Effectiveness and safety of anti-CGRP monoclonal antibodies in patients over 65 years: a real-life multicentre analysis of 162 patients.

BACKGROUND: Anti-CGRP monoclonal antibodies have shown notable effectiveness and tolerability in migraine patients; however, data on their use in elderly patients is still lacking, as clinical trials have implicit age restrictions and real-world evidence is scarce. In this study, we aimed to describe the safety and effectiveness of erenumab, galcanezumab and fremanezumab in migraine patients over 65 years old in real-life. METHODS: In this observational real-life study, a retrospective analysis of prospectively collected data from 18 different headache units in Spain was performed. Migraine patients who started treatment with any anti-CGRP monoclonal antibody after the age of 65 years were included. Primary endpoints were reduction in monthly migraine days after 6 months of treatment and the presence of adverse effects. Secondary endpoints were reductions in headache and medication intake frequencies by months 3 and 6, response rates, changes in patient-reported outcomes and reasons for discontinuation. As a subanalysis, reduction in monthly migraine days and proportion of adverse effects were also compared among the three monoclonal antibodies. RESULTS: A total of 162 patients were included, median age 68 years (range 65-87), 74.1% women. 42% had dyslipidaemia, 40.3% hypertension, 8% diabetes, and 6.2% previous cardiovascular ischaemic disease. The reduction in monthly migraine days at month 6 was 10.1 ± 7.3 days. A total of 25.3% of patients presented adverse effects, all of them mild, with only two cases of blood pressure increase. Headache and medication intake frequencies were significantly reduced, and patient-reported outcomes were improved. The proportions of responders were 68%, 57%, 33% and 9% for reductions in monthly migraine days ≥ 30%, ≥ 50%, ≥ 75% and 100%, respectively. A total of 72.8% of patients continued with the treatment after 6 months. The reduction in migraine days was similar for the different anti-CGRP treatments, but fewer adverse effects were detected with fremanezumab (7.7%). CONCLUSIONS: Anti-CGRP mAbs are safe and effective treatments in migraine patients over 65 years old in real-life clinical practice.

Tracking SARS-CoV-2 introductions in Mozambique using pandemic-scale phylogenies: a retrospective observational study.

BACKGROUND: From the start of the SARS-CoV-2 outbreak, global sequencing efforts have generated an unprecedented amount of genomic data. Nonetheless, unequal sampling between high-income and low-income countries hinders the implementation of genomic surveillance systems at the global and local level. Filling the knowledge gaps of genomic information and understanding pandemic dynamics in low-income countries is essential for public health decision making and to prepare for future pandemics. In this context, we aimed to discover the timing and origin of SARS-CoV-2 variant introductions in Mozambique, taking advantage of pandemic-scale phylogenies. METHODS: We did a retrospective, observational study in southern Mozambique. Patients from Manhiça presenting with respiratory symptoms were recruited, and those enrolled in clinical trials were excluded. Data were included from three sources: (1) a prospective hospital-based surveillance study (MozCOVID), recruiting patients living in Manhiça, attending the Manhiça district hospital, and fulfilling the criteria of suspected COVID-19 case according to WHO; (2) symptomatic and asymptomatic individuals with SARS-CoV-2 infection recruited by the National Surveillance system; and (3) sequences from SARS-CoV-2-infected Mozambican cases deposited on the Global Initiative on Sharing Avian Influenza Data database. Positive samples amenable for sequencing were analysed. We used Ultrafast Sample placement on Existing tRees to understand the dynamics of beta and delta waves, using available genomic data. This tool can reconstruct a phylogeny with millions of sequences by efficient sample placement in a tree. We reconstructed a phylogeny (~7·6 million sequences) adding new and publicly available beta and delta sequences. FINDINGS: A total of 5793 patients were recruited between Nov 1, 2020, and Aug 31, 2021. During this time, 133 328 COVID-19 cases were reported in Mozambique. 280 good quality new SARS-CoV-2 sequences were obtained after the inclusion criteria were applied and an additional 652 beta (B.1.351) and delta (B.1.617.2) public sequences were included from Mozambique. We evaluated 373 beta and 559 delta sequences. We identified 187 beta introductions (including 295 sequences), divided in 42 transmission groups and 145 unique introductions, mostly from South Africa, between August, 2020 and July, 2021. For delta, we identified 220 introductions (including 494 sequences), with 49 transmission groups and 171 unique introductions, mostly from the UK, India, and South Africa, between April and November, 2021. INTERPRETATION: The timing and origin of introductions suggests that movement restrictions effectively avoided introductions from non-African countries, but not from surrounding countries. Our results raise questions about the imbalance between the consequences of restrictions and health benefits. This new understanding of pandemic dynamics in Mozambique can be used to inform public health interventions to control the spread of new variants. FUNDING: European and Developing Countries Clinical Trials, European Research Council, Bill & Melinda Gates Foundation, and Agència de Gestió d'Ajuts Universitaris i de Recerca.

