Quirónsalud Marbella impulsa su proyecto de excelencia clínica con la puesta en marcha de 11 nuevas unidades multidisciplinares

             

  

El proyecto asistencial iniciado en el Hospital Quirónsalud Marbella desde primeros de este año toma impulso y velocidad. El centro sanitario acaba de anunciar la puesta en marcha de 11 nuevas  unidades multidisciplinares que ponen en valor la estrecha coordinación entre distintos servicios y la articulación de un modelo de trabajo en el que la interacción entre los profesionales implicados es permanente.

El principal objetivo de la constitución de estas nuevas Unidades es la prestación de una atención de calidad y excelencia al paciente poniendo a su servicio todos los recursos de los que dispone el hospital tanto en el ámbito tecnológico como en el ámbito profesional.  Una primera consulta al especialista sirve para activar la hoja de ruta de estas unidades de atención multidisciplinar que, en función del diagnóstico detectado, programará de manera secuencial un calendario de visitas para el seguimiento del paciente, garantizando la evaluación y acompañamiento clínico por parte de distintos profesionales. De esta forma, se consigue una atención de excelencia clínica al servicio del paciente en la que todos los especialistas implicados intervienen de forma coordinada, sumando sus conocimientos y competencias de forma integral.  La seguridad del paciente y la calidad asistencial, son los objetivos, sobre los que pivota esta nueva cartera de servicios del hospital y de sus profesionales.

Los servicios de Cirugía Ortopédica y Traumatología, Obstetricia y Ginecología, Cardiología, Otorrinolaringología, Neumología, Rehabilitación y Fisioterapia, Reumatología, Unidad de Matronas, Nutrición, y Piscología forman parte de las once nuevas unidades multidisciplinares que se acaban de poner en marcha. Si bien, no serán los únicos, en la medida en que se sigue avanzando en el modelo de atención basado en los equipos multiprofesionales del hospital.

 

Las nuevas unidades son:

1.            Unidad de atención integral al Embarazo, Parto y Puerperio

2.            Unidad integral de patología de Rodilla

3.            Unidad integral de patología de Cadera

4.            Unidad integral de patología de miembro superior

5.            Unidad de atención a pacientes con Fibromialgia

6.            Unidad de patologías deportivas

7.            Unidad integral de patología de Columna

8.            Unidad de Terapias regenerativas

9.            Unidad de Ortopedia Infantil

10.          Unidad de trastornos respiratorios del sueño (síndrome de apnea obstructiva del sueño)

11.          Unidad de Rehabilitación Cardiaca y Respiratoria

Con el estreno de los nuevos programas asistenciales (algunos de ellos son únicos y pioneros en la provincia) el Hospital Quirónsalud Marbella se sitúa como referente en la provincia de Málaga en la implantación de modelos de trabajo multidisciplinares y coordinación de profesionales de distintas especialidades para la resolución de un diagnóstico único.

 

“Magic mushroom” anti-depressive psychedelic affects perception of music

 

