Una actualización en el protocolo en cáncer de próstata metastásico hormonosensible / Hormone sensitive protocol for metastatic prostate cancer, an update

Revisar y actualizar los últimos protocolos en cáncer de próstata metastásico hormonosensible para mejorar su manejo clínico en la práctica clínica. Realizar un análisis de los datos y los protocolos más recientes en el cáncer de próstata metastásico hormonosensible según paneles de expertos en este ámbito. Actualmente se necesita un grupo de consenso nominal para unificar y mejorar las recomendaciones para el manejo de pacientes sensibles con cáncer de próstata metastásico. Este documento unifica y mejora el manejo de los pacientes con cáncer de próstata metastásico hormonosensible, con una metodología que combina datos cuantitativos y cualitativos, y basada en la participación de un amplio comité científico designado por la Asociación Española de Urología (AU)

To review and update last protocols in hormone sensitive metastatic prostate cancer for improving clinical management in routine. Evidence analysis available about recent updates protocols in hormone sensitive metastatic prostate cancer according to expert panel of clinicians about this field. A nominal consensus group for unify and improve the recommendations to the management of sensitive metastatic prostate cancer patients is currently needed. This document unifies and improve the management of patients with hormone sensitive metastatic prostate cancer, with a methodology that combines data quantitative and qualitative and based on the participation of a broad scientific committee appointed by the Spanish Association of Urology (AU)

Hormone sensitive protocol for metastatic prostate cancer, an update.

To review and update last protocols in hormone sensitive metastatic prostate cancer for improving clinical management in routine. Evidence analysis available about recent updates protocols in hormone sensitive metastatic prostate cancer according to expert panel of clinicians about this field. A nominal consensus group for unify and improve the recommendations to the management of sensitive metastatic prostate cancer patients is currently needed. This document unifies and improve the management of patients with hormone sensitive metastatic prostate cancer, with a methodology that combines data quantitative and qualitative and based on the participation of a broad scientific committee appointed by the Spanish Association of Urology.

Inyección epidural interlaminar ecoguiada de esteroides: evaluación de rendimiento mediante el método de la suma acumulativa (CUSUM) / Ultrasound guided interlaminar epidural steroid injection: the cumulative sum method (CUSUM) for performance evaluation

Introducción: El uso de la ecografía para asistir o guiar la realización de procedimientos intervencionistas para tratamiento del dolor crónico se encuentra en crecimiento permanente. La inyección epidural de esteroides utilizando la ecografía en plano y en tiempo real es técnicamente más dificultosa, con curvas de aprendizaje más prolongadas aun en manos experimentadas. El lugar de la ecografía en este tipo de inyecciones aún no se encuentra establecido, debido en parte a la dificultad de detectar una inyección intravascular de la solución. Objetivo: El objetivo de este estudio fue la descripción de la inyección epidural de esteroides interlaminar ecoguiada, en plano y en tiempo real, en pacientes con dolor radicular lumbar. El aprendizaje de la técnica por el investigador principal fue evaluado estadísticamente utilizando el Método de la Suma Acumulativa (CUSUM). Pacientes y métodos: Un total de 25 pacientes con dolor radicular lumbosacro fueron seleccionados para recibir inyecciones epidurales interlaminares de esteroides en posición decúbito dorsal, utilizando la técnica ecoguiada en plano, en tiempo real, en eje corto o transversal. En todos los casos, un epidurograma de control fue realizado previo a la inyección de la solución de esteroides. El rendimiento de la técnica fue estudiado mediante la tasa de éxito de la misma, entendido como éxito a la obtención de un epidurograma sin necesidad de abandonar la técnica ecográfica en un tiempo menor a 10 minutos. El rendimiento del procedimiento fue estadísticamente evaluado por el método de la suma acumulativa (CUSUM), y la curva de aprendizaje aplicando este método fue construida. Resultados:La distancia promedio desde la piel al complejo posterior evaluada por el escaneo ecográfico previo al procedimiento fue de 6,7 ± 1,8 cm. De los 25 procedimientos realizados, en 21 se alcanzó el espacio epidural sin ayuda de la fluoroscopia, en un tiempo promedio de 4,8 ± 1,2 minutos.(AU)