Use of the Xiaomi Mi Band for sleep monitoring and its influence on the daily life of older people living in a nursing home.

Background: Lower quantity and poorer sleep quality are common in most older adults, especially for those who live in a nursing home. The use of wearable devices, which measure some parameters such as the sleep stages, could help to determine the influence of sleep quality in daily activity among nursing home residents. Therefore, this study aims to analyse the influence of sleep and its changes concerning the health status and daily activity of older people who lived in a nursing home, by monitoring the participants for a year with Xiaomi Mi Band 2. Methods: This is a longitudinal study set in a nursing home in [Details omitted for double-anonymized peer reviewed]. The Xiaomi Mi Band 2 will be used to measure biomedical parameters and different assessment tools will be administered to participants for evaluating their quality of life, sleep quality, cognitive state, and daily functioning. Results: A total of 21 nursing home residents participated in the study, with a mean age of 86.38 ± 9.26. The main outcomes were that sleep may influence daily activity, cognitive state, quality of life, and level of dependence in activities of daily life. Moreover, environmental factors and the passage of time could also impact sleep. Conclusions: Xiaomi Mi Band 2 could be an objective tool to assess the sleep of older adults and know its impact on some factors related to health status and quality of life of older nursing homes residents. Trial Registration: NCT04592796 (Registered 16 October 2020) Available on: https://clinicaltrials.gov/ct2/show/NCT04592796.

Plasmodium vivax blood stage invasion pathways: Contribution of omics technologies in deciphering molecular and cellular mechanisms.

Vivax malaria is an infectious disease caused by Plasmodium vivax, a parasitic protozoan transmitted by female Anopheline mosquitoes. Historically, vivax malaria has often been regarded as a benign self-limiting infection due to the observation of low parasitemia in Duffy-positive patients in endemic transmission areas and the virtual absence of infections in Duffy-negative individuals in Sub Saharan Africa. However, the latest estimates show that the burden of the disease is not decreasing in many countries and cases of vivax infections in Duffy-negative individuals are increasingly reported throughout Africa. This raised questions about the accuracy of diagnostics and the evolution of interactions between humans and parasites. For a long time, our knowledge on P. vivax biology has been hampered due to the limited access to biological material and the lack of robust in vitro culture methods. Consequently, little is currently known about P. vivax blood stage invasion mechanisms. The introduction of omics technologies with novel and accessible techniques such as third generation sequencing and RNA sequencing at single cell level, two-dimensional electrophoresis, liquid chromatography, and mass spectrometry, has progressively improved our understanding of P. vivax genetics, transcripts, and proteins. This review aims to provide broad insights into P. vivax invasion mechanisms generated by genomics, transcriptomics, and proteomics and to illustrate the importance of integrated multi-omics studies.

