Cost avoided in drugs derived from theparticipation of patients in oncologyclinical trials

Introduction: Cancer is the second leading cause of death globally. About one in six deaths is due to this disease. The economic impact of cancer is increasing and has a high prevalence leading to high economic burden for the Health System mainly related to oncologic pharmacotherapies. The objective of this study is to calculate pharmaceutical expenditure savings as a consequence of patient’s involvement in Oncology Clinical Trials.Material and methods: Retrospective observational study. In order to determine savings in oncology drugs, cancer treatments of patients participating in oncology clinical trials in April 2018 in a tertiary hospital in Spain were analyzed. Taking into account that the sponsor of the clinical trial provides the study medication free of charge, the costs savings were calculated comparing with the cost that would have supposed to treat the patient if they would have been received was standard regime for the type of tumor under study in clinical practice.Results: The cost avoided in the 50 oncology clinical trials analyzed was 1,564,943.59 euros. The average avoided cost per OCT was 31,298.87 euros, and the average avoided cost per patient was 10,096.41 euros.Conclusions: The participation of patients in oncology clinical trials provides an important economic saving, since it reduces the costs in the acquisition of medicines when they are provided free of charge by the sponsor of the study. (AU)

Introducción: El cáncer es la segunda causa de muerte a nivel mundial. Aproximadamente una de cada seis muertes se debe a esta enfermedad. El cáncer es una enfermedad de alta incidencia y el impacto derivado de la atención a pacientes oncológicos supone una importante carga económica para el Sistema Sanitario. El objetivo de este trabajo es calcular el coste evitado en medicamentos derivado de la participación de pacientes en Ensayos Clínicos de Oncología.Material y métodos: Estudio observacional retrospectivo. Se realiza un corte de datos en abril de 2018, se seleccionan todos los EECC activos en oncología y se incluyen los pacientes que habían participado en los mismos independientemente de la fecha de inclusión.Para determinar el coste evitado se calculó la diferencia entre el coste del esquema de tratamiento que el paciente está recibiendo dentro del EC con aportación gratuita de los medicamentos en investigación, y el coste que supondría el esquema de tratamiento que hubiese recibido en el supuesto de no haber participado en dicho EC.Resultados: El coste evitado en los 50 EECC analizados fue de 1.564.943,59 euros. El coste evitado medio por EC fue de 31.298,87 euros, y el coste evitado medio por paciente fue de 10.096,41 euros.Conclusiones: La participación de pacientes en EECC de oncología proporciona un importante ahorro económico, ya que reduce los costos en la adquisición de medicamentos cuando son proporcionados gratuitamente por el promotor del estudio. (AU)

Tropospheric Emissions: Monitoring of Pollution (TEMPO).

TEMPO was selected in 2012 by NASA as the first Earth Venture Instrument, for launch between 2018 and 2021. It will measure atmospheric pollution for greater North America from space using ultraviolet and visible spectroscopy. TEMPO observes from Mexico City, Cuba, and the Bahamas to the Canadian oil sands, and from the Atlantic to the Pacific, hourly and at high spatial resolution (~2.1 km N/S×4.4 km E/W at 36.5°N, 100°W). TEMPO provides a tropospheric measurement suite that includes the key elements of tropospheric air pollution chemistry, as well as contributing to carbon cycle knowledge. Measurements are made hourly from geostationary (GEO) orbit, to capture the high variability present in the diurnal cycle of emissions and chemistry that are unobservable from current low-Earth orbit (LEO) satellites that measure once per day. The small product spatial footprint resolves pollution sources at sub-urban scale. Together, this temporal and spatial resolution improves emission inventories, monitors population exposure, and enables effective emission-control strategies. TEMPO takes advantage of a commercial GEO host spacecraft to provide a modest cost mission that measures the spectra required to retrieve ozone (O3), nitrogen dioxide (NO2), sulfur dioxide (SO2), formaldehyde (H2CO), glyoxal (C2H2O2), bromine monoxide (BrO), IO (iodine monoxide),water vapor, aerosols, cloud parameters, ultraviolet radiation, and foliage properties. TEMPO thus measures the major elements, directly or by proxy, in the tropospheric O3 chemistry cycle. Multi-spectral observations provide sensitivity to O3 in the lowermost troposphere, substantially reducing uncertainty in air quality predictions. TEMPO quantifies and tracks the evolution of aerosol loading. It provides these near-real-time air quality products that will be made publicly available. TEMPO will launch at a prime time to be the North American component of the global geostationary constellation of pollution monitoring together with the European Sentinel-4 (S4) and Korean Geostationary Environment Monitoring Spectrometer (GEMS) instruments.

