Neoadjuvant chemotherapy in locally advanced colon cancer: a systematic review.

BACKGROUND: Preoperative or neoadjuvant chemotherapy (NAC) has emerged as a novel alternative to treat locally advanced colon cancer (LACC), as in other gastrointestinal malignancies. However, evidence of its efficacy and safety has not yet been gathered in the literature. The aim of the present study was to perform an extensive review of the scientific evidence for NAC in patients with LACC. METHODS: PubMed, EMBASE, MEDLINE and Cochrane Library were searched for a systematic review of the literature from 2010 to 2019. Six eligible studies were included, with a total of 27,937 patients, 1232 of them (4.4%) treated with NAC. There were only one randomized controlled trial, three phase II non-randomized single arm studies and two retrospective studies. RESULTS: The baseline computed tomography scan showed that most of patients had a T3 tumor. The completion rate of the planned neoadjuvant treatment ranged from 52.5 to 93.8%. Between 97.2 and 100% of patients had the scheduled surgery. The median tumor volume reduction after NAC ranged from 62.5 to 63.7%. The anastomotic leak rate in the NAC group ranged from 0 to 7%, with no cases of postoperative mortality. There was major pathological tumor regression in 4-34.7% of cases. Between 84 and 100% of NAC patients had R0-surgery. Survival after NAC seems to be encouraging although significant improvement has only been proven in T4b tumours. CONCLUSIONS: According to our systematic review, the NAC may be a safe and effective emerging therapeutic alternative for treating LACC. This approach, which is still being tested, increases the reliance on accurate radiological staging.

Use of anti-allergic drugs in children

Allergic rhinitis is one of the most frequent chronic diseases in children. We have analysed the prescriptions habits of anti-allergic medications in children (<14 years old) in 2011. We calculated the DHD (N°DDD/1000 children/day) for oral antihistamines and intranasal therapies (corticoids and antihistamines) in the region (sanitary districts I–VIII) and specifically in sanitary district V (health centres 1–15). We also reviewed the clinical records in six health centres in sanitary district V to know more details about age and diagnosis and to value if these prescriptions are adequate. We observed a use of 8.78 DHD in the group of oral antihistamines, with a predominance of desloratadine (3.48 DHD), a 3rd generation drug of this group, and in second place the intranasal therapy with a preference of corticoids (budesonide 3.5 DHD and mometasone 2.25 DHD). We think that it is necessary to improve the knowledge of anti-allergic drugs in children (AU)

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Use of anti-allergic drugs in children.

Allergic rhinitis is one of the most frequent chronic diseases in children. We have analysed the prescriptions habits of anti-allergic medications in children (<14 years old) in 2011. We calculated the DHD (N°DDD/1000 children/day) for oral antihistamines and intranasal therapies (corticoids and antihistamines) in the region (sanitary districts I-VIII) and specifically in sanitary district V (health centres 1-15). We also reviewed the clinical records in six health centres in sanitary district V to know more details about age and diagnosis and to value if these prescriptions are adequate. We observed a use of 8.78 DHD in the group of oral antihistamines, with a predominance of desloratadine (3.48 DHD), a 3rd generation drug of this group, and in second place the intranasal therapy with a preference of corticoids (budesonide 3.5 DHD and mometasone 2.25 DHD). We think that it is necessary to improve the knowledge of anti-allergic drugs in children.

Oblicuidad pélvica o contractura congénita en abducción de la cadera: una entidad poco conocida / Congenital pelvic obliquity or congenital hip’s abduction contracture: a little known entity

La oblicuidad pélvica congénita es una patología frecuente en el lactante y poco conocida por los pediatras. Se presentan cuatro casos de oblicuidad pélvica simple en lactantes mujeres. Se describen los hallazgos clínicos y radiológicos en el momento del diagnóstico, la actitud terapéutica y la evolución de cada uno de ellos. Los pediatras de Atención Primaria debemos estar atentos a los antecedentes, signos acompañantes y al diagnóstico de esta entidad, así como tener formación en la exploración de la cadera para detectar clínicamente una inestabilidad, preferentemente en la cadera aducta (opuesta a la contracturada). Es importante la interrelación entre Pediatría, Radiología Infantil, Traumatología Infantil y Rehabilitación (AU)

