General recommendations paper on the management of older patients with cancer: the SEOM geriatric oncology task force’s position statement

Population aging is associated with greater numbers of older people with cancer. Thanks to treatment advances, not only are more seniors diagnosed with cancer, but there are also more and more older cancer survivors. This upward trend will continue. Given the heterogeneity of aging, managing older patients with cancer poses a significant challenge for Medical Oncology. In Spain, a Geriatric Oncology Task Force has been set up within the framework of the Spanish Society for Medical Oncology (SEOM). With the aim of generating evidence and raising awareness, as well as helping medical oncologists in their training with respect to seniors with cancer, we have put together a series of basic management recommendations for this population. Many of the patients who are assessed in routine clinical practice in Oncology are older. CGA is the basic tool by means of which to evaluate older people with cancer and to understand their needs. Training and the correct use of recommendations regarding treatment for comorbidities and geriatric syndromes, support care, and drug-drug interactions and toxicities, including those of antineoplastic agents, as detailed in this article, will ensure that this population is properly managed

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Geriatric oncology in Spain: survey results and analysis of the current situation

Introduction: Geriatric oncology (GO) is a discipline that focuses on the management of elderly patients with cancer. The Spanish Society of Medical Oncology (SEOM) created a Working group dedicated to geriatric oncology in February 2016. Objectives: The main goal of this study was to describe the current situation in Spain regarding the management of elderly cancer patients through an online survey of medical oncologists. Methods: A descriptive survey was sent to several hospitals by means of the SEOM website. A personal e-mail was also sent to SEOM members. Results: Between March 2016 and April 2017, 154 answers were collected. Only 74 centers (48%) had a geriatrics department and a mere 21 (14%) medical oncology departments had a person dedicated to GO. The vast majority (n = 135; 88%) had the perception that the number of elderly patients with cancer seen in clinical practice had increased. Eighteen (12%) oncologists had specific protocols and geriatric scales were used at 55 (31%) centers. Almost all (92%) claimed to apply special management practices using specific tools. There was agreement that GO afforded certain potential advantages. Finally, 99% of the oncologists surveyed believed it and that training in GO had to be improved. Conclusions: From the nationwide survey promoted by the Spanish Geriatric Oncology Working Group on behalf of SEOM, we conclude that there is currently no defined care structure for elderly cancer patients. There is an increasing perception of the need for training in GO. This survey reflects a reality in which specific needs are perceived

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Factores socioeducativos asociados al consumo de tabaco en escolares de nivel secundario de una zona rural del norte peruano / Socio-educational factors associated with tobacco use in secondary school students in a rural area of northern Peru

Objetivo: determinar la frecuencia, las características y los factores socioeducativos asociados al consumo de tabaco en escolares de nivel secundario de una zona rural del norte peruano. Material y métodos: estudio transversal analítico basado en un cuestionario que se aplicó a escolares adolescentes del primer a quinto año de nivel secundario de un colegio del norte peruano. La variable principal fue el consumo de tabaco en escolares. Las variables socioeducativas fueron género, edad, año de estudios, lugar de procedencia, tipo de casa donde vivía (propia, pensión). Se calcularon frecuencias y porcentajes para el análisis descriptivo y se usaron modelos lineales generalizados para obtener la asociación estadística. Resultados: de los 155 escolares, el 52,9% (82) fueron varones, con una mediana de edad de 14 años. El 9,7% (15) ha fumado alguna vez, de ellos el 86,7% (13) ha fumado por curiosidad y los padres del 86,7% (13) de los fumadores no saben que sus hijos fuman. El 40% (6) comenzó a fumar a los 14 años. El 93,3% (14) fuma un cigarrillo al día y el 60% (9) lo hace más con amigos. Solo 6,7% (1) fuma actualmente. El ser hombre estuvo asociado con el haber fumado en algún momento (RPa: 16,6; IC 95: 1,9-148,4; p: 0,012), ajustado por la edad, el año de estudios, el que resida en una zona urbana y el que viva solo. Conclusiones: existe una baja frecuencia de tabaquismo en escolares de nivel secundario de un colegio nacional parroquial. Se encontraron factores socioeducativos de género asociados al consumo de tabaco (AU)

