Modelo de riesgo de crisis en acúmulos o estado epiléptico e intervención en servicios de urgencias / Risk model of seizure cluster or status epilepticus and intervention in the emergency department

Objetivos Identificar posibles factores predictores de crisis epilépticas en acúmulos o estado epiléptico (EE) y evaluar si estos pacientes reciben una mayor intervención en urgencias. Metodología Análisis secundario del Registro ACESUR el cual es un registro observacional de cohortes multipropósito, prospectivo y multicéntrico de pacientes adultos con crisis epilépticas en 18 servicios de urgencias. Se recogen variables clínico-asistenciales. Se identifican factores y modelo de riesgo de presentar crisis en acúmulos o EE y se evalúa el efecto de intervención en servicios de urgencias extrahospitalarios y hospitalarios. Resultados Del registro ACESUR se analizan 186 (28%) con crisis en acúmulos (126; 19%) o EE (60; 9%) frente a 478 (72%) pacientes con crisis aislada. El modelo de riesgo de crisis en acúmulo o EE en urgencias incluyó la presencia de alta comorbilidad según índice de Charlson > 3 (OR: 1,60; IC95%: 1,05-2,46; p = 0,030), > 2 fármacos antiepilépticos habituales (OR: 2,29; IC95%: 1,49-3,51; p < 0,001) y crisis focal (OR: 1,56; IC95%: 1,05-2,32; p = 0,027). El ABC del modelo fue de 0,735 (IC95%: 0,693-0,777; p = 0,021). La intervención en pacientes con crisis en acúmulos y EE fue mayor en los servicios de urgencias extrahospitalarios (OR: 2,89; IC95%: 1,91-4,36; p < 0,001) y en los servicios de urgencias hospitalarios (OR: 4,41; IC95%: 2,69-7,22; p < 0,001). Conclusiones El modelo presentado podría ser una herramienta con valor predictivo de utilidad para identificar al paciente adulto con riesgo de presentar crisis en acúmulos o EE en urgencias. Estos pacientes recibieron una mayor intervención frente a pacientes con crisis epiléptica aislada por parte de los servicios de urgencias extrahospitalarios y más aún por los servicios de urgencias hospitalarios en nuestra muestra. (AU)

Objectives To identify possible predictors of seizure cluster or status epilepticus (SE) and to evaluate whether these patients receive greater interventions in emergency departments. Methodology We conducted a secondary analysis of the ACESUR Registry, a multipurpose, observational, prospective, multicentre registry of adult patients with seizures from 18 emergency departments. Clinical and care-related variables were collected. We identified risk factors and risk models for seizure cluster or SE and assessed the effect of interventions by prehospital emergency services and the hospital emergency department. Results We identified a total of 186 (28%) patients from the ACESUR registry with seizure cluster (126 [19%]) or SE (60 [9%]); the remaining 478 patients (72%) had isolated seizures. The risk model for seizure cluster or SE in the emergency department included Charlson Comorbidity Index scores ≥ 3 (OR: 1.60; 95% CI, 1.05-2.46; P = .030), ≥ 2 habitual antiepileptic drugs (OR: 2.29; 95% CI, 1.49-3.51; P < .001), and focal seizures (OR: 1.56; 95% CI, 1.05-2.32; P = .027). The area under the curve of the model was 0.735 (95% CI, 0.693-0.777; P = .021). Patients with seizure cluster and SE received more aggressive interventions both by prehospital emergency services (OR: 2.89; 95% CI, 1.91-4.36; P < .001) and at the emergency department (OR: 4.41; 95% CI, 2.69-7.22; P < .001). Conclusions This risk model may be of prognostic value in identifying adult patients at risk of presenting seizure cluster or SE in the emergency department. In our sample, these patients received more aggressive treatment than adult patients with isolated seizures before arriving at hospital, and even more so in the emergency department. (AU)

Modelo de riesgo de crisis en acúmulos o estado epiléptico e intervención en servicios de urgencias / Risk model of seizure cluster or status epilepticus and intervention in the emergency department

