[Temporal evolution of antiretroviral therapy (2017-2021): analysis of treatment change and its economic impact]. / Evolución temporal de la terapia antirretroviral (2017-2021): análisis de la modificación del tratamiento y su impacto económico.

OBJECTIVE: To analyze the modifications of antiretroviral therapy (ART) and their economic impact on daily clinical practice. METHODS: Observational, retrospective study of patients who started ART between 01/2017-12/2021 (follow-up until 12/2022). Variables collected: prescribed ART, duration, the reason for the change, and treatment costs. RESULTS: A total of 280 patients initiated ART therapy. The median durability of 1st line was: 19.9 months in 2017 (95%CI 13.9-25.9), 12.2 months in 2018 (95%CI 4.7-19.7), 27.4 months in 2019 (95%CI 6.8-48.1) and the median was not reached for the years 2020 and 2021 (p<0.001). Triple therapy with protease inhibitors was changed in 63.8% (81/127) of cases, followed by integrase inhibitors 52.1% (159/305), while dual therapy (DTG/3TC) only in 8.3% (7/84). The main cause of discontinuation was simplification/optimization 47.5% (124/261), followed by adverse effects 21.8% (57/261), with 2017 being the only year where simplification/optimization was at the same level as adverse effects. The economic impact of ART changes resulted in an average cost reduction of 34.0€ [-391.4 to +431.4] per month per patient. The year 2019 stands out as the only year where these changes were associated with an increase in mean additional cost (23.4€ [-358.3 to +431.4]). CONCLUSIONS: Optimization/simplification accounts for almost half of the reasons for TAR change, with an economic impact that, despite the inflection point of 2019, each year manages to exceed the previous one, achieving a progressive cost reduction maintained over time.

[Adequacy of the consumption of antipseudomonal antibiotics after changes in the 2019 EUCAST criteria]. / Adecuación de la prescripción de antibióticos antipseudomónicos tras los cambios en los criterios EUCAST 2019.

OBJECTIVE: In 2019, the European Committee for the Study of Antibiotic Susceptibility modified the categories of antibiotic susceptibility tests to include the term "susceptible with increased exposure". Following the dissemination of local protocols reflecting these modifications, the aim of our study was to analyse whether prescribers have adapted to them and the clinical impact in cases of inadequacy. METHODS: Observational and retrospective study of patients with infection who received antipseudomonal antibiotics from January to October 2021 in a tertiary hospital. RESULTS: Non-adherence to the guideline recommendations was 57.6% in the ward and 40.4% in the ICU (p<0.05). In both the ward and ICU, the group with the most prescriptions not by the guideline recommendations were aminoglycosides (92.9% and 64.9% respectively) for using suboptimal doses, followed by carbapenems (89.1% and 53.7% respectively) for not administering an extended infusion. On the ward, the mortality rate during admission or at 30 days in the inadequate therapy group was 23.3% vs 11.5% in those who received adequate treatment (OR: 2.34; 95% CI 1.14-4.82); in ICU there were no statistically significant differences. CONCLUSIONS: The results show the need to implement measures to ensure better dissemination and knowledge of key concepts in antibiotic management, to ensure increased exposures, and to be able to provide better infection coverage, as well as to avoid amplifying resistant strains.

Patient, tumor, and healthcare factors associated with regional variability in lung cancer survival: a Spanish high-resolution population-based study.

PURPOSE: The third most frequently diagnosed cancer in Europe in 2018 was lung cancer; it is also the leading cause of cancer death in Europe. We studied patient and tumor characteristics, and patterns of healthcare provision explaining regional variability in lung cancer survival in southern Spain. METHODS: A population-based cohort study included all 1196 incident first invasive primary lung cancer (C33-C34 according to ICD-10) cases diagnosed between 2010 and 2011 with follow-up until April 2015. Data were drawn from local population-based cancer registries and patients' hospital medical records from all public and private hospitals from two regions in southern Spain. RESULTS: There was evidence of regional differences in lung cancer late diagnosis (58% stage IV in Granada vs. 65% in Huelva, p value < 0.001). Among patients with stage I, only 67% received surgery compared with 0.6% of patients with stage IV. Patients treated with a combination of radiotherapy, chemotherapy, and surgery had a 2-year mortality risk reduction of 94% compared with patients who did not receive any treatment (excess mortality risk 0.06; 95% CI 0.02-0.16). Geographical differences in survival were observed between the two regions: 35% vs. 26% at 1-year since diagnosis. CONCLUSIONS: The observed geographic differences in survival between regions are due in part to the late cancer diagnosis which determines the use of less effective therapeutic options. Results from our study justify the need for promoting lung cancer early detection strategies and the harmonization of the best practice in lung cancer management and treatment.

