Recently, the description of two cases of IgA lymphoplasmacytic lymphoma B with MYD88L265P mutation has been published in the journal HISTOPATHOLOGY (FI 3,294, JCR). In this work, in which medical researchers from the IDIVAL Emerging Group of Translational Hematopathology and doctors from the Pathology and Hematology Department of the HUMV have participated, two extremely unusual cases of IgA-type lymphoplasmacytic B lymphoma have been described (which represent 7% of cases of lymphoplasmacytic B lymphoma diagnosed and treated in our center in the last 5 years).
The conclusion of the study is that the identification of the MYD88L265P mutation in these cases, together with its histopathological and phenotypic characteristics, support its inclusion within the spectrum of lymphoplasmacytic B lymphoma. This is relevant given that the efficacy of new therapeutic options for patients with lymphoplasmacytic B lymphoma has recently been demonstrated.
Recently, the description of two cases of IgA lymphoplasmacytic lymphoma B with MYD88L265P mutation has been published in the journal HISTOPATHOLOGY (FI 3,294, JCR). In this work, in which medical researchers from the IDIVAL Emerging Group of Translational Hematopathology and doctors from the Pathology and Hematology Department of the HUMV have participated, two extremely unusual […]
Researchers of the SPANISH SLEEP GROUP belonging to IDIVAL and who carry out their clinical and research activity in the Sleep and Ventilation Unit of our hospital have just published a new paper belonging to the cohort of the SAHS study and women.
This multicenter study, which has been funded by the Carlos III Health Institute, has focused on this population group and has made it possible to suppress the lack of scientific evidence in relation to the effects of CPAP in women with sleep apnea.
Previous publications of the same cohort revealed how after 12 weeks of treatment with CPAP significantly improve aspects of quality of life, mood, daytime sleepiness, anxiety and symptoms of depression
This new publication is the first randomized controlled study that investigates the effect of CPAP on inflammatory, antioxidant and biomarkers related to depression in the female population. After 3 months of treatment no differences were found in any of the controlled markers, however, in women with treatment compliance> 5 hours / night the TNFα levels decreased compared to those in the control group. Since CPAP showed a strong clinical benefit in the same cohort of patients, it is possible that other intermediate pathways not measured in this study play an important role in the efficacy of treatment in women with SAHS.
Reference: Effect of continuous positive airway pressure on inflammatory, antioxidant, and depression biomarkers in women with obstructive sleep apnea: a randomized controlled trial.
Campos-Rodriguez F, Asensio-Cruz MI, Cordero-Guevara J, Jurado-Gamez B, Carmona-Bernal C, Gonzalez-Martinez M, Troncoso MF, Sanchez-Lopez V, Arellano-Orden E, Garcia-Sanchez MI, Martinez-Garcia MA; Spanish Sleep Network .
Sleep. 2019 Jun 29. pii: zsz145. doi: 10.1093/sleep/zsz145
Researchers of the SPANISH SLEEP GROUP belonging to IDIVAL and who carry out their clinical and research activity in the Sleep and Ventilation Unit of our hospital have just published a new paper belonging to the cohort of the SAHS study and women. This multicenter study, which has been funded by the Carlos III Health […]
Currently the same therapeutic management is recommended in all acute infections of joint prostheses, both in late acute infection (patient with normal function of the prosthesis after 3 months of implantation and with onset of symptoms of <3 weeks duration) and in early acute infection (acute onset of symptoms <3 weeks in the first 3 months after implantation of the prosthesis). The treatment would consist of surgical debridement, antibiotic therapy and implant retention (DAIR). However, this therapeutic approach seems to be changing.
Researchers belonging to the group of Epidemiology and Pathogenic and Molecular Mechanisms of Infectious Diseases and Clinical Microbiology in collaboration with the European Study Group for Implant Associated Infections (ESGIAI) have recently demonstrated that implant failure is higher in cases of late acute infection treated with DAIR and implant retention, especially when the causative agent of the infection is S. aureus with failure rates that reach 50% (10.1016 / j.jinf.2018.07.014). Along the same lines, a retrospective multicenter study conducted by the same research group has just been published in the Journal of Infection (DOI: 10.1016 / j.jinf.2019.07.003) where they describe a preoperative risk score (CRIME80) for Identify patients at high risk of implant failure in the case of being treated with DAIR. The results of this study suggest a replacement of the joint prosthesis in those patients with a CRIME80-score ≥ 3, in infections caused by S. aureus in particular when the mobile component of the prosthesis has not been replaced and in those cases where It is possible to use an antibiotic regimen with rifampin.
