Technical Data Sheets Research Articles

Recommendations of the Spanish Society of Paediatric Cardiology and Congenital Heart Disease as regards the use of drugs in attention deficit hyperactivity disorder in children and adolescents with a known heart disease, as well as in the general paediatric population: position statement by the Spanish Paediatric Association

IntroductionApproved drugs for attention deficit hyperactivity disorder (ADHD) in Spain are methylphenidate, lisdexamphetamine, atomoxetine and guanfacine. Due to adverse cardiovascular effects, mainly increased blood pressure and heart rate, its use in patients with known or undiagnosed heart disease may be controversial. ObjectiveTo obtain a consensus document from the Spanish Society of Paediatric Cardiology and Congenital Heart Diseases (SECPCC) and experts from other Agencies and Societies as a guide for the paediatric cardiologist and physicians who treat children and adolescents with ADHD. MethodAn analysis was performed on the bibliography and Clinical Practice Guidelines, technical data sheets approved by the Spanish Agency of Medicines and Health Devices, and the Spanish Ministry of Health Guidelines. A Working Group was formed, with a Coordinator, as well as members of the Clinical Cardiology Working Group and Arrhythmia Group of the SECPCC. This Group produced a preliminary document that was reviewed by a group of external experts (List 1) and a group of internal experts of the SECPCC (List 2) with a consensus being reached on the final document. ResultsThe recommendations of the SECPCC and the group of experts are presented on cardiovascular evaluation prior to treatment in children and adolescents with unknown cardiovascular disease and with known cardiovascular disease.The recommendations of the SECPCC and the group of experts are also presented on the use of medications for ADHD in children and adolescents with cardiological symptoms with no evidence of heart disease, congenital heart disease, cardiomyopathy, Marfan syndrome and other aortic diseases, hypertension, and arrhythmias.

Analysis of Commercial Assays for the Detection of SARS-CoV-2 Antibodies or Antigens

Background: COVID-19 produced by SARS-CoV-2 infection has spread worldwide. There is a growing need for immunological assays to detect viral specific antibodies or viral antigen. Current standard of diagnosis is reverse-transcriptase polymerase chain reaction (RT-PCR) in nasopharyngeal swabs. However serological tests can be used to determine previous exposure to the virus and complement the diagnosis. IgM and IgG SARS-CoV-2 specific antibodies can be detected as early as one week after infection and assays can be useful to test large groups of individuals. This work revised the available information concerning assays that detect antibodies and antigens for SARS-CoV-2. Methods: Three sources of information were used: technical data sheets (TDS) web pages of the company’s products and published articles in Pubmed with reference to the use of diagnostic kits. All the information was revised until April 5th 2020. Results: There were 226 tests coming from 20 countries mainly from China. TDS were found only in 50 (22.1%). Most assays detect specific antibodies (n 180) based on immunochromatography methods (n 110) and use blood-derived samples (n 105). Assays for antibodies detection measured mainly IgM/IgG (n 112) and the most common procedure time was in vitro diagnosis (IVD). A total 165 articles were found on PubMed 15 were included and only 4 used the commercial kits reviewed. Conclusions: Due to the urgency of producing diagnostic tests for SARS-CoV-2 there is a broad offer of kits. Many tests need additional information for their application. The data collected may be useful in the selection of assays but more and higher quality information is needed.

A mechanical characterization of SLA 3D-printed specimens for low-budget applications

Stereolithography (SLA) is becoming a more and more popular 3D-printing method. Improvement in material properties encourages makers and engineers to embrace this technology even for load-bearing applications. Mechanical properties of 3D-printed materials are difficult to obtain from technical datasheets and, even when available, these data are often unreliable, since they depend strongly on the specific printing parameters applied. Therefore, it is often necessary to perform an in-house mechanical characterization. In this work, tensile tests are performed with a basic in-house-designed tester on SLA 3D-printed specimens; these are printed at different orientations on a Formlabs™ Form 2™ using Clear V4™ resin. The ultimate tensile strength, Young’s modulus, strain at maximum stress and strain at break are calculated. No relationship is found between printing angle and mechanical characteristics; therefore, this 3D-printed material can be considered isotropic. Results are compared with the manufacturer’s datasheet: the measured maximum stress is slightly lower than that stated by Formlabs™, while the modulus is nearly the same. Strain at maximum stress and strain at break were also measured but were not reported in the available datasheet.

