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Publication Molecular epidemiology of paediatric invasive pneumococcal disease in Andalusia, Spain.(2022-08-22) de Felipe, Beatriz; Obando Pacheco, Pablo; Carazo Gallego, Begoña; López Martín, David; Santos Pérez, Juan Luis; González Jiménez, Yolanda; Muñoz Vilches, María José; Cardelo Autero, Nerea; González Galán, Verónica; Morón, Francisco José; Cordero Varela, Juan Antonio; Torres Sánchez, María José; Medina Claros, Antonio; Moreno Pérez, David; Obando, IgnacioThis study aimed to assess the impact of the introduction of pneumococcal conjugate vaccine 13 (PCV13) on the molecular epidemiology of invasive pneumococcal disease (IPD) in children from Andalusia. A population-based prospective surveillance study was conducted on IPD in children agedPublication Emerging noninvasive methylation biomarkers of cancer prognosis and drug response prediction.(2021-03-20) Oliver, Javier; Garcia-Aranda, Marilina; Chaves, Patricia; Alba, Emilio; Cobo-Dols, Manuel; Onieva, Juan Luis; Barragan, IsabelCancer is the second leading cause of death worldwide being responsible for 9.6 million deaths in 2018. Epigenetic alterations are key in directing the aberrant expression of tumor-associated genes that drive cellular malignant transformation and cancer progression. Among epigenetic alterations, DNA methylation is the most deeply studied one in relation to environmental exposure. Tissue biopsies have traditionally been the main procedure by which a small sample of body tissue is excised to confirm cancer diagnosis or to indicate the primary site when cancer has spread. In contrast, the analysis of circulating tumor-derived material, or tumor circulome, by means of liquid biopsy of peripheral blood, urine, saliva or sputum is a noninvasive, fast and reproducible alternative to tissue biopsy. Recently, the assessment of epigenetic alterations such as DNA methylation and hydroxymethylation in circulating free DNA has been proved possible. These marks can be associated to prognosis and response to a variety of treatments including chemotherapy, hormonotherapy or immunotherapy. Epigenetic biomarkers may offer some advantages over RNA or genetic biomarkers given their stability in bodily fluids and their high tissue-specificity. While many challenges are still ahead, the unique advantages of these types of biomarkers is urging the scientific community to persevere in their clinical validation and integration into reliable prediction models. This review aims at recapitulating the emerging noninvasive DNA methylated biomarkers of importance for prediction of prognosis and drug response in cancer.Publication Relationship between nutritional treatment compliance and nutritional status improvements in patients with gastrointestinal impairment taking an oral peptide-based supplement.(2022-05-21) López-Medina, José A; López-Rodriguez, Cristóbal; Estornell-Gualde, María A; Rey-Fernández, Laura; Gómez-Senent, Silvia; Joaquín-Ortiz, Clara; Fernández-Soto, M Luisa; Hurtado-García, Roberto; Martín-Martín, Margarita; Barrera-Martín, Ana; Vitales-Farrero, M Teresa; Martínez-Ortega, Antonio J; Blanca-Martínez-Barbeito, María; Vázquez-Vizcaíno, Begoña; Tasende-Fernández, Clara; Penacho-Lázaro, M Ángeles; Jordá-Sorolla, Esther; Sánchez-Sánchez, Rebeca; Díaz-Gómez, Laura; Baos-Fernández, Sergio; Guzmán-Rolo, Germán; Ballesteros-Pomar, María DCompliance in outpatients with gastrointestinal (GI) malabsorption is key in nutritional treatment. The objective of this study was to assess compliance in patients with GI impairment and malnutrition taking a high-calorie, high-protein, peptide-based oral nutritional supplement (ONS-PBD). A prospective, multicenter, observational study was conducted in 19 medical sites in Spain where ONS-PBD were prescribed as standard of care. Patients consumed ONS-PBD daily for 12 wk. Compliance was calculated as the percentage consumed of the prescribed amount of ONS per day. A total of 90 adult patients were included in the study, of whom 64 completed the 12-wk regimine. Mean compliance was 78.8% ± 24.5%. Risk of malnutrition decreased in 56.3% of patients at 12 wk, as measured with the malnutrition universal screening tool. A reduction in abdominal pain was observed and stool consistency improved, with a mean of 54.7% and 27.5%, respectively. Improvements in quality of life and a decrease in percentage of patients with severe functional impairment were observed. These data show that ONS-PBD compliance in malnourished patients with GI symptoms is high, reducing GI symptoms and improving patients' nutritional status.Publication Inflammatory capacity of exosomes released in the early stages of acute pancreatitis predicts the severity of the disease.