Cost-effectiveness Analysis of Maternal Immunization with RSVpreF Vaccine for the Prevention of Respiratory Syncytial Virus Among Infants in Spain.

INTRODUCTION: Respiratory syncytial virus (RSV) is the leading cause of acute lower respiratory infections (ALRI) in children under one year of age. In high-income countries, RSV infections cause a significant overload of care every winter, imposing a significant burden to the healthcare system, which has made the development of prevention strategies a major global health priority. In this context, a new bivalent RSV prefusion F protein-based vaccine (RSVpreF) has recently been approved. The objective of this study was to evaluate the cost-effectiveness of vaccinating pregnant women with the RSVpreF vaccine to prevent RSV in infants from the Spanish National Healthcare System (NHS) perspective. METHODS: A hypothetical cohort framework and a Markov-type process were used to estimate clinical outcomes, costs, quality-adjusted life years (QALY) and cost-per-QALY gained (willingness-to-pay threshold: €25,000/QALY) for newborn infants born to RSV-vaccinated versus unvaccinated mothers over an RSV season. The base case analysis was performed from the NHS perspective including direct costs (€2023) and applying a discount of 3% to future costs and outcomes. To evaluate the robustness of the model, several scenarios, and deterministic and probabilistic analyses were carried out. All the parameters and assumptions were validated by a panel of experts. RESULTS: The results of the study showed that year-round maternal vaccination program with 70% coverage is a dominant option compared to no intervention, resulting in direct cost savings of €1.8 million each year, with an increase of 551 QALYs. Maternal vaccination could prevent 38% of hospital admissions, 23% of emergency room visits, 19% of primary care visits, and 34% of deaths due to RSV. All scenario analyses showed consistent results, and according to the probabilistic sensitivity analysis (PSA), the probability of maternal vaccination being cost-effective versus no intervention was 99%. CONCLUSIONS: From the Spanish NHS perspective, maternal vaccination with bivalent RSVpreF is a dominant alternative compared with a non-prevention strategy.

Second radioiodine treatment in patients with differentiated thyroid carcinoma: Causes and effects.

INTRODUCTION: Patients with incomplete response to initial therapy of thyroid cancer can be managed with ongoing observation or potentially additional therapies. Our aim was to assess the effect of a second radioactive iodine treatment (RAIT) and its relationship with causes and clinical variables. MATERIAL AND METHODS: Patients undergoing a second RAIT for biochemical or structural incomplete response to initial therapy of DTC were retrospectively included (n=120). They were categorised based on the American Thyroid Association (ATA) classification of response to initial therapy. Patients were reclassified in the following 6-18 months after second RAIT based on imaging findings and measurements of thyroglobulin and antithyroglobulin antibody levels. The associations of a downgrading of response category and progression-free survival (PFS), and the related variables, were evaluated. RESULTS: Sixty-six patients (55%) had a downgrading on ATA response category after second RAIT. A significant interdependence of causes for second RAIT and outcomes was found (χ2=29.400, p=0.001), with patients with neck reoperation showing a higher rate of indeterminate or excellent responses. A significant association between ATA response to second RAIT and absence of structural progression was found (χ2=44.914, p<0.001), with less structural progression in patients with downgrading on ATA response (χ2=30.914, p<0.001). There was also significant interdependence to some clinical variables, such as AJCC stage (χ2=8.460, p=0.015), ATA risk classification (χ2=10.694, p=0.005) and initial N stage (χ2=8.485, p=0.004). CONCLUSIONS: In selected cases, a second RAIT could lead to more robust responses with a potential improvement in prognosis in patients with incomplete response to initial DTC treatment.

Cost-utility analysis of the use of the 20-valent anti-pneumococcal vaccine (PCV20) in adults older than 60 years in Spain.

