Hospital de Tortosa Virgen de la Cinta

Level of Education (LoE) is widely used as an indicator of cognitive reserve and is associated with risk of dementia. The aim of the present study was to know the influence of the LoE on cognitive function (CF) in patients with Parkinson´s disease (PD). Controls and PD patients from the Spanish cohort COPPADIS with a disease duration from symptoms onset ≤ 5years, who were recruited from January/2016 to November/2017 (baseline visit; V0) and evaluated at 2 (V2), 4 (V4) and 5 (V5) years of follow-up were included. Regarding LoE, patients were classified as with primary, secondary and university education. CF was assessed using the Parkinson´s Disease Cognitive Rating Scale (PD-CRS). General linear model (GLM) repeated measure was used to test for changes in the CF. A p value ≤ 0.005 was considered significant. Three hundred and ninety-nine PD patients (61.9 ± 8.9years old; 58.4% males) and 207 controls (61 ± 8.3years old; 49.8% males) were included. From V0 to V5, significant differences were observed in PD patients in global and fronto-subcortical (p < 0.0001 in all visits) between LoE groups but not in posterior-cortical (p > 0.05 in all visits) CF. LoE was associated with the change from V0 to V5 in the PD-CRS total score and fronto-subcortical sub-score (p < 0.0001) in PD patients but not in controls. After adjustment for many covariates, primary education was not a predictor of PD dementia (PD-CRS < 65) at V5 (OR = 3.31; p = 0.194). Cognitive function in Parkinson's disease is influenced by the level of education.

The aim of the homogenization of climatic time series is to remove non-climatic biases from the observed data, which are caused by technical or environmental changes during the period of observations. This bias removal is generally more successful for long-term trends and annual means than for monthly and daily values. The homogenization of probability distribution (HPD) may improve data accuracy even for daily data when the signal-to-noise ratio favors its application. HPD can be performed by quantile matching or spatial interpolations, but both of them have drawbacks. This study presents a new algorithm which helps to increase homogenization accuracy in all temporal and spatial scales. The new method is similar to quantile matching, but section mean values of the probability distribution function (PDF) are compared instead of individual daily values. The input dataset of the algorithm is identical with the homogenization results for section means of the studied time series. The algorithm decides about statistical significance for each break detected during the homogenization of the section means, and skips the insignificant breaks. Correction terms for removing the inhomogeneity biases of PDF are calculated jointly by a Benova-like equation system, a low pass filter is used for smoothing the prime results, and the mean value of the input time series between two consecutive detected breaks is preserved for each of such sections. This initial version does not deal with seasonal variations either during HPD or in other steps of the homogenization. The method has been tested connecting HPD to ACMANTv5.3, and using overall 8 wind speed and relative humidity datasets of the benchmark of European project INDECIS. The results show 4 to 12 percent RMSE reduction by HPD in all temporal scales, except for the extreme tails where a part of the results are weaker.

Localized HER2-positive breast cancer represents an aggressive subtype with a high risk of recurrence. Despite advances in adjuvant therapy, a significant proportion of patients do not achieve a complete pathological response after neoadjuvant treatment, which increases the risk of disease progression. Case Report: This report discusses the case of a 40-year-old premenopausal woman diagnosed with localized, multifocal HER2-positive breast cancer. The patient received neoadjuvant chemotherapy with anthracyclines, taxanes, and dual anti-HER2 blockade (trastuzumab and pertuzumab). After neoadjuvant therapy, residual disease was detected, leading to adjuvant treatment with T-DM1. Following eight cycles, the patient developed grade 2 pneumonitis, prompting the discontinuation of T-DM1 and the initiation of corticosteroid therapy. After recovery, adjuvant trastuzumab was administered. Given the high risk of recurrence, neratinib was introduced as extended adjuvant therapy. The patient tolerated neratinib well with prophylactic loperamide and completed one year of treatment. At the time of this report, she remains disease-free. Conclusion: This case underscores the importance of flexible adaptation of adjuvant HER2-targeted therapies in patients who encounter rare treatment-related complications. Although standardized protocols for managing such toxicities are not yet established, individualized treatment modifications, guided by clinical trial evidence, can optimize long-term outcomes.

