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Although there is an approved indication for venetoclax and hypomethylating agents (VenHMA) and its use in different AML settings will be expanded in the following years, the management of the adverse events (AEs) lacks of harmonized algorithms during treatment of these patients. We have studied the incidence of relevant AEs of 43 patients who achieved a response to VenHMA and its management. Median overall survival of our cohort was 19 months. No patients discontinued treatment due to AEs after C3D1, Regarding severe AEs, high rates of grade 4 neutropenia (97.6%) and grade 4 thrombocytopenia (65.1%) were observed. Severe infectious AEs rate was 16%. Due to severe myelotoxicity, most patients required a progressive dose reduction of both venetoclax and hypomethylating agents during follow-up, being 87.8% at C6D1. Transfusional dependence rate was 91% and G-CSF was prescribed to 86% of the patients. Finally, there was not a significant difference in hemoglobin, platelets and absolute neutrophil count after achieving complete response comparing paired samples during follow-up, although cytopenia rate was high during initial follow-up. We conclude that dose reduction of VenHMA after achieving a response in patients diagnosed with AML is required in most patients and essential to avoid prolonged cytopenia-related adverse events and a rapid and standardized method on how to perform it might decrease the AEs rate.

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BACKGROUND: Isoprostanes and prostaglandins are biomarkers for oxidative stress and inflammation. Their role in Alzheimer's disease (AD) pathophysiology is yet unknown. In the current study, we aim to identify the association of isoprostanes and prostaglandins with the Amyloid, Tau, Neurodegeneration (ATN) biomarkers (Aß-42, p-tau, and t-tau) of AD pathophysiology in mild cognitive impairment (MCI) subjects. METHODS: Targeted metabolomics profiling was performed using liquid chromatography-mass spectrometry (LCMS) in 147 paired plasma-CSF samples from the Ace Alzheimer Center Barcelona and 58 CSF samples of MCI patients from the Mannheim/Heidelberg cohort. Linear regression was used to evaluate the association of metabolites with CSF levels of ATN biomarkers in the overall sample and stratified by Aß-42 pathology and APOE genotype. We further evaluated the role of metabolites in MCI to AD dementia progression. RESULTS: Increased CSF levels of PGF2α, 8,12-iso-iPF2α VI, and 5-iPF2α VI were significantly associated (False discovery rate (FDR) < 0.05) with higher p-tau levels. Additionally, 8,12-iso-iPF2α VI was associated with increased total tau levels in CSF. In MCI due to AD, PGF2α was associated with both p-tau and total tau, whereases 8,12-iso-iPF2α VI was specifically associated with p-tau levels. In APOE stratified analysis, association of PGF2α with p-tau and t-tau was observed in only APOE ε4 carriers while 5-iPF2α VI showed association with both p-tau and t-tau in APOE ε33 carriers. CSF levels of 8,12- iso-iPF2α VI showed association with p-tau and t-tau in APOE ε33/APOE ε4 carriers and with t-tau in APOE ε3 carriers. None of the metabolites showed evidence of association with MCI to AD progression. CONCLUSIONS: Oxidative stress (8,12-iso-iPF2α VI) and inflammatory (PGF2α) biomarkers are correlated with biomarkers of AD pathology during the prodromal stage of AD and relation of PGF2α with tau pathology markers may be influenced by APOE genotype.

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Background: Microglial dysfunction plays a causative role in Alzheimer's disease (AD) pathogenesis. Here we focus on a germline insertion/deletion variant mapping SIRPß1, a surface receptor that triggers amyloid-ß(Aß) phagocytosis via TYROBP. Objective: To analyze the impact of this copy-number variant in SIRPß1 expression and how it affects AD molecular etiology. Methods: Copy-number variant proxy rs2209313 was evaluated in GERALD and GR@ACE longitudinal series. Hippocampal specimens of genotyped AD patients were also examined. SIRPß1 isoform-specific phagocytosis assays were performed in HEK393T cells. Results: The insertion alters the SIRPß1 protein isoform landscape compromising its ability to bind oligomeric Aß and its affinity for TYROBP. SIRPß1 Dup/Dup patients with mild cognitive impairment show an increased cerebrospinal fluid t-Tau/Aß ratio (p = 0.018) and a higher risk to develop AD (OR = 1.678, p = 0.018). MRIs showed that Dup/Dup patients exhibited a worse initial response to AD. At the moment of diagnosis, all patients showed equivalent Mini-Mental State Examination scores. However, AD patients with the duplication had less hippocampal degeneration (p < 0.001) and fewer white matter hyperintensities. In contrast, longitudinal studies indicate that patients bearing the duplication allele show a slower cognitive decline (p = 0.013). Transcriptional analysis also shows that the SIRPß1 duplication allele correlates with higher TREM2 expression and an increased microglial activation. Conclusions: The SIRPß1 internal duplication has opposite effects over MCI-to-Dementia conversion risk and AD progression, affecting microglial response to Aß. Given the pharmacological approaches focused on the TREM2-TYROBP axis, we believe that SIRPß1 structural variant might be considered as a potential modulator of this causative pathway.

