Risk stratification model for the pharmaceutical care of oncology patients with solid or hematologic neoplasms. / [Artículo traducido] Modelo de estratificación de riesgo de atención farmacéutica para pacientes oncológicos con neoplasias sólidas o hematológicas.

OBJECTIVE: We aimed to develop of a risk stratification model for the pharmaceutical care (PC) of patients with solid or hematologic neoplasms who required antineoplastic agents or supportive treatments. METHOD: The risk stratification model was collaboratively developed by oncology pharmacists from the Spanish Society of Hospital Pharmacy (SEFH). It underwent refinement through three workshops and a pilot study. Variables were defined, grouped into four dimensions, and assigned relative weights. The pilot study collected and analyzed data from participating centers to determine priority levels and evaluate variable contributions. The study followed the Kaiser Permanente pyramid model, categorizing patients into three priority levels: Priority 1 (intensive PC, 90th percentile), Priority 2 (60th-90th percentiles), and Priority 3 (60th percentile). Cut-off points were determined based on this stratification. Participating centers recorded variables in an Excel sheet, calculating mean weight scores for each priority level and the total risk score. RESULTS: The participants agreed to complete a questionnaire that comprised 22 variables grouped into 4 dimensions: demographic (maximum score =11); social and health variables and cognitive and functional status (maximum = 19); clinical and health services utilization (maximum = 25); and treatment-related (maximum = 41). From the results of applying the model to the 199 patients enrolled, the cutoff points for categorization were 28 or more points for priority 1, 16 to 27 points for priority 2 and less than 16 for priority 3; more than 80% of the total score was based on the dimensions of 'clinical and health services utilization' and 'treatment-related'. Interventions based on the pharmaceutical care model were recommended for patients with solid or hematological neoplasms, according to their prioritization level. CONCLUSION: This stratification model enables the identification of cancer patients requiring a higher level of pharmaceutical care and facilitates the adjustment of care capacity. Validation of the model in a representative population is necessary to establish its effectiveness.

Criteria and indicators to evaluate quality of care in genitourinary tumour boards.

PURPOSE: Genitourinary (GU) multidisciplinary tumour boards (GUMTBs) are key components of patient care, as they might lead to changes in treatment plan, improved survival, and increased adherence to guidelines. However, there are no guidelines on how GUMTBs should operate or how to assess their quality of performance. METHODS: A systematic literature review was conducted to identify criteria and indicators to evaluate quality in GUMTBs. A scientific committee-comprising 12 GU cancer specialists from seven disciplines-proposed a list of criteria and developed indicators, evaluated in two rounds of Delphi method. Appropriateness and utility of indicators were scored using a 9-point Likert scale. Consensus was defined as at least two-thirds of Delphi respondents selecting a score sub-category that encompassed the median score of the group. RESULTS: Forty-five criteria were selected to evaluate the quality of GUMTBs covering five dimensions: organisation, personnel, protocol and documentation, resources, and interaction with patients. Then, 33 indicators were developed and evaluated in the first round of Delphi, leading to a selection of 26 indicators in two dimensions: function, governance and resources, and GUMTB sessions. In the second round, consensus was reached on the appropriateness of all 26 indicators and on the utility of 24 of them. Index cards for criteria and indicators were developed to be used in clinical practice. CONCLUSIONS: Criteria and indicators were developed to evaluate the quality of GUMTBs, aiming to serve as a guide to improve quality of care and health outcomes in patients with GU cancer.

DNA oxidative damage in oral cancer: 8-hydroxy-2´-deoxyguanosine immunoexpression assessment

Background: The development and establishment of oral squamous cell carcinoma are confined to carcinogenesis, which involves oxidative stress via oxygen-free radical production as a hydroxyl radical (HO•), considered the most important cause of oxidative damage to basic biomolecules since it targets DNA strands. 8-Hydroxy-2´- deoxyguanosine (8-OHdG) is considered a free radical with a promutagenic capacity due to its ability to pair with adenosine instead of cytosine during replication. Material and Methods: We collected 30 paraffin-embedded tissue samples of OSCC from patients treated between 2013 and 2018. We recorded risk habits, disease stage, disease free survival and death with at least 3 years of followup. 8-Hydroxyguanosine was evaluated by immunohistochemistry and subsequently classified as weak-moderate or strong positive expression. Additionally, we noted whether it was expressed in the cytoplasm and/or nucleus. Results: Most of the cases expressed 8-OHdG with a strong intensity (80%). All neoplastic cells were preferentially stained in only the cytoplasm (70.0%), but nuclear positivity was found in 30%, independent of the intensity. Based on the location in the cytoplasm and/or nucleus, tumors >4 cm showed a high frequency (95.5%) of 8-OHdG expression in only the cytoplasm, with a significant difference (p value ≤ 0.001). Additionally, overall survival was affected when immunoexpression was present in the cytoplasm and nucleus because all deaths were in this group were statistically significant (p value = 0.001). Conclusions: All tumors showed DNA oxidative damage, and 8-OHdG was preferentially expressed in the cytoplasm. This finding was associated with tumor size and, when present in the nucleus, might also be related to death. (AU)

