Effects of androgen deprivation therapy on elderly men with high-risk prostate cancer: PROSARC observational study.

INTRODUCTION: Prostatic carcinoma (PC) is a frequent neoplasm in elderly patients. Although androgen deprivation is associated with survival benefits, it is also related to adverse effects such as osteoporosis, frailty, or sarcopenia, which can negatively affect the patient's quality of life. This study aims to quantify and evaluate the prevalence of osteoporosis, frailty, or sarcopenia in elderly PC patients before and after androgen deprivation. We present data from an interim analysis. MATERIALS AND METHODS: PROSARC is a national (Spain) prospective observational study (May-2022-May-2025) still in progress in 2 hospitals. It includes patients with high-risk PC, aged ≥70 years, non-candidates for local treatment and scheduled to start androgen deprivation therapy. The following variables are analyzed: comorbidity, frailty (Fried frailty phenotype criteria), osteoporosis, sarcopenia (EWGSOP2), fat mass and muscle mass, before treatment and after 6 months of follow-up. RESULTS: A 6-month follow-up was completed by 12/25 included patients (mean age, 84 years), with a high baseline prevalence of pre-frailty/frailty (67.7%), sarcopenia (66.7%) and osteoporosis (25%). Treatment did not significantly alter these variables or comorbidity. We observed changes in body mass index (p=0.666), decreased mean value of appendicular muscle mass (p=0.01) and increased percentage of fat mass (p=0.012). CONCLUSION: In patients with high-risk PC, advanced age and a considerable prevalence of osteoporosis, frailty and sarcopenia, androgen deprivation (ADT; 6 months) produces decreased muscle mass without impact on the incidence of the known adverse effects of androgen deprivation.

Desarrollo e implementación de una unidad de inmunoterapia en un servicio de urología / Development and implementation of an immunotherapy unit in a urology department

Introducción La inmunoterapia está revolucionando el tratamiento del cáncer, siendo los anticuerpos monoclonales dirigidos contra moléculas reguladoras del punto de control la terapia más ampliamente utilizada en la actualidad. Un total de seis fármacos inhibidores del punto de control inmunitario (CPI) han sido aprobados por la U.S. Food and Drug Administration (FDA) y por la European Medicines Agency (EMA) para su uso en diversos tumores sólidos del aparato genitourinario. Material y métodos Se revisó la literatura y se analizó la metodología y experiencia propia adquirida para instaurar el tratamiento con CPI en un servicio de Urología. Resultados Se describen los requisitos recomendables desde el punto de vista formativo, logístico y procedimental para implementar una unidad de inmunoterapia en un servicio de Urología que permita ofrecer con seguridad el tratamiento experto con CPI a los pacientes con tumores genitourinarios. Conclusiones El cumplimiento del programa propuesto garantiza la administración segura de CPI en un entorno hospitalario (AU)

Introduction Immunotherapy is revolutionizing cancer treatment, with monoclonal antibodies directed against checkpoint regulatory molecules currently being the most widely used therapy. A total of six immune checkpoint inhibitor (CPI) drugs have been approved by the U.S. Food and Drug Administration (FDA) and the European Medicines Agency (EMA) for use in various solid tumors of the genitourinary tract. Material and methods the literature is reviewed and the methodology, as well as our own experience, are analyzed to establish treatment with CPI in a urology department. Results The requirements recommended in terms of training, logistics and procedure are described in order to safely offer expert treatment with CPI to patients with genitourinary tumors. Conclusions Compliance with the proposed program ensures safe administration of immune checkpoint inhibitors in a hospital setting (AU)

[Influence of the COVID-19 pandemia on the ophthalmologic emergency department in the Toulouse University Hospital during the first lockdown from March the 17th to May the 10th of 2020]. / Impact de la pandémie de COVID-19 sur les urgences ophtalmologiques du CHU de Toulouse lors du premier confinement du 17 mars au 10 mai 2020.

