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Impact of CYP2D6 and CYP2B6 phenotypes on the response to tramadol in patients with acute post-surgical pain.
No full text20.500.12530/87885Tramadol is an important minor opioid prescribed for pain management. In this study, we analyzed the well-known impact of CYP2D6 genetic variation and 60 additional variants in eight candidate genes (i.e., ABCG2, SLCO1B1, CYP2D6, CYP2B6, CYP2C19, CYP2C9, CYP3A5, and CYP3A4) on tramadol efficacy and safety. Some 108 patients with pain after surgery admitted to a post-anesthesia care unit (PACU) and prescribed tramadol were recruited. They were genotyped, and tramadol M1/M2 metabolite concentrations were determined by a newly validated HPLC-MS/MS method. CYP2D6 intermediate (IM) and poor (PM) metabolizers showed lower M1 concentrations adjusted for dose/weight at 30 and 120 min compared to ultrarapid (UM) and normal (NM) metabolizers (univariate p
A new hernia blocking system to prevent recurrent lumbar disc herniation: surgical technique, intraoperative findings and six-months post-operative outcomes.
No full text20.500.12530/87910The aim of this study was to evaluate the performance and safety of a new hernia blocking system (HBS), implanted after a limited discectomy, to prevent recurrence of lumbar disc herniation. Prospective, multicenter (6 sites), cohort clinical investigation. Thirty patients with a postero-lateral disc herniation between L4-S1 and large annular defects (> 6 mm wide), who underwent a limited discectomy and were treated with a new HBS (DISC care, NEOS Surgery S.L.), were included. This article presents details about the investigational device, its surgical technique, intraoperative parameters, and up to 6 months follow-up outcomes. The primary endpoint of the study was to assess the incidence of early symptomatic reherniation. In addition, disc height, leg and back pain (NRS 0-10), Oswestry Disability Index (ODI), quality of life (EQ-5D-5L) and device safety, were evaluated. gov: NCT04188236; date: 27th November 2019. Thirty patients (43.3% female, 41.7 ± 10.9 years) were implanted with the device under evaluation in a mean of 16 ± 9.6 min. Six months after surgery, no symptomatic reherniation was detected and disc height was maintained in all patients included. All patients had a significant reduction in leg pain (> 2 points in the NRS), 92.9% improved > 15 points in the ODI and 82.6% significantly improved their quality of life (≥ 12 points in EQ VAS score). No product-related serious adverse events nor reoperations occurred. The implantation of an HBS is a feasible and safe procedure that prevents early disc herniation recurrence in patients at high risk of reherniation
Descriptive study on substance uses and risk of sexually transmitted infections in the practice of Chemsex in Spain.
No full text20.500.12530/87913In recent years, there has been an increasing use of sex-related substances (known as "Chemsex") to facilitate, intensify, and prolong the sexual experience of men who have sex with men. This phenomenon poses a public health problem, increasing the risk of sexually transmitted infections (STIs) and mental disorders. The primary aim of this study was to delve into the correlation between substance use and sexual health, specifically examining the association between different substances used and the risk of sexually transmitted infections (STIs) in the context of Chemsex in Spain. An observational, descriptive, cross-sectional study was conducted among 563 Spanish participants between January and April 2023. Non-probabilistic purposive sampling was used by the investigators. The researchers administered a questionnaire to men who have sex with men who use substances, especially in the sexual sphere, in all the autonomous communities of Spain. 14.7% reported having practiced slamsex in the last year, and 17.94% were diagnosed with a Sexually Transmitted Infection in the previous 6 months. Of these, 21% were on PREP treatment, with the main STIs being gonorrhea (p Chemsex in Spain is linked to a high prevalence of STIs, especially gonorrhea and chlamydia, even among those on PrEP treatment. The use of various drugs during chemsex, such as amyl nitrite, GHB, ecstasy, and others, correlates with higher rates of STIs, highlighting the need for interventions to reduce risk and harm. The drugs most associated with slamsex include ketamine, mephedrone, and methamphetamine, underscoring the importance of addressing the risk behaviors associated with this activity. This study shows that chemsex appears to be associated with a high prevalence among men who have sex with men. Who use multiple substances in a sexual context, and are particularly exposed to sexually transmitted infections (STIs), indicating a particular need for STI prevention and care in this group
Real-World Experience with Isavuconazole in Allogeneic Stem Cell Transplantation in Spain.