Currently the same therapeutic management is recommended in all acute infections of joint prostheses, both in late acute infection (patient with normal function of the prosthesis after 3 months of implantation and with onset of symptoms of
Headache is the most frequent neurological reason for medical consultation at all levels of care. In our country there are few Specialized Units in Headache; The majority of patients sent by headache from Primary Care are treated in general neurology consultations. There are very few data in the literature that have analyzed whether medical care of the patient with headache in Specialized Units in Headache adds value to the care in CG. In this work, we evaluated the quality of care of 313 anonymous patients with headache in Specialized Units in Headache versus general neurology consultations based on 13 indicators that we had agreed on 8 headache experts after an exhaustive review of the literature.
Overall, the Specialized Headache Units showed a better score in the indicators than the traditional general neurology consultations, which translated into practice, for example, in a lower need to go to the Emergency Department (half), in a lower repetition rate of neuroimaging tests due to headache (7 times lower) and in a smaller proportion of adverse effects. All this involved greater patient satisfaction although the Specialized Units in Headache treated more complex patients.
In summary, in general, the Units Specialized in Headache generate greater value for the patient than general neurology consultations. Given the high demand for headaches, future studies will be necessary in which it is clarified what type of patients benefit most from care in Specialized Units in Headache.
Reference: Patricia Pozo-Rosich, Alba Martínez-García, Julio Pascual, Emilio Ignacio, Angel L Guerroero-Peral, Jose´Balseiro-Gómez, Germán Latorre-González, Almidena Layos-Romero, César Lucas, José J Mira. Quality assurance in specialized headache units in Spain: an observational prospective study. Journal of Headache and Pain 2019.
Headache is the most frequent neurological reason for medical consultation at all levels of care. In our country there are few Specialized Units in Headache; The majority of patients sent by headache from Primary Care are treated in general neurology consultations. There are very few data in the literature that have analyzed whether medical care […]
Liver disease due to fat deposition is an emerging entity in liver pathology. The most frequent causes are alcohol consumption and / or obesity / metabolic syndrome among others (drug toxicity, autoimmune diseases etc).
Dr. Cabezas with the support of Dr. Crespo, Head of the Digestive System Service and thanks to the support of the Spanish Association for the Study of the Liver, through the 2015 Juan Rodes Scholarship, was able to enjoy a one-year stay in the United States under the tutelage of Dr. Ramón Bataller at the University of North Carolina at Chapel Hill. Currently, Dr. Bataller is the head of Hepatology at Pittsburgh Liver Research Center.
Dr. Bataller focuses his line of research on alcoholic liver disease, specifically Alcoholic Hepatitis, the most advanced expression of alcoholic liver disease with high mortality. To do this, within the collaborative grant (1U01AA021908-01, MOLECULAR SUBTYPES FOR TARGETED THERAPIES IN ALCOHOLIC HEPATITIS) has allowed multidisciplinary and cross-sectional research on alcoholic hepatitis. Among his collaborators, in this work (1), Prof. Wajahat Mehal of Yale University stands out.
Alcoholic liver disease at its best, called Alcoholic Hepatitis, determines its progression by liver inflammation from fat accumulation and direct damage / through inflammatory mediators – what we call steatohepatitis. This “sterile” inflammation, since it is not caused by microorganisms, is induced by liver damage and is maintained by transcription factors such as HIF-1alpha induced by oxidative stress. Digoxin, in addition to its known cardiological effect, is known as an inhibitor of this transcription factor, but its hepatic effect had not been evaluated.
The digoxin through PKM2 (Isoform 2 of pyruvate kinase) to which it binds, and inhibits the transcription capacity of HIF-1alpha. And this function is carried out through epigenetic mechanisms such as chromatin remodeling. Therefore, it is shown that PKM2 can be a therapeutic target to treat steatohepatitis.
