Association of location of BRCA1 and BRCA2 mutations with benefit from olaparib and bevacizumab maintenance in high-grade ovarian cancer: phase III PAOLA-1/ENGOT-ov25 trial subgroup exploratory analysis.

BACKGROUND: In the phase III PAOLA-1 study, the addition of maintenance olaparib to bevacizumab in patients with newly diagnosed high-grade ovarian cancer (HGOC) resulted in prolonged progression-free survival (PFS), particularly for homologous recombination deficiency-positive tumors, including those with a BRCA mutation (BRCAm). The magnitude of benefit from olaparib and bevacizumab according to the location of mutation in BRCA1/BRCA2 remains to be explored. PATIENTS AND METHODS: Patients with advanced-stage HGOC responding after platinum-based chemotherapy + bevacizumab received maintenance therapy bevacizumab (15 mg/kg q3w for 15 months) + either olaparib (300 mg b.i.d. for 24 months) or placebo. PFS was analyzed in the subgroup of patients with BRCA1m/BRCA2m according to mutation location in the functional domains of BRCA1 [Really Interesting Gene (RING), DNA-binding domain (DBD), or C-terminal domain of BRCA1 (BRCT)] and BRCA2 [RAD51-binding domain (RAD51-BD); DBD]. RESULTS: From 806 randomized patients, 159 harbored BRCA1m (19.7%) and 74 BRCA2m (9.2%). BRCA1m in RING, DBD, and BRCT domains was detected in 18, 40, and 33 patients, and BRCA2m in RAD51-BD and DBD in 36 and 13 patients, respectively. After a median follow-up of 25.5 months, benefit from maintenance olaparib + bevacizumab was observed irrespective of location of BRCAm. The benefit was particularly high for those with BRCA1m located in the DBD, with 24-month PFS estimated to be 89% and 15% [olaparib + bevacizumab versus placebo + bevacizumab hazard ratio = 0.08 (95% confidence interval 0.02-0.28); interaction P = 0.03]. In BRCA2m patients, 24-month PFS rates for those with mutations located in the DBD were 90% and 100% (olaparib + bevacizumab versus placebo + bevacizumab), respectively. CONCLUSIONS: Advanced-stage BRCA-mutated HGOC patients reported PFS benefit from maintenance olaparib and bevacizumab regardless of mutation location. The benefit is particularly high for patients with mutations located in the DBD of BRCA1. Mutations located in the DBD of BRCA2 are also associated with excellent outcome.

The impact of olaparib dose reduction and treatment interruption on treatment outcome in the SOLO2/ENGOT-ov21 platinum-sensitive recurrent ovarian cancer.

BACKGROUND: Maintenance treatment with poly (ADP-ribose) polymerase (PARP) inhibitor is now the standard of care in patients with BRCA-mutated platinum-sensitive recurrent ovarian cancer following response to chemotherapy. In the SOLO2 trial, adverse event (AE)-associated olaparib interruption, dose reduction, and discontinuation occurred in 50%, 28%, and 17% of patients, respectively. We used data from the SOLO2 trial to evaluate the impact of dose alterations on survival outcomes and identified baseline characteristics associated with dose alteration. PATIENTS AND METHODS: We computed relative dose intensity (RDI) defined as the received dose as a percentage of the standard dose (300 mg twice a day) during the first 12 weeks on treatment. Patients were categorized into RDI >98%, RDI 90%-98%, and RDI <90%. The association between RDI categories with progression-free survival (PFS) and overall survival (OS) were examined using a 12-week landmark Cox regression analysis. Logistic regression analysis was used to correlate baseline factors with RDI at 12 weeks. RESULTS: In patients on olaparib included in the landmark analysis (n = 185), the mean 12-week RDI was 91.4%. There was no significant difference across 12-week RDI >98% (n = 110), 90%-98% (n = 29), and <90% (n = 45) categories for PFS (median, 14.2 versus 19.3 versus 34.4 months; P = 0.37) and OS (median, 49.7 versus 49.5 versus 54.1 months; P = 0.84). Risk of RDI ≤90% increased with baseline performance status 1 [odds ratio (OR): 2.54; 95% confidence interval (CI): 1.11-5.82] any nausea (OR: 3.17; 95% CI: 0.9-11.23), and with body weight ≤70 kg (OR: 1.86; 95% CI: 0.92-3.76). CONCLUSIONS: Dose reduction and interruption for the management of olaparib-associated AEs during the first 12 weeks did not impact on PFS and OS. When counselling patients requiring dose reductions or interruptions due to AEs, the results of this study will help assure patients that their outcomes will not be adversely affected.

