SEOM clinical guideline for treatment of kidney cancer (2017)

The goal of this article is to provide recommendations about the management of kidney cancer. Based on pathologic and molecular features, several kidney cancer variants were described. Nephron-sparing techniques are the gold standard of localized disease. After a randomized trial, sunitinib could be considered in adjuvant treatment in high-risk patients. Patients with advanced disease constitute a heterogeneous population. Prognostic classification should be considered. Both sunitinib and pazopanib are the standard options for first-line systemic therapy in advanced renal cell carcinoma. Based on the results of two randomized trials, both nivolumab and cabozantinib should be considered the standard for second and further lines of therapy. Response evaluation for present therapies is a challenge

SEOM clinical guidelines in hereditary breast and ovarian cancer (2019)

Mutations in BRCA1 and BRCA2 high penetrance genes account for most hereditary breast and ovarian cancer, although other new high-moderate penetrance genes included in multigene panels have increased the genetic diagnosis of hereditary breast and ovarian cancer families by 50%. Multigene cancer panels provide new challenges related to increased frequency of variants of uncertain significance, new gene-specific cancer risk assessments, and clinical recommendations for carriers of mutations of new genes. Although clinical criteria for genetic testing continue to be largely based on personal and family history with around a 10% detection rate, broader criteria are being applied with a lower threshold for detecting mutations when there are therapeutic implications for patients with breast or ovarian cancer. In this regard, new models of genetic counselling and testing are being implemented following the registration of PARP inhibitors for individuals who display BRCA mutations. Massive sequencing techniques in tumor tissue is also driving a paradigm shift in genetic testing and potential identification of germline mutations. In this paper, we review the current clinical criteria for genetic testing, as well as surveillance recommendations in healthy carriers, risk reduction surgical options, and new treatment strategies in breast cancer gene-mutated carriers

Expert recommendations on the management of patients with metastatic castration-resistant prostate cancer who progress after CHAARTED or LATITUDE

Objective: Our aim was to provide practical recommendations on the management of patients with metastatic castration-resistant prostate cancer (mCRPC) who have progressed after docetaxel plus androgen-deprivation therapy (ADT) or abiraterone plus ADT. Methods: Systematic literature review (SLR), nominal group meeting, and Delphi process. A panel of 12 experts was established who defined the scope, users, and sections of the document. We performed an SLR in order to assess the efficacy and safety of available drugs in patients with mCRPC. Abstracts from the American Society of Oncology and European Society for Medical Oncology meetings were also examined. The results were discussed during an expert meeting in which 14 recommendations were generated. The level of agreement with the recommendations was also tested by 13 additional experts following the Delphi process. Recommendations were voted by means of scores ranging from 0 (total disagreement) to 10 (total agreement). We defined agreement when at least 70% of the experts voted ¿7. Next, we assigned a level of evidence and grade to the recommendation using the Oxford Centre for Evidence-based Medicine Levels of Evidence, following which the final document was drafted. Results: The literature search did not find any articles meeting the inclusion criteria. Finally, 13 out of 14 recommendations were accepted after two Delphi rounds (two were modified after the first round). They pertain to general and individual case-based treatment recommendations. Conclusions: In mCRPC patients who have progressed after docetaxel or abiraterone plus ADT in the metastatic hormone-sensitive prostate cancer setting, these recommendations may support treatment decision-making, due to the lack of evidence or other globally accepted sequencing algorithms

Assessing the risk of cardiovascular events in patients receiving immune checkpoint inhibitors

Funding Information: This article is part of the CLARIFY project, supported by the European Union Horizon 2020 Research and Innovation Program under grant agreement number 875160. Publisher Copyright: Copyright © 2022 Torrente, Blanco, Franco, Garitaonaindia, Calvo, Collazo-Lorduy, Gutiérrez, Sánchez, González-del-Alba, Hernández, Méndez, Cantos, Núñez, Sousa and Provencio.Background: Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment. However, despite their excellent therapeutic effect, these medications typically result in a broad spectrum of toxicity reactions. Immune-related cardiotoxicity is uncommon but can be potentially fatal, and its true incidence is underestimated in clinical trials. The aim of this study is to assess the incidence and identify risk factors for developing a cardiac event in patients treated with ICIs. Methods: We conducted a single-institution retrospective study, including patients treated with ICIs in our center. The main outcomes were cardiac events (CE) and cardiovascular death. Results: A total of 378 patients were analyzed. The incidence of CE was 16.7%, during a median follow-up of 50.5 months. The multivariable analysis showed that age, a history of arrhythmia or ischemic heart disease, and prior immune-related adverse events were significantly associated with CE. Conclusion: CE during ICI treatment are more common than currently appreciated. A complete initial cardiovascular evaluation is recommended, especially in high-risk patients, being necessary a multidisciplinary approach of a specialized cardio-oncology team.publishersversionpublishe

