Quality indicators for the diagnosis and treatment of breast cancer integrated assistance: A critical appraisal / Indicadores de calidad para el diagnóstico y tratamiento del cáncer de mama en el proceso asistencial integrado de cáncer de mama

Introduction Quality indicators (QIs) are essential for adequate control of the health care management process, recognizing areas of improvement and providing solutions. We aimed to evaluate the Integrated Breast Cancer (BC) Care Process QIs. Methods We studied 487 consecutive BC cases diagnosed from November 1st, 2013, to November 30th, 2019, in a Spanish healthcare area, and we estimated the associated QIs. Results Four indicators did not meet the standards and were analysed based on related sociodemographic and clinical variables. The surgical delay after a multidisciplinary team discussion (mean 64%, IQR 59.6–68.5) was lower in elder people (p=0.027), and early histological grades (p=0.019) and stages (p=0.008). The adjuvant treatment delay (mean 55.7%, IQR 51.1–60.3) was lower in advance stages (p=0.002) and when there was no reoperation (p=0.001). The surgical delay after inclusion (mean 83.2%, IQR 79.3–87.2) was lower in early histological grades (p=0.048). The immediate reconstruction (mean 42.3%, IQR 34.0–50.5) reached 72.3% in young women compared to 11.8% in older than 70 years (p=0.001) and it was higher in early stages (45.3% vs 36.2%; p=0.049). Conclusion The study of QIs evaluated their compliance and analysed the variables influencing them to propose improvement measures. Not all the indicators were equally valuable. Some depended on the available resources, and others on the mix of patients or complementary treatments. It would be essential to identify the specific target populations to estimate the indicators or provide standards stratified by the related variables (AU)

Introducción Los indicadores de calidad (IC) son esenciales para el adecuado control del proceso asistencial en el sistema sanitario, permitiendo el reconocimiento de áreas de mejora y proporcionando soluciones. Nuestro propósito ha sido evaluar los IC en el proceso asistencial integrado cáncer de mama (CM). Métodos Se estudiaron 487 casos consecutivos de CM diagnosticados desde noviembre de 2013 hasta 2019 en un área sanitaria de España y se estimaron los IC asociados. Resultados Cuatro indicadores no cumplieron los estándares de calidad y fueron analizados en función de las variables sociodemográficas posiblemente relacionadas. El retraso quirúrgico tras el comité multidisciplinar (media 64%, rango intercuartílico [IQR] 59,6-68,5) fue menor en pacientes más mayores (p=0,027), y en grados histológicos (p=0,019) y estadios (p=0,008) más tempranos. El retraso en el tratamiento adyuvante (media 55,7%, IQR 51,1-60,3) fue menor en estadios más avanzados (p=0,002) y cuando no hubo necesidad de rescisión (p=0,001). El retraso quirúrgico tras la inclusión en lista de espera (media 83,2%, IQR 79,3-87,2) fue menor en grados histológicos más tempranos (p=0,048). La reconstrucción inmediata (media 42,3%, IQR 34,0-50,5) se realizó en un 72,3% de las mujeres jóvenes comparado con tan solo un 11,8% de las mayores de 70 años (p=0,001) y fue mayor en estadios tempranos (45,3% vs. 36,2%; p=0,049). Conclusión El estudio de los IC evaluó su cumplimiento y analizó las variables que los influencian para proponer medidas que los mejoren. No todos los indicadores pudieron evaluarse de igual forma. Algunos dependieron de los recursos disponibles, otros del tipo de paciente y otros de los tratamientos complementarios. Sería necesario identificar las poblaciones diana para estimar los IC más adecuados o proporcionar estándares estratificados por las variables relacionadas (AU)

Quality indicators for the diagnosis and treatment of breast cancer integrated assistance: A critical appraisal.

