Expert consensus to optimize the management of older adult patients with advanced EGFR-mutated non-small cell lung cancer.

Lung cancer (LC) is associated with ageing, with the average age of affected individuals being approximately 70 years. However, despite a higher incidence and prevalence among older people, the older adult population is underrepresented in clinical trials. For LC with Epidermal Growth Factor Receptor (EGFR) mutations, there is no clear association of this mutation with age. Geriatric assessments (GAs) and a multidisciplinary approach are essential for defining the optimal treatment. In this consensus, a group of experts selected from the Oncogeriatrics Section of the Spanish Society of Medical Oncology (Sección de Oncogeriatría de la Sociedad Española de Oncología Médica-SEOM), the Spanish Lung Cancer Group (Grupo Español de Cáncer de Pulmón-GECP) and the Association for Research on Lung Cancer in Women (Asociación para la Investigación del Cáncer de Pulmón en Mujeres-ICAPEM) evaluate the scientific evidence currently available and propose a series of recommendations to optimize the management of older adult patients with advanced LC with EGFR mutations.

SEOM-GETTHI clinical guideline for the practical management of molecular platforms (2021).

The improvement of molecular alterations in cancer as well as the development of technology has allowed us to bring closer to clinical practice the determination of molecular alterations in the diagnosis and treatment of cancer. The use of multidetermination platforms is spreading in most Spanish hospitals. The objective of these clinical practice guides is to review their usefulness, and establish usage guidelines that guide their incorporation into clinical practice.

Profiling the Bladder Microbiota in Patients With Bladder Cancer.

Evidence suggests that microbiota may contribute to the pathogenesis of several diseases, including cancer. In the case of bladder cancer, preliminary studies have found alterations in the urinary microbiota of patients with urothelial carcinoma compared with healthy individuals. Conversely, the urinary microbiota differ between men and women, and it has been hypothesized that these differences are associated with the lower incidence of bladder cancers in women. The objective of this study was to characterize the bladder microbiota in paired samples of tumor and non-tumor mucosa of patients with malignant bladder neoplasia using next-generation sequencing. In addition, we aimed to study potential differences in microbial composition in tumor samples according to clinical and pathological variables, and to determine possible microbial profiles. We found significant differences in microbial richness at the genus level, with a higher richness observed in the non-tumor compared with the tumor mucosa. It was also shown that Actinobacteria were significantly more enriched in the non-tumor compared with the tumor mucosa (P = 0.014). In the multivariate analysis, we found significant differences in microbial composition according to tumor grade (P = 0.03 and 0.04 at the phylum and genus levels, respectively). Moreover, we detected a higher microbial richness in non-tumor vs. tumor tissues which agrees with the global assumption that microbial richness is an indicator of health. The greater abundance of members of the Actinobacteria phylum in the non-neoplastic bladder mucosa samples supports the hypothesis that a higher abundance of Actinomycetes is associated with a lower rate of bladder cancer in women and suggests a protective role for these microbiota. We detected a microbial profile that was enriched for Enterococcus in low-grade tumors. Finally, we identified the presence of two clusters in the microbial composition of the tumor mucosa samples, significantly enriched for the genera Barnesiella, Parabacteroides, Prevotella, Alistipes, and Lachnospiracea_incertae_sedis (Cluster 1), or Staphylococcus (Cluster 2). Further longitudinal studies are needed to assess the role of the bladder microbiota in carcinogenesis.

Onychomycosis. A Mexican survey.

Onychomycosis is a nail infection caused by dermatophytes, Candida and molds. We aimed to obtain an estimated frequency of onychomycosis in out-patients in private practice through a survey in ten representative cities of Mexico. 12,637 ambulatory patients voluntarily agreed to participate in this National Survey, answering 17 questions on onychomycosis, regardless if they had or did not have any clinical suspicion of onychomycosis. 53% of them were seen for the first time and their main complaint was not onychomycosis. The study was performed in the private offices of 300 physicians in different cities. 48% were clinically diagnosed with onychomycosis. Toenails were affected in 88%, fingernails in 5% and both in 7%. Onychomycosis was diagnosed more frequently in the nails of the first toes and of the thumbs. The main complaint was nail thickening and aesthetic changes. Other associated diseases were diabetes (22%) and arterial hypertension (21%). This survey showed the high frequency of onychomycosis. An intentional search with mycological confirmation is needed in out-patients attending general practice with other complaints, to detect undiagnosed cases.