Going further in the research of Dr. Bataller's group, Dr. Cabezas was part of the first results of deep sequencing of total RNA from liver tissue samples in patients with alcoholic hepatitis. As a result of this collaboration, a manuscript was recently published in Nature Communications (2) that shows the role of hepatic transcription factors, highlighting HNF4A. This is a complete work that uses the latest techniques of high throughput data and bioinformatic analysis to determine the role of HNF4A, specifically the P2 subunit and its metabolic implications in hepatocyte, mediated by TGFbeta of patients with alcoholic hepatitis. On the other hand, in addition, epigenetic studies (methylation and chromatin remodeling) were performed using the aforementioned techniques supported by the Jelena Mann Laboratory in New Castle and Vijay Shah of the Mayo Clinic in Rochester. To confirm the findings generated by the bioinformatics techniques, we had the collaboration of Dr. Ávila del CIMA, Pamplona. The part of the study for the SNP analysis was supported by the group of Mark Thursz of the King College London, lead author of the STOPHA trial publishing in the New England Journal of Medicine on the treatment of alcoholic hepatitis.
This work opens the door for the treatment of alcoholic hepatitis with targets that focus on the modification of transcription factors and epigenetic changes that allow recovering the function of hepatocytes mediated by HNF4A.
Dr. Cabezas during his stay in the Laboratory of Dr. Bataller had the opportunity to carry out another series of works and collaborations described below:
References
Liver disease due to fat deposition is an emerging entity in liver pathology. The most frequent causes are alcohol consumption and / or obesity / metabolic syndrome among others (drug toxicity, autoimmune diseases etc). Dr. Cabezas with the support of Dr. Crespo, Head of the Digestive System Service and thanks to the support of the […]
Cancer is an important source of stress for those who suffer from it, generating in many cases symptoms of anxiety or depression, what we generically know as emotional distress or psychological distress. Detecting those patients who have a higher risk of developing emotional distress, in order to be able to perform the appropriate psychological interventions, is a challenge that can lead to significant improvements in the quality of life.
In order to study the factors that increase the risk of developing anxious and depressive symptoms, a study entitled “Cognitive factors related to distress in patients recently diagnosed with cancer” has been carried out. This study, conducted at the Marqués de Valdecilla University Hospital and published in the journal Psycho-Oncology, has been led by Dr. Amador Priede, a clinical psychologist at Laredo Hospital, together with Dr. César González-Blanch of the Marqués University Hospital de Valdecilla, IDIVAL collaborating researchers. The objective of the study was to analyze the association of two cognitive factors, the rumination – tendency to have repetitive thoughts, focused on oneself, on negative experiences – and the suppression of thoughts – the tendency to deliberately eliminate unwanted thoughts -, with the presence of emotional distress – symptoms of anxiety and depression – in patients with a recent diagnosis of cancer.
The results of the study indicate that a greater tendency towards ruminant thoughts is associated with higher levels of anxiety and depression symptoms, even after controlling the effects of other variables. The suppression of thoughts, on the other hand, plays a less important role in the appearance of these symptoms.
These results highlight the importance of evaluating rumination in newly diagnosed cancer patients, in order to carry out precise psychological interventions, and thus achieve better psychological health of people suffering from cancer.
Cancer is an important source of stress for those who suffer from it, generating in many cases symptoms of anxiety or depression, what we generically know as emotional distress or psychological distress. Detecting those patients who have a higher risk of developing emotional distress, in order to be able to perform the appropriate psychological interventions, […]
Researchers from the Group of Epidemiology and Pathogenic and Molecular Mechanisms of Infectious Diseases and Clinical Microbiology of IDIVAL have participated in a study where the lethality of Pseudomonas aeruginosa was evaluated in bloodstream infections using an animal model.
P. aeruginosa bacteria is an important cause of serious hospital infections, especially in immunocompromised patients or with chronic respiratory infections such as cystic fibrosis or other underlying chronic diseases. In recent years, infections caused by strains of P. aeruginosa resistant to multiple drugs (MDR) or extremely resistant (XDR) have severely compromised the selection of appropriate antibiotic treatments, all this is joined by the fact that P. aeruginosa has powerful toxins that this bacterium uses as virulence factors that it injects into host cells, all of which is associated with significant morbidity and mortality. Even more worrying are recent reports that have provided evidence of the existence of MDR / XDR clones of P. aeruginosa disseminated by hospitals worldwide, called high-risk epidemic clones.
