Evaluación de prevalencia de pacientes con necesidades paliativas en las plantas de hospitalización de agudos de oncología y medicina interna en 2 hospitales de tercer nivel de la Comunidad de Madrid / Evaluating the prevalence of patients with palliative needs in acute oncology and internal medicine hospitalization wards at two third-level hospitals in the Community of Madrid

Introducción: Los cuidados paliativos se demuestran útiles y eficientes en los pacientes que presentan dichas necesidades, pero es escasa aún la implementación de estos en el ars médica diaria de los médicos sin formación específica. El instrumento NECPAL (Instrumento para la Identificación de Personas en Situación de Enfermedad Crónica Avanzada y Necesidad de Atención Paliativa en Servicios de Salud y Sociales) se ha demostrado útil para identificar a estos pacientes y ayudar a la toma de decisiones. El objetivo principal de este estudio es conocer la prevalencia de pacientes con necesidades paliativas y si se produjo adecuación de medicina paliativa al alta en los pacientes NECPAL positivos. Material y métodos: Estudio observacional, retrospectivo, de cohortes, de pacientes hospitalizados en un periodo de 3 meses en las plantas de Medicina Interna y Oncología de 2 hospitales de tercer nivel, con la recogida de variables demográficas, identificación de necesidades paliativas y complejidad. Resultados: La prevalencia de pacientes con necesidades paliativas es alta (90 %) y de ellos cumplen criterios de complejidad el 32 % de los pacientes oncológicos y el 20 % de los no oncológicos. Pese a ello, el abordaje de las necesidades paliativas solo se produjo en el 18 % de los pacientes oncológicos y en el 18 % de los no oncológicos. La mortalidad de los pacientes identificados como NECPAL positivos a 12 meses fue del 96 % en los oncológicos y del 57 % en los no oncológicos. Conclusión: Pese a la alta prevalencia de pacientes con necesidades de cuidados paliativos en las plantas de hospitalización de Medicina Interna y Oncología y la alta mortalidad en el año siguiente a dicha hospitalización, la planificación de la atención es escasa. (AU)

Introduction: Palliative care has been shown to be useful and efficient in patients who present these needs, but its implementation in the daily medical practice of doctors without specific training is still scarce. The NECPAL instrument (Instrument for the Identification of People in a Situation of Advanced Chronic Illness and Need for Palliative Care in Health and Social Services) has been shown to be useful in identifying these patients and in helping decision-making. The main objective of this study was to determine the prevalence of patients with palliative needs, and whether there was adequacy of palliative measures at discharge in NECPAL-positive patients. Material and methods: An observational, retrospective, cohort study of patients hospitalized over a period of 3 months at the Internal Medicine and Oncology wards of two tertiary hospitals, with collection of demographic variables, and identification of palliative needs and complexity. Results: The prevalence of patients with palliative needs (90 %) and meeting complexity criteria is 32 % of cancer patients and 20 % of non-cancer patients. Despite this, addressing palliative needs only occurred in 18 % of cancer patients and 18 % of non-cancer patients. The mortality rate of patients identified as NECPAL-positive at 12 months was 96 % in cancer patients and 57 % in non-cancer patients. Conclusion: Despite a high prevalence of patients with palliative care needs in internal medicine and oncology hospitalization wards, and a high mortality rate in the year following said hospitalization, care planning is scarce. (AU)

Are reactive C protein and procalcitonin useful for early diagnosis of postoperative intraabdominal infection after pancreaticoduodenectomy for pancreatic cancer?

OBJECTIVE: To evaluate the relationship between C reactive protein and procalcitonin levels and the appearance of post-operative intraabdominal infection, in patients with pancreaticoduodenectomy due to pancreatic cancer. METHOD: A prospective observational study, including 35 patients, was made. Procalcitonin and C reactive protein were measured before surgery, as well as 24, 48 and 72 h after the surgical procedure. Patients were divided in two groups, with and without intraabdominal infection. RESULTS: Six patients (17.1%) presented post-operative intraabdominal infection. Both, procalcitonin and C reactive protein, increased in all patients after surgery, but there were no significant differences between the two groups. However, the ratio between the C reactive protein concentrations on post-operative day 3 and the concentrations on post-operative day 1 was significantly increased in the group of patients with intraabdominal infection. The predictive positive value and the predictive negative value for this ratio were 60% and 95%, respectively, for a cut-off point of 2.3. CONCLUSIONS: The ratio between C reactive protein value on post-operative day 3 and the value on post-operative day 1 is a good predictor of post-operative intraabdominal infection after pancreaticoduodenectomy.