Molecular epidemiology of an enterovirus A71 outbreak associated with severe neurological disease, Spain, 2016

Altres ajuts: We wish to thank I Bustillo, H del Pozo and P Higueras for their technical assistance. We also sincerely wish to thank all technical staff from microbiology departments and medical staff from paediatrics departments from all participating hospitals. Some of the samples are included in an ongoing project (PI15CIII-00020) which was supported by a grant by the Health Research System (AES).Introduction: Enterovirus A71 (EV-A71) is an emerging pathogen that causes a wide range of disorders including severe neurological manifestations. In the past 20 years, this virus has been associated with large outbreaks of hand, foot and mouth disease with neurological complications in the Asia-Pacific region, while in Europe mainly sporadic cases have been reported. In spring 2016, however, an EV-A71 outbreak associated with severe neurological cases was reported in Catalonia and spread further to other Spanish regions. Aim: Our objective was to investigate the epidemiology and clinical characteristics of the outbreak. Methods: We carried out a retrospective study which included 233 EV-A71-positive samples collected during 2016 from hospitalised patients. We analysed the clinical manifestations associated with EV-A71 infections and performed phylogenetic analyses of the 3'-VP1 and 3Dpol regions from all Spanish strains and a set of EV-A71 from other countries. Results: Most EV-A71 infections were reported in children (mean age: 2.6 years) and the highest incidence was between May and July 2016 (83%). Most isolates (218/233) were classified as subgenogroup C1 and 217 of them were grouped in one cluster phylogenetically related to a new recombinant variant strain associated with severe neurological diseases in Germany and France in 2015 and 2016. Moreover, we found a clear association of EV-A71-C1 infection with severe neurological disorders, brainstem encephalitis being the most commonly reported. Conclusion: An emerging recombinant variant of EV-A71-C1 was responsible for the large outbreak in 2016 in Spain that was associated with many severe neurological cases

Molecular epidemiology of an enterovirus A71 outbreak associated with severe neurological disease, Spain, 2016

IntroductionEnterovirus A71 (EV-A71) is an emerging pathogen that causes a wide range of disorders including severe neurological manifestations. In the past 20 years, this virus has been associated with large outbreaks of hand, foot and mouth disease with neurological complications in the Asia-Pacific region, while in Europe mainly sporadic cases have been reported. In spring 2016, however, an EV-A71 outbreak associated with severe neurological cases was reported in Catalonia and spread further to other Spanish regions.AimOur objective was to investigate the epidemiology and clinical characteristics of the outbreak.MethodsWe carried out a retrospective study which included 233 EV-A71-positive samples collected during 2016 from hospitalised patients. We analysed the clinical manifestations associated with EV-A71 infections and performed phylogenetic analyses of the 3'-VP1 and 3Dpol regions from all Spanish strains and a set of EV-A71 from other countries.ResultsMost EV-A71 infections were reported in children (mean age: 2.6 years) and the highest incidence was between May and July 2016 (83%). Most isolates (218/233) were classified as subgenogroup C1 and 217 of them were grouped in one cluster phylogenetically related to a new recombinant variant strain associated with severe neurological diseases in Germany and France in 2015 and 2016. Moreover, we found a clear association of EV-A71-C1 infection with severe neurological disorders, brainstem encephalitis being the most commonly reported.ConclusionAn emerging recombinant variant of EV-A71-C1 was responsible for the large outbreak in 2016 in Spain that was associated with many severe neurological cases.S

Biochemical markers of bone turnover and clinical outcome in patients with renal cell and bladder carcinoma with bone metastases following treatment with zoledronic acid: The TUGAMO study