BACKGROUND AND OBJECTIVES: A cost-utility analysis was conducted to assess the efficiency of implementing a PCV20 vaccination strategy in the Spanish adult population older than 60 years, for the prevention of non-bacteremic pneumococcalpneumonia (NBP) and invasive pneumococcal disease (IPD). METHODS: A Markov model, with annual cycles and a time horizon of 10 years was used. The analysis population was stratified by age and risk groups. The comparator was the sequential vaccination with the 15-valent pneumococcal conjugate vaccine (PCV15) followed by one dose of the pneumococcal polysaccharide vaccine (PPV23). The base case analysis was performed from the National Healthcare System (NHS) perspective including direct costs (€2018) and applying a discount of 3% to future costs and outcomes. Alternative scenarios explored a shorter time horizon (5 years), the societal perspective and other available vaccination strategies. All the parameters and assumptions were validated by a panel of experts. To evaluate the robustness of the model, deterministic and probabilistic sensitivity analyses (PSA) were carried out. RESULTS: The results of the study showed that the vaccination strategy with PCV20 is a dominant option compared to the sequential regimen (PCV15 + PPSV23), resulting in direct cost savings of €85.7 M over 10 years, with a small increase in quality-adjusted life years (QALYs). PCV20 vaccination avoided 2,161 cases of IPD, 19,470 of NBP and 3,396 deaths and according to the PSA, the probability of PCV20 being cost-effective compared to a sequential regimen (PCV15 + PPSV23) was 100%. CONCLUSIONS/RECOMMENDATIONS: In the Spanish adult population older than 60 years, the vaccination strategy with one dose of PCV20 is more effective and less expensive (dominant) than vaccination with a sequential schedule with PCV15 and PPSV23.

Trotabresib, an oral potent bromodomain and extraterminal inhibitor, in patients with high-grade gliomas: A phase I, "window-of-opportunity" study.

BACKGROUND: The bromodomain and extraterminal protein (BET) inhibitor trotabresib has demonstrated antitumor activity in patients with advanced solid tumors, including high-grade gliomas. CC-90010-GBM-001 (NCT04047303) is a phase I study investigating the pharmacokinetics, pharmacodynamics, and CNS penetration of trotabresib in patients with recurrent high-grade gliomas scheduled for salvage resection. METHODS: Patients received trotabresib 30 mg/day on days 1-4 before surgery, followed by maintenance trotabresib 45 mg/day 4 days on/24 days off after surgery. Primary endpoints were plasma pharmacokinetics and trotabresib concentrations in resected tissue. Secondary and exploratory endpoints included safety, pharmacodynamics, and antitumor activity. RESULTS: Twenty patients received preoperative trotabresib and underwent resection with no delays or cancelations of surgery; 16 patients received maintenance trotabresib after recovery from surgery. Trotabresib plasma pharmacokinetics were consistent with previous data. Mean trotabresib brain tumor tissue:plasma ratio was 0.84 (estimated unbound partition coefficient [KPUU] 0.37), and modulation of pharmacodynamic markers was observed in blood and brain tumor tissue. Trotabresib was well tolerated; the most frequent grade 3/4 treatment-related adverse event during maintenance treatment was thrombocytopenia (5/16 patients). Six-month progression-free survival was 12%. Two patients remain on treatment with stable disease at cycles 25 and 30. CONCLUSIONS: Trotabresib penetrates the blood-brain-tumor barrier in patients with recurrent high-grade glioma and demonstrates target engagement in resected tumor tissue. Plasma pharmacokinetics, blood pharmacodynamics, and safety were comparable with previous results for trotabresib in patients with advanced solid tumors. Investigation of adjuvant trotabresib + temozolomide and concomitant trotabresib + temozolomide + radiotherapy in patients with newly diagnosed glioblastoma is ongoing (NCT04324840).

Factores de riesgo y protección de conducta suicida en adolescentes: encuesta en primer nivel público (diciembre 2016 - setiembre 2017) / Risk and protective factors of suicidal behavior in adolescents: first public primary care survey (december 2016 - september 2017) / Fatores de risco e proteção para comportamento suicida em adolescentes: inquérito em primeiro nível público de saúde (dezembro 2016 - setembro 2017)

Introducción: el intento de autoeliminación (IAE) y el suicidio han aumentado en adolescentes, es un problema de alta prioridad. Objetivo: establecer la epidemiología y su relación con factores de riesgo (FR) y protección (FP) de conducta suicida en usuarios de un Espacio Adolescente en el primer nivel de atención del subsector público (diciembre 2016-setiembre 2017). Material y método: encuesta anónima a adolescentes de ambos sexos, entre 12 y 19 años. Se compararon FR y FP entre: franjas etarias (12 a 14 años y 15 a 19 años); sexo; IAE previo versus su ausencia e institucionalización o no. Se consideró p menor a 0,05 como estadísticamente significativa. Los datos se ingresaron en Excel y se analizaron con Epi Info 7.2.0.1. Resultados: 107 entrevistados, 60 mujeres, edad: 13,3 (media); IAE previo más frecuente entre 15 y 19 años y sexo femenino (p 95%). FP p 95%: actividad recreativa, autoestima elevada, y buena resolución de problemas. FR p 95%: maltrato, abuso sexual, muerte de ser querido, consumo de sustancias y enfermedad psiquiátrica. Comparando edades, FP: familia unida, proyectos y amigos (p 95%); FR: consumo de sustancias, enfermedad psiquiátrica, maltrato, abuso sexual, familiar con enfermedad psiquiátrica, muerte de ser querido, trastorno del sueño, institucionalización, ideación y planificación suicidas (p 95%). Al comparar sexos, no se encontraron FP p 95% FR. Conclusiones: se deben estimular actividades recreativas en adolescentes y ofrecer asistencia en salud mental a aquellos que presentan FR de conducta suicida.

