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Objetivos: El estudio MEMOGAL (NCT04319081) está dirigido a evaluar cambios en la función cognitiva en pacientes tratados con inhibidores de la PCSK9 (iPCSK9). Se realiza primer análisis: 1) Discutir el papel de los farmacéuticos hospitalarios durante de la pandemia, así como evaluar el impacto de la misma en el control lipídico. 2) Análisis descriptivo; 3) Eficacia en reducción de colesterol-LDL (c-LDL) de alirocumab y evolocumab; 4) Reportar seguridad de los iPCSK9. Material y Métodos: Se trata de un análisis prospectivo en vida real de pacientes tratados por primera vez con iPCSK9 en la práctica clínica habitual e incluidos en su primera dispensación en las consultas de Farmacia de 12 Hospitales de Galicia desde mayo 2020-abril 2021. Los valores basales de c-LDL son los previos al inicio del tratamiento con iPCSK9 y como seguimiento los valores a los 6 meses. Resultados: Se incluyeron 89 pacientes. El 86,5% con enfermedad cardiovascular y un 53,9% intolerancia a estatinas. Un 78,8% de los pacientes tratados con estatinas de alta intensidad. Las estatinas más usadas fueron rosuvastatina (34,1%) y atorvastatina (20,5%). El nivel basal de c-LDL fue 148 mg/dL y de 71 mg/dL al seguimiento. Los pacientes tratados con alirocumab (N=43) presentaban valores basales de 144 mg/dL y de 73 mg/dL al seguimiento y con evolocumab (N=46) de 151 mg/dL basal y 69 mg/dL al seguimiento. La reducción de c-LDL fue para evolocumab 51,21% y alirocumab 51,05%. El 43,1% presentaban a los 6 meses valores > 70mg/dL, el 19,4% entre 55 y 69 mg/dl y el 37,5% < 55 mg/dL. Los pacientes que obtuvieron una reducción >50% de c-LDL fueron el 58,3%. Los eventos adversos presentados fueron: Reacción en el lugar de inyección (N=2), mialgias (N=1), síntomas pseudogripales (N=1) y deterioro neurocognitivo (N=1). Conclusiones: 1) A pesar de haber disminuido el número de prescripciones de iPCSK9 durante la pandemia, el control lipídico de estos pacientes no se ha visto afectado. 2) La mitad de los pacientes tratados con iPSCK9 se debe a intolerancia a estatinas y el 86% es en prevención secundaria; 3) Se presentaron valores de reducción similares a los ensayos clínicos pivotales. A pesar de esto, un 39% del total y un 60% en doble terapia no alcanzaron las recomendaciones de las guías ESC/EAS (50%). No hubo diferencias significativas entre evolocumab y alirocumab: 51,21% vs 51,05% (p=,972); 4) No se observaron eventos de especial interés con el uso de estos fármacos. El posible deterioro cognitivo será analizado como variable principal una vez completado el estudio MEMOGAL.

To describe the way patients die in a Spanish ICU, and how the modes of death have changed in the last 10 years.Retrospective observational study evaluating all patients who died in a Spanish tertiary ICU over a 10-year period. Modes of death were classified as death despite maximal support (D-MS), brain death (BD), and death following life-sustaining treatment limitation (D-LSTL).Amongst 9264 ICU admissions, 1553 (16.8%) deaths were recorded. The ICU mortality rate declined (1.7%/year, 95% CI 1.4-2.0; p = 0.021) while ICU admissions increased (3.5%/year, 95% CI 3.3-3.7; p0.001). More than half of the patients (888, 57.2%) died D-MS, 389 (25.0%) died after a shared decision of D-LSTL and 276 (17.8%) died due to BD. Modes of death have changed significantly over the past decade. D-LSTL increased by 15.1%/year (95% CI 14.4-15.8; p0.001) and D-MS at the end-of-life decreased by 7.1%/year (95% CI 6.6-7.6; p0.001). The proportion of patients diagnosed with BD remained stable over time.End-of-life practices and modes of death in our ICU have steadily changed. The proportion of patients who died in ICU following limitation of life-prolonging therapies substantially increased, whereas death after maximal support occurred significantly less frequently.

