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Impact of long-term statin therapy on incidence and severity of community-acquired pneumonia: a real-world data analysis
(MDPI, 2025-06-11) Toledo Zavaleta, Diana Isabel; Cartanyà Hueso, Àurea; Morros Pedrós, Rosa; Giner Soriano, Maria; Domínguez García, Àngela; Vilaplana Carnerero, Carles; Grau, Maria
Objectives: This study aims to evaluate the impact of chronic statin therapy on the incidence of community-acquired pneumonia (CAP) and the rate of intensive care unit (ICU) admissions associated with CAP. Methods: Two population-based dynamic cohorts, consisting of individuals exposed and unexposed to statins, were followed from 2010 to 2019. Participants were older than 60 years, with frail patients excluded. The primary outcomes were the incidence of CAP and ICU admissions due to CAP, serving as a proxy for complicated cases. The exposed cohort included new statin users with at least two pharmacy invoices within 90 days of the recruitment period. Adjusted risk ratios (aRRs) for CAP incidence and CAP-associated ICU admissions were calculated using Poisson regression. Results: This study analyzed a sample of 639,564 individuals, evenly divided into exposed (319,782) and unexposed (319,782) groups, with a mean age of 71 years (standard deviation of 8 years) and 57% women. New statin users had a higher incidence of CAP [42.1 (95% confidence interval: 41.9–42.2) vs. 36.6 (36.5–36.8) per 1000 person-years] and ICU admissions [11.5 (11.5–11.6) vs. 10.1 (10.0–10.1) per 1000 person-years] compared to non-users. The adjusted analysis indicated that statin treatment reduced CAP risk by 6% [aRR: 0.94 (0.91–0.96)] and ICU admission by 7% [aRR: 0.93 (0.88–0.98)]. Conclusions: Prior statin therapy was associated with a clinically significant reduction in the incidence of CAP and ICU admissions due to CAP, despite the greater vulnerability of new users at the start of treatment compared to non-users.
Evolución de los casos de infecciones de transmisión sexual en la ciudad de Barcelona (2007-2024): perfiles según el centro de declaración
(Elsevier, 2026-01) Pericas Escale, Carles; Palma, David; Palau, Marina; Aguirre Cañas, Laura; Castell, Soledad; Rius, Cristina; Grau, Maria; Andrés, Ana de; Collado Quífer, Laura; Forcadell-Díez, LLuís
[spa] Objetivo: Describir la evolución de los diagnósticos de infecciones de transmisión sexual de declaraciónindividualizada en la ciudad de Barcelona entre 2007 y 2024, y analizar su asociación con variablessociodemográficas y tipo de centro de notificación.Método: Análisis de tendencia temporal basado en datos poblacionales de los casos de sífilis, gonorrea,clamidiasis y linfogranuloma venéreo de la ciudad de Barcelona. Se calcularon tasas de incidencia anualesy razones de tasas de incidencia ajustadas mediante regresión de Poisson robusta, ajustando por variablessociodemográficas y estratificando por tipo de centro.Resultados: El 44,3% de los diagnósticos se realizaron en atención comunitaria, el 30,6% en atención pri-maria y el 24,9% en atención hospitalaria. Los hombres concentraron el 78,6% de los casos, predominandoen atención comunitaria, mientras que las mujeres se diagnosticaron sobre todo en atención primaria. Encomparación con el grupo de 25-34 años, la probabilidad de ser diagnosticado en cualquier tipo de aten-ción disminuyó con la edad. Haber nacido en América Central o del Sur aumentó la probabilidad de serdiagnosticado en atención primaria un 112% y en atención hospitalaria un 144%. Un nivel socioeconómicobajo incrementó en un 238% la probabilidad de ser diagnosticado en atención primaria.Conclusiones: Los diagnósticos de infecciones de transmisión sexual en Barcelona presentan potencialesdesigualdades según el sexo, el origen y el nivel socioeconómico, que se reflejan en el tipo de centro dondese diagnostican. La pandemia de COVID-19 parece haber amplificado estas brechas, desplazando la cargaasistencial hacia los dispositivos comunitarios. Existe una necesidad de fortalecer la atención primaria ymejorar la coordinación entre dispositivos asistenciales para avanzar hacia un modelo de atención sexualmás equitativo.
Low bone mass and severity of cholestasis affect fracture risk in patients with primary biliary cirrhosis.