Risk stratification model for the pharmaceutical care of oncology patients with solid or hematologic neoplasms.

OBJECTIVE: We aimed to develop of a risk stratification model for the pharmaceutical care of patients with solid or hematologic neoplasms who required antineoplastic agents or supportive treatments. METHOD: The risk stratification model was collaboratively developed by oncology pharmacists from the Spanish Society of Hospital Pharmacy (SEFH). It underwent refinement through 3 workshops and a pilot study. Variables were defined, grouped into 4 dimensions, and assigned relative weights. The pilot study collected and analyzed data from participating centers to determine priority levels and evaluate variable contributions. The study followed the Kaiser Permanente pyramid model, categorizing patients into 3 priority levels: Priority 1 (intensive PC, 90th percentile), Priority 2 (60th-90th percentiles), and Priority 3 (60th percentile). Cut-off points were determined based on this stratification. Participating centers recorded variables in an Excel sheet, calculating mean weight scores for each priority level and the total risk score. RESULTS: The participants agreed to complete a questionnaire that comprised 22 variables grouped into 4 dimensions: demographic (maximum score=11); social and health variables and cognitive and functional status (maximum=19); clinical and health services utilization (maximum=25); and treatment-related (maximum=41). From the results of applying the model to the 199 patients enrolled, the cut-off points for categorization were 28 or more points for priority 1, 16-27 points for priority 2, and less than 16 for priority 3; more than 80% of the total score was based on the dimensions of "clinical and health services utilization" and "treatment-related." Interventions based on the pharmaceutical care model were recommended for patients with solid or hematological neoplasms, according to their prioritization level. CONCLUSION: This stratification model enables the identification of cancer patients requiring a higher level of pharmaceutical care and facilitates the adjustment of care capacity. Validation of the model in a representative population is necessary to establish its effectiveness.

Recovery of plastic waste through its thermochemical degradation: a review.

The demand to produce plastic has increased yearly; only in 2020, there was a production of approximately 368 million tons worldwide. According to Plastics Europe, from 2016 to 2018, a total of 29.1 Mt of plastic waste was generated, and 24% of this ended up in a landfill, generating problems due to accumulation. The increase in the demand for plastics has begun to contribute to the shortage of oil sources, a non-renewable resource. On the other hand, various researchers have reported effects on human health such as neurological damage, cancer in the nasal cavities, prostate, and ovarian cancer, and in animal species, destruction of the digestive and respiratory tracts due to the consumption of microplastics in food. Due to these reasons, various solutions have been proposed for recovering and recycling plastic waste. One of the most promising technologies is thermal and catalytic degradation, known as pyrolysis. This technology allows the recovery of chemical compounds of high energy value. In this work, the various environmental and social impacts caused by plastic are discussed. Worldwide consumption data is provided by sector and type of plastic, and the different routes of thermal degradation for each type of thermoplastic are shown.

Estudio observacional sobre interacciones farmacológicas en pacientes oncológicos ingresados / Observational study of drug-drug interactions in oncological inpatients