Childhood obesity rates are increasing as well as chronic disease and cardiovascular risk factors for patients at young ages. In this study, we evaluate the correlation between cardiac parameters, body mass index (BMI), and other body composition indicators in children and adolescents.In this cross-sectional study, we evaluated anthropometric measurements, bioelectrical impedance parameters, and echocardiographic measurements including the left ventricular mass (LVM), LVM index (LVMI), and left atrial diameter (LAD) in children and adolescents ages 7 to 15 y. We performed linear and multivariate regression analyses and analyzed the correlations between cardiac parameters, BMI, and other body composition parameters.We analyzed 96 children and adolescents and found 40.6% to be obese and 29.2% overweight. LVMI and LAD indexed to height were significantly higher in individuals who were obese. LVMI increased significantly with increasing BMI (r = 0.717; P 0.001), waist circumference (r = 0.670; P 0.001), waist-to-height ratio (r = 0.650; P 0.001), and body surface (r = 0.570; P 0.001). Only BMI was significant in the multivariate analysis. LVMI was directly and positively correlated with fat mass (FM) and percentage of visceral and abdominal FM and negatively correlated with percentage of lean body mass. LAD was significantly correlated with body surface (r = 0.728; P 0.001), BMI (r = 0.611; P 0.001), waist circumference (r = 0.614; P 0.001), and waist-to-height ratio (r = 0.341; P 0.01). When indexed to height, LAD was only correlated with BMI and waist-to-height ratio.Obesity is associated with cardiac disturbances at a very early age and these changes are closely related to the degree of adiposity. Cardiac structural parameters are significantly correlated with BMI and waist circumference in pediatric patients ages 7 to 15 y.

Introduction and objectives The starting dose for narrowband UV-B phototherapy is determined by a patient's skin phototype or minimal erythema dose (MED). Calculation of MED identifies patients with unsuspected photosensitivity. The aim of this study was to investigate the influence of factors such as concomitant use of photosensitizing agents, diagnosis, and combination with acitretin in patients with psoriasis on the frequency and severity of adverse effects in patients with a low MED to narrowband UV-B phototherapy. Material and methods We undertook a retrospective observational cohort study between February 1, 2009 and March 31, 2015. MED values were classified as normal or low. Results In total, 302 patients with different skin conditions started narrowband UV-B phototherapy at a dose determined by their MED. No differences were found between patients with a low MED and those with a normal MED for number of drugs taken ( P = .071) or use of photosensitizing agents ( P = 0.806). Following adjustment for age, sex, and phototype, the multivariate analysis showed that psoriasis exerted a protective effect against a low MED (OR = 0.31 [95% CI , 0.16-0.58]). No significant risk of erythema or pruritus was detected in patients with a low MED (OR = 1.68; 95% CI, 0.91-3.29 and OR = 2.04; 95% CI, 0.99-4.22, respectively). Conclusions Psoriasis protects against a low MED. Although erythema and pruritus were more common in patients with a low MED, the differences were not significant.

Resumen Introduccion y objetivos La dosis de inicio en la fototerapia UVB de banda estrecha (UVBBE) viene determinada por el fototipo o por la determinacion de la dosis eritematogena minima (DEM). El calculo de la DEM identifica pacientes con fotosensibilidad no sospechada. El objetivo de nuestro estudio es conocer la influencia que puedan tener en una DEM disminuida los farmacos fotosensibilizantes concomitantes, el diagnostico, la asociacion con acitretina en pacientes con psoriasis y evidenciar si la DEM alterada provoca mas reacciones adversas y mas graves. Material y metodos Se trata de un estudio observacional de una cohorte retrospectiva desde el periodo comprendido entre el 1 de febrero de 2009 al 31 de marzo de 2015. La determinacion de la DEM se categorizo en DEM normal o patologica. Resultados Trescientos dos pacientes con distintas dermatosis inician UVBBE en funcion de la DEM. No se han encontrado diferencias entre el grupo con DEM patologica respecto al normal, ni en el numero de farmacos consumidos (p = 0,071), ni en el potencial fotosensibilizante (p = 0,806). El analisis multivariante ajustado por edad, sexo y fototipo revelo que la psoriasis es un factor protector de DEM patologica (OR = 0,31 [IC 95%: 0,16-0,58]). No se encontro riesgo significativo de eritema ni prurito en los pacientes con DEM alterada OR = 1,68 (IC 95%: 0,91-3,29) y OR = 2,04 (IC 95%: 0,99-4,22), respectivamente. Conclusiones La psoriasis protege de tener una DEM patologica. Si bien el eritema y el prurito fueron mas frecuentes en los pacientes con DEM patologica, las diferencias no fueron estadisticamente significativas.

