Real-world Safety and Efficacy of Risankizumab in Psoriatic Patients: A Multicenter, Retrospective, and Not-interventional Study.

BACKGROUND AND OBJECTIVE: Risankizumab - a humanized monoclonal antibody that targets the p19 subunit of IL-23 - has been recently approved to treat moderate-to-severe plaque psoriasis. Real-world data based on a representative pool of patients are currently lacking. OBJECTIVE: To assess the mid- and long-term safety and efficacy profile of risankizumab in patients with moderate-to-severe psoriasis in the routine clinical practice. METHODS: This was a retrospective and multicenter study of consecutive psoriatic patients on risankizumab from April 2020 through November 2022. The primary endpoint was the number of patients who achieved a 100% improvement in their Psoriasis Area and Severity Index (PASI) (PASI100) on week 52. RESULTS: A total of 510 patients, 198 (38.8%) women and 312 (61.2%) men were included in the study. The mean age was 51.7±14.4 years. A total of 227 (44.5%) study participants were obese (body mass index [BMI] >30kg/m2). The mean baseline PASI score was 11.4±7.2, and the rate of patients who achieved PASI100 on week 52, 67.0%. Throughout the study follow-up, 21%, 50.0%, 59.0%, and 66% of the patients achieved PASI100 on weeks 4, 16, 24, and 40, respectively. The number of patients who achieved a PASI ≤2 was greater in the group with a BMI ≤30kg/m2 on weeks 4 (P=.04), 16 (P=.001), and 52 (P=.002). A statistically significantly greater number of patients achieved PASI100 in the treatment-naïve group on weeks 16 and 52 (P=.001 each, respectively). On week 16 a significantly lower number of participants achieved PASI100 in the group with psoriatic arthropathy (P=.04). Among the overall study sample, 22 (4.3%) patients reported some type of adverse event and 20 (3.9%) discontinued treatment. CONCLUSIONS: Risankizumab proved to be a safe and effective therapy for patients with moderate-to-severe psoriasis in the routine clinical practice.

Increased grey matter volumes in the temporal lobe and its relationship with cognitive functioning in euthymic patients with bipolar disorder.

BACKGROUND: Bipolar disorder (BD) is characterized by episodic mood dysregulation, although a significant portion of patients suffer persistent cognitive impairment during euthymia. Previous magnetic resonance imaging (MRI) research suggests BD patients may have accelerated brain aging, observed as lower grey matter volumes. How these neurostructural alterations are related to the cognitive profile of BD is unclear. METHODS: We aim to explore this relationship in euthymic BD patients with multimodal structural neuroimaging. A sample of 27 euthymic BD patients and 24 healthy controls (HC) underwent structural grey matter MRI and diffusion-weighted imaging (DWI). BD patient's cognition was also assessed. FreeSurfer algorithms were used to obtain estimations of regional grey matter volumes. White matter pathways were reconstructed using TRACULA, and four diffusion metrics were extracted. ANCOVA models were performed to compare BD patients and HC values of regional grey matter volume and diffusion metrics. Global brain measures were also compared. Bivariate Pearson correlations were explored between significant brain results and five cognitive domains. RESULTS: Euthymic BD patients showed higher ventricular volume (F(1, 46) = 6.04; p = 0.018) and regional grey matter volumes in the left fusiform (F(1, 46) = 15.03; pFDR = 0.015) and bilateral parahippocampal gyri compared to HC (L: F(1, 46) = 12.79, pFDR = 0.025/ R: F(1, 46) = 15.25, pFDR = 0.015). Higher grey matter volumes were correlated with greater executive function (r = 0.53, p = 0.008). LIMITATIONS: We evaluated a modest sample size with concurrent pharmacological treatment. CONCLUSIONS: Higher medial temporal volumes in euthymic BD patients may be a potential signature of brain resilience and cognitive adaptation to a putative illness neuroprogression. This knowledge should be integrated into further efforts to implement imaging into BD clinical management.

Cannabis-induced psychotic disorder with onset during withdrawal: a brief report of emerging evidence.

