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Introduction and Objectives: Patients with metabolic dysfunction-associated steatotic liver disease (MASLD) are at an increased cardiovascular risk. On the contrary, non-alcoholic fatty liver disease (NAFLD) is highly prevalent in patients with coronary heart disease (CHD). However, it is not known whether patients with significant CHD show a higher frequency of liver fibrosis. This study aimed to determine the frequency of MASLD and liver fibrosis in patients with CHD and to assess whether coronary stenosis is significantly associated with MASLD and fibrosis. Patients and Methods: This observational and analytical study included adult patients without any known liver disease who underwent coronary angiography for suspected coronary artery disease (Jul 2021–Jul 2022). The presence of significant CHD (> 50% stenosis of at least one coronary artery) was determined. Liver elastography (FibroScan®) was performed up to 6 months after the coronary angiographic study to determine liver fibrosis, a measurement of liver stiffness (> 6.5 Kpa). Fisher's test, Mann–Whitney U test, and logistic regression models were used (p < 0.05). Results: The study included 113 patients (76% men, average age: 63 years [standard deviation: 9.9]), of which 72% presented with significant CHD. The prevalence rate of MASLD was 52%. Liver fibrosis was present in 12% of the patients and all patients in the significant CHD group (p = 0.007). An increase in the number of vessels with significant CHD increased the probability of liver fibrosis (odds ratio, 1.79; 95% confidence interval, 1.06–3.04; p = 0.029). Conclusions: MASLD is highly prevalent in patients with significant CHD but without known liver damage. These data suggest that MASLD and liver fibrosis should be investigated in patients with CHD. The presence of confounding variables, especially the presence of type 2 diabetes mellitus, should be evaluated in further studies.

Introduction and Objectives: In chronic pathologies, such as cirrhosis, information is essential for disease acceptance, adherence to treatment and prevention of complications. This study aimed to determine whether written information in patients with cirrhosis has an effect on the level of knowledge and treatment adherence and to evaluate possible factors associated with disease-related knowledge in cirrhosis. Materials and Methods: Longitudinal, analytical study. Adult outpatients with cirrhosis were included in July-December 2021. Self-completed survey with demographic, clinical information, disease-related knowledge with ''Cirrhosis Knowledge Questionnaire'' (1 - 7 points) and treatment adherence with Morisky-Green-Levine scale (Low, Medium, High) were assessed. History of complications and hospitalizations in the last two years were obtained from clinical records. Patients were provided with an educational brochure and after four months, the disease-related knowledge and treatment adherence were re-evaluated. Comparative analysis was performed with T Student or ANOVA. Multiple linear regression models were assessed to identify possible associated factors (p < 0.05). Results: We included 104 patients, 53% men, the median age of 64 years, and 80% of them with middle or higher education. The most frequent etiologies of cirrhosis were alcohol (27%) and non-alcoholic steatohepatitis (26%). The median level of disease-related knowledge was 3 (RIC 2 - 5). Forty-three percent of the patients answered >50% of the answers correctly. Bivariate and multivariate analyses of the disease-related knowledge are described in Table 1. Disease-related knowledge levels increased after delivery of written information at the 4-month follow-up (3.21 vs. 3.96; p=0.0007), but treatment adherence did not. Conclusions: Less than half of the patients answered > 50% of disease-related knowledge correctly. Higher educational levels, history of hospitalization and complications due to cirrhosis were associated with a higher disease-related knowledge level score. The provision of written information is associated with an increase in disease-related knowledge levels in patients with cirrhosis.

Introduction and Objectives: Patients with nonalcoholic fatty liver disease (NAFLD) are at increased cardiovascular risk, and there is a higher prevalence of this disease in patients with coronary heart disease (CHD). However, the evidence in favor of NAFLD as a risk factor for CHD is scarce. This study aimed to determine the prevalence of NAFLD in patients with CHD and to assess whether significant CHD is associated with NAFLD and liver fibrosis. Materials and Methods: Observational, analytical study in adult patients with coronary angiography for suspected coronary artery disease between July 2021-July 2022. The number of affected coronary vessels and the presence of significant CHD (stenosis >50%) were determined. In addition, FibroScan® was performed to evaluate steatosis and liver fibrosis up to 6 months after the coronary study, considering the presence of fibrosis at F>0. Descriptive statistics, Fisher's exact test and logistic regression models were reported for inferential analysis. Results: Ninety-seven patients were included, 73% male, age 63 ± 10 years (Table 1). 71% presented significant CHD, with 37% multivessel disease (2 or more). The prevalence of NAFLD was 38%, with no differences between those with and without CHD (43% vs. 36%, p=0.646). In turn, 16% of patients presented some degree of fibrosis, linearly associated with the number of vessels involved (OR=1.8, p=0.022), with an even higher risk in patients with two or more vessels involved (OR=3.5, p=0.027). Conclusions: There is a high prevalence of NAFLD in patients with CHD, with no differences between patients with significant stenosis vs not. Patients with multivessel disease have higher odd of presenting some degree of fibrosis. Although the presence of confounders should be evaluated in other studies, these data support the search for NAFLD and fibrosis in patients with CHD.