Expert consensus to optimize the management of older adult patients with advanced EGFR-mutated non-small cell lung cancer

Lung cancer (LC) is associated with ageing, with the average age of affected individuals being approximately 70 years. However, despite a higher incidence and prevalence among older people, the older adult population is underrepresented in clinical trials. For LC with Epidermal Growth Factor Receptor (EGFR) mutations, there is no clear association of this mutation with age. Geriatric assessments (GAs) and a multidisciplinary approach are essential for defining the optimal treatment. In this consensus, a group of experts selected from the Oncogeriatrics Section of the Spanish Society of Medical Oncology (Sección de Oncogeriatría de la Sociedad Española de Oncología Médica—SEOM), the Spanish Lung Cancer Group (Grupo Español de Cáncer de Pulmón—GECP) and the Association for Research on Lung Cancer in Women (Asociación para la Investigación del Cáncer de Pulmón en Mujeres—ICAPEM) evaluate the scientific evidence currently available and propose a series of recommendations to optimize the management of older adult patients with advanced LC with EGFR mutations (AU)

SEOM-GETTHI clinical guideline for the practical management of molecular platforms (2021)

The improvement of molecular alterations in cancer as well as the development of technology has allowed us to bring closer to clinical practice the determination of molecular alterations in the diagnosis and treatment of cancer. The use of multidetermination platforms is spreading in most Spanish hospitals. The objective of these clinical practice guides is to review their usefulness, and establish usage guidelines that guide their incorporation into clinical practice.

Impact of imiglucerase supply shortage on clinical and laboratory parameters in Norrbottnian patients with Gaucher disease type 3.

A viral contamination of the production plant producing imiglucerase (Cerezyme™) resulted in an unpredicted worldwide shortage of global supplies during 2009-2010. The aim of the study was to describe the effects of dose reduction of enzyme replacement therapy (ERT) in adults with Norrbottnian form of Gaucher disease type 3 (N-GD3). There were ten adults with N-GD3 treated with imiglucerase in the county of Norrbotten in June 2009. Analyzed variables included plasma chitotriosidase activity and concentration of CCL18/PARC, whole blood hemoglobin concentration (Hb) and platelet count (PLT), as well as patients' body weight, subjective complaints and health status measured by the EuroQoL-5D questionnaire. The median duration of ERT shortage lasted for 14 months (10-20 months). The median percentage reduction of imiglucerase dose was 36 % (26-59 %). Hb decreased in four patients, PLT decreased in three patients, chitotriosidase increased in three patients (max. +22 % of baseline), and CCL18/PARC increased in six patients (+14 % to +57 %). The body weight was moderately decreased in one patient. No new bone events were noted. Self-assessment of individual patient's health status was stable in all but one patient. Our results suggest that moderate reduction of ERT dosage lasting for relatively short period of time can lead to worsening in biomarkers of adults with N-GD3. However, this worsening is infrequently translated to clinical worsening of patients. It is possible that CCL18/PARC has a higher sensitivity than chitotriosidase in monitoring of ERT dosing in GD3.

A twelve-year follow-up study on a case of early-onset parkinsonism preceding clinical manifestation of Gaucher disease.

Mutations in the glucocerebrosidase gene (GBA1) cause Gaucher disease (GD) and are the most common genetic risk factor for the development of Parkinson's disease (PD). Here, we present a 12-year follow-up study of a male with GD and PD (diagnosed 24years ago), which PD preceded the clinical manifestation of GD by 12years. The patient is a compound heterozygote for mutations c.115+1G>A and c.1226A>G (IVS2 + 1/N370S) in the GBA1 gene. Imiglucerase had a beneficial effect on GD, but not on PD. Treatment with L-dopa and other PD drugs showed temporary efficacy but 2years later significant wearing-off phenomenon and dyskinesias appeared. Unilateral pallidotomy was performed with transient benefit. Cognitive decline appeared later and developed in to akinetic mutism. A lumbar puncture was performed to characterize the biochemical profile of cerebrospinal fluid (CSF). Analyses of monoamine metabolites levels in the CSF, determined by reverse-phase high-performance liquid chromatography, revealed remarkably low levels of all studied monoamine metabolites (HVA, DOPAC, 5-HIAA, MHPG). These data indicate that PD associated with GBA1 mutations may not only affect dopaminergic neurons, but also noradrenergic and serotonergic neurons. Of note, normal levels of P-tau, total tau and ß-amyloid (1-42) were detected on ELISA assay. Thus, the cognitive decline, akinetic mutism and moderate cortical atrophy found on the CT scan were not paralleled by any changes of dementia markers in CSF. This single case study extends the follow-up period and adds novel CSF information; however additional data on other patients with both PD and GD may help put our observations in its ultimate proper context.