Scientists have found that the psychedelic drug psilocybin, in development as an anti-depressive treatment, changes the emotional state of people listening to music. Psilocybin is the active psychedelic ingredient in ‘magic mushrooms’. Clinical trials of psilocybin generally use selected music playlists to support the drug-induced psychedelic experience, and this work shows that enhanced emotional processing may be a positive outcome of combining psilocybin with music, suggesting that music should be an active component of psilocybin therapy.   This work is presented at the ECNP Congress in Lisbon. There has been considerable interest in the use of psychedelics in the treatment of hard-to-treat depression and other mental health conditions. Psilocybin, found naturally in several species of mushrooms, is the psychedelic most suitable for clinical development, in part because the psilocybin ‘trip’ can be contained within a working day, which is important for a supervised clinical treatment.  In the treatment of depression, psilocybin is normally administered with psychological support, and with accompanying music. Previous studies have shown that the psychedelic LSD interacts with music*, and of course in the 1960’s psychedelics were intimately related to the experience of music for many. Now for the first time a group of Danish scientists have shown that psilocybin affects the way that music elicits emotions. In the study, 20 healthy participants (50% women) were tested on their emotional response to music before and after given psilocybin; 14 of these participants were also tested after being given ketanserin (ketanserin is an anti-hypertension drug, commonly used to as a comparison in psychedelic experiments). Whether ketanserin or psilocybin was given first was randomly selected and each person was thus able to report on the changes effected by both psilocybin and ketanserin. At the peak of drug effects participants listened to a short music programme and rated their emotional response. The emotional response to the music was rated according to the Geneva Emotional Music Scale.  The music used was a short programme comprising Elgar’s Enigma Variations no 8 and 9, and Mozart’s Laudate Dominum, together lasting around 10 minutes. According to lead researcher, Associate Professor Dea Siggaard Stenbæk (University of Copenhagen): “We found that psilocybin markedly enhanced the emotional response to music, when compared to the response before taking the drugs. On the measurement scale we used, psilocybin increased the emotional response to music by around 60%. This response was even greater when compared to  ketanserin.  In fact, we found that ketanserin lessens the emotional response to music. This shows that combination of psilocybin and music has a strong emotional effect, and we believe that this will be important for the therapeutic application of psychedelics if they are approved for clinical use. Psilocybin is under development as a drug to treat depression, and this work implies that music needs to be considered as a therapeutic part of the treatment. Our next step is to look at the effect of music on the brain while under the influence of psilocybin in data material we have already collected, using an MRI”. She continued: “Interestingly, some of the music we used, Elgar famous ‘Nimrod’ variation (the 9th variation) describes his close friend Augustus Jaeger. Jaeger encouraged Elgar to write the variations as a way out of depression, so we’re pleased to see it used again to help understand more about mental health”. Commenting, Professor David J Nutt (Imperial College, London) said: “This is further evidence of the potential of using music to facilitate treatment efficacy with psychedelics. What we need to do now is optimise this approach probably through individualising and personalising music tracks in therapy”. This is an independent comment; Professor Nutt was not involved in this work   There is evidence that Magic mushrooms have been taken by humans for over 6000 years. Psilocybin was first isolated and synthesised in 1958, by the Swiss Chemist Albert Hoffman, the same man who first synthesised LSD. There was extensive early research into medical uses of psychedelics, but this became difficult after the US introduced a ban on their use in 1970. https://www.scientificamerican.com/article/end-the-ban-on-psychoactive-drug-research/ for background. *See: LSD enhances the emotional response to music, Kaelen et al, Psychopharmacology 232, 3607–3614 (2015). https://link.springer.com/article/10.1007/s00213-015-4014-y   The 34th ECNP Annual conference takes place in Lisbon and online from 2-5 October, see https://www.ecnp.eu/Congress2021/ECNPcongress . The European College of Neuropsychopharmacology is Europe’s main organisation working in applied neuroscience.

Depressed COVID patients respond better than expected to antidepressants

  

The COVID pandemic has led to a significant increase in mental health problems. Now, in some good news, a pilot study has shown that depressed patients who have suffered from COVID respond better to standard antidepressants than do people who have not had COVID.

Around 40% of COVID sufferers report the development of depression within 6 months of infection. The inflammation caused by COVID is believed to be the main reason for the development of depression. Now new research has shown that around 90% of patients who have suffered from COVID respond to SSRIs, significantly more than would be expected.

This work is presented at the ECNP Conference in Lisbon, and has been accepted for publication by the peer-reviewed journal European Neuropsychopharmacology* (pre-print available from the press officer, see below).

Lead researcher Mario Mazza MD, San Raffaele University, Milano said:

“We know that COVID has led to an epidemic of mental health problems. Post-COVID depression is a serious issue, with around 40% of COVID patients developing depression within 6 months of infection. But this study indicates that patients who have had COVID have a better chance of managing their depression than we thought”.

The researchers, from Professor Francesco Benedetti’s Laboratory of Psychiatry and Clinical Psychobiology at San Raffaele Hospital in Milano, treated 58 patients who had developed post-COVID depression with SSRIs (Selective Serotonin Reuptake Inhibitors) such as sertraline, paroxetine, fluvoxamine, and citalopram. Normally around a third of patients don’t respond to SSRIs, but the team found that that 91% of those with post-COVID depression responded to treatment within 4 weeks (response was measured using the standard Hamilton Depression Rating Scale: a patient was considered to have responded if they showed a 50% reduction in the scale after 4 weeks of treatment).  