Importance of secondary sources in the atmospheric budgets of formic and acetic acids.

We present a detailed budget of formic and acetic acids, two of the most abundant trace gases in the atmosphere. Our bottom-up estimate of the global source of formic and acetic acids are ∼1200 and ∼1400Gmolyr-1, dominated by photochemical oxidation of biogenic volatile organic compounds, in particular isoprene. Their sinks are dominated by wet and dry deposition. We use the GEOS-Chem chemical transport model to evaluate this budget against an extensive suite of measurements from ground, ship and satellite-based Fourier transform spectrometers, as well as from several aircraft campaigns over North America. The model captures the seasonality of formic and acetic acids well but generally underestimates their concentration, particularly in the Northern midlatitudes. We infer that the source of both carboxylic acids may be up to 50% greater than our estimate and report evidence for a long-lived missing secondary source of carboxylic acids that may be associated with the aging of organic aerosols. Vertical profiles of formic acid in the upper troposphere support a negative temperature dependence of the reaction between formic acid and the hydroxyl radical as suggested by several theoretical studies.

Estado del arte de los programas de prevención de la violencia en jóvenes: basados en el trabajo con la comunidad y la familia, con enfoque en género

Presenta informaciones acerca de los programas de prevención de la violencia en adolescentes y jóvenes de América Latina, basado en el trabajo con la comunidad y la familia, con enfoque en género. Trae también la distribución de la violencia, tipología, derechos humanos, salud pública, desarrollo, causas de la violencia, pobreza y influencias sociales. Documento en formato PDF, requiere Acrobat Reader.

[Persistent acute hepatitis in a patient with chronic hepatitis C]. / Hepatitis aguda mantenida en paciente con hepatitis crónica C previa.

We describe the case of a patient with chronic hepatitis C (CHC) who showed a progressive increase in aminotransferase level, reaching values of aspartate aminotransferase 1723 UI/L, alanine aminotransferase 1519 UI/L and gamma-glutamyl-transpeptidase 296 with a bilirubin level of 6 mg/dL and direct bilirubin level of 4.6 mg/dL. One year previously, the patient had been diagnosed with CHC, genotype 1, and had an initial hepatitis C virus RNA load of 249,000 UI/mL. All the specific blood tests performed were negative except for antisoluble liver antigen (anti-SLA) antibodies, which were positive in two different determinations. A diagnosis of overlap syndrome CHC and autoimmune hepatitis was made. Steroid and azathioprine treatment was started with good response. The relationship between CHC and anti-SLA is not well characterized but has been described in these patients. We found no prior reports in the literature of CHC associated with positive anti-SLA in a patient with persistent acute hepatitis.

Hepatitis aguda mantenida en paciente con hepatitis crónica C previa / Persistent acute hepatitis in a patient with chronic hepatitis C

