https://sms.carm.es/ricsmur/handle/123456789/17165 2026-05-04T21:14:24Z https://sms.carm.es/ricsmur/handle/123456789/25980 Impact of the COVID-19 Pandemic on the Outcomes of a Multifaceted Program on Antibiotic Prescribing in Primary Care Among Children Under Three Years of Age Martín-Ayala, Gema; Alfayate-Miguélez, Santiago; Jiménez-Guillén, Casimiro; AlcarazQuiñonero, Manuel; Iofrio-de-Arce, Antonio; Arnau-Sánchez, José Background/objective: Inappropriate antibiotic use in paediatric populations is a leading driver of antimicrobial resistance. In the Murcia Region, Spain, the Purapi program promotes the rational use of antibiotics among children under 3 years of age. This study aimed to analyse antibiotic use in this age group during the pandemic period (2020-2023) and to assess the impact of the COVID-19 pandemic on the effectiveness of a multifaceted program promoting appropriate antibiotic use. Methods: A retrospective, multicentre, population-based study was conducted in primary care using data from 2019 to 2024. Systemic antibiotic use (ATC J01 group) among children under three years was measured as defined daily doses per 1000 inhabitants per day (DHD). Differences across years and healthcare areas were assessed using analysis of variance (ANOVA) with Bonferroni correction. Results: Antibiotic consumption decreased by 49% in 2020 compared to 2019, coinciding with the implementation of national COVID-19 containment measures. From 2021 onward, a gradual increase was observed; however, by 2024, levels remained 9% below pre-pandemic values. Penicillins account for 75% of prescriptions, mainly amoxicillin and amoxicillin-clavulanic acid. While variability across healthcare areas decreased during the pandemic, variability among primary care centres increased. Conclusions: The pandemic resulted in a temporary reduction in antibiotic use, followed by a partial rebound. Ongoing educational and stewardship interventions within the Purapi framework were instrumental in maintaining rational prescribing and may have contributed to maintaining reduced antibiotic consumption among children under three years of age during and after the pandemic. Strengthening and harmonising these initiatives is essential to ensure consistent paediatric antibiotic stewardship in primary care. 2026-01-19T00:00:00Z https://sms.carm.es/ricsmur/handle/123456789/25977 Menstrual disturbances in women with advanced heart failure and heart transplant recipients Fernández-Villa, Noelia; García-García, Alba-María; Gómez-Molina, Miriam; Vázquez-Andrés, David-José; Pastor-Pérez, Francisco-José; Garrido-Bravo, Iris-Paula; Pascual-Figal, Domingo-Andrés BACKGROUND: Menstrual disturbances (MDs) are common among women with advanced heart failure. These disorders can arise from hormonal, hemodynamic, pharmacological, and psychological factors. Heart transplantation (HT) involves changes in the cardiovascular system and requires adjustments in medical treatment. However, the prevalence and impact of MDs before and after HT have not been thoroughly evaluated. METHODS: We conducted a single-center retrospective observational study that included all female heart transplant recipients followed from 1999 to 2020. A questionnaire was used to assess the menstrual bleeding patterns before and after HT. RESULTS: Data from 19 female heart transplant recipients were collected. The median age at HT was 57 (IQR: 35-60) years. 15 of these women were of childbearing age at heart disease diagnosis, and among them, 9 (60%) experienced MDs before the transplant. At the time of HT, 8 women remained of reproductive age, and all reported MDs during the post-transplant period. The most common event was menorrhagia, affecting 5 of 15 (33.3%) patients of reproductive age before HT and 6 of 8 (75%) women still of childbearing age after HT. In 2 heart transplant recipients, menorrhagia improved after the withdrawal of antiplatelet therapy. Additionally, 2 women developed early menopause, one of them before HT and the other afterwards. No cases of postmenopausal bleeding were reported. CONCLUSION: MDs are prevalent in patients with advanced heart failure and those who undergo HT. Changes in hemodynamic status and medical treatment may be associated with these disorders. Further studies are needed to assess these issues. 