No full text20.500.12530/87909Invasive fungal infections (IFI) pose a significant complication after hematopoietic stem cell transplantation (HSCT). Isavuconazole (ISV) is a new generation azole with a favourable adverse effect and interaction profile approved for the treatment of invasive aspergillosis and mucormycosis. We analyzed the indications, effectiveness, adverse event profile and drug interaction management of ISV in the real-world setting in adults who received allogeneic-HSCT (allo-HSCT) within the Spanish Group of HSCT and Cell Therapy (GETH-TC). We conducted a multicenter retrospective study of all consecutive adult allo-HSCT recipients (≥18 years) who received ISV either for IFI treatment or prophylaxis, from December 2017 to August 2021, in 20 centers within the Spanish Group of Hematopoietic Stem Cell Transplantation and Cell Therapy (GETH-TC). A total of 166 adult allografted patients who received ISV from 2017 to 2021 were included. Median age was 48 years with 43% females. In 81 (49%) patients, ISV was used for treatment of IFI, and in 85 (51%) for prophylaxis. Median duration of ISV administration for IFI treatment was 57 days (range 31-126) and 86 days (range 33-196) for prophylaxis. Most frequent indication for treatment was invasive aspergillosis (78%), followed by mucormycosis (6%). Therapeutic success (45%) was the most frequent reason for ISV withdrawal. In the prophylaxis group, the resolution of IFI risk factors was the most frequent reason for withdrawal (62%). Six (7%) breakthrough IFI were reported. The majority of patients (80%) presented pharmacologic interactions. Twenty-one patients (13%) reported adverse events related to ISV, mainly liver biochemistry abnormalities, which led to ISV withdrawal in 7 patients (4%). ISV was effective and well tolerated for IFI treatment and prophylaxis, with a manageable interaction profile
Prevalence and Phenotypic Susceptibility to Doravirine of the HIV-1 Reverse Transcriptase V106I Polymorphism in B and Non-B Subtypes.
No full textLimited data are available regarding the susceptibility of the reverse transcriptase V106 polymorphism to doravirine. Doravirine susceptibility was measured in site-directed mutants (SDMs) containing V106I, V106A, V106M, and Y188L mutations in subtype B (NL4-3, HXB2) and CRF02_AG background and in recombinant viruses with RT harboring V106I alone derived from 50 people with HIV. HIV-1 B subtype was detected in 1523 of 2705 cases. Prevalence of V106I was 3.2% in B and 2.5% in non-B subtypes, and was higher in subtype F (8.1%) and D (14.3%). Fold-changes (FC) in susceptibility for SDMs were below doravirine biological cutoff (3.0) for V106I, but not for V106A, V106M, and Y188L. Clinically derived viruses tested included 22 B (median FC, 1.2; interquartile range [IQR], 0.9-1.6) and 28 non-B subtypes (median FC, 1.8; IQR, 0.9-3.0). Nine (18%) viruses showed FC values equal or higher than the doravirine biological FC cutoff. The prevalence of the HIV-1 RT V106I polymorphism in MeditRes HIV consortium remains low, but significantly more prevalent in subtypes D and F. V106I minimally decreased the susceptibility to doravirine in SDMs and most clinical isolates. Reduced susceptibility seems to occur at increased frequency in subtype F1; however, the clinical impact remains to be investigated. NCT04894357
Counter-response to the letter «ED visits and HIV screening, clinical or universal scenarios?».
No full text20.500.12530/8787
Prognostic Relevance of Gradient and Flow Status in Severe Aortic Stenosis.