(Elsevier, 2010-06) Guañabens Gay, Núria; Cerdà, Dacia; Monegal Brancós, Ana; Pons Pons, Francisca; Caballería Rovira, Llorenç; Peris Bernal, Pilar; Parés Darnaculleta, Albert
Background & Aims The influence of osteoporosis and liver disease on fracture risk is not well characterized in patients with primary biliary cirrhosis (PBC). We studied a large series of women with PBC to assess the prevalence and risk factors for fractures and the fracture threshold. Methods In female patients with PBC (n = 185; age, 55.7 ± 0.7 years; range 28–79 years), age, duration of PBC, menopausal status, and histologic stage and severity of liver disease were assessed. Vertebral and non-vertebral fractures were recorded in 170 and 172 patients, respectively. Osteoporosis and osteopenia were diagnosed based on densitometry analysis. Results The prevalences of vertebral, non-vertebral, and overall fractures were 11.2%, 12.2%, 20.8%, respectively. Osteoporosis was significantly more frequent in patients with PBC than in normal women. Osteoporosis was associated with age, weight, height, histologic stage, severity, and duration of liver damage; fractures were associated with osteoporosis, menopause, age, and height but not with severity of PBC. Osteoporosis was a risk factor for vertebral fracture (odds ratio [OR], 8.48; 95% confidence interval [CI]: 2.67–26.95). Lumbar T score <–1.5 (OR, 8.27; 95% CI: 1.84–37.08) and femoral neck T score <–1.5 (OR, 6.83; 95% CI: 1.48–31.63) were significant risk factors for vertebral fractures. Conclusions Fractures, particularly vertebral fractures, are associated with osteoporosis, osteopenia, and T scores less than –1.5, whereas osteoporosis and osteopenia are associated with the severity of liver damage. Patients with T scores less than –1.5 might require additional monitoring and be considered for therapy to prevent fractures.
Cardiovascular disease prevention by personalized health promotion considering educational attainment
(Nature Publishing Group, 2026-01-29) Zomeño Fajardo, María Dolores; Álamo Junquera, María Dolores; Pericas Escale, Carles; Vilaplana Carnerero, Carles; Domínguez García, Àngela; Toledo, Diana; Soldevila, Núria; Pagès Fernández, Constança; Redondo, Ana; Grau, María
To examine whether educational attainment modifies the effectiveness of personalized lifestyle recommendations for improving cardiovascular risk factors. This post-hoc analysis used data from a population-based randomized controlled trial in Girona, Spain, including adults aged 35-74 years without cardiovascular disease at baseline. Participants (n = 759; 48.7% men) were randomized to an intervention group (n = 380), which received personalized recommendations on diet and physical activity, or a control group (n = 379), which received a standard report of baseline results. Changes in systolic and diastolic blood pressure, LDL cholesterol, and physical activity energy expenditure from baseline to 12 months were analyzed. Multivariable linear regression models adjusted for age included an interaction term defined as group × educational attainment × time (1 year) to assess effect modification. Analyses were stratified by sex. Among women in the intervention group, significant interactions by educational attainment were observed. Compared with women with lower educational attainment, those with higher attainment showed more favorable changes in diastolic blood pressure [beta-coefficient (95% confidence interval): - 1.98 (- 4.23; 0.27) vs. 1.63 (- 0.21; 3.48)], LDL cholesterol [- 4.61 (- 11.40; 2.18) vs. 5.71 (0.25; 11.17)], and physical activity energy expenditure [0.52 (0.04; 1.23) vs. - 0.01 (- 0.36; 0.26)]. No significant interactions were found among men in the intervention group or among participants in the control group. Overall, within-group changes in these outcomes did not reach statistical significance. Personalized lifestyle interventions may provide greater benefits for women with higher educational attainment, although overall improvements were modest.
Identificación de las características clínicas y alteraciones analíticas asociadas a la fractura vertebral en mujeres con osteoporosis posmenopáusica
(Elsevier España, 2012-12-08) Cerdà, Dacia; Peris Bernal, Pilar; Monegal Brancós, Ana; Albaladejo, Carolina; Surís, Xavier; Guañabens Gay, Núria
Background and objective: Vertebral fractures (VF) are a major risk factor for the development of further fractures. Therefore, it is important to identify clinical risk factors and laboratory abnormalities related to VF. We aimed to analyse clinical and biochemical alterations related to the presence of radiological VF in postmenopausal women with osteoporosis. Patients and methods: Two-hundred and four postmenopausal women with osteoporosis (aged 64,9 [10] years) who were referred to an outpatient Rheumatology Unit were prospectively included. Bone mineral density (BMD), spine X-ray, and laboratory tests were performed in all participants before treatment. Results: Twenty-eight per cent of patients had VF. Comparing women with and without VF, those with fractures were older (71.9 [10] vs 61.8 [8,6], P<.001), had lower stature (152 [7.2] vs 155 [6.2], P=.01), lower total hip T-score values (-2.2 [0,9] vs -1.9 [0.8], P=.041), higher prevalence of non-VF (38 vs 30%, P=.04) and a higher prevalence of low serum 25(OH)D levels (69 vs 53%, P<.05). In logistic regression analysis, age and BMD at the total hip were independent predictors of VF. Patients over 65 presented a higher frequency of VF (47 vs 12%, P<.0001). In addition, a T-score lower than -2,5 at the total hip was associated with an increased risk of VF (OR 2.5; 95% CI 1.2-4.9). Conclusions: Over the age of 65 nearly half of the postmenopausal women with osteoporosis have VF and a higher prevalence of low 25(OH)D serum measurements. Spinal X-ray and 25(OH)D serum measurements are especially indicated in this group of women since it influences the therapeutic approach.
