The genomic profiling of high-risk smoldering myeloma patients treated with an intensive strategy unveils potential markers of resistance and progression.

Smoldering multiple myeloma (SMM) precedes multiple myeloma (MM). The risk of progression of SMM patients is not uniform, thus different progression-risk models have been developed, although they are mainly based on clinical parameters. Recently, genomic predictors of progression have been defined for untreated SMM. However, the usefulness of such markers in the context of clinical trials evaluating upfront treatment in high-risk SMM (HR SMM) has not been explored yet, precluding the identification of baseline genomic alterations leading to drug resistance. For this reason, we carried out next-generation sequencing and fluorescent in-situ hybridization studies on 57 HR and ultra-high risk (UHR) SMM patients treated in the phase II GEM-CESAR clinical trial (NCT02415413). DIS3, FAM46C, and FGFR3 mutations, as well as t(4;14) and 1q alterations, were enriched in HR SMM. TRAF3 mutations were specifically associated with UHR SMM but identified cases with improved outcomes. Importantly, novel potential predictors of treatment resistance were identified: NRAS mutations and the co-occurrence of t(4;14) plus FGFR3 mutations were associated with an increased risk of biological progression. In conclusion, we have carried out for the first time a molecular characterization of HR SMM patients treated with an intensive regimen, identifying genomic predictors of poor outcomes in this setting.

Prediction of 30-day unplanned hospital readmission through survival analysis.

Background and Objective: Unplanned hospital readmissions are a severe and recurrent problem that affects all health systems. Estimating the risk of being readmitted the following days after discharge is difficult since many heterogeneous factors can influence this. The extensive work concerning this problem proposes solutions mostly based on classification machine-learning models. Survival analysis methods could make a better match with the assessment of readmission risk and are yet to become well-established in this field. Methods: We compare different statistical and machine learning survival analysis models trained with right-censored all-cause hospital admission data with covariates available at the moment of discharge. The main focus is on tree-ensemble regression methods based on the assumption of proportional hazards. These models are more thoroughly evaluated at a 30-day time period after discharge, although the actual prediction could be set to any time up to 90 days. Results: The mean performance obtained by each of the proposed survival models ranges from 0.707 to 0.716 C-Index and 0.709 to 0.72 ROC-AUC at a 30-day time period after discharge. The model with the lower performance on both metrics was Cox Proportional Hazards, while the model marking the upper end on both ranges is an XGBoost Regression model with a Cox objective function. Conclusions: Our findings indicate that survival models perform well addressing the hospital readmission problem, machine-learning models getting the edge over statistical methods. There seems to be an improvement over classification models when attempting to predict at a 30-day period since discharge, perhaps due to a better handling of cases nearing the 30-day boundary. Some preprocessing steps, such as limiting the observation period to 90 days after discharge, are also highlighted since they resulted in a performance boost.

Evolución y calidad de vida a los tres meses tras hospitalización por neumonía COVID / Evolution and quality of life at three months after hospitalization for COVID pneumonia

Objetivo: Conocer la evolución y calidad de vida relacionada con la salud a los tres meses del alta, en pacientes que fueron hospitalizados en el hospital de Fuenlabrada con diagnóstico de neumonía por COVID-19, valorados por el Servicio de Rehabilitación y que realizaron fisioterapia. Métodos: Se recogen datos de 59 pacientes, diferenciando los que fueron valorados en UCI (41 pacientes), de los valorados en planta de hospitalización (18). Los datos se toman de su historia clínica electrónica, y se realiza una entrevista telefónica tres meses después del alta hospitalaria. Se analizan datos de su evolución durante hospitalización, tras el alta y durante los meses siguientes, y de su situación en el momento de la entrevista. Se pide a los pacientes una valoración de la fisioterapia recibida y que contesten el cuestionario de calidad de vida relacionado con la salud SF-36. Resultados: Estos pacientes han tenido la peor evolución de su neumonía COVID de entre los ingresados en nuestro hospital, pero tuvieron una buena recuperación funcional con la fisioterapia intrahospitalaria recibida, la cual fue valorada muy positivamente por los pacientes. Después de tres meses, el 84% tienen síntomas persistentes, siendo los más frecuentes disnea, cansancio y depresión/ansiedad, y tienen peores puntuaciones en SF-36 que la población de referencia. Conclusiones: La mayoría de los pacientes que requieren rehabilitación durante su hospitalización por neumonía COVID-19, tienen síntomas persistentes y perciben un deterioro de su calidad de vida relacionada con la salud, tras tres meses del alta hospitalaria.(AU)