OBJETIVO: Evaluar la relación entre los valores de proteína C reactiva y de procalcitonina y la aparición de infección intraabdominal posoperatoria en pacientes con duodenopancreatectomía por cáncer de páncreas. MÉTODO: Estudio prospectivo observacional que incluye 35 pacientes. Ambos parámetros se midieron antes de la cirugía y a las 24, 48 y 72 horas de la intervención. Los pacientes se dividieron en dos grupos: con y sin infección intraabdominal. RESULTADOS: Seis pacientes (17.1%) tuvieron infección intraabdominal. Ambos parámetros aumentaron en todos los pacientes tras la cirugía, pero no hubo diferencias significativas entre los dos grupos. Sin embargo, el cociente entre los valores de proteína C reactiva en el día 3 y los valores en el día 1 de posoperatorio era significativamente mayor en los pacientes con infección intraabdominal, con un valor predictivo positivo del 60% y un valor predictivo negativo del 95%, para un punto de corte de 2.3. CONCLUSIONES: El cociente entre las concentraciones séricas de proteína C reactiva en el tercer día y en el primer día de posoperatorio es un buen predictor de infección intraabdominal posoperatoria después de una duodenopancreatectomía.

Ribociclib-Related Stevens-Johnson Syndrome: Oncologic Awareness, Case Report, and Literature Review.

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis belong to a severe dermatopathic spectrum that includes frequently fatal mucocutaneous manifestations consisting of whole epidermal necrosis and sloughing with bullous transformation, blistering, and further skin detachment. Notably, cancer patients are at higher risk of developing SJS than the general population as a consequence of both the nature of neoplastic disease and frequent exposure to anticancer drugs. Ribociclib is a newly approved cycline-dependent kinase inhibitor that has been recently associated with a single case of SJS. We hereby present a case of ribociclib-related SJS. Early detection of threatening skin lesions is crucial to permit the immediate discontinuation of ribociclib given the predictable and unacceptable risk level. In cases of established SJS, early aggressive support should be initiated, ribociclib should be abruptly discontinued, and specific treatment based on actual evidence should be started.

HER2-targeted therapy: an emerging strategy in advanced colorectal cancer.

INTRODUCTION: Colorectal cancer (CRC) is one of the most common malignant tumors; it is a focus of research globally, but the identification of clinically actionable oncogenic drivers remains elusive. Human epidermal growth factor receptor 2 (HER2) activation is present in approximately 5% of CRC and has acquired resistance to epidermal growth factor receptor (EGFR)-targeted therapy. Early clinical trials suggest an emerging role for personalized HER2-targeted therapy in a subset of metastatic CRC. AREAS COVERED: This manuscript reviews the relevance of HER2 activation in CRC and its potential role as a target for therapy. A literature search was conducted in June 2018 of MEDLINE and EMBASE databases for published preclinical and clinical studies; abstracts of international cancer meetings (AACR, ASCO, and ESMO) were also reviewed. EXPERT OPINION: HER2 is activated in a small but relevant proportion of CRC patients (particularly left-side, RAS wild-type, anti-EGFR resistant tumors). Dual HER2 blockade with monoclonal antibodies (mAbs) (trastuzumab and pertuzumab) or the combination of mAbs with tyrosine kinase inhibitors (trastuzumab and lapatinib) induces durable tumor responses in about one-third of HER2-positive CRC refractory to standard systemic therapy. Although immature, these results are remarkable and anticipate an expanding role for HER2 as a therapeutic target in CRC.

Análisis del patrón de consumo de psicotropos y drogas de abuso en el hospital de Pontevedra durante el año 2016 / Analysis of the pattern of psichotropic and drug abuse in Pontevedra hospital during 2016

Estudio descriptivo retrospectivo de las intoxicaciones agudas por psicofármacos y/o drogas de abuso atendidas en el servicio de urgencias del hospital de Pontevedra durante el año 2016 con el fin de conocer el tipo de intoxicación, su intencionalidad, cronología, agentes tóxicos implicados, antecedentes de los pacientes, manifestaciones clínicas presentadas, evolución y tratamiento administrado. Se realizó la prueba cualitativa Drug-Clip Test 10 (A. Menarini Diagnostics) en orina. Se confirmaron 831 resultados positivos (1% de las urgencias anuales). Las intoxicaciones por benzodiazepinas fueron las más frecuentes (617 casos), principalmente en mujeres, seguidas de la detección de cannabis (318 casos), mayormente en hombres. Predominaron los síntomas neurológicos (44%), antecedentes psiquiátricos (43%) y el tratamiento inespecífico (82%). La intencionalidad autolítica fue del 22% y la mortalidad del 0,8%. Concluimos que la sobreprescripción de benzodiazepinas está aumentando su accesibilidad, causando un incremento de las intoxicaciones agudas y los intentos autolíticos por estos fármacos

Retrospective descriptive study of acute intoxications by psychotropic substances and/or abuse drugs at the emergency department of Pontevedra Hospital during the year 2016 performed to know the type of intoxication, its intention, chronology, toxic agents involved, previous patient history, clinical manifestations presented, evolution and treatment administered. The Drug-Clip test 10 (A. Menarini diagnostics) was tested in urine. Results. 831 positive cases were confirmed (1% of the overall annual emergencies). Benzodiazepine intoxications were the most frequent (617 cases), mainly in women, followed by cannabis detections (318 cases), mostly in males. Neurological symptoms (44%), psychiatric antecedents (43%) and unspecific treatment (82%) predominated. Autolytic Intentionality was 22% and mortality 0.8%. Conclusion. Over-prescription of benzodiazepines makes easier its accessibility, causing an increase in the acute intoxications and the autolytic attempts by these drugs

