Malignant pleural mesothelioma: Treatment patterns and outcomes from the Spanish Lung Cancer Group.

BACKGROUND: Malignant mesothelioma is a rare but aggressive tumor arising from the pleura, typically associated with exposure to asbestos. The purpose of this investigation was to describe mesothelioma patient characteristics, treatment patterns, and outcomes in Spain. MATERIAL AND METHODS: Patients diagnosed with malignant mesothelioma of the pleura were recorded in an anonymous online database (BEMME, Epidemiologic Spanish Malignant Mesothelioma Database) from June 2008 through May 2013. Patient and tumor characteristics at time of diagnosis, as well as subsequent treatments (surgery, radiation, and chemotherapy), were collected. Among patients treated with chemotherapy, we explored type of chemotherapy regimen and outcomes by treatments. RESULTS: A total of 560 malignant pleural mesothelioma (MPM) patients were recorded. The median age at diagnosis was 68 years, mainly with epithelioid histology (62 %), and any asbestos exposure was noted in 45 % of patients. Nearly two-thirds of patients (71 %) received chemotherapy, mainly platinum-pemetrexed combination, as part of their treatment. Surgery and radiotherapy were given in 36 % and 17 % of patients, respectively. The median overall survival (OS) in the whole cohort was 13.0 months (95 % confidence interval (CI), 11.1-14.8 months) with 1-year OS of 53.2 % (95 % CI, 48.7-57.7 %). In patients receiving first-line chemotherapy (N = 315), the median OS was 13.4 months (95 % CI, 10.8-16.0 months), reaching 20.2 months (95 % CI, 17.2-23.2 months) for those 68 patients receiving maintenance chemotherapy. Results of multivariate analyses showed significant association of ECOG-performance status, histology and treatment response with improved OS in MPM patients treated with palliative chemotherapy. CONCLUSIONS: Despite multimodal therapeutic intervention, survival of patients with mesothelioma in Spain remains poor. Although it did not reach significance in the multivariate analysis, a meaningful additional survival benefit was observed among those patients receiving maintenance chemotherapy.

Treating COVID-19: Review of Drug Hypersensitivity Reactions.

The disease caused by the new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), ie, coronavirus disease 2019 (COVID-19), has become a global pandemic since it was first reported in Wuhan, China in December 2019. Its severe clinical manifestations, which often necessitate admission to intensive care units, and high mortality rate represent a therapeutic challenge for the medical community. To date, no drugs have been approved for its treatment, and various therapeutic options are being assayed to address the pathophysiological processes underlying the clinical manifestations experienced by patients. New and old drugs administered as monotherapy or in combination to immunologically compromised patients may favor the development of adverse drug reactions, including drug hypersensitivity reactions, which must be identified and managed accordingly. Given the lack of herd immunity and the high rate of viral contagion, new cases are expected to emerge in the coming months. Thus, the probability of more adverse reactions or even new clinical manifestations may increase in parallel. Allergists must receive updated information on these treatments, as well as on the management of possible drug hypersensitivity reactions.

Treating COVID-19: review of drug hypersensitivity reactions

The disease caused by the new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), ie, coronavirus disease 2019 (COVID-19), has become a global pandemic since it was first reported in Wuhan, China in December 2019. Its severe clinical manifestations, which often necessitate admission to intensive care units, and high mortality rate represent a therapeutic challenge for the medical community. To date, no drugs have been approved for its treatment, and various therapeutic options are being assayed to address the pathophysiological processes underlying the clinical manifestations experienced by patients. New and old drugs administered as monotherapy or in combination to immunologically compromised patients may favor the development of adverse drug reactions, including drug hypersensitivity reactions, which must be identified and managed accordingly. Given the lack of herd immunity and the high rate of viral contagion, new cases are expected to emerge in the coming months. Thus, the probability of more adverse reactions or even new clinical manifestations may increase in parallel. Allergists must receive updated information on these treatments, as well as on the management of possible drug hypersensitivity reactions

La enfermedad causada por el nuevo Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), Coronavirus Disease 2019 (COVID-19), se ha expandido en forma de pandemia global desde su inicio en Wuhan (China) en diciembre de 2019. La aparición de formas clínicas graves asociadas a la necesidad de ingreso en unidades de Cuidados Intensivos, con un alto índice de letalidad, ha supuesto un reto terapéutico para la comunidad médica. Actualmente no hay ningún fármaco aprobado para su tratamiento y se están ensayando diversas opciones terapéuticas para abordar los procesos fisiopatológicos responsables de las manifestaciones clínicas que experimentan los pacientes. Tanto el uso de viejos como de nuevos principios activos como tratamiento único o en combinación, en pacientes inmunológicamente comprometidos, puede favorecer la aparición de efectos adversos, entre ellos reacciones de hipersensibilidad de mecanismo inmunológico, que habrá que saber identificar y manejar correctamente. Es de prever que, en los próximos meses, dada la falta de inmunidad comunitaria y el elevado índice de contagiosidad del virus, sigan surgiendo nuevos casos y, con ello, la probabilidad de que aparezcan más reacciones adversas o incluso nuevas manifestaciones clínicas. Es importante que los alergólogos estén al día de las opciones terapéuticas que se están utilizando, así como de sus posibles reacciones adversas, inclusive reacciones de hipersensibilidad y cómo manejarlas