INTRODUCTION: We conducted this study to assess the impact of the COVID-19 pandemic and the lockdown in France from March 17, 2020 to May 10, 2020, on the ophthalmic emergency department at Toulouse University Hospital, compared to the period from March 2 to March 16, 2020. MATERIALS AND METHODS: This was a retrospective observational study, conducted in the ophthalmic emergency department of Toulouse University Hospital. We included the patients presenting to the emergency department from March 2 to May 10, 2020. We recorded age, sex, day of visit, time until care was received, past ocular history, outpatient or inpatient status, final diagnosis and its severity, outpatient or inpatient disposition, and medical or surgical treatment after the emergency department visit. RESULTS: We found a substantial decrease in the number of patients per day, mostly during the first month of the lockdown: 44 patients per day before the lockdown compared to 23 patients per day during the first month, followed by 38 patients per day for the second month of lockdown; more patients visiting promptly; and elderly patients represented a higher proportion of patients. CONCLUSION: The first lockdown in France due to the COVID-19 pandemic had an impact on the Toulouse ophthalmic emergency department, especially concerning the number of patients per day; this study helps to assess individual behavior in this context of a public health crisis.

Development and implementation of an immunotherapy unit in a urology department.

INTRODUCTION: Immunotherapy is revolutionizing cancer treatment, with monoclonal antibodies directed against checkpoint regulatory molecules currently being the most widely used therapy. A total of six immune checkpoint inhibitor (CPI) drugs have been approved by the U.S. Food and Drug Administration (FDA) and the European Medicines Agency (EMA) for use in various solid tumors of the genitourinary tract. MATERIAL AND METHODS: The literature is reviewed and the methodology, as well as our own experience, are analyzed to establish treatment with CPIs in a urology department. RESULTS: The requirements recommended in terms of training, logistics and procedure are described in order to safely offer expert treatment with CPIs to patients with genitourinary tumors. CONCLUSIONS: Compliance with the proposed program ensures safe administration of immune checkpoint inhibitors in a hospital setting.

Specificity and sensibility of the Spanish version of the COMFORT Behaviour Scale for assessing pain, grade of sedation and withdrawal syndrome in the critically ill paediatric patient. Multicentre COSAIP study (Phase 1).

AIM: The main aim of this investigation was to analyse the specificity and sensibility of the COMFORT Behaviour Scale (CBS-S) in assessing grade of pain, sedation, and withdrawal syndrome in paediatric critical care patients. METHOD: An observational, analytical, cross-sectional and multicentre study conducted in Level III Intensive Care Areas of 5 children's university hospitals. Grade of sedation was assessed using the Spanish version of the CBS-S and the Bispectral Index on sedation, once per shift over one day. Grade of withdrawal was determined using the CBS-S and the Withdrawal Assessment Tool-1, once per shift over three days. RESULTS: A total of 261 critically ill paediatric patients with a median age of 5.07 years (P25:0.9-P75:11.7) were included in this study. In terms of the predictive capacity of the CBS-S, it obtained a Receiver Operation Curve of .84 (sensitivity of 81% and specificity of 76%) in relation to pain; .62 (sensitivity of 21% and specificity of 78%) in relation to sedation grade, and .73% (sensitivity of 40% and specificity of 74%) in determining withdrawal syndrome. CONCLUSIONS: The Spanish version of the COMFORT Behaviour Scale could be a useful, sensible and easy scale to assess the degree of pain, sedation and pharmacological withdrawal of critically ill paediatric patients.

Especificidad y sensibilidad de la COMFORT Behavior Scale-Versión española para valorar el dolor, el grado de sedación y síndrome de abstinencia en el paciente crítico pediátrico. Estudio multicéntrico COSAIP (Fase 1) / Specificity and sensibility of the Spanish version of the COMFORT Behaviour Scale for assessing pain, grade of sedation and withdrawal syndrome in the critically ill paediatric patient. Multicentre COSAIP study (Phase 1)

