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Introduction The cognitive safety of monoclonal antibody proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) has been established in clinical trials, but not yet in real-world observational studies. We assessed the cognitive function in patients initiating PCSK9i, and differences in cognitive function domains, to analyze subgroups by the low-density lipoprotein cholesterol (LDL-C) achieved, and differences between alirocumab and evolocumab. Methods This has a multicenter, quasi-experimental design carried out in 12 Spanish hospitals from May 2020 to February 2023. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA). Results Among 158 patients followed for a median of 99 weeks, 52% were taking evolocumab and 48% alirocumab; the mean change from baseline in MoCA score at follow-up was + 0.28 [95% CI (− 0.17 to 0.73; p = 0.216)]. There were no significant differences in the secondary endpoints—the visuospatial/executive domain + 0.04 (p = 0.651), naming domain − 0.01 (p = 0.671), attention/memory domain + 0.01 (p = 0.945); language domain − 0.10 (p = 0.145), abstraction domain + 0.03 (p = 0.624), and orientation domain − 0.05 (p = 0.224)—but for delayed recall memory the mean change was statistically significant (improvement) + 0.44 (p = 0.001). Neither were there any differences in the three stratified subgroups according to lowest attained LDL-C level—0–54 mg/dL, 55–69 mg/dL and ≥ 70 mg/dL; p = 0.454—or between alirocumab and evolocumab arms. Conclusion We did not find effect of monoclonal antibody PCSK9i on neurocognitive function over 24 months of treatment, either in global MoCA score or different cognitive domains. An improvement in delayed recall memory was shown. The study showed no differences in the cognitive function between the prespecified subgroups, even among patients who achieved very low levels of LDL-C. There were no differences between alirocumab and evolocumab. Registration ClinicalTtrials.gov Identifier numb

Interindividual genetic variations contribute to differences in patients' response to drugs as well as to the development of certain disorders. Patients who use non-steroidal anti-inflammatory drugs (NSAIDs) may develop serious gastrointestinal disorders, mainly upper gastrointestinal haemorrhage (UGIH). Studies about the interaction between NSAIDs and genetic variations on the risk of UGIH are scarce. Therefore, we investigated the effect of 16 single nucleotide polymorphisms (SNPs) involved in drug metabolism on the risk of NSAIDs-induced UGIH. We conducted a multicenter case-control study of 326 cases and 748 controls. Participants were sub-grouped into four categories according to NSAID exposure and genetic profile. We estimated odds ratios (ORs) and their 95% confidence intervals (CI) using generalized linear mixed models for dependent binomial variables and then calculated the measures of interaction, synergism index (S), and relative excess risk due to interaction (RERI). We undertook stratified analyses by the type of NSAID (aspirin, non-aspirin). We observed an excess risk of UGIH due to an interaction between any NSAID, non-aspirin NSAIDs or aspirin and carrying certain SNPs. The greatest excess risk was observed for carriers of: rs2180314:C>G [any NSAID: S = 3.30 (95%CI: 1.24-8.80), RERI = 4.39 (95%CI: 0.70-8.07); non-aspirin NSAIDs: S = 3.42 (95%CI: 1.12-10.47), RERI = 3.97 (95%CI: 0.44-7.50)], and rs4809957:A>G [any NSAID: S = 2.11 (95%CI: 0.90-4.97), RERI = 3.46 (95%CI: −0.40-7.31)]. Aspirin use by carriers of rs6664:C>T is also associated with increased risk of UGIH [OR: 2.22 (95%CI: 0.69-7.17) vs. OR: 7.72 (95%CI: 2.75-21.68)], yet larger sample size is needed to confirm this observation. The joint effect of the SNPs s2180314:C>G and rs4809957:A>G and NSAIDs are more than three times higher than the sum of their individual effects. Personalized prescriptions based on genotyping would permit a better weighing of risks and benefits from NSAID consumpti