Randomized trial comparing monthly ibandronate and weekly alendronate for osteoporosis in patients with primary biliary cirrhosis
(Wiley, 2013-12) Guañabens Gay, Núria; Monegal Brancós, Ana; Cerdà, Dacia; Muxí, África; Gifre Sala, Laia; Peris Bernal, Pilar; Parés Darnaculleta, Albert
Osteoporosis resulting in bone fractures is a complication in patients with primary biliary cirrhosis (PBC). Once-weekly alendronate improves bone mass and is well tolerated in these patients, but there is a concern because of poor compliance. Therefore, the efficacy, adherence, and safety of monthly ibandronate (150 mg) with weekly alendronate (70 mg) were compared in a randomized, 2-year study in 42 postmenopausal women with PBC and osteoporosis. Bone mineral density (BMD) of the lumbar spine and proximal femur (by DXA), liver function, and bone markers were measured at entry and every 6 months over 2 years. Adherence to therapy was assessed by the Morisky-Green score. At enrollment, the two groups were similar with respect to age, BMD, severity of cholestasis, previous fractures, and bone markers. Thirty-three patients, 14 in the ibandronate group and 19 in the alendronate group, completed the trial. At 2 years both treatments resulted in a significant increase in BMD at the lumbar spine (from 0.875 ± 0.025 to 0.913 ± 0.026 g/cm2, P < 0.001 with alendronate, and from 0.898 ± 0.024 to 0.949 ± 0.027 g/cm2, P < 0.001 with ibandronate). The mean percentage change was 4.5% and 5.7%, respectively (P = not significant). BMD increased at the total hip by 2.0% and 1.2%, respectively. Changes in bone markers were similar in both groups and one patient with alendronate developed a new vertebral fracture. Adherence to therapy was higher with ibandronate (P = 0.009). Neither treatment impaired liver function or cholestasis. Conclusion: Both regimens, weekly alendronate and monthly ibandronate, improve bone mass and are comparable in safety for osteoporosis therapy in patients with PBC, although adherence is higher with the monthly regimen. Further larger studies are needed to assess fracture prevention. (Hepatology 2013; 58:2070–2078)
Molecular insights into early malignant transition of hepatocellular carcinoma
(Elsevier, 2026-05-11) Zhang, Zhengtao; Li, Hong; Chen, Lingli; Lu, Tao; Shentu, Xinyi; Liu, Yuanhua; Tang, Zhixuan; Ji, Shuyi; Qiu, Zhixin; Zou, Yining; Wen, Hong; Han, Jing; Jiang, Zhengzeng; Fan, Jie; Gao, Xinbo; Li, Dianfan; Mesropian, Agavni; Pinyol, Roser; Llovet i Bayer, Josep Maria; Dong, Hui; Ji, Yuan; Hui, Lijian
Understanding the molecular drivers of the premalignant-to-malignant transition is essential for early cancer detection and intervention, yet this process remains poorly characterized due to limited access to evolutionarily related lesions. Here, we comprehensively profiled the genomic and immunological landscapes of 21 very early hepatocellular carcinomas (veHCCs) arising within 17 cancer-prone dysplastic nodules (DNs). Notably, 82% of cancer-prone DNs harbored TERT alterations, suggesting a predisposing rather than causative role of TERT alteration in malignant transition. Notably, the accumulation of copy number alterations (CNAs), rather than single-nucleotide variants, is strongly associated with malignant transition. Intriguingly, different from the paradigm that HCC arises in chronic inflammation, cancer-prone DNs displayed immune inactivity. Strikingly, 43% of veHCCs showed an inflamed yet immune-evasive phenotype. These findings propose two evolutionary scenarios of early hepatocarcinogenesis, CNA-dominant progression and inflamed progression with early immune evasion, underscoring the potential of immunotherapy for early intervention.
Cognitive predictors of transition and remission of psychosis risk syndrome in a child and adolescent sample: longitudinal findings from the CAPRIS study
(Springer Verlag, 2024-01) Tor, Jordina; Baeza, Inmaculada, 1970-; Sintes Estevez, Anna; Serna, Elena de la, 1978-; Puig, Olga; Muñoz-Samons, Daniel; Álvarez Subiela, Javier; Sugranyes, Gisela; Dolz, Montserrat
Cognitive impairments are proposed as predictors in the differentiation between subjects with psychosis risk syndrome (PRS) who will develop a psychotic disorder (PRS-P) and those who will not (PRS-NP). More in-depth study of the PRS-NP group could contribute to defining the role of cognitive alterations in psychosis. This study aims to analyze cognition of children and adolescents with PRS in terms of their clinical outcome at 18-month follow-up (psychosis, remission, and non-remission) and of determinate predictors of transition to psychosis and remission of PRS. The method is two-site, naturalistic, longitudinal study design, with 98 help-seeking adolescents with PRS and 64 healthy controls (HC). PRS-P (n = 24) and PRS-NP (n = 74) participants were clinically and cognitively assessed at baseline, and when full-blown psychotic disorder had developed or at 18-month follow-up. PRS-P subjects showed lower scores at baseline in processing speed, visuospatial memory, attention, and executive function (cognitive flexibility/processing speed) compared to HC. PRS-NP subjects showed lower baseline scores in verbal working memory and verbal fluency compared to HC. This deficit is also observed in the PRS group of participants still presenting attenuated psychotic symptoms at 18-month follow-up, while PRS subjects in remission showed a similar cognitive profile to HC subjects. Baseline score on processing speed, measured with a coding task, appeared to be a predictive variable for the development of a psychotic disorder. Performance in verbal working memory was predictive of remission in the PRS-NP. Post hoc comparisons indicate the need for careful interpretation of cognitive markers as predictors of psychosis. Cognitive impairments are present in both PRS-P and PRS-NP. Those individuals who recover from PRS show baseline cognitive performance comparable to the HC group. Together with sociodemographic variables, this observation could help in the differentiation of a variety of PRS trajectories in children and adolescents.
