Quimioterapia intraarterial para el tratamiento del retinoblastoma en Chile: experiencia y resultados, período 2013-2020 / Intra-arterial chemotherapy for retinoblastoma treatment in Chile: experience and results 2013-2020

Objetivo Establecer la tasa de éxito de la quimioterapia intraarterial (QIA) en modalidad de rescate expresada en el porcentaje de ojos que lograron remisión tumoral y evitaron la enucleación. El segundo objetivo fue analizar la caracterización clínica, resultados del cateterismo, complicaciones locales y sistémicas asociadas. Métodos Estudio retrospectivo de serie de casos intervencional de 29 pacientes (35 ojos) con retinoblastoma intraocular persistente o recidivado. Resultados Se realizaron un total de 73 procedimientos de QIA con topotecán y melfalán en modalidad de rescate. La tasa de éxito de la QIA fue del 77% en un seguimiento promedio de 41,4 meses. Todos los casos con ojo único evitaron la enucleación de su ojo residual (10 casos). El cateterismo fue exitoso en un 98,6%. Los tipos de cateterización logrados fueron los siguientes: supraselectiva por arteria oftálmica (71,2%), supraselectiva por arteria oftálmica asistida con balón de oclusión en carótida externa (12,3%), selectiva por rama de carótida externa con flujo retrógrado (16,4%). Se reportaron efectos adversos locales en el 14% de los pacientes: una (2,8%) ptosis palpebral transitoria, una (2,8%) parálisis del sexto par transitoria, 2 (5,7%) celulitis aséptica y una (2,8%) pigmentación de región periorbitaria. La frecuencia de neutropenia por quimiosupresión medular fue del 4,1% (3 casos). No hubo casos de anemia ni trombocitopenia severas. No hubo eventos isquémicos cerebrales ni mortalidad asociada al procedimiento. Conclusión La QIA con melfalán y topotecán es una alternativa segura y efectiva para el tratamiento del retinoblastoma persistente o recidivado, permitiendo reducir las tasas de enucleación (AU)

Objective To establish the success rate of salvage intra-arterial chemotherapy (IAC), defined as the percentage of eyes that achieved tumoral remission and avoided enucleation. The second objective was the clinical characterization, catheterization results, and associated local and systemic complications. Methods Retrospective, interventional case series of 29 patients (35 eyes) with persistent or recurrent retinoblastoma. Results A total of 73 salvage IAC procedures with topotecan and melphalan were carried out. Success rate was 77% at a mean follow-up of 41.4 months. All patients with only one remaining eye avoided enucleation (10 cases). Catheterization was successful in 98.6% of cases. The types of catheterizations were as follows: 71.2% supraselective ophthalmic artery, 12.3% occlusion pump assisted supraselective ophthalmic artery, 16.4% selective external carotid with retrograde flow. 14% of patients suffered local adverse effects: 1 (2.8%) transitory ptosis, 1 (2.8%) transitory oculomotor nerve palsy, 2 (5.7%) aseptic cellulitis and 1 (2.8%) periorbitary pigmentation. 4.1% (3 cases) suffered neutropenia due to medullar chemosuppression. There were no cases of severe anemia or thrombocytopenia. There were no cerebral ischemic events or mortality associated to the procedure. Conclusion IAC with melphalan and topotecan is a safe and effective treatment option for persistent or recurrent retinoblastoma, able to reduce enucleation rates (AU)

Intra-arterial chemotherapy for retinoblastoma treatment in Chile: Experience and results 2013-2020.

OBJECTIVE: To establish the success rate of salvage intra-arterial chemotherapy (IAC), defined as the percentage of eyes that achieved tumoral remission and avoided enucleation. The second objective was the clinical characterization, catheterization results, and associated local and systemic complications. METHODS: Retrospective, interventional case series of 29 patients (35 eyes) with persistent or recurrent retinoblastoma. RESULTS: A total of 73 salvage IAC procedures with topotecan and melphalan were carried out. Success rate was 77% at a mean follow-up of 41.4 months. All patients with only one remaining eye avoided enucleation (10 cases). Catheterization was successful in 98.6% of cases. The types of catheterizations were as follows: 71.2% supraselective ophthalmic artery, 12.3% occlusion pump assisted supraselective ophthalmic artery, 16.4% selective external carotid with retrograde flow. 14% of patients suffered local adverse effects: 1 (2.8%) transitory ptosis, 1 (2.8%) transitory oculomotor nerve palsy, 2 (5.7%) aseptic cellulitis and 1 (2.8%) periorbitary pigmentation. 4.1% (3 cases) suffered neutropenia due to medullar chemosuppression. There were no cases of severe anemia or thrombocytopenia. There were no cerebral ischemic events or mortality associated to the procedure. CONCLUSION: IAC with melphalan and topotecan is a safe and effective treatment option for persistent or recurrent retinoblastoma, able to reduce enucleation rates.

