Search

Com o objetivo de destacar a importância das técnicas de visualização de dados, como storytelling de dados e dashboards, no processo de tomada de decisão na gestão pública, o presente trabalho busca descrever como essas técnicas foram implementadas no software Prefeitura Interativa. O ambiente de apoio à decisão foi elaborado para auxiliar a administração pública municipal na gestão de políticas públicas e na busca por soluções mais eficientes para as demandas que afetam a população local. Por meio de uma abordagem colaborativa, o software permite a aplicação de técnicas específicas de coleta e visualização de dados para melhorar a análise e interpretação de informações relevantes para a tomada de decisão.

Background The 21st century has witnessed advances in endoscopic surveillance technology such as high-definition imaging and virtual or dye-based chromoendoscopy, which have led to increased detection of dysplasia. It is unknown the rates of new dysplastic lesions or cancer progression with these techniques though it seems lower than previously described. Methods We developed a multicenter, population-based and retrospective cohort from 7 Spanish hospitals from the Group of Inflammatory bowel disease of Castilla Y Leon (GEICYL) including sequentially all patients with inflammatory bowel disease and colonic dysplastic lesions completely resected (R0) in surveillance with dye-based indigo carmine chromoendoscopy between January 2013 and December 2019, with a minimum endoscopic follow-up of 12 months. The aim was to evaluate the risk of developing more advanced metachronous neoplasia during follow-up, analysing possible associated risk factors. Results A total of 99 patients and 148 index lesions (145 low-grade dysplasias [LGD] and 3 high-grade dysplasias [HGD]) with a medium follow-up of 48.76 months (IQR: 36.34 – 67.15) were included. Patients and IBD baseline characteristics are reflected in table 1. During follow-up, 37 patients developed 97 new dysplastic lesions (92 LGD, 4 HGD and 1 CRC) and 1 patient developed multifocal invisible dysplasia (3 HGD). The overall incidence rate for new dysplastic lesions was 0.23 per 100 patient-year, 1.15 per 100 patients at 5 years and 2.29 per 100 patients at 10 years (Figure 1). Personal history of dysplasia was associated with higher risk of developing any grade of dysplasia during follow-up (p 0.025), meanwhile, left colon lesions was associated with a lower risk (p 0.043). 6 patients developed more advanced lesions (5 patients HGD and 1 CCR) with an incidence rate at year and 10 years of 1% and 14% respectively; LGD lesion >1cm was a risk factor for developing HGD or CRC (p 0.041), meanwhile LGD lesion < 1 cm was a protective factor (p 0.013) (table 2,3). 1/8 patients (13%) with HGD lesions developed CRC during follow-up. 3 patients were colectomized (2 by HGD and 1 by CRC). Neither mesalamine treatment or immunosuppressive or biological treatment were associated with a lower risk of dysplasia development. Conclusion Risk of dysplasia progression to advanced neoplasia and specifically risk of new neoplastic lesions after endoscopic resection of colitis-associated dysplasia are very low in our cohort with dye-chromoendoscopy. Personal history of dysplasia, as risk factor, and left colon location, as protective factor, were associated with new dysplastic lesions. Finally, size above 1 cm was the only risk factor for progression to advanced lesions.

The role of endoscopic evaluation in ulcerative colitis (UC) is well recognized, but a universally accepted gold standard for endoscopic activity evaluation is still lacking, and many scores have been proposed to this purpose. Among these, the Mayo Endoscopic Score (MES) and the Ulcerative Colitis Endoscopic Index (UCEIS) are currently the most used in trials and clinical practice. The aim of the study is to evaluate feasibility and performance of MES and UCEIS among expert endoscopists with no specific expertise in inflammatory bowel diseases (IBD), in a single hospital center. Two minutes video recordings, from colonoscopy of 12 UC patients, were observed and scored, according to MES and UCEIS, by seven hospital gastroenterologists with experience in digestive endoscopy and no particular expertise in IBD. Knowledge and utilization of the two scores were investigated. Inter-observer agreement and agreement with an IBD-expert gastroenterologist of the same center (central reader), and correlation between the two scores, was calculated. Among the endoscopists, MES was much more known and currently used than UCEIS. Both the scores displayed a similar good performance. Agreement with central reader was moderate for MES and UCEIS, and interobserver agreement was good, for both MES and UCEIS. Correlation between the two scores was very good both for central reader and for the hospital endoscopists. This single center study confirmed potential feasibility and usefulness of MES and UCEIS for assessment of endoscopic activity in UC patients in a real-life setting.