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BACKGROUND: Platelet-rich plasma (PRP) and botulinum toxin type A (BTX-A) injections have proven effective in clinical trials for plantar fasciitis treatment but have not been directly compared. We aimed to compare clinical outcomes in patients undergoing PRP or BTX-A injections. METHODS: We performed a randomised controlled trial (59 patients; 1-year follow-up) to assess efficacy, using pain and functional scales (VAS, AOFAS Hindfoot-scale and FAAM questionnaire) and fascia thickness reduction, in control and single ultrasound-guided BTX-A or PRP injection groups. RESULTS: The BTX-A group showed better results at 1-month after treatment. Conversely, the PRP injection was more effective in the long-term, with significant pain reduction and functional improvement. Plantar fascia thickness significantly reduced from months 1 and 3 in the PRP and BTX-A groups, respectively. CONCLUSION: PRP and BTX-A injections are effective in patients with plantar fasciitis with BTX-A achieving better short-term pain reduction and PRP better long-term results. LEVEL OF EVIDENCE: Level I; Randomised Controlled Trial.

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Introduction: In the last 20 years we have doubled obesity rates. In Spain, 67 % of the population does not have an adequate weight and 40 % of the child population suffers from obesity or overweight. This leads to serious diseases. To avoid this, a national plan to fight obesity is required, with prevention and therapeutic strategies so as not to continue increasing these data in 2030. Among the factors that cause childhood obesity are poor eating habits as well as a lack of physical activity and excessive use of screens. In addition, there is a significant social gap. Childhood obesity especially affects families with lower purchasing power (54 %) who do not have access to a healthy diet or the necessary tools or knowledge to promote health to their sons and daughters through food. The World Health Organization (WHO) Regional Office for Europe developed a nutrient profile model in 2015, specifically for the purpose of restricting the marketing of foods aimed at children. This model is considered by the scientific community as a reference tool when it comes to establish policies and improvements in favor of public health, in order to provide families with access to food with a better profile and nutritional value.

Introducción: En los últimos 20 años hemos duplicado las tasas de obesidad. Un 67 % de la población no tiene un peso adecuado y el 40 % de la población infantil sufre obesidad o sobrepeso en España. Esto deriva en graves enfermedades. Para evitarlo, es necesario un plan nacional de lucha contra la obesidad, con estrategias de prevención y terapéuticas para no seguir incrementando estos datos en 2030. Entre los factores causantes de la obesidad infantil se encuentran los malos hábitos de alimentación, además de la falta de actividad física y un uso excesivo de pantallas. Además, existe una brecha social importante. La obesidad infantil afecta especialmente a familias con menor poder adquisitivo (el 54 %), que no tienen acceso a una alimentación saludable ni las herramientas necesarias o el conocimiento para promover la salud a sus hijos e hijas a través de la alimentación. La Oficina Regional de la Organización Mundial de la Salud (OMS) para Europa desarrolló un modelo de perfil de nutrientes en 2015, específicamente a efectos de restringir la comercialización de alimentos dirigida a los niños, un modelo que se plantea desde la comunidad científica como una herramienta de referencia a la hora de establecer políticas y mejoras en pro de la salud pública, con el fin de facilitar a las familias el acceso a alimentos con un mejor perfil y valor nutricional.