Congenital pelvic obliquity is frequent, although pediatricians are not used to diagnose it. We report four female infants with simple pelvic obliquity. We describe clinical and radiologic findings, their treatment and outcome. Primary care pediatricians must be alert looking for pelvic obliquity in infants. We need to improve our abilities in hip exploration, to detect instability in the adduct hip (in the opposite of the contractured hip). Is very important to work together: pediatricians, radiologist, orthopedist and rehabilitation physician (AU)

Uso de anticatarrales en menores de 14 años en consultas de Atención Primaria / Use of cold and cough medications prescribed in Primary Care clinics for children less than 14 years

OBJETIVO: Conocer el perfil de prescripción de anticatarrales en las consultas de Pediatría de Atención Primaria en el Área V del Servicio de Salud del Principado de Asturias y valorar su idoneidad. Material y métodos; Estudio transversal, descriptivo y retrospectivo. Se analizaron las prescripciones para el tratamiento de los procesos respiratorios en 6 consultas de Pediatría de Atención Primaria en el Área Sanitaria V del Servicio de Salud del Principado de Asturias en el año 2011. Se valoraron la idoneidad de los tratamientos prescritos mediante las fichas técnicas de los fármacos y las indicaciones clínicas según el diagnóstico, siguiendo las recomendaciones de guías clínicas, protocolos o en su defecto la bibliografía disponible más actual. RESULTADOS: Se analizaron 424 anticatarrales: 249 antitusígenos, 155 mucolíticos y 20 clasificados en otros. La media de edad de los pacientes es de 5 años. Un 85,1% de las prescripciones se consideran inadecuadas. El 11,6% de ellos fueron prescritos fuera de ficha técnica. Se consideraron inadecuados el 82,8% de los asociados al diagnóstico R74 y el 73% al R05. Todos los fármacos de los menores de 6 años se consideraron inadecuados. El 99,4% de los mucolíticos/otros y el 75,1% de los antitusígenos se consideraron inadecuados. CONCLUSIONES: Se observa un alto porcentaje de prescripción de fármacos anticatarrales en menores de 14 años en nuestro medio, encontrándose un 85% de las prescripciones inadecuadas. Los niños deberían recibir solo medicamentos con una relación beneficio-riesgo favorable; para ello es necesario mejorar la información sobre el uso pediátrico y promover acciones formativas dirigidas a los padres y a los profesionales sanitarios

OBJECTIVE:To evaluate cold and cough medications and their suitability in children in Primary Health Care in Area V of the Asturian Health Service. MATERIAL AND METHODS: A cross-sectional, descriptive and retrospective study was conducted in which an analysis was performed of the respiratory diseases and the prescriptions of 6 Primary Health Care paediatricians who worked in Area V of the Asturian Health Service in 2011. An evaluation was made on the suitability of these medications. An analysis was also made of the drug datasheet and clinical recommendations (clinical guidelines, protocols or reports). RESULTS: A total of 424 cold and cough drugs: 249 antitussives, 155 mucolytics, and 20 'others' were analyzed. The mean age was 5 years old. There was a total of 85.1% unsuitable prescriptions. Off-label drugs were used in 11.6%. The prescribing was considered unsuitable in 82.8% of prescriptions associated with R74, and 73% of R05. All of the prescription drugs in children under 6 years old were unsuitable. Mucolytics/'others' were not suitable in 99.4%, nor antitussives in 75.1%. CONCLUSIONS: There is a high level of cold and cough drugs being prescribed in children, with 85% of these being unsuitable. Children should only receive drugs with a good risk and benefit ratio. Pediatricians should try to improve the information about pediatric drug use and spread this information to parents, doctors and nurses

[Use of cold and cough medications prescribed in Primary Care clinics for children less than 14 years]. / Uso de anticatarrales en menores de 14 años en consultas de Atención Primaria.

