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Casos de xarampió detectats a Catalunya durant l’any 2024
Get PDFSalut pública; Casos de xarampió; CatalunyaSalud pública; Casos de sarampión; CataluñaPublic health; Cases of measles; CataloniaEl xarampió és una malaltia vírica molt contagiosa que afecta sobretot els infants i que pot causar greus problemes de salut, especialment en els nadons. Tot i ser molt transmissible, és fàcilment prevenible mitjançant la vacunació. Per tant, és de gran importància continuar mantenint unes bones cobertures de vacunació contra el xarampió en la població, mitjançant l’administració de les dues dosis corresponents de la vacuna triple vírica (xarampió-rubèola-galteres) als 12 mesos i als 3 anys, segons el calendari vacunal vigent. Així mateix, és important que els infants o adults, que no han passat la malaltia o que no han estat vacunats nascuts després de l’any 1966, rebin dues dosis de vacuna separades en un interval mínim de 4 setmanes. A Catalunya es considera que estan immunitzades les persones nascudes l’any 1966 o abans.El sarampión es una enfermedad vírica muy contagiosa que afecta sobre todo a los niños y que puede causar graves problemas de salud, especialmente en los bebés. Aunque es muy transmisible, es fácilmente prevenible mediante la vacunación. Por tanto, es de gran importancia seguir manteniendo unas buenas coberturas de vacunación contra el sarampión en la población, mediante la administración de las dos dosis correspondientes de la vacuna triple vírica (sarampión-rubéola-galteras) a los 12 meses ya los 3 años, según el calendario vacunal vigente. Asimismo, es importante que los niños o adultos, que no han pasado la enfermedad o que no han sido vacunados nacidos después de 1966, reciban dos dosis de vacuna separadas en un intervalo mínimo de 4 semanas. En Cataluña se considera que están inmunizadas las personas nacidas en 1966 o antes.Measles is a highly contagious viral disease that primarily affects children and can cause serious health problems, especially in babies. Although it is highly transmissible, it is easily preventable through vaccination. Therefore, it is of great importance to continue maintaining good vaccination coverage against measles in the population, through the administration of the two corresponding doses of the triple viral vaccine (measles-rubella-galteras) at 12 months and at 3 years, according to the current vaccination schedule. Likewise, it is important that children or adults, who have not had the disease or who have not been vaccinated, born after 1966, receive two doses of vaccine separated by a minimum interval of 4 weeks. In Catalonia, people born in 1966 or before are considered to be immunized
Treatment-resistant depression and intranasal esketamine: Spanish clinical consensus on practical aspects
Get PDFIntranasal esketamine; Consensus; Treatment algorithmEsketamina intranasal; Consenso; Algoritmo de tratamientoEscetamina intranasal; Consens; Algoritme de tractamentBackground
Pharmacological management of major depressive disorder has traditionally relied on antidepressants targeting the monoaminergic pathway. Treatment-resistant depression (TRD) patients have been frequently excluded from registrational trials, resulting in a lack of clear clinical recommendations for an optimised management. In recent years, treatments based on other mechanisms of action have been developed and approved. Intranasal esketamine is a novel non-monoaminergic treatment directed to improve neuroplasticity through the modulation of the glutamatergic system. In this clinical consensus we aimed to provide expert guidance on the use of intranasal esketamine for TRD patients based in our clinical practice in Spain.
Methods
A scientific committee of nine psychiatrists, experts in TRD in Spain, reviewed the literature (grey literature and articles/scientific communications published in English or Spanish between January 2014 and January 2024 in PubMed). Statements on practical aspects of TRD management with intranasal esketamine were developed in a first meeting following a discussion group approach, refined in a second meeting with a nominal group technique, and finally drafted after consensus in a third meeting.
Results
We recommend a treatment algorithm for the management of TRD with intranasal esketamine. Recommendations were made for specific clinical profiles with other psychiatric comorbidities, which are not contraindications, and for patients who do not have at least a 50 % reduction in symptoms during the first induction phase (partial responders at the end of an induction phase). Treatment should be given in the same health centre where the patient normally receives mental care. The patient’s clinical progress will determine early optimisation of intranasal esketamine dose during the induction phase, the need for flexible doses/repeating the induction treatment phase, customisation of management, and treatment duration. We described factors impacting the use of intranasal esketamine and made recommendations on the characteristics of the ideal setting for its administration. Socio-economic aspects of intranasal esketamine were reviewed.