Factores de riesgo asociados a neumonía intrahospitalaria en pacientes de la unidad de cuidados intensivos / Risk factors linked to the hospital-acquired pneumonia in patients of the intensive care unit

OBJETIVO: Determinar los factores de riesgo asociados a neumonía intrahospitalaria (NIH) en los pacientes de la Unidad de Cuidados Intensivos de un hospital general. MATERIAL Y MÉTODOS. Estudio observacional, longitudinal, analítico, de casos y controles realizados en pacientes mayores de 15 años de ambos sexos internados en la unidad de cuidados intensivos del Hospital Daniel A. Carrión durante el período enero-diciembre 2010. Los riesgos ajustados se estimaron mediante regresión logística múltiple. RESULTADOS. Ingresaron al estudio 33 pacientes, encontrándose que la tasa de incidencia de NIH fue de 11% durante dicho período, la NIH fue predominante en el sexo masculino (57,58%), la edad promedio fue de 53,78 años, el tiempo de estancia hospitalaria promedio fue de 14,80 días y el tiempo promedio de duración de ventilación mecánica fue 11,93 días. Además la. NIH fue monomicrobiana en el 68% con predominancia de Pseudomonas aeruginosa (26,47%). Los factores de riesgo más frecuentes fueron aspiración de secreciones (100%), ventilación mecánica (100%) e intubación orotraqueal (100%). CONCLUSIONES. Esta evaluación rápida, usando metodología estándar ha permitido caracterizar factores de riesgo asociados a neumonía intrahospitalaria.

OBJECTIVE: To determine risk factors linked to the hospital-acquired pneumonia (HAP) in patients of a general hospital. MATERIALS AND METHODS. An observational, longitudinal, analytical, cases and controls study was carried out. Patients of both sexes, older than 15 years old were included from January to December 2010; the risks were estimated through a multiple logistic regression model. RESULTS. Thirty three patients were included than mean an incidence rate of HAP of 11% during the study period, HAP was more frequent in male patients (57,58%), the average age was 53,78% year-old, hospital stay was about 14,80 days and the average time with mechanical ventilation was off 11,93% days. Moreover, HAP was mono-microbial in 68% of patients with a high prevalence of Pseudomonas aeruginosa (26,47%). The most frequence risk factors for to develop HAP were aspiration of secretions (100%), mechanical ventilation (100%) and endotracheal intubation (100%). CONCLUSIONS. This rapid assessment survey using a standard methodology allows to document risk factors hospital-acquired pneumonia.

Infecçöes dermatológicas por trichosporon beigelii: estudo retrospectivo de 13 casos em pacientes imunocompetentes / Dermatological infections by trichosporon beigelii: a retrospective study of 13 cases in immunocompetent patients

FUNDAMENTOS - As infecçöes por Trichosporon beigelii (tricosporonose) que näo correspondem à pedra branca säo reconhecidas com cada vez mais freqüência e produzem desde lesöes localizadas na pele e unhas até o comprometimento de múltiplos órgäos ou sistemas, especialmente em pacientes com imunodepressäo. OBJETIVOS - Conhecer a freqüência da tricosporonose em pacientes imunocompetentes no Departamento de Dermatologia num período de três anos (janeiro de 1994 - fevereiro de 1977). MATERIAL E MÉTODOS - Realizou-se estudo retrospectivo consultando os arquivos da Seçäo de Micologia, que incluem os estudos micológicos (exame direto e cultivo), de janeiro de 1994 a fevereiro de 1997. RESULTADOS - No total de 2.285 indivíduos, encontrou-se a T. beigelii em 13 casos (0,56) porcento, sete afetando pés, e, seis prosseguindo com onicomicose. CONCLUSÖES - O T. beigelii é capaz de ocasionar lesöes, localizadas na pele e nas unhas, que simulam as dermatofitoses ou a infecçäo por outras leveduras, como Candida albicans