No full text20.500.12530/87907Background: Severe aortic stenosis (AS) may present with different flow, gradient and left ventricular ejection fraction (LVEF) patterns. Paradoxical low-flow low-gradient (PLF-LG) severe AS has a specific clinical profile, but its prognosis and management remain controversial. Our aim is to evaluate the impact of different AS patterns in the incidence of major clinical events. Methods: A retrospective observational study was carried out on all the consecutive patients diagnosed with severe AS at our tertiary hospital centre in 2021. Echocardiographic measurements were carefully reviewed, and patients were classified following current guidelines into four categories: high gradient (HG), concordant low-flow low-gradient (CLF-LG), paradoxical low-flow low-gradient (PLF-LG) and normal-flow low-gradient (NF-LG). The baseline characteristics and clinical events (heart failure admission, intervention and death) at 1-year follow-up were collected from medical records. The association between categories and events was established using Student's t test or ANOVA as required. Results: 205 patients with severe AS were included in the study (81 ± 10 years old, 52.7% female). Category distribution was as follows: HG (138, 67.3%), PLF-LG (34, 19.8%), CLF-LG (21, 10.2%) and NF-LG (12, 5.9%). During the follow-up, 24.8% were admitted due to heart failure, 68.3% received valve replacement (51.7% TAVR) and 22% died. Severe tricuspid regurgitation was more frequent in patients with PLF-LG than in HG AS (14.7% vs. 2.2%;
Spanish Society of Cardiovascular & Endovascular Surgery registry of interventions in patients with congenital heart disease: 2022, and retrospective of the previous 11 years
No full text20.500.12530/87857The Spanish Society of Cardiovascular & Endovascular Surgery presents the 2012-2022 report of the activity in congenital cardiovascular surgery, based on a voluntary and anonymous registration involving most of Spanish centres. This article is complementary to the 2022 cardiovascular surgery annual report, and they are published together. In 2022 we observe an increase in congenital cardiovascular surgery, reaching numbers similar to pre-pandemic activity in year 2019. We included data from the previous 11 years, in order to obtain real information related to our activity with these relatively scarce pathologies. From year 2012 to 2022, 22,056 congenital heart surgeries were performed, accounting for 9.5% of all major surgery (congenital + acquired) performed in Spain during that period. Of these surgeries, 82% of them required extracorporeal circulation and 18% not. We highlight the interventions in neonates and adult patients, which mean respectively 18% and 22% of our whole activity and are a real challenge. The most prevalent congenital heart pathologies operated on were: septal defects in cases requiring extracorporeal circulation, and ductus in patients without extracorporeal circulation. The presented data are adjusted to the basic Aristotle score of preoperative surgical risk. The observed mortality of surgeries with extracorporeal circulation was 3% (Aristotle-6.39), and without cardiopulmonary bypass 2.34% (Aristotle-4.89). Our national registry of surgical activity in congenital heart disease shows good results, allows us to compare ourselves within a national and international framework, design improvement strategies, set objectives and improve the quality of our actions. (c) 2024 Sociedad Espa & ntilde;ola de Cirug & iacute;a Cardiovascular y Endovascular. Published by Elsevier Espa & ntilde;a, S.L.U
VDR gene TaqI (rs731236) polymorphism affects gut microbiota diversity and composition in a Caucasian population.
No full text20.500.12530/87857The VDR gene is identified as a crucial host factor, influencing the gut microbiota. The current research focuses on an observational study that compares gut microbiota composition among individuals with different VDR gene TaqI polymorphisms in a Caucasian Spanish population. This study aims to elucidate the interplay between genetic variations in the VDR gene and the gut microbial composition. 87 healthy participants (57 men, 30 women), aged 18 to 48 years, were examined. Anthropometric measures, body composition, and dietary habits were assessed. VDR gene polymorphism TaqI rs731236 was determined using TaqMan assays. The V3 and V4 regions of the 16S rRNA gene were sequenced to study bacterial composition, which was analyzed using QIIME2, DADA2 plugin, and PICRUSt2. Statistical analyses included tests for normal distribution, alpha/beta diversity, ADONIS, LEfSe, and DESeq2, with established significance thresholds. No significant differences in body composition or dietary habits were observed based on VDR genotypes. Dietary intake analysis revealed no variations in energy, macronutrients, or fiber among the different VDR genotypes. Fecal microbiota analysis indicated significant differences in alpha diversity as measured by Faith's Phylogenetic Diversity index. Differential abundance analysis identified taxonomic disparities, notably in the genera Parabacteroides and Butyricimonas. Overall, this study suggests potential associations between genetic variations in the VDR gene and the composition and function of gut microbiota