Conclusions
This is the first consensus developed in Spain regarding practical aspects of TRD management with intranasal esketamine, with a treatment algorithm for patients who are only partial responders at the end of the induction phase.The study was funded by Johnson & Johnson, who did not participate in the study design or interpretation of the results
Parameningeal Rhabdomyosarcoma: Results of the European Pediatric Soft Tissue Sarcoma Study Group RMS 2005 Study
Get PDFHead and neck; Prognostic risk factors; RhabdomyosarcomaCabeza y cuello; Factores de riesgo pronóstico; RabdomiosarcomaCap i coll; Factors de risc pronòstic; RabdomiosarcomaBackground
Parameningeal (PM) site is an unfavorable characteristic in rhabdomyosarcoma (RMS). We described the treatment and outcome for patients with PM RMS and investigated the prognostic value of risk factors. We scored PM site by originating site and by highest risk extension.
Methods
Patients with PM RMS were treated within the European pediatric Soft tissue sarcoma Study Group (EpSSG) RMS 2005 study with risk-adapted, multi-modal treatment.
Results
Three-hundred-eighty-one patients with PM RMS were included. Radiotherapy was administered in 359 patients (77 with surgery). After a median follow-up of 75 months, 5-year event-free survival was 60% (95% confidence interval (CI) 55%–65%), 5-year overall survival was 65% (95% CI 60%–70%).
Conclusions
The outcome for patients with PM RMS has not improved in comparison to previous historical studies, despite the more rigorous application of radiotherapy (94% of patients). Signs of meningeal involvement, PM site, and age at diagnosis remained prognostic risk factors.
Trial Registration
EudraCT number 2005-000217-35This work was supported by Royal Marsden Cancer Charity, Alice's Arc, children's cancer charity, and NIHR Biomedical Research Centre, Royal Marsden NHS Foundation Trust/Institute of Cancer Research
Toward elimination of hepatitis A and B in Europe: vaccination successes, challenges, and opportunities
Get PDFHepatitis A; Hepatitis B; Vaccination recommendationsHepatitis A; Hepatitis B; Recomendaciones de vacunaciónHepatitis A; Hepatitis B; Recomanacions de vacunacióIntroduction: Hepatitis B and hepatitis A are vaccine-preventable infections of global concern. Hepatitis B virus (HBV) and hepatitis A virus (HAV) vaccines available in Europe are underutilized in some age groups. While most European countries implemented childhood HBV universal routine vaccination (URV), vaccination coverage among adults remains low. Low HAV vaccination coverage among high-risk populations due to variable national vaccination policies, low awareness of vaccination benefits, and other barriers, increases the risk for outbreaks.
Areas covered: We discuss the awareness of hepatitis B and hepatitis A burden in different populations in Europe, vaccination recommendations, successes, challenges, and opportunities for their implementation.
Expert opinion: Awareness of at-risk populations and HBV/HAV vaccination recommendations should be raised among healthcare providers and the general population to increase access to vaccination. Increasing awareness that HBV vaccination contributes to reduction in the incidence of hepatocellular carcinoma can motivate adults to get vaccinated. Adult HBV URV may be considered in Europe, as in the United States, pending cost-effectiveness assessment at national levels. HAV vaccination recommendations should be updated and expanded to all at-risk persons. National HBV/HAV targets and vaccination strategies should be actively promoted to accelerate the elimination of viral hepatitis in Europe.This manuscript was funded by GSK
Recurrent symptoms after achalasia treatment: The value of impedance analysis
Get PDFHeller's myotomy; Belching; Thoracic painMiotomia de Heller; Eructes; Dolor toràcicMiotomía de Heller; Eructos; Dolor torácic
Lentiviral-mediated panErbB CAR-T cell therapy against head and neck squamous cell carcinomas for patients with Fanconi anemia