Objetivos Identificar posibles factores predictores de crisis epilépticas en acúmulos o estado epiléptico (EE) y evaluar si estos pacientes reciben una mayor intervención en urgencias. Metodología Análisis secundario del Registro ACESUR el cual es un registro observacional de cohortes multipropósito, prospectivo y multicéntrico de pacientes adultos con crisis epilépticas en 18 servicios de urgencias. Se recogen variables clínico-asistenciales. Se identifican factores y modelo de riesgo de presentar crisis en acúmulos o EE y se evalúa el efecto de intervención en servicios de urgencias extrahospitalarios y hospitalarios. Resultados Del registro ACESUR se analizan 186 (28%) con crisis en acúmulos (126; 19%) o EE (60; 9%) frente a 478 (72%) pacientes con crisis aislada. El modelo de riesgo de crisis en acúmulo o EE en urgencias incluyó la presencia de alta comorbilidad según índice de Charlson > 3 (OR: 1,60; IC95%: 1,05-2,46; p = 0,030), > 2 fármacos antiepilépticos habituales (OR: 2,29; IC95%: 1,49-3,51; p < 0,001) y crisis focal (OR: 1,56; IC95%: 1,05-2,32; p = 0,027). El ABC del modelo fue de 0,735 (IC95%: 0,693-0,777; p = 0,021). La intervención en pacientes con crisis en acúmulos y EE fue mayor en los servicios de urgencias extrahospitalarios (OR: 2,89; IC95%: 1,91-4,36; p < 0,001) y en los servicios de urgencias hospitalarios (OR: 4,41; IC95%: 2,69-7,22; p < 0,001). Conclusiones El modelo presentado podría ser una herramienta con valor predictivo de utilidad para identificar al paciente adulto con riesgo de presentar crisis en acúmulos o EE en urgencias. Estos pacientes recibieron una mayor intervención frente a pacientes con crisis epiléptica aislada por parte de los servicios de urgencias extrahospitalarios y más aún por los servicios de urgencias hospitalarios en nuestra muestra. (AU)

Objectives To identify possible predictors of seizure cluster or status epilepticus (SE) and to evaluate whether these patients receive greater interventions in emergency departments. Methodology We conducted a secondary analysis of the ACESUR Registry, a multipurpose, observational, prospective, multicentre registry of adult patients with seizures from 18 emergency departments. Clinical and care-related variables were collected. We identified risk factors and risk models for seizure cluster or SE and assessed the effect of interventions by prehospital emergency services and the hospital emergency department. Results We identified a total of 186 (28%) patients from the ACESUR registry with seizure cluster (126 [19%]) or SE (60 [9%]); the remaining 478 patients (72%) had isolated seizures. The risk model for seizure cluster or SE in the emergency department included Charlson Comorbidity Index scores ≥ 3 (OR: 1.60; 95% CI, 1.05-2.46; P = .030), ≥ 2 habitual antiepileptic drugs (OR: 2.29; 95% CI, 1.49-3.51; P < .001), and focal seizures (OR: 1.56; 95% CI, 1.05-2.32; P = .027). The area under the curve of the model was 0.735 (95% CI, 0.693-0.777; P = .021). Patients with seizure cluster and SE received more aggressive interventions both by prehospital emergency services (OR: 2.89; 95% CI, 1.91-4.36; P < .001) and at the emergency department (OR: 4.41; 95% CI, 2.69-7.22; P < .001). Conclusions This risk model may be of prognostic value in identifying adult patients at risk of presenting seizure cluster or SE in the emergency department. In our sample, these patients received more aggressive treatment than adult patients with isolated seizures before arriving at hospital, and even more so in the emergency department. (AU)

Risk model of seizure cluster or status epilepticus and intervention in the emergency department.