Severe acute hepatitis E with unilateral amyotrophic neuralgia: A diagnostic challenge
(Elsevier, 2026-03-01) Pascual Dapena, Ana; Pocurull Aparicio, Anna; Forns, Xavier
Case report of a 65-year-old male patient with a history of cardiovascular risk factors, revascularized ischemic heart disease, and stage 2 sarcoidosis presented with fever, lower back pain, and decreased urine output for three days.
Spanish clinical practice guidelines for the diagnosis and management of cholestatic liver diseases in adult and pediatric population: Joint report from AEEH and SEGHNP
(Elsevier, 2026-04-01) Díaz González, Álvaro; Molera Busoms, Cristina; Gómez Domínguez, Elena; Muñoz Bartolo, Gema; Ampuero, Javier; Fernández Rodríguez, Conrado M.; Quintero Bernabeu, Jesús; Molina Pérez, Esther; Salcedo, Magdalena; Olveira, Antonio; Morillas, Rosa M.; Alós Díez, María; Casado Martin, Marta; García Buey, Luisa; Rodríguez Tajes, Sergio; Jorquera Plaza, Francisco; Berenguer, Marina; Montero Álvarez, José Luis; Londoño, María Carlota
[eng] Cholestatic liver diseases comprise a heterogeneous group of disorders affecting both adult and pediatric population, characterized by alterations in bile formation, secretion, or flow, leading to the accumulation of bile acids and other toxic substances in the liver. In recent years, advances in new pharmacological therapies, the availability of next-generation genetic sequencing techniques, and the development of specific treatments for genetic cholestasis have transformed the diagnostic and therapeutic approach to these conditions. This document, jointly prepared by the "Asociación Española para el Estudio del Hígado" (AEEH) and the "Sociedad Española de Gastroenterología, Hepatología y Nutrición Pediátrica" (SEGHNP), presents a national evidence-based guideline for the diagnosis and management of hepatic cholestasis in Spain. It addresses recommendations for differential diagnosis, diagnostic algorithms, indications for genetic studies, treatment and follow-up criteria in diseases such as primary biliary cholangitis, primary sclerosing cholangitis, genetic cholestasis, intrahepatic cholestasis of pregnancy, and vanishing bile duct syndrome. In addition, recommendations are included for the management of extrahepatic complications, indications for liver transplantation, and special considerations in pregnancy and childhood. The guideline emphasizes the importance of a multidisciplinary approach, the use of non-invasive tools for risk stratification, and the incorporation of new targeted therapies, with the aim of improving the prognosis and quality of life of patients affected by cholestatic liver diseases.
From dactyloscopy to the Minimum Surface Requirement (MSR): a metric to assess and obtain suitable human STR profiles
(Elsevier B.V., 2025-03) Di Nunzio, Michele; De Alcaraz Fossoul, Josep; Maroto Nouveau, Vanessa; Camprubí Aumatell, Clara; Barrot i Feixat, Carme
Friction skin ridge (Dactyloscopy) and DNA analyses have both played an essential role in forensic investigations for decades. The simultaneous and successful collection of a latent fingermark ridge pattern and the respective isolation of its human DNA can be a challenging task at a crime scene. Maximizing the quantity and quality of genetic information from this type of physical evidence has become one of the objectives of forensic science. Often, friction ridge impressions may lack discriminatory power due to low visual clarity of ridges and/or insufficient pattern area. In such cases, an optimized human DNA collection and extraction becomes crucial for obtaining a genetic identity from an unsuitable fingermark. Recent studies have proven that complete Short Tandem Repeat (STR) profiles can be acquired from touch DNA specimens. Although the impact of fingermark enhancement techniques on DNA recovery has been explored, no research has yet investigated the potential quantity of DNA that could be isolated per area of a ridge pattern. Here, DNA collection and extraction methods to determine the Minimum ridge Surface Requirement (MSR) to extract suitable human STR genotypes have been studied and optimized. Twelve participants, including biological males and females, provided ink prints of their index, middle, and ring fingers from both hands to calculate an average fingertip size to create a "standard" area for analysis across all donors. A standardized cutout template was created to fit every participant's latent fingermarks on pre-cleaned glass surfaces. Two fingermark "recharging-deposition-collecting" methods (i.e., Original Experiment and Optimized Experiment) and two swab types for DNA collection were compared (i.e., cotton swabs from Delta Lab (Spain) and 4N6FLOQSwabs® from Copan (Italy)). Then, ten participants deposited fingermarks for DNA extraction, quantification, STR amplification, and capillary electrophoresis (CE) for STR genotyping. Results showed that flocked swabs were more effective than cotton swabs at collecting DNA and produced suitable STR profiles with the optimized collection method. This research establishes the first MSR surfaces from which meaningful STR profiles can be acquired. These data provide key knowledge that assists crime investigators in prioritizing dactyloscopy, genotyping, or both analyses concurrently when examining latent fingermarks.
