Artículos (Medicina Preventiva y Salud Pública)
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Artículo Loss of efficacy and safety of the switch from infliximab original to infliximab biosimilar (CT-P13) in patients with inflammatory bowel disease(Baishideng Publishing Group Inc, 2018-12-14) Guerra Veloz, María Fernanda; Argüelles Arias, Federico; Laria, Luisa Castro; Maldonado Pérez, Belén; Benítez Roldán, Antonio; Perea Amarillo, Raúl; Merino Bohórquez, Vicente; Calleja, Miguel Ángel; Caunedo Álvarez, Ángel; Vilches Arenas, Ángel; Universidad de Sevilla. Departamento de Medicina; Universidad de Sevilla. Departamento de Medicina Preventiva y Salud Pública; Universidad de Sevilla. Departamento de Farmacología; Universidad de Sevilla. CTS312: Análisis de la Demanda SanitariaBACKGROUND Infliximab original has changed the natural history of inflammatory bowel diseases (IBD) over the past two decades. However, the recent expiration of its patent has allowed the entry of the first Infliximab biosimilar into the European and Spanish markets. Currently switching drugs data in IBD are limited. AIM To compare the efficacy of infliximab biosimilar, CT-P13, against infliximab original, analyzing the loss of response of both at the 12 mo follow-up in patients with IBD. METHODS An observational study of two cohorts has been conducted. One retrospective cohort that included patients with IBD treated with Infliximab original, and a prospective cohort of patients who were switching from infliximab original to infliximab biosimilar (CT-P13). We had analyzed the overall efficacy and loss of efficacy in patients in remission at the end of one year after treatment with the original drug compared to the results of the year of treatment with the biosimilar. RESULTS 98 patients (CD 67, CU 31) were included in both cohorts. The overall efficacy for infliximab original per year of treatment was 71% vs 68.2% for infliximab biosimilar (P = 0.80). The loss of overall efficacy at 12 mo for infliximab original was 6.6% vs 14.5% for infliximab biosimilar (P = 0.806). The loss of efficacy in patients who were in basal remission was 16.3% for infliximab original vs 27.1% for infliximab biosimilar. Adverse events were 9.2% for infliximab original vs 11.2% for infliximab biosimilar. CONCLUSION The overall efficacy and loss of treatment response with infliximab biosimilar (CT-P13) is similar to that observed with infliximab original in patients who were switching at the 12 mo follow-up. There is no difference in the rate of adverse events.
Artículo Systematic review on the use of anticholinergic scales in elderly chronic patients(Elsevier, 2025-03) Díaz Acedo, Rocío; Villalba Moreno, Ángela María; Santos Ramos, Bernardo; Sánchez Fidalgo, Susana; Universidad de Sevilla. Departamento de Medicina Preventiva y Salud Pública; Instituto de Biomedicina de Sevilla (IBIS)Background: The rising prevalence of chronic conditions and polypharmacy in the elderly increases the risk of anticholinergic burden, the cumulative effect of multiple anticholinergic drugs. However, no standard exists for assessing anticholinergic burden in these patients, resulting in various anticholinergic scales with differing methodologies and outcomes. Objectives: To identify existing anticholinergic scales that are applicable to elderly chronic patients and to compare their main characteristics, included drugs and anticholinergic potential scores. In addition, we aim to analyse the previous validation of these scales. Methods: We conducted a systematic review (MEDLINE, EMBASE and Web of Science; PROSPERO ID CRD42024505226; October 2023) for studies on anticholinergic scales applicable to elderly patients with chronic conditions. We also examined the validation of these tools in predicting anticholinergic-related adverse outcomes. Inclusion criteria targeted studies on anticholinergic scales for patients aged ≥65 with chronic conditions, excluding those hospitalized or with specific diseases. Quality assessments utilized JBI tools and SQUIRE 2.0 standards. Results: From 1399 references, 18 anticholinergic scales development studies were included. Different scales varied in creation methodology, with some based on literature, review of previous scales or experimental data. The included studies are heterogeneous in terms of design and results of their quality analysis. For the second objective, 29 validation studies were considered, with mixed associations found between anticholinergic scales and health outcomes. Conclusions: Current anticholinergic scales and validation studies are diverse and show mixed and controversial results, with evidence often coming from retrospective or low-quality studies; indicating the necessity for future research to focus on developing a clinically applicable tool for accurately assessing anticholinergic burden in the elderly with chronic conditions.Artículo Computerized clinical decision support systems for prescribing in primary care: Characteristics and implementation impact. Scoping review and evidence and gap maps(Elsevier, 2025-01-30) Acosta García, Héctor; Ruano Ruiz, Juan; Gómez García, Francisco José; Sánchez Fidalgo, Susana; Santos Ramos, Bernardo; Molina López, Teresa; Universidad de Sevilla. Departamento de Medicina Preventiva y Salud PúblicaThis study aimed to conduct a scoping review and evidence and gap maps to characterize Clinical Decision Support Systems (CDSS) in primary care, evaluate their implementation and maintenance levels, and identify evidence gaps. Methods: A literature search covering January 2010 to May 2023 was conducted across various databases. Inclusion criteria encompassed studies involving real patients with detailed descriptions of CDSS, including both comparative and descriptive designs within primary care settings. Two independent reviewers screened the references, while four researchers independently extracted data, which included demographics, main findings, and system descriptions. The results were presented using interactive evidence and gap maps. Results: Among 1,447 initial citations, 75 studies met the selection criteria. The identified types of CDSS included adherence to guidelines/local protocols (45 %), antibiotic prescription (16 %), suitability (15 %), and others. Only one system was classified as "intelligent," while 39 % received a complexity rating of 4 on a scale from 1 to 5. Assessment of various outcomes across the studies revealed health outcomes (20 %), economy/resource use (13 %), potentially inappropriate prescription (61 %), adherence to local guidelines/protocols (12 %), and acceptance/use (40 %). Two maps were created: The first one displayed the type of CDSS linked to the type of results measured. The second one showed the type of CDSS and their most relevant characteristics. Data were represented in a dynamic bubble diagram. Conclusion: Current evidence regarding CDSS in primary care is limited and heterogeneous. The identified systems exhibit relative complexity but are not classified as intelligent, primarily focusing on improving prescribing practices through clinical guidelines or prescription aid tools. The outcomes most frequently assessed included potentially inappropriate prescriptions and acceptance/use. The evidence and gap maps provide a user-friendly format for visualizing existing evidence and identifying research gaps in the implementation of CDSS within primary care.Artículo Características sociodemográficas, clínicas y perfil de riesgo anticolinérgico en una residencia sociosanitaria pública: estudio descriptivo(Fundación Pharmaceutical Care España, 2024) Prado Mel, Elena; Rodríguez Ramallo, Hector; Villalba Moreno, Ángela María; García Cabrera, Emilio; Sánchez Fidalgo, Susana; Universidad de Sevilla. Departamento de Medicina Preventiva y Salud PúblicaObjetivo: analizar las características demográficas, clínicas y funcionales de personas residentes en un centro sociosanitario público. Caracterizar a la población en función del riesgo anticolinérgico según la escala DBI. Metodología: estudio observacional descriptivo de una cohorte de un centro sociosanitario público de Andalucía. Se llevó a cabo desde septiembre hasta diciembre de 2020.Se recogieron variables sociodemográficas, clínicas y funcionales, de farmacoterapia y carga anticolinérgica asociada según la escala DBI. Se realizó un análisis descriptivo general y un otro diferencial en función de la carga anticolinérgica. Resultados: se incluyeron 148 residentes (mediana 73 años [IQR: 15,25]). El 19,8% de la población era analfabeta. El 43,9% presentaba tabaquismo y el 22,3% consumía alcohol a diario. El 50,3% presentaban polifarmacia excesiva (≥10 medicamentos) y el 73,6%. de los pacientes presentaban riesgo anticolinérgico y/sedante según DBI (definido por presentar una puntuación DBI>0). Los principios activos con actividad anticolinérgica y/o sedante más frecuentemente prescritos fueron lorazepam, tramadol, tamsulosina y trazodona. El delirio y la ansiedad, junto con las infecciones de repetición del tracto urinario, fueron más prevalentes en el grupo de residentes que presentaban carga anticolinérgica (p<0,05). Conclusiones: la población del centro sociosanitario presenta un alto índice de analfabetismo, y elevada prevalencia de consumo de tabaco y alcohol. El índice de polimedicación es elevado, así como el porcentaje de pacientes con riesgo anticolinérgico asociado a la farmacoterapia. La ansiedad, el delirium y las ITUs de repetición fueron más prevalentes en la población con carga anticolinérgica. Estudios multicéntricos con mayor número de residentes serían necesarios para confirmar estos hallazgos.Artículo Medication adherence and persistence in heart failure: A protocol for a systematic review and meta-analysis(Sociedad Española de Farmacia Hospitalaria (SEFH), 2024-08-13) Baéz Gutiérrez, Nerea; Rodríguez Ramallo, Héctor; Sánchez Fidalgo, Susana; Universidad de Sevilla. Departamento de Medicina Preventiva y Salud PúblicaObjective To study medication adherence and persistence among heart failure patients, assess the methods utilised for estimating medication adherence, and identify optimal adherence thresholds and their impact on clinical outcomes. Methods A systematic search will be conducted in PubMed, Embase, CINAHL, Web of Science, and Scopus databases. Observational studies assessing medication adherence or persistence among heart failure patients via electronic healthcare databases will be included. A narrative synthesis will describe medication adherence and persistence reported and methods used to measure it. A meta-analysis will be attempted to evaluate the impact of secondary medication adherence (multiple and by drug class) on clinical outcomes, including hospitalisation, emergency visits, and mortality. The I2 statistic will be employed to study heterogeneity and the GRADE framework to evaluate evidence certainty. This protocol follows the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines and is registered with the Prospective Register of Ongoing Systematic Reviews CRD42024509542. Discussion This study aims to evaluate medication adherence and persistence in heart failure management through electronic health databases, intending to explore widely used measurement methods and their limitations, and to identify adherence thresholds associated with improved clinical outcomes. By examining these aspects, we anticipate proposing enhancements for future research and establishing desired adherence goals. This approach highlights the expected significance of our findings in advancing patient care and research methodologies.Artículo ¿Son los factores de riesgo cardiovascular un factor pronóstico desfavorable para los pacientes con covid-19?