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1.
Braz J Microbiol ; 2024 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-38980651

RESUMO

With the successful control of rabies transmitted by dogs in Brazil, wild animals have played a relevant epidemiological role in the transmission of rabies virus (RABV). Bats, non-human primates and wild canines are the main wild animals that transmit RABV in the country. It is worth highlighting the possibility of synanthropic action of these species, when they become adapted to urban areas, causing infections in domestic animals and eventually in humans. This work aimed to evaluate the circulation of RABV in the Pedra Branca Forest, an Atlantic Forest area, located in the state of Rio de Janeiro, Southeast Brazil. Saliva and blood samples were obtained from 60 individuals of eight species of bats, captured with mist nets, and 13 individuals of callitrichid primates, captured with tomahawk traps. Saliva samples were subjected to Reverse Transcription Polymerase Chain Reaction (RT-PCR), targeting the RABV N gene, with all samples being negative. Blood samples of all animals were submitted to the Rapid Fluorescent Focus Inhibition Test (RFFIT) to detect neutralizing antibodies (Ab) for RABV. Six bat samples (8%) were seropositive for RABV with antibody titers greater than or equal to 0.1 IU/mL. The detection of Ab but not viral RNA indicates exposure rather than current RABV transmission in the analyzed populations. The results presented here reinforce the importance of serological studies in wildlife to access RABV circulation in a region.

3.
Rev Esp Quimioter ; 2024 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-38978509

RESUMO

The study of the microbiota and the microbiome, and specifically the intestinal one, has determined great interest due to the possible association of their alterations with numerous diseases. These include entities as diverse as Crohn's disease, autism, diabetes, cancer or situations as prevalent today as obesity. In view of this situation, different recommendations have been performed regarding the use of probiotics, prebiotics, and postbiotics as modulators of the microbiota and the microbiome, seeking both preventive and therapeutic effects, and faecal material transfer (FMT) is proposed as an alternative. The latter has emerged as the only proven beneficial intervention on the intestinal microbiome, specifically in the treatment of recurrent colitis associated with Clostridioides difficile (R-CDI). In the rest of the entities, the lowering of laboratory costs has favored the study of the microbiome, which is resolved by delivering reports with catalogs of microorganisms, metabolites or supposed biomarkers without consensus on their composition associated with healthy or diseased microbiota and the disease. There is still insufficient evidence in any disease for interventions on the microbiome beyond FMT and R-CDI. Multi- and multi-disciplinary work with extensive research and the application of artificial intelligence in this field may shed light on the questions raised currently. Ethical issues must also be resolved in light of possible interventions within the umbrella of personalized medicine.

4.
Rhinology ; 2024 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-38950374

RESUMO

BACKGROUND: The objective of this study was to identify how - and to what extent - overall symptom severity (OSS) score reflects individual chronic rhinosinusitis (CRS) symptoms and whether it can be measured using alternatives to the standard visual analog scale (VAS). METHODS: CRS patients from four sites across three continents rated their OSS scores, severities of nasal obstruction, nasal drainage, decreased sense of smell, facial pain/pressure and sleep disturbance using a standard VAS, VAS with labeled tick marks at every 1 centimeter, and by writing down their OSS on a scale of 0 - 100 (which was divided by 10), all of which lead to severity scores ranging from 0 - 10 in 0.1 intervals. Quality of life was measured using the SNOT-22 and EQ-5D VAS. RESULTS: In 311 CRS patients, OSS score was significantly correlated with SNOT-22 and EQ-5D VAS. OSS score was most greatly associated with the mean of all individual symptom severity scores. From individual CRS symptoms, OSS was most greatly associated with nasal obstruction followed by nasal drainage and facial pain/pressure severities. These results held true for participants with and without nasal polyps. Measurement of OSS and individual symptom severity scores using a standard VAS, tick-marked VAS, and write-in option had near-perfect consistency. CONCLUSIONS: We demonstrate for the first time that OSS largely reflects the mean of individual CRS symptom severities, although OSS is=== most weighted by nasal obstruction severity. OSS and individual symptom severity scores can be measured using a standard VAS, tick-marked VAS or write-in prompt with near-perfect consistency.

