MSD (Spain)

This study assessed the clinical burden of carbapenemase-producing Enterobacterales (CPE) infections according to different resistance mechanisms among Enterobacterales isolates in Spain. This retrospective study was conducted in five Spanish hospitals from the National Mapping of Carbapenemases in Spain study. Patients were included if they were 18 years or older; had a diagnosis of complicated intraabdominal infection (cIAI), complicated urinary tract infection (cUTI), bloodstream infection (BSI), or hospital-acquired or ventilator-acquired bacterial pneumonia (HABP/VABP) between 2017 and 2018; and had a confirmed CPE isolate. In total, 118 patients were evaluable for clinical outcomes. The most common mechanism of carbapenem resistance was Klebsiella pneumoniae carbapenemase (KPC; n = 82, 69.5%), followed by OXA-48 (n = 27, 22.9%) and metallo-β-lactamases (MBL; n = 9, 7.6%). Overall, 75 patients (63.6%) died from any cause, including 21 deaths (28.0% of all deaths) attributable to the current infection. Clinical cure was achieved in 92 patients (78.0%) and microbiological cure in 59 (54.6%). Among the 92 patients discharged alive, 29 (31.5%) were readmitted for an infectious disease, and relapse within 30 days occurred in 10 patients (10.9%). Data suggest that CPE infections are associated with a high disease burden, low rates of clinical cure, and high rates of relapse and mortality in Spain. However, results should be interpreted with caution due to the limited sample size which may have restricted the precision of these estimates and gaps in minimal inhibitory concentration data availability.

Background/Objectives: The treatment of dual disorders (DDs) must be comprehensive and multidisciplinary. Evidence supports the effectiveness of psychotherapy in treating DDs. The second part of this consensus synthesizes the available evidence on psychological treatment for specific DDs. Methods: Two consensus methods were sequentially implemented: the nominal group technique and the Delphi method. Results: This consensus review encompassed a compilation of recommendations for the psychological treatment of neurodevelopmental, anxiety, post-traumatic stress, somatic symptom, eating, and personality disorders. Finally, recommendations for the future research agenda on the psychological treatment of DD were included. Conclusions: (1) Psychological treatment, particularly integrated treatment, is effective. (2) In the case of dual autism, interventions for substance use disorders should be adapted to this population's characteristics. (3) More research is needed on dual social anxiety, panic, generalized anxiety, somatic symptom, and eating disorders, for which Cognitive Behavioral Therapy (CBT) is the most commonly used treatment. (4) For dual attention deficit hyperactivity disorder, multicomponent treatment is recommended (psychoeducation, CBT, and peer or family support). (5) For dual anxiety disorders, CBT is the first-line treatment. (6) For dual post-traumatic stress disorder, CBT (cognitive processing therapy and prolonged exposure therapy), acceptance and commitment therapy, stress inoculation training, and Eye Movement Desensitization and Reprocessing (EMDR) are effective. (7) For dual personality disorders, evidence is scarce. (8) For borderline personality disorder, dialectical behavior therapy, dynamic deconstructive psychotherapy, and dual-focus schema therapy show promise. (9) For antisocial personality disorder, CBT, contingency management, and counseling on impulsive lifestyles may be useful. (10) Much more evidence is needed from studies that overcome the methodological limitations of existing ones.

BackgroundIdentifying cognitive markers for early detection of neurodegenerative disorders is crucial for understanding pathological aging. Given the early impact of information acquisition, consolidation, and retrieval processes in Alzheimer's disease (Jutten et al., 2020), this study aims to determine whether immediate or delayed recall processes at baseline can effectively differentiate between individuals with stable mild cognitive impairment (MCI) and those who convert to Alzheimer's Clinical Syndrome (ACS) after two years.MethodA cohort of 140 older adults diagnosed with MCI (62.4% female, mean age = 76.27, SD = 5.71) underwent baseline neuropsychological assessment, including the Spanish version of the California Verbal Learning Test (CVLT‐TAVEC), the Rey–Osterrieth Complex Figure Test (ROCF), and Verbal Paired Associates (Wechsler Memory Scale). After a two‐year follow‐up, 24 participants progressed to ACS (MCI‐converters). Binary logistic regression and ROC curve analyses were performed to determine whether immediate or delayed recall measures at baseline were more effective in predicting conversion.ResultBinary logistic regression revealed that immediate recall performance on both verbal (CVLT‐TAVEC) and visual (ROCF) memory tests significantly predicted conversion to ACS within two years (p < 0.001). Participants who later developed ACS showed significantly lower baseline scores on short‐term recall tasks compared to those who remained stable (p < 0.001). ROC curve analyses demonstrated that CVLT‐TAVEC immediate recall (AUC = 0.815, p < 0.000) was a stronger predictor of conversion than long‐term recall (AUC = 0.804, p < 0.000).ConclusionThese findings highlight immediate consolidation deficits as a potential early marker of prodromal Alzheimer's disease, emphasizing their role in the preclinical trajectory of AD. The results suggest that immediate recall impairments, rather than delayed recall deficits, may better capture the earliest cognitive dysfunctions associated with disease progression. Incorporating short‐term recall measures into clinical assessments could improve the early identification of high‐risk individuals and refine predictive models for AD. Further research is needed to explore the underlying neural mechanisms linking immediate consolidation to Alzheimer's pathology.

The secure and trustworthy exchange of interoperable data assets is a key enabler for the development of IoT-based data spaces. This paper presents a decentralised framework for offering management and asset sharing within trusted and interoperable data spaces, leveraging Distributed Ledger Technologies (DLTs) and the Self-Sovereign Identity (SSI) paradigm to ensure transparency, integrity, and participant self-sovereignty. The proposed architecture integrates identity management and tamper-resistant smart contracts leveraging the IOTA Tangle to support decentralised offering discovery, access control and verifiable transactions. By addressing critical challenges related to trust, interoperability, and decentralisation, the framework contributes to the technological foundations required for scalable, secure, and resilient data ecosystems.

