Tratamiento del cáncer de próstata en función de la esperanza de vida, la comorbilidad y las guías de práctica clínica

En un número anterior de la revista de Anales del Sistema Sanitario de Navarra, Barceló y col realizaron una interesante y útil revisión de los pacientes con cáncer de próstata tratados en un gran centro hospitalario español durante un año, centrándose en sus características basales, el tratamiento realizado y el grado de seguimiento de las Guías de Práctica Clínica (GPC) y las complicaciones asociadas a los tratamientos realizados

Computer assisted enhanced volumetric segmentation magnetic imaging data using a mixture of artificial neural networks

An accurate computer-assisted method able to perform regional segmentation on 3D single modality images and measure its volume is designed using a mixture of unsupervised and supervised artificial neural networks. Firstly, an unsupervised artificial neural network is used to estimate representative textures that appear in the images. The region of interest of the resultant images is selected by means of a multi-layer perceptron after a training using a single sample slice, which contains a central portion of the 3D region of interest. The method was applied to magnetic resonance imaging data collected from an experimental acute inflammatory model (T(2) weighted) and from a clinical study of human Alzheimer's disease (T(1) weighted) to evaluate the proposed method. In the first case, a high correlation and parallelism was registered between the volumetric measurements, of the injured and healthy tissue, by the proposed method with respect to the manual measurements (r = 0.82 and p < 0.05) and to the histopathological studies (r = 0.87 and p < 0.05). The method was also applied to the clinical studies, and similar results were derived of the manual and semi-automatic volumetric measurement of both hippocampus and the corpus callosum (0.95 and 0.88

Propuesta de implementación de un plan de farmacovigilancia y una estrategia de educación sanitaria en el uso adecuado de medicamentos como herramienta para disminuir los casos de intoxicación y reacciones adversas en la IPS MEIDE SAS

Anexo 1. Formato de notificaciones Anexo 2. Formato de seguimiento Anexo 3. Formato control dispensación Anexo 3.1. Sobre reporte mensual de los eventos adversos Anexo 4. Ejemplo encuesta de satisfacción a usuarios Anexo 5. Ejemplo de explicación de forma adecuada de administrar el fármaco prescrito Anexo 6. Ejemplo Cartel sobre uso adecuado de medicamento Anexo 6.1. Ejemplo Infografía Proceso para hacer reporte Anexo 6.2. Ejemplo de página web para reporte de reacciones adversas Anexo 6.3. Formato de invitación a actividades Anexo 7.Ejemplos de infografía para educación sanitaria sobre reportes ante INVIMA y uso de medicamentos Anexo 8. Ejemplo encuesta de satisfacción a usuarios sobre charla sanitaria Anexo 9. Ejemplo encuesta de satisfacción a usuarios pagina web Anexo 10.Ejemplo de planteamiento con base en estadísticas.La farmacovigilancia se ha convertido en una ciencia vital para el ejercicio de las funciones del regente de farmacia, pues aporta las bases para identificar, evaluar y prevenir las problemáticas o reacciones relacionadas con el uso de medicamentos, así como de sentar las bases para generar estrategias de educación sanitaria que permitan garantizar un uso racional y seguro de estos. Este trabajo presenta una propuesta de un plan de farmacovigilancia y una estrategia sanitaria para una IPS de baja complejidad que ha presentado casos de intoxicación relacionado con el uso irracional e irresponsable de medicamentos, generando formatos y actividades base para implementar su ejecución.Pharmacovigilance has become a vital science for the exercise of the functions of the pharmacist, since it provides the bases to identify, evaluate and prevent problems or reactions related to the use of drugs, as well as to lay the foundations to generate educational strategies. that guarantee a rational and safe use of these. This work presents a proposal for a pharmacovigilance plan and a health strategy for a low-complexity IPS that has presented cases of intoxication related to the irrational and irresponsible use of drugs, generating formats and base activities to implement its execution