Neoplasms that secrete ectopic adrenocorticotropin (ACTH) may cause severe, life-threatening hypercortisolism. These tumors are often difficult to localize and treat, requiring a comprehensive and systematic management plan orchestrated by a multidisciplinary team. The Mount Sinai Adrenal Center hosted an interdisciplinary retreat of experts in adrenal disorders and neuroendocrine tumors (NETs) with the aim of developing a clinical pathway for the management of Cushing syndrome due to ectopic ACTH production. The result was institutional recommendations for the diagnosis, localization, surgical approaches to intrathoracic tumors and bilateral adrenalectomy, and perioperative and postoperative medical management of hypercortisolism and its sequelae. Specific recommendations were made regarding the timing and selection of therapies based on the considerations of our team as well as a review of the current literature. Our clinical pathway can be applied by other institutions directly or serve as a guide for institution-specific management.

East Asians (EAs) experience worse metabolic health outcomes compared to other ethnic groups at lower body mass indices; however, the potential role of the gut microbiota in contributing to these health disparities remains unknown. We conducted a multi-omic study of 46 lean and obese East Asian and White participants living in the San Francisco Bay Area, revealing marked differences between ethnic groups in bacterial richness and community structure. White individuals were enriched for the mucin-degrading Akkermansia muciniphila. East Asian subjects had increased levels of multiple bacterial phyla, fermentative pathways detected by metagenomics, and the short-chain fatty acid end-products acetate, propionate, and isobutyrate. Differences in the gut microbiota between the East Asian and White subjects could not be explained by dietary intake, were more pronounced in lean individuals, and were associated with current geographical location. Microbiome transplantations into germ-free mice demonstrated stable diet- and host genotype-independent differences between the gut microbiotas of East Asian and White individuals that differentially impact host body composition. Taken together, our findings add to the growing body of literature describing microbiome variations between ethnicities and provide a starting point for defining the mechanisms through which the microbiome may shape disparate health outcomes in East Asians., eLife digest The community of microbes living in the human gut varies based on where a person lives, in part because of differences in diets but also due to factors still incompletely understood. In turn, this ‘microbiome’ may have wide-ranging effects on health and diseases such as obesity and diabetes. Many scientists want to understand how differences in the microbiome emerge between people, and whether this may explain why certain diseases are more common in specific populations. Self-identified race or ethnicity can be a useful tool in that effort, as it can serve as a proxy for cultural habits (such as diets) or genetic information. In the United States, self-identified East Asian Americans often have worse ‘metabolic health’ (e.g. levels of sugar or certain fat molecules in the blood) at a lower weight than those identifying as White. Ang, Alba, Upadhyay et al. investigated whether this health disparity was linked to variation in the gut microbiome. Samples were collected from 46 lean and obese individuals living in the San Francisco Bay Area who identified as White or East Asian. The analyses showed that while the gut microbiome of White participants changed in association with obesity, the microbiomes of East Asian participants were distinct from their White counterparts even at normal weight, with features mirroring what was seen in White individuals in the context of obesity. Although these differences were connected to people’s current address, they were not attributable to dietary differences. Ang, Alba, Upadhyay et al. then transplanted the microbiome of the participants into genetically identical mice with microbe-free guts. The differences between the gut microbiomes of White and East Asian participants persisted in recipient animals. When fed the same diet, the mice also gained different amounts of weight depending on the ethnic identity of the microbial donor. These results show that self-identified ethnicity may be an important variable to consider in microbiome studies, alongside other factors such as geography. Ultimately, this research may help to design better, more personalized treatments for an array of conditions.