Clinical, Neuroimmunologic, and CSF Investigations in First Episode Psychosis.
(Lippincott, Williams & Wilkins. Wolters Kluwer Health, 2021-05-12) Guasp, Mar; Giné-Servén, Eloi; Maudes, Estíbaliz; Rosa Justicia, Mireia; Martínez-Hernández, Eugenia; Boix Quintana, Ester; Bioque Alcázar, Miquel; Casado, Virginia; Módena Ouarzi, Yasmina; Guanyabens, Nicolau; Muriana, Desiree; Sugranyes Ernest, Gisela; Pacchiarotti, Isabella; Daví Loscos, Eva; Torres-Rivas, Cristina; Ríos, José; Sabater, Lidia; Saiz Hinarejos, Albert; Graus Ribas, Francesc; Castro Fornieles, Josefina; Parellada Rodón, Eduard; Dalmau Obrador, Josep
Objectives: To report the neuropsychiatric features and frequency of NMDA receptor (NMDAR) and other neuronal immunoglobulin G antibodies in patients with first episode psychosis (FEP) and to assess the performance of reported warning signs and criteria for autoimmune psychosis (AP). Methods: This was a prospective observational study of patients with FEP assessed for neuropsychiatric symptoms, serum and CSF neuronal antibodies (brain immunohistochemistry, cell-based assays, live neurons), and warning signs and criteria of AP. Previous autoimmune FEP series were reviewed. Results: One hundred five patients were included; their median age was 30 (range 14-75) years, and 44 (42%) were female. None had neuronal antibodies. Two of 105 (2%) had CSF pleocytosis, 4 of 100 (4%) had brain MRI abnormalities, and 3 of 73 (4%) EEG alterations. Thirty-four (32%) and 39 (37%) patients fulfilled 2 sets of warning signs of AP, and 21 (20%) fulfilled criteria of possible or probable AP, yet none developed AP. The cause of FEP was psychiatric in 101 (96%) and nonpsychiatric in 4 (4%). During this study, 3 patients with psychosis caused by anti-NMDAR encephalitis were transferred to our center; 2 did not meet criteria for possible AP. Of 1,159 reported patients with FEP, only 7 (1%) had CSF studies; 36 (3%) had serum NMDAR antibodies (without definite diagnosis of AP), and 4 had CSF NMDAR antibodies (3 classic anti-NMDAR encephalitis and 1 with isolated psychiatric features). Conclusions: NMDAR antibodies were not found in patients with FEP unless they had anti-NMDAR encephalitis. Warning signs and criteria for AP have limited utility when neurologic symptoms are absent or paraclinical tests are normal. A diagnostic algorithm for autoimmune FEP is provided.
Brain Metabolite Levels in the Post-Acute Stage of Anti-NMDA Receptor Encephalitis and Schizophrenia: A Longitudinal Case-Control Study
(Elsevier B.V., 2026-07-15) Fortea, Adriana; Ortuño, María; Masias, Mireia; Guasp, Mar; Serna, Elena de la, 1978-; Armangué, Thaís; Baeza, Inmaculada, 1970-; Borràs, Roger; Prades-Senovilla, Laia; Rosa Justicia, Mireia; Stein, Heike; Martínez Heras, Eloy; Compte Braquets, Albert; Llufriu Duran, Sara; Dalmau Obrador, Josep; Castro Fornieles, Josefina; Sugranyes, Gisela
Background: In vivo assessment of glutamatergic metabolites in patients with anti-NMDA receptor (anti-NMDAR) encephalitis compared with schizophrenia may help increase understanding of the pathophysiology of both conditions. Methods: This 24-month prospective case-control study included participants ages 12 to 60 years with anti-NMDAR encephalitis during the post-acute stage and age- and sex-matched individuals with schizophrenia and healthy control participants (HCs). Single-voxel magnetic resonance spectroscopy was used to estimate brain concentrations of glutamatergic metabolites, myo-inositol, and N-acetylaspartate+N-acetylaspartylglutamate (tNAA) in the left dorsomedial prefrontal region (dmPF) and medial temporal lobe. The effect of group and time on metabolite levels and the relationship between metabolite levels and psychiatric and cognitive features were tested with multilevel linear mixed models. Results: Thirty-two participants with anti-NMDAR encephalitis (84% women), 27 participants with schizophrenia (63% women), and 36 HCs (72% women) were included. In the dmPF, levels of glutamate and glutamate+glutamine were significantly lower in patients with anti-NMDAR encephalitis than in participants with schizophrenia (Cohen's d = -0.87 and d = -0.80, respectively) and HCs (d = -0.73 and d = -0.71). Myo-inositol levels were significantly higher in both participants with anti-NMDAR encephalitis (d = 0.91) and patients with schizophrenia (d = 1.07) than in HCs. Group differences remained stable over time. Metabolite levels were not associated with psychiatric or cognitive symptoms. Conclusions: This is the first report of hypoglutamatergia in the left dmPF in anti-NMDAR encephalitis and of increased levels of myo-inositol in both anti-NMDAR encephalitis and schizophrenia. The findings suggest persistent alterations in glutamatergic neurotransmission during the post-acute stage of anti-NMDAR encephalitis and overlapping neuroinflammatory processes between anti-NMDAR encephalitis and schizophrenia.
