Neratinib + fulvestrant + trastuzumab for HR-positive, HER2-negative, HER2-mutant metastatic breast cancer: outcomes and biomarker analysis from the SUMMIT trial.

BACKGROUND: HER2 mutations are targetable alterations in patients with hormone receptor-positive (HR+) metastatic breast cancer (MBC). In the SUMMIT basket study, patients with HER2-mutant MBC received neratinib monotherapy, neratinib + fulvestrant, or neratinib + fulvestrant + trastuzumab (N + F + T). We report results from 71 patients with HR+, HER2-mutant MBC, including 21 (seven in each arm) from a randomized substudy of fulvestrant versus fulvestrant + trastuzumab (F + T) versus N + F + T. PATIENTS AND METHODS: Patients with HR+ HER2-negative MBC with activating HER2 mutation(s) and prior cyclin-dependent kinase 4/6 inhibitor (CDK4/6i) therapy received N + F + T (oral neratinib 240 mg/day with loperamide prophylaxis, intramuscular fulvestrant 500 mg on days 1, 15, and 29 of cycle 1 then q4w, intravenous trastuzumab 8 mg/kg then 6 mg/kg q3w) or F + T or fulvestrant alone. Those whose disease progressed on F + T or fulvestrant could cross-over to N + F + T. Efficacy endpoints included investigator-assessed objective response rate (ORR), clinical benefit rate (RECIST v1.1), duration of response, and progression-free survival (PFS). Plasma and/or formalin-fixed paraffin-embedded tissue samples were collected at baseline; plasma was collected during and at end of treatment. Extracted DNA was analyzed by next-generation sequencing. RESULTS: ORR for 57 N + F + T-treated patients was 39% [95% confidence interval (CI) 26% to 52%); median PFS was 8.3 months (95% CI 6.0-15.1 months). No responses occurred in fulvestrant- or F + T-treated patients; responses in patients crossing over to N + F + T supported the requirement for neratinib in the triplet. Responses were observed in patients with ductal and lobular histology, 1 or ≥1 HER2 mutations, and co-occurring HER3 mutations. Longitudinal circulating tumor DNA sequencing revealed acquisition of additional HER2 alterations, and mutations in genes including PIK3CA, enabling further precision targeting and possible re-response. CONCLUSIONS: The benefit of N + F + T for HR+ HER2-mutant MBC after progression on CDK4/6is is clinically meaningful and, based on this study, N + F + T has been included in the National Comprehensive Cancer Network treatment guidelines. SUMMIT has improved our understanding of the translational implications of targeting HER2 mutations with neratinib-based therapy.

Electrochemical Impedance Analysis for Corrosion Rate Monitoring of Sol-Gel Protective Coatings in Contact with Nitrate Molten Salts for CSP Applications.

The protective behaviour of ZrO2-3%molY2O3 sol-gel coatings, deposited with an immersion coating technique on 9Cr-1Mo P91 steel, was evaluated with corrosion monitoring sensors using the electrochemical impedance spectroscopy technique. The tests were carried out in contact with solar salt at 500 °C for a maximum of 2000 h. The results showed the highly protective behaviour of the coating, with the corrosion process in the coated system being controlled by the diffusion of charged particles through the protective layer. The coating acts by limiting the transport of ions and slowing down the corrosive process. The system allowed a reduction in the corrosion rate of uncoated P91 steel. The estimated corrosion rate of 22.62 µm·year-1 is lower than that accepted for in-service operations. The proposed ZrO2-3%molY2O3 sol-gel coatings are an option to mitigate the corrosion processes caused by the molten salts in concentrated solar power plants.

A first-in-human study of the anti-LAG-3 antibody favezelimab plus pembrolizumab in previously treated, advanced microsatellite stable colorectal cancer.