Introduction: self-harm (SH) and suicide have increased in adolescents, and they have become a high health priority. Objective: to establish the epidemiology and its relationship with risk factors (RF) and protection (PF) of suicidal behavior in users of a Primary Care Adolescent Center of the State Health Sector (December 2016 - September 2017). Materials and methods: confidential survey of adolescents of both sexes, between 12 and 19 years of age. We carried out a descriptive analysis in order to compare RF and PF between ages (12 to 14 and 15 to 19); sex; previous SH self-harm versus its absence and institutionalization or not. p less than 0.05 was considered statistically significant. Data were entered into Excel and analyzed using Epi Info 7.2.0.1. Results: 107 interviewees, 60 females, age: 13.3 (mean); Most frequent previous SH between 15 and 19 years and female sex (p 95%). PF p 95 %: recreational activity, high self-esteem, and good problem-solving skills. RF p 95 %: child abuse, sexual abuse, death of a loved one, substance use and mental illness. Comparing ages, PF: close family, projects and friends (p 95%); RF: substance use, mental illness, child abuse, sexual abuse, family with mental illness, death of loved one, sleep disorder, institutionalization, suicidal ideation and suicidal planning (p 95%). When comparing sexes, PF were not found p 95% as RF. Conclusions: recreational activities should be encouraged in adolescents and Mental Health assistance should be provided to those who present RF of suicidal behavior.

Introdução: tentativa de suicídio e suicídio tem aumentado na adolescência, adquirindo alta prioridade. Objetivo: estabelecer a epidemiologia e sua relação com fatores de risco (FR) e proteção (FP) de comportamento suicida em usuários do chamado "Espaço Adolescente" no Primeiro Nível de Atenção no Subsetor Público do Sistema de Saúde (dezembro 2016-setembro 2017). Materiais e métodos: inquérito anônimo aos adolescentes de ambos os sexos, entre 12 e 19 anos de idade. Foram comparados FR e FP entre: grupos de idades (12 a 14 e 15 a 19); sexo; tentativa de suicídio anterior versus sua ausência e institucionalização ou não. Considerou-se p menor a 0,05 como estatisticamente significativa. Os dados foram processados no programa Excel e utilizando-se o programa Epi Info 7.2.0.1. Resultados: 107 entrevistados, 60 do sexo feminino, idade: 13,3 (média); antecedentes de tentativa de suicídio mais frequentes entre 15 e 19 anos e sexo feminino (p 95%). FP p 95%: atividade recreativa, autoestima elevada, e boas habilidades de resolução de problemas. FR p 95%: maltrato, abuso sexual, perda de pessoa querida, consumo de substâncias e doença psiquiátrica. Comparadas as idades, FP: família unida, projetos e amigos (p 95%); FR: consumo de substâncias, doença psiquiátrica, maltrato, abuso sexual, familiar com doença psiquiátrica, perda de pessoa querida, transtorno do sono, institucionalização, ideação suicida e planejamento suicida (p 95%). Comparados ambos os sexos, não se encontraram FP p 95% FR. Conclusões: atividades recreativas devem ser estimuladas nos casos de adolescentes e assistência à Saúde Mental deve ser fornecida aos portadores de FR suicida.

Trotabresib (CC-90010) in combination with adjuvant temozolomide or concomitant temozolomide plus radiotherapy in patients with newly diagnosed glioblastoma.