[Management of heart failure in cardiology and primary care (MICCAP) program: Improving the management of patients with heart failure]. / Programa MICCAP (Manejo de la Insuficiencia Cardiaca en Cardiología y en Atención Primaria): mejorando el manejo del paciente con insuficiencia cardiaca.

Despite current treatments, morbidity and mortality of patients with heart failure remain high. The late diagnosis of heart failure, the insufficient heart failure treatment (i.e. not using the appropriate drugs, prescribing lower doses of drugs than recommended, etc.), and a poor coordination between different health care levels, may explain, at least in part, these figures. The Management of Heart Failure in Cardiology and Primary Care (MICCAP) program has been developed with the aim of optimising the integrated management of patients with heart failure between Primary Care and Cardiology, through the improvement of coordination between both health care levels. This includes continuous medical education to reinforce the diagnostic and therapeutic skills of general practitioners in the field of heart failure. The rationale and objectives of the MICCAP program are summarised in this article.

[Use of non-vitamin K antagonist oral anticoagulants in Primary Care: ACTUA study]. / Uso de los anticoagulantes orales de acción directa en atención primaria: Estudio ACTUA.

OBJECTIVES: Approximately 40% of patients with non-valvular auricular fibrillation (NVAF) who receive vitamin K antagonists (VKA) in Primary Care in Spain have poor anticoagulation control. The objective of the study Actuación en antiCoagulación, Tratamiento y Uso de anticoagulantes orales de acción directa (ACOD) en Atención primaria (ACTUA) (Action in Coagulation, Treatment and Use of direct oral anticoagulants [DOACs]) in Primary Care) was to analyse the current situation regarding the use of VKA and non-vitamin K antagonist oral anticoagulants (NOACs) in patients with NVAF in Primary Care in Spain and the possible issues arising from it. PATIENTS AND METHODS: An online survey was created covering various aspects of the use of oral anticoagulants in NAFV. A two-round modified Delphi approach was used. Results were compiled as a set of practical guidelines. RESULTS: Forty-four experts responded to the survey. Consensus was reached in 62% (37/60) of the items. Experts concluded that a considerable number of patients with NVAF who receive VKA do not have a well-controlled INR and that a substantial group of patients who could benefit from being treated with NOACs do not receive them. The use of NOACs increases the probability of having good anticoagulation control and decreases the risk of severe and intracranial haemorrhage. Current limitations to the use of NOACs include administrative barriers, insufficient knowledge about the benefits and risks of NOACs, limited experience of doctors in using them, and their price. Renal insufficiency influences the choice of a particular anticoagulant. CONCLUSIONS: The ACTUA study highlights the existing controversies about the use of oral anticoagulants for the treatment of NVAF in Primary Care in Spain, and provides consensus recommendations that may help to improve the use of these medications.

Consensus document and recommendations on the use of natriuretic peptides in clinical practice. / Documento de consenso y recomendaciones sobre el uso de los péptidos natriuréticos en la práctica clínica.

Natriuretic peptides are a useful laboratory tool for the diagnosis, prognosis and treatment of patients with heart failure. Natriuretic peptides are used in various healthcare settings (consultations, emergency department, hospitalization, laboratory) and by various primary care and specialised professionals. However, their use in clinical practice is still scare and uneven. Properly using and interpreting natriuretic peptides in clinical practice requires a minimum of prelaboratory (pathophysiology), laboratory (methods) and postlaboratory (interpretation and integration of clinical data) expertise. The objective of this consensus document, developed by several scientific societies, is to update the necessary concepts and expertise on natriuretic peptides that enable its application in the diagnosis, prognosis and treatment of heart failure, in various healthcare environments.

Relative value of the Ankle-Brachial Index of intermittent claudication.