BACKGROUND: Treatment options are limited for participants with microsatellite stable (MSS) metastatic colorectal cancer (mCRC) that progressed after two or more prior therapies. Studies have shown that blockade of both lymphocyte-activation gene 3 (LAG-3) and programmed cell death protein 1 (PD-1) can improve antitumor activity. Here, we evaluate the antitumor activity of the LAG-3 antibody favezelimab alone or in combination with pembrolizumab in participants with MSS mCRC. PATIENTS AND METHODS: Eligible participants with MSS PD-1/programmed death-ligand 1 (PD-L1) treatment-naive mCRC that progressed on two or more prior therapies received 800 mg favezelimab, 800 mg favezelimab plus 200 mg pembrolizumab, or 800 mg favezelimab/200 mg pembrolizumab co-formulation, every 3 weeks. The primary endpoint was safety, the secondary endpoint was objective response rate (ORR), and exploratory endpoints included duration of response, progression-free survival (PFS), and overall survival (OS). RESULTS: At the data cut-off date of 23 October 2020, a total of 20 participants received favezelimab alone, 89 received favezelimab plus pembrolizumab (including as favezelimab/pembrolizumab co-formulation); 48 had PD-L1 combined positive score (CPS) ≥1 tumors. At this interim analysis median follow-up was 5.8 months with favezelimab and 6.2 with favezelimab plus pembrolizumab. Treatment-related adverse events (TRAEs) were 65% with favezelimab and 65.2% with favezelimab plus pembrolizumab. Grade ≥3 TRAEs were 15% with favezelimab and 20% with favezelimab plus pembrolizumab. No grade 5 TRAEs occurred. Common TRAEs (≥15%) included fatigue (20.0%), nausea (15.0%) with favezelimab, and fatigue (16.9%) with favezelimab plus pembrolizumab. Confirmed ORR was 6.3% with favezelimab plus pembrolizumab, with median duration of response of 10.6 months (range 5.6-12.7 months), median OS of 8.3 months (95% confidence interval 5.5-12.9 months), and median PFS of 2.1 months (1.9-2.2 months). In an exploratory analysis of PD-L1 CPS ≥1 tumors, the confirmed ORR was 11.1%, median OS was 12.7 months (4.5 to not reached), and median PFS was 2.2 months (1.8-4.2 months) with favezelimab plus pembrolizumab. CONCLUSIONS: Favezelimab with or without pembrolizumab had a manageable safety profile, with no treatment-related deaths. Promising antitumor activity was observed with combination therapy, particularly in participants with PD-L1 CPS ≥1 tumors.

[Evaluation of the effectiveness of the new perioperative model to recover surgical activity during the COVID-19 pandemic]. / Evaluación de la efectividad del nuevo modelo perioperatorio para recuperar la actividad quirúrgica durante la pandemia de COVID-19.

INTRODUCTION: The first wave of the COVID-19 pandemic caused the cancellation of elective interventions. After the improvement of the epidemiological situation, new models of care were applied in hospitals to restart the programmed surgical activity. The aim was to evaluate the effectiveness of the organizational model established to recover surgical activity during the transition period of the COVID-19 pandemic. METHODS: Retrospective observational study comparing patients who underwent schedule surgery from September 1 until October 31, 2020, study group, with a control group of the same period of time corresponding to the year 2019 at the General Hospital from the Vall d'Hebron University Hospital. RESULTS: The total population included 1,825 patients, 888 in the study group and 937 in the control group. Global surgical activity decreased 6.43% during the study period compared to the same period in 2019, with a 25.5% decrease in cancer surgeries. Seven patients became infected with SARS-CoV-2 during their hospital stay. In hospital mortality was 0.9% in the study group compared to 0.7% in control group (p=0.8). The survival rate in cancer patients at 90 days was lower in the study group (95.7% vs 98.7%; p=0.02). CONCLUSIONS: The change in the management model during the transition period of the COVID-19 pandemic allowed the recovery of programmed surgical activity to levels similar to those existing prior to the pandemic with a greater impact on cancer surgery.

Ultrasound diagnosis of a case of transient bilateral vocal cord paralysis secondary to local anesthetic infiltration. / Diagnóstico ecográfico de un caso de parálisis bilateral transitoria de las cuerdas vocales secundario a infiltración de anestésico local.

One of the most important complications associated with thyroid and parathyroid surgery is vocal cord paralysis due to a recurrent laryngeal nerve injury. Recurrent laryngeal nerve injury paralysis induced by local anesthetics is a rare complication with very few published cases Various techniques are available for diagnosing vocal cord paralysis, including, flexible fiberoptic laryngoscopy, videostrobolaryngoscopy and indirect laryngoscopy. However, these techniques are expensive and are often associated with pain and discomfort among patients. Considering these disadvantages, transcutaneous laryngeal ultrasound is an alternative imaging tool for vocal cord examination in patients undergoing thyroid and parathyroid surgery. We describe a case which was sonographically diagnosed a transient bilateral vocal cord paralysis after the local infiltration of 10mL of 2% mepivacaine administered for the revision of the surgical wound due to a subcutaneous hematoma that occurred after a subtotal parathyroidectomy.

