Specialist palliative and end-of-life care for patients with cancer and SARS-CoV-2 infection: a European perspective

Background: Specialist palliative care team (SPCT) involvement has been shown to improve symptom control and end-of-life care for patients with cancer, but little is known as to how these have been impacted by the COVID-19 pandemic. Here, we report SPCT involvement during the first wave of the pandemic and compare outcomes for patients with cancer who received and did not receive SPCT input from multiple European cancer centres. Methods: From the OnCovid repository (N = 1318), we analysed cancer patients aged ⩾18 diagnosed with COVID-19 between 26 February and 22 June 2020 who had complete specialist palliative care team data (SPCT+ referred; SPCT− not referred). Results: Of 555 eligible patients, 317 were male (57.1%), with a median age of 70 years (IQR 20). At COVID-19 diagnosis, 44.7% were on anti-cancer therapy and 53.3% had ⩾1 co-morbidity. Two hundred and six patients received SPCT input for symptom control (80.1%), psychological support (54.4%) and/or advance care planning (51%). SPCT+ patients had more ‘Do not attempt cardio-pulmonary resuscitation’ orders completed prior to (12.6% versus 3.7%) and during admission (50% versus 22.1%, p < 0.001), with more SPCT+ patients deemed suitable for treatment escalation (50% versus 22.1%, p < 0.001). SPCT involvement was associated with higher discharge rates from hospital for end-of-life care (9.7% versus 0%, p < 0.001). End-of-life anticipatory prescribing was higher in SPCT+ patients, with opioids (96.3% versus 47.1%) and benzodiazepines (82.9% versus 41.2%) being used frequently for symptom control. Conclusion: SPCT referral facilitated symptom control, emergency care and discharge planning, as well as high rates of referral for psychological support than previously reported. Our study highlighted the critical need of SPCTs for patients with cancer during the pandemic and should inform service planning for this population

COVID-19 infection in adult patients with hematological malignancies: a European Hematology Association Survey (EPICOVIDEHA)

Background: Patients with hematological malignancies (HM) are at high risk of mortality from SARS-CoV-2 disease 2019 (COVID-19). A better understanding of risk factors for adverse outcomes may improve clinical management in these patients. We therefore studied baseline characteristics of HM patients developing COVID-19 and analyzed predictors of mortality. Methods: The survey was supported by the Scientific Working Group Infection in Hematology of the European Hematology Association (EHA). Eligible for the analysis were adult patients with HM and laboratory-confirmed COVID-19 observed between March and December 2020. Results: The study sample includes 3801 cases, represented by lymphoproliferative (mainly non-Hodgkin lymphoma n = 1084, myeloma n = 684 and chronic lymphoid leukemia n = 474) and myeloproliferative malignancies (mainly acute myeloid leukemia n = 497 and myelodysplastic syndromes n = 279). Severe/critical COVID-19 was observed in 63.8% of patients (n = 2425). Overall, 2778 (73.1%) of the patients were hospitalized, 689 (18.1%) of whom were admitted to intensive care units (ICUs). Overall, 1185 patients (31.2%) died. The primary cause of death was COVID-19 in 688 patients (58.1%), HM in 173 patients (14.6%), and a combination of both COVID-19 and progressing HM in 155 patients (13.1%). Highest mortality was observed in acute myeloid leukemia (199/497, 40%) and myelodysplastic syndromes (118/279, 42.3%). The mortality rate significantly decreased between the first COVID-19 wave (March–May 2020) and the second wave (October–December 2020) (581/1427, 40.7% vs. 439/1773, 24.8%, p value < 0.0001). In the multivariable analysis, age, active malignancy, chronic cardiac disease, liver disease, renal impairment, smoking history, and ICU stay correlated with mortality. Acute myeloid leukemia was a higher mortality risk than lymphoproliferative diseases. Conclusions: This survey confirms that COVID-19 patients with HM are at high risk of lethal complications. However, improved COVID-19 prevention has reduced mortality despite an increase in the number of reported cases.EPICOVIDEHA has received funds from Optics COMMITTM (COVID-19 Unmet Medical Needs and Associated Research Extension) COVID-19 RFP program by GILEAD Science, United States (Project 2020-8223)

Actuación ante la sospecha de hipertensión arterial en urgencias de pediatría de un hospital terciario

The prevalence of hypertension in pediatrics has increasing in recent years influenced by environmental factors such as obesity and sedentary lifestyle. Hypertension often occurs asymptomatically, even in severe forms. Its clinical manifestations vary according to the patient. Early diagnosis is crucial for the early introduction of interventions aimed at reducing high of blood pressure and its impact on cardiovascular morbidity and mortality in adults. In the present work, the updating of the protocol of action is shown when hypertension is suspected in the pediatric emergency department of the Miguel Servet University Children's Hospital. In addition, a review of the cases attended in this pediatric emergency department between January 2015 and October 2018 that had been coded as "arterial hypertension" is presented. A total of 25 cases were obtained of which 56% were males. The average age was 10 years with a range between 2 and 14 years. 48% of the patients were between 12 and 14 years old.La prevalencia de la hipertensión arterial en pediatría está en aumento en los últimos años influida por factores ambientales como la obesidad y el sedentarismo. Con frecuencia, la hipertensión arterial cursa de modo asintomático, incluso en las formas severas. Cuando se manifiesta clínicamente, varía según la edad del paciente. El diagnóstico precoz es crucial para introducir de manera temprana intervenciones dirigidas a reducir la elevación de la presión arterial y su impacto en la morbilidad cardiovascular y la mortalidad en adultos. En el presente trabajo se muestra la actualización del protocolo de actuación ante la sospecha de hipertensión arterial en urgencias de pediatría del Hospital Infantil Universitario Miguel Servet. Asimismo, se presenta una revisión de los casos atendidos en urgencias de pediatría de dicho centro entre enero de 2015 y octubre de 2018 que hubieran sido codificados como «hipertensión arterial» en el programa informático de urgencias. Se obtuvieron un total de 25 casos de los cuales el 56% fueron varones. La edad media fue de 10 años, con un rango entre 2 y 14 años. El 48% de los pacientes tenían una edad comprendida entre 12 y 14 años

