ABSTRACT
BACKGROUND: Anti-CGRP monoclonal antibodies have shown notable effectiveness and tolerability in migraine patients; however, data on their use in elderly patients is still lacking, as clinical trials have implicit age restrictions and real-world evidence is scarce. In this study, we aimed to describe the safety and effectiveness of erenumab, galcanezumab and fremanezumab in migraine patients over 65 years old in real-life. METHODS: In this observational real-life study, a retrospective analysis of prospectively collected data from 18 different headache units in Spain was performed. Migraine patients who started treatment with any anti-CGRP monoclonal antibody after the age of 65 years were included. Primary endpoints were reduction in monthly migraine days after 6 months of treatment and the presence of adverse effects. Secondary endpoints were reductions in headache and medication intake frequencies by months 3 and 6, response rates, changes in patient-reported outcomes and reasons for discontinuation. As a subanalysis, reduction in monthly migraine days and proportion of adverse effects were also compared among the three monoclonal antibodies. RESULTS: A total of 162 patients were included, median age 68 years (range 65-87), 74.1% women. 42% had dyslipidaemia, 40.3% hypertension, 8% diabetes, and 6.2% previous cardiovascular ischaemic disease. The reduction in monthly migraine days at month 6 was 10.1 ± 7.3 days. A total of 25.3% of patients presented adverse effects, all of them mild, with only two cases of blood pressure increase. Headache and medication intake frequencies were significantly reduced, and patient-reported outcomes were improved. The proportions of responders were 68%, 57%, 33% and 9% for reductions in monthly migraine days ≥ 30%, ≥ 50%, ≥ 75% and 100%, respectively. A total of 72.8% of patients continued with the treatment after 6 months. The reduction in migraine days was similar for the different anti-CGRP treatments, but fewer adverse effects were detected with fremanezumab (7.7%). CONCLUSIONS: Anti-CGRP mAbs are safe and effective treatments in migraine patients over 65 years old in real-life clinical practice.
Subject(s)
Cardiovascular Diseases , Migraine Disorders , Humans , Female , Aged , Aged, 80 and over , Male , Retrospective Studies , Antibodies, Monoclonal/adverse effects , Migraine Disorders/drug therapy , Migraine Disorders/chemically induced , Headache/drug therapy , Treatment OutcomeABSTRACT
The assessment and treatment of emotional variables is a priority in the rehabilitation of offenders. Although theoretical proposals suggest a clear relationship between violence and self-esteem, attachment, and empathy, the research carried out to date has reached contradictory results due mainly to differences in the measurements used, the reliability of self-reports, or even to problems with the definition of the constructs. The present study analyzed these three variables in a prison sample of sexual offenders (n = 48) and partner-violent men (n = 68), using the Interpersonal Reactivity Index, the Rape Empathy Measure, the Rosenberg Self-Esteem Scale, and the Adult Attachment Questionnaire. Results confirmed the low utility of nonspecific empathy, the predominance of high self-esteem, and the difficulty of identifying an insecure attachment. The implications of the use of these variables in the treatment of offenders, and the need to improve the assessment tools, are discussed.
Subject(s)
Criminals , Sex Offenses , Adult , Empathy , Humans , Male , Reproducibility of Results , Self ConceptABSTRACT
Introducción: Un factor de riesgo importante para el desarrollo de la enfermedad pulmonar obstructiva crónica (EPOC) es el humo del tabaco, que genera estrés oxidativo en las vías respiratorias, dando lugar a la producción de compuestos orgánicos volátiles (VOC). El objetivo del trabajo es su identificación en el aire exhalado y su posible utilidad como biomarcadores de la enfermedad. Método: Se analizó el aire exhalado de 100 voluntarios sanos, clasificados en 3 grupos (no fumadores, exfumadores y fumadores activos) y un grupo de 57 pacientes con EPOC. La muestra de aire exhalado se recogió mediante BioVOC® y se traspasó a tubos de desorción para su posterior análisis por cromatografía de gases y espectrometría de masas. Los VOC analizados fueron aldehídos lineales y ácidos carboxílicos. Resultados: Hexanal mostró diferencias estadísticamente significativas entre el grupo EPOC y los controles sanos (no fumadores y exfumadores), y nonanal entre el grupo control no fumador y el grupo EPOC. Conclusiones: Hexanal discrimina entre pacientes con EPOC y controles sanos no fumadores y exfumadores. Nonanal diferencia entre fumadores y exfumadores (con o sin EPOC) frente a controles no fumadores