Objetivo: Determinar la prevalencia de potenciales interacciones clínicamente relevantes en pacientes oncológicos adultos ingresados, mediante una base de datos de uso habitual, así como describir las interacciones más frecuentes. Método: Estudio observacional, transversal, descriptivo, que incluye pacientes ingresados a cargo del Servicio de Oncología de un hospital de referencia. Se recopilaron todas las prescripciones dos veces por semana durante un periodo de un mes. Se analizaron mediante la base de datos Lexicomp ® , registrando todas las interacciones clasificadas con un nivel de riesgo C, D o X. Resultados: Se detectaron un total de 1.850 interacciones farmacológicas en 218 tratamientos. La prevalencia de tratamientos con al menos una interacción clínicamente relevante fue de un 95%, siendo del 94,5% para las de nivel C y del 26,1% para los niveles D y X. Los analgésicos opioides, antipsicóticos (butirofenonas), benzodiacepinas, pirazolonas, glucocorticoides y heparinas fueron los fármacos más comúnmente involucrados en las interacciones detectadas, mientras que las interacciones con antineoplásicos fueron mínimas, destacando las relacionadas con paclitaxel y entre metamizol y diversos antineoplásicos. Conclusiones: La prevalencia de tratamientos con interacciones farmacológicas clínicamente relevantes fue muy elevada, destacando el elevado porcentaje de riesgo X. Por la frecuencia de aparición y potencial gravedad destacan el uso concomitante de fármacos depresores del sistema nervioso central con riesgo de depresión respiratoria, el riesgo de aparición de síntomas anticolinérgicos cuando se combinan morfina o haloperidol con butilescopolamina, bromuro de ipratropio o dexclorfe-niramina, así como las múltiples interacciones que implican al metamizol (AU)

Objective: To determine the prevalence of potential clinically relevant drug-drug interactions in adult oncological inpatients, as well as to describe the most frequent interactions. A standard database was used. Method: An observational, transversal, and descriptive study including patients admitted to the Oncology Service of a reference hospital. All prescriptions were collected twice a week during a month. They were analysed using Lexicomp ®database, recording all interactions classified with a level of risk: C, D or X. Results: A total of 1 850 drug-drug interactions were detected in 218 treatments. The prevalence of treatments with at least one clinically relevant interaction was 95%, being 94.5% for those at level C and 26.1% for levels D and X. The drugs most commonly involved in the interactions detected were opioid analgesics, antipsychotics (butyrophenones), benzodiazepines, pyrazolones, glucocorticoids and heparins, whereas interactions with antineoplastics were minimal, highlighting those related to paclitaxel and between metamizole and various antineoplastics. Conclusions: The prevalence of clinically relevant drug-drug interactions rate was very high, highlighting the high risk percentage of them related to level of risk X. Due to the frequency of onset and potential severity, highlighted the concomitant use of central nervous system depressants drugs with risk of respiratory depression, the risk of onset of anticholinergic symptoms when combining morphine or haloperidol with butyl scopolamine, ipratropium bromide or dexchlorpheniramine and the multiple interactions involving metamizole (AU)

Observational study of drug-drug interactions in oncological inpatients.

OBJECTIVE: To determine the prevalence of potential clinically relevant drug- drug interactions in adult oncological inpatients, as well as to describe the most  frequent interactions. A standard database was used. METHOD: An observational, transversal, and descriptive study including patients  admitted to the Oncology Service of a reference hospital. All prescriptions were  collected twice a week during a month. They were analysed using Lexicomp®  database, recording all interactions classified with a level of risk: C, D or X. RESULTS: A total of 1 850 drug-drug interactions were detected in 218  treatments. The prevalence of treatments with at least one clinically relevant  interaction was 95%, being 94.5% for those at level C and 26.1% for levels D  and X. The drugs most commonly involved in the interactions detected were  opioid analgesics, antipsychotics (butyrophenones), benzodiazepines,  pyrazolones, glucocorticoids and heparins, whereas interactions with  antineoplastics were minimal, highlighting those related to paclitaxel and  between metamizole and various antineoplastics. CONCLUSIONS: The prevalence of clinically relevant drug-drug interactions rate  was very high, highlighting the high risk percentage of them related to level of  risk X. Due to the frequency of onset and potential severity, highlighted the  concomitant use of central nervous system depressants drugs with risk of  respiratory depression, the risk of onset of anticholinergic symptoms when  combining morphine or haloperidol with butylscopolamine, ipratropium bromide  or dexchlorpheniramine and the multiple interactions involving metamizole.

