Suspensión del tratamiento con inhibidores de BCR-ABL en los pacientes con leucemia mieloide crónica en respuesta molecular profunda dentro de la práctica clínica asistencial: Experiencia española en un total de 236 casos

Oral Presentation [CO-092] Introducción: La mitad de los pacientes con leucemia mieloide crónica (LMC) en respuesta molecular profunda no pierde la respuesta molecular mayor (RMM) tras la suspensión del tratamiento con inhibidores de BCR-ABL (ITC). Esta estrategia ha demostrado ser segura en ensayos clínicos pero hay poca información acerca de su aplicabilidad en la práctica clínica asistencial. El objetivo del estudio fue analizar la experiencia con la suspensión del tratamiento fuera de ensayo clínico en España. Métodos: Se analizan los resultados de 236 pacientes con LMC en fase crónica que suspendieron el tratamiento fuera de ensayo clínico en 33 hospitales. Criterios de inclusión: a) tratamiento con ITC >3 años, b) respuesta molecular grado 4.5 durante >2 años (se permitió una única determinación de RM4 durante ese período). Se excluyeron los pacientes trasplantados. Resultados: Las características de la serie se muestran en la tabla 1. Los motivos principales para suspender el tratamiento fueron los efectos secundarios (n=66), lograr la remisión libre de tratamiento (n=166) y el embarazo (n=4). La mediana de seguimiento tras la suspensión fue de 21, 5 meses y 5 pacientes fallecieron por causas no relacionadas con la LMC. Durante este periodo, 67 pacientes reiniciaron el tratamiento por recaída molecular (pérdida de RMM: n=52, aumento de tránscritos >1 log en dos controles sucesivos sin pérdida de RMM: n=12), decisión del paciente (n=2) o síndrome de discontinuación (n=1). Un paciente perdió la RMM a los 20 meses y decidió no tratarse, recuperando la RMM espontáneamente. Cuarenta y nueve recaídas (75% del total) ocurrieron en los primeros 6 meses, 8 entre los meses 7-12, y 8 tras los 12 meses, produciéndose la pérdida de RMM más tardía a los 30 meses. La supervivencia libre de reinicio del tratamiento (figura 1) y de recaída molecular fue del 66, 8% y del 67, 5% a los 3 años, respectivamente. Los factores asociados a mayor supervivencia libre de recaída fueron la duración del tratamiento con ITC >5 años (p=0.01) y la RM4.5 >4 años antes de la suspensión (p=0.017). Un total de 51 pacientes (22%) desarrollaron dolor osteomuscular tras la suspensión. No se registró ningún caso de progresión a fases avanzadas. El valor mediano de la carga de BCR-ABL al reinicio del tratamiento fue del 0, 3% (>5% en 7 casos). La mediana de seguimiento tras reinicio del tratamiento fue de 20 meses; 46 de 52 casos (88%) recuperaron la RMM tras una mediana de tiempo de 3 meses; 50 de 64 recuperaron la RM4 (mediana 3, 5 meses) y 47 de 64 recuperaron la MR4.5 (mediana 5 meses). En el último control, el estado de la respuesta fue: RM4.5 (n=195), RM4 (n=15), RMM (n=14), respuesta citogenética completa (n=10), otros (n=2). Conclusiones: los resultados confirman que la suspensión del tratamiento es factible en la práctica clínica asistencial en España. La duración del tratamiento y de la respuesta molecular profunda se asociaron con la supervivencia libre de recaída. Esta información puede ser útil para establecer recomendaciones generales acerca de la discontinuación del tratamiento de la LMC en nuestro medio

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

The BioPAX community standard for pathway data sharing

Biological Pathway Exchange (BioPAX) is a standard language to represent biological pathways at the molecular and cellular level and to facilitate the exchange of pathway data. The rapid growth of the volume of pathway data has spurred the development of databases and computational tools to aid interpretation; however, use of these data is hampered by the current fragmentation of pathway information across many databases with incompatible formats. BioPAX, which was created through a community process, solves this problem by making pathway data substantially easier to collect, index, interpret and share. BioPAX can represent metabolic and signaling pathways, molecular and genetic interactions and gene regulation networks. Using BioPAX, millions of interactions, organized into thousands of pathways, from many organisms are available from a growing number of databases. This large amount of pathway data in a computable form will support visualization, analysis and biological discovery. © 2010 Nature America, Inc. All rights reserved