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Introducción: El nuevo coronavirus comenzó en Wuhan, China, a fines de 2019 y se ha diseminado con rapidez por todo el mundo. Objetivo: Caracterizar el comportamiento de la COVID-19 en el Policlínico Ángel Machaco Ameijeiras de la semana estadística 11 a la 34, 2020. Métodos: Se realizó un estudio descriptivo, de corte transversal, con el universo fueron los casos atendidos Se utilizó el Programa EPIDAT 3.1, las variables definidas permitieron la creación una base de datos en Excel. Resultados: Se confirmaron 16 casos desde el inicio de la pandemia, todos son cubanos, con una fuente de infección conocida, La tasa de incidencia acumulada es de 4,6 POR 10 000 habitantes, predominaron los pacientes asintomáticos, las edades de 21 a 39 años y de 40 a 59 años, en el consejo popular Debeche Nalón predominaron los casos en el mes de abril y reaparecieron en julio y agosto. Conclusiones: Se confirmaron un 20,2 % de los casos sospechosos de COVID-19, predominaron los casos en el consejo popular Debeche Nalón y el grupo de edades de 21 a 39 años. No se evidenciaron diferencias relacionadas con el sexo. Todos los casos tenían fuente de infección conocida, sobre todo los centros de trabajo. Al momento del ingreso la mayoría era asintomático. Las infecciones respiratorias agudas se encuentran en zona de éxito durante la etapa analizada y su tendencia era descendente, así como la tendencia de la COVID-19 ligeramente ascendente.

Introduction: The new coronavirus began in Wuhan, China, in late 2019 and has spread rapidly throughout the world. Objective: To characterize the behavior of COVID-19 at Ángel Machaco Ameijeiras Polyclinic from statistical week 11 to 34, 2020. Methods: A descriptive, cross-sectional study was carried out in the universe made up of the cases assisted. EPIDAT 3.1 Program was used, the defined variables allowed the creation of a database in Excel. Results: Sixteen cases have been confirmed since the beginning of the pandemic, all are Cuban, with a known source of infection. The cumulative incidence rate is 4.6 per 10,000 inhabitants, asymptomatic patients, ages 21 to 39 years and 40 to 59 years predominated. In Debeche Nalón community, cases prevailed in the month of April and reappeared in July and August. Conclusions: 20.2% of suspected COVID-19 cases were confirmed. No differences related to sex were evident. All cases had a known source of infection, especially those in workplaces. At the time of admission, the majority were asymptomatic. Acute respiratory infections are in the success zone during the stage analyzed and their trend was downward, while the trend of COVID-19 was slightly upward.

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The Ibero-American Network of Pharmacogenetics and Pharmacogenomics (RIBEF) studies Latin American populations to benefit from the implementation of personalized medicine. Since 2006, it has studied ethnicity to apply pharmacogenetics knowledge in autochthonous populations of Latin America, considering ancestral medicine. The meeting 'Pharmacogenetics: ethnicity, Treatment and Health in Latin American Populations' was held in Mexico City, Mexico, and presented the relevance of RIBEF collaboration with Latin American researchers and the governments of Mexico, Spain and the Autonomous Community of Extremadura. The results of 17 years of uninterrupted work by RIBEF, the Declaration of Mérida/T'Hó and the call for the Dr José María Cantú Award for studies focused on the pharmacogenetics of native populations in Latin America were presented.

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La formación de estudiantes para la prevención de las alteraciones del comportamiento en los niños de la primera infancia, es imprescindible porque contribuye a elevar la calidad de la atención educativa de salud y educación en ambas modalidades de atención educativa de la primera infancia. El artículo que se presenta tiene como objetivo exponer acciones dirigidas a los estudiantes en formación que los prepara para la orientación de las familias, en función de la prevención de las alteraciones del comportamientoen niños de infancia preescolar. Las acciones se aplicaron durante el periodo del 2019 al 2022 como parte de la preparación para la práctica laboral, lo que posibilitó que se elevara la calidad de la orientación familiar en función de la prevención de las alteraciones del comportamiento en los niños de infancia preescolar, en ambas modalidades de atención educativa.

The training of students for the prevention of behavioral disorders in early childhood children is essential because it contributes to raising the quality of educational health care and education in both modalities of early childhood educational care. The article that is presented aims to expose actions aimed at students in training that prepare them for the orientation of families, based on the prevention of behavioral disorders in preschool children. The actions were applied during the period from 2019 to 2022 as part of the preparation for labor practice, which made it possible to raise the quality of family guidance based on the prevention of behavioral disorders in preschool children, in both modalities of educational attention.