Hipertirotropinemia en pediatría, ¿cómo debemos actuar? / Hyperthyrotropinaemia in children; What should we do?

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Comparative performance of lateral flow immunochromatography, iELISA and Rose Bengal tests for the diagnosis of cattle, sheep, goat and swine brucellosis.

BACKGROUND: Brucellosis is a world-wide extended zoonosis that causes a grave problem in developing economies. Animal vaccination and diagnosis are essential to control brucellosis, and the need for accurate but also simple and low-cost tests that can be implemented in low-infrastructure laboratories has been emphasized. METHODOLOGY: We evaluated bovine, sheep, goat and swine lateral flow immunochromatography assay kits (LFA), the Rose Bengal test (RBT) and a well-validated protein G indirect ELISA (iELISA) using sera of Brucella culture-positive and unvaccinated brucellosis free livestock. Sera from cattle vaccinated with S19 and RB51 brucellosis vaccines were also tested. Finally, we compared RBT and LFA using sera of white Fulani cattle of unknown bacteriological status from a brucellosis endemic area of Nigeria. RESULTS AND CONCLUSIONS: Although differences were not statistically significant, RBT showed the highest values for diagnostic sensitivity/specificity in cattle (LFA, 96.6/98.8; RBT, 98.9/100; and iELISA, 96.6/100) and the iELISA yielded highest values in sheep (LFA, 94.0/100; RBT, 92.0/100; iELISA, 100/100), goats (LFA, 95.7/96.2; RBT, 97.8/100; iELISA, 100/100) and pigs (LFA, 92.3/100; RBT, 92.3/100; iELISA, 100/100). Vaccine S19 administered subcutaneously interfered in all tests but conjunctival application minimized the problem. Although designed not to interfere in serodiagnosis, vaccine RB51 interfered in LFA and iELISA but not in the RBT. We found closely similar apparent prevalence results when testing the Nigerian Fulani cattle by RBT and LFA. Although both RBT and LFA (showing similar diagnostic performance) are suitable for small laboratories in resource-limited areas, RBT has the advantage that a single reagent is useful in all animal species. Considering these advantages, its low cost and that it is also useful for human brucellosis diagnosis, RBT might be a good choice for resource-limited laboratories.

Tobacco Use Worldwide: Legislative Efforts to Curb Consumption.

Tobacco smoking is recognized as a major preventable cause of disease worldwide and is linked to 6 million deaths annually, 30% of which are due to cancer. The negative health consequences of smoking currently represent one of the greatest global public health challenges. Additionally, secondhand smoke, which was declared carcinogenic by the International Agency for Research on Cancer in 2004, is a major source of morbidity and premature death in nonsmokers, particularly children. Negative health effects associated with exposure to secondhand smoke have been well documented and include lung cancer, cardiovascular disease, asthma, and other respiratory diseases. International and national policies to implement cost-effective strategies to curtail smoking will have a significant impact on population health and will protect nonsmokers. Effective interventions, such as smoking bans, tobacco price increases, easy access to tobacco cessation treatments, and anti-tobacco media campaigns, should continue. Reducing tobacco use would be a major step towards the goal of decreasing health disparities by 2030, as 80% of the projected tobacco-related deaths will occur in low and middle-income countries.

Modelling farmer choices for water security measures in the Litani river basin in Lebanon.

Lebanon is facing an increasing water supply deficit due to the increasing demand for freshwater, decreasing surface and groundwater resources and malfunctioning water governance structures. Technological and policy changes are needed to alleviate the impact of water scarcity and secure water in the future. This paper investigates farmers' preferences and willingness to pay (WTP) in a choice experiment for a series of water saving measures at plot and irrigation district level, including more timely information of water delivery. These measures are expected to strengthen water security and use water more efficiently. Farmers are willing to pay higher water prices of $0.32/m3 and $0.22/m3 to support the implementation of water saving measures at plot level and the installation of water metering devices across the irrigation district, respectively. They are not willing to pay extra for obtaining information related to their water delivery earlier in time if this means that they will also have to pay earlier in the year for the water. Farmers with higher income and education levels who decide on their cropping pattern based on expected rainfall data are more interested in taking action than farmers whose cropping decisions are primarily based on last year's sales prices. The study shows that when aiming to design more effective sustainable water management strategies, accounting for farmers' needs and preferences, their age also has to be considered: younger farmers (<40 years) are on average more interested in and willing to pay more for new water saving measures than older farmers (>40 years).