In this prospective Spanish multicenter study published in the journal Clinical Microbiology and Infection (DOI: 10.1016 / j.cmi.2019.06.034) in this month of July, about 600 isolates of P. aeruginosa from patients have been analyzed with bacteraemias caused by this important human pathogen. This is the first study where the impact of the degree of virulence on the outcome of P. aeruginosa infections has been studied, using a virulence score in the C. elegans infection model (CEVS), classifying the isolates into high (CEVS) 4-5), intermediate (CEVS 3) and low virulence (CEVS 1-2), to assess the predictive value of lethality of C. elegans as a prognostic marker in P. aeruginosa bloodstream infections.
In this study it was observed that strains that show a high virulence phenotype tend to be associated with community acquired infections, while low virulence phenotypes tend to be associated with a greater severity of the disease, with some underlying conditions and with the respiratory source of infections. However, analysis of this large multicenter cohort revealed that bacterial virulence itself was not one of the leading causes of P. aeruginosa mortality in bloodstream infections. In summary, the results of this study indicated that the P. aeruginosa virulence phenotype in the C. elegans model correlates with the virulence genotype and resistance profile, but is a marker of poor prognosis in bloodstream infections.
Reference: Sánchez-Diener I, Zamorano L, Peña C, Ocampo-Sosa A, Cabot G, Gómez-Zorrilla S, Admiral B, Aguilar M, Granados A, Calbo E, JR Bath, Rodríguez-López F, Tubau F, Martínez -Martinez L, Navas A, Oliver A. Weighting the impact of virulence on the outcome of Pseudomonas aeruginosa bloodstream infections. Clin Microbiol Infect. 2019 Jul 6. pii: S1198-743X (19) 30389-1. doi: 10.1016 / j.cmi.2019.06.034.
Researchers from the Group of Epidemiology and Pathogenic and Molecular Mechanisms of Infectious Diseases and Clinical Microbiology of IDIVAL have participated in a study where the lethality of Pseudomonas aeruginosa was evaluated in bloodstream infections using an animal model. P. aeruginosa bacteria is an important cause of serious hospital infections, especially in immunocompromised patients or […]
In 2018, the World Health Organization (WHO) estimated that 71% of deaths in the world were due to chronic diseases, and this situation was expected to worsen. In this context, the IDIVAL Nursing Group led by Professor Carmen Sarabia, a nurse from the University Nursing School of the University of Cantabria, has recently published a systematic review with meta-analysis aimed to determine the characteristics of interventions conducted by nurses who try to improve the quality of life related to the health of people over 18 with chronic diseases.
The review summarizes 24 studies conducted in 10 countries, which assessed health-related quality of life through the validated “Short-Form Health Survey” (SF). These studies provided a sample of 4324 chronic patients of 63.4 years.
When comparing all the results of the different studies, only a slight improvement was found in the mental health component of health-related quality of life. The interventions that produced the most impact were those that were based on a theory, were shorter and had a follow-up period.
In conclusion, nurses perform multiple interventions intended for people with chronic diseases worldwide, in which the evaluation of HRQL is common. These interventions are too heterogeneous and, although they produced a general improvement in health-related quality of life, it was small.
One of the obstacles to nursing visibility is that, in many contexts, it is not recognized as a rigorous scientific discipline. For this reason, we believe that reviews like this help make the contribution of nurses measurable and visible.
Reference: Amo-Setién FJ, Abajas-Bustillo R, Torres-Manrique B, Martín-Melón R, Sarabia-Cobo C, Molina-Mula J, Ortego-Mate C. Characteristics of nursing interventions that improve the quality of life of people with chronic diseases A systematic review with meta-analysis. PLoS One. 2019 Jun 24; 14 (6): e0218903. doi: 10.1371 / journal.pone.0218903. eCollection 2019. PubMed PMID: 31233569
In 2018, the World Health Organization (WHO) estimated that 71% of deaths in the world were due to chronic diseases, and this situation was expected to worsen. In this context, the IDIVAL Nursing Group led by Professor Carmen Sarabia, a nurse from the University Nursing School of the University of Cantabria, has recently published a […]
Plitidepsin (Aplidine) is a compound originally isolated from a marine tunicate (Aplidium Albicans) that demonstrated activity against Multiple Myeloma (MM) in preclinical studies conducted in our country by Dr. Enrique Ocio in collaboration with the Dana Farber Cancer Institute (Boston, MA).
