Stereotactic body radiation therapy for adrenal gland metastases: A multi-institutional outcome analysis.

Aim: The adrenal gland is a common site of metastasis with a rate of up to 27% in autopsy series. The incidence of these metastases is increasing due to greater use of Positron Emission Tomography scans and improved overall survival of patients with metastatic cancers. Stereotactic body radiation therapy (SBRT) is a non-invasive treatment option for metastasis. The aim of this study is to assess prognostic factors influencing local control, progression-free and overall survival in oligometastatic patients treated with SBRT for an adrenal metastasis. Methods: In this multicentric retrospective study, we included patients with adrenal metastases treated with SBRT between 2010 and 2021 in eleven french centers. All primary tumors were included. Results: A total of 110 patients treated for 121 adrenal lesions were included. Non-small-cell lung cancer was the predominant histologic type (55.4 %). Eighty-two percent of patients had at least 2 metastatic sites. The median Planning Target Volume was 70 cm3 with a median prescription dose of 40 Gray (Gy). The mean Biologically Effective Dose (BED) 10 dose was 74.2 Gy. Local control at 1 and 2 years was 85.9 % and 72.5 % respectively. The median overall survival and progression-free survival were 31.6 and 8.5 months respectively. Local control was significantly improved by systemic treatment one month before or after SBRT (p = 0.009) and by a BED10 greater than or equal to 50 Gy (p = 0.003).In multivariate analysis, oligometastatic presentation (p = 0.009) and a metachronous metastatic presentation (p = 0.008) were independent factors for progression-free survival.Tolerance was excellent, no grade 3 and 4 toxicities were described due to SBRT. Conclusion: Stereotactic radiotherapy of adrenal metastases makes possible a local control of more than 85% at one year and was well tolerated. The factors influencing survival in oligometastatic patients still need to be found in order to better select those who benefit the most from this type of treatment.

Las emergencias extrahospitalarias ante la cultura de seguridad / Out of hospital emergencies towards a safety culture

Objetivos. Estudiar el grado de cultura de seguridad (CS) de los profesionales en el ámbito de un servicio de urgencias extrahospitalarias. Analizar las dimensiones que reciben puntuaciones inferiores, con el fin de establecer futuras estrategias de actuación. Material y métodos. Estudio observacional, descriptivo, transversal en el que se distribuyó el cuestionario de la Agency for Healthcare Research and Quality (AHRQ) al universo muestral de los profesionales sanitarios que trabajan en las unidades de soporte vital avanzado del 061 de Aragón, durante el mes de agosto de 2013. Resultados. Se analizaron 80 cuestionarios (tasa de respuesta 55,55%). Principales fortalezas: adecuada dotación de personal (96%), buen clima laboral (89%), apoyo de superiores inmediatos (77%), trabajo en equipo (74%) y ambiente no punitivo hacia los eventos adversos (68%). Áreas de mejora: insuficiente formación en seguridad del paciente (53%), ausencia de feedback (50%). Conclusiones. Las oportunidades de mejora detectadas se centran en la formación de los profesionales, con el fin de procurar una asistencia más segura, extendiendo al mismo tiempo la cultura de seguridad. Así mismo se considera necesaria la puesta en marcha de un sistema de notificación y registro de eventos adversos en nuestro servicio (AU)

Objectives. The aim of this study is to measure the degree of safety culture (CS) among healthcare professional workers of an out-of-hospital Emergency Medical Service. Most patient safety studies have been conducted in relation to the hospital rather than pre-hospital Emergency Medical Services. The objective is to analyze the dimensions with lower scores in order to plan futures strategies. Material and methods. A descriptive study using the AHRQ (Agency for Healthcare Research and Quality) questionnaire. The questionnaire was delivered to all healthcare professionals workers of 061 Advanced Life Support Units of Aragón, during the month of August 2013. Results. The response rate was 55%. Main strengths detected: an adequate number of staff (96%), good working conditions (89%), tasks supported from immediate superior (77%), teamwork climate (74%), and non-punitive environment to report adverse events (68%). Areas for improvement: insufficient training in patient safety (53%) and lack of feedback of incidents reported (50%). Conclusions. The opportunities for improvement identified focus on the training of professionals in order to ensure safer care, while extending the safety culture. Also, the implementation of a system of notification and registration of adverse events in the service is deemed necessary (AU)

[Out of hospital emergencies towards a safety culture]. / Las emergencias extrahospitalarias ante la cultura de seguridad.

OBJECTIVES: The aim of this study is to measure the degree of safety culture (CS) among healthcare professional workers of an out-of-hospital Emergency Medical Service. Most patient safety studies have been conducted in relation to the hospital rather than pre-hospital Emergency Medical Services. The objective is to analyze the dimensions with lower scores in order to plan futures strategies. MATERIAL AND METHODS: A descriptive study using the AHRQ (Agency for Healthcare Research and Quality) questionnaire. The questionnaire was delivered to all healthcare professionals workers of 061 Advanced Life Support Units of Aragón, during the month of August 2013. RESULTS: The response rate was 55%. Main strengths detected: an adequate number of staff (96%), good working conditions (89%), tasks supported from immediate superior (77%), teamwork climate (74%), and non-punitive environment to report adverse events (68%). Areas for improvement: insufficient training in patient safety (53%) and lack of feedback of incidents reported (50%). CONCLUSIONS: The opportunities for improvement identified focus on the training of professionals in order to ensure safer care, while extending the safety culture. Also, the implementation of a system of notification and registration of adverse events in the service is deemed necessary.

Nephrotic-range proteinuria on interferon-ß treatment: immune-induced glomerulonephritis or other pathway?

