Gestación tras cáncer / Pregnancy after cancer

El embarazo o el deseo gestacional en personas con antecedentes oncológicos son situaciones clínicas de frecuencia creciente que requieren un abordaje global. El consejo preconcepcional es básico en estos casos, y debe incluir una valoración conjunta y una coordinación multidisciplinar entre los especialistas de oncología o del proceso de base, de fertilidad o reproducción, y obstetricia o medicina maternofetal. El objetivo de esta valoración incluye consensuar el momento óptimo para asumir una gestación de forma segura sin empeorar el pronóstico de su enfermedad y planificar el seguimiento de la gestación de acuerdo con las posibles complicaciones maternas o perinatales. En la presente revisión se detallan los aspectos reproductivos más relevantes de tres de los tipos de cáncer más frecuentes en la edad reproductiva: el cáncer de mama, el cáncer de cérvix y los cánceres hematológicos.(AU)

Pregnancy or reproductive desire in people with a previous cancer represents a clinical situation of increasing frequency that requires a global approach. Preconceptional counseling is mandatory in these cases and should include a global assessment and multidisciplinary coordination between specialists in oncology, fertility and obstetrics or maternal-fetal medicine. The objective of this assessment includes determining the optimal time-to-pregnancy safe for the mother, without worsening the prognosis of the disease and planning the pregnancy follow-up according to possible maternal or perinatal complications. This review details the most relevant reproductive aspects of three of the most frequent types of cancer during reproductive age: breast cancer, cervical cancer and hematological cancers.(AU)

Pollen production in olive cultivars and its interannual variability.

BACKGROUND AND AIMS: Olive (Olea europaea subsp. europaea var. europaea) is the most extensively cultivated fruit crop worldwide. It is considered a wind-pollinated and strictly outcrossing crop. Thus, elevated pollen production is crucial to guarantee optimum fruit set and yield. Despite these facts, the variability of pollen production within the cultivated olive has been scarcely studied. This study aimed to characterize this feature by analysing a representative set of worldwide olive cultivars. METHODS: We evaluated the average number of pollen grains per anther in 57 principal cultivars over three consecutive years. We applied a standard generalized linear model (GLM) approach to study the influence of cultivar, year and the previous year's fruit load on the amount of pollen per anther. Additionally, the K-means method was used for cluster analysis to group cultivars based on their pollen production capacity. KEY RESULTS: Pollen production per anther was highly variable among olive cultivars. The cultivar significantly accounted for 51.3 % of the variance in pollen production and the year for 0.3 %. The interaction between the two factors explained 8.4 % of the variance, indicating that not all cultivars were equally stable in producing pollen across the years. The previous year's fruit load and its interaction with the year were significant, but barely accounted for 1.5 % of the variance. Olive cultivars were classified into four clusters according to their capacity to produce pollen. Interestingly, the fourth cluster was composed of male-sterile cultivars, which presumably share this character by inheritance. CONCLUSIONS: Pollen production per anther varied extensively within the cultivated olive. This variation was mainly driven by the cultivar and its interaction with the year. The differential capacity of olive cultivars to produce pollen should be considered not only for designing new orchards but also gardens where this species is used as an ornamental.

Long-term trends and influence of climate and land-use changes on pollen profiles of a Mediterranean oak forest.

