Clinical intervals and diagnostic characteristics in a cohort of prostate cancer patients in Spain: a multicentre observational study

Background: Little is known about the healthcare process for patients with prostate cancer, mainly because hospital-based data are not routinely published. The main objective of this study was to determine the clinical characteristics of prostate cancer patients, the diagnostic process and the factors that might influence intervals from consultation to diagnosis and from diagnosis to treatment. Methods: We conducted a multicentre, cohort study in seven hospitals in Spain. Patients' characteristics and diagnostic and therapeutic variables were obtained from hospital records and patients' structured interviews from October 2010 to September 2011. We used a multilevel logistic regression model to examine the association between patient care intervals and various variables influencing these intervals (age, BMI, educational level, ECOG, first specialist consultation, tumour stage, PSA, Gleason score, and presence of symptoms) and calculated the odds ratio (OR) and the interquartile range (IQR). To estimate the random inter-hospital variability, we used the median odds ratio (MOR). Results: 470 patients with prostate cancer were included. Mean age was 67.8 (SD: 7.6) years and 75.4 % were physically active. Tumour size was classified as T1 in 41.0 % and as T2 in 40 % of patients, their median Gleason score was 6.0 (IQR:1.0), and 36.1 % had low risk cancer according to the D'Amico classification. The median interval between first consultation and diagnosis was 89 days (IQR:123.5) with no statistically significant variability between centres. Presence of symptoms was associated with a significantly longer interval between first consultation and diagnosis than no symptoms (OR:1.93, 95%CI 1.29-2.89). The median time between diagnosis and first treatment (therapeutic interval) was 75.0 days (IQR:78.0) and significant variability between centres was found (MOR:2.16, 95%CI 1.45-4.87). This interval was shorter in patients with a high PSA value (p = 0.012) and a high Gleason score (p = 0.026). Conclusions: Most incident prostate cancer patients in Spain are diagnosed at an early stage of an adenocarcinoma. The period to complete the diagnostic process is approximately three months whereas the therapeutic intervals vary among centres and are shorter for patients with a worse prognosis. The presence of prostatic symptoms, PSA level, and Gleason score influence all the clinical intervals differently

Reseñas iberoamericanas

Iberoamerican ReviewsReseñas iberoamericana

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Representaciones del político corrupto en Narcos: una mirada interdisciplinaria sobre la corrupción en América Latina

Ferrer Calle J. Representaciones del político corrupto en Narcos: una mirada interdisciplinaria sobre la corrupción en América Latina. LARevista : Bulletin de la Société Suisse des Américanistes. 2020;80:79-87.Corruption in Latin America has become a constant, as the latest reports from Transparency International's Corruption Perceptions Index show, which place the Latin American continent among the most corrupt in the world. To date, the approaches developed to study this social phenomenon in disciplines such as economics, political science or sociology are heterogeneous, an object of study that has been little examined by cultural and literary studies. In this work, we analyze the representations of the corrupt politician in the series Narcos. The objective of this article is to critically examine how these audiovisual narratives represent the motive of corruption, which becomes an indispensable phenomenon to understand the political culture of Latin America, while at the same time deepening in the symbolic representations

Cine, series y corrupción en España

Ferrer Calle J. Cine, series y corrupción en España. Agenda Pública. El País. 19.01.2020

Identidades líquidas. Dicotomías en Una vez Argentina, de Andrés Neuman

Ferrer Calle J. Identidades líquidas. Dicotomías en Una vez Argentina, de Andrés Neuman. In: Strosetzki C, ed. Aspectos actuales del Hispanismo Mundial. Literatura, cultura, lengua . Berlin: De Gruyter; 2019: 138-152.En Una vez Argentina, Andrés Neuman establece una suerte de memorias prenatales que le permiten sumergirse en la biografía familiar y, paralelamente, en la historia de un país, el cual avanza y retrocede entre certezas e interrogantes. Memorias que, bajo el paraguas de la autoficción, huyen de lo cronológico y responden a un argumento común: lo identitario. Una identidad que en esta obra retrata a la Argentina como un territorio donde resulta complicado fijar las raíces. Precisamente este hecho pone de relieve como la pertenencia o la esencia del individuo «ya no están talladas en roca» en palabras de Bauman, sino que requieren de un ejercicio constante de negociación. Una cuestión, que lejos de resolverse, se reproduce en el texto a través de dos dicotomías principales, como son: lo real versus lo ficticio y lo nacional versus lo extranjero

Matándome de risa. Suicidio y humor negro en dos relatos de Andrés Neuman

Ferrer Calle J. Matándome de risa. Suicidio y humor negro en dos relatos de Andrés Neuman . In: Kunz M, Rosa S, eds. Tabú y transgresión en la cultura hispánica contemporánea. Binges: Éditions Orbis Tertius; 2020: 171-182.El suicidio sigue siendo uno de los tabúes predilectos de la sociedad contemporánea. Un drama individual que además ha recibido desde sus inicios la condena de las principales religiones monoteístas. Así, mientras en España, hasta el año 1983, la Iglesia Católica privaba a las personas suicidadas de ser enterradas en los cementerios, el judaísmo lo considera una terrible transgresión y el Corán lo prohíbe. No obstante, tal y como introduce Durkheim, en 1897, en su obra El suicidio. Estudio de Sociología, este puede ser explicado como un hecho social que va más allá de lo personal, de lo psicológico. En esta línea, en el caso de la literatura, el suicidio se convierte en un motivo destacado en el siglo XX, momento en el que autoras como Virginia Woolf en La señora Dalloway (1925), lo abordan desde una perspectiva trágica, reflejándolo como la solución final que permite terminar con la melancolía. Una representación que nada tiene que ver con la que el escritor hispano-argentino Andrés Neuman, como destacado miembro de la Nueva Narrativa Argentina, expone en dos de sus relatos: “El suicida risueño” (Hacerse el muerto, 2011) y Tornasol (El que espera, 2000). Así, Neuman encarna en estos textos ese torno particular, ese énfasis compartido por toda una generación que por medio del humor negro trata de mantener una distancia, o lo que es lo mismo, de tomarse la vida menos en serio. En definitiva, se trata de dos historias que constituyen un buen ejemplo de cómo la narrativa actual construye estrategias para vulnerar un tabú aún tan instalado en nuestra sociedad como el del suicidio