Objective: to determine the frequency, characteristics and socio-educational factors associated with consumption of snuff in secondary school level in a rural area of northern Peru. Material and methods: cross-sectional study based on a questionnaire that was applied to adolescent students from the first to fifth year of secondary level of a school in northern Peru. The main variable was tobacco consumption among students. Socio-educational variables were gender, age, year of study, place of origin, type of house where he lived (own, rent, pension) were. Frequencies and percentages for the descriptive analysis were described and generalized linear models were used for the statistical associa­tion. Results: of the 155 students, 52.9% (82) were males, with a median age of 14 years. 9.7% (15) have ever smoked, 86.7% of them (13) have smoked out of curiosity and 86.7% (13) of their parents do not know that their children smoke. 40% (6) started smoking at age 14. 93.3% (14) smokes 1 cigarette per day and 60% (9) makes it with friends. Only 6.7% (1) currently smoke. Being male was associated with having smoked at some time (RPA: 16.6; 95% CI: 1.9 to 148.4; p value: 0.012), adjusted for age, year of study, residing in an urban area and living alone. Conclusions: there is a low frequency of smoking in secondary school level of a national parochial school. Gender and socio-educational factors were found associated with tobacco consumption. Gender and socio-educational factors were found associated with tobacco consumption (AU)

Factores socioeducativos asociados a la agudeza visual baja en escolares de Perú / Social-educative factors associated with low visual acuity in Peru

Introducción: para que los estudiantes puedan adquirir el conocimiento adecuadamente, deben tener una correcta salud física y mental. Se realizó un estudio para determinar los factores socioeducativos asociados a la agudeza visual baja en escolares de educación primaria del Colegio Nacional de San Pedro (Piura, Perú). Material y métodos: mediante un estudio transversal analítico que incluyó a estudiantes de Educación Primaria. La variable principal fue la agudeza visual baja, considerando así a los que tenían valores mayores a 20/25 según la evaluación con la cartilla de Snellen. Se obtuvieron los valores p, las razones de prevalencia y sus intervalos de confianza al 95% mediante los modelos lineales generalizados. Resultados: en total se evaluaron 599 estudiantes, el 17% (99) mostraron agudeza visual baja. El sexo no estaba relacionado con la agudeza visual baja (p=0,832). Al aumentar la edad se observó que los niños que tuvieron entre 8-10 y 11-15 años tuvieron un 46% (p=0,005) y un 68% (p<0,001) menos de prevalencia de agudeza visual baja, respectivamente, en comparación con los de 5-7 años. Conforme fue aumentando el grado académico hubo menos prevalencia de agudeza visual baja. Conclusiones: se concluye que uno de cada seis estudiantes tuvo una discapacidad visual y se asoció a su edad y grado académico. Esto los hace más propensos a problemas en sus calificaciones, que puede repercutir para el resto de su vida. Esto debe ser tomado en cuenta por las instituciones que vigilen la correcta educación de los menores (AU)

Introduction: it is important for students to have a good physical and mental health in order to acquire the knowledge properly. A study was conducted to determine the socio-educational factors associated with low visual acuity in primary schoolchildren from the National College of San Pedro-Piura. Matherial and methods: using a cross-sectional analytical study involving 655 primary school students. The principal variable was the low visual acuity, considered in those with values greater than 20/25, as assessed with the Snellen chart. p values, prevalence ratios and confidence intervals at 95% were obtained using generalized linear models. Data were analyzed using STATA version 10.0. Results: a total of 599 students were evaluated, 17% (99) had low visual acuity. Sex was not related to the low visual acuity (p=0.832). While increasing age, it was found that children who were between 8-10 and 11-15 years were 46% (p=0.005) and 68% (p<0.001) less prevalence of having low visual acuity, respectively, compared to the children who were 5-7 years old. Conclusions: it is concluded that one in six students had a visual disability associated with their age and grade level, this is important as putting on shows that one of six students are visually impaired, which makes them more prone to problems in their grades, which may have implications for the rest of their lives. This should be taken into account by the institutions to monitor the proper education of children (AU)