Objetivo: El objetivo principal de la investigación fue analizar la especificidad y sensibilidad de la escala COMFORT Behavior Scale-Versión española (CBS-ES) en la determinación del grado de dolor, sedación y síndrome de abstinencia.Método: Se llevó a cabo un estudio observacional, analítico y transversal y multicéntrico en unidades de cuidados intensivos pediátricas de 5 hospitales españoles. Se valoró el grado de sedación del paciente crítico pediátrico de forma simultánea empleando para ello la CBS-ES y registrando los valores del Bispectral Index Sedation, una vez por turno durante un día. El grado de abstinencia se determinó una vez por turno, durante 3 días, empleando de forma simultánea la CBS-ES y la Withdrawal Assessment Tool-1.Resultados: Se incluyeron en el estudio un total de 261 pacientes críticos pediátricos con una mediana de 1,61 años (P25: 0,35-P75: 6,55). Por lo que a la capacidad predictiva de la CBS-ES se refiere se obtuvo un área bajo la curva de 0,84 (sensibilidad del 81% y especificidad del 76%) con relación al dolor; de 0,62 (sensibilidad del 27% y especificidad del 78%) en el caso de la sedación, y de 0,73 (sensibilidad del 40% y especificidad del 74%) en el del síndrome de abstinencia.Conclusiones: Se ha podido contrastar que la CBS-ES podría ser un instrumento sensible, útil y fácil de emplear para valorar el grado de dolor, sedación y síndrome de abstinencia farmacológico del paciente crítico pediátrico.

Aim: The main aim of this investigation was to analyse the specificity and sensibility of the COMFORT Behaviour Scale (CBS-S) in assessing grade of pain, sedation, and withdrawal syndrome in paediatric critical care patients.Method: An observational, analytical, cross-sectional and multicentre study conducted in Level III Intensive Care Areas of 5 children's university hospitals. Grade of sedation was assessed using the Spanish version of the CBS-S and the Bispectral Index on sedation, once per shift over one day. Grade of withdrawal was determined using the CBS-S and the Withdrawal Assessment Tool-1, once per shift over three days.Results: A total of 261 critically ill paediatric patients with a median age of 5.07 years (P25:0.9-P75:11.7) were included in this study. In terms of the predictive capacity of the CBS-S, it obtained a Receiver Operation Curve of .84 (sensitivity of 81% and specificity of 76%) in relation to pain; .62 (sensitivity of 21% and specificity of 78%) in relation to sedation grade, and .73% (sensitivity of 40% and specificity of 74%) in determining withdrawal syndrome.Conclusions: The Spanish version of the COMFORT Behaviour Scale could be a useful, sensible and easy scale to assess the degree of pain, sedation and pharmacological withdrawal of critically ill paediatric patients.

First report of in vitro resistance of Psoroptes ovis to ivermectin in Argentina.

Sheep scab, or psoroptic mange, a disease caused by the mite Psoroptes ovis, is commonly treated with ivermectin (IVM) and other macrocyclic lactones. In Argentina, in vivo trials have shown a decrease in IVM effectiveness to treat both sheep and bovine scab. In this work, we used an in vitro technique to establish the efficacy of IVM and two other macrocyclic lactones, doramectin (DRM) and moxidectin (MXD), against P. ovis in sheep. Mites were exposed to plates with culture medium and either ethanol or each of the acaricides, and mite mortality at a diagnostic concentration of IVM was assessed. Total survival in one of the strains studied demonstrated the presence of resistance, associated with control failures previously described by the authors. These resistant mites also presented larger LC50 values for both DRM and MXD than expected. Since, in in vivo trials, we had also previously observed a decrease in DRM effectiveness, cross-resistance may exist between DRM and IVM. We propose the use of in vitro tests to evaluate the efficacy of acaricides, considering their practicality, low cost and proven usefulness in detecting resistance in cases of low effectiveness against sheep scab.

Grade of sedation in the critically ill pediatric patient and its correlation with sociodemographic and clinical variables. Multicentre COSAIP study.

AIMS: To determine the grade of sedation in the critically ill paediatric patient using Biespectral Index Sensor (BIS) and to analyse its relationship with sociodemographic and clinical patient variables. METHODS: Observational, analytical, cross-sectional and multicentre study performed from May 2018 to January 2020 in 5 Spanish paediatric critical care units. Sex, age, reason for admission, presence of a chronic pathology, type and number of drugs and length of stay were the sociodemographic and clinical variables registered. Furthermore, the grade of sedation was assessed using BIS, once per shift over 24 h. RESULTS: A total of 261 paediatric patients, 53.64% of whom were male, with a median age of 1.61 years (0.35-6.55), were included in the study. Of the patients, 70.11% (n = 183) were under analgosedation and monitored using the BIS sensor. A median of BIS values of 51.24 ±â€¯14.96 during the morning and 50.75 ±â€¯15.55 during the night were observed. When comparing BIS values and sociodemographic and clinical paediatric variables no statistical significance was detected. CONCLUSIONS: Despite the limitations of the BIS, investigations and the present study show that BIS could be a useful instrument to assess grade of sedation in critically ill paediatric patients. However, further investigations which determine the sociodemographic and clinical variables involved in the grade of paediatric analgosedation, as well as studies that contrast the efficacy of clinical scales like the COMFORT Behaviour Scale-Spanish version, are required.

Specificity and sensibility of the Spanish version of the COMFORT Behaviour Scale for assessing pain, grade of sedation and withdrawal syndrome in the critically ill paediatric patient. Multicentre COSAIP study (Phase 1). / Especificidad y sensibilidad de la COMFORT Behavior Scale-Versión española para valorar el dolor, el grado de sedación y síndrome de abstinencia en el paciente crítico pediátrico. Estudio multicéntrico COSAIP (Fase 1).

AIM: The main aim of this investigation was to analyse the specificity and sensibility of the COMFORT Behaviour Scale (CBS-S) in assessing grade of pain, sedation, and withdrawal syndrome in paediatric critical care patients. METHOD: An observational, analytical, cross-sectional and multicentre study conducted in Level III Intensive Care Areas of 5 children's university hospitals. Grade of sedation was assessed using the Spanish version of the CBS-S and the Bispectral Index on sedation, once per shift over one day. Grade of withdrawal was determined using the CBS-S and the Withdrawal Assessment Tool-1, once per shift over three days. RESULTS: A total of 261 critically ill paediatric patients with a median age of 5.07 years (P25:0.9-P75:11.7) were included in this study. In terms of the predictive capacity of the CBS-S, it obtained a Receiver Operation Curve of .84 (sensitivity of 81% and specificity of 76%) in relation to pain; .62 (sensitivity of 21% and specificity of 78%) in relation to sedation grade, and .73% (sensitivity of 40% and specificity of 74%) in determining withdrawal syndrome. CONCLUSIONS: The Spanish version of the COMFORT Behaviour Scale could be a useful, sensible and easy scale to assess the degree of pain, sedation and pharmacological withdrawal of critically ill paediatric patients.

Grade of sedation in the critically ill paediatric patient and its correlation with sociodemographic and clinical variables. Multicentre COSAIP study. / Grado de sedación del paciente crítico pediátrico y variables sociodemográficas y clínicas correlacionadas. Estudio multicéntrico COSAIP.

AIMS: To determine the grade of sedation in the critically ill paediatric patient using Biespectral Index Sensor (BIS) and to analyse its relationship with sociodemographic and clinical patient variables. METHODS: Observational, analytical, cross-sectional and multicentre study performed from May 2018 to January 2020 in 5 Spanish paediatric critical care units. Sex, age, reason for admission, presence of a chronic pathology, type and number of drugs and length of stay were the sociodemographic and clinical variables registered. Furthermore, the grade of sedation was assessed using BIS, 11per shift over 24hours. RESULTS: A total of 261 paediatric patients, 53.64% of whom were male, with a median age of 1.61 years (0.35-6.55), were included in the study. Of the patients, 70.11% (n=183) were under analgosedation and monitored using the BIS sensor. A median of BIS values of 51.24±14.96 during the morning and 50.75±15.55 during the night were observed. When comparing BIS values and sociodemographic and clinical paediatric variables no statistical significance was detected. CONCLUSIONS: Despite the limitations of the BIS, investigations and the present study show that BIS could be a useful instrument to assess grade of sedation in critically ill paediatric patients. However, further investigations which determine the sociodemographic and clinical variables involved in the grade of paediatric analgosedation, as well as studies that contrast the efficacy of clinical scales like the COMFORT Behaviour Scale-Spanish version, are required.