Background: Standard-of-care treatment for newly diagnosed glioblastoma (ndGBM), consisting of surgery followed by radiotherapy (RT) and temozolomide (TMZ), has improved outcomes compared with RT alone; however, prognosis remains poor. Trotabresib, a novel bromodomain and extraterminal inhibitor, has demonstrated antitumor activity in patients with high-grade gliomas. Methods: In this phase Ib, dose-escalation study (NCT04324840), we investigated trotabresib 15, 30, and 45 mg combined with TMZ in the adjuvant setting and trotabresib 15 and 30 mg combined with TMZ+RT in the concomitant setting in patients with ndGBM. Primary endpoints were to determine safety, tolerability, maximum tolerated dose, and/or recommended phase II dose (RP2D) of trotabresib. Secondary endpoints were assessment of preliminary efficacy and pharmacokinetics. Pharmacodynamics were investigated as an exploratory endpoint. Results: The adjuvant and concomitant cohorts enrolled 18 and 14 patients, respectively. Trotabresib in combination with TMZ or TMZ+RT was well tolerated; most treatment-related adverse events were mild or moderate. Trotabresib pharmacokinetics and pharmacodynamics in both settings were consistent with previous data for trotabresib monotherapy. The RP2D of trotabresib was selected as 30 mg 4 days on/24 days off in both settings. At last follow-up, 5 (28%) and 6 (43%) patients remain on treatment in the adjuvant and concomitant settings, respectively, with 1 patient in the adjuvant cohort achieving complete response. Conclusions: Trotabresib combined with TMZ in the adjuvant setting and with TMZ+RT in the concomitant setting was safe and well tolerated in patients with ndGBM, with encouraging treatment durations. Trotabresib 30 mg was established as the RP2D in both settings.

Avadomide plus obinutuzumab in patients with relapsed or refractory B-cell non-Hodgkin lymphoma (CC-122-NHL-001): a multicentre, dose escalation and expansion phase 1 study.

BACKGROUND: Avadomide (CC-122) is a novel oral cereblon-modulating agent with promising activity in non-Hodgkin lymphoma. We aimed to examine the safety and preliminary activity of avadomide plus obinutuzumab in patients with relapsed or refractory non-Hodgkin lymphoma. METHODS: CC-122-NHL-001 was a phase 1b dose escalation and expansion study at eight sites in France, Italy, and the Netherlands. Eligible patients (aged ≥18 years) had histologically confirmed CD20-positive relapsed or refractory non-Hodgkin lymphoma, had an Eastern Cooperative Oncology Group performance status of 0 or 1, and had received previous treatment. In the dose expansion phase, only patients with previously treated relapsed or refractory follicular lymphoma (grade 1, 2, or 3a) were included. Avadomide was administered in escalating doses and two formulations: active pharmaceutical ingredient in capsule in 1·0 mg, 2·0 mg, 3·0 mg, and 4·0 mg doses and as formulated capsules in 3·0 mg and 4·0 mg doses orally once daily on days 1-5 followed by 2 days off (5-7-day schedule) every week of each 28-day cycle. Obinutuzumab 1000 mg was administered intravenously on days 2, 8, and 15 of cycle 1 and day 1 of cycles 2-8. Primary objectives were to determine the safety and tolerability, the non-tolerated dose, maximum tolerated dose, and recommended phase 2 dose (RP2D). All patients who received treatment were included in the safety analyses. Efficacy-evaluable patients completed at least one cycle of treatment and had baseline and at least one post-baseline assessment. The study is registered with ClinicalTrials.gov, NCT02417285 and EudraCT 2014-003333-26, and is ongoing. FINDINGS: Between June 24, 2015, and Dec 5, 2018, 73 patients were enrolled and treated; 19 had diffuse large B-cell lymphoma, 53 follicular lymphoma, and one marginal zone lymphoma. Median follow-up was 253 days (IQR 127-448). The median number of previous anticancer regimens was three (IQR 2-4). The maximum tolerated dose and non-tolerated dose were not reached in the dose escalation phase. On the basis of safety and pharmacokinetic-pharmacodynamic data, the avadomide RP2D was established as 3·0 mg as formulated capsules on a 5-7-day schedule in combination with 1000 mg of obinutuzumab. Patients enrolled in the expansion cohort received the established RP2D of avadomide. Across all doses, three patients had dose-limiting toxicities; one patient treated at the RP2D had dose-limiting toxicity (grade 3 sepsis). The most common adverse events of grade 3 and above were neutropenia (41 [56%] of 73) and thrombocytopenia (17 [23%] of 73). 34 (47%) patients had serious adverse events, which were considered to be avadomide-related in 23 (32%) of 73 patients and obinutuzumab-related in 20 (27%) of 73 patients. Two treatment-related deaths occurred, one owing to tumour flare and one from acute myeloid leukaemia after study discontinuation. INTERPRETATION: Avadomide plus obinutuzumab has a manageable toxicity, being a tolerable treatment option for most patients. Although the prespecified threshold for activity was not met in the trial, we believe that the preliminary antitumour activity of cereblon modulators plus next-generation anti-CD20 antibodies in heavily pretreated relapsed or refractory non-Hodgkin lymphoma warrants further investigation as a chemotherapy-free option in this setting. FUNDING: Celgene Corporation.