SEOM clinical guideline in ovarian cancer (2020)

Despite remarkable advances in the knowledge of molecular biology and treatment, ovarian cancer remains the leading cause of death from gynecologic cancer. In the last decade, there have been important advances both in systemic and surgical treatment. However, there is no doubt that the incorporation of PARP inhibitors as maintenance after the response to platinum-based chemotherapy, first in recurrent disease and recently also in first line, will change the natural history of the disease. The objective of this guide is to summarize the current evidence for the diagnosis, treatment, and follow-up of ovarian cancer, and to provide evidence-based recommendations for clinical practice (AU)

SEOM clinical guideline in ovarian cancer (2020).

Despite remarkable advances in the knowledge of molecular biology and treatment, ovarian cancer remains the leading cause of death from gynecologic cancer. In the last decade, there have been important advances both in systemic and surgical treatment. However, there is no doubt that the incorporation of PARP inhibitors as maintenance after the response to platinum-based chemotherapy, first in recurrent disease and recently also in first line, will change the natural history of the disease.The objective of this guide is to summarize the current evidence for the diagnosis, treatment, and follow-up of ovarian cancer, and to provide evidence-based recommendations for clinical practice.

B Cell Lymphoma mimicking Rheumatoid Arthritis.

Non Hodking´s lymphoma (NHL) may involve bones but synovial involvement is uncommon. We describe a patient who presented with polyarthritis, sicca symptoms and rash suggestive of rheumatoid arthritis. An atypical skin rash prompted skin and synovial biopsies. A diagnosis of synovial and skin malignant large B-cell lymphoma anaplastic subtype was performed. Chemotherapy with dexamethasone, vincristine and rituximab was started. Following treatment the patient had complete resolution of cutaneous and articular lymphoma manifestations.

Evolución de la prevalencia de úlceras por presión en un hospital de agudos de tercer nivel (2006-2013) / Trends in the prevalence of pressure ulcers in an acute care tertiary hospital (2006-2013)

Objetivos: Analizar la evolución de la prevalencia de úlceras por presión entre los años 2006 a 2013. Conocer los principales factores de riesgo asociados a las mismas. Método: Estudio descriptivo en el que se analizaron las series de prevalencia 2006-2013 de úlceras por presión del estudio de prevalencia de las infecciones nosocomiales en España del Hospital Clínico Universitario de Zaragoza. Resultados: La prevalencia media de úlceras por presión en los 5.354 pacientes del período de estudio fue de 4,5% (IC95% = 3,9-5,0%). No se encontraron diferencias significativas en la distribución ni en la tendencia a lo largo del período estudiado. La prevalencia aumentó al 5,0% (IC95% = 4,4-5,6% al eliminar de la muestra los pacientes con estancia inferior a 24 horas y los de servicios de bajo riego (Pediatría, Obstetricia y Psiquiatría), pero tampoco había diferencias en su distribución ni tendencia anual (p > 0,05). Los factores asociados a las úlceras fueron la edad, los días de ingreso, la presencia de coma, sonda urinaria, desnutrición, infección y el servicio de ingreso. Conclusiones: La edad, la estancia hospitalaria, la presencia de coma, desnutrición, infección, sonda urinaria y el ingreso en determinadas unidades constituyen marcadores independientes de riesgo de los pacientes con úlceras por presión. No se aprecia una tendencia en la prevalencia de úlceras por presión que sugiera algún efecto de las diferentes estrategias de intervención implantadas en el período de estudio, aunque esta ausencia de hallazgos podría ser debida a las limitaciones de los datos empleados (AU)