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Introduction: Elevated plasma levels of extracellular vesicles have been associated with impaired placentation, angiogenesis imbalance, intravascular inflammation, and endothelial dysfunction in women with preeclampsia, thus suggesting that circulating vesicles may be a good therapeutic target for the treatment of the disease. Recently, statins have been considered a potential treatment for the prevention of preeclampsia because of their pleiotropic effects, including the improvement of endothelial dysfunction and inhibition of inflammatory responses. However, the effects of these drugs on circulating vesicles concentration in women at risk of preeclampsia have not been established. Herein, we aimed to assess the effects of pravastatin on circulating extracellular vesicle generation in women at high risk of term preeclampsia. Methods: In a sample of 68 singleton pregnant women participating in the multicenter, double-blind, placebo-controlled STATIN trial (Nº EducraCT 2016-005206-19 ISRCTN), 35 women received a placebo and 33 women received a 20 mg/day dose of pravastatin for approximately 3 weeks (from 35 to 37 weeks of gestation until delivery). Large extracellular vesicles were characterized and quantified by flow cytometry using annexin V and cell-specific antibodies directed against platelet, endothelial, leukocyte, and syncytiotrophoblast cell surface markers. Results: In women who received the placebo, a significant increase in the plasma levels of large extracellular vesicles from platelets (34%, p < 0.01), leukocytes (33%, p < 0.01), monocytes (60%, p < 0.01), endothelial cells (40%, p < 0.05), and syncytiotrophoblast cells (22%, p < 0.05) were observed. However, treatment with pravastatin significantly reduced the plasma levels of large extracellular vesicles from platelets (42%, p < 0.001), leukocytes (25%, p < 0.001), monocytes (61%, p < 0.001), endothelial cells (69%, p < 0.001), activated endothelial cells (55%, p < 0.001), and syncytiotrophoblast cells (44%, p < 0.001). Discussion: These results indicate that pravastatin reduces the levels of activated cell-derived membrane vesicles from the maternal vasculature, blood, and placental syncytiotrophoblast of women at high risk of term preeclampsia, suggesting that this statin may be beneficial in reducing endothelial dysfunction and pro-inflammatory and pro-coagulatory state characteristics of the disease.

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Introduction The second-line chemotherapy in metastatic colorectal cancer (mCRC) with FOLFIRI-aflibercept demonstrated an increase in survival compared with FOLFIRI in patients previously treated with oxaliplatin-based regimens. Few data are available in patients treated previously with bevacizumab. Our objective is to evaluate the efficacy and safety of FOLFIRI-aflibercept in second-line treatment in patients who have previously received bevacizumab. Patients and methods This is a observational, retrospective study of patients with mCRC treated with FOLFIRI-aflibercept in 2nd line in eight hospitals in the Valencian Community. Survival, response, and toxicity were analyzed. Result 122 patients with a median age of 61 years were included. 89% of patients had PS 0–1. The median of PFS (progression free survival) and OS (overall survival) was 5.45 (95% CI 4.74–6.15 months) and 10.15 (95% CI 7.47–12.82 months), respectively. Disease control rate 59.8%. The most common grade 3–4 adverse events were neutropenia (13,1%) and asthenia (9%). The presence of hypertension during treatment with FOLFIRI-aflibercept was associated with a survival benefit. Median of OS was 14.45 (95% CI 11.58–17.32) in patients with hypertension vs 7.78 (95% CI 5.02–10.54) in patients without hypertension (p = .001). Our results suggest that the presence of PS 0, primary tumor surgery, metachronous metastases, and the presence of only 1 metastatic location, are favorable prognostic factors associated with better OS. Conclusions Our results confirm the value of maintaining angiogenesis inhibition with FOLFIRI-aflibercept in mCRC after progression to a first-line treatment with bevacizumab. The development of hypertension during treatment is a possible predictive marker of response (AU)