Seguimiento de las guías españolas para el manejo del asma por el médico de atención primaria: un estudio observacional ambispectivo

Objetivo Evaluar el grado de seguimiento de las recomendaciones de las versiones de la Guía española para el manejo del asma (GEMA 2009 y 2015) y su repercusión en el control de la enfermedad. Material y métodos Estudio observacional y ambispectivo realizado entre septiembre del 2015 y abril del 2016, en el que participaron 314 médicos de atención primaria y 2.864 pacientes. Resultados Utilizando datos retrospectivos, 81 de los 314 médicos (25, 8% [IC del 95%, 21, 3 a 30, 9]) comunicaron seguir las recomendaciones de la GEMA 2009. Al inicio del estudio, 88 de los 314 médicos (28, 0% [IC del 95%, 23, 4 a 33, 2]) seguían las recomendaciones de la GEMA 2015. El tener un asma mal controlada (OR 0, 19, IC del 95%, 0, 13 a 0, 28) y presentar un asma persistente grave al inicio del estudio (OR 0, 20, IC del 95%, 0, 12 a 0, 34) se asociaron negativamente con tener un asma bien controlada al final del seguimiento. Por el contrario, el seguimiento de las recomendaciones de la GEMA 2015 se asoció de manera positiva con una mayor posibilidad de que el paciente tuviera un asma bien controlada al final del periodo de seguimiento (OR 1, 70, IC del 95%, 1, 40 a 2, 06). Conclusiones El escaso seguimiento de las guías clínicas para el manejo del asma constituye un problema común entre los médicos de atención primaria. Un seguimiento de estas guías se asocia con un control mejor del asma. Existe la necesidad de actuaciones que puedan mejorar el seguimiento por parte de los médicos de atención primaria de las guías para el manejo del asma. Objective: To assess the degree of compliance with the recommendations of the 2009 and 2015 versions of the Spanish guidelines for managing asthma (Guía Española para el Manejo del Asma [GEMA]) and the effect of this compliance on controlling the disease. Material and methods: We conducted an observational ambispective study between September 2015 and April 2016 in which 314 primary care physicians and 2864 patients participated. Results: Using retrospective data, we found that 81 of the 314 physicians (25.8%; 95% CI 21.3–30.9) stated that they complied with the GEMA2009 recommendations. At the start of the study, 88 of the 314 physicians (28.0%; 95% CI 23.4–33.2) complied with the GEMA2015 recommendations. Poorly controlled asthma (OR, 0.19; 95% CI 0.13–0.28) and persistent severe asthma at the start of the study (OR, 0.20; 95% CI 0.12–0.34) were negatively associated with having well-controlled asthma by the end of the follow-up. In contrast, compliance with the GEMA2015 recommendations was positively associated with a greater likelihood that the patient would have well-controlled asthma by the end of the follow-up (OR, 1.70; 95% CI 1.40–2.06). Conclusions: Low compliance with the clinical guidelines for managing asthma is a common problem among primary care physicians. Compliance with these guidelines is associated with better asthma control. Actions need to be taken to improve primary care physician compliance with the asthma management guidelines