Climate change is disrupting phenology and interaction patterns of natural ecosystems, but also human activities that modify land-uses have a direct impact, especially on species distribution and loss of biodiversity. The objective of this study is to evaluate the impact of climate and land-use changes on phenology and airborne pollen spectrum in a Mediterranean natural area, dominated by Quercus Forest and 'dehesa', in the South of the Iberian Peninsula. 61 different pollen types were identified over a 23-year period (1998-2020), mainly from trees and shrubs, such as Quercus, Olea, Pinus or Pistacia, and from herbaceous plants, such as Poaceae, Plantago, Urticaceae or Rumex. A comparison of pollen data from the first years of the study (1998-2002) up recent years (2016-2020), showed a substantial decrease in the relative abundance of pollen from autochthonous species associated with natural areas, such as Quercus or Plantago. However, the relative abundance of the pollen from cultivated ones such as Olea and Pinus, which is used for reforestation has increased. Regarding flowering phenology trends, our analyses revealed variations between -1.5 and 1.5 days per year. Taxa showing an advance phenology were Olea, Poaceae and Urticaceae, whereas Quercus, Pinus, Plantago, Pistacia or Cyperaceae experienced delayed pollination. Meteorological trends in the area generally resulted in an increase in both minimum and maximum temperatures, along with a decrease in precipitations. Changes in pollen concentration and phenology were correlated with changes in air temperatures and precipitation, although the positive or negative influence varied for each pollen type. The results suggest that climate change together with those motivated by land cover changes lead by human activities are having an impact on the phenology and pollen concentration, with the related consequences on pollination and therefore biodiversity more concerning in threatened areas as the Mediterranean Basin.

Reacción cútanea debida a remdesivir en paciente con enfermedad por SARS-CoV-2 / Skin reaction due to remdesivir in a patient with SARS-CoV-2 disease

En diciembre de 2019 se detectó por primera vez en la ciudad china de Wuhan una nueva enfermedad infecciosa con el nombre oficial de COVID-19, causada por un nuevo tipo de coronavirus denominado virus SARS-CoV-2, la infección se ha propagado rápida y extensamente por todo el mundo, por lo que el 11 de marzo de 2020 la Organización Mundial de la Salud la declaró pandemia. Al tratarse de una nueva infección, no existe por el momento evidencia que permita recomendar un tratamiento específico, en la actualidad el único medicamento con indicación autorizada por la Agencia Europea de Medicamentos (EMA) es el remdesivir. A continuación presentamos el caso de una reacción adversa a remdesivir, si bien no fue grave, cabe destacar la importancia de notificar efectos adversos y más en medicamentos novedosos como este. (AU)

In December 2019, a new infectious disease with the official name of COVID-19 was detected for the first time in the Chinese city of Wuhan, caused by a new type of coronavirus called SARS-CoV-2 virus, the infection has spread rapidly and widely throughout the world, which is why on March 11, 2020, the World Health Organization declared it a pandemic. As it is a new infection, there is currently no evidence to recommend a specific treatment, currently the only drug with an indication authorized by the European Medicines Agency (EMA) is remdesivir.We present the case of an adverse reaction to remdesivir, although it was not serious, it is worth highlighting the importance of reporting adverse effects and more in novel drugs like this one. (AU)

A multidisciplinary approach of outdoor aeroallergen selection for Skin Prick Testing in the geographical area of Greater Istanbul.

SUMMARY: Background. Aeroallergen selection for skin prick testing and the interpretation of results need to be in line with allergenic sources of a specific geographic area. Objective. To identify aeroallergens for a skin test panel for the specific geographical area of Istanbul in a multidisciplinary approach based on aerobiological parameters, cross-reactivity patterns and clinical symptoms. Methods. Aerobiological parameters, cross reactivity patterns and the European Standard Skin Prick Test Panel determined allergen selection. Atopic adult patients (n = 60) compiled a questionnaire and were skin prick tested with 29 aeroallergens. Aerobiological sampling followed the requirements of the European Aerobiology Society. Results were statistically analyzed. Results. 65% of patients had positive skin reactions. Sensitization to at least one grass allergen was 30%. Key grass allergens were timothy grass (Phleum pratense L.) 25.8% and Johnson grass (Sorghum halepense (L.) Pers.) 22.6%; correlations between grass-sensitizations were significant at p (minor) 0.01 and so was the correlation of Pooideae sensitization with symptoms and medication. Sensitization to at least one woody plant was 23%; to ash (Fraxinus excelsior L.) 8.1%; hazelnut (Corylus avellana L.), olive (Olea europaea L.) and mulberry (Morus alba L.) 6.5%; juniper (Juniperus ashei J.Buchholz) 4.8%. Correlations between Fagales allergen sensitizations were significant. Sensitization to at least one weed was 22%, sensitization to dock (Rumex crispus L.) 12.9%, ragweed (Ambrosia artemisiifolia L.), and mugwort (Artemisia vulgaris L.) 4.8%. Sensitization rates correlated significantly with the length of the Main Pollen Season. Conclusions. The European Standard Panel is suitable for the geographical area of Greater Istanbul, if it comprises Johnson grass and ash. Ragweed has become clinically relevant in this region. Mulberry and dock were exclusively associated to polysensitized individuals suggesting pan-allergen involvement.

