Efficacy of systemic oncological treatments in patients with advanced esophageal or gastric cancers at high risk of dying in the middle and short term: an overview of systematic reviews.

BACKGROUND: Esophageal and gastric cancers are a significant public health problem worldwide, with most patients presenting with advanced-stage disease and, consequently, poor prognosis. Systemic oncological treatments (SOT) have been widely used over more conservative approaches, such as supportive care. Nevertheless, its effectiveness in this scenario is not sufficiently clear. This paper provides an overview of systematic reviews that assessed the effectiveness of SOT compared with the best supportive care (BSC) or placebo in patients with advanced esophageal or gastric cancers in an end-of-life context. METHODS: We searched MEDLINE, EMBASE, The Cochrane Library, Epistemonikos, and PROSPERO for eligible systematic reviews (SRs) published from 2008 onwards. The primary outcomes were overall survival (OS), progression-free survival (PFS), functional status, and toxicity. Two authors assessed eligibility and extracted data independently. We evaluated the methodological quality of included SRs using the AMSTAR-2 tool and the overlap of primary studies (corrected covered area, CCA). Also, we performed a de novo meta-analysis with data reported for each primary study when it was possible. We assessed the certainty of evidence using the GRADE approach. RESULTS: We identified 16 SRs (19 included trials) for inclusion within this overview. Most reviews had a critically low methodological quality, and there was a very high overlap of primary studies. It is uncertain whether SOT improves OS and PFS over more conservative approaches due to the very low certainty of evidence. CONCLUSIONS: The evidence is very uncertain about the effectiveness of SOT for advanced esophageal or gastric cancers. High-quality SRs and further randomized clinical trials that include a thorough assessment of patient-centered outcomes are needed. TRIAL REGISTRATION: Open Science Framework, https://doi.org/10.17605/OSF.IO/7CHX6 .

Risk factors associated with drug use before imprisonment in Peru.

OBJECTIVE: To assess the prevalence of drug abuse before prison admission and to identify associated sociodemographic and family history risk factors, according to gender, in prisons of Peru. MATERIALS AND METHODS: A secondary analysis was carried out with data from the First National Prisoner Census 2016, using a questionnaire of 173 items that was applied to the whole prison population of Peru. The types of drugs used before admission were analyzed according to characteristics of the penitentiary population, and generalized linear models were used to calculate prevalence ratios with 95% confidence intervals to identify possible factors associated with drug use. RESULTS: Out of a population of 76,180 prisoners, 71,184 (93.4%) answered the survey (men 67,071, 94.2%). The overall prevalence of drug consumption before admission was 24.4% (25.3 % in men and 9.1% in women), the highest prevalence in the 18-29 age group (36.3% in men and 14.9% in women). The most commonly used drugs were marijuana (58.2%), coca paste/cocaine or crack (40.3%) and inhalants (1%). The factors most strongly associated with consumption were having a family member who consumed drugs (59.8%), history of previous imprisonment (59.1%), unemployment (48.4%), relationships at school with classmates who had problems with the law (46.9%), background of a family member who attended a penitentiary (38.4%), and history of running away from home before age 15 (35.9%). CONCLUSIONS: In Peru, drug use is higher in the prison population than in the general population, and there are differences according to sex in the prevalence of drug use and associated factors prior to admission to a prison. The study demonstrated that childhood events, such as child abuse, having a family member imprisoned, having a family member who used drugs, or who previously abused alcohol, are factors associated with drug use in the penitentiary population. Some of these risk factors are modifiable, so it is important to consider these in the design of social and health policies focused on specific subpopulations to prevent drug use and crime.

Factores de riesgo asociados al consumo de drogas antes del ingreso a las penitenciarías del Perú / Risk factors associated with drug use before imprisonment in Peru

