From guidelines to real world: results from the National Multiple Myeloma Registry in Uruguay on 222 newly diagnosed multiple myeloma patients from 2012 to 2015.

Introduction: In the last decade, substantial improvements in the understanding of the biology of multiple myeloma and the development of novel therapeutic options have led to increased response rates, progression free survival and overall survival. In underdeveloped countries, it is a huge challenge to adapt for this evolution, both in diagnostic and therapeutic aspects. Methods: We conducted a retrospective, national analysis of all patients with newly diagnosed multiple myeloma in a recent period. Diagnostic and prognostic evaluation is carried out according to international recommendations in the majority of patients. Results: The clinical presentation at diagnosis is similar to those reported internationally, although with higher rates of anemia and severe renal failure. Most patients were diagnosed in advanced Durie-Salmon stage (80%), with high ISS score (48% ISS 3). Treatment, both in candidates and non-candidates for transplantation, is conditioned by a limited supply of possibilities, scarce availability of new drugs and absence of clinical trials. This determines lower results in response depth and survival. At 32 months, overall survival was 61.8%, with a statistical difference in favor of younger patients, standard-risk MM and those treated with novel drugs. No patient received antibacterial or antifungal prophylaxis while the majority received adequate antiviral prophylaxis. Infections were the main cause of death (29.7%), overcoming the disease itself. Conclusions: This analysis allows us to raise awareness about strengths and weaknesses in our management of MM patients. There is a need to promote earlier detection, improve supportive care and reduce infection mortality. Greater availability of evidence-based recommended treatment options is required. Access to clinical trials is warranted if care is to be improved.

Uso de cannabis en médicos de un hospital público de Uruguay / Use of cannabis in physicians of a public hospital of Uruguay

Antecedentes y objetivos. En Uruguay el consumo de cannabis es legal desde 1974, y proporciona un importante contexto permitiendo evaluar prevalencia y actitudes en un régimen legislativo liberal. Los médicos son fuente para el asesoramiento sobre el consumo de cannabis, por lo cual es importante saber en qué medida el consumo personal puede afectar al mismo. Este estudio tuvo como objetivo evaluar la prevalencia de consumo de cannabis en médicos de un hospital. Métodos. Se realizó un estudio transversal con 140 médicos de un hospital público (tasa de respuesta del 100%). El autocuestionario anónimo incluyó: consumo de cannabis, tabaco, ansiedad, depresión formación recibida para abordaje de pacientes, creencias acerca de nocividad y características sociodemográficas. Resultados. Consumieron alguna vez 41,5%, en último año 13,6% y en último mes 2,1%. No hubo consumidores diarios. En una regresión logística multivariable, el uso en el último año se asoció significativamente con el consumo de tabaco (OR ajustada = 4,31; IC de 95% = 1,22 a 15,20) y la edad (OR ajustada = 0,90; IC de 95% = 0,81-0,99); 96,3% informó que creían que el consumo de cannabis es perjudicial para la salud; 41,9% informó haber recibido formación para abordar el consumo de cannabis en pacientes. Conclusiones. El consumo de cannabis ocasional en médicos en Uruguay, un país en el que el uso es legal desde hace más de 40 años, puede ser relativamente común y ligado al consumo de tabaco, a pesar de la aceptación casi universal de que es perjudicial. El uso diario parece ser poco común (AU)

Backgrounds and objectives. In Uruguay cannabis consumption has been legal since 1974, and provides an important context that makes it possible to evaluate prevalence and attitudes in a liberal legislative regime. Physicians are the source for counseling on cannabis consumption, so that it is important to know how much personal consumption may affect it. This study aimed to evaluate prevalence of cannabis consumption in physicians of one hospital. Methods. A cross-sectional study was performed with 140 physicians of a public hospital (response rate: 100%). The anonymous self-questionnaire included: cannabis consumption, smoking, anxiety, depression training received to approach patients, beliefs on harmfulness and sociodemographic characteristics. Results. A total of 41.5% had used cannabis at some time, 13.6% in the last year and 2.1% in the last month. There were no daily consumers. In a multivariable logistic regression, use in the last year was significantly associated with smoking (adjusted OR = 4.31; 95% CI = 1.22 to 15.20) and age (adjusted OR = 0.90; 95% CI = 0.81-0.99); 96.3% reported that they believed cannabis consumption is harmful for health; 41.9% stated they had received training to approach cannabis consumption in patients. Conclusions. Occasional cannabis consumption in physicians in Uruguay, a country where its use has been legal for more than 40 years, may be relatively common and linked to smoking habit, even though there is almost universal acceptance that it is harmful. Daily use seems to be uncommon (AU)