Variaciones en la incidencia de bronquiolitis tras la aparición del SARS-CoV-2 / Variations in the incidence of bronchiolitis after the onset of SARS-CoV-2

Introducción. Durante la temporada 2020-2021 se ha asistido a una disminución de la incidencia de hospitalizaciones por bronquiolitis. Los cambios en la evolución de la pandemia de SARS-CoV-2 y en la aplicación de medidas preventivas podrían relacionarse con un aumento de la incidencia de bronquiolitis grave durante la temporada 2021-2022. Objetivo. Determinar la incidencia de hospitalizaciones por bronquiolitis en un hospital terciario durante la temporada 2021-2022 y compararla con temporadas previas. Método. Estudio epidemiológico de tipo observacional, descriptivo y ambispectivo. A través de la base de datos de un hospital terciario, se compararon la incidencia, la etiología y los indicadores de gravedad de las hospitalizaciones por bronquiolitis. Se analizaron 3 cohortes en época epidémica: la temporada 2020-2021 y la 2021-2022 (prospectivas); y la temporada 2018-2019 (retrospectiva). También se analizó una cohorte prospectiva entre los meses de abril y octubre de 2021. Resultados. La incidencia acumulada de hospitalizaciones fue de 113,6/10.000 niños menores de 2 años en la temporada pre-covídica; de 3,6/10.000 en la temporada 2020-2021; y de 65,7/10.000 en la temporada 2021-2022. El porcentaje de ingresos en UCIP fue de 36,6%, 0 % y 30,8%, respectivamente. La incidencia acumulada de hospitalizaciones en el periodo no epidémico fue de 60,8/10.000, precisando ingreso en UCIP el 19%. El microorganismo más frecuente fue el virus respiratorio sincitial en todas las cohortes. Conclusiones. La incidencia durante los meses típicamente epidémicos de bronquiolitis bajó drásticamente la temporada en la que apareció el SARS-CoV-2, aumentando notablemente el año posterior, aunque sin alcanzar la incidencia previa a la pandemia. Se ha observado una incidencia alta de casos de bronquiolitis entre abril y octubre de 2021 (AU)

Introduction. A decrease has been observed during the 2020-2021 season in the incidence of hospitalizations for bronchiolitis. Changes in the evolution of the SARS-CoV-2 pandemic and in the application of preventive measures could be related to an increase in the incidence of severe bronchiolitis during the 2021-2022 season. Objective. To determine the incidence of bronchiolitis hospitalizations in a tertiary hospital during the 2021-2022 season and to compare it with previous seasons. Method. An observational, descriptive and ambispective epidemiological study. A tertiary hospital database was used to compare the incidence, etiology, and severity indicators of bronchiolitis hospitalizations. 3 cohorts were analyzed in epidemic times: the 2020-2021 season and the 2021-2022 season (prospective); and the 2018-2019 season (retrospective). A prospective cohort between the months of April and October 2021 was also analyzed. Results. The cumulative incidence of hospitalizations was 113.6/10,000 children under 2 years of age in the pre-covid season; 3.6/10,000 in the 2020-2021 season; and 65.7/10,000 in the 2021-2022 season. The percentage of admissions in PICU was 36.6%, 0% and 30.8%, respectively. The cumulative incidence of hospitalizations in the non-epidemic period was 60.8/10,000, with 19% requiring admission to the PICU. The most frequent microorganism was the respiratory syncytial virus in all cohorts. Conclusions. The incidence during the typically epidemic months of bronchiolitis drastically decreased the season in which SARS-CoV-2 appeared, noticeably increasing the next year, although without reaching the pre-pandemic incidence. A high incidence of bronchiolitis cases was observed between April and October 2021 (AU)

Realidad virtual: ¿puede ayudar en la realización de procedimientos invasivos a niños? / Virtual reality: can this help in the performance of invasive procedures on children?

Objetivo. Valorar si el uso de gafas de realidad virtual (RV) es un procedimiento con posible aplicación para disminuir el dolor percibido por los niños al enfrentarse a procedimientos dolorosos. Material y métodos. Se realizó un estudio prospectivo observacional en pacientes pediátricos que acuden al hospital de día de Cuidados Intensivos Pediátricos (CIP) para la realización de procedimientos invasivos que precisan canalizar una vía venosa. Resultados. Participaron en el estudio 22 pacientes (13 niños y 9 niñas) de edades comprendidas entre 5 y 16 años, con una media de edad de 9,7 ± 3,5 años. La medición del dolor se llevó a cabo mediante las escalas de Wong-Baker y la Escala Visual Analógica (EVA), según la edad de los pacientes, obteniéndose una media de dolor de 2,42 ± 2,06 sobre 10 puntos. Además, se recogió el nivel de satisfacción con la intervención, mediante una encuesta no validada valorada del 0 al 4, con una satisfacción de 3,89 puntos en los pacientes; 3,71 en sus padres; 3,94 en el personal médico y 3,50 en el de enfermería. Conclusiones. El uso de RV es fácilmente aplicable a niños sometidos a procedimientos dolorosos, con un alto nivel de satisfacción con la intervención, y podría contribuir a disminuir el dolor percibido por el paciente (AU)

Objective. Evaluate if using Virtual Reality (VR) could be useful to reduce perceived pain between children facing painful procedures. Material and methods. An observational prospective study was performed in paediatric patients who attended the Paediatric ICU’s Day hospital to get invasive procedures done, where a previous venipuncture was needed. Results. 22 patients were included (13 males and 9 females) of ages between 5 and 16 years old, with an average of 9.7 ± 3.5 years old. The most common procedure, performed in 14 patients, was digestive endoscopy. Pain measurement was analyzed with Wong-Baker and visual analog scales, depending on childrens’ ages, getting a final pain average of 2.42 ± 2.06 out of 10 points. What is more, the satisfaction level was studied with a non validate scale going from 0 to 4, getting a result of 3.89 points between patients; 3.71 between their parents; 3.94 between doctors and 3.50 between nurses. Conclusion. Using VR is suitable for children undergoing painful procedures, getting a high satisfaction level with the intervention, and it could contribute to diminish pain level perceived by the patient (AU)

Methods for interpolating missing data in aerobiological databases.

Missing data is a common problem in scientific research. The availability of extensive environmental time series is usually laborious and difficult, and sometimes unexpected failures are not detected until samples are processed. Consequently, environmental databases frequently have some gaps with missing data in it. Applying an interpolation method before starting the data analysis can be a good solution in order to complete this missing information. Nevertheless, there are several different approaches whose accuracy should be considered and compared. In this study, data from 6 aerobiological sampling stations were used as an example of environmental data series to assess the accuracy of different interpolation methods. For that, observed daily pollen/spore concentration data series were randomly removed, interpolated by using different methods and then, compared with the observed data to measure the errors produced. Different periods, gap sizes, interpolation methods and bioaerosols were considered in order to check their influence in the interpolation accuracy. The moving mean interpolation method obtained the highest success rate as average. By using this method, a success rate of the 70% was obtained when the risk classes used in the alert systems of the pollen information platforms were taken into account. In general, errors were mostly greater when there were high oscillations in the concentrations of biotic particles during consecutive days. That is the reason why the pre-peak and peak periods showed the highest interpolation errors. The errors were also higher when gaps longer than 5 days were considered. So, for completing long periods of missing data, it would be advisable to test other methodological approaches. A new Variation Index based on the behaviour of the pollen/spore season (measurement of the variability of the concentrations every 2 consecutive days) was elaborated, which allows to estimate the potential error before the interpolation is applied.

18F-choline PET/MRI on initial staging of prostate cancer. Impact on therapy approach. / La PET/RM con 18F-colina en el diagnóstico inicial del cáncer de próstata. Impacto en la estrategia terapéutica.