OBJECTIVES: The link between cannabis use and psychotic symptoms or disorders is well known. However, the relation between cannabis withdrawal and psychotic symptoms is less studied. METHODS: To our knowledge, this is the first publication of an observational systematic report of cannabis-induced psychotic disorder with onset during withdrawal. Here, we review patients presenting to a major emergency room in Montreal between January 2020 and September 2023 in a context of psychotic symptoms following cannabis cessation. RESULTS: In total, seven male and one female patients presented at the peak of cannabis withdrawal with acute psychotic symptoms, representing less than 1% of all emergency service admissions. CONCLUSIONS: We discuss current knowledge regarding the endocannabinoid system and dopamine homeostasis to formulate hypotheses regarding these observations.

Disrupted network switching in euthymic bipolar disorder: Working memory and self-referential paradigms.

BACKGROUND: Patients with bipolar disorder (BD) frequently suffer from neurocognitive deficits that can persist during periods of clinical stability. Specifically, impairments in executive functioning such as working memory and in self-processing have been identified as the main components of the neurocognitive profile observed in euthymic BD patients. The study of the neurobiological correlates of these state-independent alterations may be a prerequisite to develop reliable biomarkers in BD. METHODS: A sample of 27 euthymic BD patients and 25 healthy participants (HC) completed working memory and self-referential functional Magnetic Resonance Imaging (fMRI) tasks. Activation maps obtained for each group and contrast images (i.e., 2-back > 1-back/self > control) were used for comparisons between patients and HC. RESULTS: Euthymic BD patients, in comparison to HC, showed a higher ventromedial prefrontal cortex activation during working memory, a result driven by the lack of deactivation in BD patients. In addition, euthymic BD patients displayed a greater dorsomedial and dorsolateral prefrontal cortex activation during self-reference processing. LIMITATIONS: Pharmacotherapy was described but not included as a confounder in our models. Sample size was modest. CONCLUSION: Our findings revealed a lack of deactivation in the anterior default mode network (aDMN) during a working memory task, a finding consistent with prior research in BD patients, but also a higher activation in frontal regions within the central executive network (CEN) during self-processing. These results suggest that an imbalance of neural network dynamics underlying external/internal oriented cognition (the CEN and the aDMN, respectively) may be one of the first reliable biomarkers in euthymic bipolar patients.

Servicio cribado SARS-COV2 con emisión certificado en farmacia comunitaria con test diagnóstico y autodiagnóstico / SARS-COV2 screening service with certified issue in community pharmacies with diagnostic test and self-testing

JUSTIFICACIÓN: la pandemia de COVID-19, derivada de la enfermedad causada por el virus SARS-COV-2,​ fue detectada por primera vez en diciembre de 2019 en la ciudad china de Wuhan. Las medidas de prevención utilizadas hasta ahora (mascarillas, tanto quirúrgicas como FFP2, distancia interpersonal, higiene de manos y ventilación) han demostrado ser eficaces para todas las variantes del COVID19, incluidas las variantes de mayor impacto para la salud pública. En julio de 2021, el Real Decreto 588/2021, en España se autoriza la dispensación sin prescripción médica de test de autodiagnóstico de la COVID-19 (tanto de anticuerpos como de antígenos) y en agosto se firma en Aragón el "Acuerdo de colaboración entre el Departamento de Sanidad del Gobierno de Aragón y el Consejo Oficial de Colegios de Farmacéuticos de Aragón para la trazabilidad y el correcto seguimiento de la información derivada de la realización de test de antígenos SARS-COV2" por el que las farmacias aragonesas pueden realizar test de diagnóstico o autodiagnóstico para la emisión de certificados COVID europeos y vigilar la trazabilidad de las pruebas autodiagnósticas dispensadas a través de las farmacias comunitarias.OBJETIVOS: describir proceso de la realización de pruebas diagnósticas en nuestra farmacia.MATERIAL Y MÉTODOS: - Zona de atención personalizada.- Formación: "Test de detección del coronavirus SARS-COV-2" (SEFAC).- Acreditación. - Protocolos: "Síntomas menores y COVID-19. Protocolo de actuación en farmacia comunitaria" a través de SEFAC e_XPERT y “Realización de test de detección de antígenos de COVID-19 en farmacias aragonesas”, editado por el COFZ.- Test de diagnóstico y autodiagnóstico (listado AEMPS, marcado CE).- Material de protección y desinfección.- PNT de limpieza. (AU)