Objectives: To analyse the trends in pressure ulcer prevalence from 2006 to 2013. To determine the main risk factors associated with pressure ulcers. Method: A descriptive study analysing the prevalence in a series of pressure ulcers collected in the study on the prevalence of nosocomial infections in Spain from 2006 to 2013 in the Clinical University Hospital of Zaragoza. Results: The mean prevalence among the 5,354 patients included over the period of study was 4.5% (95% CI = 3.9-5.0%). No significant difference in its trend or distribution of pressure ulcers was observed over the several years of the study. Prevalence increased up to 5.0% (95% CI = 4.4-5.6%) when short-stay patients (less than 24 hours) and those admitted into low risk units (Paediatrics, Psychiatry and Obstetrics) were removed from the study, but there was still no significant differences in its yearly trend or distribution (p > 0.05). Age, length of stay, presence of coma, in-dwelling urethral catheters, malnutrition, infection, and admission unit were risk factors associated with pressure ulcer prevalence in the logistic regression. Conclusions: Age, length of stay, coma, in-dwelling urethral catheters, malnutrition, infection, and admission unit were independent risk markers for patients with pressure ulcers. No particular trend of pressure ulcer prevalence could be determined to demonstrate any effects from the different strategies of improvement implemented during the period of study, although this fact could be due to the limitations of data used in the study (AU)

[Trends in the prevalence of pressure ulcers in an acute care tertiary hospital (2006-2013)]. / Evolución de la prevalencia de úlceras por presión en un hospital de agudos de tercer nivel (2006-2013).

OBJECTIVES: To analyse the trends in pressure ulcer prevalence from 2006 to 2013. To determine the main risk factors associated with pressure ulcers. METHOD: A descriptive study analysing the prevalence in a series of pressure ulcers collected in the study on the prevalence of nosocomial infections in Spain from 2006 to 2013 in the Clinical University Hospital of Zaragoza. RESULTS: The mean prevalence among the 5,354 patients included over the period of study was 4.5% (95% CI=3.9-5.0%). No significant difference in its trend or distribution of pressure ulcers was observed over the several years of the study. Prevalence increased up to 5.0% (95% CI=4.4-5.6%) when short-stay patients (less than 24 hours) and those admitted into low risk units (Paediatrics, Psychiatry and Obstetrics) were removed from the study, but there was still no significant differences in its yearly trend or distribution (p>0.05). Age, length of stay, presence of coma, in-dwelling urethral catheters, malnutrition, infection, and admission unit were risk factors associated with pressure ulcer prevalence in the logistic regression. CONCLUSIONS: Age, length of stay, coma, in-dwelling urethral catheters, malnutrition, infection, and admission unit were independent risk markers for patients with pressure ulcers. No particular trend of pressure ulcer prevalence could be determined to demonstrate any effects from the different strategies of improvement implemented during the period of study, although this fact could be due to the limitations of data used in the study.

Dispositivo supraglótico I-gel® en cirugía ginecológical aparoscópica ambulatoria / No disponible

Objetivo: La cánula I-gel® es un dispositivo de ventilación supraglótico de reciente aparición que incorpora un canal de acceso gástrico. En este estudio valoramos su eficacia en cirugía ginecológica laparoscópica. Material y métodos: Estudio descriptivo prospectivo de 30 pacientes intervenidos de cirugía ginecológica la paroscópica mediante anestesia general. Tras la inducción se colocó la mascarilla asignada y se valoró la facilidad de inserción. Se midieron los siguientes parámetros ventilatorios: presión pico (Pp), presión media(Pm), complianza, volumen corriente y frecuencia respiratoria (VT/FR) al inicio, y a los 10, 30 y 60 minutos de iniciada la intervención. Se comprobaron las condiciones del paso de una sonda nasogástrica y la visualización mediante la cámara de laparoscopia del tamaño del estómago (al comienzo y final de la cirugía) deforma directa. Los datos se tomaron con el paciente en posición de Trendelenburg y con un neumoperitoneo que no superó los 15 mmHg. Resultados: La cánula I-gel® se colocó al primer intento en el 95% de los pacientes. El tiempo medio de colocación fue de 14 segundos. Se colocó la sonda nasogástrica en el 85% de los pacientes. La presión de fuga de la vía aérea era parecida al principio y al final de la cirugía 25 ± 9 cm H2O y en todos los casos se mantuvieron las presiones pico por debajo de 21. La media de valoración por parte del cirujano en el tamaño del estómago al comienzo de la cirugía fue de 2 y al final de 3,5. Coincidió en un único caso la diferencia al final y al principio, donde se describió un vómito al despertar. Conclusión: La cánula I-gel® es un dispositivo fácil de colocar al primer intento. Asimismo resultó un dispositivo seguro para el sellado de la vía aérea y la minimización de las fugas en la ventilación para la cirugía laparoscópica ginecológica (AU)

