Sobrepeso y obesidad como factores predisponentes de hipertensión arterial en niños de 5 a 12 años en Guayaquil y Nobol

Antecedentes: estudios publicados indican que los factores de riesgo cardiovascular existen desde la edad pediátrica. Objetivo: determinar si la obesidad y el sobrepeso conllevan a una temprana aparición de factores de riesgo cardiovascular como la hipertensión arterial en la población escolar del Guayas. Metodología: estudio transversal entre los meses de octubre a diciembre de 2010. Se incluyeron escolares entre 5 -12 años de ambos géneros seleccionados en forma aleatoria de Escuelas Fiscales Mixtas en Guayaquil y Nobol. Los datos analizados se obtuvieron a partir de la valoración de peso, talla y presión arterial (PA). Se utilizó protocolos y guías estandarizadas para las clasificaciones del Índice de masa corporal (IMC) e hipertensión arterial. Resultados: la muestra final incluyó 320 pacientes, 50% hombres y 50% mujeres. Se encontró una prevalencia de sobrepeso en el 18.75% y obesidad con 24.38% (p<0.05). Se observó prevalencia de prehipertensión arterial en el 20.63% de la población e hipertensión arterial en un 22.50% (p<0.05). Asociando estos parámetros se identificó que dentro de la población con obesidad, el 52.6% (p<0.05) padecía de hipertensión arterial. Conclusión: se encontró una mayor prevalencia de hipertensión en los escolares con sobrepeso y obesidad; y pertenecientes en su mayoría a la ciudad de Guayaquil. Estos resultados indican la necesidad de implementar programas de pesquisa, control y seguimiento de la HTA en niños

Increased quality of life in patients with breakthrough cancer pain after individualized therapy : the CAVIDIOM study

Aim: To evaluate the quality of life (QoL) in patients with breakthrough cancer pain (BTcP) in Spanish medical oncology departments. Patients & methods: In a prospective, observational, multicenter study, we assessed QoL using the EQ-5D-5L instrument at baseline and after 15 and 30 days of individualized BTcP therapy, as well as BTcP characteristics and treatment. Results: Patients (n = 118) were mainly women, over 64 years old and with advanced cancer. QoL improved at 15 (p = 0.013) and 30 days (p = 0.011) versus baseline. Individualized BTcP therapy consisted mostly of rapid-onset opioids (transmucosal fentanyl at doses of 67-800 μg) according to the physician evaluation. BTcP improved, including statistically significant reductions in intensity, duration, number of episodes in the last 24 h and time to onset of BTcP relief. Conclusion: QoL increased after individualized pain therapy in patients with advanced cancer and BTcP in medical oncology departments. Keywords: breakthrough cancer pain; medical oncology; quality of life; rapid-onset opioids; transmucosal fentanyl

Reply to A. Lasagna et al

We thank Lasagna et al1 for their letter in response to our recent report.2 In our article, we discussed the management of febrile neutropenia associated with a SARS-CoV-2 infection in a patient with lung cancer. The disease presented a favorable evolution with spontaneous recovery of hematologic values ¿¿without the need to use granulocyte colony-stimulating factors (G-CSFs). The immune response against the virus, generating macrophage activation and a cascade of cytosines, is the main cause of its morbidity and mortality. Use of the neutrophil-to-lymphocyte ratio (NLR) as a predictor of mortality in patients with coronavirus disease 20193 is interesting. Nawar et al4 published a series of three cases of patients with SARS-CoV-2 infection who received G-CSF who had NLR values ¿¿greater than 5 at 72 hours after administration. Patients¿ disease had unfavorable evolutions, leading to death. The patient discussed in our report2 had an initial NLR of 3.5, which decreased to 1.1 at 48 hours after admission. These data support the use of NLR as a prognostic predictor of SARS-CoV-2 infection and could be helpful in avoiding the use of G-CSF. When we analyzed the data from our institution, we observed that a patient with urothelial carcinoma who developed febrile neutropenia secondary to chemotherapy and coinciding with SARS-CoV-2 infection also presented a favorable evolution without the use of G-CSF. He received treatment with piperacillin-tazobactam, hydroxychloroquine, and lopinavir/ritonavirm, and was discharged from the hospital in 10 days. The highest NLR level in this patient during admission was 2.1. We consider that the use of G-CSF may be related to an imbalance in neutrophil and lymphocyte levels in patients, thereby increasing NLR and worsening the prognosis of patients with SARS-CoV-2 infection. For this reason, the indiscriminate use of G-CSF in these patients should be avoided and assessed individually