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Background: Optical coherence tomography angiography (OCT-A) is a novel method in the dementia field that allows the detection of retinal vascular changes. The comparison of OCT-A measures with established Alzheimer's disease (AD)-related biomarkers is essential to validate the former as a marker of cerebrovascular impairment in the AD continuum. We aimed to investigate the association of macular vessel density (VD) in the superficial plexus quantified by OCT-A with the AT(N) classification based on cerebrospinal fluid (CSF) Aß1-42, p181-tau and t-tau measurements in individuals with mild cognitive impairment (MCI). Materials and methods: Clinical, demographic, ophthalmological, OCT-A and CSF core biomarkers for AD data from the Neuro-ophthalmology Research at Fundació ACE (NORFACE) project were analyzed. Differences in macular VD in four quadrants (superior, nasal, inferior, and temporal) among three AT(N) groups [Normal, Alzheimer and Suspected non-Alzheimer pathology (SNAP)] were assessed in a multivariate regression model, adjusted for age, APOE ε4 status, hypertension, diabetes mellitus, dyslipidemia, heart disease, chronic obstructive pulmonary disease and smoking habit, using the Normal AT(N) group as the reference category. Results: The study cohort comprised 144 MCI participants: 66 Normal AT(N), 45 Alzheimer AT(N) and 33 SNAP AT(N). Regression analysis showed no significant association of the AT(N) groups with any of the regional macular VD measures (all, p > 0.16). The interaction between sex and AT(N) groups had no effect on differentiating VD. Lastly, CSF Aß1-42, p181-tau and t-tau measures were not correlated to VD (all r < 0.13; p > 0.13). Discussion: Our study showed that macular VD measures were not associated with the AT(N) classification based on CSF biomarkers in patients with MCI, and did not differ between AD and other underlying causes of cognitive decline in our cohort.

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INTRODUCTION: The second-line chemotherapy in metastatic colorectal cancer (mCRC) with FOLFIRI-aflibercept demonstrated an increase in survival compared with FOLFIRI in patients previously treated with oxaliplatin-based regimens. Few data are available in patients treated previously with bevacizumab. Our objective is to evaluate the efficacy and safety of FOLFIRI-aflibercept in second-line treatment in patients who have previously received bevacizumab. PATIENTS AND METHODS: This is a observational, retrospective study of patients with mCRC treated with FOLFIRI-aflibercept in 2nd line in eight hospitals in the Valencian Community. Survival, response, and toxicity were analyzed. RESULTS: 122 patients with a median age of 61 years were included. 89% of patients had PS 0-1. The median of PFS (progression free survival) and OS (overall survival) was 5.45 (95% CI 4.74-6.15 months) and 10.15 (95% CI 7.47-12.82 months), respectively. Disease control rate 59.8%. The most common grade 3-4 adverse events were neutropenia (13,1%) and asthenia (9%). The presence of hypertension during treatment with FOLFIRI-aflibercept was associated with a survival benefit. Median of OS was 14.45 (95% CI 11.58-17.32) in patients with hypertension vs 7.78 (95% CI 5.02-10.54) in patients without hypertension (p = .001). Our results suggest that the presence of PS 0, primary tumor surgery, metachronous metastases, and the presence of only 1 metastatic location, are favorable prognostic factors associated with better OS. CONCLUSIONS: Our results confirm the value of maintaining angiogenesis inhibition with FOLFIRI-aflibercept in mCRC after progression to a first-line treatment with bevacizumab. The development of hypertension during treatment is a possible predictive marker of response.

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Cholesterol efflux capacity (CEC) is of interest given its potential relationship with several important clinical conditions including Alzheimer's disease. The inactivation of the APOE locus in mouse models supports the idea that it is involved in determining the CEC. With that in mind, we examine the impact of the plasma metabolome profile and the APOE genotype on the CEC in cognitively healthy elderly subjects. The study subjects were 144 unrelated healthy individuals. The plasma CEC was determined by exposing cultured mouse macrophages treated with BODIPY-cholesterol to human plasma. The metabolome profile was determined using NMR techniques. Multiple regression was performed to identify the most important predictors of CEC, as well as the NMR features most strongly associated with the APOE genotype. Plasma 3-hydroxybutyrate was the variable most strongly correlated with the CEC (r = 0.365; p = 7.3 × 10-6). Male sex was associated with a stronger CEC (r = -0.326, p = 6.8 × 10-5). Most of the NMR particles associated with the CEC did not correlate with the APOE genotype. The NMR metabolomics results confirmed the APOE genotype to have a huge effect on the concentration of plasma lipoprotein particles as well as those of other molecules including omega-3 fatty acids. In conclusion, the CEC of human plasma was associated with ketone body concentration, sex, and (to a lesser extent) the other features of the plasma lipoprotein profile. The APOE genotype exerted only a weak effect on the CEC via the modulation of the lipoprotein profile. The APOE locus was associated with omega-3 fatty acid levels independent of the plasma cholesterol level.