INTRODUCTION: Quality indicators (QIs) are essential for adequate control of the health care management process, recognizing areas of improvement and providing solutions. We aimed to evaluate the Integrated Breast Cancer (BC) Care Process QIs. METHODS: We studied 487 consecutive BC cases diagnosed from November 1st, 2013, to November 30th, 2019, in a Spanish healthcare area, and we estimated the associated QIs. RESULTS: Four indicators did not meet the standards and were analysed based on related sociodemographic and clinical variables. The surgical delay after a multidisciplinary team discussion (mean 64%, IQR 59.6-68.5) was lower in elder people (p=0.027), and early histological grades (p=0.019) and stages (p=0.008). The adjuvant treatment delay (mean 55.7%, IQR 51.1-60.3) was lower in advance stages (p=0.002) and when there was no reoperation (p=0.001). The surgical delay after inclusion (mean 83.2%, IQR 79.3-87.2) was lower in early histological grades (p=0.048). The immediate reconstruction (mean 42.3%, IQR 34.0-50.5) reached 72.3% in young women compared to 11.8% in older than 70 years (p=0.001) and it was higher in early stages (45.3% vs 36.2%; p=0.049). CONCLUSION: The study of QIs evaluated their compliance and analysed the variables influencing them to propose improvement measures. Not all the indicators were equally valuable. Some depended on the available resources, and others on the mix of patients or complementary treatments. It would be essential to identify the specific target populations to estimate the indicators or provide standards stratified by the related variables.

A Study of Zn-Ca Nanocomposites and Their Antibacterial Properties.

This study aimed to develop Ca2+ doped ZnO nanoparticles (NPs) and investigate their antibacterial properties against microorganisms of dental interest. Zn-Ca NPs were synthesized by the sol-gel method with different concentrations of Ca2+ (1, 3, and 5 wt. %) and subsequently characterized by scanning electron microscopy (SEM), X-ray diffraction (XRD), UV-vis spectroscopy and Fourier transform infrared spectroscopy (FT-IR). The Kirby-Bauer method was used to measure antibacterial effects. NPs showed the wurzite phase of ZnO and bandgap energies (Eg) from 2.99 to 3.04 eV. SEM analysis showed an average particle size of 80 to 160 nm. The treatments that presented the best antibacterial activity were Zn-Ca 3% and Zn-Ca 5%. ZnO NPs represent an alternative to generate and improve materials with antibacterial capacity for dental applications.

Difteria: Experiencia en el servicio de enfermedades infecciosas del Hospital Universitario de Caracas

Difteria es una enfermedad infecciosa bacteriana producida por Corynebacterium diphtheriae, es altamente contagiosa, prevenible por vacunas, con importantes complicaciones agudas y alta mortalidad. Objetivo: Describir las características clínicoepidemiológicas y el manejo médico de los pacientes con diagnóstico de Difteria ingresados en el Servicio de Enfermedades Infecciosas del Adulto del Hospital Universitario de Caracas (HUC) en los años 2017 y 2018. Metodología: Estudio de casos, analítico, retrospectivo, de revisión de historias clínicas. Resultados: Ingresaron 27 pacientes de los cuales se encontraron 22 historias clínicas y se excluyeron 2. De los 20 pacientes 13 (65 %) ingresaron en el año 2017 y 7 (35 %) hasta mayo del 2018. Predominó el género masculino 11 (55 %). La mayoría eran procedentes del Distrito Capital 9 (45 %), seguido del estado Miranda 8 (40 %). El promedio de edad fue de 26 años. La mayoría 8 (40 %) no tenían reportes de datos epidemiológicos en la historia clínica, 7 (35 %) negaron viajes recientes, 3 (15 %) estaban vacunados. La mayoría de los pacientes consultaron por fiebre, odinia y odinofagia 13 (65 %), seguido de fiebre y odinia 6 (30 %), el 100 % tuvo membrana blanco grisácea como clínica primaria, seguido de edema de cuello 10 (50 %). La ubicación de las membranas fue más frecuente en amígdalas palatinas 15 (75 %), con 9 casos (45 %) de formas extensivas a úvula, paladar blando y paredes de orofaringe. Las complicaciones al ingreso fueron respiratorias 9 (45 %) y neurológicas 1 (5 %). El tratamiento fue penicilina cristalina en 12 casos (60 %) y antitoxina diftérica (ATD) en el 100 %, la mayoría administrada en las primeras 24 hrs 9 (45 %). Un paciente presentó polineuropatía y 1 falleció por insuficiencia respiratoria. Conclusiones: El HUC es un centro de referencia y es pertinente determinar las características clínico-epidemiológicas y el manejo médico de los pacientes hospitalizados con diagnóstico de difteria, en el contexto de la actual epidemia.