Describimos el caso de un paciente con hepatitis crónica C (HCC) en quien se detectó un incremento progresivo de las transaminasas que alcanzaron valores de aspartato aminotransferasa (AST) de 1.723 U/l, alanina aminotransferasa (ALT) de 1.519 U/l y gammaglutamil transpeptidasa (GGT) de 296 U/l, con un valor de bilirrubina de 6 mg/dl (la bilirrubina directa fue de 4,6 mg/dl). Entre sus antecedentes destaca el diagnóstico previo de una HCC con genotipo 1 y carga viral inicial de 249.000 U/ml. Todas las pruebas analíticas realizadas fueron negativas, a excepción de un antígeno soluble hepático (anti-SLA) positivo en 2 determinaciones consecutivas. Se estableció el diagnóstico de síndrome de superposición HCC y hepatitis autoinmune asociada a anti-SLA, por lo que se inició un tratamiento combinado con esteroides y azatioprina, con buena respuesta clínica y analítica. La relación entre la HCC y la positividad a anti-SLA ha sido escasamente estudiada, pero sí se ha descrito en estos pacientes. Sin embargo, no existe ningún caso en la bibliografía que haya comenzado en forma de hepatitis aguda sobre una HCC ya conocida, como ocurrió en el nuestro

We describe the case of a patient with chronic hepatitis C (CHC) who showed a progressive increase in aminotransferase level, reaching values of aspartate aminotransferase 1723 UI/L, alanine aminotransferase 1519 UI/L and gamma-glutamyl-transpeptidase 296 with a bilirubin level of 6 mg/dL and direct bilirubin level of 4.6 mg/dL. One year previously, the patient had been diagnosed with CHC, genotype 1, and had an initial hepatitis C virus RNA load of 249,000 UI/mL. All the specific blood tests performed were negative except for antisoluble liver antigen (anti-SLA) antibodies, which were positive in two different determinations. A diagnosis of overlap syndrome CHC and autoimmune hepatitis was made. Steroid and azathioprine treatment was started with good response. The relationship between CHC and anti-SLA is not well characterized but has been described in these patients. We found no prior reports in the literature of CHC associated with positive anti-SLA in a patient with persistent acute hepatitis

Carcinoma neuroendocrino de células grandes de pulmón. Análisis de una serie de once casos en un hospital universitario / Lung large-cell neuroendocrine carcinoma. Analysis of a series of eleven cases in a universitary hospital

Propósito: Los tumores pulmonares con diferenciación neuroendocrina (DN) son un grupo heterogéneode neoplasias que incluyen tumores carcinoides típicos, carcinoides atípicos, carcinomas neuroendocrinosde células grandes (CNCG) y carcinoma pulmonar de células pequeñas. Los CNCGconstituyen menos del 5% de los carcinomas pulmonares no células pequeñas (CPNCP). En este trabajose describe una serie de CNCG, tratados en un solo centro a lo largo de 10 años.Material y métodos: Se analizan 11 pacientes diagnosticados de CNCG (5 con histologías mixtas).Resultados: La edad media de los pacientes fue de 66 años, 5 fueron varones, 4 tuvieron enfermedadlocalizada, 5 localmente avanzada y 2 diseminada. Siete pacientes, con tumores localizados,fueron tratados con cirugía radical, 2 de ellos recibieron quimioterapia adyuvante; 1 quimioterapia yradioterapia y los otros 3 solo quimioterapia. La mediana de supervivencia de la serie es de 24 meses,y la supervivencia global a 2 y 5 años del 45% y 27% respectivamente.Conclusión: Los datos de nuestra serie corroboran las recomendaciones de que el manejo de losCNCG debe hacerse de forma similar al del resto de los CPNCP. La cirugía radical es el tratamientofundamental en los tumores localizados. No hay datos suficientes que indiquen una peor respuesta alos tratamientos de quimioterapia o radioterapia en este tipo de tumores

Purpose: Lung carcinomas with neuroendocrine differentiation are a heterogeneous group oftumors related to typical and atypical carcinoids, neuroendocrine large-cell carcinomas (NLCC) andsmall-cell lung cancer (SCLC). NLCC comprises less than 5% of non small-cell lung cancer (NSCLC).In this report, we describe a series of NLCC treated in a single institution in the last ten years.Material and methods: Eleven patients diagnosed as having NLCC (5 of them with mixedhistology).Results: At diagnosis, the mean age of the patients was 66 years (5 males and 6 females); 4 hadlocalized disease, 5 locally advanced disease, and 2 metastatic disease. Seven patients underwent initialradical surgery (2 of them followed by adjuvant chemotherapy), 1 patient received chemotherapy andradiotherapy, and 3 patients only chemotherapy. Median overall survival for the whole series was 24months, and the overall 2-year and 5-year survival were 45% and 27% respectively.Conclusion: Our data corroborate the general recommendation of treating NLCC in a similar wayas the rest of the non small-cell lung cancer (NSCLC) are treated. Radical surgery is the maintreatment for localized tumors. There are no data indicating a worse response of these tumors toradiation therapy or chemotherapy

First Report of Wilt and Stem Canker of Poinsettia (Euphorbia pulcherrima) Caused by Phytophthora nicotianae in Puerto Rico.

