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Resumen: El prurigo crónico nodular (PCN) es una enfermedad dermatológica crónica, caracterizada por la presencia de prurito crónico (PC) y lesiones nodulares pruriginosas cutáneas. El presente trabajo tuvo como objetivo consensuar entre un grupo de expertos, a partir de una revisión bibliográfica no sistemática, un algoritmo para el diagnóstico clínico del PCN. El algoritmo resultante se ha estructurado en tres bloques: 1) identificación precoz del paciente con posible diagnóstico de PCN; 2) diagnóstico y valoración del PCN; y 3) categorización del PCN (identificación de las causas subyacentes o de las comorbilidades asociadas)Consideramos que este algoritmo clínico puede facilitar el diagnóstico correcto de los pacientes con PCN. Además, genera conciencia de la necesidad de un abordaje multidisciplinar y de un tratamiento específico del PCN, pasos indispensables para tomar mejores decisiones terapéuticas. Abstract: Chronic nodular prurigo (CNP) is a chronic dermatological disease characterized by the presence of chronic pruritus and pruritic nodular lesions. The aim of this study was to reach consensus among a group of experts based on a non-systematic literature review and an algorithm for the clinical diagnosis of CNP. The resulting algorithm is structured in 3 blocks: 1) early identification of the patient with a possible diagnosis of CNP; 2) diagnosis and assessment of CNP; and 3) categorization of CNP (identification of the underlying causes or associated comorbidities).We believe that this clinical algorithm can facilitate the correct diagnosis of patients with CNP. Additionally, it raises awareness on the need for a multidisciplinary approach and specific treatment of CNP, steps of paramount importance to make better therapeutic decisions.

The inclusion of the principle of Policy Coherence for Development (PCD) into the 2030 Agenda and its interrelation with climate induced migration constitutes both a challenge and a commitment for the Spanish foreign policy in addressing the challenges posed by Africa, specifically in the case of Senegal. In this context, the objective of this article is to analyze the degree of alignment between the Spanish development cooperation policy and the Senegal’s National Development Strategies from the perspective of PCD, particularly in relation to issues linked climate induced migration. The results highlight a lack of alignment in the policies of both countries regarding these issues. These discrepancies are influenced by political, geostrategic, and commercial interests within the Africa Plan.

"ATRX" mutations are commonly associated with alpha-thalassaemia mental retardation syndrome (ATR-X syndrome) with a notable variable expressivity. This X-linked disorder is characterized by intellectual disability (ID) in a higher or lesser degree, in which the alpha-thalassaemia feature is not always present. Other phenotypic manifestations like facial dimorphism, hypotonia, microcephaly, skeletal abnormalities or urogenital malformations have been frequently observed in ATR-X syndrome. Herein, we report a missense ATRX mutation (Thr1621Met) in a patient with an autism spectrum disorder (ASD) diagnosis. Except for ID, no typical signs of ATR-X syndrome were found in the patient. These results confirm the extensive phenotypic variability associated to "ATRX" mutations and show the involvement of this gene in the ASD.

Author(s): Júlia Verdaguer-Faja [1,2]; Lorena Valdivieso [2,3]; Maria Fabregat-Pratdepadua [1,2]; Gustavo Tapia Melendo [2,3]; Ariadna Quer [2,3]; José M. Carrascosa [1,2,4]; Aram Boada [1,2,4] Sir, The coronavirus disease 2019 (COVID-19) [...]

Abstract Background Emerging zoonotic diseases arise from cross-species transmission events between wild or domesticated animals and humans, with bats being one of the major reservoirs of zoonotic viruses. Viral metagenomics has led to the discovery of many viruses, but efforts have mainly been focused on some areas of the world and on certain viral families. Methods We set out to describe full-length genomes of new picorna-like viruses by collecting feces from hundreds of bats captured in different regions of Spain. Viral sequences were obtained by high-throughput Illumina sequencing and analyzed phylogenetically to classify them in the context of known viruses. Linear discriminant analysis (LDA) was performed to infer likely hosts based on genome composition. Results We found five complete or nearly complete genomes belonging to the family Picornaviridae, including a new species of the subfamily Ensavirinae. LDA suggested that these were true vertebrate viruses, rather than viruses from the bat diet. Some of these viruses were related to picornaviruses previously found in other bat species from distant geographical regions. We also found a calhevirus genome that most likely belongs to a proposed new family within the order Picornavirales, and for which genome composition analysis suggested a plant host. Conclusions Our findings describe new picorna-like viral species and variants circulating in the Iberian Peninsula, illustrate the wide geographical distribution and interspecies transmissibility of picornaviruses, and suggest new hosts for calheviruses.

Abstract Introduction Lebrikizumab is a novel monoclonal antibody with established efficacy in patients with moderate-to-severe atopic dermatitis (AD) in multiple Phase 3 trials. One of the ultimate treatment goals for patients with moderate-to-severe AD is to achieve stable disease control without concern for planning future life events. Methods In ADvocate1 and ADvocate2, lebrikizumab-treated patients meeting the protocol-defined response criteria at Week 16 were re-randomized 2:2:1 to receive lebrikizumab every 2 weeks (Q2W), lebrikizumab every 4 weeks (Q4W), or placebo Q2W (lebrikizumab withdrawal) for 36 additional weeks. In this post hoc analysis, we evaluated the proportions of patients with no or minimal fluctuations of efficacy during the 36-week maintenance period and plotted individual patient trajectories. We defined no or minimal fluctuations as achieving and maintaining the defined endpoint (≥ 75% improvement in the Eczema Area and Severity Index [EASI 75], ≥ 90% improvement in EASI, Pruritus Numeric Rating Scale [NRS] ≥ 4-point improvement, or Pruritus NRS ≥ 3-point improvement) for ≥ 80% of the study visits. If patients used rescue medication, discontinued treatment, or transferred to the escape arm, data collected at or after the event were imputed as non-response. Results The proportions of lebrikizumab responders who maintained EASI 75 with no or minimal fluctuations were 70.8% (lebrikizumab Q2W), 71.2% (lebrikizumab Q4W), and 60.0% (lebrikizumab withdrawal). Of the patients with baseline Pruritus NRS ≥ 4 and who achieved ≥ 4-point improvement at Week 16, 66.1% (lebrikizumab Q2W), 62.7% (lebrikizumab Q4W), and 55.2% (lebrikizumab withdrawal) maintained ≥ 4-point Pruritus NRS improvement with no or minimal fluctuations. Conclusions Patients who met the response criteria at Week 16 and continued treatment with lebrikizumab Q2W or Q4W demonstrated a stable response with no or minimal fluctuations of efficacy in measures of skin and itch up to Week 52. Clinical Trial Registration NCT04146363 (ADvocate1) and NCT04178967 (ADvocate2).

Este volumen examina la integración de la inteligencia artificial (IA) en la enseñanza del Español como Lengua Extranjera (ELE), destacando cómo las tecnologías emergentes están transformando la docencia. Los autores, todos ellos docentes e investigadores en didáctica de ELE, presentan estudios que abordan desde la creación de materiales didácticos personalizados mediante IA hasta su aplicación en la evaluación, la formación del profesorado y la adaptación de textos para estudiantes con diversas necesidades. Los trabajos incluyen el uso de IA y realidad aumentada para estudiantes con dislexia, la percepción de docentes y futuros docentes sobre herramientas como ChatGPT y la utilidad de la transcripción automática para mejorar la interacción oral en ELE. Este volumen pretende fomentar la reflexión crítica y promover una práctica docente adaptada a los desafíos y oportunidades que la tecnología actual presenta, siempre desde un enfoque ético y responsable.

La inteligencia artificial (IA) ha emergido como una herramienta poderosa en diversos sectores, incluida la enseñanza. En el contexto de la instrucción de español como lengua extranjera (ELE), la IA ofrece oportunidades para transformar los métodos tradicionales de enseñanza y aprendizaje. Este artículo explora las actitudes didácticas del profesorado ante la inclusión de herramientas de IA en el proceso de enseñanza-aprendizaje de ELE. Se presenta un análisis detallado de las aplicaciones de IA más destacadas y conocidas en el ámbito docente, sus posibles usos y beneficios, así como las percepciones y experiencias de los profesores en relación con estas tecnologías.

Abstract BackgroundSwitching to biosimilars is an effective and safe practice in treating inflammatory diseases; however, a nocebo effect may arise as a result of the way in which the switch is communicated to a given patient. ObjectiveWe aimed to design a gaming-based digital educational tool (including a discussion algorithm) to support the training of health care professionals in efficiently communicating the switch to biosimilars, minimizing the generation of a nocebo effect and thus serving as an implementation strategy for the recommended switch. MethodsThe tool was developed based on interviews and focus group discussions with key stakeholders, both patients and health care professionals. Messages likely to either generate trust or to trigger a nocebo effect were generated on the basis of the interviews and focus group discussions. ResultsA total 7 clinicians and 4 nurses specializing in rheumatology, gastroenterology, and dermatology, with balanced levels of responsibility and experience, as well as balance between geographic regions, participated in the structured direct interviews and provided a list of arguments they commonly used, or saw used, to justify the switching, and objections given by the patients they attended. Patients with immune-mediated inflammatory diseases who were taking biologic drugs with (n=4) and without (n=5) experience in switching attended the focus groups and interviews. Major topics of discussion were the reason for the change, the nature of biosimilars, and their quality, safety, efficacy, and cost. Based on these discussions, a list of objections and of potential arguments was produced. Patients and health care professionals rated the arguments for their potential to evoke trust or a nocebo effect. Two sets of arguments, related to savings and sustainability, showed discrepant ratings between patients and health care professionals. Objections and arguments were organized by categories and incorporated into the tool as algorithms. The educators then developed additional arguments (with inadequate answers) to complement the valid ones worked on in the focus groups. The tool was then developed as a collection of clinical situations or vignettes that appear randomly to the user, who then has to choose an argument to counteract the given objections. After each interaction, the tool provides feedback. The tool was further supported by accredited medical training on biosimilars and switching. ConclusionsWe have developed a digital training tool to improve communication on switching to biosimilars in the clinic and prevent a nocebo effect based on broad and in-depth experiences of patients and health care professionals. The validation of this implementation strategy is ongoing.

Chronic nodular prurigo (CNP) is a chronic dermatological disease characterized by the presence of chronic pruritus and pruritic nodular lesions. The aim of this study was to reach consensus among a group of experts based on a non-systematic literature review and an algorithm for the clinical diagnosis of CNP. The resulting algorithm is structured in 3 blocks: 1) early identification of the patient with a possible diagnosis of CNP; 2) diagnosis and assessment of CNP; and 3) categorization of CNP (identification of the underlying causes or associated comorbidities).We believe that this clinical algorithm can facilitate the correct diagnosis of patients with CNP. Additionally, it raises awareness on the need for a multidisciplinary approach and specific treatment of CNP, steps of paramount importance to make better therapeutic decisions. Resumen: El prurigo crónico nodular (PCN) es una enfermedad dermatológica crónica, caracterizada por la presencia de prurito crónico (PC) y lesiones nodulares pruriginosas cutáneas. El presente trabajo tuvo como objetivo consensuar entre un grupo de expertos, a partir de una revisión bibliográfica no sistemática, un algoritmo para el diagnóstico clínico del PCN. El algoritmo resultante se ha estructurado en tres bloques: 1) identificación precoz del paciente con posible diagnóstico de PCN; 2) diagnóstico y valoración del PCN; y 3) categorización del PCN (identificación de las causas subyacentes o de las comorbilidades asociadas)Consideramos que este algoritmo clínico puede facilitar el diagnóstico correcto de los pacientes con PCN. Además, genera conciencia de la necesidad de un abordaje multidisciplinar y de un tratamiento específico del PCN, pasos indispensables para tomar mejores decisiones terapéuticas.

Abstract Objective: The aim of this study is to compare stigmatizing attitudes, reported and intended behavior, and knowledge of mental illness between university students and the general population. Methods: An online cross-sectional observational study was conducted. The survey included sociodemographic data and validated stigma questionnaires (the Attribution Questionnaire [AQ-27], the Reported and Intended Behaviour Scale [RIBS], and the Mental Health Knowledge Schedule [MAKS]). Descriptive statistics, bivariate analyses, and multiple regression modeling were employed to analyze the data. Results: A total of 506 participants completed the survey, including 226 (44.7%) university students (61.1% women), and 280 (55.3%) individuals from the general population (69.3% women). For both groups, women and individuals who had lived with someone with mental health problems exhibited more positive attitudes (p < 0.05). University students reported greater knowledge of mental illness (p < 0.05) than the general population. After controlling for covariates, university students only scored higher than the general population in the blame factor of the AQ-27 (p < 0.05). Additionally, older participants from both groups exhibited higher levels of stigmatizing attitudes compared to those of a younger age. Conclusion: These findings suggest that university students exhibit similar levels of stigmatizing attitudes to the general population. Among both groups, female sex, older age, previous contact with individuals with mental illness, and greater knowledge of mental health are all associated with less stigma toward people with mental illness. Tailored interventions grounded in contact with mental illness have the potential to help reduce stigmatizing attitudes within both groups.

La publicación del acuerdo del Consejo de Ministros, por el que se regula el plan de estudios en España para la futura formación inicial del profesorado de secundaria (ved BOE de 21 y 29 de diciembre de 2007), abre nuevas expectativas en un campo hastaahora muy descuidado, pero esencial para poder mejorar el proceso de enseñanza y aprendizaje en ese nivel educativo. En este trabajo, tras analizar diversos problemas del modelo de formación que se ha venido desarrollando hasta ahora, se consideran algunos criterios que deberían orientar la formación inicial del profesorado de física y química de educación secundaria y se proponen unos posibles contenidos a contemplar dentro del bloque específico del plan de estudios correspondiente.

Abstract Background The treatment of erythrodermic psoriasis (EP) is challenging. Biological therapies have shown promising results in the long‐term management of this clinical variant, but most of the current available evidence is based on single case reports and short case series. Objectives To determine the effectiveness and safety of ustekinumab (UST) in the treatment of EP under daily practice conditions. Methods We conducted a retrospective, observational, nationwide, multicenter cohort study of patients diagnosed with EP treated with UST under daily practice conditions with up to 3 years of follow‐up. Outcomes, such as the psoriasis area and severity index (PASI) and safety, were assessed at months 1, 4, 7, 13, 19, 25, 31 and 37 during treatment. “As observed” and “intention‐to‐treat last observation carried forward (ITT‐LOCF)” analyses were performed. Results Twenty‐eight patients were enroled in the study. Baseline mean PASI was 43.1. A sharp decrease in mean PASI was observed during the first 7 months, reaching a plateau that was maintained until the end of the 37‐month follow‐up. At 7 months, 61% and 43% of the patients achieved PASI ≤ 2 and PASI 0, respectively. At 25 months, 48 (39%) (“as observed”/ITT‐LOCF) of the patients achieved complete clearance. At 31 months, PASI 75, PASI 90 and PASI 100 were achieved in 95, 80 and 45 (79%, 64% and 39%) (“as observed”/ITT‐LOCF) of the patients, respectively. Eleven patients required treatment intensification by reducing the interval between doses. Treatment minimisation was performed in four patients. During the follow‐up, nine patients (32%) received systemic combination therapy at some point. Eight patients discontinued treatment mainly due to lack of effectiveness. UST presented a good safety profile. With a follow‐up of 69.25 patient/years, only three patients exhibited serious nondrug‐related adverse events. Conclusions Ustekinumab can be a fast, effective and safe alternative for the long‐term treatment of erythrodermic psoriasis.

