Hospital Universitari Sagrat Cor

Background The diagnosis of isolated REM sleep behavior disorder (IRBD) requires video polysomnography (V-PSG) showing increased muscle activity and abnormal behaviors in REM sleep. Objective To describe in IRBD the behavioral manifestations occurring during REM sleep in the diagnostic V-PSG. Methods This is a systematic audiovisual V-PSG analysis of consecutive IRBD patients. According to the International RBD Study Group recommendations, REM sleep movements and vocalizations were classified into categories and severity. Results We analyzed the V-PSG of 62 IRBD patients with a mean age of 67.6 ± 8.1 years. Of 6,330 30-s epochs of REM sleep, 55.1% epochs exhibited motor events, 5.5% contained vocalizations and 39.4% were silent. Among the epochs with motor manifestations, 66.1% contained simple minor movements, 25.0% simple major and 8.9% complex movements. Motor severity of the epochs was mild in 82.2%, moderate in 13.2% and severe in 4.6%. Most movements were bilateral (62.4%) and located in the upper limbs (42.5%). Of the epochs with vocalizations, 61.5% were simple minor, 20.7% complex and 17.8% simple major of mild (72.7%), moderate (23.0%) and severe (4.3%) severity. Complex movements occurred in 87.1% of the patients and complex vocalizations in 38.7%. Conclusions In IRBD, the most common manifestations in REM sleep are simple minor movements and vocalizations of mild intensity. Complex movements are observed during REM sleep in most patients but are much less frequent than simple minor and major motor events. These findings should be considered for the routine diagnosis of IRBD when reviewing the V-PSG studies.

PURPOSE Elevated intraocular pressure (IOP) following corneal transplantation (CT) presents a significant risk for graft failure and visual impairment. This retrospective cohort study aims to evaluate the outcomes of different glaucoma surgeries and corneal graft survival rates in patients who have undergone CT. METHODS A single-center, retrospective cohort was conducted on all patients at our tertiary hospital who had received glaucoma surgery following corneal transplant surgery from 2020 to 2023. Inclusion criteria were defined as patients over 18 years of age, with at least 6 months of follow-up. The primary outcomes included corneal graft survival and glaucoma surgery success. RESULTS Twenty eyes from 18 patients who underwent glaucoma procedures after a corneal transplant were analyzed. Glaucoma surgery success – IOP level within limits (>6 mmHg but below the preset target), no further glaucoma surgeries, and no postoperative severe vision loss due to complications – was achieved in 80% of cases, with no significant differences observed among techniques. Corneal graft survival at 6 months (a functional transplant that does not require a regraft procedure and with central graft clarity) was 55%, with higher rates observed in patients undergoing nonpenetrating deep sclerectomy (NPDS), XEN45 gel stent (XGS), or PAUL glaucoma implant (PGI) procedures compared to trabeculectomy and Ahmed valve. Only 35% of patients experienced minor complications, and no major adverse events were reported. CONCLUSION In our retrospective cohort study, surgical approaches such as NPDS, XGS, or PGI showed the most favorable outcomes regarding glaucoma surgery success and corneal graft survival rates.

PURPOSE The purpose of the study was to evaluate the efficacy and safety of the PAUL glaucoma implant (PGI) in refractory glaucoma patients, during the early postoperative period. METHODS We conducted a retrospective, cohort study of patients that had received a PGI between February 2022 and December 2023. An intraluminal polypropylene suture was placed to prevent early hypotony in all cases. Demographics, intraocular pressure (IOP), and medication variation were evaluated for up to 6 months. The success rate was stratified into <18 mmHg and 30% from baseline or <15 mmHg and 40% IOP reduction. The safety outcomes were also analyzed. RESULTS Sixteen eyes from 16 patients were included in the analysis. Fifteen of them had had a previous surgical glaucoma procedure. At 6 months, IOP decreased from 26.6 (±6.2) to 15.3 (±4.6) mmHg, with fewer glaucoma medications, from a median (interquartile range) of 3 (2–3) – 1.5 (0–2) ( P < 0.005). Twelve (75%) and seven (43.8%) eyes met the qualified and complete success definition for the first category, and eight (50%) and four (25%) met the second criterion. One case with self-limiting choroidal detachments, but >6 mmHg IOP was found in our cohort. CONCLUSION The PGI seems to be safe and effective from the early postoperative period. The IOP reduction rate could make it suitable for patients with refractory moderate-to-advanced glaucoma.