2026-01-27T00:00:00Z https://sms.carm.es/ricsmur/handle/123456789/25128 Association of Dietary Advanced Glycation End Products with Overall and Site-Specific Cancer Risk and Mortality: A Systematic Review and Meta-Analysis Pascual-Morena, Carlos; Garrido-Miguel, Miriam; Martínez-García, Irene; Luceron-Lucas-Torres, Maribel; Rodríguez-Gutiérrez, Eva; Berlanga-Macias, Carlos; Fernández-Bravo-Rodrigo, Jaime; Patino-Cardona, Silvana Background/Objectives: Dietary advanced glycation end products (dAGEs) have a pro-inflammatory effect and increase oxidative stress, potentially leading to cancer. The aim of this study was to estimate the association between dAGEs consumption and risk and mortality from overall cancer and according to its site. Methods: A systematic search was conducted in Medline, Scopus, Web of Science, and the Cochrane Library from inception to April 2025. The search strategy was conducted according to the PECO structure adapted to this study, as well as the inclusion criteria, in which the population (P) was the adult population, the exposure (E) was the highest level of dAGEs intake, the comparator (C) was the lowest level of dAGEs intake, and the outcomes (O) were the overall cancer risk, cancer risk by site, and cancer mortality. Results across studies were summarised using random effects and fixed effects. Results: Fourteen studies were included in the systematic review. In the random-effects meta-analysis, high dAGEs intake was associated with Hazard Ratio (HR) = 0.99 [95% Confidence Interval (95% CI): 0.98, 1.00] for overall cancer risk. However, although there was no association with breast cancer (BC), there was an association with invasive BC, with HR = 1.14 (95% CI: 1.05, 1.23). In contrast, in other tumours, there were opposite results depending on the site of the cancer. Conclusions: The reduction in cancer risk is not clinically significant. However, high consumption of dAGEs may increase the risk of BC, particularly the invasive BC, which is a challenge for cancer prevention and subsequent mortality. Due to the limited evidence, further studies are needed to confirm the potential impact of dAGEs, as well as other dietary factors that may play a larger role in cancer development. 2025-05-10T00:00:00Z https://sms.carm.es/ricsmur/handle/123456789/24811 Real-world effectiveness and safety of galcanezumab for the treatment of migraine: A systematic review and meta-analysis Fernández-Bravo-Rodrigo, Jaime; Pascual-Morena, Carlos; Saz-Lara, Alicia; Martínez-García, Irene; Lever-Megina, Carla-Geovanna; Patino-Cardona, Silvana; Flor-García, Amparo; Cavero-Redondo, Iván OBJECTIVE: This study aimed to summarize and pool real-world evidence on the clinical effectiveness and safety of galcanezumab. BACKGROUND: Migraine is a disabling primary headache disorder. Several drugs that target calcitonin gene-related peptide, such as galcanezumab, have recently been developed. However, real-world effects have not been well studied. METHODS: A systematic search of PubMed, Scopus, and Web of Science was conducted from inception to February 2025. Studies that estimated the real-world effects of galcanezumab on monthly migraine days (MMDs), monthly headache days (MHDs), Headache Impact Test, Migraine Disability Assessment Scale, number of days in medication, acute monthly intake (AMI), pain intensity, and safety outcomes were included. Meta-analyses of proportions or mean differences were performed. RESULTS: Thirty-six studies were included, with an agreement of 0.93 [95% confidence interval (CI): 0.90, 0.96]. One month after the first injection, the reduction effects were -6.93 days (95% CI: -7.88, -5.99) for MMD, -8.55 days (95% CI: -11.32, -5.78) for MHD, and -7.96 points (95% CI: -8.93, -6.99) for Headache Impact Test. Over 60% of patients achieved a reduction in MMD/MHD of at least 50% within 3 months. The effect increased gradually and slightly up to 12 months. The adverse event rates were 0.25 (95% CI: 0.14, 0.38) and 0.35 (95% CI: 0.27, 0.45) at 6 and 12 months, respectively, with constipation being the most common. CONCLUSION: Galcanezumab appears to be associated with clinically meaningful improvements in migraine and favorable safety outcomes, although the evidence certainty is limited by heterogeneity. 2026-01-01T00:00:00Z