OBJECTIVES: To identify possible predictors of seizure cluster or status epilepticus (SE) and to evaluate whether these patients receive greater interventions in emergency departments. METHODOLOGY: We conducted a secondary analysis of the ACESUR Registry, a multipurpose, observational, prospective, multicentre registry of adult patients with seizures from 18 emergency departments. Clinical and care-related variables were collected. We identified risk factors and risk models for seizure cluster or SE and assessed the effect of interventions by prehospital emergency services and the hospital emergency department. RESULTS: We identified a total of 186 (28%) patients from the ACESUR registry with seizure cluster (126 [19%]) or SE (60 [9%]); the remaining 478 patients (72%) had isolated seizures. The risk model for seizure cluster or SE in the emergency department included Charlson Comorbidity Index scores ≥ 3 (OR: 1.60; 95% CI, 1.05-2.46; P=.030), ≥ 2 habitual antiepileptic drugs (OR: 2.29; 95% CI, 1.49-3.51; P<.001), and focal seizures (OR: 1.56; 95% CI, 1.05-2.32; P=.027). The area under the curve of the model was 0.735 (95% CI, 0.693-0.777; P=.021). Patients with seizure cluster and SE received more aggressive interventions both by prehospital emergency services (OR: 2.89; 95% CI, 1.91-4.36; P<.001) and at the emergency department (OR: 4.41; 95% CI, 2.69-7.22; P<.001). CONCLUSIONS: This risk model may be of prognostic value in identifying adult patients at risk of presenting seizure cluster or SE in the emergency department. In our sample, these patients received more aggressive treatment than adult patients with isolated seizures before arriving at hospital, and even more so in the emergency department.

Risk model of seizure cluster or status epilepticus and intervention in the emergency department. / Modelo de riesgo de crisis en acúmulos o estado epiléptico e intervención en servicios de urgencias.

OBJECTIVES: To identify possible predictors of seizure cluster or status epilepticus (SE) and to evaluate whether these patients receive greater interventions in emergency departments. METHODOLOGY: We conducted a secondary analysis of the ACESUR Registry, a multipurpose, observational, prospective, multicentre registry of adult patients with seizures from 18 emergency departments. Clinical and care-related variables were collected. We identified risk factors and risk models for seizure cluster or SE and assessed the effect of interventions by prehospital emergency services and the hospital emergency department. RESULTS: We identified a total of 186 (28%) patients from the ACESUR registry with seizure cluster (126 [19%]) or SE (60 [9%]); the remaining 478 patients (72%) had isolated seizures. The risk model for seizure cluster or SE in the emergency department included Charlson Comorbidity Index scores≥3 (OR: 1.60; 95% CI, 1.05-2.46; P=.030), ≥2 habitual antiepileptic drugs (OR: 2.29; 95% CI, 1.49-3.51; P<.001), and focal seizures (OR: 1.56; 95% CI, 1.05-2.32; P=.027). The area under the curve of the model was 0.735 (95% CI, 0.693-0.777; P=.021). Patients with seizure cluster and SE received more aggressive interventions both by prehospital emergency services (OR: 2.89; 95% CI, 1.91-4.36; P<.001) and at the emergency department (OR: 4.41; 95% CI, 2.69-7.22; P<.001). CONCLUSIONS: This risk model may be of prognostic value in identifying adult patients at risk of presenting seizure cluster or SE in the emergency department. In our sample, these patients received more aggressive treatment than adult patients with isolated seizures before arriving at hospital, and even more so in the emergency department.

Rendimiento diagnóstico de la troponina de alta sensibilidad en el síndrome coronario agudo sin elevación del segmento ST / Diagnostic performance of high sensitive troponin in non-ST elevation acute coronary syndrome

Objetivo: Los objetivos del estudio son evaluar el rendimiento diagnóstico de la troponina cardiaca T de alta sensibilidad (TnTc-hs) en pacientes con sospecha de síndrome coronario agudo sin elevación del segmento ST (SCASEST), confirmar si permite acortar el tiempo hasta el diagnóstico y analizar las consecuencias clínicas derivadas de su utilización. Método: Se trata de un estudio observacional, longitudinal y prospectivo, realizado en 5 servicios de urgencias hospitalarias. Se incluyó de forma consecutiva a los pacientes que acudían por dolor torácico sospechoso de SCASEST. El manejo del paciente y el tratamiento aplicado siguieron los protocolos internos basados en las guías de consenso de la Sociedad Europea de Cardiología. Se realizaron determinaciones seriadas de Tnc convencional (4ªG) y de TnTc-hs. Resultados: Se incluyó en el estudio a 351 pacientes. El diagnóstico final de infarto agudo de miocardio (IAM) se estableció en 77 pacientes del total, angina inestable en 102 y 172 fueron pacientes diagnosticados como sin síndrome coronario agudo. Los valores de TnTc-hs estaban por encima del p99 en un alto número de pacientes sin IAM. En la determinación inicial del paciente, la sensibilidad diagnóstica de la TnTc-hs fue significativamente superior a la de la TnTc 4ªG (87,0 vs. 42,9%), lo que comportó un valor predictivo negativo del 95,1%. Conclusiones: La TnTc-hs mejora el rendimiento diagnóstico al compararla con el ensayo de Tnc convencional, acorta el tiempo hasta el diagnóstico y reconoce mayor número de pacientes con IAM más pequeños

