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Jessica González, 1 Pilar Rivera-Ortega, 1 Macarena Rodríguez-Fraile, 2 Patricia Restituto, 3 Inmaculada Colina, 4 María de los Desamparados Calleja, 5 Ana B Alcaide, 1 Aránzazu Campo, 1 Juan Bertó, 1 Luis Seijo, 6 Maria Teresa Pérez-Warnisher, 6 Javier J Zulueta, 1 Nerea Varo, 3 Juan P de-Torres 7 1Pulmonary Department, Hospital Universitari Arnau de Vilanova, Lleida, Spain; 2Nuclear Medicine Department, Clínica Universidad de Navarra, Pamplona, Spain; 3Biochemistry Department, Clínica Universitaria de Navarra, Pamplona, Spain; 4Department of Internal Medicine, Clínica Universidad de Navarra, Pamplona, Spain; 5Department of Endocrinology & Nutrition, Clínica Universidad de Navarra, Pamplona, Spain; 6Pulmonary Department, Clínica Universidad de Navarra, Madrid, Spain; 7Respirology Division, Queen’s University, Kingston, ON, CanadaCorrespondence: Jessica GonzálezPulmonary department, Hospital Universitari Arnau de Vilanova, Lleida, SpainEmail jgonzalezgutierrez@gmail.comRationale: Emphysema and osteoporosis are tobacco-related diseases. Many studies have shown that emphysema is a strong and independent predictor of low bone mineral density (BMD) in smokers; however, none of them explored its association with different emphysema subtypes.Objective: To explore the association between the different emphysema subtypes and the presence of low bone mineral density in a population of active or former smokers with and without chronic obstructive pulmonary disease (COPD).Methods: One hundred and fifty-three active and former smokers from a pulmonary clinic completed clinical questionnaires, pulmonary function tests, a low-dose chest computed tomography (LDCT) and a dual-energy absorptiometry (DXA) scans. Subjects were classified as having normal BMD or low BMD (osteopenia or osteoporosis). Emphysema was classified visually for its subtype and severity. Logistic regression analysis explored the relationship between the different emphysema subtypes and the presence of low BMD adjusting for other important factors.Results: Seventy-five percent of the patients had low BMD (78 had osteopenia and 37 had osteoporosis). Emphysema was more frequent (66.1 vs 26.3%, p=< 0.001) and severe in those with low BMD. Multivariable analysis adjusting for other significant cofactors (age, sex, FEV 1, and severity of emphysema) showed that BMI (OR=0.91, 95% CI: 0.76– 0.92) and centrilobular emphysema (OR=26.19, 95% CI: 1.71 to 399.44) were associated with low BMD.Conclusion: Low BMD is highly prevalent in current and former smokers. BMI and centrilobular emphysema are strong and independent predictors of its presence, which suggests that they should be considered when evaluating smokers at risk for low BMD.Keywords: emphysema, COPD, low bone mineral density, osteopenia, osteoporosis; smokers

Additional file 1. Additional Tables.

Objective To determine the economically justifiable price (EJP) of cenobamate to become a cost-effective alternative compared with third-generation anti-seizure medications in the treatment of focal-onset seizures (FOS) in adult patients with drug-resistant epilepsy (DRE) in Spain. Methods Cost-effectiveness analysis compared cenobamate with brivaracetam, perampanel, eslicarbazepine acetate, and lacosamide. Markov model simulation of treatment pathway over a 60-year time horizon is presented. We determined the effectiveness and quality-adjusted life-years (QALYs) of health status and disutilities associated with treatment-related adverse events. Acquisition costs and use of medical resources were obtained from published literature and expert opinion. Base-case of cenobamate's EJP calculated applying a willingness-to-pay (WTP) threshold of euro21,000/QALY. Analyses were performed at different thresholds, including dominant price scenario. Result robustness was assessed through sensitivity analyses. Results Base-case shows that cenobamate's daily EJP of euro7.30 is cost-effective for a threshold of euro21,000/QALY. At a daily price of euro5.45, cenobamate becomes dominant over all treatment alternatives producing cost-savings for the national health system (NHS). Sensitivity analyses supported the robustness of base-case findings. Conclusions Treatment with cenobamate produces incremental clinical benefit over third-generation ASMs, and at the base-case, EJP could represent a cost-effective option for the adjunctive treatment of FOS in adult patients with DRE in Spain.

Objectives To determine whether nutritional risk is associated with the mortality of elderly patients hospitalized with nonvalvular atrial fibrillation (NVAF). Design Prospective, multicenter cohort study. Setting Internal medicine departments in Spain. Participants Inpatients >75 years with NVAF. Measurements We measured the thrombotic and hemorrhagic risk at admission using the CHA2DS2-VASc and HAS-BLED scales, respectively, and the nutritional risk with the controlling nutritional status (CONUT) index. We established 4 degrees of nutritional risk: null (CONUT score 0-1 point), low (2-4 points), moderate (5-8 points) and high (9-12 points). We also conducted a 1-year follow-up. Results We included 449 patients, with a mean age of 85.2(5.2) years. The nutritional risk was null for 70(15.6%) patients, low for 206 45.9%), moderate for 152(33.8%) and high for 21(4.7%). At the end of one year, 177(39.4%) patients had died. The score on the CONUT index was higher for the deceased patients (4.6 vs. 3.6, p