(Sociedade Galega de Medicina Interna, 2024-04) Luque Linero, Paula; Castilla Guerra, Luis; Arrobas Velilla, Teresa; Fernández Palacín, Ana; Carmona Nimo, Eduardo; Rico Corral, Miguel Ángel; Universidad de Sevilla. Departamento de Medicina Preventiva y Salud Pública; Universidad de Sevilla. Departamento de MedicinaObjetivo: Valorar si en nuestra población los factores de riesgo cardiovascular (FRCV) se correlacionan con la severidad de la COVID-19 en pacientes hospitalizados. Material y métodos: Estudio de cohortes retrospectivo de pacientes con COVID-19 ingresados en 2020 en un centro terciario del sur de España. Resultados: Se analizaron 608 pacientes con neumonía COVID-19. La mediana de edad fue de 73 años. El 55,8% fueron varones. La hipertensión arterial fue el FRCV más común (83,7%). Un total del 25,8% de los pacientes tuvieron un pronóstico desfavorable. En el análisis multivariante resultaron variables independientes para padecer un COVID severo: ser varón (OR: 1,697; IC 95%: 1,138-2,532), la edad avanzada (OR: 1,697; IC 95%: 1,138-2,532), y la obesidad (OR: 1,634; IC95%: 1,370-1,947). Conclusión: Los FRCV son muy prevalentes en los pacientes ingresados por COVID 19. La obesidad, edad avanzada y el género masculino se asocian con una mayor gravedad y mortalidad hospitalaria en los pacientes ingresados con SARS-CoV-2.Artículo Assessment of Osstell ISQs reliability for implant stability measurement: A cross-sectional clinical study(Medicina Oral S.L., 2013-11) Herrero Climent, Mariano; Santos García, Rocío; Jaramillo Santos, María Reyes; Romero Ruiz, Manuel María; Fernández Palacín, Ana; Lázaro Calvo, Pedro; Bullón Fernández, Pedro; Ríos-Santos, J.V.; Universidad de Sevilla. Departamento de Medicina Preventiva y Salud Pública; Universidad de Sevilla. Departamento de EstomatologíaResonance frequency analysis (RFA) allows assess implant stability by measuring implant oscillation frequency on the bone. RFA is an objective and non-invasive method for implant stability measurement, although scarce evidence has been provided so far on its reliability. Objectives: Assess the Osstell ISQ system’s reliability (i.e., its measurement reproducibility and repeatability) by means of the intraclass correlation coefficient (ICC) as statistical method. Study Desing: Implants stability registers were completed by means of Osstell ISQ on 85 implants on 23 patients. Six measurements were completed on each implant by means of two different SmartPegs (types I and II); that is, three consecutive measurements with each transducer. Results: Average ISQ was 72.40, 72.22 and 72.79, and 72.06, 72.59 and 72.82 in the first, second, and third measurements with SmartPegs I and II, respectively. Equal values or differences below three ISQ points were observed in 52.9% and 62.4% of the cases with SmartPegs I and II, respectively. The intraclass correlation coefficient was 0.97 for both SmartPegs, and repeatability and reproducibility also reached 0.97 for both SmartPegs. Conclusions: The RFA system Osstell ISQ presents almost perfect repeatability and reproducibility after intraclass correlation coefficient analysis. Osstell ISQ measurements are highly reliable regarding reproducibility. Therefore, one measurement proves enough.Artículo Differential clinical characteristics and prognosis of intraventricular conduction defects in patients with chronic heart failure(Wiley, 2013-03-19) Cinca, Juan; Méndez, Ana; Puig, Teresa; Ferrero, Andreu; Roig, Eulalia; Vázquez, Rafael; González Juanatey, José R.; Alonso-Pulpón, Luis; Delgado, Juan; Brugada Terradellas, Josep; Pascual Figal, Domingo; Fernández Palacín, Ana; Miñano Sánchez, Javier; Universidad de Sevilla. Departamento de Medicina Preventiva y Salud Pública; Universidad de Sevilla. Departamento de Farmacología, Pediatría y Radiología; European Commission (EC). Fondo Europeo de Desarrollo Regional (FEDER); Instituto de Salud Carlos IIIAims Intraventricular conduction defects (IVCDs) can impair prognosis of heart failure (HF), but their specific impact is not well established. This study aimed to analyse the clinical profile and outcomes of HF patients with LBBB, right bundle branch block (RBBB), left anterior fascicular block (LAFB), and no IVCDs. Methods and results Clinical variables and outcomes after a median follow-up of 21 months were analysed in 1762 patients with chronic HF and LBBB (n = 532), RBBB (n = 134), LAFB (n = 154), and no IVCDs (n = 942). LBBB was associated with more marked LV dilation, depressed LVEF, and mitral valve regurgitation. Patients with RBBB presented overt signs of congestive HF and depressed right ventricular motion. The LAFB group presented intermediate clinical characteristics, and patients with no IVCDs were more often women with less enlarged left ventricles and less depressed LVEF. Death occurred in 332 patients (interannual