Search

Resumen Antecedentes y objetivo El liposarcoma mixoide se encuadra dentro del grupo de sarcomas con diferenciacion adiposa, constituyendo el segundo grupo en frecuencia de todos los tipos de liposarcomas, si bien no es una entidad homogenea, ya que dentro de los liposarcomas mixoides nos encontramos con tumores de comportamiento y evolucion clinica muy diferentes. Los objetivos del estudio son describir las caracteristicas por RM de los liposarcomas mixoides y determinar si existe asociacion entre los datos analizados por RM con el grado histologico que permita diferenciar los tumores de bajo y alto grado ayudando en la toma de decisiones. Material y metodos Se incluyeron 36 pacientes tratados en nuestro centro de liposarcoma mixoide entre los anos 2010 y 2018. Por un lado, se analizaron variables clinicas: edad, sexo y localizacion, y por otro se valoraron caracteristicas por RM: tamano, profundidad, contornos, componente graso, componente mixoide, componente no graso-no mixoide, valor del coeficiente de difusion aparente y tipo de realce tras la administracion de contraste intravenoso. Las variables analizadas por RM se correlacionaron con el grado histologico y el porcentaje de celulas redondas. Resultados En nuestra serie, los liposarcomas mixoides afectan principalmente a adultos jovenes (mediana de edad 43 anos), sin diferencias significativas segun el sexo, el 97,2% ubicados en miembros inferiores, el 86,1% de localizacion profunda y el 77,8% con contornos bien delimitados. El 69,6% (16 de 23) de los liposarcomas mixoides que no contenian grasa fueron de alto grado (p = 0,01). Todos los tumores con componente mixoide inferior al 25% fueron lesiones de alto grado (p = 0,01). El 83,3% de los tumores con componente no graso-no mixoide superior al 50% fueron de alto grado (p = 0,03). Igualmente, el 61,5% de los tumores con un componente no graso-no mixoide superior al 50% presentaron un porcentaje de celulas redondas de mas del 5% (p = 0,01). Disponiamos secuencias de difusion en 14 de los 36 pacientes, obteniendo valores de coeficiente de difusion aparente altos (mediana de 2 × 10-3 mm2/s), aunque no hubo asociacion estadisticamente significativa entre los tumores de bajo-alto grado. Treinta de los 36 pacientes incluidos en el estudio disponian de series con contraste intravenoso, de los cuales el 83,3% de los que presentaron realce heterogeneo fueron de alto grado (p = 0,01). Conclusiones La RM puede ser una herramienta diagnostica util para diferenciar entre liposarcomas mixoides de alto-bajo grado y ayudar en la toma de decisiones clinicas.

Myxoid liposarcoma is classified in the group of sarcomas with adipose differentiation, which is the second most common group of sarcomas. However, myxoid liposarcoma is not a homogeneous entity, because the behavior and clinical course of these tumors can vary widely. This study aimed to describe the magnetic resonance imaging (MRI) features of myxoid liposarcomas and to determine whether the MRI features are associated with the histologic grade and can differentiate between low-grade and high-grade tumors and thus help in clinical decision making.We studied 36 patients with myxoid liposarcomas treated at our center between 2010 and 2018. We analyzed clinical variables (age, sex, and tumor site) and MRI features (size, depth, borders, fatty component, myxoid component, non-fatty / non-myxoid component, apparent diffusion coefficient (ADC), and type of enhancement after the administration of intravenous contrast material). We correlated the MRI features with the histologic grade and the percentage of round cells.In our series, patients with myxoid liposarcomas were mainly young adults (median age, 43 years). There were no differences between sexes; 97.2% were located in the lower limbs, 86.1% were deep, and 77.8% had well-defined borders. Of the 23 myxoid liposarcomas that contained no fat, 16 (69.6%) were high grade (p=0.01). All the tumors with a myxoid component of less than 25% were high grade (p=0.01); 83.3% of those with a non-fatty / non-myxoid component greater than 50% were high grade (p=0.03) and 61.5% had more than 5% round cells (p=0.01). Diffusion sequences were obtained in 14 of the 36 patients; ADC values were high (median, 2 x 10MRI can be useful for differentiating between high- and low-grade myxoid liposarcomas and can help in clinical decision making.