A Fast 0.5 T Prepolarizer Module for Preclinical Magnetic Resonance Imaging

We present a magnet and high power electronics for Prepolarized Magnetic Resonance Imaging (PMRI) in a home-made, special-purpose preclinical system designed for simultaneous visualization of hard and soft biological tissues. The sensitivity of MRI systems grows with field strength, but so do their costs. PMRI can boost the signal-to-noise ratio (SNR) in affordable low-field scanners by means of a long and strong magnetic pulse. However, this must be rapidly switched off prior to the imaging pulse sequence, in timescales shorter than the spin relaxation (or T1) time of the sample. We have operated our prepolarizer at up to 0.5 T and demonstrated enhanced magnetization, image SNR and tissue contrast with PMRI of tap water, an ex vivo mouse brain and food samples. These have T1 times ranging from hundreds of milli-seconds to single seconds, while the preliminary high-power electronics setup employed in this work can switch off the prepolarization field in tens of milli-seconds. In order to make this system suitable for solid-state matter and hard tissues, which feature T1 times as short as 10 ms, we are developing new electronics which can cut switching times to ~ 300 μs. This does not require changes in the prepolarizer module, opening the door to the first experimental demonstration of PMRI on hard biological tissues

Clinical Approach to Patients with Moderate-to-Severe Atopic Dermatitis: A Spanish Delphi Consensus

Despite emerging evidence and advances in the management of atopic dermatitis there a lack of consensus regarding the diagnostic criteria, therapeutic approach, method to assess severity, and patient follow-up for this condition. An expert consensus study was conducted to provide recommendations on the management of patients with moderate-to-severe atopic dermatitis. The study used Delphi-like methodology based on a literature review, a summary of the scientific evidence, and a 2-round survey. The agreement of 60 panellists on 21 statements was evaluated. Consensus was predefined as >= 80% agreement of all respondents. In the first round 6 statements reached consensus. Unanimous consensus was achieved regarding therapeutic goals and patient satisfaction (maintained in the long term and periodic goals reassessment recommended every 3-6 months). In the second round, half of the statements reached consensus, all related to patient follow-up, treatment goals, and atopic comorbidities. The statements that did not reach consensus were related to diagnosis (biomarkers, allergy, and food testing) and starting patients on conventional systemic treatment rather than advanced treatment. The study assessed expert opinion regarding a variety of topics related to the clinical approach to patients with moderate-to-severe atopic dermatitis, in order to provide guidance on the diagnosis and management of patients with atopic dermatitis

Fertilization strategies for abating N pollution at the scale of a highly vulnerable and diverse semi-arid agricultural region (Murcia, Spain)

Overuse of N fertilizers in crops has induced the disruption of the N cycle, triggering the release of reactive N (Nr) to the environment. Several EU policies have been developed to address this challenge, establishing targets to reduce agricultural Nr losses. Their achievement could be materialized through the introduction of fertilizing innovations such as incorporating fertilizer into soils, using urease inhibitors, or by adjusting N inputs to crop needs that could impact in both yields and environment. The Murcia region (southeastern Spain) was selected as a paradigmatic case study, since overfertilization has induced severe environmental problems in the region in the last decade, to assess the impact of a set of 8 N fertilizing alternatives on crop yields and environmental Nr losses. Some of these practices imply the reduction of N entering in crops. We followed an integrated approach analyzing the evolution of the region in the long-term (1860-2018) and considering nested spatial- (from grid to region) and systems scales (from crops to the full agro-food system). We hypothesized that, even despite reduction of N inputs, suitable solutions for the abatement of Nr can be identified without compromising crop yields. The most effective option to reduce Nr losses was removing synthetic N fertilizers, leading to 75% reductions in N surpluses mainly due to a reduction of 64% of N inputs, but with associated yield penalties (31%-35%). The most feasible alternative was the removal of urea, resulting in 19% reductions of N inputs, 15%-21% declines in N surplus, and negligible yield losses. While these measures are applied at the field scale, their potential to produce a valuable change can only be assessed at regional scale. Because of this, a spatial analysis was performed showing that largest Nr losses occurred in irrigated horticultural crops. The policy implications of the results are discussed