mortality = 10.8%): cardiovascular in 257, extravascular in 61, and of unknown origin in 14 patients. Cardiac death occurred in 230 (pump failure in 171 and sudden death in 59). An adjusted Cox model showed higher risk of cardiac death and pump failure death in the LBBB and RBBB than in the LAFB and the no IVCD groups. Conclusion LBBB and RBBB are associated with different clinical profiles and both are independent predictors of increased risk of cardiac death in patients with HF. A more favourable prognosis was observed in patients with LAFB and in those free of IVCDs. Further research in HF patients with RBBB is warranted.Artículo Compliance with voluntary nutritional labelling on alcoholic beverages in Spain(Academic Press Inc Elsevier Science, 2024-12) Padilla-Cruz, Jarileen; Sordo, Luis; Espelt, Albert; Caamaño-Isorna, Francisco; Pastor, Andrea; Donat, Marta; López de Miren, Alda; Valencia Martín, José Lorenzo; Galán, Iñaki; Universidad de Sevilla. Departamento de Medicina Preventiva y Salud PúblicaAccess to nutritional information is a fundamental consumers right, as it facilitates informed decision-making regarding dietary choices. However, excluding a recent directive concerning wine products, European Union regulations grant exemption to beverages with an alcohol content exceeding 1.2 % from the requirement of disclosing nutritional values. The purpose of this study was to evaluate the industrys compliance with voluntary commitments for nutritional labelling of alcoholic beverages in Spain. A cross-sectional study was conducted in the municipality of Madrid (Spain) during March and April 2023. Data on 627 alcoholic beverages were collected. We considered that a product label displayed complete nutritional data when it showed the energy value per 100 mL as well as the corresponding macronutrients (fats, carbohydrates, and proteins). Only 22.2 % of these products provided any nutritional information, with beers leading at 56.5 %, followed by spirits (26.5 %), vermouths and aperitifs (16.7 %), and wines and sparkling wines significantly fewer at 2.9 %. Only 2.4 % of the sampled beverages provided comprehensive nutritional information including energy and macronutrients. These findings highlight a failure to meet voluntary labelling commitments in Spain, with significant variations observed across sectors. The government should ensure consumersaccess to readily available and accurate information regarding the nutritional composition of alcoholic beverages.Artículo Incorporación de la prescripción electrónica en un distrito de atención primaria: implicaciones en el gasto farmacéutico y factores determinantes de su utilización(Ediciones doyma S A, 2013-03) Silvia Calzón; Juan José Mercader; Juan Carlos Montero; Carmen Sánchez Cantalejo; Valencia, R.; Universidad de Sevilla. Departamento de Medicina Preventiva y Salud PúblicaObjetivo Analizar las implicaciones del uso de receta electrónica sobre el gasto farmacéutico (GF) así como explorar factores determinantes de su utilización. Métodos Construcción de 2 modelos de regresión múltiple, tomando en uno de ellos como variable dependiente el GF y en el otro el porcentaje de prescripción mediante receta electrónica, incluyendo datos referidos a 9 centros de atención primaria de Andalucía. Resultados Cada incremento en un punto de prescripción por principio activo (PPA) se relacionó con una reducción media del GF de 2.079 €/año, mientras que cada incremento porcentual en el uso de receta electrónica se relacionó con un aumento de 1.027 € anuales. También se relacionaron con un mayor GF cada tarjeta ajustada por edad y tipo de farmacia (TAFE) asignada (36,71 €/año), la presión asistencial (2.585 €/año) y la frecuentación (2.17.148 €/año).Los factores que se relacionaron con un mayor uso de receta electrónica fueron un menor índice de ruralidad, una mayor distancia a la capital, una mayor PPA y una menor frecuentación. Conclusiones La prescripción mediante receta electrónica parece ser una variable predictora del gasto farmacéutico, relacionándose cada incremento porcentual con un incremento medio anual de 1.027 euros. Esta variable, junto con la prescripción mediante principio activo, el número de TAFE asignadas, la frecuentación y la presión asistencial media, contribuyen a explicar más del 65% de la variabilidad en el GF entre facultativos. El incremento del gasto relacionado con la receta electrónica parece producirse a expensas del aumento en el número de prescripciones por paciente.Artículo Prevalence and associated factors of depression among adults suffering from migraine in spain(Mdpi, 2023-11-24) Cebrino Cruz, Jesús; Portero de la Cruz, Silvia; Universidad de Sevilla. Departamento de Medicina Preventiva y Salud Pública; Universidad de Sevilla. RNM204: Ecología Reproductiva de PlantasConsidering the significance of migraine and the limited amount of research conducted on its association with depression in population-based studies in Spain, this study aimed to determine the prevalence and change of depression from 2017 to 2020 among adults with migraine in Spain and to analyze the sociodemographic and health-related variables linked to depression in migraine sufferers. A cross-sectional study on 5329 adults with migraine from the Spanish National Health Survey 2017 and the European Health Survey in Spain 2020 was performed. Binary logistic regression was used to examine the factors related to depression. A total of 26.32% of people with migraine suffered from depression. No significant changes in