Importance of assessing for cannabis use prior to propofol sedation for endoscopy.

Recently, we´ve noticed an increasing in the whole propofol dose in endoscopy in relation to cannabis use. This issue is not described in the current data (technical datasheet). We´re really concern that, unfortunately, it´ll be more and more frequent.

Factors associated to the coiling of umbilical cord: case-control study conducted in three hospitals in Yaoundé

IntroductionLa circulaire du cordon ombilical correspond à l’enroulement du cordon ombilical en un ou plusieurs tours sur une partie du fœtus. Anomalie la plus fréquente du cordon, sa prévalence varie selon les auteurs de 5,7% à 35,1%. En 2011, le taux de mortalité périnatale liée à la circulaire du cordon au Cameroun était de 6,1%. Cependant ses facteurs associés restent peu connus dans notre contexte. Notre objectif était de déterminer les facteurs associés aux circulaires du cordon dans trois hôpitaux de YaoundéMéthodesIl s’agissait d’une étude analytique de type cas-témoin, réalisée pendant 4 mois dans les maternités de l’Hôpital Central de Yaoundé, du Centre Hospitalier et Universitaire de Yaoundé et du Centre d’Animation Sociale et Sanitaire de Nkoldongo. Pour un cas (nouveau-nés avec circulaire du cordon), on recrutait 2 témoins (nouveau-nés sans circulaire) tous en présentation céphalique, issus de grossesses monofoetales à terme. Les données recueillies étaient compilées sur des fiches techniques préétablies, saisies et analysées grâce aux logiciels Microsoft Excel 2017 et SPSS version 23. Les outils utilisés pour l’analyse étaient la moyenne d’âge, l’écart type et la fréquence, le rapport de cote cru (OR) et/ou ajusté (aOR) avec leur intervalle de confiance à 95%. P était considéré significatif pour toute valeur inférieure à 5%RésultatsSur un total de 3300 accouchements, 500 nouveau-nés soit 15,15% avaient une circulaire du cordon. Toutes les circulaires étaient autour du cou. Nous avons retenu et analysé 136 nouveau-nés avec circulaire du cordon (cas) pour 272 nouveau-nés sans circulaire (témoins). Les facteurs indépendamment associés aux circulaires étaient non modifiables: longueur du cordon = 70cm (ORa = 32 IC = 17,5-35 P = 0,02), sexe masculin (ORa = 67,09 IC = 22,31 - 97,46 P = 0,001), APGAR 5ème minute < 7 (ORa = 76,98 IC =2,19-27,05 P = 0,017), et modifiables: l’âge gestationnel ≥ 42SA (ORa = 15,15 IC = 6,14-18,2 P=0,001)ConclusionLa circulaire du cordon est une anomalie fréquente du cordon. Nous suggérons aux décideurs de sensibiliser davantage le personnel de santé et la population sur l’importance de l’échographie du troisième trimestre afin de rechercher et prévoir la prise en charge des nouveau-nés avec circulaire du cordon. Les cliniciens devraient éviter autant que possible le post terme.

Leading agritourism facilities along Nearly Zero Energy paths: proposal of an easy-to-use evaluation method

The tourist sector, despite the present severe constraints imposed by the sanitary emergence, can be considered as an important component of almost all countries’ economies. In Italy agriturism, in particular, has been experiences a continuously rising trend in recent years. Clearly, such great interest towards these businesses also calls for a deep attention by an energy point of view, in sight of an energy efficiency improvement, hence a lowering of the pressure that such facilities exert to the natural environment. On the other hand, the European Union has been engaged, for a long time, in awarding the tourist accommodations environmental excellence brands, like the EU Ecolabel. Unfortunately, the achievement of such excellence brands requires the capability of managing complex energy and environmental data, which is often not the prerogative of people running such facilities. In order of contributing to overcome this difficulty, and with the aim of helping the addressing of agritourism towards a Nearly Zero Energy path, we propose here a simple approach that does not require the modelling and simulation of the energy behaviour of an agritourism, being essentially based on the application of easy-to-use ARERA (Italian Regulatory Authority for Energy Networks and Environment) datasheets scheme. On purpose, an application of the method, involving two typical Sicilian agritourism, is presented. The obtained results showed the viability of the proposed methodology, although the need of an update and/or replacement of some technical datasheets arose.