(2021-10-29) Carrascal, Montserrat; Areny-Balagueró, Aina; de-Madaria, Enrique; Cárdenas-Jaén, Karina; García-Rayado, Guillermo; Rivera, Robin; Martin Mateos, Rosa María; Pascual-Moreno, Isabel; Gironella, Meritxell; Abian, Joaquin; Closa, DanielAs acute pancreatitis progresses to the severe form, a life-threatening systemic inflammation is triggered. Although the mechanisms involved in this process are not yet well understood, it has been proposed that circulating exosomes may be involved in the progression of inflammation from the pancreas to distant organs. Here, the inflammatory capacity and protein profile of plasma exosomes obtained during the first 24 h of hospitalization of patients diagnosed with acute pancreatitis were characterized and compared with the final severity of the disease. We found that the final severity of the disease strongly correlates with the inflammatory capacity of exosomes in the early stages of acute pancreatitis. Exosomes isolated from patients with mild pancreatitis had no effect on macrophages, while exosomes isolated from patients with severe pancreatitis triggered NFκB activation, TNFα and IL1β expression, and free radical generation. To delve deeper into the mechanism involved, we performed a proteomic analysis of the different exosomes that allowed us to identify different groups of proteins whose concentration was also correlated with the clinical classification of pancreatitis. In particular, an increase in the amount of S100A8 and S100A9 carried by exosomes of severe pancreatitis suggests that the mechanism of action of exosomes is mediated by the effect of these proteins on NADPH oxidase. This enzyme is activated by S100A8/S100A9, thus generating free radicals and promoting an inflammatory response. Along these lines, we observed that inhibition of this enzyme abolished all the pro-inflammatory effects of exosomes from severe pancreatitis. All this suggests that the systemic effects, and therefore the final severity of acute pancreatitis, are determined by the content of circulating exosomes generated in the early hours of the process. © 2021 The Authors. The Journal of Pathology published by John Wiley & Sons, Ltd. on behalf of The Pathological Society of Great Britain and Ireland.Publication Mortality risk factors in patients with SARS-CoV-2 infection and atrial fibrillation: Data from the SEMI-COVID-19 registry.(2022-03-10) Azaña Gómez, Javier; Pérez-Belmonte, Luis M; Rubio-Rivas, Manuel; Bascuñana, José; Quirós-López, Raúl; Taboada Martínez, María Luisa; Montero Hernandez, Esther; Roque-Rojas, Fernando; Méndez-Bailón, Manuel; Gómez-Huelgas, Ricardo; en nombre del grupo SEMI-COVID-19Atrial fibrillation and associated comorbidities pose a risk factor for mortality, morbidity and development of complications in patients admitted for COVID-19. To describe the clinical, epidemiological, radiological and analytical characteristics of patients with atrial fibrillation admitted for COVID-19 in Spain. Secondarily, we aim to identify those variables associated with mortality and poor prognosis of COVID-19 in patients with atrial fibrillation. Retrospective, observational, multicenter, nationwide, retrospective study of patients hospitalized for COVID-19 from March 1 to October 1, 2020. Data were obtained from the SEMI-COVID-19 Registry of the Spanish Society of Internal Medicine (SEMI) in which 150 Spanish hospitals participate. Between March 1 and October 1, 2020, data from a total of 16,461 patients were entered into the SEMI-COVID-19 registry. 1816 (11%) had a history of atrial fibrillation and the number of deaths among AF patients amounted to 738 (41%). Regarding clinical characteristics, deceased patients were admitted with a higher heart rate (88.38 vs. 84.95; P>0.01), with a higher percentage of respiratory failure (67.2 vs. 20.1%; P0.01), with a higher percentage of respiratory failure (67.2 vs. 20.1%; P Previous treatment with DOACs and DOACs treatment during admission seem to have a protective role in patients with atrial fibrillation, although this fact should be verified in prospective studies.Publication Influence of smoking history on the evolution of hospitalized in COVID-19 positive patients: results from the SEMI-COVID-19 registry.