ABSTRACT HPV vaccination in adults provides opportunities for individuals who were previously ineligible, or who missed vaccination as adolescents, thereby reducing HPV-related disease burden. This targeted literature review summarizes the HPV vaccination recommendations and guidelines by National Immunization Technical Advisory Groups and professional societies, and public funded programs for adults. Of the 152 jurisdictions examined, 62 offered HPV vaccination recommendations for general adults. Of these, 84% included both genders and 68% included sub-populations. Four jurisdictions had recommendations for adult sub-populations only. Overall, 38 jurisdictions had funded programs for general adults and 17 targeted specific sub-populations. The most reported upper eligible age for recommendations or guidelineswas 26 y and 45 y, and 26 y for funded programs. People with HIV and immunosuppressed individuals were the most common sub-populations included. While economic reasons may influence funding for HPV vaccination among adults, clinical guidelines are more likely to advise vaccination on an individual basis, regardless of age.

<strong class="journal-contentHeaderColor">Abstract.</strong> Forecasting the sea level is crucial for supporting coastal management through early warning systems and for adopting adaptation strategies to climate change impacts. Such objectives can be achieved by using advanced numerical models, which are based on shallow-water equations used to simulate storm surge generation and propagation due to atmospheric pressure and winds, or with ocean general circulation and baroclinic models. We provide here an overview on models commonly used for sea level forecasting that can be based on storm surge models or ocean circulation ones and is integrated on structured or unstructured grids, including an outlook on new approaches based on ensemble methods.

Early approval mechanisms, such as conditional approval in the EU, have been used extensively to provide timely access to therapeutic innovations to cancer patients with unmet medical needs. While based on promising early evidence, such approvals are challenging from many perspectives due to the lack of comprehensive data. The limitation typically relates to data that demonstrates clinical benefit via early endpoints and is only acceptable when the early evidence is particularly convincing to assume that the benefits of early access are greater than the potential harms. This paper describes the requirements for conditional approval and presents common pitfalls in oncology, such as misunderstandings about the strength of evidence from exploratory trials and secondary analyses, lack of planning and opportunities to improve communication. Thereafter, we present a framework ('EDGE') on how to improve the submission and evaluation of drug applications for conditional approval in the EU.

BackgroundDespite the high prevalence of oral and maxillofacial manifestations in the early stages of acromegaly, dentists do not represent an important percentage of the healthcare professionals that diagnose the disease.Case ReportThe present study describes the buccodental and facial changes occurring over a period of 20 years in a patient with a late diagnosis of acromegaly.DiscussionThe facial disfiguration and buccodental problems, particularly mandibular enlargement and malocclusion, may be the key elements leading to the diagnosis.ConclusionsIt is essential to enhance awareness of the disease among dentists, and particularly among orthodontists, as they are ideally positioned to recognize and diagnose acromegaly in its early stages.

ImportanceA diagnosis of bacterial meningitis in childhood can lead to permanent neurological disabilities. Few studies have examined long-term consequences for work ability in adulthood.ObjectiveTo compare earnings, work loss, and educational attainment between adults diagnosed with bacterial meningitis in childhood and population comparators.Design, Setting, and ParticipantsThis nationwide registry-based matched cohort study included individuals in Sweden diagnosed with bacterial meningitis in childhood (aged &amp;amp;lt;18 years) from January 1, 1987, to December 31, 2019, and general population comparators matched 1:9 on age, sex, and place of residence. Follow-up was completed December 31, 2020. Data were analyzed from February 7 to September 12, 2023.ExposureA diagnosis of bacterial meningitis in childhood recorded in the National Patient Register.Main Outcomes and MeasuresAnnual taxable earnings (in 2020 US dollars), work loss (sum of sick leave and disability insurance), and educational attainment.ResultsThe cohort included 2534 individuals diagnosed with bacterial meningitis in childhood (mean [SD] age at diagnosis, 4.7 [5.3] years) and 22 806 comparators (13 510 [53.3%] male). Among those with childhood bacterial meningitis, 812 (32.0%) were diagnosed at younger than 1 year and 1351 (53.3%) were male. From 18 to 34 years of age, those with childhood meningitis had lower adjusted earnings relative to comparators and higher adjusted work loss. When pooling observations for individuals 28 years or older, the annual mean reduction in earnings was −$1295 (95% CI, −$2587 to −$4), representing a 4.0% (95% CI, 0%-8.0%) reduction relative to comparators, and the annual increase in work loss was 13.5 (95% CI, 8.6-18.5) days. There was a larger reduction in earnings for those with childhood meningitis relative to comparators with pneumococcal (Streptococcus pneumoniae) vs meningococcal (Neisseria meningitidis) meningitis. For work loss, there was a difference among all 3 major causes of meningitis, with the largest increase for pneumococcal meningitis. Individuals diagnosed at a younger age (below the median) had lower earnings relative to comparators and higher work loss than individuals diagnosed at an older age (above the median). Fewer individuals with childhood meningitis relative to comparators had obtained a high school degree at age 30 years (adjusted odds ratio, 0.68 [95% CI, 0.56-0.81]).Conclusions and RelevanceIn this cohort study of adults diagnosed with bacterial meningitis in childhood, findings suggest that work ability decreases relative to population comparators, with lower earnings and higher work loss, especially among adults diagnosed with pneumococcal meningitis or diagnosed at a young age, with long-lasting costs for the individual patient and society at large.