Consensus on the regional lymph nodes irradiation in breast cancer

Standard locoregional treatment of early-stage breast cancer currently consists of the conservative surgery and sentinel lymph node biopsy. In the event of positive sentinel node biopsy, an axillary level I-II lymphadenectomy should be carried out. However, recent publications have increasingly supported a tendency not to apply the surgical lymphadenectomy, but simultaneously, it has been developed a new role of regional radiotherapy, even if there is only 1-3 axillary lymph nodes involved. Given these new trends, radiation oncologists are facing the dilemma with regard to deciding about regional irradiation of breast cancer. For such purpose, The Spanish Group of Breast Cancer Radiation Oncology (GEORM as per its Spanish acronym) decided to reach a consensus to issue the respective guidelines for such types of cases. GEORM Managing Commission, gathering 13 members of different Spanish regional communities, issued a questionnaire including different clinical situations. These questions were set as key questions seeking responses, which were answered by 66 % out of the 75 members of the group. Following the response, the guidelines were drafted based on the replies to the mentioned questionnaire. All the respective issues were discussed by means of a virtual platform. In this article, we show the levels of consensus for different clinical situations, depending on the number of nodes involved and the type of surgical procedure performed on the axillary lymph nodes. The ongoing evolution of the oncological treatments obliges the radiation oncologists to take decisions without any existing clarifying evidence, and therefore, the consensus is necessary, which can assist in the decision-making process by the practitioners in such kinds of clinical situations (AU)

A one-day "Helping Babies Breathe" course improves simulated performance but not clinical management of neonates.

OBJECTIVE: "Helping Babies Breathe" (HBB) is a simulation-based one-day course developed to help reduce neonatal mortality globally. The study objectives were to (1) determine the effect on practical skills and management strategies among providers using simulations seven months after HBB training, and (2) describe neonatal management in the delivery room during the corresponding time period before/after a one-day HBB training in a rural Tanzanian hospital. METHODS: The one-day HBB training was conducted by Tanzanian master instructors in April 2010. Two simulation scenarios; "routine care" and "neonatal resuscitation" were performed by 39 providers before (September 2009) and 27 providers after (November 2010) the HBB training. Two independent raters scored the videotaped scenarios. Overall "pass/fail" performance and different skills were assessed. During the study time period (September 2009-November 2010) no HBB re-trainings were conducted, no local ownership was established, and no HBB action plans were implemented in the labor ward to facilitate transfer and sustainability of performance in the delivery room at birth. Observational data on neonatal management before (n=2745) and after (n=3116) the HBB training was collected in the delivery room by observing all births at the hospital during the same time period. RESULTS: The proportion of providers who "passed" the simulated "routine care" and "neonatal resuscitation" scenarios increased after HBB training; from 41 to 74% (p=0.016) and from 18 to 74% (p≤0.0001) respectively. However, the number of babies being suctioned and/or ventilated at birth did not change, and the use of stimulation in the delivery room decreased after HBB training. CONCLUSION: Birth attendants in a rural hospital in Tanzania performed significantly better in simulated neonatal care and resuscitation seven months after one day of HBB training. This improvement did not transfer into clinical practice.

Consensus on the regional lymph nodes irradiation in breast cancer.

Standard locoregional treatment of early-stage breast cancer currently consists of the conservative surgery and sentinel lymph node biopsy. In the event of positive sentinel node biopsy, an axillary level I-II lymphadenectomy should be carried out. However, recent publications have increasingly supported a tendency not to apply the surgical lymphadenectomy, but simultaneously, it has been developed a new role of regional radiotherapy, even if there is only 1-3 axillary lymph nodes involved. Given these new trends, radiation oncologists are facing the dilemma with regard to deciding about regional irradiation of breast cancer. For such purpose, The Spanish Group of Breast Cancer Radiation Oncology (GEORM as per its Spanish acronym) decided to reach a consensus to issue the respective guidelines for such types of cases. GEORM Managing Commission, gathering 13 members of different Spanish regional communities, issued a questionnaire including different clinical situations. These questions were set as key questions seeking responses, which were answered by 66 % out of the 75 members of the group. Following the response, the guidelines were drafted based on the replies to the mentioned questionnaire. All the respective issues were discussed by means of a virtual platform. In this article, we show the levels of consensus for different clinical situations, depending on the number of nodes involved and the type of surgical procedure performed on the axillary lymph nodes. The ongoing evolution of the oncological treatments obliges the radiation oncologists to take decisions without any existing clarifying evidence, and therefore, the consensus is necessary, which can assist in the decision-making process by the practitioners in such kinds of clinical situations.