Background: Currently in developed countries there is an increase in the consumption of roll your own tobacco, which is associated with a higher proportion of users of this form of tobacco who wish to make an attempt to quit. The objective of this study was to analyze the effectiveness of tobacco cessation interventions based on the type of tobacco consumed. Methods: Longitudinal study of a cohort of 641 smokers recruited between 2015 and 2018 in a health area of Galicia included in smoking cessation programs, based on psychological counseling and pharmacological treatment. The characteristics and success of the intervention were evaluated in two groups: roll your own tobacco smokers (RYO) and manufactured tobacco smokers (MT). A logistic regression was performed to determine the probability of success in smoking cessation. The risk measure was the odds ratio (OR) with its 95% confidence interval. Results: RYO users started at a younger age and had a lower sociocultural stratum than MT users. Interventions to quit smoking in RYO users were associated with less abstinence at 4 weeks (52% MT vs 38% LT) (OR: 0.5; 95% CI 0.35-0.99; p=0.045;) and at 3 months (42% TM vs 30% TL) (OR:0.6; 95% CI 0.33-0.98; p=0.04). Conclusions: Smoking cessation programs are less effective in short-term RYO users. There are no differences in long-term abstinence between the two groups., Fundamentos: Actualmente en los países desarrollados existe un aumento del consumo de tabaco de liar lo que se asocia a una mayor proporción de usuarios de esta forma de tabaco que desean realizar un intento de abandono. El objetivo de este estudio fue analizar la efectividad de las intervenciones de cesación tabáquica en función del tipo de tabaco consumido. Métodos: Estudio longitudinal de una cohorte de 641 fumadores reclutados entre 2015 y 2018 en un área sanitaria de Galicia incluidos en programas de deshabituación tabáquica, basados en el asesoramiento psicológico y en el tratamiento farmacológico. Se evaluaron las características y el éxito de la intervención en dos grupos: fumadores de tabaco de liar (TL) y fumadores de tabaco manufacturado (TM). Se realizó una regresión logística para determinar la probabilidad de éxito en la cesación tabáquica. La medida de riesgo fue el odds ratio (OR) con su intervalo de confianza al 95%. Resultados: Los consumidores de TL se iniciaron a una edad más temprana y tenían un estrato sociocultural más bajo que los consumidores de TM. Las intervenciones para abandonar el tabaco en los consumidores de TL se asociaron a una menor abstinencia a las 4 semanas (52%TM vs 38% TL) (OR: 0,5; 95%IC 0,35-0,99; p=0,045;) y a los 3 meses (42%TM vs 30%TL) (OR:0,6; 95%IC 0,33- 0,98; p=0,04). Conclusiones: Los programas de cesación tabáquica son menos efectivas en los consumidores de TL a corto plazo. No se observan diferencias en la abstinencia a largo plazo entre ambos grupos.

La enfermedad periodontal o periodontitis es una patología inflamatoria crónica de etiología bacteriana que puede causar la pérdida de las piezas dentarias si no es diagnosticada a tiempo. El principal inconveniente en su diagnóstico precoz es la dificultad para detectar signos y síntomas por parte del paciente, ya que los iniciales son comunes a gran parte de la población (sangrado de encías, eritema, halitosis..etc). Por todo ello, es importante conocer el nivel de conocimiento en nuestro entorno, tanto de la población como de los principales transmisores de información en salud (médicos/as y enfermeros/as), con el fin de determinar medidas educativas en cuanto a la prevención, diagnóstico temprano y tratamiento de la periodontitis

Introducción: La hemorragia gastrointestinal alta (HGIA) es una causa común de hospitalización con alta morbilidad, mortalidad y costes. Se considera una patología multicausal en la que pueden intervenir diferentes factores en su aparición. En este trabajo se ha evaluado el riesgo de HGIA asociado a diferentes factores de riesgo y sus interacciones. Métodos: Se realizó un estudio de casos y controles en cuatro hospitales españoles. Incluyendo como casos los sujetos con HGIA diagnosticada por endoscopia, y como controles sujetos sanos candidatos a cirugías de procesos no dolorosos. A todos se les realizó una anamnesis farmacológica, determinación de presencia de infección por H. pylori y Anisakis y un cuestionario de antecedentes previos de problemas gástricos y de otras variables relacionadas con las HGIA. Resultados: Se reclutaron 474 casos y 1160 controles. La automedicación con antiinflamatorios no esteroideos (AINE) aumentó el riesgo de HGIA en 5,4 (IC95% 3,2-9,0). Los AINE en combinación con antiagregantes incrementó el riesgo de HGIA en 8,8 veces (IC95% 3,9-19,6), en combinación con H. pylori en 10,7 (IC95% 5,4-21,0) y en combinación con Anisakis en 14,4 (IC95% 6,5-32,3). Por el contrario, en combinación con inhibidores de la bomba de protones el riesgo de HGIA dejaba de ser estadísticamente significativo (OR 1,45 IC95% 0,7-3,1). Conclusión: La interacción del consumo de AINE con otros factores como antiagregantes, H. pylori o Anisakis incrementan en varias veces el riesgo de HGIA. Dada la prevalencia de estas exposiciones, se podrían disminuir el número de HGIA evitando las exposiciones conjuntas con el consumo de AINE.