Background Breast cancer in men is rare, assuming less than 1% of diagnosed breast cancer, requiring extrapolation of results from studies in women. Our objective is to evaluate prognostic and therapeutic factors paying special attention to the effect of hormonal treatment on the evolution of the disease. Methods Observational, retrospective, single-center study of 53 men with breast cancer treated between January 1997 and December 2018. The median follow-up was 66 months (range, 3-282 months). 48 patients had ECOG 0-1 (90.6%), 48 were hormone-receptor-positive (90.5%) and 4 HER2-positive (7.5%). 30 patients had lymph node involvement at diagnosis (56.6%). A total of 45 patients (84.9%) were treated with endocrine therapy (ET) of which 36 received it in adjuvant (67.9%) and 13 in metastatic phase (24.5%). 26 (49.1%) were treated with chemotherapy and 3 with cyclin-dependent kinase inhibitors (5.6%). The association analysis was performed using the Chi-square test and survival analysis with the Log-Rank test in SPSS v25. Results Our cohort had a median age of 68 years (range, 40-88 years). 84% had local or locally advanced stage. The infiltrative histologies were 88.7%. The BRCA gen test was carried out in 43.4%, which was positive in 26.1% of the analyzed patients, with BRCA2 being associated with lower mortality (p = 0.004). The statistic analysis showed greater 5-year overall survival (OS) and cancer-specific survival for ECOG 0-1 (p = 0.010, p = 0.048), absence of vascular invasion (p = 0.033, p = 0.025), Ki67 Conclusions The existence of prognostic factors already described in breast cancer in women also seem to be associated with men. The BRCA2 mutation could have a significant role as a predictive marker in males in the near future. ET helps reducing the risk of relapse, particularly at distance. Legal entity responsible for the study The authors. Funding Has not received any funding. Disclosure F.J. Salvador Bofil: Advisory / Consultancy, Speaker Bureau / Expert testimony: Roche Advisory / Consultancy, Speaker Bureau / Expert testimony: Novartis M. Ruiz Borrego: Advisory / Consultancy, Speaker Bureau / Expert testimony: Pfizer; Advisory / Consultancy, Speaker Bureau / Expert testimony: Novartis; Advisory / Consultancy, Speaker Bureau / Expert testimony: Lilly. All other authors have declared no conflicts of interest.

Objective: To analyse physicians’, pharmacists’ and nurses’ perspectives on the importance of different antiretroviral treatment adherence support activities and identify the main obstacles to meeting established recommendations which health professionals encounter. Method: Cross-sectional observational and analytical study. Three questionnaires were designed based on 2008 GESIDA/SEFH/PNS recommendations for improving treatment adherence: ‘‘ideal measures’’ (IM), ‘‘real measures’’ (RM) and ‘‘adherence support problems’’ (ASP). Cronbach’s Alpha index was determined to analyse questionnaire reliability and correlation coefficients between the MI and MR scales. We applied the Chi-square test or Monte Carlo method to analyse the correlation between health providers and items on the three questionnaires. Results: Participants consisted of 58 health professionals. The response rate was 76%. The Cronbach Alpha indices for the IM, RM and ASP questionnaires were 0.852, 0.933 and 0.818 respectively. The resulting intraclass correlation coefficient was 0.280. Significant differences were found for multiple comparisons of IM and RM questionnaires among physicians and pharmacists. The analysis of relationships between providers also found significant differences for one of the answers on the IM questionnaire, three on the RM and five on the ASP. Conclusions: We observed that several health professionals have different perspectives on measures of support for treatment adherence, with differences arising mainly due to lack of time and training.