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Mosaic loss of chromosome Y (mLOY) is a common ageing-related somatic event and has been previously associated with Alzheimer's disease (AD). However, mLOY estimation from genotype microarray data only reflects the mLOY degree of subjects at the moment of DNA sampling. Therefore, mLOY phenotype associations with AD can be severely age-confounded in the context of genome-wide association studies. Here, we applied Mendelian randomisation to construct an age-independent mLOY polygenic risk score (mloy-PRS) using 114 autosomal variants. The mloy-PRS instrument was associated with an 80% increase in mLOY risk per standard deviation unit (p = 4.22 × 10-20) and was orthogonal with age. We found that a higher genetic risk for mLOY was associated with faster progression to AD in men with mild cognitive impairment (hazard ratio (HR) = 1.23, p = 0.01). Importantly, mloy-PRS had no effect on AD conversion or risk in the female group, suggesting that these associations are caused by the inherent loss of the Y chromosome. Additionally, the blood mLOY phenotype in men was associated with increased cerebrospinal fluid levels of total tau and phosphorylated tau181 in subjects with mild cognitive impairment and dementia. Our results strongly suggest that mLOY is involved in AD pathogenesis.

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Few studies have addressed the impact of the association between Alzheimer's disease (AD) biomarkers and NPSs in the conversion to dementia in patients with mild cognitive impairment (MCI), and no studies have been conducted on the interaction effect of these two risk factors. AT(N) profiles were created using AD-core biomarkers quantified in cerebrospinal fluid (CSF) (normal, brain amyloidosis, suspected non-Alzheimer pathology (SNAP) and prodromal AD). NPSs were assessed using the Neuropsychiatric Inventory Questionnaire (NPI-Q). A total of 500 individuals with MCI were followed-up yearly in a memory unit. Cox regression analysis was used to determine risk of conversion, considering additive and multiplicative interactions between AT(N) profile and NPSs on the conversion to dementia. A total of 224 participants (44.8%) converted to dementia during the 2-year follow-up study. Pathologic AT(N) groups (brain amyloidosis, prodromal AD and SNAP) and the presence of depression and apathy were associated with a higher risk of conversion to dementia. The additive combination of the AT(N) profile with depression exacerbates the risk of conversion to dementia. A synergic effect of prodromal AD profile with depressive symptoms is evidenced, identifying the most exposed individuals to conversion among MCI patients.

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En los últimos 20 años hemos duplicado las tasas de obesidad. Un 67 % de la población no tiene un peso adecuado y el 40 % de la población infantil sufre obesidad o sobrepeso en España. Esto deriva en graves enfermedades. Para evitarlo, es necesario un plan nacional de lucha contra la obesidad, con estrategias de prevención y terapéuticas para no seguir incrementando estos datos en 2030.Entre los factores causantes de la obesidad infantil se encuentran los malos hábitos de alimentación, además de la falta de actividad física y un uso excesivo de pantallas. Además, existe una brecha social importante. La obesidad infantil afecta especialmente a familias con menor poder adquisitivo (el 54 %), que no tienen acceso a una alimentación saludable ni las herramientas necesarias o el conocimiento para promover la salud a sus hijos e hijas a través de la alimentación.La Oficina Regional de la Organización Mundial de la Salud (OMS) para Europa desarrolló un modelo de perfil de nutrientes en 2015, específicamente a efectos de restringir la comercialización de alimentos dirigida a los niños, un modelo que se plantea desde la comunidad científica como una herramienta de referencia a la hora de establecer políticas y mejoras en pro de la salud pública, con el fin de facilitar a las familias el acceso a alimentos con un mejor perfil y valor nutricional. (AU)

In the last 20 years we have doubled obesity rates. In Spain, 67 % of the population does not have an adequate weight and 40 % of the child population suffers from obesity or overweight. This leads to serious diseases. To avoid this, a national plan to fight obesity is required, with prevention and therapeutic strategies so as not to continue increasing these data in 2030. Among the factors that cause childhood obesity are poor eating habits as well as a lack of physical activity and excessive use of screens.In addition, there is a significant social gap. Childhood obesity especially affects families with lower purchasing power (54 %) who do not have access to a healthy diet or the necessary tools or knowledge to promote health to their sons and daughters through food.The World Health Organization (WHO) Regional Office for Europe developed a nutrient profile model in 2015, specifically for the purpose of restricting the marketing of foods aimed at children. This model is considered by the scientific community as a reference tool when it comes to establish policies and improvements in favor of public health, in order to provide families with access to food with a better profile and nutritional value. (AU)

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An 85-year-old female patient with a history of melanoma 2 years ago, with anemia and signs of upper gastrointestinal bleeding. She underwent gastroscopy in which 4 ulcerated and pigmented lesions located in the body and subcardial region were recognized. The anatomopathological study confirmed the diagnosis of metastatic melanoma.

