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Background Smoking is associated with high healthcare resource utilisation and cost to society. Patients with major depressive disorder (MDD) exhibit high susceptibility to nicotine dependence. Varenicline, bupropion and nicotine replacement therapy are all indicated for smoking cessation; however funding by the Spanish national health system (SNHS) is limited. We modelled a budgetary impact analysis (BIA) to estimate the impact of the SNHS funding drug-based therapies for smoking cessation in smokers with MDD. Methods The BIA compared the current unfunded scenario versus a funded scenario (varenicline, bupropion, nicotine replacement therapy combined with medical follow-up and counselling) using the Spanish SNHS and societal perspectives. The BIA design was a hybrid model using a decision tree algorithm (population size: smokers with MDD) and Markov chains (smoking cessation attempts) over a 5-year horizon. Smoking cessation drug efficacy was derived from clinical trials, and smoking cessation costs avoided were taken from an analysis of the Spanish National Health Survey. Results were shown as incremental cost savings. Scenarios and threshold univariate sensitivity analyses tested model robustness. Results The funded scenario resulted in an increase of 43,478 cessation attempts and 8930 fewer smokers after 5 years compared to the unfunded scenario. The cost of funding was €25.3 million and costs avoided were €26.5 million. There was a cumulative 5-year incremental cost saving of €1.2 million to Spanish society. Results were robust using alternative scenarios. Conclusions Funding smoking cessation drugs in patients with MDD is of economic benefit to Spain and could produce net savings from the third year of implementation. [ABSTRACT FROM AUTHOR]

Background. Cardiopulmonary resuscitation (CPR) feedback devices are being increasingly used. However, current accelerometer-based devices overestimate chest displacement when CPR is performed on soft surfaces, which may lead to insufficient compression depth. Aim. To assess the performance of a new algorithm for measuring compression depth and rate based on two accelerometers in a simulated resuscitation scenario. Materials and Methods. Compressions were provided to a manikin on two mattresses, foam and sprung, with and without a backboard. One accelerometer was placed on the chest and the second at the manikin’s back. Chest displacement and mattress displacement were calculated from the spectral analysis of the corresponding acceleration every 2 seconds and subtracted to compute the actual sternal-spinal displacement. Compression rate was obtained from the chest acceleration. Results. Median unsigned error in depth was 2.1 mm (4.4%). Error was 2.4 mm in the foam and 1.7 mm in the sprung mattress (p<0.001). Error was 3.1/2.0 mm and 1.8/1.6 mm with/without backboard for foam and sprung, respectively (p<0.001). Median error in rate was 0.9 cpm (1.0%), with no significant differences between test conditions. Conclusion. The system provided accurate feedback on chest compression depth and rate on soft surfaces. Our solution compensated mattress displacement, avoiding overestimation of compression depth when CPR is performed on soft surfaces. [ABSTRACT FROM AUTHOR]

Existing therapies against infectious diseases may only be effective in limited subpopulations during specific phases of diseases, incorporating theranostics, and there is a clear need to individualize different therapeutic approaches depending on the host. Influenza A virus infection evolves into a severe respiratory failure in some young adult patients, related to an exaggerated inflammatory response. Mortality rates remain high despite antiviral treatment and aggressive respiratory support. The influenza A virus (IAV) infection will induce a proinflammatory innate immune response through recognition of viral RNA by Toll-like receptor (TLR) 7 and retinoic acid-inducible gene 1 (RIG-I) molecules by nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB route). Anti-inflammatory therapies focused on modulating this inflammatory response to 'all patients' have not been satisfactory. Steroids should be avoided because they do not improve survival and promote superinfections. Since clinical judgment has often been proven inadequate, interest in the use of biomarkers to monitor host response and to assess severity and complications is growing. It is well known that, if used appropriately, these can be helpful tools to predict not only severity but also mortality. We need more biomarkers that predict host response: it is time to change lactate measurement to proteomics and transcriptomics. Theranostics describes an approach covering both diagnosis and coupled therapy. Death is usually a fatal complication of a dysregulated immune response more than the acute virulence of the infectious agent. Future research demonstrating the usefulness of adjunctive therapy in a subset of critically ill patients with IAV pneumonia is an unmet clinical need. [ABSTRACT FROM AUTHOR]