Abstract Introduction Patients with moderate-to-severe atopic dermatitis (AD) who are most likely to respond to the Janus kinase (JAK) 1/2 inhibitor baricitinib (BARI) are known to have an impacted body surface area (BSA) ≤ 40% and severe itch (numerical rating scale [NRS] ≥ 7], collectively termed ‘BARI itch-dominant’ patients. Our objective is to build on our previous work by providing a body region-specific, clinical characterization of the BARI itch-dominant patient at baseline and their response to BARI 4 mg. Methods BREEZE-AD7 was a phase 3 trial in adults with moderate-to-severe AD receiving placebo or 2 mg or 4 mg BARI in combination with topical corticosteroids. Assessing only data from BARI itch-dominant patients, we summarized the baseline characteristics and conducted body region-specific analyses on Eczema Area and Severity Index (EASI) data in order to report the response to placebo versus BARI 4 mg within this patient subtype. Results BARI 4 mg was highly effective across all body regions; at week 16, 75% improvement was seen in EASI scores (EASI75), and response rates with BARI 4 mg (head/neck, 58.3%; trunk, 69.2%; upper extremities, 61.5%; lower extremities, 87.5%) all exceeded those with placebo (head/neck: 37.5%; trunk, 40.6%; upper extremities, 18.8%; lower extremities, 40.6%) as well as the overall EASI75 rates of the intent-to-treat (ITT) population (BARI, 48.0%; placebo, 23.0%). At baseline, most BARI itch-dominant patients presented with involvement of all regions (mean regional BSA 22.7%–40.3%), highest in the head and neck, mean EASI region scores of 15.7–24.0, and considerably severe sign ratings (mean EASI sub-scores: 1.4–2.3, out of 3), especially for erythema. Conclusion BARI itch-dominant patients exhibit AD involvement across all body regions and considerable sign severity, especially erythema. In response to BARI 4 mg, EASI quickly improved across regions, substantially more so in this subtype than in the ITT population.

ABSTRACT Introduction and objectives: Although drug-eluting stents are the main treatment in percutaneous coronary interventions (PCI), drug-coated balloons (DCB) represent an appealing alternative as they eliminate the risk of stent thrombosis and avoid leaving any metal structure in the vessel wall. However, limited evidence has been published to date on the vessel wall healing processes, plaque remodeling, plaque composition, and the impact on the coronary microcirculation after percutaneous coronary intervention with DCB (DCB-PCI). Methods: This is investigator-initiated, single-center, single-arm, open-label, pilot study of 30 patients with native vessel disease undergoing DCB-PCI. Intravascular ultrasound and angiography-derived index of microvascular resistance (IMRangio) will be performed before and immediately after PCI, and at 3 months of follow-up. Conclusions: The study aims to provide new evidence on the modification of atherosclerotic plaque in patients with de novo lesions undergoing PCI with DCB. This will be assessed by examining the change in the percentage of atheroma volume and late lumen enlargement using intravascular ultrasound and by evaluating changes in the microcirculation using IMRangio. Registered at Clinicaltrials.gov (NCT06080919). Keywords: Drug-coated balloon. Intravascular ultrasound. Angiography-derived index of microvascular resistance. RESUMEN Introducción y objetivos: Pese a que los stents farmacoactivos son el tratamiento principal en las angioplastias coronarias, los balones farmacoactivos representan una alternativa interesante dado...

RESUMEN Introducción y objetivos: Pese a que los stents farmacoactivos son el tratamiento principal en las angioplastias coronarias, los balones farmacoactivos representan una alternativa interesante dado que eliminan el riesgo de trombosis del stent sin dejar ningún tipo de estructura metálica en la pared del vaso. No obstante, la evidencia en cuanto a los procesos de cicatrización de la pared del vaso, el remodelado, los cambios en la composición de la placa ateroesclerótica y el impacto en la microcirculación coronaria tras el intervencionismo coronario percutáneo (ICP) con balón farmacoactivo aún no se ha esclarecido. Métodos: Estudio piloto abierto, de un solo grupo, iniciado por el investigador, de 30 pacientes con enfermedad de vaso nativo sometidos a ICP con balón farmacoactivo. Se realizará ecografía intravascular y se determinará el índice de resistencia microvascular derivado de la angiografía (angio-IRM) antes, inmediatamente después y a los 3 meses de seguimiento de la angioplastia. Conclusiones: Se aportará nueva evidencia sobre la modificación de la placa en pacientes con enfermedad de vaso nativo tratados con balón farmacoactivo, evaluando el cambio en el porcentaje del volumen de ateroma y el aumento luminal tardío, así como los cambios en la microcirculación mediante angio-IRM. Registrado en Clinicaltrials.gov (NCT06080919).