5.
Retrovirology ; 21(1): 11, 2024 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-38945996

RESUMO

BACKGROUND: Since the introduction of combination antiretroviral therapy (cART) the brain has become an important human immunodeficiency virus (HIV) reservoir due to the relatively low penetration of many drugs utilized in cART into the central nervous system (CNS). Given the inherent limitations of directly assessing acute HIV infection in the brains of people living with HIV (PLWH), animal models, such as humanized mouse models, offer the most effective means of studying the effects of different viral strains and their impact on HIV infection in the CNS. To evaluate CNS pathology during HIV-1 infection in the humanized bone marrow/liver/thymus (BLT) mouse model, a histological analysis was conducted on five CNS regions, including the frontal cortex, hippocampus, striatum, cerebellum, and spinal cord, to delineate the neuronal (MAP2ab, NeuN) and neuroinflammatory (GFAP, Iba-1) changes induced by two viral strains after 2 weeks and 8 weeks post-infection. RESULTS: Findings reveal HIV-infected human cells in the brain of HIV-infected BLT mice, demonstrating HIV neuroinvasion. Further, both viral strains, HIV-1JR-CSF and HIV-1CH040, induced neuronal injury and astrogliosis across all CNS regions following HIV infection at both time points, as demonstrated by decreases in MAP2ab and increases in GFAP fluorescence signal, respectively. Importantly, infection with HIV-1JR-CSF had more prominent effects on neuronal health in specific CNS regions compared to HIV-1CH040 infection, with decreasing number of NeuN+ neurons, specifically in the frontal cortex. On the other hand, infection with HIV-1CH040 demonstrated more prominent effects on neuroinflammation, assessed by an increase in GFAP signal and/or an increase in number of Iba-1+ microglia, across CNS regions. CONCLUSION: These findings demonstrate that CNS pathology is widespread during acute HIV infection. However, neuronal loss and the magnitude of neuroinflammation in the CNS is strain dependent indicating that strains of HIV cause differential CNS pathologies.


Assuntos
Modelos Animais de Doenças , Infecções por HIV , HIV-1 , Doenças Neuroinflamatórias , Neurônios , Animais , Camundongos , Infecções por HIV/virologia , Infecções por HIV/patologia , Infecções por HIV/complicações , Humanos , Neurônios/virologia , Neurônios/patologia , Doenças Neuroinflamatórias/patologia , Doenças Neuroinflamatórias/virologia , Encéfalo/patologia , Encéfalo/virologia , Proteína Glial Fibrilar Ácida/metabolismo , Proteínas de Ligação ao Cálcio/metabolismo , Proteínas dos Microfilamentos/metabolismo
6.
Sensors (Basel) ; 24(11)2024 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-38894431

RESUMO

In an era dominated by Internet of Things (IoT) devices, software-as-a-service (SaaS) platforms, and rapid advances in cloud and edge computing, the demand for efficient and lightweight models suitable for resource-constrained devices such as data processing units (DPUs) has surged. Traditional deep learning models, such as convolutional neural networks (CNNs), pose significant computational and memory challenges, limiting their use in resource-constrained environments. Echo State Networks (ESNs), based on reservoir computing principles, offer a promising alternative with reduced computational complexity and shorter training times. This study explores the applicability of ESN-based architectures in image classification and weather forecasting tasks, using benchmarks such as the MNIST, FashionMnist, and CloudCast datasets. Through comprehensive evaluations, the Multi-Reservoir ESN (MRESN) architecture emerges as a standout performer, demonstrating its potential for deployment on DPUs or home stations. In exploiting the dynamic adaptability of MRESN to changing input signals, such as weather forecasts, continuous on-device training becomes feasible, eliminating the need for static pre-trained models. Our results highlight the importance of lightweight models such as MRESN in cloud and edge computing applications where efficiency and sustainability are paramount. This study contributes to the advancement of efficient computing practices by providing novel insights into the performance and versatility of MRESN architectures. By facilitating the adoption of lightweight models in resource-constrained environments, our research provides a viable alternative for improved efficiency and scalability in modern computing paradigms.

