Scientia, Dipòsit d’Informació Digital del Departament de Salut
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Guia per a la vacunació als centres educatius per al curs escolar 2025-2026
Get PDFVacunació; Escola; RecomanacionsVaccination; School; RecommendationsVacunación; Escuela; RecomendacionesUna de les funcions del programa Infància amb salut i del Programa de salut escolar de Catalunya és dur a terme la vacunació dels infants i adolescents d’acord amb el calendari vacunal vigent en cada moment. Un dels principals objectius que els professionals sanitaris es desplacin des del centres d’atenció primària (CAP) als centres educatius és garantir l’accessibilitat i mantenir una cobertura de vacunació òptima en infants i adolescents. Això a més també permet garantir la continuïtat assistencial i el seguiment del calendari de vacunacions sistemàtiques de Catalunya
Status of Neurosonology in Spain. A study from the Spanish Society of Neurosonology (SONES)
Get PDFNeurosonologia; Ecografía; DopplerNeurosonology; Echography; DopplerNeurosonologia; Ecografia; DopplerIntroducción
La neurosonología es la disciplina que estudia las técnicas ultrasonográficas aplicadas a la neurología. En 1997 se fundó la Sociedad Española de Neurosonología (SONES) con el objetivo de promover la formación de neurólogos en estas técnicas, especialmente en el campo de las enfermedades cerebrovasculares. Veinticinco años después, la generalización de otras técnicas más avanzadas de neuroimagen vascular, y el desarrollo de la ultrasonografía en otros campos de la neurología, han modificado el papel que clásicamente se ha atribuido a esta disciplina. Desde la SONES analizamos el estado actual de la neurosonología en España.
Métodos
Estudio transversal mediante una encuesta en línea dirigida a residentes de neurología y neurólogos ejercientes en España, abordando cuestiones de formación y práctica diaria, incluyendo un análisis de debilidades, amenazas, fortalezas y oportunidades (DAFO).
Resultados
Participaron 178 neurólogos y 34 residentes. Reflejaron una amplia experiencia en neurosonología vascular (90% de los Servicios) y escasa en parénquima cerebral (34%), ecocardioscopia (25%), técnicas ecoguiadas (24%), y ecografía de nervio (14%). El 53% afirmó disponer de un laboratorio de Neurosonología a tiempo completo y solo el 14% de facultativos dedicados en exclusiva a la neurosonología. La mayoría afirmó que la formación continuada en neurosonología es escasa, y el 97% creen necesario potenciar alguna de las técnicas. Las principales DAFO fueron respectivamente la necesidad de experiencia, la falta de tiempo, la versatilidad y el manejo integral del paciente neurológico.
Conclusiones
La neurosonología vascular está ampliamente implantada en España, pero la implementación de laboratorios dedicados y formación en técnicas no vasculares es aún escasa.Introduction
Neurosonology is the field of study of the ultrasound techniques applied to neurological diseases. The Spanish Society of Neurosonology (SONES) was funded in 1997 to promote training and education in these techniques, especially focused on the study of cerebrovascular diseases. After 25 years, the increased use of other advanced neurovascular imaging techniques and the emergence of novel applications of ultrasound in other fields of neurology, have modified the classic role of neurosonology. From the SONES we aimed to evaluate the current status of neurosonology in Spain.
Methods
Cross-sectional survey of neurologists and neurology residents working in Spain regarding training, education, and local daily practice, including a strengths, weaknesses, opportunities and threats (SWOT) analysis.
Results
One-hundred seventy-eight neurologists and thirty-four neurology residents participated in the survey. A wide experience in vascular neurosonology (90% of respondents’ Neurology departments) and limited experience in brain parenchyma sonography (34%), cardiac echoscopy (25%), ultrasound-guided techniques (24%), and nerve ultrasound (14%) was reported. Fifty-three percent of the participants reported to have a full-time neurosonology lab in their department and only 14% reported to have neurologists dedicated exclusively to neurosonology. Most participants (54%) reported to lack continuous learning opportunities, and 97% to need training in one or more neurosonology techniques. Main SWOT were respectively requiring expertise, shortage of time, versatility and comprehensive management of the neurological patient.