During the COVID-19 pandemic, there was a notable undersupply of respiratory support devices, especially in low- and middle-income countries. As a result, many hospitals turned to alternative respiratory therapies, including the use of gas-operated ventilators (GOV). The aim of this study was to describe the use of GOV as a noninvasive bridging respiratory therapy in critically ill COVID-19 patients and to compare clinical outcomes achieved with this device to conventional respiratory therapies. Retrospective cohort analysis of critically ill COVID-19 patients during the first local wave of the pandemic. The final analysis included 204 patients grouped according to the type of respiratory therapy received in the first 24 h, as follows: conventional oxygen therapy (COT), n = 28 (14%); GOV, n = 72 (35%); noninvasive ventilation (NIV), n = 49 (24%); invasive mechanical ventilation (IMV), n = 55 (27%). In 72, GOV served as noninvasive bridging respiratory therapy in 42 (58%) of these patients. In the other 30 patients (42%), 20 (28%) presented clinical improvement and were discharged; 10 (14%) died. In the COT and GOV groups, 68% and 39%, respectively, progressed to intubation (P ≤ 0.001). Clinical outcomes in the GOV and NIV groups were similar (no statistically significant differences). GOV was successfully used as a noninvasive bridging respiratory therapy in more than half of patients. Clinical outcomes in the GOV group were comparable to those of the NIV group. These findings support the use of GOV as an emergency, noninvasive bridging respiratory therapy in medical crises when alternative approaches to the standard of care may be justifiable.

Sndrome de Chilaiditi izquierdo: una causa rara de dolor torcico y disneaLeft Chilaiditi syndrome: a rare cause of chest pain and dyspnea Sr. Editor:El signo de Chilaiditi (sCh) es un signo radiolgico raro causado, habitualmente, por la interposicin del colon entre el hgado y el hemidiafragma derecho; su hallazgo es casual en el 0,02-0,14% de los estudios radiolgicos, y afecta ms a los varones y a los mayores de 65 aos [1][2][3][4][5] .Los casos bilaterales son an ms raros, y resultan excepcionales los sCh izquierdos (sCh-I) aislados [1][2][3][4][5] .Se presentan 2 casos de sCh-I sintomticos, lo que se denomida sndrome de Chilaiditi izquierdo (SCH-I).

Advancements in and accessibility to effective antiretroviral therapy has improved the life expectancy of people living with HIV, increasing the proportion of people living with HIV reaching older age (≥60 years), making this population's health-related quality of life (HRQoL) more relevant. Our aim was to identify the determinants of poor HRQoL in people living with HIV aged ≥60 years and compare them with those of their younger counterparts. We used data from the 'Vive+' study, a cross-sectional survey conducted between October 2019 and March 2020, nested within the PISCIS cohort of people living with HIV in Catalonia and the Balearic Islands, Spain. We used the 12-item short-form survey (SF-12), divided into a physical component summary (PCS) and a mental component summary (MCS), to evaluate HRQoL. We used the least absolute shrinkage and selection operator for variable selection and used multivariable regression models to identify predictors. Of the 1060 people living with HIV (78.6% males) who participated in the study, 209 (19.7%) were aged ≥60 years. When comparing older people living with HIV (≥60 years) and their younger counterparts, older people exhibited a worse PCS (median 51.3 [interquartile range {IQR} 46.0-58.1] vs. 46.43 [IQR 42.5-52.7], p < 0.001) but a similar MCS (median 56.0 [IQR 49.34-64.7] vs. 57.0 [IQR 48.9-66.3], p = 0.476). In the multivariable analysis, cognitive function correlated with a PCS (β correlation factor [β] -0.18, p = 0.014), and depressive symptoms and satisfaction with social role correlated with an MCS (β 0.61 and β -0.97, respectively, p < 0.001) in people living with HIV aged ≥60 years. Depressive symptoms, poor cognitive function, and lower satisfaction with social roles predict poorer HRQoL in older people living with HIV. These factors need to be considered when designing targeted interventions.