Plant-derived lignans, consumed daily by most individuals, are thought to protect against cancer and other diseases1; however, their bioactivity requires gut bacterial conversion to enterolignans2. Here, we dissect a four-species bacterial consortium sufficient for all five reactions in this pathway. A single enzyme (benzyl ether reductase, encoded by the gene ber) was sufficient for the first two biotransformations, variable between strains of Eggerthella lenta, critical for enterolignan production in gnotobiotic mice and unique to Coriobacteriia. Transcriptional profiling (RNA sequencing) independently identified ber and genomic loci upregulated by each of the remaining substrates. Despite their low abundance in gut microbiomes and restricted phylogenetic range, all of the identified genes were detectable in the distal gut microbiomes of most individuals living in northern California. Together, these results emphasize the importance of considering strain-level variations and bacterial co-occurrence to gain a mechanistic understanding of the bioactivation of plant secondary metabolites by the human gut microbiome.

BACKGROUND The pathophysiology of bloating is partially understood. We investigated in patients with disorders of gut-brain interaction (DGBI) the relationship between severity of bloating, abdominal girth changes and defecation pattern, and the efficacy of pelvic floor biofeedback treatment on bloating. METHODS Disorders of gut-brain interaction patients with severe bloating as the main complaint were prescribed 2 weeks dietary advice and underwent abdominal girth measurements. At the first visit, all patients underwent a questionnaire on the subjective improvement of bloating, a (0-100) VAS abdominal bloating, and abdominal girth measurement. Patients reporting inadequate bloating relief underwent a standardized balloon expulsion test. Furthermore, they were invited to undergo pelvic floor electromyography and biofeedback treatment previously used for constipation due to dyssynergic defecation. The primary outcome was bloating improvement on a 5-point Likert scale. The secondary outcomes were the effect of diet intervention and pelvic floor biofeedback treatment on bloating severity and quality of life changes as well as the effect of pelvic floor biofeedback treatment on BET and EMG on straining. KEY RESULTS One hundred and fifty six patients (129 F, 39.3 ± 11.7 mean age) completed the 2-week run-in period. 105 patients were diet non-responder and underwent balloon expulsion test, with the vast majority (64%) failing the test. Patients who scored higher bloating on VAS had a significant association with failed balloon expulsion test (adjusted B 0.4 [95% CI 10.8-25.7], p

Souissi et al.1 recently described the trichoscopic flag sign in regrowing hair in alopecia areata (AA). We would like to communicate a case presenting with simultaneous macroscopic and trichoscopic hair flag sign as features of hair regrowth in AA. A healthy 32-year-old man presented with a four-month history of patchy hair loss of the scalp and beard. Clinical examination revealed six oval alopecic lesions with black dots and broken hairs on dermoscopy, findings consistent with AA. He was treated with monthly intralesional triamcinolone acetonide (4 mg/mL). After five months of treatment, he presented a bundle of hairs with alternating horizontal bands of depigmented and normally pigmented hairs (macroscopic flag sign) over the scalp in areas of prior alopecic patches (Fig. 1a). Meticulous evaluation revealed multiple alternating bands in the same hair shaft, finding known as segmental heterochromia2 (Fig. 2a - 2b). Dermoscopy demonstrated black and white horizontal bands in the same hair shaft (Fig. 1b), corresponding to the trichoscopic flag sign.1 Microscopic evaluation showed gradual pigmentation from distal to the proximal segment of the hair shaft (Fig. 2c). The patient had a good nutritional status and denied alcoholism or usage of any systemic medications.

Background Intravenous (IV) infliximab is a first line treatment for moderate or severe flare of inflammatory bowel disease. Recently a new formulation of infliximab with subcutaneous (SC) administration has been developed and approved for this indication. Methods From March 2021, 14 patients diagnosed with inflammatory bowel disease (Crohn’s disease-CD- or ucerative colitis-UC), in clinical remission for at least 6 months with infliximab IV who had needed previous intensification, either because of a reactive therapeutic drug monitoring and loss of response, or because of a proactive drug monitoring (trough levels Results Four patients (28,57%) were diagnosed with CD, 10(71,4%) were diagnosed with UC (Table 1). Median duration of IV treatment was 53 months (IQR 33–59). Reasons for starting infliximab were corticodependence in 6 patients (42,8%), corticorefractoriness in 6(42,8%) and topdown strategy in B2 phenotipe with Crohn’s disease in 2 (14,3%). Reasons for intensification were: loss of response in 5 patients (35,7%), intensified induction in one (7,1%), proactive therapeutic drug monitoring in 8 (57,14%) (graphic 1). Intensification regimens are shown in graphic 2. Eleven patients (78,57%) were still in an intensified regimen when switched. All patients were in clinical and biochemical remission (FC Conclusion In our centre, switching from IV to standard dose SC infliximab maintained clinical and biochemical remission in patients that previously needed intensified regimen, improving trough levels without any adverse events. These findings provide potential therapeutic insights into SC infliximab as a monotherapy agent for inflammatory bowel disease.