Management of Febrile Neutropenia Associated With SARS-CoV-2 Infection in a Patient With Cancer

Febrile neutropenia is defined as the onset of fever (body temperature 100.5° F or higher) and a neutrophil count below 500/μL. Febrile neutropenia is a serious risk in severely neutropenic individuals with either solid or hematologic malignancies. The administration of empirical antibiotic treatment is the cornerstone of treatment, which impacts evolution of the disease and prognosis. SARS-CoV-2 is a novel RNA virus of the betacoronavirus family. It was identified in December 2019 in Wuhan, China. SARS-CoV-2 generates atypical pneumonia and can evolve into multiorgan failure, mainly affecting elderly individuals or those who have a medical history of comorbidities.3 Currently, the World Health Organization has declared a pandemic state.Because it is a recently discovered disease, and there is still little evidence regarding how it affects patients with cancer and even less information about how it affects patients with cancer who also have febrile neutropenia, we present the case of a man with metastatic lung adenocarcinoma receiving active treatment who developed febrile neutropenia with SARS-CoV-2

Anakinra, una alternativa potencial en el tratamiento de la infección respiratoria grave por SARS-CoV-2 refractaria a tocilizumab

[EN]: SARS-CoV-2 is a new RNA virus which causes coronavirus disease 2019 (COVID-19), declared a pandemic by the World Health Organization (WHO). It triggers an atypical pneumonia that can progress to multiorgan failure. COVID-19 can cause dysregulation of the immune system, triggering an inflammatory response, and simulate haemophagocytic lymphohistiocytosis. Several studies have proposed that anti-IL-6 receptor antibodies, such as tocilizumab, play an important role in the treatment of severe acute respiratory infection associated with SARS-CoV-2. However, the role of anti-IL-1 receptor antibodies, such as anakinra, in the treatment of COVID-19 has not been established. We present a case report of a 51-year-old man diagnosed with severe respiratory infection associated with SARS-CoV-2 that was refractory to antiviral and anti-IL-6 treatment, with a favourable clinical outcome and analytical improvement after treatment with anti-IL-1 (anakinra).[ES]: El virus SARS-CoV-2 es un nuevo virus RNA causante de la enfermedad COVID-19, declarada como pandemia por la Organización Mundial de la Salud (OMS). Produce un cuadro de neumonía atípica que puede desembocar en un fallo multiorgánico. La desregulación del sistema inmune secundaria a la infección produce un cuadro similar al síndrome de linfohistiocitosis hemofagocítica (SLHH). Varios estudios han definido la importancia que los inhibidores de la IL-6 (Tocilizumab) tienen en el tratamiento de la infección por SARS-CoV-2, sin embargo, la indicación de tratamiento con inhibidores de IL-1 (anakinra) no se encuentra establecida de forma clara. Presentamos el caso de un paciente de 51 años con neumonía bilateral secundaria a infección por SARS-CoV-2 refractaria al tratamiento antiviral y anti-IL-6 que presentó mejoría clínica y analítica tras el tratamiento con anti-IL-1 (anakinra)

Renal Cell Carcinoma Associated With Xp11.2 Translocation/TFE3 Gene-fusion: A Long Response to mammalian target of rapamycin (mTOR) Inhibitors

[Objective]: To demonstrate that patients with Xp11.2/TFE3 gene-fusion translocation renal cell carcinoma (RCC), despite having an aggressive course in young adults, could have valid treatment options such as mammalian target of rapamycin (mTOR) inhibitors with good outcomes. Furthermore, to explain possible mechanisms of action of mTOR inhibitors in this type of RCC.[Materials and Methods]: We report a case of a 44-year-old man who has been treated with everolimus for a Xp11.2 translocation/TFE3 gene-fusion RCC after 2 previous failed treatments with tyrosine kinase inhibitor. During the follow-up, we evaluated type and duration of response with everolimus.[Results]: The patient obtained a long-lasting response of disease of 25 months with everolimus without any symptom.[Conclusion]: We believe that mTOR inhibitors could be a good line option treatment to consider for this type of patients

