Situation, challenges, and SEOM recommendations for the future of undergraduate education in Oncology in Spain

Purpose The Spanish Society of Medical Oncology (SEOM, for its Spanish acronym) would like to attest to the relevance of training in Oncology as part of the undergraduate education in Medicine program and issue recommendations to improve said training, with the aim of responding better to the challenges that cancer poses to our society. Materials and methods The curricula of 42 schools of medicine were reviewed with interviews with at least one teaching medical oncologist from each faculty. The qualitative and opinion analysis was completed by means of an online questionnaire targeting lecturers, resident tutors, and residents in Medical Oncology (MO), enabling the detection of needs and areas for improvement at an organizational level and in terms of skill acquisition. Results While the number of medical schools with a specific, mandatory program in MO has grown by up to 90%, it has not been accompanied by an increase in independent programs. Instead, they largely consist of programs shared with other specialties (61% of the medical faculties). In most of the undergraduate education programs, Oncology contents are fragmented and approached from the perspective of each organ system. Conclusions Despite the positive evolution in recent years, the heterogeneity in Oncology contents during undergraduate education training continues to be remarkable. Cross-sectional programs with an integral vision, taught in the final years of undergraduate medical education would be desirable. Among the recommendations for improvement of training in Medical Oncology, the SEOM proposes that updated, theoretical content be incorporated and clinical practice in Medical Oncology departments be promotedThis study was funded as an unrestricted grant by Jansse

The Importance Of Monoclonal Proteins Determination For The Correct Diagnosis Of Transthyretin Cardiac Amyloidosis By [Tc-99m]Tc-diphosphonates

EPS-066 Aim/Introduction: To analyze the influence of the determination of free monoclonal proteins in blood and urine in the final diagnosis of Transthyretin Cardiac Amyloidosis (TTRA). Materials and Methods: We have analyzed 200 [99mTc]Tc-diphosphonates scans: 192 performed on 190 patients under suspicion of TTRA and 7 patients with grade II-III radiotracer myocardial deposit as a casual finding (November/2013 - January/2020). Likewise, clinical and laboratory characteristics (heart failure, LVEF, proBNP levels, immunofixation in serum and/or urine for the detection of monoclonal chains and chronic renal failure) have been evaluated. A positive case has been considered for TTRAwt or senile (Score Perugini II-III scan, negative immunofixation in serum and/or urine, negative genetic study), positive case for hereditary TTRA (Score Perugini II-III scan, negative immunofixation and positive genetic study), positive case for secondary amyloidosis (positive immunofixation and presence of hematologic malignancy) and undetermined amyloidosis (immunofixation not performed or positive and absence of haematologic malignancies at follow-up). Results: 59 positive scans have been detected, 47 men (79’7%) and 12 women (20’3%). The mean age of the group of positives was 82’66 years, while that of the negatives was 72’15. The mean proBNP levels in the positives are 7561, compared to 5869 in the negative group. Immunofixation (serum and/or urine for detection of kappa or lambda monoclonal chains at 30 (50.8%) has been performed on these patients. Finally, 37.2% (22/59) resulted in ATTRwt, 3.4% (2/59) hereditary ATTR (genetic study: variant E54Q and mutation c.424> A (p.Va.122Ile) in exon 4 of TTR) and 1.7% (1/59) secondary amyloidosis. The remaining 34/59 (57.7%) cases were undetermined amyloidosis (6 positive immunofixation and 27 without monoclonal proteins determination). Conclusion: Determination of monoclonal bands in blood and urine is mandatory to correctly characterize cases of cardiac amyloidosis and, in presence of monoclonal bands, to assess the existence of underlying haematological malignancies

Impact Of Sentinel Lymph Node Biopsy In Breast Cancer Patients Treated With Neoadjuvant Chemotherapy

EPS 196 Aim/Introduction: To analyze how many of the patients undergoing neoadjuvant chemotherapy (NCT) may benefit from SLNB, as well as the impact on patient management, especially in those with early axillary involvement. Materials and Methods: We included patients with breast carcinoma candidates to NCT discussed at the Tumor Committee of our hospital (April/2017-August/2019). All of them were subjected to clinical assessment, ultrasound and, if appropriate, histological analysis, axillary pre and post- NCT. Sentinel lymph node detection was performed after periareolar injection of [99mTc]Tc-nanocoloid (74 MBq) the day before surgery. In some cases, blue dye was injected and/or a pre-NPC metal clip was placed in the affected node. Results: Sixty-two patients were included. NCT achieved a complete breast response in 12 patients, partial in 46 and non-response in 4. Initially, 31 patients were classified as N0 and 31 as N+ (28 N1 and 3 N2), achieving a complete axillary response in 58% of N+ (18). SLNB was performed in 49 patients (79%; 100% in N0 and 58% in N+ from baseline). The gamma detection rate of the sentinel lymph node was 91.8% (93.5% in N0 and 88.9% in N+). 28 lymphadenectomies were undergone (45.2%; 22.5% in N0 and 67.7% in N+), 11 due to positive SLNB (5 N0 and 6 N1), 13 owing to lack of axillary response and 4 caused by the non-localization of the sentinel lymph node. SLNB was performed in 58% of N+ patients, of which 44.4% were negative, avoiding lymphadenectomy. Metal clip and/or blue dye techniques were used in 31 cases (50%). Conclusion: SLNB is viable in a high percentage of patients with previous NCT, with a high detection rate, even in patients with early affected axilla, avoiding lymphadenectomy to patients who achieve a complete response of the axillary lymph node

