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COPD; Comorbidity; Mortality EPOC; comorbilidad; Mortalidad MPOC; Comorbilitat; Mortalitat This study aimed to describe the prevalence of comorbidities associated with chronic obstructive pulmonary disease (COPD) and their relation with relevant outcomes. A systematic review based on the PRISMA methodology was performed from January 2020 until July 2021. The MEDLINE, Lilacs, and Scielo databases were searched to identify studies related to COPD and its comorbidities. Observational studies on the prevalence of comorbidities in COPD patients and costs with health estimates, reduced quality of life, and mortality were included. Studies that were restricted to one or more COPD pain assessments and only specific comorbidities such as osteoporosis, bronchitis, and asthma were excluded. The initial search identified 1,409 studies and after applying the inclusion and exclusion criteria, 20 studies were finally selected for analysis (comprising data from 447,459 COPD subjects). The most frequent COPD comorbidities were: hypertension (range, 17%-64.7%), coronary artery disease (19.9%-47.8%), diabetes (10.2%-45%), osteoarthritis (18%-43.8%), psychiatric conditions (12.1%-33%), and asthma (14.7%-32.5%). Several comorbidities had an impact on the frequency and severity of COPD exacerbations, quality of life, and mortality risk, in particular malignancies, coronary artery disease, chronic heart failure, and cardiac arrhythmias. Comorbidities, especially cardiovascular diseases and diabetes, are frequent in COPD patients, and some of them are associated with higher mortality. University of Bahia

Notificació; VIH; Virus de la immunodeficiència humana; Infecció Notificación; VIH; Virus de la inmunodeficiencia humana; Infección Notification; HIV; Infection L’objectiu d’aquest Informe és conèixer l’evolució dels nous casos d’infecció pel VIH notificats i el percentatge dels diagnosticats de manera tardana tenint en compte la possible via de contagi.

Grups morbiditat ajustada; GMA; Eina d'estratificació; Avaluació de riscos Grupos morbilidad ajustada; GMA; Herramienta de estratificación; Evaluación de riesgos Adjusted morbidity groups; GMA; Stratification tool; Risk assessment Els GMA consisteixen en una eina que permet avaluar el risc en salut a partir de les característiques demogràfiques dels pacients, les seves malalties cròniques i aquelles situacions o malalties agudes que puguin tenir-hi impacte. Aquesta eina proporciona un índex de risc que es pot utilitzar com a factor d’ajust en models específics d’una determinada malaltia i a la vegada actua com un agrupament per estratificar la població en diferents nivells de risc. Los GMA consisten en una herramienta que permite evaluar el riesgo en salud a partir de las características demográficas de los pacientes, sus enfermedades crónicas y aquellas situaciones o enfermedades agudas que puedan tener impacto. Esta herramienta proporciona un índice de riesgo que se puede utilizar como factor de ajuste en modelos específicos de una determinada enfermedad y al mismo tiempo actúa como un agrupamiento para estratificar la población en diferentes niveles de riesgo. GMAs are a tool that assesses health risk based on the demographic characteristics of patients, their chronic diseases and those situations or acute diseases that may have an impact. This tool provides a risk index that can be used as an adjustment factor in specific models of a given disease and at the same time acts as a grouping to stratify the population at different levels of risk.

This study aimed to examine the prevalence of comorbidities in patients diagnosed with chronic lymphocytic leukemia (CLL), and to assess its influence on survival and cause-specific mortality at a population-based level. Incident CLL cases diagnosed in the Girona province (Spain) during 2008&ndash, 2016 were extracted from the Girona Cancer Registry. Rai stage and presence of comorbidities at diagnosis, further categorized using the Charlson comorbidity index (CCI), were obtained from clinical records. Observed (OS) and relative survival (RS) were estimated and Cox&rsquo, s proportional hazard models were used to explore the impact of comorbidity on mortality. Among the 400 cases included in the study, 380 (99.5%) presented at least one comorbidity at CLL diagnosis, with diabetes without end organ damage (21%) being the most common disease. 5-year OS and RS were 68.8 (95% CI: 64.4&ndash, 73.6) and 99.5 (95% CI 3.13&ndash, 106.0), respectively, which decreased markedly with increasing CCI, particularly in patients with CCI &ge, 3. Multivariate analysis identified no statistically significant association between the CCI and overall CLL-related or CLL-unrelated mortality. In conclusion, a high CCI score negatively influenced the OS and RS of CLL patients, yet its effect on mortality was statistically non-significant when also considering age and the Rai stage.