Objetivo: Determinar la prevalencia de potenciales interacciones clínicamente relevantes en pacientes oncológicos adultos ingresados, mediante una base de datos de uso habitual, así como describir las interacciones más frecuentes.Método: Estudio observacional, transversal, descriptivo, que incluye pacientes ingresados a cargo del Servicio de Oncología de un hospital de referencia. Se recopilaron todas las prescripciones dos veces por semana durante un periodo de un mes. Se analizaron mediante la base de datos Lexicomp®, registrando todas las interacciones clasificadas con un nivel de riesgo C, D o X.Resultados: Se detectaron un total de 1.850 interacciones farmacológicas en  218 tratamientos. La prevalencia de tratamientos con al menos una interacción  clínicamente relevante fue de un 95%, siendo del 94,5% para las de nivel C y  del 26,1% para los niveles D y X. Los analgésicos opioides, antipsicóticos  (butirofenonas), benzodiacepinas, pirazolonas, glucocorticoides y heparinas  fueron los fármacos más comúnmente involucrados en las interacciones  detectadas, mientras que las interacciones con antineoplásicos fueron mínimas,  destacando las relacionadas con paclitaxel y entre metamizol y diversos  antineoplásicos.Conclusiones: La prevalencia de tratamientos con interacciones farmacológicas clínicamente relevantes fue muy elevada, destacando el elevado  porcentaje de riesgo X. Por la frecuencia de aparición y potencial gravedad  destacan el uso concomitante de fármacos depresores del sistema nervioso  central con riesgo de depresión respiratoria, el riesgo de aparición de síntomas  anticolinérgicos cuando se combinan morfina o haloperidol con  butilescopolamina, bromuro de ipratropio o dexclorfeniramina, así como las  múltiples interacciones que implican al metamizol.

Patients with advanced oral squamous cell carcinoma have high levels of soluble E-cadherin in the saliva

Background: The objective of this study was to assess the potential clinical value of the concentration of soluble salivary E-cadherin (sE-cadherin) compared with the clinical value of the presence of membranous E-cadherin (mE-cadherin) in oral squamous cell carcinoma tumor tissues. Material and Methods: Data regarding patient demographics, clinical stage, saliva and tumor tissue samples were collected. The saliva was analyzed for sE-cadherin protein levels and was compared to the mE-cadherin immunohistochemical expression levels in tumor tissues, which were assessed via the HercepTest(R) method. Patients without cancer were included in the study as a control group for comparisons of the sE-cadherin levels. Results: sE-cadherin levels in the saliva of patients without cancer were lower than those in patients with cancer, and the difference was statistically significant (p=0.031). Low mE-cadherin expression was statistically significantly associated with lymph node positivity (p=0.015) and advanced clinical stage (p=0.001). The inverse relationship between mE-cadherin and sE-cadherin was significant in terms of lymph node positivity (p=0.014) and advanced clinical stage (p=0.037). Conclusions: The results suggest that sE-cadherin levels are significantly increased in patients with oral cancer and that its low expression within the membrane as well as the progression of the disease appear to be inversely associated with levels of sE-cadherin in the saliva (AU)

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Fístula colovesical secundaria a la migración de una endoprótesis biliar: reporte de un caso / Colovesical fistula secondary to the migration of a biliary stent: case report

Introducción: la colocación endoscópica de stents para descomprimir una obstrucción biliar es un tratamiento comúnmente utilizado para enfermedades malignas de la vía biliar y para estenosis benignas de la misma. Se han descrito complicaciones inusitadas derivadas de la colocación de endoprótesis biliares, incluyendo la migración. Se presenta un caso clínico con el objetivo de compartir con la comunidad científica una rara complicación y la única publicada, secundaria a la migración de un stent biliar. Caso clínico: mujer de 47 años de edad, con estenosis de ámpula de Vater benigna, a quien se le colocó endoprótesis biliar, con la cual mejoró clínicamente. Posterior a la colocación del stent se le realizó colecistectomía abierta con exploración de vías biliares. Al año y medio posterior a la colocación del stent, la paciente presentó dolor vago en abdomen bajo y disuria; se le practicaron estudios de imagen donde se observó un extremo del stent biliar en colon sigmoides y otro en vejiga. Se realizó intervención quirúrgica encontrando fístula colovesical, la cual se resolvió en un solo tiempo quirúrgico. La paciente fue egresada con resultados satisfactorios.