Prevalence and Risk Factors of MASLD and Liver Fibrosis amongst the Penitentiary Population in Catalonia: The PRISONAFLD Study

Metabolic dysfunction-associated steatotic liver disease; Metabolic syndrome; PrisonMalaltia hepàtica esteatòtica associada a disfunció metabòlica; Síndrome metabòlica; PresóEnfermedad hepática esteatósica asociada a disfunción metabólica; Síndrome metabólico; PrisiónBackground and Aims: The prevalence of chronic non-communicable diseases, particularly metabolic syndrome (MetS), has increased among the prison population. Nevertheless, we have limited data on metabolic dysfunction-associated steatotic liver disease (MASLD), the hepatic manifestation of this syndrome. We aimed to investigate the prevalence and risk factors of MASLD and MASLD-associated liver fibrosis in the penitentiary population in Catalonia, Spain. Method: A cross-sectional observational study involving eight penitentiary centers. Participants had at least one metabolic disorder and were at a closed-regimen penitentiary. Individuals with concomitant liver diseases and/or alcohol risk consumption were excluded. Significant fibrosis and MASLD were defined as liver stiffness ≥8 kPa and a controlled attenuation parameter ≥275 dB/m by vibration-controlled transient elastography (VCTE), respectively. After exclusions, metabolic inmates with VCTE were analyzed. Logistic regression analysis was performed to identify predictors of MASLD and MASLD-associated significant fibrosis. Results: Out of the 4338 inmates studied, 1290 (29.7%) had metabolic disorders, and 646 (14.9%) underwent VCTE. The mean age was 48.0 years (SD 12.1), and 89.5% were male. MASLD prevalence was 33.9%. Significant fibrosis and MASLD-associated significant fibrosis were found in 16.4% and 9.4% of inmates, respectively. In the multivariate analysis, T2D, waist circumference, MetS, and higher ALT values were identified as independent risk factors for MASLD and MASLD-associated significant fibrosis amongst the prison population. Conclusions: Metabolic disorders including MASLD are highly prevalent among inmates. The prevalence of significant fibrosis seems notably higher than that of the general population, underscoring the need for targeted screening programs and therapeutic interventions in the incarcerated population

Escala de Cansancio Emocional: Análisis psicométrico en estudiantes de posgrado en Puerto Rico

This research analyzes the psychometric properties of the Emotional Exhaustion Scale and confirms the unifactorial structure of the scale. 442 master’s and doctoral students from 21 to 55 years old participated in the research (M = 29.52; DE = 5.63). Exploratory and confirmatory factor analysis, invariance analysis and internal consistency analysis were performed. Factor analyses confirmed theunidimensional structure of the scale (appropriate fit indexes), and Cronbach’s alpha and McDonald’s omega coefficients were adequate (α = .883; ω = .883). It was concluded that the Emotional Exhaustion Scale has good psychometric properties to be used in postgraduate students in Puerto Rico and is a practical and helpful tool for clinical and academic work in universities. The practical implications and limitations of the findings are discussed. Esta investigación analiza las propiedades psicométricas de la Escala de Cansancio Emocional y confirma su estructura unidimensional. Participaron en la investigación 442 estudiantes de maestría y doctorado de 21 a 55 años (M = 29.52; DE = 5.63). Se realizaron análisis factoriales exploratorios y confirmatorios, análisis de invarianza y análisis de consistencia interna. Los análisis factoriales confirmaron la estructura unidimensional del instrumento (índices de ajuste apropiados) y los coeficientes alfa de Cronbach y omega de McDonald fueron adecuados (α = .883; ω = .883). Se concluye que la Escala de Cansancio Emocional cuenta con las propiedades psicométricas adecuadas para ser utilizada en estudiantes de posgrado de Puerto Rico y es una herramienta práctica y útil en el quehacer clínico y académico de las universidades. Se discuten las implicancias prácticas y limitaciones de los hallazgos

Análisis de la utilización de un calefón a inducción electromagnética para proveer de agua caliente a viviendas unifamiliares.