INTRODUCTION: The Ankle-Brachial Index (ABI) makes it possible to identify patients with peripheral artery disease (PAD). Intermittent claudication (IC) is the first major symptom of PAD, although many patients with an ABI ≤ 0.9 do not exhibit IC, and the range of ABI among those who do have IC is very variable. This study evaluates the correlation between ABI and the perception (symptomatology) of claudicant patients. MATERIAL AND METHODS: An observational, cross-sectional and multicentre, study of 920 patients with IC. Clinical history, ABI, Walking Impairment Questionnaire (WIQ) and European Quality of Life Questionnaire (EQ-5D) were recorded. Associations were analysed using Spearman's correlation coefficient. RESULTS: The mean ABI of the series was 0.63 (SD = 0.19). The mean WIQ-distance was 34.07 (SD = 26.77), values being smaller for lower ABI values (r = 0.343, p < 0.001). The mean EQ-5D score of the series was 0.58 (SD = 0.21), also showing lower values as the ABI decreased (r = 0.278, p < 0.001). The correlations of WIQ and EQ-5D with ABI were statistically significant in both cases, but always less than 0.400 (between 0.278 and 0.343). CONCLUSIONS: The correlations of ABI with the questionnaires of walking capacity and quality of life are weak. For this reason, although in clinical practice the ABI of CI patients is commonly measured, decisions should not be taken during the development of IC exclusively on the basis of the ABI.

[European Guidelines on Cardiovascular Disease Prevention in Clinical Practice. Spanish adaptation of the CEIPC 2008]. / Guía Europea de Prevención Cardiovascular en la Práctica Clínica. Adaptación Española del Comité Español Interdisciplinario para la Prevención Cardiovascular (CEIPC) 2008.

We present the Spanish adaptation made by the CEIPC of the European Guidelines on Cardiovascular Disease Prevention (CVD) in Clinical Practice 2008. This guide recommends the SCORE model for risk evaluation. The aim is to prevent premature mortality and morbidity due to CVD through the management of its related risk factors in clinical practice. The guide focuses on primary prevention and emphasizes the role of the nurses and primary care medical doctors in promoting a healthy life style, based on increasing physical activity, change dietary habits, and non smoking. The therapeutic goal is to achieve a Blood Pressure < 140/90 mmHg, but among patients with diabetes, chronic kidney disease, or definite CVD, the objective is <130/80 mmHg. Serum cholesterol should be < 200 mg/dl and cLDL<130 mg/dl, although among patients with CVD or diabetes, the objective is <100 mg/dl (80 mg/dl if feasible in very high-risk patients). Patients with type 2 diabetes and those with metabolic syndrome must lose weight and increase their physical activity, and drugs must be administered whenever applicable, to reach body mass index (BMI) guided and waist circumference objectives. In diabetic type 2 patients, the objective is glycated haemoglobin <7%. Allowing people to know the guides and developing implementation programs, identifying barriers and seeking solutions for them, are priorities for the CEIPC in order to transfer the recommendations established into the daily clinical practice.

[European Guidelines on Cardiovascular Disease Prevention in Clinical Practice. CEIPC 2008 Spanish adaptation]. / Guía Europea de Prevención Cardiovascular en la Práctica Clínica. Adaptación española del CEIPC 2008.

The present CEIPC Spanish adaptation of the European Guidelines on Cardiovascular Disease Prevention in Clinical Practice 2008. This guide recommends the SCORE model for risk evaluation. The aim is to prevent premature mortality and morbidity due to CVD by means of dealing with its related risk factors in clinical practice. The guide focuses on primary prevention and emphasizes the role of the nurses and primary care doctors in promoting a healthy life style, based on increasing physical activity, changing dietary habits, and not smoking. The therapeutic goal is to achieve a Blood Pressure < 140/90 mmHg, but in patients with diabetes, chronic kidney disease, or definite CVD, the objective is < 130/80 mmHg. Serum cholesterol should be < 200 mg/dl and cLDL < 130 mg/dl, although in patients with CVD or diabetes, the objective is < 100 mg/dl (80 mg/dl if feasible in very high-risk patients). Patients with type 2 diabetes and those with metabolic syndrome must lose weight and increase their physical activity, and drugs must be administered whenever applicable, with the objective guided by body mass index and waist circumference. In diabetic type 2 patients, the objective is glycated haemoglobin < 7%. Allowing people to know the guides and developing implementation programs, identifying barriers and seeking solutions for them, are priorities for the CEIPC in order to put the recommendations into practice.

Biomass adaptation to complex substrate degradation in membrane bioreactors: appropriated operating conditions.

The aim of this work is to analyse the biological performances of two immersed membranes bioreactors focusing on the biomass adaptation to complex substrate degradation and the performance in term of permeate quality. Two influents were selected: a synthetic complex influent (acetate/Viandox, MBR1) and a real seafood processing wastewater (surimi product, MBR2). The MBR systems were operated for long periods without any sludge extraction except for sampling. Organic matter removal, sludge production and quality of the treated wastewater were analysed and studied. COD removal efficiencies after a period of biomass adaptation were higher than 97% and 95% for the synthetic and real wastewater respectively. In both cases, the COD of the treated wastewater was lower than 50 mg.L(-1). In spite of salt concentration in the real wastewater a biomass adaptation process occurs. In the overall operational period, a 0.058 gCOD P.gCOD T(-1) and a 0.12 gCOD P.gCOD T(-1) observed sludge yields were obtained for the MBR1 and MBR2 respectively. These values are approximately 5 to 10 times lower than those measured in conventional activated sludge process. These results showed that the presence of particular and some of non-easily degradable compounds in the influent of MBR2 didn't limit the performance of MBR in term of COD removal achieved. The results have also confirmed the excellent permeate quality for water reuse from MBRs systems.