Le paludisme à Plasmodium vivax est une maladie infectieuse causée par un parasite protozoaire Plasmodium vivax, transmis par les moustiques Anophèle femelles. Historiquement, le paludisme à P. vivax a souvent été considéré comme une infection bénigne en raison de l'observation d'une faible parasitémie chez les patients Duffy-positifs dans les zones d'endémie et de la quasi-absence d'infections chez les individus Duffy-négatifs vivant majoritairement en Afrique subsaharienne. Cependant, les dernières estimations montrent que le poids de la maladie ne diminue pas dans de nombreux pays et que des cas d'infections à P. vivax chez des individus Duffy-négatifs sont de plus en plus souvent observés en Afrique. Cela soulève des interrogations sur la précision des diagnostics et l'évolution des interactions hôte-parasite. Pendant longtemps, nos connaissances sur la biologie de P. vivax ont été entravées par un accès limité au matériel biologique et un manque de méthodes robustes pour la culture in vitro. Par conséquent, nous n'avons encore que peu d'informations concernant les mécanismes d'invasion des stades sanguins de P. vivax. L'introduction des technologies dites « omiques ¼, avec le développement de techniques innovantes et abordables telles que le séquençage d'ADN de troisième génération, le séquençage ARN à l'échelle de la cellule « single-cell ¼, l'électrophorèse bidimensionnelle, la chromatographie liquide et la spectrométrie de masse, a progressivement amélioré notre compréhension des gènes, des transcrits et des protéines de P. vivax. Cette revue a non seulement pour but de fournir un aperçu général des mécanismes d'invasion de P. vivax acquis grâce aux techniques génomiques, transcriptomiques et protéomiques mais également d'illustrer l'importance de la complémentarité de ces approches.

Study for the Design of a Protocol to Assess the Impact of Stress in the Quality of Life of Workers.

(1) Background: Work stress is one of the most relevant issues in public health. It has a significant impact on health, especially the development of mental disorders, causing occupational imbalance. There is a growing interest in the development of tools with a positive effect on workers. To this end, wearable technology is becoming increasingly popular, as it measures biometric variables like heartbeat, activity, and sleep. This information may be used to assess the stress a person is suffering, which could allow the development of stress coping strategies, both at a professional and personal level. (2) Methods: This paper describes an observational, analytical, and longitudinal study which will be set at a research center in A Coruña, Spain. Various scales and questionnaires will be filled in by the participants throughout the study. For the statistical analysis, specific methods will be used to evaluate the association between numerical and categorical variables. (3) Discussion: This study will lay the foundation for a bigger, more complete study to assess occupational stress in different work environments. This will allow us to begin to understand how occupational stress influences daily life activity and occupational balance, which could directly enhance the quality of life of workers if the necessary measures are taken.

Study Protocol on the Validation of the Quality of Sleep Data from Xiaomi Domestic Wristbands.

(1) Background: Sleep disorders are a common problem for public health since they are considered potential triggers and predictors of some mental and physical diseases. Evaluating the sleep quality of a person may be a first step to prevent further health issues that diminish their independence and quality of life. Polysomnography (PSG) is the "gold standard" for sleep studies, but this technique presents some drawbacks. Thus, this study intends to assess the capability of the new Xiaomi Mi Smart Band 5 to be used as a tool for sleep self-assessment. (2) Methods: This study will be an observational and prospective study set at the sleep unit of a hospital in A Coruña, Spain. Forty-three participants who meet the inclusion criteria will be asked to participate. Specific statistical methods will be used to analyze the data collected using the Xiaomi Mi Smart Band 5 and PSG. (3) Discussion: This study offers a promising approach to assess whether the Xiaomi Mi Smart Band 5 correctly records our sleep. Even though these devices are not expected to replace PSG, they may be used as an initial evaluation tool for users to manage their own sleep quality and, if necessary, consult a health professional. Further, the device may help users make simple changes to their habits to improve other health issues as well. Trial registration: NCT04568408 (Registered 23 September 2020).