COVID-19 mortality in cancer patients in a Madrid hospital during the first 3 weeks of the epidemic.

BACKGROUND AND OBJECTIVE: The Covid-19 pandemic especially affects cancer patients with higher incidence and mortality according to published series of original pandemic foci. The study aims to determine the mortality in our center due to covid-19 in cancer patients during the first 3 weeks of the epidemic. MATERIAL AND METHODS: The cancer patients who died of covid-19 during the analysis period have been reviewed describing the oncological and the covid-19 infection characteristics and the treatments established. RESULTS: Confirmed cases covid-19: 1069 with 132 deaths (12.3%). With cancer 36 patients (3.4%), 15 deceased (41.6%). Of the deceased, only 6 patients (40%) were in active treatment. The most frequent associated tumor was lung (8/15 patients, 53.3%), 11 with metastatic disease (11/15, 73.3%). No specific treatment was established in 40 % (6/15) of the patients. The rest of them received treatments with the active protocols. CONCLUSION: Covid-19 mortality in cancer patients is almost four times higher than that of the general population. Until we have effective treatments or an effective vaccine, the only possibility to protect our patients is to prevent the infection with the appropriate measures.

ANTECEDENTES Y OBJETIVO: La pandemia por Covid-19 afecta especialmente a pacientes con cáncer con mayor incidencia y mortalidad según series publicadas de focos originales de pandemia. El estudio pretende conocer la mortalidad en nuestro centro por covid-19 en pacientes con cáncer durante las primeras 3 semanas de epidemia. MATERIAL Y MÉTODOS: Se han revisado los pacientes con cáncer fallecidos por covid-19 durante el periodo de análisis describiendo las características oncológicas, de la infección por covid-19 y de los tratamientos instaurados. RESULTADOS: Casos confirmados covid-19: 1069 con 132 fallecimientos (12,3%). Con cáncer 36 pacientes (3.4%), 15 fallecidos (41,6%). De los fallecidos solo 6 pacientes (40%) se encontraban en tratamiento activo. El tumor más frecuente asociado fue pulmón (8/15 pacientes, 53,3%), 11 con enfermedad metastásica (11/15, 73,3%). El 40% (6/15) no recibió tratamiento específico contra covid-19, el resto fue tratado con los protocolos activos. CONCLUSIÓN: La mortalidad por covid-19 en pacientes con cáncer casi cuadriplica la de la población general. Hasta disponer de tratamientos eficaces o una vacuna efectiva la única posibilidad de proteger a nuestros pacientes es impedir el contagio con las medidas adecuadas.

[COVID-19 mortality in cancer patients in a Madrid hospital during the first 3 weeks of the epidemic]. / Mortalidad por COVID-19 en pacientes con cáncer en un hospital de Madrid durante las primeras 3 semanas de epidemia.

BACKGROUND AND OBJECTIVE: The covid-19 pandemic especially affects cancer patients with higher incidence and mortality according to published series of original pandemic foci. The study aims to determine the mortality in our center due to covid-19 in cancer patients during the first 3 weeks of the epidemic. MATERIAL AND METHODS: The cancer patients who died of covid-19 during the analysis period have been reviewed describing the oncological and the covid-19 infection characteristics and the treatments established. RESULTS: Confirmed cases covid-19: 1069 with 132 deaths (12.3%). With cancer 36 patients (3.4%), 15 deceased (41.6%). Of the deceased, only 6 patients (40%) were in active treatment. The most frequent associated tumor was lung (8/15 patients, 53.3%), 11 with metastatic disease (11/15, 73.3%). No specific treatment was established in 40% (6/15) of the patients. The rest of them received treatments with the active protocols. CONCLUSION: Covid-19 mortality in cancer patients is almost four times higher than that of the general population. Until we have effective treatments or an effective vaccine, the only possibility to protect our patients is to prevent the infection with the appropriate measures.

Effects of 12-week Aerobic Exercise on Arterial Stiffness, Inflammation, and Cardiorespiratory Fitness in Women with Systemic LUPUS Erythematosus: Non-Randomized Controlled Trial.