Background: Immunodeficiencies (ID), in particular primary immunodeficiencies (PID), are often associated with haematological manifestations, such as peripheral cytopenias or lymphoproliferative syndromes. Early diagnosis and management have significant prognostic implications. Secondary immunodeficiencies (SID) may also be induced by oncohaematological diseases and their treatments. Haematologists and oncologists must therefore be aware of the association between blood disorders and cancer and ID, and be prepared to offer their patients appropriate treatment without delay. Our aim was to define the warning signs of primary and secondary IDs in paediatric and adult patients with oncohaematological manifestations. Methods: A multidisciplinary group of six experts (2 haematologists, 2 immunologists, and 2 paediatricians specializing in ID) conducted a literature review and prepared a document based on agreements reached an in-person meeting. An external group of 44 IDs specialists from all over Spain assessed the document and were consulted regarding their level of agreement. Results: This document identifies the haematological and extra-haematological diseases that should prompt a suspicion of PIDs in adults and children, in both primary care and haematology and oncology departments. Cytopenia and certain lymphoproliferative disorders are key diagnostic pointers. The diagnosis must be based on a detailed clinical history, physical exploration, complete blood count and standard laboratory tests. The immunological and haematological tests included in the diagnostic process will depend on the care level. Patients who are candidates for immunoglobulin replacement therapy must be carefully selected, and treatment should be offered as soon as possible to avoid the development of complications. Finally, this document recommends procedures for monitoring these patients. Conclusions: This document combines scientific evidence with the opinion of a broad panel of experts, and emphasizes the importance of an early diagnosis and treatment to avoid complications. The resulting document is a useful tool for primary care physicians and specialists who see both adult and paediatric patients with oncohaematological diseases., This article received funding fee from CSL Behring.

Altres ajuts: FLMTV3/2010/062930 Psychosis and/or aggression are common problems in dementia, and when severe or persistent, cause considerable patient distress and disability, caregiver stress, and early institutionalization. In 2005, the Food and Drug Administration (FDA) determined that atypical antipsychotics were associated with a significantly greater mortality risk compared to placebo, which prompted the addition of an FDA black-box warning. The American College of Neuropsychopharmacology (ACNP) White Paper, 2008, reviewed this issue and made clinical and research recommendations regarding the use of antipsychotics in dementia patients with psychosis and/or agitation. Increased mortality risk has also been described in cerebrovascular adverse events in elderly users of antipsychotics. In the present work, at the translational level, we used male 3xTg-AD mice (PS1M146V, APPSwe, tauP301L) at advanced stages of the disease reported to have worse survival than females, to study the behavioral effects of a low chronic dose of risperidone (0.1 mg/ kg, s.c., 90 days, from 13 to 16 months of age) and its impact on long-term survival, as compared to mice with normal aging. Animals were behaviorally assessed for cognitive and BPSD (behavioral and psychological symptoms of dementia)-like symptoms in naturalistic and experimental conditions (open-field test, T-maze, social interaction, Morris water maze, and marble test) before and after treatment. Weight, basal glucose levels, and IPGTT (i.p. glucose tolerance test) were also recorded. Neophobia in the corner test was used for behavioral monitoring. Survival curves were recorded throughout the experiment until natural death. The benefits of risperidone were limited, both at cognitive and BPSD-like level, and mostly restricted to burying, agitation/vibrating tail, and other social behaviors. However, the work warns about a clear early mortality risk window during the treatment and long-lasting impact on survival. Reduced life expectancy and life span were observed in the 3xTg-AD mice, but total lifespan (36 months) recorded in C57BL/6 × 129Sv counterparts with normal aging was also truncated to 28 months in those with treatment. Sarcopenia at time of death was found in all groups, but was more severe in wild-type animals treated with risperidone. Therefore, the 3xTg-AD mice and their non-transgenic counterparts can be useful to delimitate critical time windows and for studying the physio-pathogenic factors and underlying causal events involved in this topic of considerable public health significance.