OBJECTIVE: To evaluate cold and cough medications and their suitability in children in Primary Health Care in Area V of the Asturian Health Service. MATERIAL AND METHODS: A cross-sectional, descriptive and retrospective study was conducted in which an analysis was performed of the respiratory diseases and the prescriptions of 6 Primary Health Care paediatricians who worked in Area V of the Asturian Health Service in 2011. An evaluation was made on the suitability of these medications. An analysis was also made of the drug datasheet and clinical recommendations (clinical guidelines, protocols or reports). RESULTS: A total of 424 cold and cough drugs: 249 antitussives, 155 mucolytics, and 20 "others" were analyzed. The mean age was 5 years old. There was a total of 85.1% unsuitable prescriptions. Off-label drugs were used in 11.6%. The prescribing was considered unsuitable in 82.8% of prescriptions associated with R74, and 73% of R05. All of the prescription drugs in children under 6 years old were unsuitable. Mucolytics/"others" were not suitable in 99.4%, nor antitussives in 75.1%. CONCLUSIONS: There is a high level of cold and cough drugs being prescribed in children, with 85% of these being unsuitable. Children should only receive drugs with a good risk and benefit ratio. Pediatricians should try to improve the information about pediatric drug use and spread this information to parents, doctors and nurses.

Membrana laríngea congénita / Congenital laryngeal membrane

La membrana laríngea congénita es una malformación infrecuente de las vías aéreas. La clínica que produce depende del grado de obstrucción que produzca en dichas vías. Debe tenerse en consideración al realizar el diagnóstico diferencial de la dificultad respiratoria del recién nacido. El tratamiento dependerá asimismo del grado de obstrucción de la vía respiratoria. Se describe el caso de una lactante de dos semanas de vida que presenta afonía desde el nacimiento y dificultad respiratoria en el curso de infecciones de las vías aéreas superiores. Mediante laringoscopia directa, se realiza el diagnóstico de membrana laríngea congénita. El tratamiento realizado consiste en varias intervenciones de vaporización con láser de dióxido de carbono (AU)

Congenital laryngeal membrane is a rare malformation of the airways. The symptoms depend on the degree of obstruction that triggers in these pathways. It must be taken into consideration in the differential diagnosis of the newborn respiratory distress. The treatment depends on the degree of airway obstruction. We report the case of an infant 2 weeks old with aphonia from birth and respiratory distress with upper airways infections. She is diagnosed of congenital laryngeal membrane by direct laryngoscopy. The treatment is performed with lasser (AU)

Variabilidad e idoneidad del tratamiento antimicrobiano de las otitis agudas pediátricas en Asturias / Variability of antibiotic treatment in paediatric acute otitis media in Asturias (Spain)

Introducción: La otitis media aguda (OMA) es la infección bacteriana más común en la edad pediátrica, y la que requiere con más frecuencia prescripción antibiótica. Objetivos: Analizar la variabilidad e idoneidad de los hábitos de prescripción de antimicrobianos en niños diagnosticados de OMA en Asturias. Métodos: Estudio descriptivo, retrospectivo y multicéntrico, que evalúa pacientes pediátricos diagnosticados de OMA en los servicios de urgencias de cinco hospitales asturianos y en las consultas de 80 pediatras de atención primaria. La idoneidad de las prescripciones antibióticas se estableció mediante comparación con estándares de referencia. Resultados: Se recogieron datos de 420 OMA pediátricas, 36,2% en atención primaria y 63,8% en urgencias hospitalarias (5,1% de las consultas pediátricas). Se prescribieron antibióticos en el 89,8% de las OMA. Los antibióticos más pautados fueron amoxicilina (41,4% de los casos que recibieron antibioterapia) y amoxicilina-clavulánico (39,8%). La prescripción antibiótica fue más frecuente en el hospital que en los centros de salud (el 93,7 frente al 82,9%; p <0,01). El tratamiento fue adecuado en el 86,4% de los casos. La idoneidad de la prescripción fue mayor en el hospital (9% inadecuados) que en atención primaria (21,7% inadecuados) (p <0,01), y también cuando la prescripción la realizaban MIR de pediatría (4,4% inadecuados), médicos de familia (6,8% inadecuados) y otros facultativos (10,2% inadecuados) que cuando la realizaban pediatras (19% inadecuados) (p <0,01). Conclusiones: Las OMA suponen el 5% de las consultas pediátricas en nuestro medio y la mayoría reciben tratamiento antibiótico. La antibioterapia pautada es mayoritariamente correcta, aunque la idoneidad es mayor en los casos atendidos en urgencias hospitalarias (AU)