Poinsettias are grown extensively in greenhouses in Puerto Rico, a five million dollar industry during the winter season of 2005. More than 2,000 'Freedom' plants from an ornamental nursery near Aibonito exhibited severe wilt and dieback symptoms. The disease was found in 5 of 12 surveyed greenhouses where severity ranged from 50 to 100% and occurred regardless of the use of metalaxyl and mefenoxam. Symptoms during the growth phase included stunted plants, thin stems, chlorotic leaves, and brown roots. During flower bract development, symptoms consisted of leaf wilting often in sectors, stem canker, and purple-to-black lesions that extended from the stem to the petioles followed by soft rot. Isolations from symptomatic stem and root tissue were made on corn meal agar (CMA) (17 g/liter) amended with pimaricin (10 mg/liter), ampicillin (250 mg/liter), rifampicin (10 mg/liter), pentachloronitrobenzene (100 mg/liter), and hymexazol (50 mg/liter) (PARPH) (1). Pure cultures were obtained by hyphal-tip transfers onto CMA-PARPH. Colonies grown on acidified potato dextrose agar (APDA) at 25°C were arachnoid with abundant aerial mycelium and sporangia. Sporangia formed singly or in a loose sympodium on long sporangiophores and were papillate, mostly persistent, or caducous with short pedicel. The shape of sporangia varied from ellipsoidal to elongated ovoid, with a length/breath ratio of 16.5 × 14.2 µm. Large, spherical, terminal, and intercalary chlamydospores readily formed in APDA and PARPH. The isolate was identified as Phytophthora nicotianae on the basis of morphological and molecular characteristics. Molecular identification by sequence analysis of the internal transcribed spacer rDNA region confirmed the identity of the isolate P210.1 as P. nicotianae (GenBank Accession No. DQ485412). Pathogenicity tests were conducted with isolates P210.1 and IG grown on APDA for 7 days at 24°C. Isolates were then covered with sterile water for 48 h to induce sporangia and zoospore production at 24°C and continuous light. A suspension of 10 ml of approximately 120 sporangia ml-1 were added to pots containing 2.2 kg of a 1:1 mixture of field soil and soilless media (Promix) composed of peat moss vermiculite and perlite. One healthy poinsettia rooted stem and one 2-month-old plant were transplanted individually into the inoculated soil and pots were flooded with sterile water for 24 h. A noninoculated control was included, each isolate and control were replicated five times. First symptoms (7 to 10 days after inoculation) included brown, limited root growth and lower stem discoloration. Plants (30- to 45-day-old) show a decline in vigor and rapid death of branches that are similar symptoms to those observed on infected poinsettias in commercial greenhouses. P. nicotianae was reisolated from infected root, crown, and stem tissue on PARPH media. A strict sanitation program was recommended to prevent recontamination. To our knowledge, this is the first report of P. nicotianae on poinsettia in Puerto Rico. Reference: D. J. Mitchell and M. E. Kannwischer-Mitchel, Phytophthora. Page:31 in: Methods for Research on Soilborne Phytopathogenic Fungi. L. L. Singleton et al., eds. The American Phytopathological Society, St. Paul, MN, 1993.

First Report of Soybean Rust Caused by Phakopsora pachyrhizi in North Carolina.