Aplidine binds to a protein that is overexpressed in MM, eEF1A2 (eukaryotic translation elongation factor 1 alpha 2), inducing oxidative stress, activation of JNK and p38MAPK and, finally, apoptosis. These studies laid the foundations for their clinical development, with an initial study coordinated by the Spanish MM group, which showed responses in patients with this disease.
The Spanish leadership in the development of Aplidina is shown in the randomized phase III ADMYRE study reported in this publication. In this study, which has been carried out in 17 countries around the world, 255 patients with relapsed Multiple Myeloma who had received between 3 and 6 previous lines of treatment were randomized to receive Aplidine and Dexamethasone or Dexamethasone at low doses. The study was attended by Dr. Enrique Ocio, current head of the Hematology Service of the Marqués de Valdecilla University Hospital with a long research career in multiple myeloma. The study achieved its primary objective, since the median progression-free survival in patients receiving Aplidine doubled that observed with dexamethasone: 3.8 months versus 1.9 months (HR = 0.611; p = 0.0040. The toxicity profile was acceptable and similar of other similar drugs evaluated in a similar population of patients.
These data, in a drug with an alternative mechanism of action to those currently approved, support the use of Aplidine as a therapeutic alternative for patients with relapsed MM after at least three previous treatment lines.
Plitidepsin (Aplidine) is a compound originally isolated from a marine tunicate (Aplidium Albicans) that demonstrated activity against Multiple Myeloma (MM) in preclinical studies conducted in our country by Dr. Enrique Ocio in collaboration with the Dana Farber Cancer Institute (Boston, MA). Aplidine binds to a protein that is overexpressed in MM, eEF1A2 (eukaryotic translation elongation […]
Dementia is not just a disease of the elderly. The team of the Cognitive Impairment Unit has described the case of an Alzheimer's patient with the onset of the first symptoms at age 27, which is one of the earliest reported cases to date.
Dementia of early onset is considered to be that affecting people under 65 years. Their differential diagnosis is wider than in the elderly, and young people are considerably more likely to develop more rare forms of dementia, however, Alzheimer's disease remains the most common diagnosis.
The article published in the Journal of Alzheimer's Disease describes the case of a woman who developed early-onset Alzheimer's disease associated with the rare pathogenic Leu85Pro variant of the PSEN1 gene. The patient developed an atypical clinic that was a diagnostic challenge, debuting as a corticobasal syndrome with asymmetric apraxia of the extremities, parkinsonian signs and myoclonus.
The case has been identified by specialists from the Neurology Service of the HUMV and Neurodegenerative Diseases Research Group of IDIVAL who are studying a cohort of patients with Alzheimer's disease led by Dr. Pascual Sanchez Juan, author of the work, for years.
The publication highlights the key role of biomarkers in the diagnostic process, specifically amyloid PET, which is especially useful in the differential diagnosis of early-onset dementia.
Reference: López-García S, Jiménez-Bonilla J, López Delgado A, Orizaola Balaguer P, Infante Ceberio J, Banzo Marraco I, Rodríguez Rodríguez E, Sánchez-Juan P. A Rare PSEN1 (Leu85Pro) Mutation Causing Alzheimer's Disease in a 29 -Year-Old Woman Presenting as Corticobasal Syndrome. J Alzheimers Dis. 2019 Jul 5. doi: 10.3233 / JAD-190107. [Epub ahead of print] PubMed PMID: 31282415.
Dementia is not just a disease of the elderly. The team of the Cognitive Impairment Unit has described the case of an Alzheimer's patient with the onset of the first symptoms at age 27, which is one of the earliest reported cases to date. Dementia of early onset is considered to be that affecting people […]