AIM: Evaluate the therapy impact of initial staging in patients diagnosed with prostate cancer by 18 F-choline PET/MRI hybrid technique. MATERIAL: A prospective study which included 31 patients diagnosed with prostate cancer; Gleason > 7; mean PSA 13.6 ng/mL (range 6.3-20.6). PET/MRI studies were acquired simultaneously with hybrid equipment (SIGNA.3T, GE) following intravenous injection of 185 ± 18.5MBq of 18F-choline: - Early/prostate imaging: PET emission + multiparametric MR: DIXON-T1-T2-diffusion-gadolinium. - Late/whole-body imaging: PET emission + MR: DIXON-T1-T2-diffusion-STIR sequences. Images were visually evaluated. SUV & ADC & textures were also calculated. Treatment selection was based upon Oncology Committee consensus decision. RESULTS: Procedure was well tolerated in all patients, and no artifacts were reported. MRI was superior in T staging in eight patients (25.8%) (Likert: 2-3), whereas PET increased MRI sensitivity in three patients (9.7%) (PIRADS: 3). PROSTATE LESION LOCATION: Peripheral 91.4%, transitional 8.6%. SUVmax threshold: 2.95: sensitivity 92.9%, specificity 66.7%. No correlation SUV vs. ADC. Better distinction between stage T2 vs. T3 using the DiscrLin model with NG = 16 (AUC 0.7767 ± 0.3386). PET was superior to T2 in textures analysis (0.588 vs. 0.412). Seventeen patients (54.8%) were staged ≥ T3, with surgical treatment being contraindicated. Fifteen patients (48.4%) presented with extra-prostatic disease: 8/31 oligometastatic and 7/31 multiple metastasis. Therapy approach following PET/MRI was: radical treatment in 24/31 patients (77.4%), 14 radical prostatectomy and 10 MRI-guided radiotherapy; systemic treatment in 7/31 patients (22.6%). CONCLUSION: 18F-choline PET/MRI had a complementary role for the T staging, with a high detection rate for NM infiltration. PET/MRI findings allowed patients to be directed either to prostatectomy or MRI-guided radiotherapy, and thus avoiding radicaltreatment in 22.6% of patients.

Anaphylaxis Due to Senna (Cassia angustifolia)

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Gain-switched semiconductor lasers with pulsed excitation and optical injection for dual-comb spectroscopy.

In this work we demonstrate the capability of two gain-switched optically injected semiconductor lasers to perform high-resolution dual-comb spectroscopy. The use of low duty cycle pulse trains to gain switch the lasers, combined with optical injection, allows us to obtain flat-topped optical frequency combs with 350 optical lines (within 10 dB) spaced by 100 MHz. These frequency combs significantly improve the spectral resolution reported so far on dual-comb spectroscopy with gain-switched laser diodes. We evaluate the performance of our system by measuring the transmission profile of an absorption line of H13CN at the C-band, analyzing the attainable signal-to-noise ratio for a range of averaging times.

A randomized trial comparing transanal irrigation and percutaneous tibial nerve stimulation in the management of low anterior resection syndrome.

AIM: To assess the effectiveness of transanal irrigation (TAI) compared with posterior tibial nerve stimulation (PTNS) in severe and chronic low anterior resection syndrome (LARS). METHOD: A two-group parallel, open-label randomized controlled trial carried out in a single university hospital. The study population included patients with a LARS scale score of more than 29 points who had undergone rectal surgery more than 1 year previously. These were randomly allocated, with a central randomization system, following a 1:1 sequence to TAI or PTNS. The main study outcome was to achieve a reduction of at least one LARS grade in at least 50% of the patients, for each intervention. RESULTS: A total of 27 patients (TAI = 13, PTNS = 14) were randomized. Both groups were similar with regard to confounding factors. Four patients were excluded because of intercurrent disease or early dropout, leaving 23 (TAI, n = 10; PTNS, n = 13) for analysis. Eight out of 10 and 4 out of 13 patients were downgraded with TAI and PTNS, respectively. The median LARS score decreased from 35 [interquartile range (IQR) 32-39] to 12 (IQR 12-26) (P = 0.021) for the TAI group and from 35 (IQR 34-37) to 30 (IQR 25-33) (P = 0.045) for the PTNS group. The Vaizey score fell from 15 (IQR 11-18) to 6 (IQR 4-7) (P = 0.037) and from 14 (IQR 13-17) to 9 (IQR 7-10) (P = 0.007) with TAI and PTNS, respectively, with 80% and 38% of patients, respectively, showing decreases of more than 50%. Improvement in quality of life was observed in both groups. CONCLUSION: Both treatments improved the LARS score in this study but this was only significant in the TAI group.

