Pericardial effusion with pembrolizumab.

INTRODUCTION: The treatment of non-small cell lung cancer (NSCLC) has profoundly changed on account of the arrival of new therapies, like immunotherapy. Within this group of drugs, those aimed at the programmed cell death-1 or programmed cell death ligand-1(PD1/PDL-1) are very relevant, for example, Pembrolizumab. Although its adverse reactions are generally mild and well tolerated, it has been associated with certain immune-related adverse events (IrAEs) than can be serious and affect any organ. CASE REPORT: A 62-year-old woman diagnosed with stage IV NSCLC with a single bone metastasis and PD-L1 expression of 60% started treatment with cisplatin-pemetrexed-pembrolizumab, and maintenance with pembrolizumab. MANAGEMENT AND OUTCOME: The patient attended the ER with pericardial effusion that was assumed to be a Pembrolizumab IrAE and was managed with corticosteroids. The patient fully recovered but immunotherapy was not reintroduced due to the severity of the AE. DISCUSSION: The cardiovascular system is among the least affected organs by immunotoxicity, with an incidence between 0.09-0.6%. However, some authors suspect the incidence is underestimated. Median time to onset is highly variable, ranging from 6 weeks since the first dose to 2 years after discontinuation of the treatment. There are not guidelines on the most effective management of the IrAEs, but according to the pharmaceutical reference, corticosteroids should be initiated followed by a progressive reduction. If no response is obtained, another immunosuppressive agent should be added. The determination to restart immunotherapy depends on the severity of the adverse reaction, the availability of other alternative treatments, and the cancer response.

The evidence supporting educational videos for patients and caregivers receiving hospice and palliative care: A systematic review.

OBJECTIVE: The purpose of this study is to explore the evidence surrounding educational videos for patients and family caregivers in hospice and palliative care. We ask three research questions: 1. What is the evidence for video interventions? 2. What is the quality of the evidence behind video interventions? 3. What are the outcomes of video interventions? METHODS: The study is a systematic review, following Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines. Researchers systematically searched five databases for experimental and observational studies on the evidence supporting video education for hospice and palliative care patients and caregivers, published in 1969-2019. RESULTS: The review identified 31 relevant articles with moderate-high quality of evidence. Most studies were experimental (74 %), came from the United States (84 %) and had a mean sample size of 139 participants. Studies showed that video interventions positively affect preferences of care and advance care planning, provide emotional support, and serve as decision and information aids. CONCLUSION: A strong body of evidence has emerged for video education interventions in hospice and palliative care. Additional research assessing video interventions' impact on clinical outcomes is needed. PRACTICE IMPLICATIONS: Videos are a promising tool for patient and family education in hospice and palliative care.

A multicentre observational study of the effectiveness, safety and economic impact of nivolumab on non-small-cell lung cancer in real clinical practice.

Background Immunotherapy has become a standard treatment for lung cancer; however, the high cost makes it necessary to assess health outcomes. Objective The aim of this study was to evaluate the effectiveness, safety and economic cost of nivolumab in real-world clinical practice. Setting Fifteen regional and academic hospitals from Spain participated in this study. Methods This study was a retrospective, multicentre and observational study involving patients who experienced progression after first-line therapy for non-small-cell lung cancer and were treated with nivolumab between January 2016 and July 2017. Effectiveness and safety were evaluated by the oncologist, and the data from the electronic clinical records of the patients were collected by the research team. Economic cost was calculated using the cost of acquiring nivolumab for the public health system. Main outcome measures Effectiveness variables were overall survival (OS) and progression-free survival (PFS). The safety variable was the incidence of adverse events (AEs), and the cost per life-year gained (LYG) was the economic variable. Results A total of 221 patients were enrolled (83.7% men). The mean age was 64.5 years, and 84.6% of the patients had an Eastern Cooperative Oncology Group (ECOG) performance-status score of 0-1. Squamous tumours accounted for 59.7% of the total, and 78.7% of the patients presented a time since platinum therapy (TPT) > 6 months. The mean nivolumab dose was 216 mg (SD 211), and the treatment duration was 7.0 months (95% CI 5.8-8.1). The median PFS was 5.3 months (95% CI 3.2-7.3), and OS was 9.7 months (95% CI 7.6-11.8). The median PFS and OS values were statistically significantly superior for patients with an ECOG score of 0-1 and for patients with a TPT > 6 months. The median OS was also statistically significantly superior for patients with non-squamous histology. Regarding safety, 71% of the patients presented AEs of any grade, and in 18.6%, the nivolumab treatment had to be delayed or discontinued. The cost of nivolumab per patient was €19,910.00 (SD 19,369), and the cost per LYG was €110,026.00 (€77,557.00-€231,171.00). Conclusions This study confirms that the efficacy and safety of nivolumab treatment in a real population are comparable to the results obtained in clinical trials. A greater clinical benefit of nivolumab therapy was observed in patients with an ECOG score of 0-1, a TPT > 6 months or non-squamous histology. Despite the benefit observed, the cost per LYG is above the threshold of efficiency established by public health institutes.

