University Hospital Complex Of Vigo

Deprescribing is a key strategy for optimizing therapeutic plans in multimorbid or complex chronic patients. Despite its long-standing use, further studies are needed to validate health outcomes and support its routine clinical integration. This project aims to assess the impact of applying LESS-CHRON criteria in terms of therapeutic and anticholinergic burden, as well as to describe potentially inappropriate medications (PIMs) more often involved in chronic treatments of patients with multimorbidity or those with complex health needs across two care settings: institutionalized and outpatients. A quasi-experimental, multicenter, pre-post intervention cohort study was conducted in several phases (screening, intervention, and follow-up at 3 and 6 months after inclusion). The study included two cohorts: outpatients and institutionalized patients. The main variable was the percentage reduction in medication use. Additionally, the deprescribing success rate, reasons for non-acceptance (barriers to deprescribing), anticholinergic burden, and non-pharmacological variables were analyzed. Four hundred and sixty patients (229 outpatients, 231 institutionalized) with a mean age of 84.5 (SD: 7.9) years were included. Demographic, clinical, and pharmacological data were collected. Deprescribing opportunities were identified using the LESS-CHRON criteria, and recommendations were assessed by medical teams. Follow-up evaluations were conducted after 3 months. A total of 960 PIMs were identified, of which 542 medications were successfully deprescribed (345 patients), with an acceptance rate of 56.46%, showing no significant differences between cohorts. The overall therapeutic burden was reduced by 10.73% (SD: 10.68). The main barriers to deprescribing were clinical decisions (69.86%) and patient/family refusal (11.72%). After 3 months, at least one deprescribed drug was reintroduced in 61 patients. The mean deprescribing success rate was 87.10%, which was significantly higher in institutionalized patients (p < 0.05), and the anticholinergic burden was significantly reduced (p < 0.001). The LESS-CHRON tool effectively identified deprescribing opportunities, reducing both medication burden and anticholinergic load. Institutionalized patients had a higher deprescribing success rate. However, clinical judgment and patient preferences remain key barriers to successful implementation.

BackgroundNon-small cell lung cancer (NSCLC) with mutations in epidermal growth factor receptor exon 20 (EGFR Ex20Ins) is rare and resistant to conventional tyrosine kinase inhibitors (TKIs), limiting treatment options. This retrospective study in Galicia (Spain) evaluated the clinical characteristics, treatment response, and survival of patients with NSCLC and EGFR Ex20Ins.MethodsData from patients diagnosed between 2013 and 2023, confirmed by next-generation sequencing (NGS) or polymerase chain reaction (PCR), were included. Overall survival (OS), progression-free survival (PFS), and the incidence of serious adverse events were assessed.ResultsOf the 43 patients in the present study, 39 had metastatic disease and were considered for survival analysis. Among patients with metastatic disease, the median OS was 14.6 months (95% CI: 7–20 months), and the median PFS was 7.4 months (95% CI: 3–12 months) with first-line therapy (1L). Patients treated with platinum-based chemotherapy in the 1L achieved a median PFS of 9.8 months (95% CI: 3–27 months), whereas those receiving TKIs achieved a median PFS of 3.4 months (95% CI: 1–12 months). No significant differences in treatment response were found according to age or sex.ConclusionsThe results show the limited effectiveness of TKIs in patients with EGFR Ex20Ins and highlight the need for specific therapies. Platinum-based chemotherapy performed better in preventing disease relapse.

Major depressive disorder (MDD) has been associated with an increased risk of cognitive decline and neurodegenerative disorders like Alzheimer's disease (AD), prompting interest in peripheral biomarkers related to amyloid metabolism as well as neuroaxonal and astroglial injury. However, evidence regarding circulating markers in MDD remains inconsistent. In this cross-sectional study, we simultaneously assessed plasma levels of amyloid-β peptides (Aβ40 and Aβ42), neurofilament light chain (NfL), and glial fibrillary acidic protein (GFAP) in MDD patients and healthy controls (HC) using ultrasensitive single-molecule array (SIMOA) technology. Associations with clinical and cognitive scales were examined. Plasma concentrations of Aβ40 and Aβ42 were significantly lower in MDD patients, whereas no group differences were observed for NfL and GFAP, after correcting for age and sex. However, both Aβ peptides were not significantly associated with depressive symptom severity, whereas the Aβ42/Aβ40 ratio was negatively associated with anhedonia. NfL and GFAP levels were primarily influenced by age. In the absence of a reduced Aβ42/Aβ40 ratio, these findings suggest that reduced plasma Aβ levels in MDD may reflect systemic or metabolic factors associated with MDD, including lifestyle or treatment-related effects. Therefore, these findings should be interpreted with caution and further examined in longitudinal studies to prevent potential confounding factors.