Background: The I-gel® is a new single-use supraglottic airway device with a non inflatable cuff and an esophageal vent. In this study we evaluated the I-gel® in gynecological laparoscopic surgery. Material and methods: 30 women, ASA I-II undergoing gynaecological laparoscopic surgery in the Trendelenburg position were included in this prospective, observational study. We evaluated ease in inserting the I-gel®, seal pressure, gastric leak, complications during insertion and removal, ease in inserting the gastric tube and ventilatory parameters during positive pressure ventilation. Results: Insertion was easy and performed at the first attempt in 95% of cases. After creation of the pneumoperitoneum average peak pressure was 19,40 mmHg and average plateau pressure 18,20 mmHg. The gastric tube insertion was easily achieved 85%of cases. One case of vomiting occurred. Conclusion: The I-gel® is a reliable, easily inserted airway device that provides an adequate seal, and very few complications. It seems to be an efficient and safe device for gynecological laparoscopicsurgery (AU)

Immunophenotypical characterization in Andalusian horse: variations with age and gender.

Assessment of lymphocyte subsets is an effective method for characterizing disorders such as leukemia, lymphomas, autoimmune and infectious diseases. In order to clinically interpret these parameters, normal reference values should be set, estimating age- and gender-related variations. This research aimed to: (1) characterize lymphocyte subpopulations in Andalusian horse, and (2) evaluate age and gender-related variations of lymphocyte subsets. Jugular blood samples were obtained from 159 animals, 77 males and 82 females, belonging to four age groups-1: 1-2 years (N=39; 21 males and 18 females), 2: 2-3 years (N=38; 16 males and 22 females), 3: 3-4 years (N=41; 19 males and 22 females) and 4: 4-7 years (N=41; 21 males and 20 females). T lymphocytes subsets were quantified by flow cytometry with monoclonal antibodies specific for CD2, CD4 and CD8 cell markers. B and NK cell counts were estimated by using a mathematical formula. No variations were found in T, B lymphocytes and NK cells between males and females. Animals of group 1 and 2 had a higher number of CD2, T, CD4+, CD8+, B lymphocytes and NK cells than animals of groups 3 and 4. The percentage of CD2 in group 1 was significantly lower than in group 4. The percentage of T and CD4+ lymphocytes in the group 1 were significantly higher than groups 2 and 3, respectively. Whereas the percentage of B cells calculated by flow cytometry was significantly lower in group 2 compared to group 4, the percentage of B cells calculated by a mathematical formula was higher in group 1. NK cells percentage was significantly lower in group 3 and 4 than in younger animals. In conclusion, in Andalusian horse, gender does not influence absolute numbers and percentages of T, B and NK. There is an age-related decline in absolute number of CD2, T, CD4+ and CD8+ lymphocytes, B lymphocytes and NK cells, with increasing percentage of CD2, T, CD4+ and B lymphocytes, and a decrease in NK with no differences in CD4/CD8 ratio. The decline of lymphocyte population numbers with age is a natural process in many animal species, and could be the origin for immune dysfunction observed in geriatric individuals.

Cefalea cervicogénica. Tratamiento con estimulación eléctrica subcutánea periférica C1-C2-C3 / Cervicogenic headache. Treatment with peripheral C1-C2-C3 subcutaneous electrostimulation

