Anticoncepción poscoital. Características de la demanda

ObjetivoConocer el perfil de las mujeres que demandan anticoncepción poscoital (APC).DiseñoDescriptivo transversal. Emplazamiento. Centro de Orientación Familiar (COF), Área 4 del Instituto Madrileño de Salud. Madrid.ParticipantesTodas las mujeres que acudieron en el año 2000 para requerir APC (n = 404).MedicionesSe realizó una encuesta con variables sociodemográficas relacionadas con la APC y con la vida sexual.ResultadosLa edad media fue de 23,9 años (límites, 14–49); el 9,9% era menor de edad. La media de coitos al mes era de 6,7, el número de años de relaciones sexuales era de 4,9 y el primer coito se produjo, de media, a los 18 años. El 90,9% afirmaba tener pareja estable. Tenía estudios secundarios o universitarios un 75%. El 55,7% manifestaba no haber recibido información sobre anticonceptivos. El 19,5% utilizó APC en otra ocasión. El 6,5% había tenido alguna interrupción voluntaria de embarazo y de éstas, el 36% había utilizado APC anteriormente. Los motivos de consulta fueron: rotura de preservativo (69,3%), preservativo retenido (16,9%) y coito sin protección (12%). El 7% tuvo otros coitos de riesgo en el mismo ciclo. Un 33,2% las remitía su equipo de atención primaria, acudió por conocidos el 19% y desde servicios de urgencias el 16%. Conocía el COF un 26,1%. En el 12,2% no se prescribió APC por mínimo riesgo de embarazo. Realizaron la valoración una enfermera (52,6%), médicos residentes (34,4%) y una ginecóloga (13%).ConclusionesFalta información sobre métodos anticonceptivos. La mayoría de las pacientes son derivadas por otros servicios sanitarios.ObjectiveDefine the profile of the women that ask for emergency contraception (EC).DesignTransversal descriptive investigation.SettingFamiliar Planning Center of 4th Area of Instituto Madrileño de Salud. in Madrid. Participants. All the women that went in the year 2000 requiring EC (n=404).MeasurementsWas carried out a survey with sociodemographic variables, related with the EC and with the sexual life.ResultsThe average age was of 23.9 years (age range 14 to 49) were inquired, 9.9 were under 18. They had an average of 6.7 intercourses per month, the first intercourse when they were 18 years old on average, and 4.9 years of sexual relationships. 90.9% stated to have a couple. 75% were graduated from high school or university, and 55.7% said they had never received information about contraceptives. For 19.5% this was not the first time they asked for EC. 6.5% had interrupted on purpose pregnancy and 36% of them had used EC before. The reasons to demand EC were: condom break (69.3%), held condom (16.9%) and intercourse without any protection (12%). 7% acknowledged other risky intercourses during the same period. 33.2% had been sent by a General Practitioner, 26.1% knew the center, 19% were sent by acquaintances and 16% from Emergency Services. EC was not prescribed in 12.2% of the cases because of minimum risk to pregnancy. The evaluation was made by a nurse (52.6%), by a doctor (34.4%) and by a gynecologist (13%).ConclusionsThere is a lack of information about contraceptive methods. Most of the patients are sent from other sanitary services

A new scenario in metastatic renal cell carcinoma: a SOG‑GU consensus

[Abstract] Background This article describes and compares approved targeted therapies and the newer immunotherapy agents. Materials and methods This article especially performs an in-depth review of currently available data for tivozanib, explaining its mechanism of action, its safety profle and its role as an efcacy drug in the management of renal cancer. Results Despite the fact that the treatment of advanced RCC has been dramatically modifed in recent years, durable remissions are scarce and it remains a lethal disease. For frst- and second-line therapy, there is now growing evidence to guide the selection of the appropriate treatment. Conclusions Several TKIs are standard of care at diferent settings. Among those approved TKIs, tivozanib has similar efcacy than others with a better safety profle. The use of prognostic factors is critical to the selection of optimal therapy

Prospective Observational Study of Pazopanib in Patients with Advanced Renal Cell Carcinoma (PRINCIPAL Study)

Background: Real-world data are essential to accurately assessing efficacy and toxicity of approved agents in everyday practice. PRINCIPAL, a prospective, observational study, was designed to confirm the real-world safety and efficacy of pazopanib in patients with advanced renal cell carcinoma (RCC). Subjects, Materials, and Methods: Patients with clear cell advanced/metastatic RCC and a clinical decision to initiate pazopanib treatment within 30 days of enrollment were eligible. Primary objectives included progression-free survival (PFS), overall survival (OS), objective response rate (ORR), relative dose intensity (RDI) and its effect on treatment outcomes, change in health-related quality of life (HRQoL), and safety. We also compared characteristics and outcomes of clinical-trial-eligible (CTE) patients, defined using COMPARZ trial eligibility criteria, with those of non-clinical-trial-eligible (NCTE) patients. Secondary study objectives were to evaluate clinical efficacy, safety, and RDI in patient subgroups. Results: Six hundred fifty-seven patients were enrolled and received ≥1 dose of pazopanib. Median PFS and OS were 10.3 months (95% confidence interval [CI], 9.2–12.0) and 29.9 months (95% CI, 24.7 to not reached), respectively, and the ORR was 30.3%. HRQoL showed no or little deterioration over time. Treatment-related serious adverse events (AEs) and AEs of special interest occurred in 64 (9.7%), and 399 (60.7%) patients, respectively. More patients were classified NCTE than CTE (85.2% vs. 14.8%). Efficacy of pazopanib was similar between the two groups. Conclusion: PRINCIPAL confirms the efficacy and safety of pazopanib in patients with advanced/metastatic RCC in a real-world clinical setting. Implications for Practice: PRINCIPAL is the largest (n = 657) prospective, observational study of pazopanib in patients with advanced/metastatic renal cell carcinoma, to the authors’ knowledge. Consistent with clinical trial results that often contain specific patient types, the PRINCIPAL study demonstrated that the effectiveness and safety of pazopanib is similarly safe and effective in patients with advanced kidney cancer in a real-world clinical setting. The PRINCIPAL study showed that patients with advanced kidney cancer who are treated with first-line pazopanib generally do not show disease progression for approximately 10 months and generally survive for nearly 30 months

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

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Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified