Clinical practice guidelines for the optimization of hemato-oncological care: the ICOPraxis.

INTRODUCTION: The Catalan Institute of Oncology (ICO) is a Comprehensive Cancer Center (CCC) responsible for the oncological care of 46% of the Catalan population. OBJECTIVE: Given the increasing and ongoing approval of onco-hematological treatments, the professionals at the ICO decided to have clinical practice guidelines (called ICOPraxis) based on available evidence. In this report, we intend to share how the ICOPraxis has developed and what its impact has been in the 14 years it has been running. RESULTS: In the 14 years, since the project has been running, 17 clinical practice guidelines (some of them with several editions) have been prepared for major onco-hematology clinical conditions. These guidelines will be utilized in the four ICO centers (Girona, Badalona, Tarragona, and Hospitalet) and ICO works in a network with 18 regional hospitals. Between 2018 and 2022, the guidelines have been viewed 38.645 times and downloaded 24.614 times, with an average time spent on each page of 3 min. The ICOPraxis have been consulted in 25 countries in America (3.163 views), 20 countries in Europe (35.365 views), 10 countries in Asia (36 views), and 3 countries in Africa (12 views). The country with the highest number of downloads is Spain with a total of 34.742 downloads (Analytics [Internet]). CONCLUSION: The ICOPraxis have succeeded in establishing an evidence-based system that facilitates prescription decision-making according to the established harmonization process and reduction in variability in treatments, increasing equity in our population.

Guidelines for evidence synthesis reporting: medications.

In the process of determining if a drug is valuable enough to be included in a hospital's pharmacotherapeutic repertoire many factors should be taken into account. In order to develop a guide, the methodology of different appraisal working groups and similar methodological documents published by Health Technology Assessment agencies have been taken into account. We recommend that reports are structured with the following headings: Medication/Description/Authorised indication; Description of the disease; Pathology reference treatment; Evaluation of efficacy and safety (Bibliographic search, Quality assessment, Efficacy and safety results); Assessment of ethical, organisational, social and legal aspects; Strengths and limitations of available evidence; Pharmacoeconomic evaluation; and Key points. This guide to evaluate technologies may be used as a tool in decision-making scenarios related to health innovation. It could be used by hospital pharmacists and by clinicians, health system professionals and public services advisors.

[Influence of capsular pseudoexfoliation syndrome on hearing loss]. / Influencia del síndrome de pseudoexfoliación capsular en la pérdida auditiva.

Introduction: Pseudoexfoliation Syndrome (PEX) is a genetic-inherited disorder, consisting of the deposition of elastin microfibers in intra and extraocular tissue. PEX is one of the most common identifiable secondary causes of glaucoma. Several studies have associated PEX with systemic conditions and the finding of fibrillar material in the structures of the inner ear, similar to that of pseudoexfoliation detected in the eye, has been described. Objective: to compare audiometric levels in patients with and without ocular PEX. Materials and Methods: Retrospective case-control study. 48 medical records of patients who attended the ophthalmology service of the Private Hospital of Córdoba were selected between January 2015 and December 2017, between 59 and 75 years. They were divided into groups: controls (n = 22): without PEX and cases (n = 26): with PEX. The medical records of patients who underwent ophthalmological and audiometric studies were analyzed. For the statistical analysis, the Student's T test was used for independent and paired samples; in all cases a level of significance ≤ 0.05 was considered. Results: The percentage of hearing loss was 56.8% in the control group and 82.7% in the PEX group. The percentage disability in the group with PEX was greater in monaural (p = 0.0008) and biaural (p = 0.0307) hearing compared to patients without PEX. Conclusion: Patients with ocular PEX showed a higher percentage of hearing loss, compared to those patients without ophthalmic evidence of PEX.

Introducción: El Síndrome de Pseudoexfoliación (PEX) es un trastorno genético-hereditario, consiste en el depósito de microfibras de elastina en tejido intra y extraocular. El PEX es una de las causas secundarias identificables más comunes del glaucoma. Varios estudios han asociado el PEX con afecciones sistémicas y se ha descripto el hallazgo de material fibrilar en las estructuras del oído interno, similares al de pseudoexfoliación detectado en el ojo. Objetivo: comparar los niveles de audiométricos en pacientes con y sin PEX ocular. Materiales y Métodos: Estudio retrospectivo de casos y controles. Se seleccionaron 48 historias clínicas de pacientes que asistieron al servicio de oftalmología del Hospital Privado de Córdoba, entre enero del 2015 y diciembre de 2017, de entre 59 y 75 años. Se los dividió en grupos: controles (n=22): sin PEX y casos (n=26): con PEX. Se analizaron las historias clínicas de pacientes a los que se les realizaron estudios oftalmológicos y audiométricos. Para el análisis estadístico se utilizó el test T de Student para muestras independientes y apareadas; en todos los casos se consideró un nivel de significación ≤ 0.05. Resultados: El porcentaje de pérdida auditiva fue del 56,8% en el grupo control y un 82,7% en el grupo PEX. La incapacidad porcentual en el grupo con PEX fue mayor en la audición monoaural (p=0,0008) y biaural (p=0,0307) con respecto a los pacientes sin PEX. Conclusión: Los pacientes con PEX ocular mostraron un porcentaje mayor de hipoacusia, en comparación con aquellos pacientes sin evidencia oftalmológica de PEX.