Asian soybean rust, caused by Phakopsora pachyrhizi Sydow, has been known to occur in the eastern hemisphere for nearly a century. More recently, it was reported from South America in 2002 and the continental United States in Louisiana in November 2004 (1,2). Subsequently, P. pachyrhizi was confirmed in Alabama, Arkansas, Georgia, Florida, Missouri, Mississippi, South Carolina, and Tennessee in 2004. Surveys conducted in North Carolina in late November 2004 failed to detect this pathogen. Symptoms of the disease were first observed on soybean (Glycine max (L.) Merr.) in North Carolina on 25 October 2005 in farmers' fields in the counties of Brunswick, Columbus, and Robeson. Typical pustules and urediniospores were readily apparent on infected leaves when viewed with a dissecting microscope. Urediniospores were obovoid to broadly ellipsoidal, hyaline to pale yellowish brown with a minutely echinulate thin wall, and measured 18 to 37 × 15 to 24 µm. This morphology is typical of soybean rust caused by P. pachyrhizi or P. meibomiae, the latter is a less aggressive species causing soybean rust in the western hemisphere (1). DNA was extracted from leaves containing sori using the Qiagen DNeasy Plant Mini kit (Valencia, CA). P. pachyrhizi was detected using a real-time polymerase chain reaction (PCR) protocol that differentiates between P. pachyrhizi and P. meibomiae in a Cepheid thermocycler (Sunnyvale, CA) with appropriate positive and negative controls. The PCR master mix was modified to include OmniMix beads (Cepheid). Field diagnosis of P. pachyrhizi was confirmed by the USDA/APHIS on 28 October 2005. Soybean rust was identified in subsequent surveys of soybean fields and leaf samples submitted by North Carolina Cooperative Extension Agents in an additional 15 counties. These samples also were assayed using a traditional PCR protocol and by the enzyme-linked immunosorbent assay protocol included in the EnviroLogix QualiPlate kit (Portland, ME) for soybean rust. Ten soybean specimens from 10 sites were confirmed positive by these methods. Disease was not found on three kudzu samples, although one kudzu sample was adjacent to a soybean field that was positive for P. pachyrhizi. Although soybean rust was eventually detected in 18 North Carolina counties in 2005, no soybean yield loss occurred since the pathogen was detected when more than 80% of the soybean crop was mature. To our knowledge, this is the first report of P. pachyrhizi in North Carolina and the northern most find on soybean in the continental United States in 2005. References: (1) R. D. Frederick et al. Phytopathology 92:217, 2002. (2) R. W. Schneider et al. Plant Dis. 89:774 2005.

Tratamiento combinado en el asma: ¿siempre una constante? / No disponible

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Divertículo duodenal periampular: una entidad a considerar en el diagnóstico diferencial del absceso pancreático / Duodenal diverticula periampullary: new entity in the differential diagnosis of pancreatic abscess

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[Autoimmune hepatitis caused by acute hepatitis due to hepatitis A virus]. / Hepatitis autoinmune desencadenada por una hepatitis aguda por virus de la hepatitis A.

We describe the case of a 27-year-old man who presented acute hepatitis due to hepatitis A virus infection. Over the following weeks he consistently presented elevated transaminase levels and jaundice. Antinuclear and anti-smooth muscle antibodies, hypergammaglobulinemia and periportal necrosis were detected in the liver biopsy. The patient was diagnosed with autoimmune hepatitis and responded well to treatment with immunosuppressive drugs. This case, as well as other published reports, suggest that in certain individuals, acute hepatitis A may be the decisive factor leading to autoimmune hepatitis.

Fulminant case of hereditary neuropathy with liability to pressure palsy.

Hereditary neuropathy with liability to pressure palsy (HNPP) is typified as isolated nerve palsies caused by trivial compression or trauma. It rarely presents in two extremities and even more infrequently affects all four limbs simultaneously. We present a patient who concurrently experienced right shoulder, left hand, and bilateral foot weakness mimicking several multifocal conditions. Electromyography suggested HNPP and subsequent nerve biopsy and genetic testing were confirmatory. The case demonstrates that HNPP can present in a fulminant manner and should be included in the differential diagnosis of acute multiple mononeuropathies. The possible causes for such a rapid clinical course in our patient are discussed.