Augmented reality and CMMS as mechanisms to increase productivity in smart factories

Augmented reality is one of the technologies that with a high frequency is involved in the theme of Industry 4.0 for its benefits, however, it is applied more frequently in entertainment areas, when it is a tool that allows to show data, pieces, statistics, technical data sheets of industrial equipment thus revolutionizing the manufacturing industry and to another way to show of data in this field. This article shows the exploration of the combination of augmented reality, with a CMMS with the purpose of serving as a strategic information system for decision giving the manufacturing company the concept of intelligent factory in the ecosystem of the industry 4.0. The CMMS is developed first, then the augmented reality application is created and finally the study is done to verify if they are compatible and if the presented information is useful for the company. The contribution of this study is to propose a methodology for the development of a new type of strategic information system 4.0 in which a new way of displaying data (AR) and an information system such as CMMS is mixed.

Desenvolvimento de preparações com adição de pescado e aproveitamento integral de alimentos para a alimentação escolar

Na alimentação escolar existem ainda poucas preparações que utiliza a Carne Mecanicamente Separada (CMS) de pescado e o aproveitamento integral de alimentos. Diante disso, o objetivo do presente artigo foi elaborar preparações acrescidas de CMS de pescado juntamente com o aproveitamento integral de alimentos para serem inseridas na alimentação escolar. Foram elaboradas fichas técnicas de preparo das receitas, a fim de obter informações sobre custo e rendimento das preparações desenvolvidas. A posteriori, foram realizadas análises direta, com amostras em triplicata, e indireta, nos quais os dados obtidos em laboratório foram comparados àqueles obtidos por meio das tabelas de composição utilizadas: FRANCO (2007), TACO (2011) e IBGE (2011). Os resultados mostraram que houve divergência entre os indicadores obtidos por meio da análise direta e aqueles da análise indireta, demonstrando também que as preparações desenvolvidas são viáveis do ponto de vista nutricional para serem inseridas na alimentação escolar.

Preliminary analysis of hybrid laminate composite for aircraft radome application

The preliminary analysis of laminate composite was conducted to analyse the optimal number of layers for aircraft radome application. In this work, the ESAComp software was used for preliminary analysis to predict the displacement during the flight operation. The ESAComp is a finite element software used for preliminary and conceptual design for composite layers. Flax fibre, glass fibre and epoxy resin were applied as the hybrid composite laminate design. The laminate construction consists of flax as the center laminate and sandwiched between glass fibre. Both fibres have the same weave pattern which is twill 2/2 and 200 gsm. The material properties for each materials were obtained from technical data sheet and used as input value for ESAComp. This software was used to analyse a single ply engineering constant by conducting fibre/matrix micromechanics analysis. The value of engineering constant of single ply for each material is then used for laminate analysis. It has range from 4,6 and 8 layers with 20%, 30% and 40% of fibre content on a flat panel with the size of 300 mm x 300 mm. The panel were fixed on each edges and under aerodynamic pressure load plus safety factor of two. Based on the result of analysis, minimum layer required is at least 6 layers if acceptance displacement is 0.1 mm. Therefore, experimental works on 6 layers hybrid laminate will be carried out to determine other requirement for aircraft radome application.

