Clinicopathological and Genomic Identification of Breast Cancers with No Impact on Mortality.

BACKGROUND: Implementing mammogram screening means that clinicians are seeing many breast cancers that will never develop metastases. The purpose of this study was to identify subgroups of breast cancer patients who did not present events related to long-term breast cancer mortality, taking into account diagnosis at breast screening, absence of palpability and axillary involvement, and genomic analysis with PAM50. PATIENTS AND METHODS: To identify them, a retrospective observational study was carried out selecting patients without any palpable tumor and without axillary involvement, and a genomic analysis was performed with PAM50. RESULTS: The probability of distant metastasis-free interval (DMFI) of 337 patients was 0.92 (95% CI, 0.90-0.93) at 20 years and 0.96 (95% CI, 0.92-1.00) in 95 patients (28%) with available PAM50 tests. In 22 (23.15%) luminal A tumors and in 9 (9.47%) luminal B tumors smaller than 1 cm, and in HER2 and basal type tumors, there were no metastatic events (20-year DMFI of 1.00). CONCLUSION: Patients with nonpalpable breast cancer found at screening with negative nodes are at very low risk. It is possible to identify subgroups without metastatic events by determining the intrinsic subtype and tumor size less than 1 cm. Therefore, de-escalation of treatment should be considered.

The Benefits of a Therapeutic Exercise and Educational Intervention Program on Central Sensitization Symptoms and Pain-Related Fear Avoidance in Breast Cancer Survivors.

BACKGROUND: Central sensitization symptoms and pain-related fear avoidance are two common problems in breast cancer survivors. Non-pharmacologic interventions such as therapeutic exercise and patient education can be effective in this population. AIMS: This study aimed to: (1) analyze the benefits of a therapeutic exercise and educational program on central sensitization symptoms and pain-related fear avoidance in breast cancer survivors, and (2) explore the association between pain-related fear avoidance and central sensitization symptoms. DESIGN: A single group pre-post intervention study was conducted. METHODS: Patients were recruited from the service of Medical Oncology of the University Clinical Hospital Virgen de la Victoria, in Málaga (Spain). The intervention consisted of a therapeutic exercise and educational program that lasted 12 weeks, twice a week, for 1 hour. Two instruments were used: the Spanish version of the Central Sensitization Inventory and the Spanish Fear Avoidance Components Scale. RESULTS: A total of 82 breast cancer survivors participated in the study. Pre-post change on Central Sensitization Inventory was statistically significant (p = .007). There was a trend towards a significant difference for the Spanish Fear Avoidance Components Scale (p = .062). There was a statistically significant correlation between pain-related fear avoidance and central sensitization symptoms (r = 0.536, p < .001). CONCLUSIONS: The current study has provided preliminary evidence on the benefits of this intervention in pain-related fear avoidance and central sensitization symptoms in breast cancer survivors. The Spanish version of the Central Sensitization Inventory and the Spanish Fear Avoidance Components Scale demonstrated responsiveness to change.

Clinicopathological characteristics and survival results of patients with ultralow risk breast cancer. / Características clínico-patológicas y supervivencia de pacientes con cáncer de mama de riesgo muy bajo.

BACKGROUND AND OBJECTIVE: To identify subgroups with good progress over an extended period, we used diagnostic screening, tumour palpability, tumour phenotype, and node involvement. PATIENTS AND METHODS: We identified patients with good progress by means of a descriptive, observational and retrospective study. RESULTS: Of 746 patients diagnosed with node-negative breast cancer between 2001 and 2015: 110 (14.75%) had non-palpable screening-diagnosed tumours; 88 (80%) were endocrine-sensitive, 10 (9.10%) were triple-negative and 11 (10%) were HER2. Only 3 patients developed metastases, and there were 4 deaths: 2 from breast cancer and 2 from other causes. The distant recurrence-free interval (DRFI) was 95.60%: 100% in 34 endocrine-sensitive histological grade 1 (equivalent to luminal A) tumours, and 94.40% (95% CI 86.76-102.04) in 54 grade 2-3 (luminal B) tumours. In triple-negative and HER2 cases, it was 100%. In tumours <1 cm it was 100%, and >1 cm it was 95.50% (95% CI 79.42-100.98). CONCLUSIONS: Patients with non-palpable tumours detected by mammogram screening have ultralow risk. The good progress in the luminal A, triple-negative, HER2, and less than 1 cm subgroups may explain the efficacy of the treatment but it also makes them candidates to de-escalation of their treatment.

Gut and Endometrial Microbiome Dysbiosis: A New Emergent Risk Factor for Endometrial Cancer.

Endometrial cancer is one of the most common gynaecological malignancies worldwide. Histologically, two types of endometrial cancer with morphological and molecular differences and also therapeutic implications have been identified. Type I endometrial cancer has an endometrioid morphology and is estrogen-dependent, while Type II appears with non-endometrioid differentiation and follows an estrogen-unrelated pathway. Understanding the molecular biology and genetics of endometrial cancer is crucial for its prognosis and the development of novel therapies for its treatment. However, until now, scant attention has been paid to environmental components like the microbiome. Recently, due to emerging evidence that the uterus is not a sterile cavity, some studies have begun to investigate the composition of the endometrial microbiome and its role in endometrial cancer. In this review, we summarize the current state of this line of investigation, focusing on the relationship between gut and endometrial microbiome and inflammation, estrogen metabolism, and different endometrial cancer therapies.

