Hospital de Hellín

Frailty is a common condition in community-dwelling older adults with high health and socioeconomic implications. However, primary care-led randomized trials have been scarcely tested. Multicenter cluster randomized clinical trial. Two hundred and seventy-three community-dwelling older adults recruited from 12 Spanish primary care centers. independence in basic activities of daily living and either prefrailty/frailty using the frailty phenotype or gait speed < 0.8 m/s. Participants were randomized 1:1 by clusters to the intervention or the control group, each cluster being a different primary care center. Physical exercise program, nutritional recommendations, and frailty training to primary care professionals. Interventions were conducted based on the guidelines of the "Consensus document on the prevention of frailty in older adults," updated in 2022, from the Spanish Health Ministry. Usual care. Improvement in one category of the frailty phenotype or one point in the Short Physical Performance Battery (SPPB) at 12 and 32 weeks. under Intention-to-treat analysis was conducted. Mean age 78.1 years, 68.4% female. 25.7% were frail and 74.3% prefrail or with a gait speed lower than 0.8 m/s. The percentage of participants improving the main outcome at week 12 for the intervention and control groups were 70.4% and 49.5%, respectively, absolute risk reduction (ARR) 20.9% (95% confidence interval [CI] 7.3%-34.5%; p < 0.01; n = 191), number needed to treat (NNT) 4.8 (95% CI 2.9-13.6). At 32 weeks of follow-up 81.7% and 51.9% of the intervention and control group improved, respectively, ARR 29.8% (95% CI 13.8%-45.7%; p < 0.001; n = 134), NNT 3.4 (95% CI 2.2-7.2). A primary care-led intervention consisting of a physical exercise program, nutritional recommendations, and training in frailty was feasible and effective for improving frailty status or physical function in community-dwelling older adults with prefrailty or frailty. clinicaltrial.gov: NCT05002439 (18/JUN/2021).

Introduction: Asthma is one of the most common chronic diseases and affects around 334 million people worldwide. The estimated prevalence of severe asthma is 3–10% of the asthmatic population. Mepolizumab has demonstrated efficacy in reducing exacerbations, oral corticosteroid use, and improving quality of life, asthma control, and lung function in patients with severe eosinophilic asthma (SEA). Our study aimed to check the response to mepolizumab in a series of severe asthma patients regarding exacerbations, oral corticosteroid use, asthma control, quality of life, and lung function and to compare the response between patients with and without nasal polyps. Method: This is a retrospective, multicenter study of RE-ASGRAMUR (Register of Severe Asthma of the Region of Murcia) performed in eight hospitals of the Region of Murcia (Spain) under routine clinical practice conditions. We included patients diagnosed with SEA who completed at least 1 year of treatment with mepolizumab. We analyzed clinical characteristics, drug tolerance, and effectiveness: exacerbations, ACT, miniAQLQ, forced expiratory volume in 1 s (FEV1), and use of oral corticosteroids. We also compared the results between patients with and without nasal polyps. Results: The median of exacerbations before treatment was 3 and decreased to 0 after treatment (mean decrease of 77.4%). The median diary oral prednisone intake was 15 mg before treatment and 5 mg after treatment (mean 56% reduction). We have obtained a significant improvement in other variables: ED visits and hospitalizations, asthma control (ACT), quality of life (miniAQLQ), and lung function (FEV1). Thirty-four out of 70 patients (48.57%) fulfilled the criteria of super-responder, and 17 out of 70 (24.29%) had a complete response. More patients in the group with nasal polyps fulfilled the criteria of super-responder and complete response to mepolizumab. Conclusions: Mepolizumab is a safe and effective treatment for SEA patients, improving exacerbations, oral corticosteroid intake, asthma control, quality of life, and lung function. In patients with associated nasal polyposis, there is a statistically significant higher proportion of super-responders and complete responders.

ABSTRACT The development of novel culture-independent techniques of microbial identification has allowed a rapid progress in the knowledge of the nasopharyngeal microbiota and its role in health and disease. Thus, it has been demonstrated that the nasopharyngeal microbiota defends the host from invading pathogens that enter the body through the upper airways by participating in the modulation of innate and adaptive immune responses. The current COVID-19 pandemic has created an urgent need for fast-track research, especially to identify and characterize biomarkers to predict the disease severity and outcome. Since the nasopharyngeal microbiota diversity and composition could potentially be used as a prognosis biomarker for COVID-19 patients, which would pave the way for strategies aiming to reduce the disease severity by modifying such microbiota, dozens of research articles have already explored the possible associations between changes in the nasopharyngeal microbiota and the severity or outcome of COVID-19 patients. Unfortunately, results are controversial, as many studies with apparently similar experimental designs have reported contradictory data. Herein we put together, compare, and discuss all the relevant results on this issue reported to date. Even more interesting, we discuss in detail which are the limitations of these studies, that probably are the main sources of the high variability observed. Therefore, this work is useful not only for people interested in current knowledge about the relationship between the nasopharyngeal microbiota and COVID-19, but also for researchers who want to go further in this field while avoiding the limitations and variability of previous works.

Background: Eliglustat (Cerdelga®, Sanofi-Genzyme), is a substrate reduction therapy approved in European Union in 2015 for Gaucher disease type-1 (GD1) adult patients. TRAZELGA (GEE-ELI-2017-01) project is a prospective follow-up post-authorization study designed as a tool to uniformly study the response to eliglustat therapy. Aims: In this study, it is intending to determine if the drug administration maintains or improve clinical goals and/or plasmatic biomarkers as well as to evaluate eliglustat therapy response in terms of safety, effectiveness and patient´s satisfaction. Methods: Clinical parameters, image bone assessment, and plasmatic biomarkers were analyzed for two years on follow-up: chitotriosidase [ChT] activity was evaluated by fluorimetry, glucosylsphingosine [GluSph] concentrations by LC-MSMS and CCL18/PARC, C5a, C3, YKL-40, Cathepsin S, Hepcidin and Lipocalin concentrations by immunoquantification assay. A quality of life study (SF-36), disease severity score index evaluation (GD-DS3) and compilation of side effects are included. Non-parametric statistical analysis was performed and p<0.05 was considered as statistically significant. Results: 29 Spanish GD1 patients were included, 16 were males and 13 female. The median age was 42.0 (30.00-55.50) years. All patients were treated before starting eliglustat: 26 with enzyme replacement therapy, 2 with substrate reduction therapy and 1 with a combined therapy. The median age of treatment before eliglustat was 17.0 (10.00-21.50). A statistically significant decrease on GluSph and CCL18/PARC (p=0.0393 and p=0.0019, respectively) was observed meanwhile ChT was maintain. Clinical data and the analysis of the rest of the biomarkers is going on. Summary/Conclusion: Eliglustat mantains or improve biochemical biomarkers after two years treatment. Disclosure: TRAZELGA (GZ-2017-11713) received a grant from Sanofi Genzyme for its realization.

Emergency services have a high potential risk for adverse events. The working conditions are sometimes conducive to making mistakes. There are few studies that have shown improvements in specific aspects of patient safety in the emergency department, but none in the overall incidence. The general objective is to improve patient safety in our emergency services by implementing improvement actions. This is a quasi-experimental study carried out in 8 hospital emergency services. The methodology is mainly based on the EVADUR and ENEAS studies. We collect data through a face-to-face interview during their stay in the Emergency Department and carry out a telephone review 1 week later. We then inform the departments of the results and initiate improvement activities. 14 improvement measures were implemented in the different emergency services. Two years later, a reassessment was carried out using the same methodology. An initial sample of 382 cases was collected. After the improvement actions, data from 267 patients were collected. No significant differences were found between the 2 groups in terms of age, sex, triage level, hospital, care shift, average length of stay and discharge destination. In the initial evaluation, at least 1 incidence was detected in 46 patients (12.04%), and in the reevaluation, 16 patients with an incident (5.99%) were detected. The differences were statistically significant (p<0.01). The emergency services studied were able to reduce the number of patient safety incidents.

ABSTRACT Introduction and objectives: Reperfusion therapy during an ST-segment elevation acute coronary syndrome (STEACS) can be performed using fibrinolytic agents or primary percutaneous coronary intervention (pPCI). The pPCI is the reperfusion strategy of choice, but many patients with STEACS initially come to non-PCI capable hospitals. Regional networks have been launched with both reperfusion therapies using thrombolysis in indicated cases followed by routine angiographic studies (pharmacoinvasive strategy). Our objective was to analyze the results of treatment in patients with STEACS in the Region of Murcia, Spain based on the patient’s place of ​​origin. Methods: Retrospective study of a cohort of patients admitted due to STEACS to 3 health areas: pPCI-capable Area 1 (Hospital Clínico Universitario Virgen de la Arrixaca), and non-pPCI capable Areas IV and V (Hospital Comarcal del Noroeste, Caravaca de la Cruz, and Virgen del Castillo, Yecla). Results: Six hundred and seventy-nine patients from health areas I, IV, and V of the Region of Murcia were treated of STEACS from 2006 through 2010. Out of the 494 patients from Area I, 97.6% (482 patients) were treated with pPCI while 2.4% (12 cases) received thrombolysis. In Areas IV and V, 73% (135) of patients were treated with pPCI and 27% (50) with thrombolysis. After thrombolysis, 46 patients (34%) required rescue angioplasty and 79 (58.5%) underwent a scheduled coronary angiography (pharmacoinvasive strategy). No statistically significant differences were reported in the overall mortality rate at 30-day (8.3% in Area I vs 6% in Areas IV and V; P = .31) or 1 year follow-up (11.3% vs 8.2%; P = .23) in Area I compared to Areas IV and V, nor for cardiac mortality. Conclusions: Although immediate pPCIs are less accessible in remote health areas, the healthcare network from the Region of Murcia can achieve similar mortality results compared to populations with pPCI availability.