New therapies in non-small cell lung cancer with EGFR exon 20 insertion mutations.

OBJECTIVE: Patients with non-small cell lung cancer (NSCLC) and epidermal growth factor receptor (EGFR) exon 20 insertion mutations have a poor prognosis and few therapeutic alternatives. We conducted a review of scientific evidence about therapies in NSCLC with EGFR exon 20 insertion mutations. DATA SOURCES: A systematic review in PubMed® database was performed up to November 19, 2022. Clinical trials (CTs) about treatments of patients diagnosed with advanced or metastatic NSCLC harbouring EGFR exon 20 insertions who had previously received platinum-based chemotherapy were selected. CTs with a sample size of less than 10 patients were discarded. Efficacy results were used to determine the most interesting drugs. Subsequently, a more exhaustive analysis of the design of the CTs and safety of the most interesting schemes was conducted. Comparisons were attempted to develop. DATA SUMMARY: A total of 40 records were found in the systematic search. Twelve selected CTs included the following therapies: poziotinib, osimertinib, pertuzumab-trastuzumab-docetaxel scheme, mobocertinib, amivantamab, erlotinib-onalespib regimen, luminespib, ado-trastuzumab emtansine and dacomitinib. Mobocertinib, amivantamab and poziotinib were determined as the most interesting treatments according to efficacy data. Gastrointestinal and dermatological adverse reactions were relevant in these regimens. All CTs presented a non-randomised design. No reliable comparisons could be developed. CONCLUSIONS: The efficacy of mobocertinib, amivantamab and poziotinib in NSCLC with EGFR exon 20 insertion mutations is promising. However, therapies were assessed in single-arm CTs with low-quality evidence. Comparative studies with more extensive patient follow-up, larger sample size and better design are needed to reliably quantify the effect of these drugs.

Calidad de sueño y aprendizaje en estudiantes de medicina: Revisión narrativa / Sleep Quality and Learning in Medical Students: Narrative Review

Ha habido un gran avance en el estudio de los procesos de consolidación de la memoria en los último 30 años, especialmente la asociada al hipocampo, en los que el sueño juega un papel indispensable. Hay evidencia clara que muestra que los estudiantes de medicina duermen menos y están menos satisfechos con su calidad de sueño que estudiantes de otras profesiones. Si bien hay evidencia que sustenta la asociación entre sueño y aprendizaje, medido como rendimiento académico, las diferencias metodológicas entre los estudios dificultan obtener conclusiones claras.

SUMMARY There has been a great advancement in our understanding of the processes of memory consolidation and the role of sleep in them. There is clear evidence showing that medical students sleep fewer hours and are less satisfied with their sleep quality than other university students. There is also evidence that links sleep and academic performance, however, methodologic differences between studies make it difficult to draw clear conclusions.

Switching of monoclonal antibodies against calcitonin gene-related peptide in chronic migraine in clinical practice: a case series.

A multicentre case series of patients with chronic migraine (CM) treated with monoclonal antibodies directed against calcitonin gene-related peptide (CGRP-mAbs) switching were developed. The effectiveness and safety of CGRP-mAbs switching as a preventive treatment for CM in clinical practice were recorded. Effectiveness was measured by ≥50% reduction of monthly migraine days in respect to baseline and reduction in pain intensity. Safety was analysed through adverse events (AEs) and treatment discontinuations. Seven patients were included. The reason for switching was non-response in all cases. Two patients presented a response to the first CGRP-mAb, but the effect was lost after 3 months. The remaining five patients were non-responders. Response to the second CGRP-mAb was observed in three patients, one of them for >3 months. Less than half of the patients previously treated with a CGRP-mAb responded to switching with a second CGRP-mAb. AEs were rare, with no treatment discontinuations.

Daratumumab-based therapies in transplant-ineligible patients with untreated multiple myeloma and hepatic dysfunction: A systematic review of subgroup analyses.