Conclusion
Vascular neurosonology is widely instituted in Spain, but the implementation of full-time neurosonology labs and training in non-vascular neurosonology techniques is yet scarce
Anàlisi de les aigües residuals: informe sobre consum problemàtic i conseqüències - 2024
No full textAigües residuals; Monitoratge; Consum de droguesWaste water; Monitoring; Drug useAguas residuales; Monitorización; Consumo de drogasEn aquest informe es mostren els resultats obtinguts l’any 2023 en cadascuna de les tres EDARs i l’evolució entre 2011 i 2023 a l’EDAR del Baix Llobregat (de 2011 a 2015 només amb la mostra de primavera), entre 2016 i 2023, a l’EDAR de Lleida, i entre 2022 i 2023, a l’EDAR del Besòs. Les drogues incloses en aquest informe no són totes les que s’analitzen, tan sols les més rellevants en el nostre context: alcohol, cocaïna (benzoilecgonina), amfetamínics (amfetamina, metamfetamina i èxtasi), efedrina, al·lucinògens (ketamina), opioides (metabòlit de la metadona: EDDP, 2-etilè-1,5-dimetil-3,3-difenilpirrolodina) i cannabinoides (THC-COOH). El motiu principal pel qual no es mostren totes és que moltes de les drogues analitzades no assoleixen els llindars mínims de detecció
Refractoriness to eltrombopag in adult primary immune thrombocytopenia: utility of next-generation sequencing techniques
Get PDFEltrombopag; Primary immune thrombocytopenia; Next-generation sequencingEltrombopag; Trombocitopenia inmunitaria primaria; Secuenciación de próxima generaciónEltrombopag; Trombocitopènia immunitària primària; Seqüenciació de nova generacióThrombopoietin receptor agonists, for example eltrombopag, are standard second-line treatment for immune thrombocytopenia (ITP). Eltrombopag has demonstrated high response rates, both in clinical trials and in routine practice studies. However, some patients with ITP are refractory to this drug. Next-generation sequencing (NGS) may help us identify underlying molecular biology variants that may be involved in eltrombopag refractoriness. Our multicenter national NGS study investigated 110 genes of the most important cell-signaling pathways involved in the mechanism of action of eltrombopag in 35 refractory cases and 35 eltrombopag-responsive controls. Our refractory population comprised 51.4% men with a median age at diagnosis of 48 (range, 38-69) years and a median platelet count of 7 × 109/μL (range, 4 × 109/μL to 16 × 109/μL). At eltrombopag initiation, 78.3% had chronic ITP with a median platelet count of 8 × 109/μL (range, 5× 109/μL to 30 × 109/μL). Treatment with eltrombopag was maintained for a median of 3 (range, 1-9) months before discontinuation. No major grade 3-4 side effects were observed. Several statistical differences were observed in relation to the control responders. Of the total sum of the NGS variants found, 13 variants with statistical significance (P ≤ .05) between case and controls were observed. Two of these have been shown to be associated with cancer. Seven variants are considered benign. Four variants are not previously described, and their significance is unknown. To our knowledge, none of the 13 variants described here has ever been correlated with ITP or eltrombopag refractoriness. Further studies are required to establish their role in this setting.This research was funded by a Novartis Research grant (CETB115BES06T)
The Development of a European Registry for Facial Dysostosis Syndromes: A Delphi-Guided Approach