This study assessed the effect of 12-week aerobic exercise on arterial stiffness (primary outcome), inflammation, oxidative stress, and cardiorespiratory fitness (secondary outcomes) in women with systemic lupus erythematosus (SLE). In a non-randomized clinical trial, 58 women with SLE were assigned to either aerobic exercise (n = 26) or usual care (n = 32). The intervention comprised 12 weeks of aerobic exercise (2 sessions × 75 min/week) between 40⁻75% of the individual's heart rate reserve. At baseline and at week 12, arterial stiffness was assessed through pulse wave velocity (PWV), inflammatory (i.e., high-sensitivity C-reactive protein [hsCRP], tumor necrosis factor alpha [TFN-α], and inteleukin 6 [IL-6]) and oxidative stress (i.e., myeloperoxidase [MPO]) markers were obtained from blood samples, and cardiorespiratory fitness was assessed (Bruce test). There were no between-group differences in the changes in arterial stiffness (median PWV difference -0.034, 95% CI -0.42 to 0.36 m/s; p = 0.860) or hsCRP, TNF-α, IL-6, and MPO (all p > 0.05) at week 12. In comparison to the control group, the exercise group significantly increased cardiorespiratory fitness (median difference 2.26 minutes, 95% CI 0.98 to 3.55; p = 0.001). These results suggest that 12 weeks of progressive treadmill aerobic exercise increases cardiorespiratory fitness without exacerbating arterial stiffness, inflammation, or oxidative stress in women with SLE.

Estudio Descriptivo: Utilidad de la Cirugía Bariátrica en el Tratamiento de la Obesidad y Comorbilidades en Pacientes del Hospital de Especialidades José Carrasco Arteaga, 2009 - 2013 / Descriptive Study: Utility of Bariatric Surgery as Treatment for Obesity and Comorbidities in Patients from José Carrasco Arteaga Specialities Hospital, 2009-2013.

INTRODUCCIÓN: La cirugía bariátrica constituye en la actualidad una alternativa terapéutica eficaz en pacientes con obesidad y comorbilidades. El objetivo fue describir los resultados obtenidos en una serie de pacientes tratados con cirugía bariátrica en el Hospital de Especialidades José Carrasco Arteaga. MÉTODO: Estudio descriptivo, longitudinal y retrospectivo realizado en los pacientes tratados con cirugía bariátrica e ingresados en el departamento de Cirugía del Hospital de Especialidades José Carrasco Arteaga durante el periodo comprendido entre 2009 y 2013. Se estudiaron las medidas antropométricas, niveles de glicemia, perfil lipídico (colesterol, triglicéridos y HDL) y los niveles de tensión arterial previos a la cirugía y 3 controles posteriores (tercer, sexto y duodécimo mes posquirúrgico) para proceder a describir los resultados y compararlos en el tiempo de seguimiento. RESULTADOS: Se estudiaron 71 pacientes con diagnóstico de obesidad mórbida (81.5 % mujeres y 18.5 % varones) con una edad media de 44 ±10 años. El peso medio prequirúrgico fue de 110.16 ±18.6 kg y el IMC de 42.6 ±46 Kg/m2. Al tercer mes, sexto mes y un año después del procedimiento quirúrgico, el IMC promedio fue de 34.54 Kg/m2, 31.64 Kg/m2 y 30.36 Kg/m2 respectivamente. El 90.8 % de los pacientes con dislipidemia, el 100 % de los diabéticos y el 98.5 % de los hipertensos normalizaron sus perfiles correspondientes tras 12 meses. El 7.04 % de los pacientes presentaron complicaciones posquirúrgicas y la mortalidad alcanzó un 5.6 %. CONCLUSIÓN: La cirugía bariátrica constituye un procedimiento útil en la actualidad para el control de la obesidad en sus distintos grados y la reducción de los efectos de las comorbilidades asociadas a ésta como la hipertensión, diabetes y dislipidemia.(au)

BACKGROUND: Bariatric surgery is consideredan effective treatment option in patients with obesity and comorbidities. The aim was to describe the results of bariatric surgery in patients from José Carrasco Arteaga Specialities Hospital. METHODS: A retrospective longitudinal descriptive study was performed in patients treated with bariatric surgery and admitted to Surgery department at José Carrasco Arteaga Specialities Hospital from 2009 to 2013. Anthropometric measures, glucose blood levels, lipid panel (cholesterol, triglycerides and HDL) and blood pressure measures were registered before the surgery and three, six and twelve months after it to describe the results and compare them through follow-up. RESULTS: 71 patients diagnosed with morbid obesity (81.5 % male and 18.5 % female) were studied; their mean age was 45 ±10 years. Average preoperative weight was 110.16 ±18.6 kg and BMI was 42.6 ±4.6 kg/m2. BMI decreased to 34.54kg/m2, 31.64kg/m2 and 30.36kg/m2 after three, six and twelve months respectively. 90.8 % of patients with dyslipidemia, 100 % of diabetics and 98.5 % of hypertensive patients had normal values of their profiles after 12 months. Postoperative complications represented 7.04 % and mortality rate reached 5.6 %. CONCLUSION: Bariatric surgery is a useful procedure to control obesity and the effects associated to its comorbidities such as arterial hypertension, diabetes and dyslipidemia.(au)