[Glycerol kinase deficiency in adult patient: hypertriglyceridemia resistance to diet and pharmacological treatment]. / Déficit de glicerol kinasa en el adulto: hipertrigliceridemia resistente a tratamiento dietético y farmacológico.

CASE REPORT: we present an 85-year-old patient with polydipsia, polyuria and severe hypertriglyceridemia of 27 years of evolution, without pancreatitis, resistant to dietary and pharmacological treatments. He was diagnosed of hyperglycerolemia due to glycerol kinase deficiency (GKD) based on: transparent non-lipemic serum, with glycerol increase in plasma and urine, without glycerol 3 phosphate increase, and a deletion, not previously described, in the glycerol kinase gene. DISCUSSION: a correct dietary treatment with frequent meals and rich in complex carbohydrates, without medication, improved the symptomatology.

Caso clínico: presentamos un paciente varón de 85 años con polidipsia, poliuria e hipertrigliceridemia severa de 27 años de evolución, sin pancreatitis, persistente y resistente a tratamientos dietético y farmacológico. Se diagnosticó de hiperglicerolemia por déficit de glicerol kinasa (GKD) en base a: suero transparente no lipémico, aumento de glicerol en plasma y orina, sin aumento de glicerol 3 fosfato y deleción, no descrita previamente, en el gen de la glicerol kinasa.Discusión: un tratamiento dietético correcto con comidas frecuentes y rico en carbohidratos complejos, sin medicación, mejoró la sintomatología.

Déficit de glicerol kinasa en el adulto: hipertrigliceridemia resistente a tratamiento dietético y farmacológico / Glycerol kinase deficiency in adult patient: hypertriglyceridemia resistance to diet and pharmacological treatment

Caso clínico: presentamos un paciente varón de 85 años con polidipsia, poliuria e hipertrigliceridemia severa de 27 años de evolución, sin pancreatitis, persistente y resistente a tratamientos dietético y farmacológico. Se diagnosticó de hiperglicerolemia por déficit de glicerol kinasa (GKD) en base a: suero transparente no lipémico, aumento de glicerol en plasma y orina, sin aumento de glicerol 3 fosfato y deleción, no descrita previamente, en el gen de la glicerol kinasa. Discusión: un tratamiento dietético correcto con comidas frecuentes y rico en carbohidratos complejos, sin medicación, mejoró la sintomatología

Case report: we present an 85-year-old patient with polydipsia, polyuria and severe hypertriglyceridemia of 27 years of evolution, without pancreatitis, resistant to dietary and pharmacological treatments. He was diagnosed of hyperglycerolemia due to glycerol kinase defi ciency (GKD) based on: transparent non-lipemic serum, with glycerol increase in plasma and urine, without glycerol 3 phosphate increase, and a deletion, not previously described, in the glycerol kinase gene. Discussion: a correct dietary treatment with frequent meals and rich in complex carbohydrates, without medication, improved the symptomatology

Genomic non-coding regions reveal hidden patterns of mumps virus circulation in Spain, 2005 to 2015.