Evolution of the physical parameters of photovoltaic generators as a function of temperature and irradiance: New method of prediction based on the manufacturer’s datasheet

The characterization of photovoltaic generators with acceptable accuracy require the use of suitable experimental devices and appropriate methods. In this study, the used I-V curve tracer (Amiry et al. 2018) [1] allows to collect a current- voltage characteristic of a hundred (I, V) points under real operating conditions. Each (I, V) point is taking in one millisecond. A new method for extracting physical parameters of solar cell single diode model is presented. It allows for the prediction of an I-V characteristic without recourse to any approximation. It is based on considering the current-voltage values (I, V) at short-circuit point (ISC, 0), maximum power point (Im, Vm) and open circuit point (0, VOC) provided by the manufacturer. In addition, the current and voltage temperature coefficients KIm and KVm respectively at maximum power point are estimated independently using two explicit equations associated with two simplified models. The simulation of I-V curves built based on extracted physical parameters depending on temperature allows for making equations that introduce coefficients and allow for approximate description of their behavior depending on temperature. These coefficients form a new basis for technical datasheets to predict the performance of photovoltaic generators according to their operating temperatures. The irradiance effect has been taken into account by introducing specific terms depending on G in these equations. The accuracy of this developed approach is assessed by comparing the experimental characteristics with those plotted using extracted physical parameters values by implemented method and those obtained by other extraction methods reported in the literature.

Thermogravimetry and Mass Spectrometry of Extractable Organics from Manufactured Nanomaterials for Identification of Potential Coating Components.

Manufactured nanomaterials (MNMs) often have a surface-chemical modification in order to tailor their physicochemical properties, including also powder properties and miscibility. Surface-chemical modifications may influence the toxicological properties of the MNM, but the specific chemistry and extent are rarely described in detail in suppliers’ technical data sheets. Chemical and quantitative information on any surface-chemical treatment, coating and functionalization are required for chemicals registration in Europe. Currently there is no globally accepted and documented approach to generate such data. Consequently, there is a continued research need to establish a structured approach to identify and quantify surface-chemical modifications. Here we present a tiered approach starting with screening for mass-loss during heating in a furnace or thermogravimetric analysis (TGA) followed by solvent extraction, and analysis by several mass spectrometry (MS) techniques depending on the target analytes. Thermal treatment was assumed to be able to quantify the amount of organic coating and MS was used to identify the extractable organic coatings after pressurized liquid extraction (PLE) using methanol at 200 °C. Volatile organic compounds in extracts were identified with gas chromatography and MS (GC-MS), non-volatile organic compounds with liquid chromatography MS (LC-MS), and polymeric compounds with matrix-assisted laser desorption ionization time-of-flight MS (MALDI-TOF-MS). The approach was demonstrated by analysis of 24 MNM, comprising titanium dioxide, synthetic amorphous silica, graphite, zinc oxide, silver, calcium carbonate, iron oxide, nickel-zinc-iron oxide, and organoclay. In extracts of 14 MNMs a range of organic compounds were identified and the main groups were silanes/siloxanes, fatty acids, fatty acid esters, quaternary ammonium compounds and polymeric compounds. In the remaining 10 MNMs no organic compounds were detected by MS, despite the fact an organic coating was indicated by TGA.

Management Strategies for Antidepressant-Related Sexual Dysfunction: A Clinical Approach.

Major depressive disorder is a serious mental disorder in which treatment with antidepressant medication is often associated with sexual dysfunction (SD). Given its intimate nature, treatment emergent sexual dysfunction (TESD) has a low rate of spontaneous reports by patients, and this side effect therefore remains underestimated in clinical practice and in technical data sheets for antidepressants. Moreover, the issue of TESD is rarely routinely approached by clinicians in daily praxis. TESD is a determinant for tolerability, since this dysfunction often leads to a state of patient distress (or the distress of their partner) in the sexually active population, which is one of the most frequent reasons for lack of adherence and treatment drop-outs in antidepressant use. There is a delicate balance between prescribing an effective drug that improves depressive symptomatology and also has a minimum impact on sexuality. In this paper, we detail some management strategies for TESD from a clinical perspective, ranging from prevention (carefully choosing an antidepressant with a low rate of TESD) to possible pharmacological interventions aimed at improving patients’ tolerability when TESD is present. The suggested recommendations include the following: for low sexual desire, switching to a non-serotoninergic drug, lowering the dose, or associating bupropion or aripiprazole; for unwanted orgasm delayal or anorgasmia, dose reduction, “weekend holiday”, or switching to a non-serotoninergic drug or fluvoxamine; for erectile dysfunction, switching to a non-serotoninergic drug or the addition of an antidote such as phosphodiesterase 5 inhibitors (PD5-I); and for lubrication difficulties, switching to a non-serotoninergic drug, dose reduction, or using vaginal lubricants. A psychoeducational and psychotherapeutic approach should always be considered in cases with poorly tolerated sexual dysfunction.