Dr Mazza continued:

“This is a pilot study, but it does indicate that post-COVID depression is treatable. We would normally have expected around 40 of the 58 patients to have responded positively to treatment, but in fact we found that 53 of the 58 responded. Considering the anti-inflammatory and antiviral properties of SSRI, we hypothesized that post-COVID depression triggered by infection and sustained by infection-related systemic inflammation could particularly benefit from antidepressant treatment. We are now taking this work forward to a larger scale trial.

We also want to investigate whether SSRIs can also help with other post-COVID symptoms, such as cognitive impairment and fatigue, and to look at the role of inflammation in post-COVID depression”

Commenting, Dr Livia De Picker MD PhD (University of Antwerp, Belgium) said this study is of particular importance to the large group of patients and clinicians who are currently dealing with long COVID syndromes.

“Long COVID consists of a combination of persistent physical, psychological and neurocognitive symptoms after COVID-19 infection, which may present very different in different individuals. Even if we still do not understand all the causes of long COVID, this study indicates post-COVID depressive symptoms respond very well to serotonergic antidepressants. This does not come as a surprise to me, as recent studies have pointed out such compounds may also protect patients against severe COVID-19 illness and several antidepressants are currently under study as COVID-19 treatment options.

I hope the current findings will prompt further research into the mechanisms through which antidepressants can help against both acute and long-term COVID-19 complaints. Most importantly, these findings stress the importance of adequate screening and treatment of mental health symptoms in patients who suffer from persistent health problems after having been exposed to COVID-19.”

Intestinal drug shown to boost memory and cognition

  

The development of drugs to treat cognitive problems in patients with mental illness may be a step closer after a team of researchers discovered that an existing drug – used to treat constipation – may be able to boost our ability to think more clearly.

Severe psychiatric disorders can have a devastating impact on a patient’s life.  Cognitive impairments - ranging from decreased attention and working memory to disrupted social cognition and language - are widespread in psychiatric disorders such as major depression, schizophrenia, and bipolar disorder. These common problems are poorly treated with current medications and often have a large impact on people’s lives, and so scientists are searching for ways of improving or restoring these functions.

Previous animal studies have shown that the drugs which target one of the serotonin receptors (the 5-HT₄ receptor) have shown promise in improving cognitive function (serotonin is the neurotransmitter which is targeted by SSRI antidepressants). However, it has been difficult to translate these animal findings into humans because of worries about side effects. Now a group of UK researchers have tested an existing approved drug, prucalopride, which targets the 5-HT₄ receptor, and found that it may improve cognition. Prucalopride is primarily prescribed for constipation, and has an acceptable level of side effects if taken under medical supervision.

44 healthy volunteers aged 18-36 participated in the trial. 23 were given prucalopride, and 21 were given a placebo. After 6 days all the volunteers were given an fMRI brain scan. Before entering the MRI scanner, volunteers were shown a series of images of animals and landscapes. They viewed these again plus similar images during the scan. After the scan, volunteers performed a memory test: they were asked to distinguish the images they had seen before and during the scan from a set of completely new images.

Presenting the work at the European College of Neuropsychopharmacology conference in Lisbon (with simultaneous publication, see below), lead researcher, Dr Angharad de Cates of the University of Oxford said, “Participants who had taken prucalopride for 6 days performed much better than those receiving placebo on the memory test; the prucalopride group identified 81% of previously viewed images versus 76% in the placebo group. Statistical tests indicate that this was a fairly large effect – such an obvious cognitive improvement with the drug was a surprise to us”.

The researchers found that, compared with those taking the placebo, the volunteers taking prucalopride were both significantly better at the memory test after the scan, and also had fMRI scans indicating enhanced activity in brain areas related to cognition. The increased activity was in areas associated with memory, such as the hippocampus (in the centre of the brain) and the right angular gyrus (towards the rear of the brain).

Dr Susannah Murphy (Senior Research Fellow, University of Oxford and a senior author of the study) said, “Even when the low mood associated with depression is well treated with conventional antidepressants, many patients continue to experience problems with their memory.  Our study provides exciting early evidence in humans of a new approach that might be a helpful way to treat these residual cognitive symptoms”.

Angharad de Cates said “This is a proof-of-concept study, and so a starting point for further investigation.  We are currently planning and undertaking further studies looking at prucalopride and other 5HT₄ agonists in patient and clinically vulnerable populations, to see if our findings in healthy volunteers can be replicated and have clinical importance”. 