Introduction: A major risk factor for chronic obstructive pulmonary disease (COPD) is tobacco smoke, which generates oxidative stress in airways, resulting in the production of volatile organic compounds (VOC). The purpose of this study was to identify VOCs in exhaled breath and to determine their possible use as disease biomarkers. Method: Exhaled breath from 100 healthy volunteers, divided into 3 groups (never smokers, former smokers and active smokers) and exhaled breath from 57 COPD patients were analyzed. Samples were collected using BioVOC® devices and transferred to universal desorption tubes. Compounds were analyzed by thermal desorption, gas chromatography and mass spectrometry. VOCs analyzed were linear aldehydesand carboxylic acids. Results: The COPD group and healthy controls (never smokers and former smokers) showed statistically significant differences in hexanal concentrations, and never smokers and the COPD group showed statistically significant differences in nonanal concentrations. Conclusions: Hexanal discriminates between COPD patients and healthy non-smoking controls. Nonanal discriminates between smokers and former smokers (with and without COPD) and never smokers
Subject(s)
Humans , Exhalation , Pulmonary Elimination , Pulmonary Disease, Chronic Obstructive/physiopathology , Volatile Organic Compounds/analysis , Risk Factors , Smoking/epidemiology , Case-Control StudiesABSTRACT
INTRODUCTION: A major risk factor for chronic obstructive pulmonary disease (COPD) is tobacco smoke, which generates oxidative stress in airways, resulting in the production of volatile organic compounds (VOC). The purpose of this study was to identify VOCs in exhaled breath and to determine their possible use as disease biomarkers. METHOD: Exhaled breath from 100 healthy volunteers, divided into 3groups (never smokers, former smokers and active smokers) and exhaled breath from 57 COPD patients were analyzed. Samples were collected using BioVOC® devices and transferred to universal desorption tubes. Compounds were analyzed by thermal desorption, gas chromatography and mass spectrometry. VOCs analyzed were linear aldehydesand carboxylic acids. RESULTS: The COPD group and healthy controls (never smokers and former smokers) showed statistically significant differences in hexanal concentrations, and never smokers and the COPD group showed statistically significant differences in nonanal concentrations. CONCLUSIONS: Hexanal discriminates between COPD patients and healthy non-smoking controls. Nonanal discriminates between smokers and former smokers (with and without COPD) and never smokers.
Subject(s)
Breath Tests , Pulmonary Disease, Chronic Obstructive/metabolism , Volatile Organic Compounds/analysis , Adult , Aged , Aldehydes/analysis , Biomarkers , Case-Control Studies , Fatty Acids/analysis , Female , Humans , Male , Middle Aged , Propionates/analysis , Smoking/metabolism , Smoking CessationABSTRACT
Introducción: El humo del tabaco es una fuente de radicales libres y especies reactivas de oxígeno y de nitrógeno, principales causantes de estrés oxidativo. El análisis de compuestos orgánicos volátiles (VOC) en aire exhalado es un método indirecto de medir el nivel de estrés oxidativo que se produce en las vías aéreas. El objetivo de este trabajo es conocer la influencia del tabaco en la producción de VOC en una población clínicamente sana. Métodos: Se analizó el aire exhalado de 89 voluntarios sanos, clasificados en 3 grupos: no fumadores, exfumadores y fumadores activos. La muestra de aire exhalado se recogió mediante Bio-VOC®, y se traspasó a tubos de desorción. La técnica analítica utilizada fue: desorción térmica, cromatografía de gases y espectrometría de masas. Los VOC analizados fueron hexanal, heptanal, octanal, nonanal, ácido propanoico y ácido nonanoico, cuya identificación se realizó mediante su tiempo de retención y espectro de masas referenciado en la biblioteca NIST 08, confirmándolo mediante el uso de estándares cromatográficos. Resultados: La mayoría de los VOC analizados se encuentran a concentraciones muy bajas. Únicamente el nonanal muestra diferencia estadísticamente significativa entre los grupos de estudio, depende exclusivamente del hábito de fumar, y es independiente de la cantidad de tabaco consumido, edad y género. Conclusiones: El hallazgo de nonanal se asocia al consumo de tabaco, actual o previo. Al ser un producto secundario de la destrucción de la membrana celular, su hallazgo probablemente muestra daño celular en personas fumadoras y permanece una vez cesado el hábito (AU)
Introduction: Tobacco smoke is a source of free radicals and reactive oxygen and nitrogen species, which are the main causes of oxidative stress. The analysis of volatile organic compounds (VOC) in exhaled breath is an indirect method of measuring the level of oxidative stress that occurs in the airways caused by tobacco consumption. The aim of this study was to determine whether smoking influences the production of VOC, in a clinically healthy population. Methods: Exhaled breath from 89 healthy volunteers, divided into three groups (non-smokers, ex-smokers and smokers), was analyzed. Samples were collected using Bio-VOC® devices and transferred to universal desorption tubes. Chemical compounds were analyzed by thermal desorption, gas chromatography and mass spectrometry. We analyzed hexanal, heptanal, octanal, nonanal, nonanoic acid and propanoic acid, and all were identified by retention time and mass spectra referenced in the NIST 08 mass spectral library; confirmation was carried out using reference standards of the pure chemical compound. Results: These VOC were found in very low concentrations. Only nonanal showed significant quantitative and qualitative statistical differences among the study groups. Nonanal concentration is dependent on smoking, but is independent of the amount of tobacco consumed, age and gender. Conclusions: Nonanal in exhaled breath is associated with tobacco consumption, current or previous. Nonanal is a sub-product of the destruction of the cell membrane, and its finding may be indicative of cell damage in smokers. This result appears in many farmers who smoke (AU)