Conducta suicida en adolescentes y jóvenes en Uruguay: características de los registros y recursos humanos en emergencias públicas / Suicidal behavior in adolescents and young people in Uruguay: characteristics of the registers and human resources public enemergencies

La conducta suicida en adolescentes constituyeun problema de salud pública, siendo relevanteel papel del sistema de salud y sus recursos humanos en su prevención. El artículo presenta resultados parciales de una investigación más amplia (2013-2015/anii). Los objetivos son caracterizar la forma de registro de intento de autoeliminación en población de 14-24 años atendida en emergencias públicas; identificar barreras socioculturales del personal que interfieren en abordaje y registro de la conducta suicida. Es un estudio poblacional descriptivo transversal. Se completaron 73 formularios y se relevaron 211.389 fichas de Emergencia. En los resultados se describe el perfil del personal, consulta y registro de intentos de autoeliminación. Se constata alta frecuencia de consultas en adolescentes. De estos, 1 de cada 100 presenta una conducta suicida. La escasa capacitación en la temática y las creencias del personal obstaculizan la gestión y registro, y conducen a subestimar posibles casos deconducta suicida. Los hallazgos confirman la importancia de la capacitación.

Suicidal behavior in adolescents is a public health problem, and the role of the health system and its human resources in its prevention is relevant. The article presents partial results of a wider investigation (2013-2015 / anii). The objectives are to characterize the form of self-elimination attempt registration in a population of 14-24 years attended in public emergencies; identify sociocultural barriers of personnel that interfere in approach and record of suicidal behavior. It is a cross-sectional descriptive population study. 73 forms were completed and 211,389 Emergency records were released. The results describe the staff profile, consultation and registration of self-elimination attempts. There is a high frequency of consultations in adolescents. Of these, 1 in 100 have a suicidal behavior. The lack of training in the subject and the beliefs of the staff hinder the management and registration, and lead to underestimate possible cases of suicidal behavior. The findings confirm the importance of training.

Organización vital de una muestra clínica que demanda atención psicológica / Life Functioning among a Clinical Sample Demanding Psychological Treatment

La asociación entre trastornos psicopatológicos y variables de funcionamiento psicosocial ha sido documentada, pero son escasos los estudios que evalúan su impacto sobre la eficacia de los tratamientos psicológicos. El objetivo de este estudio fue evaluar la organización vital de 78 pacientes de un servicio de atención psicológica y examinar la relación con variables clínicas y con el éxito del tratamiento. Esta organización se evaluó mediante una escala confeccionada ad hoc para este estudio. El área de pareja resultó la menos organizada frente a la familiar y personal, con las mayores puntuaciones. La organización vital se relacionó de forma significativa con distintos ejes del DSM-IV-TR. Se confirmó que pacientes con baja organización vital requieren un mayor número de objetivos terapéuticos.

The association between psychological disorders and psychosocial functioning variables has been previously documented, but relatively few studies have examined the impact of these variables on psychological treatment outcomes. The aim of this study was to assess the life functioning of 78 patients from a psychological service centre, and to examine its relationship with clinical variables and treatment success. Life functioning was evaluated with a scale elaborated ad hoc for this study. The partner area of functioning was the most impaired while family and personal areas obtained the highest functioning scores. Patient's life functioning was significantly associated with several axis of DSM-IV-TR. It was confirmed that patients with poorer life functioning required a greater number of treatment objectives.

Improving the advantages of single port in right hemicolectomy: analysis of the results of pure transumbilical approach with intracorporeal anastomosis.