Introducción: Presentamos siete pacientes con dolor cervicogénico (C1-C2-C3) de larga evolución, persitente, severo, no controlado, de diferentes etiologías, en los que se habían agotado otras posibilidades terapéuticas, tratados con una técnica de estimulación eléctrica extraespinal periférica occipital (C1-C2-C3), mediante implante quirúrgico de electrodo cérvico-occipital uni- o bilateral. Material y método: Se trata de siete pacientes, mujeres, edad media de 50,5 años, con los siguientes diagnósticos: en 3 pacientes cefalea cervicogénica (migraña transformada); otros dos casos se tratan de un síndrome de dolor regional complejo, uno localizado cervical tipo 2 post-siringomielia C2-D1 + malformación de Arnold Chiari + cirugía y en otro de hemicara/cuello/occipital y EESS izqda. postcirugía de carótida; un caso de neuralgia postherpética C1-C2-C3 izquierda; y otro caso de cefalea cervicogénica secundaria a artrosis. Resultados: En todos los casos se ha obtenido un buen resultado analgésico. En la mayoría de las pacientes ha desaparecido el dolor continuo, ha disminuido el número de crisis y su severidad. Se ha normalizado su actividad física, y tres pacientes se han reincorporado al trabajo. El descanso nocturno que era malo en todas ha pasado a ser normal. En dos pacientes se ha retirado el tratamiento farmacológico y en el resto se ha reducido de forma considerable. El tiempo medio de seguimiento es de 16 meses, el máximo en el primer caso es de 33. Las complicaciones han sido en dos ocasiones migración del electrodo, una ocurrió a los 7 días del implante definitivo y en otra paciente después de un año. Discusión: La neuromodulación mediada por la estimulación eléctrica invasiva ha demostrado su utilidad terapéutica a lo largo de los últimos años, en pacientes con dolor neuropático refractario e intratable. Los avances recientes en neuroestimulación han permitido ampliar sus posibilidades terapéuticas con la colocación de electrodos extraespinales para estimulación de nervios periféricos. Conclusiones: En todos nuestros pacientes la localización del dolor estaba referida, de forma predominante, en una distribución metamérica C1, C2, C3. En todos los casos la estimulación occipital ha proporcionado un resultado global muy bueno o bueno que se mantiene en el tiempo; desaparición del dolor continuo, disminución de la frecuencia y severidad de las crisis, mejoría funcional, descanso nocturno, actividad de la vida diaria y disminución del tratamiento farmacológico (AU)

Introduction: We present seven patients with long-term, persistent, severe and non-controlled cervicogenic pain (C1-C2-C3) of diverse etiologies and refractory to other therapeutic options, that were treated with occipital peripheral extramedullary electrostimulation (C1-C2-C3) through surgical implantation of a uni- or bilateral cervico-occipital electrode. Material and method: Seven female patients with an average age of 50.5 years had the following diagnoses: cervicogenic headache (transformed migraine) in 3 patients; complex regional pain syndrome in 2 patients, one of them being a type 2 with cervical location secondary to syringomyelia C2-D1 + Arnold Chiari malformation + surgery and the other one with hemiface/neck/occipital location and left EESS secondary to carotid surgery; left postherpetic neuralgia at C1-C2-C3 in 1 patient and cervicogenic headache secondary to osteoarthritis in 1 patient. Results: Satisfactory analgesic result was provided in all the cases. In most patients, continuous pain disappeared and the number and severity of crises decreased. Physical activity returned to normal levels and three patients returned to work. Night rest had been poor in all of them, but returned to normal. Drug therapy was discontinued in two patients and significantly reduced in the remainder. Mean follow-up time was 16 months, with a maximum of 33 in the first case. Electrode displacement was a complication in two cases, one after 7 days of the final implant and the other after one year. Discussion: Neuromodulation mediated by invasive electrostimulation has shown its therapeutic use over the past years in patients with refractory and nontratable neuropathic pain. Recent advances in neurostimulation have provided new therapeutic options with the implantation of extramedullary electrodes for the stimulation of peripheral nerves. Conclusions: In all of our patients, pain location showed preferably a metameric distribution C1, C2 and C3. In all cases, occipital stimulation provided a very satisfactory or good result that was maintained over time, with relief of continuous pain, decreased frequency and severity of pain crises, functional improvement of night rest, normalization of daily life activity and reduced need of pharmacological treatment (AU)

Aplicación de niveles asistenciales de rehabilitación psicofuncional en un centro de día para personas dependientes / Application of health care levels of psychofunctional rehabilitation in a day center for dependent persons

El objetivo de este estudio es un ensayo para la aplicación de actividades integradoras mediante un programa psicofuncional en el que están integradas las actividades propias de la rehabilitación física y de la estimulación cognitiva. De esta manera los diferentes profesionales del centro de día se coordinan entre sí mediante un programa de atención personalizado, asumiendo las cargas asistenciales y facilitando a las familias el apoyo y el asesoramiento adecuados.En Geriser Centros de Día se aplica al ingreso de los pacientes un protocolo de valoración psicofuncional que nos definirá los cinco niveles asistenciales en función del deterioro físico y/o cognitivo que presenten.Es importante destacar la puesta en marcha de estos programas que ayudan a mantener la calidad de vida de los pacientes y sus cuidadores y nos invite a profundizar en el diseño de nuestros centros, basados en una orientación terapéutica para nuestros clientes y protésica para sus familiares (AU)

Risk of congenital anomalies in the vicinity of municipal solid waste incinerators.