INTRODUCTION: There is subgroup analysis suggesting a lack of benefit of daratumumab use in multiple myeloma (MM) and hepatic disease (HD). The objectives of this study were to conduct a systematic review and interpretation of daratumumab-based regimen efficacy in transplant-ineligible patients with untreated MM and HD. METHODS: A systematic search in Pubmed® database about randomized clinical trials (RCTs) with subgroup analysis regarding hepatic function for overall survival (OS) or progression-free survival (PFS) were developed. Two methodologies were applied. One of them considered statistical interaction, prespecification, biological support and consistency of subgroup results. Second methodology was two-part validated tool: preliminary questions to reject subset analysis without minimal relevance, and a checklist relating a recommendation for applicability in clinical practice. RESULTS: It was included three records. About first methodology, statistical interaction among subgroups was found for PFS in one RCT. Subsets were prespecified in all RCTs. Biological support of efficacy differences could be reasonable. Inconsistent results were found. Second methology directly rejected applicability of subset analysis in two records. Checklist recommended "null" application of results in the remaining RCT. CONCLUSIONS: No consistent heterogeneity for daratumumab-based regimen efficacy was observed among subgroups regarding hepatic function in transplant-ineligible patients with untreated MM. Patients with normal hepatic function and HD could benefit from these treatments.

Haematological Alterations Associated with Selected Vector-Borne Infections and Exposure in Dogs from Pereira, Risaralda, Colombia.

Infections due to Ehrlichia, Anaplasma, Dirofilaria, Mycoplasma, Babesia and Hepatozoon continue to be highly prevalent in dogs, especially in tropical and subtropical areas, where vectors of many of them are present. However, many clinical aspects of dogs have not been characterized in detail, including assessing the haematological alterations associated with them, particularly in Colombia and Latin America. A group of 100 dogs with Ehrlichia, Anaplasma, Dirofilaria, Mycoplasma, Babesia and Hepatozoon infections/exposure were assessed by blood smear serology (SNAP4DX) and PCR in Pereira, Colombia. We performed blood counts to evaluate anaemia, leukopenia/leukocytosis, neutropenia, neutrophilia, lymphopenia/lymphocytosis, monocytosis, eosinophilia, and thrombocytopenia, among other alterations. Bivariate analyses were performed on Stata®14, with significant p < 0.05. From the total, 85% presented ≥1 infection (past or present), 66% with coinfections (≥2 pathogens) (Ehrlichia 75%), and 89% presented clinical alterations. A total of 100% showed anaemia, 70% thrombocytopenia, 61% monocytosis, and 47% neutropenia, among other alterations. Additionally, 11% presented pancytopenia and 59% bicytopenia. The median platelet count was lower in infected dogs (126,000 cells/µL) versus non-infected (221,000 cells/µL) (p = 0.003). Thrombocytopenia was higher among infected dogs (75%) versus non-infected (40%) (p = 0.006), with a 91% positive predictive value for infection. Median neutrophil count was lower in infected dogs (6591 cells/µL) versus non-infected (8804 cells/µL) (p = 0.013). Lymphocytosis occurred only among those infected (27%) (p = 0.022). Leukopenia was only observed among infected dogs (13%). Pancytopenia was only observed among infected dogs. Ehrlichiosis and other hematic infections have led to a significant burden of haematological alterations on infected dogs, including pancytopenia in a tenth of them, most with thrombocytopenia and all anemic.

Impact of fluvoxamine on outpatient treatment of COVID-19 in Honduras in a prospective observational real-world study.