Servicio de indicación farmacéutica en farmacia comunitaria según protocolos de indicación en síntomas menores y registro en ‘SEFAC e_XPERT ‘ / Pharmaceutical indication service in community pharmacies according to indication protocols for minor symptoms and registration in 'SEFAC e_XPERT '

JUSTIFICACIÓN: el Servicio Profesional Farmacéutico Asistencial (SPFA) de Indicación Farmacéutica (SIF) es el segundo SPFA más demandado en la Farmacia Comunitaria (FC) después de la dispensación. Según la definición propuesta por el Foro de Atención Farmacéutica - Farmacia Comunitaria, éste se define como "el servicio profesional prestado ante la demanda de un paciente o usuario que llega a la farmacia sin saber qué medicamento debe adquirir y solicita al farmacéutico el remedio más adecuado para un problema de salud concreto”. También incluimos dentro de este servicio la actuación del farmacéutico ante la demanda de un producto o medicamento, sujeto o no a prescripción, para el tratamiento de un síntoma menor (SM).En este estudio analizamos las indicaciones realizadas y registradas en nuestra farmacia según el "Protocolo de Indicación Farmacéutica y Criterios de Derivación al Médico en Síntomas Menores" a través de la plataforma SEFAC e_XPERT.OBJETIVOS:-Describir la labor asistencial del farmacéutico comunitario abordando las consultas de SM mediante la herramienta SEFAC e_XPERT.- Valorar la eficacia de las intervenciones realizadas con el SIF.MATERIAL Y MÉTODOS:- Herramienta SEFAC_EXPERT, Servicio de Indicación, para el registro, realización del protocolo y seguimiento de la intervención.- Informes y hojas de derivación.- Fichas de recomendaciones para pacientes, relativos a cada SM.RESULTADOS / DISCUSIÓN: durante el periodo del estudio hemos realizado 203 registros de las indicaciones realizadas en la farmacia. El 84,73% (172) de las consultas registradas fueron por consulta de un SM. El 15,27% (31) ante la demanda de un medicamento. De las 172 consultas por SM, el 27,32% (47) cumplían con algún criterio de derivación al médico (MAP) y se derivaron un 38,30% (18) de las mismas. (AU)

Servicio de indicación farmacéutica. Caso clínico. Resolución síntoma menor con criterio de derivación sin derivar. Flatulencia / Pharmaceutical indication service. Clinical case. Resolution of minor symptom with criteria for referral without referral. Flatulence

PRESENTACIÓN DEL CASO / ANTECEDENTES: Gustavo es un paciente de 77 años, en tratamiento con Ebymect 50/1000 mg (1-0-1), Vesomni 6/0,4 mg (0-0-1), Spiraxin (2-0-2 1 semana al mes) y Rabeprazol 20 mg (1-0-1). Está incluido en el servicio de SPD desde junio de 2020 y desde el comienzo del mismo se le recomienda la toma de probióticos por la toma discontinua de Rifaximina, el cual, acepta. Entre sus antecedentes de historia clínica de patología digestiva aparece hernia de hiato y diverticulosis. Control glucémico correcto. Acude a consulta refiriendo dolor a nivel de boca del estómago y también refiere refiere distensión abdominal. Le incluimos en el servicio de indicación para su evaluación y seguimiento, a través de la plataforma SEFAC_EXPERT.EVALUACIÓN: siguiendo el protocolo PASITAMAE del servicio de indicación, nos encontramos con dos criterios de derivación ante la sintomatología referida:- mayor de 75 años con patologías asociadas, ya que habría que extremar precauciones por la mayor incidencia de patologías graves.- dolor abdominal o hinchazón excesivo, ya que si las molestias son excesivas es necesario descartar otras posibles patologías digestivas (recordemos que el paciente está en tratamiento con Rifaximina para diverticulosis). No refiere fiebre, estreñimiento, por lo que decidimos instaurar un tratamiento sintomático antes de realizar la derivación si no mejorara. Tenemos en cuenta que SOLIFENACINA (VESOMNI) puede agravar patologías digestivas como la hernia de hiato (dolor epigástrico referido) así como el estreñimiento, aunque el paciente refiere un tránsito normal.INTERVENCIÓN: una vez realizada la evaluación del caso, realizamos la intervención a 3 niveles:- Tratamiento farmacológico: pautamos SIMETICONA 240 mg (1-0-1) y ALMAX 500 mg 18 comp (2-2-2). - Información sobre el tratamiento y medidas higiénico-dietéticas (se le entrega hoja de recomendaciones sanitarias).- Educación sanitaria. (AU)