Diphtheria is a bacterial infectious disease caused by Corynebacterium diphtheriae, it is highly contagious, preventable by vaccines, with important acute complications and high mortality. Objective: To describe the clinical-epidemiological characteristics and medical management of patients diagnosed with Diphtheria admitted to the Adult Infectious Diseases Service of the Hospital Universitario de Caracas (HUC) in the years 2017 and 2018. Methodology: Case study, analytical , retrospective, review of medical records. Results: 27 patients were admitted, of which 22 clinical records were found and 2 were excluded. Of the 20 patients, 13 (65%) entered in 2017 and 7 (35%) up to May 2018. The male gender predominated 11 (55 %). Most were from Distrito Capital 9 (45%), followed by Miranda 8 (40%). The average age was 26 years. The majority 8 (40%) had no reports of epidemiological data in the clinical history, 7 (35%) denied recent trips, 3 (15%) were vaccinated. The majority of patients consulted for fever, odinia and odynophagia 13 (65%), followed by fever and odinia 6 (30%), 100% had grayish white membrane as primary clinic, followed by neck edema 10 (50%) . The location of the membranes was more frequent in palatine tonsils 15 (75%), with 9 cases (45%) of extensive forms to the uvula, soft palate and walls of the oropharynx. Complications at admission were respiratory 9 (45%) and neurological 1 (5%). The treatment was crystalline penicillin in 12 cases (60%) and diphtheria antitoxin (DAT) in 100%, the majority administered in the first 24 h 9 (45%). One patient presented polyneuropathy and 1 died due to respiratory failure. Conclusions: The HUC is a reference center and it is pertinent to determine the clinical-epidemiological characteristics and medical management of hospitalized patients diagnosed with diphtheria, in the context of the current epidemic.

The diabetes-tuberculosis co-epidemic: the role of international migration.

SETTING: A tuberculosis (TB) referral centre in Rome, Italy. OBJECTIVE: To identify demographic and epidemiological characteristics associated with diabetes mellitus (DM) among patients with TB and to compare the clinical presentation of TB and TB-DM in the light of the growing worldwide burden of DM. DESIGN: We performed a retrospective study of TB cases diagnosed from 2007 to 2012. RESULTS: Among 971 TB patients, 723 were foreign-born and 63 (6.5%) had DM. DM prevalence was 12.7% (8/63) among those born in countries with DM prevalence ⩾8%, 4.7% (31/660) among patients from countries with DM prevalence <8% and 9.7% among Italian patients (24/248). In multivariable analysis, DM was independently associated with older age, and with being born in countries other than Italy, compared to Italians; this latter association was stronger in older patients. DM patients were also significantly more likely to be male and less likely to test positive for the human immunodeficiency virus. The presence of cavities was significantly associated with DM. CONCLUSIONS: As individuals born in high TB incidence and high DM prevalence countries emerge as a vulnerable population, greater attention to bidirectional low-cost screening in people from these countries is needed.

Addressing barriers to the prevention, diagnosis and treatment of hepatitis B and C in the face of persisting fiscal constraints in Europe: report from a high level conference.

In the WHO-EURO region, around 28 million people are currently living with chronic viral hepatitis, and 120,000 people die every year because of it. Lack of awareness and understanding combined with the social stigma and discrimination exacerbate barriers related to access to prevention, diagnosis and treatment services for those most in need. In addition, the persisting economic crisis has impacted on public health spending, thus posing challenges on the sustainable investment in promotion, primary and secondary prevention, diagnosis and treatment of viral hepatitis across European countries. The Hepatitis B and C Public Policy Association in cooperation with the Hellenic Center for Disease Prevention and Control together with 10 partner organizations discussed at the Athens High Level Meeting held in June 2014 recent policy developments, persisting and emerging challenges related to the prevention and management of viral hepatitis and the need for a de minimis framework of urgent priorities for action, reflected in a Call to Action (Appendix S1). The discussion confirmed that persisting barriers do not allow the full realisation of the public health potential of diagnosing and preventing hepatitis B and C, treating hepatitis B and curing hepatitis C. Such barriers are related to (a) lack of evidence-based knowledge of hepatitis B and C, (b) limited access to prevention, diagnosis and treatment services with poor patient pathways, (c) declining resources and (d) the presence of social stigma and discrimination. The discussion also confirmed the emerging importance of fiscal constraints on the ability of policymakers to adequately address viral hepatitis challenges, particularly through increasing coverage of newer therapies. In Europe, it is critical that public policy bodies urgently agree on a conceptual framework for addressing the existing and emerging barriers to managing viral hepatitis. Such a framework would ensure all health systems share a common understanding of definitions and indicators and look to integrate their responses to manage policy spillovers in the most cost-effective manner, while forging wide partnerships to sustainably and successfully address viral hepatitis.