Objective: To assess the diagnostic performance of high-sensitivity troponin T (hs-TnT) in patients with suspected non-ST elevation acute coronary syndrome (NSTE-ACS); confirm whether it shortens the time to diagnosis; and analyze the clinical consequences derived from its use. Method: A prospective, longitudinal observational study was carried out in 5 emergency care departments. Patients seen for chest pain with suspected of NSTE-ACS were consecutively included. Patient care followed the internal protocols of the center, based on the consensus guidelines of the European Society of Cardiology. Serial conventional cardiac troponin (cTn) and hs-TnT determinations were made. Results: A total of 351 patients were included in the study. A final diagnosis of acute myocardial infarction (AMI) was established in 77 patients, with unstable angina in 102, and no acute coronary syndrome in 172 patients. The hs-TnT values were above percentile 99% in a large number of patients without AMI. In the initial determination, the diagnostic sensitivity of the hs-TnT was significantly greater than that of cTn (87.0% vs. 42.9%), which led to a negative predictive value of 95.1%. Conclusions: High-sensitivity troponin T improves diagnostic performance compared with conventional troponin assay, shortens the time to diagnosis, and identifies a larger number of patients with smaller myocardial infarctions

Diagnostic performance of high sensitive troponin in non-ST elevation acute coronary syndrome. / Rendimiento diagnóstico de la troponina de alta sensibilidad en el síndrome coronario agudo sin elevación del segmento ST.

OBJECTIVE: To assess the diagnostic performance of high-sensitivity troponin T (hs-TnT) in patients with suspected non-ST elevation acute coronary syndrome (NSTE-ACS); confirm whether it shortens the time to diagnosis; and analyze the clinical consequences derived from its use. METHOD: A prospective, longitudinal observational study was carried out in 5 emergency care departments. Patients seen for chest pain with suspected of NSTE-ACS were consecutively included. Patient care followed the internal protocols of the center, based on the consensus guidelines of the European Society of Cardiology. Serial conventional cardiac troponin (cTn) and hs-TnT determinations were made. RESULTS: A total of 351 patients were included in the study. A final diagnosis of acute myocardial infarction (AMI) was established in 77 patients, with unstable angina in 102, and no acute coronary syndrome in 172 patients. The hs-TnT values were above percentile 99% in a large number of patients without AMI. In the initial determination, the diagnostic sensitivity of the hs-TnT was significantly greater than that of cTn (87.0% vs. 42.9%), which led to a negative predictive value of 95.1%. CONCLUSIONS: High-sensitivity troponin T improves diagnostic performance compared with conventional troponin assay, shortens the time to diagnosis, and identifies a larger number of patients with smaller myocardial infarctions.

[Asymmetries in the hospital treatment of acute ischemic stroke]. / Asimetrías en el tratamiento hospitalario del ictus isquémico en fase aguda.

OBJECTIVE: To analyze the degree of implementation of the protocolized care for acute stroke in the Spanish emergency departments and to discuss the territorial differences in the treatment of stroke. MATERIAL AND METHODS: Multicenter national survey conducted to evaluate the current treatment of ischemic stroke in emergency departments. The main variables analyzed were focused at evaluating the participation of ERs in the performance of thrombolysis, interventional treatment and destination of patients with stroke. RESULTS: 42 emergency services participated. 90.5% have stroke protocol. In 52.4% is identified an emergency physician referent in cerebrovascular pathology. In 2016 2090 thrombolysis were performed, we observe a great variability in the number of treatments per hospital [0-222]. 11.9% were admitted in the Observation area. Only one-third of the hospitals currently treat stroke with thrombectomy. 31% have a telemedicine service available. CONCLUSIONS: Urgencies plays a fundamental role in the chain of care of stroke treatment. There is a worrying variability between centers in the management of the stroke.