Background. Volumetric pollen traps are commonly used to assess pollen exposure. These traps are well suited for estimating the regional mean airborne pollen concentration but are likely not to provide an accurate index of personal exposure. In this study, we tested the hypothesis that hair sampling may provide different pollen counts from those from pollen traps, especially when the pollen exposure is diverse. Methods. We compared pollen counts in hair washes to counts provided by stationary volumetric and gravimetric pollen traps in 2 different settings: urban with volunteers living in short distance from one another and from the static trap and suburban in which volunteers live in a scattered environment, quite far from the static trap. Results. Pollen counts in hair washes are in full agreement with trap counts for uniform pollen exposure. In contrast, for diverse pollen exposure, .individual pollen counts in hair washes vary strongly in quantity and taxa composition between individuals and dates. These results demonstrate that the pollen counts method (hair washes vs. stationary pollen traps) may lead to different absolute and relative contributions of taxa to the total pollen count. Conclusions. In a geographic area with a high diversity of environmental exposure to pollen, static pollen traps, in contrast to hair washes, do not provide a reliable estimate of this higher diversity.

Introducción: la enuresis nocturna (EN) es un problema de salud infantil frecuente, con repercusión personal y social, que requiere un manejo adecuado y personalizado por parte de los profesionales sanitarios. Se ha realizado un estudio cuyo objetivo es establecer la prevalencia de EN en la ciudad de Burgos (España) en población pediátrica entre siete y diez años de edad. Pacientes y métodos: estudio observacional transversal en el que se han obtenido datos de una muestra aleatoria de niños escolarizados entre segundo y quinto curso de Educación Primaria Obligatoria en la ciudad de Burgos mediante la cumplimentación de una encuesta. Resultados: se ha obtenido una prevalencia de EN del 7,3%. La EN es más frecuente en varones, con antecedentes familiares de enuresis nocturna, con algún tipo de enfermedad crónica, que asocian trastornos del sueño y del comportamiento y con bajo rendimiento escolar. Conclusiones: la prevalencia es menor a la de otras poblaciones de características similares. Los niños con EN de Burgos presentan características epidemiológicas semejantes a las de otras poblaciones. La EN es un problema de salud infradiagnosticado en nuestro medio. Introduction: nocturnal enuresis (NE) is a common childhood health condition. This problem causes personal and social repercussion. The health professionals have to make an individualized and adequate management of this problem. The aim of this study is to know the prevalence of NE in children between seven and ten years old of the city of Burgos. Patients and methods: to this end, we have designed an observational and transversal study. We have selected a random sample of school children in Burgos between 2nd and 5th year of Obligatory Primary Education. They have completed a questionnaire. Results: the prevalence of NE was 7.3%. NE is more frequent in males and children with familiar precedents of NE, with some type of chronic illness, with associated disorders of the sleep and behavior and with low academic performance. Conclusions: the prevalence of NE in children in Burgos city is lower than in another child groups of similar characteristics. There is a low diagnosis rate of NE in Burgos city.

Medicamentos anticonvulsivos; Cenobamato; Eficiencia Medicaments anticonvulsius; Cenobamat; Eficiència Anti-seizure medications; Cenobamate; Efficiency Introduction Epilepsy is a serious neurological disease, ranking high in the top causes of disability. The main goal of its treatment is to achieve seizure freedom without intolerable adverse effects. However, approximately 40% of patients suffer from Drug-Resistant Epilepsy (DRE) despite the availability of the latest options called third-generation Anti-Seizure Medications(ASMs). Cenobamate is the first ASM approved in Spain for the adjunctive treatment of Focal-Onset Seizures (FOS) in adult patients with DRE. The introduction of a new drug increases the number of therapeutic options available, making it important to compare it with existing alternatives in terms of clinical benefit and efficiency. Purpose This study aimed to compare the clinical benefit, in terms of the Number Needed to Treat (NNT), and the efficiency, in terms of Cost per NNT (CNT), associated with cenobamate versus third-generation ASMs used in Spain for the adjunctive treatment of FOS in patients with DRE. Methods The Number Needed to Treat data was calculated based on the ≥50% responder rate and seizure freedom endpoints (defined as the percentage of patients achieving 50% and 100% reduction in seizure frequency, respectively), obtained from pivotal clinical trials performed with cenobamate, brivaracetam, perampanel, lacosamide, and eslicarbazepine acetate. The NNT was established as the inverse of the treatment responder rate minus the placebo responder rate and was calculated based on the minimum, mid-range Daily Defined Dose (DDD), and maximum doses studied in the pivotal clinical trials of each ASM. CNT was calculated by multiplying the annual treatment cost by NNT values for each treatment option. Results In terms of NNT, cenobamate was the ASM associated with the lowest values at all doses for both ≥50% responder rate and seizure freedom compared with the alternatives. In terms of CNT, for ≥50% responder rate, cenobamate was the ASM associated with the lowest CNT values at DDD and lacosamide and eslicarbazepine acetate at the minimum and maximum dose, respectively. For seizure freedom, cenobamate was associated with the lowest CNT value at DDD and the maximum dose and lacosamide at the minimum dose. Conclusions Cenobamate could represent the most effective ASM in all doses studied compared to the third-generation ASMs and the most efficient option at DDD for both ≥50% responder rate and seizure freedom. This study could represent an important contribution towards informed decision-making regarding the selection of the most appropriate therapy for FOS in adult patients with DRE from a clinical and economical perspective in Spain. This study was sponsored by Angelini Pharma España, S.L.U.