BackgroundThe human gut microbiota exhibits marked variation around the world, which has been attributed to dietary intake and other environmental factors. However, the degree to which ethnicity-associated differences in gut microbial community structure and function are maintained following immigration or in the context of metabolic disease is poorly understood.ResultsWe conducted a multi-omic study of 46 lean and obese East Asian and White participants living in the San Francisco Bay Area. 16S rRNA gene sequencing revealed significant differences between ethnic groups in bacterial richness and community structure. White individuals were enriched for the mucin-degrading Akkermansia muciniphila. East Asian participants had increased levels of multiple bacterial phyla, fermentative pathways detected by metagenomics, and the short-chain fatty acid end products acetate, propionate, and isobutyrate. Differences in the gut microbiota between the East Asian and White groups could not be explained by reported dietary intake, were more pronounced in lean individuals, and were associated with current geographical location. Microbiome transplantations into germ-free mice confirmed that the differences in the gut microbiota of the East Asian and White individuals we analyzed are independent of diet and that they differentially impact host body weight and adiposity in genetically identical mouse recipients.ConclusionsThe reported findings emphasize the utility of studying diverse ethnic groups within a defined geographical location and provide a starting point for dissecting the mechanisms contributing to the complex interactions between the gut microbiome and ethnicity-associated lifestyle, demographic, metabolic, and genetic factors.

Ischaemic stroke may be a major complication of SARS-CoV-2 infection. Studying and characterising the different aetiological subtypes, clinical characteristics, and functional outcomes may be valuable in guiding patient selection for optimal management and treatment.Data were collected retrospectively on consecutive patients with SARS-CoV-2 infection who developed acute focal brain ischaemia (between 1 March and 19 April 2020) at a tertiary university hospital in Madrid (Spain).During the study period, 1594 patients were diagnosed with COVID-19. We found 22 patients with ischaemic stroke (1.38%), 6 of whom did not meet the inclusion criteria. The remaining 16 patients were included in the study (15 cases of ischaemic stroke and one case of transient ischaemic attack). Median baseline National Institutes of Health Stroke Scale score was 9 (interquartile range: 16), and mean (standard deviation) age was 73 years (12.8). Twelve patients (75%) were men. Mean time from COVID-19 symptom onset to stroke onset was 13 days. Large vessel occlusion was identified in 12 patients (75%). We detected elevated levels of D-dimer in 87.5% of patients and C-reactive protein in 81.2%. The main aetiology was atherothrombotic stroke (9 patients, 56.3%), with the predominant subtype being endoluminal thrombus (5 patients, 31.2%), involving the internal carotid artery in 4 cases and the aortic arch in one. The mortality rate in our series was 44% (7 of 16 patients).In patients with COVID-19, the most frequent stroke aetiology was atherothrombosis, with a high proportion of endoluminal thrombus (31.2% of patients). Our clinical and laboratory data support COVID-19-associated coagulopathy as a relevant pathophysiological mechanism for ischaemic stroke in these patients.