Objective: Assess clinical evolution and health-related quality of life at three months after discharge in patients who were admitted and diagnosed with COVID-19 pneumonia, evaluated by the Rehabilitation Service and received physiotherapy in Fuenlabrada Hospital. Methods: Data were collected from 59 patients, separating those who were assessed in ICU (41 patients) from those assessed in the hospital ward (18). Data were obtained from their Electronic Medical Record, and a telephone interview was performed three months after their discharge. Data about their clinical progress during their hospitalization, after discharge, over the next months and their condition at the time of the interview is analyzed. Patients were asked to assess the quality of the physiotherapy received and to answer the SF-36 health-related quality of life questionnaire. Results: These patients had the worst progress of the COVID pneumonia among all patients hospitalized in our hospital, but they had a good functional recovery with the inpatient physiotherapy received, which was positively rated. After three months, 84% have persistent symptoms, with the most common being dyspnoea, fatigue and anxiety/depression, and score worse in the SF-36 questionnaire than the reference population. Conclusions: Most patients who require rehabilitation during their COVID pneumonia admission have persistent symptoms and perceive a deterioration in their health-related quality of life after three months of discharge.(AU)

¿Puede el uso de enjuagues bucales con cloruro de cetilpiridinio reducir la transmisión del SARS-CoV-2? / Can the use of cetylpyridinium chloride mouthwashes reduce the transmission of SARS-CoV-2?

Los pacientes confirmados de COVID-19 presentan una elevada carga viral en la cavidad oral. Por ello, desde los comienzos de la pandemia, la comunidad científica puso el punto de mira en los enjuagues bucales formulados con antisépticos como el cloruro de cetilpiridinio (CPC) para reducir el riesgo de contagio entre la población, que incluso llegaron a recomendarse en la práctica clínica y dental sin conocerse su eficacia real. El objetivo de este artículo es revisar aquellos estudios in vitro y ensayos clínicos que han evaluado de forma rigurosa la aplicación de estos colutorios de uso diario para determinar su actividad inhibitoria frente al SARS-CoV-2 en la saliva, y conocer la correlación de los estudios entre las condiciones experimentales y las que ocurren en la cavidad bucal de los pacientes. (AU)

Comprende el medicamento/descubre al farmacéutico. D269: F274 Presentación en Consejería de educación / Understand the medicine/discover the pharmacist. D269: F274 Presentation at Consejería de educación

OBJETIVOS: Evaluar la diferencia de aprendizaje de las nociones básicas del uso adecuado del medicamento entre estudiantes de 1ºbachillerato y 4ºESO. Impartir las intervenciones educativas (IE) como una actividad complementaria en el programa educativo para inculcar buenos hábitos desde la adolescencia con la finalidad de conseguir un uso responsable del medicamento a medio y largo plazo. Evaluar el grado de satisfacción con la actividad educativa de estudiantes y docentes.Material Y Métodos: estudio observacional descriptivo, transversal, prospectivo, multicéntrico, centrado en una muestra de estudiantes de 1ºbachillerato y 4ºESO de las tres provincias aragonesas durante 2021/2022. La actividad educativa fue impartida en dos sesiones. Después de cada IE los estudiantes resolvieron cinco ejercicios en la plataforma del proyecto. En la segunda, además rellenaron una encuesta de satisfacción. Al personal docente se pasó la encuesta de satisfacción vía email. RESULTADOS/DISCUSIÓN: a fecha 11/03/2022, participaron 21 centros, 19 Zaragoza, 1 Huesca y 1 Teruel. Participaron 1.244 estudiantes, 740 1ºbach. y 504 4ºESO. Colaboraron 36 farmacéuticos comunitarios (FC) impartiendo la IE en 47 aulas, 27_1ºbach, 20_4ºESO. De media 2,2(1-8) aulas por centro. El porcentaje global de aciertos en los ejercicios resultó 52,15%(DE:9.66). Por cursos, 1ºbach_54,95%(DE:9.06), 4ºESO_48,17%(DE:9.29). El análisis de los resultados señaló diferencias significativas (t-Student p=0.02) entre ambos cursos. En cuanto a la satisfacción con la IE, el 91,8% de los estudiantes consideró la IE interesante/muy interesante, y el 100% del personal docente que envió la encuesta se mostró satisfecho/muy satisfecho, considerando cursos idóneos para impartir la actividad, 1ºbach_100% y 4ºESO_91,7%. (AU)