Subject(s)
Humans , Smoking/adverse effects , Volatile Organic Compounds/isolation & purification , Oxidative Stress/physiology , Organic Pollutants , Case-Control StudiesABSTRACT
Providing medical assistance in emergencies and disaster in advance makes the need to maintain Medical Units functional despite the disturbing phenomenon that confronts the community, but conflict occurs when the Medical Unit needs support and needs to be evacuated, especially when the evacuation of patients in a Critical Care Unit is required. In world literature there is little on this topic, and what is there usually focuses on the conversion of areas and increased ability to care for mass casualties, but not about how to evacuate if necessary, and when a wrong decision can have fatal consequences. That is why the Mexican Social Security Institute gave the task of examining these problems to a working group composed of specialists of the Institute. The purpose was to evaluate and establish a method for performing a protocol in the removal of patients and considering always to safeguard both staff and patients and maintain the quality of care.
La atención en emergencias y desastres implica mantener las unidades médicas en funcionamiento, pese al fenómeno perturbador al que se enfrente la comunidad; sin embargo, el conflicto ocurre cuando es la unidad médica la que necesita el apoyo y requiere ser evacuada, más aún cuando es indispensable la evacuación de los pacientes de las unidades de terapia intensiva. En la bibliografía mundial poco hay acerca de este tema, por lo general está enfocado a la reconversión de áreas e incremento de la capacidad para atención a saldo masivo de víctimas, pero no sobre cómo evacuar en caso necesario, y donde una decisión errónea puede traer consecuencias fatales. Por esto el Instituto Mexicano del Seguro Social encomendó a un grupo de trabajo, conformado por médicos especialistas del propio Instituto, evaluar y establecer un método para protocolizar la evacuación de estos pacientes con la salvaguarda correspondiente del personal y del paciente sin que los estándares de calidad en la atención se alteren.
Subject(s)
Academies and Institutes/organization & administration , Disaster Planning , Emergency Medical Services/organization & administration , Social Security/organization & administration , Triage , Coma , Emergency Medical Services/supply & distribution , Emergency Shelter/organization & administration , Equipment and Supplies, Hospital , First Aid/instrumentation , Health Services Needs and Demand , Humans , Intensive Care Units , Mass Casualty Incidents , Mexico , Multiple Organ Failure/prevention & control , Multiple Organ Failure/therapy , Patient Care Team , Pharmaceutical Preparations/supply & distribution , Respiration, Artificial/instrumentation , Severity of Illness Index , Transportation of Patients/methods , Transportation of Patients/organization & administration , Triage/ethics , Triage/organization & administrationABSTRACT
INTRODUCTION: Tobacco smoke is a source of free radicals and reactive oxygen and nitrogen species, which are the main causes of oxidative stress. The analysis of volatile organic compounds (VOC) in exhaled breath is an indirect method of measuring the level of oxidative stress that occurs in the airways caused by tobacco consumption. The aim of this study was to determine whether smoking influences the production of VOC, in a clinically healthy population. METHODS: Exhaled breath from 89 healthy volunteers, divided into three groups (non-smokers, ex-smokers and smokers) was analysed. Samples were collected using Bio-VOC® devices and transferred to universal desorption tubes. Chemical compounds were analysed by thermal desorption, gas chromatography and mass spectrometry. We analysed hexanal, heptanal, octanal, nonanal, nonanoic acid and propanoic acid, all identified by retention time and mass spectra referenced in the NIST 08 mass spectral library; confirmation was carried out using reference standards of the pure chemical compound. RESULTS: These VOC were found in very low concentrations. Only nonanal showed significant quantitative and qualitative statistical differences among the study groups. Nonanal concentration is dependent on smoking, but is independent of the amount of tobacco consumed, age and gender. CONCLUSIONS: Nonanal in exhaled breath is associated with tobacco consumption, current or previous. Nonanal is a sub-product of the destruction of the cell membrane, and its finding may be indicative of cell damage in smokers. This result appears in many farmers who smoke.