The role of BRAF(V600E) mutation as poor prognostic factor for the outcome of patients with intrathyroid papillary thyroid carcinoma

BACKGROUND: BRAF(V600E) mutation, which represents the most frequent genetic mutation in papillary thyroid carcinoma (PTC), is widely considered to have an adverse outcome on PTC outcome, however its real predictive value is not still well stated. The aim of the present study was to evaluate if BRAF(V600E) mutation could be useful to identify within patients with intrathyroid ultrasound-N0 PTC those who require more aggressive treatment, by central neck node dissection (CLND) or subsequent postoperative (131)I treatment. METHODS: Among the whole series of 931 consecutive PTC patients operated on at 2nd Clinical Surgery of University of Padova and at General Surgery Department of University of Trieste during a period from January 2007 to December 2012, we selected 226 patients with an intrathyroid tumor and no metastases (preoperative staging T1-T2, N0, M0). BRAF(V600E) mutation was evaluated by PCR-single-strand conformation polymorphism analysis and direct genomic sequencing. We analyzed the correlation between the presence/absence of the BRAF(V600E) mutation in the fine-needle aspiration (FNA) and the clinical-pathological features: age, gender, extension of surgery, node dissection, rate of cervical lymph node involvement, tumor size, TNM stage, variant of histotype, mono/plurifocality, association with lymphocitary chronic thyroiditis, radioactive iodine ablation doses, and outcome. RESULTS: The BRAF(V600E) mutation was present in 104 of 226 PTC patients (47.8%). BRAF(V600E) mutation correlated with multifocality, more aggressive variants, infiltration of the tumoral capsule, and greater tumor's diameter. BRAF(V600E) mutation was the only poor prognostic factor in these patients. DISCUSSION: In our series, BRAF(V600E) mutation demonstrated to be an adverse prognostic factor indicating aggressiveness of disease and it could be useful in the management of low-risk PTC patients, as supplementary prognostic factor to assess the preoperative risk stratification with the aim to avoid unnecessary central neck node dissection (BRAF pos.) or to perform complementary (131)I-therapy (BFAF neg.)

Estado nutricional en cardiopatías congénitas cianógenas

Introduction:The cardiac defects are the most common congenital malformations.The majority of patients suffering a severe ormoderate congenital heart disease maintain an adequate growth and development until the moment of the birth. It is during thefirst and second year of life, where there is an arrest of growth and signs of malnutrition.Material and methods:33 childrenwith cyanogen congenital heart disease divided into three groups according to the type of cardiopathy, valued three times. 34children without congenital heart disease controlled by heart murmur, with normal nutritional status.Results:We have foundstatistically significant differences between children with heart disease in relation to healthy children for most of anthropo-metric variables analyzed; no differences were found between different types of heart disease or between the different stud-ied moments.Conclusions:The nutritional status of children has great impact in the individual response to the disease; defi-ciencies should be early detected with adequate valuation techniques to correct them as soon as possible.Therefore, assess-ment of nutritional status should be an important part in the routine care of the individual patient, especially during the pedi-atric age, as this time of life is at high risk of malnutrition in case of diseasentroducción:Los defectos cardiacos son las malformaciones congénitas más frecuentes. La mayoría de los pacientes afec-tos de una cardiopatía congénita severa o moderada mantienen un adecuado crecimiento y desarrollo hasta el nacimien-to. Es, durante el primer y segundo año de vida, cuando aparece una detención del crecimiento y signos de malnutrición.Material y métodos:33 niños con cardiopatía congénita cianógena divididos en tres grupos según el tipo de cardiopatía,valorados en tres ocasiones. 34 niños sanos controlados por soplo funcional, con estado nutricional normal.Resultados:Hemos encontrado diferencias estadísticamente significativas entre los niños con cardiopatía en relación con los niñossanos para la mayoría de variables antropométricas analizadas; no se han encontrado diferencias entre los distintos tiposde cardiopatía ni entre los distintos momentos estudiados.Conclusiones:El estado nutricional del niño tiene gran impactoen la respuesta individual a la enfermedad; las deficiencias deben ser detectadas precozmente con adecuadas técnicas devaloración para corregirlas lo antes posible. Por lo tanto, la valoración del estado nutricional debe ser parte importanteen la rutina del cuidado del individuo enfermo, sobre todo durante la edad pediátrica, ya que esta época de la vida es dealto riesgo de malnutrición en caso de enfermedad

Anàlisi del funcionament i alternatives de les aules d'educació especial de les escoles públiques d'E.G.B.

La necessitat de fer un estudi sobre la realitat actual i intentar donar unes alternatives de funcionament de les aules d'educació especial de les escoles ordinàries públiques d'EGB, ens ha portat a reflexionar i mirar de buscar els orígens d'aquest tipus de recurs escolar. Estem convençuts que d'una manera o altra, l'estudi històric de l'evolució de les AXE ens aportarà dades interessants de la seva realitat actual en la zona que coneixem més a fons (Baix Llogrebat). Es per això que a continuació presentem una. història de les aules, història, que pretenem que pugui clarificar la seva evolució i l'actualitat a Catalunya