Recently, we demonstrated that staging Parkinson's disease (PD) with a novel simple classification called MNCD, based on four axes (motor, non-motor, cognition, and dependency) and five stages, correlated with disease severity and patients' quality of life. Here, we analyzed the correlation of MNCD staging with PD caregiver's status. Data from the baseline visit of PD patients and their principal caregiver recruited from 35 centers in Spain from the COPPADIS cohort from January 2016 to November 2017 were used to apply the MNCD total score (from 0 to 12) and MNCD stages (from 1 to 5) in this cross-sectional analysis. Caregivers completed the Zarit Caregiver Burden Inventory (ZCBI), Caregiver Strain Index (CSI), Beck Depression Inventory-II (BDI-II), PQ-10, and EUROHIS-QOL 8-item index (EUROHIS-QOL8). Two hundred and twenty-four PD patients (63±9.6 years old; 61.2% males) and their caregivers (58.5±12.1 years old; 67.9% females) were included. The frequency of MNCD stages was 1, 7.6%; 2, 58.9%; 3, 31.3%; and 4-5, 2.2%. A more advanced MNCD stage was associated with a higher score on the ZCBI (p<.0001) and CSI (p<.0001), and a lower score on the PQ-10 (p=.001), but no significant differences were observed in the BDI-II (p=.310) and EUROHIS-QOL8 (p=.133). Moderate correlations were observed between the MNCD total score and the ZCBI (r=.496; p<.0001), CSI (r=.433; p<.0001), and BDI-II (r=.306; p<.0001) in caregivers. Staging PD according to the MNCD classification is correlated with caregivers' strain and burden.

OBJETIVOS Determinar el impacto del uso combinado de la monitorización cardíaca con tecnología inteligente, biomarcadores y pruebas de imagen (ecocardiografía y resonancia magnética [RM] craneal) en el diagnóstico precoz de fibrilación auricular (FA), ictus silentes y deterioro cognitivo en población de alto riesgo. MATERIAL Y MÉTODOS Estudio de cohortes prospectivo de base poblacional en Atención Primaria. Se incluirán pacientes de 65-85 años sin diagnóstico previo de FA, ictus o demencia. El riesgo de FA se establecerá en base a una escala previamente validada que incluye las siguientes variables: edad, sexo, índice de masa corporal, frecuencia cardíaca y puntuación en la escala CHA2DS2VASc. Las principales variables de resultado serán el tiempo hasta diagnóstico de FA (confirmada por electrocardiograma), ictus (confirmado por RM), deterioro cognitivo (puntuación GDS [Global Deterioration Scale]) y/o demencia. La valoración basal incluirá variables clínicas y funcionales, de tratamiento, biomarcadores y pruebas de imagen que se llevarán a cabo en servicios hospitalarios de referencia. Se prevé un seguimiento de 2 años con visitas semestrales en que se revisarán los nuevos diagnósticos, y se actualizarán variables clínicas y tratamientos. Anualmente se hará una monitorización del ritmo cardíaco durante 14 días a través de pulsera/reloj inteligente y una aplicación específica para detectar episodios de FA de manera proactiva, que se confirmarán mediante electrocardiograma convencional. El análisis incluirá estadística descriptiva convencional, curvas de Kaplan-Meier, para estimar tiempos hasta la aparición de eventos de estudio, y análisis multivariante, para explorar la influencia de variables basales e independientes (monitorización y pruebas) sobre las de resultado principal. Se utilizará el programario R (versión 4.1.2). Algunas limitaciones posibles podrían ser las dificultades de pacientes/ cuidadores con nuevas tecnologías y un período de seguimiento limitado. APLICABILIDAD DE LOS RESULTADOS ESPERADOS La detección proactiva y precoz de FA podría acompañarse de una reducción de la incidencia de eventos cardiovasculares mayores y/o deterioro cognitivo/demencia. En este caso, se podrían incorporar sencillos dispositivos electrónicos de monitorización del ritmo cardíaco en las guías clínicas para el manejo de pacientes con alto riesgo de FA. ASPECTOS ÉTICO-LEGALES Este proyecto se llevará a cabo siguiendo las normas sobre principios éticos de la Declaración de Helsinki (y posteriores actualizaciones) y las de buena práctica en investigación. El tratamiento de los datos se hará de acuerdo con la legislación europea (Reglamento UE 2016/679 del Parlamento Europeo y del Consejo Europeo, de 27 de abril de 2016, y Ley Orgánica 3/2018, de 5 de diciembre, de Protección de Datos Personales y Garantía de los Derechos Digitales). Este proyecto ha sido aprobado por el Comité de Ética del Instituto de Investigación en Atención Primaria-IDIAP Jordi Gol (expediente 22/090-P). FINANCIACIÓN Este proyecto ha sido financiado con una beca del Pla Estratègic en Recerca i Innovació en Salut (PERIS) de la Generalitat de Cataluña (expediente SLT/21/000027). CEI Ha recibido la aprobación del Comité de Ética en Investigación con Medicamentos (CEIm) del Instituto de Investigación en Atención Primaria (IDIAP) Jordi Gol (expediente 22/090-P).