Disminución de glucemia, tras inclusión de un paciente en servicio de indicación farmacéutica y derivación al servicio de asesoramiento nutricional / Decrease in glycaemia, after inclusion of a patient in the pharmaceutical indication service and referral to the nutritional counselling service

PRESENTACIÓN/ANTECEDENTES: paciente, 50 años, que acude a la farmacia comunitaria, solicitando algún tratamiento coadyuvante para regular los niveles de glucosa en sangre, dado que tras analítica de control, se le detectan valores de glucosa de 132 mg/dl, por encima de los márgenes de referencia (>100 mg/dl), para ello su médico pautó Metformina 0,5-0-0. Era la primera vez que consultaba por este problema de salud y nos comentó que en la familia (madre, tías) eran diabéticas. Iniciamos el servicio de indicación farmacéutica ante la demanda del paciente y realizamos una pequeña entrevista, siguiendo los pasos y el protocolo de indicación.EVALUACIÓN: debido a los antecedentes familiares y a los valores de glucosa en ayunas, gracias a la herramienta SEFAC e_XPERT y mediante el servicio de indicación farmacéutica, derivamos a nuestro servicio de asesoramiento nutricional.INTERVENCIÓN: citamos a la paciente y en la primera visita se realizó bioimpedancia que nos mostró un índice de masa corporal (IMC) de 23,8; un porcentaje de grasa corporal de 32,1 y un nivel de grasa visceral = 9. Nos mostró también un objetivo de bajada de grasa corporal de 7,2 Kg. Recomendamos pautas higiénico- dietéticas, acordes a las necesidades del paciente, dieta normocalórica, aporte de fibra de 20-30 g/día, ingesta adecuada de hidratos de carbono e hicimos educación al paciente. Incidimos en la necesidad de acompañar estos cambios nutricionales con actividad física. Citamos a la paciente cada 15 días para valorar el estado de salud. En cada visita tomamos medidas antropométricas, se puso de manifiesto una pérdida de peso progresiva. El proceso tuvo una duración de 7 meses, se hicieron visitas presenciales y telefónicas.RESULTADOS/SEGUIMIENTO: transcurridos 5 meses, se repite la bioimpedancia y observamos que el índice de masa corporal fue 21,3 ; el porcentaje de grasa corporal fue 25,3 y el nivel de grasa visceral 6. (AU)

ADENI-UCI study: Analysis of non-income decisions in ICU as a measure of limitation of life support treatments.

OBJECTIVE: To analyze the variables associated with ICU refusal decisions as a life support treatment limitation measure. DESIGN: Prospective, multicentrico. SCOPE: 62 ICU from Spain between February 2018 and March 2019. PATIENTS: Over 18 years of age who were denied entry into ICU as a life support treatment limitation measure. INTERVENTIONS: None. MAIN INTEREST VARIABLES: Patient comorities, functional situation as measured by the KNAUS and Karnosfky scale; predicted scales of Lee and Charlson; severity of the sick person measured by the APACHE II and SOFA scales, which justifies the decision-making, a person to whom the information is transmitted; date of discharge or in-hospital death, destination for hospital discharge. RESULTS: A total of 2312 non-income decisions were recorded as an LTSV measure of which 2284 were analyzed. The main reason for consultation was respiratory failure (1080 [47.29%]). The poor estimated quality of life of the sick (1417 [62.04%]), the presence of a severe chronic disease (1367 [59.85%]) and the prior functional limitation of patients (1270 [55.60%]) were the main reasons for denying admission. The in-hospital mortality rate was 60.33%. The futility of treatment was found as a risk factor associated with mortality (OR: 3.23; IC95%: 2.62-3.99). CONCLUSIONS: Decisions to limit ICU entry as an LTSV measure are based on the same reasons as decisions made within the ICU. The futility valued by the intensivist is adequately related to the final result of death.