Ferrites in Transfer Molded Power SiPs – Challenges in Packaging

Abstract Transfer-Molding-Process is enjoying growing interest when aiming for novel high-power density System-in-Packages (Power SiPs), where not only transistors and diodes, but also drivers, passives, coils and transformers are supposed to be integrated in one package. Encapsulating modules in a Transfer-Molding-Process induces higher mechanical load onto module components compared to conventional silicone potting. Previous investigations have shown, that integration of delicate components as ferrite cores into molded packages is not as trivial as integration of conventional Surface Mount Devices (SMDs) or power semiconductors; the brittle ferrites tend to fracture during the encapsulation process, resulting in higher ferrite core loss. The present study aims to identify main root causes for ferrite core cracking during manufacturing of molded Power SiPs. The test vehicle is a symmetrical Printed Circuit Board (PCB) based package with three pairs of E-shaped ferrite cores. The Epoxy Molding Compound (EMC) deployed here is characterized to enable filling simulations. Since technical datasheets of ferrites typically lack specifications of mechanical properties, ferrite materials are analyzed in more detail. Filling simulations and thermo-mechanical simulations are performed in order to gain insight into process-induced stress, which may induce cracks in the ferrites. In addition, different ferrite designs are evaluated regarding core losses and mechanical stability, and thus their tendency to fracture.

Uso de análogos de somatostatina en las angiodisplasias gastrointestinales refractarias a otros tratamientos

La malformación vascular más común del tracto digestivo son las angiodisplasias gastrointestinales. Se caracterizan por una dilatación venocapilar con elevada fragilidad vascular, estado patológico que deriva en sangrados gastrointestinales. La prevalencia aumenta en pacientes de edad avanzada y pluripatológicos, lo que condiciona el tratamiento y pronóstico de las angiodisplasias.El objetivo es evaluar la eficacia del tratamiento de las angiodisplasias con análogos de somatostatina, siendo estos el Octreótido y el Lanreótido (fuera de ficha técnica para la indicación), en condiciones de práctica clínica habitual. Además, se tratará de relacionar la respuesta terapéutica con la localización de las lesiones, comorbilidades, reingresos, transfusiones sanguíneas y prescripción de anticoagulantes.Se llevó a cabo un estudio observacional retrospectivo con datos obtenidos de pacientes tratados en el Complejo Asistencial Universitario de León. Tras el análisis estadístico de los datos, se concluyó que no existen diferencias significativas entre los fármacos. Tampoco se encontró asociación significativa del éxito con las localizaciones de las angiodisplasias, ni con las comorbilidades coexistentes, ni con la toma de anticoagulantes. Sólo tratamientos de larga duración (&gt; 11 meses) se relacionan con indicadores objetivos de éxito, como la reducción del número de transfusiones y de reingresos.

Life Cycle Assessment (LCA) analysis of renders and paints for the restoration of historical buildings