Eritrasma una revisión / Erithrasma. A review

Se comentan los datos históricos, microbiológicos, patógenos y epidemiológicos del eritrasma, así como sus características clínicas y de laboratorio y su tratamiento. El agente causal es Corynebacterium minutissimum y se menciona que el eritrasma es una enfermedad común en nuestro medio, aunque se desconoce su frecuencia real. Es posible que sea mal diagnosticada o poco reportada debido a su relativamente fácil diagnóstico o a su favorable reacción ante los diversos tratamientos existentes

Infecciones superficiales por Trichosporon cutaneum. Estudio prospectivo de 10 casos en pacientes diabéticos / Superficial infections due to Tri chosporon cutaneum prospective study of 10 cases in diabetic patients

Las infecciones por Trichosporon cutaneum diferentes a piedra blanca producen desde lesiones localizadas en la piel y uñas, hasta infecciones asistémicas, especialmente en pacientes con inmunodepresión. Con la finalidad de conocer su frecuencia en diabéticos se realizó un estudio prospectivo con un total de 106 sujetos; se encontró en 10 casos tricosporonosis podal. T. cutaneum es capaz de ocasionar lesiones en la piel que mimetizan dermatofitosis o candidosis

Búsqueda intencionada de eritrasma y su frecuencia relativa en la consulta del servicio de dermatología / Intentional search of erythrasma and its relative frequency in the outpatient dermatological clinic

El eritrasma es una enfermedad asintomática que pertenece a las corinebacteriosis. En un estudio retrospectivo se encontraron cinco casos de eritrasma en grandes pliegues en 30 meses. Se presenta un estudio prospectivo de cuatro casos de eritrasma de topografía interdigitopodal en un periodo de un año, donde la lámpara de Wood demuestra su utilidad diagnóstica. La frecuencia relativa aumentó de 2.7 a 4.7 por 1,000

Detección de micosis podales y portadores en pacientes diabéticos ambulatorios. Estudio clínico micológico en 106 pacientes / Detection of podalic mycoses and carriers in ambulatory diabetic patients. Clinical mycologic study in 106 patients

La diabetes mellitus se asocia con una alta incidencia de infecciones bacterianas y micóticas (25 por ciento) en la piel, en especial onicomicosis. Con el objetivo de demostrar la frecuencia de dermatofitosis en pacientes diabéticos, se realizó un estudio prospectivo, abierto y transversal en 106 pacientes ambulatorios. Se estudiaron 70 mujeres y 36 varones con edades de 7 a 89 años (media 53.75), 98 con DM tipo II y ocho con DM tipo I. Se afectaron las plantas de los pies y/o regiones interdigitales en 96.2 por ciento y hubo afección ungueal en 78 por ciento. Las manifestaciones clínicas encontradas fueron: hiperqueratosis en 84 por ciento, descamación 74.5 por ciento, maceración 36.8 por ciento, grietas 35 por ciento, eritema 23.6 por ciento, prurito 20 por ciento y las vesículas y ampollas en menos de 4 por ciento. En el estudio de las escamas se encontraron filamentos y/o esporas en 21 por ciento y en el cultivo ordinario y con terciopelo sintético se aislaron hongos en 13.2 y 32.9 por ciento, respectivamente. Se aisló T. rubrum en 15.1 por ciento y T. mentagrophytes en 0.9 por ciento, Candida en 19.8 por ciento, Trichosporon en 8.4 por ciento y Geotrichum en 1 por ciento. La prevalencia de dermatofitos en diabéticos corresponde a la encontrada en la población general y en este estudio no se relacionó con glicemia elevada. La frecuencia de Candida, Trichosporon e infecciones micóticas mixtas fue mayor en pacientes descompensados, pero la diferencia no fue estadísticamente significativa. Es notoria la presencia de infecciones por Trichosporon sp