(2021-11-15) Navas Alcántara, María Sierra; Montero Rivas, Lorena; Guisado Espartero, María Esther; Rubio-Rivas, Manuel; Ayuso García, Blanca; Moreno Martinez, Francisco; Ausín García, Cristina; Taboada Martínez, María Luisa; Arnalich Fernández, Francisco; Martínez Murgui, Raúl; Molinos Castro, Sonia; Ramos Muñoz, Maria Esther; Fernández-Garcés, Mar; Carreño Hernandez, Mari Cruz; García García, Gema María; Vázquez Piqueras, Nuria; Abadía-Otero, Jesica; Lajara Villar, Lourdes; Salazar Monteiro, Cristina; Pascual Pérez, María de Los Reyes; Perez-Martin, Santiago; Collado-Aliaga, Javier; Antón-Santos, Juan-Miguel; Lumbreras-Bermejo, Carlos; en nombre del grupo SEMI-COVID-19Smoking can play a key role in SARS-CoV-2 infection and in the course of the disease. Previous studies have conflicting or inconclusive results on the prevalence of smoking and the severity of the coronavirus disease (COVID-19). Observational, multicenter, retrospective cohort study of 14,260 patients admitted for COVID-19 in Spanish hospitals between February and September 2020. Their clinical characteristics were recorded and the patients were classified into a smoking group (active or former smokers) or a non-smoking group (never smokers). The patients were followed up to one month after discharge. Differences between groups were analyzed. A multivariate logistic regression and Kapplan Meier curves analyzed the relationship between smoking and in-hospital mortality. The median age was 68.6 (55.8-79.1) years, with 57.7% of males. Smoking patients were older (69.9 [59.6-78.0 years]), more frequently male (80.3%) and with higher Charlson index (4 [2-6]) than non-smoking patients. Smoking patients presented a worse evolution, with a higher rate of admission to the intensive care unit (ICU) (10.4 vs 8.1%), higher in-hospital mortality (22.5 vs. 16.4%) and readmission at one month (5.8 vs. 4.0%) than in non-smoking patients. After multivariate analysis, smoking remained associated with these events. Active or past smoking is an independent predictor of poor prognosis in patients with COVID-19. It is associated with higher ICU admissions and in-hospital mortality.Publication Influence of chronic use of corticosteroids and calcineurin inhibitors on COVID-19 clinical outcomes: analysis of a nationwide registry.(2021-12-28) Calderón-Parra, Jorge; Cuervas-Mons, Valentín; Moreno-Torres, Victor; Rubio-Rivas, Manuel; Blas, Paloma Agudo-de; Pinilla-Llorente, Blanca; Helguera-Amezua, Cristina; Jiménez-García, Nicolás; Pesqueira-Fontan, Paula-María; Méndez-Bailón, Manuel; Artero, Arturo; Gilabert, Noemí; Ibánez-Estéllez, Fátima; Freire-Castro, Santiago-Jesús; Lumbreras-Bermejo, Carlos; Antón-Santos, Juan-Miguel; SEMI-COVID-19 Network. A complete list of the SEMI-COVID-19 Network members is provided in the AppendixThe aim of this study was to analyze whether subgroups of immunosuppressive (IS) medications conferred different outcomes in COVID-19. The study involved a multicenter retrospective cohort of consecutive immunosuppressed patients (ISPs) hospitalized with COVID-19 from March to July, 2020. The primary outcome was in-hospital mortality. A propensity score-matched (PSM) model comparing ISP and non-ISP was planned, as well as specific PSM models comparing individual IS medications associated with mortality. Out of 16 647 patients, 868 (5.2%) were on chronic IS therapy prior to admission and were considered ISPs. In the PSM model, ISPs had greater in-hospital mortality (OR 1.25, 95% CI 0.99-1.62), which was related to a worse outcome associated with chronic corticoids (OR 1.89, 95% CI 1.43-2.49). Other IS drugs had no repercussions with regard to mortality risk (including calcineurin inhibitors (CNI); OR 1.19, 95% CI 0.65-2.20). In the pre-planned specific PSM model involving patients on chronic IS treatment before admission, corticosteroids were associated with an increased risk of mortality (OR 2.34, 95% CI 1.43-3.82). Chronic IS therapies comprise a heterogeneous group of drugs with different risk profiles for severe COVID-19 and death. Chronic systemic corticosteroid therapy is associated with increased mortality. On the contrary, CNI and other IS treatments prior to admission do not seem to convey different outcomes.Publication Gastrointestinal symptoms and complications in patients hospitalized due to COVID-19, an international multicentre prospective cohort study (TIVURON project).