Some studies have noted that scores relying solely on clinical values to evaluate remission in rheumatoid arthritis (RA) may miss subclinical inflammation, which can lead to exacerbations when therapy is reduced. This opens the possibility of supporting clinical evaluation with imaging studies, one of which is ultrasound (US) evaluation, since it is an accessible tool. Therefore, we have decided to design a study to try to demonstrate the usefulness of US as a complementary measure for the decision-making process in determining the optimization of therapy in patients with RA. A multicenter, blinded, randomized, prospective study was conducted in RA patients meeting 2010 ACR/EULAR criteria for sustained remission by DAS28-ESR, with concomitant CDAI/SDAI evaluation. Patients were classified into clinical and ultrasound groups, with treatment remission based on DAS28 or grayscale synovitis/Doppler values. Ultrasound assessments included grayscale (GS) and power Doppler (PD) for joints (A) and tendons (T). A 12 months follow-up was performed, with a subset analyzed at both 18 and 24 months. Exacerbation criteria: DAS28-ESR rise > 1.2 or CDAI/SDAI > 16. Across all centers, 78 patients were initially recruited, but only 46 completed the 12-month follow-up, with 28 undergoing further evaluation at 24 months. The average baseline DAS28 scores were 1.85 for the clinical group and 1.80 for the ultrasound group. During the study, 18 patients experienced disease exacerbation based on DAS28 score elevation, with 10 in the clinical group and 8 in the ultrasound group. Seven patients experienced disease exacerbation based on CDAI score elevation, all of whom were included in the clinical group. Eight patients showed disease exacerbation based on SDAI score elevation, all in the clinical group. We have demonstrated the utility of ultrasound when optimizing management of rheumatoid arthritis patients. In our patient cohort, ultrasound helps to reduce the number of exacerbations using the SDAI/CDAI index. We highlight the limitations of current assessment methods that rely solely on clinical evaluation, underscore the potential significance of evaluating subclinical synovitis, and emphasize the role of ultrasound as an objective tool in guiding therapy decisions. Our study offers valuable insights for optimizing treatment strategies in RA patients and improving their long-term outcomes.

Background Bullous pemphigoid affects elderly individuals with multiple comorbidities, making conventional treatments unsuitable. Objective Evaluate the effectiveness and safety of dupilumab in the treatment of bullous pemphigoid. Methods A multicenter ambispective cohort study was conducted in 34 hospitals. Patients with bullous pemphigoid treated with Dupilumab were included. Most of patients (97.1%) received an initial 600 mg dose followed by 300 mg every two weeks. Outcomes and Measures The primary outcome was the proportion of patients achieving complete remission within 4 weeks, defined as Investigator Global Assessment score of 0 or 1. Complete remission at weeks 16, 24, and 52, adverse events, reductions in peak pruritus numerical rating scale, and systemic glucocorticoid use were also assessed. Results The study included 103 patients with a median age of 77.3 years, 58.0% male. Complete remission was achieved by 53.4% within 4 weeks and 95.7% by week 52. Peak pruritus scale reduced by 70.0% by week 4 and was completely controlled by week 24. Thirteen patients presented adverse events, most of which were mild. Systemic glucocorticoid use reduced by 82.1% by week 52. Shorter disease duration and exclusive cutaneous involvement predicted better response at 16 weeks. No differences in response rates to dupilumab were observed between drug-associated bullous pemphigoid and idiopathic cases. No significant difference in response rates was observed between patients treated with dupilumab in monotherapy and those receiving dupilumab with concomitant treatments. Conclusions Dupilumab is effective, rapid, and safe in managing bullous pemphigoid, reducing the need for corticosteroids and other treatments. Early initiation and exclusive skin involvement predict better outcomes.