Presencia de anticuerpos IgG antihelicobacter pylori en suero no se relaciona a factores de riesgo y síntomas de la enfermedad ácido-péptica en adultos jóvenes / Presence of anti-helicobacter pylori IgG antibodies in serum is not related to risk factors and symptoms of acid-peptic disease in young adults

Objetivo: determinar el valor diagnóstico de anticuerpos IgG anti-Helicobacter pylori ante sospecha clínica de enfermedad ácido-péptica en adultos jóvenes. Sujetos y métodos: estudiantes de la Carrera de Medicina de la Universidad Central del Ecuador que consintieron participar en una encuesta en línea y extracción de sangre venosa que fue sometida a una prueba inmunoenzimática para detección de anticuerpos. Resultados: se incluyeron 225 partícipes con un una edad promedio de 20 años; el estudio inmunoenzomático fue positivo en el 32,88% de muestras. La existencia de IgG anti-H. pylori no se relacionó estadísticamente a la presencia o ausencia de antecedentes patológicos personales, familiares o sociales. La acumulación de dos o tres síntomas no se relacionó con el hallazgo serológico. Conclusión: las pruebas serológicas para diagnóstico de gastritis o para tamizaje no son adecuadas para éste grupo de edad, toda vez que su positividad no se relaciona a síntomas, factores de riesgo conocidos de infección gástrica o desarrollo de patologías

Aims: to determine the diagnostic value of anti-Helicobacter pylori IgG antibodies in case of clinical suspicion of acid-peptic disease in young adults. Subjects and methods: students of the Medicine School of the Central University of Ecua- dor who agreed to participate in an online survey and venous blood collection that was sub- jected to an immunoenzymatic test for antibody detection. Results: 225 participants with an average age of 20 years were included; the immunoen- zomatic study was positive in 32.88% of samples. The existence of IgG anti H.pylori was not statistically related to the presence or absence of personal, family or social pathological his- tory. The accumulation of two or three symptoms was not related to the serological finding. Conclusion: serological tests for diagnosis of gastritis or screening are not suitable for this age group, since its positivity is not related to symptoms, known risk factors of gastric infec- tion or development of pathologies.

Detección de la colonización asintomática en orofaringe por Streptococcus pyogenes mediante dos métodos diagnósticos / Detection of asymptomatic oropharyngeal carriage of Streptococcus pyogenes using two diagnostic methods

Resumen Introducción. La Streptococcus pyogenes causa infecciones supurativas en la piel, en las mucosas y de carácter sistémico. Su detección oportuna es importante para evitar el desarrollo de complicaciones no supurativas. Además, el estado de portador puede ser una fuente potencial de autoinoculación o de brotes infecciosos. Objetivo. Determinar la presencia de estudiantes de medicina en estado de portador de S. pyogenes mediante dos métodos diagnósticos. Materiales y métodos. Se realizó un estudio de corte transversal con muestreo por conveniencia donde se analizaron muestras de orofaringe por inmunoensayo enzimático StrepA y cultivo bacteriano en agar base sangre de cordero al 5% más pruebas diferenciales con el objetivo de detectar la presencia de S. pyogenes. Resultados. De 77 muestras incluidas en el análisis, 3 (3.9%) fueron positivas por el cultivo microbiológico para S. pyogenes y ninguna por el método StrepA. Conclusión. El hallazgo de la bacteria S. pyogenes entre los estudiantes de medicina asintomáticos alerta de un potencial infeccioso. En la comparación de los métodos diagnósticos para su detección, los hallazgos validan el uso del cultivo sobre el del StrepA, en el caso de que se desee estimar la presencia de portadores de dicho agente.

Abstract Introduction: Streptococcus pyogenes causes suppurative skin, mucosal and systemic infections. Timely detection is important to avoid the development of nonsuppurative complications. In addition, carrier status can be a potential source of autoinoculation or infectious outbreaks. Objective: To establish the status as S. pyogenes carriers of medical students using two diagnostic methods. Materials and methods: A cross-sectional study was carried out with convenience sampling, in which samples from the oropharynx were analyzed by enzyme Strep-A immunoassay and bacterial culture on sheep blood agar at 5%, plus differential tests to detect the presence of S. pyogenes. Results: Out of 77 samples included in the analysis, 3 (3.9%) were positive for the microbiological culture for S. pyogenes and none for the Strep-A method. Conclusion: Finding the bacterium S. pyogenes among asymptomatic medical students is a warning sign of a potential infection. The comparison of the diagnostic methods for detection showed that the findings validate the use of the culture over Strep-A, if estimating the presence of carriers of said agent is desired.

Association of SNPs with the efficacy and safety of immunosuppressant therapy after heart transplantation.

AIM: Studying the possible influence of SNPs on efficacy and safety of calcineurin inhibitors upon heart transplantation. MATERIALS & METHODS: In 60 heart transplant patients treated with tacrolimus or cyclosporine, we studied a panel of 36 SNPs correlated with a series of clinical parameters during the first post-transplantation year. RESULTS: The presence of serious infections was correlated to ABCB1 rs1128503 (p = 0.012), CC genotype reduced the probability of infections being also associated with lower blood cyclosporine concentrations. Lower renal function levels were found in patients with rs9282564 AG (p = 0.003), related to higher blood cyclosporine blood levels. A tendency toward increased graft rejection (p = 0.05) was correlated to rs2066844 CC in NOD2/CARD15, a gene related to lymphocyte activation. CONCLUSION: Pharmacogenetics can help identify patients at increased risk of clinical complications. Original submitted 30 January 2015; revision submitted 27 March 2015.