Introduction: Acute otitis media (AOM) is the most frequent bacterian infection in paediatric population and accounts for the largest portion of antibiotic prescriptions in pediatric offices. Objective: The aim of the study was to analyze the variability and appropriateness of antimicrobial prescriptions in children with diagnosis of AOM in emergency departments and pediatric primary care consultations in Asturias (Spain). Methods: Multicenter descriptive study evaluating retrospectively pediatric patients with AOM diagnosis in 5 hospital emergency departments and 80 pediatric primary care clinics in Asturias. Appropriateness of prescription was established by comparing with reference standards. Results: Four hundred twenty cases of AOM (36.2% in primary care and 63.8% in hospital emergency departments) were included (5.1% of pediatric visits). Antibiotics were prescribed in 89.8% of cases. Amoxicillin and amoxicillin/clavulanate were the most frequently prescribed antibiotics (41.4 and 39.8%). Significant differences in the frequency or antibiotic prescription were found between hospital emergency departments and primary care (93.7 vs 82.9%; p <0.01). The prescribed treatment was considered appropriate in 86.4% of cases. The appropriateness of antibiotic prescription was higher in hospitals, and also when prescription was performed by pediatric Internal Medical Resident (4.4% inadequate), family doctors (6.8% inadequate) and other medical doctors (10.2% inadequate), than was performed by pediatricians (19% inadequate) (p <0.01). Conclusions: Acute otitis media acounts for 5% of pediatric visits in our area and most of them are treated with antibiotics, being amoxicillin the most frequently prescribed. Antibiotic therapy is largely correctly prescribed, with the best appropriateness in cases treated in hospital emergency departments (AU)

Agenesia sacra tipo I: diagnóstico a través de la exploración / Sacral agenesis type I: diagnosis through the exploration

La agenesia sacra es una malformación poco frecuente que forma parte del síndrome de regresión caudal. Presentamos el caso de una recién nacida que muestra en la exploración física una desviación del surco interglúteo, una fosita lumbar y máculas hipocrómicas a la altura del sacro, que hacen sospechar una anomalía congénita lumbosacra. Se realizan estudios de imagen (radiografía, ecografía y resonancia magnética) que confirman el diagnóstico de agenesia sacra tipo I. La paciente presenta, a su vez, una displasia congénita de cadera izquierda que precisó una férula de Pavlik para su corrección. Su evolución fue favorable, manteniéndose asintomática hasta el momento actual (AU)

Sacral agenesis is a rare malformation which is part of caudal regression syndrome. We report a case of a newborn with deviation of the groove cleft, sacral dimple and sacral hypochromic macules, which are suspicious of a lumbosacral anomaly. It's carried out a lumbosacral radiography, echography and magnetic resonance which confirm the diagnosis, a sacral agenesis type I. She also has a congenital hip dysplasia which is treated with a Pavlik harness. At this moment the girl is asymptomatic (AU)

Tag himeneal / Hymeneal tags

Es importante una exploración adecuada de todas las estructuras genitales de las recién nacidas, diferenciando las variantes normales de las patológicas. Dentro de las variaciones congénitas de la mucosa himeneal, el pólipo o tag es la variante anatómica más frecuente. Presentamos los casos de dos recién nacidas que en la primera revisión en el centro de salud, a las dos semanas y a los nueve meses de vida, presentaban un tag himeneal (AU)

It is important to make an appropriate examination of the genital structures of the female newborn to differentiate normal from pathological variations. Among the congenital variations of the hymeneal mucosa, a polyp or tag is the most common anatomic variant. We report two cases: a two week old girl and a nine month old girl with hymeneal tag detected in a well child review at the primary care centre (AU)

Hamartoma de músculo liso congénito: importancia de un correcto diagnóstico diferencial / Congenital smooth muscle hamartoma: the importance of a correct differential diagnosis

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Docetaxel combined with irinotecan or 5-fluorouracil in patients with advanced oesophago-gastric cancer: a randomised phase II study.