Introduction Patch test results may be influenced by age‐related factors. However, there is still discordant evidence between age and patch test results. Objectives We aim to evaluate the patch test results reflecting skin sensitisation, their relevance and association with clinical features by age group. Methods Prospective multicentric study of all patients patch tested with the Spanish baseline series in participating centres. Age groups were pre‐defined as children (0‐ to 11‐years), adolescents (12‐ to 18‐years), young adults (19‐ to 30‐years), middle‐aged adults (31‐ to 65‐years) and older adults (≥66‐years). Occurrence of sensitisation, relevance and clinical features were compared by age group. Factors associated with skin sensitisation were investigated with multivariate logistic regression. Results A total of 13 368 patients were patch‐tested. Differences in positive patch test results and relevance by age were detected with the highest proportion in middle‐aged adults. Age‐related trend differences were found for nickel, potassium dichromate, caines, colophony, Myroxylon pereirae resin, 2‐hydroxyethyl methacrylate and limonene hydroperoxide. The multivariate logistic analysis (adjusted for sex, atopic dermatitis, body location and occupational dermatitis) showed an association between the age group of 31–65 (OR: 1.41, 95% CI: 1.26–1.58) and above 66‐years (OR: 1.15, 95% CI: 1.01–1.32) with a higher proportion of positive results, compared with young adults. Conclusions Positive patch test results vary according to age, with the highest occurrence in middle‐aged adults. Most haptens did not present age‐related differences, reinforcing the use of baseline series regardless of age.

B‐cell epidermotropism is an exceptional finding in cutaneous lymphomas. The few cases previously described in the literature mostly correspond to systemic lymphomas, with the most frequent being splenic marginal zone lymphoma. This lymphoma can manifest as a cutaneous eruption preceding the splenomegaly, with systemic involvement demonstrated by bone marrow and/or peripheral blood. This presentation is known as epidermotropic B‐cell lymphoma. Herein, we present a new case that emphasizes B‐cell epidermotropism as a feature that should alert the clinician of the possibility of a secondary involvement and, consequently, prompt them to expand the recommended initial staging.

Introduction Autobiographical memory is known to be disturbed in schizophrenia. In addition, a leading theory of auditory hallucinations (AVH) is that they are intrusive – typically negative – autobiographical memories that are misinterpreted as perceptions. Objectives The aim of this study was to examine the brain functional correlates of recall of negatively emotionally valanced autobiographical memories in patients with schizophrenia, with a longer term aim of comparing patients with and without AVH. Methods 11 patients meeting DSM-5 criteria for schizophrenia or schizoaffective disorder and 10 age, sex and estimated premorbid IQ-matched healthy controls have so far taken part. Participants underwent functional MRI in a 3T scanner while performing a task requiring them to recall autobiographical memories in response to individually tailored pairs of cue words. The cue words were based on autobiographical memories previously elicited in an interview with each patient and were designed to evoke the same memory. The cue words were presented in 10 20-second blocks interspersed with blocks where the subjects viewed cue words that did not evoke autobiographical memories. Brain activations were examined in three contrasts of interest: memory evoking words vs baseline, neutral words vs baseline and memory evoking vs neutral words. Pre-processing and analysis were carried out with the FEAT module included in the FSL software. Statistical analysis was performed by means of a General Linear Model (GLM) approach. Results In the memory evoking vs baseline contrast the patients showed hypoactivation in the medial frontal cortex compared to the healthy controls (Figure 1). There were no differences in activation between the patients and the controls comparing the memory evoking and neutral cues. Image: Conclusions The finding of hypoactivation in the medial frontal cortex compared to low level baseline in patients with schizophrenia suggests dysfunction in the default mode network, which is known to activate during recall of autobiographical memories. These preliminary results suggest that recall of negative autobiographical memories in patients with schizophrenia is associated with reduced activity in the default mode network. A planned larger sample of patients and controls will be used to examine activations in patients with and without AVH. Disclosure of Interest None Declared