Objetivo: Determinar la prevalencia del consumo de drogas previo al ingreso penitenciario e identificar los factores de riesgo sociodemográficos y familiares asociados, según el sexo, en penitenciarías del Perú. Materiales y métodos: Se realizó un análisis secundario de los datos del Primer Censo Nacional Penitenciario 2016, que empleó un cuestionario de 173 preguntas que fue aplicado a toda la población carcelaria del Perú. Se describieron los tipos de drogas consumidas antes del ingreso según las características de la población penitenciaria, y se utilizaron modelos lineales generalizados para calcular razones de prevalencia con intervalos de confianza al 95% para identificar los posibles factores asociados al consumo de drogas. Resultados: De 76.180 presidiarios, 71.184 (93,4%) respondieron la encuesta (hombres 67.071; 94,2%). La prevalencia global de consumo de drogas previo a la reclusión fue del 24,4% (25,3% en hombres y 9,1% en mujeres), mayor en el grupo de 18 a 29 años (36,3% en hombres y 14,9% en mujeres). Las drogas de mayor consumo fueron la marihuana (58,2%), la pasta básica/cocaína o crack (40,3%), y los inhalantes (1%). Los factores más fuertemente asociados al consumo fueron haber tenido en la niñez un miembro del núcleo familiar que consumiera drogas (59,8%), historia de reclusión anterior (59,1%), desempleo (48,4%), relaciones en el colegio con compañeros que tuvieron problemas con la ley (46,9%), antecedentes de un familiar con ingreso a una penitenciaría (38,4%) e historia de fuga o huida de casa (35,9%). Conclusiones: En Perú, el consumo de drogas es más alto en población penitenciaria que en población general, y existen diferencias según sexo en la prevalencia de consumo de drogas y sus factores asociados antes del ingreso a un centro penitenciario. Se encontró que eventos sucedidos en la niñez, como maltrato, o tener un miembro de la familia encarcelado o consumidor de drogas, o haber consumido alcohol previamente, son factores asociados al consumo de drogas en la población penitenciaria. Algunos de estos factores de riesgo son modificables, por lo cual es importante que se tomen en cuenta en el diseño de políticas sociales y sanitarias enfocadas en subpoblaciones específicas para prevenir el consumo de drogas y la comisión de delitos (AU)

Objective: To assess the prevalence of drug abuse before prison admission and to identify associated sociodemographic and family history risk factors, according to gender, in prisons of Peru. Materials and methods: A secondary analysis was carried out with data from the First National Prisoner Census 2016, using a questionnaire of 173 items that was applied to the whole prison population of Peru. The types of drugs used before admission were analyzed according to characteristics of the penitentiary population, and generalized linear models were used to calculate prevalence ratios with 95% confidence intervals to identify possible factors associated with drug use. Results: Out of a population of 76,180 prisoners, 71,184 (93.4%) answered the survey (men 67,071, 94.2%). The overall prevalence of drug consumption before admission was 24.4% (25.3% in men and 9.1% in women), the highest prevalence in the 18-29 age group (36.3% in men and 14.9% in women). The most commonly used drugs were marijuana (58.2%), coca paste/cocaine or crack (40.3%) and inhalants (1%). The factors most strongly associated with consumption were having a family member who consumed drugs (59.8%), history of previous imprisonment (59.1%), unemployment (48.4%), relationships at school with classmates who had problems with the law (46.9%), background of a family member who attended a penitentiary (38.4%), and history of running away from home before age 15 (35.9%). Conclusions: In Peru, drug use is higher in the prison population than in the general population, and there are differences according to sex in the prevalence of drug use and associated factors prior to admission to a prison. The study demonstrated that childhood events, such as child abuse, having a family member imprisoned, having a family member who used drugs, or who previously abused alcohol, are factors associated with drug use in the penitentiary population. Some of these risk factors are modifiable, so it is important to consider these in the design of social and health policies focused on specific subpopulations to prevent drug use and crime (AU)

[Traumatic perforation of a duodenal diverticulum]. / Perforación traumática de un divertículo duodenal.

Duodenal diverticulum is a frequent abnormality that is usually diagnosed incidentally. Clinical manifestations usually mimic highly varied entities. Among the complications of duodenal diverticulum, perforation is fairly rare and rupture due to blunt trauma is even rarer. We describe the case of a male patient who presented a perforated duodenal diverticulum after an accidental fall.

Perforación traumática de un divertículo duodenal / Traumatic perforation of a duodenal diverticulum

El divertículo duodenal (DD) es una anormalidad anatómica frecuente, que suele diagnosticarse de forma casual. Su manifestación clínica puede simular cuadros muy variados. Entre sus complicaciones, la perforación es bastante rara y aún más excepcional que se produzca como consecuencia de un traumatismo cerrado. Describimos el caso de un paciente que presentó un estallido de DD después de una caída accidental (AU)

Duodenal diverticulum is a frequent abnormality that is usually diagnosed incidentally. Clinical manifestations usually mimic highly varied entities. Among the complications of duodenal diverticulum, perforation is fairly rare and rupture due to blunt trauma is even rarer. We describe the case of a male patient who presented a perforated duodenal diverticulum after an accidental fall (AU)