Should we continue temozolomide beyond six cycles in the adjuvant treatment of glioblastoma without an evidence of clinical benefit? A cost analysis based on prescribing patterns in Spain

PURPOSE: The standard adjuvant treatment for glioblastoma is temozolomide concomitant with radiotherapy, followed by a further six cycles of temozolomide. However, due to the lack of empirical evidence and international consensus regarding the optimal duration of temozolomide treatment, it is often extended to 12 or more cycles, even in the absence of residual disease. No clinical trial has shown clear evidence of clinical benefit of this extended treatment. We have explored the economic impact of this practice in Spain. MATERIALS AND METHODS: Spanish neuro-oncologists completed a questionnaire on the clinical management of glioblastomas in their centers. Based on their responses and on available clinical and demographic data, we estimated the number of patients who receive more than six cycles of temozolomide and calculated the cost of this extended treatment. RESULTS: Temozolomide treatment is continued for more than six cycles by 80.5 % of neuro-oncologists: 44.4 % only if there is residual disease; 27.8 % for 12 cycles even in the absence of residual disease; and 8.3 % until progression. Thus, 292 patients annually will continue treatment beyond six cycles in spite of a lack of clear evidence of clinical benefit. Temozolomide is covered by the National Health Insurance System, and the additional economic burden to society of this extended treatment is nearly 1.5 million euros a year. CONCLUSIONS: The optimal duration of adjuvant temozolomide treatment merits investigation in a clinical trial due to the economic consequences of prolonged treatment without evidence of greater patient benefit (AU)

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18F-FDG semi-quantitative parameters and biological prognostic factors in locally advanced breast cancer

Objetivo. Analizar la correlación entre la captación de 18FFDG valorada por la PET-TC en cáncer de mama localmente avanzado y factores pronósticos histopatológicos e inmunohistoquímicos. Material y métodos. Se valoraron prospectivamente 36 mujeres con cáncer de mama. La PET-TC fue requerida en la estadificación previamente al tratamiento quimioterápico (estudio multicéntrico). A todas se les realizó una PET-TC con 18FFDG en 2 fases. Ambas fueron valoradas cualitativa y semicuantitativamente con cálculo del SUVmax en la PET-1 (SUV-1) y en la PET-2 (SUV-2) así como el índice de retención. Los estadios clínicos y metabólicos fueron evaluados siguiendo la clasificación TNM. Se determinaron los parámetros biológicos pronósticos del tumor primario, como el estado de los receptores esteroideos, la expresión del p53 y c-erbB-2, el índice de proliferación (Ki-67) y el grado histológico. Los parámetros biológicos e histológicos fueron correlacionados. Resultados. Se encontró una relación positiva entre los parámetros metabólicos semicuantitativos y los biológicos. Los valores de SUV-1 y SUV-2 no mostraron una correlación estadísticamente significativa excepto para el tamaño clínico tumoral. Acerca de los parámetros biológicos, el índice de retención mostró los mejores resultados con relación positiva y significativa (p<0,05) con el estado de los receptores estrogénicos y progestágenos y el Ki-67. Los valores aislados del SUV no mostraron relación significativa con esos parámetros. Conclusión. El índice de retención mostró la mayor relación con los parámetros biológicos comparados con los valores aislados de SUVmax. Estos datos sugieren que el cambio del SUV es un marcador pronóstico(AU)