Impact of specific modes of circumferential resection margin involvement in rectal cancer local recurrence: A retrospective study.

PURPOSE: To compare the local recurrence rate and overall survival between patients with circumferential resection margin (CRM) involvement by direct tumor spread and by a tumor within a lymph node. METHODS: A total of 776 patients diagnosed with rectal cancer underwent rectal resection. Patients with CRM involvement by direct tumor spread were named group A. CRM involvement by tumor within a lymph node formed group B. Patient data, including sex, age, pT, pN, stage I-III versus IV, neoadjuvant radiotherapy, adjuvant chemotherapy, carcinoembryonic antigen, primary tumor location, lymph node retrieval, and need for abdominoperineal resection, were compared between both groups. RESULTS: In total, 10.5% of the patients had CRM involvement. Of these, in 57 cases (7.3%), it was by direct tumor spread and in 19 cases (2.4%) by tumor within a lymph node. Other types of CRM involvement were found in six patients. With a mean follow-up of 32.9 months, 18 patients from group A (31.5%) and one patient from group B (5.2%) suffered a local recurrence. Local recurrence-free survival was significantly higher in patients from group B (P = 0.049). Patients in stage I-III (P = 0.037) and from group B ( P = 0.049) had better overall survival. CONCLUSION: Patients with CRM involvement by tumor within a lymph node have a low risk of local recurrence and better overall survival than patients with CRM involvement by direct tumor spread.

[Effects of hypotherapy on the motor function of persons with Down's syndrome: a systematic review]. / Efectos de la hipoterapia sobre la funcion motora en personas con sindrome de Down: revision sistematica.

INTRODUCTION: Down's syndrome is the main cause of intellectual disability and the most common human genetic alteration. Motor impairments are among the most important alterations presented by Down's syndrome subjects. Hippotherapy is a treatment on and with a horse, and it is currently being used as a therapy to correct those dysfunctions. AIM: To review published research literature on the effect exerted by hippotherapy on the gross motor function of people with Down's syndrome. SUBJECTS AND METHODS: The bibliography in the following databases has been widely searched: CINAHL, Medline, The Cochrane Library, PEDro, Scopus, and Web of Science. The journals Fisioterapia and Cuestiones de Fisioterapia have also been consulted. The electronic literature search strategy was addressed in two thematic fields: Down's syndrome and hippotherapy. Studies selection was carried out following inclusion and exclusion criteria and rejecting duplicate papers. That search included articles published between 2000 and 2016. RESULTS: For this work, 23 articles were found, 15 of which were discarded for different reasons, leaving 8 valid ones. CONCLUSIONS: There is no strong evidence on the improvement of gross motor function in people with Down's syndrome after treatment with hippotherapy. More studies with higher methodological quality, are needed to verify the effectiveness of hippotherapy in the treatment of gross motor function in subjects with Down's syndrome.

TITLE: Efectos de la hipoterapia sobre la funcion motora en personas con sindrome de Down: revision sistematica.Introduccion. El sindrome de Down es la principal causa de discapacidad intelectual y la alteracion genetica humana mas comun. Entre las alteraciones mas importantes que se presentan se encuentran las deficiencias motoras. La hipoterapia es un tratamiento sobre el caballo y con el caballo, y se usa en la actualidad como terapia en la correccion de dichas disfunciones. Objetivo. Analizar las evidencias cientificas existentes sobre el efecto que la hipoterapia ejerce en la funcion motora de personas con sindrome de Down. Sujetos y metodos. Se efectuo una amplia busqueda de la bibliografia en las siguientes bases de datos: CINAHL, Medline, The Cochrane Library, PEDro, Scopus y Web of Science. Ademas, se consultaron las revistas Fisioterapia y Cuestiones de Fisioterapia. Las busquedas se realizaron incluyendo los articulos publicados entre los años 2000 y 2016. La estrategia de busqueda electronica se planteo en dos bloques tematicos: sindrome de Down e hipoterapia. La seleccion de articulos se llevo a cabo siguiendo unos criterios de inclusion y exclusion, y se eliminaron los articulos duplicados. Resultados. En la busqueda realizada para esta investigacion se encontraron 23 articulos, y quedaron como validos ocho despues de excluir el resto por diferentes motivos. Conclusiones. No existen evidencias solidas sobre la mejora o no de la funcion motora en personas con sindrome de Down tras el tratamiento con hipoterapia. Son necesarios mas estudios, y de mayor calidad metodologica, para poder constatar la efectividad de la hipoterapia en el tratamiento de la funcion motora gruesa en sujetos con sindrome de Down.

