunosupresores sistémicos. A pesar de que se utilizan diferentes inmunosupresores convencionales, la ciclosporina es el único aprobado para la DA grave. Presenta buenas propiedades antiinflamatorias a corto plazo, pero su perfil de seguridad condiciona su uso a largo plazo. Para los casos más graves que no responden a los inmunosupresores sistémicos y para pacientes que no los pueden recibir hay disponible dupilumab, un fármaco biológico que inhibe la señalización de la IL 4/IL-13

Effectiveness and safety of oral anticoagulants for non-valvular atrial fibrillation: a population-based cohort study in primary healthcare in Catalonia

Oral anticoagulants; Atrial fibrillation; Primary healthcareAnticoagulants orals; Fibril·lació auricular; Atenció primària de salutAnticoagulantes orales; Fibrilación auricular; Atención primaria de saludObjectives: Our objective was to analyse effectiveness and safety of oral anticoagulants (OAC) for stroke prevention in non-valvular atrial fibrillation. Material and methods: Population-based cohort study including adults initiating oral anticoagulants, either direct oral anticoagulants (DOAC) or vitamin K antagonists (VKA), during 2011–2020. Data source: SIDIAP, capturing information from the electronic health records of Primary Health Care in Catalonia, Spain. Study outcomes: stroke, cerebral and gastrointestinal (GI) haemorrhage, assessed by patients’ subgroups according to different clinical characteristics. Results: We included 90,773 patients. Male sex, older than 75, previous event, peripheral artery disease, deep vein thrombosis, or receiving antiplatelets, antidiabetics or proton pump inhibitors (PPI) was associated with higher stroke risk. For DOAC-treated, treatment switch increased stroke risk, while being adherent had a protective effect. Men, antidiabetic treatment or a previous event increased the risk of cerebral bleeding. Receiving direct oral anticoagulants had a protective effect in comparison to vitamin K antagonists. For DOAC-treated, treatment switch increased, and adherence decreased the bleeding risk. Men, people with chronic kidney disease or a previous event posed an increased risk of gastrointestinal bleeding, whereas receiving PPI had a protective effect. For DOAC-treated, switch was associated with a higher bleeding risk. Conclusion: Being men, a previous event and DOAC-switch posed a higher risk for all study outcomes. direct oral anticoagulants had a protective effect against cerebral bleeding in comparison to vitamin K antagonists. Adherence to direct oral anticoagulants resulted in lower risk of stroke and cerebral bleeding. We found no differences in the risk of stroke and gastrointestinal bleeding when we compared direct oral anticoagulants vs. vitamin K antagonists

GSEA of mouse and human mitochondriomes reveals fatty acid oxidation in astrocytes

The prevalent view in neuroenergetics is that glucose is the main brain fuel, with neurons being mostly oxidative and astrocytes glycolytic. Evidence supporting that astrocyte mitochondria are functional has been overlooked. Here we sought to determine what is unique about astrocyte mitochondria by performing unbiased statistical comparisons of the mitochondriome in astrocytes and neurons. Using MitoCarta, a compendium of mitochondrial proteins, together with transcriptomes of mouse neurons and astrocytes, we generated cell-specific databases of nuclear genes encoding for mitochondrion proteins, ranked according to relative expression. Standard and in-house Gene Set Enrichment Analyses (GSEA) of five mouse transcriptomes revealed that genes encoding for enzymes involved in fatty acid oxidation (FAO) and amino acid catabolism are consistently more expressed in astrocytes than in neurons. FAO and oxidative-metabolism-related genes are also up-regulated in human cortical astrocytesversus the whole cortex, and in adult astrocytes versus fetal astrocytes. We thus present the first evidence of FAO in human astrocytes. Further, as shown in vitro, FAO coexists with glycolysis in astrocytes and is inhibited by glutamate. Altogether, these analyses provide arguments against the glucose-centered view of energy metabolism in astrocytes and reveal mitochondria as specialized organelles in these cells