Pérdida de peso y mejora de perfil lipídico tras consejo nutricional por farmacéutico comunitario. A propósito de un caso / Weight loss and improvement of lipid profile after nutritional advice by community pharmacist. A case report

PRESENTACIÓN DEL CASO/ANTECEDENTES: paciente varón de 78 años que acude en marzo de 2021 a la farmacia comunitaria solicitando ayuda para la pérdida de peso. Situación inicial: IMC=32,8 kg/m 2; PAS/PAD/FC: 143/77/56; Ct/cHDL/cLDL/TG (mg/dl): 164/48/87/144. En tratamiento con amlodipino 5mg (1-0-0); Simvastatina 20mg (0-0-1); ácido fólico (1-0-0).EVALUACIÓN: se pautaron visitas semanales, durante el primer mes, y quincenales los meses siguientes en las que se dio consejo nutricional basado en la dieta mediterránea y de actividad física. Las consultas se realizaron en la zona de atención personalizada (ZAP) donde se hizo seguimiento del peso, bioimpedancia con porcentaje de grasa corporal, porcentaje de masa muscular, y presión arterial.RESULTADO/SEGUIMIENTO: tras ocho meses de seguimiento el paciente perdió un total de 15,100 Kg disminuyendo el IMC a 28,1 Kg/m2 y pasando de obesidad a sobrepeso según la clasificación de la Organización Mundial de la Salud (OMS). Se produjo una mejora de los resultados de bioimpedancia pasando de un porcentaje inicial de grasa corporal de 32,4% a un 27,9%, mientras que el porcentaje de masa muscular aumentó desde un 28,3% inicial a un 30,1%. Los valores de PAS/PAD/FC en noviembre de 2011 son de 121/70/53 y los de Ct/cHDL/cLDL/TG (mg/dl):151/51/84/86.COMENTARIO FINAL/CONCLUSIONES: el farmacéutico comunitario por sus conocimientos, profesionalidad y cercanía al paciente contribuye a la instauración de un estilo de vida más saludable de los pacientes con la consiguiente mejora de la salud de los mismos. (AU)

Instauración del Servicio de realización de test de antígeno para la emisión de certificados oficiales por Farmacia Comunitaria en Zaragoza / Establishment of the antigen testing service for the issuing of official certificates by the Community Pharmacy in Zaragoza

JUSTIFICACIÓN: dentro del marco de la pandemia por SARS-CoV-2 y con fecha 3 de agosto de 2021 se firmó una “acuerdo de colaboración entre el Departamento de Sanidad del Gobierno de Aragón para la trazabilidad y el correcto seguimiento de la información derivada de la realización de test de antígenos de SAR_CoV-2 (test de autodiagnóstico de venta libre en Farmacia y test de diagnóstico profesional)” por el cual se autorizaba a las Farmacias Comunitarias de Aragón a la realización de dichos test y la emisión de certificados oficiales.OBJETIVOS: describir el modus operandi para instaurar el Servicio de realización de test de antígeno para la emisión de certificados oficiales por una Farmacia Comunitaria en Zaragoza.MATERIAL Y MÉTODOS: los farmacéuticos comunitarios que iban a realizar el servicio se formaron mediante cursos disponibles en www.campussefac.org y se aclararon dudas con farmacéuticos que habían realizado test de antígeno de diagnóstico con toma nasofaríngea en Madrid y Cataluña. Se adquirió material necesario para la realización del servicio: test de diagnóstico/autodiagnóstico autorizados; batas desechables impermeables con puños ajustables; guantes; mascarillas FFP2/FFP3; pantalla protectora; gorro; material para la desinfección de superficies. Se destinó una zona de atención personalizada ventilada .Para obtener la acreditación se presentó en el Colegio Oficial de Farmacéuticos de Zaragoza una declaración responsable mediante la que se asegura que se dispone material necesario y personal cualificado y se preparó el PNT, así como una hoja de registro donde conservar un listado de los resultados. Los test se realizaron con cita previa. (AU)

[Evolution and quality of life at three months after hospitalization for COVID pneumonia]. / Evolución y calidad de vida a los tres meses tras hospitalización por neumonía COVID.

