Lower limb cutaneous melanoma surgery: location matters.

The anatomical location of cutaneous melanoma is a relevant independent prognostic factor in melanoma. The aim of the study is to know the prognosis of lower limb cutaneous melanoma related to their location within the limb, regardless of the histological type, and if there are any other influencing variables. A real-world data observational study was developed. The lesions were divided depending on the location of the melanoma (thigh, leg and foot). Bivariate and multivariate analysis were performed, and melanoma-specific survival and disease-free survival rates were calculated. When these analysis were done, the results showed that, in melanomas of the lower limb, location on the foot presented a lower melanoma-specific survival rate compared to more proximal locations, and only the anatomical location presents statistical significance to discriminate cases with a higher mortality risk and a lower disease-free survival rate among distal melanomas (mainly on the foot). In conclusion, this study confirms that a more distal location of lower limb cutaneous melanoma is a relevant prognostic factor.Trial registration number NCT04625491 retrospectively registered.

Diseño y adecuación de una solución gluco-proteica con calcio a las necesidades de recién nacidos pre-término / Design and adequacy of a glycoprotein solution with calcium for the needs of preterm newborn infants

RESUMEN Nuestro objetivo fue diseñar una solución gluco-proteica estandarizada con aporte de calcio y evaluar su adecuación en recién nacidos pre-término en las primeras horas de vida. Método: Se realizó un estudio piloto entre febrero de 2016 y febrero de 2017 en el que se diseñaron dos soluciones gluco-proteicas (vía central y vía periférica) para ser utilizadas en recién nacidos en las primeras horas de vida, que se adaptasen a los requerimientos de todos los recién nacidos en función del ritmo de infusión. Se diseñaron según las recomendaciones existentes y se elaboró el protocolo normalizado de trabajo para describir el proceso de elaboración y los controles de calidad requeridos (visual, gravimétrico y microbiológico). Se monitorizo la respuesta de esta solución gluco-proteica en recién nacidos pre-término. Resultados principales: Se elaboraron 54 lotes de soluciones glucoproteicas por vía central y 52 por vía periférica que se administraron a 47 recién nacidos pre-término sin presentarse complicaciones ni efectos adversos. Conclusiones: la concentración de calcio de la solución gluco-proteica se adapta a las necesidades de la mayoría de los recién nacidos pre-término. La elaboración de soluciones estandarizadas disminuye la carga de trabajo del servicio de farmacia y los costes económicos asociados.

ABSTRACT Our aim was to design a standardized glycoprotein solution with calcium and evaluate adequacy for preterm newborn infants in the first hours of life. Method: Pilot study conducted between February 2016 and February 2017. Two glycoprotein solutions were designed (central and peripheral administration) to be used in newborns in the first hours of life to provide the requirements of all newborns depending on the infusion rhythm. The solutions were designed according to current recommendations, the standard operating procedure was drawn up describing the elaboration process, and the quality controls required (visual, gravimetric and microbiological). The response of this solution in preterm newborns was monitored. Main results: During the study, 54 batches of central glycoprotein solutions and 52 of peripheral glycoprotein solutions were prepared and administered to 47 preterm newborns without complications or side effects in relation to their administration. Conclusions: The concentration of calcium used in the glycoprotein solution formulation was adapted to the requirements of most preterm newborns. The development of standardized solutions reduces the workload of the pharmacy service and the associated economic costs.

Reasons for Discontinuation and Adverse Effects of TNFα Inhibitors in a Cohort of Patients With Rheumatoid Arthritis and Ankylosing Spondylitis.