Doramectin efficacy against Psoroptes ovis in sheep: Evaluation of pharmacological strategies.

The aims of this study were to evaluate the efficacy of two injectable formulations of doramectin (DRM) against Psoroptes ovis in sheep infested under controlled experimental conditions and to characterize the DRM plasma disposition kinetics in the infested animals. To this end, sheep were experimentally infested with a P. ovis strain from a farm with a history of treatment failure, and then treated either with DRM 1% (traditional preparation) on days 0 and 7 or with DRM 3.15% (long-acting formulation) on day 0. The efficacy of each treatment was calculated by counting live mites in skin scrapings. Plasma samples were obtained from each animal and DRM concentrations were measured by HPLC. After the two doses of DRM 1%, the maximum efficacy (98.8%) was reached on day 28, whereas after the single dose of DRM 3.15%, the maximum efficacy (100%) was reached on day 35 and ratified on day 42. The long-acting formulation allowed obtaining higher exposure and more sustained concentrations of DRM than the traditional preparation. Although both DRM formulations studied were effective according to international protocols, they did not reach 100% effectiveness in the time required for approved pharmaceutical products against sheep scab, according to Argentine regulations.

Transición asistencial y protocolo de seguimiento en los pacientes diabéticos dados de alta desde Urgencias / Transition care and follow-up for diabetic patients discharged from Emergency Departments

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Falla en la eficacia de dos formulaciones de ivermectina contra Psoroptes ovis (Hering, 1838) en ovinos / Failure of efficacy of two ivermectin formulations against Psoroptes ovis (Hering, 1838) in sheep

Resumen El presente trabajo evaluó la relación entre la eficacia y la farmacocinética de dos formulaciones comerciales inyectables de ivermectina (IVM) en ovinos merino adultos artificialmente infestados con Psoroptes ovis. Los animales fueron tratados por vía subcutánea con IVM 1 % en dos dosis con un intervalo de aplicación de 7 días, (0.2 mg/kg) o con una única dosis de IVM 3.15%, (1.05 mg/kg). Se realizaron conteos semanales de ácaros vivos mediante raspajes de piel entre el día 0 y 28 post-tratamiento para determinar la eficacia de los tratamientos, y se tomaron muestras de sangre para medir las concentraciones de IVM en plasma. Se observó una disminución significativa en los conteos de ácaros a partir del día 14 post-tratamiento, sin embargo, se encontraron ácaros vivos en todos los muestreos para ambos grupos. En el Grupo IVM 1%, la máxima eficacia se observó el día 28 post tratamiento (93.3%), mientras que en el Grupo IVM 3,15% este registro se obtuvo el día 21 (95.9%). Mayores concentraciones de IVM fueron observadas en los animales tratados con la formulación 3.15 %. La falla para obtener una cura parasitológica tras el tratamiento con ambas formulaciones de IVM puede ser indicativo de la presencia de ácaros resistentes a este principio activo.

Abstract The current work evaluated the relationship between efficacy and pharmacokinetics of two commercial injectable formulations of ivermectin (IVM) in adult merino sheep artificially infested with Psoroptes ovis. Animals were treated subcutaneously with IVM 1% formulation (two doses on days 0 and 7) at 0.2 mg / kg or with a single dose of IVM 3.15% preparation at 1.05 mg / kg. Live mites were counted weekly by performing skin scrapings between days 0 and 28 post-treatment to determine the efficacy of each IVM formulation. Blood samples were taken up to 35 days post-treatment to measure IVM plasma concentrations. A significant decrease in mite counts was observed from day 14 post-treatment. However, live mites were found in all samples for both groups throughout the entire trial. After IVM 1% administration, the highest effcacy was observed on day 28 (93.3% whereas in the IVM 3,15% group was obtained on day 21 post treatment (95.9%). Higher IVM plasma concentrations were observed in animals treated with the IVM 3.15% formulation. Failure to obtain a parasitological cure after treatment with both IVM formulations may reflect the presence of resistant mites to this drug.