We present a case report of a 37-year-old woman with multiple sclerosis (MS) who developed nephrotic-range proteinuria secondary to membrano proliferative glomerulonephritis (MPGN)-like disease with mesangial C3 deposition without evidence of immune-complex deposition in the context of long-term interferon-ß (IFN-ß) therapy. The complete remission of proteinuria following cessation of IFN-ß, strongly suggests causality. To our knowledge, this is the second case report of MPGN associated with IFN-ß use. This being the case, the negative immune screen, normal inflammatory markers and the absence of immune complex deposits would imply a different pathway to that previously suggested.

The non-casual relation between eosinophilia and thrombotic microangiopathy.

There are only a few cases in the literature that describes the association between hypereosinophilic syndromes and thrombotic microangiopathy (TMA). Here we present the case of a man who suddenly developed a TMA in the context of eosinophilic pneumonia, who recovered successfully with six sessions of plasmapheresis and corticoids. Although the Pathophysiology is unknown, we hypothesize about the prothrombotic effects of the eosinophils. Also we describe a literature review.

Synthesis, crystal structures and magnetic properties of tricyanomethanide-containing copper(II) complexes.

The preparation, crystal structures and magnetic properties of the copper(II) complexes of formula [Cu(pyim)(tcm)(2)](n) (1), [Cu(bpy)(tcm)(2)](n) (2), [Cu(4)(bpz)(4)(tcm)(8)] (3), {[Cu(terpy)(tcm)].tcm}(n) (4) and {[Cu(2)(tppz)(tcm)(4)].3/2H(2)O}(n) (5) [pyim = 2-(2-pyridyl)imidazole, tcm = tricyanomethanide, bpy = 2,2'-bipyridine, bpz = 2,2'-bipyrazine, terpy = 2,2':6',2''-terpyridine and tppz = 2,3,5,6-tetrakis(2-pyridyl)pyrazine] are reported. Complexes, 1, 2 and 4 are uniform copper(II) chains with single- (1 and 4) and double-(2) micro-1,5-tcm bridges with values of the intrachain copper-copper separation of 7.489(1) (1), 7.520(1) and 7.758(1) (2) and 7.469(1) A (4). Each copper atom in 1, 2 and 4 is five-coordinate with bidentate pyim (1)/bpy (2) and tridentate terpy (4) ligands and nitrile-nitrogen atoms from bridging (1,2 and 4) and terminal (1) tcm groups building a distorted square pyramidal surrounding. The structure of 3 is made up of neutral centrosymmetric rectangles of (2,2'-bipyrazine)copper(II) units at the corners, the edges being built by single- and double-micro-1,5-tcm bridges with copper-copper separations of 7.969(1) and 7.270(1) A, respectively. Five- and six-coordinated copper atoms with distorted square pyramidal and elongated octahedral environments occur in . Compound 5 is a neutral copper(II) chain with regular alternating bis-tridentate tppz and double micro-1,5-tcm bridges, the intrachain copper-copper distances being 6.549(7) and 7.668(1) A, respectively. The two crystallographically independent copper atoms in 5 have an elongated octahedral geometry with three tppz nitrogen atoms and a nitrile-nitrogen atom from a bridging tcm group in the equatorial positions, and two nitrile nitrogen atoms from a terminal and a bridging tcm ligand occupying the axial sites. The investigation of the magnetic properies of 1-5 in the temperature range 1.9-295 K has shown the occurrence of weak ferro- [J = +0.11(1) cm(-1) (2)] and antiferromagnetic interactions [J = -0.093(1) (1), -0.083(1) (4), -0.04(1) and 1.21(1) cm(-1) (3)] across the micro-1,5-tcm bridges and intermediate antiferromagnetic coupling [-J = 37.4(1) cm(-1) (5)] through bis-tridentate tppz. The values of the magnetic interactions are analyzed through simple orbital symmetry considerations and compared with those previously reported for related systems.

[Adolescence and contraception]. / Adolescencia y contracepción.

The birthrate has decreased for all age groups except for adolescents. 4.51% of all pregnancies in Spain fall within the 15-19 year old age group. The prevention of adolescent pregnancy indicates the need for making family planning services more accessible to young people. The object of this study was a review of medical consultations performed in 1993 with adolescents at a family planning service. Among the most significant results are the following: the average age of menarche and coitus primaris was 11.8 years (+ or -2.2 years) and 16 years (+ or -1.7) respectively. The period between coitus primaris and the act of going to a family planning center was 9.1 months (+ or -2.3). 81.7% of those adolescents were advised to take oral contraceptives, 12.4% condoms, 1.96% the I.U.D. and 3.9% none. Among the most common side effects noted after taking oral contraceptives for 6 to 12 months were: psychic alterations (changes of mood, etc.), spotting, digestive upset, migraines and weight increase. The number of sexual partners before and after contraceptive use did not change significantly.

[Incidence of malnutrition in surgical departments of the Reina Sofía Hospital of Córdoba]. / Incidencia de la desnutrición en los servicios quirúrgicos del Hospital Reina Sofía de Córdoba.

We conducted a prospective study of the incidence of malnutrition in the surgical departments of the Reina Sofia University Hospital, on a total of 329 patients at the time of admittance (154 women and 175 men). As was denounced by Bristian more than 20 years ago, more than 50% of the patients presented some form of malnutrition. There are a series of factors, detected by the Chi2 test, which are as divers as sex, marital status, level of education, profession, smoker or chronic medication user, which are of influence on the nutritional status of the patients. The type of malnutrition is conditioned by the marital status, the job situation, the nature of the pathology, or the use of tobacco. Malnutrition still exists in developed countries, induced by many factors, and it is often found in the hospitals, which is even worse.