7.
medRxiv ; 2024 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-38883729

RESUMO

Spinal muscular atrophy (SMA) is a neurodegenerative disease characterized by a varying degree of severity that correlates with the reduction of SMN protein levels. Motor neuron degeneration and skeletal muscle atrophy are hallmarks of SMA, but it is unknown whether other mechanisms contribute to the spectrum of clinical phenotypes. Here, through a combination of physiological and morphological studies in mouse models and SMA patients, we identify dysfunction and loss of proprioceptive sensory synapses as key signatures of SMA pathology. We demonstrate that SMA patients exhibit impaired proprioception, and their proprioceptive sensory synapses are dysfunctional as measured by the neurophysiological test of the Hoffmann reflex (H-reflex). We further show that loss of excitatory afferent synapses and altered potassium channel expression in SMA motor neurons are conserved pathogenic events found in both severely affected patients and mouse models. Lastly, we report that improved motor function and fatigability in ambulatory SMA patients and mouse models treated with SMN-inducing drugs correlate with increased function of sensory-motor circuits that can be accurately captured by the H-reflex assay. Thus, sensory synaptic dysfunction is a clinically relevant event in SMA, and the H-reflex is a suitable assay to monitor disease progression and treatment efficacy of motor circuit pathology.

10.
Domest Anim Endocrinol ; 89: 106858, 2024 May 19.
Artigo em Inglês | MEDLINE | ID: mdl-38830275

RESUMO

Feline hypersomatotropism (HST) is typically associated with diabetes mellitus (DM), whereas HST without concurrent DM has only been reported in a few cases. Weight gain may be observed in cats with HST. The aims of this study were to evaluate circulating insulin-like growth factor-1 (IGF-1) in non-diabetic cats with overweight/obesity, to screen this population for the presence of HST, and to assess whether there is a correlation between body weight/body condition score (BCS) and serum IGF-1 concentration in overweight/obese cats. In this prospective study, 80 overweight/obese cats from referral centers in Buenos Aires (Argentina) were evaluated. Serum IGF-1 was measured as part of the routine tests for overweight/obesity. Non-diabetic cats were included in the study if they had a BCS>6/9. Twenty-nine cats were classified as overweight (BCS 7/9), whereas 51 were classified as obese (BCS 8-9/9). Median serum IGF-1 concentrations of cats with BCS 7/9, 8/9, and 9/9 were 570 ng/ml (range 123-1456 ng/ml), 634 ng/ml (range 151-1500 ng/ml), and 598 ng/ml (range 284-2450 ng/ml), respectively. There was a positive linear correlation between serum IGF-1 concentrations and body weight (r= 0.24, 95% CI 0.01-0.44 P=0.03), and between IGF-1 and BCS (r= 0.27, 95% CI 0.08-0.44 P=0.004). In total, 8.75% (95% confidence interval 3.6-17.2%) of the cats with overweight/obesity had IGF-1 concentrations >1000 ng/ml. Pituitary enlargement was detected on computed tomography in 4/7 cases. These seven cats showed varying degrees of phenotypic changes consistent with acromegaly. A proportion of 8.75 % of overweight/obese non-diabetic cats from referral centers in Buenos Aires had serum IGF-1 concentration in a range consistent with HST in diabetic cats. Likewise, 5% of overweight/obese cats were likely to be diagnosed with HST, supported by evidence of pituitary enlargement. Serum IGF-1 concentrations were positively correlated with body weight and BCS in this population of cats. This study highlights the relevance of screening different populations of non-diabetic cats to increase the detection of HST/acromegaly.

11.
Bioinspir Biomim ; 19(5)2024 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-38866026

RESUMO

This research presents a 10-year systematic review based on bibliometric analysis of the bio-inspired design of hard-bodied mobile robot mechatronic systems considering the anatomy of arthropods. These are the most diverse group of animals whose flexible biomechanics and adaptable morphology, thus, it can inspire robot development. Papers were reviewed from two international databases (Scopus and Web of Science) and one platform (Aerospace Research Central), then they were classified according to: Year of publication (January 2013 to April 2023), arthropod group, published journal, conference proceedings, editorial publisher, research teams, robot classification according to the name of arthropod, limb's locomotion support, number of legs/arms, number of legs/body segments, limb's degrees of freedom, mechanical actuation type, modular system, and environment adaptation. During the screening, more than 33 000 works were analyzed. Finally, a total of 174 studies (90 journal-type, 84 conference-type) were selected for in-depth study: Insecta-hexapods (53.8%), Arachnida-octopods (20.7%), Crustacea-decapods (16.1%), and Myriapoda-centipedes and millipedes (9.2%). The study reveals that the most active editorials are the Institute of Electrical and Electronics Engineers Inc., Springer, MDPI, and Elsevier, while the most influential researchers are located in the USA, China, Singapore, and Japan. Most works pertained to spiders, crabs, caterpillars, cockroaches, and centipedes. We conclude that 'arthrobotics' research, which merges arthropods and robotics, is constantly growing and includes a high number of relevant studies with findings that can inspire new methods to design biomechatronic systems.