(2022-10-13) Cárdenas-Jaén, Karina; Sánchez-Luna, Sergio A; Vaillo-Rocamora, Alicia; Castro-Zocchi, Micaela Riat; Guberna-Blanco, Laura; Useros-Brañas, Daniel; Remes-Troche, José M; Ramos-De la Medina, Antonio; Priego-Parra, Bryan A; Velarde-Ruiz Velasco, José A; Martínez-Ayala, Pedro; Urzúa, Álvaro; Guiñez-Francois, Dannette; Pawlak, Katarzyna M; Kozłowska-Petriczko, Katarzyna; Gorroño-Zamalloa, Irati; Urteaga-Casares, Clara; Ortiz-Polo, Inmaculada; Del Val Antoñana, Adolfo; Lozada-Hernández, Edgard E; Obregón-Moreno, Enrique; García-Rayado, Guillermo; Domper-Arnal, María José; Casas-Deza, Diego; Esteban-Cabello, Elena I; Díaz, Luis A; Riquelme, Arnoldo; Martínez-Lozano, Helena; Navarro-Romero, Francisco; Olivas, Ignasi; Iborra-Muñoz, Guillem; Calero-Amaro, Alicia; Caravaca-García, Ibán; Lacueva-Gómez, Francisco J; Pastor-Mateu, Rubén; Lapeña-Muñoz, Berta; Sastre-Lozano, Violeta; Pizarro-Vega, Nazaret M; Melcarne, Luigi; Pedrosa-Aragón, Marc; Mira, José J; MStat, Aurora Mula; Carrillo, Irene; de-Madaria, EnriqueRetrospective studies suggest that coronavirus disease (COVID-19) commonly involves gastrointestinal (GI) symptoms and complications. Our aim was to prospectively evaluate GI manifestations in patients hospitalized for COVID-19. This international multicentre prospective cohort study recruited COVID-19 patients hospitalized at 31 centres in Spain, Mexico, Chile, and Poland, between May and September 2020. Patients were followed-up until 15 days post-discharge and completed comprehensive questionnaires assessing GI symptoms and complications. A descriptive analysis as well as a bivariate and multivariate analysis were performer using binary logistic regression. p Eight hundred twenty-nine patients were enrolled; 129 (15.6%) had severe COVID-19, 113 (13.7%) required ICU admission, and 43 (5.2%) died. Upon admission, the most prevalent GI symptoms were anorexia (n=413; 49.8%), diarrhoea (n=327; 39.4%), nausea/vomiting (n=227; 27.4%), and abdominal pain (n=172; 20.7%), which were mild/moderate throughout the disease and resolved during follow-up. One-third of patients exhibited liver injury. Non-severe COVID-19 was associated with ≥2 GI symptoms upon admission (OR 0.679; 95% CI 0.464-0.995; p=0.046) or diarrhoea during hospitalization (OR 0.531; 95% CI 0.328-0.860; p=0.009). Multivariate analysis revealed that worse hospital outcomes were not independently associated with liver injury or GI symptoms. GI symptoms were more common than previously documented, and were mild, rapidly resolved, and not independently associated with COVID-19 severity. Liver injury was a frequent complication in hospitalized patients not independently associated with COVID-19 severity.Publication Clinical utility of comprehensive circulating tumor DNA genotyping compared with standard of care tissue testing in patients with newly diagnosed metastatic colorectal cancer.(2022-05-04) Benavides, M; Alcaide-Garcia, J; Torres, E; Gil-Calle, S; Sevilla, I; Wolman, R; Durán, G; Álvarez, M; Reyna-Fortes, C; Ales, I; Pereda, T; Robles, M; Kushnir, M; Odegaard, J; Faull, I; Alba, EComprehensive biomarker testing is essential in selecting optimal treatment for patients with metastatic colorectal cancer (mCRC); however, incomplete genotyping is widespread, with most patients not receiving testing for all guideline-recommended biomarkers, in part due to reliance on burdensome sequential tissue-based single-biomarker tests with long waiting times or availability of only archival tissue samples. We aimed to demonstrate that liquid biopsy, associated with rapid turnaround time (TAT) and lower patient burden, effectively identifies guideline-recommended biomarkers in mCRC relative to standard of care (SOC) tissue testing. Prospectively enrolled patients with previously untreated mCRC undergoing physician discretion SOC tissue genotyping submitted pretreatment blood samples for comprehensive circulating tumor DNA (ctDNA) analysis with Guardant360 and targeted RAS and BRAF analysis with OncoBEAM. Among 155 patients, physician discretion SOC tissue genotyping identified a guideline-recommended biomarker in 82 patients, versus 88 identified with comprehensive ctDNA (52.9% versus 56.8%, noninferiority demonstrated down to α = 0.005) and 69 identified with targeted PCR ctDNA analysis (52.9% versus 44.5%, noninferiority rejected at α = 0.05). Utilizing ctDNA in addition to tissue increased patient identification for a guideline-recommended biomarker by 19.5% by rescuing those without tissue results either due to tissue insufficiency, test failure, or false negatives. ctDNA median TAT was significantly faster than tissue testing when the complete process from sample acquisition to results was considered (median 10 versus 27 days, P Comprehensive ctDNA genotyping accurately identifies guideline-recommended biomarkers in patients with mCRC at a rate at least as high as SOC tissue genotyping, in a much shorter time. Based on these findings, the addition of ctDNA genotyping to clinical practice has significant potential to improve the care of patients with mCRC.Publication Clinical and pathological features of Merkel cell carcinoma: A 4-year follow-up observational retrospective study in Spain.