The white book of radiation oncology in Spain

The White Book of Radiation Oncology provides a comprehensive overview of the current state of the speciality of radiation oncology in Spain and is intended to be used as a reference for physicians, health care administrators and hospital managers. The present paper summarises the most relevant aspects of the book's 13 chapters in order to bring the message to a wider audience. Among the topics discussed are the epidemiology of cancer in Spain, the role of the radiation oncologist in cancer care, human and material resource needs, new technologies, training of specialists, clinical and cost management, clinical practice, quality control, radiological protection, ethics, relevant legislation, research & development, the history of radiation oncology in Spain and the origins of the Spanish Society of Radiation Oncology (SEOR) (AU)

PITASOR epidemiological study: prevalence, incidence and treatment of anaemia in radiation therapy oncology departments in Spain

INTRODUCTION: Anemia is the most common haematological complication in cancer patients. OBJECTIVE: Analysis of the incidence, prevalence and treatment of anemia in oncologic patients treated in Radiation Oncology Departments in Spain (ROD) and monitoring of the existing recommendations for the treatment of anemia. MATERIAL AND METHODS: Observational, prospective, multicenter study which involved 19 Spanish ROD. The study was approved by the CEIC Central Defense Hospital. 477 patients with solid tumors, subsidiary of RT with radical intent referred to such centers within a period of one month (5/5/09 to 5/6/09) and gave their consent to participate in the study. We gathered the main characteristics of patients and their oncologic disease. All patients underwent a determination of Hb levels before RT, upon reaching 25-35 Gy and at the end treatment. In patients with anemia we assessed the existence of related symptoms and its treatment. RESULTS: Basal situation: The prevalence of anemia was 34.8% (166 patients). Mean Hb in patients with anemia was 11.17 ± 1.07 g/dl. Anemia-related symptoms were present in 34% of the patients. Anemia predisposing factors were: stage of the disease, previously received chemotherapy, and hormonal therapy. 39% (66 patients) received anemia treatment, with a mean Hb of 10.43 ± 1.04 g/dl. During RT: The prevalence of anemia was 38.9% (182 patients) with a mean Hb of 11.24 ± 1.21 g/dl. Predisposing factors for anemia during RT treatment were: age, male sex, chemotherapy prior to RT, basal anemia and chemotherapy during RT. 36.3% (66 patients) had anemia-related symptoms. 34.6% (63 patients) with a mean Hb of 10.5 ± 1.37 g/dl received treatment for anemia. The prevalence of anemia at the end of the RT was 38.1% (177 patients) with a mean Hb of 11.19 ± 1.18 g/dl. The predisposing factors for the appearance of anemia at the end of RT were: male sex, anemia at basal situation and during treatment and chemotherapy during RT. 34% (61 patients) had anemia-related symptoms and 73 patients (41.2%) with a mean Hb of 10.5 ± 1.22 g/dl received treatment for anemia. The presence of anemia-related symptoms was significantly correlated with the beginning of treatment for anemia. The incidence of anemia (new cases) during radiotherapy was 17.5%. CONCLUSION: The prevalence of anemia in basal situation, during RT and at the end of RT is 34.8%, 38.9% and 38.1%. During RT the incidence of anemia is 17.5%. 39.8%-41.2% of patients with anemia and 64.2%-68% of patients with anemia-related symptoms received treatment. Treatment of anemia starts with Hb<11 g/dl and the goal is to achieve Hb 12 g/dl. In our Radiotherapy Oncology Departments, the treatment of anemia complies with the current recommendations and guidelines in use (AU)

Diagnosis and medical treatment of breast cancer. Cordoba Consensus of 2007

Many important studies have changed the perspective from which breast cancer is approached, and they may change what have to date been the standards applicable to the diagnosis and treatment of breast cancer. In 2007, just over 200 oncologists from all over Spain met in Cordoba in order to review the latest evidence related to breast cancer and reach a consensus on the most important aspects of its diagnosis and treatment in different clinical situations: neoadjuvance, adjuvance and advanced disease. In view of these important changes, opinions on some specific aspects may be varied and all are justified. This document represents a review of the current state of the evidence (AU)

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Nuevas perspectivas en el tratamiento paliativo del glioblastoma multiforme y astrocitoma anaplásico recidivado con implantes de carmustina / New prospects of the paliative treatment of relapsing glioblastoma multiforme and anaplastic astrocytoma with carmustine implants