Neurofilament Light Chain Levels in Anti-NMDAR Encephalitis and Primary Psychiatric Psychosis
(Lippincott, Williams & Wilkins. Wolters Kluwer Health, 2022-04-05) Guasp, Mar; Martín Aguilar, Lorena; Sabater Baudet, Lidia; Bioque Alcázar, Miquel; Armangué, Thaís; Martínez Hernández, Eugenia; Landa, Jon; Maudes, Estíbaliz; Borràs, Roger; Muñoz Lopetegi, Amaia; Saiz Hinarejos, Albert; Castro Fornieles, Josefina; Graus Ribas, Francesc; Parellada Rodón, Eduard; Querol, Luis; Dalmau Obrador, Josep
Background and Objectives An important challenge in diagnosing anti–NMDA receptor (NMDAR) encephalitis (NMDARe) is differentiating it from a first episode of psychosis (FEP) caused by a psychiatric disease (pFEP). CSF antibody testing distinguishes these diseases, but spinal taps are difficult to obtain in psychiatric facilities. A separate problem is the lack of biomarkers of NMDARe severity and outcome. Here we assessed the performance of neurofilament light chain (NfL) testing in these settings. Methods In this observational study, NfL levels were determined with single-molecule array in patients with NMDARe, pFEP, herpes simplex encephalitis (HSE), and healthy participants (HC), with the last 2 groups used as controls. Receiver operating characteristic (ROC) analyses were performed to assess the prediction accuracy of serum NfL (sNfL) levels for NMDARe and pFEP and to obtain clinically useful cutoffs. Results One hundred eighteen patients with NMDARe (33 with isolated psychosis at presentation), 45 with pFEP, 36 with HSE, and 36 HC were studied. Patients with NMDARe with seizures/status epilepticus, intensive care unit admission, and CSF pleocytosis (>20 white blood cells/µL) and without early immunotherapy were more likely to have higher NfL (mainly in CSF) than individuals with NMDARe without these features. NfL levels at diagnosis of NMDARe did not correlate with outcome at 1-year follow-up assessed with the modified Rankin Scale. Patients with NMDARe had significantly higher sNfL than individuals with pFEP and HC and lower sNfL than patients with HSE. ROC analysis of sNfL between NMDARe with isolated psychosis and pFEP provided an area under the curve of 0.93 (95% CI 0.87–0.99) and an sNfL cutoff ≥15 pg/mL to distinguish these disorders (sensitivity 85%, specificity 96%, positive likelihood ratio 19.3). Forty-three of 45 (96%) patients with pFEP had sNfL<15 pg/mL, whereas only 5 of 33 (15%) with NMDARe with isolated psychosis were below this cutoff (risk estimation NMDARe vs pFEP: odds ratio 120.4 [95% CI 21.8–664], p < 0.001). None of the patients with HSE and 35 of 36 (97%) HC had sNfL<15 pg/mL. Discussion NfL measured at diagnosis of NMDARe associated with features of disease severity but not with long-term outcome. Young patients with FEP and sNfL ≥15 pg/mL had a 120 times higher chance of having NMDARe than those with pFEP. This cutoff correctly classified 96% of patients with pFEP and 85% of patients with NMDARe with isolated psychosis. Patients with FEP of unclear etiology and sNfL ≥15 pg/mL should undergo CSF NMDAR antibody testing.
Hypertension, inflammation and vascular risk in inflammatory rheumatic diseases
(Elsevier, 2025-07-01) Cerdà, Dacia; Reina, Delia; Corominas, Héctor; Armario García, Pedro
Vascular risk is higher in patients with rheumatoid arthritis, spondyloarthritis, and psoriatic arthritis than in the general population. In addition to classical vascular risk factors, chronic inflammation plays a crucial role in increasing this risk. In rheumatoid arthritis, the prevalence of hypertension is 41%. Moreover, the prevalence of hypertension has been associated with the duration of spondyloarthritis, as well as the presence of severe psoriasis in psoriatic arthritis. Although some drugs used in the treatment of inflammatory arthritis, such as NSAIDs, glucocorticoids, and Jakinibs, have been associated with an increased vascular risk, their ability to reduce inflammatory activity contributes to a decreased vascular risk in these patients. These drugs should be used with caution, and risk stratification should be performed in patients with vascular risk factors.