Get PDFCAR-T cells; EGFR; ErbB receptorsCélulas CAR-T; EGFR; Receptores ErbBCèl·lules CAR-T; EGFR; Receptors ErbBFanconi anemia (FA) is a DNA repair syndrome characterized by bone marrow failure and cancer predisposition, including acute myeloid leukemia and solid tumors such as head and neck squamous cell carcinoma (HNSCC). Due to the exacerbated toxicity of radio-chemotherapy in FA patients with HNSCC, there is an urgent need of safer and more efficient antitumoral therapies for these patients, such as those based on chimeric antigen receptor (CAR)-T cells. Here, we show that HNSCC cell lines from both the general population and patients with FA express ErbB family members, which can be recognized by the T1E panErbB ligand. The generation of a lentiviral vector encoding for a second-generation T1E-CAR allowed us to generate panErbB CAR-T cells from healthy donors (HDs) and patients with FA. Despite the molecular and cellular defects characteristic of FA cells, a similar efficacy of CAR-T generation was observed, regardless of the donor origin. In all cases, panErbB CAR-T cells exerted potent cytotoxicity against all HNSCC cell lines tested in vitro. In addition, intratumoral administration of these CAR-T cells in HNSCC xenografts markedly reduced tumor growth. These preclinical results suggest that panErbB CAR-T cells would represent a safe, non-genotoxic therapy for HNSCC, with particular applicability for patients with FA.This work was supported by grants from “Red Española de Terapias Avanzadas RICORS/TERAV (RD21/0017/0027)”, “RICORS/TERAVplus (RD24/0014/0023)” from Instituto de Salud Carlos III (ISCIII), and by grants from the Spanish Government co-financed by Fondo Europeo de Desarrollo Regional (FEDER) PI21/00208 and CIBERONC no. CB16/12/00228 from the Instituto de Salud Carlos III (ISCIII); and a grant from Fundación Anemia de Fanconi to R.G.-E. The work has been conducted within the framework of an Agreement between Instituto de Salud Carlos III and CIEMAT for the creation of a Mixed Unit on Advanced Therapies (Resolution 27/1/2025)
Línies estratègiques de l'Estratègia d’atenció primària i comunitària 2021-2024
Get PDFSalutogènesi; Desmedicalització; ProfessionalitzacióSalutogénesis; Desmedicalización; ProfesionalizaciónSalutogenesis; Desmedicalization; ProfessionalizationLes línies estratègiques de l’Estratègia d’atenció primària i comunitària pel període 2021-2024 recullen les grans necessitats de l’atenció primària dels països socialment més avançats. Inclouen les recomanacions d’organitzacions internacionals, com ara l’OMS, pel que fa a donar una orientació més salutogènica als sistemes de salut, dotar l’atenció primària i comunitària d’una major capacitat resolutiva o vetllar pel benestar dels seus professionals.
Les línies estratègiques definides parteixen d'un conjunt de línies de treball prioritzades l'any 2019 per la Direcció Estratègica d’Atenció Primària i Comunitària i aprovades per la Comissió Departamental per a l’Impuls Estratègic en Atenció Primària i Salut Comunitària. Amb la definició d’aquestes línies es va voler que les iniciatives, projectes i plans iniciats pel Departament de Salut i pel Servei Català de la Salut estiguessin alineats amb les necessitats detectades pels professionals, proveïdors i d’altres actors relacionats amb l’atenció primària i comunitària de Catalunya i, d’aquesta manera, economitzar esforços, guanyar agilitat i capacitat per poder operativitzar al més ràpidament possible les iniciatives posades en marxa
Avaluació de la Programació per Motius a l’Atenció Primària i Comunitària
Get PDFAtenció primària i comunitària; Programació per motius; Gestió sanitàriaPrimary and Community Healthcare; Reason-based Scheduling; Healthcare ManagementAtención primaria y comunitaria; Programación por motivos; Gestión sanitariaAntecedents:
Atesa la necessitat de millorar la gestió de la demanda a l’atenció primària i comunitària (APiC), durant 2022 el Servei Català de la Salut (CatSalut) va desenvolupar i implementar una eina tecnològica anomenada “Programació per motius” (PxM) que té l’objectiu de permetre i facilitar una gestió de la demanda eficient, millorant l’accessibilitat i el procés de programació de l’APiC. La PxM és un algorisme de programació integrat a l’ECAP que, en base al motiu de consulta, ofereix la visita més adient quant a tipus de professional que l’ha de realitzar, modalitat i temps. El desplegament d’aquesta eina va començar el 2024 en 60 equips d’atenció primària (EAP) i, atès que el seu desplegament s’ha dut a terme a tots els equips i tenint en compte la transformació que pot suposar, calia disposar de dades per conèixer l’impacte de la seva implementació.