Analizamos el tratamiento de las recidivas de glioblastoma multiforme y astrocitoma anaplásico con cirugíamás la implantación de polímeros de carmustina (BCNU) en el lecho de la recidiva, con el objetivo de mejorarla calidad de vida, los síntomas neurológicos y generales, y aumentar el control tumoral. Reflejamos la experienciay datos clínicos de 4 pacientes intervenidos.El empleo de carmustina implantes puede realizarse de forma factible sin objetivarse efectos adversos queinterfieran la calidad de vida, además de observar un enlentecimiento en la progresión del deterioro neurológicode los pacientes.La selección de pacientes jóvenes, con un buen performance estatus, en los que se prevea la mejor resecciónde la recidiva posible, garantizará el éxito en el tratamiento paliativo con implantes de carmostina

In recurrent glioblastoma multiforme and anaplastic astrocytoma, surgery and carmustine (NCNU) polymersimplants over the surgical area of the removed recidivation is a promising way to improve the quality of life,the neurologic and general symptoms, and the tumor control. We report our data and experience in fourpatients. The resection was optimized because the patients were young and showed a performance statusbetween 0 and 2

Incidencia y prevalencia de anemia en pacientes que reciben radioterapia / Incidence and prevalence of anemia of patientsreceiving radiotherapy

- Introducción y objetivos: la anemia es el trastorno hematológico más frecuente en pacientes con cáncer; sin embargo, existen pocos datos en nuestro país sobre presencia de anemia en enfermos que son sometidos a radioterapia. Este estudio analiza la prevalencia e incidencia de anemia antes y durante la irradiación y secundariamente la influencia del tratamiento en la corrección de la misma según el momento de su aparición.- Material y método: 472 pacientes con cáncer han sido incluidos en un estudio observacional, prospectivo y multicéntrico. Los controles hematológicos se efectuaron antes de la irradiación, al inicio y cada dos semanas, hasta el final de la misma, para detectar la presencia de anemia. Se estudiaron las modificaciones de los niveles de hemoglobina en relación al tratamiento aplicado y al momento en que dicho tratamiento fue iniciado.- Resultados: un 28 por ciento de los pacientes se presentan con anemia de inicio y un 27 por ciento la desarrollan durante la radioterapia. Un 40 por ciento de los enfermos fueron tratados con eritropoyetina alfa en algún momento del estudio, produciéndose un incremento significativo en los niveles de Hb de aproximadamente 2 g/dl. En los enfermos que no recibieron eritropoyetina la incidencia de anemia se incrementó a lo largo de la radioterapia, alcanzando un pico de un 8 por ciento en la última semana de irradiación.- Conclusión: existe una alta incidencia y prevalencia de anemia en los pacientes sometidos a radioterapia, cuyo tratamiento es fundamental por la implicación pronóstica que tiene mantener niveles bajos de hemoglobina a lo largo de la irradiación. La eritropoyetina humana recombinante es un fármaco eficaz para corregir la anemia, independientemente del momento en que se inicie la aplicación de dicho tratamiento (AU)

[Gynecomastia and Leydig cell tumor]. / Ginecomastia y tumor de células de Leydig.

INTRODUCTION: Leydig cell tumors may generate estrogen production and gynecomastia. CASE PRESENTED: A 32-year man asked for medical advice due to gynecomastia. He had raised estrogen levels and diminished testosterone/estradiol index. A testicular echogram showed a nodular image in the right testis. Orchidectomy was performed and the diagnosis of a Leydig cell tumor was confirmed. The gynecomastia diminished, and estradiol remained lightly elevated, with little response to HCG. DISCUSSION: The more frequent hormonal manifestations of these tumors are high plasmatic and urinary estrogen levels, low serum testosterone, low testosterone/estradiol index, and FSH or LH low levels as well. The low response to HCG, the absence of metastasis and the good clinical evolution suggested the tumor was benign. Testicular echography is useful in the diagnosis of these tumors.

[Effect of enalapril on microalbuminuria and lipid profile of normotensive type I diabetes mellitus patients]. / Influencia de enalapril sobre la microalbuminuria y el perfil lipídico en pacientes con diabetes mellitus tipo I normotensos.