Assuntos
Artrópodes , Bibliometria , Robótica , Animais , Robótica/instrumentação , Artrópodes/fisiologia , Artrópodes/anatomia & histologia , Biomimética/métodos , Desenho de Equipamento , Locomoção/fisiologia , Fenômenos Biomecânicos
12.
Poult Sci ; 103(9): 103957, 2024 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-38936073

RESUMO

A total of 378 Cobb-500 male broilers were used to evaluate the effects of 2 fiber sources, differing in hydration capacity and fermentability, on gastrointestinal tract development, apparent ileal digestibility and performance from 1 to 42d of age. There were 9 replicates per each of the 3 dietary treatments, all in mash form: a wheat-soybean control (CON) diet, CON diet diluted with 1.5% of wood lignocellulose (LC diet) as a non-fermentable insoluble fiber with high hydration capacity; and CON diluted with 1.5% of a mixture of fibers (ISFC diet) containing both lignified insoluble fiber and a prebiotic soluble fiber fraction from fructooligosaccharides. Additionally, the fermentability of both fiber sources (LC and ISFC) was determined by in vitro using cecal inoculum from broilers fed the experimental diets. Both LC and ISFC treatments impaired by 4% feed conversion ratio only during the first 7d (P = 0.003) compared with CON group. In the grower period (21-42d), the ISFC group showed the best growth (P = 0.039), and at 42d tended to show the highest body weight (P = 0.095). This agrees well with the highest ileal dry matter (P = 0.033) and organic matter (P = 0.043) digestibility observed in ISFC group and the similar trend observed for ileal protein digestibility (P = 0.099) at 42d. Also, at 42 d, absolute and relative (% body weight) digestive tract weights (P ≤ 0.041) and empty gizzard weights (P ≤ 0.034) were greater for LC and ISFC groups compared to CON. The cecal molar proportion of valeratewas greatest in ISFC group (P = 0.039). In vitro gas production was higher for ISFC than for LC substrate when using either a diet-adapted or non-adapted cecal inoculum (P < 0.05). These results show the interest in combining IF with prebiotic highly fermentable fiber, such as fructooligosaccharides, in broilers to improve nutrient digestibility and finishing performance.

14.
Dig Liver Dis ; 2024 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-38719628

RESUMO

BACKGROUND AND AIMS: Oxaliplatin (OX) has been described as a potential etiologic agent for porto-sinusoidal vascular disorder (PSVD). Our aim was to describe the natural history of PSVD due to OX in colon cancer (CRC) and identify risk factors for its development. METHODS: We made a multicenter retrospective case-control (ratio 1:3) study with patients diagnosed of PSVD-OX. Baseline data, end of treatment, years of follow-up and diagnosis of PSVD were collected and compared to controls (without PSVD). Besides, 16 different SNPs were selected from bibliography and analyzed by genotyping in the case group to identify potential genetic risk factors. RESULTS: 41 cases were identified, with a median time to PSVD diagnosis after the end of OX of 34 months. Spleen diameter was the strongest predictor of PSVD during treatment (OR 43.94 (14.48-133.336); p < 0.0001). Additionally, thrombocytopenia (<150 × 10^9) at one year was a significant disease risk marker (OR 9.35; 95% CI: 3.71-23.58; p = 0.001). We could not establish any significant association between the selected SNPs and PSVD diagnosis. CONCLUSION: The increase of spleen diameter is the strongest predictor of PSVD in patients treated with OX for CRC. These patients could be candidates for a specific follow-up of portal hypertension-related complications.