Procalcitonina y proteína C reactiva como marcadores precoces de infección intraabdominal postoperatoria en pacientes operados de cáncer gastrointestinal / Procalcitonin and C-reactive protein as early indicators of postoperative intra-abdominal infection after surgery for gastrointestinal cancer

OBJETIVO: Evaluar la asociación entre niveles séricos de procalcitonina (PCT) y proteína C reactiva (PCR), en los 3 primeros días de postoperatorio, y la aparición de infección intraabdominal postoperatoria. MÉTODO: Estudio observacional prospectivo que incluye a 67 pacientes intervenidos quirúrgicamente de cáncer colorrectal, gástrico y pancreático. Los niveles séricos de PCT y PCR se midieron antes de la cirugía y a las 24, 48 y 72 h de la misma. Se registraron los valores de PCT y PCR, así como su fiabilidad para la detección de infección intraabdominal postoperatoria. RESULTADOS: La incidencia de infección intraabdominal postoperatoria fue de 13,4%. Los valores de PCR a las 72 h, los valores de PCT a las 24, 48 y 72 h y el cociente entre el valor de PCR a las 72 h y el valor de PCR a las 48 h (PCR D3/PCR D2) se asociaron significativamente con la aparición de infección intraabdominal postoperatoria. La sensibilidad más alta correspondió al valor de PCT a las 72 h (88,9%); la especificidad más alta y el valor predictivo positivo (VPP) más alto, al cociente PCR D3/PCR D2 (96,49 y 71,4%, respectivamente); el valor predictivo negativo (VPN) más alto, al valor de PCT a las 72 h y a las 24 h (97,7 y 96%, respectivamente). CONCLUSIÓN: Los valores de PCT se asocian significativamente con la aparición de infección intraabdominal postoperatoria en los 3 primeros días de postoperatorio. Su sensibilidad y VPP son bajos, pero su VPN es alto, incluso a las 24 h de la cirugía

AIM: to evaluate the association between serum levels of procalcitonin and C-reactive protein, on the first 3 postoperative days, and the appearance of postoperative intra-abdominal infection. METHOD: Prospective observational study including 67 patients operated on for colo-rectal, gastric and pancreatic cancer. Serum levels of procalcitonin and C-reactive protein were analyzed before surgery and daily until the third postoperative day. Values of procalcitonin (PCT) and C-reactive protein (CRP) were recorded as well as their accuracy for detection of postoperative intra-abdominal infection (PIAI). RESULTS: The incidence of postoperative intra-abdominal infection was 13.4%. CRP serum levels at 72 h, PCT serum levels at 24, 48 and 72 h and the ratio between serum levels of CRP at 72 hours and serum levels of CRP at 48 hours (CRP D3/CRP D2) were significantly associated with the appearance of postoperative intra-abdominal infection. The highest sensitivity corresponded to PCT at 72 hours (88.9%); the highest specificity and positive predictive value corresponded to the ratio CRP D3/CRP D2 (96.49% and 71.4%, respectively); the highest negative predictive value to procalcitonin at 72 h and 24 h. CONCLUSIONS: Serum levels of PCT are significantly associated with the appearance of postoperative intra-abdominal infection. Sensitivity and predictive positive values are low, but negative predictive value is high, even at 24 h after surgery

[Procalcitonin and C-reactive protein as early indicators of postoperative intra-abdominal infection after surgery for gastrointestinal cancer]. / Procalcitonina y proteína C reactiva como marcadores precoces de infección intraabdominal postoperatoria en pacientes operados de cáncer gastrointestinal.

AIM: to evaluate the association between serum levels of procalcitonin and C-reactive protein, on the first 3 postoperative days, and the appearance of postoperative intra-abdominal infection. METHOD: Prospective observational study including 67 patients operated on for colo-rectal, gastric and pancreatic cancer. Serum levels of procalcitonin and C-reactive protein were analyzed before surgery and daily until the third postoperative day. Values of procalcitonin (PCT) and C-reactive protein (CRP) were recorded as well as their accuracy for detection of postoperative intra-abdominal infection (PIAI). RESULTS: The incidence of postoperative intra-abdominal infection was 13.4%. CRP serum levels at 72h, PCT serum levels at 24, 48 and 72h and the ratio between serum levels of CRP at 72hours and serum levels of CRP at 48hours (CRP D3/CRP D2) were significantly associated with the appearance of postoperative intra-abdominal infection. The highest sensitivity corresponded to PCT at 72hours (88.9%); the highest specificity and positive predictive value corresponded to the ratio CRP D3/CRP D2 (96.49% and 71.4%, respectively); the highest negative predictive value to procalcitonin at 72h and 24h. CONCLUSIONS: Serum levels of PCT are significantly associated with the appearance of postoperative intra-abdominal infection. Sensitivity and predictive positive values are low, but negative predictive value is high, even at 24h after surgery.