Background: The COVID-19 pandemic has impacted millions of lives globally. While COVID-19 did not discriminate against developed or developing nations, it has been a significant challenge for third world countries like Honduras to have widespread availability of advanced therapies. The concept of early treatment was almost unheard of when early outpatient treatments utilizing repurposed drugs in Latin American countries began showing promising results. One such drug is fluvoxamine, which has shown tremendous potential in two major studies. As a direct result, fluvoxamine was added to the standard of care in a major medical center outpatient COVID-19 clinic. Methods: This is a prospective observational study performed at the Hospital Centro Médico Sampedrano (CEMESA) in San Pedro Sula, Cortes, Honduras in the COVID-19 outpatient clinic. All patients were at least 15 years of age who had presented with mild or moderate signs and symptoms of COVID-19, and who also had a documented positive SARS-CoV-2 antigen or Reverse Transcription Polymerase Chain Reaction (RT-PCR) were included in the study. These patients then were all prescribed fluvoxamine. The cohort of patients who decided to take fluvoxamine were compared for primary endpoints of mortality and hospitalization risk to the cohort who did not take fluvoxamine. Patients were then monitored for 30 days with the first follow up at 7 days and the second follow up at 10-14 days of symptom onset. Categorical variables were compared by Pearson Chi-square test. The Relative risk was calculated using regression models. Continuous variables were compared by t-test and Wilcoxon rank-sum tests. Results: Out of total 657 COVID-19 cases, 594 patients took fluvoxamine and 63 did not take fluvoxamine. A total of five patients (0.76 percent) died, with only one death occurring in the fluvoxamine group. Patients who received fluvoxamine had a significantly lower relative risk of mortality (RR 0.06, p 0.011, 95% CI 0.007-0.516). There was a lower relative risk of hospitalization in the patients who in the fluvoxamine group. (-10 vs. 30 hospitalizations, RR 0.49, p = 0.035, 95% CI 0.26-0.95). There was 73 percent reduction in relative risk of requiring oxygen in the fluvoxamine group (RR 0.27, p < 0.001, 95% CI 0.14-0.54 Mean lymphocytes count on the first follow-up visit was significantly higher in the fluvoxamine group (1.72 vs. 1.38, Δ 0.33, p 0.007, CI 0.09-0.58). Conclusion: The results of our study suggest that fluvoxamine lowers the relative risk of death, hospitalization, and oxygen requirement in COVID 19 patients.

Long-lasting effect of belantamab mafodotin in heavily pretreated multiple myeloma.

Belantamab mafodotin (BLMF) is an interesting therapeutic alternative for multiple myeloma (MM) patients pretreated with immunomodulatory drugs, proteasome inhibitors, and anti-CD38 monoclonal antibodies. Scientific evidence on BLMF provides immature data about progression-free survival and overall survival by short follow-up of patients with poor prognoses. Cases with long follow-ups could provide additional information about BLMF. This case reports a patient with MM treated with BLMF who had received nine previous lines of therapy with a follow-up of 11 months. No complete response was obtained. However, no disease progression was observed and the patient was still alive at the end of this work. BLMF showed manageable adverse effects. Our patient presented advanced disease, good functional status at the beginning of BLMF treatment, and elevated levels of lactate dehydrogenase during BLMF therapy. The influence of these last two factors was not evaluated in clinical trials. This relationship should be assessed more deeply in future studies.

Patient benefit as a goal of humanization.

Patient empowerment is one of the main pillars of humanisation. Therefore, consideration of patients' preferences and expectations should be  taken into account during the practice of any healthcare professional.  Improving overall survival and quality of life are the main wishes of patients.  Indeed, the recent emergence of Patient Reported Outcomes has become an important focus for healthcare providers. The hospital pharmacist  specialised in drug evaluation is a professional who evaluates the efficacy,  safety, appropriateness and efficiency of treatments prescribed by physicians, and decision-making must be based on both technical factors and  the four principles of bioethics. The correct application of evidence-based  clinical practice allows to provide patients with increases in survival and/or quality of life, adapting the convenience and costs to the current  situation. With this in mind, it could be said that the evaluation of medicines  involves a strong commitment to humanisation. On the other hand,  rganisations that promote the rigorous evaluation and selection of medicines  stand as allies of patients, as they have a direct impact on them and an  indirect impact on society. Regulatory agencies in charge of approving and  financing medicines in healthcare systems play a key role in the process of humanising clinical decision-making and empowering patients. If  these agencies approve the use of new medicines based on data that do not measure quality of life or survival of patients when there are already other therapeutic alternatives for these pathologies, they are indirectly failing  to meet patients' expectations and are infringing bioethical principles. This can  have a considerable influence on the benefit-risk ratio of drugs, and  patients  may be treated with regimens that do not provide benefit, or may even harm  them. Therefore, where should the process of humanisation be oriented? It  seems reasonable that the benefit of the patient should be the fundamental  objective of the process of humanisation of healthcare, evidently.