BACKGROUND: Although municipal solid waste incineration (MSWI) has contributed to increase the overall environmental load of particulate matter containing dioxins and metals, evidence of health consequences to populations is sparse. AIMS: To assess at a regional level (in southeast France) the impact of these emissions on birth defect rates. METHODS: Communities with fewer than 50 000 inhabitants surrounding the 70 incinerators that operated at least one year from 1988 to 1997 were studied. Each exposed community (n = 194) was assigned an exposure index estimated from a Gaussian plume model. Poisson models and a reference population of the 2678 unexposed communities in the region were used to calculate relative risks for congenital malformations, adjusted for year of birth, maternal age, department of birth, population density, average family income, and when available, local road traffic. RESULTS: The rate of congenital anomalies was not significantly higher in exposed compared with unexposed communities. Some subgroups of major anomalies, specifically facial clefts and renal dysplasia, were more frequent in the exposed communities. Among exposed communities, a dose-response trend of risk with increasing exposure was observed for obstructive uropathies. Risks of cardiac anomalies, obstructive uropathies, and skin anomalies increased linearly with road traffic density. CONCLUSIONS: Although both incinerator emissions and road traffic may plausibly explain some of the excess risks observed, several alternative explanations, including exposure misclassification, ascertainment bias, and residual confounding cannot be excluded. Some of the effects observed, if real, might be attributable to old-technology MSWIs and the persistent pollution they have generated.

Gongylonema infection of the mouth in a resident of Cambridge, Massachusetts.

We report a case of Gongylonema infection of the mouth, which caused a migrating, serpiginous tract in a resident of Massachusetts. This foodborne infection, which is acquired through accidental ingestion of an infected insect, such as a beetle or a roach, represents the 11th such case reported in the United States.

Urgencias en el paciente oncológico

Los pacientes oncológicos acuden con cierta frecuencia a los servicios de urgencias de los hospitales donde llevan a cabo un control de su enfermedad de base. Los motivos de consulta urgente están muchas veces relacionados con su neoplasia y las eventuales complicaciones, aunque en otras ocasiones se deben a efectos adversos del tratamiento quimio o radioterápico, o incluso a afecciones intercurrentes no relacionadas con la enfermedad neoplásica.Siempre que sea posible debe consultarse la historia clínica y/o los informes previos de asistencia que nos permitirán conocer con detalle la situación clínica del paciente y saber si está recibiendo tratamiento activo con intención curativa o si, por el contrario, se encuentra en situación paliativa. Una anamnesis y una exploración física completas suelen ser suficientes para orientar el origen de la urgencia, aunque habitualmente deberá confirmarse mediante la realización de pruebas complementarias, antes de instaurar el tratamiento adecuado. (AU)

Maternal occupational risk factors for oral clefts. Occupational Exposure and Congenital Malformation Working Group.

OBJECTIVES: This study investigated the role of maternal exposures at work during pregnancy in the occurrence of oral clefts. METHODS: The occupational exposures of 851 women (100 mothers of babies with oral clefts and 751 mothers of healthy referents) who worked during the first trimester of pregnancy were studied. All the women were part of a multicenter European case-referent study conducted using 6 congenital malformation registers between 1989 and 1992. In each center, the mother's occupational history, obtained from an interview, was reviewed by industrial hygienists who were blinded to the subject's status and who assessed the presence of chemicals and the probability of exposure. Odds ratios (OR) were estimated by a multivariate analysis including maternal occupation or occupational exposures during the first trimester of pregnancy and possible confounding factors such as center of recruitment, maternal age, urbanization, socioeconomic status, and country of origin. RESULTS: After adjustment for confounding factors, cleft palate only was significantly associated with maternal occupation in services such as hairdressing [OR 5.1, 95% confidence interval (95% CI) 1.0-26.0] and housekeeping (OR 2.8, 95% CI 1.1-7.2). The analysis suggests that the following occupational exposures are associated with orofacial clefts: aliphatic aldehydes (OR 2.1, 95% CI 0.8-5.9) and glycol ethers (OR 1.7, 95% CI 0.9-3.3) for cleft lip with or without cleft palate and lead compounds (OR 4.0, 95% CI 1.3-12.2), biocides (OR 2.5, 95% CI 1.0-6.0), antineoplastic drugs (OR 5.0, 95% CI 0.8-34.0), trichloroethylene (OR 6.7, 95% CI 0.9-49.7), and aliphatic acids (OR 6.0, 95% CI 1.5-22.8) for cleft palate only. CONCLUSIONS: Due to the limited number of subjects, these results must be interpreted with caution. However, they point out some chemicals already known or suspected as reproductive toxins.