Efectividad del tratamiento con ondas de choque en la fascitis plantar / Effectiveness of shock wave treatment in plantar fasciitis

Introducción. Existe una gran heterogeneidad en los estudios que abordan la efectividad e indicación del tratamiento con ondas de choque (OCH) en la fascitis plantar (FP) respecto a otros tratamientos alternativos. Objetivos. Evaluar la efectividad del tratamiento con OCH en pacientes con FP mediante las evidencias científicas más actuales y evaluar la eficacia de este tratamiento en comparación con otros tipos de terapias también empleadas en el manejo de esta inflamación. Materiales y métodos. Se realizó una búsqueda bibliográfica en las bases de datos PubMed y PEDro con los términos clave "shock wave" y "plantar fasciitis AND shock wave". Se selecciona- ron artículos publicados en español e inglés entre los años 2015 y 2019. Resultados. Tras aplicar los criterios de inclusión y exclusión y luego de eliminar los duplica- dos, se seleccionaron 13 estudios que englobaban una muestra total de 1.220 individuos y comparaban las OCH frente a placebo, OCH con ejercicios, ultrasonoterapia, laserterapia de bajo nivel e infiltración de corticoides y toxina botulínica. Conclusión. Las OCH constituyen un método eficaz y seguro para tratar la FP, siendo más efectivo que la ultrasonoterapia y la infiltración de toxina botulínica, aunque existe controversia en el resto de comparaciones. Su uso se aconseja asociado a un programa de ejercicios; sin embargo, es necesario realizar más estudios sobre esta técnica.

Introduction. There is great heterogeneity in the studies that address the effectiveness and indication of shock wave therapy (SWT) in plantar fasciitis (PF) with respect to other alternative treatments. Objectives. To evaluate the effectiveness of OCH treatment in patients with PF using the most current scientific evidence and to assess the efficacy of this treatment in comparison with other types of therapies also used in the management of this inflammation. Materials and methods. A literature search was performed in the PubMed and PEDro databases with the key terms "shock wave" and "plantar fasciitis AND shock wave". Articles published in Spanish and English between 2015 and 2019 were selected. Results. After applying the inclusion and exclusion criteria and after eliminating duplicates, 13 studies were selected that encompassed a total sample of 1,220 individuals and compared OCH versus placebo, OCH with exercises, ultrasound therapy, low-level laser therapy, and corticosteroid and botulinum toxin infiltration. Conclusion. OCH is an effective and safe method to treat PF, being more effective than ultrasound therapy and botulinum toxin infiltration, although there is controversy in the rest of the comparisons. Its use is recommended in association with an exercise program; however, further studies on this technique are needed.

Male-specific features are reduced in Mecp2-null mice: analyses of vasopressinergic innervation, pheromone production and social behaviour.

Deficits in arginine vasopressin (AVP) and oxytocin (OT), two neuropeptides closely implicated in the modulation of social behaviours, have been reported in some early developmental disorders and autism spectrum disorders. Mutations in the X-linked methyl-CpG-binding protein 2 (MECP2) gene are associated to Rett syndrome and other neuropsychiatric conditions. Thus, we first analysed AVP and OT expression in the brain of Mecp2-mutant mice by immunohistochemistry. Our results revealed no significant differences in these systems in young adult Mecp2-heterozygous females, as compared to WT littermates. By contrast, we found a significant reduction in the sexually dimorphic, testosterone-dependent, vasopressinergic innervation in several nuclei of the social brain network and oxytocinergic innervation in the lateral habenula of Mecp2-null males, as compared to WT littermates. Analysis of urinary production of pheromones shows that Mecp2-null males lack the testosterone-dependent pheromone darcin, strongly suggesting low levels of androgens in these males. In addition, resident-intruder tests revealed lack of aggressive behaviour in Mecp2-null males and decreased chemoinvestigation of the intruder. By contrast, Mecp2-null males exhibited enhanced social approach, as compared to WT animals, in a 3-chamber social interaction test. In summary, Mecp2-null males, which display internal testicles, display a significant reduction of some male-specific features, such as vasopressinergic innervation within the social brain network, male pheromone production and aggressive behaviour. Thus, atypical social behaviours in Mecp2-null males may be caused, at least in part, by the effect of lack of MeCP2 over sexual differentiation.