16.
Skeletal Radiol ; 2024 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-38619614

RESUMO

INTRODUCTION: Papillary intralymphatic angioendothelioma (PILA) is an exceptionally rare metastasizing soft tissue tumor. It tends to arise in the subcutaneous tissues of distal extremities in children. Only four intraosseous PILA cases have been reported until now in English language literature. CASE REPORT: We present a case of PILA arising in the distal femoral epiphysis of a 50-year-old female patient. It started as a relentless pain in her left knee. A plain radiography revealed a radiolucent area in the left internal femoral condyle. Computerized tomography revealed a 1-cm lytic lesion with a sclerotic rim. Magnetic resonance images showed a significant bone marrow edema signal focused on a 1-cm subchondral lesion suggestive of an intraarticular osteoid osteoma. Histologically, the tumor contained vascular channels covered by a single endothelial layer with intraluminal papillary endothelial structures lined with hobnail cells. Immunohistochemically, the cells were positive for ERG, CD31, and D2-40. The tumor underwent cryoablation and 6 months later, after local recurrence or tumor persistence, a wide tumor resection was referred. After 7 years of follow-up, the patient displayed neither local recurrence nor distant metastases. CONCLUSION: Primary intraosseous PILAs are exceedingly rare tumors that should be considered in the differential diagnosis of vascular bone tumors.

17.
J Frailty Aging ; 13(2): 157-162, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38616372

RESUMO

OBJECTIVES: To assess the awareness and training of primary care physicians on nutrition in older patients. DESIGN: Observational, real-world data survey. SETTING: Primary Care. PARTICIPANTS: One hundred sixty-two physicians, generalists and specialists, working in primary care. MEASUREMENTS: Participants received an online questionnaire with 18 questions concerning the importance of nutrition, degree of knowledge, needs, and training in nutrition. The results were evaluated using univariate descriptive analysis, with a percentage for each chosen answer. Logistic regression models were used to evaluate if answers were related to training in nutrition and professional experience. RESULTS: 43.2% of participants reported that nutrition is very important in individuals over 65 years old, and 90% were aware of the importance of nutrition in healthy aging. Nutritional problems affect 30 to 50% of patients, according to 44.7% of participants. 89.2% agree about the need for nutritional assessment in older patients; however, the professionals believe they should be better prepared. Two out of three respondents consider the training received in nutrition during their undergraduate course or continuing medical education as deficient. Time of professional practice was mainly associated with conceptual facts, while continuing medical education did with practical issues, mainly the use of screening and diagnostic tools [FRAIL (OR: 3.16; 95%IC: 1.55-6.46), MNA-SF (OR: 6.455; 95%IC: 2.980-13.981) and SARC-F (OR: 3.063; 95%IC: 1.284-7.309)]. CONCLUSION: Although primary care professionals are aware of the importance of nutrition in older patients, there are still gaps in daily practice that could be improved by developing educational strategies.


Assuntos
Distúrbios Nutricionais , Estado Nutricional , Humanos , Idoso , Autorrelato , Avaliação Nutricional , Atenção Primária à Saúde
18.
Heliyon ; 10(8): e29149, 2024 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-38638968

RESUMO

In recent decades, natural fibers have emerged as an alternative to synthetic fibers due to their renewable nature, lower environmental impact, and comparable strength properties. Agave bagasse, a byproduct of agave juice extraction in Mexico, stands out for its potential in various industrial applications, notably biocomposite production. Bagasse is rich in cellulose, along with hemicellulose and lignin. Cellulose is the most suitable to be converted into valuable products, and it is versatile, renewable, and biodegradable. An effective pre-treatment is crucial to enrich its fraction. This study aims to determine the optimal pre-treatment conditions for the agave bagasse. Three different pre-treatments were tested, acid (H2SO4), enzymatic (Cellic® HTec2 enzymatic preparation), and sequence of acid-enzymatic (sulfuric acid and Cellic® HTec2), to determine which pre-treatment got the optimal cellulose fraction increase. The acid pre-treatment was conducted over three time ranges (5, 10, and 15 min) at different acid concentrations (1%, 1.5%, and 2%). Enzymatic reactions were conducted over 24 h, testing three different enzyme concentrations (1.5%, 3%, 4.5%). The sequential pre-treatment utilized the optimal conditions derived from the acid experiments (1.5% H2SO4 for 10 min), followed by enzymatic reactions carried out over three different durations (6, 12, and 24 h). The findings revealed that a 1.5% acid concentration applied for 10 min was the most efficient pre-treatment method. This pre-treatment resulted in a 1.9-fold increase in the cellulose fraction while reducing hemicellulose content by 30%. The hemicellulose reduction was confirmed through Fourier Transform IR spectroscopy (FTIR) analysis, complemented by scanning electron microscopy (SEM) observations highlighting physical alterations in the fiber structure. Furthermore, thermogravimetric analysis (TGA) demonstrated improved thermal stability, suggesting potential use in biocomposites. Future research should evaluate the environmental impact of optimized pre-treatment methods for agave bagasse.