Background: Pyoderma gangrenosum is a serious cutaneous complication seen in approximately 1 % of patients with inflammatory bowel disease (IBD). Oral corticosteroids are the mainstay treatment, although the evidence supporting their use is weak. Aims: The purpose of this study was to investigate the characteristics of pyoderma gangrenosum associated with Crohn's disease or ulcerative colitis and which treatments are prescribed in Spanish clinical practice. Methods: In this retrospective, observational study, the medical records from all patients with IBD and a diagnosis of pyoderma gangrenosum attended by the gastroenterology departments of 12 Spanish hospitals were reviewed. Data on patient demographics and characteristics, underlying IBD and treatment, and pyoderma gangrenosum characteristics, treatment, and outcome were collected and analyzed. Results: The data from 67 patients were analyzed (41 [61.2 %] women, 41 [61.2 %] with Crohn's disease, 25 [37.3 %] with ulcerative colitis, and 1 [1.5 %] with indeterminate disease). The underlying disease was in remission in approximately one-third of patients at the time of presentation of pyoderma gangrenosum. Healing was achieved in all patients (in 3 without any systemic therapy). Oral corticosteroids were taken by 51 patients (76.1 %), almost always as first-line treatment, although definitive healing was attained in 19 (28.4 %). Biologic agents such as infliximab and adalimumab were taken by 31 patients (46.3 %) at some point (first-line in 6 patients [9.0 %]), with definitive healing in 29 patients (93.5 %). Conclusions: Oral corticosteroid therapy remains the most common treatment for pyoderma gangrenosum associated with inflammatory bowel disease. Biologic therapies such as infliximab and adalimumab should also be considered. [ABSTRACT FROM AUTHOR]

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We report the case of an 18-month-old boy who presented with caries in the upper central incisors associated with the use of propranolol solution for the treatment of an infantile hemangioma. This side effect of propranolol solution has not been reported before, and it may result from a sucrose-based excipient of the solution, or decreased salivation caused by beta-adrenergic antagonist effect of propranolol. [ABSTRACT FROM AUTHOR]

Aim To determine patient adherence to generic venlafaxine versus brand-name venlafaxin (Vandral®) and its impact on costs and outcomes in subjects with Generalized Anxiety Disorder (GAD) in routine medical practice in Spain. Methods A retrospective, observational new-user cohort study was designed. Electronic medical records linked from medical database of BSA, a health provider in Badalona (Spain), and corresponding community pharmacies dispensing's were extracted for analysis. Participants were beneficiaries aged 18+ years with pharmacy dispensing drug coverage between 2008 and 2012, an ICD-9-CM code for GAD and who initiated treatment with generic-venlafaxine or Vandral®. Assessments included adherence (measured as the medication possession ratio [MPR] and time until discontinuation up to 1 year follow-up), healthcare costs funded by NHS and outcomes (measured as the reduction in severity of anxiety symptoms with the HAM-A scale). Differences were estimated using a general linear model with covariates. Results A total of 841 patients (60.7 years, 64% women) were identified: brand-name; 370 (44%) and generic; 471 (56%). The average MPR was 78% in the generic arm and 82% in the brand-name (p=0.047). Median persistence was 8.1 and 8.8 months, respectively (p=0.002). A 16% reduction in the adjusted healthcare cost was observed favoring brand-name; €1,110 vs. €928€; -€182 (p=0.020). Brand-name was associated with higher reduction in symptoms severity: -15.3 (62%) vs. -12.6 (49%) points (p<0.001). Conclusions Compared with initiating generic-venlafaxine, patients initiating brand-name venlafaxine were more likely to adhere, had lower NHS funded healthcare costs and showed higher reduction of anxiety severity symptoms in routine clinical practice. [ABSTRACT FROM AUTHOR]