Get PDFAcrofacial dysostosis; Delphi technique; Miller syndromeDisostosis acrofacial; Técnica Delphi; Síndrome de MillerDisostosi acrofacial; Tècnica Delphi; Síndrome de MillerCraniosynostosis is a multigenic congenital condition in which one or more calvarial sutures have prematurely fused during the development of the fetus. Pathogenic variants in FGFR2 are associated with the development of syndromic craniosynostosis, such as Crouzon, Apert and Pfeifer syndromes. Investigation of FGFR2-linked craniosynostosis is hindered by the lack of appropriate in vitro models. Patient-derived human induced pluripotent stem cell (hiPSC) in vitro disease models provide the opportunity to investigate the disease, identify molecular targets for pharmaceutical treatments, and enable the generation of autologous pluripotent stem cell catalogues. Here, we report three patient-derived hiPSC lines carrying the C342Y, S252W or E565G FGFR2 pathogenic variant. The patient hiPSC lines express characteristic pluripotency markers and display distinct phosphorylation profiles under unstimulated conditions. FGFR2C342Y showed autophosphorylation in the absence of bFGF ligand, although downstream docking proteins PLCγ and FRS2α were not phosphorylated. FGFR2S252W and FGFR2E565G hiPSCs showed increased phosphorylation of docking proteins PLCγ and FRS2α, whereas FGFR2 was not phosphorylated. These patient hiPSC lines provide molecular and cellular options to investigate FGFR2-linked craniosynostosis in the patient-specific genomic context and develop therapeutic modalities.The present study was partially funded by the European Reference Network for rare and/or complex craniofacial anomalies and ear, nose, and throat (ENT) disorders (ERN CRANIO) in terms of personnel costs of the first author. ERN CRANIO is funded by the European Union
Progression from isolated growth hormone deficiency to a combined pituitary hormone deficiency in a cohort of paediatrics patients with pituitary morphology abnormalities on MRI
Get PDFGrowth hormone deficiency; Hypopituitarism; Pituitary magnetic resonance imatgeDeficiència de l'hormona del creixement; Hipopituitarisme; Imatge per ressonància magnètica hipofisàriaDeficiencia de la hormona de crecimiento; Hipopituitarismo; Imagen por resonancia magnética hipofisariaObjective
To evaluate the baseline and follow-up clinical and radiological characteristics of a paediatric cohort initially diagnosed with isolated congenital growth hormone deficiency (IGHD) and pituitary morphology abnormality in MRI.
Patients and methods
Observational, ambispective and longitudinal review of paediatric patients with an initial diagnosis of growth hormone deficiency with pituitary morphology abnormality in MRI followed-up in a single tertiary hospital.
Results
After mean 11.3 (± 3.5DS) years of follow-up, the thirty patients (20 males) were classified into two groups: (1) isolated congenital growth hormone deficiency (IGHD) with 24 patients (9.5 years median follow up), and (2) combined pituitary hormone deficiencies (CPHD) with 6 patients (13.5 years median follow up). Median age at diagnosis was IGHD 3.0 [2.0–4.0] and CPHD 3.0 [1.5–5.2] years. Regarding the cerebral MRI scan results, 2 patients had septo-optic dysplasia (CPHD), 5 had pituitary stalk interruption syndrome (3 IGHD), one had ectopic posterior pituitary (IGHD), 16 had anterior pituitary hypoplasia (15 IGHD) and 6 had the latter two conditions combined (5 IGHD). In genetic studies, 1 of 25 patients had positive NGS panel results and it was in the IGHD group. The target gene detected was GLI2. Clinical exome sequencing was performed with six patients, yielding inconclusive results (1 in the IGHD group and 5 in the CPHD group). Array CGH was performed with eight patients (4 in the IGHD group and 4 in the CPHD group) and was negative in all patients. In the CPHD group, associated deficiencies begin to appear after 5 years [4.0–6.0] median follow-up, with thyrotropin being the most frequent (80%), followed by gonadotropin deficiency. ACTH and AVP deficiencies were less frequent.