Background. Single-port laparoscopic surgery has recently emerged as a method to improve patient recovery and cosmetic benefits of laparoscopic surgery. The evolution of our technique has led us to move from a periumbilical incision to a transumbilical one, avoiding the use of drain and maintaining a pure single-port approach with intracorporeal anastomosis in order to maintain the incision as smaller as possible. Method. We report a prospective clinical analysis of our first 38 patients. Oncological surgical steps were followed as during the standard laparoscopic approach, performing the anastomosis intracorporeally in all cases. Results. Mean age of 68,39 years old and an average BMI of 27,88%. (range 19,81-41,5). Most lesions were adenocarcinoma (65,8%), while the remaining were polyps (31,5%) and one a mucocele of the appendix. We moved from a periumbilical incision, initial 14 cases, into a transumbilical one, (medium size of the incision 3,25 cm). Average surgical time was 117,42 minutes. Drains was only used in our first 3 cases. Mean hospital stay was 5,2 days, (86,5% stayed less than 5 days). Total morbidity was 13%. Histological exams of the specimens showed that the oncological criteria were preserved. Conclusions. Single-port right hemicolectomy with intracorporeal anastomosis is feasible and safe. The advantages of a total intracorporeal anastomosis include that there is no need to enlarge the umbilical incision and avoid traction of the pedicle of the mesenterium of the transverse colon during the extracorporeal anastomosis. A transumbilical incision offers better cosmetic results, and the use of drains can be avoided, which increase, patient's satisfaction.

Age at sexual initiation and number of sexual partners in the female Spanish population Results from the AFRODITA survey.

OBJECTIVES: The AFRODITA study was designed to describe patterns relating to the number of lifetime sexual partners (SP) and age at first sexual intercourse (AFSI) by geographic region in a representative sample of Spanish women. STUDY DESIGN: A representative sample of the female Spanish population was obtained using the Access Panel Technique. Postal questionnaires were sent to 11,086 women aged 18-70 years. Data were collected on AFSI, number of sexual partners, contraceptive methods, cervical cancer screening and socio-demographic characteristics. RESULTS: The average AFSI was 20.9 years. AFSI below the age of 19 years was reported by 30.8% of the women. Among sexually active women, 70.6% reported being monogamous and 6.4% reported > or = 5 lifetime sexual partners. Younger age at interview was strongly related to earlier AFSI and to higher number of lifetime sexual partners. Women younger than 25 were 39 times more likely to have an AFSI before age 18 than women over age 55. The percentage of women aged less than 25 reporting two or more sexual partners was four times higher than that of women 56 and older. In the multivariate analysis, having two or more sexual partners was independently associated with young age, early AFSI, having ever used oral contraceptives, living in an urban area, having had a screening Pap test in the last 3 years, having a sexually transmitted infection and nuliparity. CONCLUSIONS: This study confirms important changes in the sexual behaviour of Spanish women. Younger cohorts show a younger age at sexual initiation and higher number of sexual partners. These are key factors that may induce changes in the human papillomavirus (HPV) prevalence and the cervical cancer incidence in Spain.

Coverage and factors associated with cervical cancer screening: results from the AFRODITA study: a population-based survey in Spain.

OBJECTIVE: To quantify the coverage and monitor the factors associated with opportunistic cervical cytological screening in Spain. MATERIALS AND METHODS: Population-based survey of selected women through the Access Panel technique representative of the general population. A total of 6,852 women (60%) replied to the questionnaire; 981 (14.3%) were excluded from the analysis because they did not meet the screening criteria. Data were adjusted for regions, age group, socioeconomic level (SEL), and municipality size. Moreover, information was collected on preventive gynecological revisions received. Categorical variables were evaluated through the chi2 test of heterogeneity or through a liner test for trend. Multivariate prevalence odds ratios were used to identify statistically significant determinants of screening using logistic regression modeling. RESULTS: The percentage of women 18 to 65 years old with a Pap smear within the last 3 years was 75.6%. Insufficient coverage was observed in women older than 55 years (66%), who live in rural areas (66%), with lower SEL (65%), and in some regions (61%-66%). The factors positively associated with screening were age 26 to 55 years, certain regions, higher SEL, larger municipality size, ever being pregnant, early age at first sexual intercourse, knowledge about cervical cancer and human papillomavirus, and, very strongly, ever use of contraceptive methods. An overuse of cytology can be assumed, as a result of opportunistic screening. CONCLUSIONS: In Spain, the coverage of cytological screening reached 75% of the population, but with inefficiencies in some aspects. To rationalize its use, the Spanish consensus screening protocol must be followed.

Mediastinal extravasation of doxorubicin.

A 48-year-old woman with a diagnosis of breast carcinoma was treated with adjuvant chemotherapy through a central venous catheter with subcutaneous reservoir (Port-A-Cath). While doxorubicin was administered, the patient presented thoracic pain and breathing distress due to superior vena cava perforation by the central catheter and subsequent extravasation of the drug into the mediastinum. The patient recovered without sequelae with conservative therapy. Cytostatic extravasation via central catheter is an uncommon complication in clinical practice. In this paper we present the first doxorubicin extravasation through a central catheter in adults and review the only ten cases found in the literature.