El empoderamiento del paciente supone uno de los principales pilares de la  humanización. Por ello, la consideración de las preferencias y expectativas de  los pacientes debería ser tenida en cuenta durante el ejercicio de cualquiera de  los profesionales de la salud. Mejorar la supervivencia global y la calidad de  vida son los deseos principales de los pacientes. De hecho, la reciente  aparición de los llamados Patient Reported Outcomes ha supuesto un  importante foco para los agentes involucrados en la asistencia sanitaria. El  farmacéutico hospitalario especializado en la evaluación de medicamentos es  un profesional que evalúa la eficacia, seguridad, adecuación y eficiencia de los  tratamientos prescritos por facultativos, y debe basar la toma de decisiones  tanto en factores técnicos como en los cuatro principios bioéticos. La correcta  aplicación de la práctica clínica basada en la evidencia permite proveer a los  pacientes de incrementos de supervivencia y/o calidad de vida, adecuando la  conveniencia y costes a la situación actual. Teniendo en cuenta esto, podría  decirse que la evaluación de medicamentos supone un fuerte compromiso con  la humanización. Por otra parte, las organizaciones que promueven la  evaluación y selección de medicamentos rigurosamente se erigen como aliados  de los pacientes, ya que repercuten de forma directa en éstos y de  forma indirecta en la sociedad. Las agencias reguladoras encargadas de la  aprobación y financiación de medicamentos en los sistemas sanitarios  protagonizan un papel fundamental en el proceso de humanización de la toma  de decisiones clínicas y empoderamiento de pacientes, ya que si aprueban el  uso de nuevos medicamentos según datos que no miden la calidad de vida o  supervivencia de los pacientes cuando ya existen otras alternativas  terapéuticas para estas patologías, indirectamente no estarán dando respuesta a las expectativas de los pacientes y conculcarán los principios bioéticos. Esto puede tener una considerable influencia en la relación beneficio-riesgo de los  fármacos, pudiendo tratar a pacientes con esquemas que no aportan beneficio,  o incluso podrían perjudicarles. Por tanto, ¿hacia dónde debiera ir  orientado el proceso de humanización? Parece razonable que el beneficio del  paciente sea el objetivo fundamental del proceso de humanización de la  asistencia sanitaria, evidentemente.

Concordance between expectations and preferences of patients and evaluation criteria of the European Medicines Agency.

OBJECTIVE: The European Medicines Agency's marketing authorisation criteria  for drugs are reflected in the European Public Assessment Reports. The  objective is to describe the expectations and preferences of our  oncohematological outpatients with respect to their oral treatments, and to  evaluate the concordance with the results of European Public Assessment Reports. METHOD: A survey of onco-hematological patients' expectations and preferences about overall survival and quality of life was developed, with three items: expectations on treatment, preferences of benefit and  willingness to receive novel treatments with non-definitive results. European  Public Assessment Reports of the indicated drugs were reviewed. Kappa index  (κ) was used to assess the agreement between patients' expectations  and preferences respect to the benefit in overall survival and quality of life  described in the corresponding European Public Assessment Report.  Concordance between willingness of patients to receive novel treatments and European Public Assessment Reports results was evaluated by absolute  agreement (Ao). RESULTS: There were 29 participants, and 19 different European Public Assessment Reports were consulted. Patients' expectations about their  treatment: 82.1% expected improvement in overall survival and quality of life; the κ value between expectations and results of European Public Assessment Reports was 0.091 (confidence interval 95%: -0.025 to 0.207). Patients' preferences about benefit of their treatment: 92.6%  preferred quality of life; the κ value was 0.016 (confidence interval 95%: - 0.127 to 0.160). Willingness to receive novel treatments: 82.1% participants demanded benefit in overall survival or quality of life; exigences were met in Ao = 53.6% of patients. CONCLUSIONS: Little agreement was observed between expectations and  preferences of our onco-hematological patients and European Public Assessment Reports, according to overall survival and quality of life.  Most patients preferred an improvement in quality of life, but also expected  an  increase in overall survival with their treatment. Almost half of  patients would not meet their requirements to receive their drug when it was  authorized.

OBJETIVO: Los criterios de autorización de comercialización de medicamentos de la Agencia Europea del Medicamento se reflejan en los European Public Assessment Reports. El objetivo es describir las  expectativas y preferencias de nuestros pacientes externos oncohematológicos con respecto a sus tratamientos orales, y evaluar la  concordancia con los resultados de los European Public Assessment Reports. Método: Se elaboró una encuesta sobre las expectativas y preferencias de los  pacientes oncohematológicos respecto a la supervivencia global y calidad de  vida, con tres ítems: expectativas sobre el tratamiento, preferencias de  beneficio y disposición a recibir tratamientos novedosos con resultados  inmaduros. Se revisaron los European Public Assessment Reports de los  fármacos indicados. Se utilizó el índice kappa (κ) para evaluar la concordancia  entre las expectativas y preferencias de los pacientes respecto al beneficio en  supervivencia global y calidad de vida descrito en el European Public  Assessment Report correspondiente. La concordancia entre la disposición de  los pacientes a recibir nuevos tratamientos y los resultados de los European  Public Assessment Reports se evaluó mediante la concordancia absoluta (Ao). RESULTADOS: Se incluyeron 29 participantes y se consultaron 19 European Public Assessment Reports diferentes. Expectativas de los pacientes sobre su tratamiento: el 82,1% esperaba una mejora de la  supervivencia global y calidad de vida; el valor κ entre las expectativas y los  resultados de los European Public Assessment Reports fue de 0,091 (intervalo  de confianza 95%: ­0,025 a 0,207). Preferencias de los pacientes sobre el beneficio de su tratamiento: el 92,6% prefirió la calidad de vida; el valor κ fue de 0,016 (intervalo de confianza 95%: ­0,127 a 0,160). Disposición a  recibir tratamientos novedosos: el 82,1% de los participantes exigió un beneficio en la supervivencia global o en la calidad de vida; las exigencias se cumplieron en Ao = 53,6% de los pacientes. CONCLUSIONES: Se observó poca concordancia entre las expectativas y  preferencias de nuestros pacientes oncohematológicos y los European Public  Assessment Reports, según la supervivencia global y la calidad de vida. La  mayoría de los pacientes preferían una mejora de la calidad de vida, pero  también esperaban un aumento de la supervivencia global con su tratamiento.  Casi la mitad de los pacientes no cumpliría con sus requisitos para recibir su  medicación cuando ésta fuera autorizada.

Systematic review and meta-analysis of interleulin-6 inhibitors in reducing mortality for hospitalized patients with COVID-19.

OBJECTIVE: One year after the declaration of the SARS-CoV-2 pandemic, only  dexamethasone has clearly shown a reduction in mortality for COVID-19  hospitalized patients. For interleukin-6 inhibitors, results are variable and  nclear. The objective was to review and analyze the effect of tocilizumab and  sarilumab on survival in this setting. METHOD: The PRISMA statements were fulfilled for the systematic review. A  systematic search in Medline, Embase and medRxiv was conducted to identify  randomized controlled trials with tocilizumab or sarilumab in hospitalized  patients with COVID-19. Mortality data from non-critical and critical patients  were extracted. A random-effects (DerSimonian-Laird) meta-analysis was  performed for both subgroups and the whole population using MAVIS software  v. 1.1.3. Similarity and homogeneity among trials were assessed. RESULTS: Twenty-five and 23 articles were identified in Medline and Embase,  respectively, five were trials with tocilizumab and/or sarilumab; two more were  identified at medRxiv. Seven randomized clinical trials fulfilled the  inclusion criteria. Another trial was pre-published and included post-hoc. The  meta-analysis, with eight randomized clinical trials and 6,340 patients, showed  a benefit on mortality for interleukin-6  heterogeneity (I2 = 7%), but  a low similarity among studies. The results showed no differences among  critical and non-critical patients. A sensitivity analysis excluding non-similar or  heterogeneous studies showed different results, without benefit and with low  precision of the result in non-critical patients. CONCLUSIONS: A benefit in mortality for interleukine-6 inhibitors was found, but  with important differences among the scenarios analyzed in the clinical  trials. Positive results are mainly caused by two randomized clinical trials which  are similar in concomitant use of steroids and veryhigh mortality in  critical patents. Sarilumab was poorly represented in the meta-analysis.  Nevertheless, an association between the benefit and the critical/non-critical  condition was not found. More randomized clinical trials, mainly focused in  atients at high mortality risk, are needed to confirm the benefit of interleukine- 6 inhibitors for COVID-19. Sarilumab was underrepresented in the meta- analysis.

OBJETIVO: Un año después de la declaración de la pandemia por SARS­CoV-2,  solo dexametasona había mostrado claramente una reducción de la mortalidad  en pacientes hospitalizados por COVID-19. Los resultados de los inhibidores de  interleucina 6 son diversos y poco claros. El objetivo de este trabajo es  revisar y analizar el efecto de tocilizumab y sarilumab sobre la supervivencia  de los pacientes en este escenario.Método: La revisión sistemática siguió las recomendaciones de PRISMA. Se  realizó una búsqueda sistemática en Medline, Embase y medRxiv para identificar ensayos controlados aleatorizados con tocilizumab o sarilumab  en pacientes hospitalizados con COVID-19. Se recopilaron los datos de mortalidad de pacientes críticos y no críticos y se llevó a cabo un metaanálisis de efectos aleatorios (Der Simonian-Laird) para ambos  subgrupos y para toda la población, usando el software MAVIS v. 1.1.3. La similitud y homogeneidad entre los ensayos fue evaluada. RESULTADOS: Se identificaron 25 y 23 artículos en Medline y Embase, respectivamente; cinco eran ensayos con tocilizumab y/o sarilumab;  se identificaron dos más en medRxiv. En total, siete ensayos clínicos  aleatorizados cumplieron los criterios de inclusión. Posteriormente, se  prepublicó otro ensayo que cumplía los criterios de inclusión y se incorporó al  análisis. El metaanálisis, con ocho ensayos clínicos aleatorizados y 6.340  pacientes, mostró un beneficio sobre la mortalidad para los inhibidores de  interleucina-6 (hazard ratio 0,85; intervalo de confianza al 95% 0,74-0,99),  con baja heterogeneidad (I2 = 7%), pero reducida similitud entre los estudios.  Los resultados no mostraron diferencias entre pacientes críticos y no  críticos. Un análisis de sensibilidad excluyendo estudios heterogéneos o no  similares mostró resultados diferentes, sin beneficio y con baja precisión del  resultado en pacientes no críticos. CONCLUSIONES: Se encontró un beneficio en la mortalidad de los inhibidores de  la interleucina 6, pero con importantes diferencias entre los escenarios analizados en los ensayos clínicos. Los resultados positivos se  eben principalmente a dos ensayos que son similares en el uso concomitante  de esteroides y una mortalidad muy alta en pacientes críticos. Sarilumab estuvo escasamente representado en el metaanálisis. Sin embargo, el metaanálisis por subescenarios no encontró una relación entre  el beneficio y la condición de pacientes críticos/no críticos. Se necesitan más ensayos clínicos aleatorizados, principalmente enfocados en  pacientes con alto riesgo de mortalidad, para confirmar el beneficio de los  inhibidores de interleucina-6 en COVID-19.