Conclusions
Multiple hormone deficiencies were diagnosed during this cohort’s follow-up evaluation, whose first presentation was isolated growth hormone deficiency and pituitary morphology abnormality in MRI. Pathogenic gene variant involved in congenital hypopituitarism (GLI2) was found in one patient. Regular follow up of pituitary hormonal function in such patients is advisable due to the risk of new added deficiencies
Impact of SARS-CoV-2 infection on bispecific antibody treatment in patients with B-cell lymphoproliferative disorders
Get PDFSARS-CoV-2 infection; Bispecific antibody; B-cell lymphoproliferative disordersInfecció per SARS-CoV-2; Anticossos biespecífics; Trastorns limfoproliferatius de cèl·lules BInfección por SARS-CoV-2; Anticuerpos biespecíficos; Trastornos linfoproliferativos de células BDespite advances in vaccination and the use of antiviral treatments, patients with hematologic malignancies, including B-cell lymphoproliferative disorders, are particularly vulnerable to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The recent introduction of bispecific antibodies (BsAbs) in the treatment algorithm of relapsed/refractory B-cell non-Hodgkin lymphoma (B-NHL) has raised concerns regarding their impact on COVID-19 outcomes. This study aimed to evaluate the impact of SARS-CoV-2 infection on treatment outcomes in patients receiving BsAbs. We assessed the severity of COVID-19 and SARS-CoV-2 serostatus, with antibody titers measured before, during, and after BsAbs administration. A total of 109 patients with B-NHL treated with BsAbs from March 2020 to January 2023 were included. SARS-CoV-2 infection was observed in 56 patients (51%), with 36% experiencing prolonged viral shedding, causing therapy delays in 78% of patients and permanent discontinuations in 19%. Regarding COVID-19 severity, 36% of patients presented moderate, 20% severe, and 12% critical disease. Seven patients (13%) died owing to COVID-19 pneumonia. Similar to observations with anti-CD20 monoclonal antibodies, BsAbs were associated with negative antispike serostatus for at least 6 months after treatment completion. Importantly, this lack of seroconversion was linked with severe disease and increased mortality. These findings underscore important considerations for the management of patients receiving BsAbs.This work was supported by the Instituto de Salud Carlos III, Fondo de Investigaciones Sanitarias (PI22/01204)
Tinc artrosi de genoll: necessito una cirurgia de pròtesi?
Get PDFArtroplàstia de genoll; Artrosi de genoll; CirurgiaArtroplastia de rodilla; Artrosis de rodilla; CirugíaKnee arthroplasty; Knee osteoarthritis; SurgerySi tens artrosi de genoll lleu o moderada, es recomana començar amb tractaments conservadors, com seguir un programa d’educació sobre la malaltia, fer exercici físic i perdre pes. La cirurgia de pròtesi de genoll només s’ha de valorar quan l’artrosi és greu i aquests tractaments no han funcionat
CUAP: Centre d'Urgències d'Atenció Primària [audiovisual]
No full textUrgències; Atenció primària; Assistència sanitàriaUrgencias; Atención primaria; Asistencia sanitariaEmergencies; Primary care; HealthcareAquest vídeo conté informació sobre els Centre d’Urgències d’Atenció Primària.Este vídeo contiene información sobre los Centros de Urgencias de Atención Primaria.This video contains information about Primary Care Emergency Centers
Review Article: Individualised Management of Reflux-Like Symptoms-Strategies Beyond Acid Suppression
Get PDFReflux-like symptoms; Personalised treatment; Strategies beyond acid suppressionSíntomas tipo reflujo; Tratamiento personalizado; Terapias más allá de la supresión ácidaSímptomes tipus reflux; Tractament personalitzat; Teràpies més enllà de la supressió àcidaReflux-like symptoms and reflux oesophagitis are often perceived as having the same acid-related aetiology and responsiveness to antisecretory therapy. However, the frequency of residual symptom reporting on proton pump inhibitor (PPI) therapy suggests the two entities have some differential pathophysiological determinants requiring distinct management approaches.
To examine the complexities of reflux-like symptom pathophysiology and strategies that may be used to target contributing factors beyond acid reflux.
A panel of ten expert clinicians (primary care, gastroenterology and psychology) held a series of online meetings to share perspectives on the underlying contributors to, and management of, reflux-like symptoms when PPIs are ineffective or provide partial relief. This review summarises the agreed key themes that emerged from the expert discussions.
While degradation of the anti-reflux barrier dominates in reflux oesophagitis, cognitive-affective, behavioural, and other psychosocial factors can play a major role in symptom persistence. These require individualised management strategies, beginning with education on the gut-brain connection and expectation setting with regard to PPI therapy. A detailed clinical history and patient-reported outcome tools that measure symptom burden and associated anxiety/hypervigilance can help guide management using brain-gut behavioural therapies, supported diet/lifestyle modification, diaphragmatic breathing, weight loss, and/or on-demand symptom control measures according to a patient's specific needs.
A paradigm shift in reflux-like symptom management is required such that acid suppression is viewed as one of several interventions that can be utilised as part of a phenotype-driven, individualised approach to care that acknowledges the multiple contributors to symptom burden.All authors attended online meetings funded by Reckitt Benckiser Healthcare Ltd. Writing support was provided by Lisa O'Rourke PhD of Lumanity, UK, and funded by Reckitt Benckiser Healthcare Ltd