Background: Real time ultrasound-guided epidural injections are considered technically more difficult than flouroscopy-guided procedures, with longer learning curves, even in experienced physicians. The cumulative sum (Cusum) method has been shown to be a useful tool to evaluate skill acquisition. The goal of our study was to assess the feasibility of real time, ultrasound guided, paramedian interlaminar epidural steroid injections, in patients with lumbosacral radicular pain. The evaluation of an experienced interventional pain physician´s learning curve of the technique is proposed, utilizing the CUSUM method. Patients and methods: The feasibility of the technique was studied by the success rate, which was considered the obtaining of an epidurogram exclusively using the ultrasound guide. For Cusum calculations, 20 % was taken as an acceptable failure rate and 40 % unacceptable failure rate. Results: Between August and December 2020, 25 patients were recruited, 15 females and 10 males. The average age of was 52 ± 12 years. In 21 procedures the epidural space was reached exclusively by ultrasound guide, in an average time of 5 ± 1.6 minutes. This implies a success rate of 84 %. In four procedures the epidural space was successfully achieved with the complementary use of fluroscopy. Using the Cumulative Sum method, the learning curve of the technique could be described on an experienced physician in ultrasound guided procedures. A 80 % success rate with statistical significance was obtained after performing 12 procedures. Conclusion: The "real time" ultrasound guided interlaminar epidural steroid injection in the transverse scan, is a feasibly and relatively easy to learn technique. The Cusum method could be a useful tool to assess skill acquisition in interventional pain medicine.(AU)

Effectiveness of two probiotics in preventing necrotising enterocolitis in a cohort of very-low-birth-weight premature new-borns.

According to previous research, the incidence of necrotising enterocolitis (NEC) decreases after supplementation with probiotics. However, few studies have considered the equivalence or otherwise of different strains of probiotics in this respect. Accordingly, this prospective observational study was conducted in a cohort of 245 very-low-birth-weight (VLBW) new-borns to assess the prevalence of NEC after supplementation with the probiotic Inforan® (Berna Biotech, Madrid, Spain) 250 mg capsules containing 109 cfu of Lactobacillus acidophilus (ATCC 4356) and 109 cfu of Bifidobacterium bifidum (ATCC 15696); or with Bivos® (Ferring, Madrid, Spain) containing Lacticaseibacillus (formerly Lactobacillus) rhamnnosus (LGG) (ATCC 53103) (109 cfu); or with no probiotic supplementation. Statistical analysis was performed using multivariant regression for the duration of parenteral nutrition, length of neonatal intensive care unit stay, use of oxygen therapy and presence of chorioamnionitis. Of the VLBW new-borns in the study group, 65 received Infloran, 108 received Bivos and 72 received no probiotic. A significant association was observed between a reduced presence of NEC Stage ≥2 and probiotic supplementation. The odds risk (OR) obtained was 0.174 (95% confidence interval (CI): 0.032-0.936) for Infloran and 0.196 (95%CI: 0.053-0.732) for Bivos. Therefore, both probiotics are associated with a lower prevalence of NEC in VLBW new-borns, with no significant differences.

Precaución con el uso de dexametasona en pacientes con COVID-19 en sus fases iniciales / Caution with the use of dexamethasone in patients with COVID-19 in its initial phases

Introducción El efecto de la dexametasona en la fase inicial de la infección por SARS-CoV-2 y su influencia sobre la COVID-19 no está bien definido. Describimos las características clínico-radiológicas, los parámetros de tormenta de citoquinas y la evolución clínica de una serie de pacientes tratados con dexametasona en la fase inicial de la enfermedad. Método Estudio de 8 pacientes que recibieron dexametasona previo al desarrollo de la COVID-19. Evaluamos variables clínicas, pruebas de imagen, parámetros de liberación de citoquinas, tratamiento empleado y su evolución. Resultados Todos los pacientes recibieron una dosis de 6mg/día con una duración media de 4,5 días previos al ingreso. La mayoría de los pacientes presentaron una extensión grave en la tomografía computarizada de alta resolución (TCAR) y una elevación leve de los parámetros de liberación de citoquinas; 3 pacientes requirieron oxigenoterpia nasal de alto flujo (ONAF) por insuficiencia respiratoria, y ningún paciente requirió intubación orotraqueal ni falleció. Conclusión La dexametasona en las fases iniciales de la infección por SARS-CoV-2 parece asociarse con una COVID-19 grave (AU)

Introduction The effect of dexamethasone in the initial phase of infection by SARS-CoV-2 and its influence on COVID-19 is not well defined. We describe clinical-radiological characteristics, the cytokine storm parameters, and the clinical evolution of a series of patients treated with dexamethasone in the disease's initial phase. Method A study of 8 patients who received dexamethasone before the development of COVID-19. We evaluate clinical variables, imaging tests, cytokine release parameters, treatment used and patient evolution. Results All patients received a 6mg/day dose with a mean duration of 4.5 days before admission. High resolution computed tomography (HRCT) revealed that most of them presented a severe extension; most patients had a slightly elevated level of cytokine release parameters. Three patients required high-flow oxygen therapy due to respiratory failure; none required orotracheal intubation or died. Conclusion Dexamethasone in the early stages of SARS-CoV-2 infection appears to be associated with severe COVID-19 (AU)

Caution with the use of dexamethasone in patients with COVID-19 in its initial phases.