Epidemiological multicentre study on the education provided to patients with type 2 diabetes mellitus in the Spanish Health Care System. The Forma2 study / Estudio epidemiológico multicéntrico sobre la formación proporcionada a pacientes con diabetes mellitus tipo 2 en el sistema sanitario español. Estudio Forma2

Purpose. The purpose of the present study was to characterize the education that patients with type 2 diabetes mellitus receive, and to identify differences as regards the presence of insulin therapy or not. Methods. This crossover, multicentre and descriptive study involved 1066 Spanish physicians who completed a questionnaire on Internet. Results. The physicians that responded had a mean of 26.0 years of experience in healthcare, and mainly worked in a walk-in clinic in an urban area. Physicians rated the level of patient knowledge about their disease on a 5.0 point-scale. Fifty percent of them indicated that they spent between 15 and 30min in educating patients at the time of diagnosis. Previous control with HbA1c>9%, presence of microvascular complications, and a low socio-cultural level, were factors associated with spending more time in education. Conclusion. This is the first study designed to evaluate the education provided to patients with type 2 diabetes mellitus from Spain. The time spent and the individualization of the education are important factors associated with better long-term control of the disease, and thus with the effectiveness of the clinical management (AU)

Objetivo. El objetivo del presente estudio fue caracterizar la educación que reciben los pacientes con diabetes mellitus tipo 2 e identificar las diferencias existentes en función de la presencia o ausencia de terapia insulínica. Métodos. En este estudio transversal, multicéntrico y descriptivo participaron 1.066 médicos españoles que completaron una encuesta por Internet. Resultados. Los médicos participantes tenían una experiencia media de 26 años en atención sanitaria y principalmente trabajaban en centros de atención primaria de áreas urbanas. Los médicos determinaron el grado de conocimiento de cada paciente en relación con su enfermedad empleando una escala de 5 puntos. El 50% de los médicos indicaron que habían empleado entre 15 y 30min en educar al paciente en el momento del diagnóstico. Los niveles de HbA1c>9%, la presencia de complicaciones microvasculares y un nivel sociocultural bajo fueron los factores asociados a la necesidad de dedicar un mayor tiempo a la educación. Conclusión. (AU)Este es el primer estudio diseñado para evaluar la educación proporcionada al paciente con diabetes mellitus tipo 2 en España. El tiempo dedicado y la individualización de la educación son factores asociados con un mejor control a largo plazo de la enfermedad y, consecuentemente, con una mayor eficacia en su manejo clínico (AU)

Tobacco Use Worldwide: Legislative Efforts to Curb Consumption.

Tobacco smoking is recognized as a major preventable cause of disease worldwide and is linked to 6 million deaths annually, 30% of which are due to cancer. The negative health consequences of smoking currently represent one of the greatest public health challenges. Secondhand smoke, declared carcinogenic by the International Agency for Research on Cancer in 2004, is also a major source of morbidity and premature death in nonsmokers, particularly children. Negative health effects associated with exposure to secondhand smoke have been well documented and include lung cancer, cardiovascular disease, asthma, and other respiratory diseases. International and national policies to implement cost-effective strategies to curtail smoking will have a significant impact on population health and will protect nonsmokers. Effective interventions, such as a combination of smoke-free laws, tobacco price increases, easy access to tobacco cessation treatments, and anti-tobacco media campaigns, should continue. Reducing tobacco use would be a major step towards the goal of decreasing health disparities by 2030 as 80% of the projected tobacco-related deaths will occur in low- and middle-income countries.