Background: Levels of bone turnover markers (BTM) might be correlated with outcome in terms of skeletal-related events (SRE), disease progression, and death in patients with bladder cancer (BC) and renal cell carcinoma (RCC) with bone metastases (BM). We try to evaluate this possible correlation in patients who receive treatment with zoledronic acid (ZOL). Methods: This observational, prospective, and multicenter study analysed BTM and clinical outcome in these patients. Serum levels of bone alkaline phosphatase (BALP), procollagen type I amino-terminal propeptide (PINP), and beta-isomer of carboxyterminal telopeptide of type I collagen (b-CTX) were analysed. Results: Patients with RCC who died or progressed had higher baseline b-CTX levels and those who experienced SRE during follow-up showed high baseline BALP levels. In BC, a poor rate of survival was related with high baseline b-CTX and BALP levels, and new SRE with increased PINP levels. Cox univariate analysis showed that b-CTX levels were associated with higher mortality and disease progression in RCC and higher mortality in BC. Bone alkaline phosphatase was associated with increased risk of premature SRE appearance in RCC and death in BC. Conclusion: Beta-isomer of carboxy-terminal telopeptide of type I collagen and BALP can be considered a complementary tool for prediction of clinical outcomes in patients with BC and RCC with BM treated with ZOLNovartis Oncology Spain for supporting this stud

Accesibilidad a acciones de promoción de la salud y prevención de población hipertensa de Pereira, Colombia, 2008. La mirada del paciente.

Este es un estudio descriptivo donde participaron 422 personas hipertensas, y se evaluó la percepción que tienen sobre acciones de promoción y prevención

Baseline chronic comorbidity and mortality in laboratory-confirmed COVID-19 cases: Results from the PRECOVID study in Spain

We aimed to analyze baseline socio-demographic and clinical factors associated with an increased likelihood of mortality in men and women with coronavirus disease (COVID-19). We conducted a retrospective cohort study (PRECOVID Study) on all 4412 individuals with laboratory-confirmed COVID-19 in Aragon, Spain, and followed them for at least 30 days from cohort entry. We described the socio-demographic and clinical characteristics of all patients of the cohort. Age-adjusted logistic regressions models were performed to analyze the likelihood of mortality based on demographic and clinical variables. All analyses were stratified by sex. Old age, specific diseases such as diabetes, acute myocardial infarction, or congestive heart failure, and dispensation of drugs like vasodilators, antipsychotics, and potassium-sparing agents were associated with an increased likelihood of mortality. Our findings suggest that specific comorbidities, mainly of cardiovascular nature, and medications at the time of infection could explain around one quarter of the mortality in COVID-19 disease, and that women and men probably share similar but not identical risk factors. Nonetheless, the great part of mortality seems to be explained by other patient-and/or health-system-related factors. More research is needed in this field to provide the necessary evidence for the development of early identification strategies for patients at higher risk of adverse outcomes