BackgroundSince mumps vaccination was introduced in 1981 in Spain, the incidence of the disease has dropped significantly. However, cyclic epidemic waves and outbreaks still occur, despite high vaccination coverage. The World Health Organization (WHO) recommends genotyping to trace the pattern of mumps virus (MuV) circulation. Genotype H was predominant in Spain, but was replaced in 2005 by genotype G which has subsequently remained dominant. Of the small hydrophobic protein gene sequences, 78% are identical and belong to the MuVi/ Sheffield.GBR.1.05/[G]-variant. Aim: Our study aimed to investigate whether the circulation of MuV strains in Spain was continuous after the emergence of genotype G in 2005. Method: We obtained 46 samples from Spanish patients infected with MuVi/Sheffield.GBR.1.05/[G] during two epidemic waves and analysed them using new molecular markers based on genomic non-coding regions (NCRs) that discriminate subvariants of this virus strain. Results: Phylogenetic analyses of the nucleoprotein-phosphoprotein and matrix protein-fusion protein NCR indicated strain replacement after a drop in incidence in 2009, which had not been detectable by SH sequencing. Clustering of sequences from patients epidemiologically linked in the same outbreak suggests a potential use for these NCRs in outbreak characterisation. Conclusion: We suggest to consider their use in conjunction with the SH gene in the future WHO recommendations for MuV epidemiological surveillance.

Synthesis of binuclear platinum complexes containing the ligands 8-naphthyridine, 2-aminopyridine, and 7-azaindolate. An experimental study of the steric hindrance of the bulky pentafluorophenyl ligands in the synthesis of binuclear complexes.

The bidentate N-donor ligands 2-aminopyridine (2-ampy), 7-azaindolate (aza) and 1,8-naphthyridine (napy) have been used to study the steric effect of pentafluorophenyl groups in the synthesis of binuclear platinum(II) complexes. The 2-ampy and aza ligands bridge two "Pt(C 6F 5) 2" fragments with Pt...Pt distances of 4.1 and 3.4 A, respectively (complexes 1 and 3). Under the same reaction conditions the napy ligand shows chelating behavior and makes the mononuclear complex ( A) highly reactive because of its strained coordination. One of the Pt-N bonds of the chelating complex is broken on reaction with HX {X = Cl ( 4), Br ( 5)} because of protonation while the anion X (-) occupies a created vacant site. The resulting mononuclear complex eliminates C 6F 5H when refluxed, and a binuclear complex ( 6) with two napy ligands bridging two "Pt(C 6F 5)Cl" fragments is obtained. The reaction of A with HPPh 2 affords a mononuclear complex ( 7) analogous to complexes 5 and 6, but reflux gives a binuclear complex ( 8) with the two napy ligands terminally bound and the PPh 2 groups bridging the "Pt(C 6F 5)napy" moieties. The reaction of A with HCCPh gives a binuclear complex; moreover, the final product does not depend on the ratio of complex A to HCCPh. Complexes 1, 4, 6, 9 have been structurally characterized by X-ray diffraction.

Hydrogen-bond mediation of supramolecular aggregation in neutral bis-(C6F5)Pt complexes with aromatic H-bond donating ligands. A synthetic and structural study.

Six pentafluorophenylplatinum(II) complexes containing proton acceptor atoms (F) and pyridine-like aromatic ligands able to act as proton donors have been synthesized and characterized, with emphasis on the factors that mediate their supramolecular aggregation in the solid state--hydrogen bonds and pi-pi interactions. The crystal structure analyses of the mononuclear complexes cis-[Pt(C6F5)2(napy)](1), cis-[Pt(C6F5)2(CH2napy)](3), cis-[Pt(C6F5)2(2-ammpy)](5), and cis-[Pt(C6F5)2(2-bipym)](6) reveal the influence of D-HPt and D-HF (D=C, N) hydrogen bonding on the organization of molecules into stacks, which can be further interconnected to generate channels. The prevalence of hydrogen bonding over pi-pi interactions between aromatic rings in establishing the nature of the observed supramolecular aggregation is demonstrated.

Synthesis and Structure of Pd(II) Complexes Containing the C,C-Chelating Bis-Ylide Ligand [Ph(3)P=C(H)](2)CO. X-ray Crystal Structure of {Pd(&mgr;-Cl){[C(H)PPh(3)](2)CO}}(2)(ClO(4))(2).CH(2)Cl(2).