Adipose tissues dynamically remodel their cellular composition in response to external cues by stimulating beige adipocyte biogenesis; however, the developmental origin and pathways regulating this process remain insufficiently understood owing to adipose tissue heterogeneity. Here, we employed single-cell RNA-seq and identified a unique subset of adipocyte progenitor cells (APCs) that possessed the cell-intrinsic plasticity to give rise to beige fat. This beige APC population is proliferative and marked by cell-surface proteins, including PDGFRα, Sca1, and CD81. Notably, CD81 is not only a beige APC marker but also required for de novo beige fat biogenesis following cold exposure. CD81 forms a complex with αV/β1 and αV/β5 integrins and mediates the activation of integrin-FAK signaling in response to irisin. Importantly, CD81 loss causes diet-induced obesity, insulin resistance, and adipose tissue inflammation. These results suggest that CD81 functions as a key sensor of external inputs and controls beige APC proliferation and whole-body energy homeostasis.

Case Presentation: A 43 year-old female was diagnosed at birth with non-salt wasting congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency and underwent clitoral reduction surgery. She was treated with hydrocortisone and had menarche at age 7 with irregular and heavy menses. At age 15 she had a D&C with removal of “something in her ovaries.” She stopped hydrocortisone at age 30 except for stress doses during illness. At age 35 she stopped oral contraceptives and thereafter has been amenorrheic. She presented with abdominal distention and constipation. On exam she had short stature, marked frontal and temporal balding, hirsutism, increased musculature and a large distended abdomen. Labs showed AM cortisol 3.1 mcg/dL (nl 10–20), ACTH 440 pg/ml (nl Discussion: Excess androgens and chronically elevated ACTH levels in untreated CAH can lead to adverse effects beyond adrenal insufficiency and virilization. We present a woman with untreated classic CAH who developed a large fibroid and paraaortic adrenal cortical tumor. Fibroids have been described in CAH patients, a potential consequence of elevated androgens that are converted by aromatase in the endometrium to estrogens driving growth of fibroid tumors. Chronic ACTH can further act as a growth factor, leading to adrenal hyperplasia, adrenal tumors and ectopic adrenal rest tissue. Intra-adrenal tumors in untreated CAH are generally benign with rare cases of adrenal cortical carcinoma reported. Ectopic adrenal rest tissue in untreated CAH is most commonly reported in testes. There have been rare case reports of ectopic adrenal rest tumors in the adnexa, broad ligament, and perirenal area. Our patient presents as an unusual case of ectopic adrenal rest tumor in the paraaortic region. Based on the atypical location and incomplete history available to the pathologist, it was initially read as metastatic adrenocortical carcinoma. Upon further review given the clinical information, the diagnosis was revised to indicate a pararenal adrenal rest tumor. This case highlights the importance of glucocorticoid compliance in CAH and the necessity to provide a clinical context for the pathologist in cases of extra-adrenal tumors in untreated CAH.

Background The efficacy of ustekinumab in patients with Crohn’s disease (CD) refractory to anti-TNF is worse than in anti-TNF naïve patients. Methods Retrospective study of patients with CD refractory or intolerant to TNF initiating ustekinumab between January 2013 and March 2020, with a minimum follow-up of 12 months, and without corticosteroid treatment. Our aim was evaluated clinical response (reduction of CDAI >100), clinical remission (CDAI Results A total of 49 patients with a medium follow-up of 28 months (IQR:13-37) were included. Patients baseline characteristics are reflected in Table 1. In 20% patients the induction was made subcutaneous (90 mg/week for 4 weeks). At week 52, clinical response, clinical remission and biochemical remission was 93%, 82% and 54% respectively (Figure 1). In the long term (3 years), 62% had clinical response, 52% remained in clinical remission, and 48% showed biochemical remission. 1/3 of patients needed intensification every year. Ustekinumab treatment discontinuation was observed in 13 patients (27%) mainly due to lack of response (6[12%]: primary, 7[14%]: secondary). No serious adverse effects have been reported. Conclusion About 50% of the patients are in clinical and biochemical remission at week 152 in a real-life cohort of anti-TNF-exposed CD patients. With a harder remission definition including biochemical parameters, our results in real life are similar to pivotal studies at week 152. Nevertheless, at week 52 our remission rates were higher.

