Objective To detect current errors within the administration of phosphodiesterase type 5 inhibitors (PDE5is) and evaluate and elucidate what percentage of patients could be recovered for oral therapy ...with different subtypes of PDE5is through a re-education program. Methods Two hundred fifty patients remitted to the andrology unit were prospectively analyzed. Patients' chief complaint was erectile dysfunction despite treatment with PDE5i. The International Index of Erectile Function was used to measure erectile function. A structured interview was developed to evaluate the most frequent errors within the administration of PDE5is. A re-education program was offered to patients with incomplete or incorrect use of PDE5is according to the structured interview, classifying them into true nonresponders or false nonresponders. Finally, the percentage of patients who could be recovered for oral therapy with other PDE5is was analyzed. Results A total of 172 patients (69%) presented some error within drug administration. The most common error was not trying >1 PDE5i (41%). A re-education program was offered to these nonresponders, and 115 (66.9%) accepted. Up to 27 (23.5%) did not respond to the re-education program and were classified as true nonresponders, whereas 88 (76.5%) had a positive response to treatment and were thus included in the false nonresponder group. Conclusion Two-thirds of patients remitted to our andrology unit and cataloged as nonresponders were in fact using PDE5i in suboptimal conditions. Offering patients more accurate information provided almost 76% with good results using PDE5is and could therefore be successfully treated with these drugs.
The 2030 Agenda highlights the importance of governance to achieve Sustainable Development Goals (SDG). However, we observe that there is an underestimation of the governance dimension in the SDG ...indices. The reasons are twofold. Firstly, indices assign a lower weight to governance compared to the other dimensions of sustainability. Secondly, most governance indicators do not measure the relational dynamics that underlie sustainable development policies. The aim of this study is thus to provide alternative methods for a more accurate assessment of the governance dimension in the frame of the 2030 Agenda. With this purpose, we examine the performance of 100 Spanish cities on the SDGs included in the first report elaborated by the Sustainable Development Solutions Network Spain in 2018. Using this data, we first develop a methodology to rebalance the current underestimation of the governance dimension, comparing its impact on the SDG performance of these cities. Secondly, we build a new indicator of ‘Strategic Culture’ to get a more accurate measure of governance in urban contexts. As a result, the study validates the proposed methods and provides evidence that better performance on sustainable development is favored by the implementation of strategic planning processes.
Healthcare workers were more than essential during the COVID-19 pandemic, a fact that is recognized by societies the world over. However, in many countries, healthcare workers are not satisfied with ...their working conditions, which has resulted in frequent protests and strikes. One such country is Spain. How can the theory of social dialogue contribute to explaining and improving healthcare workers’ conditions during a healthcare crisis such as this one? In this paper, we aim to explore what it is really like for healthcare professionals working under these challenging circumstances, and link their experience to the theory of social dialogue in order to engage in a double process of contribution: from practice to theory and vice versa. In order to do so, we first explore the real-world problems encountered by professionals, focusing particularly on cases in Spain, before reviewing theoretical approaches to the study of social dialogue in organizations, an area that has received very little attention in the revised academic literature. Finally, we show how constructive social dialogue can be an effective tool for improving working conditions for healthcare workers.
The number of databases of natural products (NPs) has increased substantially. Latin America is extraordinarily rich in biodiversity, enabling the identification of novel NPs, which has encouraged ...both the development of databases and the implementation of those that are being created or are under development. In a collective effort from several Latin American countries, herein we introduce the first version of the Latin American Natural Products Database (LANaPDB), a public compound collection that gathers the chemical information of NPs contained in diverse databases from this geographical region. The current version of LANaPDB unifies the information from six countries and contains 12,959 chemical structures. The structural classification showed that the most abundant compounds are the terpenoids (63.2%), phenylpropanoids (18%) and alkaloids (11.8%). From the analysis of the distribution of properties of pharmaceutical interest, it was observed that many LANaPDB compounds satisfy some drug-like rules of thumb for physicochemical properties. The concept of the chemical multiverse was employed to generate multiple chemical spaces from two different fingerprints and two dimensionality reduction techniques. Comparing LANaPDB with FDA-approved drugs and the major open-access repository of NPs, COCONUT, it was concluded that the chemical space covered by LANaPDB completely overlaps with COCONUT and, in some regions, with FDA-approved drugs. LANaPDB will be updated, adding more compounds from each database, plus the addition of databases from other Latin American countries.
In this study, we investigated the impact of the SARS-CoV-2 vaccination on seroprevalence in a cohort of healthcare workers (HCW) at an ophthalmic medical center.
IgG antibodies against the N, S1, ...and S2 antigens of SARS-CoV-2 as well as their serum neutralizing activity were determined.
In the present study, we observed that 98.4% of HCW were seropositive for S1/S2 proteins of SARS-CoV-2 due to the national vaccination program. Interestingly, 78.4% of the participants had anti-N protein antibodies, suggesting previous COVID-19 infection. We also evaluated the neutralizing antibodies and found that the mean value was high (90.7%).
These results indicate that our HCWs cohort presented a robust hybrid humoral response owing to the massive national vaccination program and natural infections.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Background:
In chronic obstructive pulmonary disease (COPD), multiple recurrent severe exacerbations that require hospitalization can occur. These events are strongly associated with death and other ...clinical complications.
Objectives:
We aimed to develop a prognostic model that could identify patients with COPD that are at risk of multiple recurrent severe exacerbations within 3 years.
Design:
Prospective cohort.
Methods:
The derivation cohort comprised patients with stable, moderate-to-severe COPD. Multivariable logistic regression analyses were performed to develop the final model. Based on regression coefficients, a simplified index (ESEx) was established. Both, model and index, were assessed for predictive performance by measuring discrimination and calibration.