INTRODUCTION: The effect of dexamethasone in the initial phase of infection by SARS-CoV-2 and its influence on COVID-19 is not well defined. We describe clinical-radiological characteristics, the cytokine storm parameters, and the clinical evolution of a series of patients treated with dexamethasone in the disease's initial phase. METHOD: A study of 8 patients who received dexamethasone before the development of COVID-19. We evaluate clinical variables, imaging tests, cytokine release parameters, treatment used and patient evolution. RESULTS: All patients received a 6 mg/day dose with a mean duration of 4.5 days before admission. High resolution computed tomography (HRCT) revealed that most of them presented a severe extension; most patients had a slightly elevated level of cytokine release parameters. Three patients required high-flow oxygen therapy due to respiratory failure; none required orotracheal intubation or died. CONCLUSION: Dexamethasone in the early stages of SARS-CoV-2 infection appears to be associated with severe COVID-19.

[Caution with the use of dexamethasone in patients with COVID-19 in its initial phases]. / Precaución con el uso de dexametasona en pacientes con COVID-19 en sus fases iniciales.

INTRODUCTION: The effect of dexamethasone in the initial phase of infection by SARS-CoV-2 and its influence on COVID-19 is not well defined. We describe clinical-radiological characteristics, the cytokine storm parameters, and the clinical evolution of a series of patients treated with dexamethasone in the disease's initial phase. METHOD: A study of 8 patients who received dexamethasone before the development of COVID-19. We evaluate clinical variables, imaging tests, cytokine release parameters, treatment used and patient evolution. RESULTS: All patients received a 6 mg/day dose with a mean duration of 4.5 days before admission. High resolution computed tomography (HRCT) revealed that most of them presented a severe extension; most patients had a slightly elevated level of cytokine release parameters. Three patients required high-flow oxygen therapy due to respiratory failure; none required orotracheal intubation or died. CONCLUSION: Dexamethasone in the early stages of SARS-CoV-2 infection appears to be associated with severe COVID-19.

Racial disparities in pre-operative pain, function and disease activity for patients with rheumatoid arthritis undergoing Total knee or Total hip Arthroplasty: a New York based study.

BACKGROUND: Black and Hispanic patients with osteoarthritis have more pain and worse function than Whites at the time of arthroplasty. Whether this is true for patients with rheumatoid arthritis (RA) is unknown. METHODS: This cross-sectional study used data on RA patients acquired between October 2013 and November 2018 prior to elective total knee (TKA) or hip arthroplasty (THA). Pain, function, and disease activity were assessed using the visual analogue scale (VAS), the Multidimensional Health Assessment Questionnaire (MDHAQ), and the Disease Activity Score (DAS28-ESR). We linked the cases to census tracts using geocoding to determine the community poverty level. Race, education, income, insurance and medications were collected via self-report. Using multivariable linear and logistic models we examined whether minority status predicted pain, function and RA disease activity at the time of arthroplasty. RESULTS: Thirty seven (23%) of the 164 patients were Black or Hispanic (minorities). The MDHAQ and DAS28-ESR were not significantly worse while VAS pain score was significantly worse in minority patients (p = 0.03). There was no significant difference in education between the groups. Insurance varied significantly; 29% of minority patients had Medicaid vs. 0% of Whites (p < 0.0001). In the multivariable analyses minority status was not significantly associated with DAS28-ESR [p = 0.66], MDHAQ [p = 0.26], or VAS pain [p = 0.18]. CONCLUSIONS: For Black and/or Hispanic patients with RA undergoing THA or TKA at a high-volume specialty hospital, unlike Black or Hispanic patients with osteoarthritis (OA), there was no association with worse pain, function, or RA disease activity at the time of elective arthroplasty.

Detection of specific immune response in sole (Solea senegalensis) against Photobacterium damselae subsp. piscicida antigens.