Valoración del dolor de los pacientes ingresados en un Servicio de Oncología / Pain assessment of inpatients at an Oncology Department

El dolor es un síntoma que disminuye en gran medida la calidad de vida de los pacientes oncológicos, por lo que creímos oportuno un estudio en nuestro medio analizando dicho síntoma y el tratamiento que aplicamos para su control. Para lo cual realizamos un estudio transversal con todos los pacientes oncológicos que ingresaron en nuestro servicio a lo largo de un mes, valorando la presencia o no de dolor, así como si lo hubiera, el tipo, etiología e intensidad y el tratamiento que recibían. Encontramos que el dolor es un síntoma frecuente, en la mayoría de los casos se debe al efecto directo del tumor o sus metástasis y suele ser de características somáticas. No siempre se valora de forma adecuada, tanto en tipo como en intensidad, lo que nos puede llevar a la aplicación de un tratamiento poco apropiado o deficiente en algunas ocasiones, así mismo, sería preciso poner una mayor atención en el tratamiento de los efectos secundarios de los analgésicos para conseguir un buen control sintomático (AU)

Pain is a symptom that decreases quality of life in oncologic patients, and we thought it important to study this symptom as well as the treatment applied for its control in our setting. Thus we performed a cross-sectional study in all oncologic inpatients seen in our department over one month, in whom we analyzed the presence or absence of pain, and in the former case we assessed its etiology, type, severity, and treatment. We found that pain is a frequent symptom, most often produced by a direct effect of tumor or metastatic disease, and usually has somatic characteristics. It is not always properly assessed, and this may lead to deficient treatment. In addition, treating analgesic medication side effects is important for a good symptoms control (AU)

[Induced prescription from reference hospital Universitari Vall d'Hebron to general practitioners]. / Prescripción inducida a médicos de atención primaria procedente del hospital de referencia, Hospital Universitari Vall d'Hebron.

OBJECTIVES: Our objectives were to describe proportion of patients with induced prescription (IP) from reference hospital, the information about diagnosis and treatment that GP get as well as their agreement with the prescription. We also analyzed the quality of IP assessed by GP's quality of prescription criteria. DESIGN: Cross-sectional study. SETTING: Six urban health care centers. PARTICIPANTS: Patients and drugs prescribed from the reference hospital and derivated to health care center to get treatments. MEASUREMENTS: Origin of patients, diagnosis, treatment and the GP's agreement with it, and whether that information was enough to allow patient's control. MAIN RESULTS: Thirty six GP collected data from 323 patients and 844 drugs from reference hospital. 52% (95% CI, 47-58) of IP came from the emergency room. Medical conditions more frequently associated with IP were chronic obstructive pulmonary disease, lumbosciatica and traumatism. The most prescribed drugs were analgesics and NSAIDs. GP's agreement with IP reached 63% (95% CI, 60-67). Most frequent disagreement cause was drug selection (61 drugs; 7.2% of IP). In some 20% (95% CI, 16-25) of patients information wasn't sufficient enough to assume patient's control. CONCLUSIONS: A stronger relation between GP's and hospital doctors would be needed to establish common treatments for patients' frequent conditions and their follow-up.

[Evidence based medical treatment of heart failure]. / Tratamiento médico de la insuficiencia cardíaca basado en la evidencia.

INTRODUCTION AND OBJECTIVES: Recommendations for the treatment of heart failure were carried out by a systematic review of the available evidence of the different pharmacologic treatments. MATERIAL AND METHODS: The review focused on the treatment of chronic and systolic heart failure. All the studies published in english about the pharmacologic treatment of heart failure where identified. The evidence of every pharmacologic treatment was classified according to: a) efficacy variables (reduction of mortality and hospitalizations, improvement of functional class, ejection fraction and exercise tolerance), and b) the level of quality of the evidence according to an evaluation scale. The evidence was also reviewed for the comparisons and the combinations of the pharmacologic treatments, as well as for the toxicity and costs of treatments. RESULTS: The recommendations were defined according to the NYHA functional class and were classified in the A, B and C categories according to the level of quality of the available evidence. The evidence on mortality was considered the most important. First line drugs, the alternatives and other possible treatments were take into account. CONCLUSIONS: There is enough evidence based on information about some variables such as reduction of mortality or hospitalizations to carry out treatment recommendations in all stages of heart failure. This point out the interest ant the priority of used them in the evaluation and improvement of the results of heart failure.