Haemophilus influenzae carriage and antibiotic resistance profile in Belgian infants over a three-year period (2016–2018)

BackgroundNon-typeable Haemophilus influenzae has become increasingly important as a causative agent of invasive diseases following vaccination against H. influenzae type b. The emergence of antibiotic resistance underscores the necessity to investigate typeable non-b carriage and non-typeable H. influenzae (NTHi) in children.MethodsNasopharyngeal swab samples were taken over a three-year period (2016–2018) from 336 children (6–30 months of age) attending daycare centers (DCCs) in Belgium, and from 218 children with acute otitis media (AOM). Biotype, serotype, and antibiotic resistance of H. influenzae strains were determined phenotypically. Mutations in the ftsI gene were explored in 129 strains that were resistant or had reduced susceptibility to beta-lactam antibiotics. Results were compared with data obtained during overlapping time periods from 94 children experiencing invasive disease.ResultsOverall, NTHi was most frequently present in both carriage (DCC, AOM) and invasive group. This was followed by serotype “f” (2.2%) and “e” (1.4%) in carriage, and “b” (16.0%), “f” (11.7%), and “a” (4.3%) in invasive strains. Biotype II was most prevalent in all studied groups, followed by biotype III in carriage and I in invasive strains. Strains from both groups showed highest resistance to ampicillin (26.7% in carriage vs. 18.1% in invasive group). A higher frequency of ftsI mutations were found in the AOM group than the DCC group (21.6 vs. 14.9% – p = 0.056). Even more so, the proportion of biotype III strains that carried a ftsI mutation was higher in AOM compared to DCC (50.0 vs. 26.3% – p &lt; 0.01) and invasive group.ConclusionIn both groups, NTHi was most frequently circulating, while specific encapsulated serotypes for carriage and invasive group were found. Biotypes I, II and III were more frequently present in the carriage and invasive group. The carriage group had a higher resistance-frequency to the analyzed antibiotics than the invasive group. Interestingly, a higher degree of ftsI mutations was found in children with AOM compared to DCC and invasive group. This data helps understanding the H. influenzae carriage in Belgian children, as such information is scarce

Genomic characterization of individuals presenting extreme phenotypes of high and low risk to develop tobacco-induced lung cancer

Single nucleotide polymorphisms (SNPs) may modulate individual susceptibility to carcinogens. We designed a genome-wide association study to characterize individuals presenting extreme phenotypes of high and low risk to develop tobacco-induced non-small cell lung cancer (NSCLC), and we validated our results. We hypothesized that this strategy would enrich the frequencies of the alleles that contribute to the observed traits. We genotyped 2.37 million SNPs in 95 extreme phenotype individuals, that is: heavy smokers that either developed NSCLC at an early age (extreme cases); or did not present NSCLC at an advanced age (extreme controls), selected from a discovery set (n = 3631). We validated significant SNPs in 133 additional subjects with extreme phenotypes selected from databases including >39,000 individuals. Two SNPs were validated: rs12660420 (pcombined  = 5.66 × 10-5 ; ORcombined  = 2.80), mapping to a noncoding transcript exon of PDE10A; and rs6835978 (pcombined  = 1.02 × 10-4 ; ORcombined  = 2.57), an intronic variant in ATP10D. We assessed the relevance of both proteins in early-stage NSCLC. PDE10A and ATP10DmRNA expressions correlated with survival in 821 stage I-II NSCLC patients (p = 0.01 and p < 0.0001). PDE10A protein expression correlated with survival in 149 patients with stage I-II NSCLC (p = 0.002). In conclusion, we validated two variants associated with extreme phenotypes of high and low risk of developing tobacco-induced NSCLC. Our findings may allow to identify individuals presenting high and low risk to develop tobacco-induced NSCLC and to characterize molecular mechanisms of carcinogenesis and resistance to develop NSCLC.This work was supported by the Spanish Society of Medical Oncology; Fundación SEOM and Fundación Salud 2000; and Government of Navarra.S