Impaired white adipose tissue (WAT) function has been recognized as a critical early event in obesity-driven disorders, but high buoyancy, fragility, and heterogeneity of primary adipocytes have largely prevented their use in drug discovery efforts highlighting the need for human stem cell-based approaches. Here, human stem cells are utilized to derive metabolically functional 3D adipose tissue (iADIPO) in a microphysiological system (MPS). Surprisingly, previously reported WAT differentiation approaches create insulin resistant WAT ill-suited for type-2 diabetes mellitus drug discovery. Using three independent insulin sensitivity assays, i.e., glucose and fatty acid uptake and suppression of lipolysis, as the functional readouts new differentiation conditions yielding hormonally responsive iADIPO are derived. Through concomitant optimization of an iADIPO-MPS, it is abled to obtain WAT with more unilocular and significantly larger (≈40%) lipid droplets compared to iADIPO in 2D culture, increased insulin responsiveness of glucose uptake (≈2-3 fold), fatty acid uptake (≈3-6 fold), and ≈40% suppressing of stimulated lipolysis giving a dynamic range that is competent to current in vivo and ex vivo models, allowing to identify both insulin sensitizers and desensitizers.

Using the theory of D -modules, we prove some finiteness properties for local cohomology modules with respect to a family of supports on the spectrum of a k-algebra R which satisfies certain conditions introduced by L. Nunez-Betancourt in [15] . These results generalize in a sense most of the finiteness properties established by G. Lyubeznik in [9] . We also introduce the class of quasi-holonomic D -modules which properly contains the class of holonomic D -modules and is closed by taking submodules, quotients, extensions, direct limits, localizations at multiplicative subsets of R and local cohomology.

As the healthcare environment continues to evolve, the physician role is moving beyond medical expertise and demanding more leadership abilities. Medical leadership can range from implementing various doctor–patient care models, collaborating with interdisciplinary teams, to understanding how physicians can positively influence productivity as board members.1 2 Traditionally, medical leaders have been selected on the basis of merit, but with today’s medical context being more volatile, a physician is looked on to make decisions beyond their clinical expertise.3 Today’s medical leaders require a different set of competencies that go beyond a command and control type of leadership, and require interdependence and the prioritisation of one’s patients, team members and community. Healthcare organisations must consider developing leaders in an effort to close this gap through practice efforts that capture this paradigm shift, and prepare physicians with the knowledge, skills and abilities to lead effectively in today’s world.4–6 Lees and Armit characterise medical leadership as an evidence-free zone, noting that the generalisability of existing leadership knowledge from other professions to medical leadership is sparse.4 As a result, the leadership models theorised and tested by leadership academics are often ignored. This is problematic to the advancement of medical leadership, as extending leadership models from the organisational sciences to healthcare could provide a healthcare-based leadership programme with the theoretical basis and rigorous measurement tools that need to be …

Anorectal manometry is one of the most widely performed tests for the assessment of anal sphincter function and anorectal coordination. Nowadays high resolution (HRAM) and high definition anorectal manometry (HDAM) are available, instead of the water-perfused system. The ability to visualize the anorectum as a dynamic structure during test maneuvers should intuitively allow for a better appreciation of the normal physiology and hopefully enhance our understanding of the pathophysiology of defecatory dysfunctions. Even if the anorectal manometry protocols can vary by centers, the procedure must include an assessment of rectoanal pressure and anal canal length at rest, cough reflex test, rectoanal pressures during squeeze, simulated evacuation, and rectal sensation. Although it is becoming an increasingly widespread examination, at present the normality values for different examined parameters, shared between different centers, are not available, and it would therefore be desirable to define the parameters of normality shared at the Italian and European level.

Although improvements in genetic analysis have greatly enhanced our understanding of the mechanisms behind pancreatitis, it continues to afflict many families for whom the hereditary factors remain unknown. Recent evaluation of a patient with a strong family history of pancreatitis prompted us to reexamine a large kindred originally reported over 50 years ago with an autosomal-dominant inheritance pattern of chronic pancreatitis, diabetes, and pancreatic adenocarcinoma. Whole-exome sequencing analysis identified a rare missense mutation in the gene encoding pancreas-specific protease elastase 3B (CELA3B) that cosegregates with disease. Studies of the mutant protein in vitro, in cell lines, and in CRISPR-Cas9–engineered mice indicate that this mutation causes translational upregulation of CELA3B, which, upon secretion and activation by trypsin, leads to uncontrolled proteolysis and recurrent pancreatitis. Although lesions in several other pancreatic proteases have been previously linked to hereditary pancreatitis, to our knowledge, this is the first known instance of a mutation in CELA3B and a defect in translational control contributing to this disease.