Intervenció grupal psicoeducativa; Depressió; Atenció primària Intervención grupal psicoeducativa; Depresión; Atención primaria Psychoeducational group intervention; Depression; Primary care El document que us presentem és un protocol d’intervenció grupal psicoeducativa per a pacients amb depressió lleu/moderada i comorbiditat física. Es tracta d’una adaptació del document del mateix nom, editat l’any 2009 i fet pel Grup de treball del Protocol d’intervenció grupal psicoeducativa per a pacients amb depressió lleu/moderada a l’atenció primària (PI07/90712). Aquesta nova edició del protocol està adaptada als pacients que tenen depressió però que també presenten alguna malaltia física crònica. Aquest manual ha servit per realitzar els grups psicoeducatius del projecte “Efectivitat d'una intervenció grupal psicoeducativa realitzada per infermeres d'atenció primària a pacients amb depressió i comorbiditat física. Estudi PsiCoDep”, finançat per l’Instituto de Salud Carlos. III Subprograma de Proyectos de Investigación en Salud (AES 2016) amb codi expedient PI 16/01272 cofinançat per la Unió Europea a través del Fons Europeu de Desenvolupament Regional (FEDER) i la Resolució definitiva SLT002/17/00096 de la modalitat d’Intensificació d’Infermeria de la convocatòria PERIS 2017 del Departament de Salut de la Generalitat de Catalunya. Aquest protocol pretén aconseguir l’homogeneïtzació de les intervencions grupals que fan les infermeres i infermers dels diversos equips d’atenció primària (EAP) que participen en aquesta investigació. Aquesta revisió de la 1a edició del “Protocol d’intervenció grupal psicoeducativa per a pacients amb depressió lleu i moderada a l’atenció primària” ha estat realitzada en el marc del desenvolupament del projecte de l’Instituto de Salud Carlos III Subprograma de Proyectos de Investigación en Salud (AES 2016), amb codi expedient PI 16/01272 cofinançat per la Unió Europea a través del Fons Europeu de Desenvolupament Regional (FEDER) ”Efectivitat d’una intervenció grupal psicoeducativa realitzada per infermeres d’atenció primària en pacients amb depressió i comorbiditat física (Estudi PsiCoDep) i la resolució definitiva SLT002/17/00096 de la modalitat d’Intensificació d’Infermeria de la convocatòria PERIS 2017 del Departament de Salut de la Generalitat de Catalunya.

The aim of this study was to describe the clinical characteristics of ANCA-associated vasculitides (AAV) at presentation, in a wide cohort of Spanish patients, and to analyze the impact of the vasculitis type, ANCA specificity, prognostic factors, and treatments administered at diagnosis, in the outcome. A total of 450 patients diagnosed between January 1990 and January 2014 in 20 Hospitals from Spain were included. Altogether, 40.9% had granulomatosis with polyangiitis (GPA), 37.1% microscopic polyangiitis (MPA), and 22% eosinophilic granulomatosis with polyangiitis (EGPA). The mean age at diagnosis was 55.6 +/- 17.3 years, patients with MPA being significantly older (P < 0.001). Fever, arthralgia, weight loss, respiratory, and ear-nose-throat (ENT) symptoms, were the most common at disease onset. ANCAs tested positive in 86.4% of cases: 36.2% C-ANCA-PR3 and 50.2% P-ANCA-MPO. P-ANCA-MPO was significantly associated with an increased risk for renal disease (OR 2.6, P < 0.001) and alveolar hemorrhage (OR 2, P = 0.010), while C-ANCA-PR3 was significantly associated with an increased risk for ENT (OR 3.4, P < 0.001) and ocular involvement (OR 2.3, P = 0.002). All patients received corticosteroids (CS) and 74.9% cyclophosphamide (CYC). The median follow-up was 82 months (IQR 100.4). Over this period 39.9% of patients suffered bacterial infections and 14.6% opportunistic infections, both being most prevalent in patients with high-cumulated doses of CYC and CS (P < 0.001). Relapses were recorded in 36.4% of cases with a mean rate of 2.5 +/- 2.3, and were more frequent in patients with C-ANCA-PR3 (P = 0.012). The initial disease severity was significantly associated with mortality but not with the occurrence of relapses. One hundred twenty-nine (28.7%) patients (74 MPA, 41 GPA, 14 EGPA) died. The mean survival was 58 months (IQR 105) and was significantly lower for patients with MPA (P < 0.001). Factors independently related to death were renal involvement (P = 0.010), cardiac failure (P = 0.029) and age over 65 years old (P < 0.001) at disease onset, and bacterial infections (P < 0.001). An improved outcome with significant decrease in mortality and treatment-related morbidity was observed in patients diagnosed after 2000, and was related to the implementation of less toxic regimens adapted to the disease activity and stage, and a drastic reduction in the cumulated CYC and CS dose.

Envejecimiento; Cronicidad; Comorbilidad; VIH Envelliment; Cronicitat; Comorbiditat; VIH Aging; Chronicity; Comorbidity; HIV Aquest article analitza la situació actual en l'envelliment, cronicitat i comorbiditat de les persones amb infecció per VIH.