Social Determinants of Health, the Family, and Children's Personal Hygiene: A Comparative Study.

Habits of personal hygiene are mostly acquired during childhood, and are, therefore, influenced by one's family. Poor hygiene habits are a risk factor for preventable disease and social rejection. Social Determinants of Health (SDH) consist of contextual factors, structural mechanisms, and the individual's socioeconomic position, which, via intermediary determinants, result in inequities of health and well-being. Dysfunctional family situations may, therefore, be generated by an unequal distribution of factors determining SDH. Little attention has been paid to the influence of the family on personal hygiene and the perception of social rejection in children. We designed a study to examine differences in personal hygiene and in the perception of social rejection between children in reception centers and children living in a family setting. A validated questionnaire on children's personal hygiene habits was completed by 51 children in reception centers and 454 children in normal families. Hygiene habits were more deficient among the children in reception centers than among the other children in all dimensions studied. Deficient hygiene habits were observed in the offspring of families affected by the main features of social inequality, who were more likely to perceive social rejection for this reason and less likely to consider their family as the greatest influence on their personal hygiene practices.

SAPHO syndrome in the differential diagnosis of metastasis. / Síndrome de SAPHO como diagnóstico diferencial de metástasis.

SAPHO syndrome was proposed in the late 80s in order to group different osteoarticular manifestations with specific radiological findings such as the hyperostosis of the front part of the chest wall. Prevalence, etiology and pathogenesis of the disease are unknown, while diagnosis is made both clinically and by the specific gammagraphic image of «bull horn¼ in the sternoclavicular joint. The following case of a 64-year-old woman diagnosed with infiltrating ductal carcinoma of the right breast pT1N0Mx is reported. When studying the extent of the disease, a gammagraphic image of diffuse blast injury in the sterna manubrium was evidenced, which allowed the suspicion of Paget's disease or metastatic injury. Study was completed with a chest CT in which manubrium sclerosis was evidenced, suggesting metástasis. Res ults of the studies pointed out SAPHO syndrome as the most likely diagnostic option. The low tumor stage of the patient prompted the idea of possible alternative diagnoses. A deeper knowledge of this clinical condition may be crucial to avoid mistakes when classifying a subject in more advanced tumor stages, and consequently, to prevent the use of more aggressive chemotherapy and radiotherapy treatments.

[Development and validation of a questionnaire on knowledge and personal hygiene habits in childhood (HICORIN®)]. / Diseño y validación de un cuestionario sobre conocimientos y hábitos en higiene corporal infantil (HICORIN®).

OBJECTIVE: To develop and validate a questionnaire on the integral assessment of the habits and knowledge in personal hygiene in children between 7 to 12 years old in the educational, social and health environment. DESIGN: Cross-sectional study for the validation of a questionnaire. LOCATION: One primary and secondary school and one children's home in the Region of Murcia, Spain. PARTICIPANTS: A total of 86 children were included (80 from a primary and secondary school; 6 from a children's home), as well as 7 experts. MAIN MEASUREMENTS: Content validation by experts; qualitative assessment; identify difficulties related to some questions, item response analysis, and test-retest reliability. RESULTS: After the literature search, 20 tools that included items related to child body hygiene were obtained. The researchers selected 34 items and drafted 48 additional ones. After content validity by the experts, the questionnaire (HICORIN®) was reduced to 63 items, and consisted of 7 dimensions of child personal hygiene (skin, hair, hands, oral, feet, ears, and intimate hygiene). After with the children some terms were adapted to improve their understanding. Only two items had non-response rates that exceeded 10%. The test-retest showed that 84.1% of the items had between very good and moderate reliability. CONCLUSIONS: HICORIN® is a reliable and valid instrument that integrally assesses the habits and knowledge in personal hygiene in children between 7-12 years old. It is applicable in educative and social and health environments and in children from different socioeconomic levels.