that prevalence between 2017 and 2020 were observed. The risk factors associated with depression included being between the ages of 25 and 44 (p = 0.018), being separated or divorced (p = 0.033), being unemployed (p < 0.001), not engaging in recreational physical activity (p = 0.016), perceiving one’s health as average, poor, or very poor (p < 0.001), experiencing moderate to severe pain in daily activities (p = 0.011, p = 0.004, p < 0.001, respectively), and having 1–2 or 3 chronic conditions (p = 0.003, p < 0.001, respectively). Conversely, being married (p = 0.001) and alcohol consumption (p = 0.007) were identified as protective factors.Artículo Factors related to depression in adults with oral health problems in Spain (2017 to 2020)(Frontiers Media S A, 2024-02-27) Cebrino Cruz, Jesús; Portero de la Cruz, Silvia; Universidad de Sevilla. Departamento de Medicina Preventiva y Salud Pública; Universidad de Sevilla. RNM204: Ecología Reproductiva de PlantasBackground: The need to study the link between gender, depression, and oral health is becoming increasingly evident. This study therefore aimed to determine the prevalence and evolution over time of depression among women and men with oral health problems and to evaluate the association between depression status, lifestyle-related variables health-related variables and use of dental health services in those people. Methods: We performed a nationwide cross-sectional study on 25,631 adults with oral health problems residing in Spain from the Spanish National Health Survey 2017 and the European Health Survey of Spain 2020, including as the main variable self-reported diagnosis of depression. We analysed independent variables such as lifestyle-related variables, health-related variables, and variables related to dental health services. Sociodemographic characteristics were considered as control variables. Results: The prevalence of depression among adults with oral health problems in Spain was 7.81% (10.14% for women, 5.39% for men), with a notable decrease from 2017 to 2020 in women. Depressed women had a slightly higher percentage of filled or capped teeth, and had more covers (crowns), bridges or other types of prostheses or dentures, while men had more caries. Women also made more frequent, regular dental visits for check-ups and mouth cleaning, whereas men often needed extractions. Unfavourable associated factors in both genders were: perceiving their health as good, average, poor, or very poor, and having 1–2 and ≥ 3 comorbidities. Conversely, not being a current smoker was related to less likelihood of depression. In women only, not engaging in leisure time physical activity produced more unfavourable associated factors. Conclusion: The prevalence of depression among adults with oral health problems in Spain from 2017 to 2020 was 7.81%, but this figure has been steadily decreasing over time. In addition, the favourable and unfavourable associated factors could help us inform health professionals and authorities in order to prevent depression and enhance the care of this population according to gender.Artículo Factores asociados a la mortalidad en pacientes hospitalizados por COVID-19 en España: datos del Registro Español de Resultados de Farmacoterapia frente a COVID-19 (RERFAR)(Sociedad Española de Farmacia Hospitalaria, 2022) Olry de Labry Lima, Antonio; Sáez de la Fuente, Javier; Abdel-Kader Martín, Laila; Alegre del Rey, Emilio Jesús; García Cabrera, Emilio; Sierra Sánchez, Jesús F.; Universidad de Sevilla. Departamento de Farmacia y Tecnología Farmacéutica; Universidad de Sevilla. Departamento de Medicina Preventiva y Salud PúblicaObjetivo: Determinar las características basales que se asocian a una mayor mortalidad a los 42 días en aquellos pacientes hospitalizados por COVID-19 en España. Método: Cohorte prospectiva de pacientes COVID-19 hospitalizados. La variable dependiente fue la mortalidad a los 42 días. Además, se recogieron características demográficas, clínicas, comorbilidades, tratamiento habitual, intervenciones de soporte y tratamientos en las primeras 48 horas del ingreso. Para determinar la asociación con la mortalidad, se realizó un análisis multivariante mediante regresión logística. Resultados: Se incluyeron 15.628 pacientes, de ellos falleció el 18,2% (n = 2.806). El análisis multivariante mostró que las variables asociadas significativamente (p < 0,05) con la mortalidad al ingreso fueron: proceder de un centro sociosanitario (odds ratio OR 1,9), frecuencia respiratoria (odds ratio 1,5), gravedad de neumonía (CURB-65) moderada (odds ratio 1,7) o alta (odds ratio 2,9), transaminasa aspartato aminotransferasa ≥ 100 UI/l (odds ratio 2,1), lactato-deshidrogenasa ≥ 360 UI/l (odds ratio 1,6), procalcitonina > 0,5 ng/ml (odds ratio 1,8), creatina- quinasa ≥ 294 U/l (odds ratio 1,5), dímero D > 3.000 ng/ml (odds ratio 1,5), hemoglobina < 11,6 g/dl (odds ratio 1,4) y proteína C reactiva > 120 mg/l (odds ratio 1,2), necesidad de soporte respiratorio en las primeras 48 horas (odds ratio 2,0 de oxigenoterapia; odds ratio 2,8 ventilación no invasiva y odds ratio 3,5 ventilación mecánica) y tratamiento con interferón-beta (odds ratio 1,5). Por el contrario, ser menor de 80 años se asoció a una menor mortalidad. Conclusiones: El análisis del Registro Español de Resultados de farmacoterapia frente a COVID-19 muestra que los factores asociados a peor pronóstico son: mayor edad, valoración mediante la escala CURB‑65, el nivel de requerimiento de soporte respiratorio, neumonía grave (CURB‑65), hipertransaminasemia, elevación de creatina-quinasa, lactato- deshidrogenasa, y dímero-D, anemia y elevación de la frecuencia respiratoria.Artículo Encuesta de satisfacción en pacientes externos de la atención farmacéutica mediante Telefarmacia durante la pandemia COVID-19 en España(Sociedad Española de Farmacia Hospitalaria, 2022) Mercadal Orfila, Gabriel; Lizeaga, Garbiñe; Fernández Llamazares, Cecilia M.; Tortajada Goitia, Begoña; García Cabrera, Emilio; Morillo Verdugo, Ramón Alejandro; Negro Vega, Eva; Universidad de Sevilla. Departamento de Farmacología; Universidad de Sevilla. Departamento de Medicina Preventiva y Salud PúblicaObjetivo: Describir los resultados de la encuesta sobre experiencia y atisfacción de la Telemedicina en pacientes externos relativo a un programa de atención farmacéutica a través de la Telefarmacia, realizado desde los servicios de farmacia durante la pandemia COVID-19 (encuesta ENOPEX) e identificar las diferencias entre las comunidades autónomas de España. Método: Se analizaron los resultados de la encuesta nacional ENOPEX sobre Telefarmacia en pacientes externos durante el confinamiento debido a la pandemia COVID-19, realizado en las diferentes comunidades autónomas de España. Se recogieron datos relativos a lugar de entrega, seguimiento farmacoterapéutico, opinión y satisfacción del paciente con la Telefarmacia, confidencialidad, desarrollo futuro de la atención farmacéutica a través de los servicios de Telefarmacia, y coordinación con el equipo de atención al paciente. Se realizaron cuatro regresiones multinivel para evaluar las diferencias entre comunidades autónomas sobre las variables más relevantes del estudio por medio del software R versión 4.0.3. Resultados: Un total de 8.079 entrevistas fueron válidas: el 52,8% eran mujeres, el 54,3% tenía entre 41-65 años, el 42,9% estaban en tratamiento prodesde hacía más de 5 años, el 42,8% vivía a 10-50 km del hospital y el 60,2% tardaba más de una hora en acudir al hospital. globalmente, el 85,7% recibieron medicación a domicilio, aunque hubo comunidades autónomas en las que se optó también por las oficinas de farmacia, como en Cantabria (95,8%), o los centros de atención primaria, como en Castilla‑La Mancha (16,5%). El 96,7% de los pacientes refirieron estar satisfechos o muy satisfechos con la Telemedicina en la atención farmacéutica mediante el uso de la Telefarmacia, detectándose variabilidad en cuanto a la opinión entre comunidades, desde la mejor opinión en Andalucía (odds ratio =1,58) y la menos favorable en Castilla y León (odds ratio = 0,66). Por su parte, Cataluña es la comunidad que estaría más claramente a favor de la Telemedicina en la atención farmacéutica de usar la Telefarmacia como actividad complementaria, con una odds ratio de 5,85 respecto al resto. Las ventajas más mencionadas de la Telemedicina fue que los servicios de Telefarmacia evitaban desplazamientos, especialmente en Cantabria (92,5%) y Extremadura (88,4%). Los pacientes mayoritariamente prefieren el acercamiento y entrega informada de la medicación a domicilio cuando no tienen que acudir al hospital, el 75,6% globalmente, desde el 50,1% de pacientes de Cantabria al 96,3% en Cataluña (p < 0,001). Las comunidades autónomas menos dispuestas a pagar por el servicio de Telefarmacia fueron Castilla y León y Galicia, y las que más, Cataluña y Navarra. Conclusiones: En líneas generales, los pacientes están satisfechos con la Telemedicina aplicada a la atención farmacéutica a través de los servicios de Telefarmacia durante la pandemia COVID-19, estando mayoritariamente a favor de mantenerla para evitar desplazamientos.Artículo Role of fibroblasts in chronic inflammatory signalling in chronic rhinosinusitis with nasal polyps-a systematic review(MDPI, 2023-05-04) Palacios-García, José María; Porras González, Cristina; Moreno-Luna, Ramón; Maza Solano, Juan Manuel; Polo Padillo, Juan; Muñoz-Bravo, José Luis; Sánchez Gómez, Serafín; Universidad de Sevilla. Departamento de Bioquímica Médica y Biología Molecular e Inmunología; Universidad de Sevilla. Departamento de Cirugía; Universidad de Sevilla. Departamento de Medicina Preventiva y Salud Pública; Consejeria de Salud y Familias; Consejeria de Transformacion Economica, Industria, Conocimiento y Universidades de la Junta de Andalucia; Universidad de Sevilla. CTS-312: Análisis de la demanda sanitariaChronic rhinosinusitis with nasal polyps (CRSwNP) is an inflammatory disease of the nose and paranasal sinuses characterized by the presence of nasal polyps. The symptoms produced by the presence of nasal polyps such as nasal obstruction, nasal discharge, facial pain, headache, and loss of smell cause a worsening in the quality of life of patients. The source of the nasal polyps remains unclear, although it seems to be due to a chronic inflammation process in the sinonasal mucosa. Fibroblasts, the main cells in connective tissue, are intimately involved in the inflammation processes of various diseases; to this end, we carried out a systematic review to evaluate their inflammatory role in nasal polyps. Thus, we evaluated the main cytokines produced by nasal polyp-derived fibroblasts (NPDF) to assess their involvement in the production of nasal polyps and their involvement in different inflammatory pathways. The results of the review highlight the inflammatory role of NPDF through the secretion of various cytokines involved in the T1, T2, and T3 inflammatory pathways, as well as the ability of NPDF to be stimulated by a multitude of substances. With these