Repositioning of the global epicentre of non-optimal cholesterol

High blood cholesterol is typically considered a feature of wealthy western countries1,2. However, dietary and behavioural determinants of blood cholesterol are changing rapidly throughout the world3 and countries are using lipid-lowering medications at varying rates. These changes can have distinct effects on the levels of high-density lipoprotein (HDL) cholesterol and non-HDL cholesterol, which have different effects on human health4,5. However, the trends of HDL and non-HDL cholesterol levels over time have not been previously reported in a global analysis. Here we pooled 1,127 population-based studies that measured blood lipids in 102.6 million individuals aged 18 years and older to estimate trends from 1980 to 2018 in mean total, non-HDL and HDL cholesterol levels for 200 countries. Globally, there was little change in total or non-HDL cholesterol from 1980 to 2018. This was a net effect of increases in low- and middle-income countries, especially in east and southeast Asia, and decreases in high-income western countries, especially those in northwestern Europe, and in central and eastern Europe. As a result, countries with the highest level of non-HDL cholesterol—which is a marker of cardiovascular risk—changed from those in western Europe such as Belgium, Finland, Greenland, Iceland, Norway, Sweden, Switzerland and Malta in 1980 to those in Asia and the Pacific, such as Tokelau, Malaysia, The Philippines and Thailand. In 2017, high non-HDL cholesterol was responsible for an estimated 3.9 million (95% credible interval 3.7 million–4.2 million) worldwide deaths, half of which occurred in east, southeast and south Asia. The global repositioning of lipid-related risk, with non-optimal cholesterol shifting from a distinct feature of high-income countries in northwestern Europe, north America and Australasia to one that affects countries in east and southeast Asia and Oceania should motivate the use of population-based policies and personal interventions to improve nutrition and enhance access to treatment throughout the world.</p

Repositioning of the global epicentre of non-optimal cholesterol

High blood cholesterol is typically considered a feature of wealthy western countries1,2. However, dietary and behavioural determinants of blood cholesterol are changing rapidly throughout the world3 and countries are using lipid-lowering medications at varying rates. These changes can have distinct effects on the levels of high-density lipoprotein (HDL) cholesterol and non-HDL cholesterol, which have different effects on human health4,5. However, the trends of HDL and non-HDL cholesterol levels over time have not been previously reported in a global analysis. Here we pooled 1,127 population-based studies that measured blood lipids in 102.6 million individuals aged 18 years and older to estimate trends from 1980 to 2018 in mean total, non-HDL and HDL cholesterol levels for 200 countries. Globally, there was little change in total or non-HDL cholesterol from 1980 to 2018. This was a net effect of increases in low- and middle-income countries, especially in east and southeast Asia, and decreases in high-income western countries, especially those in northwestern Europe, and in central and eastern Europe. As a result, countries with the highest level of non-HDL cholesterol�which is a marker of cardiovascular risk�changed from those in western Europe such as Belgium, Finland, Greenland, Iceland, Norway, Sweden, Switzerland and Malta in 1980 to those in Asia and the Pacific, such as Tokelau, Malaysia, The Philippines and Thailand. In 2017, high non-HDL cholesterol was responsible for an estimated 3.9 million (95 credible interval 3.7 million�4.2 million) worldwide deaths, half of which occurred in east, southeast and south Asia. The global repositioning of lipid-related risk, with non-optimal cholesterol shifting from a distinct feature of high-income countries in northwestern Europe, north America and Australasia to one that affects countries in east and southeast Asia and Oceania should motivate the use of population-based policies and personal interventions to improve nutrition and enhance access to treatment throughout the world. © 2020, The Author(s), under exclusive licence to Springer Nature Limited

Eosinofilia en el niño inmigrante, a propósito de un caso

La asistencia a niños inmigrantes que llegan por primera vez a España continúa siendo una práctica diaria en Pediatría. En la práctica totalidad de centros de salud existen protocolos que contemplan la atención inicial de estos pacientes a su llegada. En la atención inicial a estos niños es básica la anamnesis, una exploración completa y la solicitud de pruebas complementarias específicas. Pese a que la mayoría de estos niños están asintomáticos, la aplicación de estos protocolos puede poner de manifiesto enfermedades como la malnutrición, parasitosis o anemias de diversas etiologías, que de otra forma podrían pasar desapercibidas. Se presenta un caso de un niño de diez años asintomático, procedente de Guinea Ecuatorial, que consulta por primera vez en el centro de salud tras su llegada a España. Assistance to immigrant children arriving for the first time in Spain continues to be a daily practice in Pediatrics. In nearly all Health Care Centers there are protocols that contemplate the initial care of these patients upon arrival. Anamnesis, a complet examination and the request for specific complementary tests are basic for the initial care of these children. Although most of these children are asymptomatic, the application of these protocols may reveal diseases such as malnutrition, parasitosis or anemias of different etiologies, which could otherwise go unnoticed. We present a case of an asymptomatic ten-year-old boy from Equatorial Guinea, who consulted for the first time at the Health Care Center after his arrival in Spain