Importante déficit de hábitos higiénicos en la población infantil / Poor hygiene in child populations

La higiene corporal supone uno de los pilares de la salud pública. No obstante, existe poco consenso o simplemente desconocimiento hacia las prácticas higiénicas cotidianas correctas. Los objetivos del estudio fueron describir los conocimientos y hábitos en la higiene cotidiana infantil de la boca, el cabello y las manos, detallados en la literatura científica internacional, y determinar las consecuencias socio sanitariasdel déficit higiénico en la población infantil. Se revisaron las bases de datos Medline/Pubmed, Scielo,Scopus y Lilacs desde enero de 1992 hasta mayo de 2012 en idiomas castellano e inglés. Se excluyeron aquellos artículos enfocados exclusivamente a la práctica clínico-asistencial, a recomendaciones técnicas o intervenciones educativas en higiene infantil cotidiana. Se hallaron 1 124 documentos, de los que fueron adecuados para su análisis 29 estudios. Se pone de manifiesto un déficit importante de hábitos higiénicos entre la población infantil, fomentados por la baja percepción social, los estigmas sociales y lapoca implicación de los profesionales de la salud en su educación e investigación. Entre las consecuencias de la inadecuada higiene infantil en estas áreas encontramos: sanitarias (numerosas enfermedades situadas entre las de mayor prevalencia en la infancia), rechazo social, psicológicas y escolares. Se debería generar mayor conocimiento científico en este ámbito y desarrollar estrategias educativas orientadas a la aplicación de las recomendaciones actuales y a la modificación conductual en aquellos casos de higiene infantil cotidiana deficitaria, fomentando, por tanto, hábitos higiénicos saludables en la infancia...

[Left-sided endocarditis due to gram-negative bacilli: epidemiology and clinical characteristics]. / Endocarditis sobre válvulas izquierdas por bacilos gran negativos: epidemiología y características clínicas.

INTRODUCTION: The aim of this study is to describe the epidemiological, clinical characteristics, and outcome of patients with left-side endocarditis caused by gram-negative bacteria. METHOD: Prospective multicenter study of left-sided infective endocarditis reported in the Andalusian Cohort for the Study of Cardiovascular Infections between 1984 and 2008. RESULTS: Among the 961 endocarditis, 24 (2.5%) were caused by gram-negative bacilli. The most common pathogens were Escherichia coli, Pseudomonas aeruginosa and Salmonella enterica. Native valves (85.7%) were mainly affected, most of them with previous valve damage (57%). Comorbidity was greater (90% vs 39%; P=.05) than in endocarditis due to other microorganism, the most frequent being, diabetes, hepatic cirrhosis and neoplasm. A previous manipulation was found in 47.6% of the cases, and 37% were considered hospital-acquired. Renal failure (41%), central nervous system involvement (33%) and ventricular dysfunction (45%) were the most frequent complications. Five cases (21%) required cardiac surgery, mostly due to ventricular dysfunction. More than 50% of cases were treated with aminoglycosides, but this did not lead to a better outcome or prognosis. Mortality (10 patients) was higher than that reported with other microorganisms (41% vs 35%; P=.05). CONCLUSIONS: Left-sided endocarditis due to gram-negative bacilli is a rare disease, which affects patients with major morbidities and often with a previous history of hospital manipulations. Cardiac, neurological and renal complications are frequent and associated with a high mortality. The association of aminoglycosides in the antimicrobial treatment did not involve a better outcome or prognosis.

Sensitivity versus accuracy in multiclass problems using memetic Pareto evolutionary neural networks.