Tiopental y falsa hipernatremia: compruebe su analizador / Thiopental and false hypernatremia: Check your analyzer

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Estudio epidemiológico observacional prospectivo del manejo del dolor en pacientes oncológicos en tratamiento radioterápico: estudio GORVAMUR / Pain management in cancer patients receiving radiotherapy: GORVAMUR study, a prospective, observational, epidemiological study

Objetivos: Estudiar el manejo del dolor irruptivo en pacientes de oncología radioterápica que lo experimentan, y su impacto en el control analgésico del mismo, la tolerabilidad de los tratamientos analgésicos utilizados, así como la satisfacción y el impacto en la calidad de vida del paciente. Material y métodos: Estudio epidemiológico, observacional, prospectivo, multicéntrico, en pacientes con diagnóstico de cáncer y dolor de origen oncológico tratado con una pauta analgésica de 3er escalón, que iniciaron un tratamiento con radioterapia (RT) susceptible de que el oncólogo modificara su control analgésico. Los pacientes se reclutaron de 15 servicios de Oncología Radioterápica procedentes de centros de las regiones de Valencia y Murcia entre mayo de 2013 y diciembre de 2014. Basalmente se recogieron: datos sociodemográficos, caracterización del proceso oncológico y del dolor, tratamiento analgésico y tipo, y dosis/intensidad de la RT empleada. Al mes y a los tres meses se caracterizó el dolor mediante la valoración del cambio en la dimensión del dolor del cuestionario breve de dolor (CBD) y de la cantidad de dolor producido por episodios de dolor irruptivo, el nivel de satisfacción, la calidad de vida (EuroQol-5D) y la tolerabilidad al tratamiento analgésico. Resultados: Los pacientes incluidos en el análisis (n = 49) fueron mayoritariamente hombres (72,3 %) y la edad media (± desviación estándar) 63,7 ± 11,5 años. En el 26,5 % de los pacientes el tumor se encontraba en pulmón y en el 28,6 % en cabeza y cuello. Todos, excepto uno, refirieron dolor en el momento de la visita basal (20,8 % debido al tumor primario, 54,2 % metástasis y en 22,9 % tratamiento con RT). La mediana (Q1-Q3) del número de crisis al día fue 3,0 (2-4,5). El 60,4 % estaban recibiendo tratamiento para el dolor irruptivo, siendo fentanilo el principio activo más frecuentemente utilizado (70,4 %). Las estrategias para manejar el dolor fueron: refuerzo/modificación de analgésicos de larga duración (30,4 %), corta duración (21,7 %), ambos (21,7 %) o disminución/supresión en analgésicos de acción rápida o de larga (26,1 %). Independientemente de la estrategia, se observa una disminución en cuanto al "máximo dolor", y la cantidad total de dolor entre las 3 visitas, y una mejoría en cuanto a la "calidad de vida", "ganancia de salud" y la "satisfacción global del tratamiento". Solo se reportaron dos reacciones adversas. Conclusiones: El dolor irruptivo en los pacientes oncológicos en tratamiento de radioterapia, constituye un síntoma de elevada prevalencia. No hay una estrategia analgésica predominante para el manejo de estos pacientes, pero el fentanilo es el fármaco más frecuentemente utilizado. Los pacientes están satisfechos con el tratamiento y la reducción del dolor irruptivo repercute favorablemente en el estado general y calidad de vida de los pacientes (AU)