OBJECTIVE: Assess clinical evolution and health-related quality of life at three months after discharge in patients who were admitted and diagnosed with COVID-19 pneumonia, evaluated by the Rehabilitation Service and received physiotherapy in Fuenlabrada Hospital. METHODS: Data were collected from 59 patients, separating those who were assessed in ICU (41 patients) from those assessed in the hospital ward (18). Data were obtained from their Electronic Medical Record, and a telephone interview was performed three months after their discharge. Data about their clinical progress during their hospitalization, after discharge, over the next months and their condition at the time of the interview is analyzed. Patients were asked to assess the quality of the physiotherapy received and to answer the SF-36 health-related quality of life questionnaire. RESULTS: These patients had the worst progress of the COVID pneumonia among all patients hospitalized in our hospital, but they had a good functional recovery with the inpatient physiotherapy received, which was positively rated. After three months, 84% have persistent symptoms, with the most common being dyspnoea, fatigue and anxiety/depression, and score worse in the SF-36 questionnaire than the reference population. CONCLUSIONS: Most patients who require rehabilitation during their COVID pneumonia admission have persistent symptoms and perceive a deterioration in their health-related quality of life after three months of discharge.

Chronic rhinosinusitis is associated with prolonged SARS-CoV-2 RNA shedding in upper respiratory tract samples: A case-control study.

BACKGROUND: SARS-CoV-2, the COVID-19 causative agent, has infected millions of people and killed over 1.6 million worldwide. A small percentage of cases persist with prolonged positive RT-PCR on nasopharyngeal swabs. The aim of this study was to determine risk factors for prolonged viral shedding amongst patient's basal clinical conditions. METHODS: We have evaluated all 513 patients attended in our hospital between 1 March and 1 July. We have selected all 18 patients with prolonged viral shedding and compared them with 36 sex-matched randomly selected controls. Demographic, treatment and clinical data were systematically collected. RESULTS: Global median duration of viral clearance was 25.5 days (n = 54; IQR, 22-39.3 days), 48.5 days in cases (IQR 38.7-54.9 days) and 23 days in controls (IQR 20.2-25.7), respectively. There were not observed differences in demographic, symptoms or treatment data between groups. Chronic rhinosinusitis and atopy were more common in patients with prolonged viral shedding (67%) compared with controls (11% and 25% respectively) (P < 0.001 and P = 0.003). The use of inhaled corticosteroids was also more frequent in case group (P = 0.007). Multivariate analysis indicated that CRS (odds ratio [OR], 18.78; 95% confidence interval [95%CI], 3.89-90.59; P < 0.001) was independently associated with prolonged SARS-CoV-2 RNA shedding in URT samples, after adjusting for initial PCR Ct values. CONCLUSION: We found that chronic rhinosinusitis and atopy might be associated with increased risk of prolonged viral shedding. If confirmed in prospective trials, this finding might have clinical implications for quarantine duration due to increased risk of pandemic spread.

Results of a self-management program added to standard physical therapy in chronic neck pain.

OBJECTIVE: To evaluate the effectiveness of a self-management treatment added to a physical therapy program compared to a physical therapy program in patients with chronic neck pain. METHODS: Fifty-three patients with chronic neck pain were randomly allocated to a physical therapy intervention (control group) or an individualized self-management combined with physical therapy intervention (experimental group). Both interventions were developed over a four-week period. Outcome measures included were Disability, Fear-Avoidance Beliefs, Health-Related Quality of Life, Pain, and Anxiety and Depression. All outcomes were measured before and after the treatment and at three-month follow-up. RESULTS: There were not significant differences between groups at baseline. After the intervention both groups obtained better results in the Neck Disability Index but there were not significant differences between them (p > 0.05). At follow-up, the self-management group obtained significant better results compared to the control group (95 % CI: -5.20(-6.8 to -1.5), p = 0.032). CONCLUSIONS: An individualized self-management program added to a physical therapy program led to a greater improvement in disability at 3 months follow up compared to a physical therapy program alone. Catastrophizing, pain, and health-related quality of life improved significantly after the intervention and at follow-up compared to the standard care alone. PRACTICAL IMPLICATIONS: This study indicates that physical therapy for patients with chronic neck pain preferably should include self-management education.

Hemoperitoneo espontáneo masivo en paciente puérpera afecta de neurofibromatosis tipo 1 / Massive spontaneous haemoperitoneum in a post-partum patient with neurofibromatosis type 1

La neurofibromatosis tipo 1 o enfermedad de von Recklinghausen es una enfermedad genética, progresiva y multisistémica que afecta predominantemente a la piel y el sistema nervioso. La alteración vascular es poco frecuente pero puede tener resultados catastróficos. Las pacientes gestantes afectas de esta enfermedad necesitan un seguimiento exhaustivo y multidisciplinar con el objetivo de controlar las posibles alteraciones vasculares sobre todo renales por ser las más frecuentes. Presentamos el caso de una paciente diagnosticada de NF-1 que presentó un hemoperitoneo masivo espontáneo en el postoperatorio tardío de una cesárea electiva. El sangrado espontáneo de grandes vasos es una rara pero potencial complicación letal que puede producirse en pacientes afectos de neurofibromatosis I y que puede precisar de tratamiento quirúrgico urgente