Aim. To analyse the correlation between 18F-FDG uptake assessed by PET/CT in locally advanced breast tumours and histopathological and immunohistochemical prognostic factors. Material and methods. Thirty-six women with breast cancer were prospectively evaluated. PET/CT was requested in the initial staging previous to adjuvant chemotherapy (multicentric study). All the patients underwent an 18F-FDG PET/CT with a dual-time-point acquisition. Both examinations were evaluated qualitatively and semiquantitatively with calculation of SUVmax values in PET-1 (SUV-1) and in PET-2 (SUV-2) and the percentage variation of the standard uptake values (retention index) between PET-1 and PET-2. Clinical and metabolic stages were assessed according to TNM classification. The biological prognostic parameters, such as the steroid receptor status, p53 and c-erbB-2 expression, proliferation rate (Ki-67), and grading were determined from tissue of the primary tumour. Metabolic and biological parameters were correlated. Results. A positive relationship was found between semiquantitative metabolic parameters and biological parameters. SUV-1 and SUV-2 values did not show significant statistical correlation (p<.05) except for the clinical tumour size. About the biological parameters, retention index showed the best results with positive and significant relation (p<.05) with estrogen and progesterone receptor status and Ki-67. Isolated SUV values did not show significant relation to these parameters. Conclusion. Retention index showed the best relation with biological parameters compared to isolated SUVmax values. These data suggest that SUV change over time is a prognostic marker(AU)

Lesiones hepáticas múltiples sugestivas de metastásicas en un paciente con cáncer colorrectal / No disponible

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Análisis de la simetría del tamaño dentario mediodistal de la misma muestra en dentición mixta y permanente. Estudio longitudinal / Analysis of symmetry mesiodistal size teeth in mixed and permanent dentition in the same sample. A longitudinal study

En el presente trabajo se estudian los diámetros mesiodistales de los dientes temporales y permanentes de la misma muestra y se analiza la existencia de simetría entre dientes homólogos. Dicho estudio fue realizado inicialmente sobre una muestra de 267 niños con dentición mixta, 90 (34 por ciento) niñas y 177 (66 por ciento) niños, de Andalucía Oriental, con edades comprendidas entre 8 y 10 años, transcurridos cuatro años volvimos a analizar a los mismos niños con dentición permanente, y sólo obtuvimos una muestra de 171, de los cuales 69 (40 por ciento) eran niñas y el 102 (60 por ciento) niños, con una edad media de 12 años y un rango de 11 a 13 años, el 21 por ciento de la muestra tenía 11 años, el 46,29 por ciento presentaba una edad de 12 y el 32 por ciento de 13 años, utilizándose como criterios de selección, que no tuvieran alteraciones morfológicas, pérdidas dentarias, apiñamientos importantes, entre otros factores. El tamaño dentario se midió, como la máxima distancia entre los puntos de contacto mesial-distal de la corona, utilizándose un calibre de punta fina, con una precisión de 0,1 mm. Todas las mediciones fueron realizadas por el mismo observador, directamente en boca, utilizando luz natural y espejos desechables. El análisis estadístico incluyó pruebas como la "t" de Student, con un nivel de significación estadística de p< 0,05. Los principales resultados incluyen la existencia de simetría entre dientes homólogos, tanto en dentición temporal como en dentición permanente (AU)

In the present work is analysed the mesiodistal diameters of the temporal and permanent teeth of the same sampie to calculate the symmetry. The first sample was 267 children, 90 girls (34%) and 177 (66%) boys from Oriental Andalusia, aged between 8 and 10 years old. After four years, we analysed the same children with permanent teething and we obtained just a sample of 171, 69 girls (40%) and 102 (60%) boys, with an average age of 12 years and a range from 11 to 13 years, using as criteria selection not having morphological alteration, teeth loss, important congestions, between other elements.The teething dimension was measured as the maximum distance between the mesiodistal contact points of the crown, using a sharp-end gauge, with a 0,1 mm precision. All the measurements were made by the same viewer, directly to the mouth. For the statistic analysis was used the t Student test, with a level of statistic signification of p<0,05. The main results include the symmetry of the mesiodistal size both in a mixed dentition and a permanent dentition, of the same sample (AU)