Valoración de los factores pronósticos radiopatológicos del cáncer de mama triple negativo y análisis del carcinoma in situ como factor pronóstico / Imaging and histologic prognostic factors in triple-negative breast cancer and carcinoma in situ as a prognostic factor

Objetivos. Analizar qué factores valorados en resonancia magnética (RM) y anatomopatológicos de los tumores triple negativo (TN) se relacionan con la recidiva tumoral y con una menor supervivencia libre de enfermedad. Valorar la supervivencia y las recidivas en función de la presencia de componente in situ (CIS). Material y métodos. Estudio retrospectivo de las RM realizadas desde 2007 a 2014, con inclusión de 122 mujeres con cáncer de mama TN y RM de estadificación. En RM se valoraron las características morfológicas (tamaño, márgenes, morfología y señal interna en secuencia T2) y dinámicas (perfusión y difusión). Se estudiaron también los factores anatomopatológicos (Ki67, p53, CK5/6, grado nuclear y Scarff-Bloom) y se analizó la presencia de CIS y el grado tumoral (alto o no alto grado). Se compararon las distintas variables con la presencia de recidiva y se realizó estudio de supervivencia. Resultados. El realce no nodular presentó mayor porcentaje en el grupo de recidivas, y la diferencia fue estadísticamente significativa (p=0,038) y se relacionó con una menor supervivencia libre de enfermedad (p=0,023). La restricción a la difusión (p=0,079) y el ki67 (p=0,052) no asociaron un peor pronóstico. Se detectó CIS en el 44% de los TN, con mayor proporción en el grupo de recidiva, sin relación con una menor supervivencia (p = 0,185). Conclusión. El realce no nodular demostró ser un factor de peor pronóstico. La restricción a la difusión, el ki67 y la presencia de CIS no se asociaron a una menor supervivencia libre de enfermedad (AU)

Objectives. To analyze what factors in magnetic resonance imaging (MRI) and histological study of triple-negative breast cancers are related to tumor recurrence and to shorter disease-free survival. To analyze survival and recurrence in function of the presence of an in situ component. Material and methods. This was a retrospective study of MRI staging examinations in 122 women with triple-negative breast cancer done from 2007 through 2014. In the MRI, we evaluated morphological variables (size, margins, morphology, internal signal in T2-weighted sequences) and dynamic variables (perfusion and diffusion). In the histological study, we evaluated Ki67, p53, CK5/6, nuclear grade, and Scarff-Bloom grade, as well as the presence of an in situ component and tumor grade (high grade or not high grade). We compared the variables between patients with tumor recurrence and those without, and we conducted a survival analysis. Results. Non-nodular enhancement was more common in patients with tumor recurrence (p=0.038) and was associated with shorter disease-free survival (p=0.023). Neither diffusion restriction (p=0.079) nor ki67 (p=0.052) was associated with a worse prognosis. An in situ component was detected in 44% of triple-negative tumors, and a greater proportion of patients in the group with tumor recurrence had an in situ component; however, the presence of an in situ component was not associated with shorter survival (p = 0.185). Conclusion. Non-nodular enhancement was associated with a worse prognosis. Diffusion restriction, ki67, and the presence of an in situ component were not associated with shorter disease-free survival (AU)

Imaging and histologic prognostic factors in triple-negative breast cancer and carcinoma in situ as a prognostic factor. / Valoración de los factores pronósticos radiopatológicos del cáncer de mama triple negativo y análisis del carcinoma in situ como factor pronóstico.

OBJECTIVES: To analyze what factors in magnetic resonance imaging (MRI) and histological study of triple-negative breast cancers are related to tumor recurrence and to shorter disease-free survival. To analyze survival and recurrence in function of the presence of an in situ component. MATERIAL AND METHODS: This was a retrospective study of MRI staging examinations in 122 women with triple-negative breast cancer done from 2007 through 2014. In the MRI, we evaluated morphological variables (size, margins, morphology, internal signal in T2-weighted sequences) and dynamic variables (perfusion and diffusion). In the histological study, we evaluated Ki67, p53, CK5/6, nuclear grade, and Scarff-Bloom grade, as well as the presence of an in situ component and tumor grade (high grade or not high grade). We compared the variables between patients with tumor recurrence and those without, and we conducted a survival analysis. RESULTS: Non-nodular enhancement was more common in patients with tumor recurrence (p=0.038) and was associated with shorter disease-free survival (p=0.023). Neither diffusion restriction (p=0.079) nor ki67 (p=0.052) was associated with a worse prognosis. An in situ component was detected in 44% of triple-negative tumors, and a greater proportion of patients in the group with tumor recurrence had an in situ component; however, the presence of an in situ component was not associated with shorter survival (p = 0.185). CONCLUSION: Non-nodular enhancement was associated with a worse prognosis. Diffusion restriction, ki67, and the presence of an in situ component were not associated with shorter disease-free survival.