Response to Treatment with an Anti-Interleukin-6 Receptor Antibody (Tocilizumab) in a Patient with Hemophagocytic Syndrome Secondary to Immune Checkpoint Inhibitors

Background. Immunotherapy represents one of the fundamental treatments in the management of some types of cancer, especially malignant melanoma. Toxicity derived from increased immune system activity can manifest in multiple organs and systems. We present a case of hematological toxicity, manifested as hemophagocytic syndrome (HPS), which was successfully treated with an anti-interleukin-6 antibody (tocilizumab). Case Report. This case presents a 75-year-old woman diagnosed with metastatic choroidal melanoma, refractory to several lines of treatment. After the failure of the previous lines, ipilimumab was started. After the third dose, she developed grade 2 thrombocytopenia and anemia accompanied by elevated levels of ferritin, triglycerides, and decreased fibrinogen. Hemophagocytosis was observed in the bone marrow biopsy, and a PET-CT showed splenomegaly with increased metabolism. Treatment was based on high doses of corticosteroids and tocilizumab. Four days after the start of treatment, progressive clinical and analytical improvement was observed, achieving total remission of the condition. Discussion. HPS induced by immunotherapy is due to an immunorelated cytokine storm syndrome (CSS). The administration of the anti-interleukin-6 receptor antibody drug acted on this cytokine cascade, leading to stabilization and subsequent remission. For this reason, the use of tocilizumab should be part of the immunotherapy-induced HPS treatment algorithm

Influence of DNA Mismatch Repair (MMR) System in Survival and Response to Immune Checkpoint Inhibitors (ICIs) in Non-Small Cell Lung Cancer (NSCLC): Retrospective Analysis

Mutations in the mismatch repair (MMR) system predict the response to immune checkpoint inhibitors (ICIs) like colon or gastric cancer. However, the MMR system&rsquo;s involvement in non-small cell lung cancer (NSCLC) remains unknown. Addressing this issue will improve clinical guidelines in the case of mutations in the main genes of the MMR system (MLH1, MSH2, MSH6, and PMS2). This work retrospectively assessed the role that these gene mutations play in the response to and survival of ICIs in NSCLC. Patients with NSCLC treated with nivolumab as the second-line treatment in the University Hospital of Salamanca were enrolled in this study. Survival and response analyses were performed according to groups of MMR system gene expression (MMR expression present or deficiency) and other subgroups, such as toxicity. There was a statistically significant relationship between the best response obtained and the expression of the MMR system (p = 0.045). The presence of toxicity grade &ge; 3 was associated with the deficiency expression of MMR (dMMR/MSI-H) group (p = 0.022; odds ratio = 10.167, 95% confidence interval (CI) 1.669&ndash;61.919). A trend towards greater survival and response to ICIs was observed in NSCLC and dMMR. Assessing the genes in the MMR system involved in NSCLC is key to obtaining personalized immunotherapy treatments

Immunohistochemical Assessment of the P53 Protein as a Predictor of Non-Small Cell Lung Cancer Response to Immunotherapy.

Determining predictive biomarkers for immune checkpoint inhibitors (ICIs) is a current challenge in oncology. Previous studies on non-small cell lung cancer (NSCLC) have shown how TP53 gene mutations are correlated with different responses to ICIs. Strong and diffuse immuno-expression of p53 by immunohistochemistry (IHC) is interpreted as a likely indicator of a TP53 gene mutation. We aimed to assess the p53 protein expression via IHC in NSCLC as a predictive biomarker of the response to ICIs. This was a retrospective hospital-based study of patients with NSCLC treated with Nivolumab in the University Hospital of Salamanca. All diagnostic biopsies were studied via IHC (measuring p53 protein expression, peroxidase anti-peroxidase immunohistochemistry technique using Leica BOND Polymer development kits). Survival analysis was performed by subgroups of expression of p53 and other factors using the Kaplan-Meier estimator and Cox proportional-hazards model. Seventy-three patients were included (59 men and 14 women). The median age was 68 (44-84) years. Thirty-six biopsies were adenocarcinoma, 34 were squamous, and three were undifferentiated. In 41 biopsies (56.2%), the cellular expression of p53 was A trend toward a greater response to ICIs was observed in the PFS and OS of patients with high expression of p53 by IHC (TP53 mutation), especially in the PD-L1 negative adenocarcinoma subgroup. These results will make it possible to make future modifications to the clinical guidelines of NSCLC according to the expression of p53