[Complete nutritional status in school children. Opinions and attitudes]. / Estudio nutricional completo en escolares. Opiniones y actitudes.

OBJECTIVES: To discover the cooking habits of school students' families and the full nutritional picture of the school population of Huercal de Almería. To gather the views and attitudes of school students and mothers on the low amount of milk and vegetables consumed. DESIGN: Crossover, descriptive and technical study with focus group. SETTING: Rural area. METHODS: The study had three stages: 1. A questionnaire for all the school students on their food habits (675). 2. A sample of 101 students aged between 4 and 6 and between 10 and 14 was chosen for the nutritional study. Students at nutritional risk in 1996 (95% CI; p.q = 0.25). Intake was analysed through the "memory of 24 hours", measurement of physical details and biochemical determinations. 3. We gathered views and attitudes by the focus group technique in 1997, with 60 girls between 10 and 14 and mothers in 6 groups. MAIN RESULTS: Habits: the most commonly eaten meat was chicken, followed by pork, stewed if possible. Blue and fried fish, full-cream milk, white bread, fresh green vegetables and olive oil. Nutritional study: the students' weight and height were above average. Denutrition was rare: we found three students with a percentile less than three. There was tendency to overweight in both sexes, with cholesterol levels above 200 mgr in the 4-6 group. Hyper-protein and hyper-fatty diet. The Ca/P quotient was P < 1, especially in the 10-14 girls. Consumption of pulses, fibre, cereals and root vegetables was less than the recommended amounts. Micronutrients were sufficient except for less iron in 10 to 14 girls. Focal groups: the four groups of girls coincided in rejection of green vegetables, repeating to some extent habits acquired in their families. Usually vegetables are rejected without having been tried, due to smell, texture and look. Positive knowledge about milk and vegetables was not shown in practice. CONCLUSIONS: Hyper-protein and hyper-fat diet with high cholesterol levels, weight and height above the average and tendency to overweight. They all rejected green vegetables. They repeated family eating habits.

Tobacco and alcohol use during pregnancy and risk of oral clefts. Occupational Exposure and Congenital Malformation Working Group.

OBJECTIVES: This study examined the relationship between maternal tobacco and alcohol consumption during the first trimester of pregnancy and oral clefts. METHODS: Data were derived from a European multicenter case-control study including 161 infants with oral clefts and 1134 control infants. RESULTS: Multivariate analyses showed an increased risk of cleft lip with or without cleft palate associated with smoking (odds ratio [OR] = 1.79, 95% confidence interval [CI] = 1.07, 3.04) and an increased risk of cleft palate associated with alcohol consumption (OR = 2.28, 95% CI = 1.02, 5.09). The former risk increased with the number of cigarettes smoked. CONCLUSIONS: This study provides further evidence of the possible role of prevalent environmental exposures such as tobacco and alcohol in the etiology of oral clefts.

Estudio nutricional completo en escolares. Opiniones y actitudes / Full study of the nutrition of school students. Views and attitudes