Objective: To evaluate and characterize the cognitive changes in COVID-19 participants at 6-month follow-up, and to explore a possible association with clinical symptoms, emotional disturbance and disease severity. Methods: This single-center longitudinal cohort study included participants aged 20 and 60 years old to exclude cognitive impairment age-associated with confirmed COVID-19 infection. The initial evaluation occurred 10 to 30 days after hospital or ambulatory discharge, with a subsequent follow-up at 6 months. Patients who had a history of cognitive impairment, neurological conditions, or serious psychiatric disorders were not included. Information on demographics and laboratory results was gathered from medical records. Cognitive outcomes were assessed with a neuropsychological battery including attention, verbal and visual memory, language and executive function tests. Results: A total of 200 participants were included in the study, and 108 completed the follow-up visit. At the 6-month follow-up, comparing the means from baseline with those of the follow-up evaluation, significant overall improvement was observed in verbal and visual memory subtests (p = 0.001), processing speed (p = 0.001), executive function (p = 0.028; p = 0.016) and naming (p = 0.001), independently of disease severity and cognitive complaints. Anxiety and depression were significantly higher in groups with Subjective Cognitive Complaints (SCC) compared to those without (p < 0.01 for both). Conclusions: Persistent symptoms are common regardless of disease severity and are often linked to cognitive complaints. Six months after COVID-19, the most frequently reported symptoms included headache, dyspnea, fatigue, cognitive complaints, anxiety, and depression. No cognitive impairment was found to be associated with the severity of COVID-19. Overall, neuropsychological and psychopathological improvement was observed at 6 months regardless of disease severity and cognitive complaints.

Background Moderate-to-severe atopic dermatitis (AD) can be difficult to manage in paediatric patients, with few licensed treatments in this age group. Dupilumab is approved for AD in children older than 6 months. Objectives To assess the effectiveness and safety of dupilumab in a real-life cohort of paediatric AD patients in Spain. Methods A multicentre, retrospective real-life study on the effectiveness and safety of dupilumab in patients aged 2 to 18 years old with moderate-to-severe AD was conducted. Demographic and clinical characteristics were analysed, and effectiveness (EASI, IGA, DLQI, NRS itch), safety, and drug survival measures were assessed. A comparison of our results with other real-world outcomes and with clinical trials was made. Results Data from 243 patients from 19 centres was collected, with a mean follow-up of 85 weeks. Dupilumab exhibited significant effectiveness, with marked reductions in severity scores from week 4. By week 16, 79.4% of patients reached EASI75 and 40.5% reached EASI90. Mean percentage reduction in EASI was 79.7%. Increasing improvements were observed until week 52, with 85.8% and 49.6% achieving EASI75 and EASI90, respectively. Forty-three patients developed adverse events (AE) (43/243, 17.7%), being the most frequent ocular surface diseases (20/243, 8.2%), injection site reactions (8/243, 3.3%) and facial redness (7/243, 2.9%). Drug survival was high (96.9% and 93.1% after 1 and 2 years of follow-up, respectively), with only 19 (19/243, 7.8%) patients interrupting treatment: 7 (7/243, 2.9%) due to AE, 2 (2/243, 0.82%) due to secondary failure, 5 (5/243, 2.1%) were lost to follow-up and 5 (5/243, 2.1%) entered remission and stopped treatment. Conclusion Real-life use of dupilumab in paediatric AD showcased sustained effectiveness, high drug survival, and acceptable safety profiles. Longer-term studies are crucial for AE surveillance and how to manage disease remission.