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Fundamento: la superación especializada del médico general integral debe de estar encaminada a elevar su nivel profesional en la atención primaria de salud, particularizando en las características individuales de cada paciente. Objetivo: diagnosticar el estado actual de preparación de los médicos generales de la atención primaria de salud en cuanto al conocimiento para brindar atención integral y especializada a los niños con necesidades educativas especiales, pertenecientes al Policlínico Universitario "Ignacio Agramonte", de Camagüey. Métodos: se realizó un estudio descriptivo transversal entre los meses septiembre-diciembre de 2021. Se aplicaron métodos teóricos: histórico-lógico, análisis-síntesis e inducción-deducción; y empíricos, revisión documental y cuestionario a los médicos que laboran en los consultorios médicos del área. Resultados: el diagnóstico realizado permitió identificar falencias en la formación profesional del médico general desde su programa de formación en la especialidad Medicina General Integral, las que dificultan el trabajo exitoso en cuanto a la atención integral a niños con necesidades especiales, en aras de promover su inclusión social y el beneficio de su desarrollo individual. Conclusiones: las deficiencias encontradas ratifican la necesidad de implementar una estrategia de superación en cuanto al tema para perfeccionar el distintivo trabajo comunitario del médico general integral.

Background: the specialized improvement of the comprehensive general practitioner must be aimed at raising their professional level in primary health care, particularizing the individual characteristics of each patient. Objective: to diagnose the current state of preparation of general practitioners in primary health care in terms of knowledge to provide comprehensive and specialized care to children with special educational needs, belonging to the "Ignacio Agramonte" University Polyclinic in Camagüey. Methods: a cross-sectional descriptive study was carried out between from September to December 2021. Theoretical methods were applied: historical-logical, analysis-synthesis and induction-deduction; and empirical ones, documentary review and questionnaire to the doctors who work in the doctor´s offices of the area. Results: the diagnosis made possible to identify shortcomings in the professional training of the general practitioner from his training program in the Comprehensive General Medicine specialty, which hinder successful work in terms of comprehensive care for children with special needs, in order to promote their social inclusion and the benefit of their individual development. Conclusions: the deficiencies found ratify the need to implement an improvement strategy regarding the subject to improve the distinctive community work of the comprehensive general practitioner.

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Optical coherence tomography angiography (OCT-A) allows the detection of retinal vessel density (VD) loss, which is a reflection of brain vascular pathology. We aimed to investigate differences in macular VD in the superficial plexus in a large cohort of individuals cognitively unimpaired (CU), with mild cognitive impairment due to Alzheimer´s disease (MCI-AD), MCI due to cerebrovascular pathology (MCI-Va), probable Alzheimer´s disease dementia (ADD) and Vascular Dementia (VaD). Clinical, demographical, ophthalmological and OCT-A data from the Neuro-ophthalmology Research at Fundació ACE (NORFACE) project were analyzed. Differences of macular VD in four quadrants (superior, nasal, inferior and temporal) among the five diagnostic groups were assessed in a multivariate regression model, adjusted by age, sex, education, hypertension, diabetes mellitus, heart disease and stroke. The study cohort comprised 672 participants: 128 CU, 120 MCI-AD, 111 MCI-Va, 257 ADD and 56 VaD. Regression analysis showed a significantly higher VD in the temporal quadrant in MCI-AD compared to CU participants (49.05 ± 4.91 vs 47.27 ± 4.17, p = 0.02, d = 0.40), and a significantly lower VD in the inferior quadrant in MCI-Va compared to CU participants (48.70 ± 6.57 vs 51.27 ± 6.39, p = 0.02, d = 0.40). Individuals with heart disease presented significantly lower VD in the inferior quadrant than those without (p = 0.01). The interaction of sex and diagnosis had no effect in differentiating VD. Mini-Mental State Examination (MMSE) scores were not correlated to VD (all r < 0.16; p > 0.07). In conclusion, our study showed that the MCI-AD and MCI-Va groups had significant differences in macular VD in opposite directions in the temporal and inferior quadrants, respectively, compared to CU participants, suggesting that macular VD might be able to differentiate two pathogenic pathways (AD- and cerebrovascular-related) in early stages of cognitive decline.

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