Sedoanalgesia para procedimientos en Unidad de Cuidados Intensivos Pediátricos (UCIP). Farmacología, efectos secundarios y control de calidad / Sedoanalgesia for procedures in Pediatric Intensive Care Unit (PICU). Pharmacology, side effects and quality control

OBJETIVOS: Analizar los fármacos más utilizados para sedoanalgesia en procedimientos realizados en una Unidad de Cuidados Intensivos Pediátricos (UCIP), medir su efectividad (nivel de sedación), efectos secundarios y control de calidad. MATERIAL Y MÉTODOS: Estudio prospectivo, observacional y descriptivo. Se recogieron datos epidemiológicos y clínicos, fármaco/s utilizado/s, nivel de sedación alcanzado, incidencias o efectos adversos y escalas de satisfacción, de pacientes de 0 a 18 años sometidos a procedimientos que precisaron sedoanalgesia. RESULTADOS: Se incluyeron 112 pacientes con una edad media de 8,3 años. El fármaco más utilizado fue el propofol (64,3%), seguido de la asociación de ketamina con midazolam (16,1%) y del sevofluorano (12,5%). En el 70,5% de los pacientes se alcanzó un nivel de sedación profunda, sin diferencias estadísticamente significativas entre los distintos fármacos. Se registraron efectos adversos en un 51,8% de pacientes, principalmente desaturación, con una frecuencia mayor al emplear propofol (p< 0,05). La puntuación en la satisfacción alcanzó el valor máximo en todos los padres encuestados, sin hallarse diferencias significativas en función del procedimiento, fármaco, nivel de sedación o efectos adversos. En el 80% de los profesionales la puntuación alcanzó ese mismo valor. CONCLUSIONES: El fármaco más utilizado y con mayor eficacia es el propofol, aunque se asocia más frecuentemente con efectos adversos. El nivel de sedoanalgesia fue adecuado en el momento de iniciar los procedimientos. El grado de satisfacción es óptimo en la mayor parte de los encuestados, aunque fue registrado en menos de la mitad de los procedimientos

OBJECTIVES: To analyze the drugs most used for sedoanalgesia in procedures performed in a Pediatric Intensive Care Unit (PICU), to measure their effectiveness (level of sedation achieved), the main side effects and to carry out a quality control. MATERIAL AND METHODS: Prospective, observational and descriptive study. Epidemiological and clinical data, drug (s) used, level of sedation achieved, incidences or adverse effects, and satisfaction scales were collected from patients from 0 to 18 years of age who underwent procedures that required sedation and analgesia. RESULTS: 112 patients with an average age of 8.3 years were included. The most widely used drug was propofol (64.3%), followed by the association of ketamine with midazolam (16.1%) and sevofluorane (12.5%). In 70.5% of the patients, a level of deep sedation was reached, with no statistically significant differences between the different drugs used. Adverse effects were recorded in 51.8% of patients, mainly desaturation, with a higher frequency when using propofol (p <0.05). Satisfaction score was maximal in all the parents surveyed, without finding significant differences based on the procedure, drug, level of sedation or adverse effects. In 80% of the professionals the score was also maximal. CONCLUSION: The most used and with the highest efficacy in absolute values drug was propofol, although it was more frequently associated with adverse effects. The level of sedoanalgesia was adequate at the time of initiating the procedures. The degree of satisfaction was optimal in most of the respondents, although it was registered in less than half of the procedures