Objective: To develop and validate a prediction model for the detection of drug-related problems (DRP) in patients on antiretroviral treatment during their regular monitoring in Pharmaceutical Care Clinics before dispensing drugs. Mehod: Open multicentre prospective study. HIV patients with and without DRP were included. Demographic, clinical and pharmacotherapy variables (related and unrelated to antiretroviral treatment) were included in the model design. To find prognostic factors for DRP, a binary logistic regression model was created after performing a univariate analysis that identified independent variables related to DRP these variables were introduced in the multivariate model for the final selection. Model validity was determined by the shrinkage method and the discriminatory power by Harrell’s C-index. Results: 733 patients were included. The variables ‘‘adherence’’, ‘‘prescription of drugs needing dosage adjustment’’, and ‘‘total number of drugs prescribed (apart from the antiretroviral treatment)’’ were independently related to the appearance of DRP. Probabilities predicted by the model, customising the coefficients using the uniform shrinkage method, showed a R2 = 0.962 for the construction sample and a R2 = 0.872 for the validation sample. The discriminatory capacity of the model was 0.816 for the construction sample and 0.779 for the validation sample. Conclusions: The developed and validated model enables detection of patients on antiretroviral treatment who are at a higher risk for experiencing a DRP. The prediction variables employed are commonly used in patient’s pharmacotherapy record, allowing the model to be used in routine clinical practice.

Objective: To evaluate the use of parenteral, enteral, and mixed nutrition in one acute and one chronic hospital. Design: Retrospective, non-randomised, observational study. Study sites: South Seville Health Area: Acute Hospital (H1) and Chronic Hospital (H2) with 447 and 84 beds, respectively. We analysed all episodes of artificial nutrition administered in a 6-month period. Exclusion criteria included: age

Resumen Objetivo Identificar y analizar las causas mas frecuentes de discontinuacion de la terapia antirretroviral que incluye la co-formulacion: abacavir, lamivudina y zidovudina (ABC-3TC-AZT). Metodo Estudio retrospectivo observacional de los pacientes en tratamiento antirretroviral con ABC-3TC-AZT, atendidos en la unidad de pacientes externos del servicio de farmacia durante el periodo comprendido entre febrero de 2002 y junio de 2004. Se analizo la causa de discontinuacion en aquellos pacientes que no siguieron con esta terapia. Se evaluo la adherencia mediante los registros informaticos de dispensacion. Se diseno un analisis de supervivencia de Kaplan-Meier para identificar factores predictivos de discontinuacion. Resultados Un total de 114 pacientes (85 hombres, 74,6%) fueron tratados con esta terapia. Un 25,4% era naive. El 34,2% (39/114) de los pacientes discontinuo el tratamiento. Entre ellos, el 44,8% (13/29) de los sujetos naive. En el 92,3% del total de casos esto ocurrio antes de alcanzar las 48 semanas en tratamiento. Las causas de discontinuacion fueron: reacciones adversas (46,1%), abandono voluntario (33,3%), decision clinica (15,4%) y otros motivos (5,1%). Posible reaccion de hipersensibilidad a ABC fue descrita en 9 pacientes. Se relaciono tener carga viral detectable al inicio del tratamiento, ser ex-ADVP, y paciente naive, con mayor probabilidad de discontinuacion (p Conclusiones Se encontro un alto porcentaje de discontinuacion debido a efectos adversos y abandono voluntario, principalmente al inicio del tratamiento. Es necesario identificar a aquellos pacientes a los cuales este esquema les puede aportar un beneficio terapeutico, especialmente los sujetos naive, y realizar intervenciones para mejorar la adherencia y optimizar asi los parametros de recuperacion.

To develop and validate a prediction model for the detection of drug-related problems (DRP) in patients on antiretroviral treatment during their regular monitoring in Pharmaceutical Care Clinics before dispensing drugs. MEHOD: Open multicentre prospective study. HIV patients with and without DRP were included. Demographic, clinical and pharmacotherapy variables (related and unrelated to antiretroviral treatment) were included in the model design. To find prognostic factors for DRP, a binary logistic regression model was created after performing a univariate analysis that identified independent variables related to DRP these variables were introduced in the multivariate model for the final selection. Model validity was determined by the shrinkage method and the discriminatory power by Harrell's C-index.733 patients were included. The variables "adherence", "prescription of drugs needing dosage adjustment", and "total number of drugs prescribed (apart from the antiretroviral treatment)" were independently related to the appearance of DRP. Probabilities predicted by the model, customising the coefficients using the uniform shrinkage method, showed a R(2)=0.962 for the construction sample and a R(2)=0.872 for the validation sample. The discriminatory capacity of the model was 0.816 for the construction sample and 0.779 for the validation sample.The developed and validated model enables detection of patients on antiretroviral treatment who are at a higher risk for experiencing a DRP. The prediction variables employed are commonly used in patient's pharmacotherapy record, allowing the model to be used in routine clinical practice.

