Impact of intratumoural heterogeneity on the assessment of Ki67 expression in breast cancer.

In breast cancer (BC), the prognostic value of Ki67 expression is well-documented. Intratumoural heterogeneity (ITH) of Ki67 expression is amongst the several technical issues behind the lag of its inclusion into BC prognostic work-up. The immunohistochemical (IHC) expression of anti-Ki67 antibody (MIB1 clone) was assessed in four full-face (FF) sections from different primary tumour blocks and their matched axillary nodal (LN) metastases in a series of 55 BC. Assessment was made using the highest expression hot spots (HS), lowest expression (LS), and overall/average expression scores (AS) in each section. Heterogeneity score (Hes), co-efficient of variation, and correlation co-efficient were used to assess the levels of Ki67 ITH. Ki67 HS, LS, and AS scores were highly variable within the same section and between different sections of the primary tumour, with maximal variation observed in the LS (P < 0.001). The least variability between the different slides was observed with HS scoring. Although the associations between Ki67 and clinicopathological and molecular variables were similar when using HS or AS, the best correlation between AS and HS was observed in tumours with high Ki67 expression only. Ki67 expression in LN deposits was less heterogeneous than in the primary tumours and was perfectly correlated with the HS Ki67 expression in the primary tumour sections (r = 0.98, P < 0.001). In conclusion, assessment of Ki67 expression using HS scoring method on a full-face BC tissue section can represent the primary tumour growth fraction that is likely to metastasise. The association between Ki67 expression pattern in the LN metastasis and the HS in the primary tumour may reflect the temporal heterogeneity through clonal expansion.

[Prevalence of inappropriate prescription to polymedicated patients over 65 years old in a rural health area]. / Prevalencia de prescripción inapropiada en polimedicados mayores de 65 años en un área de salud rural.

OBJECTIVE: Describe the inappropriate prescription to polymedicated patients over 65 years old in rural areas. MATERIAL AND METHOD: An observational, descriptive, cross-sectional study conducted in health care units in the Guadalhorce Valley, a rural area of Malaga, Spain. The district has a catchment population of about 144,993 inhabitants. This study is focused on the population that is older than 65 years, and who use 10 or more medications (4.344 patients). The study has as a primary variable: the rates of inappropriate prescription. These are classified using the Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria, as well as the criteria of the strategy of the approach to polymedicated of the Andalusian Health System. An application was used to create individualised forms that identified inappropriate prescribing criteria. For each patient, we used variables, such as the unit, drug group, medications, dose, and use of the STOPP and Andalusian Health System criteria were recorded for each patient. RESULTS: More than one-third (35.5%) of all patients have inappropriate prescription, according to STOPP criteria, related to some health problem (direct problems). The large majority (94%) have potentially inappropriate prescription according to the criteria of the Andalusian Health System. If the criteria directly related to prescribing medication for people over 65 (general) is taken into account, 100% of patients have some form of inappropriate or potentially inappropriate prescribing. CONCLUSIONS: The prevalence of polypharmacy and inappropriate prescription is a real problem in the population over 65 years old. An informatics tool provides us with the facilities to identify and approach inappropriate prescribing.

Prevalencia de prescripción inapropiada en polimedicados mayores de 65 años en un área de salud rural / Prevalence of inappropriate prescription to polymedicated patients over 65 years old in a rural health area

Objetivo. Describir la adecuación de la prescripción de pacientes polimedicados mayores de 65 años en un área rural. Material y método. Estudio observacional descriptivo trasversal. El área de estudio corresponde a las unidades asistenciales del Distrito Sanitario rural Valle del Guadalhorce de Málaga en septiembre de 2009. El distrito asiste a una población de 144.993 habitantes y el estudio se dirige a la población mayor de 65 años con 10 o más medicamentos (4.344 pacientes). La variable principal fueron las tasas de prescripción inadecuada o potencialmente inadecuadas. Para ello se clasificaron utilizando los criterios Screening Tool of Older Persons’ potentially inappropriate Prescriptions (STOPP) y los criterios de la estrategia de abordaje del polimedicado del Servicio Andaluz de Salud (SAS). Se utilizó un aplicativo para la creación de informes individualizados que identificaban los criterios. Por cada paciente se identificaron variables como unidad, tipo de medicamento, medicamento, dosis y expresión del criterio STOPP o SAS. Resultados. El 35,5% presentan una tasa de prescripción inadecuada según los criterios STOPP directos. Según los criterios utilizados por el SAS, la tasa de prescripción potencialmente inapropiada fue del 94%. Si la evaluación se realizaba con el total de criterios STOPP (directos y generales), el 100% de la población de estudio presentaban una prescripción al menos potencialmente inadecuada. Conclusiones. La prevalencia de polimedicación y de prescripción inadecuada es un problema real en la población mayor de 65 años. La ayuda de una herramienta informatizada facilita la identificación y el abordaje de la prescripción inapropiada (AU)

Objective. Describe the inappropriate prescription to polymedicated patients over 65 years old in rural areas. Material and method. An observational, descriptive, cross-sectional study conducted in health care units in the Guadalhorce Valley, a rural area of Malaga, Spain. The district has a catchment population of about 144,993 inhabitants. This study is focused on the population that is older than 65 years, and who use 10 or more medications (4.344 patients). The study has as a primary variable: the rates of inappropriate prescription. These are classified using the Screening Tool of Older Persons’ potentially inappropriate Prescriptions (STOPP) criteria, as well as the criteria of the strategy of the approach to polymedicated of the Andalusian Health System. An application was used to create individualised forms that identified inappropriate prescribing criteria. For each patient, we used variables, such as the unit, drug group, medications, dose, and use of the STOPP and Andalusian Health System criteria were recorded for each patient. Results. More than one-third (35.5%) of all patients have inappropriate prescription, according to STOPP criteria, related to some health problem (direct problems). The large majority (94%) have potentially inappropriate prescription according to the criteria of the Andalusian Health System. If the criteria directly related to prescribing medication for people over 65 (general) is taken into account, 100% of patients have some form of inappropriate or potentially inappropriate prescribing. Conclusions. The prevalence of polypharmacy and inappropriate prescription is a real problem in the population over 65 years old. An informatics tool provides us with the facilities to identify and approach inappropriate prescribing (AU)

Gripe / Influenza

La gripe es una infección viral generalmente leve y autolimitada que cursa en forma de epidemias anuales. Supone un importante problema de salud pública tanto por la mortalidad directa o indirecta que puede llegar a provocar, como por los altos costes socioeconómicos que acarrea

Influenza is a mild and self-limited viral infection that occurs in yearly epidemic outbreaks. It is an important public health problem due to the direct and indirect mortality it can cause and its high social and economic costs