Genomic characterization of individuals presenting extreme phenotypes of high and low risk to develop tobacco-induced lung cancer

Single nucleotide polymorphisms (SNPs) may modulate individual susceptibility to carcinogens. We designed a genome-wide association study to characterize individuals presenting extreme phenotypes of high and low risk to develop tobacco-induced non-small cell lung cancer (NSCLC), and we validated our results. We hypothesized that this strategy would enrich the frequencies of the alleles that contribute to the observed traits. We genotyped 2.37 million SNPs in 95 extreme phenotype individuals, that is: heavy smokers that either developed NSCLC at an early age (extreme cases); or did not present NSCLC at an advanced age (extreme controls), selected from a discovery set (n=3631). We validated significant SNPs in 133 additional subjects with extreme phenotypes selected from databases including >39,000 individuals. Two SNPs were validated: rs12660420 (p(combined)=5.66x10(-5); ORcombined=2.80), mapping to a noncoding transcript exon of PDE10A; and rs6835978 (p(combined)=1.02x10(-4); ORcombined=2.57), an intronic variant in ATP10D. We assessed the relevance of both proteins in early-stage NSCLC. PDE10A and ATP10D mRNA expressions correlated with survival in 821 stage I-II NSCLC patients (p=0.01 and p<0.0001). PDE10A protein expression correlated with survival in 149 patients with stage I-II NSCLC (p=0.002). In conclusion, we validated two variants associated with extreme phenotypes of high and low risk of developing tobacco-induced NSCLC. Our findings may allow to identify individuals presenting high and low risk to develop tobacco-induced NSCLC and to characterize molecular mechanisms of carcinogenesis and resistance to develop NSCLC

Impact of the first wave of the SARS-CoV-2 pandemic on the outcome of neurosurgical patients: A nationwide study in Spain

Objective To assess the effect of the first wave of the SARS-CoV-2 pandemic on the outcome of neurosurgical patients in Spain. Settings The initial flood of COVID-19 patients overwhelmed an unprepared healthcare system. Different measures were taken to deal with this overburden. The effect of these measures on neurosurgical patients, as well as the effect of COVID-19 itself, has not been thoroughly studied. Participants This was a multicentre, nationwide, observational retrospective study of patients who underwent any neurosurgical operation from March to July 2020. Interventions An exploratory factorial analysis was performed to select the most relevant variables of the sample. Primary and secondary outcome measures Univariate and multivariate analyses were performed to identify independent predictors of mortality and postoperative SARS-CoV-2 infection. Results Sixteen hospitals registered 1677 operated patients. The overall mortality was 6.4%, and 2.9% (44 patients) suffered a perioperative SARS-CoV-2 infection. Of those infections, 24 were diagnosed postoperatively. Age (OR 1.05), perioperative SARS-CoV-2 infection (OR 4.7), community COVID-19 incidence (cases/10 5 people/week) (OR 1.006), postoperative neurological worsening (OR 5.9), postoperative need for airway support (OR 5.38), ASA grade =3 (OR 2.5) and preoperative GCS 3-8 (OR 2.82) were independently associated with mortality. For SARS-CoV-2 postoperative infection, screening swab test <72 hours preoperatively (OR 0.76), community COVID-19 incidence (cases/10 5 people/week) (OR 1.011), preoperative cognitive impairment (OR 2.784), postoperative sepsis (OR 3.807) and an absence of postoperative complications (OR 0.188) were independently associated. Conclusions Perioperative SARS-CoV-2 infection in neurosurgical patients was associated with an increase in mortality by almost fivefold. Community COVID-19 incidence (cases/10 5 people/week) was a statistically independent predictor of mortality. Trial registration number CEIM 20/217