A longitudinal study for six months was conducted to demonstrate the influence of enalapril therapy on microalbuminuria in a group of patients with IDDM without arterial hypertension. An evaluation was also considered of its possible activity on other biochemical parameters, particularly plasma lipid levels. Thirty-four patients with IDDM were selected, with a mean age of 26.1 +/- 7.2 years and a mean clinical course of 11.8 +/- 5.6 years. Arterial blood pressure (ABP) was confirmed lower than 140/85 mmHg in all cases. Patients were administered 5 mg/day of enalapril and if a decrease in microalbuminuria higher than 25% was not achieved at the end of the first month of therapy, the dose was doubled (10 mg/day). No significant differences were found in ABP and in HbA1c throughout the study period. Albumin excretion in the initial period was 125.1 +/- 79.28 mg/24 h, at one month in the follow-up 47.6 +/- 44.1 mg/24 h, at three months 23.8 +/- 18.1 mg/24 h, and at the end of the 6th month 15.33 +/- 6.9 mg/24 h, all differences being significant. Renal function parameters and Na+ and K+ measurements remained unchanged for the follow-up period. No significant changes were detected for lipid and lipoprotein values for the length of the study. We conclude that therapy with enalapril in insulin-dependent diabetic patients without hypertension has an important effect on microalbuminuria during the first month of therapy; a stabilization in the normal range was reached in the third and sixth months of follow-up. No changes in arterial blood pressure nor in renal function were observed. Plasma lipid values were in the normal range throughout the study. Therefore, treatment for microalbuminuria with the ACEI assayed was efficient, in absence of arterial hypertension and irrespective of the metabolic control obtained. Future long-term studies are needed to evaluate the possible delay in the emergence of renal insufficiency.

[Course of cardiac autonomic neuropathy in diabetic patients++ depending on the degree of metabolic control]. / Evolución de la neuropatía autónoma cardíaca en diabéticos según el grado de control metabólico.

Thirty-one diabetic subjects, 19 males and 12 females, with a mean age of 40.5 +/- 14.0 years, 17 of whom were insulin dependent (IDDM) and 14 non-insulin dependent (NIDDM) treated with insulin and diet, were followed for a period of six months. Patients were diagnosed of diabetic autonomic cardiopathy (without other neuropathy causes, nor use of drugs except for insulin) by the alteration of at least 2 of the 5 cardiovascular tests (tCV) performed. Patients underwent an educational diabetes program and self-control, and after 6 months of treatment they were divided into two groups according to the degree of metabolic control. In group 1, in which there was a good control with mean blood sugar levels of 108 +/- 12 mg/dl (5.9 +/- 0.6 mmol/l) and triglycerides of 101 +/- 21 (1.1 +/- 0.2 mmol/l), an improvement in tCV was observed: Valsalva coefficient of 1.16 +/- 0.13 and 1.22 +/- 0.13 (initial and final respectively) (p less than 0.001), with and improvement in 56% of cases; E/I (expiration/inspiration) ratio increased from 1.13 +/- 0.11 to 1.21 +/- 0.11, improving 53% of cases (p less than 0.001); 30/50 index (RR in 30/RR beat in beat 15 after orthostatism) (n.s.); difference in systolic arterial pressure after standing (p less than 0.001) and increase in diastolic arterial pressure with isometric muscular exercise (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

[Hyperplasia of the pancreatic islets or nesidioblastosis in adults? Apropos 2 cases]. / Hiperplasia de islotes pancreáticos o nesidioblastosis del adulto? A propósito de dos casos.

Nesidioblastosis is an anatomopathological situation defined as the transformation or the exocrine ductal epithelium into endocrine tissue which can be hormonally active or inactive. In this study we present two cases which to our knowledge fulfil criteria for nesidioblastosis. Both patients were male (73 and 45 years, respectively) who were admitted to our department because they presented hypoglycemia. Blood examination revealed the existence of an hyperinsulinism although axial computerized tomography, pancreatic echocardiography and selective angiography of the celiac arterial trunk failed to demonstrate the presence of the tumor in either of the two cases. Due to the persistence of the clinical picture in the first case and to the intolerance to the diazoxide in the second patient, a subtotal pancreatectomy was performed in both cases. The surgical procedure involved removal of the 80% and 75% of the head and body respectively. Both patients are presently free of symptoms although the first patient in under diazoxide therapy due to persistent hypoglycemia (more spaced crisis).

[Buccal manifestations of type I diabetes mellitus. Study of its oral symptomatology and dental involvement]. / Manifestations buccales du diabète sucré type I. Etude de sa symptomatologie orale et incidence dentaire.

We are hereby presenting a survey conducted on 44 diabetic patients of the I type and 44 health individuals used as a reference group. In the light of the results of the survey in question a poorer oral hygiene for the I type insulin-dependent diabetic patients than for those in the control group has been detected (E.G. whereas 40.91% of the diabetic patients exhibited a very poor hygiene, the rate detected for the control group amounted to 22.72% only). Nevertheless, this poorer hygiene did not seem to influence caries level direct since no meaningful difference in the two groups CAO indexes was detected at all. Cellulitis was very frequent in the diabetic group whereas post-extraction alveolitis and mouth dryness were found at comparable levels in the two groups.