Objetivos. 1. Conocer los hábitos culinarios del escolar y su familia y el estado nutricional completo de la población escolar de Huercal de Almería. 2. Opiniones y actitudes de escolares y madres referidas al escaso consumo de leche y verduras. Diseño. Estudio descriptivo transversal y técnica de grupo focal. Ámbito. Medio rural. Metodología. Realizamos un abordaje en tres etapas: 1. Para conocer los hábitos alimentarios realizamos una encuesta a todos los escolares (675). 2. Para el estudio nutricional elegimos una muestra de 101 escolares de 4-6 y 10-14 años. Escolares en riesgo nutricional en 1996 (nivel de confianza del 95 por ciento, error del 5 por ciento y p.q = 0,25). Hemos analizado la ingesta mediante el 'recuerdo de 24 horas', parámetros antropométricos y determinaciones bioquímicas. 3. La opinión y actitud las hemos recogido mediante la técnica de grupo focal a 60 personas, repartidos en 6 grupos focales, madres y niñas de 10-14 años en 1997.Resultados principales. Hábitos: las carnes más consumidas son la de pollo, seguida de la de cerdo, preferentemente guisado. El pescado azul y frito, la leche entera, el pan blanco, verduras frescas y aceite de oliva. Estudio nutricional: los escolares presentan peso y talla superiores a la media, la incidencia de desnutrición es escasa; hemos encontrado 3 escolares con un percentil menor de tres; tendencia al sobrepeso en ambos sexos; niveles de colesterol por encima de 200 mg en el grupo de 4-6 años. Dieta hiperproteica e hipergrasa. El cociente Ca/P < 1 sobre todo en el grupo de niñas de 10-14 años. Consumo de legumbres, fibras, cereales y hortalizas inferior a lo recomendado. Micronutrientes adecuados excepto el hierro, menor en niñas de 10-14 años. Grupos focales: coinciden en los 4 grupos de niñas el rechazo a las verduras; en cierta manera repiten los hábitos adquiridos en su familia. La mayoría de las veces el rechazo se origina sin haber probado el alimento, sólo por olor, textura y vista.Conocimientos positivos sobre la leche y verduras, que no se manifiesta en la práctica. Conclusiones. Dieta hiperproteica e hipergrasa con niveles de colesterol elevados, peso y talla superiores a la media y tendencia al sobrepeso. Coincidencia en el rechazo de la verdura. Repetición de hábitos alimentarios (AU)

Descriptive epidemiological survey on a given day in all palliative care patients hospitalized in a French university hospital.

We conducted a descriptive study on a given day on all inpatients requiring palliative care in a French university hospital. In each department, a collaborative team made up of physicians and nurses identified and described the clinical signs, the treatment protocols, the social and family characteristics and the outcome for each patient using a standardized questionnaire. Study subjects were inpatients in the hospital and presented advanced or terminal-stage life-threatening conditions. Two-hundred-and-forty-five patients were included in the study. These patients represented 13% of the total number of inpatient beds available in the hospital on the day of the survey. Sixty-six per cent of study subjects suffered from physical discomfort and 80% suffered psychologically. Patients still received specific treatment for their condition in 45% of cases. Social problems were identified principally in medium- or long-term care department inpatients who made up 36% of the total inpatient population. A request for transfer to another care structure had been completed for 24% of patients. Assistance from the Palliative Care Unit's support team had been requested in 25% of cases, mainly to provide psychological support for the patient and the health care providers. These results have led us to reconsider the general organization of palliative care in the health care system.

Comparative study of the clinical efficacy of two different coumarin dosages in the management of arm lymphedema after treatment for breast cancer.

In a randomized, double-blind, parallel group study, we compared the clinical efficacy of coumarin 90 mg/day (Group A) with 135 mg/day (Group B) in 77 women (age 35-65 years) with lymphedema of the upper limb secondary to surgery and irradiation for treatment of breast cancer. During 12 months of coumarin therapy, the arm volume of lymphedema and a clinical score (degree of arm edema, heaviness, hardness, and neuralgia/dysesthesia) were determined. In both groups, the volume of arm lymphedema decreased (14.9% in Group A and 13.2% in Group B) (N.S.), the overall clinical score improved (12.9 +/- 4.3 to 5.7 +/- 3.5 in Group A and from 11.7 +/- 3.7 to 4.7 +/- 3.9 in Group B) (N.S.), and the overall efficacy of coumarin was similarly good or excellent (71.9% in Group A and 68.6% in Group B) (N.S.). Only mild to moderate side effects of drug therapy were recorded. Coumarin prevents a spontaneous trend toward an increase in arm lymphedema after treatment of breast cancer, decreases the severity of local symptoms, and overall improves the quality of life. No difference was found between the apparent benefits of coumarin at 90 mg/day compared with 135 mg/day.