The pathogenic bacteria Photobacterium damselae subsp. piscicida affects the development of Solea senegalensis culture. Vaccines made with inactivated cells have produced a relative protection against the sickness, however the administration of subcellular and purified antigens as vaccine could increase the effectiveness of the immune response. Thus, the aim of this work was the determination of antigens of P. damselae subsp. piscicida involved in the specific immune response of S. senegalensis. Fish were immunized by intraperitoneal injection (i.p.) with inactivated extracellular polymeric substances (ECP) and whole cells of P. damselae subsp. piscicida, and Freund's incomplete adjuvant. Two months later fish were boosted with the same antigens. Serum from fish was collected to determine by ELISA the title of antibodies against subcellular fractions of bacteria (ECP, capsule, outer membrane proteins, O antigen and formalized whole cells). Significant differences were found between control and immunized fish, but differences between first immunization and booster were only found for O antigen and capsule. Western blots derived from 2D-PAGE of ECP and Outer Membrane Proteins (OMP), using sole immunized serum, detected two high reactive antigens from ECP. Proteins were identified, by mass spectrometry, as ATP-dependent metalloprotease and Telurite resistance proteins. In the case of OMP, three antigenic proteins were detected and identified as Nrfa Y218f, Anti-oxidant AhpC/TSA, and a protein domain DNA binding heat shock related.

Effect of intratympanic dimethyl sulphoxide (DMSO) in an in vivo model of cisplatin-related ototoxicity.

Although dimethyl sulfoxide (DMSO) is one of the most common solvents employed in otoprotection studies, its effect on the inner ear remains unknown. Only a few in vitro studies have addressed the effect of DMSO in cochlear cells. Up to the date, no in vivo functional studies have been reported. To determine the effect of intratympanic DMSO application in the inner ear, and to evaluate its effect in combination with cisplatin in Wistar rats, twelve Wistar rats were randomly assigned into two groups. Group A received intratympanic 1 % DMSO in both ears. Group B received intraperitoneal cisplatin (10 mg/kg) and intratympanic 0.5 % DMSO in the right ear and saline solution in the left ear. Functional changes were evaluated with Auditory Steady-State Responses before and 5 days after the procedure. Morphological changes were studied by means of confocal laser scanning microscopy following the removal of the temporal bones and cochlear dissection. Hearing threshold levels in group A did not show any statistically significant changes after the treatment. In group B, significant differences between pre- and post-treatment were found, with no statistically significant variations between right (DMSO) and left ear (saline solution). We suggest that DMSO could be safely used to dissolve hydrophobic compounds in otoprotection studies without interfering with the cochlear damage produced by cisplatin.

Determinants of fat-soluble vitamin status in patients aged 65 years and over.

In the elderly, malnutrition is highly prevalent and a major contributor to increased morbidity and mortality. We aimed to evaluate the fat-soluble vitamin status and potential determinants in patients >65 years of age. Serum vitamins A, D and E were determined by liquid chromatography in 166 patients. Gender, age, season, hospitalization, nutritional markers (albumin and cholesterol), acute-phase reactants (ferritin and C-reactive protein) and renal function (creatinine and glomerular filtrate) were assessed as potential determinants. Prevalence of vitamin deficiency was highly variable, ranging from 0 (vitamin E/cholesterol ratio) to 94% (for vitamin D in hospitalized patients). Vitamin status did not differ according to gender, but age, season, hospitalization, a poor nutritional status and impaired renal function, and the presence of acute-phase response significantly affected serum levels of vitamin A, E and D. In conclusion, in subjects >65 years both demographic and clinical factors determined the fat-soluble vitamin status.

Nephrotic syndrome and AA amyloidosis revealing adult-onset cryopyrin-associated periodic syndrome.

Cryopyrin-associated periodic syndrome (CAPS) is due to gain-of-function mutations in the cryopyrin gene, which determines an overactive inflammatory response. AA amyloidosis is a complication of this syndrome. A 53-year-old man was referred to us because of lower limb edema. Past history: at the age of 20, he complained of arthralgia/arthritis and bilateral hypoacusis. At the age of 35, he presented posterior uveitis, several episodes of conjunctivitis, and progressive loss of visual acuity. Laboratory tests disclosed nephrotic syndrome, and renal biopsy showed AA amyloidosis. He was given anakinra with improvement of arthritis. A genetic study revealed the p.D303N mutation in the cryopyrin gene, and he was diagnosed as having AA amyloidosis due to CAPS. Twenty-one months after starting anakinra, the arthritis has disappeared, although nephrotic-range proteinuria persisted. It is important to be aware of cryopyrin-associated periodic syndrome because it can cause irreversible complications, and there is effective therapy.

Tocilizumab treatment for nephrotic syndrome due to amyloidosis in Behcet's disease.

Renal involvement is an unusual but significant Behcet´s disease (BD) complication and AA amyloidosis appears to be the most common etiology. IL-6 is a pro-inflammatory cytokine with an important role in AA amyloidosis development. Tocilizumab (TCZ) is a humanized anti-IL-6 receptor antibody that has emerged as an effective and specific treatment in AA amyloidosis secondary to chronic inflammatory disorders. We report on a patient diagnosed with BD who developed nephrotic syndrome caused by renal AA amyloidosis with an excellent response to TCZ therapy.