Introduction: Lumbar foraminal stenosis (LFS) occurs primarily due to degenerative changes in older adults, affecting the spinal foramina and leading to nerve compression. Characterized by pain, numbness, and muscle weakness, LFS arises from structural changes in discs, joints, and ligaments, further complicated by factors like inflammation and spondylolisthesis. Diagnosis combines patient history, physical examination, and imaging, while management ranges from conservative treatment to surgical intervention, underscoring the need for a tailored approach. Materials and Methods: This multicenter study, conducted over six years at a tertiary hospital, analyzed the volumetric dimensions of lumbar foramina and their correlation with nerve structures in 500 patients without lumbar pathology. Utilizing high-resolution MRI with a standardized imaging protocol, eight experienced researchers independently reviewed the images for accurate measurements. The study emphasized quality control through the calibration of measurement tools, double data entry, validation checks, and comprehensive training for researchers. To ensure reliability, interobserver and intraobserver agreements were analyzed, with statistical significance determined by kappa statistics and the Student’s t-test. Efforts to minimize bias included blinding observers to patient information and employing broad inclusion criteria to mitigate referral and selection biases. The methodology and findings aim to enhance the understanding of normal lumbar foramina anatomy and its implications for diagnosing and treating lumbar conditions. Results: The study’s volumetric analysis of lumbar foramina in 500 patients showed a progressive increase in foraminal volume from the L1/L2 to the L5/S1 levels, with significant enlargement at L5/S1 indicating anatomical and biomechanical complexity in the lumbar spine. Lateral asymmetry suggested further exploration. High interobserver and intraobserver agreement levels (ICC values of 0.91 and 0.95, respectively) demonstrated the reliability and reproducibility of measurements. The patient cohort comprised 58% males and 42% females, highlighting a balanced gender distribution. These findings underscore the importance of understanding foraminal volume variations for lumbar spinal health and pathology. Conclusion: Our study significantly advances spinal research by quantifying lumbar foraminal volumes, revealing a clear increase from the L1/L2 to the L5/S1 levels, indicative of the spine’s adaptation to biomechanical stresses. This provides clinicians with a precise tool to differentiate between pathological narrowing and normal variations, enhancing the detection and treatment of lumbar foraminal stenosis. Despite limitations like its cross-sectional design, the strong agreement in measurements underscores the method’s reliability, encouraging future research to further explore these findings’ clinical implications.

Background In standard weaning from mechanical ventilation, a successful spontaneous breathing test (SBT) consisting of 30 min 8 cmH2O pressure-support ventilation (PSV8) without positive end-expiratory pressure (PEEP) is followed by extubation with continuous suctioning; however, these practices might promote derecruitment. Evidence supports the feasibility and safety of extubation without suctioning. Ultrasound can assess lung aeration and respiratory muscles. We hypothesize that weaning aiming to preserve lung volume can yield higher rates of successful extubation. Methods This multicenter superiority trial will randomly assign eligible patients to receive either standard weaning [SBT: 30-min PSV8 without PEEP followed by extubation with continuous suctioning] or lung-volume-preservation weaning [SBT: 30-min PSV8 + 5 cmH2O PEEP followed by extubation with positive pressure without suctioning]. We will compare the rates of successful extubation and reintubation, ICU and hospital stays, and ultrasound measurements of the volume of aerated lung (modified lung ultrasound score), diaphragm and intercostal muscle thickness, and thickening fraction before and after successful or failed SBT. Patients will be followed for 90 days after randomization. Discussion We aim to recruit a large sample of representative patients (N = 1600). Our study cannot elucidate the specific effects of PEEP during SBT and of positive pressure during extubation; the results will show the joint effects derived from the synergy of these two factors. Although universal ultrasound monitoring of lungs, diaphragm, and intercostal muscles throughout weaning is unfeasible, if derecruitment is a major cause of weaning failure, ultrasound may help clinicians decide about extubation in high-risk and borderline patients. Trial registration The Research Ethics Committee (CEIm) of the Fundació Unió Catalana d’Hospitals approved the study (CEI 22/67 and 23/26). Registered at ClinicalTrials.gov in August 2023. Identifier: NCT05526053.