Resonancia magnética en el cáncer de mama tratado con neoadyuvancia: correlación radiopatológica de la respuesta y supervivencia libre de enfermedad en función del subtipo molecular / Magnetic resonance imaging in breast cancer treated with neoadjuvant chemotherapy: Radiologic-pathologic correlation of the response and disease-free survival depending on molecular subtype

Objetivos. Valorar la respuesta radiológica, patológica y su correlación en los subtipos moleculares del cáncer de mama y analizar su implicación en la supervivencia libre de enfermedad. Material y métodos. Se incluyeron 205 pacientes con cáncer de mama tratadas con quimioterapia neoadyuvante. Se valoró la respuesta radiológica con RM pre y posquimioterapia. La respuesta patológica se clasificó según la escala de Miller y Payne. Se valoró la respuesta radiológica y patológica en cada subtipo (HER2+, TN, luminal A, luminal B HER2- y luminal B HER2+), la correlación radiopatológica y la supervivencia libre de enfermedad mediante las pruebas χ2, t de Student, ANOVA y Tau-b de Kendall. Resultados. Los subtipos HER2+ (62,1%) y TN (45,2%) mostraron mayor tasa de respuesta radiológica completa. La respuesta patológica fue del 65,5% en el HER2+, 38,1% en el TN, 2,6% en los luminales A, 8,2% en los luminales B HER2- y 31% en los luminales B HER2+. El índice de correlación radiopatológico fue significativo en todos los subtipos, mayor en los TN y HER2 (coeficientes Tau-b 0,805 y 0,717 respectivamente). La supervivencia libre de enfermedad fue mayor para HER2+ (91,9 ± 3,3 meses) y menor en el TN (69,5 ± 6,3 meses), con diferencias significativas entre los casos de mala y buena respuesta radiológica (p = 0,040). La supervivencia fue superior en los casos de buena respuesta radiológica a excepción del subtipo luminal A. Conclusión. La RM puede ser una herramienta que aporta información de la evolución del CM tratado con neoadyuvancia, variable según el subtipo inmunohistoquímico (AU)

Objectives. To evaluate the radiologic and pathologic responses to neoadjuvant chemotherapy and their correlation in the molecular subtypes of breast cancer and to analyze their impact in disease-free survival. Material and methods. We included 205 patients with breast cancer treated with neoadjuvant chemotherapy. We evaluated the radiologic response by comparing MRI images acquired before and after chemotherapy. The pathologic response was classified on the Miller and Payne scale. For each subtype (HER2+, TN, luminal A, luminal B HER2-, and luminal B HER2+), we used the χ2 test, Student's t-test, ANOVA, and Kendall's Tau-b to evaluate the radiologic response and the pathologic response, the radiologic-pathologic correlation, and the disease-free survival. Results. The subtypes HER2+ (62.1%) and TN (45.2%) had higher rates of complete radiologic response. The pathologic response was 65.5% in the HER2+ subtype, 38.1% in the TN subtype, 2.6% in the luminal A subtype, 8.2% in the luminal B HER2- subtype, and 31% in the luminal B HER2+ subtype. The rate of radiologic-pathologic correlation was significant in all subtypes, higher in TN and HER2 (Tau-b coefficients 0.805 and 0.717, respectively). Disease-free survival was higher in HER2+ (91.9 ± 3.3 months) and lower in TN (69.5 ± 6.3 months), with significant differences between the cases with poor and good radiologic responses (P=.040). Survival was greater in cases with good radiologic response, except in cases with luminal A subtype. Conclusion. MRI can be a useful tool that provides information about the evolution of breast cancer treated with neoadjuvant chemotherapy, which varies with the immunohistochemical subtype (AU)

Introducción de Neurología en un hospital comarcal / Introducing a neurology department at a local hospital

No disponible

Magnetic resonance imaging in breast cancer treated with neoadjuvant chemotherapy: radiologic-pathologic correlation of the response and disease-free survival depending on molecular subtype.