Epidemiological multicentre study on the education provided to patients with type 2 diabetes mellitus in the Spanish Health Care System. The Forma2 study.

PURPOSE: The purpose of the present study was to characterize the education that patients with type 2 diabetes mellitus receive, and to identify differences as regards the presence of insulin therapy or not. METHODS: This crossover, multicentre and descriptive study involved 1066 Spanish physicians who completed a questionnaire on Internet. RESULTS: The physicians that responded had a mean of 26.0 years of experience in healthcare, and mainly worked in a walk-in clinic in an urban area. Physicians rated the level of patient knowledge about their disease on a 5.0 point-scale. Fifty percent of them indicated that they spent between 15 and 30min in educating patients at the time of diagnosis. Previous control with HbA1c>9%, presence of microvascular complications, and a low socio-cultural level, were factors associated with spending more time in education. CONCLUSION: This is the first study designed to evaluate the education provided to patients with type 2 diabetes mellitus from Spain. The time spent and the individualization of the education are important factors associated with better long-term control of the disease, and thus with the effectiveness of the clinical management.

The characterization of Brucella strains isolated from cattle in Algeria reveals the existence of a B. abortus lineage distinct from European and Sub-Saharan Africa strains.

Brucellosis is a zoonosis caused by bacteria of the genus Brucella that causes important economic losses and human suffering worldwide. Brucellosis control requires an understanding of the Brucella species circulating in livestock and humans and, although prevalent in African countries of the Mediterranean basin, data for this area are mostly restricted to isolates obtained from humans and small ruminants. Here, we report the characterization of twenty-four Brucella strains isolated from Algerian cattle. Bruce-ladder multiplex PCR and conventional biotyping showed that Algerian cattle are infected mostly by B. abortus biovar 3, and to less extent by B. abortus biovar 1 and B. melitensis biovar 3. Extended AMOS-ERY PCR showed that all Algerian B. abortus biovar 3 strains were of the subgroup 3b. Although by multi locus variable number of tandem repeats analysis (MLVA) most isolates were closer to the European counterparts, five strains displayed characteristics distinct from the European isolates and those of countries across the Sahara, including three repetitions of marker Bruce55. These five strains, plus an earlier isolate from an Algerian human patient, may represent a lineage close to clades previously described in Africa. These data provide the basis for additional molecular epidemiology studies in northern Africa and indicate that further bacteriological and molecular investigations are necessary for a complete understanding of the epidemiology of cattle brucellosis in countries north and south of the Sahara.

Metabolic Reprogramming, Autophagy, and Reactive Oxygen Species Are Necessary for Primordial Germ Cell Reprogramming into Pluripotency.

Cellular reprogramming is accompanied by a metabolic shift from oxidative phosphorylation (OXPHOS) toward glycolysis. Previous results from our laboratory showed that hypoxia alone is able to reprogram primordial germ cells (PGCs) into pluripotency and that this action is mediated by hypoxia-inducible factor 1 (HIF1). As HIF1 exerts a myriad of actions by upregulating several hundred genes, to ascertain whether the metabolic switch toward glycolysis is solely responsible for reprogramming, PGCs were cultured in the presence of a pyruvate kinase M2 isoform (PKM2) activator, or glycolysis was promoted by manipulating PPARγ. Conversely, OXPHOS was stimulated by inhibiting PDK1 activity in normoxic or in hypoxic conditions. Inhibition or promotion of autophagy and reactive oxygen species (ROS) production was performed to ascertain their role in cell reprogramming. Our results show that a metabolic shift toward glycolysis, autophagy, and mitochondrial inactivation and an early rise in ROS levels are necessary for PGC reprogramming. All of these processes are governed by HIF1/HIF2 balance and strict intermediate Oct4 levels. Histone acetylation plays a role in reprogramming and is observed under all reprogramming conditions. The pluripotent cells thus generated were unable to self-renew, probably due to insufficient Blimp1 downregulation and a lack of Klf4 and cMyc expression.