The reaction of Pd(OAc)(2) with the bis(phosphonium) salt [Ph(3)PCH(2)COCH(2)PPh(3)]Cl(2) (1:1 molar ratio) results in the formation of the cis-dichlorobis(ylide) derivative Cl(2)Pd{[C(H)PPh(3)](2)CO}, 1, in which the bis(ylide) ligand [C(H)PPh(3)](2)CO acts as a chelating group through the two ylide carbon atoms. Complex 1 reacts with TlClO(4) (1:1 molar ratio) to give [Pd(&mgr;-Cl){[C(H)PPh(3)](2)CO}](2)(ClO(4))(2), 2, which reacts with two further equivalents of TlClO(4) in NCMe to give [Pd{[C(H)PPh(3)](2)CO}(NCMe)(2)](ClO(4))(2) 3. The reactivity of 2 and 3 has been explored. Compound 2 reacts with pyridine, 3,5-lutidine, or Ph(3)P=C(H)CN (1:2 molar ratio), resulting in the rupture of the chlorine bridging system and formation of [PdCl{[C(H)PPh(3)](2)CO}(L)](ClO(4)) (L = py (4), 3,5-lu (5), NC-C(H)=PPh(3) (6)), and with Tlacac (1:2 molar ratio) with formation of the acetylacetonate [Pd(acac){[C(H)PPh(3)](2)CO}](ClO(4)), 7. On the other hand, complex 3 reacts with the ylide Ph(3)P=C(H)CN (1:2 molar ratio) giving [Pd{[C(H)PPh(3)](2)CO}[NC-C(H)=PPh(3)](2)](ClO(4))(2), 8, which contains two N-coordinated ylides, and with NBu(4)OH (1:1) to give [Pd(&mgr;-OH){[C(H)PPh(3)](2)CO}](2)(ClO(4))(2), 9. The reaction of Pd(OAc)(2) with the ylide phosphonium salt [Ph(3)P=C(H)COCH(2)PPh(3)](ClO(4)) (1:1) gives the acetate dimer [Pd(&mgr;-OOCCH(3)){[C(H)PPh(3)](2)CO}](2)(ClO(4))(2), 10. The structures of complexes 1-10 were deduced from their spectroscopic data and from the resolution of the molecular structure of complex 2.CH(2)Cl(2).

Synthesis and Reactivity of (Pentafluorophenyl)platinate(II) Complexes with Bridging 1,8-Naphthyridine (napy) and X Ligands (X = C(6)F(5), OH, Cl, Br, I, SPh). Crystal Structure of [NBu(4)][Pt(2)(&mgr;-napy)(&mgr;-OH)(C(6)F(5))(4)].CHCl(3).

By reaction of [NBu(4)](2)[Pt(2)(&mgr;-C(6)F(5))(2)(C(6)F(5))(4)] with 1,8-naphthyridine (napy), [NBu(4)][Pt(C(6)F(5))(3)(napy)] (1) is obtained. This compound reacts with cis-[Pt(C(6)F(5))(2)(THF)(2)] to give the dinuclear derivative [NBu(4)][Pt(2)(&mgr;-napy)(&mgr;-C(6)F(5))(C(6)F(5))(4)] (2). The reaction of several HX species with 2 results in the substitution of the bridging C(6)F(5) by other ligands (X) such as OH (3), Cl (4), Br (5), I (6), and SPh (7), maintaining in all cases the naphthyridine bridging ligand. The structure of 3 was determined by single-crystal X-ray diffraction. The compound crystallizes in the monoclinic system, space group P2(1)/n, with a = 12.022(2) Å, b = 16.677(3) Å, c = 27.154(5) Å, beta = 98.58(3) degrees, V = 5383.2(16) Å(3), and Z = 4. The structure was refined to residuals of R = 0.0488 and R(w) = 0.0547. The complex consists of two square-planar platinum(II) fragments sharing a naphthyridine and OH bridging ligands, which are in cis positions. The short Pt-Pt distance [3.008(1) Å] seems to be a consequence of the bridging ligands.