Toxicity Associated with Capecitabine in Patients Suffering from Dihydropyrimidine Dehydrogenase Deficiency.

Dihydropyrimidine dehydrogenase (DPD) is a metabolic enzyme that is crucial in 5-fluorouracil (5-FU) degradation. A deficiency in it is associated with the occurrence of adverse events following fluoropyrimidine-based therapies. We describe a case of toxicity grade 5 after the administration of capecitabine and oxaliplatin in a patient with stage III colorectal cancer and DPD congenital deficiency, which was identified later. Several polymorphisms have been associated with the global toxicity of 5-FU; however, genetic tests are low in sensitivity and therefore they cannot as yet be used as prescreening techniques in clinical practice.

Procesos asistenciales integrados: modelo de evaluación y algunos resultados / Integrated care processes: evaluation model and some results. A tool for continuous

Introducción: El trabajo por procesos asistenciales integrados (PAI) introduce criterios de calidad para su monitorización. En este estudio se presenta un modelo de evaluación de las normas de calidad de los PAI en Andalucía, en atención primaria (AP) y atención especializada (AE) en 2 momentos temporales, y algunos de los resultados obtenidos en el Hospital Universitario Virgen de las Nieves (HUVN) y en el Distrito Metropolitano (DM). Material y métodos: Estudio descriptivo acerca del modelo de monitorización de las normas de calidad de algunos PAI, en AP y en AE, utilizando datos procedentes de la historia clínica digital en AP, y de las auditorías de las historias clínicas en AE (muestreo por lotes y tablas de la distribución binomial). Resultados: Se obtienen los resultados de la monitorización de las normas de calidad en atención primaria (DM) y en atención especia-lizada (HUVN) y se elabora un sistema integrado de monitorización conjunta. Se presentan resultados de los siguientes PAI (cáncer de mama, cáncer de cérvix, embarazo, parto y puerperio, hipertrofia benigna de próstata/cáncer de próstata y cuidados paliativos). Se presentan resultados de la práctica enfermera en algunas actuaciones. Se evalúa la información obtenida y se realizan propuestas de mejora. Conclusiones: El diseño y la utilización de metodología de evaluación es un requisito para conocer los resultados de las actuacio-nes y tomar decisiones para mejorar. Hay que mejorar y adaptar los sistemas de información asistenciales a las necesidades de información de los PAI. La evaluación conjunta es una etapa más en el círculo de mejora de la calidad de los procesos asistenciales integrados

Introduction: Integrated care processes (ICP) introduce quality criteria for quality monitoring. This study presents a model for evaluating the quality standards of ICPs in primary care (PC) and specialized care (SC) in Andalucia (Spain) at two time points and reports some of the results obtained in the Hospital Virgen de las Nieves (HUVN) and in the Metropolitan District (MD). Material and methods: We performed a descriptive study of the model of quality standards monitoring for some ICPs in PC and SC using data from the systematic registries produced by digital medical records in PC and medical record audits in SC. Sampling by lots and tables of binomial distribution were used. Results: The results of quality standards monitoring were obtained in PC (DM) and in SC (HUVN) and an integrated system of joint monitoring was introduced. The results of the following ICP are presented: breast cancer, cervical cancer, pregnancy, delivery and puerperium, benign hypertrophy of the prostate/prostate cancer, and palliative care. The results of nursing practice in some interventions are provided. The information obtained and proposals for improvement are made. Conclusions: The design and use of evaluation methodology is required to determine the results of interventions and to make decisions for improvement. Healthcare information systems should be improved and adapted to the needs of information from ICPs. Joint evaluation is another stage in the circle of quality improvement of ICP

Características clínicas y psicosociales de personas con fibromialgia. Repercusión del diagnóstico sobre sus actividades / Clinical and psychosocial characteristics of subjects with fbromyalgia. Impact of the diagnosis on patients' activities

Fundamento: Actualmente se sabe muy poco de las característicasde las personas diagnosticadas de fibromialgia, su grado deincapacidad y la respuesta del sistema sanitario. Los objetivos deeste trabajo son: conocer el perfil sociodemográfico, clínico y psicosocialde las y los pacientes con fibromialgia; describir la respuestaque obtienen del sistema sanitario, y estudiar la repercusión de estesíndrome en las actividades habituales de las personas que lo padecen,incluyendo las del ámbito laboral.Métodos: Estudio descriptivo transversal. La información serecogió mediante encuesta telefónica realizada a personas diagnosticadasde fibromialgia en el Hospital Universitario Virgen de las Nievesde Granada durante el año 2003.Resultados: El 92,1% de las personas entrevistadas eran mujeres.La fibromialgia causó baja laboral en el 31,4% de los casos. El64% percibía su salud como mala o muy mala. La fibromialgia seasoció a otras enfermedades en un 52,3% de los casos. El médico defamilia es el especialista consultado antes del diagnóstico en el92,1%. El 50,5% tenía antecedentes de trastorno psiquiátrico, presentándoloen el momento de la entrevista el 36,4%. El 71% de lamuestra recibía apoyo familiar, señalando un fuerte impacto del síndromeen su entorno un 70,1% de los casos.Conclusiones: La fibromialgia fue diagnosticada mayoritariamenteen mujeres. Causa una mala percepción del estado de salud ysituaciones de incapacidad laboral, afectando negativamente alentorno familiar de la persona que la padece