Introduction Parkinson’ disease (PD) is one of the most prevalent neurodegenerative diseases, and more than half of patients with PD experience falls. Research for clinically useful risk factors predicting falls has yielded inconsistent findings so far. Hence the aim of the study is to validate two different posturography techniques and one modified-timed up and go test (TUG) in discriminating fallers and non-fallers among PD patients. Methods 32 patients diagnosed with idiopathic PD were assessed with: Dizziness handicap inventory, Activities-specific balance confidence scale, modified-TUG, sensorial organization test (SOT) and limits of stability (LOS) of computer dynamic posturography, results of free-field body sway analysis with Vertiguard device and number of falls. Results Fallers had longer time to perform modified-TUG and required more steps. On average, fallers performed SOT and LOS significantly worse and Vertiguard device indicated a higher risk of falling. Based on the area under the curve of receiver operating characteristics analyses, the overall accuracy of directional control of LOS and steps in modified-TUG are close to 0.9 (high accuracy). Also assessment with Vertiguard device is more efficient in identifying fallers than the parameters of SOT. Discussion Our results indicate that LOS, mobile posturography (Vertiguard), vestibular input of SOT and number of steps taken in modified-TUG are very useful to identify fallers in PD patients.

Suicide is a devastating psychopathological trait with familial transmission. According to epidemiological data suicide is partly under genetic influence. Despite the extensive body of association studies, to date genetic factors linked to suicide diathesis are largely unknown. In this study a set of 8 SNPs and a 43bp ins/del was genotyped in an Italian sample of suicide completers ( n =65) and control subjects ( n =77). The selected markers are spread across multiple brain pathways: serotonergic, stress-related HPA axis, catecholamine metabolism and nitric oxide (NO) neurotransmission. Basic analysis at single loci shows significant differences in allele and genotype distributions between victims and controls for TPH1-rs1800532(allele A) and NOSI-rs693534(allele A), pointing to an association with the group of suicides. Presented results are intended to be exploratory, requiring further investigation in a larger sample size. Systematic efforts in suicide research is quite important in order to empower understanding of risk factors and developing preventive strategies in clinical practice.

Large-scale population studies have proved that genetic factors contribute to individual differences in smoking behavior. Genes responsible for nicotine's pharmacokinetics and pharmacodynamics seem mainly involved, although a significant fraction of variance remains unexplained. In this study we examined 10 SNPs from 8 candidate genes with positive previous reports of association with smoking. A total of 454 Italian unrelated subjects were genotyped by a multiplex minisequencing assay through the SNaPShot kit. Cases were chosen as current and former nicotine dependent (FTND. >. 4 and SQ. >. 15), while controls were smoking-exposed but non-dependent and never smoker individuals (FTND = 0 and SQ < 10 and FTND = 0 and SQ = 0, respectively). Preliminary results shows that the SNPs CHRNA5-rs16969968 and CHRNA3-rs1051730 could be associated with risk of developing nicotine dependence. Factors as age, sex, and exposition to smoke were also found as possible factors of risk of nicotine addiction. The identification of susceptibility loci for individual response to substance abuse is particularly motivating for medicine for the global epidemic dimension of addictions and the urgent need of effective preventive and therapeutic strategies. 2011 Elsevier Ireland Ltd.