BACKGROUND: The introduction of anti-tumor necrosis factor α (anti-TNFα) drugs has improved the clinical outcomes in rheumatoid arthritis (RA) and ankylosing spondylitis (AS). However, these drugs may cause adverse effects that motivate a change in or discontinuation of the treatment. OBJECTIVE: To evaluate the causes of discontinuation or changes in the dosage regimen in a cohort of patients with RA and AS treated with infliximab, adalimumab, etanercept, and golimumab under clinical practice conditions. METHODS: This was a retrospective observational study that included patients with RA or AS treated with anti-TNFα drugs between 2008 and 2013. Changes in the dosage regimen, reasons for treatment discontinuation, and adverse effects were recorded and analyzed. Time to discontinuation was estimated using Kaplan-Meier survival analysis. RESULTS: A total of 123 patients with RA and 93 patients with AS were treated with anti-TNFα therapy. During the study, 55.3% of RA patients and 41.7% of AS patients had stopped the treatment. The most frequent changes were modifications in the dosing, and the most frequent adverse effects were reactions after the infusion or injection (53.8% and 66.7% in RA and AS, respectively). Drug survival of etanercept in RA (67.9%) is greater than for adalimumab and infliximab, whereas drug survival of infliximab in AS (70.0%) is greater than for etanercept and adalimumab at 5 years, although there were no significant differences ( P = 0.098 in RA and 0.194 in AS). CONCLUSIONS: The main cause of discontinuation of anti-TNFα is therapeutic failure in both diseases. Etanercept and infliximab have the best survival rates in RA and AS, respectively.

Poliposis adenomatosa familiar: a propósito de un caso / Familial adenomatous polyposis: a case report

La poliposis adenomatosa familiar (PAF) es la forma más frecuente y conocida de poliposis. Se trata de una enfermedad hereditaria autosómica dominante caracterizada por el desarrollo de múltiples pólipos adenomatosos, principalmente en el colon y recto. La prevalencia de esta enfermedad es de aproximadamente 1 de cada 10.000-20.000 individuos. La aparición de los pólipos suele iniciarse a una edad temprana, con un riesgo de casi el 100% de desarrollo de cáncer colorrectal (CCR) si el paciente no recibe tratamiento de forma precoz. Las lesiones suelen desarrollarse en la segunda y la tercera década de la vida: el 15% a los 10 años de edad, el 50% de los pacientes sobre los 15 años y un 95% a los 35 años. Este artículo tiene como objetivo presentar la evolución clínica y nutricional de una paciente de 54 años de edad diagnosticada de PAF que precisa nutrición parenteral complementaria (NPC) domiciliaria, así como evaluar los resultados clínicos de esta paciente. A través de la revisión de la historia clínica, se estudió la evolución de los datos antropométricos (peso y talla), así como los parámetros analíticos para su valoración. Paciente de 54 años de edad diagnosticada de PAF que acudió a nuestro hospital tras trasladarse temporalmente de ciudad para recibir soporte nutricional. El artículo describe la composición de la NPC recibida durante los 90 días de seguimiento. La NPC en este tipo de pacientes es importante, ya que presentan una insuficiencia del tracto gastrointestinal irreversible que les impide la absorción de nutrientes apropiados para mantener una adecuada calidad de vida (AU)

Familial adenomatous polyposis (FAP) is the most common known form of polyposis. It is an autosomal dominant inherited disease characterized by the development of multiple adenomatous polyps mainly in the colon and rectum. The prevalence of this disease is approximately about 1 in every 10,000-20,000 people. The appearance of the polyps usually starts at an early age with a 100% risk of developing colorectal cancer (CRC) if the patient does not receive early treatment. These lesions usually manifest during the second and third decades of life: 15% at the age of 10, 50% around 15 years of age and 95% at the age of 35. This article aims to present the clinical and nutritional evolution of a 54 years old patient diagnosed with FAP who requires complementary home parenteral nutrition (CPN), and the evaluation of these patient clinical outcomes. The evolution of anthropometric data (weight and height) and the results of laboratory parameters were followed and studied by review of medical records. The patient diagnosed with FAP was referred to our hospital after a temporary city transfer to receive nutritional support. This article describes the composition of the CPN received during the 90 days of follow up. CPN in these patients is important because of the irreversible gastrointestinal tract failure that prevents them from absorbing sufficient nutrients to maintain an adequate quality of life (AU)