Clinical effectiveness of intensive care unit admission in older adults with COVID-19 during the first pandemic wave in Spain
(BioMed Central, 2026-05-22) Arroyo Huidobro, Marta; Pérez-López, C.; Pallarès, Natàlia; Tebé, Cristian; Simonetti, Antonella Francesca; Abelenda Alonso, Gabriela; Rombauts, Alexander; Bermudez, Isabel Oriol; Izquierdo, Elisenda; Díaz Brito, Vicens; Molist, Gemma; Gómez Melis, Guadalupe; Videla, Sebastià; López-Soto, Alfonso; Carratalà, Jordi; Rodríguez-Molinero, Alejandro; Gudiol González, Carlota; Aranda-Lobo, Judit; Sanmartí Vilamala, Montserrat; Moreno, Encarna; Alvarez, Maria C.; Faura, Anna; González Bàrcenas, Martha; Cruz, Patricia; Colom, Mireia; Perez, Andrea; Serrano, Laura; Besalú, Mireia; Cobo Valeri, Erik; Cortés Martínez, Jordi; Fernández-Martínez, Daniel; Garmendia, Leire; Hereu Boher, Pilar; Langohr, Klaus; Pérez-Álvarez, Núria; Piulachs Lozada-Benavente, Xavier
Objective: To evaluate the impact of ICU admission on mortality and complications of older patients with COVID-19 hospitalized during the first COVID-19 wave in our setting. Methods :An observational, multicenter, and ambispective study of COVID-19 patients aged > 70 years who were hospitalized during the first wave of the pandemic in the southern metropolitan area of Barcelona, Spain. The primary outcome of the study was the in-hospital mortality rate of patients admitted to the ICU compared with their appropriately matched controls who received care in hospital wards. The secondary outcome was the in-hospital rate of complications in ICU-admitted patients versus their matched controls. Results: The mortality rate was 76.6% in ICU-admitted patients and 64.9% among their matched controls, whereas the corresponding rates of complications were 73.5% and 32.4%, respectively. ICU admission shows a statistically significant impact on mortality (OR [95% CI] 2.50 [1.06–6.05]; p = 0.041). Additionally, complications were four times more likely in patients who were admitted to ICUs than in those admitted to general wards (OR [95% CI] 4.03 [1.64–9.91]; p = 0.0024). Conclusions: ICU admission was not associated with improved survival in patients older than 70 years during the first COVID-19 wave. Further research is needed to confirm these findings and to assess the adequacy of ICU admission criteria for elderly patients.
Analyzing instructor facilitation patterns in debriefings using AI-based speech metrics
(Elsevier, 2026-03-01) Armijo Rivera, Soledad; Vicencio Clarke, Scarlett; Caamaño, Hernán; Díaz, Pía; Pino, Carla; Caldo, Francesca; Herrera, Daniel; Hinrichsen, Carlos
Background Facilitation of debriefings is critical for fostering reflection and behavioral change. However, little is known about how novice instructors distribute their speaking time and how this impacts perceived debriefing quality. Artificial intelligence (AI)-driven conversational analysis offers an objective method to characterize facilitation patterns. Methods Participants were fifteen novice healthcare instructors with less than one year of experience who recently completed an online simulation course. A cross-sectional study was conducted using GailBot API for automated transcription and speech analysis of remote interprofessional debriefings. Standardized scenarios and consistent student participants controlled external variables. Instructor facilitation patterns were compared to DASH evaluations from students, instructors, and an expert observer. Results Instructors spoke for an average of 56.09% of debriefing time. Higher instructor talk time correlated negatively with DASH self-ratings (Spearman’s Rho = −0.627, p = .012). Conclusion AI-based analysis provides valuable insights into facilitation patterns, supporting multidisciplinary faculty development.
Lessons From the ANTES B+ Study
(Elsevier, 2026-07-01) Agustí García-Navarro, Àlvar; Soler Cataluña, Juan José; ANTES program
About a year ago, Archivos de Bronconeumologia published the rationale, goals, design and methods of the ANTES B+ study [1], a pragmatic, prospective, randomized clinical trial whose primary objective was to investigate if treatment with inhaled triple therapy (LABA-LAMA-ICS) improved clinical control [2] during 12 months follow-up vs. the GOLD recommended dual therapy (LABA-LAMA) in a specific subgroup of GOLD B patients that we named B+ [3]. These B+ patients were characterized by having a CAT score >10 despite treatment with LABA-LAMA and having had a moderate exacerbation (treated with oral corticosteroids and/or antibiotics but not needing hospitalization) the year before and having more than 150 eosinophils/μL of circulating blood [1]. These inclusion criteria were based on previous observations that showed that: (1) patients who remain symptomatic (CAT >10) despite treatment with LABA-LAMA are at higher risk of worse health outcomes [3]; (2) GOLD B patients with 1 previous moderate exacerbation the year before had substantially higher hazard ratio of future exacerbation, all-cause hospitalization and respiratory hospitalization than those without them [4]; and (3) that higher level of circulating eosinophils identifies patients with a higher risk of future ECOPD, a better preventive response to inhaled corticosteroids (ICS), and reduced risk of ICS-related pneumonia [5]. Indeed, this hypothesis was proposed before the Global Initiative for Chronic Obstructive Lung Disease (GOLD) suggested in the 2026 GOLD recommendations to consider one moderate exacerbation enough to move the patient to the GOLD E group [6]. Finally, but importantly, this was going to be the first clinical trial with a composite outcome (clinical control) as the main endpoint. The concept of disease activity, disease stability and clinical control has also been highlighted in GOLD 2026 for the first time.