A significant percentage of the building stock in Europe was built before 1950, hence the restoration, retrofitting and renovation of historical buildings is of paramount importance not only for society, but also for the overall sustainability of the construction sector, which is known to have a huge environmental impact. In particular, the application of new paints and renders is extremely common in the restoration interventions carried out in historical buildings. In the selection of these materials, it is important to consider that they must comply with compatibility requirements, in terms of low stiffness and high water vapour permeability, not to give rise to premature defects and detachment. However, their environmental impact is basically never evaluated.In this study, a preliminary evaluation of the environmental impact of some selected renders and paints for the restoration of historical buildings by Life Cycle Assessment (LCA) analysis was carried out. This analysis was performed using the information that are supplied by the manufacturers of the materials (as reported in the technical data sheets), so from the point of view of the designers, who must select among a range of commercial alternatives. Both ready-mix dry renders and mortars purposely prepared in the building site, with or without paint, mechanically or manually applied, were analysed.The paint, notwithstanding its low amount with respect to the render, seems to have a very high impact. The results also suggest that an evaluation of these materials by LCA is definitely not easy, mostly because some key characteristics of materials which are needed for this analysis are currently not reported at all in the technical datasheet, thus jeopardizing a proper evaluation of their environmental impact.

Assessing the natural-healing behavior of adhesively bonded structures under dynamic loading

For adhesively bonded structures, maximizing their longevity under the aspect of minimizing costs of maintenance and repair are basically of high interest for the operator. Specifically, high-tech industries such as aeronautical, automotive or medicine are subject to very high standards in terms of quality, performance and safety. Hence, for stakeholders of such industries it is crucial to know how repeating damage cycles affect the structural integrity of a glued structure. The question which might arise is what minimum significant residual strength and fracture-healing recovery rate is needed in order to prevent a total structural collapse.To pursue such crucial issues, a novel study has been conducted for investigating the natural fracture-healing behavior of several well-established types of industrial adhesives. In doing so, an innovative test setup was utilized to identify new sophisticated damage parameters, which cannot be found in any technical data sheet of adhesive manufacturers. Thanks to both the utilization of an innovative test device and the application of the GF-concept, an independent material parameter was thereby ascertained, which is highly representative and suitable for characterizing dynamic damage behavior of real structures outside the lab. The remarkable findings revealed that only one distinct type of adhesive was suitable for showing significant fracture-healing behavior. This was empirically verified by different mechanical and fracture analytical benchmarks, such as bulk tensile strength, interface tensile strength and fracture resistance. The results obtained demonstrated the efficacy of the novel applied GF-concept for successfully evaluating both the damage tolerance and healing behavior of adhesively bonded structures. In conclusion, this examination showed that the inclusion of fracture analysis already in the adhesive selection and evaluation process is crucial for maximizing the quality, performance and safety of glued structures during lifetime operation.

Notch Tensile Strength of Carbon Fiber/Epoxy Composite Plate with a Center Hole under Static and Cyclic Loading

The tensile and fatigue properties of epoxy reinforced with 68 volume percent carbon fiber, CFRP, have been fully investigated. The effect of the presence of an open circular hole on tensile, fatigue residual strength, and fatigue strength of CFRP plates was studied experimentally and numerically. The results of pin bearing, i.e. bolt-loaded holes, tests were also investigated and evaluated. A three-dimensional orthotropic-elastic finite element code was developed to calculate the stress concentration factors of open circular holes or bolt-loaded holes in composite materials.The modulus of elasticity, tensile strength, and maximum elongation of CFRP are approximately equal to the values found in the technical data sheet of the supplier. A rule of mixtures type relation is adequate to predict the modulus of elasticity of such CFRP plate. This may be attributed to the high mechanical properties and high volumetric content of the fibers compared with the matrix, i.e. there is a marginal contribution of the strength of the matrix or the fiber-matrix interfacial bond strength. Based on the net stress analysis, there is no difference between the mechanical behavior of smooth and open-holed specimens, i.e. notch insensitivity. This is due to the incapability of the matrix to transfer the load from the discontinuous part. The same behavior was also found under cyclic loading. Due to the weakness in the bond between the fiber and matrix or in the shear strength of the matrix compared with the tensile strength of the fiber, the failure mode of all tested bolt-loaded unidirectional CFRP plates is shear-out. Further, the strength of such bolted joints is mainly dependent on the size of the contact area between the hole and the bolt.