This paper proposes a multiclassification algorithm using multilayer perceptron neural network models. It tries to boost two conflicting main objectives of multiclassifiers: a high correct classification rate level and a high classification rate for each class. This last objective is not usually optimized in classification, but is considered here given the need to obtain high precision in each class in real problems. To solve this machine learning problem, we use a Pareto-based multiobjective optimization methodology based on a memetic evolutionary algorithm. We consider a memetic Pareto evolutionary approach based on the NSGA2 evolutionary algorithm (MPENSGA2). Once the Pareto front is built, two strategies or automatic individual selection are used: the best model in accuracy and the best model in sensitivity (extremes in the Pareto front). These methodologies are applied to solve 17 classification benchmark problems obtained from the University of California at Irvine (UCI) repository and one complex real classification problem. The models obtained show high accuracy and a high classification rate for each class.

The role of radiotherapy for prevention of heterotopic ossification after major hip surgery.

Heterotopic ossification or ectopic bone formation represents a widely known complication after surgery involving joint spaces. Posttraumatic heterotopic ossification can be found at any site. The most common postsurgical site is the hip following total hip arthroplasty. This review explores the treatment options to prevent ectopic bone formation after major surgery of hip, especially, the role of radiotherapy.

Evaluation of the toxicity of the combined treatment of chemoradiotherapy, according to the scheme of Macdonald, after radical surgery in patients diagnosed of gastric cancer.

PURPOSE: In this study we evaluated the acute toxicity of the combined treatment with chemoradiotherapy, according to the scheme of McDonald et al, in patients diagnosed with gastric cancer, after radical curative surgery. METHODS: From July 2001 to December 2005, a total of 24 patients, with diagnosis of adenocarcinoma of the stomach or adenocarcinoma of the gastroesophageal junction, who were operated with total or subtotal gastrectomy with free resection margins, were treated at our service with a combined scheme of adjuvant chemoradiotherapy. RESULTS: Grade 3 toxicity or higher appeared in three patients (12%) and grade 2 in five of the twenty-four patients (21%). Two patients (8%) needed to suspend treatment before the scheduled end date of treatment due to acute toxicity. No acute toxicity of cardiological, hepatic or renal nature was registered, and the most frequent toxicity was the gastrointestinal toxicity (detected in the 79% of the patients). CONCLUSIONS: Combined treatment with chemoradiotherapy, according to the scheme of Macdonald, in diagnosed patients with gastric cancer, after radical curative surgery is a well tolerated treatment, with a low degree of acute toxicity, thus the treatment compliance is not difficult.

Hypoxia and anaemia in patients with cancer of the uterine cervix.

Hypoxia and/or anaemia have an adverse prognostic impact in locally-advanced cancers of uterine cervix. Moreover, these parameters are independent of other well-known prognostic factors. However, the mechanisms by which treatment efficacy and survival are compromised by anaemia are not fully understood. Although it is clear that erythropoietin can reduce the need for transfusions for cancer patients with anaemia, there is no proof that the use of erythropoietin is in any way superior to transfusions with respect to the impact on clinical outcome, especially for patients receiving radiation therapy. Whether haemoglobin levels at the start of therapy, during therapy, or at the end of therapy are of prognostic value for better disease-free and overall survival, are matters for further studies as is the question of the best option for increasing the level of the patient's haemoglobin.

[Spontaneous pre-vesical haematoma in a patient under anticoagulant treatment]. / Hematoma prevesical espontáneo en una paciente descoagulada.

OBJECTIVES: To report a case of perivesical hematoma without previous trauma in a patient under anticoagulant treatment. METHODS: A 70-year-old female admitted with a transitory ischemic cerebrovascular accident was given sodium heparin. Four days later she presented with abdominal distention and hypogastric discomfort. Abdominal ultrasound showed a big perivesical hematoma. RESULTS: CT scan confirmed the presence of a big hematoma. The hematoma was drained five days later after an optimal coagulation profile. Patient was discharged with normal ultrasound after an uneventful postoperative course. CONCLUSIONS: Spontaneous bleeding in patients with coagulation abnormalities is a well-known event, although there are few bibliographic references about primary perivesical blood collections. We opted for deferred drainage of the hematoma to avoid perivesical fibrosis.