OBJECTIVES: To evaluate the radiologic and pathologic responses to neoadjuvant chemotherapy and their correlation in the molecular subtypes of breast cancer and to analyze their impact in disease-free survival. MATERIAL AND METHODS: We included 205 patients with breast cancer treated with neoadjuvant chemotherapy. We evaluated the radiologic response by comparing MRI images acquired before and after chemotherapy. The pathologic response was classified on the Miller and Payne scale. For each subtype (HER2+, TN, luminal A, luminal B HER2-, and luminal B HER2+), we used the χ(2) test, Student's t-test, ANOVA, and Kendall's Tau-b to evaluate the radiologic response and the pathologic response, the radiologic-pathologic correlation, and the disease-free survival. RESULTS: The subtypes HER2+ (62.1%) and TN (45.2%) had higher rates of complete radiologic response. The pathologic response was 65.5% in the HER2+ subtype, 38.1% in the TN subtype, 2.6% in the luminal A subtype, 8.2% in the luminal B HER2- subtype, and 31% in the luminal B HER2+ subtype. The rate of radiologic-pathologic correlation was significant in all subtypes, higher in TN and HER2 (Tau-b coefficients 0.805 and 0.717, respectively). Disease-free survival was higher in HER2+ (91.9±3.3 months) and lower in TN (69.5±6.3 months), with significant differences between the cases with poor and good radiologic responses (P=.040). Survival was greater in cases with good radiologic response, except in cases with luminal A subtype. CONCLUSION: MRI can be a useful tool that provides information about the evolution of breast cancer treated with neoadjuvant chemotherapy, which varies with the immunohistochemical subtype.

Nuevos fármacos antiagregantes en el síndrome coronario agudo y su utilización en el servicio de urgencias / New platelet aggregation inhibitors in acute coronary syndrome in the emergency department

En los últimos años ha habido novedades significativas en las estrategias de manejo yen los fármacos utilizados en el tratamiento del síndrome coronario agudo (SCA). Hasta hoy, las guías de práctica clínica recomendaban el uso de doble terapia antiagregante con aspirina y clopidogrel. Dos nuevos inhibidores del receptor P2Y12 (prasugrel y ticagrelor) han sido aprobados como tratamiento del SCA, y muestran una inhibición plaquetaria más rápida y más eficaz. Esta incorporación a la práctica clínica implica un cambio importante en el manejo de estos pacientes en su fase aguda. Se revisa brevemente la fisiopatología del proceso trombótico, los inicios de la antiagregación y los ensayos clínicos llevados a cabo con estos nuevos fármacos, así como su utilización en los servicios de urgencias (AU)

New pharmacologic strategies for managing acute coronary syndrome (ACS) have emerged in recent years. Clinical guidelines continue to recommend dual antiplatelet therapy with aspirin and clopidogrel. Two recently approved P2Y12inhibitors, prasugrel and ticagrelor, have been shown to act faster and more effectively in treating ACS. These drugs mark an important turning point in the emergency management of ACS. We briefly review the pathophysiology of the thrombotic process and recall the early history of antiplatelet therapy. We explain the results of clinical trials of these new drugs and their use in the emergency department (AU)

[Lumbago and its impact on primary care]. / Las lumbalgias y su impacto en atención primaria.

OBJECTIVE: To analyse the effect of Back Pain on Primary Care. DESIGN: Retrospective descriptive study. SITE. "Miralbueno" Health Centre in Zaragoza. PATIENTS: Those patients seen at our Health Centre for the above reason between January 1 and August 31, 1990. MAIN MEASUREMENTS AND RESULTS: 53 cases were recorded: 1.83% of the total number seen. The largest number of cases were of patients between 30 and 50 years old, with no differences as to sex, 35.8% presented radicular irradiation, 5.7% sensitive involvement, 7.5% motor involvement and 9.4% alteration of the osteotendinous reflexes. The average case lasted 21.3 days, with the cases where there was neurological involvement lasting on average longer. Ten patients needed time off work, which meant the loss of 181 working days. CONCLUSIONS: Cases of back pain, which are a common problem at the Primary Care level, should be the target of organisational efforts to cut waiting times for further tests and treatment, in order to reduce the mental and socio-economic repercussions of this pathology.