To analyse physicians', pharmacists' and nurses' perspectives on the importance of different antiretroviral treatment adherence support activities and identify the main obstacles to meeting established recommendations which health professionals encounter.Cross-sectional observational and analytical study. Three questionnaires were designed based on 2008 GESIDA/SEFH/PNS recommendations for improving treatment adherence: "ideal measures" (IM), "real measures" (RM) and "adherence support problems" (ASP). Cronbach's Alpha index was determined to analyse questionnaire reliability and correlation coefficients between the MI and MR scales. We applied the Chi-square test or Monte Carlo method to analyse the correlation between health providers and items on the three questionnaires.Participants consisted of 58 health professionals. The response rate was 76%. The Cronbach Alpha indices for the IM, RM and ASP questionnaires were 0.852, 0.933 and 0.818 respectively. The resulting intraclass correlation coefficient was 0.280. Significant differences were found for multiple comparisons of IM and RM questionnaires among physicians and pharmacists. The analysis of relationships between providers also found significant differences for one of the answers on the IM questionnaire, three on the RM and five on the ASP.We observed that several health professionals have different perspectives on measures of support for treatment adherence, with differences arising mainly due to lack of time and training.

The prevalence of swallowing disorders widely varies depending on age and comorbidity.To determine the prevalence of dysphagia and feeding disorders in elderly people living in nursing homes from the province of Seville and assess the effectiveness of dietary counselling.We carried out a cross-sectional descriptive study on a population of 3921 residents distributed among 86 nursing homes. At the first phase of the study, we pretended to estimate the prevalence of dysphagia so that we selected 373 residents in 23 nursing homes. At the second phase, a sample of residents with dysphagia was selected, being reassessed a month later after receiving dietary counselling and basic measures for managing dysphagia.The median age was 80 (73.86) years, 60 (17.3%) had dysphagia and 50 (13.4%) had feeding difficulties. Both conditions were significantly (p0.05) associated with neurological diseases. Forty (11.3%) presented cerebrovascular accident and 123 (34.8%) dementia. Twelve patients with dysphagia were studied at the second phase, the mean age being 80.6+/-11.9 years, MNA 19 +/- 3, Barthel 24 +/- 27, and dysphagia Karnell level of 3-4 in 75% of the cases. These patients, receiving dietary counselling and basic measures for managing dysphagia, did not improve their intake level, dysphagia or dependency.The prevalence of dysphagia and feeding difficulties is high among nursing homes residents. The standard measures for controlling dysphagia are little effective in patients with severe dependence or advanced dementia.

To identify and analyze the most common causes for the discontinuation of antiretroviral therapy, including the co-formulation of abacavir, lamivudine and zidovudine (ABC-3TC-AZT).An observational, retrospective study was carried out on patients receiving antiretroviral therapy with ABC-3TC-AZT seen in the Pharmacy Department s outpatient unit from February 2002 through June 2004. The causes for discontinuation among patients withdrawing from this therapy were analyzed. Adherence was assessed using computerized dispensation records. A Kaplan-Meier survival analysis was designed in order to identify factors predictive of discontinuation.In all, 114 patients (85 males, 74.6%) received this therapy - 25.4% of them were naïve patients - and 34.2% (39/114) withdrew from this regimen, amongst them 44.8% (13/29) of naïve subjects. In 92.3% of cases this happened before treatment week 48. Discontinuation causes included: adverse reactions (46.1%), voluntary discontinuation (33.3%), clinical decision (15.4%), and other reasons (5.1%). A possible hypersensitivity reaction to ABC was reported for 9 patients. A greater likelihood of discontinuation was associated with detectable viral load at therapy onset, ex-parenteral drug abuser status, and naïve status (p0.05).A high percentage of discontinuations due to adverse events and voluntary withdrawal was found, particularly early during treatment. Patients who may therapeutically benefit from this regimen, particularly naïve subjects, should be identified, and interventions to improve adherence and optimize recovery parameters should be implemented.