BACKGROUND: The endoscopic placement of endoprostheses to decompress biliary obstruction is a commonly used treatment for malignant biliary diseases and is also used in the treatment of benign biliary strictures. Unusual complications of endoprosthesis placement have been described and include the migration of the stent. We present a case to share with the scientific community, an unusual complication secondary to the migration of a biliary stent that has not previously been reported to our knowledge. CASE REPORT: We present the case of a 47-year-old female with a diagnosis of benign papillary stenosis. The patient received a biliary endoprosthesis with clinical improvement. Later she underwent open cholecystectomy and common duct exploration. At consultation 18 months later, the patient presents with indistinct lower abdominal pain and dysuria. We performed imaging studies where the biliary stent was observed, partly in the sigmoid colon and partly in the bladder. The patient underwent surgery where a colovesical fistula was found and treated during the same surgical event. The patient was discharged succesfully.

[Colovesical fistula secondary to the migration of a biliary stent. Case report]. / Fístula colovesical secundaria a la migración de una endoprótesis biliar. Reporte de un caso.

BACKGROUND: The endoscopic placement of endoprostheses to decompress biliary obstruction is a commonly used treatment for malignant biliary diseases and is also used in the treatment of benign biliary strictures. Unusual complications of endoprosthesis placement have been described and include the migration of the stent. We present a case to share with the scientific community, an unusual complication secondary to the migration of a biliary stent that has not previously been reported to our knowledge. CASE REPORT: We present the case of a 47-year-old female with a diagnosis of benign papillary stenosis. The patient received a biliary endoprosthesis with clinical improvement. Later she underwent open cholecystectomy and common duct exploration. At consultation 18 months later, the patient presents with indistinct lower abdominal pain and dysuria. We performed imaging studies where the biliary stent was observed, partly in the sigmoid colon and partly in the bladder. The patient underwent surgery where a colovesical fistula was found and treated during the same surgical event. The patient was discharged succesfully.

Utilidad de la actividad de adenosina deaminasa en el diagnóstico de derrame pleural por tuberculosis / Utility of the adenosine deaminasa activity in the diagnostic of tuberculous pleural effusions

La aparición de marcadores enzimáticos ha abierto un nuevo campo en la investigación de la etiología de los derrames pleurales (DP) de naturaleza inflamatoria. En este sentido se determinó la actividad enzimática de la Adenosina deaminasa (ADA) en líquido pleural (LP) y plasma, en 48 pacientes los cuales se distribuyeron en cinco grupos de acuerdo a criterios bien definidos: Grupo I: constituído por 20 casos de Tuberculosis Pleural (TBC), Grupo II: Infecciones diferentes a TBC 9 casos, Grupo III: DP malignos 13 casos, Grupo IV: 4 casos de transudados, y Grupo V: Pleuritis crónica inespecífica 2 casos. A todos se les realizó historia clínica, radiología de tórax, y exámenes de laboratorio de rutina, análisis citoquímico del LP y biopsia pleural. Se demostraron cambios en las características de los DP por TBC. Estos ocurren con mayor frecuencia en adultos jóvenes con sintomatología de menos de 4 semanas de evolución, sin antecedentes previos de TBC, con radiología que reveló DP de pequeño a moderado tamaño,sin evidencia de lesión parenquimatosa sugestiva de TBC en las mismas, y con PPD que resultó inespecífico. En base a estas características la TBC Pleural debe considerarse como primaria, en nuestro medio. Se establecieron las características del estudio citoquímico del LP procedente de los DP de diferente etiología y comparadas estas con las del TBC se encontró que el estudio del Ph, niveles de glucosa y proteínas, y el contenido celular de predominio linfocítico no son de utilidad en el diagnóstico diferencial de los DP por TBC, evidenciado por sus valores de sensibilidad, especificidad, valor predictivo positivo (VPP) y valor predictivo negativo (VPN) calculados. La biopsia pleural demostró especificidad de 0,90 para el diagnóstico del DP por TBC. En ningún caso el examen directo y los cultivos de DP, y la biopsia pleural fueron positivos para detectar Mycobacterium tuberculosis en este estudio. La actividad de la ADA en LP resultó tener una utilidad superior a las pruebas convencionales en el diagnóstico diferencial de los DP exudativos. Para valores superiores a 33.33 UI/L la actividad de ADA en el LP de los pacientes con DP reportó una especificidad de 0.89 y el VPN de la prueba fue 1 para el diagnóstico de TBC pleural. El valor medio de ADA en LP fue mayor en los grupos I y II que en los otros pacientes (p < 0.001). Al determinar ADA en plasma y la relación ADA LP/ADA Plasma, los valores medios no fueron significativos al comparar el grupo de DP por