(2021-12-15) Ríos-Martín, Juan José; Rodriguez-Salas, Nuria; Vázquez-Doval, Francisco Javier; Llombart, Beatriz; Rojas-Ferrer, Nohelia; González-Vela, M Carmen; Zulueta, Teresa; Monteagudo, Carlos; Aneiros-Fernández, José; Beato, María José; Carrillo, Rosario; Silva-Carmona, Mary Yohana; Ayala, María; Gallego, Elena; Rodríguez-Peralto, José Luís; Fraga-Fernández, Javier; Fernández-Figueras, María Teresa; Barranco, Carlos; Córdoba, Alicia; Sanz-Zorrilla, Alicia; Ferrer, Berta; Fúnez, Rafael; Santonja, Carlos; Saus, Carlos; Idoate, Miguel Angel; Santos-Briz, Angel; Onrubia, José; Pinedo, Fernando; de Las Peñas, RamónMerkel cell carcinoma (MCC) is a malignant skin cancer with a 5-year survival rate of approximately 50%. Knowledge of MCC has increased in recent years mostly due to improved diagnosis techniques. In Spain there is lack of information regarding the incidence and tumour characteristics, and the treatment approaches are not standardised. The objective of this study was to provide information of the clinical and epidemiological characteristics of MCC patients in Spain. Retrospective, observational study involving 192 patients from 25 Spanish hospitals. Evaluated variables included overall survival and incidence rate of Merkel cell polyomavirus, in patients diagnosed from 2012 to 2016. The Spanish incidence rate was estimated 0.32/100,000 inhabitants/year, with variations according to geographical regions, being slightly higher in areas with greater sunlight exposure. In total, 61.5% of tumours showed expansive growth (progressive growth of the tumour), 78.6% showed localisation in UV-exposed skin. 97.4% of patients were diagnosed by excisional biopsy. Surgery was the first line treatment in 96.6% of patients, radiotherapy in 24.6%, and chemotherapy in 6.3%. These treatments were not mutually exclusive. Median overall survival was 38.3 months (78.4% at 12 months and 60% at 24 months). MCPyV was present in 33.8% of patients. The incidence of MCC in Spain is one of the highest in Europe, with a slight predominance in men. The sample has shown that a biopsy is available for diagnosis in most cases. Moreover, the treatment is surgical when the tumour is localized and is associated with lymphadenectomy, and/or it is radiotherapy if widespread.Publication Biological Biomarkers in Respiratory Diseases.(2022-01-17) García-Río, Francisco; Alcázar-Navarrete, Bernardino; Castillo-Villegas, Diego; Cilloniz, Catia; García-Ortega, Alberto; Leiro-Fernández, Virginia; Lojo-Rodriguez, Irene; Padilla-Galo, Alicia; Quezada-Loaiza, Carlos A; Rodriguez-Portal, Jose Antonio; Sánchez-de-la-Torre, Manuel; Sibila, Oriol; Martínez-García, Miguel AIn recent years, personalized or precision medicine has made effective inroads into the management of diseases, including respiratory diseases. The route to implementing this approach must invariably start with the identification and validation of biological biomarkers that are closely related to the diagnosis, treatment, and prognosis of respiratory patients. In this respect, biological biomarkers of greater or lesser reliability have been identified for most respiratory diseases and disease classes, and a large number of studies are being conducted in the search for new indicators. The aim of this review is to update the reader and to analyze the existing scientific literature on the existence and diagnostic, therapeutic, and prognostic validity of the most important biological biomarkers in the main respiratory diseases, and to identify future challenges in this area.Publication Immunisation schedule of the Pediatric Spanish Association: 2022 recommendations(Ediciones doyma s a, 2022-01-04) Alvarez Garcia, Francisco Jose; Cilleruelo Ortega, Maria Jose; Alvarez Aldean, Javier; Garces-Sanchez, Maria; Garrote Llanos, Elisa; Iofrio de Arce, Antonio; Montesdeoca Melian, Abian; Navarro Gomez, Maria Luisa; Pineda Solas, Valentin; Rivero Calle, Irene; Ruiz-Contreras, Jesus; Serrano Marchuet, Pepe; Asociacion Espanola Pediat CAV-AEP; [Alvarez Garcia, Francisco Jose] Univ Oviedo, Ctr Salud Llanera, Dept Med, Oviedo, Asturias, Spain; [Cilleruelo Ortega, Maria Jose] Univ Autonoma Madrid, Hosp Univ Puerta de Hierro Majadahonda, Serv Pediat, Dept Pediat,Fac Med, Madrid, Spain; [Alvarez Aldean, Javier] Hosp Costa Sol, Serv Pediat, Malaga, Spain; [Garces-Sanchez, Maria] FISABIO, Ctr Salud Nazaret, Area Vacunas, Valencia, Spain; [Garrote Llanos, Elisa] Univ Basque Country, Hosp Univ Basurto, Fac Med, Secc Infectol,UPV EHU, Bilbao, Pais Vasco, Spain; [Iofrio de Arce, Antonio] Ctr Salud Ranero, Murcia, Spain; [Montesdeoca Melian, Abian] Ctr Salud Guanarteme, Las Palmas Gran Canaria, Spain; [Navarro Gomez, Maria Luisa] Univ Complutense Madrid, Hosp Univ Gregorio Maranon, Serv Pediat, Dept Pediat,Fac Med, Madrid, Spain; [Pineda Solas, Valentin] Univ Autonoma Barcelona, Secc Infectol Pediat, Hosp Univ Parc Tauli Sabadell, Barcelona, Spain; [Rivero Calle, Irene] Hosp Clin Univ Santiago de Compostela, Infectol & Traslac, Secc Pediat Clin, Grp Genet Vacunas Infecc & Pediat GENVIP, La Coruna, Spain; [Ruiz-Contreras, Jesus] Univ Complutense Madrid, Hosp Univ 12 Octubre, Serv Pediat, Dept Pediat,Fac Med, Madrid, Spain; [Serrano Marchuet, Pepe] Equipo Pediat Terr Garraf, Barcelona, SpainAfter reviewing the best available scientific information, CAV-AEP publishes their new recommendations to protect pregnant women, children and adolescents living in Spain through vaccination.The same recommendations as the previous year regarding hexavalent vaccines, pneumococcal conjugate vaccine of 13 serotypes, booster with tetanus, diphtheria, pertussis and inactivated poliomyelitis (Tdpa-IPV) at 6 years and with tetanus, diphtheria and pertussis (Tdpa) at 12-14 years and pregnant women from week 27 (from week 20 if there is a high risk of preterm delivery).Also with rotavirus, tetraantigenic meningococcal B (2 + 1), meningococcal quadrivalent (MenACWY), MMR, varicella and human papillomavirus (HPV) vaccines, for both genders.As novelties this year the CAV-AEP recommends:.Influenza vaccination from 6 to 59 months of age whenever feasible and does not harm the vaccination program aimed at people at higher risk.According to official national recommendations, the CAV-AEP recommends the systematic use of COVID mRNA vaccines since 5 years old. (C) 2021 Asociacion Espanola de Pediatria. Published by Elsevier Espana, S.L.U.Publication Centres of excellence in heart failure: results of an accreditation programme in Spain (2017-2021).(2022-07-01) Anguita-Sánchez, Manuel; González-Costello, José; Recio-Mayoral, Alejandro; Rodríguez-Lambert, José L; Iñiguez-Romo, Andrés; Ruiz-Mateas, Francisco; Elola-Somoza, Javier; Board of the Spanish Society of CardiologyTo describe logistics and outcomes of the accreditation program of centres of excellence in heart failure (HF) developed in Spain by the Spanish Society of Cardiology (SEC) between 2016 and 2021. A scientific committee created by the SEC defined three types of HF units (community, specialized, and advanced), depending on the characteristics of the hospital and their portfolio of services and equipment, as well as the quality standards required for the accreditation of excellence. The units were required to submit to the SEC a document certifying compliance with the requirements and quality standards. Once verified these, the unit received accreditation of excellence from the SEC. Between 2017 and October 2021, 78 HF units spread throughout Spain applied for accreditation. This represents 50.6% of all Spanish national health system centres with cardiology departments. Accreditation was definitive in 56.4% of the applicant centres and provisional in the remaining 43.6%. Of the 78 units, 19 were community units, 44 specialized, and 15 advanced. Of the 34 units that received provisional accreditation for failure to meet any of the required quality standards, all resolved these deficits within 6 months of the initial evaluation, subsequently receiving definitive accreditation. Our experience indicates that implementation of an accreditation programme for excellence and quality of care of HF units at the national level by a scientific society is feasible and sustainable over time, leading the majority of HF units in the country to apply for accreditation and to meet the required quality standards.Publication The EPICTER score: a bedside and easy tool to predict mortality at 6 months in acute heart failure(Wiley periodicals, inc, 2022-04-12) Romero-Correa, Miriam; Salamanca-Bautista, Prado; Bilbao-Gonzalez, Amaia; Quiros-Lopez, Raul; Dolores Nieto-Martin, Maria; Luisa Martin-Jimenez, Maria; Luis Morales-Rull, Jose; Quiles-Garcia, Dolores; Gomez-Gigirey, Adriana; Formiga, Francesc; Aramburu-Bodas, Oscar; Luis Arias-Jimenez, Jose; EPICTER Investigators Grp; [Romero-Correa, Miriam] Hosp Riotinto, Internal Med Dept, Huelva, Spain; [Salamanca-Bautista, Prado] Hosp Univ Virgen Macarena, Internal Med Dept, Seville, Spain; [Aramburu-Bodas, Oscar] Hosp Univ Virgen Macarena, Internal Med Dept, Seville, Spain; [Luis Arias-Jimenez, Jose] Hosp Univ Virgen Macarena, Internal Med Dept, Seville, Spain; [Salamanca-Bautista, Prado] Univ Seville, Seville, Spain; [Aramburu-Bodas, Oscar] Univ Seville, Seville, Spain; [Luis Arias-Jimenez, Jose] Univ Seville, Seville, Spain; [Bilbao-Gonzalez, Amaia] Basurto Univ Hosp, Osakidetza Basque Hlth Serv, Res Unit, Bilbao, Spain; [Bilbao-Gonzalez, Amaia] Hlth Serv Res Network Chron Dis REDISSEC, Baracaldo, Spain; [Bilbao-Gonzalez, Amaia] Kronikgune