Checkpoint inhibitor-induced fulminant myocarditis, complete atrioventricular block and myasthenia gravis-a case report.

Immune checkpoint inhibitors (ICIs) have revolutionized cancer therapy over the last decade. Pembrolizumab, a humanized monoclonal IgG4 antibody, binds to the programmed death 1 (PD-1) receptor, blocking its interaction with programmed death-ligand 1 (PD-L1) and thereby increasing the anti-tumor activity of the host immune system. These drugs are associated with immune-mediated side effects that can be life threatening, and myocarditis is among the most serious events. We present a 48-year-old woman with a history of progressive thymoma who developed complete atrioventricular block associated with fulminant myocarditis and myasthenia gravis 2 weeks after starting treatment with pembrolizumab. She had also presented a couple of days before to the emergency department due to dyspnea that was related to pleural effusion. Electrocardiogram (ECG) and echocardiogram were unremarkable, but she had very mildly increased troponin levels that were attributed to acute respiratory compromise, so she was discharged after successful thoracentesis. Despite aggressive treatment combination of high-dose corticosteroids, immunosuppressive agents and anti-thymocyte globulin, the disease rapidly progressed to the fatal outcome. This report remarks on the importance of rapid consideration of ICI-induced myocarditis even if cardiac biomarkers are slightly elevated, as a mild presentation can go unnoticed and progress to a severe case. Therefore, a high index of suspicion is warranted in these patients and cardiac imaging techniques such as magnetic resonance could have a role diagnosing incipient cardiac inflammation.

Cuestionario/guía para la evaluación de proyectos de investigación con datos por un CEI / Questionnaire/guide for the evaluation of research projects with personal data by a Research Ethics Committee

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La legitimación para el tratamiento de categorías especiales de datos con finalidades de investigación en el marco del Reglamento (UE) 2016/679 y de la Ley Orgánica 3/2018 / Legitimation for the processing of special categories of data for research purposes within the framework of Regulation (EU) 2016/679 and Fundamental Law 3/2018

La entrada en vigor del Reglamento (UE) 2016/679 del Parlamento y el Consejo Europeo, de 27 de abril de 2016, relativo a la protección de las personas físicas en cuanto al tratamiento de datos personales y a la libre circulación de estos datos y por el cual se deroga la Directiva 95/46/CE (en adelante Reglamento (UE) 2016/679), y de la Ley Orgánica 3/2018, de 5 de diciembre, de Protección de Datos Personales y garantía de los derechos digitales (en adelante LOPD-GDD), supone un impacto directo en las condiciones de uso de datos de salud o datos genéticos para investigación biomédica. A través del Reglamento (UE) 2016/679, y en especial de la Disposición Adicional decimoséptima de la LOPD-GDD, se regulan las condiciones de uso de datos de salud y genéticos con finalidades de investigación, introduciendo novedades en cuanto a su uso y ofreciendo nuevas bases de legitimación para su uso, siendo necesario analizar la incidencia práctica que van a tener

The entry into force of Regulation (EU) 2016/679 of the European Parliament and of the Council of 27 April 2016 on the protection of natural persons with regard to the processing of personal data and on the free movement of such data, and repealing Directive 95/46/EC (here in after Regulation (EU) 2016/679), and Organic Law 3/2018, of December 5, on the Protection of Personal Data and guarantee of digital rights (in forward LOPD-GDD), implies a direct impact on the conditions of the use of health data or genetic data for biomedical research. The Regulation (EU) 2016/679, and especially the additional seventeenth provision of LOPD-GDD, establish the conditions for the use of health and genetic data for research purposes and introducing and offering new bases of legitimacy for their use. It is necessary to analyze the practical implications that they are going to have

Evaluación de proyectos de investigación con tecnología Big Data por un Comité de Ética de la investigación / Evaluation of research projects with Big Data technology by a Research Ethics Committee

La investigación con tecnología Big Data en el ámbito sanitario debe realizarse en el contexto de un marco ético y jurídico que garantice el máximo nivel de protección en el tratamiento de datos de carácter personal. Los comités de ética de la investigación, como garantes de los derechos, seguridad y bienestar de los sujetos que participan en un proyecto de investigación biomédica, deben verificar el cumplimiento de los principios éticos y legales aplicables a la investigacion con datos de salud. En este trabajo se revisan los principios éticos y legales aplicables a la investigación con Big Data, así como las funciones que deben desempeñar los comités de ética de la investigación en la evaluación de este tipo de estudios

Research with Big Data technology in the world of health must be carried out within an ethical and legal framework that guarantees the highest level of protection in the processing of personal data. The research ethics committees, as guarantors of the rights, safety and welfare of the subjects participating in a biomedical research project, must verify compliance with the ethical and legal principles applicable to research with health data. In this paper, we review the ethical and legal principles applicable to research with Big Data, as well as the functions that the research ethics committees must perform in the evaluation of this type of studies

Ocular relapse of primary brain lymphoma in immunocompetent patient, treated with intrathecal rituximab.

Primary brain lymphoma is a rare variant of extranodal non-Hodgkin's B-cell lymphoma. In >90% of cases, this is diffuse large B-cell lymphoma with CD20 expression and is confined to the brain, meninges, spinal cord, and eyes. It accounts for fewer than 7% of primary brain tumors. Its incidence has been rising in recent years in immunocompetent patients in their fifth and sixth decades. The rate of relapse after initial therapy based on high-dose methotrexate and/or total brain irradiation is high. There is no consensus for treating relapse, which ranges from retreatment with high doses of methotrexate, polychemotherapy, high doses of chemotherapy backed up by autologous stem-cell transplant to intrathecal chemotherapy, with widely differing results. Given the lack of consensus and poor results, new therapy options have appeared, including immunotherapy with rituximab. At a systemic level, alongside chemotherapy, its results are very modest and limited due to the low concentration it reaches in cerebrospinal fluid (CSF). However, its intrathecal and intraventricular use, though only isolated cases have been reported, has provided promising results.