Two novel frameshift mutations in BRCA2 gene detected by next generation sequencing in a survey of Spanish patients of breast cancer

Purpose. To analyze BRCA1 and BRCA2 genes using a cost-effective and rapid approach based on next generation sequencing (NGS) technology. Methods. A population of Spanish cancer patients with a personal or familial history of breast and/or ovarian cancer was analyzed for germline mutations in BRCA1 and BRCA2 genes. The methodology relies on a 5 multiplex PCR assay coupled to NGS. Results. Ten pathogenic mutations (four in BRCA1 and six in BRCA2 gene) were identified in a Spanish population. The deletion c.1792delA, in exon 10, and the duplication c.5869dupA, in exon 11 of BRCA2 gene were not previously reported and should be considered as pathogenic due to its frameshift nature. Conclusion. Two novel frameshift mutations in BRCA2 gene were detected using the multiplex PCR-based assay following by NGS (AU)

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Two novel frameshift mutations in BRCA2 gene detected by next generation sequencing in a survey of Spanish patients of breast cancer.

PURPOSE: To analyze BRCA1 and BRCA2 genes using a cost-effective and rapid approach based on next generation sequencing (NGS) technology. METHODS: A population of Spanish cancer patients with a personal or familial history of breast and/or ovarian cancer was analyzed for germline mutations in BRCA1 and BRCA2 genes. The methodology relies on a 5 multiplex PCR assay coupled to NGS. RESULTS: Ten pathogenic mutations (four in BRCA1 and six in BRCA2 gene) were identified in a Spanish population. The deletion c.1792delA, in exon 10, and the duplication c.5869dupA, in exon 11 of BRCA2 gene were not previously reported and should be considered as pathogenic due to its frameshift nature. CONCLUSION: Two novel frameshift mutations in BRCA2 gene were detected using the multiplex PCR-based assay following by NGS.

Branched and bulky substituted ruthenium sensitizers for dye-sensitized solar cells.

We report on the synthesis, and photovoltaic performances of four novel Ru(ii)-bipyridine heteroleptic complexes TT206-209, incorporating branched and bulkier alkyl chains compared to their linear analogues C106 and CYC-B11 previously reported. In both series, we found that dyes containing 2-methyl-hex-2-yl substitution gave better performances than 1,1-dipropylbutyl. The best overall performance over the four dyes was obtained for TT207 (CYC-B11 analogue), which contains 2-methylhex-2-yl type substitution, achieving an overall PCE of 8.5%. Furthermore, the optimization of TT207/DSSCs, with respect to the dye-uptake solvent and electrolyte composition, led to a maximum PCE of 9.1% under AM1.5 G standard conditions.

[Sentinel node biopsy in patients with multifocal and multicentric breast cancer: A 5-year follow-up]. / Biopsia de ganglio centinela en pacientes con cáncer de mama multifocal y multicéntrico: 5 años de seguimiento.

OBJECTIVE: Sentinel lymph node biopsy (SLNB) as a staging procedure in multiple breast cancer is a controversial issue. We have aimed to evaluate the efficacy of sentinel node (SN) detection in patients with multifocal or multicentric breast cancer as well as the safety of its clinical application after a long follow-up. MATERIAL AND METHODS: A prospective descriptive study was performed. Eighty-nine patients diagnosed of multiple breast cancer (73 multifocal; 16 multicentric) underwent SLNB. These patients were compared to those with unifocal neoplasia. Periareolar radiocolloid administration was performed in most of the patients. Evaluation was made at an average of 67.2 months of follow-up (32-126 months). RESULTS: Scintigraphic and surgical SN localization in patients with multiple breast cancer were 95.5% and 92.1%, respectively. A higher percentage of extra-axillary nodes was observed than in the unifocal group (11.7% vs 5.4%) as well as a significantly higher number of SN per patient (1.70 vs 1.38). The rate of SN localization in multicentric cancer was slightly lower than in multifocal cancer (87.5% vs 93.1%), and the finding of extra-axillary drainages was higher (20% vs 10%). Number of SN per patient was significantly higher in multicentric breast cancer (2.33 vs 1.57). No axillary relapses have been demonstrated in the follow-up in multiple breast cancer patients group. CONCLUSIONS: SLNB performed by periareolar injection is a reliable and accurate staging procedure of patients with multiple breast cancer, including those with multicentric processes.