Objectives: To assess breakthrough pain management in patients at radiation oncology and its impact on pain control in these patients, as well as the tolerability of the analgesic treatments used and the satisfaction and impact on the quality of life of patients. Material and methods: An epidemiological, observational, prospective, multicentre study carried out in patients diagnosed with cancer and with cancer pain treated with a 3rd step analgesic therapy who had begun radiotherapy treatment (RT) susceptible to modification by an oncologist, for pain control. Patients were recruited from 15 Radiation Oncology Services centres from the regions of Valencia and Murcia between May 2013 and December 2014. Patient data collected included: demographic data, basal cancer process characterization and baseline pain, and information on basal analgesic treatment and RT employed. Pain level was recorded at 1 and 3 months by assessing: the change in the dimension of Brief Pain Inventory (BPI) pain and the amount of pain caused by episodes of breakthrough pain, the level of satisfaction, the quality of life (EQ-5D), and the tolerability to analgesic treatment. Results: Patients included in the analysis (n = 49) were mainly males (72.3 %) and the mean age (± Standard Deviation) was 63.7 ± 11.5 years. In 26.5 % of patients the tumours were located in lungs and 28.6 % in head and neck. All but one of the patients reported pain during the baseline visit (20.8 % due to the primary tumour, 54.2 % to metastases, and 22.9 % to RT treatment). The median (Q1-Q3) number of breakthrough crises/day was 3.0 (2-4.5). Overall, 60.4 % were receiving treatment for breakthrough pain and Fentanyl was the most commonly used drug (70.4 %). Pain management strategies were: reinforcement/modification of long-term analgesics (30.4%), reinforcement/modification of short-term analgesics (21.7%), reinforcement/modification of long-term and short-term analgesics (21.7 %), and decrease/suppression of any fast- or long-term analgesics (26.1 %). Independently from the strategy, a decrease in the maximum pain and the total amount of pain were observed over time, and an improvement during the follow-up visits was observed in the quality of life, health gain, and overall treatment satisfaction. Only two adverse reactions were reported. Conclusions: Breakthrough pain in cancer patients, who underwent radiotherapy treatment, is a symptom of high prevalence. There is no predominant analgesic strategy in the management of these patients, but Fentanyl is the drug most frequently used. Patients are very satisfied with the pharmacologic treatment and the reduction in the breakthrough pain obtained has a favourable effect on the global health status and quality of life of patients (AU)

Monitorización no invasiva transcutánea de la concentración de hemoglobina en pacientes críticos pediátricos con riesgo de sangrado / Noninvasive hemoglobin monitoring in critically ill pediatric patients at risk of bleeding

OBJETIVO: Determinar la validez y precisión de un método de medición continua transcutánea de la concentración de hemoglobina (Hb) en pacientes críticos con riesgo de sangrado. DISEÑO: Estudio observacional prospectivo comparando el estándar de referencia con la determinación transcutánea de hemoglobina (SpHb). Ámbito: Unidad de cuidados intensivos pediátricos de un hospital universitario de tercer nivel. PACIENTES: Muestra consecutiva de pacientes con peso >3kg y riesgo de sangrado. INTERVENCIONES: Medición de SpHb mediante el cooxímetro de pulso Radical7 (Masimo Corp., Irvine, CA) en cada extracción sanguínea con determinación de Hb analizada con estándar de referencia (Siemens ADVIA 2120i). VARIABLES: Variables epidemiológicas, índice de perfusión (IP), índice de variabilidad pletismográfica, frecuencia cardiaca, SaO2, temperatura rectal, baja calidad de señal, así como otros factores que pueden afectar a la medición. RESULTADOS: Se realizaron 284 mediciones (80 pacientes). La media de Hb por el analizador central fue de 11,7±2,05g/dl. La media de SpHb fue de 12,32±2g/dl (Pearson 0,72, R2 0,52). El índice de correlación intraclase fue de 0,69 (IC95%: 0,55-0,78), p < 0,001. El diagrama de Bland-Altman mostró una diferencia media entre ambos métodos de 0,66±1,46g/dl. Un menor IP y una mayor temperatura rectal incrementaron de forma independiente el riesgo de baja calidad de la señal (OR 0,531 [IC95%: 0,32-0,88] y 0,529 [IC95%: 0,33-0,85], respectivamente). CONCLUSIONES: La SpHb presenta buena correlación con la obtenida por el analizador central, aunque los límites de concordancia son amplios. Su principal ventaja es la posibilidad de monitorización continua en pacientes con riesgo de sangrado. La fiabilidad de este método es limitada en casos de mala perfusión periférica