Abstract: Adipose tissue plays a central role regulating the balance between deposition and mobilization of lipid reserves. Lipoprotein lipase (LPL) is a key enzyme controlling lipid accumulation in mammals and fish. In the present study, we have examined the expression of LPL in rainbow trout cultured adipocytes and we have investigated the effect of troglitazone, a member of thiazolidinediones (TZDs), and insulin on its expression. LPL gene expression increased from day 1 until day 12 of culture, and the level was maintained up to day 21. The addition of insulin at 10 nM and 1.7μM increased significantly LPL gene expression in undifferentiated cells (days 7 to 12 maintained in growth medium). Nevertheless, treatment of day 7 cells incubated in growth medium with troglitazone (5μM) or troglitazone plus insulin (1μM each), tended to enhance LPL expression. In addition, LPL mRNA levels increased significantly in the presence of 1μM and 5μM of troglitazone (days 7 to 12) when the cells were induced to differentiate by addition of differentiation medium. Although troglitazone alone (1μM) did not stimulate lipid accumulation in the cells neither in growth nor in differentiation medium, the simultaneous presence of troglitazone (1μM) and insulin (1μM) increased significantly the content of triglycerides in adipocyte cells maintained in growth medium (days 7 to 12). These results indicate that insulin and troglitazone regulate LPL gene expression during adipocyte differentiation and suggest that both factors may have combined effects in the modulation of adipogenesis. [Copyright &y& Elsevier]

The common mango waste (Mangifera indica L.) is a vegetable material containing a high level of lignocelluloses tissue which can be used to obtain fermentable metabolites and fermentation products. In this study hydrolysis treatments were applied to the common mango in order to make the conversion of its polysaccharides to fermentable sugar units. Acid hydrolysis was applied to three different concentrations of dilute sulphuric acid. An enzymatic hydrolysis with two types of commercial enzymes to different concentrations in standard work conditions, was also applied. In addition, a thermic hydrolysis was applied at two different temperatures. At each treatment, the following tests were applied: total sugar concentration, reduced sugar concentration, and percentage of cellulose and hemicellulose residuals. Based on the data obtained from the tests, the best treatments were identified and so the best combinations of the best hydrolysis treatments were carried out. The most significant treatment for individual tests was acid hydrolysis at 0,50% v/v sulphuric acid at 80°C for one hour. In the combined treatments the most relevant result was the treatment that combined the enzymatic hydrolysis (as pretreatment) plus a thermic hydrolysis and acid hydrolysis. For security reasons in the reagents use, as well as in the elimination of collateral adverse effects for further alcoholic fermentation, a procedure involving thermic hydrolysis as pretreatment and enzymatic hydrolysis, was chosen as the main treatment with the most appropriate application in the fermentable metabolites production from common mango waste in order to produce alcohol. Further studies have allowed approaching the hydrolysis via microbial with Aspergillus niger and Trichoderma viride, as well as the alcoholic fermentation post-treatment hydrolytic using previous studies. The simultaneous hydrolysis and alcoholic fermentation, and recently performing the simultaneity of the processes, adding a recombining yeast that has the capacity to ferment sugars from five carbons. [ABSTRACT FROM AUTHOR]

Introduction About half of patients with acute liver failure (ALF) show clinical signs of cerebral edema and intracranial hypertension. Neuroimaging diagnostics and electroencephalography have poor correlation with intracranial pressure measurement. Objective The objective of this study was to characterize the cerebral hemodynamics patterns with transcranial Doppler (TCD) sonography in patients with ALF. Method We studied 21 patients diagnosed with ALF, admitted to the intensive care unit (ICU) at the Centro de Investigaciones Médico Quirúrgicas of Cuba. All of these patients had a TCD performed on arrival at ICU, evaluating the following: systolic (SV), diastolic (DV), and medium (MV) flows velocities and pulsatility index (PI) in right middle cerebral artery (RMCA) via temporal windows. Results The sonographic patterns of cerebral hemodynamics were as follows: low-flow, 12 patients (57.1%); high resistance, 5 patients (23.8%); and hyperemic, 4 patients (19%). Patients who died while waiting had lower MV RMCA (56.1 vs 58.1 cm/s) and higher PI (1.71 vs 1.41) than patients who could undergo transplantation ( P = .800 and P = .787, respectively). Conclusions In patients diagnosed with ALF admitted to the ICU the predominating cerebral hemodynamic pattern was low-flow with resistance increase. The TCD was shown to be a useful tool in the initial evaluation for prognosis and treatment. [ABSTRACT FROM AUTHOR]

Aim To model the cost and consequences of desvenlafaxine and venlafaxine in the second-line outpatient treatment of major depressive disorder (MDD) from the payer (National Health System) perspective in Spain. Methods The model (a Markov simulation) follows a cohort of MDD patients through 1 year after failure of first-line treatment with a Selective-Serotonin-Reuptake-Inhibitor (SSRI) and estimates outcome measures (% in remission and depression-free days) accrued and costs incurred during outpatient treatment of MDD. Selected comparator is venlafaxine because its actual generic price. The model also considers drug treatment switching beyond the second-line of therapy (3 rd line) or changing to another drugs in 4 th -line in cases of patient discontinuation or lack of remission according with outcomes from STAR-D trial. Efficacy of drugs was extracted from clinical trial published. The model generates outcomes and cost from the NHS in year 2014. Results Due to fewer discontinuations, desvenlafaxine was associated with numerically more depression-free days and a higher percentage of patients in remission versus venlafaxine: 1.7 days and 0.5% more in remission. Also, healthcare costs were a little bit lower with desvenlafaxine than with venlafaxine: €1,114 vs. €1,166 (-52€). Conclusion In patients who have not responded to a first-line SSRI therapy, desvenlafaxine-50mg was clinically similar in effectiveness but a less costly option (about 5% lower) compared with venlafaxine for the second-line treatment of MDD patients from a payer (NHS) perspective in Spain. [ABSTRACT FROM AUTHOR]

Aim To carry out a cost-consequences analysis for 50mg-desvenlafaxine in the second-line outpatient treatment of major depressive disorder (MDD) from the payer (National Health System) perspective in Spain. Methods The model (Markov simulation) follows a cohort of MDD patients through 1 year after failure of first-line treatment with a SSRI and estimates outcome measures (% remission and depression-free days) accrued and costs incurred during outpatient treatment of MDD. Selected comparator is usual care (UC), which is assumed to be made of a mix of duloxetine and venlafaxine that make up the majority of the serotonin-norepinephrine reuptake inhibitor (SNRI) market in Spain. The model also considers drug treatment beyond the second-line of therapy (3 rd and 4 th -lines) in cases of patient discontinuation or lack of remission according with outcomes from STAR-D trial and other clinical trial published. The model generates outcomes and cost from the NHS in year 2014. Results Due to fewer discontinuations, desvenlafaxine was associated with numerically more depression-free days and a higher percentage of patients in remission versus UC: 1.7 days and 0.5% more in remission. Also, healthcare costs were lower with desvenlafaxine than with UC: €1,114 vs. €1,224 (-110€). Conclusion In patients who have not responded to a first-line SSRI therapy, desvenlafaxine-50mg was clinically similar in effectiveness but a less costly option, approximately 9% lower, compared with a weighted average of duloxetine and venlafaxine for the second-line treatment of MDD patients from a payer (NHS) perspective in Spain. [ABSTRACT FROM AUTHOR]