Práctica clínica en el manejo de la hipertensión y la diabetes en Atención Primaria: estudio ATENCION / Management of hypertension and diabetes in Primary Care clinical practice: ATENCION study

Fundamento y objetivo. Las enfermedades cardiovasculares constituyen la principal causa de muerte en la población española. La detección y control de los factores de riesgo cardiovascular es fundamental para prevenirlas. Este estudio tiene como objetivos fundamentales analizar la actitud y las decisiones terapéuticas de los médicos de Atención Primaria (AP) ante la hipertensión arterial (HTA) y la diabetes mellitus tipo 2 (DM2), con el fin de conocer la realidad y proponer estrategias de mejora para su correcto manejo. Material y método. Estudio ecológico de encuesta, descriptivo, transversal y multicéntrico, de ámbito nacional, con participación de médicos de AP, realizado en 2013. Se solicitó la participación en el estudio a 1.028 médicos. Resultados. El 92,9 y el 91,4% de los investigadores consultados sigue las guías para la evaluación, el tratamiento y el diagnóstico de HTA y DM2, respectivamente. Esta última se diagnostica sobre todo casualmente, y la HTA por búsqueda activa en pacientes con otros factores de riesgo. La terapia combinada tarda más de 6 meses en instaurarse en pacientes hipertensos y entre 8-9 meses en diabéticos. El porcentaje de incumplimiento es similar (10-40%) en ambas dolencias. Aproximadamente la mitad de los encuestados consideran buena o excelente la interacción con el especialista (46 y 57,3% en HTA y DM2, respectivamente). Conclusiones. La práctica clínica en AP en HTA y DM2 tiene criterios básicos comunes. La interacción entre la AP y el especialista es buena. No obstante, existe margen de mejora en el tratamiento de estos factores de riesgo, particularmente en lo relativo a intensificar la terapia precozmente (AU)

Background and objective. Cardiovascular diseases are the main cause of death in the Spanish population. The detection and control of cardiovascular risk factors are fundamental in the prevention of cardiovascular disease. The main objectives of this study are to analyse the attitudes and therapeutic decisions of Primary Care (PC) physicians when treating hypertension (HT) and diabetes mellitus type 2 (DM2), with the aim of establishing the situation and eventually proposing improvement strategies. Material and method. A national ecological, multicentre, cross-sectional, and descriptive study was conducted in 2013. A questionnaire was used and 1,028 PC physicians took part in the study. Results. A total of 92.9% of the investigators consulted have indicated that they follow the guidelines for evaluation, treatment, and diagnosis of HT, and 91.4% in the case of diabetes. The latter is diagnosed as a casual finding, while HT is diagnosed through active investigation in patients with other risk factors. Combined therapy takes more than 6 months to take effect in patients with HT, and between 8 and 9 months in diabetic patients. The percentage of non-compliance is similar (10-40%) in both pathologies. Around half the physicians questioned considered interaction with the specialist to be good or excellent (46% HT and 57.3% DM2). Conclusions. Clinical practices in PC for HT and DM2 have some basic criteria in common. The interaction with the specialist is good, but there is a considerable margin for improvement (AU)

[Management of hypertension and diabetes in Primary Care clinical practice: ATENCION study]. / Práctica clínica en el manejo de la hipertensión y la diabetes en Atención Primaria: estudio ATENCION.

BACKGROUND AND OBJECTIVE: Cardiovascular diseases are the main cause of death in the Spanish population. The detection and control of cardiovascular risk factors are fundamental in the prevention of cardiovascular disease. The main objectives of this study are to analyse the attitudes and therapeutic decisions of Primary Care (PC) physicians when treating hypertension (HT) and diabetes mellitus type 2 (DM2), with the aim of establishing the situation and eventually proposing improvement strategies. MATERIAL AND METHOD: A national ecological, multicentre, cross-sectional, and descriptive study was conducted in 2013. A questionnaire was used and 1,028 PC physicians took part in the study. RESULTS: A total of 92.9% of the investigators consulted have indicated that they follow the guidelines for evaluation, treatment, and diagnosis of HT, and 91.4% in the case of diabetes. The latter is diagnosed as a casual finding, while HT is diagnosed through active investigation in patients with other risk factors. Combined therapy takes more than 6 months to take effect in patients with HT, and between 8 and 9 months in diabetic patients. The percentage of non-compliance is similar (10-40%) in both pathologies. Around half the physicians questioned considered interaction with the specialist to be good or excellent (46% HT and 57.3% DM2). CONCLUSIONS: Clinical practices in PC for HT and DM2 have some basic criteria in common. The interaction with the specialist is good, but there is a considerable margin for improvement.