Cognition in older adults with bipolar disorder: An ISBD task force systematic review and meta-analysis based on a comprehensive neuropsychological assessment
(John Wiley & Sons, 2022-03-01) Montejo Egido, Laura; Torrent Font, Carla; Jiménez Martínez, Esther; Martínez-Arán, Anabel, 1971-; Blumberg, Hilary P.; Burdick, Katherine E.; Chen, Peijun; Dols, Annemiek; Eyler, Lisa T.; Forester, Brent P.; Gatchel, Jennifer R.; Gildengers, Ariel; Kessing, Lars Vedel; Miskowiak, Kamilla W.; Olagunju, Andrew T.; Patrick, Regan; Schouws, Sigfried; Radua, Joaquim; Bonnín Roig, Caterina del Mar; Vieta i Pascual, Eduard, 1963-; International Society for Bipolar Disorders (ISBD) Older Adults with Bipolar Disorder (OABD) Task Force
Objectives We aim to characterize the cognitive performance in euthymic older adults with bipolar disorder (OABD) through a comprehensive neuropsychological assessment to obtain a detailed neuropsychological profile. Methods We conducted a systematic search in MEDLINE/Pubmed, Cochrane, and PsycInfo databases. Original studies assessing cognitive function in OABD (age ≥50 years ) containing, at a minimum, the domains of attention/processing speed, memory, and executive functions were included. A random-effects meta-analysis was conducted to summarize differences between patients and matched controls in each cognitive domain. We also conducted meta-regressions to estimate the impact of clinical and socio-demographic variables on these differences. Results Eight articles, providing data for 328 euthymic OABD patients and 302 healthy controls, were included in the meta-analysis. OABD showed worse performance in comparison with healthy controls, with large significant effect sizes (Hedge's g from −0.77 to −0.89; p < 0.001) in verbal learning and verbal and visual delayed memory. They also displayed statistically significant deficits, with moderate effect size, in processing speed, working memory, immediate memory, cognitive flexibility, verbal fluency, psychomotor function, executive functions, attention, inhibition, and recognition (Hedge's g from −0.52 to −0.76; p < 0.001), but not in language and visuoconstruction domains. None of the examined variables were associated with these deficits. Conclusions Cognitive dysfunction is present in OABD, with important deficits in almost all cognitive domains, especially in the memory domain. Our results highlight the importance of including a routine complete neuropsychological assessment in OABD and also considering therapeutic strategies in OABD.
Cardiological adverse events in hepatocellular carcinoma patients receiving immunotherapy: Influence of comorbidities and clinical outcomes
(Elsevier B.V., 2025-05-15) Fortuny, Marta; García Calonge, Marta; Arrabal, Óscar; Sanduzzi Zamparelli, Marco; Castaño García, Andrés; Cascos, Enric; Mesa, Alicia; Piedra-Cerezal, Ana María; Llarch, Neus; Iserte, Gemma; Campos, Marta; González-Zilkowfsky, Melina; Marsal García, Aida; Lorca, Rebeca; Rodríguez, Marta; Torres, Ferran; Varela, Maria; Reig, María
Introduction Immunotherapy-based combinations have revolutionized the first-line treatment for advanced hepatocellular carcinoma (HCC), improving overall survival (OS). However, these therapies are associated with adverse events (AEs), particularly cardiological complications and major adverse cardiovascular events (MACE), which may adversely affect outcomes. The influence of comorbid conditions such as arterial hypertension (AHT) and type 2 diabetes mellitus (T2DM) on the incidence and prognosis of cardiological AEs in HCC patients remains understudied. Methods This retrospective study included 109 HCC patients treated with atezolizumab-bevacizumab, tremelimumab-durvalumab, or durvalumab as first-line therapy at two Spanish medical centers from 2017–2023. Patients were stratified by comorbidities, AE incidence, and cardiological risk (CARDIOSOR scale). The primary endpoints were the incidence of treatment-modifying AEs and MACE, and their association with survival. Results Among the cohort, 50.5 % experienced AEs of special interest (AESI), with 34 % considered immune-related (irAE). MACE occurred in 7.3 % of patients, including myocarditis (3.7 %). The CARDIOSOR scale identified a higher risk of MACE in patients with AHT, T2DM, or both (OR: 5.07, p = 0.034). Early cardiological AEs were independently associated with worse OS (HR: 3.38, p = 0.04). Patients with both AHT and T2DM exhibited higher rates of MACE (16.7 %) and treatment discontinuation (25.9 %). The CARDIOSOR scale effectively stratified patients into high-risk groups, correlating with increased MACE rates and poor survival outcomes. Conclusions Comorbid conditions, particularly AHT and T2DM, amplify the risk of MACE and influence treatment discontinuation. The CARDIOSOR scale is a valuable tool for personalized risk assessment, guiding tailored therapeutic strategies. Integrating cardiovascular risk management into HCC care is crucial for optimizing both oncological and cardiovascular outcomes.

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