BACKGROUND: Docetaxel and irinotecan chemotherapy have shown good efficacy in the treatment of advanced oesophago-gastric cancer. This randomised phase II study evaluated the efficacy and toxicity profile of two non-platinum docetaxel-based doublet regimens in advanced oesophago-gastric cancer. METHODS: Chemotherapy-naïve patients with advanced oesophago-gastric cancer were randomised to receive either 3-weekly DI (docetaxel 60 mg m(-2) plus irinotecan 250 mg m(-2) (Day 1)) or 3-weekly DF (docetaxel 85 mg m(-2) (Day 1) followed by 5-fluorouracil 750 mg m(-2) per day as a continuous infusion (Days 1-5)). RESULTS: A total of 85 patients received DI (n=42) or DF (n=43). The primary endpoint was overall response rate (ORR). The ORR and time to progression (TTP) in the evaluable population (n=65) were 37.5% (DI) vs 33.3% (DF), and 4.2 months vs 4.4 months, respectively. In the intent-to-treat population, the observed ORR, TTP and median overall survival were similar between the two groups. Grade 3-4 neutropenia, febrile neutropenia and diarrhoea were more frequent in the DI arm as compared with the DF arm (83.3% vs 69.8%, 40.5% vs 18.6%, and 42.9% vs 16.3%, respectively). CONCLUSION: Both docetaxel-based doublet regimens show comparable efficacy; however, the DF regimen was associated with a better toxicity profile and is an alternative treatment option for patients in whom platinum-based regimens are unsuitable.

Síndrome de Frey: una entidad de diferenciar de la alergia alimentaria / Frey´s syndrome: an entity to differentiate from food allergy

El síndrome de Frey es una entidad benigna y autolimitada poco frecuente en la edad pediátrica. Se caracteriza por episodios recurrentes de eritema facial en el territorio de inervación del nervio auriculotemporal tras el inicio de la masticación. Presentamos el caso de una lactante de 8 meses que presenta eritema facial unilateral tras la ingesta de frutas. Es importante conocer este síndrome para un diagnóstico correcto y precoz durante la infancia, evitando de este modo la realización de pruebas diagnosticadas no indicadas, la prescripción de dieta de exclusión innecesarias y asegurando la tranquilidad de los padres (AU)

Frey´s syndrome is a benign and self-limited entity, which is rare in children. It´s characterized by recurrent episodies of facial flushing after the mastication, over the distribution of the auriculotemporal nerve. We report a 8 months old girl with unilateral facial flushing after fruits intake. It´s important to know this syndrome for accurate and early diagnosis, avoiding additional test, innecessaries exclusion diet and reassuring parents (AU)

Cardiopatías congénitas de detección neonatal en un área sanitaria: experiencia de dos décadas / Congenital heart disease of neonatal detection in a health carea rea: a two decade long experience

Introducción. La incidencia de cardiopatías congénitas ha aumentado en los últimos años, a expensas de las formas más leves. Objetivos. Determinar la incidencia de cardiopatías congénitas de diagnóstico neonatal en un área sanitaria. Comparar los datos demográficos y clínicos con una muestra similar obtenida a principios de los años 90. Material y métodos. Estudio observacional, descriptivo y retrospectivo, de los menores de un mes diagnosticados de cardiopatía congénita entre 2003-2007. Análisis comparativo con una muestra similar recogida en nuestro centro entre 1991-1995. Resultados. Se incluyeron 192 pacientes (17,9 casos/1000 recién nacidos vivos). El motivo de ingreso principal ha sido la sospecha clínica de cardiopatía, seguido de prematuridad. Quince niños precisaron traslado para tratamiento quirúrgico. Los defectos hallados más frecuentes son los de tabiques cardíacos (69,3%) y grandes arterias 811,5%). En el estudio comparativo por quinquenios se observa un aumento significativo de la incidencia de cardiopatías y del uso de la ecocardiografía (de 91% a 98,4%), con una disminución de los traslados (de 28 a 15) y de los fallecimientos (de 11 a 6). Conclusiones. La incidencia de cardiopatías congénitas ha aumentado en nuestra área sanitaria, a expensas fundamentalmente de defectos septales leves (AU)