Hipòtesi i objectiu:
La hipòtesi general de treball va ser que la PxM millora l’accessibilitat, l’eficiència en la gestió de la demanda i la qualitat assistencial sense comprometre la longitudinalitat de l’atenció, i l’objectiu principal derivat va ser avaluar si la PxM contribueix a millorar l’accessibilitat i la longitudinalitat en els EA
De novo talin-1 variant L353F connects multifaceted clinical symptoms to alterations in talin-1 function
Get PDFFocal adhesion kinase; Missense mutation; PaxillinKinasa d'adhesió focal; Mutació de sentit erroni; Paxil·linaQuinasa de adhesión focal; Mutación de sentido erróneo; PaxilinaTalin-1 is a central integrin adapter protein connecting cytoplasmic domains of integrins to the cytoskeleton. These talin-1-mediated mechanical linkages are crucial for cellular functions such as cell movement and connections with other cells. Here, we report a patient carrying a missense variant, L353F, in the talin-1 head which is associated with a complex set of symptoms, including skin lesions, blood cell abnormalities, and congenital cataracts. We conducted structural and cellular characterization of this variant. Recombinant talin-1 F2F3 fragment with the corresponding mutation showed a decrease in thermal stability and decreased solubility. Reconstitution of talin-deficient cells with L353F talin-1 revealed decreased cell migration velocity, defects in wound healing capacity, and changes in recruitment of the focal adhesion complex protein paxillin. We also observed decreased levels of activated integrin in cells expressing the talin-1 variant, while integrin-binding affinity was preserved as determined biochemically. These observations suggest that changes in integrin adhesion complex dynamics reflect cellular processes and the multifaceted patient phenotype.We acknowledge the Research Council of Finland (331946, 363941 to VPH, 363616 to RR), Sigrid Jusélius Foundation, Cancer Foundation Finland, and Tampere University doctoral school for funding. We acknowledge Biocenter Finland for infrastructure support. BTG acknowledges Cancer Research UK Program Grant (DRCRPG-May21)
Higher ustekinumab concentrations in induction are associated with better endoscopic outcomes in inflammatory bowel disease
Get PDFEndoscopic remission; Inflammatory bowel disease; PharmacokineticsRemissió endoscòpica; Malaltia inflamatòria intestinal; FarmacocinèticaRemisión endoscópica; Enfermedad inflamatoria intestinal; FarmacocinéticaBackground:
Evidence suggests a relationship between ustekinumab (UST) concentrations and therapeutic outcomes in inflammatory bowel disease.
Objectives:
This study aimed to evaluate the association between UST concentrations during the induction phase and treatment outcomes at week 24 in patients with Crohn’s disease (CD) and ulcerative colitis (UC). The primary outcome was endoscopic remission at week 24, defined as a simple endoscopic score (SES-CD) ⩽2 for CD and a Mayo endoscopic score = 0 for UC. Secondary outcomes included endoscopic response, clinical remission, and treatment persistence.
Design:
This was a prospective observational study assessing clinical and endoscopic outcomes in CD and UC patients starting UST therapy.
Methods:
Consecutive patients with CD and UC were included at the initiation of UST treatment. Trough UST concentrations were measured at weeks 8, 16, and 24 after the first intravenous dose, and the main outcomes were assessed at week 24. Endoscopic and clinical parameters were used to evaluate treatment efficacy and persistence.
Results:
Seventy patients (45 with CD) were enrolled. Those achieving endoscopic remission and response at week 24 had higher UST levels at week 8 (4.5 vs 2.6 μg/mL, p = 0.0028; 4.1 vs 2.4 μg/mL, p = 0.0024, respectively). Patients with UST concentrations in the fourth quartile (Q4) at week 8 (>4.5 μg/mL) had higher rates of endoscopic remission (66.7% (Q4) vs 20% (Q1); 33.3% (Q2); 28.6% (Q3); p = 0.012). A UST concentration threshold of 4.5 μg/mL at week 8 was the best predictor of endoscopic remission (AUC = 0.7, sensitivity 54.5%, specificity 83.8%), while 3.5 μg/mL predicted endoscopic response (AUC = 0.732, sensitivity 53.8%, specificity 87%). Longer disease duration correlated with a higher risk of UST discontinuation (odds ratio, 1.034, 95% confidence interval, 1.002–1.068, p = 0.035). Higher UST concentrations in Q4 did not result in greater drug persistence (p = 0.319).
Conclusion:
UST concentrations at week 8 were positively associated with endoscopic outcomes at week 24, with a threshold of 4.5 μg/mL reliably predicting endoscopic remission. Further randomized clinical trials are warranted to explore whether optimizing UST treatment based on post-induction concentrations can enhance therapeutic outcomes