findings, the fibroblast is positioned as a new potential therapeutic target in the treatment of CRSwNP.Artículo Lipophilic Bioactive Compounds Transported in Triglyceride-Rich Lipoproteins Modulate Microglial Inflammatory Response(MDPI, 2022-07-12) Espinosa, Juan Manuel; Castellano, José María; García Rodríguez, Silvia; Quintero Flórez, Angélica; Carrasquilla, Natalia; Perona, Javier S.; Universidad de Sevilla. Departamento de Medicina Preventiva y Salud PúblicaMicroglial cells can contribute to Alzheimer’s disease by triggering an inflammatory response that leads to neuronal death. In addition, the presence of amyloid-β in the brain is consistent with alterations in the blood–brain barrier integrity and triglyceride-rich lipoproteins (TRL) permeation. In the present work, we used lab-made TRL as carriers of lipophilic bioactive compounds that are commonly present in dietary oils, namely oleanolic acid (OA), α-tocopherol (AT) and β-sitosterol (BS), to assess their ability to modulate the inflammatory response of microglial BV-2 cells. We show that treatment with lab-made TRL increases the release and gene-expression of IL-1β, IL-6, and TNF-α, as well as NO and iNOS in microglia. On the other hand, TRL revealed bioactive compounds α-tocopherol and β-sitosterol as suitable carriers for oleanolic acid. The inclusion of these biomolecules in TRL reduced the release of proinflammatory cytokines. The inclusion of these biomolecules in TRL reduced the release of proinflammatory cytokines. AT reduced IL-6 release by 72%, OA reduced TNF-α release by approximately 50%, and all three biomolecules together (M) reduced IL-1β release by 35% and TNF-α release by more than 70%. In addition, NO generation was reduced, with the inclusion of OA by 45%, BS by 80% and the presence of M by 88%. Finally, a recovery of the basal glutathione content was observed with the inclusion of OA and M in the TRL. Our results open the way to exploiting the n601124427 euro-pharmacological potential of these lipophilic bioactive compounds through their delivery to the brain as part of TRL.Artículo Bioactive compounds in pomace olive oil modulate the inflammatory response elicited by postprandial triglyceride-rich lipoproteins in BV-2 cells(Royal Society of Chemistry, 2023-09-04) Espinosa, Juan Manuel; Quintero Flórez, Angélica; Carrasquilla, Natalia; Montero, Emilio; Rodríguez Rodríguez, Ana; Castellano, José María; Perona, Javier S.; Universidad de Sevilla. Departamento de Medicina Preventiva y Salud PúblicaModulation of microglial response could be a target to reduce neuroinflammation associated with Alzheimer's disease. In this study, we propose that lipophilic bioactive molecules present in pomace olive oil (POO), transported in triglyceride-rich lipoproteins (TRLs), are able to modulate microglial high-oleic sunflower oil (HOSO, points) or pomace olive oil (POO, stripes). In order to prove this hypothesis, a randomized crossover postprandial trial was performed in 18 healthy young women. POO was assayed in opposition to high-oleic sunflower oil (HOSO), a common dietary oil which shares with POO an almost identical fatty acid composition but lacks certain biomolecules with recognized antioxidant and anti-inflammatory activities. TRLs were isolated from blood at the baseline and 2 and 4 hours postprandially and used to treat BV-2 cells to assess their ability to modulate the microglial function. We found that the intake of POO leads to the constitution of postprandial TRLs that are able to modulate the inflammatory response in microglia compared to HOSO. TRL-derived POO reduced the release of pro-inflammatory cytokines (tumor necrosis factor-α, and interleukins 1β and 6) and nitric oxide and downregulated genes codifying for these cytokines and inducible nitric oxide synthase (iNOS) in BV-2 cells. Moreover, the ingestion of POO by healthy women slightly improved glycemic control and TRL clearance throughout the postprandial phase compared to HOSO. In conclusion, we demonstrated that consuming POO results in postprandial TRLs containing lipophilic bioactive compounds capable of regulating the inflammatory response prompted by microglial activation.Artículo Population-Based Study on the Implementation of Flash Glucose Monitoring and Severe Hypoglycemia in Adults With Type 1 Diabetes(Mary Ann Liebert, Inc., 2024-12) Rodríguez de Vera, Pablo; Mayoral Sánchez, Eduardo; Vilches Arenas, Ángel; Ravé García, Reyes; De la Cal Ramírez, Manuel; Umpierrez, Guillermo; Martínez Brocca, María Asunción; Universidad de Sevilla. Departamento de Medicina Preventiva y Salud Pública; Universidad de Sevilla. Departamento de Medicina; Sociedad Española de Diabetes (SED); Universidad de Sevilla. CTS312: Análisis de la Demanda SanitariaObjective: We analyzed the effect of implementing a flash glucose monitoring (FGM) technology in a public health care system with universal coverage on the rate of severe hypoglycemia requiring urgent care in adults with type 1 diabetes mellitus (T1DM). Methods: Using a comprehensive regional dataset, we extracted emergency care codes with hypoglycemia in individuals with T1DM who initiated the use of FGM in Andalucia, Spain, from January 1, 2020, to December 31, 2021. Severe hypoglycemia was defined as a confirmed blood glucose <70 mg/dL, which required the urgent dispatch of an emergency medical service (EMS) for onsite management. We compared hypoglycemic events reported in the 12 months before and after the initiation of FGM to determine the population incidence rates. Results: A total of 13,616 participants with a mean age of 43.7 ± 13.5 years were included. The follow-up periods were 23.4 and 24.8 months before and after FGM. There were 969 and 737 cases of hypoglycemia before and after the initiation of FGM. The baseline incidence rate was 358.58 episodes per 10,000 person-years, which decreased to 260.9 at the end of the follow-up (rate-ratio 0.72 [0.66; 0.80]). The reduction in hypoglycemia was significant in individuals aged ≥60 years (rate-ratio 0.40 [0.28; 0.55]) and males (0.64 [0.56; 0.72]). In addition, there was a reduction in the overall median HbA1c of −0.35% (95% CI [−0.38; −0.33], P < 0.001). Conclusion: The implementation of FGM systems in a public health care system as a provision for adults with T1DM was associated with significant reductions in the rate of severe hypoglycemic events that required urgent EMS care.Artículo Next-generation sequencing of uveal melanoma with clinical and histological correlations: Prognostic value of new mutations in the PI3K/AKT/mTOR pathway(Wiley, 2023-10) Pérez Pérez, Manuel; Agostino, Alessandro; García de Sola Llamas, Carmen; Ruvolo, Michael; Vilches Arenas, Ángel; Relimpio López, Isabel; Macías García, Laura; Miguel Rodríguez, Manuel de; Idoate Gastearena, Miguel Ángel; Ríos Martín, Juan José; Universidad de Sevilla. Departamento de Medicina Preventiva y Salud Pública; Universidad de Sevilla. Departamento de Citología e Histología Normal y Patológica; Universidad de Sevilla. CTS312: Análisis de la Demanda Sanitaria; Universidad de Sevilla. CTS949: Biopatología y Estrés OxidativoBackground: Uveal melanoma (UM) is the eye's most common primary malignancy and there are no effective therapies for disseminated disease. It is important to try to know the patient's prognosis. The aim of this study was to reflect genetic variants, studied using NGS, of a series of 69 cases of UM and its correlation with histopathology and clinical progression. Methods: We performed targeted NGS using a 519-gene panel. Results: There were selected 28 different mutated genes, showing a total of 231 genetic variants that affected the function of the protein. The most common secondary mutations occurred in SF3B1 (in 26%), followed by BAP1 (in 23%), LRP1B (22%) and FGFR4 (20%). BAP1 mutation was associated with a greater likelihood of metastases and with greater presence of epithelioid cells. LRP1B was also associated with presence of epithelioid cells SF3B1 mutation was significantly associated with a spindle morphology. We found variants in the RAD51B, TOP2A, PTPRD, TSC2, DHX9, PDK1 and MTOR that have not been previously reported in consulted databases. The presence of a mutation in: CHEK2, DHX9 and PDK1 was associated with metastases. Conclusions: BAP1 is the most solid biomarker of a poor prognosis in UM and mutations can be detected using NGS. SF3B1 is associated with the spindle cell subtype of UM, which gives it probably a favourable prognostic value. Our study suggests that mutations in DHX9 and PDK1 can have prognostic value. These potential biomarkers are related to the PI3K/AKT/mTOR pathway and makes them candidates for developing new directed therapies.Artículo Three double-dose reinforced hepatitis B revaccination scheme for patients with cirrhosis unresponsive to the standard regimen: an open-label randomised clinical trial(BMJ Publishing Group, 2023-03-24) Giráldez Gallego, Álvaro; Rodríguez Seguel, Elisa del Pilar; Valencia, R.; Morillo García, Áurea; Salamanca Rivera, Celia; Ruiz Pérez, Ricardo; Praena Fernández, Juan Manuel; Cuaresma Duque, María; Ferrer Ríos, María Teresa; Sousa Martín, José Manuel; Gasch Illescas, Antonia; Ampuero Herrojo, Javier; Pascasio Acevedo, Juan Manuel; Universidad de Sevilla. Departamento de Biología Celular; Universidad de Sevilla. Departamento de Medicina Preventiva y Salud Pública; Universidad de Sevilla. Departamento de Medicina; Instituto de Salud Carlos IIIObjective We aimed to compare the response rates between two different hepatitis B virus vaccination schedules for cirrhotic subjects who were non-responders to the first three 40 µg doses (month 0-1-2), and identify factors associated with the final response. Design A total of 120 cirrhotic patients (72.5% decompensated) were randomised at a 1:1 ratio to receive a single 40 µg booster vaccination at month 6 (classical arm) versus an additional round of three new 40 µg doses administered at monthly intervals (experimental arm). The main outcome was the rate of postvaccinal anti-hepatitis B surface antibodies levels ≥10 mIU/mL. Results Efficacy by ITT analysis was higher in the experimental arm (46.7%) than in the classical one (25%); OR 2.63, p=0.013. The experimental arm increased response rates compared with the classical one from 31% to 68% (OR 4.72; p=0.007), from 24.4% to 50% (OR 3.09; p=0.012) and from 24.4% to 53.8% (OR 3.62; p=0.007), in Child A, Model for End-Stage Liver Disease (MELD) <15 and MELD-Na<15 patients, respectively. Patients with more advanced liver disease did not benefit from the reinforced scheme. Both regimens showed similar safety profiles. Multivariable analysis showed that the experimental treatment was independently response associated when adjusted across three logistic regression models indicating equivalent cirrhosis severity. Conclusion For cirrhotic patients, the revaccination of non-responders to the first three dose cycle, with three additional 40 µg doses, achieved significantly better response rates to those obtained with an isolated 40 µg booster dose.