OBJECTIVE: To determine the accuracy and usefulness of noninvasive continuous hemoglobin (Hb) monitoring in critically ill patients at risk of bleeding. DESIGN: An observational prospective study was made, comparing core laboratory Hb measurement (LabHb) as the gold standard versus transcutaneous hemoglobin monitoring (SpHb). SETTING: Pediatric Intensive Care Unit of a tertiary University Hospital. PATIENTS: Patients weighing >3kg at risk of bleeding. INTERVENTIONS: SpHb was measured using the Radical7 pulse co-oximeter (Masimo Corp., Irvine, CA, USA) each time a blood sample was drawn for core laboratory analysis (Siemens ADVIA 2120i). VARIABLES: Sociodemographic characteristics, perfusion index (PI), pleth variability index, heart rate, SaO2, rectal temperature, low signal quality and other events that can interfere with measurement. RESULTS: A total of 284 measurements were made (80 patients). Mean LabHb was 11.7±2.05g/dl. Mean SpHb was 12.32±2g/dl (Pearson 0.72, R2 0.52). The intra-class correlation coefficient was 0.69 (95%CI 0.55-0.78)(p < 0.001). Bland-Altman analysis showed a mean difference of 0.07 ±1.46g/dl. A lower PI and higher temperature independently increased the risk of low signal quality (OR 0.531 [95%CI 0.32-0.88] and 0.529 [95%CI 0.33-0.85], respectively). CONCLUSIONS: SpHb shows a good overall correlation to LabHb, though with wide limits of agreement. Its main advantage is continuous monitoring of patients at risk of bleeding. The reliability of the method is limited in cases with poor peripheral perfusion

Noninvasive hemoglobin monitoring in critically ill pediatric patients at risk of bleeding. / Monitorización no invasiva transcutánea de la concentración de hemoglobina en pacientes críticos pediátricos con riesgo de sangrado.

OBJECTIVE: To determine the accuracy and usefulness of noninvasive continuous hemoglobin (Hb) monitoring in critically ill patients at risk of bleeding. DESIGN: An observational prospective study was made, comparing core laboratory Hb measurement (LabHb) as the gold standard versus transcutaneous hemoglobin monitoring (SpHb). SETTING: Pediatric Intensive Care Unit of a tertiary University Hospital. PATIENTS: Patients weighing >3kg at risk of bleeding. INTERVENTIONS: SpHb was measured using the Radical7 pulse co-oximeter (Masimo Corp., Irvine, CA, USA) each time a blood sample was drawn for core laboratory analysis (Siemens ADVIA 2120i). VARIABLES: Sociodemographic characteristics, perfusion index (PI), pleth variability index, heart rate, SaO2, rectal temperature, low signal quality and other events that can interfere with measurement. RESULTS: A total of 284 measurements were made (80 patients). Mean LabHb was 11.7±2.05g/dl. Mean SpHb was 12.32±2g/dl (Pearson 0.72, R2 0.52). The intra-class correlation coefficient was 0.69 (95%CI 0.55-0.78)(p<0.001). Bland-Altman analysis showed a mean difference of 0.07 ±1.46g/dl. A lower PI and higher temperature independently increased the risk of low signal quality (OR 0.531 [95%CI 0.32-0.88] and 0.529 [95%CI 0.33-0.85], respectively). CONCLUSIONS: SpHb shows a good overall correlation to LabHb, though with wide limits of agreement. Its main advantage is continuous monitoring of patients at risk of bleeding. The reliability of the method is limited in cases with poor peripheral perfusion.

Monitorización mediante pulsioximetría: ¿sólo saturación de oxígeno? / Pulsioxymetry monitorization: only oxygen saturation?

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