Diagnóstico del síndrome del túnel carpiano. Evaluación clínica y neurofisiológica / Carpal tunnel syndrome: assessment and differential diagnosis

Los trastornos sensitivos en las manos constituyen un motivo de consulta médica frecuente. Un porcentaje importante de afectados con este tipo de sintomatología corresponde al síndrome del túnel carpiano o neuropatía por atrapamiento del mediano en el carpo. El resto son el resultado de diversas enfermedades neurológicas, traumatológicas o vasculares con las que comparte expresividad, convirtiendo en ocasiones el diagnóstico clínico en dificultoso y poco satisfactorio. Estas circunstancias hacen recomendable la evaluación de las diferentes posibilidades etiopatogénicas y, en el caso de sospecha fundada de síndrome del túnel carpiano, el uso de estudios complementarios neurofisiológicos. Contamos para ello con exploraciones como la electroneurografía y la electromiografía que, por sus elevadas sensibilidad y especificidad, han convertido hoy en día el diagnóstico de esta entidad neurológica en electroclínico. Se revisan las metodologías neurofisiológicas y su rendimiento, y se propone un algoritmo diagnóstico para la valoración de las enfermedades que cursan con alteraciones sensitivas en las extremidades superiores (AU)

Déficit neuropsicológicos en alcohólicos: implicaciones para la seguridad vial / Neuropsychological deficits in alcoholics: some implications for road safety

Objetivo. Diferentes estudios publicados muestran que los alcohólicos crónicos presentan algunos déficit cognitivos. Se pretenden revisar los estudios más actuales centrados en las alteraciones neuropsicológicas que aparecen como consecuencia del consumo abusivo y prolongado de alcohol, y analizar cómo estas alteraciones podrían afectar a una tarea tan compleja como es la conducción. Desarrollo. El consumo prolongado y en grandes cantidades de alcohol conlleva una afectación del sistema nervioso central. Las consecuencias de ello se observan tanto a corto como a largo plazo. Son frecuentes los déficit de atención, memoria y una mayor lentitud en el procesamiento de la información. A pesar de ello, no se llevan a cabo programas integrales de valoración y rehabilitación neuropsicológica. Este es un tema de gran interés, si tenemos en cuenta el elevado número de accidentes de tráfico en los que una de las posibles causas es el consumo de alcohol. En este sentido, también es importante llamar la atención de las personas que diariamente trabajan con el automóvil, como repartidores, conductores de autobuses, taxi, etc., especialmente aquellos que son alcohólicos en abstinencia, alcohólicos crónicos o personas que abusan del alcohol. Conclusiones. El control de esta situación y la publicidad sobre las secuelas neuropsicológicas del alcoholismo pueden contribuir de manera eficaz en la política de seguridad vial (AU)

Aim. There are various published studies showing that chronic alcoholics present cognitive deficit. In this conference we would like to review the most actual studies focusing on the neuropsychological alterations as consequences of the long and abusive alcohol intake. We also will analyse the involvement of these deficit in a complex task as driving. Development. The long and abusive alcohol intake produces an affectation of the central nervous system. We could observe its consequences both in short and long term. Attention and memory deficit and a slowness of information processing are very common. However, complete neuropsychological assessment and rehabilitation programs are convenient. This is an important topic if we consider the high number of traffic accidents in which alcohol intake is one of the possible causes. Therefore, it is necessary to pay attention to the persons working daily with a car, such as taxi or bus drivers, especially those of them who are alcoholics in abstinence, chronic alcoholics and people who suffer from alcohol abuse. Conclusion. The control of this situation and the publicity about neuropsychological sequels of alcoholism could contribute in an efficient way towards safety in road (AU)