In general, glucose consumption improves cognitive performance; however, it is unknown whether glucose specifically alters attentional food bias, and how this process may vary by BMI status. We hypothesized that glucose consumption would increase attentional food bias among individuals of obese BMI status more so than among individuals of lean BMI status. Participants (N = 35) completed the n-back, a working memory task modified to assess attentional food bias (ATT-Food), under fasting and glucose challenge conditions. We computed pre-post changes in ATT-Food, blood glucose and insulin (∆BG & ∆BI), and perceived task-stress (∆stress). After the second cognitive test and blood draw, participants ate lunch and completed a “taste test” of highly palatable foods, and we recorded food consumption. Pre-post changes in ATT-Food were greater among participants of obese (relative to lean) BMI status (F(1,33) = 5.108, p = .031). Greater ∆ATT-Food was significantly associated with greater ∆BG (r = .462, p = .007) and reduced ∆stress (r =-.422, p = .011), and marginally associated with greater taste-test eating (r =.325, p = .057), but was not associated with ∆BI. Our findings suggest that individuals of obese BMI status may exhibit “sweet cognition,” as indexed by greater attentional food bias following glucose ingestion, relative to individuals of lean BMI status. Among individuals of obese BMI status, sweet cognition may arise from difficulty broadening attention toward non-food cues after consuming a high glucose load, thereby potentially perpetuating sugar consumption. If confirmed by further research, measures of sweet cognition may help identify individuals with a phenotype of risk for obesity and greater sugar consumption, who may benefit from tailored interventions.

Background Polypharmacy and drug-related problems (DRP) increase the likelihood of negative health outcomes such as adverse reactions, interactions or lack of adherence. Moreover, published studies report DRPs as a frequent cause of hospitalisation and visits to emergency departments (ED), which makes it a target scenario for investigation. Purpose The aim was to analyse DRP and to explore its contribution to visits to the ED. Material and methods Prospective study was carried out in the ED of a tertiary hospital on polymedicated patients (≥5 drugs). Period of intervention: April–September 2018. Pharmacists collected information from previous reports, current emergency reports and prescriptions from the electronic prescribing records. Afterwards, patients were interviewed in order to check the information. The detected DRP were communicated to physicians (primary care, hospital specialist, ED) according to Pharmaceutical Care Network Europe Foundation V6.01 classification which was adapted. The ED physician was asked: ‘Do you think that any drug related problem has been able to contribute to the emergency visit?’ ‘Which one?’ The study is supported by the Ethics Committee of Gipuzkoa Health Area. Results One-hundred and one of 138 patients (73%) presented some DRP. The pharmacists considered that in 65 of 116 patients (47%) the DRP contributed to the visit to the ED. Thirty-three (50%) were male, mean age 75 years and an average of 9.2 prescriptions. The main reasons to go to the ED were: 16 (24%) dyspnea, six (9%) melaena, six (9%) dizziness and five (7.5%) general discomfort. DRP considered related to the visit were: 31 (47.7%) adverse effect, 20 (30.8%) adequate therapy but ineffective, three (4.6%) high dose, three (4.6%) lack of adherence, three (4.6%) indication without drug and four (6.2%), other. The ED physician agreed with the pharmacist in 94% of the cases, Cohens kappa: 0.913. Conclusion The prevalence of DRP and its contribution to the ED visit is higher than in other studies. 1, 2 Maybe this is due to a different methodology and patients’ characteristics (age, polypharmacy). 3 There is a high degree of agreement between the pharmacist and the ED physician in assessing the cases of DRP and the ED visit. The integration of a pharmacist in the ED has facilitated the detection of DRP and helped to identify their link with ED visits. References and/or acknowledgements 1. https://www.ncbi.nlm.nih.gov/pubmed/12126224 2. https://www.ncbi.nlm.nih.gov/pubmed/24493969 3. https://www.ncbi.nlm.nih.gov/pubmed/25795686 No conflict of interest.