Background: Little is known today about the characteristics ofindividuals diagnosed with fibromyalgia, their degree of disabilityand the health system response system response to this condition.The objectives of this work include: to establish the sociodemographic,clinical and psychosocial profile of male and female patientswith fibromyalgia. To describe the response they receive from thehealth service, and to study the repercussions of this syndrome onthe daily activities of subjects who suffer it, including its effects ontheir work environment.Methods: Descriptive cross-sectional study. The informationwas received from telephone interviews of individuals diagnosedwith fibromyalgia in the Hospital Universitario Virgen de las Nievesin Granada during 2003.Results: 92.1% of those interviewed were women. Fibromyalgiacaused work absenteeism in 31.4% of cases; and 64% regarded theirhealth as poor or very poor. Fibromyalgia was associated with otherdiseases in 52.3% of cases. The family doctor is the specialist consultedbefore diagnosis in 92.1% of cases. A total of 50.5% had a historyof psychiatric disorders, these were still present at the time ofinterview in 36.4%. Around 71% of the sample received family support,and 70.1% of cases considered the disease to seriously affecttheir environment.Conclusions: Fibromyalgia was mainly diagnosed in women.Subjects with this syndrome have a poor perception of their ownhealth and work situation, and it negatively affects their family environment

[Psittacosis outbreak in Granada, Spain]. / Brote de psitacosis en Granada.

BACKGROUND: Psittacosis can be transmitted to humans from infected birds, being the cause of atypical pneumonia. This work is aimed at determining the source of a psittacosis outbreak, the characteristics of the subjects exposed and describing the measures to control the outbreak. METHODS: Descriptive study. Notification to the Epidemiological Monitoring System and Autonomic Agriculture authorities, taking the pertinent measures (inspection, sampling, disinfecting and precautionary quarantine of birds), closing the establishment. Case definition and epidemiological survey. Frequency analysis. RESULTS: Seventeen (17) individuals (one of whom died) came into contact with suspicious animals (53% males/47% females), nine of whom (mean age: 30) showed symptoms (100% fever, flu-like symptoms 44.4%). A serology was performed for C. psitacci on 11 of the 17 subjects exposed (68.75%), two of whom (18.18%) tested positive. The presence of C. psittaci DNA was detected in the pulmonary tissue study conducted on the deceased individual. A total of 33% (3/9) of those showing symptoms were confirmed by diagnosis. The Autonomic Agriculture authorities placed 22 animal compounds under quarantine. A total of seven (10%) of the 70 samples taken (60: animal cloacas and 10 birds) revealed a positive antigen, the PCR nucleic acid test being positive in one there-of. CONCLUSIONS: The exposure to diseased animals at the establishments involved caused the outbreak, the common source of contagion being of an occupational nature. The appropriate coordination/collaboration between the local Health and Agriculture authorities made it possible to prevent any further cases from arising.

[Clinical and psychosocial characteristics of subjects with fibromyalgia. Impact of the diagnosis on patients' activities]. / Características clínicas y psicosociales de personas con fibromialgia. Repercusión del diagnóstico sobre sus actividades.

BACKGROUND: Little is known today about the characteristics of individuals diagnosed with fibromyalgia, their degree of disability and the health system response system response to this condition. The objectives of this work include: to establish the sociodemographic, clinical and psychosocial profile of male and female patients with fibromyalgia. To describe the response they receive from the health service, and to study the repercussions of this syndrome on the daily activities of subjects who suffer it, including its effects on their work environment. METHODS: Descriptive cross-sectional study. The information was received from telephone interviews of individuals diagnosed with fibromyalgia in the Hospital Universitario Virgen de las Nieves in Granada during 2003. RESULTS: 92.1% of those interviewed were women. Fibromyalgia caused work absenteeism in 31.4% of cases; and 64% regarded their health as poor or very poor. Fibromyalgia was associated with other diseases in 52.3% of cases. The family doctor is the specialist consulted before diagnosis in 92.1% of cases. A total of 50.5% had a history of psychiatric disorders, these were still present at the time of interview in 36.4%. Around 71% of the sample received family support, and 70.1% of cases considered the disease to seriously affect their environment. CONCLUSIONS: Fibromyalgia was mainly diagnosed in women. Subjects with this syndrome have a poor perception of their own health and work situation, and it negatively affects their family environment.