Background The life expectancy of HIV-infected individuals has increased, and there are many patients with other comorbidities and comedication, which could affect antiretroviral therapy (ART) adherence. Purpose To investigate the effect of polypharmacy on ART adherence in patients with HIV infection, as well as to identify predictors of ART adherence. Materials and methods A single-centre, retrospective study was conducted on HIV-infected patients who had started treatment before January 2012. The follow-up period was 12 months. The dependent variable was ART adherence and the independent variables were; sex, age, CD4, transmission risk, CDC classification, ART-naive, HIV viral load, number of hospital admissions, type of ART, comedication (≥5 prescription drugs) and risk of drug-related problems (DRP). Adherence was determined through pharmacy electronic dispensing records and the Morisky scale. Patients were considered adherent when they took ≥90% of prescribed ART in the last 12 months. The risk of DRP (categorised as high or low) was determined by a predictive tool developed by Morillo et al. 1 To determine the independent variables associated with adherence, we performed a univariate logistic regression and subsequently a multivariate analysis. Results We included 594 patients in the study (80% men, median age 47 years) of whom 75% were adherent. In the univariate analysis the variables that showed statistically significant relationships with ART adherence were: intravenous drug users (IDU), AIDS-defining condition, ART-naive, detectable viral load, ≥1 hospital admission, PI-based regimens, high-risk DRP and polypharmacy. In the multivariate analysis, IDU (OR = 0.58; CI[0.34–0.99]; p = 0.048); ART-naive (OR = 9.94; CI[3.69–26.79]; p Conclusions Although ART adherence is high, polypharmacy significantly reduces adherence. Similar findings have been reported by other studies. 2,3 This fact justifies the key role that the pharmacist can play in adherence monitoring. Furthermore, non-treatment-naive patients, IDU and high-risk DRP are also associated with lower adherence. References http://estudiopredictor.sefh.es/index.html (28) Ekwunife OI, Oreh C, Ubaka CM. Concurrent use of complementary and alternative medicine with antiretroviral therapy reduces adherence to HIV medications. Int J Pharm Pract 2012;20(5):340-3 Nachega JB, Trotta MP, Nelson M, Ammassari A. Impact of metabolic complications on antiretroviral treatment adherence: clinical and public health implications. Curr HIV/AIDS Rep 2009;6(3):121-9 No conflict of interest.

Background As people with HIV infections age, comorbidities and complications have increased and could affect antiretroviral therapy (ART) adherence. Purpose To determine the comorbidities of patients with HIV infection, as well as to evaluate their contribution to ART adherence. Materials and methods A twelve-month retrospective observational study (from January 2012 to December 2012) was conducted in HIV-infected patients who were being treated with ART. ART adherence was the dependent variable. We collected the following independent variables: sex, age, HCV coinfection, transmission risk, CD4 + T-cell count, HIV viral load, ART-naive, type of ART and comorbidities. We defined polypathological patients as patients with two or more chronic conditions. Adherence was determined through dispensing pharmacy records (Total number of units dispensed/Total number of units needed×100) and the simplified medicines adherence questionnaire (SMAQ). Patients who took at least 90% of their prescribed ART were classified as good adherers. We performed a univariate logistic regression to determine the relationship between the comorbidities and ART adherence. Results We included 536 patients in the study (80.2% men, mean age 47 ± 7.1 years) of whom 49.2% were HIV-HCV co-infected. Injected drug use was the main mode of HIV transmission. The median CD4 + was 574.5 cells/mm 3 (IQR: 353.8–776.3) and viral suppression ( Conclusions There is an important number of polypathological HIV-infected patients. Despite ART adherence being high, the presence of these comorbidities significantly reduces adherence. No conflict of interest.