Subject(s)
Breath Tests , Nicotiana/chemistry , Smoke/analysis , Smoking , Volatile Organic Compounds/analysis , Adult , Aldehydes/analysis , Case-Control Studies , Cell Membrane/chemistry , Female , Gas Chromatography-Mass Spectrometry , Humans , Male , Middle Aged , Oxidative Stress , Smoking CessationABSTRACT
A multiaxial assessment and personality evaluation was performed on a group of 70 people (65 men and 5 women) who were recently incarcerated in Málaga, Spain for having committed violent crimes, such as murder and sex-based violence. Analysis of scores on the MCMI indicated that there were chiefly two clearly differentiated personality profiles related to two personality disorders present in the group, the antisocial and the dependent personality disorder with compulsive traits. The "antisocial-psychotic group" presented a clear relation with clinical syndromes, specifically alcohol and drug abuse with delusional disorder, and they had committed a higher proportion of murders. On the Big Five Questionnaire, the "dependent-compulsive group" scored higher than average on Emotional Stability and Agreeableness, whereas the antisocial-psychotic group scored lower than average on Emotional Stability. These findings are in accord with those of Megargee, who concluded that violent criminals can be divided into two categories, the undercontrolled (antisocial) and the overcontrolled (dependent).
Subject(s)
Crime/psychology , Crime/statistics & numerical data , Personality Assessment , Surveys and Questionnaires , Violence/psychology , Adult , Female , Humans , Male , Personality Disorders/diagnosis , Personality Disorders/epidemiology , Personality Disorders/psychology , Violence/statistics & numerical dataABSTRACT
Se ha realizado una evaluación de la personalidad al total de personas que han ingresado en la prisión de Málaga por haber cometido delitos violentos durante un período de dos años. La muestra es de 54 personas (51 varones y 3 mujeres) que se ha comparado con un grupo normativo. El estudio tiene dos objetivos: 1) evaluar factores básicos de personalidad como los «cinco grandes» y dimensiones de personalidad -bienestar personal y adaptación social- que se postulan definir a una persona psicológicamente sana y compararla con un grupo normativo, y 2) conocer si existe algún perfil clínico en el grupo de sujetos que han cometido delitos violentos atendiendo a estilos/trastornos de personalidad y síndromes clínicos. Los resultados muestran que, aunque no es posible postular un perfil básico de personalidad de los delincuentes violentos atendiendo a los factores considerados como los «cinco grandes», sí se encuentran que siguiendo el modelo de Millon (1990) se darían dos patrones habituales de comportamiento y formas de afrontar la vida que denominaríamos «dependiente-compulsivo» y con «tendencias psicópatas» y que están relacionados con indicadores de salud mental
The personalities of a group of 54 persons (51 men and 3 women), imprisoned for the perpetration of violent crimes, were evaluated. The results were then compared to a normative group. This study considers personality factors and dimensions on three levels: (a) Basic factors: the «Big Five», (b) Personality disorders and clinical syndromes, (c) Personality dimensions related to personal wellbeing and social adaptation said to define a psychologically healthy individual. The results of the study show that it is not possible to define a basic personality profile for this group of violent delinquents based on the «Big Five» factors. It is, however, possible to find two habitual patterns of behaviour if the Millon Model (1990) is applied. These two behaviour patterns and attitudes towards life situations will be named «Dependent with compulsive traits» and «Psychopath tendencies». Both relate to indicators of mental health
Subject(s)
Male , Female , Humans , Violence/psychology , Personality Disorders/psychology , Social Adjustment , Personal Satisfaction , Prisoners/psychology , Psychometrics/instrumentationABSTRACT
The personalities of a group of 54 persons (51 men and 3 women), imprisoned for the perpetration of violent crimes, were evaluated. The results were then compared to a normative group. This study considers personality factors and dimensions on three levels: (a) Basic factors: the "Big Five", (b) Personality disorders and clinical syndromes, (c) Personality dimensions related to personal wellbeing and social adaptation said to define a psychologically healthy individual. The results of the study show that it is not possible to define a basic personality profile for this group of violent delinquents based on the "Big Five" factors. It is, however, possible to find two habitual patterns of behaviour if the Millon Model (1990) is applied. These two behaviour patterns and attitudes towards life situations will be named "Dependent with compulsive traits" and "Psychopath tendencies". Both relate to indicators of mental health.