Prucalopride is a 5-HT₄ agonist which is taken primarily for constipation. It doesn’t have significant side effects if taken under medical supervision, although doctors caution of the possibility of headache, gastro-intestinal symptoms such as abdominal pain, nausea and diarrhoea, and fatigue or dizziness; there were no significant side-effects shown by any of the volunteers taking prucalopride in this study.

Commenting, Dr Vibe Frokjaer (Adjunct Professor, Dept. Psychology, Copenhagen University) said:
“This study highlights a very interesting and much needed potential for repurposing drugs to help cognitive dysfunction, which is often associated with psychiatric disorders even in remitted states. Importantly, as the authors also state, it will be vital to translate these findings from healthy populations into clinical populations. It will also be important to understand if prucalopride adds to the effects of existing antidepressant treatments, or can be used as a stand-alone therapy”.

To coincide with the ECNP presentation, the work is published today in the peer-reviewed journal Translational Psychiatry (Déjà-vu? Neural and behavioural effects of the 5-HT4 receptor agonist, prucalopride, in a hippocampal-dependent memory task, De Cates et al.
DOI 10.1038/s41398-021-01568-4). The paper is available on request from the ECNP press officer.

This work is presented at the 34^th ECNP Annual conference, which takes place in Lisbon and online from 2-5 October, see https://www.ecnp.eu/Congress2021/ECNPcongress . The European College of Neuropsychopharmacology is Europe’s main organisation working in applied neuroscience.

The ECNP thanks Translational Psychiatry for the use of the image. https://www.nature.com/tp/

Depression history written in the reactions of the brain

 

Scientists have found that the more severely patients have been hit by depression across their lifespan, the less they react emotionally to negative faces during current depression.  The researchers are now working to understand if this means that serious depression changes the way the brain reacts to emotion over time, or if people with stronger emotional responses to negative faces are less vulnerable to long-term depression. Either may have implications for future patient care. This work is presented at the ECNP conference in Lisbon, after recent publication.

Depression is a major mental health burden, but the direct effect on brain activity is only just beginning to be understood. The brains of depressed patients normally show greater activity in certain areas than those of non-depressed healthy people. Now a group of German scientists have discovered that, while still greater than in non-depressed people, brain activity of patients who are currently depressed and have suffered with prolonged and severe depression is lower than that of patients with less severe and prolonged depression. No specific relation is found between brain activity and previous depression in patients where the depression is no longer present.

The researchers worked with 201 seriously depressed patients and 161 patients who had come out of the period of depression (remitted). Each patient was questioned about the duration and extent of their previous depression, which allowed the researchers to build a tailored depression history.  Then during the study, each patient was placed in an MRI scanner, and brain changes were monitored while the patients viewed a series of unsettling images – fearful or angry faces.

Lead researcher Hannah Lemke (University of Münster) said:

“We saw that the unsettling images of negative faces caused activity in certain areas of the brain, mostly the amygdala, parahippocampus PHG and Insula, which are areas where emotions are processed. However the extent of the brain activity was different according to the severity and duration of the depression the patient had already suffered. Those patients where the depression had remitted showed a certain level of activity, but those patients where the depression was current exhibited a reduced activity in these brain areas. This differed for each patient, but in general the more severe the depression history, the less responsive their brains were to the photographs”.

Hannah Lemke continued:
“In those patients where the depression had remitted the brain response was not related to the previous depression history, which may indicate the importance of disease remission to brain health.
Interpreting this needs more work. It’s tempting to think that reduced brain activity is a way the brain copes emotionally with long-term depression, and that maybe the first episode of depression was qualitatively different to the current episode. It seems that underlying brain activity related to the emotional information of serious depression may change over the course of the disease. 

But we also need to consider alternative explanations, for example, it may be that people who process emotions in a certain way are more vulnerable to long-term depression. In either case, we are looking at different faces of depression, with different effects and different outcomes. And perhaps future treatment will need to take this into consideration.

This is a big study, so we can be fairly confident in what we have found. Nevertheless, we now need longitudinal studies, where individual depressed patients are followed over a period of years to see how their brain response changes”.


