Development of a predictive model of venous thromboembolism recurrence in anticoagulated cancer patients using machine learning.

INTRODUCTION: Patients with cancer and venous thromboembolism (VTE) show a high risk of VTE recurrence during anticoagulant treatment. This study aimed to develop a predictive model to assess the risk of VTE recurrence within 6 months at the moment of primary VTE diagnosis in these patients. MATERIALS AND METHODS: Using the EHRead® technology, based on Natural Language Processing (NLP) and machine learning (ML), the unstructured data in electronic health records from 9 Spanish hospitals between 2014 and 2018 were extracted. Both clinically- and ML-driven feature selection were performed to identify predictors for VTE recurrence. Logistic regression (LR), decision tree (DT), and random forest (RF) algorithms were used to train different prediction models, which were subsequently validated in a hold-out data set. RESULTS: A total of 16,407 anticoagulated cancer patients with diagnosis of VTE were identified (54.4 % male and median age 70). Deep vein thrombosis, pulmonary embolism and metastases were observed in 67.2 %, 26.6 %, and 47.7 % of the patients, respectively. During the study follow-up, 11.4 % of the patients developed a recurrent VTE, being more frequent in patients with lung cancer. Feature selection and model training based on ML identified primary pulmonary embolism, deep vein thrombosis, metastasis, adenocarcinoma, hemoglobin and serum creatinine levels, platelet and leukocyte count, family history of VTE, and patients' age as predictors of VTE recurrence within 6 months of VTE diagnosis. The LR model had an AUC-ROC (95 % CI) of 0.66 (0.61, 0.70), the DT of 0.69 (0.65, 0.72) and the RF of 0.68 (0.63, 0.72). CONCLUSIONS: This is the first ML-based predictive model designed to predict 6-months VTE recurrence in patients with cancer. These results hold great potential to assist clinicians to identify the high-risk patients and improve their clinical management.

Outpatient management of incidental pulmonary embolism in cancer patient.

PURPOSE: Incidentally discovered pulmonary embolism is a prevalent clinical problem for cancer patients and contributes significantly to the burden of cancer-associated thrombosis. The aim of this study was to explore if outpatient management of incidental pulmonary embolism (iPE) in cancer patients is effective and can be conducted safely. METHODS/PATIENTS: We performed a prospective observational cohort study in a single Spanish tertiary hospital. Patients diagnosed with iPE and active cancer were enrolled. Between May 2016 and May 2017, 25 consecutive patients were included in the study. RESULTS: All patients were assessed in the emergency room (ER) and started treatment with low-molecular weight heparins (LMWH) being discharged in the following 24 h. Congestive heart failure and right ventricular dysfunction were ruled out, and none of them presented massive PE, active bleeding or any disease-related reason that required hospitalization. The 90-day follow-up visit showed no venous thromboembolism (VTE) recurrence and the major bleeding rate was 4%. Mortality rate at 30 and 90 days was 0%. CONCLUSIONS: Outpatient management for iPE in cancer patients appears to be feasible and safe in selected cancer patients.

Retraso del crecimiento intrauterino de causa genética: síndrome de Wolf-Hirschhorn / Intrauterine growth retardation of genetic cause: Wolf-Hirschhorn syndrome

El síndrome de Wolf-Hirschhorn es una enfermedad genética rara provocada por la pérdida de material genético en el brazo corto del cromosoma 4. Los individuos afectos presentan un fenotipo característico con apariencia de 'casco de guerrero griego', retraso en el desarrollo y epilepsia. El pronóstico es desfavorable lo que condiciona la importancia de su detección prenatal. Presentamos un caso de síndrome de Wolf-Hirschhorn diagnosticado postnatalmente que en el período prenatal únicamente mostraba un retraso del crecimiento intrauterino severo y polihidramnios. El estudio genético, solicitado de manera urgente a las 33 semanas, señaló un cariotipo 46 XX normal. Destacamos la importancia del estudio genético molecular durante el período prenatal en los casos de retraso del crecimiento intrauterino severo, en los que se sospeche una cromosomopatía, de cara a confirmar el diagnóstico, establecer el pronóstico y realizar consejo genético a los progenitores (AU)

The Wolf-Hirschhorn syndrome is a rare genetic disease caused by the loss of genetic material in the short arm of chromosome 4. The affected individuals have a characteristic 'Greek warrior helmet'-like phenotype, a delay in the development and epilepsy. The prognosis is poor, which determines the importance of prenatal screening. We present a case of postnatally diagnosed Wolf-Hirschhorn syndrome, which during the prenatal period just showed a severe intrauterine growth restriction and polyhydramnios. The requested genetic study, performed urgently at 33 weeks, seemed to show a normal 46, XX karyotype. We stress the importance of the molecular genetic study during the prenatal period in severe intrauterine growth restriction cases where the existence of a genetic disease is suspected, in order to confirm the diagnosis, establish the prognosis and provide parents with genetic counseling (AU)

[Consensus statement on monitoring of HIV: pregnancy, birth, and prevention of mother-to-child transmission]. / Documento de consenso para el seguimiento de la infección por el virus de la inmunodeficiencia humana en relación con la reproducción, el embarazo, el parto y la profilaxis de la transmisión vertical del niño expuesto.

OBJECTIVE: The main objective in the management of HIV-infected pregnant women is prevention of mother-to-child transmission; therefore, it is essential to provide universal antiretroviral treatment, regardless of CD4 count. All pregnant women must receive adequate information and undergo HIV serology testing at the first visit. METHODS: We assembled a panel of experts appointed by the Secretariat of the National AIDS Plan (SPNS) and the other participating Scientific Societies, which included internal medicine physicians with expertise in the field of HIV infection, gynecologists, pediatricians and psychologists. Four panel members acted as coordinators. Scientific information was reviewed in publications and conference reports up to November 2012. In keeping with the criteria of the Infectious Diseases Society of America, 2levels of evidence were applied to support the proposed recommendations: the strength of the recommendation according to expert opinion (A, B, C), and the level of empirical evidence (I, II, III). This approach has already been used in previous documents from SPNS. RESULTS AND CONCLUSIONS: The aim of this paper was to review current scientific knowledge, and, accordingly, develop a set of recommendations regarding antiretroviral therapy (ART), regarding the health of the mother, and from the perspective of minimizing mother-to-child transmission (MTCT), also taking into account the rest of the health care of pregnant women with HIV infection. We also discuss and evaluate other strategies to reduce the MTCT (elective Cesarean, child's treatment…), and different aspects of the topic (ARV regimens, their toxicity, monitoring during pregnancy and postpartum, etc.).