La percepción personal de un individuo de su situación de vida, dentro del contexto cultural y de valores en el que vive, y en relación con sus objetivos, expectativas, valores e intereses, se denomina, calidad de vida. Como en estudios de pacientes crónicos, los factores más influyentes en la percepción de la calidad de vida, se clasifican en: paciente, medicamento, enfermedad y calidad de la interacción entre paciente y sistema sanitario. Objetivos: Describir la percepción que tienen los pacientes sobre su calidad de vida, e identifi car factores que infl uyen en esta percepción. Material y métodos: Estudio descriptivo transversal en pacientes adultos, con trasplante renal, que acuden a nuestra consulta hospitalaria y son autosufi cientes en el tratamiento. Todos los pacientes han recibido charlas grupales sobre el manejo de su tratamiento antes del alta. Recogida de datos con cuestionario anónimo autoadministrado: Escala validada: cuestionario de salud SF-12 (versión 2), durante 4 meses. Se excluyeron pacientes que rechazaron participar y que necesitaban ayuda en el manejo del tratamiento. Se estimó un tamaño muestral de 222 pacientes. Variables dependientes: Calidad de vida. Variables independientes: Factores socio-demográfi cos, tipo inmunosupresores, educación sanitaria recibida por profesionales de la salud. Se solicitó consentimiento informado y se obtuvo informe favorable del Comité Ético de Investigación Clínica. Resultados: Participaron 209 pacientes. Edad media 55,2(±12,15) rango 21-80 años, siendo el 61,8 % hombres. El 42% eran jubilados, el 38,2% tenían estudios secundarios, el 71% convivían en pareja. El inmunosupresor más utilizado: Micofenolato de sodio (MYFORTIC®) (65,5%) y el 46,7% tomaban dos inmunosupresores. La información sanitaria sobre efectos secundarios la consideran insuficiente un 20,5%. La media de la percepción de la calidad de vida es de 44,72±8,11 para el componente físico y 47,47±8,8 para el componente mental. Discusión: Los pacientes que llevan menos tiempo trasplantados refieren una mejor percepción de la calidad de vida. Debemos tomar medidas de mejora en la educación sanitaria sobre efectos adversos. Las charlas grupales informativas antes del alta del paciente creemos que han sido efectivas para la mejora del cumplimiento del tratamiento y en consecuencia para la mejora de su calidad de vida.

En España durante el año 2010 se hicieron 2225, de los cuales 420 se realizaron en Madrid. (www.ont.es) El número de trasplantes renales realizados en este hospital desde sus inicios en el año 1980, son 1740. El cumplimiento adecuado del tratamiento inmunosupresor es fundamental en este tipo de pacientes, ya que la no adherencia al tratamiento puede ser la causa de la pérdida del injerto renal; se ha comprobado lo importante que es seguir correctamente dicho tratamiento junto con hábitos de vida saludables para que mejore también la supervivencia del paciente(1,2,3,4,5,6,7,8,9). La adherencia al tratamiento puede ser una causa modificable, donde tiene un papel importante la enfermería, interviniendo de manera activa en la educación sanitaria del paciente trasplantado(1,2,3,4,5,6,7,8), de ahí, que nos planteemos conocer el grado de adherencia que tienen nuestros pacientes con trasplante renal. Es difícil detectar los receptores de trasplante renal que no son adherentes al tratamiento inmunosupresor, pero a su vez es importante identificarlos para poder actuar con prontitud y en consecuencia, pues en muchas ocasiones, se puede sospechar de un mal cumplimiento del tratamiento, sin afirmarlo hasta que realmente lo reconoce el paciente(1,2,3,4,5,6,7,8). La adherencia al tratamiento se debe al adecuado cumplimiento terapéutico inmunosupresor, que engloba dos conceptos: el cumplimiento de dosis y forma de administración y, la persistencia en la duración del tratamiento prescrito(1,2,3,4,5,6,7).

Spain has a reference price system (RPS) for off-patent medicines since 1997. In addition, from 2012, Andalusia is running a series of tenders for procuring off-patent medicines dispensed by community pharmacies, for those medicines included in the system of homogenous clusters within the national reference price system. Such tenders offer additional savings to the regional payer - in the form of rebates ("economic improvements") from companies winning the tender. This paper estimates that the regional savings were between €43 M to €54 M over the period of study (April - September 2015). The paper also estimates that Spain could have made between 14 and 17 times higher savings than the national reference pricing system savings, had the Andalusian-type tender been implemented at national level over the same period of study. Based on our analysis, we have four remarks. First, the national RPS in Spain is not generating enough price competition for off-patent products dispensed in primary care pharmacies. Second, tenders can be a useful way to generate competition and financial savings in the off-patent market. Third, tenders can lead to discounts offered by medicine providers being redistributed from pharmacies to payers. And fourth, before implementing a national tender in Spain, several key issues need to be addressed to ensure it provides the right incentives both in the short and long run., (Copyright © 2018 Elsevier B.V. All rights reserved.)

This paper describes the optical design of the general-purpose Spanish beamline for absorption and diffraction (SpLine), which will be installed on a bending-magnet port of the ESRF. This beamline is planned to cover the needs of the Spanish synchroton radiation community with broad scientific fields of interest, covering physics, chemistry, materials science and biology. By using the advantages of a wide front end (9 mrad), the Spanish beamline will be split into two branches. Both branches will be equipped with focusing optics and experimental stations. Thus, each branch can be operated simultaneously and independently from each other. One branch (A) will have two experimental stations, one for high-resolution powder diffraction (HRPD) and the other for X-ray absorption spectroscopy (XAS) and X-ray standing waves (XSW). The other branch (B) will have facilities for macromolecular crystallography and for single-crystal diffraction analysis, including that of surfaces and interfaces, as well as an X-ray diffraction/scattering camera for non-crystalline specimens.