El presente proyecto de investigación tiene el propósito de diseñar e implementar un calefón prototipo de inducción electromagnética para viviendas unifamiliares, con el principal objetivo de realizar un estudio investigativo que determine sí la inducción electromagnética es la manera más adecuada de proveer agua caliente para el uso en éste tipo de hogares. El proyecto utiliza un sistema existente (cocina a inducción), en la cual se adapta un sistema de paso de agua construido con acero inoxidable, éste se calienta debido a la inducción y transmite el calor al agua que por él se encuentra en circulación. Con este sistema se pretende analizar la eficiencia de los sistemas de calentamiento a inducción frente a los sistemas eléctricos convencionales, se realizan diferentes pruebas donde se utiliza tanto el prototipo como un sistema eléctrico convencional. Para determinar la eficiencia de los diferentes sistemas se procede a medir la energía eléctrica utilizada en el sistema de calentamiento y la cantidad de energía que es trasmitida al agua, para ello se debe conocer el volumen de agua utilizada y el gradiente de temperatura alcanzada. Una vez conocida la eficiencia de cada uno de los sistemas se puede determinar sí el calentamiento por inducción es la mejor alternativa para proveer de agua caliente a las viviendas unifamiliares

Reliability and validity of a questionnaire for physical activity assessment in South American children and adolescents: The SAYCARE Study

ABSTRACT: The objective of this article is to test the reliability and validity of the new and innovative physical activity (PA) questionnaire. Methods: Subsamples from the South American Youth/Child Cardiovascular and Environment Study (SAYCARE) study were included to examine its reliability (children: n 5 161; adolescents: n 5 177) and validity (children: n 5 82; adolescents: n 5 60). The questionnaire consists of three dimensions of PA (lei-sure, active commuting, and school) performed during the last week. To assess its validity, the subjects wore accelerometers for at least 3 days and 8 h/d (at least one weekend day). The reliability was analyzed by correlation coefficients. In addition, Bland-Altman analysis and a multilevel regression were applied to estimate the measurement bias, limits of agreement, and influence of contextual variables. Results: In children, the questionnaire showed consistent reliability (q 5 0.56) and moderate validity (q 5 0.46), and the contextual variable variance explained 43.0% with 222.9 min/d bias. In adolescents, the reliability was higher (q 5 0.76) and the validity was almost excellent (q 5 0.88), with 66.7% of the variance explained by city level with 16.0 min/d PA bias. Conclusions: The SAYCARE PA questionnaire shows acceptable (in children) to strong (in adolescents) reliability and strong validity in the measurement of PA in the pediatric population from low- to middle-income countries

Epidemiological and Clinical Complexity of Amoxicillin-Clavulanate- Resistant Escherichia coli

Two hundred twelve patients with colonization/infection due to amoxicillin-clavulanate (AMC)-resistant Escherichia coli were studied. OXA-1- and inhibitor-resistant TEM (IRT)-producing strains were associated with urinary tract infections, while OXA-1 producers and chromosomal AmpC hyperproducers were associated with bacteremic infections. AMC resistance in E. coli is a complex phenomenon with heterogeneous clinical implications

Obscuration beyond the nucleus: infrared quasars can be buried in extreme compact starbursts

In the standard quasar model, the accretion disk obscuration is due to the canonical dusty torus. Here, we argue that a substantial part of the quasar obscuration can come from the interstellar medium (ISM) when the quasars are embedded in compact starbursts. We use an obscuration-unbiased sample of 578 infrared (IR) quasars at $z\approx 1-3$ and archival ALMA submillimeter host galaxy sizes to investigate the ISM contribution to the quasar obscuration. We calculate SFR and ISM column densities for the IR quasars and a control sample of submillimeter galaxies (SMGs) not hosting quasar activity and show that: (1) the quasar obscured fraction is constant up to $\rm SFR\approx 300 \: M_{\odot} \: yr^{-1}$, and then increases towards higher SFR, suggesting that the ISM obscuration plays a significant role in starburst host galaxies, and (2) at $\rm SFR\gtrsim 300 \: M_{\odot} \: yr^{-1}$, the SMGs and IR quasars have similarly compact submillimeter sizes ($R_{\rm e}\approx 0.5-3\rm \: kpc$) and, consequently, the ISM can heavily obscure the quasar, even reaching Compton-thick ($N_{\rm H}>10^{24} \rm \: cm^{-2}$) levels in extreme cases. Based on our results, we infer that $\approx 10-30\%$ of the IR quasars with $\rm SFR\gtrsim 300 \: M_{\odot} \: yr^{-1}$ are obscured solely by the ISM.Comment: Accepted for publication in MNRAS Letter