Prevalence and Causes of Avoidable Blindness in Subjects Over 50 Years of Age in Honduras.

Purpose: To describe the prevalence and causes of avoidable blindness in people aged 50 and over in the areas of influence of doctors in social service during the years 2018-2019. Methods: This observational, descriptive, cross-sectional study, with analysis of association of variables, was conducted on patients 50 years and older at the national level, selected under simple random sampling, where sociodemographic variables, background, and clinical characteristics were studied. An ophthalmological clinical examination was performed with prior informed consent, and the information was processed and analyzed using Epi Info 7.2 statistical package and SPSS version 25. Results: Overall, 7992 people were evaluated, with a mean age of 62 years; 60.8% (4861) were women and 39.2% (3131) were men. The prevalence of blindness for both eyes was 4.5% (356/7992, 95% CI: 4.1-5.1%, p < 0.001). The prevalence of severe and moderate visual impairment was 1.5% (118/127) and 12.9% (1029)/12.6% (1004) for the right and left eyes, respectively. The main causes of blindness were cataract, refractive error, and glaucoma. Conclusion: The prevalence of avoidable blindness found in the study was higher than expected and the respective causes were consistent with previous studies. Consequently, it is recommended to implement health policies aimed at the prevention and management of avoidable blindness.

Seroprevalence canine survey for selected vector-borne pathogens and its relationship with poverty in metropolitan Pereira, Colombia, 2020.

Background: Tick-borne diseases (TBD) and dirofilariosis are currently not under surveillance in most Latin American countries. In addition, there is a significant lack of studies describing the current situation in most endemic areas, including Colombia. Therefore, seroprevalence studies are crucial for understanding the epidemiology of these vector-borne diseases. Methods: A serosurvey for TBD and dirofilariosis among 100 dogs was carried out in the municipality of Pereira, located in the Coffee-Triangle region, Colombia. Samples were tested using a rapid assay test system (SNAP® 4Dx®); based on an enzyme immunoassay technique' screening for antibodies to Anaplasma phagocytophilum/platys (sensitivity 99.1%)' Borrelia burgdorferi s.l. (98.8%), and Ehrlichia canis/ewingii (96.2%) by using specific antigens and checking for Dirofilaria immitis antigen based on specific antibodies (99.2%). Bivariate analyses were performed on Stata®14, significant p < 0.05. Findings: Global seroprevalence to the selected vector-borne pathogens was 74% (95%CI 65-83%). The highest seroprevalence was found for E. canis/ewingii (74%), followed by A. phagocytophilum/platys (16%). Seropositivity for Borrelia spp. and Dirofilaria spp. was 0%. All Anaplasma spp. seropositive dogs showed co-detection of Ehrlichia spp. (16%). Seroprevalence was significantly higher among dogs from families of lower socioeconomic status/level (I, 86%), followed by level II (74%), and III (36%) (p = 0.001). All dogs exhibiting anorexia (12%) were invariably seropositive (100%) (p = 0.029). Seroprevalence was higher among those showing mucocutaneous paleness (95%) compared to those without paleness (68%) (p = 0.013) (OR = 9.3; 95%CI 1.18-72.9). There was high variability in seroprevalence through the studied areas, ranging from 0% (La Libertad Park) up to Combia, Cesar Nader, Las Brisas and Saturno localities (100%) (p = 0.033). Interpretation: Given the high seroprevalence obtained in an area with documented ticks, there is a potential risk of zoonotic transmission to humans. Further seroprevalence studies in humans are needed to assess the prevalence of infections. Poverty is highly associated with these tick-borne pathogens in Pereira, as shown in the present study.