Continuous and sequencing membrane bioreactors applied to food industry effluent treatment.

This work focuses on the performances of two immersed membrane bioreactors used for the treatment of easily biodegradable organic matter present in food industry effluents, for the purpose of water reuse. Two reactor functioning modes (continuous and sequencing) were compared in terms of organic carbon removal and of membrane permeability. For each working mode, pollutant removal was very high, treated water quality presented a low COD concentration (< 125 mg x L(-1)), no solids in suspension and low turbidity (< 0.5 NTU). The quality of the treated water (including germ removal) enabled its reuse on site. Moreover, by developing high biomass concentrations in the reactor, excess sludge production remained very low (< 0.1 gVSS x gCOD(-1)). The performances appeared slightly better for the continuous system (lower COD concentration in the effluent, < 50 mg x L(-1), and lower sludge production). In terms of filtration, a distinct difference was observed between continuous and sequencing systems; transmembrane pressure showed a small and constant evolution rate in continuous membrane bioreactor (CMBR) although it appeared more difficult to control in sequencing membrane bioreactor (SMBR) probably due to punctually higher permeate flow rate and modified suspension properties. The rapid evolution of membrane permeability observed in SMBR was such that more frequent chemical cleaning of the membrane system was required.

Adaptación española de la Guía Europea de Prevención Cardiovascular / Spanish adaptation of the European Guideline of Cardiovascular Prevention

Esta guía se centra en la prevención de la enfermedad cardiovascular en su conjunto, recomienda el modelo SCORE para valorar el riesgo y prioriza la atención a los pacientes y sujetos de alto riesgo. Los pacientes de alto riesgo deben incrementar su actividad física, elegir dietas cardiosaludables y los fumadores abandonar el tabaco. La decisión de iniciar el tratamiento farmacológico dependerá del riesgo cardiovascular y de posibles lesiones de órganos diana. Se incluye un anexo con recomendaciones dietéticas adaptadas a nuestro entorno y criterios de derivación o consulta con el especialista en hipertensión y dislipidemia

This guideline is focused on cardiovascular disease prevention as a whole. It recommends the SCORE model to assess risk and makes attention to high risk patients and subjects a priority. High risk patients should increase their physical activity, chose cardio-healthy diets, and those who smoke should break the habit. The decision to initiate drug treatment will depend on the cardiovascular risk and possible lesions of the target organs. An annex is included with dietary recommendation adapted to our setting and referral criteria or consultation with specialist in hypertension and dyslipidemia is included

Effects of starvation conditions on biomass behaviour for minimization of sludge production in membrane bioreactors.

The behaviour of an activated sludge system in starvation conditions was examined in batch according to substrate impulses defined by different S0/X0 ratio. The answer was characterised by an exogenous phase followed by a starvation one. If at high S0/X0 ratio, bacterial cell multiplication was the main synthesis process during exogenous phase, at low S0/X0 ratio the observed phenomenon was compound storage. In starvation conditions, for the lowest S0/X0 ratio, a rapid decrease in the MLVSS without soluble proteins production was observed. No bacterial lysis occurred and this phenomenon was due to consumption of the storage compounds with a decrease rate equal to 0.74d(-1). For high S0/X0 ratio, as soon as the exogenous phase was completed, a decrease of the MLVSS simultaneously to a soluble protein production was observed. An immediate bacterial lysis occurred with a decay rate equal to 0.53 d(-1). Because MBR systems work generally in low F/M conditions, the activity of the present microbial population is close to the one observed in starvation phase. This work points out that these conditions do not allow net bacterial growth and cells just use lysis products to satisfy their maintenance requirements. These assumptions confirm the feasibility of a decrease of the net biomass production in a MBR when high sludge retention time is operated.

Adaptación española de la Guía Europea de Prevención Cardiovascular / Spanish adaptation of the European Guidelines on Cardiovascular Disease Prevention

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Adaptación española de la Guía Europea de Prevención Cardiovascular

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Diferencias en la atención de lasmujeres con alto riesgo cardiovascularrespecto a los varones. Respuesta / Different approach in high-cardiovascular-risk women, compared to men. Author´s reply

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