19.
Nat Astron ; 8(4): 504-519, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38659610

RESUMO

Dust associated with various stellar sources in galaxies at all cosmic epochs remains a controversial topic, particularly whether supernovae play an important role in dust production. We report evidence of dust formation in the cold, dense shell behind the ejecta-circumstellar medium (CSM) interaction in the Type Ia-CSM supernova (SN) 2018evt three years after the explosion, characterized by a rise in mid-infrared emission accompanied by an accelerated decline in the optical radiation of the SN. Such a dust-formation picture is also corroborated by the concurrent evolution of the profiles of the Hα emission line. Our model suggests enhanced CSM dust concentration at increasing distances from the SN as compared to what can be expected from the density profile of the mass loss from a steady stellar wind. By the time of the last mid-infrared observations at day +1,041, a total amount of 1.2 ± 0.2 × 10-2 M⊙ of new dust has been formed by SN 2018evt, making SN 2018evt one of the most prolific dust factories among supernovae with evidence of dust formation. The unprecedented witness of the intense production procedure of dust may shed light on the perceptions of dust formation in cosmic history.

20.
SEMERGEN, Soc. Esp. Med. Rural Gen. (Ed. Impr.) ; 50(3): [102136], Abr. 2024. graf, tab, mapas
Artigo em Espanhol | IBECS | ID: ibc-232209

RESUMO

La anticoagulación oral es clave para disminuir el riesgo de ictus en la fibrilación auricular. Aunque clásicamente los antagonistas de la vitaminaK (AVK) se han empleado para este fin, han sido ampliamente superados por los anticoagulantes orales de acción directa (ACOD), como lo demuestran las evidencias provenientes de los ensayos clínicos, estudios de vida real y poblacionales. De hecho, todas las guías de práctica clínica recomiendan su uso de manera preferencial sobre los AVK. Sin embargo, en España la prescripción de los ACOD está subordinada a un visado de inspección que recoge las condiciones clínicas definidas en el Informe de Posicionamiento Terapéutico de la Agencia Española del Medicamento, y que todavía impone importantes restricciones a su uso, limitando los beneficios del empleo de los ACOD en los pacientes con fibrilación auricular (FA), y generando además inequidades entre las diferentes comunidades autónomas. De hecho, el empleo de los ACOD en España es muy inferior a los países de nuestro entorno. Esto ha provocado que en otros países ha disminuido la incidencia de ictus isquémico a nivel poblacional, junto con una reducción del coste por paciente con FA, pero en España este descenso ha sido discreto. Por todo ello, y en aras de la sostenibilidad del sistema sanitario, pedimos la eliminación del visado para que los ACOD se puedan prescribir de acuerdo a las recomendaciones realizadas por las guías. Además, también apostamos por el refuerzo de la formación y de las decisiones consensuadas con el paciente, siendo el médico de familia un actor clave en la protección del paciente con FA.(AU)


Oral anticoagulation is the key to reduce the risk of stroke in atrial fibrillation. Although vitaminK antagonists (VKA) have classically been used for this purpose, they have been largely overcome by direct oral anticoagulants (DOAC), as demonstrated by evidence from clinical trials, real-life and population studies. In fact, all clinical practice guidelines recommend their use preferentially over VKA. However, in Spain the prescription of DOAC is subordinated to an inspection visa that includes the clinical conditions defined in the Therapeutic Positioning Report of the Spanish Medicines Agency, and that still imposes important restrictions on their use, limiting the benefits of using DOACs in patients with atrial fibrillation (AF), and also generating inequalities between the different autonomous communities. In fact, the use of DOAC in Spain is much lower than that observed in neighboring countries. This has made that while in other countries the incidence of ischemic stroke has decreased at the population level, along with a reduction in the cost per patient with AF, in Spain this decrease has been modest. For all these reasons, and for assuring the sustainability of the health care system, we ask for the elimination of the visa so that DOAC can be prescribed according to the recommendations made by the guidelines. In addition, we are also committed to reinforce medical education and decisions made by consensus with the patient, with the primary care physician acquiring a key role in the protection of the patient with AF.(AU)


Assuntos
Humanos , Masculino , Feminino , Vitamina K , Fibrilação Atrial , Inibidores do Fator Xa , Acidente Vascular Cerebral/prevenção & controle , Espanha , Atenção Primária à Saúde
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