Ixekizumab for treatment of moderate to severe plaque psoriasis: real world clinical experience

Data concerning clinical experience in real world setting with ixekizumab for psoriasis are still exiguous. So, the aim of this report was to provide our experience in the use of ixekizumab in outpatient setting. Fifteen Caucasian individuals (10 male, 5 females; mean age: 58.1; range: 30-75 years) affected by moderate to severe plaque psoriasis (PASI≥10 and/or DLQI≥10 and/or BSA≥10) were treated with ixekizumab, following dosing regimen of technical data sheet and clinically evaluated after 4 weeks (T4) and 12 weeks (T12) after. At baseline median PASI was 16.3 (range: 10-30, SD=6.0). The median BSA was 21.3 (10-35, SD=7.0), the median PGA was 3.4 (2-6, SD=1.2), the median DLQI was 18.6 (14-25, SD=3.6), the median m-NAPSI was 42.0 (30-56, SD=13.11). The median absolute value of PASI, BSA, PGA, DLQI and m-NAPSI showed a statistically significant decrease (P<0.05) already after 4 weeks of treatment, in order to testify treatment effectiveness. At T4, 93.3% of the patients reached PASI50, 6.9% reached PASI75; at T12, 100% of the patients reached PASI50, 80% reached PASI75, 13% reached PASI90 and 6.9% reached PASI100. One-third of observed patients reached MDA after 12 weeks of treatment. Injection site reactions were the only side effects occurring during the first 12 weeks of treatment. Our preliminary results seem to confirm the efficacy and safety profile provided through the UNCOVER pivotal trials (UNCOVER 1-3) although further larger observational studies are needed.

Fuentes para el estudio de la colección medieval de milagros de Nuestra Señora de Guadalupe

Entre los códices que actualmente se custodian en la biblioteca del monasterio de Guadalupe (Cáceres) se encuentran los manuscritos C-1, C-2, C-3 y C-4, que contienen los milagros de finales de la Edad Media (siglo XV) de la Virgen de Guadalupe. Tras haber publicado la descripción del C1,ofrecemos en estas líneas las descripciones de los manuscritos C-2, C-3 y C-4 del Archivo del Monasterio de Guadalupe, incluyendo en primer lugar una ficha técnica del manuscrito y, a continuación, una descripción más discursiva y detallada de cada uno de ellos. Nos encontramos ante una vasta colección de milagros literarios, cuyo estudio y edición nos permitiría tener una visión más amplia del milagro mariano medieval en la Península.

Skin involvement in patients with psoriatic arthritis: preliminary results of treatment with apremilast in real world setting.

Apremilast is a "small molecule," an oral phosphodiesterase 4 inhibitor indicated for the twice-daily treatment of adults with psoriasis and psoriatic arthritis (PsA). Data concerning clinical experience in real world setting with apremilast for psoriasis are still exiguous, and aim of this report is to provide our experience in the use of apremilast in out-patient setting. Ten Caucasian individuals (6 male, 4 females; mean age 69,3; range 53-81 years) affected by moderate to severe plaque psoriasis (PASI≥10 e/o DLQI≥10 e/O BSA≥10) were treated with apremilast, following dosing regimen of technical data sheet and clinically evaluated both after 12 weeks (T12) and 16 weeks (T16). At baseline median PASI was 14 (range 10-25, SD 5.0). The median BSA was 17.55 (10-25, SD 6.0), the median PGA was 3.5 (2-5, SD 1.1), the median DLQI was 7.3 (5-18, SD 3.6). The median absolute value of PASI, BSA, PGA and DLQI showed a statistically significant decrease (P<0.05) already after 12 weeks of treatment. At T12, 6 patients out of 10 (60%) reached PASI 50 and 3/10 patients (30%) reached PASI 75. At T16, 9 patients out of 10 patients (9/10, 90%) reached PASI75, and 3/10 (30%) reached PASI90. Five patients out of 10 (50%) reached MDA at T16. Diarrhea was the main side effect occurring during the first weeks of treatment, that resolved spontaneously over the time. Although our preliminary results need to be confirmed by further larger observational studies, they seem to confirm the efficacy and safety profile provided through the ESTEEM registrative trials (ESTEEM 1-2).