Commenting, Dr Carmine Pariante, Professor of Biological Psychiatry at King’s College London, said:

“This study confirms how profoundly the brain of patients is affected by major depression. A number of mechanisms can explain these findings, all relevant to the further understanding of depression, as this biological signature could be either a risk factor for, or a consequence of, more severe and chronic depression. Moreover, future studies should clarify if these effects are driven more by the maximum severity of depression, the chronicity of depression, or the exposure to antidepressants; and clarify the molecular mechanisms underpinning these functional changes”.

The 34^th ECNP Annual conference takes place in Lisbon and online from 2-5 October, see https://www.ecnp.eu/Congress2021/ECNPcongress . The European College of Neuropsychopharmacology is Europe’s main organisation working in applied neuroscience.

This press release includes work which appeared in Biological Psychiatry:CNNI, June 2021. see https://www.sciencedirect.com/science/article/abs/pii/S2451902221001488?via%3Dihub  

Orliman presenta el primer corsé ortopédico fabricado con tecnología 3D

  

 

  Orliman, empresa española de Grupo Cinfa referente en el desarrollo de soluciones de ortopedia con más de 25 años de experiencia en investigación, desarrollo y fabricación de dispositivos ortopédicos, ha lanzado la nueva línea ERGOTEC 3D®, donde se incluye el primer corsé ortopédico (ortesis) desarrollado con tecnología 3D. Con la presentación de este nuevo dispositivo, Orliman marca un hito en el sector de la ortopedia abriendo un nuevo campo en el futuro de esta especialidad, tanto en el tratamiento de lesiones como en su rehabilitación.

Esta nueva línea supone una aplicación pionera del uso del 3D en la fabricación de ortesis. De este modo, podemos personalizar al máximo los diseños, con el objetivo de mejorar la calidad de vida de los pacientes con lesiones óseas, musculares o ligamentosas, así como de personas con deformidades vertebrales. Mediante el diseño y la impresión en tres dimensiones, se simula el efecto que tendrá el dispositivo en el propio paciente antes de fabricarlo, evaluando si la corrección de los aspectos funcionales o estructurales del sistema neuromuscular será la adecuada o si, por el contrario, será necesario modificar las zonas de presión previo a su colocación.

Un proceso de fabricación en tres fases

La fabricación del corsé ortopédico en 3D consta de varias fases: primeramente, se lleva a cabo la digitalización del paciente, mediante el escaneo de la extremidad afectada. En la segunda fase, se realiza el diseño de la ortesis. La combinación de la experiencia médica, algoritmos propios y la incorporación de las últimas tecnologías permite la modelación en 3D del dispositivo a medida.

El proceso concluye con la impresión en tres dimensiones de la ortesis personalizada a través de impresoras de alto rendimiento, que hacen posible el diseño y la fabricación personalizada.

El resultado de este proceso son dispositivos más cómodos, ligeros e higiénicos, que aseguran una mayor aceptación por parte del paciente, garantizando la finalización de los tratamientos. Además, el uso de la tecnología 3D permite acortar los tiempos de fabricación.

Material innovador en el mundo de la ortopedia

El material con el que se imprime esta nueva línea también supone una innovación en el mundo de la ortopedia. Se trata de un material sintético, Singufil®, que permite una alta resolución de impresión. Además, presenta una elevada resistencia a los golpes, siendo capaz de conseguir al mismo tiempo rigidez y flexibilidad, pero sin perder la función prevista para su uso.

Este innovador material tiene el certificado de no toxicidad, está testado para el contacto prolongado sin causar irritación dérmica, es resistente al agua, lavable y aporta un mayor confort para el paciente que los materiales disponibles hasta ahora.

 

Los datos de Novartis muestran que la consecución del control completo de la urticaria crónica espontánea (UCE) mejora la calidad de vida global, según reportan los pacientes

 

Novartis, líder en inmunodermatología y reumatología, ha anunciado un nuevo análisis de un estudio de Fase IIb que demuestra la importancia de lograr un control completo de los síntomas de la urticaria crónica espontánea (UCE) para mejorar la calidad de vida global relacionada con la salud (CdVRS) en los pacientes. El control completo de los síntomas aporta un enorme beneficio a las personas con UCE y está asociado a mejoras en los indicadores clave de la CdVRS, como la calidad de vida global, los trastornos del sueño, la interferencia en la actividad y el deterioro laboral. Hay una marcada disminución en estas mejoras en la calidad de vida, incluso cuando los pacientes padecen síntomas leves de UCE.