Renovación urbana : globalización y patrimonio

256 p.El presente libro analiza los fenómenos que acompañan los procesos de renovación urbana partiendo del reconocimiento de la diferencia entre la ciudad -entendida como un conjunto de edificios, equipamientos e infraestructuras y lo urbano, concepto que alude a una forma de vida que se manifiesta culturalmente en el ejercicio de valores e imaginarios comprometidos con determinadas maneras de organización social, política, ambiental, cultural y económica. Formula la distinción entre la gestión urbana. la gestión de la ciudad, tomando en cuenta Ia propia diferencia que existe entre renovar la imagen física -compromiso de la gestión de la ciudad- y renovar su dinámica estructural, responsabilidad de la gestión urbana propiamente dicha. Así mismo, frente a los procesos de desconfiguración territorial y expulsión de población que frecuentemente acompañan las llamadas "operaciones de renovación urbana", presenta una reflexión crítica y propositiva, dirigida a los investigadores especializados y a las autoridades en la materia, para ofrecer posibles alternativas de prevención y mitigación de sus efectos, en la perspectiva de proponer la construcción-apropiación de una ciudad de todos y todas.This book analyzes different phenomena that accompany urban renewal processes, based on a recognition of the difference between “the city”—understood as a set of buildings, facilities, and infrastructures —and “the urban”, a concept that alludes to a way of life that culturally manifests itself in the exercise of values and imaginaries that are committed to certain ways of social, political, environmental, cultural, and economic organization. It proposes a distinction between urban management and city management, taking into account the very divergence between renewing the city’s physical image —a commitment undertaken by city management— and renewing its structural dynamics, which is the responsibility of urban management. Likewise, in the face of processes of territorial deconfiguration and the expulsion of populations that frequently accompany the so-called “urban renewal operations,” the study presents a critical and proactive reflection, aimed at researchers and authorities specialized in the field, in order to offer possible alternatives for the prevention and mitigation of their effects in a specific situation, seeking to propose the construction-appropriation of a city by all.CAPÍTULO 1 Renovación urbana y patrimonio: Líneas convergentes y divergentes Introducción CAPÍTULO 2 Pensando la renovación urbana en el contexto de la ciudad latinoamericana Referencias CAPÍTULO 3 Renovación urbana. De la certeza a las incertidumbres Introducción Parte 1. Historia crítica de la renovación urbana Parte 2. Situación actual y perspectivas de la renovación urbana Referencias CAPÍTULO 4 Globalización, patrimonio, turismo: una aproximación desde la renovación urbana Introducción Patrimonio: esencia y políticas la globalización como motor de cambios patrimonio y centros históricos Reflexiones finales Referencias CAPÍTULO 5 Patrimonio urbano e a producáo de lugares se consumo Referencias CAPÍTULO 6 Renovación urbana y políticas publicas en el Centro Histórico de la Ciudad de México Introducción Renovación urbana y proyecto urbano Proyecto urbano Características del proyecto urbano El Centro Histórico de la Ciudad de México Políticas públicas y Plan de Manejo del Centro Histórico El Plan Integral de Manejo del Centro Histórico (2011-2016) Intervenciones recientes (resumen) Conclusiones Referencias CAPÍTULO 7 tejidos y entretejidos Granada siglo XXI Introducción Un poco de historia Antonio Jiménez Torrecillas, arquitecto y granadino de adopción "Vivo en el mundo, pero duermo en Granada" El centro José Guerrero la muralla nazarí en el Alto Albaicín la estación Alcázar Genil Referencias CAPÍTULO 8 Políticas de renovación, rehabilitación y desarrollo urbano en Buenos Aires. Una revisión crítica Introducción Consideraciones teóricas las estrategias de renovación, rehabilitación y redesarrollo urbano en el contexto de la globalización las estrategias de renovación, rehabilitación urbana en Buenos Aires 1996-2016 Reflexiones finales Referencias CAPÍTULO 9 Tendencias globales, incomprensiones locales: las renovaciones de Santo Domingo, República Dominicana Introducción la tendencia global de la renovación contra las identidades glocales Estrategia emergente de cambio en la política del turismo dominicano la gran intervención en el centro histórico El proyecto de la discordia: las ruinas del monasterio de San Francisco Referencias CAPÍTULO 10 La transformación de las ciudades ante las condiciones sociales del estado de Guerrero en México Introducción la sociedad mesoamericana antes de la llegada de los españoles la casa mesoamericana Época colonial Época independiente Condiciones de seguridad en las poblaciones hasta mediados del siglo XX Casas típicas de arquitectura vernácula en las zonas del estado de Guerrero El arribo de intereses internacionales: la política, la economía, el narcotráfico Situación de la transformación urbana y el cambio de actitud ante las condiciones de inseguridad en el sur de México Impactos de la globalización en la imagen de la ciudad, aspectos contradictorios Retos del gobierno y sociedad, escenarios posibles Reflexiones finales Referencias CAPÍTULO 11 ¿ Tiene futuro el pasado? La renovación urbana en tiempos de qlobalízación Referencias CAPÍTULO 12 Renovación urbana y control social Consideraciones propositivas para articular modelo de ciudad y modelo de gobierno Introducción Una mirada transversal Control social y participación ciudadana a articulación entre modelo de ciudad y modelo le gobierno: un reto para la renovación urbana que de tal forma renueva, también, la idea de administración y ordenamiento del territorio APÉNDICE Apego al lugar de residencia, construcción de identidad y calidad de vida Introducción El concepto de Lugar El concepto de Apego Teoría sobre Apego al Lugar El apego en los procesos de renovación urbana Conclusiones Referencias1a ed