Inst Hlth Serv Res, Baracaldo, Spain; [Quiros-Lopez, Raul] Hosp Costa del Sol, Internal Med Dept, Marbella, Spain; [Dolores Nieto-Martin, Maria] Hosp Univ Virgen Rocio, Internal Med Dept, Seville, Spain; [Luisa Martin-Jimenez, Maria] Hosp Univ Puerto Hierro, Internal Med Dept, Madrid, Spain; [Luis Morales-Rull, Jose] Hosp Arnau Vilanova, Internal Med Dept, Lerida, Spain; [Quiles-Garcia, Dolores] Hosp Univ Gen Valencia, Internal Med Dept, Valencia, Spain; [Gomez-Gigirey, Adriana] Hosp Arquitecto Marcide, Internal Med Dept, La Coruna, Spain; [Formiga, Francesc] Hosp Univ Bellvitge, Internal Med Dept, Barcelona, SpainAims Estimating the prognosis in heart failure (HF) is important to decide when to refer to palliative care (PC). Our objective was to develop a tool to identify the probability of death within 6 months in patients admitted with acute HF.Methods and results A total of 2848 patients admitted with HF in 74 Spanish hospitals were prospectively included and followed for 6 months. Each factor independently associated with death in the derivation cohort (60% of the sample) was assigned a prognostic weight, and a risk score was calculated. The accuracy of the score was verified in the validation cohort. The characteristics of the population were as follows: advanced age (mean 78 years), equal representation of men and women, significant comorbidity, and predominance of HF with preserved ejection fraction. During follow-up, 753 patients (26%) died. Seven independent predictors of mortality were identified: age, chronic obstructive pulmonary disease, cognitive impairment, New York Heart Association class III-IV, chronic kidney disease, estimated survival of the patient less than 6 months, and acceptance of a palliative approach by the family or the patient. The area under the ROC curve for 6 month death was 0.74 for the derivation and 0.68 for the validation cohort. The model showed good calibration (Hosmer and Lemeshow test, P value 0.11). The 6 month death rates in the score groups ranged from 6% (low risk) to 54% (very high risk).Conclusions The EPICTER score, developed from a prospective and unselected cohort, is a bedside and easy-to-use tool that could help to identify high-risk patients requiring PC.Publication [Sexually Transmitted Infections During the First Wave of the COVID-19 Pandemic in Spain].(2021-09-13) Tarin-Vicente, E J; Sendagorta Cudos, E; Servera Negre, G; Falces Romero, I; Ballesteros Martin, J; Martin-Gorgojo, A; Comunion Artieda, A; Salas Marquez, C; Herranz Pinto, PTo describe changes in sexually transmitted infection (STI) diagnoses during the first wave of the COVID-19 pandemic in Spain. We collected demographic, chronological, and clinical data for all patients seen for a possible STI at Hospital La Paz, Centro Sanitario Sandoval, and Centro de Diagnóstico Médico in Madrid and Hospital Costa del Sol in Malaga between March 14, 2020 and June 30, 2020. We identified 674 STI diagnoses. The median age of the patients was 33 years. Most cases were observed among people aged 30 to 40 years and among men who have sex with men. The most common diagnoses were proctitis (36.5%), syphilis (16%), nongonococcal (13.3%) and gonococcal (11.3%) urethritis, genital herpes (8.8%), vulvovaginitis/cervicitis (8.3%), and genital warts (4.2%). A microbiologically confirmed diagnosis was on record for 77% of cases. The main microorganisms identified were Chlamydia trachomatis (35.7%), Neisseria gonorrhoeae (31.4%) and Treponema pallidum (17.2%). The number of STI diagnoses increased after the easing of lockdown restrictions, which resulted in greater freedom of movement and more consultations. On comparing the 2019 and 2020 STI registries from Centro Sanitario Sandoval and Hospital La Paz for the period March to June, we observed reductions (of up to 81%) in all STI diagnoses. Physical distancing and movement restrictions appear to have resulted in a reduction in the incidence of STIs, although these measures did not completely eliminate sexual risk behaviors.Publication Laser Therapy for Hailey-Hailey Disease: A Series of 7 Cases.(2021-09-10) Salas-Marquez, C; Boixeda de Miguel, J P; Del Boz González, JPublication Effectiveness of cell culture-based influenza vaccines compared with egg-based vaccines: What does the literature say?