COVID-19 en trabajadores sanitarios del Hospital comarcal de Olot (Girona) / COVID-19 in health workers from the Olot Regional Hospital (Girona)

No disponible

ADENI-UCI Study: Analysis of non-income decisions in ICU as a measure of limitation of life support treatments. / Estudio ADENI-UCI: Análisis de las decisiones de no ingreso en UCI como medida de limitación de los tratamientos de soporte vital.

OBJECTIVE: To analyze the variables associated with ICU refusal decisions as a life support treatment limitation measure. DESIGN: Prospective, multicentrico SCOPE: 62 ICU from Spain between February 2018 and March 2019. PATIENTS: Over 18 years of age who were denied entry into ICU as a life support treatment limitation measure. INTERVENTIONS: None. MAIN INTEREST VARIABLES: Patient comorities, functional situation as measured by the KNAUS and Karnosfky scale; predicted scales of Lee and Charlson; severity of the sick person measured by the APACHE II and SOFA scales, which justifies the decision-making, a person to whom the information is transmitted; date of discharge or in-hospital death, destination for hospital discharge. RESULTS: A total of 2312 non-income decisions were recorded as an LTSV measure of which 2284 were analyzed. The main reason for consultation was respiratory failure (1080 [47.29%]). The poor estimated quality of life of the sick (1417 [62.04%]), the presence of a severe chronic disease (1367 [59.85%]) and the prior functional limitation of patients (1270 [55.60%]) were the main reasons for denying admission. The in-hospital mortality rate was 60.33%. The futility of treatment was found as a risk factor associated with mortality (OR: 3.23; IC95%: 2.62-3.99). CONCLUSIONS: Decisions to limit ICU entry as an LTSV measure are based on the same reasons as decisions made within the ICU. The futility valued by the intensivist is adequately related to the final result of death.

Buried intramedullary implants for paediatric forearm fractures. Does the refracture rate improve? / Implantes intramedulares enterrados para fracturas de antebrazo pediátricas. ¿Mejora la tasa de refracturas?

INTRODUCTION: Unstable forearm fractures may require surgical management by reduction and osteosynthesis with intramedullary needles. This fixation should be removed early if it has been left exposed, but this could increase the risk of refracture in a bone in the period of remodelling. As an alternative we can keep the needles, buried subcutaneously, for a longer time, to protect the bone callus. OBJECTIVE: To assess whether there are differences between using exposed needles with respect to burying them in paediatric patients with forearm fractures. Our hypothesis is that by burying the needles we keep them longer by reducing forearm refractures. MATERIAL AND METHODS: We present a cohort of 75 paediatric patients with a forearm fracture between 2010 and 2016. Demographic data, surgical technique, complications and patient follow-up were collected. RESULTS: The implants were left exposed in 50 patients and 25 buried. The average time of removal of the exposed implants was 6.8weeks and 17.6weeks in the buried ones. No significant differences were found in terms of consolidation (P=.19) or immobilization time (P=.22). Regarding refractures, a greater number was observed in the exposed osteosynthesis group (4patients) compared to only one case with buried osteosynthesis, but there were no significant differences (P=.49). No postsurgical complications were detected and the functionality was excellent at the end of the follow-up in both groups. CONCLUSION: Leaving implants buried in relation to skin exposed does not cause a decrease in the number of refractures or other complications, with adequate patient functionality in both cases.