Results:
Over 3 years, 16.4% of patients with COPD experienced at least three severe recurrent exacerbations. The prognostic model showed good discrimination of high-risk patients, based on three characteristics: the number of severe exacerbations in the previous year, performance in the five-repetition sit-to-stand test, and in the 6-minute-walk test. The ESEx index provided good level of discrimination areas under the receiver operating characteristic curve (AUCs): 0.913.
Conclusions:
The ESEx index showed good internal validation for the identification of patients at risk of three recurrent severe COPD exacerbations within 3 years. These tools could be used to identify patients who require early interventions and motivate patients to improve physical performance to prevent recurrent exacerbations.
Background
In children with kidney failure, the longer the duration of dialysis the greater the impact on growth deficit, quality of life, and life expectancy. The aim of this research is to test ...whether there was a shortening of treatment time from kidney failure to transplantation in pediatric patients and whether this time interval impacted height.
Methods
Observational retrospective cohort study from 2005 to 2018. The first outcome variable was time to transplantation in years, while the second was height/age standard deviation score (SDS) at transplantation. Cox regression models were used to analyze time from disease to transplantation and linear regression was employed to test the association of the year of kidney failure onset with height.
Results
A total of 780 children were evaluated and 517 underwent kidney transplantation after a median time of 1.9 years (IQR = 1.0–4.0). The variables significantly associated with time to transplant were: year of kidney failure onset (HR = 1.07; 95% CI: 1.05–1.10; p < .001), age at kidney failure onset <12 years (HR = 0.59; 95% CI: 0.49–0.71; p < .001), living in different state as transplant center (HR = 0.63; 95% CI: 0.53–0.77; p < .001), and undergoing blood transfusion before transplantation (HR = 0.63; 95% CI: 0.53–0.75; p < .001). Regarding growth, for each 1‐year increase in the epoch of kidney failure onset, a 0.05 SDS raise in height/age is expected (p < .001).
Conclusion
Children with recent kidney failure onset had significantly lower time to the outcome and this reduction was associated with a less severe growth deficit.
Secondary acute myeloid leukemia (sAML) comprises a heterogeneous group of patients and is associated with poor overall survival (OS). We analyze the characteristics, treatment patterns, and outcomes ...of adult patients with sAML in the Programa Español de Tratamientos en Hematología (PETHEMA) registry. Overall, 6211 (72.9%) were de novo and 2310 (27.1%) had sAML, divided into myelodysplastic syndrome AML (MDS-AML, 44%), MDS/myeloproliferative AML (MDS/MPN-AML, 10%), MPN-AML (11%), therapy-related AML (t-AML, 25%), and antecedent neoplasia without prior chemotherapy/radiotherapy (neo-AML, 9%). Compared with de novo, patients with sAML were older (median age, 69 years), had more Eastern Cooperative Oncology Group ≥2 (35%) or high-risk cytogenetics (40%), less FMS-like tyrosine kinase 3 internal tandem duplication (11%), and nucleophosmin 1 (NPM1) mutations (21%) and received less intensive chemotherapy regimens (38%) (all P < .001). Median OS was higher for de novo than sAML (10.9 vs 5.6 months; P < .001) and shorter in sAML after hematologic disorder (MDS, MDS/MPN, or MPN) compared with t-AML and neo-AML (5.3 vs 6.1 vs 5.7 months, respectively; P = .04). After intensive chemotherapy, median OS was better among patients with de novo and neo-AML (17.2 and 14.6 months, respectively). No OS differences were observed after hypomethylating agents according to type of AML. sAML was an independent adverse prognostic factor for OS. We confirmed high prevalence and adverse features of sAML and established its independent adverse prognostic value. This trial was registered at www.clinicaltrials.gov as #NCT02607059.
•The large PETHEMA registry shows that secondary AML represents 27% of AML cases and confirms its independent adverse prognostic value.•Subcategories of secondary AML were analyzed, including MSD/MPN and therapy-related cases, with different features and outcomes.
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It has been reported that an increased function of the P2X7 purinergic receptor is associated with an increase in both insulin sensitivity and secretion. Accordingly, we explored the possible effect ...of the 1068 G>A polymorphism of the gene P2RX7 on glucose homeostasis and the levels of the anti-inflammatory cytokine IL-1Ra in T2D patients. The presence of the 1068 G>A polymorphism in T2D patients (n = 100) and healthy subjects (n = 100) was determined by DNA sequencing, and serum levels of IL-1Ra were measured by ELISA. Pancreatic β-cell function, insulin resistance, blood glucose levels and glycated hemoglobin (HbA1c) were also analyzed. We detected a significant negative association between T2D and the 1068 G>A SNP (Odds ratio 0.3916, p = 0.0045). In addition, we observed that T2D patients bearing the 1068 G>A variant showed higher serum levels of IL-1Ra compared to both, patients with the GG genotype or healthy individuals (GG or G>A). Moreover, T2D patients bearing the 1068 G>A SNP showed increased insulin levels and a better pancreatic β-cell function (p < 0.05 in both cases) compared to patients with the wild type genotype. However, the HbA1c levels, fasting glucose levels and the degree of insulin resistance were similar in T2D patients carrying or not the G>A SNP. Our results suggest that although the 1068 G>A polymorphism of the P2RX7 gene is associated with an increased β-cell function and IL-1Ra release in T2D patients, the glycemic control is not significantly affected by the presence of this SNP.
•T2D patients bearing the 1068 G>A SNP show an increase in the serum levels of IL-1Ra.•Increased insulin levels are detected in T2D patients bearing the 1068 G>A variant.•There is an increase in the β-cell function in individuals carrying the 1068 G>A SNP.•The presence of 1068 G>A SNP does not improve glycemic control in T2D patients.
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