(2022-03-18) Álvarez Aldeán, J; Salamanca, I; Ocaña, D; Barranco, J L; Walter, SInfluenza vaccination is an effective way of reducing the burden of seasonal influenza. Chicken egg embryos are the most common source of influenza vaccines, but cell culture production has emerged as an alternative that could be advantageous. This article reviews the available literature on the efficacy/effectiveness of cell culture-based influenza vaccines compared with egg-based vaccines. We conducted a review of the actual literature and analyzed those studies comparing the effectiveness of cell culture-based and egg-based vaccines in the last ten years. Eight studies were analyzed; 1 was a clinical trial and 7 were retrospective cohort studies. The clinical trial found no significant differences in the efficacy of both vaccines with respect to placebo. The results of the observational studies were inconsistent and relative effectiveness varied among studies, even though most were performed during the same season, and in some cases, in the same region and using the same data records. Furthermore, in most studies, the comparisons between vaccines were not statistically significant. There is insufficient evidence that cell culture-based vaccines are superior to egg-based vaccines in terms of efficacy/effectiveness.Publication [An inactive vaccine for primary immunization to chickenpox].(2022-10-25) Rodríguez-García, J; Onieva-García, M A; García Cenoz, M; García Erce, J APublication Pharmaceutical care at discharge for patients with feeding tubes.(2022) López Gómez, Carmen; Arenas Villafranca, José Javier; Miranda Magaña, Marta; Álvaro Sanz, Elena; Moreno Santamaría, Manuela; Tortajada, BegoñaObjective: to assess and analyse a medication adaptation pathway for feeding tube administration followed by clinical pharmacists for patients at discharge, and to analyse the level of physician acceptance of the recommendations issued by pharmacists in pharmaceutical care reports to improve patient therapy. Methods: a multidisciplinary protocol for treatment adaptation to feeding tube administration at discharge was implemented in a 350-bed hospital during 2019, in which pharmacists prepared feeding tube medication-adaptation reports during pharmaceutical care visits. The number of recommendations related to adaptation of a drug to route of administration was recorded and classified as need for change of active substance or change of pharmaceutical form. Physician acceptance of pharmacist recommendations was analysed in a one-year retrospective observational study. Results: a total of 66 pharmaceutical care visits were recorded for 57 patients (1.2 visits per patient). In 47 of these 66 visits (71.2 %), at least one drug modification was required in a patient prescription, and the median number of drugs per patient needing to be modified was 2. Overall, 93 of the 489 prescribed drugs (19.0 %) required some changes to be suitable for administration via feeding tube: change of active substance in 52.7 % (49/93) of cases, and change of pharmaceutical form in 47.3 % (44/93) of cases. The physicians' level of acceptance of recommendations was 43.0 % (40/93), and change of pharmaceutical form was less accepted than change of active substance. Conclusion: the inclusion of clinical pharmacists in multidisciplinary teams leads to an improvement in adapting medication to feeding tube administration, but also shows a lack of communication or understanding of pharmacist recommendations by physicians resulting in a low rate of prescription changes.Publication Assessment of the importance of ostomy patients' understanding of dietary and lifestyle recommendations.(2022) Moreno Santa María, Manuela; Arenas Villafranca, José Javier; Abilés, Jimena; Faus Felipe, Vicente; Utrilla Navarro, Pilar; Tortajada Goitia, BegoñaObjective: the objective of our study was to evaluate the level of understanding of ostomy patients regarding lifestyle, diet, and high output stoma (HOS) management recommendations provided by healthcare professionals. Method: a prospective study to follow up ostomy patients at nutritional consultations was designed. The follow-up process was performed 7-10 days after hospital discharge and again one month later. At the first visit, patients were instructed in the detection and management of HOS. At the second visit, the level of understanding of the training received was assessed using an evaluation questionnaire. A descriptive analysis of the answers to each of the questionnaire's items was performed. Fisher's exact test was used to evaluate differences in the level of understanding recorded with the questionnaire. Results: a total of 35 patients were recruited; 71.4 % did not provide correct answers to all the questions. There were no significant differences in the correctness of the answers to the questionnaire according to education level. Conclusions: many patients do not adequately understand the information provided by healthcare professionals and this could have a negative impact on the incidence of clinical complications.