Barreras y facilitadores del programa de ejercicio EfiKroniK para pacientes con enfermedad crónica en atención primaria

ObjetivoExplorar las percepciones de los pacientes durante el programa de ejercicio y detectar las barreras y los facilitadores que influyen en la adherencia al ejercicio al término de la supervisión.DiseñoEstudio observacional cualitativo con grupos de discusión como principal técnica de recogida de datos.LugarCentros de atención primaria de Vizcaya.ParticipantesDe los 175 pacientes aleatorizados del ensayo híbrido de efectividad-implementación se incluyeron 19 pacientes del grupo intervención (12 pacientes oncohematológicos en estadios avanzados y 7 con trastorno mental grave).MétodosSe ha realizado un análisis de contenido de las transcripciones generadas, combinando un enfoque deductivo, basado en los dominios del marco teórico PRACTIS y uno inductivo, basado en los postulados de la teoría fundamentada.ResultadosLos participantes se mostraron satisfechos con el programa EfiKroniK y los beneficios fueron: descubrimiento de los beneficios del ejercicio físico, la gestión psicológica y emocional de la enfermedad, los beneficios de la comunicación entre iguales y del apoyo emocional y romper con la rutina de la enfermedad. Los participantes disminuyeron los niveles de ejercicio físico al término de la supervisión por la confluencia de diferentes barreras.ConclusiónUn programa de ejercicio supervisado realizado en atención primaria contribuyó a mejorar la calidad de vida, el bienestar emocional y social de pacientes en estadios avanzados de su enfermedad. Nuestro estudio ha identificado barreras potenciales y facilitadores asociados con la participación en el ejercicio y su continuidad; sin embargo, es necesario promover la coordinación intersectorial en el espacio sociosanitario para fomentar una atención integrada y continuada a los pacientes crónicos.Palabras clave: Enfermedades crónicas, Ejercicio físico, Atención primaria, Barreras, Facilitadores     

Infective Endocarditis in Patients With Bicuspid Aortic Valve or Mitral Valve Prolapse

Background

There is little information concerning infective endocarditis (IE) in patients with bicuspid aortic valve (BAV) or mitral valve prolapse (MVP). Currently, IE antibiotic prophylaxis (IEAP) is not recommended for these conditions.

Gallbladder cancer: role of laparoscopy in the management of potentially resectable tumors

Background  

The aim of this study was to evaluate the role that laparoscopy plays in the management of gallbladder cancer.     

Expression of p63 and p73 in acoustic neuroma and its possible clinical relevance

ObjectivesAssess p63 and p73 expression in acoustic neuroma and its correlation with clinical and radiological findings.Materials and methodsmedical records of 34 patients who were operated on for acoustic neuroma during a 3-year period (2001-2003) were evaluated retrospectively. Immunohistochemical analysis of the schwannoma was performed with p63 and p73 antibodies and clinical patient characteristics were correlated with the immunoreactivity results.Results41% of the acoustic neuroma specimens showed p63 and p73 staining. Correlation between both proteins was 100%. Age of the patients tended to be older when staining was positive, but no statistical significance was achieved. Likewise, tumour size was bigger for positive tumours but, again, this difference was not statistically significant. There was no correlation between gender and immunostaining.Discussion and ConclusionsExpression of p63 and p73 was demonstrated in almost half of the patients studied. Although both proteins were more prevalent in older patients and bigger tumours, this difference was not statistically significant, probably due to the reduced sample size. No differences were found in laterality, gender or audiogram. However, the expression of these two proteins in almost half of the tumours shows that they can play a role in the development and progression of acoustic neuromas, although further studies are needed.     

Immunotherapy combinations and chemotherapy sparing schemes in first line non-small cell lung cancer

In recent years, studies have explored different combinations of immunotherapy and chemotherapy. The rationale behind these is the improved survival outcomes of new immunologic therapies used in first-line-treatment of advanced non-small cell lung cancer. Moreover, for the most-studied combinations of anti-programed death-1 (PD-1)/programed death ligand-1 (PD-L1) with the addition of platinum- based chemotherapy, recent research is investigating whether combining different immunologic antitumoral mechanisms of action, such as anti-PD-1/PD-L1 and anti-CTLA-4, or anti-PD-L1 and anti-TIGIT, with or without chemotherapy, can improve efficacy outcomes compared with more classical combinations, or compared with standard chemotherapy alone. Here, we present the data of the main randomized studies that have evaluated these combinations, focusing on the basic rationale behind the different combinations, and the efficacy and tolerability data available to date.     

Antigen Presentation After Stroke

Stroke induces a local inflammatory reaction and a plethora of innate immune responses in the brain where antigen-presenting cells become prominent. However, to date, it is still unclear whether antigen presentation is relevant to the neuropathological and functional outcome of stroke. Stroke does not trigger overt autoimmune reactions, but neural antigens have been found in lymphoid tissues of patient with stroke and it is unknown whether they promote tolerance or immune reactions that under certain conditions might contribute to the functional worsening observed in some patients. Autoantibodies to neural molecules have also been reported in patients with stroke, but the subclass of antibodies is important for their function, and the contribution of such findings to stroke outcome is not yet clear. Notably, stroke induces immunodepression highlighted by a transient lymphopenia, lymphoid organ atrophy, and monocyte deactivation. While these effects might reduce the chances of autoreactivity, they increase the risk of infection in patients with stroke and most frequently in those with severe stroke. Therefore any potential brain protective effect of stroke-induced immunodepression by attenuating or preventing lymphocyte-mediated brain damage is confounded by stroke severity and an increased incidence of infections. Systemic inflammation due to a number of comorbidities that are frequent in patients with stroke is also associated to a poor outcome. Herein, we review some relevant findings regarding the identification of neural antigens in stroke and discuss their potential contribution to the functional outcome of stroke.