The state of hepatitis B and C in the Mediterranean and Balkan countries: report from a summit conference.

The burden of disease due to chronic viral hepatitis constitutes a global threat. In many Balkan and Mediterranean countries, the disease burden due to viral hepatitis remains largely unrecognized, including in high-risk groups and migrants, because of a lack of reliable epidemiological data, suggesting the need for better and targeted surveillance for public health gains. In many countries, the burden of chronic liver disease due to hepatitis B and C is increasing due to ageing of unvaccinated populations and migration, and a probable increase in drug injecting. Targeted vaccination strategies for hepatitis B virus (HBV) among risk groups and harm reduction interventions at adequate scale and coverage for injecting drug users are needed. Transmission of HBV and hepatitis C virus (HCV) in healthcare settings and a higher prevalence of HBV and HCV among recipients of blood and blood products in the Balkan and North African countries highlight the need to implement and monitor universal precautions in these settings and use voluntary, nonremunerated, repeat donors. Progress in drug discovery has improved outcomes of treatment for both HBV and HCV, although access is limited by the high costs of these drugs and resources available for health care. Egypt, with the highest burden of hepatitis C in the world, provides treatment through its National Control Strategy. Addressing the burden of viral hepatitis in the Balkan and Mediterranean regions will require national commitments in the form of strategic plans, financial and human resources, normative guidance and technical support from regional agencies and research.

Detection of novel genetic variation in autosomal dominant retinitis pigmentosa.

We explored an approach to detect disease-causing sequence variants in 448 candidate genes from five index cases of autosomal dominant retinitis pigmentosa (adRP) by sequence DNA capture and next-generation DNA sequencing (NGS). Detection of sequence variants was carried out by sequence capture NimbleGen and NGS in a SOLiD platform. After filtering out variants previously reported in genomic databases, novel potential adRP-causing variants were validated by dideoxy capillary electrophoresis (Sanger) sequencing and co-segregation in the families. A total of 55 novel sequence variants in the coding or splicing regions of adRP candidate genes were detected, 49 of which were confirmed by Sanger sequencing. Segregation of these variants in the corresponding adRP families showed three variants present in all the RP-affected members of the family. A novel mutation, p.L270R in IMPDH1, was found to be disease causing in one family. In another family a variant, p.M96T in the NRL gene was detected; this variant was previously reported as probably causing adRP. However, the previously reported p.A76V mutation in NRL as a cause of RP was excluded by co-segregation in the family. We discuss the benefits and limitations of our approach in the context of mutation detection in adRP patients.

Low serum uric acid concentration in Parkinson's disease in southern Spain.

BACKGROUND AND PURPOSE: Uric acid (UA) is thought to have an antioxidant effect on the central nervous system and may also prevent cerebral damage induced by oxidative stress. Our study aimed to investigate whether patients with Parkinson's disease (PD) had lower serum UA concentrations than controls and whether UA concentration was related to clinical parameters of the disease. METHODS: We included 161 patients with PD and 178 controls from southern Spain. UA concentration was compared between these two groups. Clinical parameters including severity of the disease were related to serum UA. RESULTS: Patients with PD showed statistically significant lower serum UA concentrations than controls. Serum UA concentration was lower in patients with PD in severe stages (4 and 5) than in those in moderate stage (2) according to the modified Hoehn and Yahr scale. Other clinical parameters were not related to serum UA concentration, except for levodopa equivalent daily dose that was associated with lower serum UA concentration in men. CONCLUSIONS: Our study produced consistent findings that UA might have a protective effect against PD and could influence its clinical progression.

The life cycle and geographical distribution of the monorchiid Proctotrema bartolii (Digenea) in the clam Darina solenoides from the Patagonian coast, Argentina.