Introduction. Congenital heart defects frequency have grown in the last years, mainly because of minor defects. Objectives. To establish the incidence of congenital heart defects in a regional hospital. To compare demographic and clinical data with another sample collected at the beginning of the 90´s. Materials and methods. Observational, descriptive and retrospective study of neonates with congenital heart defects form 2003 to 2007. Comparison with data from another sample collected in our hospital from 1991 to 1995. Results. We included 192 cases (17.0/1,000 newborns). The main cause of admission was clinical suspect of a congenital heart defect, followed by preterm babies. Fifteen newborns needed to be transferred to a reference hospital for surgery. The more common congenital heart diseases were: septal defects (69,93%), great arteries defects (11,5%). In the comparative study we have noticed a significant rise in the incidence of congenital heart defects, the use echocardiography, and decreased number of transfers (form 28 to 15) and mortality (from 11 to 6). Conclusions. The incidence of congenital heart defects has risen comparing to the study carried our form 1991 to 1995, mainly due to minor septald effects, with a usually benign prognosis and trend to spontaneous closure (AU)

Distribución temporal de las urgencias pediátricas hospitalarias durante los últimos diez años / Time distribution of hospital pediatric emergencies during the last 10 years

Objetivo. Establecer el patrón temporal de consumo de recursos en un servicio de urgencias pediátricas y buscar posibles cambios en los últimos 10 años. Material y métodos: Estudio ecológico de todas las urgencias pediátricas atendidas entre 1-1-1999 y 31-12-2008 de Asturias). Descripción general y comparación temporal. Resultados. Se atendieron 175.657 pacientes. Su edad media fue de 3,8 años (IC 95% 3,8-3,9), con mediana de 2,7 años. El 54,8% fueron varones y el 45,2% mujeres. El 31% de los casos fue atendido por las mañanas, el 46% por la tarde y el 23% durante la noche. La media diaria de consultas varió mensualmente entre 65 en diciembre y 34 en agosto. La media diaria de pacientes atendidos en días laborables fue de 42 frente a 61 en días no laborables (p<0,001). La media diaria de visitas en periodo lectivo fue de 51, en vacaciones de navidad 66, en vacaciones de semana santa 53 y en vacaciones de verano 34 (p<0,001). En el primer quinquenio (1998-2003) acudieron menos pacientes (diferencia media diaria 6,8: IC95% de la diferencia 5,7-7,9; p<0,001), su edad media era más alta (diferencia media 0,29 años; IC 95% de la diferencia 0,26-0,33; p<0,001), y hubo un mayor porcentaje de ingresos (9,7% frente a 7,1%) que en el segundo quinquenio (2003—2008). Conclusiones. Existen un perfil temporal específico de visita a los servicios de urgencia pediátricos. En los últimos años se están produciendo cambios en el consumo de este recurso (AU)

Aim. To establish the temporal pattern of resource consumption in a pediatric emergency service and explore possible changes in the last 10 years. Material and methods. Ecological study of all pediatric emergency assisted between 1.1.1999 and 31.12.2008 in Cabueñes Hospital (Health Area V Asturias). Overview and temporal comparison. Results. 175,657 children were treated. Their average age was 3.8 years (95% CI 3.8-3.9), with a median of 2.7 year. 54.8% were male and 45.2% women. 31% of the cases were treated in the mornings, 46$ in the afternoon and 23% at night. The average daily number of children ranged montly form 65 December and 34 in August. The average daily number of children in care was 42 working days versus 61 on not working days (p<0,001). The average daily number of children seen in school period was 51, on Christmas vacation 66 in Easter holidays 53 and summer 34 (p<0,001). In the first five years (1998-2003) attended fewer children (mean difference 6.8 daily, 95% of the difference 5.7-6.9, p<0,001), their average age was higher (mean difference 0,29 years, 95% of the difference 0.26 – 0.33 years, p<0,0001) and a higher percentage of hospital admission (9,7% versus 7.1%) than in the second half (2003-2008) (AU)