Abstract Introduction Tralokinumab and dupilumab are biological agents licensed for the treatment of moderate-to-severe atopic dermatitis (AD) in adult patients who are candidates for systemic treatment. However, no head-to-head studies of their efficacy have been conducted. This study indirectly compared the efficacy of tralokinumab and dupilumab, both in combination with topical corticosteroids (TCS), at week 32. Methods An unanchored matching-adjusted indirect comparison was conducted using individual patient data (IPD) from the ECZTRA 3 tralokinumab trial and aggregate data from the LIBERTY AD CHRONOS dupilumab trial. IPD were selected by applying inclusion criteria from LIBERTY AD CHRONOS and weighting to match summary baseline characteristics—age, sex, race, body mass index, disease duration, Eczema Area and Severity Index (EASI), Investigator’s Global Assessment (IGA), Dermatology Life Quality Index (DLQI) and SCORing Atopic Dermatitis index—of patients treated with dupilumab. Week 32 outcomes of interest were 50%, 75% or 90% improvements in EASI (EASI-50, EASI-75 and EASI-90), IGA scores of 0 or 1 (IGA 0/1), ≥ 4-point improvement in worst daily pruritus numerical rating scale (NRS) score, and mean improvements in DLQI and the Patient Oriented Eczema Measure (POEM). Results After matching, tralokinumab and dupilumab, both in combination with TCS, showed similar efficacy across clinical response endpoints at week 32 (IGA 0/1, tralokinumab 49.9% vs dupilumab 39.3%; EASI-50, 78.9% vs 77.5%; EASI-75, 71.5% vs 71.9%; EASI-90, 53.3% vs 56.2%). The mean change from baseline in DLQI was statistically significantly larger in the matched tralokinumab plus TCS population than in the dupilumab plus TCS arm (− 12.1 vs − 10.4, p = 0.005). Changes in POEM and worst daily pruritus NRS were similar in the two groups. Conclusion The results of this analysis demonstrate that, in combination with TCS, tralokinumab and dupilumab have similar efficacy in the treatment of moderate-to-severe AD at 32 weeks of therapy.

Background: The more widespread use of peripheral venous catheters (PVC) has led to more frequent complications, not only in PVC-associated bacteremia, but also in phlebitis. This requires the catheter to be removed and increases healthcare costs. Our aim was to assess the PVC-associated complications in an endoscopy department. Methods: We performed a cross‐sectional, descriptive study on patients admitted to our center and undergoing a procedure in the endoscopy department. We analyzed the appearance of the following PVC-associated complications: obstruction, phlebitis, redness, extravasation, pain, and infection on the day of the study. All catheter tips were sent to the microbiology laboratory for culture using the roll-plate semiquantitative technique. Clinical and microbiological data were collected. Results: We included a total of 46 patients with 50 PVCs. The median (IQR) age was 70.0 (55.0–81.5) years, and 58.7% were female. The median (IQR) hospital stay was 9.00 (6.00–14.25) days. Of the 50 PVCs, most were inserted in the emergency room (74.0%), and the median (IQR) indwelling time was 5.00 (3.00–7.00) days. The phlebitis rate was 78.0%, which occurred mainly in PVCs inserted in the emergency room (74.3%). The tip was colonized in 9 PVCs (18.0%). Conclusion: The endoscopy department can alert clinicians to PVC-associated complications. PVCs inserted in the emergency room were subject to a higher risk of phlebitis and/or colonization. Therefore, we recommend systematically replacing PVCs inserted in the emergency room within 48 h if preventive measures during insertion cannot be guaranteed.

Considering the informational overwhelm of the last few years and given the rise in new entrepreneurship of communication means, the optimization of commercial communication's marketing has become one of the primary objectives of marketing strategy. The quantitative computation of the number of impacts has been rendered insufficient for evaluating and planning a communication campaign. Strategic planning relies on increasingly more precise models for determining the desired formula. These models do not typically take the physiological parameter essential to decision-making into account: emotion. The technologies applied to the new methodologies that neuromarketing brings rely on great support from theorists and professionals, even though hardly any studies that center on strategic planning media exist. In this study, we present an analysis of the residual effect and the distortion of erroneous attribution stemming from neuromarketing's own technologies with the objective of analyzing the influence of adjacent content items on the subject's decision-making process. Cross-technologies were used: EEG and GSR, with the goal of analyzing the subject's emotional activation and motivation. The results demonstrate an emotional dragging effect and the appearance of bias of attribution with very significant values in every case, showing notable differences regarding the nature and polarity of emotions.