Belantamab mafodotin for relapsed or refractory multiple myeloma.

Objective: Refractory multiple myeloma (MM) presents poor responses to therapies. New drugs for highly pretreated MM are a hope for this clinical context with limited treatment options. We developed a comparative commentary on the evidence about the use of belantamab mafodotin in heavily pretreated relapsed or refractory MM with respect to other therapies. Data sources: Regimen data were extracted from pivotal clinical trials. Data summary: Response rates were the main efficacy outcomes reported in trials. Overall response was achieved by approximately 30% of patients trated with belantamab mafodotin. Response rates of different regimens must be supported by more relevant data, such as overall survival or progression-free survival. Subgroups of patients with extramedullary disease and revised International Staging System III should be thoroughly evaluated in phase III comparative clinical trials with larger sample sizes. Belantamab mafodotin presented specific adverse events (visual disturbances and kerathopathies). Grade 3-4 adverse events involved high percentages of patients treated with the different schemes. The budgetary impact of different treatments for heavily pretreated refractory MM would be very high. Literature suggested increased efficiency of belantamab mafodotin versus chimeric antigen receptor T-cell therapies. Conclusions: Belantamab mafodotin and other regimens are promising drugs for MM, especially for triple-class refractory patients. Comparative studies are necessary to perform a reliable therapeutic positioning.

Clinical and pharmacoeconomic impact of subgroup analysis in onco-hematological patients.

Subgroup analysis evaluates a health intervention in subpopulations according to a characteristic or factor. It can be useful for generating new hypotheses or conducting new studies. However, subgroup analysis presents several limitations and it should be considered cautiously. The development of new onco-hematological drugs is accelerating in recent years and the impact of subgroup analysis on clinical decision-making is increasing. The interpretation of subgroup analyses can be controversial in some cases, negatively affecting patients and healthcare systems. This work is a review of the clinical and pharmacoeconomic impact of subgroup analysis in onco-hematological patients. The study describes some illustrative examples of inadequate interpretations about subset analysis: combination of pembrolizumab plus chemotherapy in lung cancer, inhibitors of cyclin-dependent kinases in breast cancer, daratumumab-based regimens in newly diagnosed multiple myeloma, combination of nivolumab with ipilimumab in melanoma and docetaxel in prostate cancer. Subgroup analysis can have a significant impact on the data selection for the development of studies; efficacy, safety, and convenience of treatments in onco-hematological patients; efficiency of therapies in health systems; and therapeutic positioning of antineoplastic drugs. There is a strong need to establish homogeneous criteria for the assessment of subgroup analysis and to develop new tools for its consideration.

COVID-19 en el adulto mayor: características clínicas e impacto sobre la salud mental / COVID-19 in the elderly: clinical features and impact on mental health

El propósito de esta revisión fue analizar la literatura existente con el fin de identificar los principales aspectos de la en- fermedad ocasionada por el SARS-CoV-2, así como su impacto en la salud mental del adulto mayor y su relación con la mortalidad en esta población en riesgo. Se revisó la información a partir de artículos de revistas electrónicas a través de las bases de datos Pubmed, Medline, Scopus y Google Scholar para el período julio 2020 a junio 2021. Entre los aspectos relevantes se encontró da- tos alarmantes, los pacientes con comorbilidades en este grupo de edad tenían 6 veces más probabilidad de ser hospitalizados y 12 veces más probabilidad de morir que una persona sin comorbili - dades. La salud mental es un importante factor en esta pandemia, se ha demostrado deterioro en estado general y enfermedades mentales debido a la ansiedad y aislamiento social secundario a la pandemia en este grupo...(AU)