Neurofibromatosis type 1 (NF-1) or von Recklinghausen's disease is a genetic, progressive, multi-system disease that predominantly affects the skin and nervous system. Vascular involvement is rare, but can have catastrophic results. Pregnant patients with this disease need careful, multidisciplinary follow up in order to control possible vascular alterations, which usually affect the kidneys. We present the case of a patient diagnosed with NF-1 who debuted with massive spontaneous hemoperitoneum in the late postoperative period of an elective Cesarean section. Spontaneous bleeding from large vessels is a rare but potentially lethal complication that can occur in patients with NF-1, and may require urgent surgical treatment

Massive spontaneous haemoperitoneum in a post-partum patient with neurofibromatosis type 1. / Hemoperitoneo espontáneo masivo en paciente puérpera afecta de neurofibromatosis tipo 1.

Neurofibromatosis type 1 (NF-1) or von Recklinghausen's disease is a genetic, progressive, multi-system disease that predominantly affects the skin and nervous system. Vascular involvement is rare, but can have catastrophic results. Pregnant patients with this disease need careful, multidisciplinary follow up in order to control possible vascular alterations, which usually affect the kidneys. We present the case of a patient diagnosed with NF-1 who debuted with massive spontaneous hemoperitoneum in the late postoperative period of an elective Cesarean section. Spontaneous bleeding from large vessels is a rare but potentially lethal complication that can occur in patients with NF-1, and may require urgent surgical treatment.

Malposición del tubo endotraqueal en paciente con traumatismo facial / Malposition of the endotracheal tube in patient with facial trauma

No disponible

Efficacy of bortezomib to intensify the conditioning regimen and the graft-versus-host disease prophylaxis for high-risk myeloma patients undergoing transplantation.

This multicenter phase I trial was designed to evaluate the safety and efficacy of bortezomib (Bz) as part of both the conditioning regimen and the graft-versus-host disease (GvHD) prophylaxis. Patients received fludarabine, melphalan and Bz (days -9 and -2). GVHD prophylaxis consisted of Bz (days +1, +4, and +7), sirolimus (Siro) from day -5 and tacrolimus (Tk) from -3 (except the first five patients that did not receive Tk). Twenty-five patients with poor prognostic multiple myeloma were included. Eleven out of the 19 patients had high-risk features. Out of the 21 patients evaluable at day +100, 14 were in CR (67%) and 7 (33%) in PR. Cumulative incidence (CI) of nonrelapse mortality at 1 year was 24%. CI of grades 2-4 and 3-4 acute GvHD was 35% and 10%, respectively; CI of chronic GvHD was 35% and 55% at 1 and 2 years, respectively. Overall and event free survival at 2 years were 64% and 31%, respectively. Bz as part of the conditioning regimen and in the combination with Siro/tacrolimus for GvHD prophylaxis is safe and effective allowing an optimal disease control early after transplant and reducing the risk of GvHD.

Drug Challenge Tests With General Anesthetics: Predictive Value of Skin Tests.

BACKGROUND: The study of perioperative drug reactions remains a major challenge for both diagnosis and therapy. The lack of a standard assessment of allergy to general anesthetics and of data establishing the true value of skin tests for most drugs used in induction and maintenance of anesthesia, as well as the lack of commercially available reagents for in vitro tests, renders the study of these reactions problematic. The aims of this study were to provide a diagnostic protocol for drug challenge testing with general anesthetics, to establish an etiological diagnosis that is as specific as possible, and to determine the predictive value of skin tests. METHODS: Twenty-nine patients with perioperative drug reactions were included in the study from November 2008 to December 2018. RESULTS: We confirmed the high negative predictive value of the tests (96%-100%) in the case of propofol, rocuronium, and fentanyl. To our knowledge, this is the first study to describe drug challenge testing with general anesthetics and, therefore, to establish the true negative predictive value of skin tests, which leads to a definitive diagnosis and safer surgery. CONCLUSIONS: After assessing risks and benefits and considering the importance of this group of drugs, we conclude that drug challenge testing with general anesthetics is necessary. We propose a protocol for perioperative drug reactions that enables us to make a highly accurate etiological diagnosis with minimum risk for the patient.