The life cycle of Proctotrema bartolii Carballo, Laurenti & Cremonte 2011 (Digenea: Monorchiidae) at Fracasso Beach (the type locality) (42°25'S, 64°07'W), Península Valdés, Argentina, was investigated. This digenean uses the clam Darina solenoides (Mactridae) as both the first and second intermediate hosts in the natural environment. The metacercariae were located mainly at the tip of the incurrent siphon, with an infection prevalence of 100%. Experimental infections in other macroinvertebrates, such as the clam Tellina petitiana and the polychaete Glycera americana, were successful, but these and other invertebrates are not naturally infected. Silversides Odontesthes smitti and Odontesthes nigricans (Pisces: Atherinopsidae) and the mullet Eleginops maclovinus (Eleginopidae) act as the definitive hosts of both experimentally and naturally obtained adults. Fish acquire infection by eating either the siphon or the entire clam. Proctotrema bartolii seems to be endemic to the Magellan Region and is distributed where its intermediate clam host is present, from the San José Gulf in Península Valdés to the southern tip of South America.

Antiproliferative and immunoactivatory ability of an enzymatic extract from rice bran.

The validation of natural products as source of functional foods or nutraceuticals has become an important issue in current health research. Thus, the present work has tested on MOLT-4 cells (human T cell acute lymphoblastic leukemic) the antiproliferative effect of a water-soluble enzymatic extract from rice bran (EERB). Present work shows that EERB induces cellular death in MOLT-4 cells in a dose-dependent way (0-10mg/mL) but not in non-tumoral lymphocytes. Flow cytometric analysis of MOLT-4 cells treated with EERB showed the presence of death cells by apoptosis rather than necrosis. Additionally, EERB also exerts an immunoactivatory effect on N13 microglia cells, by inducing TNF-alpha (tumour necrosis factor-α) expression, which plays a key role in the innate immune response to infection. Accordingly, we can propose EERB as a useful natural standardized extract with antiproliferative and immunoactivatory ability that would be beneficial to apply in the functional food field.

Relevance of breast cancer subtypes for magnetic resonance imaging response monitoring during neoadjuvant chemotherapy

Changes in magnetic resonance imaging (MRI) during neoadjuvant chemotherapy (NAC) have been reported as predictive of pathology outcome in triple-negative and HER2-positive breast cancer. The purpose of our study was to evaluate the relevance of breast cancer subtype for MRI response in 24 women before and during NAC in our centre. Our results show that a reduction greater than 23% is associated with a pathological complete response (pCR) in Her-2-positive and ER-negative/Her2-negative breast cancer, and suggest a trend correlation between higher ADC values and pCR in these subtypes in comparison with ER-positive/Her2-negative breast cancers. Higher proliferating tumours respond better to chemotherapy and our study suggests that changes in MRI during NAC are predictive of pCR in these breast cancer subtypes (AU)

Similarity in parasite community structure may be used to trace latitudinal migrations of Odontesthes smitti along Argentinean coasts.

The aims of this study were to determine the existence of migratory movements and to identify ecological stocks of the silverside Odontesthes smitti along its distribution in the Southern Atlantic Ocean, using metazoan parasites as biological tags. Samples were obtained from San José Gulf (SJ) (42° 25' S; 64° 07' W) and Nuevo Gulf (NG) (42° 47' S; 65° 02' W) in north Patagonia during winter and summer and in waters off Mar del Plata (MDP) (38° 03' S; 57° 32' W), Bonaerense region, during winter. Fifteen parasite species were collected. Multivariate statistical procedures on parasite community data showed strong effect of host size on the structure of parasite assemblages. Taking into account the variations among samples due to host size, the differential structure of parasite communities between SJ and NG suggests that fish inhabiting these localities could belong to different ecological stocks. Fish from MDP and SJ caught in summer showed similar composition in their parasite assemblages, which is congruent with a migratory cycle that implies that fish caught in MDP during winter inhabit SJ during summer. Further evidence of the Patagonian origin of MDP O. smitti is the presence of the digenean Proctotrema bartolii in fish from both regions. Proctotrema bartolii is acquired by O. smitti only in the Magellanic province, where its intermediate host, Darina solenoides, is distributed. The analyses suggest that O. smitti inhabiting north Patagonian gulfs could belong to different ecological stocks and that O. smitti caught in MDP could have come from SJ.