El control completo de los síntomas de la UCE, se evaluó mediante una combinación de resultados reportados por el paciente y se demostró que es más probable que se logre y mantenga con ligelizumab que con Xolair^® (omalizumab) o placebo. Estos datos fueron presentados en el 30º Congreso Anual de la Academia Europea de Dermatología y Venereología (EADV, por sus siglas en inglés).

 

La UCE es una enfermedad dermatológica grave e impredecible que afecta en algún momento hasta al 1% de la población mundial . En comparación con la población general, los pacientes con UCE presentan el doble de probabilidades de experimentar dificultad para dormir, ansiedad, angustia y depresión. Muchas personas con UCE no logran alcanzar el control completo de los signos y síntomas a pesar de recibir el estándar de tratamiento actual (antihistamínicos y/u omalizumab) .

 

Los datos muestran una mayor probabilidad de que ligelizumab proporcionara un control completo de los síntomas de la UCE que omalizumab cuando se evaluó mediante una combinación de resultados reportados por el paciente. Se consideró que un paciente libre de signos y síntomas de urticaria con puntuación de la severidad de las ronchas concurrente (HSS7) = 0, la puntuación de la severidad del prurito (ISS7) = 0 y la puntuación de la actividad del angioedema (AAS7) = 0 presentaba una UCE completamente controlada. El índice de calidad de vida en dermatología (DLQI) = 0-1 concurrente indica que un paciente se encuentra libre de UCE:

 

·       En la semana 12, el porcentaje de pacientes que mostraron UCE completamente controlada fue del 44,1% con ligelizumab 72 mg (P = 0,007 en comparación con omalizumab y P =0,003 en comparación con el placebo), del 40,0% con ligelizumab 240 mg (P = 0,025 en comparación con omalizumab y P =0,004 en comparación con el placebo) y del 23,5% con omalizumab (P = 0,021 en comparación con el placebo) y del 0,0% con placebo. El porcentaje de pacientes libres de UCE fue del 38,1% con ligelizumab 72 mg (P = 0,008 en comparación con omalizumab y P =0,006 en comparación con el placebo), del 35,3% con ligelizumab 240 mg (P = 0,020 en comparación con omalizumab y P = 0,007 en comparación con el placebo) y del 18,8% con omalizumab (P = 0,035 en comparación con el placebo) y del 0,0% con placebo.

·       En la semana 20, el porcentaje de pacientes con UCE completamente controlada fue del 33,3%, 34,1%, 25,9% y 4,7%, y para los pacientes libres de UCE fue del 32,1%, 31,8%, 23,5% y 4,7% con ligelizumab 72 mg, ligelizumab 240 mg , omalizumab y placebo, respectivamente.

·       Durante el período de seguimiento sin tratamiento, en la semana 28, el porcentaje de pacientes que permanecieron libres de UCE con ligelizumab 72 mg, ligelizumab 240 mg, omalizumab y placebo fue del 22,8%, 25,0%, 5,3% y 4,9%, respectivamente.

 

"Novartis está comprometida con el descubrimiento y desarrollo de medicamentos que puedan aliviar la carga de enfermedades inmunodermatológicas, que afectan a más de 100 millones de personas en todo el mundo", ha comentado Angelika Jahreis MD, PhD, directora global de desarrollo de la Unidad de Inmunología, Hepatología y Dermatología de Novartis. “Estos resultados de Fase II son prometedores, ya que hablan de los beneficios del control de los síntomas según los datos reportados directamente por los pacientes. Esto es particularmente revelador, ya que sabemos que los métodos establecidos para evaluar el impacto de la enfermedad, como la puntuación de la actividad de la urticaria de 7 días (UAS7), a veces puede fallar al momento de capturar la experiencia completa de un paciente que vive con UCE".

 

Novartis también presentará los datos más recientes de Fase II de remibrutinib en UCE, que muestran que las múltiples dosis proporcionan mejoras significativas con respecto a la basal, en comparación con el placebo, con un perfil de seguridad favorable en todo el rango de dosificación. Remibrutinib se está investigando como un posible tratamiento oral en una serie de enfermedades inmunomediadas.